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Nasal povidone-iodine reduced S. aureus SSI incidence
SAN DIEGO — Nasal povidone-iodine solution reduced the incidence of surgical site infections due to Staphylococcus aureus after arthroplasty or spine fusion, according to research presented here at ID Week 2012.
“We started instructing patients to take mupirocin prior to surgery to prevent infections back in 2009,”Michael S. Phillips, MD, clinical associate professor and hospital epidemiologist at NYU Langone Medical Center, told Infectious Disease News. “In 2010, we conducted an anonymous patient survey and found that a significant number of patients had a hard time paying for the medication, which was not covered by many insurance companies in New York. We found an alternative, cheaper treatment — the povidone-iodine — but we did not have any data on whether the two treatments were equivalent.”
Phillips and colleague conducted an open-label, randomized trial comparing the rates of surgical site infection in patients who received topical chlorhexidine gluconate with either one application of nasal povidone-iodine or 5 days of nasal mupirocin ointment before surgery.
In the modified intention-to-treat analysis, of 887 surgical patients who received povidone-iodine, only one patient developed a deep S. aureus surgical site infection. Among the 879 surgical patients who received mupirocin, five developed a deep S. aureus surgical site infection. There was one superficial S. aureus infection in the povidone-iodine group and none in the mupirocin group. Six patients in the povidone-iodine group developed a deep surgical site infection due to any pathogen, as did 14 patients in the mupirocin group.
In the per-protocol analysis, no patients developed deep S. aureus surgical site infections vs. five patients in the mupirocin group. Adverse event rates were 3% among those who received povidone-iodine and 10% among those who received mupirocin. In addition, colonization with S. aureus before surgery was associated with S. aureus surgical site infection.
“We feel physicians should consider the use of povidone-iodine as part of a multifaceted approach to reduce surgical infections, especially in patients at high risk for infection, such as those who are colonized with S. aureus prior to surgery,” Phillips said.
For more information:
Phillips M. #LB-3. Presented at: ID Week 2012; Oct. 17-21, 2012; San Diego.
Disclosure: Phillips reports no relevant financial disclosures.