***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We analyzed the effect of perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment on the reduction of the postoperative wound infection rate in orthopedics . In an unblinded intervention trial , we compared 1,044 patients treated with mupirocin ( intervention group ) with 1,260 historical controls ( control group ) . From each group a r and om sample of 50 patients was taken . Risk factors were analyzed in these r and om sample s and we found it unlikely that different distributions of risk factors might have influenced the results . The wound infection rates were 14/1,044 in the intervention group and 34/1,260 in the control group ( p = 0.02 ) . The rates of wound infections caused by S. aureus were subsequently 7/1,044 and 14/1,260 ( p = 0.3 ) . On checking the data we found that prophylaxis had unintentionally not been given to 172 patients in the intervention group . Correction of the data gave a comparable total infection rate , but a further reduced infection rate by S. aureus . Our findings suggest that prophylactic treatment with mupirocin in orthopedic surgery can reduce the infection rate Mupirocin has been used in nursing homes to prevent the spread of methicillin-resistant Staphylococcus aureus ( MRSA ) , despite the lack of controlled trials . In this double-blind , r and omized study , the efficacy of intranasal mupirocin ointment versus that of placebo in reducing colonization and preventing infection was assessed among persistent carriers of S. aureus . Twice-daily treatment was given for 2 weeks , with a follow-up period of 6 months . Staphylococcal colonization rates were similar between residents at the Ann Arbor Veterans Affairs ( VA ) Extended Care Center , Michigan ( 33 % ) , and residents at a community-based long-term care facility in Ann Arbor ( 36 % ) , although those at the VA Center carried MRSA more often ( 58 % vs. 35 % ; P=.017 ) . After treatment , mupirocin had eradicated colonization in 93 % of residents , whereas 85 % of residents who received placebo remained colonized ( P<.001 ) . At day 90 after study entry , 61 % of the residents in the mupirocin group remained decolonized . Four patients did not respond to mupirocin therapy ; 3 of the 4 had mupirocin-resistant S. aureus strains . Thirteen ( 86 % ) of 14 residents who became recolonized had the same pretherapy strain ; no strain recovered during relapse was resistant to mupirocin . A trend toward reduction in infections was seen with mupirocin treatment BACKGROUND H and hygiene prevents cross infection in hospitals , but compliance with recommended instructions is commonly poor . We attempted to promote h and hygiene by implementing a hospital-wide programme , with special emphasis on bedside , alcohol-based h and disinfection . We measured nosocomial infections in parallel . METHODS We monitored the overall compliance with h and hygiene during routine patient care in a teaching hospital in Geneva , Switzerl and , before and during implementation of a h and -hygiene campaign .  Seven hospital-wide observational surveys were done twice yearly from December , 1994 , to December , 1997 . Secondary outcome measures were nosocomial infection rates , attack rates of methicillin-resistant Staphylococcus aureus ( MRSA ) , and consumption of h and rub disinfectant .  FINDINGS We observed more than 20,000 opportunities for h and hygiene .  Compliance improved progressively from 48 % in 1994 , to 66 % in 1997 ( p<0.001 ) . Although recourse to h and washing with soap and water remained stable , frequency of h and disinfection substantially increased during the study period ( p<0.001 ) . This result was unchanged after adjustment for known risk factors of poor adherence . H and hygiene  improved significantly among nurses and nursing assistants , but remained poor among doctors . During the same period , overall nosocomial infection decreased ( prevalence of 16.9 % in 1994 to 9.9 % in 1998 ; p=0.04 ) , MRSA transmission rates decreased ( 2.16 to 0.93 episodes per 10,000 patient-days ; p<0.001 ) , and the consumption of alcohol-based h and rub solution  increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 ( p<0.001 ) . INTERPRETATION The campaign produced a sustained improvement in compliance with h and  hygiene  , coinciding with a reduction of nosocomial infections and MRSA transmission . The promotion of bedside , antiseptic h and rubs largely contributed to the increase in compliance Background . Infections with Staphylococcus aureus are a significant problem in patients in liver transplant units . An association between prior nasal carriage with S. aureus and subsequent infections has been documented previously in liver transplant recipients and patients with cirrhosis . However , the role of decolonization with mupirocin applied intranasally for the prevention of S. aureus infections in these patients has not been determined . Methods . S. aureus nasal carriage was prospect ively sought in 70 consecutive liver transplant c and i date s.  Mupirocin two times per day for 5 days was administered to the carriers . Follow-up nasal cultures to document decolonization were performed 5 days after the final application of mupirocin . The primary endpoint was the development of S. aureus infections . Results . Thirty-one of 70 patients ( 44 % ) were found to be nasal carriers and 27 of 31 nasal carriers ( 87 % ) were successfully decolonized . However , 12 of 27 patients ( 37 % ) successfully decolonized became recolonized with S. aureus , and an additional nine patients who were initially noncarriers became newly colonized with S. aureus during the study period . Despite the use of mupirocin , 16 of 70 patients ( 23 % ) developed an infection with S. aureus . No isolate was found to be mupirocin resistant . Conclusion . Elimination of S. aureus nasal carriage by mupirocin did not prevent S. aureus infections in patients in our liver transplant unit BACKGROUND This study was design ed to determine whether decreasing nasal bacterial colonization by applying Mupirocin ( MPN ) intranasally decreases sternal wound infections . METHODS We prospect ively followed 992 consecutive open heart surgery ( OHS ) patients who did not receive MPN prophylaxis ( group I ) from January 1 , 1995 to October 31 , 1996 . Group II consisted of 854 consecutive patients followed prospect ively from December 1 , 1997 to March 31 , 1999 treated with intranasal MPN given on the evening before , the morning of OHS , and twice daily for 5 days postoperatively . RESULTS There was a significant difference in the rate of overall sternal wound infections between the untreated ( group I ) and the treated group ( group II ) : 2.7 % ( 27 of 992 ) versus 0.9 % ( 8 of 854 ) ( p = 0.005 ) . The difference was also significant in the diabetic subgroup : 5.1 % ( 14 of 277 ) ( group I ) versus 1.9 % ( 5 of 266 ) ( group II ) ( p = 0.04 ) and the nondiabetic group : 1.8 % ( 13 of 715 ) ( group I ) versus 0.5 % ( 3 of 588 ) ( group II ) ( p = 0.03 ) . The cost of MPN treatment was $ 12.47 per patient compared with $ 81,018 + /- $ 41,567 for a deep wound infection with no antibiotic-related complications recorded . CONCLUSIONS Prophylactic intranasal MPN is safe , inexpensive , and very effective in reducing the overall sternal wound infections by 66.6 % Staphylococcus aureus is the agent of community-acquired and nosocomial infections . Twenty to 35 % of the population permanently carries it in the nose and oropharynx , and additional 50 % , carries it intermittently . Topical calcium mupirocin is an antibacterial agent against Staphylococcus aureus recommended to eradicate nasal and h and colonization in patients and health care workers . The prevalence of nasal S. aureus was determined in patients undergoing cardiovascular surgery . In addition , the effect of mupirocine on the number of carriers and rate of nosocomial infections was evaluated . An experimental prospect i ve study was undertaken with two groups of patients : one treated with mupirocin ( n = 96 ) , and the other without treatment ( n = 95 ) . Tests for presence of nasal S. aureus and nosocomial infections were conducted in all patients . A 34 % prevalence of S. aureus carriers was found . A decrease of the prevalence was found in both treated ( 87 % ) and untreated patients ( 33 % ) , but in significantly different proportions ( p = 0.0002 , RR = 0.22 , 95%CI = 0.09 - 0.054 ) . This result demonstrated the effectiveness of a mupirocin treatment program to decrease numbers of nasal carriers . With regard to nosocomial infection , S. aureus prevalence was 3.6 % , occurring mostly in control patients ( 6 of 7 ) . Total nosocomial infection prevalence was 17.3 % , evenly distributed in treated and untreated patients . This suggested that mupirocin use did not decrease the number of nosocomial infections Compromised patients subjected to major digestive surgery frequently develop infective complications caused by methicillin‐resistant Staphylococcus aureus ( MRSA ) , which may have dangerous consequences . This was a prospect i ve r and omized study to determine whether intranasal mupirocin could reduce postoperative infective complications in patients having digestive surgery A six month prospect i ve study was carried out in a surgical intensive care unit ( SICU ) of a university hospital to assess the incidence and routes of exogenous colonization by Staphylococcus aureus . A total of 157 patients were included in the study . One thous and one hundred and eleven specimens ( nasal , surgical wound swabs , tracheal secretions obtained on admission and once a week thereafter , and all clinical specimens ) were collected over a four month period from patients without nasal decontamination ( A ) . They were compared with 729 specimens collected over a two month period from patients treated with nasal mupirocin ointment ( B ) . All S. aureus strains were typed by restriction fragment length polymorphism ( RFLP ) pulsed-field gel electrophoresis after SmaI macrorestriction . The nasal colonization rates on admission were 25.5 and 32.7 % in groups A and B , respectively . Thirty-one untreated patients ( 31.3 % ) and three patients ( 5.1 % ) treated with nasal ointment , acquired the nasal S. aureus in the SICU ( P = 0.00027 ) . Nasal carriers were more frequently colonized in the bronchopulmonary tract ( Bp ) and surgical wound ( Sw ) ( 62 % ) than patients who were not nasal carriers ( 14 % ) ( P < 0.00001 ) . The patterns were identical for nasal , Bp and Sw strains from the same patient . RFLP analysis characterized seven epidemic strains of methicillin-resistant S. aureus ( MRSA ) which colonized 60 % of group A and 9 % of group B patients ( P < 0.00001 ) . The bronchopulmonary tract infection rate was reduced in group B ( P = 0.032 ) . In conclusion , in an SICU , nasal carriage of S. aureus appeared to be the source of endogenous and cross-colonization . The use of nasal mupirocin ointment reduced the incidence of Bp and Sw colonization , as well as the MRSA infection rate Summary Staphylococcus aureus is a common cause of postoperative wound infections , and nasal colonization by this organism is an important factor in the development of infections . Treatment with mupirocin can eradicate the organism in the short term , and prophylactic treatment of colonized patients may prevent postoperative S. aureus infections . A double-blind , r and omized , placebo-controlled trial was performed to determine whether nasal mupirocin administered pre-operatively to S. aureus carriers reduces the rates of sternal and leg wound infections after cardiac surgery . The study enrolled 263 patients with nasal S. aureus undergoing elective cardiac surgery at St. Michael 's Hospital , Toronto , Canada . Patients were assessed for infections in the immediate postoperative period and two months later . Two hundred and fifty-seven patients were included in the intention-to-treat analysis and re-analysed according to the actual treatment applied . Wound infections occurred in 17 ( 13.5 % ) mupirocin recipients and 11 ( 9.1 % ) placebo recipients ( P = 0.319 ) , with seven ( 5.4 % ) and six ( 4.7 % ) sternal in 
    Output:
    
Prophylactic intranasal mupirocin significantly reduced the rate of post-operative S. aureus infections among surgical patients who were S. aureus carriers