The Epidemiology of Mupirocin Resistance Among Methicillin-ResistantStaphylococcus aureusat a Veterans' Affairs Hospital

Abstract

MS MRSA was recovered from 506 patients and MR MRSA from 126. Among MR MRSA isolates, 58% showed low-level mupirocin resistance (minimum inhibitory concentration [MIC] > or = 4 to 256 microg/mL), and 42% showed high-level mupirocin resistance (MIC > or = 512 microg/mL). A significant increase (P=.002) in the number of high-level MR isolates occurred during the 1993 to 1995 period. A case-control study showed that presence of a decubitus ulcer correlated with high-level resistant isolates (P<.05). The distribution of PFGE patterns did not differ for MR and MS MRSA CONCLUSIONS: Use of mupirocin ointment in a program aimed at managing endemic MRSA infection or colonization resulted in a significant increase in the recovery of high-level MR MRSA isolates. These isolates appeared to emerge from our existing MRSA pool. A case-control study provided few clues concerning patients likely to harbor MR MRSA. We confirmed the position that the extended use of mupirocin ointment should be avoided in settings where MRSA is endemic.

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

“…In den meisten Studien wurde die Mupirocin-Behandlung über fünf Tage durchgeführt. Längere Behandlungsdauer kann zur Resistenzbildung führen [373], die wiederum mit schlechteren Sanierungsergebnissen einhergehen kann [374].…”

Prevalence of Mupirocin Resistance in Patients Colonized with Staphylococcus Aureusin A Tertiary Care Rural Hospital

“…Mupirocin derived from Pseudomonas fluorescens is a topical antibiotic that has been extensively used for treating MRSA associated skin and softtissue infections, decreasing certain types of surgical site infections and eliminating nasal colonization of MRSA among patients and medical staff (14,22,1) . Prolonged, widespread or uncontrolled use and multiple courses of mupirocin are all associated with the development of mupirocin resistance…”

Current Knowledge of Methicillin-Resistant Staphylococcus Aureus and Community-Associated Methicillin-Resistant Staphylococcus Aureus

“…There is no unambiguous opinion on bathing patients with disinfection preparations or local application of antibiotics (2% mupirocin) in case of nasal carriage of MRSA 123,124 . An additional concern with routine use of mupirocin for nasal decolonization is the level of mupirocin resistance that has been observed with usage in MRSA endemic areas 125 . The plasmid-encoding mupirocin resistance has been found in the genome of the CA-MRSA strain, USA 300 (ref.…”