Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) and Use of a Nasal Mupirocin Ointment in Oral Cancer Inpatients

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Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 11, November 2007, Pages 2159-2163

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) and Use of a Nasal Mupirocin Ointment in Oral Cancer Inpatients
Minoru Miyake DDS, PhD *, Yumiko Ohbayashi DDS, PhD‹, Akinori Iwasaki DDS, PhD·, Takaaki Ogawa DDS, PhD ? and Shunichiro Nagahata DDS, PhD ||
‹ Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
· Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
* Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
|| Professor and Chair, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
? Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Available online 22 October 2007.

Purpose
Elimination of methicillin-resistant Staphylococcus aureus (MRSA) is of critical importance in oral and maxillofacial surgery because control is very difficult once infection of an oral tumor or oral wound with MRSA is established.

Patients and Methods
We retrospectively investigated the risk factors for acquiring MRSA in 518 patients with oral cancer among 1,877 inpatients in our department between 1984 and 2005.

Results
The patients with oral cancer demonstrated a high rate of MRSA colonization and infection (77.8%) relative to the population as a whole with MRSA isolated percentage in our department after 1991. The risk factors for MRSA in oral cancer patients are also related to systemic diseases and physiological and iatrogenic conditions, including cerebrovascular diseases (77.8%), peripheral arterial catheterization (69.2%), diabetes (50.0%), tracheotomy (50.0%), renal failure (50.0%), long-term broad-spectrum antibiotic use (45.7%), and malnutrition (43.3%). However, the highest risk of MRSA seems to be related to poor hygienic care.

Conclusions
Beginning in 1999, we implemented a strategy for reducing infection by MRSA that included nasal mupirocin ointment for patients at high risk of MRSA; since then, the detection rate has decreased. We suggest that the administration of nasal mupirocin ointment and provision of scrupulous hygienic care for high-risk patients are useful and effective measures for decreasing the incidence of MRSA infection.

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