Reviewed by Jen Cihlar, DO; Vanderbilt University Medical Center
In lieu of some of the challenges and rising resistance rates of mupirocin, Exeporfinium chloride (XF-73) is a dicationic porphyrin derivative with bactericidal properties, a high threshold to resistance being developed as a gel for S. aureus decolonization. This multicenter, randomized placebo-controlled, phase 2 study compared reduction of S. aureus nasal burden in patients undergoing cardiac surgery after 5 total doses with XF-73 vs placebo between August 29, 2019 through March 29, 2021. They reached their primary end point of change in S. aureus log10 CFU/ml from baseline 1 hour prior to surgery after 3 doses with significant decrease in the XF-73 arm vs the placebo (adjusted least-squares mean difference of -2.1 log10 CFU/ml). Within 1 hour of incision closure there was a significant mean difference of -2.2 log10 CFU/ml with XF-73 group and 83.7% of patients treated with XF-73 had zero nasal carriage or a ³ 2 log10 CFU/ml reduction within 1 hour prior to surgery. Overall, there were no adverse safety effects and no surgical site infections identified at follow up periods at 3 months making this a worthwhile agent to further study.
Reference: Mangino JE, Firstenberg MS, Milewski RKC, et al.. Exeporfinium chloride (XF-73) nasal gel dosed over 24 hours prior to surgery significantly reduced Staphylococcus aureus nasal carriage in cardiac surgery patients: Safety and efficacy results from a randomized placebo-controlled phase 2 study. Infection Control & Hospital Epidemiology. Published online 2023:1-3. doi:10.1017/ice.2023.17