mupirocin and Bacterial-Infections

Mupirocin is a polyketide antibiotic produced by Pseudomonas fluorescens. The biosynthetic cluster encodes 6 type I polyketide synthase multifunctional proteins and 29 single function proteins. The biosynthetic pathway belongs to the trans-AT group in which acyltransferase activity is provided by a separate polypeptide rather than in-cis as found in the original type I polyketide synthases. Special features of this group are in-cis methyltransferase domains and a trans-acting HMG-CoA synthase-cassette which insert α- and β- methyl groups respectively while enoyl reductase domains are absent from the condensing modules. In addition, for the mupirocin system, there is no obvious loading mechanism for initiation of the polyketide chain and many aspects of the pathway remain to be elucidated. Mupirocin inhibits isoleucyl-tRNA synthetase and has been used since 1985 to help prevent infection by methicillin-resistant Staphylococcus aureus, particularly within hospitals. Resistance to mupirocin was first detected in 1987 and high-level resistance in S. aureus is due to a plasmid-encoded second isoleucyl-tRNA synthetase, a more eukaryotic-like enzyme. Recent analysis of the biosynthetic pathway for thiomarinols from marine bacteria opens up possibilities to modify mupirocin so as to overcome this resistance.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Bacterial Proteins; Humans; Mupirocin; Pseudomonas fluorescens

Recently, there have been increasing concerns about the emergence of mupirocin resistance and increased infections due to lowered inhibition of Staphylococcus aureus. We conducted this systemic analysis to find out whether the application of mupirocin was effective for the prevention of exit-site infection (ESI) and peritonitis in patients undergoing peritoneal dialysis (PD).. Recruited studies met the following criteria: they were randomized controlled trials or historical cohort studies; subjects consisted of adults (age, >or= 18 years) undergoing PD; mupirocin treatment was administered to the therapy group and placebo or no treatment was administered to the control group. The primary extracted data were the difference in the episodes of ESI and peritonitis S. aureus or other organisms among treatment and control groups. Results. Fourteen studies described in 13 articles and a total of 1,233 patients versus 1,217 controls were included in the analysis. Of the 13 articles, 6 were newly published articles that had not been analysed previously and 3 were randomized controlled trials. The application of mupirocin decreased the risk by 72% [95% confidence interval (CI): 0.60-0.81] in ESI and by 70% (95% CI 0.52-0.81) in peritonitis due to S. aureus among all patients undergoing PD. Treatment of mupirocin reduced the risks of ESI and peritonitis due to all organisms by 57% (95% CI: 0.46-0.66) and 41% (95% CI: 0.24-0.54), respectively. Based on the six newly published articles, the reduced risk rate for mupirocin therapy was found to be 80% (95% CI: 0.39-0.93, P = 0.004) in ESI and 91% (95% CI: 0.72-0.97, P < 0.0001) in peritonitis due to S. aureus; 70% (95% CI: 0.47-0.82, P < 0.0001) in ESI and 42% (95% CI: 0.25-0.55, P < 0.0001) in peritonitis due to all organisms among mupirocin-treated and -untreated subjects. Based on the three randomized controlled trials, ESI and peritonitis due to S. aureus were found to be reduced by 73% (95% CI: 0.63-0.80, P < 0.0001) and 40% (95% CI: 0.17-0.56, P = 0.002), respectively. Interestingly, although mupirocin treatment can reduce the risk rate of ESI by 46% (95% CI: 0.35-0.55, P < 0.00001), it cannot decrease the risk rate of peritonitis due to all organisms (P = 0.56).. Mupirocin prophylaxis was effective on preventing ESI and peritonitis due to S. aureus and other organisms in PD patients.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cohort Studies; Humans; Mupirocin; Peritoneal Dialysis; Peritonitis; Randomized Controlled Trials as Topic

Topics: Anti-Bacterial Agents; Bacterial Infections; Catheterization; Humans; Mupirocin; Peritoneal Dialysis; Peritonitis; Randomized Controlled Trials as Topic; Staphylococcal Infections

Mupirocin is a novel antibiotic, for topical use only, which is unrelated in chemical structure and mode of action to any known class of antibacterial agent. It is active against a wide range of Gram-positive bacteria, including staphylococci and most streptococci, and is moderately active against Gram-negative bacteria. Mupirocin 2% ointment applied 2 or 3 times daily has demonstrable efficacy for the treatment of both primary and secondary skin infections and compares favourably with other topical and systemic treatments. In clinical studies, both elimination of the bacterial pathogen and clinical cure or improvement has been usual in over 90% of patients. Up to 40% of the normal population carry Staphylococcus aureus in the anterior nares and this carriage rate is often increased in hospitalized patients and their attendants. The increasing incidence of multiply- and methicillin-resistant S. aureus (MRSA) has been associated with hospital outbreaks leading to considerable morbidity and disruption of hospital services. Intranasal 2% calcium mupirocin has been shown to be effective in the eradication of nasal carriage; in bacteriologically controlled studies elimination of S. aureus, including MRSA, was achieved in over 95% of subjects. The role of mupirocin in preventing staphylococcal infection is currently undergoing evaluation.

Topics: Administration, Topical; Bacterial Infections; Gram-Positive Bacteria; Humans; Mupirocin; Nasal Cavity; Skin Diseases, Infectious; Staphylococcal Infections

Mupirocin is a novel antibiotic totally unrelated in chemical structure and mode of action to any other clinically useful class of antibiotics. It has greatest antibacterial activity against aerobic gram-positive cocci, namely, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, and other beta-hemolytic streptococci. Bactroban ointment is formulated as 2% mupirocin in polyethylene glycol ointment. No systemic absorption of mupirocin or its major metabolite, monic acid, has been detected in short courses of topical administration to healthy volunteers or to patients with epidermolysis bullosa after prolonged courses of therapy with Bactroban ointment. Randomized, multicenter, double-blind, vehicle-controlled clinical trials have shown that mupirocin is safe and effective for the treatment of impetigo.

Topics: Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Drug Resistance, Microbial; Fatty Acids; Humans; Impetigo; Mupirocin; Staphylococcal Skin Infections

Topics: Anti-Bacterial Agents; Bacterial Infections; Fatty Acids; Humans; Mupirocin

Condyloma acuminatum (CA), or genital wart, is a sexually transmitted infection caused by human papillomaviruses. Increasing evidences demonstrated that photodynamic therapy (PDT) is effective in eliminating latent HPV infection, the major reason for CA recurrence. We observed an increasing number of infections after PDT in CA patients, which has not been reported before. This study aims to evaluate the incidence and management of infection in CA patients after PDT procedure. CA patients received PDT from January 2015 to February 2016 at the outpatient setting. Patients were randomly divided into two groups: the control group and fusidic acid group. Patients in the fusidic acid group used topical fusidic acid (2%) and recombinant human interferon after 5-aminolevulinic acid (ALA)-PDT procedure, while patients in the control group only used recombinant human interferon. Patients came to our department for follow-up evaluations at 4, 8, and 12 weeks after treatment for three times of PDT. Patients with ALA-PDT-associated infection were then randomly divided into two groups: the fusidic acid group and mupirocin group. During the 13-month study period, a total of 718 patients with 2154 times of PDT procedures were enrolled. The infection rate after PDT was 8.5% in the control group, while it was 1.1% in the prophylactic topical fusidic acid group. The cure rate of PDT-associated infection was 85.7% in the fusidic acid group and 86.7% in the mupirocin group. In conclusion, prophylactic topical antibiotic was useful for reduction of PDT-associated infection and optimal wound healing in CA patients.

Topics: Adolescent; Adult; Aminolevulinic Acid; Anti-Bacterial Agents; Bacterial Infections; Beijing; Condylomata Acuminata; Female; Fusidic Acid; Genital Diseases, Female; Genital Diseases, Male; Humans; Incidence; Male; Middle Aged; Mupirocin; Photochemotherapy; Photosensitizing Agents; Prospective Studies; Young Adult

There is a paucity of evidence to guide the best strategy for prevention of peritoneal-dialysis-related infections. Antibacterial honey has shown promise as a novel, cheap, effective, topical prophylactic agent without inducing microbial resistance. We therefore assessed whether daily application of honey at the exit site would increase the time to peritoneal-dialysis-related infections compared with standard exit-site care plus intranasal mupirocin prophylaxis for nasal carriers of Staphylococcus aureus.. In this open-label trial undertaken in 26 centres in Australia and New Zealand, participants undergoing peritoneal dialysis were randomly assigned in a 1:1 ratio with an adaptive allocation algorithm to daily topical exit-site application of antibacterial honey plus standard exit-site care or intranasal mupirocin prophylaxis (only in carriers of nasal S aureus) plus standard exit-site care (control group). The primary endpoint was time to first infection related to peritoneal dialysis (exit-site infection, tunnel infection, or peritonitis). The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12607000537459.. Of 371 participants, 186 were assigned to the honey group and 185 to the control group. The median peritoneal-dialysis-related infection-free survival times were not significantly different in the honey (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83-1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05-3·24; p=0·03) and peritonitis (2·25, 1·16-4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) were not significantly different in the honey and control groups. 11 (6%) participants in the honey group had local skin reactions.. The findings of this trial show that honey cannot be recommended routinely for the prevention of peritoneal-dialysis-related infections.. Baxter Healthcare, Queensland Government, Comvita, and Gambro.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Australia; Bacterial Infections; Carrier State; Child; Child, Preschool; Female; Honey; Humans; Male; Middle Aged; Mupirocin; New Zealand; Peritoneal Dialysis; Peritonitis; Time Factors; Treatment Outcome

Little data exists comparing the safety and efficacy of triple antibiotic ointment (TAO) and mupirocin for prevention of uncomplicated soft tissue wound infections. The purpose of this investigation was to conduct a pilot study of the relative safety, efficacy, and cost effectiveness of the 2 preparations. This was a randomized, prospective, interventional study to determine the difference in infection rates of uncomplicated soft tissue wounds between subjects treated with TAO and mupirocin ointment after standard wound care and suturing. Subjects were enrolled at presentation to the ED if they met the study inclusion criteria and were required to make one follow-up visit to the ED to determine the status of their wound (infected vs. not infected). A total of 99 patients were enrolled and assessed at the follow-up visit. The groups had similar rates of self-reported compliance with wound care and dressing changes. Patients in the mupirocin group had a greater rate of signs of infection (12% vs. 6.1%), and infection (4% vs. 0%) compared with patients in the TAO group, although neither difference achieved statistical significance. There were no serious adverse effects in either group. This pilot study found a similar rate of wound infection and adverse events between TAO and mupirocin ointments. Results should be confirmed in a larger equivalency trial.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Bacitracin; Bacterial Infections; Chi-Square Distribution; Drug Combinations; Female; Humans; Male; Mupirocin; Neomycin; Ointments; Pilot Projects; Polymyxin B; Prospective Studies; Statistics, Nonparametric; Treatment Outcome; Wound Infection

Topics: Administration, Topical; Bacterial Infections; Double-Blind Method; Female; Humans; Male; Mupirocin; Varicose Ulcer

Mupirocin is a novel antibiotic totally unrelated in chemical structure and mode of action to any other clinically useful class of antibiotics. It has greatest antibacterial activity against aerobic gram-positive cocci, namely, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, and other beta-hemolytic streptococci. Bactroban ointment is formulated as 2% mupirocin in polyethylene glycol ointment. No systemic absorption of mupirocin or its major metabolite, monic acid, has been detected in short courses of topical administration to healthy volunteers or to patients with epidermolysis bullosa after prolonged courses of therapy with Bactroban ointment. Randomized, multicenter, double-blind, vehicle-controlled clinical trials have shown that mupirocin is safe and effective for the treatment of impetigo.

Topics: Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Drug Resistance, Microbial; Fatty Acids; Humans; Impetigo; Mupirocin; Staphylococcal Skin Infections

A double-blind, randomized, vehicle-controlled study was conducted to evaluate the safety and efficacy of 2% mupirocin ointment in the treatment of secondarily infected dermatoses. One hundred six patients were enrolled, 92 of whom were evaluable for efficacy. There was a significantly greater rate of eradication of Staphylococcus aureus and total pathogens in mupirocin-treated patients than in control subjects. Analysis of the clinical data relative to all pathogens showed a significant difference in skin infection evaluations performed at the interim and follow-up visits, which favored the mupirocin-treated groups. In those patients infected with S. aureus or Streptococcus pyogenes, there was a significant difference at end-point that favored mupirocin in seven clinical ratings and the skin infection evaluation at follow-up. Mild local adverse effects were noted in a small percentage of patients in each group. Mupirocin appears to be safe and effective for the treatment of secondarily infected dermatoses, especially in those infections caused by Staphylococcus aureus.

Topics: Adolescent; Anti-Bacterial Agents; Bacterial Infections; Dermatitis; Double-Blind Method; Fatty Acids; Humans; Mupirocin; Ointments; Randomized Controlled Trials as Topic; Staphylococcal Skin Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes

The efficacy and side effects of topical mupirocin (Bactroban) and fusidic acid (Fucidin) ointment were compared in a double-blind, randomized trial in 70 patients who came to the Dermatologic Clinic of L'Enfant Jésus Hospital with primary or secondary (or both) skin infections. Thirty-five patients were treated with mupirocin and 35 patients were treated with fusidic acid three times a day for seven days. Clinical and bacteriologic assessments were conducted before and after treatment. The efficacy of mupirocin, in terms of resolution and improvement of clinical signs and symptoms of infection, as well as of the elimination of infecting organisms, was similar to that of fusidic acid. Of 34 patients (1 could not be evaluated) treated with mupirocin, a clinical cure was achieved in 18, and significant improvement was demonstrated in 15. Similarly, of 35 patients treated with fusidic acid, a clinical cure was achieved in 18 and improvement occurred in 15. Bacteriologic cure rates were 97% (30 of 31 patients evaluated) in the mupirocin-treated group, compared with 87% (27 of 31 patients evaluated) in the fusidic acid-treated group. No side effects were observed in either treatment group. Because topical 2% mupirocin has little or no potential for irritation, systemic side effects, or cross-resistance with other antibiotics, its efficacy is likely to make this new compound a useful agent for the treatment of superficial skin infections.

Topics: Administration, Topical; Anti-Bacterial Agents; Bacterial Infections; Drug Evaluation; Fatty Acids; Female; Fusidic Acid; Humans; Male; Mupirocin; Ointments; Random Allocation; Skin Diseases, Infectious

A double-blinded study was conducted to compare the effects of mupirocin and tetracycline ointments in the treatment of skin infections. 111 patients were available for clinical assessment, of which 53 were treated with mupirocin and 58 treated with tetracycline. Clinically, both groups were improved, and there was no significant difference. Bacteriological assessment however revealed a better response to mupirocin. Staphylococcus aureus and Streptococcus pyogenes were the most common organisms isolated. 99% of Staphylococci were sensitive to mupirocin compared with 61% to tetracycline and 29% to penicillin G. 57% of Group A beta haemolytic Streptococci were resistant to tetracycline compared to 14% to mupirocin. Gram-negative organisms were mostly resistant to both preparations. No side effects were observed in both treatment groups. This study suggests that mupirocin is a safe and effective topical preparation for treating most of our common skin infections.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Double-Blind Method; Fatty Acids; Female; Humans; Male; Mupirocin; Ointments; Random Allocation; Skin Diseases, Infectious; Tetracycline

Ninety-eight patients suffering from skin and soft tissue infections in the Côte d'Ivoire were treated topically with a new antibiotic, mupirocine, or with placebo in a double-blind study. Patients were allocated at random to receive one or other treatment, applying the ointment, supplied in identical tubes and of similar colour base, to the lesions 3 times a day for 5 days. Overall evaluation of clinical response to treatment showed that the results with mupirocine were significantly superior to those with placebo. No unwanted effects of treatment were observed in either treatment group.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Double-Blind Method; Eczema; Fatty Acids; Female; Humans; Male; Middle Aged; Mupirocin; Random Allocation; Skin Diseases, Infectious

Topics: Anti-Bacterial Agents; Bacterial Infections; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Fatty Acids; Follow-Up Studies; Humans; Leg Ulcer; Mupirocin

Topics: Administration, Topical; Bacterial Infections; Clinical Trials as Topic; Fatty Acids; Humans; Mupirocin; Skin Diseases, Infectious

Topics: Administration, Oral; Administration, Topical; Bacterial Infections; Dermatitis; Erythromycin; Fatty Acids; Humans; Mupirocin; Staphylococcal Infections

Infection is a common cause of morbidity and mortality after kidney transplant. Based on the well-documented successes of reducing infections with decolonization of patients in intensive care units, we began a universal immediate posttransplant decolonization program for all kidney transplant recipients. Herein, we report safety and efficacy of this decolonization program.. We compared a consecutive cohort of kidney transplant recipients who underwent universal decolonization (intervention group) with a cohort of transplant patients from an era immediately prior to this practice (control group). Universal decolonization included daily chlorhexidine body wash and nasal mupirocin ointment.. Seventy-eight patients who underwent universal decolonization were compared with 43 patients in the control group. Ten microbiologically proven infections (8.3%) occurred in the 30 days after discharge: 7 (9%) in the intervention group and 3 (7%) in the control group. Forty-five transplant recipients (37.2%) were readmitted in the 30 days after discharge: 31 (39.7%) in the intervention group and 14 (32.6%) in the control group. No patients in the intervention group had adverse drug events from mupirocin and chlorhexidine use.. A universal decolonization protocol was successfully implemented and was well tolerated by all patients. Despite successful implementation, we did not observe any significant differences in infection rates between treated patients and historical controls.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacterial Infections; Chlorhexidine; Female; Humans; Infection Control; Kidney Transplantation; Male; Middle Aged; Mupirocin; Ointments; Program Evaluation; Retrospective Studies; Time Factors; Treatment Outcome

OBJECTIVE To characterize the risk of infection after MRSA decolonization with intranasal mupirocin. DESIGN Multicenter, retrospective cohort study. SETTING Tertiary care neonatal intensive care units (NICUs) from 3 urban hospitals in the United States ranging in size from 45 to 100 beds. METHODS MRSA-colonized neonates were identified from NICU admissions occurring from January 2007 to December 2014, during which a targeted decolonization strategy was used for MRSA control. In 2 time-to-event analyses, MRSA-colonized neonates were observed from the date of the first MRSA-positive surveillance screen until (1) the first occurrence of novel gram-positive cocci in sterile culture or discharge or (2) the first occurrence of novel gram-negative bacilli in sterile culture or discharge. Mupirocin exposure was treated as time varying. RESULTS A total of 522 MRSA-colonized neonates were identified from 16,144 neonates admitted to site NICUs. Of the MRSA-colonized neonates, 384 (74%) received mupirocin. Average time from positive culture to mupirocin treatment was 3.5 days (standard deviation, 7.2 days). The adjusted hazard of gram-positive cocci infection was 64% lower among mupirocin-exposed versus mupirocin-unexposed neonates (hazard ratio, 0.36; 95% confidence interval [CI], 0.17-0.76), whereas the adjusted hazard ratio of gram-negative bacilli infection comparing mupirocin-exposed and -unexposed neonates was 1.05 (95% CI, 0.42-2.62). CONCLUSIONS In this multicentered cohort of MRSA-colonized neonates, mupirocin-based decolonization treatment appeared to decrease the risk of infection with select gram-positive organisms as intended, and the treatment was not significantly associated with risk of subsequent infections with organisms not covered by mupirocin's spectrum of activity. Infect Control Hosp Epidemiol 2017;38:930-936.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Bacterial Infections; Carrier State; Cross Infection; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Retrospective Studies; Staphylococcal Infections; Tertiary Care Centers

Preoperative nasal mupirocin has been shown to reduce surgical site infections (SSIs) in patients undergoing cardiac surgery. We analyzed the effect of mupirocin plus antiseptic body wash on SSI rate and etiology.. Prospective SSI surveillance was done for patients undergoing cardiac surgery before and after implementation of mupirocin nasal ointment and chlorhexidine/octenidine body wash.. Overall SSI rate was 8.6% (81 out of 945) for the control and 6.9% (58 out of 842) for the intervention cohort (P = .19). In multivariable analysis, the study protocol was associated with an odds ratio of 0.61 (95% confidence interval, 0.41-0.91; P = .015) with regard to any SSI. This effect was exclusively due to a reduction in superficial SSIs and was observed both in patients with preoperative and postoperative treatment initiation. Coagulase-negative staphylococci (CoNS), the most commonly isolated pathogen, were found in 37% and 48% (P = .19) of patients in the control and the intervention cohort, respectively. CoNS were methicillin resistant in 69% of cases.. Mupirocin and antiseptic body wash reduced the rate of superficial but not deep or organ/space SSIs. Postoperative patient treatment may be critical in reducing the risk for superficial SSI, presumably due to a reduction of bacterial skin load. A high proportion of SSI was due to methicillin-resistant CoNS and thus not covered by routine perioperative antimicrobial prophylaxis.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antisepsis; Bacteria; Bacterial Infections; Chlorhexidine; Female; Humans; Imines; Male; Middle Aged; Mupirocin; Preoperative Care; Prospective Studies; Pyridines; Surgical Wound Infection; Thoracic Surgery; Treatment Outcome

Peritonitis remains a common complication of peritoneal dialysis (PD). The aim of this study was to analyze, in a PD center, long-term temporal trends in peritonitis rates, microbiology and outcomes. We treated 588 cases of peritonitis that occurred during 11,833.6 months at risk. Y-set and twin-bag disconnecting systems were introduced in 1990, mupirocin at the exit site in 2000 and fluconazole prophylaxis in 2005. Vancomycin and ceftazidime were the empiric protocol. Global and 5-year cohort rates were expressed as episodes/patient-year (ep/p-y). A global peritonitis rate reduction was found from 1.02 to 0.47 ep/p-y (p = 0.008). Poisson analyses performed in each of the subgroups of Gram-positive and Gram-negative peritonitis revealed no significant changes over time. No case of vancomycin resistance was identified. There was a downward trend in peritonitis-related hospitalization over time to 0.11 ep/p-y (p ≤ 0.001). Trend analysis showed a favorable, but changing evolution, highlighting the importance of accurate longitudinal PD center registry data and quality control.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Bacteria; Bacterial Infections; Ceftazidime; Cohort Studies; Female; Fluconazole; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mupirocin; Peritoneal Dialysis; Peritonitis; Treatment Outcome; Vancomycin

Topics: Anti-Bacterial Agents; Bacterial Infections; Humans; Mupirocin; Peritoneal Dialysis; Peritonitis; Treatment Outcome

For the period January 2005 to June 2008, we reviewed the rates, causes, and outcomes of exit-site infection (ESI) among 137 consecutive patients [mean age: 51 +/- 16 years; 17 (12.4%) with diabetes; 76 (55%) on automated PD; time at risk: 240.41 dialysis years; mean follow-up: 20.4 +/- 13.8 months]. Treatment protocol included mini-laparotomy and Popovich-Moncrief placement method, with presurgical cefazolin prophylaxis and routine prescription of topical mupirocin for the exit site. Oral cotrimoxazole was the initial empirical ESI treatment. A total of 49 patients (36%) experienced 76 episodes of ESI, for a global incidence of 0.31 episodes per year at risk. Gram-positive organisms occurred in 56% of the cases, and gram-negative organisms in 27%. Staphylococcus aureus caused 15 ESIs (0.06 episodes/patient-year), and only 15% of gram-positive organisms were methicillin resistant. Methicillin-resistant S. aureus were all sensitive to cotrimoxazole. Pseudomonas species caused 11 ESIs (0.04 episodes/patient-year). Other Enterobacteriaceae occurred at a rate of 0.03 episodes/patient-year. Fungal ESLs occurred at a rate of 0.004 episodes/patient-year The ESI cure rate was 96%. In 3 patients, the catheter was removed, but only 2 patients (2.6%) experienced ESI-related peritonitis. Our unit's treatment policy and prophylactic use of exit-site mupirocin resulted in a low S. aureus ESI rate without an alarming incidence of gram-negative or Pseudomonas infections. Routine microbiologic and quality control is mandatory for strategies individualized to the dialysis center.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Bacterial Infections; Catheter-Related Infections; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Mupirocin; Peritoneal Dialysis; Young Adult

Peritonitis and exit-site infections (ESI) are major causes of morbidity in peritoneal dialysis (PD) patients. The application of topical mupirocin to exit sites reduces such complications, and prolongs life in PD. Since the year 2000, this topical treatment has been used in our hospital on new PD patients. We analysed the results of this protocol, and studied the effects of comorbidities on the incidence of peritonitis.. We studied 740 incident PD patients, who were divided into two groups based on year of entry into PD (Group 1 from January 1998 to December 1999 inclusive, topical mupirocin not used, and Group 2 from January 2000 to March 2004 inclusive, topical mupirocin used). The variables we studied included gender, age, diabetic status, ischaemic heart disease, peripheral vascular disease, cerebrovascular disease and serum albumin.. The application of topical mupirocin at the exit site led to a significant reduction in the rate of peritonitis (0.443 vs 0.339 episodes per patient-year; P<0.0005) and in ESI (0.168 vs 0.156 episodes per patient-year; P<0.005), results attributed primarily by the significant (P<0.005) reduction in Staphylococcus aureus infection. There was also an unexpected lowering of Pseudomonas aeruginosa peritonitis in the mupirocin group (P<0.005). Stepwise multiple logistic regression analysis revealed that only the application of mupirocin and serum albumin levels were significant predictors of peritonitis.. Our study, although retrospective, has demonstrated that the topical use of mupirocin was associated with a significant reduction in ESI and peritonitis and, unexpectedly, with findings of fewer incidences of Pseudomonas peritonitis. Serum albumin level before the initiation of PD was a strong predictor of subsequent peritonitis. Mupirocin, with its low toxicity, ease of application and demonstrable beneficial effect in reducing ESI and peritonitis is now used on all of our incident PD patients.

Topics: Administration, Topical; Aged; Anti-Bacterial Agents; Bacterial Infections; Female; Hospitals, General; Humans; Male; Middle Aged; Mupirocin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Pseudomonas Infections; Retrospective Studies; Singapore; Staphylococcal Infections

Application of mupirocin to the nares or catheter exit site and frequency of mupirocin administration in continuous ambulatory peritoneal dialysis (CAPD) patients remain controversial. The objective of our study was to evaluate, using a historical control group, the efficacy on CAPD-related infections of once-weekly application of mupirocin at the catheter exit site. We instructed 18 CAPD patients, who did not initially use prophylactic antibiotic treatment, about once-weekly application of mupirocin ointment to the exit site as part of their exit-site care. We recorded the incidence of catheter-related infections, the causative micro-organisms, and the rate of catheter loss. We observed 17 acute exit-site infections (AESIs: 0.45 episodes/patient-year) before mupirocin treatment and 2 AESIs (0.06 episodes/patient-year) after treatment. The relative rate of AESI reduction was 86%. Before application of mupirocin, 52% of AESIs were attributable to Staphylococcus-aureus; after mupirocin administration, no AESIs were staphylococcal. Peritonitis episodes were also reduced from 21 before mupirocin treatment (0.56 episodes/patient-year), to 9 after mupirocin administration (0.29 episodes/patient-year). The relative rate of peritonitis reduction was 48%. Once-weekly application of mupirocin to the exit site resulted in a reduction in exit-site infections and peritonitis episodes comparable to those obtained with daily application.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Mupirocin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Staphylococcal Infections

Secondary metabolites of different species of lichen were tested for their activities against a variety of microbial species. While gram-negative rods and fungi were not inhibited by these compounds, Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, and some anaerobic species (Bacteroides and Clostridium species) were susceptible at the concentrations tested. Vulpinic acid generally was less active than usnic acid, regardless of its stereochemistry. The susceptibility to usnic acid was not impaired in clinical isolates of S. aureus resistant to methicillin and/or mupirocin.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Benzofurans; Fungi; Furans; Humans; Lichens; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Phenylacetates; Stereoisomerism

To assess colonization and infection with methicillin-resistant Staphylococcus aureus (MRSA), high-level gentamicin-resistant enterococci (R-ENT) and gentamicin and/or ceftriaxone-resistant Gram-negative bacilli (R-GNB) and the factors that are associated with colonization and infection with these organisms.. Monthly surveillance for colonization and infection over a period of 2 years. In the second year, an intervention to decrease MRSA colonization by the use of mupirocin ointment was carried out.. Long-term care facility attached to an acute care Veterans Affairs Medical Center.. A total of 551 patients in the facility were followed for a period of 2 years.. Colonization and infection rates with MRSA, R-ENT, and R-GNB. Analysis of risk factors associated with colonization and infection with these three groups of organisms.. In the first year, colonization rates were highest for MRSA (22.7 +/- 1% patients colonized each month) and R-ENT (20.2 +/- 1%) and lower for R-GNB (12.6 +/- 1%). After introduction of decolonization of nares and wounds with mupirocin, the rate of MRSA colonization fell significantly to 11.5 +/- 1.8%, but rates remained unchanged for R-ENT and R-GNB. Risk factors for MRSA colonization included the presence of wounds and decubitus ulcers. For R-ENT, the presence of wounds, renal failure, intermittent urethral catheterization, low serum albumin, and poor functional level were significant. For R-GNB, intermittent urethral catheterization, chronic renal disease, inflammatory bowel disease, presence of wounds, and prior pneumonia were significantly associated with colonization. Overall, of infections caused by known organisms, 49.6% were due to MRSA, R-ENT, or R-GNB, and 50.4% were due to susceptible organisms. Infections were more commonly due to R-GNB (21.1% of all infections) than to R-ENT (8.3%) or MRSA (4.6%). The most common infections were urinary tract infections (42.9% of all infections) and skin and soft tissue infections (31.9% of all infections). Risk factors for MRSA infections were diabetes mellitus and peripheral vascular disease, for R-GNB infections were intermittent urethral catheterization and indwelling urethral catheters, and no one factor was associated with R-ENT infection.. In our long-term care facility, colonization with resistant MRSA and R-ENT was more common than R-GNB, but infections were more often due to R-GNB than R-ENT and MRSA. Several host factors, which potentially could be modified in order to prevent infections, emerged as important in colonization and infection with these antibiotic-resistant organisms.

Topics: Aged; Bacterial Infections; Carrier State; Drug Resistance, Microbial; Enterococcus; Female; Gentamicins; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Hospitals, Veterans; Humans; Long-Term Care; Male; Methicillin Resistance; Michigan; Middle Aged; Mupirocin; Nursing Homes; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Bacterial Infections; Dermatomycoses; Fatty Acids; Humans; Immune Tolerance; Mupirocin; Skin Diseases; Staphylococcal Skin Infections