Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T14:17:37.028Z Has data issue: false hasContentIssue false
  • English
  • Français

Mupirocin-Resistant, Methicillin-Resistant Staphylococcus aureus: Does Mupirocin Remain Effective?

Published online by Cambridge University Press:  02 January 2015

Elaine S. Walker ,
Jose E. Vasquez ,
Roy Dula ,
Hollie Bullock  and
Felix A. Sarubbi
Elaine S. Walker
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
Jose E. Vasquez
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
Roy Dula
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
Hollie Bullock
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
Felix A. Sarubbi*
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
*
Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the efficacy of mupirocin ointment in reducing nasal colonization with mupirocin-susceptible, methicillin-resistant Staphylococcus aureus (MS MRSA) as well as mupirocin-resistant MRSA (MR MRSA).

Design:

Prospective evaluation in which patients colonized with MRSA were treated twice daily with 2% topical mupirocin ointment for 5 days.

Setting:

James H. Quillen Veterans' Affairs Medical Center.

Patients:

Forty hospitalized patients with two anterior nares cultures positive for MRSA within a 7-day period.

Methods:

Treated patients had post-treatment cultures at day 3 and weeks 1,2, and 4. Isolates underwent mupirocin-susceptibility testing and DNA typing. MRSA clearance and type turnover were assessed for isolates that were mupirocin-susceptible, low-level (LL) MR MRSA and high-level (HL) MR MRSA.

Results:

Post-treatment nares cultures on day 3 were negative for 78.5%, 80%, and 27.7% of patients with MS MRSA, LL-MR MRSA, and HL-MR MRSA, respectively. Sustained culture negativity at 1 to 4 weeks was more common in the MS MRSA group (91%) than in the LL-MR MRSA group (25%) or the HL-MR MRSA group (25%). Positive post-treatment cultures usually showed the same DNA pattern relative to baseline. Plasmid curing of 18 HL-MR MRSA resulted in 15 MS MRSA and 3 LL-MR MRSA.

Conclusions:

Mupirocin was effective in eradicating MS MRSA, but strains of MR MRSA often persisted after treatment. This appeared to reflect treatment failure rather than exogenous recolonization. MR MRSA is now more prevalent and it is appropriate to sample MRSA populations for mupirocin susceptibility prior to incorporating mupirocin into infection control programs.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 5 , May 2003 , pp. 342 - 346
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725–737.CrossRefGoogle ScholarPubMed
2.Muder, RR, Brennen, C, Wagener, MM, et al.Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
3.Spindel, SJ, Strausbaugh, LJ, Jacobson, C. Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a 5-year experience. Infect Control Hosp Epidemiol 1995;16:217–223.CrossRefGoogle Scholar
4.Nicolle, LE, Dyck, B, Thompson, G, et al.Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 1999;20:202–205.Google Scholar
5.Meier, PA, Carter, CD, Wallace, SE, Hollis, RJ, Pfaller, MA, Herwaldt, LA. A prolonged outbreak of methicillin-resistant Staphylococcus aureus in the burn unit of a tertiary medical center. Infect Control Hosp Epidemiol 1996;17:798–802.Google Scholar
6.Murray-Leisure, KA, Geib, S, Graceley, D, et al.Control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 1990;11:343–350.CrossRefGoogle ScholarPubMed
7.Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C.Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998;27:543–550.Google Scholar
8.Kotilainen, P, Routamaa, M, Peltonen, R, et al.Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001;161:859–863.Google Scholar
9.Arnold, MS, Dempsey, JM, Fishman, M, McAuley, PJ, Tibert, C, Vallande, NC. The best hospital practices for controlling methicillin-resistant Staphylococcus aureus: the cutting edge. Infect Control Hosp Epidemiol 2002;23:69–76.Google Scholar
10.Farr, BM, Jarvis, WR. Would active surveillance cultures help control healthcare-related methicillin-resistant Staphylococcus aureus infections? Infect Control Hosp Epidemiol 2002;23:65–68.Google Scholar
11.Barrett, SP. The value of nasal mupirocin in containing an outbreak of methicillin-resistant Staphylococcus aureus in an orthopaedic unit. J Hosp Infect 1990;15:137–142.CrossRefGoogle Scholar
12.Cimochowski, GE, Harostock, MD, Brown, R, Bernardi, M, Alonzo, N, Coyle, K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg 2001;71:1572–1579.Google Scholar
13.Kluytmans, JA, Mouton, JW, VandenBergh, MFQ, et al.Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 1996;17:780–785.CrossRefGoogle ScholarPubMed
14.Eltringham, I. Mupirocin resistance and methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect 1997;35:1–8.Google Scholar
15.Cookson, BD. The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998;41:11–18.Google Scholar
16.Watanabe, H, Masaki, H, Asoh, N, et al.Emergence and spread of low-level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated from a community hospital in Japan. J Hosp Infect 2001;47:294–300.Google Scholar
17.Vasquez, JE, Walker, ES, Franzus, BW, Overbay, BK, Reagan, DR, Sarubbi, FA. The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a Veterans' Affairs hospital. Infect Control Hosp Epidemiol 2000;21:459–464.Google Scholar
18.Bradley, SF, Ramsey, MA, Morton, TM, Kauffman, CA. Mupirocin resistance: clinical and molecular epidemiology. Infect Control Hosp Epidemiol 1995;16:354–358.CrossRefGoogle ScholarPubMed
19.Miller, MA, Dascal, A, Portnoy, J, Mendelson, J. Development of mupirocin resistance among methicillin-resistant Staphylococcus aureus after widespread use of nasal mupirocin ointment. Infect Control Hosp Epidemiol 1996;17:811–813.Google Scholar
20.dos Santos, KRN, Fonseca, LS, Filho, PPG. Emergence of high-level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated from Brazilian university hospitals. Infect Control Hosp Epidemiol 1996;17:813–816.Google Scholar
21.Harbarth, S, Dharan, S, Liassine, N, Herrault, P, Auckenthaler, R, Pittet, D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999;43:1412–1416.Google Scholar
22.Gilbart, J, Perry, CR, Slocombe, B. High-level mupirocin resistance in Staphylococcus aureus: evidence for two distinct isoleucyl-tRNA synthetases. Antimicrob Agents Chemother 1993;37:32–38.Google Scholar
23.Kauffman, CA, Terpenning, MS, He, X, et al.Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term care facility with the use of mupirocin ointment. Am J Med 1993;94:371–378.Google Scholar
24.Semret, M, Miller, MA. Topical mupirocin for eradication of MRSA colonization with mupirocin-resistant strains. Infect Control Hosp Epidemiol 2001;22:578–580.Google Scholar
25.Fuchs, PC, Jones, RN, Barry, AL. Interpretive criteria for disk-diffusion susceptibility testing of mupirocin, a topical antibiotic. J Clin Microbiol 1990;28:608–609.CrossRefGoogle ScholarPubMed
26.Maslow, JN, Slutsky, AM, Arbeit, RD. Application of pulsed-field electrophoresis to molecular epidemiology. In: Persing, DH, Smith, TF, White, TJ, eds. Diagnostic Molecular Microbiology Principles and Practice. Washington, DC: American Society for Microbiology; 1993:563–572.Google Scholar
27.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
28.Rahman, M, Noble, WC, Cookson, B. Mupirocin-resistant Staphylococcus aureus. Lancet 1987;2:387.Google Scholar
29.Rahman, M, Noble, WC, Cookson, B. Transmissible mupirocin resistance in Staphylococcus aureus. Epidemiol Infect 1989;102:261–270.CrossRefGoogle ScholarPubMed
30.Kavi, J, Andrews, JM, Wise, R. Mupirocin-resistant Staphylococcus aureus. Lancet 1987;2:1472.CrossRefGoogle Scholar
31.Fujimura, S, Watanabe, ABeighton, D. Characterization of the mup A gene in strains of methicillin-resistant Staphylococcus aureus with a low level of resistance to mupirocin. Antimicrob Agents Chemother 2001;45:641–642.Google Scholar
32.Layton, MC, Patterson, JE. Mupirocin resistance among consecutive isolates of oxacillin-resistant and borderline oxacillin-resistant Staphylococcus aureus at a university hospital. Antimicrob Agents Chemother 1994;38:1664–1667.Google Scholar
33.Smith, GE, Kennedy, CC. Staphylococcus aureus resistant to mupirocin. J Antimicrob Chemother 1988;21:141–142.Google Scholar
34.Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al.Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.CrossRefGoogle ScholarPubMed
35.Bradley, SF. Effectiveness of mupirocin in the control of methicillin-resistant Staphylococcus aureus. Infections in Medicine 1993;10:23–31.Google Scholar
36.Muder, RR. Mupirocin and MRSA: current status. Infections in Medicine 1993;10:21–22.Google Scholar