Acquisition of high-level mupirocin resistance in CoNS following nasal decolonization with mupirocin

Abstract

Acquisition of mupirocin resistance following decolonization was widespread in CoNS and absent in S. aureus. As almost all isolates harboured the mupA gene, monitoring resistance development in S. aureus when decolonization strategies containing mupirocin are used is recommended.

Mupirocin Resistance in Isolates of Staphylococcus spp. from Nasal Swabs in a Tertiary Hospital in France

“…These data raise the question of the risk the acquisition of mupirocin resistance by S. aureus isolates in case of cocolonization with mupirocin-resistant CoNS, especially when the bacteria are under mupirocin selective pressure (19,20). This risk was confirmed by a recent study demonstrating the acquisition of HMupR by CoNS following nasal decolonization with mupirocin, in which 21% (192/936) and 43% (406/936) of patients were found to carry mupirocin-resistant CoNS before treatment and after decolonization, respectively (P Ͻ 0.001) (21). Considering these findings, we suggest monitoring the development of resistance in S. aureus when decolonization strategies involving mupirocin are used.…”

“…This recommendation is further supported by several studies reporting high rates of mupirocin resistance or clonal dissemination of mupirocin-resistant MRSA and CoNS in hospital settings (7). Together, these findings highlight the importance of performing regular sentinel studies in different parts of the world to rapidly identify the emergence and dissemination of mupirocin-resistant staphylococci (7,11,21,22).…”

Active Surveillance Cultures and Targeted Decolonization Are Associated with Reduced Methicillin-Susceptible <b><i>Staphylococcus aureus</i></b> Infections in VLBW Infants

“…In line with these reports, we did not detect mupirocin-resistant MSSA strains during the study period. Additionally, the acquisition of high-level mupirocin resistance in coagulase-negative staphylococci has been described due to active decolonization procedures with mupirocin [20]. Unfortunately, we did not routinely screen coagulase-negative staphylococci cultures for mupirocin resistance.…”

Clinical Issues—September 2017

“…The researchers found widespread mupirocin resistance in coagulase‐negative Staphylococcus but no resistance in S aureus . Co‐colonizing bacteria acquire the mupirocin‐resistant gene, so the researchers recommend monitoring mupirocin‐resistance development in S aureus when using decolonization protocols with mupirocin 15 . Mupirocin resistance has not been shown to significantly increase in studies on mupirocin use for preoperative prophylaxis 2 .…”

“…These researchers urge caution when implementing protocols that promote widespread mupirocin use. 14 15 implemented a universal decolonization protocol (ie, mupirocin three times daily for five days, CHG bathing once daily for five days) for patients undergoing orthopedic, cardiothoracic, and neurosurgical procedures in a teaching hospital in the Netherlands and performed nasal cultures before decolonization and four days after surgery. The researchers found widespread mupirocin resistance in coagulase-negative Staphylococcus but no resistance in S aureus.…”