Emergence of Mupirocin-ResistantStaphylococcus Aureusin Chronic Peritoneal Dialysis Patients using Mupirocin Prophylaxis to Prevent Exit-Site Infection

Abstract

Objective To determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chronic peritoneal dialysis (CPD) patients after 4 years of prophylactic mupirocin application to the exit site, in a peritoneal dialysis unit. Methods Three swabs were collected from the nares, axillae/groin, and exit site, respectively, from 149 patients on CPD between May and July 2001. All swabs were cultured on solid selective agar (mannitol salt agar) and in mannitol salt broth. Staphylococcus aureus isolates were tested for methicillin resistance using oxacillin screening plates, and mupirocin resistance using E-test strips. Low-level MuRSA was defined as minimum inhibitory concentration (MIC) of 4 mg/mL or more, and high-level MuRSA as MIC of 256 mg/mL or more. Results Staphylococcus aureus was isolated from 26 (17%) patients (25 from nares/axilla/groin, and 1 from the exit site). High-level MuRSA was isolated from 4 patients (3% of the total study population; 15% of total SA isolates). No MRSA was detected. One patient with high-level MuRSA had peritonitis due to SA, resulting in treatment failure and catheter loss, soon after the swabs were collected for the study. Conclusion We report the emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in our unit. Our results may have significant implications for the future practice of prophylactic use of mupirocin by CPD patients to prevent exit-site infection.

Approach to prophylactic measures for central venous catheter‐related infections in hemodialysis: A critical review

“…They concluded by recommending the prophylactic application of mupirocin in PD patients, but emphasized that large PD centers using mupirocin in PD patients should have periodic surveillance to detect the emergence of MuRSA strains. 22 Catheter filling with chemicals and antibiotics known as lock solutions has been suggested for preventing catheter-related infections, and thus reduce morbidity and mortality rates. 9,14…”

Infection with Antimicrobial‐resistant Microorganisms in Dialysis Patients

“…In contrast, HDR to mupirocin among S. aureus isolates has been uncommon in dialysis patients (59,64,75,76). However, HDR of S. aureus to mupirocin in PD patients treated with prophylactic application of mupirocin to the peritoneal catheter exit site has been reported (72,77). Pérez‐Fontán et al (72) recently observed a dramatic increase in HDR to mupirocin among PD patients who were S. aureus carriers.…”

“…Another group that had reported an absence of mupirocin resistance after 1 year of use in their peritoneal dialysis program (78) reported finding HDR to mupirocin in S. aureus after their program of mupirocin application to the catheter exit site had been active for 4 years (77). HDR to mupirocin was detected in four patients, which was 3% of their PD population, and accounted for 15% of S. aureus isolates.…”

Efficacy and acceptability of treatment to eradicate nasal Staphylococcus aureus carriage among haemodialysis patients

“…15,17 An important concern about regular decolonization attempts is the development of antimicrobial resistance, which can occur over short time frames. 19 New Zealand has high rates of illness caused by S. aureus. 20 In 2010 and 2011, the incidence of S. aureus bacteraemia in patients requiring haemodialysis at Auckland City Hospital was approximately 3/1000 haemodialysis days (S. Ritchie and J. Wei, pers.…”