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. 2022 Jan 10;11(1):5.
doi: 10.1186/s13756-021-01043-1.

Efficacy of mupirocin, neomycin and octenidine for nasal Staphylococcus aureus decolonisation: a retrospective cohort study

J Allport  1 , R Choudhury  2 , P Bruce-Wootton  2 , M Reed  2 , D Tate  2 , A Malviya  2
Affiliations

Efficacy of mupirocin, neomycin and octenidine for nasal Staphylococcus aureus decolonisation: a retrospective cohort study

J Allport et al. Antimicrob Resist Infect Control. .

Abstract

Background: Periprosthetic joint infection (PJI) causes significant morbidity. Methicillin sensitive Staphylococcus aureus (MSSA) is the most frequent organism, and the majority are endogenous. Decolonisation reduces PJIs but there is a paucity of evidence comparing treatments. Aims; compare 3 nasal decolonisation treatments at (1) achieving MSSA decolonisation, (2) preventing PJI.

Methods: Our hospital prospectively collected data on our MSSA decolonisation programme since 2013, including; all MSSA carriers, treatment received, MSSA status at time of surgery and all PJIs. Prior to 2017 MSSA carriers received nasal mupirocin or neomycin, from August 2017 until August 2019 nasal octenidine was used.

Results: During the study period 15,958 primary hip and knee replacements were performed. 3200 (20.1%) were MSSA positive at preoperative screening and received decolonisation treatment, 698 mupirocin, 1210 neomycin and 1221 octenidine. Mupirocin (89.1%) and neomycin (90.9%) were more effective at decolonisation than octenidine (50.0%, P < 0.0001). There was no difference in PJI rates (P = 0.452).

Conclusions: Mupirocin and neomycin are more effective than octenidine at MSSA decolonisation. There was poor correlation between the MSSA status after treatment (on day of surgery) and PJI rates. Further research is needed to compare alternative MSSA decolonisation treatments.

Keywords: Decolonisation; MSSA; Methicillin sensitive Staphylococcus aureus; Periprosthetic joint infection; Surgical site infection.

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Conflict of interest statement

MR and AM have previously received research grant funding from Schϋlke, manufacturers of Octenisan.

Figures

Fig. 1
Fig. 1
Patient cohort
Fig. 2
Fig. 2
Chronology of different phases studied
See this image and copyright information in PMC

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