Prevention of nosocomial Staphylococcus aureus infections after rapid detection and eradication of S. aureus carriage in patients at risk; a randomized placebo controlled multi-centre trial
07 / 2005 - 03 / 2007
Website CCMO; ZonMw
Staphylococcus aureus is a frequent cause of nosocomial infections, including bacteremia and wound infections. Approximately twenty-five percent of all nosocomial infections are caused by S. aureus, affecting both surgical and non-surgical patients, and leading to increased hospital stay, antibiotic use, costs, and mortality. Nasal carriers of S. aureus have an increased risk of developing these infections. Recent data show that eighty percent of nosocomial bacteremic S. aureus strains are endogenous and similar to the strain from the nose of S. aureus carriers. Since 20-55% of patients admitted to the hospital is a carrier of this pathogen, a substantial number of these nosocomial infections may be prevented by eliminating S. aureus from the nose. Intranasal application of mupirocin for five days successfully eradicates S. aureus from the nose and leads to a reduction of S. aureus hand carriage. Mupirocin prophylaxis has been proven effective. The incidence of nosocomial infections is high: overall 3-5% of hospitalised patients develop nosocomial infection before discharge . In the Netherlands, the incidence of nosocomial infections is estimated to be 4,5 per 1000 patientdays  Doelstelling: This project has as a goal to reduce the number of nosocomial S. aureus infections by at least 50% and reduce related duration of hospital stay and mortality, by treating S. aureus carriers within 24 hours after admission with mupirocin nasal ointment and skin disinfection. Does the treatment of S. aureus nasal carriage with mupirocin nasal ointment in combination with skin disinfection within 24 hours after admittance, significantly reduce nosocomial S. aureus infections in S. aureus carriers admitted to departments with a relatively high prevalence of S. aureus disease? Does this prophylaxis treatment also reduce the duration of hospital stay and in-hospital mortality? Staphylococcus aureus is a frequent cause of nosocomial infections, including bacteremia and wound infections . Approximately twenty-five percent of all nosocomial infections are caused by S. aureus, affecting both surgical as non-surgical patients, and leading to increased hospital stay, antibiotic use, costs, and mortality [3-6] DESIGN: Double-blinded placebo controlled multi-center trial. Participating centers: Erasmus University Medical Center (Rotterdam), Academic Medical Center (Amsterdam), VU Medical Center (Amsterdam), Amphia hospital (Breda), University Medical Center Utrecht (Utrecht), en University Medical Center St. Radboud (Nijmegen). All centers are currently collaborating in the Working Party Nosocomial Infections Epidemiology The Netherlands (ZIEN). Four of these centers collaborated already before in a similar trial.