An extensive multistate study conducted by leading institutions – the Centers for Disease Control and Prevention, Harvard Pilgrim Health Care Institute, HCA Healthcare and the University of California, Irvine – revealed groundbreaking findings that a nasal antibiotic ointment, mupirocin, showed remarkable efficacy in preventing Staphylococcus aureus infections in critically ill patients. The study establishes mupirocin as superior to an antiseptic solution in infection prevention among ICU patients, despite its usage in only about a third of all U.S. hospitals.
The study included over 800,000 ICU patients from 137 HCA Healthcare hospitals, further building on previous research that depicted the benefits of a combination of daily chlorhexidine soap baths and nasal mupirocin for ICU patients, a regimen known as ‘decolonization.’ However, a limited number of hospital ICUs utilize nasal mupirocin for all patients, driven by concerns over escalating antibiotic resistance. To address this, the researchers compared the performance of mupirocin to another nasal antiseptic product, povidone-iodine or iodophor. Mupirocin proved significantly better at preventing S. aureus infections, including antibiotic-resistant strains like MRSA. The findings, which buttress existing CDC guidelines on the combined use of nasal decolonization and CHG bathing in ICU patients, were published in the Journal of the American Medical Association (JAMA).
The 137 hospitals involved in the research are part of HCA Healthcare, a leader in real-life setting research. Half of these hospitals persisted with their standard practice of ICU patient treatment with mupirocin nasal ointment, while the others transitioned to nasal povidone-iodine. Consistently, the trial confirmed the sustained benefit of mupirocin, suggesting that it retained effectiveness despite prolonged ICU use over the past decade—a crucial aspect, given the potential of widespread antibiotic use to prompt antibiotic resistance.
The study’s large-scale and diverse setup lends its results broad applicability for hospitals nationwide. This marks another significant step in the longstanding scientific partnership involving HCA Healthcare, Harvard Medical School’s Department of Population Medicine at the Harvard Pilgrim Health Care Institute, the University of California, Irvine, and the Centers for Disease Control and Prevention, previously responsible for a significant study demonstrating reduced MRSA by 37% and bloodstream infection rates by 44% through the same decolonization strategy. The recent Mupirocin-Iodophor Swap Out Trial, in comparison, revealed an 18% decrease in protection from S. aureus infections when switching from mupirocin to iodophor.
The study further consolidates the significance of decolonization strategies, leading to hopes for future research and the inclusion of more agents that can reduce pathogen burden in infection prevention.
The study forms another significant contribution to the field of infection prevention, emphasizing the important role of decolonization in a hospital setting and endorsing the preference of mupirocin over iodophor for nasal decolonization protocols.