Mupirocin – Are We in Danger of Losing It?

Conly, JM; Johnston, BL

doi:10.1155/2002/692581

Cited by 31 publications

(23 citation statements)

References 24 publications

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“…While this phenomenon has been described in both inpatient and outpatient settings for mupirocin, chlorhexidine resistance outside the hospital setting has not been previously studied (10)(11)(12)(13)(14)(15)(16). At the population level, widespread use of mupirocin and chlorhexidine has been associated with dramatically increased prevalence of S. aureus strains resistant to mupirocin and chlorhexidine compared to periods of time or geographic regions with limited use of these agents, likely due to the selection of resistant strains (13,(17)(18)(19)(20). Alarmingly, routine use of these measures in health care settings has contributed to outbreaks with resistant strains (18,21).…”

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“…High-level mupirocin resistance is conferred by the mupA gene, which is carried on a plasmid, enabling the spread of this resistance mechanism. The mupA gene encodes a novel isoleucyl-RNA synthetase which is not inhibited by mupirocin (16,17,24,(26)(27)(28). The plasmid carrying the mupA gene may also carry resistance determinants to other systemic antimicrobial agents, raising concern that mupirocin use could select not only for mupirocin resistance, but also for increasing antimicrobial resistance overall (10,15,16).…”

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confidence: 99%

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Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus in Patients with Community-Onset Skin and Soft Tissue Infections

Fritz

Hogan

Camins

et al. 2013

Antimicrob Agents Chemother

128

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Decolonization measures, including mupirocin and chlorhexidine, are often prescribed to prevent Staphylococcus aureus skin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level mupirocin and chlorhexidine resistance in S. aureus strains recovered from patients with SSTI before and after mupirocin and chlorhexidine administration and to determine whether carriage of a mupirocin-or chlorhexidine-resistant strain at baseline precluded S. aureus eradication. We recruited 1,089 patients with community-onset SSTI with or without S. aureus colonization. In addition to routine care, 483 patients were enrolled in a decolonization trial: 408 received intranasal mupirocin (with or without antimicrobial baths), and 258 performed chlorhexidine body washes. Patients were followed for up to 12 months with repeat colonization cultures. All S. aureus isolates were tested for high-level mupirocin and chlorhexidine resistance. At baseline, 23/1,089 (2.1%) patients carried a mupirocin-resistant S. aureus strain and 10/1,089 (0.9%) patients carried chlorhexidine-resistant S. aureus. Of 4 patients prescribed mupirocin, who carried a mupirocin-resistant S. aureus strain at baseline, 100% remained colonized at 1 month compared to 44% of the 324 patients without mupirocin resistance at baseline (P ‫؍‬ 0.041). Of 2 patients prescribed chlorhexidine, who carried a chlorhexidine-resistant S. aureus strain at baseline, 50% remained colonized at 1 month compared to 48% of the 209 patients without chlorhexidine resistance at baseline (P ‫؍‬ 1.0). The overall prevalence of mupirocin and chlorhexidine resistance is low in S. aureus isolates recovered from outpatients, but eradication efforts were less successful in patients carrying a mupirocin-resistant S. aureus strain at baseline.

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Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus in Patients with Community-Onset Skin and Soft Tissue Infections

Fritz

Hogan

Camins

et al. 2013

Antimicrob Agents Chemother

128

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“…There are no approved CLSI or FDA breakpoints for topical agents, and there is difficulty in assessing the pharmacokinetic and pharmacodynamic parameters for these agents to establish their breakpoints. Despite the latter problems, susceptibility testing should be performed for topical agents in order to monitor changes in susceptibility patterns, as decreases in susceptibility due to the development of resistance could potentially lead to poorer clinical outcomes (5,6,21).…”

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confidence: 99%

Activity of Retapamulin against Streptococcus pyogenes and Staphylococcus aureus Evaluated by Agar Dilution, Microdilution, E-Test, and Disk Diffusion Methodologies

Pankuch

Lin

Hoellman

et al. 2006

Antimicrob Agents Chemother

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The in vitro activity of retapamulin against 106 Staphylococcus aureus isolates and 109 Streptococcus pyogenes isolates was evaluated by the agar dilution, broth microdilution, E-test, and disk diffusion methodologies. Where possible, the tests were performed by using the CLSI methodology. The results of agar dilution, broth microdilution, and E-test (all with incubation in ambient air) for S. aureus yielded similar MICs, in the range of 0.03 to 0.25 g/ml. These values corresponded to zone diameters between 25 and 33 mm by the use of a 2-g retapamulin disk. Overall, 99% of the agar dilution results and 95% of E-test results for S. aureus were within ؎1 dilution of the microdilution results. For S. pyogenes, the MICs obtained by the agar and broth microdilution methods (both after incubation in ambient air) were in the range of 0.008 to 0.03 g/ml, and E-test MICs (with incubation in ambient air) were 0.016 to 0.06 g/ml. For S. pyogenes, 100% of the agar dilution MIC results were within ؎1 dilution of the broth microdilution results. E-test MICs (after incubation in ambient air) were within ؎1 and ؎2 dilutions of the broth microdilution results for 76% and 99% of the isolates, respectively. E-test MICs for S. pyogenes strains in CO 2 were up to 4 dilutions higher than those in ambient air. Therefore, it is recommended that when retapamulin MICs are determined by E-test, incubation be done in ambient air and not in CO 2 , due to the adverse effect of CO 2 on the activity of this compound. Diffusion zones (with incubation in CO 2 ) for S. pyogenes were 18 to 24 mm. Retapamulin MICs for all strains by all methods (with incubation in ambient air) were <0.25 g/ml. These results demonstrate that S. pyogenes (including macrolide-resistant strains) and S. aureus (including methicillin-resistant and vancomycin-nonsusceptible strains) are inhibited by very low concentrations of retapamulin and that all four testing methods are satisfactory for use for susceptibility testing.

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“…Several studies have found that there was increasing resistance rate to mupirocin, fusidic acid, clindamycin, erythromycin, and tetracycline [27][28][29][30]. This is due to indiscriminate use of topical antibiotics [31,32].…”

Section: Increase Of Bacterial Resistance Ratementioning

confidence: 99%