***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 
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    ***EXAMPLES*** 
    Input: BACKGROUND Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism . Decolonization of nasal and extranasal sites on hospital admission may reduce this risk . METHODS In a r and omized , double-blind , placebo-controlled , multicenter trial , we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction ( PCR ) assay , followed by treatment with mupirocin nasal ointment and chlorhexidine soap , reduces the risk of hospital-associated S. aureus infection . RESULTS From October 2005 through June 2007 , a total of 6771 patients were screened on admission . A total of 1270 nasal swabs from 1251 patients were positive for S. aureus . We enrolled 917 of these patients in the intention-to-treat analysis , of whom 808 ( 88.1 % ) underwent a surgical procedure . All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin . The rate of S. aureus infection was 3.4 % ( 17 of 504 patients ) in the mupirocin-chlorhexidine group , as compared with 7.7 % ( 32 of 413 patients ) in the placebo group ( relative risk of infection , 0.42 ; 95 % confidence interval [ CI ] , 0.23 to 0.75 ) . The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections ( relative risk , 0.21 ; 95 % CI , 0.07 to 0.62 ) . There was no significant difference in all-cause in-hospital mortality between the two groups . The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group ( P=0.005 ) . CONCLUSIONS The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission . ( Current Controlled Trials number , IS RCT N56186788 . We have studied the efficacy of topical Mupirocin for elimination of Staphylococcus aureus ( Staph . aureus ) nasal carriage in CAPD patients . Staph . aureus nasal carriers in our CAPD program were r and omized to one of two groups : Group 1 , treated with Mupirocin , and Group 2 , treated with neomycin sulphate nasal ointment . The prevalence of Staph . aureus nasal colonization was 44 % for patients ( 24/54 ) and 17 % for dialysis partners ( 5/29 ) . Group 1 included 11 patients and 1 partner , and Group 2 , 8 patients and 2 partners . In Group 1 , the eradication rate was 100 % , and the recolonization rate was 0 , 8 , 41 , 55 and 66 % at 1 , 2 , 3 , 6 and 10 months . In Group 2 , the eradication rate was 40 % , with a recolonization rate of 0.25 and 75 % at 1 , 2 and 3 months . Re-treatment with mupirocin  was successful in 66 % of the cases , compared to 20 % for neomycin . The MIC90 of mupirocin  for Staph . aureus was 0.5 mcg/mL , with an increase to 4 mcg/mL towards the end of the study . During the study period , there was a very low incidence of Staph . aureus peritonitis or catheter-related infections in patients treated with mupirocin .  Secondary effects of mupirocin were negligible . Mupirocin is more effective than neomycin sulphate for the elimination of Staph . aureus nasal colonization in patients undergoing CAPD . Periodic re-treatment is frequently necessary , given the significant recolonization rate Context Topically applied mupirocin can eradicate nasal carriage of Staphylococcus aureus , but can it prevent S. aureus infections in nonsurgical , hospitalized patients ? Contribution In this large double-blind trial , medically ill , hospitalized patients with positive nasal culture results for S. aureus were r and omly assigned to either mupirocin or placebo nasal ointment twice daily for 5 days and were followed until 6 weeks after discharge . Staphylococcus aureus infection rates were similar among patients given mupirocin ( 2.6 % ) and placebo ( 2.8 % ) . Implication s Applying intranasal mupirocin ointment to patients who carry S. aureus in the nose did not prevent S. aureus infections in hospitalized , nonsurgical patients . The Editors Staphylococcus aureus is a frequent cause of nosocomial infections , including bacteremia and wound infections ( 1 , 2 ) . Approximately 25 % of all nosocomial infections are caused by S. aureus , affecting both surgical and nonsurgical patients and leading to increased hospital stay , antibiotic use , costs , and mortality ( 3 - 5 ) . Nasal carriers of S. aureus have an increased risk for these infections ( 6 - 9 ) . Recent data show that 80 % of nosocomial bacteremic S. aureus strains are endogenous and originate from the nose of S. aureus carriers ( 7 ) . Since 20 % of the population carries this pathogen persistently and 60 % carries it intermittently , a substantial number of these nosocomial infections may be prevented by eliminating S. aureus from the nose ( 10 ) . Intranasal application of mupirocin twice daily for 5 days successfully eradicates S. aureus in 83 % to 88 % of carriers and reduces S. aureus h and carriage ( 8 , 11 - 13 ) . Several studies have shown that patients undergoing surgery or dialysis ( peritoneal and hemodialysis ) benefit from S. aureus eradication from the nose because of the reduction in nosocomial S. aureus infections ( 10 ) . Mupirocin prophylaxis has been proven to be effective in preventing nosocomial S. aureus infections in r and omized , placebo-controlled trials among dialysis and surgical patients and patients with recurrent skin infections ( 8 , 14 - 17 ) . Although the efficacy of mupirocin prophylaxis use has been confirmed only in these patients , mupirocin has many extralabel indications . The result ing widespread use has lead to mupirocin resistance ( 18 ) . Since mupirocin is a major weapon to control methicillin-resistant S. aureus outbreaks , it should be used in a prudent and restrictive manner . Prudent use implies that it be used only for patients in whom it has proven efficacy . The efficacy of mupirocin prophylaxis in a general nonsurgical patient population is not yet known . Therefore , we decided to study whether mupirocin prophylaxis in nasal S. aureus carriers hospitalized in nonsurgical wards decreases the incidence of nosocomial S. aureus infections . We assessed whether these nosocomial S. aureus infections were caused by endogenous strains , and we measured the effect of this intervention on mortality and duration of hospital stay . Methods Design and Patients This is a multicenter , r and omized , double-blind , placebo-controlled trial . The 4 participating hospitals were Erasmus University Medical Center ( Rotterdam , 1300 beds ) , University Medical Center St. Radboud ( Nijmegen , 950 beds ) , VU University Medical Center ( Amsterdam , 730 beds ) , and Amphia Hospital , Langendijk ( Breda , 500 beds ) . The first 3 hospitals are tertiary care hospitals , and all are teaching hospitals in the Netherl and s. The institutional review board of each hospital approved the study . Between 1 February 1999 and 1 February 2001 , adult patients hospitalized in nonsurgical departments were screened for nasal S. aureus carriage at the time of admission . All patients whose screening cultures grew S. aureus within 72 hours after admission were eligible for the study . Additional inclusion criteria were age 18 years or older , not being discharged or expected to be discharged within 1 day , not being transferred to a nonparticipating department , and provision of written informed consent . Exclusion criteria were known allergy to mupirocin or glycerin ester , presence of a nasal tube , recent or current mupirocin use ( mostly patients undergoing hemodialysis or peritoneal dialysis ) , and any culture-proven S. aureus infection at the time of inclusion . Trial participants were r and omly assigned to receive mupirocin 2 % nasal ointment or placebo ointment ( both were obtained from GlaxoSmithKline , Harlow , United Kingdom ) twice daily for 5 days . Mupirocin and placebo ointments were similar in appearance and odor and were supplied in identical tubes . R and omization was performed by a computer-generated allocation list and stratified for each hospital . The allocation list and study medication were stored by the departments of medical microbiology and infectious diseases at the participating centers . Study personnel and patients were blinded throughout the study . Study medication was dispensed by trained study personnel , who performed the first application according to the manufacturer 's instructions . Subsequent applications were done by the patient or nursing personnel according to oral and written instructions . Patients and nurses were informed about possible adverse events ( mainly local irritation , itching or burning , rhinorrhea , and , rarely , hypersensitivity reactions ) . They were instructed to report any adverse event related to the treatment , and medication was withdrawn if necessary . Patients did not receive follow-up cultures to check for clearance of S. aureus nasal carriage . Follow-up and Definitions At r and omization , the following patient data were collected : demographic characteristics , main diagnosis , underlying illnesses , immunosuppressive and antibiotic medication , and presence of indwelling devices or prosthetic material . The main diagnosis was coded according to the International Classification of Diseases , Ninth Revision ( ICD-9 ) . Nosocomial S. aureus infections were followed up by checking the microbiological culture data from any site of all included patients on a weekly basis until 6 weeks after discharge . In case of a positive culture result , hospital records were checked and , if necessary , the treating physician was interviewed . Nosocomial infections were defined according to criteria of the Centers for Disease Control and Prevention ( 19 ) . A nosocomial infection was caused by S. aureus when this pathogen was cultured from the site of infection . Patients with nosocomial S. aureus infection were considered to have sepsis if 2 or more of the following conditions were present : temperature greater than 38 C or less than 36 C ; heart rate greater than 90 beats/min ; respiratory rate greater than 20 breaths/min or Paco 2 level less than 4.3 kPa ; and leukocyte count greater than 12 109 cells/L or less than 4 109 cells/L ; or greater than 10 % immature ( b and ) forms , according to st and ard criteria ( 20 ) . Infections that were not clearly nosocomial were classified by an expert panel of 2 infectious disease specialists not related to the trial . Microbiology Nasal swabs were collected by nursing personnel at admission . The swabs were streaked onto 5 % sheep blood agar plates ( Becton Dickinson , Le Pont de Claix , France ) , incubated for 48 hours at 35 C , and checked each day for bacterial growth . Suspected colonies were identified as S. aureus with the Staphaurex Plus agglutination test ( Abbott Murex , Chatillon , France ) . Patients with positive culture results were eligible for r and omization . The identity of all positive isolates was later confirmed by an automated system ( MicroScan Walk-a-Way , Dade-Behring , Inc. , West Sacramento , California ) . Strains yielding negative results on confirmation were retested with the AccuProbe hybridization test ( Gen-Probe , Inc. , San Diego , California ) according to the manufacturer 's guidelines . Patients were incorrectly categorized as nasal carriers of S. aureus if the agglutination screening test result was positive but both the subsequent determination with the automated system and the hybridization test result were negative . Susceptibility to mupirocin was tested only in strains causing infections and was performed by disk diffusion ( 21 ) . Infections were treated by the patients ' physician , and treatment was not influenced by the trial team members . Cultures were processed according to st and ard microbiological methods . All S. aureus strains were stored in glycerol medium at 80 C. Nasal and clinical S. aureus isolates from the same patient were genotyped by pulsed-field gel electrophoresis and were considered to be clonally related if their genotype patterns did not differ by more than 3 b and s according to st and ard criteria ( 22 ) . Sample Size and Statistical Analysis On the basis of a literature review and pre study data from the participating centers , we estimated a priori the incidence of nosocomial S. aureus infections among S. aureus nasal carriers to be 6 % ( 9 , 23 ) . Thus , about 800 patients in each treatment group would demonstrate a statistically significant 50 % reduction in nos 
    Output:
    
In people who are nasal carriers of S. aureus , the use of mupirocin ointment results in a statistically significant reduction in S. aureus infections