The NOSE study (nasal ointment for Staphylococcus aureus eradication): a randomized controlled trial of monthly mupirocin in HIV-infected individuals

Abstract

Background: HIV-positive patients at HELP/PSI, Inc, an in-patient drug rehabilitation center, had a high baseline prevalence of Staphylococcus aureus colonization (49%) and incidence of infection (17%) in a previous year-long study.

Methods: A randomized, double-blinded, placebo-controlled study was conducted to determine whether repeated nasal application of mupirocin ointment would decrease the odds of S. aureus nasal colonization in 100 HELP/PSI patients over an 8-month period. A 5-day course of study drug was given monthly, and colonization was assessed at baseline and 1 month after each treatment. S. aureus infection was a secondary outcome.

Results: In repeated-measures analysis, mupirocin reduced the odds of monthly S. aureus nasal colonization by 83% compared with placebo [adjusted odds ratio (ORadj) = 0.17; P < 0.0001]. Subjects colonized at study entry had a 91% reduction in subsequent colonization (ORadj = 0.09; P < 0.0001). Mupirocin also suppressed S. aureus colonization in subjects not colonized at baseline (ORadj = 0.23; P = 0.006). There was no difference in infection rates between the mupirocin and placebo groups (hazard ratio = 0.49, P = 0.29).

Conclusions: Monthly application of nasal mupirocin significantly decreased S. aureus colonization in HIV patients in residential drug rehabilitation. Monthly mupirocin application has a potential role in long-term care settings or in HIV-positive patients with high rates of S. aureus colonization and infection.

Conflict of interest statement

Conflicts of Interest

None of the authors report any conflicts of interest.

Figures

Figure 1. Patient Screening, Exclusions, Randomization and Follow-up

Figure 1 describes the flow of people through the study from screening through follow-up. *For two subjects, it was unclear whether they first left the study site or withdrew from the study.

Figure 2. Effect of mupirocin on S. aureus nasal colonization

Figure 2 shows the percentage of the mupirocin and placebo groups nasally colonized with S. aureus at baseline and at each month of the subjects’ follow-up. The number of subjects cultured at each follow-up month is shown.