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Ann Thorac Surg 2006;81:2183-2188
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Safety of Targeted Perioperative Mupirocin Treatment for Preventing Infections After Cardiac Surgery

^a Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
^b Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
^c Department of Infection Control, Cleveland Clinic Foundation, Cleveland, Ohio
^d Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, Ohio
^e Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
^f Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio

Accepted for publication January 3, 2006.

^_* Address correspondence to Dr Shrestha, Department of Infectious Diseases, Cleveland Clinic Foundation, 9500 Euclid Ave, S-32, Cleveland, OH 44195. (Email: shrestn{at}ccf.org).

BACKGROUND: Indiscriminate antibiotic use may lead to development of antibiotic resistance. Preoperative mupirocin treatment decreases Staphylococcus aureus carriage and may reduce subsequent surgical site infection, but is unlikely to benefit noncarriers. This study was undertaken to evaluate whether avoiding mupirocin in noncarriers places them at increased risk for subsequent postoperative infection.

METHODS: We conducted a retrospective cohort study examining incidence of postoperative infection in patients undergoing cardiac surgery at the Cleveland Clinic after introduction of a protocol of polymerase chain reaction screening for nasal S aureus carriage, and avoiding mupirocin treatment of noncarriers.

RESULTS: Between August 1, 2002, and May 31, 2004, 6,334 patients were screened for nasal carriage of S aureus before undergoing cardiac surgery. There was no significant difference in infection rates between carriers and noncarriers when examining the incidence of all infections (5.6% and 5.0%; relative risk [RR] 1.11 [95% confidence interval (CI): 0.86 to 1.43]), infections caused specifically by S aureus (1.04% and 0.80%; RR 1.30 [95% CI: 0.71 to 2.39]), any surgical site infection (3.1% and 3.2%; RR 0.97 [95% CI: 0.69 to 1.36]), S aureus surgical site infection (0.82% and 0.58%; RR 1.41 [95% CI: 0.71 to 2.82]), any bloodstream infection (3.1% and 2.5%; RR 1.21 [95% CI: 0.86 to 1.71]), and S aureus bloodstream infection (0.37% and 0.48%; RR 0.77 [95% CI: 0.30 to 2.03]). Mupirocin use declined substantially after introduction of the protocol.

CONCLUSIONS: A strategy of targeting perioperative mupirocin treatment to carriers leads to significant reduction in mupirocin use without increasing early postoperative infectious complications in noncarriers.

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