Surgical Site Infections in Orthopedic Surgery: The Effect of Mupirocin Nasal Ointment in a Double-Blind, Randomized, Placebo-Controlled Study

The objective of this study was to determine whether use of mupirocin nasal ointment for perioperativeeradication of Staphylococcus aureus nasal carriage is effective in preventing the development of surgical site infections (SSIs). A randomized, double-blind, placebo-controlled design was used. Either mupirocin or placebo nasal ointment was applied twice daily to 614 assessable patients from the day of admission to the hospital until the day of surgery. A total of 315 and 299 patients were randomized to receive mupirocin and placebo, respectively. Erad-ication of nasal carriage was significantly more effective in the mupirocin group (eradication rate, 83.5 % versus 27.8%). In the mupirocin group, the rate of endogenous S. aureus infections was 5 times lower than in the placebo group (0.3 % and 1.7%, respectively; relative risk, 0.19; 95 % confidence interval, 0.02–1.62). Mupirocin nasal ointment did not reduce the SSI rate (by S. aureus) or the duration of hospital stay. Surgical site infections (SSIs) are important compli-cations of orthopedic procedures that involve prosthetic implants. A recent national surveillance study showed that, in The Netherlands, the mean rates of infection in orthopedic surgery that involved artificial implants ranged from 1.5 % for total knee implantation to 6.8% for femur head replacement [1]. These infections are associated with discomfort for the patient and with considerable prolongation of hospital stay and in-creased cost of care [2–7]. When a deep SSI of a pros