[Endonasal mupirocin in the prevention of nosocomial pneumonia]

Abstract

Background: To evaluate efficacy of mupirocin ointment nasal application in prevention of MRSA ventilatory associated pneumonia (VAP).

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: Chi 2 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.