Topical Antibiotics for Infection Prevention: A Review of the Clinical Effectiveness and Guidelines

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Topical Antibiotics for Infection Prevention: A Review of the Clinical Effectiveness and Guidelines

Book. 2017 03 30

Authors: Banerjee S, Argáez C

Abstract
It is estimated that worldwide, 7% to 10% of hospitalized patients are affected by skin and soft tissue infections caused by microbial invasion of the skin and underlying soft tissues. Surgical site infections (SSIs) occur in approximately 2% to 5% of patients undergoing clean extra-abdominal surgeries and in up to 20% of patients undergoing intra-abdominal surgeries. Infections lead to delay in healing, increased morbidity, and prolonged hospital stay which will impact health care resources. The bacteria, Staphylococcus aureus (S. aureus) is one of the most common causes of health care-associated infections such as SSIs, exit site infections (ESIs) in dialysis patients, and infections in patients in intensive care units (ICU). It is estimated that 20% of healthy people are chronic carriers of S. aureus, 30% are intermittent carriers, and 50% are not susceptible. The risk of infection is reported to be 2 to 12 times higher in S. aureus nasal carriers compared to non-carriers. It has been reported that nasal decolonization of patients with S. aureus significantly reduces infections caused by S. aureus. It has been reported that 18% to 25% of patients undergoing elective orthopedic surgery are nasal carriers of S. aureus and carriers are more likely to experience SSIs. One systematic review has reported that 26% of patients undergoing hemodialysis are nasal carriers of S. aureus. For patients with nasal S. aureus carriage, who were undergoing dialysis, colonization with the same bacteria was reported at the dialysis catheter exit site. Patients with S. aureus colonization are at a greater risk of developing S. aureus infection in the ICU. Topical antibiotics assist in preventing infections caused by bacteria. A variety of topical antibiotics are available such as bacitracin, mupirocin, gramicidin, fusidic acid and gentamycin. There is however some concern regarding the use of antibiotics because of the possible development of antibacterial resistance in the long term. The purpose of this report is to review the existing evidence on the clinical effectiveness of prevention of skin or wound infection with the topical antibiotics: polymyxin B sulfate-bacitracin (Polysporin ointment), polymyxin B sulfate-gramicidin (Polysporin cream), polymyxin B sulfate-bacitracin-gramicidin (Polysporin triple ointment), bacitracin (Bacitin ointment), mupirocin (Bactroban cream/ointment), silver sulfadiazine (Flamazine cream), fusidic acid/fusidate sodium (Fucidin cream/ointment), and fusidic acid 2% with hydrocortisone (Fucidin H). Additionally, this report aims to review evidence-based guidelines for the prevention of skin or wound infection using these topical antibiotics.

PMID: 29533570

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