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Comparison of global decolonization efficacy with mupirocin nasal drop and chlorhexidine mouthwash in acute leukemia patients: randomized clinical trial

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Abstract

Purpose

Neutropenic fever remains a major complication in acute leukemia. Decolonization is assumed as a promising intervention for eradicating causative agents of infection.

Methods

In this randomized clinical trial, 96 patients with acute leukemia were assigned randomly to mupirocin nasal drop 2% (n = 32), chlorhexidine mouthwash 0.2% (n = 33), and control group (n = 31). In control group, patients did not receive any medication for decolonization. All patients received treatment for 5 days (2 days prior to chemotherapy until 3 days after chemotherapy). Pharynx and nasal swabs were taken prior to the intervention and at the end of decolonization period in all groups. Antibiotic susceptibility testing was performed by the disc diffusion method in order to identify bacterial isolates.

Results

Bacterial recovery of both nasal and pharynx swabs was observed after global decolonization with mupirocin nasal drop. Decolonization with mupirocin significantly eradicated Coagulase-negative staphylococci (CONS) in both nasal and pharynx swabs (p-value = 0.000). Moreover, mupirocin decreased Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) species. Chlorhexidine mouthwash significantly eradicated CONS in pharynx swabs (p-value = 0.000). In addition, both decolonization strategies decreased both antibiotic use and frequency of fever in leukemic patients.

Conclusion

Global decolonization with mupirocin nasal drop not only eradicates both nasal and pharynx microorganisms, but also reduces antibiotic requirement and frequency of fever in patients with acute leukemia.

The protocol of the present study was approved on December 2016 (registry number: IRCT20160310026998N6).

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to information that could compromise the privacy of research participants.

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Acknowledgements

We would like to acknowledge all the nurses and staffs of Shahid Ghazi Hospital for collaboration with this research during the study.

Author information

Authors and Affiliations

  1. Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Saba Ghaffary, Aref Javidnia, Aliakbar Movassaghpour Akbari, Zohreh Sanaat, Alireza Nikanfar, Ali Esfahani, Seyed Hadi Chavoshi, Babak Nejati, Mortaza Raeisi & Nasrin Gholami

  2. Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran

    Saba Ghaffary & Samineh Beheshtirouy

  3. Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

    Javid Sadeghi

  4. Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Hamed Hamishehkar

  5. Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Parvin Sarbakhsh

Authors
  1. Saba Ghaffary
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  2. Aref Javidnia
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Contributions

Saba Ghaffary: Conceptualization, data curation, validation, investigation, visualization, methodology, supervision, writing–original draft and editing. Aref Javidnia: Data Collection, investigation, writing. Samineh Beheshtirouy: Conceptualization, writing–original draft, writing–review and editing. Javid Sadeghi: Resources, supervision, validation, investigation, methodology. Aliakbar Movassaghpour Akbari: Conceptualization, resources, validation, methodology, project administration. Hamed Hamishehkar: Resources, validation, methodology. Parvin Sarbakhsh: Methodology, analysis, writing–original draft and editing. Alireza Nikanfar: Validation, Data Collection. Zohreh Sanaat: Validation, Data Collection. Ali Esfahani: Validation, Data Collection. Seyed Hadi Chavoshi: Validation, Data Collection. Babak Nejati: Validation, Data Collection. Mortaza Raeisi: Validation, Data Collection. Nasrin Gholami: Validation, Data Collection.

Corresponding author

Correspondence to Saba Ghaffary.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The protocol of the present study was approved by the local Ethics Committee of Tabriz University of Medical Sciences, Iran on December 2016. The trial was registered in the Iranian Registry of Clinical Trials (registry number: IRCT20160310026998N6).

Consent to participate

All patients were informed about the trial and gave a written informed consent before the study initiation.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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Ghaffary, S., Javidnia, A., Beheshtirouy, S. et al. Comparison of global decolonization efficacy with mupirocin nasal drop and chlorhexidine mouthwash in acute leukemia patients: randomized clinical trial. Support Care Cancer 32, 42 (2024). https://doi.org/10.1007/s00520-023-08232-1

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