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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES CRITICAL AND INTENSIVE THERAPY
Minerva Anestesiologica 1999 March;65(3):109-13
Mupirocin nasal ointment in the prevention of nosocomial pneumonia
Di Filippo A. 1, Simonetti T. 2
1 Università degli Studi - Firenze, Istituto di Anestesiologia e Rianimazione;
2 Azienda Ospedaliera di Careggi - Firenze, Laboratorio di Microbiologia e Virologia
Background. To evaluate efficacy of mupirocin ointment nasal application in prevention of MRSA ventilatory associated pneumonia (VAP).
Methods. Design: prospective, double-blind, randomized, clinical trial. Patients: 48 consecutive intubated patients admitted in the Intensive Care Unit during a three month period. Setting: University of Florence; Intensive Care. Interventions: Randomized application of 2 ml of Mupirocin ointment three times a day for three days (Group A; n=24) or placebo (Group B n=24). Statistic: χ2 or Fisher exact test. Measurements: Bacteriologic evaluation of nasal carriage at admission in ICU, and after 3 days of prevention; evaluation of bacteriology of bronchial aspirate in the case of symptoms of ventilatory associated pneumonia.
Results and conclusions. Relative risk of nasal carriage by pathological bacterial strains is 7.2 times in hospitalized patients more than in home patients (18/25 vs 7/23); MRSA nasal carriage is present at admission on 20% of hospitalized patients. Nasal carriage of Staphylococcus strains is reduced of 90% by Mupirocin application but is reduced only of 50% by placebo application (p<0.05). In Group B, VAP occurred in 5 patients vs 3 of Group A; the more frequent incidence of VAP in group B is due to MRSA infection (p<0.01) and it is related to MRSA nasal carriage.