Mupirocin-based Nasal Decolonization to Prevent Staphylococcus aureus Surgical Site Infections: A Meta-Analysis of Randomized Control Trials

ObjectivesTo determine whether mupirocin-based decolonization, compared with placebo, no treatment, or alternative agents, reduces S. aureus-related surgical site infection (SA-SSI), nasal S. aureus colonization and overall SSIs incidence in elective surgery. MethodsWe searched EMBASE, Medline (Ovid), PubMed, CENTRAL, and Google Scholar to 15 May 2024 for randomized controlled trials.Risk ratios (RRs) were pooled using a random-effects model with the restricted maximum likelihood (REML) estimator with the Hartung-Knapp (HK) adjustment.Prespecified subgroup analyses evaluated application strategy, surgical type, and chlorhexidine gluconate (CHG) co-administration. ResultsSeventeen RCTs (15,533 participants) were included.In trials with notreatment or placebo controls, mupirocin-based decolonization reduced S. aureus-related SSI (SA-SSI) (RR 0.67, 95% CI 0.49-0.91)and nasal colonization (RR 0.22, 95% CI 0.18-0.26).Effects were larger with targeted use in confirmed carriers and when combined with CHG.No reduction was observed for overall SSIs, except in orthopedic surgery (RR 0.80, 95% CI 0.65-0.99).Head-to-head data versus active alternatives were sparse and did not show a consistent advantage for mupirocin. 4 ConclusionsTargeted preoperative mupirocin, especially when combined with CHG, reduces SA-SSI in elective surgery.The lack of significant impact on overall SSIs is interpreted as a reflection of polymicrobial etiologies in surgical infections.Given the emerging risk of mupirocin resistance, further adequately powered head-to-head trials with standardized outcomes and integrated resistance surveillance are warranted.