Bacitracin Versus Mupirocin for Staphylococcus aureus Nasal Colonization

Soto, Norberto E.; Vaghjimal, A.; Stahl-Avicolli, A.; Protic, John R.; Lutwick, Larry I.; Chapnick, Edward K.

doi:10.1086/501633

Cited by 39 publications

(14 citation statements)

References 9 publications

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“…Neben Mupirocin wurden Bacitracin, Fusidinsäure oder Neomycin als topische Antibiotika zur nasalen Therapie eingesetzt [375][376][377][378][379]. Diese Antibiotika waren jedoch zum Teil nicht besser als das Placebo [376] oder wurden nur wenig untersucht [375,377].…”

Section: Nasale Dekolonisierungunclassified

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

Ruscher

2014

Bundesgesundheitsbl.

123

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Section: Nasale Dekolonisierungunclassified

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

Ruscher

2014

Bundesgesundheitsbl.

123

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“…Bactroban Nasal (2% mupirocin ointment), a topical antimicrobial that competitively inhibits bacterial isoleucyl-tRNA synthesis and thus interferes with protein synthesis (35), is the current standard of care for elimination of S. aureus nasal colonization (15,27,31,46). S. aureus has repeatedly demonstrated its resourcefulness for developing resistance to antibiotics, and, indeed, mupirocin resistance has emerged (8,11,13,29,30,50).…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study (39), prophylactic intranasal mupirocin significantly decreased the rate of all nosocomial S. aureus infections among patients who were S. aureus carriers. Currently, Bactroban Nasal (2% mupirocin calcium ointment; SmithKline Beecham, Bristol, Tenn.) is the most widely prescribed and effective antibacterial agent for eradication of S. aureus nasal colonization (15,27,31,46). Unfortunately, as with many antimicrobials, mupirocin resistance is emerging in S. aureus (8,11,13,29,30,50).…”

mentioning

confidence: 99%

“…Furthermore, multiple applications of mupirocin are required to effect a significant reduction of nasal colonization, thus precluding its use in patients requiring rapid clearance for emergency surgical procedures. Several other interventions for the clearance of S. aureus nasal carriage have also been explored, including Neosporin ointment and Polysporin ointment (19), bacitracin (46), and other antibiotics (26,53). These alternative interventions have proven unreliable for eradication of nasal colonization by S. aureus.…”

mentioning

confidence: 99%

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Lysostaphin Cream Eradicates Staphylococcus aureus Nasal Colonization in a Cotton Rat Model

Kokai‐Kun¹,

Walsh²,

Chanturiya³

et al. 2003

Antimicrob Agents Chemother

149

115

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The anterior nares are a primary ecologic niche for Staphylococcus aureus, and nasal colonization by this opportunistic pathogen increases the risk of development of S. aureus infection. Clearance of S. aureus nasal colonization greatly reduces this risk. Mupirocin ointment is the current standard of care for clearance of S. aureus nasal colonization, but resistance to this antibiotic is emerging. Lysostaphin is a glycylglycine endopeptidase which specifically cleaves the cross-linking pentaglycine bridges in the cell walls of staphylococci. Lysostaphin is extremely staphylocidal (MIC at which 90% of isolates are inhibited, 0.001 to 0.064 g/ml) and rapidly lyses both actively growing and quiescent S. aureus. This study demonstrates that a single application of 0.5% lysostaphin (actual dose, ϳ150 g of lysostaphin), formulated in a petrolatum-based cream, dramatically reduces S. aureus nasal colonization in 100% of animals tested and eradicates S. aureus nasal colonization in 93% of animals in a cotton rat model. A single dose of lysostaphin cream is more effective than a single dose of mupirocin ointment in eradicating S. aureus nasal colonization in this animal model. The lantibiotic peptide nisin, which has potent in vitro antistaphylococcal activity, was ineffective in reducing staphylococcal nasal carriage in this model. Nasal colonization was not reduced after three treatments with 5% nisin (ϳ1,500 g/dose) in any of the treated animals. Lysostaphin formulated in cream may prove to be a superior alternative to mupirocin ointment for clearance of S. aureus nasal colonization. Staphylococcus aureus infection remains one of the most common nosocomial and community-acquired infections (1).With the continuing emergence of methicillin-resistant S. aureus (MRSA) (22) and strains of S. aureus that are intermediately resistant to glycopeptides (45) and the isolation of the first clinical strain of S. aureus that is fully vancomycin resistant (5), S. aureus is becoming an even more difficult health problem to address, particularly in settings such as hospitals and nursing homes.The anterior nares of humans are a principal ecologic niche for both methicillin-sensitive S. aureus (MSSA) and MRSA (17,26,28,51). Indeed, nasal carriage of S. aureus has been repeatedly shown to have a significant epidemiological link with subsequent development of staphylococcal disease, particularly for those requiring major surgery, implanted devices, hemodialysis, or treatment in intensive care units (6,7,18,33,37,49,53). In healthy humans there appear to be three patterns of S. aureus nasal carriage: noncarriers, intermittent carriers, and chronic carriers. One study (26) estimates the distribution of these carriers to be 20, 60, and 20%, respectively. This suggests that a significant portion of the population is at risk for development of staphylococcal disease linked to nasal carriage of S. aureus. People at greatest risk include those with diminished immunity and those with other chronic diseases (26).Studies suggest that clearance of ...

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“…Soto et al performed an RCT of a 5-day regimen of either mupirocin or bacitracin for S. aureus nasal decolonization in health care workers. It was shown that after 30 days, bacitracin was inferior to mupirocin for eradication of S. aureus (23% versus 80%; P Ͻ 0.01) (77).…”

Section: Bacitracinmentioning

confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

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Bacitracin Versus Mupirocin for Staphylococcus aureus Nasal Colonization

Cited by 39 publications

References 9 publications

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

Lysostaphin Cream Eradicates Staphylococcus aureus Nasal Colonization in a Cotton Rat Model

Decolonization in Prevention of Health Care-Associated Infections

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