Decolonization of methicillin-resistant Staphylococcus aureus using oral vancomycin and topical mupirocin

Abstract

The objective of this study was to assess the efficacy and safety of a short course of oral vancomycin and intranasal mupirocin ointment in the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization. During an outbreak of MRSA, the colonized subjects received oral vancomycin and topical mupirocin. They were screened for MRSA 1, 3, 6 and 12 months after decolonization. A questionnaire was developed to evaluate the side-effects of oral vancomycin. Thirty-five subjects were treated. Clearance was achieved in all cases, in 24 (69%) subjects after one course of therapy. Twenty-eight (80%) subjects experienced some side-effects, including six (17%) who did not tolerate oral vancomycin. Although oral vancomycin, in combination with topical mupirocin, is effective in the elimination of MRSA colonization, there is a need for further studies to confirm our results and to evaluate the safety of oral vancomycin.

Descolonização de portadores de Staphylococcus aureus: indicações, vantagens e limitações

“…35 As shown in chart 1, 68.8% of the studies that used topical mupirocin for patient decolonization achieved an effective outcome. 12,[14][15][16][19][20]22,25,31,33 Corroborating this result, it is found that topical treatment using mupirocin is indicated by most international health guidelines, including those of the CDC and WHO. 1,5,[36][37]40 The CDC recommends using topical mupirocin alone in colonized patients for only short periods of time and for professionals who have an epidemiological relationship with the transmission of the organism.…”

“…39 The main systemic antimicrobial agents used were vancomycin, rifamycin, fusidic acid and doxycycline. 12,25,32 In the main international guidelines -World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and the British Society for Antimicrobial Chemotherapy-regarding indications for use of systemic treatments for decolonization, the recommendation is that the drug be chosen based on consultation with the physicians specializing in infectious diseases and epidemiology in each individual hospital. 1,37 In terms of vancomycin, some guidelines contraindicate its use because of the possibility of increasing bacterial resistance to this particular drug.…”

“…36 It is highlighted that many patients exhibit low tolerance for vancomycin, and the following side effects are most common: dry mouth, unpleasant taste, stomatitis, nausea, abdominal pain, diarrhea, and flatulence. 25 Analyses have been performed on the isolated use of fusidic acid, but no statistically significant results were found regarding its effect on the reduction of MRSA infections. This drug increased the emergence of bacterial resistance, which reinforces the idea that the drug should not be indicated for use alone for the eradication of Staphylococcus aureus in colonized patients.…”

“…[10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]33 Nasal mupirocin is considered the best topical agent for the eradication of gram-positive bacteria immediately following the treatment, when the adherence to this protocol is high. 35 As shown in chart 1, 68.8% of the studies that used topical mupirocin for patient decolonization achieved an effective outcome.…”

“…[43][44] The latter is used more frequently, and in the analyzed studies regarding decolonization, they were always used in combination with other drugs and proved to be effective. [20][21][22][23]25 The other analyzed drugs -tea tree oil, prontoderm and polysporin -do not appear in any of the analyzed guidelines. However, with the emergence of resistance to the commonly used drugs and the search for new antimicrobial agents, they may be seen as alternative treatments for the decolonization process of patients in the battle against bacterial resistance.…”