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Mupirocin-Resistant, Methicillin-Resistant Staphylococcus aureus: Does Mupirocin Remain Effective?

Published online by Cambridge University Press:  02 January 2015

Elaine S. Walker ,
Jose E. Vasquez ,
Roy Dula ,
Hollie Bullock  and
Felix A. Sarubbi
Elaine S. Walker
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
Jose E. Vasquez
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
Roy Dula
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
Hollie Bullock
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
Felix A. Sarubbi*
Affiliation:
James H. Quillen Veterans' Affairs Hospital and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
*
Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614
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Abstract

Objective:

To determine the efficacy of mupirocin ointment in reducing nasal colonization with mupirocin-susceptible, methicillin-resistant Staphylococcus aureus (MS MRSA) as well as mupirocin-resistant MRSA (MR MRSA).

Design:

Prospective evaluation in which patients colonized with MRSA were treated twice daily with 2% topical mupirocin ointment for 5 days.

Setting:

James H. Quillen Veterans' Affairs Medical Center.

Patients:

Forty hospitalized patients with two anterior nares cultures positive for MRSA within a 7-day period.

Methods:

Treated patients had post-treatment cultures at day 3 and weeks 1,2, and 4. Isolates underwent mupirocin-susceptibility testing and DNA typing. MRSA clearance and type turnover were assessed for isolates that were mupirocin-susceptible, low-level (LL) MR MRSA and high-level (HL) MR MRSA.

Results:

Post-treatment nares cultures on day 3 were negative for 78.5%, 80%, and 27.7% of patients with MS MRSA, LL-MR MRSA, and HL-MR MRSA, respectively. Sustained culture negativity at 1 to 4 weeks was more common in the MS MRSA group (91%) than in the LL-MR MRSA group (25%) or the HL-MR MRSA group (25%). Positive post-treatment cultures usually showed the same DNA pattern relative to baseline. Plasmid curing of 18 HL-MR MRSA resulted in 15 MS MRSA and 3 LL-MR MRSA.

Conclusions:

Mupirocin was effective in eradicating MS MRSA, but strains of MR MRSA often persisted after treatment. This appeared to reflect treatment failure rather than exogenous recolonization. MR MRSA is now more prevalent and it is appropriate to sample MRSA populations for mupirocin susceptibility prior to incorporating mupirocin into infection control programs.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 5 , May 2003 , pp. 342 - 346
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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