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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 16  |  Issue : 2  |  Page : 67-69

Interventional non-RCT study on the efficacy of Mupirocin versus Neomycin in the eradication of nasal carriers of Staphylococcus aureus in theatre staff


1 Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
2 Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala, India

Date of Web Publication14-Nov-2014

Correspondence Address:
Geetha Raveendran
Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1282.144713

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  Abstract 

Aim: Nasal carriage of Staphylococcus aureus plays a pivotal role in the spread of nosocomial infections even in tertiary care centers. We decided to detect nasal carriage of S. aureus in our institution and eradicate it with local application of Mupirocin/Neomycin and to compare their efficiency. Materials and Methods: The study was conducted over a period of 12 months among 50 surgical theatre staff. In all, two nasal swabs were taken from each person at an interval of one week. Alternate nasal carriers identified were given Mupirocin/Neomycin for application in the anterior nares. A third swab was taken seven days after treatment. Observations and Result: Out of the fifty persons, 16 tested positive for S. aureus (32%). Out of the 16, two were Methicillin resistant Staphylococcus aureus (MRSA). All repeat swabs were negative after treatment with Mupirocin. However, 4% were not cured after treatment with Neomycin. Since the sample size is too small, an elaborate study should be conducted to include theatre staff of all speciality and this can confirm the promising role of Neomycin, as the percentage of resistance in this study appears negligible.

Keywords: Carrier, Neomycin, Mupirocin


How to cite this article:
Cheruvakkudy FT, Kurian JS, Raveendran G. Interventional non-RCT study on the efficacy of Mupirocin versus Neomycin in the eradication of nasal carriers of Staphylococcus aureus in theatre staff. J Acad Clin Microbiol 2014;16:67-9

How to cite this URL:
Cheruvakkudy FT, Kurian JS, Raveendran G. Interventional non-RCT study on the efficacy of Mupirocin versus Neomycin in the eradication of nasal carriers of Staphylococcus aureus in theatre staff. J Acad Clin Microbiol [serial online] 2014 [cited 2020 Apr 5];16:67-9. Available from: http://www.jacmjournal.org/text.asp?2014/16/2/67/144713


  Introduction Top


Staphylococcus aureus is recognized as an important pathogen in human disease and is the most common cause of nosocomial infections. About 10-30% of healthy persons carry staphylococci in the nose, about 10% in the perineum, about 5% in the vagina and also on the hair. [1] The cocci shed by the patients and carriers contaminate fomites such as handkerchieves, bed linen and blankets and may persist on them for days or weeks. Staphylococcal infection may be transmitted through direct contact or fomites. The link between S. aureus nasal carriage and the development of subsequent S. aureus infection has been established in patients on hemodialysis, on continuous ambulatory peritoneal dialysis and those undergoing surgery. [2]

Staphylococcus aureus carriage plays a key role in the epidemiology and pathogenesis of infection. The main ecological niche of S. aureus is the anterior nares. Elimination of carriage appears to be an attractive prevention strategy among patients at risk. Hence, regular screening of carriers is required for the prevention of nosocomial infection. Nasal ointments, sprays and oral antibiotics have variable efficacy and their frequent use results in antimicrobial resistance among S. aureus strains. Of the commonly used agents, Mupirocin ointment has been proved to be 97% effective in reducing S. aureus nasal carriage. Since Mupirocin is costly, a comparative study with Neomycin was done to detect efficacy of both, in eradicating nasal carriage of S. aureus among theatre staff, thereby reducing surgical site infections. [3],[4]

Aim

  1. To detect and eradicate nasal carriers of S. aureus in theatre staff.
  2. To compare the efficacy of Mupirocin and Neomycin in eradicating nasal carriage of S. aureus in the theatre staff as measured by the culture of nasal carriers.



  Materials and methods Top


This study was done among 50 theatre staff of surgical theaters in Government Medical College Hospital, Thiruvananthapuram for a period of 12 months. Theatre staff included surgeons, anaesthetists, nursing staff, nursing attenders, medical and nursing students posted in the theatre. Theatre staff who had active nasal infection and those who did not give consent were excluded from the study.

Sterile cotton swabs moistened with sterile normal saline were used to collect specimens from anterior nares. One sterile swab was inserted into each nostril until resistance was met, rotated 5 times and taken out of the nose. Separate swabs were used for right and left nostril. The swabs were transported to the laboratory and processed immediately.

Swabs were inoculated on blood agar, MacConkey agar and Mannitol salt agar and incubated at 37°C for 24 hours. Gram smear was also taken. S. aureus was identified using standard methods.

Nasal carriers were defined when two nasal swabs taken at an interval of one week was positive. Alternate nasal carriers identified were told to apply Mupirocin or Neomycin ointment twice daily for seven days which was given free of cost. Another swab was taken seven days after the treatment.


  Results Top


A total of 50 pairs of nasal swabs were collected from 10 male staff and 40 female staff. Of these, 16 (32% of theatre staff) were positive and found colonized with S. aureus [Table 1].
Table 1: Theater staff distribution among culture positives

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The maximum number of carriers were in the age group of 41-50 years (35%) [Table 2].
Table 2: Shows age groups distribution of culture positives

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Out of the 16 positives, 2 (12.5%) were MRSA.

Among the isolates, all the 16 strains showed resistance to Penicillin, 12 (85%) were sensitive to 1 st generation cephalosporin and Gentamicin, 14 (87.5%) sensitive to Oxacillin. Only 8 (50%) were sensitive to Erythromycin [Table 3]. All strains were sensitive to Amikacin, Rifampicin, Clindamycin and Linezolid. In all, two strains were resistant to Cefoxitin and were identified as Methicillin resistant S. aureus (MRSA).

Nasal swab for S. aureus was positive in 16 (32%) theatre staff. In all, eight were treated with Mupirocin ointment thrice daily and remaining eight were treated with Neomycin ointment twice daily for seven days.
Table 3: Antibiotic sensitivity pattern

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Repeat nasal swabs were taken seven days after stopping the local antibiotics.

Among the Neomycin group two (25%) were not cured with the local application of Neomycin (repeat swab taken after seven days was positive for S. aureus). They were given Mupirocin ointment for seven days. Repeat swabs were negative after Mupirocin treatment.

The MRSA carriers were treated with Mupirocin and the organisms were completely eradicated.

In this study, grade II nursing assistants were the major nasal carriers accounting for 6 (37.5%), followed by five (31.2%) staff nurses, three (18.8%) grade I nursing assistants 3 (18.8%), then one head nurse (6.2%), and one doctor (6.2%) among doctors including staff and post graduates were 1 (6.2%) while there were no nasal carriers among students. Hence nursing staff had more prevalence than clinical staff.


  Discussion Top


According to Perl, Mupirocin ointment has been shown to be 97% effective in reducing S. aureus nasal carriage. In our study we obtained 100% efficacy for Mupirocin. [5] We also found that Mupirocin is more effective than Neomycin sulphate for the elimination of S. aureus nasal colonization. They were directed to attend duties with standard surgical mask to prevent the spread of infection to others.

All the theatre staff were educated about universal precautions and the benefit of thorough hand washing. They were strictly advised about the continuous use of surgical mask in the theatre.


  Recommendations Top


  1. Practice universal precautions and always cover the nose with the surgical mask.
  2. Wash hands with soap and water or chlorhexidine.
  3. Educate the theatre staff about the importance of eradicating nasal carriage of S. aureus and thus decrease surgical site infection.
  4. Mupirocin nasal application thrice daily for 7 days can control nasal carriers of S. aureus.



  Acknowledgement Top


The authors are grateful to the head of the department and post graduate students of the General Surgery Department and head nurses of the operation theaters of Government Medical College Hospital, Thiruvananthapuram, for their kind co-operation in this study.

 
  References Top

1.
Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: Epidemiology, underlying mechanisms and associated risks. Clin Microbial Rev 1997;10:505-20.  Back to cited text no. 1
    
2.
Munoz P, Hortal J, Giannella M, Barrio JM, Rodriguez-Creixems M, Pérez MJ, et al. Nasal carriage of S aureus increases the risk of surgical site infection after major heart surgery. J Hosp Infect 2008;68:25-31.  Back to cited text no. 2
    
3.
Casewell MW. The nose: An underestimated source of Staphylococcus aureus causing wound infection. J Hosp Infect 1998;40:S3-11.  Back to cited text no. 3
    
4.
Darcy P. Eradication of nasal carriage of Staphylococcal aureus-is it cost effective. J Hosp Infect 1998;40:S31-7.  Back to cited text no. 4
    
5.
Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Mupirocin And The Risk Of Staphylococcus Aureus Study Team. Intra nasal mupirocin to prevent post operative Staphylococcus aureus infections. N Eng J Med 2002;346:1871-7.  Back to cited text no. 5
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
Abstract
Introduction
Materials and me...
Results
Discussion
Recommendations
Acknowledgement
References
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