Intranasal Mupirocin Treatment for MRSA Patients
Intranasal mupirocin is strongly recommended for MRSA-colonized patients, particularly before high-risk surgeries such as cardiothoracic and orthopedic procedures, as it significantly reduces the risk of subsequent MRSA infections. 1
Effectiveness of Intranasal Mupirocin for MRSA
Evidence Supporting Use
- The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) explicitly recommends screening for S. aureus before high-risk operations and decolonization with intranasal mupirocin with or without chlorhexidine bath for colonized patients 1
- In MRSA carriers, intranasal mupirocin significantly reduces the rate of nosocomial S. aureus infections (odds ratio 0.49; 95% CI, 0.25 to 0.92) 2
- A meta-analysis showed that mupirocin nasal ointment results in a statistically significant reduction in S. aureus infections in nasal carriers (RR 0.55,95% CI 0.43 to 0.70) 3
Specific Clinical Scenarios
- Pre-surgical decolonization: Particularly beneficial before cardiothoracic and orthopedic surgeries 1
- Recurrent MRSA infections: Recommended for patients with recurrent skin and soft tissue infections despite optimized wound care 4
- Ongoing transmission: Indicated in situations with ongoing MRSA transmission among household members despite hygiene measures 4
Optimal Treatment Protocol
Recommended Regimen
- Apply mupirocin 2% ointment to the anterior nares twice daily for 5-10 days 4
- A 10-dose regimen (twice daily for 5 days) is superior to shorter regimens, with 89.5% of patients remaining decolonized for at least four weeks 4
- For recurrent infections, monthly application (5-day course each month) may be considered, reducing recurrent infections by approximately 50% 4
Comprehensive Approach
- Combine nasal mupirocin with:
- Chlorhexidine body washes for 5-14 days, or
- Dilute bleach baths (1 teaspoon per gallon of water) for 15 minutes twice weekly for up to 3 months 4
- Maintain good personal hygiene with regular bathing
- Keep draining wounds covered with clean, dry bandages
- Clean hands regularly with soap and water or alcohol-based sanitizer
- Avoid sharing personal items (razors, towels, linens) 4
Important Considerations and Caveats
Potential Limitations
- Mupirocin resistance has been reported, with high-level resistance associated with treatment failure 4
- The infection rate caused by microorganisms other than S. aureus may be higher in patients treated with mupirocin (RR 1.38,95% CI 1.12 to 1.72) 3
Special Populations
- Hemodialysis patients: Mupirocin led to total eradication of nasal S. aureus carriage and a 4.26-fold reduction in S. aureus bacteremia incidence 5
- Thoracic surgery patients: Unselective use of intranasal mupirocin (three times daily for 3 days before surgery and three times weekly for 2 weeks after) prevented new MRSA colonization 6
Combined Interventions
- For MRSA carriers undergoing cardiothoracic and orthopedic surgery, combining decolonization with targeted prophylactic antibiotics (adding vancomycin to standard prophylaxis) is suggested 1
- In healthcare settings, implementing MRSA monitoring programs and contact precautions for colonized patients is recommended alongside decolonization 4
Intranasal mupirocin is a cost-effective intervention that significantly reduces MRSA infection risk in colonized patients, particularly in high-risk surgical settings and for patients with recurrent infections.