Efficacy of Staphylococcus aureus nasal decolonization at hospital admission on reduction of any infections within 90 days – a systematic review and meta-analysis

Infections with Staphylococcus aureus are associated with excess mortality and costs. Simple interventions, such as decolonization protocols, might help to reduce subsequent infections, especially in settings in which S. aureus is of major clinical relevance, such as healthcare-associated infections. The aim of this research was to determine whether S. aureus decolonization protocols, using a nasal ointment and applied at hospital admission, reduce the risk of infection. MEDLINE, EMBASE and clinicaltrials.gov were searched for all randomized controlled trials investigating the use of nasal ointments for decolonization for patients at hospital admission and reporting on infections within 90 days. Data were pooled as risk ratios using a random-effects model. The Cochrane RoB 2 tool and GRADE were used to assess the risk of bias and quality of evidence. Four (0.5%) of 833 screened studies with a total of 4150 patients met eligibility criteria. The overall certainty of evidence ranged from low to moderate across outcomes. Nasal S. aureus decolonization probably reduces infections (6.9% vs 9.5%; rate ratio (RR): 0.73 (95% confidence interval (CI) 0.57; 0.93)) and may increase microbiological eradication (82.7% vs 55.2%; RR: 1.80 (95% CI 0.73; 4.44)) compared with placebo. It may not reduce mortality (2.5 vs 2.4; RR: 1.02 (95% CI 0.67; 1.54)) but also not lead to increased adverse effects (0.7% vs 0.6%; RR: 1.01 (95% CI 0.45; 2.30)). Results were consistent across subgroups and sensitivity analyses. In conclusion, nasal decolonization at acute-care hospital admission probably reduces the risk of infections and may result in a large increase in microbiological eradication. It may not reduce mortality and also not result in an increased number of adverse events.