Mupirocin in the Treatment of Staphylococcal Infections in Chronic Rhinosinusitis: A Meta-Analysis

BackgroundSaline irrigation of the nasal cavity is a classic and effective treatment for acute or chronic rhinosinusitis. Topical antibiotics such as mupirocin have been widely used for recalcitrant chronic rhinosinusitis. Therefore, the purpose of this study was to evaluate the effect of saline irrigation using mupirocin.MethodsA systematic literature review and meta-analysis of mupirocin saline irrigation were performed using EMBASE, MEDLINE, and Cochrane library through December 2015. Data were analyzed with R 3.2.2 software. A random effects model was used because of the diversity of included studies. Sensitivity analysis of particular tested groups and single proportion tests were also performed. The main outcome measure was residual staphylococcal infection, as confirmed by culture or PCR.ResultsTwo RCTs, two prospective studies and two retrospective studies were included. A random effects model meta-analysis of the pooled data identified a relative risk of residual infection of 0.13 (95% CI: 0.06–0.26, p2 = 0%). The proportion of residual staphylococcal infections after 1 month was 0.08 (95% CI: 0.04–0.16). However, this proportion increased to 0.53 at 6 months (95% CI: 0.27–0.78).ConclusionsThe short-term use of mupirocin has a strongly reductive effect on staphylococcal infection in chronic rhinosinusitis. Although there is currently a lack of clear evidence, future studies with well-designed inclusion criteria and randomized controlled trials are needed to examine mupirocin’s long-term effect on chronic rhinosinusitis.

背景：鼻腔盐水冲洗是治疗急性或慢性鼻-鼻窦炎的经典有效疗法。局部外用抗生素如莫匹罗星（mupirocin）已被广泛应用于难治性慢性鼻-鼻窦炎。因此，本研究旨在评估莫匹罗星盐水冲洗的临床疗效。
方法：本研究通过检索截至2015年12月的EMBASE、MEDLINE及Cochrane图书馆数据库，针对莫匹罗星盐水冲洗开展系统文献回顾与荟萃分析。采用R 3.2.2统计软件进行数据分析；鉴于纳入研究间存在异质性，故选用随机效应模型。此外，本研究还针对特定受试群体开展了敏感性分析及单比例检验。本研究的主要结局指标为经微生物培养或聚合酶链反应（PCR）确认的残留葡萄球菌感染。
结果：本研究共纳入2项随机对照试验（RCT）、2项前瞻性研究及2项回顾性研究。对合并数据进行随机效应模型荟萃分析后显示，残留感染的相对风险为0.13（95%置信区间：0.06~0.26，p²=0%）。干预后1个月时，残留葡萄球菌感染的比例为0.08（95%置信区间：0.04~0.16）；但该比例在干预后6个月时升至0.53（95%置信区间：0.27~0.78）。
结论：莫匹罗星短期应用可显著降低慢性鼻-鼻窦炎患者的葡萄球菌感染率。尽管目前尚无明确证据支持，但未来仍需开展纳入标准严谨、设计规范的随机对照试验，以进一步明确莫匹罗星对慢性鼻-鼻窦炎的长期疗效。