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Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU
Journal article   Open access   Peer reviewed

Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU

Matthew Smith and Loreen Herwaldt
American journal of infection control, Vol.51(11 Suppl.), pp.A64-A71
11/2023
DOI: 10.1016/j.ajic.2023.02.004
PMID: 37890955
url
https://doi.org/10.1016/j.ajic.2023.02.004View
Published (Version of record) Open Access

Abstract

•Intranasal mupirocin is effective pre-operatively for orthopedic and cardiac procedures.•Mupirocin is effective for nasal decolonization in the intensive care unit setting.•Intranasal povidone-iodine is most effective for pre-operative nasal decolonization.•Other decolonization agents lack sufficient data for widespread use.•Additional research on decolonizing agents is still needed. Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units. We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited. Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.
 Intensive care unit decolonization Mupirocin Povidone-iodine Pre-operative antisepsis

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