mupirocin and Staphylococcal-Infections

Staphylococcus aureus (S aureus) is the foremost bacterial cause of surgical-site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization is an independent risk factor for SSI; however, this risk has been shown to diminish with screening and decolonization.. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed, Cochrane Library, and Embase data bases from inception to January 1, 2022, for the purposes of identifying all studies reporting on the use of S aureus swabbing and/or decolonization before neuromodulation procedures. A random-effects meta-analysis was performed using the metaphor package in R to calculate odds ratios (OR).. Five observational cohort studies were included after applying the inclusion and exclusion criteria. The average study duration was 6.6 ± 3.8 years. Three studies included nasal screening as a prerequisite for subsequent decolonization. Type of neuromodulation included spinal cord stimulation in two studies, deep brain stimulation in two studies, intrathecal baclofen in one study, and sacral neuromodulation in one study. Overall, 860 and 1054 patients were included in a control or intervention (ie, screening and/or decolonization) group, respectively. A combination of nasal mupirocin ointment and a body wash, most commonly chlorhexidine gluconate soap, was used to decolonize throughout. Overall infection rates were observed at 59 of 860 (6.86%) and ten of 1054 (0.95%) in the control and intervention groups, respectively. Four studies reported a significant difference. The OR for intervention (screen and/or decolonization) vs no intervention was 0.19 (95% CI, 0.09-0.37; p < 0.001). Heterogeneity between studies was nonsignificant (I. Preoperative S aureus swabbing and decolonization resulted in significantly decreased odds of infection in neuromodulation procedures. This measure may represent a worthwhile tool to reduce neuromodulation SSI, warranting further investigation.

Topics: Anti-Bacterial Agents; Humans; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units.. We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited.. Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Humans; Intensive Care Units; Mupirocin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

We performed a systematic literature search of the clinical evidence to retrieve systematic reviews and selected and reported results from one review that was recent, of high quality, and relevant to our research question. We complemented the chosen systematic review with a literature search to identify randomized controlled trials published since the systematic review was published in 2019. We used the Risk of Bias in Systematic Reviews (ROBIS) tool to assess the risk of bias of each included systematic review and the Cochrane risk-of-bias tool for randomized controlled trials to assess the risk of bias of each included primary study. We assessed the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and conducted both cost-effectiveness and cost-utility analyses using a decision-tree model with a 1-year time horizon from the perspective of Ontario's Ministry of Health. We also analyzed the budget impact of publicly funding nasal decolonization of. We included one systematic review and three randomized controlled trials in the clinical evidence review. In universal decolonization, compared with placebo or no intervention, nasal mupirocin alone may result in little to no difference in the incidence of overall and. Based on the best evidence available, decolonization of

Topics: Anti-Infective Agents, Local; Chlorhexidine; Humans; Methicillin; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Systematic Reviews as Topic; Technology Assessment, Biomedical

Staphylococcus aureus infections are associated with increased morbidity, mortality, hospital stay, and health care costs. S aureus colonization has been shown to increase risk for invasive and noninvasive infections. Decolonization of S aureus has been evaluated in multiple patient settings as a possible strategy to decrease the risk of S aureus transmission and infection. In this article, we review the recent literature on S aureus decolonization in surgical patients, patients with recurrent skin and soft tissue infections, critically ill patients, hospitalized non-critically ill patients, dialysis patients, and nursing home residents to inform clinical practice.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Critical Illness; Cross Infection; Dialysis; Drug Administration Routes; Hospitalization; Humans; Infant; Infant, Newborn; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nursing Homes; Soft Tissue Infections; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Staphylococcus aureus is one of the most common pathogens causing nosocomial and community-acquired infections associated with high morbidity and mortality. Mupirocin has been increasingly used for treatment of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) infections. The aim of this study was to determine the prevalence of mupirocin-resistant S. aureus (MuRSA), mupirocin-resistant MRSA (MuRMRSA), high-level MuRSA (HLMuRSA) and high-level MuRMRSA (HLMuRMRSA) worldwide.. Online databases including Medline, Embase and Web of Science were searched (2000-2018) to identify studies addressing the prevalence of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA. STATA v. software was used to interpret the data.. Of the 2243 records identified from the databases, 30 and 63 studies fulfilled the eligibility criteria for MuRSA and MuRMRSA, respectively. Finally, 27 and 60 studies were included separately for HLMuRSA and HLMuRMRSA, respectively. The analyses revealed pooled and averaged prevalences of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA of 7.6% [95% confidence interval (CI) 6.2-9.0%], 13.8% (95% CI 12.0-15.6%), 8.5% (95% CI 6.3-10.7%) and 8.1% (95% CI 6.8-9.4%), respectively.. Overall, these results show a global increase in the prevalence of HLMuRSA and HLMuRMRSA among clinical S. aureus isolates over time. However, there was only a significant increase in the prevalence of MuRMRSA compared with the other categories, especially MuRSA. Since mupirocin remains the most effective antibiotic for MSSA and MRSA decolonisation both in patients and healthcare personnel, a reduction of its effectiveness presents a risk for invasive infection. Monitoring of mupirocin resistance development remains critical.

Topics: Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Population Surveillance; Prevalence; Staphylococcal Infections

Only a few medications have a United States Food and Drug Administration indications for prevention and/or treatment of infections in patients with tympanic perforations or tympanostomy tubes. We examined 3 off-label agents that have become important in tympanostomy tube care hoping to demonstrate the effectiveness and safety of each in experimental assays and human application.. Computerized literature review.. (1) Oxymetazoline nasal spray applied at the time of surgery is equivalent to fluoroquinolone ear drops in the prevention of early postsurgical otorrhea and tympanostomy tube occlusion at the first postoperative visit. (2) Topical mupirocin 2% ointment is effective alone or in combination with culture-directed systemic therapy for the treatment of tympanostomy tube otorrhea caused by community-acquired, methicillin-resistant. Oxymetazoline nasal spray, mupirocin ointment, and clotrimazole cream are safe and effective as off-label medications for tympanostomy tube care in children.

Topics: Administration, Topical; Anti-Bacterial Agents; Antibiotic Prophylaxis; Child; Child, Preschool; Clotrimazole; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Ear Ventilation; Mupirocin; Nasal Sprays; Off-Label Use; Otitis; Otitis Media with Effusion; Oxymetazoline; Prosthesis-Related Infections; Staphylococcal Infections

Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Humans; Infection Control; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are Staphylococcus aureus carriers undergoing different types of surgeries and diverse measures of decolonization.. Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries and measures of decolonization that Staphylococcus aureus carriers were applied.. Twenty RCTs published between 1996 and 2019 involving 10,526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR = 0.59 and 0.47, respectively, both p < 0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies. As for the diverse measures of nasal decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used different types of antimicrobial drugs, and 5% use others. The SSIs rate were decreased after chlorhexidine (RR = 0.474, 95% CI 0.259-0.864), while no significant difference was shown in the use of mupirocin (RR = 0.871, 95% CI 0.544-1.394).. It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSIs in these patients, especially in patients who have been administered by pulmonary surgeries or treated with chlorhexidine.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

The prophylactic application of antimicrobials that are active against Staphylococcus aureus can prevent infections. However, implementation in clinical practice is limited. We have reviewed antimicrobial approaches for the prevention of S. aureus infections.. We searched the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE databases and trial registries using synonyms for S. aureus, infections and prevention as search terms. We included randomized controlled trials and systematic reviews only.. Most studies were conducted with mupirocin. Mupirocin is effective in preventing S. aureus infections in patients receiving dialysis treatment and in surgical patients, particularly if the patients are carriers of S. aureus. The combination of mupirocin and chlorhexidine, but not chlorhexidine alone, is also effective against S. aureus infections. So far, vaccines have not proven successful in protecting against S. aureus infections. Regarding prophylactic povidone-iodine and systemic antibiotics, there is limited evidence supporting their effectiveness against S. aureus infections. Antimicrobial honey has not been proven to be more effective or non-inferior to mupirocin in protecting against S. aureus infections.. The current evidence supports the use of mupirocin as prophylaxis for preventing infections with S. aureus, particularly in carriers and in the surgical setting or in patients receiving dialysis treatment. Other antimicrobial agents have not been sufficiently proven to be effective so far, or have been proven ineffective. New trials with vaccines and anti-staphylococcal peptides are currently underway and may lead to new preventive strategies in the future.

Topics: Anti-Infective Agents; Carrier State; Humans; Meta-Analysis as Topic; Mupirocin; Randomized Controlled Trials as Topic; Staphylococcal Infections; Staphylococcus aureus; Systematic Reviews as Topic

Mupirocin (MUP), bactroban, or pseudomonic acid is a natural crotonic acid derivative drug extracted from Pseudomonas fluorescens which is produced by modular polyketide synthases. This antibiotic has a unique chemical structure and mechanism of action. It is a mixture of A-D pseudomonic acids and inhibits protein synthesis through binding to bacterial isoleucyl-tRNA synthetase. MUP is often prescribed to prevent skin and soft tissue infections caused by S. aureus isolates and where the MRSA isolates are epidemic, MUP may be used as a choice drug for nasal decolonization. It is also used for prevention of recurring infections and control the outbreaks. The emergence of MUP resistance has been increasing particularly among methicillin-resistant Staphylococcus aureus (MRSA) isolates in many parts of the world and such resistance is often related with MUP widespread uses. Although both low-level and high-level MUP resistance were reported among MRSA isolates, the rate of resistance is different in various geographic areas. In this review, we will report the global prevalence of MUP resistance, discuss synergism and mechanism of action of MUP, and provide new insights into the clinical use of this antibiotic.

Topics: Animals; Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Mupirocin is an antibiotic from monocarboxylic acid class used as antibacterial agent against methicillin-resistant Staphylococcus aureus (MRSA) and can be obtained as a mixture of four pseudomonic acids by Pseudomonas fluorescens biosynthesis. Nowadays improving antibiotics occupies an important place in the pharmaceutical industry as more and more resistant microorganisms are developing. Mupirocin is used to control the MRSA outbreaks, for infections of soft tissue or skin and for nasal decolonization. Due to its wide use without prescription, the microorganism's resistance to Mupirocin increased from up to 81%, thus becoming imperative its control or improvement. As the biotechnological production of Mupirocin has not been previously reviewed, in the present paper we summarize some consideration on the biochemical process for the production of pseudomonic acids (submerged fermentation and product recovery). Different strains of Pseudomonas, different culture medium and different conditions for the fermentation were analysed related to the antibiotics yield and the product recovery step is analysed in relation to the final purity. However, many challenges have to be overcome in order to obtain pseudomonic acid new versions with better properties related to antibacterial activity.

Topics: Anti-Bacterial Agents; Carrier State; Drug Resistance, Bacterial; Fermentation; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Pseudomonas fluorescens; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Technology, Pharmaceutical

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Drug Development; Humans; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

Surgical site infection (SSI) is one of the most common health care-associated infections. Staphylococcus aureus remains the most common etiologic agent causing SSIs. Studies confirm S aureus carriage increases the risk of S aureus SSIs. The purpose of this article is to review the strategies to reduce SSIs due to S aureus focusing on nasal decolonization.. Published studies indicate screening patients for S aureus nasal carriage and decolonizing carriers during the preoperative period decreases the risk of S aureus SSIs in cardiac and orthopedic surgery. Mupirocin remains the best topical agent at eradicating nasal S aureus however, concerns over resistance have led to development of alternative agents. Nasal povidone-iodine, alcohol-based nasal antiseptic, and photodynamic therapy are promising new interventions, but more studies are needed.. Short term nasal mupirocin is still the most studied and effective topical agent in eradicating S aureus nasal colonization. However, increasing mupirocin resistance remains an ongoing concern and newer agents are needed. Currently, preoperative S aureus decolonization often uses combination chlorhexidine gluconate bathing and nasal mupirocin considering that colonization of multiple body sites is commonly seen.

Topics: Anti-Infective Agents, Local; Carrier State; Humans; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome

Topics: Animals; Anti-Bacterial Agents; Bacterial Toxins; Chlorhexidine; Community-Acquired Infections; Exotoxins; Humans; Leukocidins; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Pets; Pneumonia, Bacterial; Prevalence; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Zoonoses

Surgical site infection rates in the month following surgery vary from 1% to 5%. Due to the large number of surgical procedures conducted annually, the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Nasal decontamination using antibiotics or antiseptics is performed to reduce the risk of SSIs by preventing organisms from the nasal cavity being transferred to the skin where a surgical incision will be made. Staphylococcus aureus (S aureus) colonises the nasal cavity and skin of carriers and can cause infection in open or unhealed surgical wounds. S aureus is the leading nosocomial (hospital-acquired) pathogen in hospitals worldwide. The potential effectiveness of nasal decontamination of S aureus is thought to be dependent on both the antibiotic/antiseptic used and the dose of application; however, it is unclear whether nasal decontamination actually reduces postoperative wound infection in S aureus carriers.. To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are S aureus carriers undergoing surgery.. In September 2016 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL Plus. We also searched three clinical trial registries and the references of included studies and relevant systematic reviews. There were no restrictions based on language, date of publication or study setting.. Randomised controlled trials (RCTs) which enrolled S aureus carriers with any type of surgery and assessed the use of nasal decontamination with antiseptic/antibiotic properties were included in the review.. Two review authors independently performed study selection, data extraction, risk of bias assessment and GRADE assessment.. We located two studies (291 participants) for inclusion in this review. The trials were clinically heterogeneous with differences in duration of follow-up, and nasal decontamination regimens. One study compared mupirocin (2% contained in a base of polyethylene glycol 400 and polyethylene glycol 3350) with a placebo in elective cardiac surgery patients; and one study compared Anerdian (iodine 0.45% to 0.57% (W/V), chlorhexidine acetate 0.09% to 0.11% (W/V)) with no treatment also in cardiac surgery patients. The trials reported limited outcome data on SSI, adverse events and secondary outcomes (e.g. S aureus SSI, mortality). Mupirocin compared with placeboThis study found no clear difference in SSI risk following use of mupirocin compared with placebo (1 trial, 257 participants); risk ratio (RR) 1.60, 95% confidence interval (CI) 0.79 to 3.25 based on 18/130 events in the mupirocin group and 11/127 in the control group; low-certainty evidence (downgraded twice due to imprecision). Anerdian compared with no treatmentIt is uncertain whether there is a difference in SSI risk following treatment with Anerdian compared with no treatment (1 trial, 34 participants); RR 0.89, 95% CI 0.06 to 13.08 based on 1/18 events in the Anerdian group and 1/16 in the control group; very low certainty evidence (downgraded twice due to imprecision and once due to risk of bias).. There is currently limited rigorous RCT evidence available regarding the clinical effectiveness of nasal decontamination in the prevention of SSI. This limitation is specific to the focused question our review addresses, looking at nasal decontamination as a single intervention in participants undergoing surgery who are known S aureus carriers. We were only able to identify two studies that met the inclusion criteria for this review and one of these was very small and poorly reported. The potential benefits and harms of using decontamination for the prevention of SSI in this group of people remain uncertain.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Cardiac Surgical Procedures; Carrier State; Chlorhexidine; Drug Combinations; Humans; Iodine; Mupirocin; Nose; Randomized Controlled Trials as Topic; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

A systematic literature review and meta-analysis was performed to identify effectiveness of mupirocin decolonization in prevention of Staphylococcus aureus infections, among nonsurgical settings. Of the 15 662 unique studies identified up to August 2015, 13 randomized controlled trials, 22 quasi-experimental studies, and 1 retrospective cohort study met the inclusion criteria. Studies were excluded if mupirocin was not used for decolonization, there was no control group, or the study was conducted in an outbreak setting. The crude risk ratios were pooled (cpRR) using a random-effects model. We observed substantial heterogeneity among included studies (I(2) = 80%). Mupirocin was observed to reduce the risk for S. aureus infections by 59% (cpRR, 0.41; 95% confidence interval [CI], .36-.48) and 40% (cpRR, 0.60; 95% CI, .46-.79) in both dialysis and nondialysis settings, respectively. Mupirocin decolonization was protective against S. aureus infections among both dialysis and adult intensive care patients. Future studies are needed in other settings such as long-term care and pediatrics.

Topics: Anti-Bacterial Agents; Humans; Intensive Care Units; Mupirocin; Nose; Renal Dialysis; Staphylococcal Infections

Perioperative decolonization of Staphylococcus aureus nasal carriers with mupirocin together with chlorhexidine body washing reduces the incidence of S. aureus surgical site infection. A targeted strategy, applied in S. aureus carriers only, is costly, and implementation may reduce effectiveness. Universal decolonization is more cost-effective but increases exposure of noncarriers to mupirocin and the risk of resistance to mupirocin in staphylococci. High-level mupirocin resistance in S. aureus can emerge through horizontal gene transfer originating from coagulase-negative staphylococci (CoNS) and through clonal transmission. The current evidence on the occurrence of high-level mupirocin resistance in S. aureus and CoNS, in combination with the results of mathematical modeling, strongly suggests that the increased selection of high-level mupirocin resistance in CoNS does not constitute an important risk for high-level mupirocin resistance in S. aureus. Compared with a targeted strategy, universal decolonization seems associated with an equally low risk of mupirocin resistance in S. aureus.

Topics: Administration, Intranasal; Baths; Chlorhexidine; Decontamination; Drug Resistance, Bacterial; Humans; Models, Biological; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

In this study, we discuss a mechanism of development of access-related Staphylococcus aureus infections in patients on buttonhole (BH) method and logically construct a measure to prevent such infections on the basis of the mechanism.. S. aureus can colonize a BH track. Once S. aureus colonizes a BH track, access-related infections may develop when the equilibrium is upset between the factors of host resistance and a level of bacterial growth in a BH track. Thus, the logically constructed measure to prevent access-related infections are as follows: (1) decolonization of S. aureus from a BH track by applying mupirocin ointment to a BH entry site when a patient has been proven to be a carrier of S. aureus in the track, (2) prevention of bacterial invasion of the BH track by a new method to remove a scab completely, and (3) control of bacterial growth in the BH track by disinfecting the site with diluted povidone-iodine solution (0.1% povidone-iodine solution) before access vessel cannulation.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Catheter-Related Infections; Catheterization, Peripheral; Catheters, Indwelling; Female; Humans; Kidney Failure, Chronic; Male; Mupirocin; Povidone-Iodine; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Hospital-acquired infections cause up to 19% of infections in paediatric patients contributing to the spread of antimicrobial resistance. This review evaluates the effect of decolonization and decontamination in hospitalized children and neonates as an adjunct to standard infection control measures.. Few studies on decolonization and decontamination are available in children. The evidence about the effectiveness of daily chlorhexidine washcloths on bacteraemia in paediatric patients relies on a single randomized controlled trial, in neonates with central venous access in a single retrospective observational study. It is uncertain whether nasal mupirocin reduces methicillin-resistant Staphylococcus aureus carriage and infections in neonates, whereas oral chlorhexidine mouthwashes have not proven effective in children in intensive care settings. Scanty evidence demonstrates a reduction in the rate of ventilation-acquired pneumonia with digestive tract decontamination in paediatric patients and no studies are available in neonates. These strategies have not been extensively tested in resource-poor countries.. Strong evidence about the efficacy of decolonization and decontamination interventions exists in adult medicine but not in paediatric patients. There is an urgent need to understand how these interventions could be adapted to neonates and resource-poor settings in which the prevalence of hospital-acquired infections is higher.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Decontamination; Digestive System; Female; Humans; Infection Control; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Staphylococcal Infections

Mupirocin 2% ointment is used either alone or with skin antiseptics as part of a comprehensive MRSA decolonization strategy. Increased mupirocin use predisposes to mupirocin resistance, which is significantly associated with persistent MRSA carriage. Mupirocin resistance as high as 81% has been reported. There is a strong association between previous mupirocin exposure and both low-level and high-level mupirocin resistance. High-level mupirocin resistance (mupA carriage) is also linked to MDR. Among MRSA isolates, the presence of the qacA and/or qacB gene, encoding resistance to chlorhexidine, ranges from 65% to 91%, which, along with mupirocin resistance, is associated with failed decolonization. This is of significant concern for patient care and infection prevention and control strategies as both these agents are used concurrently for decolonization. Increasing bacterial resistance necessitates the discovery or development of new antimicrobial therapies. These include, for example, polyhexanide, lysostaphin, ethanol, omiganan pentahydrochloride, tea tree oil, probiotics, bacteriophages and honey. However, few of these have been evaluated fully or extensively tested in clinical trials and this is required to in part address the implications of mupirocin resistance.

Topics: Animals; Anti-Bacterial Agents; Chlorhexidine; Disinfectants; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Prevalence; Staphylococcal Infections

The objectives of this study were to estimate the relative transmissibility of mupirocin-resistant (MupR) and mupirocin-susceptible (MupS) MRSA strains and evaluate the long-term impact of MupR on MRSA control policies.. Parameters describing MupR and MupS strains were estimated using Markov chain Monte Carlo methods applied to data from two London teaching hospitals. These estimates parameterized a model used to evaluate the long-term impact of MupR on three mupirocin usage policies: 'clinical cases', 'screen and treat' and 'universal'. Strategies were assessed in terms of colonized and infected patient days and scenario and sensitivity analyses were performed.. The transmission probability of a MupS strain was 2.16 (95% CI 1.38-2.94) times that of a MupR strain in the absence of mupirocin usage. The total prevalence of MupR in colonized and infected MRSA patients after 5 years of simulation was 9.1% (95% CI 8.7%-9.6%) with the 'screen and treat' mupirocin policy, increasing to 21.3% (95% CI 20.9%-21.7%) with 'universal' mupirocin use. The prevalence of MupR increased in 50%-75% of simulations with 'universal' usage and >10% of simulations with 'screen and treat' usage in scenarios where MupS had a higher transmission probability than MupR.. Our results provide evidence from a clinical setting of a fitness cost associated with MupR in MRSA strains. This provides a plausible explanation for the low levels of mupirocin resistance seen following 'screen and treat' mupirocin usage. From our simulations, even under conservative estimates of relative transmissibility, we see long-term increases in the prevalence of MupR given 'universal' use.

Topics: Anti-Infective Agents, Local; Carrier State; Cross Infection; Disease Transmission, Infectious; Drug Resistance, Bacterial; Hospitals, Teaching; Humans; Infection Control; London; Methicillin-Resistant Staphylococcus aureus; Models, Statistical; Mupirocin; Organizational Policy; Prevalence; Staphylococcal Infections

Chronic haemodialysis patients are a high-risk population for meticillin-resistant Staphylococcus aureus (MRSA) colonization, which is a precursor of infection.. To summarize the effect of nasal (± whole-body wash) MRSA decolonization in haemodialysis patients by means of a systematic review and meta-analysis.. We identified eligible studies using Medline, Embase, the Cochrane database, clinicaltrials.org, and conference abstracts investigating the success of MRSA decolonization in haemodialysis patients. For the statistical analysis, we used Stata 13 to express study-specific proportions with 95% confidence intervals. A likelihood ratio test was used to assess inter-study heterogeneity.. Six published prospective cohort studies and one study described in a conference abstract met our inclusion criteria. From 1150 haemodialysis patients enrolled in these studies, MRSA was isolated from nasal swabs of 147 (12.8%) patients. Six of the trials used mupirocin nasal ointment and combined it with chlorhexidine body washes for decolonization. The most widely used protocol was a five-day course of mupirocin nasal ointment application three times a day, and chlorhexidine body wash once daily. The pooled success rate of decolonization was 0.88 (95% confidence interval: 0.75-0.95). A likelihood ratio test of the fixed versus the random-effects model showed significant inter-study heterogeneity (P = 0.047). Four of seven studies determined subsequent MRSA infections in 94 carriers overall, two (2%) of which experienced infection.. The use of mupirocin together with whole-body decolonization is highly effective in eradicating MRSA carriage in haemodialysis patients. The current literature, however, is characterized by a lack of comparative effectiveness studies for this intervention.

Topics: Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Disinfection; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Mucosa; Renal Dialysis; Staphylococcal Infections; Treatment Outcome

This study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.. A systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were "Staphylococcus aureus", "MRSA", "MSSA", "treatment", "decolonization", "nasal carrier", "colonization", "chronic kidney disease", "dialysis", and "haemodialysis" or "hemodialysis". Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia.. In total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05-0.34; p<0.001). The risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08-0.42; p<0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51-1.15; p=0.20).. Twenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.

Topics: Administration, Topical; Anti-Bacterial Agents; Bacteremia; Carrier State; Catheter-Related Infections; Catheterization, Central Venous; Humans; Mupirocin; Renal Dialysis; Renal Insufficiency, Chronic; Staphylococcal Infections; Staphylococcal Skin Infections

Despite a large body of work evaluating the ability of meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonization to decrease the risk of MRSA infection and transmission, many uncertainties remain regarding the efficacy of this strategy in hospitals located in endemic areas. With meticillin-susceptible S. aureus (MSSA), the objective is simply to eradicate the organism in order to diminish the risk of infection. MSSA decolonization was recently found to be effective in high-risk clean surgery, where the intervention was cost-effective and cost-saving. The many unanswered issues include the role for rapid screening tests, the optimal decolonization regimen, the indication for decolonization in other situations at risk, the frequency of replacement of S. aureus infections with infections due to other micro-organisms, and the risk of emergence of mupirocin resistance.

Topics: Carrier State; Cost-Benefit Analysis; Hospitals; Humans; Infection Control; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Randomized Controlled Trials as Topic; Risk Factors; Staphylococcal Infections

Staphylococcus aureus is the pathogen most frequently implicated in infection on orthopedic hardware; various strategies are deployed to limit the risk of transmission and surgical infection.. The present study is based on a meta-analysis assessing firstly the relationship between nasal carriage of S. aureus and the development of osteo-articular infection and secondly current methods of decolonization.. The meta-analysis showed increased risk of surgical site infection in case of nasal carriage of S. aureus: OR=5.92, 95% CI [1.15-30.39]; P=0.033. For cross-transmission, a scientifically proven reduction in surgical site S. aureus levels is ensured by associated mupirocin and 2% chlorhexidine antiseptic solution in subjects with positive nasal screening results for all surgical procedures taken together; the reduction was not, however, significant in the orthopedic surgery subgroup. The meta-analysis confirmed these findings: OR=0.60, 95% CI [0.34-1.06]; P=0.08.. The literature review confirmed that nasal carriage of S. aureus is a major risk factor for surgical site infection. The efficacy of eradication could not be demonstrated for orthopedic surgery as samples were too small. The positive trend found, however, should encourage further studies with sufficient power and risk/benefit should meanwhile be assessed on a case-by-case basis.. Level 2. Meta-analysis.

Topics: Antibiotic Prophylaxis; Carrier State; Female; Follow-Up Studies; Humans; Incidence; Male; Mupirocin; Musculoskeletal Diseases; Nasal Cavity; Orthopedic Procedures; Preoperative Care; Risk Assessment; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Mupirocin is a topical antibiotic used for decolonization of meticillin-susceptible S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA), both in patients and in healthcare personnel, and for treatment of local skin and soft tissue infections caused by S. aureus and streptococcal species. Mupirocin prevents bacterial protein synthesis by inhibiting the bacterial isoleucyl-tRNA synthetase (IleRS). Low-level resistance against mupirocin, defined as minimum inhibitory concentration (MIC) of 8-256mg/L, results from a point mutation in the native IleRS, and high-level resistance (MIC ≥512mg/L) is mediated by the mupA (ileS-2) gene, located on mobile genetic elements decoding for an alternate IleRS. EUCAST and BSAC clinical thresholds for S. aureus are ≤1mg/L for susceptible and >256mg/L for resistant, placing the susceptible threshold at the epidemiological cut-off value (ECOFF). Isolates with MICs above the wild type (ECOFF 1mg/L) but without a recognized resistance mechanism (MIC ≤4mg/L) will thus be reported intermediate. Resistance to mupirocin, both high- and low-level, reduces the effectiveness of decolonizing strategies for S. aureus or MRSA. Low-level resistant isolates may initially be eradicated as effectively as susceptible isolates, but recolonization appears to be more usual. Increased use of mupirocin has been associated with emergence of resistance through enhanced selective pressure and cross-transmission. Unrestricted over-the-counter use and treatment of wounds and pressure sores with mupirocin are especially strongly associated with resistance. Yet emergence of mupirocin resistance following increased use has not been reported consistently, and an integrated understanding of all factors underlying the dynamics of mupirocin resistance in hospitals and communities is lacking.

Topics: Anti-Bacterial Agents; Carrier State; Drug Resistance, Bacterial; Genes, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Preoperative Care; Staphylococcal Infections

The rate of infection following primary total knee arthroplasty (TKA) in the general population is 1% on average. However, in persons with haemophilia (PWH), the mean rate of infection following primary TKA is nearly 8%.. why is the infection rate higher in persons with haemophilia compared with the general population? what should be done to correct this? A PubMed (MEDLINE) search and a Cochrane Library search were performed. The most important articles as judged by the author were selected for this review. The main criteria for selection were that the articles addressed the prevention of infection in PWH undergoing TKA. Patient-related risk factors predisposing to postoperative infection in the general population include immunodepression and previous infection in the knee. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common organism in infected TKAs. Systematic preoperative screening by swab is very important. Prevention of MRSA-positive cases by means of nasal decontamination (mupirocin 3 days) is advisable. Preoperative antibiotic prophylaxis has shown itself to be an efficient method to lower infection rates. Operating theatres ideally should be equipped with laminar flow. In PWH, there are three additional risk factors: insufficient haemostasis, HIV-positive status, and central venous catheters (CVCs). Implementing the preventive measures for the general population and a sufficient level of clotting factor for 2-3 weeks can help diminish the infection in PWH undergoing TKA. In HIV-positive patients with CD4 count less than 200 cells/μl , early, vigorous treatment should be instituted for suspected infection and surgical intervention individualized based on the balance of risks and benefits. Strict adherence to handwashing and aseptic technique are essential elements of catheter care. Caregiver education is an integral part of CVC use and the procedural practices of users should be regularly reassessed. If TKA is contraindicated, arthroscopic knee joint debridement can relieve pain for several years and delay the need for TKA.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthroplasty, Replacement, Knee; Environment, Controlled; Hemophilia A; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Prosthesis-Related Infections; Risk Factors; Staphylococcal Infections; Surgical Wound Infection

A multi centre double-blind randomised-controlled trial (M-RCT), carried out in the Netherlands in 2005-2007, showed that hospitalised patients with S. aureus nasal carriage who were treated prophylactically with mupirocin nasal ointment and chlorhexidine gluconate medicated soap (MUP-CHX), had a significantly lower risk of health-care associated S. aureus infections than patients receiving placebo (3.4% vs. 7.7%, RR 0.42, 95% CI 0.23-0.75). The objective of the present study was to determine whether treatment of patients undergoing elective cardiothoracic or orthopaedic surgery with MUP-CHX (screen-and-treat strategy) affected the costs of patient care.. We compared hospital costs of patients undergoing cardiothoracic or orthopaedic surgery (n=415) in one of the participating centres of the M-RCT. Data from the 'Planning and Control' department were used to calculate total hospital costs of the patients. Total costs were calculated including nursing days, costs of surgery, costs for laboratory and radiological tests, functional assessments and other costs. Costs for personnel, materials and overhead were also included. Mean costs in the two treatment arms were compared using the t-test for equality of means (two-tailed). Subgroup analysis was performed for cardiothoracic and orthopaedic patients.. An investigator-blinded analysis revealed that costs of care in the treatment arm (MUP-CHX, n=210) were on average €1911 lower per patient than costs of care in the placebo arm (n=205) (€8602 vs. €10513, p=0.01). Subgroup analysis showed that MUP-CHX treated cardiothoracic patients cost €2841 less (n=280, €9628 vs €12469, p=0.006) and orthopaedic patients €955 less than non-treated patients (n=135, €6097 vs €7052, p=0.05).. In conclusion, in patients undergoing cardiothoracic or orthopaedic surgery, screening for S. aureus nasal carriage and treating carriers with MUP-CHX results in a substantial reduction of hospital costs.

Topics: Anti-Infective Agents; Chlorhexidine; Humans; Mupirocin; Orthopedics; Staphylococcal Infections; Staphylococcus aureus; Thoracic Surgery

Methicillin-resistant Staphylococcus aureus (MRSA) has a gene that makes it resistant to methicillin as well as to other beta-lactam antibiotics, including flucloxacillin, beta-lactam/beta-lactamase inhibitor combinations, cephalosporins, and carbapenems. MRSA can be part of the normal body flora (colonisation), especially in the nose, but it can cause infection. Until recently, MRSA has primarily been a problem associated with exposure to the healthcare system, especially in people with prolonged hospital admissions, with underlying disease, or after antibiotic use. In many countries worldwide, a preponderance of S aureus bloodstream isolates are resistant to methicillin.. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatment for MRSA nasal or extra-nasal colonisation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 9 systematic reviews, RCTs, or observational studies that met our inclusion criteria.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiseptic body washes, chlorhexidine-neomycin nasal cream, mupirocin nasal ointment, systemic antimicrobials, tea tree oil preparations, and other topical antimicrobials.

Topics: Administration, Oral; beta-Lactamase Inhibitors; Cross Infection; Humans; Incidence; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Tea Tree Oil

Central venous catheters (CVC) continue to play a prominent role in haemodialysis vascular access with 46% to 70% of patients commencing haemodialysis via a CVC. CVC access is associated with catheter-related infections, increased patient hospitalisations and death due to infection. A variety of interventions are used to prevent CVC infection.. To evaluate the benefits and harms of prophylactic topical antimicrobials, topical antiseptics, medicated and non-medicated dressings on infectious complications among haemodialysis patients with CVC.. We searched the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles without language restriction.. We included randomised controlled trials (RCTs) and quasi-RCTs investigating any intervention that prevented infectious complications among haemodialysis patients with CVC. We excluded antimicrobial impregnated CVC or CVC using locking solutions with antimicrobial properties.. Two authors assessed study quality and extracted data. Dichotomous outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI) and continuous outcomes as mean differences (MD).. Ten studies (786 patients) were included. Mupirocin ointment reduced the risk of catheter-related bacteraemia (RR 0.17, 95%CI 0.07 to 0.43) and had a significant effect on catheter-related infections caused by S. aureus. The risk of catheter-related bacteraemia was reduced by polysporin (RR 0.40, 95%CI 0.19 to 0.86) and povidone-iodine ointment (RR 0.10, 95%CI 0.01 to 0.72). Subgroup analysis suggested mupirocin (RR 0.12, 95%CI 0.01 to 2.13) and povidone-iodine ointment (RR 0.84, 95%CI 0.24 to 2.98) had no effect on all-cause mortality while polysporin ointment showed a significant reduction (RR 0.22, 95%CI 0.07 to 0.74). Mortality related to infection was not reduced by mupirocin, polysporin or povidone-iodine ointment. Topical honey did not reduce the risk of exit site infection (RR 0.45, 95%CI 0.10 to 2.11) or catheter-related bacteraemia (RR 0.80, 95%CI 0.37 to 1.73). Transparent polyurethane dressing compared to dry gauze dressing did not reduce the risk of CVC or exit site infection, or catheter-related bacteraemia.. Mupirocin ointment appears effective in reducing the risk of catheter-related bacteraemia. Insufficient reporting on mupirocin resistance was noted and needs to be considered in future studies. A lack of high quality data on the routine use of povidone-iodine ointment, polysporin ointment and topical honey warrant larger RCTs. Insufficient data were available to determine which dressing type (transparent polyurethane or dry gauze dressing) has the lowest risk of catheter-related infections.

Topics: Apitherapy; Bacitracin; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Drug Combinations; Gramicidin; Humans; Mupirocin; Polymyxin B; Povidone-Iodine; Randomized Controlled Trials as Topic; Renal Dialysis; Staphylococcal Infections

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Disease Transmission, Infectious; Germany; Gloves, Protective; Hand Disinfection; Hospitalization; Humans; Incidence; Infant, Newborn; Infection Control; Intensive Care Units; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Patient Isolation; Randomized Controlled Trials as Topic; Risk Factors; Sepsis; Staphylococcal Infections

The bacterial species Staphylococcus aureus, including its methicillin-resistant variant (MRSA), finds its primary ecological niche in the human nose, but is also able to colonize the intestines and the perineal region. Intestinal carriage has not been widely investigated despite its potential clinical impact. This review summarizes literature on the topic and sketches the current state of affairs from a microbiological and infectious diseases' perspective. Major findings are that the average reported detection rate of intestinal carriage in healthy individuals and patients is 20% for S. aureus and 9% for MRSA, which is approximately half of that for nasal carriage. Nasal carriage seems to predispose to intestinal carriage, but sole intestinal carriage occurs relatively frequently and is observed in 1 out of 3 intestinal carriers, which provides a rationale to include intestinal screening for surveillance or in outbreak settings. Colonization of the intestinal tract with S. aureus at a young age occurs at a high frequency and may affect the host's immune system. The frequency of intestinal carriage is generally underestimated and may significantly contribute to bacterial dissemination and subsequent risk of infections. Whether intestinal rather than nasal S. aureus carriage is a primary predictor for infections is still ill-defined.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Intestines; Linear Models; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Perineum; Pregnancy; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) bacteria are a common cause of hospital- and community-acquired infections. Persons may have asymptomatic colonization with MRSA in the nares, axillae, perineum, or groin. Since MRSA colonization often precedes infection, and infection is associated with significant morbidity and mortality, there is great interest in preventing the transmission of MRSA and decolonizing persons who harbor these bacteria. We provide an evidence-based review of MRSA decolonization agents. Our search strategy included the databases of the Cochrane Central Register of Controlled Trials, MEDLINE (1962-May 2008), and EMBASE (1980-May 2008). To identify unpublished trials, abstract books from appropriate major scientific meetings were hand searched, manufacturers were contacted, and pharmacology references were researched for available commercial products, formulations, adverse events, and dosing. The most extensive research in MRSA decolonization has been conducted with mupirocin, which is applied to the anterior nares 2-3 times/day for 5 days. Increased use is correlated to resistance development; therefore, routine decolonization is not prudent unless MRSA colonization is confirmed in the nares or other site. Retapamulin is under investigation for use in nares decolonization. If total body decolonization is necessary, bathing or showering with an antiseptic agent such as chlorhexidine gluconate is recommended in combination with mupirocin applied to the nares to improve the likelihood of eradication. Oral antibiotics have been evaluated for use in decolonization of the skin and nares but should be considered only in conjunction with topical agents and when all other decolonization attempts and environmental controls have been exhausted. Homeopathic and investigational agents may also be effective. Although mupirocin is the standard of care for decolonization of MRSA, several agents demonstrate efficacy and many merit further investigation.

Topics: Administration, Cutaneous; Administration, Intranasal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Cross Infection; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

Staphylococcus aureus in the nose is a risk factor for endogenous staphylococcal infection. UK guidelines recommend the use of mupirocin for nasal decolonization in certain groups of patients colonized with methicillin-resistant S. aureus (MRSA). Mupirocin is effective at removing S. aureus from the nose over a few weeks, but relapses are common within several months. There are only a few prospective randomized clinical trials that have been completed with sufficient patients, but those that have been reported suggest that clearance of S. aureus from the nose is beneficial in some patient groups for the reduction in the incidence of nosocomial infections. There is no convincing evidence that mupirocin treatment reduces the incidence of surgical site infection. New antibiotics are needed to decolonize the nose because bacterial resistance to mupirocin is rising, and so it will become less effective. Furthermore, a more bactericidal antibiotic than mupirocin is needed, on the grounds that it might reduce the relapse rate, and so clear the patient of MRSA for a longer period of time than mupirocin.

Topics: Anti-Bacterial Agents; Carrier State; Clinical Trials as Topic; Cross Infection; Guidelines as Topic; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Staphylococcal Infections; United Kingdom

With increasing pressure to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection, it is possible that there will be increased use of mupirocin for nasal decolonization of MRSA. Understanding the mechanisms, clinical significance, and epidemiology of mupirocin resistance is important for predicting how changes in mupirocin use may affect bacterial populations and MRSA control. High-level mupirocin resistance in S. aureus is mediated by a plasmid-encoded mupA gene. This gene can be found on conjugative plasmids that carry multiple resistance determinants for other classes of antimicrobial agents. High-level resistance has been associated with decolonization failure, and increased resistance rates have been associated with increased mupirocin use. Low-level mupirocin resistance is mediated via mutation in the native ileS gene, and the clinical significance of this resistance is unclear. Laboratory tests to detect and distinguish between these types of resistance have been described but are not widely available in the United States. Institutions that are considering the implementation of widespread mupirocin use should consider these resistance issues and develop strategies to monitor the impact of mupirocin use.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Colony Count, Microbial; Conjugation, Genetic; Drug Resistance, Bacterial; Genotype; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nuclear Proteins; Plasmids; Staphylococcal Infections

The present review describes the literature about the prevention of Staphylococcus aureus infections in surgery, published from August 2006 to January 2008, and puts it into perspective.. To prevent Staphylococcus aureus infections after surgical procedures, three methods were described, that is, isolation precautions after methicillin-resistant Staphylococcus aureus screening, vancomycin as an antibiotic prophylaxis in patients at risk for methicillin-resistant Staphylococcus aureus, and topical decolonization of carriage. Identified methicillin-resistant Staphylococcus aureus carriers can be treated with the appropriate antibiotic prophylaxis to prevent infection with methicillin-resistant Staphylococcus aureus. Topical decolonization with chlorhexidine gluconate resulted in a reduced overall nosocomial infection rate, but no effect was found on the Staphylococcus aureus infection rate. Topical decolonization with mupirocin reduced the overall Staphylococcus aureus infection rate after surgery in Staphylococcus aureus nasal carriers.. The treatment of proven carriers of Staphylococcus aureus with mupirocin is an effective method to prevent Staphylococcus aureus nosocomial infections after surgery. Cost-analysis studies show that this screen-and-treat approach is cost saving as long as the prevalence of mupirocin resistance in Staphylococcus aureus is low. The effect of chlorhexidine gluconate on the Staphylococcus aureus infection rate in carriers should be determined in future studies.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Carrier State; Chemoprevention; Chlorhexidine; Cross Infection; Humans; Mupirocin; Patient Isolation; Staphylococcal Infections; Surgical Wound Infection; Vancomycin

Staphylococcus aureus (S. aureus) is the leading nosocomial (hospital acquired) pathogen in hospitals throughout the world. Traditionally, control of S. aureus has been focused on preventing cross-infection between patients, however, it has been shown repeatedly that a large proportion of nosocomial S. aureus infections originate from the patient's own flora. Nasal carriage of S. aureus is now considered a well defined risk factor for subsequent infection in various groups of patients. Local antibiotic treatment with mupirocin ointment is often used to eradicate nasal S. aureus.. To determine whether the use of mupirocin nasal ointment in patients with identified S. aureus nasal carriage reduced S. aureus infection rates.. We searched the Cochrane Wounds Group Specialised Register (May 2008), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 2 2008), MEDLINE (1950 to May 2008), EMBASE (1980 to May 2008) and CINAHL (1982 to May 2008). To identify unpublished trials, abstract books from major scientific meetings (ICAAC, ESCMID and SHEA) were handsearched, researchers and manufacturers of mupirocin were contacted and other electronic databases were searched (SIGLE, ASLIB Index, mRCT, USA Clinical Trials).. Randomised controlled trials (RCTs) comparing nasal mupirocin with no treatment or placebo or alternative nasal treatment in the prevention of S. aureus infections in nasal S. aureus carriers were included.. Titles, abstracts and full-text articles of studies retrieved from the search process were independently assessed by two authors for inclusion. From included studies a data extraction form was made and the quality of the trial was assessed. The primary outcome was the S. aureus infection rate (any site). Secondary outcomes were time to infection, mortality, adverse events and infection rate caused by micro-organisms other than S. aureus.. Nine RCTs involving 3396 participants met the inclusion criteria. Patient populations varied and several types of nosocomial S. aureus infection were described including bacteraemia, exit-site infections, peritonitis, respiratory tract infections, skin infections, surgical site infections (SSI) and urinary tract infections. After pooling the eight studies that compared mupirocin with placebo or with no treatment, there was a statistically significant reduction in the rate of S. aureus infection associated with intranasal mupirocin (RR 0.55, 95% CI 0.43 to 0.70).A planned subgroup analysis of surgical trials demonstrated a significant reduction in the rate of nosocomial S. aureus infection rate associated with mupirocin use (RR 0.55, 95% CI 0.34 to 0.89) however this effect disappeared if the analysis only included surgical site infections caused by S. aureus (RR 0.63, 95% CI 0.38 to 1.04), possibly due to a lack of power. The infection rate caused by micro-organisms other than S. aureus was significantly higher in patients treated with mupirocin compared with control patients (RR 1.38 95% CI 1.118 to 1.72).. In people who are nasal carriers of S. aureus, the use of mupirocin ointment results in a statistically significant reduction in S. aureus infections.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Humans; Mupirocin; Nose; Ointments; Randomized Controlled Trials as Topic; Staphylococcal Infections; Staphylococcus aureus

The 'Stichting Werkgroep Antibioticabeleid' (SWAB; Dutch Working Party on Antibiotics Policy) has developed evidence-based guidelines for the antimicrobial treatment of methicillin-resistant Staphylococcus aureus (MRSA) carriers for the eradication of MRSA. A distinction was made between uncomplicated and complicated carriage depending on the presence or absence of an active MRSA infection, skin lesions, foreign body material, mupirocin resistance and/or extranasal carriage. The indication for treatment is determined by the consequences of carriage for the carrier and his/her environment, the adverse events of treatment, and the likelihood of a successful treatment. The first choice of treatment in uncomplicated carriers is a combination of mupirocin nasal ointment and disinfectant soap for 5 days, along with hygiene advice. If treatment fails, sources in the vicinity of the patient must be sought. Complicated carriers receive a combination of 2 oral antibiotics, in addition to mupirocin nasal ointment and disinfectant soap, for at least 7 days.

Topics: Carrier State; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Hygiene; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Staphylococcal Infections; Treatment Outcome

Mupirocin is a natural antibiotic from Pseudomonas fluorescens which is available as a 2% ointment. The drug has been used mainly for topical treatment of the nasal vestibulum in patients carrying methicillin-resistant Staphylococcus aureus (MRSA). However, mupirocin is also active against methicillin-sensitive S. aureus. Nasal colonization with S. aureus has been identified as a significant risk factor for surgical site infection (SSI).. Randomized trials and sequential cohort studies investigating mupirocin nasal treatment for prophylaxis of SSI in elective surgery in comparison with placebo or no treatment were found by Medline review and additional manual search. Evaluable studies were analyzed regarding the influence of mupirocin on the rate of all SSIs and, specifically, of SSIs due to S. aureus. The effect in cardiosurgical patients was analyzed in detail.. Four randomized and seven sequential open cohort studies were analyzed. Study design and mupirocin application schemes varied considerably. Three out of 5 studies carried out in cardiac surgery patients showed a significant reduction in sternotomy site infections. However, all three studies were open sequential cohort studies. By contrast, the only prospective, randomized, double-blind study in cardiosurgical patients showed no benefit of mupirocin. In other surgical disciplines, results were inconclusive or negative. Two studies specifically addressing the prevention of SSIs due to MRSA showed a significant effect of mupirocin on postsurgical infections due to this organism.. Because of the heterogeneity of the studies and the variability of results, no recommendation can be given for the general use of mupirocin in elective surgical patients. Specifically, because of the negative result of a recently published high-quality study, no recommendation can be made for the use of mupirocin in cardiosurgical patients. By contrast, eradication of MRSA before surgery appears to lower SSI rates due to MRSA and is therefore recommended.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Clinical Trials as Topic; Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The majority of nosocomial Staphylococcus aureus infections originate from the patients' own flora, with nasal carriage of S. aureus before surgical procedures being a risk factor for subsequent infection. The objective of this review was to assess whether intranasal mupirocin treatment of nasal S. aureus carriers before surgery results in a reduction of the post-operative S. aureus infection rate.. CENTRAL, EMBASE and MEDLINE were searched for the keywords mupirocin, pseudomonic acid or bactroban, combined with nasal or intranasal. Only randomized controlled studies investigating surgical patients were included. Titles and abstracts were screened independently by two reviewers. S. aureus infection data in nasal carriers with and without mupirocin treatment were pooled in the meta-analysis.. The literature search resulted in 211 hits, of which 4 articles met the inclusion criteria. Among the 686 mupirocin-treated surgical patients with S. aureus nasal carriage, there were 25 S. aureus infections (3.6%), compared with 46 (6.7%) in the controls (RR 0.55, 95% CI 0.34-0.89; P = 0.02).. Prophylactic intranasal mupirocin significantly reduced the rate of post-operative S. aureus infections among surgical patients who were S. aureus carriers.

Topics: Administration, Intranasal; Antibiotic Prophylaxis; Carrier State; Humans; Mupirocin; Postoperative Complications; Randomized Controlled Trials as Topic; Staphylococcal Infections; Staphylococcus aureus

Multidrug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), are endemic in healthcare settings in the United States and many other countries of the world. Nosocomial transmission of MRSA serves as a source of hospital outbreaks, and recent reports of vancomycin-resistant S aureus strains in the United States emphasize the need for better control of MRSA and other resistant bacteria within healthcare settings. Colonization with S aureus or MRSA is relatively common in both healthy and hospitalized individuals, most often involves the anterior nares, and is frequently asymptomatic. Colonization increases risk of infection. Patient-to-patient transmission of MRSA within healthcare settings primarily occurs via carriage on the hands of healthcare workers. The Society for Healthcare Epidemiology of America (SHEA) has developed guidelines for the prevention of transmission of MRSA and vancomycin-resistant enterococci within healthcare settings, and chief among the recommendations is an emphasis on adherence to hand hygiene guidelines. Other measures that may prevent the nosocomial transmission of MRSA include improved antibiotic stewardship, staff cohorting, maintenance of appropriate staffing ratios, reductions in length of hospital stays, contact isolation, active microbiologic surveillance, and better staff education. Currently, the efficacy of many of these individual infection control interventions remain in doubt. Many studies reporting improvement in infection control outcomes (e.g., reduced transmission, decreasing prevalence) involve simultaneous institution of several of these measures, making it impossible to tease out the effects of any of the individual components. Nonetheless, the best approach in the current environment probably involves hand hygiene plus a careful assessment of an institution's particular circumstances, applying more aggressive procedures such as patient isolation, staff cohorting, and active surveillance cultures, as indicated.

Topics: Anti-Bacterial Agents; Cross Infection; Hand Disinfection; Humans; Length of Stay; Methicillin Resistance; Mupirocin; Nursing Staff, Hospital; Patient Isolation; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Carrier State; Hospitals; Humans; Methicillin Resistance; Mupirocin; Nose; Randomized Controlled Trials as Topic; Staphylococcal Infections; Staphylococcus aureus

To review the evidence evaluating perioperative intranasal mupirocin for the prevention of surgical-site infections according to type of surgical procedure.. Systematic review and meta-analysis of published clinical trials.. Studies included were either randomized clinical trial or prospective trials at a single institution that measured outcomes both before and after an institution-wide intervention (before-after trial). In all studies, intervention and control groups differed only by the use of perioperative intranasal mupirocin in the intervention group.. Patients undergoing general or nongeneral surgery (eg, cardiothoracic surgery, orthopedic surgery, and neurosurgery).. Risk of surgical-site infection following perioperative intranasal mupirocin versus usual care.. Three randomized and four before-after trials met the inclusion criteria. No reduction in surgical-site infection rate was seen in randomized general surgery trials (summary estimates: 8.4% in the mupirocin group and 8.1% in the control group; relative risk [RR], 1.04; 95% confidence interval [CI95], 0.81 to 1.33). In nongeneral surgery, the use of mupirocin was associated with a reduction in surgical-site infection in randomized trials (summary estimates: 6.0% in the mupirocin group and 7.6% in the control group; RR, 0.80; CI95, 0.58 to 1.10) and in before-after trials (summary estimates: 1.7% in the mupirocin group and 4.1% in the control group; RR, 0.40; CI95, 0.29 to 0.56).. Perioperative intranasal mupirocin appears to decrease the incidence of surgical-site infection when used as prophylaxis in nongeneral surgery. Given its low risk and low cost, use of perioperative intranasal mupirocin should be considered in these settings.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Humans; Mupirocin; Perioperative Care; Staphylococcal Infections; Surgical Wound Infection

Although there is extensive literature on the control of MRSA, when that concerning epidemics is excluded, only a limited amount remains regarding the control of endemic MRSA. Several guidelines have been recently published recommending stringent control measures, which are often suggested based on their success in controlling MRSA outbreaks in hospitals with few MRSA or in containing MRSA cases introduced into a hospital with no MRSA. In these settings, multiple measures are usually introduced with apparently successful results. However, results may not be generalizable to other settings and we do not know the minimum effective measures required for MRSA containment. This paper aims critically to review the literature to determine whether evidence exists for the value of the infection control measures that are widely recommended in the endemic setting. Much of this literature is based on observational studies, with few randomized, controlled trials having been conducted. More well-designed studies are required before many of the principles on which we build infection control programmes can be regarded as evidence based.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Endemic Diseases; Humans; Infection Control; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

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

For the prevention of perioperative nosocomial infection, 1) topical mupirocin treatment, 2) tight perioperative glycemic control and 3) immunonutrition are described. A large, prospective, randomized trial showed that the nasal application of mupirocin may effectively reduce postoperative Staphylococcus aureus nosocomial infection in the subgroup of patients who had S. aureus in their nares. Tight glycemic control after surgery, especially in the early period after operation, may also be effective in decreasing postoperative infection. In septic ICU patients, strict glycemic control even reduces ICU and hospital mortality rates. Several specific nutritional substrates such as arginine, omega-3 fatty acids, glutamine, and RNA have been shown to modulate host immune function. Some enteral formulas enriched with such immunonutrients have been commercially available in the USA and in Europe and are now available in Japan. Recent meta-analyses of randomized, controlled trials have shown that the administration of these formulas to elective surgical patients results in a significant reduction in the risk of developing infectious complications by approximately 50% and shortens the overall hospital stay.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Arginine; Cross Infection; Enteral Nutrition; Fatty Acids, Omega-3; Glutamine; Humans; Hypoglycemic Agents; Immunocompromised Host; Meta-Analysis as Topic; Methicillin Resistance; Mupirocin; Perioperative Care; Randomized Controlled Trials as Topic; RNA; Staphylococcal Infections; Staphylococcus aureus

Postoperative nosocomial infections are associated with increased cost, hospitalization, and morbidity. S. aureus is the most common organism that contributes to postoperative nosocomial infections, and causes up to 25% of these infections. The role of the nose as a reservoir for S. aureus and possible subsequent endogenous infections has been recognized for approximately 40 years. Elimination of nasal carriage of S. aureus may be another intervention aimed at reducing postoperative infections. Mupirocin, a topical antibiotic effective against Gram-positive organisms, was proved to be effective in reducing the rates of nasal colonization of S. aureus and decreased postoperative nosocomial infections due to S. aureus.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Female; Follow-Up Studies; Humans; Male; Mupirocin; Nasal Mucosa; Postoperative Complications; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

Most Staphylococcus aureus infections are endogenously acquired, and treatment of nasal carriage is one potential strategy for prevention. We critically appraised the published evidence regarding the efficacy of intranasal mupirocin for eradication of S. aureus nasal carriage and for prophylaxis of infection. Sixteen randomized, controlled trials were appraised; 9 trials assessed eradication of colonization as a primary outcome measure, and 7 assessed the reduction in the rate of infection. Mupirocin was generally highly effective for eradication of nasal carriage in the short term. Prophylactic treatment of patients with intranasal mupirocin in large trials did not lead to a significant reduction in the overall rate of infections. However, subgroup analyses and several small studies revealed lower rates of S. aureus infection among selected populations of patients with nasal carriage treated with mupirocin. Although mupirocin is effective at reducing nasal carriage, routine use of topical intranasal mupirocin for infection prophylaxis is not supported by the currently available evidence.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Clinical Trials as Topic; Health Occupations; HIV Infections; Humans; Intensive Care Units; Mupirocin; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Health care-related infections cause significant patient morbidity and mortality rates and add excess costs that frequently are not reimbursed. Staphylococcus aureus has long been recognized as an important pathogen in human disease and is the most common cause of nosocomial infections.. The objective of this review of the English language literature and a MEDLINE search was to describe recent advances in the prevention of S aureus health care-related infections that are attributable to patients' endogenous colonization. The ecologic niche of S aureus is the anterior nares and nasal carriage increases the risk of the development of a surgical-site, lower respiratory tract, or bloodstream infection. S aureus carriers have a 2- to 9-fold increased risk of the development of a surgical-site or intravenous catheter infection.. Three treatment strategies may eliminate nasal carriage: locally applied antibiotics or disinfectants, systemic antibiotics, and bacterial interference. Among these strategies, locally applied or systemic antibiotics are used most commonly. Nasal ointments or sprays and oral antibiotics have variable efficacy, and their use frequently results in antimicrobial resistance among S aureus strains. Of the commonly used agents, mupirocin (pseudomonic acid) ointment has been shown to be 97% effective in reducing S aureus nasal carriage. In a recently published randomized, double-blind, placebo-controlled trial to determine whether intranasal mupirocin reduced the rate of S aureus-infected surgical-site and other S aureus health care-related infections; 4% of S aureus nasal carriers who received mupirocin acquired S aureus health care-related infections compared with 7.7% of S aureus nasal carriers who received placebo (P=.02). The S aureus surgical-site infection rate was not reduced significantly, but carriers who received mupirocin before cardiothoracic or general surgery operations had almost 50% fewer S aureus surgical-site infections than carriers who received placebo. In this setting resistance rarely has been reported.. Given the importance of S aureus nosocomial infections and the increased risk of S aureus nasal carriage in patients with health care-related infections, investigators must study cost-effective strategies to further prevent certain types of health care-related infections or nosocomial infections that occur in specific settings. One potential strategy is to decrease or eliminate S aureus nasal carriage among certain patient populations or in certain healthcare settings.

Topics: Carrier State; Cost-Benefit Analysis; Cross Infection; Drug Resistance, Bacterial; Humans; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

A systematic review of the English-language literature was performed to determine the overall benefit of mupirocin therapy in reducing the rate of Staphylococcus aureus infection among patients undergoing hemodialysis (HD) or peritoneal dialysis (PD). Included studies met the following criteria: they were randomized clinical trials or cohort studies; cohorts consisted of adults (age, > or =18 years) requiring HD or PD; mupirocin therapy was administered to the treatment group, and placebo or no therapy was administered to the control group; and the primary outcome of interest was the difference in the number of S. aureus infections among mupirocin-treated and -untreated patients. Ten studies described in 9 articles were analyzed. A total of 2445 patients were included in the analysis. Use of mupirocin reduced the rate of S. aureus infections by 68% (95% confidence interval [CI], 57%-76%) among all patients undergoing dialysis; risk reductions were 80% (95% CI, 65%-89%) among patients undergoing HD and 63% (95% CI, 50%-73%) among patients undergoing PD. When data were stratified by type of infection, S. aureus bacteremia was found to be reduced by 78% among patients undergoing HD, and peritonitis and exit-site infections were found to be reduced by 66% and 62%, respectively, among patients undergoing PD. Mupirocin prophylaxis substantially reduces the rate of S. aureus infection in the dialysis population. Optimal regimens that minimize the emergence of mupirocin resistance need to be explored.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Mupirocin; Peritoneal Dialysis; Randomized Controlled Trials as Topic; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Humans; Kidney Diseases; Mupirocin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

This article aims to review what is currently known of the host and bacterial factors determining S. aureus nasal carriage, including recent developments and future prospects.

Topics: Animals; Anti-Bacterial Agents; Carrier State; Disease Reservoirs; Forecasting; Global Health; Humans; Methicillin Resistance; Mupirocin; Nasal Mucosa; Population Surveillance; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Vancomycin Resistance

Methicillin-resistant Staphylococcus aureus (MRSA) infections continue to cause serious nosocomial infections in many hospitals. Measures used to control the spread of these infections include ongoing laboratory-based surveillance, placing colonized and infected patients in isolation, use of barrier precautions and handwashing and hand antisepsis. Culturing hospitalized patients at high risk of acquiring MRSA can facilitate detection and isolation of colonized patients. Eradicating MRSA nasal colonization among affected patients and healthcare personnel has also been as a control measure, with variable success. Eradicating MRSA nasal carriage from epidemiologically-implicated healthcare workers has been used on a number of occasions to control outbreaks. Attempts to eradicate MRSA colonization among affected patients has proven difficult. Of more than 40 different decolonization regimens that have been tested during the last 60 years, topical intranasal application of mupirocin ointment has proven to be the most effective. However, intranasal application of mupirocin has limited effectiveness in eradicating colonization in patients who carry the organism at multiple body sites. Furthermore, because decolonization of patients has virtually always been used in combination with other control measures, its efficacy has been difficult to determine. Because MRSA is transmitted primarily on the hands of healthcare workers, greater emphasis should be given to improving hand hygiene practices among health personnel. For patients infected with MRSA, vancomycin remains a drug of choice.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Cross Infection; Disease Outbreaks; Hand Disinfection; Health Personnel; Humans; Infection Control; Mass Screening; Methicillin Resistance; Mupirocin; Occupational Diseases; Ointments; Patient Isolation; Population Surveillance; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Catheter-related infections remain a serious problem for patients on peritoneal dialysis. Such infections can be reduced by careful patient selection and training, by the use of the best connection technology and screening and treating nasal carriage. To date, treatment is less than optimal and therefore, the primary goal should be prevention of catheter-related infections. Prevention is based on improving catheter design and implantation technique, while providing careful exit-site care. Regardless of how it is implemented, we must aggressively pursue the prevention of catheter-related infections by eradicating S. aureus exit-site carriage in PD patients. Based on its effectiveness in adult PD patients, its low rate of adverse effects, and its reasonable cost-effectiveness, application of mupirocin ointment at the exit-site is the current method of choice for preventing PD catheter infections caused by S. aureus. In addition to reducing S. aureus exit-site infections, mupirocin seems to reduce the rates of staphylococcal peritonitis and PD catheter loss. Whether the ointment should be applied in the nares, to the exit-site or both, and whether it should be used only in staphylococcal nasal carriers or all PD patients requires further study.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Catheters, Indwelling; Equipment Design; Humans; Infections; Mupirocin; Peritoneal Dialysis, Continuous Ambulatory; Primary Prevention; Randomized Controlled Trials as Topic; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

20% of the normal population are nasal carriers of Staphylococcus aureus (Sa), and the carrier rate is even higher in insulin dependent diabetics, intravenous drug addicts, patients on haemo- and peritoneal dialysis, and HIV infected patients. Nasal Sa carriers have an increased risk of Sa infections following invasive therapy. Mupirocin, a novel topical antibiotic, is highly effective against nasal Sa. A number of studies indicate that it may reduce the incidence of Sa infections in dialysis patients, however experience with other categories of patients is sparse. Surgical wound infection with Sa is a particularly serious complication after implantation of foreign body material, e.g. artificial joints. There is a need for controlled clinical trials to test the efficacy of mupirocin in eradicating Sa in these types of patients. Uncritical use of mupirocin for topical treatment of wounds should be avoided in order to prevent development of resistance.

Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Carrier State; Cross Infection; Denmark; Humans; Immunocompromised Host; Mupirocin; Nasal Mucosa; Renal Dialysis; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Mupirocin was introduced into clinical practice in the UK in 1985, and has proved to be an extremely effective treatment of skin infections and one of the most successful topical antibiotics for the clearance of nasal Staphylococcus aureus isolates including those resistant to methicillin. It is currently registered for use in more than 90 countries worldwide. Unfortunately resistance was described shortly after its initial use. Many of the issues regarding its use are reviewed here, together with the mechanisms, genetics, surveillance and epidemiology of resistance, particularly in staphylococci. The various factors that increase resistance and how they might be controlled are also discussed.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Drug Utilization; Humans; Methicillin Resistance; Mupirocin; Practice Patterns, Physicians'; Skin Diseases; Staphylococcal Infections; Staphylococcus aureus

For the last fifty years, the nose has been intermittently recognized and targeted as a source of Staphylococcus aureus causing surgical site infection. In London in 1959, Williams and co-workers established for the first time that nasal carriers had increased rates of surgical sepsis compared with non-carriers. For half of these patients, the source was the patient's own nose. Post-admission acquisition of tetracycline-resistant strains was associated with even higher rates of infection. The increasing appearance of epidemic methicillin-resistant S. aureus (MRSA) in the 1980s rekindled interest in these (largely overlooked) studies, when the elimination of nasal carriage by topical mupirocin proved pivotal for the control of MRSA in Northern Europe and elsewhere. In the late 1980s and 1990s, Boelaert, Holton and others, appreciating the work performed forty years previously, used nasal mupirocin for the successful prevention of sepsis with S. aureus in patients on haemodialysis and continuous ambulatory peritoneal dialysis without incurring problems with mupirocin resistance. In 1995, Kluytmans and colleagues demonstrated that nasal carriage of S. aureus is a significant risk factor for wound infection after cardiac surgery. Towards the year 2000, the use of prophylactic nasal mupirocin for the prevention of serious sepsis in major clean surgery is emerging as a plausible and exciting new strategy.

Topics: Anti-Bacterial Agents; Carrier State; Humans; Methicillin Resistance; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Numerous studies conducted in different countries and in different populations of patients on dialysis have consistently documented that a large proportion of such patients carry Staphylococcus aureus in their nares and that the risk of them becoming infected with their own strains is quite high. Furthermore, S. aureus infections can cause considerable morbidity and mortality in these patients. Thus, decolonization of the nares may prevent S. aureus infections and the attendant complications. The published data that support the use of rifampicin, intranasal mupirocin and povidone-iodine to prevent S. aureus infections in patients on dialysis are reviewed in detail.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Cost-Benefit Analysis; Humans; Mupirocin; Nose; Peritoneal Dialysis, Continuous Ambulatory; Povidone-Iodine; Renal Dialysis; Rifampin; Staphylococcal Infections; Staphylococcus aureus

In cardiothoracic surgery, the costs of surgical-site infection (SSI) arise from additional postoperative procedures (approximately US $5000 per patient) and prolonged hospital stay (approximately $11,500 per patient). Application of nasal mupirocin reduced SSIs by 63% compared with historical controls. This would have resulted in savings provided that the attributable cost of an SSI was more than $245. Mupirocin was estimated to reduce the risk of bacteraemia in haemodialysis patients by 84% compared with historical controls. A model using data on Medicare payments for haemodialysis admissions was used to estimate the impact on hospital costs. The conclusion was that mupirocin would have been cost-saving but the model did not provide sufficient detail about hospital costing to allow assessment of its relevance in other settings. In a prospective, randomized, placebo-controlled trial in continuous ambulatory peritoneal dialysis (CAPD) patients, mupirocin reduced the risk of staphylococcal exit-site infection (ESI) from 0.42 to 0.14 per patient-year. However, as in a previous comparison with historical controls, there was an increase in the rates of ESIs caused by Gram-negative bacteria in patients who received mupirocin, bringing the rate of total ESIs up to that observed in the placebo group. There was some evidence that infections caused by Gram-negative bacteria had less severe consequences than staphylococcal infections. It is concluded that application of nasal mupirocin to nasal carriers of Staphylococcus aureus may be cost-saving in patients undergoing cardiac surgery or haemodialysis but, if the analysis is restricted to the cost of management of ESIs, it may not be cost-saving in CAPD. However, reducing the risk of staphylococcal ESI may reduce the risk of catheter loss and subsequent transfer to haemodialysis and this merits further study.

Topics: Anti-Bacterial Agents; Carrier State; Cost-Benefit Analysis; Humans; Mupirocin; Nose; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Thoracic Surgical Procedures

Nasal mupirocin has an important role to play in the prevention of Staphylococcus aureus infection by eliminating nasal carriage of this organism. Indeed, in many countries nasal mupirocin is one of the mainstays for controlling outbreaks of methicillin-resistant S. aureus. Eradication of nasal S. aureus with mupirocin has been shown to be effective in preventing postoperative infections in patients undergoing cardiothoracic surgery and in preventing exit-site infections in patients undergoing haemodialysis. It has been proposed that the use of mupirocin should be extended to other situations, such as the prevention of postoperative infections in patients undergoing implant surgery and the prevention of bacteraemias in high-risk patients. Clinical trials are needed to establish the efficacy of mupirocin in these situations. Both low-level and high-level resistance have been reported during treatment with nasal mupirocin. Low-level resistance does not represent a significant clinical problem but high-level resistance resulting from indiscriminate use may give grounds for concern. Further review of these issues is required. As with any antibiotic, mupirocin should be used judiciously, as part of an integrated programme of infection control.

Topics: Anti-Bacterial Agents; Bacteremia; Drug Resistance, Microbial; Humans; Methicillin Resistance; Mupirocin; Nose; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Mupirocin has become the topical agent of choice for the elimination of methicillin-resistant Staphylococcus aureus (MRSA) carriage. The increased use of this antibiotic has been followed by reports of outbreaks due to MRSA with both low- and high-level resistance. Whilst low-level resistance is becoming more widespread, it is unlikely to have a major impact upon current practice. High-level resistance is plasmid borne, and although uncommon, can lead to problems with elimination especially in an outbreak situation. Alternatives are available but uncertainty exists as to their efficacy and safety. Any strategy to limit the increase of mupirocin resistance in MRSA should emphasize the importance of controlled antibiotic use both for mupirocin and other agents.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Drug Resistance, Microbial; Drug Utilization; Humans; Infection Control; Methicillin Resistance; Mupirocin; R Factors; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; United Kingdom

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of mupirocin are reviewed. Mupirocin is a naturally occurring antibiotic produced by submerged fermentation of Pseudomonas fluorescens. It inhibits bacterial protein synthesis by binding reversibly and specifically to isoleucyl-tRNA synthetase. Organisms resistant to other antimicrobials are not simultaneously resistant to mupirocin. Mupirocin is highly active against Staphylococcus aureus and other staphylococci and streptococci. When mupirocin ointment is applied topically, local concentrations exceed the inhibitory concentrations for staphylococci and remain detectable for up to 72 hours. Placebo-controlled studies demonstrate the ability of mupirocin to eliminate nasal carriage of S. aureus in health care workers. Observational studies suggest that mupirocin is efficacious in treating methicillin-resistant S. aureus (MRSA) outbreaks. Preliminary studies show that mupirocin might have a role in preventing infections in high-risk patients. Although mupirocin seems to be well tolerated, mild to moderate adverse events have been reported, including respiratory problems and effects confined to the nose--erythema, swelling, burning or stinging, pruritus, and dryness. Mupirocin calcium ointment has FDA-approved labeling for the eradication of nasal MRSA colonization in adult patients and health care workers as part of comprehensive infection-control programs to reduce the risk of infection during institutional outbreaks. The recommended dosage is 0.5 g inserted into each nostril twice daily for five days. Intranasal mupirocin ointment appears to be a useful addition to infection-control programs designed to reduce the risk of infection among patients during MRSA outbreaks.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Cross Infection; Humans; Infection Control; Methicillin Resistance; Mupirocin; Rhinitis; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Humans; Infection Control; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus infections are associated with considerable morbidity and, in certain situations, mortality. The association between the nasal carriage of S. aureus and subsequent infection has been comprehensively established in a variety of clinical settings, in particular, patients undergoing haemodialysis and continuous ambulatory peritoneal dialysis (CAPD), and in patients undergoing surgery. Postoperative wound infections are associated with a high degree of morbidity and represent an important medical issue. Until recently, eradication of S. aureus nasal carriage by various topical and systemic agents had proved unsuccessful. Mupirocin is a novel topical antibiotic with excellent antibacterial activity against staphylococci. Recent studies have demonstrated that intranasal administration of mupirocin is effective in eradicating the nasal carriage of S. aureus and in reducing the incidence of S. aureus infections in haemodialysis and CAPD patients. It has been suggested that sufficient evidence now exists to test the hypothesis that eradication of the carrier state in surgical patients preoperatively may reduce the incidence of S. aureus postoperative wound infections.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Humans; Incidence; Infection Control; Mupirocin; Nose; Peritoneal Dialysis, Continuous Ambulatory; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The antistaphylococcal activity of topical mupirocin has made it an attractive agent for the treatment of asymptomatic colonization with Staphylococcus aureus. Increasing use has been associated with the emergence of mupirocin resistance in staphyloccoci, and failure of therapy has been associated with the isolation of strains exhibiting high-level resistance (MIC > 500 micrograms/mL). Fortunately, low-level mupirocin resistance (MIC < 100 micrograms/mL) occurs most commonly. Because a novel gene encoding for mupirocin resistance resides in both low-level and high-level resistant strains, the emergence of low-level mupirocin resistance may not be as epidemiologically insignificant as previously thought.

Topics: Bacterial Typing Techniques; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Mupirocin; Mutation; Staphylococcal Infections; Staphylococcus aureus

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) varies in different European countries, in different cities in the same country or even within a city or a hospital. It is thought that the overall incidence of MRSA is higher than ever before, although the reasons for this are unclear. MRSA typing can identify epidemic MRSA in many countries. The spread of a closely related clone is Northern Europe is a cause for concern, as it is resistant to many agents. In the UK, control measures are threatened by changing patterns of health care and patient demography. Resistance to mupirocin, a valuable agent in the control of MRSA, has emerged in many hospitals in the UK, thus the agent must be used judiciously.

Topics: Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus is isolated from 42% of the bacteraemic episodes occurring in haemodialysis patients. Several epidemiological studies indicate that nasal carriage of S. aureus is of pivotal importance in determining the risk of subsequent infections by this micro-organism in haemodialysis patients. First, nasal carriage is prevalent in about 42% of these patients, this high rate being observed from the onset of maintenance dialysis therapy. Second, there is a significant relationship between nasal and hand carriage of the organisms. Third, there is usually a similarity between infecting S. aureus strains and those isolated from nasal surveillance cultures obtained from the same patient. The nares are therefore an elective site for the prevention of S. aureus infections in haemodialysis patients; this was shown with oral rifampin. The studies demonstrating the effectiveness of nasal mupirocin for this indication are summarised. The need for continued chemosuppression with maintenance application (e.g. once per week) is underscored. Such a long-term application of nasal mupirocin in haemodialysis patients with nasal carriage is very cost-effective and is only very rarely associated with the emergence of mupirocin resistance in S. aureus.

Topics: Administration, Intranasal; Carrier State; Female; Humans; Male; Mupirocin; Nasal Mucosa; Renal Dialysis; Staphylococcal Infections

Nasal carriage by health care workers represents an important hospital reservoir of Staphylococcus aureus. Approximately 25% of all hospital-based healthcare workers are stable nasal carriers. Several studies in the US and UK have shown that following treatment of this group with a single 5-day course of intranasal mupirocin, nasal carriage was usually eradicated within 24 hours, and after 12 weeks was only present in 25% of participants. Long-term follow-up in one institution after 52 weeks showed that there were significantly fewer carriers in the mupirocin group than in the group receiving identical placebo. In the same study, between 30% and 50% of those hospital workers who carried S. aureus in their nose, before the start of therapy, were also hand carriers. After treatment, a dramatic reduction in hand carriage of S. aureus was noted, in contrast to no change in the placebo group. After 6 months, the level of hand carriage was still statistically lower in the mupirocin group than in those given placebo. The association between nasal carriage and hand carriage makes it important that health care workers decontaminate their hands effectively between patients. Current evidence suggests, however, that compliance with such control measures is low. Other studies examining the role of S. aureus nasal carriage in the development of post-operative wound infection, have shown that almost half of those isolates recovered from the wound site were present in the nose of the patient pre-operatively. Due to its ability to eliminate nasal carriage of S. aureus, current studies are investigating whether intranasal mupirocin can prevent post-operative wound infections in patients undergoing surgery.

Topics: Cross Infection; Hand; Health Personnel; Humans; Incidence; Methicillin Resistance; Mupirocin; Nose; Staphylococcal Infections; Surgical Wound Infection; United States

Staphylococcal infections remain an important cause of morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) present a particular problem because of the costs of treatment and containing outbreaks. The role of nasal carriage of staphylococci in the epidemiology of staphylococcal infection has been recognized for over 30 years. Until recently, eradication of nasal carriage of S. aureus has proved difficult, with a variety of topical and systemic agents yielding poor results with either little discernible effect on nasal carriage or rapid recolonization. Mupirocin is a novel topical antibiotic with excellent antibacterial activity against staphylococci, including MRSA. Intranasal administration of calcium mupirocin has achieved excellent results in the eradication of nasal carriage of S. aureus and producing an associated reduction in S. aureus infection in a variety of clinical settings, including MRSA outbreaks, neonatal nurseries, haemodialysis, cardiothoracic surgery and familial staphylococcal infections. This article reviews the efficacy and safety of intranasal mupirocin in the prevention of staphylococcal infections.

Topics: Administration, Intranasal; Carrier State; Humans; Methicillin Resistance; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus is the pathogen most often isolated from blood during bacteraemic episodes in haemodialysis patients (42%). The pathophysiology of these infections is discussed and a prophylactic strategy is proposed. Nasal carriage of S. aureus, found in 42% of haemodialysis patients, plays a major role in its cutaneous dissemination and hence in the risk of infection by this microorganism. Long-term use of nasal mupirocin in haemodialysis patients with nasal carriage of S. aureus (t.i.d. for 3 to 5 days, followed by once a week) led to a decrease in the yearly incidence of S. aureus bacteraemia from 0.097 to 0.024 (p < 0.01). Tolerance was excellent. This chemoprophylaxis results in substantial savings. When applied as proposed (only nasal application), the long-term use of mupirocin only very rarely leads to the emergence of mupirocin-resistance in S. aureus (1 case in 165 patient-years).

Topics: Arteriovenous Shunt, Surgical; Carrier State; Catheterization, Central Venous; Catheters, Indwelling; Humans; Incidence; Mupirocin; Nasal Cavity; Renal Dialysis; Sepsis; Skin; Staphylococcal Infections; Staphylococcus aureus

This review summarizes the natural history, clinical relevance and basis of control of Staphylococcus aureus infection in UK hospitals, stressing the central role of asymptomatic carriage by patients and staff in persistence of this prolific and versatile nosocomial pathogen. The clinical relevance of methicillin-resistant and methicillin-sensitive S. aureus (MRSA and MSSA) is considered in terms of prevalence and spectrum of invasive and toxigenic infections produced, correlated with host and parasite risk factors. An assessment is made of arguments why the acquisition of methicillin-resistance or multiple antibiotic resistance might justify more than conventional methods of containment and how the control policy is influenced by the expression of enhanced virulence and epidemicity. Guidelines for control of epidemic MRSA (EMRSA) are discussed with reference to justification, feasibility and efficacy. As elimination of carriage is crucial to the success of any rational control policy the relative merits of topical antibiotics and antiseptic agents are compared. The bacterial efficacy of povidone-iodine, chlorhexidine and mupirocin are evaluated as a basis for eradication of MRSA.

Topics: Carrier State; Chlorhexidine; Cross Infection; Humans; Methicillin Resistance; Mupirocin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Erythromycin; Humans; Impetigo; Mupirocin; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes

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

Topics: Administration, Intranasal; Carrier State; Humans; Mupirocin; Nasal Cavity; Ointments; Staphylococcal Infections

The CLEAR Trial demonstrated that a multisite body decolonization regimen reduced post-discharge infection and hospitalization in methicillin-resistant Staphylococcus aureus (MRSA) carriers. Here, we describe decolonization efficacy.. We performed a large, multicenter, randomized clinical trial of MRSA decolonization among adult patients after hospital discharge with MRSA infection or colonization. Participants were randomized 1:1 to either MRSA prevention education or education plus decolonization with topical chlorhexidine, oral chlorhexidine, and nasal mupirocin. Participants were swabbed in the nares, throat, axilla/groin, and wound (if applicable) at baseline and 1, 3, 6, and 9 months after randomization. The primary outcomes of this study are follow-up colonization differences between groups.. Among 2121 participants, 1058 were randomized to decolonization. By 1 month, MRSA colonization was lower in the decolonization group compared with the education-only group (odds ration [OR] = 0.44; 95% confidence interval [CI], .36-.54; P ≤ .001). A similar magnitude of reduction was seen in the nares (OR = 0.34; 95% CI, .27-.42; P < .001), throat (OR = 0.55; 95% CI, .42-.73; P < .001), and axilla/groin (OR = 0.57; 95% CI, .43-.75; P < .001). These differences persisted through month 9 except at the wound site, which had a relatively small sample size. Higher regimen adherence was associated with lower MRSA colonization (P ≤ .01).. In a randomized, clinical trial, a repeated post-discharge decolonization regimen for MRSA carriers reduced MRSA colonization overall and at multiple body sites. Higher treatment adherence was associated with greater reductions in MRSA colonization.

Topics: Adult; Aftercare; Anti-Bacterial Agents; Carrier State; Chlorhexidine; Drug Resistance, Microbial; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Patient Discharge; Staphylococcal Infections

Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of S aureus.. Randomized controlled pilot study.. 34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus.. Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660nm, 400mW/cm. Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized.. All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P=0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group.. Testing was restricted to assessing nasal colonization; infectious complications were not assessed.. Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin.. Government grant (National Council for Scientific and Technological Development process 3146682020-9).. Registered at ClinicalTrials.gov with study number NCT04047914.

Topics: Anti-Bacterial Agents; Humans; Mupirocin; Photochemotherapy; Pilot Projects; Proteomics; Renal Dialysis; Staphylococcal Infections

Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization.. To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing.. Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included.. Universal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline).. ICU-attributable S aureus clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%.. Among the 801 668 admissions in 233 ICUs, the participants' mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P < .001). For MRSA clinical cultures, HRs were 1.13 for iodophor-CHG (raw rate: 2.3 vs 2.1/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 2.0 vs 2.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 14.1% [95% CI, 3.7%-25.5%] for mupirocin-CHG, P = .007). For all-pathogen bloodstream infections, HRs were 1.00 (2.7 vs 2.7/1000) for iodophor-CHG and 1.01 (2.6 vs 2.6/1000) for mupirocin-CHG (nonsignificant HR difference in differences, -0.9% [95% CI, -9.0% to 8.0%]; P = .84). Compared with the 2009-2011 trial, the 30-day relative reduction in hazards in the mupirocin-CHG group relative to no decolonization (2009-2011 trial) were as follows: S aureus clinical cultures (current trial: 48.1% [95% CI, 35.6%-60.1%]; 2009-2011 trial: 58.8% [95% CI, 47.5%-70.7%]) and bloodstream infection rates (current trial: 70.4% [95% CI, 62.9%-77.8%]; 2009-2011 trial: 60.1% [95% CI, 49.1%-70.7%]).. Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin.. ClinicalTrials.gov Identifier: NCT03140423.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Baths; Chlorhexidine; Cross Infection; Female; Humans; Intensive Care Units; Iodophors; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Pragmatic Clinical Trials as Topic; Sepsis; Staphylococcal Infections; Staphylococcus aureus; United States

To prevent transmission of, and infection with, meticillin-resistant Staphylococcus aureus (MRSA), eradication treatment of colonized individuals is recommended. Throat colonization is a well-known risk factor for eradication failure. Staphylococcus aureus throat colonization is associated with colonization of the rhinopharynx, but in the currently recommended Danish MRSA eradication strategies, rhinopharynx colonization is not directly targeted. Rhinopharynx colonization could therefore be an important risk factor for prolonged MRSA throat carriage.. To determine whether irrigation and wash of the rhinopharynx and mouth with dissolved mupirocin is a feasible and potentially efficacious supplementary strategy against treatment-resistant MRSA throat carriage.. The patient study was an open, non-blinded, trial including 20 treatment-resistant MRSA throat carriers. In the study, the patients received a supplementary treatment besides the standard treatment according to the Danish MRSA eradication strategy. The supplementary treatment consisted of rhinopharyngeal irrigation and mouth-gurgling twice a day for 14 days with a mupirocin ointment (22 g 2% ointment per litre of isotonic sterile saline solution) in a 37°C solution.. Eighteen patients (90%) complied with the treatment protocol and none ex-perienced any major adverse events. Out of the 18 patients who finished the study per protocol, 15 (83%) and seven (39%) patients had negative MRSA sampling results one and six months after end of treatment, respectively.. This study demonstrates the feasibility and clinical potential of also targeting the rhinopharynx and oropharynx in non-systemic throat MRSA eradication strategies.

Topics: Anti-Bacterial Agents; Carrier State; Humans; Methicillin-Resistant Staphylococcus aureus; Mouthwashes; Mupirocin; Nasopharynx; Pharynx; Proof of Concept Study; Staphylococcal Infections

Methicillin-resistant

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

Staphylococcus aureus is a frequent colonizer of the human skin and mucous membranes but can also cause a variety of serious infections. Antimicrobial resistance is an increasing worldwide challenge and is mainly driven by an overuse of antimicrobials. To avoid the spread of methicillin-resistant Staphylococcus aureus (MRSA) in Denmark, the Danish Health Authority recommends decolonization treatment of MRSA carriers and their household contacts. Standard decolonization treatment includes chlorhexidine body wash and mupirocin nasal ointment, especially throat carriage is difficult to treat. The broad-spectrum antibiotic, clindamycin, is often added to the decolonization treatment, but there is currently low scientific evidence for this treatment.. To investigate whether the addition of clindamycin to the standard decolonization treatment increases decolonization success in MRSA throat carriers.. A randomized, placebo-controlled, double-blinded trial, including patients ≥ 18 years, who tested MRSA positive in the throat after completing one standard decolonization treatment. All carriers included in the trial receive standard decolonization treatment and are randomized to treatment with either placebo or clindamycin capsules for 10 days. We plan to include 40 participants in each of the two treatment arms.. Due to the lack of consistent scientific evidence of clindamycin's effect in MRSA decolonization and the worldwide urgent need to reduce the use of antibiotics, we judged that a 30% increase in the decolonization success rate in carriers treated with clindamycin is appropriate to justify prescribing clindamycin as part of the decolonization treatment of asymptomatic MRSA carriers.. EudraCT number 2019-002631-29.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Clindamycin; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Pharynx; Staphylococcal Infections

A household approach to decolonization decreases skin and soft tissue infection (SSTI) incidence, though this is burdensome and costly. As prior SSTI increases risk for SSTI, we hypothesized that the effectiveness of decolonization measures to prevent SSTI when targeted to household members with prior year SSTI would be noninferior to decolonizing all household members.. Upon completion of our 12-month observational Household Observation of Methicillin-resistant Staphylococcus aureus in the Environment (HOME) study, 102 households were enrolled in HOME2, a 12-month, randomized noninferiority trial. Pediatric index patients with community-associated methicillin-resistant Staphylococcus aureus (MRSA) SSTI, their household contacts, and pets were enrolled. Households were randomized 1:1 to the personalized (decolonization performed only by household members who experienced SSTI during the HOME study) or household (decolonization performed by all household members) approaches. The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily bleach-water baths. At 5 follow-up visits in participants' homes, swabs to detect S. aureus were collected from participants, environmental surfaces, and pets; incident SSTIs were ascertained.. Noninferiority of the personalized approach was established for the primary outcome 3-month cumulative SSTI: 23 of 212 (10.8%) participants reported SSTI in household approach households, while 23 of 236 (9.7%) participants reported SSTI in personalized approach households (difference in proportions, -1.1% [95% confidence interval, -6.7% to 4.5%]). In multivariable analyses, prior year SSTI and baseline MRSA colonization were associated with cumulative SSTI.. The personalized approach was noninferior to the household approach in preventing SSTI. Future studies should interrogate longer durations of decolonization and/or decontamination of the household environment to reduce household MRSA burden.. NCT01814371.

Topics: Anti-Bacterial Agents; Child; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

Preoperative decolonization, especially of Staphylococcus aureus carriers, has been proposed to reduce periprosthetic joint infections (PJI), but the evidence-based consensus is still lacking and data on long-term outcomes is scarce. In a previous randomized, single-blinded trial, decolonization produced no significant reduction of surgical site infections in overall elective orthopedic surgery at 3-month follow-up. A 2-year follow-up was then performed to specifically detect the impact of decolonization on delayed-onset PJI (3-24 months after surgery). Between November 2015 and September 2017, 613 of 1318 recruited patients underwent prosthetic surgery. Individuals were allocated into either the S. aureus carrier group (34%, 207 of 613 patients) or the noncarrier group (406 of 613 patients), according to nasal swab screening results. Both groups were then randomized into intervention and control arms. In the S. aureus group, the intervention consisted of daily chlorhexidine showers and application of mupirocin nasal ointment twice a day for 5 days before surgery. In noncarriers, only chlorhexidine showers were prescribed. Sample size calculation was based on the initial trial for overall and not for the prosthetic surgery group. No PJI was found at 2 years in either the carrier or in the noncarrier group. Therefore, no definite conclusion about the efficacy of preoperative decolonization to reduce PJI can be drawn. PJI proportions in this study were lower than described in the literature (mostly around 0.3%). Despite the insufficient sample size, this trial is the largest randomized trial on decolonization with a long-term follow-up, and results may be helpful for future meta-analyses.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chlorhexidine; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mupirocin; Preoperative Care; Prosthesis-Related Infections; Staphylococcal Infections

To evaluate the efficacy of topical mupirocin in reducing Staphylococcus aureus colonization in infants in the neonatal intensive care unit (NICU).. A prospective double-blind randomized controlled trial of mupirocin vs placebo in S aureus-colonized infants was conducted in a tertiary care NICU between October 2016 and December 2019. Weekly universal active surveillance with polymerase chain reaction screening identified colonized infants. Colonized infants received a 5-day course of mupirocin (mupirocin group) or petroleum jelly (control group). Repeat courses were given for additional positive screens.. A total of 216 infants were enrolled; 205 were included in data analyses. Primary decolonization was more successful for mupirocin-treated infants (86 of 104 [83%]) than for controls (20 of 101; 20%) (P < .001). Although recurrent S aureus colonization occurred frequently (59 of 81 [73%] mupirocin-treated and 26 of 33 [79%] controls), subsequent decolonization remained more successful for mupirocin-treated infants than for controls (38 of 49 [78%] vs 2 of 21 [10%]; P < .001). Subgroup analyses of infants of ≤30 weeks' gestational age yielded similar results; decolonization occurred more often in mupirocin-treated infants compared with control infants (63 of 76 [83%] vs 13 of 74 [18%]; P < .001). Bacterial sterile site infections tended to be less frequent in mupirocin-treated infants compared with controls (2 of 104 [2%] vs 8 of 101 [8%]; P = .057). No invasive S aureus infections occurred in mupirocin-treated infants, but 50% of infections in controls were from S aureus, and 1 resulted in death.. Universal active surveillance and targeted treatment with topical mupirocin is a successful decolonization strategy for NICU infants and may prevent S aureus infection. However, S aureus colonization frequently recurs, necessitating repeat treatment.. Clinicaltrials.gov: NCT02967432.

Topics: Administration, Topical; Anti-Bacterial Agents; Bacterial Load; Double-Blind Method; Drug Resistance, Bacterial; Female; Humans; Incidence; Infant, Newborn; Intensive Care, Neonatal; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Prospective Studies; Retreatment; Staphylococcal Infections; Time Factors

Successful decolonisation of nasal Staphylococcus aureus (SA) carriage by mupirocin is limited by increasing drug resistance. This randomised, open-label, phase 1 study compared the safety and local tolerability of two nasal formulations of XF-73, a novel porphyrinic antibacterial with rapid intrinsic activity against SA.. The study was performed in 60 healthy adults. In Part 1, eight non-SA carriers were randomised to groups of four subjects each and were treated with XF-73 concentrations of 0.5mg/g 2% gel or 2.0mg/g 2% gel. In Part 2, 52 persistent SA carriers were randomised to groups of 13 subjects each and were treated with XF-73 concentrations of 0.5mg/g 2% gel, 2.0mg/g 2% gel, 0.5mg/g 4% gel or 4% viscosified placebo gel. Plasma pharmacokinetic and pharmacodynamic studies were performed. Antistaphylococcal activity was assessed as the presence/absence of SA and by quantification of colonisation using a semiquantitative scale (SA score).. 56 subjects (8/8 from Part 1 and 48/52 from Part 2) completed the study, with 47/60 comprising the pharmacokinetic population and 48/60 the pharmacodynamic population. There was no measurable systemic absorption of XF-73. XF-73 treatment was associated with rapid reduction in SA score in all subjects. The most common treatment-emergent adverse events (TEAEs) were rhinorrhoea and nasal dryness (15.5% each in Parts 1 and 2). TEAEs were mild and resolved spontaneously.. XF-73 was well tolerated with minimal side effects at doses of 0.5mg/g 2% gel and 2.0mg/g 2% gel. These findings support further development of XF-73.

Topics: Adult; Anti-Bacterial Agents; Humans; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus is a leading cause of health care-associated infections in the neonatal intensive care unit (NICU). Parents may expose neonates to S aureus colonization, a well-established predisposing factor to invasive S aureus disease.. To test whether treating parents with intranasal mupirocin and topical chlorhexidine compared with placebo would reduce transmission of S aureus from parents to neonates.. Double-blinded randomized clinical trial in 2 tertiary NICUs in Baltimore, Maryland. Neonates (n = 236) with S aureus-colonized parent(s) were enrolled. The study period was November 7, 2014, through December 13, 2018.. Parents were assigned to intranasal mupirocin and 2% chlorhexidine-impregnated cloths (active treatment, n = 117) or petrolatum intranasal ointment and nonmedicated soap cloths (placebo, n = 119) for 5 days.. The primary end point was concordant S aureus colonization by 90 days, defined as neonatal acquisition of an S aureus strain that was the same strain as a parental strain at time of screening. Secondary outcomes included neonatal acquisition of any S aureus strain and neonatal S aureus infections.. Among 236 randomized neonates, 208 were included in the analytic sample (55% male; 76% singleton births; mean birth weight, 1985 g [SD, 958 g]; 76% vaginal birth; mean parent age, 31 [SD, 7] years), of whom 18 were lost to follow-up. Among 190 neonates included in the analysis, 74 (38.9%) acquired S aureus colonization by 90 days, of which 42 (56.8%) had a strain concordant with a parental baseline strain. In the intervention and placebo groups, 13 of 89 neonates (14.6%) and 29 of 101 neonates (28.7%), respectively, acquired concordant S aureus colonization (risk difference, -14.1% [95% CI, -30.8% to -3.9%]; hazard ratio [HR], 0.43 [95.2% CI, 0.16 to 0.79]). A total of 28 of 89 neonates (31.4%) in the intervention group and 46 of 101 (45.5%) in the control group acquired any S aureus strain (HR, 0.57 [95% CI, 0.31 to 0.88]), and 1 neonate (1.1%) in the intervention group and 1 neonate (1.0%) in the control group developed an S aureus infection before colonization. Skin reactions in parents were common (4.8% intervention, 6.2% placebo).. In this preliminary trial of parents colonized with S aureus, treatment with intranasal mupirocin and chlorhexidine-impregnated cloths compared with placebo significantly reduced neonatal colonization with an S aureus strain concordant with a parental baseline strain. However, further research is needed to replicate these findings and to assess their generalizability.. ClinicalTrials.gov Identifier: NCT02223520.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Disease Reservoirs; Disease Transmission, Infectious; Disinfection; Double-Blind Method; Female; Hospitalization; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Mupirocin; Parents; Staphylococcal Infections; Staphylococcus aureus

Current international guidelines recommend the use of a daily topical exit-site antimicrobial to prevent peritoneal dialysis (PD)-related infections. Although nonantibiotic-based therapies are appealing because they may limit antimicrobial resistance, no controlled trials have been conducted to compare topical antimicrobial agents with usual exit-site care for the prevention of PD-related infections among the Thai PD population. We propose a controlled three-arm trial to examine the efficacy and safety of a daily chlorhexidine gluconate-impregnated patch versus mupirocin ointment versus usual exit-site care with normal saline for the prevention of PD-related infections.. This study is a randomized, double-blind, multicenter, active-controlled, clinical trial. Adult patients aged 18 years or older who have end-stage kidney disease and are undergoing PD will be enrolled at three PD Centers in Thailand. A total of 354 PD patients will be randomly assigned to either the 2% chlorhexidine gluconate-impregnated patch, mupirocin ointment, or usual exit-site care with normal saline dressing according to a computer-generated random allocation sequence. Participants will be followed until discontinuation of PD or completion of 24 months. The primary study outcomes are time to first PD-related infection (exit-site/tunnel infection or peritonitis) event and the overall difference in PD-related infection rates between study arms. Secondary study outcomes will include (i) the rate of infection-related catheter removal and PD technique failure, (ii) rate of nasal and exit-site Staphylococcus aureus colonization, (iii) healthcare costs, and (iv) skin reactions and adverse events. We plan to conduct a cost-utility analysis alongside the trial from the perspectives of patients and society. A Markov simulation model will be used to estimate the total cost and health outcome in terms of quality-adjusted life years (QALYs) over a 20-year time horizon. An incremental cost-effectiveness ratio in Thai Baht and U.S. dollars per QALYs gained will be illustrated. A series of probabilistic sensitivity analyses will be conducted to assess the robustness of the cost-utility analysis findings.. The results from this study will provide new clinical and cost-effectiveness evidence to support the best strategy for the prevention of PD-related infections among the Thai PD population.. ClinicalTrials.gov, NCT02547103. Registered on September 11, 2015.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Catheter-Related Infections; Catheters, Indwelling; Chlorhexidine; Clinical Trials, Phase IV as Topic; Cost-Benefit Analysis; Double-Blind Method; Drug Costs; Female; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Multicenter Studies as Topic; Mupirocin; Nasal Mucosa; Peritoneal Dialysis; Peritonitis; Pilot Projects; Randomized Controlled Trials as Topic; Saline Solution; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Between April 2014 and May 2016, infants <24 months old in the NICU at 8 study centers underwent serial screening for nasal SA. Colonized infants who met eligibility criteria were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Mupirocin effects on primary (day 8) and persistent (day 22) decolonization at all three body sites were assessed.. A total of 155 infants were randomly assigned. Mupirocin was generally well tolerated, but rashes (usually mild and perianal) occurred significantly more often in treated versus untreated infants. Primary decolonization occurred in 62 of 66 (93.9%) treated infants and 3 of 64 (4.7%) control infants (. Application of mupirocin to multiple body sites was safe and efficacious in eradicating SA carriage among infants in the NICU; however, after 2 to 3 weeks, many infants who remained hospitalized became recolonized.

Topics: Anti-Bacterial Agents; Female; Humans; Infant; Intensive Care Units, Neonatal; Male; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk for infection after discharge.. We conducted a multicenter, randomized, controlled trial of postdischarge hygiene education, as compared with education plus decolonization, in patients colonized with MRSA (carriers). Decolonization involved chlorhexidine mouthwash, baths or showers with chlorhexidine, and nasal mupirocin for 5 days twice per month for 6 months. Participants were followed for 1 year. The primary outcome was MRSA infection as defined according to Centers for Disease Control and Prevention (CDC) criteria. Secondary outcomes included MRSA infection determined on the basis of clinical judgment, infection from any cause, and infection-related hospitalization. All analyses were performed with the use of proportional-hazards models in the per-protocol population (all participants who underwent randomization, met the inclusion criteria, and survived beyond the recruitment hospitalization) and as-treated population (participants stratified according to adherence).. In the per-protocol population, MRSA infection occurred in 98 of 1063 participants (9.2%) in the education group and in 67 of 1058 (6.3%) in the decolonization group; 84.8% of the MRSA infections led to hospitalization. Infection from any cause occurred in 23.7% of the participants in the education group and 19.6% of those in the decolonization group; 85.8% of the infections led to hospitalization. The hazard of MRSA infection was significantly lower in the decolonization group than in the education group (hazard ratio, 0.70; 95% confidence interval [CI], 0.52 to 0.96; P=0.03; number needed to treat to prevent one infection, 30; 95% CI, 18 to 230); this lower hazard led to a lower risk of hospitalization due to MRSA infection (hazard ratio, 0.71; 95% CI, 0.51 to 0.99). The decolonization group had lower likelihoods of clinically judged infection from any cause (hazard ratio, 0.83; 95% CI, 0.70 to 0.99) and infection-related hospitalization (hazard ratio, 0.76; 95% CI, 0.62 to 0.93); treatment effects for secondary outcomes should be interpreted with caution owing to a lack of prespecified adjustment for multiple comparisons. In as-treated analyses, participants in the decolonization group who adhered fully to the regimen had 44% fewer MRSA infections than the education group (hazard ratio, 0.56; 95% CI, 0.36 to 0.86) and had 40% fewer infections from any cause (hazard ratio, 0.60; 95% CI, 0.46 to 0.78). Side effects (all mild) occurred in 4.2% of the participants.. Postdischarge MRSA decolonization with chlorhexidine and mupirocin led to a 30% lower risk of MRSA infection than education alone. (Funded by the AHRQ Healthcare-Associated Infections Program and others; ClinicalTrials.gov number, NCT01209234 .).

Topics: Administration, Intranasal; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Comorbidity; Disease Transmission, Infectious; Disinfection; Female; Follow-Up Studies; Hospitalization; Humans; Hygiene; Infection Control; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Patient Education as Topic; Staphylococcal Infections

Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units.. The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867.. There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73-0·87) in the decolonisation group versus 0·87 (95% CI 0·79-0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183 013 patients in units assigned to chlorhexidine, and none were reported for mupirocin.. Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients.. National Institutes of Health.

Topics: Administration, Intranasal; Aged; Anti-Infective Agents, Local; Bacteremia; Baths; Carrier State; Chlorhexidine; Drug Resistance, Multiple, Bacterial; Female; Humans; Infection Control; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Outcome Assessment, Health Care; Staphylococcal Infections; Staphylococcus aureus

Mupirocin is used specifically for the eradication of nasal meticillin-resistant Staphylococcus aureus (MRSA), but increasing mupirocin resistance restricts its repeated use. The antibacterial effects of manuka honey have been established in vitro; antibacterial activity of other honeys has also been reported.. To describe the learning experience from a randomized controlled trial (RCT) comparing the efficacy of medical-grade honey (MGH) with mupirocin 2% for the eradication of nasal MRSA.. Patients colonized in the nose with MRSA and age ≥18 years were recruited. Participants received either one or two courses of MGH or mupirocin 2%, three times per day for five consecutive days.. The proportion of patients who were decolonized after one or two courses of treatment was not significantly different between MGH [18/42; 42.8%; 95% confidence interval (CI): 27.7-59.0] and mupirocin 2% (25/44; 56.8%; 95% CI: 41.0-71.7). Non-nasal MRSA colonization was significantly associated with persistent nasal colonization (odds ratio: 5.186; 95% CI: 1.736-5.489; P = 0.003). The rate of new acquisition of mupirocin resistance was 9.75%.. Although not significant, a decolonization rate of 42.8% for MGH was impressive. Our findings suggest that this strategy, which has the potential to combat antimicrobial resistance, should be assessed in similar but larger studies.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Biological Products; Carrier State; Female; Honey; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Staphylococcal Infections; Treatment Outcome; Young Adult

Sequential methicillin-resistant

Topics: Anti-Bacterial Agents; Bacterial Load; Carrier State; Drug Resistance, Multiple, Bacterial; Humans; Longitudinal Studies; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nose; Staphylococcal Infections

To determine the efficacy in eradicating Staphylococcus aureus (SA) carriage of a 5-day preoperative decolonization bundle compared to 2 disinfectant soap showers, with both regimens self-administered at home.. Open label, single-center, randomized clinical trial.. Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular, and general surgery clinics at a tertiary-care referral center in the United States.ParticipantsPatients at the University of Minnesota Medical Center planning to have elective surgery and not on antibiotics.. Consenting participants were screened for SA colonization using nasal, throat, axillary, and perianal swab cultures. Carriers of SA were randomized, stratified by methicillin resistance status, to a decolonization bundle group (5 days of nasal mupirocin, chlorhexidine gluconate [CHG] bathing, and CHG mouthwash) or control group (2 preoperative showers with antiseptic soap). Colonization status was reassessed preoperatively. The primary endpoint was absence of SA at all 4 screened body sites.. Of 427 participants screened between August 31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers. Of these, 121 were randomized and 110 were eligible for efficacy analysis (57 decolonization bundle group, 53 control group). Overall, 90% of evaluable participants had methicillin-susceptible SA strains. Eradication of SA at all body sites was achieved for 41 of 57 participants (71.9%) in the decolonization bundle group and for 13 of 53 participants (24.5%) in the control group, a difference of 47.4% (95% confidence interval [CI], 29.1%-65.7%; P<.0001).. An outpatient preoperative antiseptic decolonization bundle aimed at 4 body sites was significantly more effective in eradicating SA than the usual disinfectant showers (ie, the control).Trial RegistrationClinicalTrials.gov identifier: NCT02182115.

Topics: Administration, Intranasal; Adult; Aged; Anti-Infective Agents, Local; Baths; Carrier State; Chlorhexidine; Disinfection; Female; Humans; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Minnesota; Mouthwashes; Mupirocin; Nasal Cavity; Patient Care Bundles; Preoperative Care; Self Administration; Soaps; Staphylococcal Infections; Surgical Wound Infection; Tertiary Care Centers

People living with HIV (PLWH) have a higher prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization and likelihood of recurrent infection than the general population. Simultaneously treating MRSA-colonized household members may improve success with MRSA decolonization strategies. This article describes a pilot trial testing household-level MRSA decolonization and documents methodologic and pragmatic challenges of this approach.. We conducted a randomized controlled trial of individual versus individual-plus-household MRSA decolonization to reduce recurrent MRSA. PLWH with a history of MRSA who are patients of an urban HIV clinic received a standard MRSA decolonization regimen. MRSA colonization at 6 months was the primary outcome.. One hundred sixty-six patients were referred for MRSA screening; 77 (46%) enrolled. Of those, 28 (36%) were colonized with MRSA and identified risk factors consistent with the published literature. Eighteen were randomized and 13 households completed the study.. This is the first study to report on a household-level MRSA decolonization among PLWH. Challenges included provider referral, HIV stigma, confidentiality concerns over enrolling households, and dynamic living situations. Although simultaneous household MRSA decolonization may reduce recolonization, recruitment and retention challenges specific to PLWH limit the ability to conduct household-level research. Efforts to minimize these barriers are needed to inform evidence-based practice.

Topics: Adult; Anti-Bacterial Agents; Carrier State; Chlorhexidine; Family Characteristics; Female; HIV Infections; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Prospective Studies; Staphylococcal Infections; Treatment Outcome

The purpose of this study was to determine if a decolonization regimen reduces the frequency of methicillin-resistant Staphylococcus aureus (MRSA) infections and if colonization isolates are genetically related to subsequent infectious strains. Trauma patients admitted to the intensive care unit with positive MRSA nasal swabs were randomized to either daily chlorhexidine gluconate (CHG) baths and mupirocin (MUP) ointment to the nares or soap and water baths and placebo ointment for five days. Nasal swabs performed at the end of treatment and invasive MRSA infections during the remaining hospitalization were compared with the original nasal isolate via polymerase chain reaction for genetic relatedness as well as CHG and MUP resistance genes. Six hundred and seventy-eight intensive care unit admissions were screened, and 92 (13.6%) had positive (+) MRSA nasal swabs over a 22-month period ending in 3/2014. After the five day treatment period, there were 13 (59.1%) +MRSA second nasal swabs for CHG + MUP and 9 (90%) for soap and water baths and placebo, P = 0.114. No isolates tested positive for the MUP or CHG resistance genes mupA and qacA/B but 7 of 20 (35%) contained smr. There were seven (31.8%) MRSA infections in the CHG group and six (60%) for soap, P = 0.244. All 13 patients with MRSA infections had the same MRSA isolate present in the original nasal swab. There was no difference in all-cause Gram-negative or positive infections for CHG versus soap, 12 (54.5%) versus 7 (70%), P = 0.467. CHG + MUP are ineffective in eradicating MRSA from the anterior nares but may reduce the incidence of infection. Subsequent invasive MRSA infections are typically caused by the endogenous colonization strain.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bacterial Proteins; Baths; Chlorhexidine; Cross Infection; Drug Resistance, Bacterial; Female; Humans; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nasal Cavity; Polymerase Chain Reaction; Prospective Studies; Staphylococcal Infections; Trauma Centers; Treatment Outcome

To identify patients who benefit most from Staphylococcus aureus screening and decolonization treatment upon admission.. S. aureus carriers are at increased risk of developing surgical-site infections with S. aureus. Previously, we demonstrated in a randomized, placebo-controlled trial (RCT) that these infections can largely be prevented by detection of carriage and decolonization treatment upon admission. In this study, we analyzed 1- and 3-year mortality rates in both treatment arms of the RCT to identify patient groups that should be targeted when implementing the screen-and-treat strategy.. Three years after enrolment in the RCT, mortality dates of all surgical patients were checked. One- and 3-year mortality rates were calculated for all patients and for various subgroups.. After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%) patients had died in the mupirocin/chlorhexidine and placebo groups, respectively. No significant differences in mortality rates were observed between the treatment groups or the subgroups according to type of surgery. In the subgroup of patients with clean procedures (382 cardiothoracic, 167 orthopedic, 61 vascular, and 56 other), mupirocin/chlorhexidine reduced 1-year mortality: 11 of 365 (3.0%) died in the mupirocin/chlorhexidine versus 21 of 301 (7.0%) in the placebo group [hazard ratio = 0.38 (95% CI: 0.18-0.81)].. Detection and decolonization of S. aureus carriage not only prevents S. aureus surgical-site infections but also reduces 1-year mortality in surgical patients undergoing clean procedures. Such patients with a high risk of developing S. aureus infections should therefore be the primary target when implementing the screen-and-treat strategy in clinical practice.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Mupirocin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Staphylococcus aureus (S. aureus) is a common pathogen in surgical site infections (SSIs). Mupirocin ointment is an effective treatment for nasal carriers. We aimed to investigate whether screening for nasal colonization of S. aureus and treating carriers prior to a cesarean section (CS) decreases the likelihood of SSI.. This is a randomized controlled trial. All participants underwent nasal culture prior to the CS. Nasal carriers of S. aureus were treated with Mupirocin ointment according to a standardized protocol. In the control group, nasal cultures were obtained immediately prior to surgery and carriers were not treated.. We recruited 568 patients. Demographic characteristics were comparable between the groups. S. aureus nasal colonization rates were 20.1% and 14.9% in the intervention and control groups, respectively (p = 0.12). S. aureus eradication rate with Mupirocin treatment was 88%. SSI rates were similar in the intervention and control groups (13.1% versus 12.1%, respectively, p = 0.78) and in treated carriers, untreated carriers, and non-carriers (7.4% versus 13.0% versus 13.1%, respectively, p = 0.69). Previous CS was the only factor found to independently predict SSI (OR 2.5, CI 1.09-5.65 p = 0.029).. Pre-cesarean screening for nasal S. aureus carriage and decolonization does not appear to be an effective intervention in reducing SSI rates.

Topics: Adult; Anti-Bacterial Agents; Carrier State; Cesarean Section; Female; Humans; Mupirocin; Nose; Pregnancy; Pregnancy Trimester, Third; Preoperative Period; Regression Analysis; Staphylococcal Infections; Staphylococcus aureus; Statistics, Nonparametric; Surgical Wound Infection

Deep infection after elective total joint arthroplasty remains a devastating complication. Preoperative nasal swab screening for Staphylococcus aureus colonization and subsequent treatment of colonized patients is one proposed method to identify at-risk patients and decrease surgical site infections (SSIs). The purpose of this study was to determine whether a preoperative staphylococcus screening and treatment program would decrease the incidence of SSI in elective joint arthroplasty patients.. Since January 2009, a total of 9690 patients having an elective joint arthroplasty were screened before surgery for Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) with nares swabs. All patients with positive nare colonization for MSSA and MRSA were treated with mupirocin and chlorhexidine gluconate showers for 5 days before surgery. MRSA patients received vancomycin preoperatively and were placed in contact isolation. All elective arthroplasty patients used chlorhexidine gluconate antiseptic cloths the evening prior and the day of surgery. Perioperative infection rates were compared from 1 year before implementation to 5 years after implementation of this screening protocol.. SSI rates have decreased from 1.11% (prescreening) to 0.34% (nasal screening; P < .05) after initiation of the process. Staphylococcus was identified in 66.7% of the SSI infections before nasal screening and in 33.3% of the SSI after routine screening (P > .05).. The addition of MRSA and/or MSSA nares screening along with a perioperative decolonization protocol has resulted in a decreased SSI rate by 69%.

Topics: Administration, Intranasal; Aged; Anti-Infective Agents, Local; Arthroplasty; Arthroplasty, Replacement; Chlorhexidine; Elective Surgical Procedures; Female; Humans; Incidence; Male; Methicillin; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nasal Cavity; Preoperative Care; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Vancomycin

OBJECTIVE To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection. DESIGN Three-arm nonmasked randomized controlled trial. SETTING Five academic medical centers in Southeastern Pennsylvania. PARTICIPANTS Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members. INTERVENTION Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders. MAIN OUTCOME MEASURES Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case. RESULTS Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018). CONCLUSIONS Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance Trial registration. ClinicalTrials.gov identifier: NCT00966446 Infect Control Hosp Epidemiol 2016;1-8.

Topics: Academic Medical Centers; Administration, Intranasal; Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Community-Acquired Infections; Family Characteristics; Family Health; Humans; Kaplan-Meier Estimate; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Patient Compliance; Patient Education as Topic; Pennsylvania; Recurrence; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Young Adult

Antibiotic resistance is a challenge in long-term care facilities (LTCFs). The objective of this study was to demonstrate that a novel, minimally invasive program not interfering with activities of daily living or socialization could lower methicillin-resistant Staphylococcus aureus (MRSA) disease.. This was a prospective, cluster-randomized, nonblinded trial initiated at 3 LTCFs. During year 1, units were stratified by type of care and randomized to intervention or control. In year 2, all units were converted to intervention consisting of universal decolonization using intranasal mupirocin and a chlorhexidine bath performed twice (2 decolonization-bathing cycles 1 month apart) at the start of the intervention period. Subsequently, after initial decolonization, all admissions were screened on site using real-time polymerase chain reaction, and those MRSA positive were decolonized, but not isolated. Units received annual instruction on hand hygiene. Enhanced bleach wipe cleaning of flat surfaces was done every 4 months.. There were 16,773 tests performed. The MRSA infection rate decreased 65% between baseline (44 infections during 365,809 patient days) and year 2 (12 infections during 287,847 patient days; P <.001); a significant reduction was observed at each of the LTCFs (P <.03).. On-site MRSA surveillance with targeted decolonization resulted in a significant decrease in clinical MRSA infection among LTCF residents.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Humans; Infection Control; Long-Term Care; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Prospective Studies; Socialization; Staphylococcal Infections

Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening and isolation without decolonization, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization without screening to prevent MRSA infection in intensive-care unit (ICU) patients. Isolates from the baseline and intervention periods were collected and tested for susceptibility to chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility was tested by Etest. The presence of the qacA or qacB gene was determined by PCR and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were nonsusceptible to CHG (MICs, 8 μg/ml), and 5/814 (0.6%) carried qacA or qacB At baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and 7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized logistic regression model, the odds of mupirocin resistance among clinical MRSA isolates or MRSA isolates acquired in an ICU in intervention versus baseline periods did not differ across arms, although estimates were imprecise due to small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of mupirocin resistance were no different in the intervention versus baseline periods across arms, but the confidence limits were broad, and the results should be interpreted with caution.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Drug Resistance, Bacterial; Genes, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Polymerase Chain Reaction; Selection, Genetic; Sequence Analysis, DNA; Staphylococcal Infections

HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIV-infected persons.. 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point.. Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIV-specific factors were not predictive of MRSA clearance at the 6-month time point.. A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population.. ClinicalTrials.gov NCT00631566.

Topics: Adult; Anti-Bacterial Agents; Double-Blind Method; Female; Hexachlorophene; HIV Infections; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Prospective Studies; Staphylococcal Infections

Previous studies suggested that a bundled intervention was associated with lower rates of Staphylococcus aureus surgical site infections (SSIs) among patients having cardiac or orthopedic operations.. To evaluate whether the implementation of an evidence-based bundle is associated with a lower risk of S. aureus SSIs in patients undergoing cardiac operations or hip or knee arthroplasties.. Twenty hospitals in 9 US states participated in this pragmatic study; rates of SSIs were collected for a median of 39 months (range, 39-43) during the preintervention period (March 1, 2009, to intervention) and a median of 21 months (range, 14-22) during the intervention period (from intervention start through March 31, 2014).. Patients whose preoperative nares screens were positive for methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA) were asked to apply mupirocin intranasally twice daily for up to 5 days and to bathe daily with chlorhexidine-gluconate (CHG) for up to 5 days before their operations. MRSA carriers received vancomycin and cefazolin or cefuroxime for perioperative prophylaxis; all others received cefazolin or cefuroxime. Patients who were MRSA-negative and MSSA-negative bathed with CHG the night before and morning of their operations. Patients were treated as MRSA-positive if screening results were unknown.. The primary outcome was complex (deep incisional or organ space) S. aureus SSIs. Monthly SSI counts were analyzed using Poisson regression analysis.. After a 3-month phase-in period, bundle adherence was 83% (39% full adherence; 44% partial adherence). Overall, 101 complex S. aureus SSIs occurred after 28,218 operations during the preintervention period and 29 occurred after 14,316 operations during the intervention period (mean rate per 10,000 operations, 36 for preintervention period vs 21 for intervention period, difference, -15 [95% CI, -35 to -2]; rate ratio [RR], 0.58 [95% CI, 0.37 to 0.92]). The rates of complex S. aureus SSIs decreased for hip or knee arthroplasties (difference per 10,000 operations, -17 [95% CI, -39 to 0]; RR, 0.48 [95% CI, 0.29 to 0.80]) and for cardiac operations (difference per 10,000 operations, -6 [95% CI, -48 to 8]; RR, 0.86 [95% CI, 0.47 to 1.57]).. In this multicenter study, a bundle comprising S. aureus screening, decolonization, and targeted prophylaxis was associated with a modest, statistically significant decrease in complex S. aureus SSIs.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cardiac Surgical Procedures; Cefazolin; Cefuroxime; Chlorhexidine; Drug Therapy, Combination; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Vancomycin; Young Adult

More than 33,000 healthcare-associated infections occur in neonatal intensive care units (NICUs) each year in the USA. Parents, rather than healthcare workers, may be a reservoir from which neonates acquire Staphylococcus aureus (S. aureus) colonisation in the NICU. This study looks to measure the effect of treating parents with short course intranasal mupirocin and topical chlorhexidine antisepsis on acquisition of S. aureus colonisation and infection in neonates.. The TREAT PARENTS trial (Treating Parents to Reduce Neonatal Transmission of S. aureus) is a multicentre randomised, masked, placebo-controlled trial. Shortly after a neonate is admitted to the NICU, parents will be tested for S. aureus colonisation. If either parent screens positive for S. aureus, then both parents as a pair will be enrolled and randomised to one of the two possible masked treatment arms. Arm 1 will include assignment to intranasal 2% mupirocin plus topical antisepsis with chlorhexidine gluconate impregnated cloths for 5 days. Arm 2 will include assignment to placebo ointment and placebo cloths for skin antisepsis for 5 days. The primary outcome will be neonatal acquisition of an S. aureus strain that is concordant to the parental baseline S. aureus strain as determined by periodic surveillance cultures or a culture collected during routine clinical care that grows S. aureus. Secondary outcomes will include neonatal acquisition of S. aureus, neonatal S. aureus infection, eradication of S. aureus colonisation in parents, natural history of S. aureus colonisation in parents receiving placebo, adverse reactions to treatment, feasibility of intervention, and attitudes and behaviour in consented parents. Four hundred neonate-parent pairs will be enrolled.. The study was approved by Johns Hopkins University IRB in June 2014 (IRB number 00092982). Protocol V.7 was approved in November 2014. Findings will be published in peer-reviewed journals.. NCT02223520.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Child; Chlorhexidine; Cross Infection; Disinfection; Double-Blind Method; Female; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Mupirocin; Parents; Staphylococcal Infections; Staphylococcus aureus

The aim of this study was to evaluate the efficacy of the topical administration of mupirocin and other practices in central venous catheter (CVC) care to prevent central line-associated bloodstream infections (CLABSI) in patients with major burns.. Patients with major burns admitted to a burn ICU were divided into four groups and disinfected at the CVC exit site with single povidone iodine (PVP-I) or PVP-I plus topical mupirocin ointment three times a day or once a day, respectively. The bacterial colonization of the skin at the CVC exit site and CVC tips and the incidence of CLABSI were recorded, and the risk factors were analyzed.. Administering mupirocin (RR=0.316, p=0.001), increasing the frequency of insertion-site care (RR=0.604, p=0.008), and avoiding cannulation at the burn site (RR=0.148, p<0.001) reduced skin colonization at the CVC insertion site. Topical administration of mupirocin significantly reduces both the bacterial colonization rate at CVC tips (RR=0.316, p=0.001) and the incidence of CLABSI (5.3 vs. 29.1 per 1000 catheter days, p<0.001).. Mupirocin is effective in the prophylaxis of CLABSI. Other CVC care practices were also found to affect the level of bacterial colonization, but their efficacy in preventing CLABSI needs to be evaluated further.

Topics: Acinetobacter Infections; Administration, Cutaneous; Adult; Anti-Bacterial Agents; Bacteremia; Burn Units; Burns; Carrier State; Catheter-Related Infections; Central Venous Catheters; Female; Humans; Male; Middle Aged; Mupirocin; Prospective Studies; Protective Factors; Pseudomonas Infections; Risk Factors; Skin; Staphylococcal Infections; Trauma Severity Indices; Young Adult

A limitation of both culture-based and molecular methods of screening for staphylococcal infection is that current tests determine only the presence or absence of colonization with no information on the colonizing strain type. A technique that couples polymerase chain reaction to mass spectrometry (PCR/ESI-MS) has recently been developed and an assay validated to identify and genotype S. aureus and coagulase-negative staphylococci (CoNS).. This study was conducted to determine the rates, risk factors, and molecular genotypes of colonizing Staphylococcus aureus in adult patients presenting to an inner-city academic emergency department. Participants completed a structured questionnaire to assess hospital and community risks for infection with methicillin-resistant S. aureus (MRSA). Nasal swabs were analyzed by PCR/ESI-MS to identify and genotype S. aureus and CoNS.. Of 200 patients evaluated, 59 were colonized with S. aureus; 27 of these were methicillin-resistant strains. Twenty-four of the 59 S. aureus carriers were co-colonized with a CoNS and 140 of the 200 patients were colonized exclusively with CoNS. The molecular genotypes of the 59 S. aureus strains were diverse; 21 unique molecular genotypes belonging to seven major clonal complexes were identified. Eighty-five of 200 patients carried strains with high-level mupirocin resistance. Of these eighty-five participants, 4 were colonized exclusively with S. aureus, 16 were co-colonized with S. aureus and CoNS, and 65 were colonized exclusively with CoNS.. The prevalence of S. aureus and methicillin-resistant S. aureus colonization in a random sample of patients seeking care in Emergency Department was 29.5% and 13.5%, respectively. A substantial fraction of the S. aureus-colonized patients were co-colonized with CoNS and high-level mupirocin-resistant CoNS. Determining the molecular genotype of S. aureus during intake screening may prove valuable in the future if certain molecular genotypes become associated with increased infection risk.

Topics: Adolescent; Adult; Emergency Service, Hospital; Female; Genotype; Genotyping Techniques; Humans; Male; Maryland; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nose; Polymerase Chain Reaction; Prevalence; Prospective Studies; Risk Factors; Spectrometry, Mass, Electrospray Ionization; Staphylococcal Infections; Staphylococcus aureus; Young Adult

The reduction in acquired infections (AI) due to methicillin-resistant Staphylococcus aureus (MRSA) with the mupirocin/chlorhexidine (M/C) decontamination regimen has not been well studied in intubated patients. We performed post hoc analysis of a prior trial to assess the impact of M/C on MRSA AI and colonization.. We conducted a multicenter, placebo-controlled, randomized, double-blind study with the primary aim to reduce all-cause AI. The two regimens used [topical polymyxin and tobramycin (P/T), nasal mupirocin with chlorhexidine body wash (M/C), or corresponding placebos for each regimen] were administered according to a 2 × 2 factorial design. Participants were intubated patients in the intensive care units of three French university hospitals. The patients enrolled in the study (n = 515) received either active P/T (n = 130), active M/C (n = 130), both active regimens (n = 129), or placebos only (n = 126) for the period of intubation and an additional 24 h. The incidence and incidence rates (per 1,000 study days) of MRSA AI were assessed. Due to the absence of a statistically significant interaction between the two regimens, analysis was performed at the margins by comparing all patient receiving M/C (n = 259) to all patients not receiving M/C (n = 256), and all patients receiving P/T (n = 259) to all patients not receiving P/T (n = 256).. Incidence [odds ratio (OR) 0.39, 95 % confidence interval (CI) (0.16-0.96), P = 0.04] and incidence rates [incidence rate ratio (IRR) 0.41, 95 % CI 0.17-0.97, P = 0.05] of MRSA AI were significantly lower with the use of M/C. We also observed an increase in the incidence (OR 2.50, 95 % CI 1.01-6.15, P = 0.05) and the incidence rate (IRR 2.90, 95 % CI 1.20-8.03, P = 0.03) of MRSA AI with the use of P/T.. Among our study cohort of intubated patients, the use of M/C significantly reduced MRSA AI.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Chlorhexidine; Double-Blind Method; Drug Therapy, Combination; Female; France; Hospitals, University; Humans; Incidence; Intubation; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Placebos; Polymyxins; Staphylococcal Infections; Tobramycin; Treatment Outcome; Young Adult

Staphylococcus aureus wound colonization frequently occurs in patients with burns and can cause impaired wound healing. Nasal mupirocin application may contribute to the reduction of burn wound colonization of endogenous origin, whereas colonization by the exogenous route can be reduced by blocking cross-infection from other sources. In this study we evaluated whether the implementation of routine treatment of patients and burn center personnel using nasal mupirocin ointment reduces S. aureus burn wound colonization.. We composed three study groups, consisting of a control period (Control), a mupirocin period (MUP), in which patients with burns were all receiving nasal mupirocin at admission, and a mupirocin+personnel period (MUP+P), in which we also screened the burn center personnel and decolonized S. aureus carriers by nasal mupirocin.. The patients who carried S. aureus in their nose and did not have S. aureus burn wound colonization at admission were considered as patients susceptible for the use of nasal mupirocin. In these patients, the S. aureus burn wound colonization rate was the same in all study groups. S. aureus nasal carriage was a significant independent risk factor for burn wound colonization (OR: 3.3; 95% CI: 1.4-7.6) when analyzed within the three study groups.. Although S. aureus carriage is a significant risk factor for developing burn wound colonization, the routine use of nasal mupirocin did not contribute to a reduction of burn wound colonization.

Topics: Administration, Intranasal; Adolescent; Adult; Anti-Bacterial Agents; Burn Units; Burns; Carrier State; Child; Child, Preschool; Humans; Infant; Infectious Disease Transmission, Professional-to-Patient; Middle Aged; Mupirocin; Staphylococcal Infections; Wound Infection; Young Adult

Chlorhexidine has been increasingly utilized in outpatient settings to control methicillin-resistant Staphylococcus aureus (MRSA) outbreaks and as a component of programs for MRSA decolonization and prevention of skin and soft-tissue infections (SSTIs). The objective of this study was to determine the prevalence of chlorhexidine resistance in clinical and colonizing MRSA isolates obtained in the context of a community-based cluster-randomized controlled trial for SSTI prevention, during which 10,030 soldiers were issued chlorhexidine for body washing. We obtained epidemiological data on study participants and performed molecular analysis of MRSA isolates, including PCR assays for determinants of chlorhexidine resistance and high-level mupirocin resistance and pulsed-field gel electrophoresis (PFGE). During the study period, May 2010 to January 2012, we identified 720 MRSA isolates, of which 615 (85.4%) were available for molecular analysis, i.e., 341 clinical and 274 colonizing isolates. Overall, only 10 (1.6%) of 615 isolates were chlorhexidine resistant, including three from the chlorhexidine group and seven from nonchlorhexidine groups (P > 0.99). Five (1.5%) of the 341 clinical isolates and five (1.8%) of the 274 colonizing isolates harbored chlorhexidine resistance genes, and four (40%) of the 10 possessed genetic determinants for mupirocin resistance. All chlorhexidine-resistant isolates were USA300. The overall prevalence of chlorhexidine resistance in MRSA isolates obtained from our study participants was low. We found no association between extended chlorhexidine use and the prevalence of chlorhexidine-resistant MRSA isolates; however, continued surveillance is warranted, as this agent continues to be utilized for infection control and prevention efforts.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Bacterial Typing Techniques; Chlorhexidine; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genes, Bacterial; Hand Disinfection; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Military Personnel; Mupirocin; Staphylococcal Infections

Treatment of Staphylococcus aureus colonization before surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone-iodine solution may provide an alternative to mupirocin.. We conducted an investigator-initiated, open-label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical chlorhexidine wipes in combination with either twice daily application of nasal mupirocin ointment during the 5 days before surgery or 2 applications of povidone-iodine solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery.. In the modified intent-to-treat analysis, a deep SSI developed after 14 of 855 surgical procedures in the mupirocin group and 6 of 842 surgical procedures in the povidone-iodine group (P = .1); S. aureus deep SSI developed after 5 surgical procedures in the mupirocin group and 1 surgical procedure in the povidone-iodine group (P = .2). In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgical procedures in the mupirocin group and 0 of 776 surgical procedures in the povidone-iodine group (P = .03).. Nasal povidone-iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI.. ClinicalTrials.gov identifier: NCT01313182.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthroplasty; Female; Humans; Intention to Treat Analysis; Male; Middle Aged; Mupirocin; Nose; Ointments; Povidone-Iodine; Spinal Fusion; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Young Adult

The REDUCE MRSA Trial (Randomized Evaluation of Decolonization vs Universal Clearance to Eliminate Methicillin-Resistant Staphylococcus aureus), a large multicenter, randomized controlled trial in adult intensive care units (ICUs), found universal decolonization to be more effective than surveillance and isolation procedures with or without targeted decolonization for reducing rates of MRSA-positive clinical cultures. The Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention subsequently published protocols for implementing universal decolonization in ICUs based on the trial's methods. Caution should be exercised before widely adopting these procedures in neonatal intensive care units (NICUs), particularly strategies that involve bathing with chlorhexidine and mupirocin application due to the potential for adverse events in their unique patient population, especially preterm infants. Large multicenter trials in the NICUs are needed to evaluate the efficacy, short- and long-term safety, and cost effectiveness of these strategies prior to their widespread implementation.

Topics: Adult; Chlorhexidine; Humans; Infant, Newborn; Infant, Premature, Diseases; Intensive Care Units; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

We tested infection prevention strategies to limit exposure of long-term care facility residents to drug-resistant pathogens in a prospective, cluster randomized 2-year trial involving 3 long-term care facilities (LTCFs) using methicillin-resistant Staphylococcus aureus (MRSA) as a model. We hypothesized that nasal MRSA surveillance using rapid quantitative polymerase chain reaction and decolonization of carriers would successfully lower overall MRSA colonization. In year 1, randomly assigned intervention units received decolonization with nasal mupirocin and chlorhexidine bathing and enhanced environmental cleaning with bleach every 4 months. Newly admitted MRSA nares-positive residents were decolonized on admission. Control units were screened but not decolonized. All units received periodic bleach environmental cleaning and instruction on hand hygiene. In year 2, all units followed intervention protocol caused by failure of the cluster randomized approach to sufficiently segregate patients. MRSA colonization was monitored using point prevalence testing every 4-6 months. Colonization status at admission and discharge was performed 1 quarter per year to determine acquisition. Fisher exact test was used for statistical analysis. Baseline MRSA colonization rate was 16.64%. In year 1, the colonization rate of intervention units was 11.61% (P = .028) and 17.85% in control units (P = .613) compared with baseline. Intervention unit rate difference compared with the controls was significant (P = .001). In year 2, the colonization rate was 10.55% (P < .001) compared with baseline. The transmission rates were 1.66% and 3.52% in years 1 and 2, respectively (P = .034). The planned interventions of screening and decolonization were successful at lowering MRSA colonization.

Topics: Anti-Bacterial Agents; Carrier State; Chlorhexidine; Cross Infection; Disinfectants; Infection Control; Long-Term Care; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Nursing Homes; Prospective Studies; Sodium Hypochlorite; Staphylococcal Infections

Prophylactic mupirocin for peritoneal catheter exit sites reduces exit site infection (ESI) risk but engenders antibiotic resistance. We present early interim safety analysis of an open-label randomized study comparing polyhexamethylene biguanide (PHMB) and mupirocin. A total of 106 patients randomized to 53 in each group were followed up for a mean of 12.68 months per patient. On safety analysis, the PHMB group had a significantly greater ESI rate than the mupirocin group (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.09 to 0.80), leading to discontinuation of the trial.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Biguanides; Catheters, Indwelling; Early Termination of Clinical Trials; Female; Humans; Male; Middle Aged; Mupirocin; Peritoneal Dialysis; Prospective Studies; Pseudomonas Infections; Staphylococcal Infections; Survival Analysis

Surgical site infection (SSI) can be a problematic complication of Mohs micrographic surgery (MMS). Previous reports have cited nasal Staphylococcus aureus (S. aureus) carriage as a risk factor for SSI, but none thus far in dermatologic surgery.. The aim was to determine the difference in infection rates between nasal carriers of S. aureus and non-carriers, and whether decolonisation with intranasal mupirocin ointment and chlorhexidine wash would reduce the infection rate in nasal carriers.. In all, 738 patients presenting for MMS at the Oxford Day Surgery and Dermatology underwent a nasal swab to determine their S. aureus carriage status. S. aureus carriers were randomised for decolonisation with intranasal mupirocin ointment and chlorhexidine body wash. Non-carriers were untreated. All patients were followed up for SSI.. The rate of SSI was 11 per cent in untreated S. aureus carriers, 4 per cent in treated carriers, and 3 per cent in non-carriers. The difference in infection rate between carriers and non-carriers was significant (P < 0.001). The difference between treated and untreated carriers was also significant (P = 0.05).. Nasal S. aureus carriage is an important risk factor for SSI in MMS, conferring an over threefold increase in SSI risk. A pre-operative nasal swab provides a simple and effective risk stratification tool. The use of a topical decolonisation regimen reduces the infection rate in carriers to a level approaching non-carriers without exposure to systemic antibiotics.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Female; Humans; Male; Middle Aged; Mohs Surgery; Mupirocin; Nose; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Mupirocin nasal ointment may be prescribed for decolonization prior to surgical procedures, especially for carriers of methicillin-resistant Staphylococcus aureus (MRSA). The approved regimen for decolonization of S. aureus from the anterior nares is twice daily for 5 d (10 doses). We performed a two-center, randomized, open-label study to compare the utility of six and 10 doses for decolonization of S. aureus.. Patients expecting to undergo surgery were screened for S. aureus nasal carriage approximately three weeks prior to the procedure. Those found to be positive were offered enrollment in the study. In the first arm (n=41), patients were randomized to receive 2, 3, or 5 d (six or 10 doses) of treatment prior to their operation. Their anterior nares were swabbed for culture and S. aureus polymerase chain reaction (PCR) during the decolonization therapy period as well as for four weeks after surgery. In the second arm (n=60), all patients were given 5 d (10 doses) of nasal mupirocin treatment, and the patient's anterior nares were swabbed for culture and S. aureus PCR for four weeks after surgery. Data from six of the patients were excluded from analysis because of failure to submit swabs after operation. All S. aureus isolates were tested for susceptibility to mupirocin and the presence of the mecA gene to detect MRSA.. In Arm 1, 16 patients received 10 doses of mupirocin, 18 received six doses (twice daily for 3 d), and 7 received six doses (thrice daily for 2 d). In the second arm, all patients received 10 doses of mupirocin (twice a day for 5 d). Overall, 89.5% patients who received 10 doses of mupirocin remained decolonized for at least four weeks after surgery versus 68.0% of patients who received six doses (p=0.016). There was no difference between arms 1 and 2 for those given mupirocin twice daily for 5 d.. The ten-dose regimen is superior to any six-dose regimen for de-colonizing S. aureus from the anterior nares of patients and for maintaining the decolonized state for at least four weeks after therapy.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Carrier State; Electrophoresis, Gel, Pulsed-Field; Humans; Mupirocin; Nasal Cavity; Ointments; Staphylococcal Infections; Staphylococcus aureus

Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA).. We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital.. A total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients who underwent decolonization. The reductions in rates of MRSA bloodstream infection were similar to those of all bloodstream infections, but the difference was not significant. Adverse events, which occurred in 7 patients, were mild and related to chlorhexidine.. In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen. (Funded by the Agency for Healthcare Research and the Centers for Disease Control and Prevention; REDUCE MRSA ClinicalTrials.gov number, NCT00980980).

Topics: Adult; Aged; Bacteremia; Baths; Carrier State; Chlorhexidine; Comparative Effectiveness Research; Cross Infection; Disease Transmission, Infectious; Disinfection; Female; Humans; Infection Control; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nasal Cavity; Staphylococcal Infections

Topics: Carrier State; Chlorhexidine; Cross Infection; Humans; Intensive Care Units; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

Chronic rhinosinusitis (CRS) recalcitrant to surgery is a frustrating clinical entity. Recently, mupirocin sinonasal rinses have been suggested as an efficacious treatment alternative in these patients where Staphylococcus aureus infection is demonstrated. To our knowledge, how best to treat this S aureus reservoir has not been previously evaluated in a double-blinded, randomized, placebo-controlled trial.. Prospective, double-blinded, placebo-controlled study.. Twenty-five S aureus-positive CRS patients with persistent sinonasal infection despite endoscopic sinus surgery received either a 1-month, twice-daily treatment course of mupirocin sinonasal rinses (MUP) or saline rinses (CON). The primary outcome was S aureus-culture negativity at the conclusion of treatment; secondary rhinological outcomes included subjective and objective measures of rhinosinusitis.. Twenty-two patients satisfactorily completed the treatment period. Of CON patients, 0/13 (0.0%) returned an S aureus-negative sinonasal culture at 1 month, compared to 8/9 (88.9%) of MUP patients (P < .01). Improvements in rhinological outcomes observed in MUP patients following treatment were not subsequently evident when these patients were followed up at a delayed assessment 2 to 6 months after completing treatment.. Mupirocin sinonasal rinses are an effective short-term anti-S aureus treatment in surgically recalcitrant CRS as assessed by microbiological and selected rhinological outcomes, although the latter improvements may not be durable with time.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Chronic Disease; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Lavage; Nose; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Surgical site infections (SSIs) are an important cause of morbidity and mortality after head and neck surgery. Our primary objective was to determine the efficacy of preoperative topical antimicrobial decolonization before head and neck surgery.. Prospective, randomized controlled trial.. This study was conducted among 84 patients presenting for head and neck surgery requiring admission to an academic medical center. Preoperative cultures were performed to identify Staphylococcus aureus carriers. Patients were randomized to preoperative topical antimicrobial decolonization with a 5-day regimen of chlorhexidine skin rinses and intranasal mupirocin coupled with standard perioperative systemic antimicrobial prophylaxis, versus standard prophylaxis alone. The main outcome was the incidence of SSIs.. Despite a trend suggesting a decrease in SSIs with perioperative topical antimicrobial decolonization (24% vs. 10%), there was no significant difference (odds ratio, 0.34; 95% confidence interval, 0.10-1.18; P = .079). Patients with a higher American Society of Anesthesiologists score (3 vs. 1; P = .02), with more operative blood loss (P = .05), and who required operative takeback (P = .04) had a higher rate of SSIs; there was a trend suggesting a higher rate of SSIs among patients undergoing clean-contaminated surgery compared to clean cases (P = .08) and among those having received prior radiation (P = .07) or chemotherapy (P = .06).. Preoperative antimicrobial decolonization did not significantly decrease the incidence of SSIs after head and neck surgery, but might be considered for high-risk groups despite the lack of conclusive evidence confirming efficacy. Risk factors for SSIs after head and neck surgery are identified for the first time in a prospective study.

Topics: Administration, Intranasal; Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Chi-Square Distribution; Chlorhexidine; Female; Head and Neck Neoplasms; Humans; Incidence; Male; Michigan; Middle Aged; Mupirocin; Prospective Studies; Risk Factors; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome

A multi centre double-blind randomised-controlled trial (M-RCT), carried out in the Netherlands in 2005-2007, showed that hospitalised patients with S. aureus nasal carriage who were treated prophylactically with mupirocin nasal ointment and chlorhexidine gluconate medicated soap (MUP-CHX), had a significantly lower risk of health-care associated S. aureus infections than patients receiving placebo (3.4% vs. 7.7%, RR 0.42, 95% CI 0.23-0.75). The objective of the present study was to determine whether treatment of patients undergoing elective cardiothoracic or orthopaedic surgery with MUP-CHX (screen-and-treat strategy) affected the costs of patient care.. We compared hospital costs of patients undergoing cardiothoracic or orthopaedic surgery (n=415) in one of the participating centres of the M-RCT. Data from the 'Planning and Control' department were used to calculate total hospital costs of the patients. Total costs were calculated including nursing days, costs of surgery, costs for laboratory and radiological tests, functional assessments and other costs. Costs for personnel, materials and overhead were also included. Mean costs in the two treatment arms were compared using the t-test for equality of means (two-tailed). Subgroup analysis was performed for cardiothoracic and orthopaedic patients.. An investigator-blinded analysis revealed that costs of care in the treatment arm (MUP-CHX, n=210) were on average €1911 lower per patient than costs of care in the placebo arm (n=205) (€8602 vs. €10513, p=0.01). Subgroup analysis showed that MUP-CHX treated cardiothoracic patients cost €2841 less (n=280, €9628 vs €12469, p=0.006) and orthopaedic patients €955 less than non-treated patients (n=135, €6097 vs €7052, p=0.05).. In conclusion, in patients undergoing cardiothoracic or orthopaedic surgery, screening for S. aureus nasal carriage and treating carriers with MUP-CHX results in a substantial reduction of hospital costs.

Topics: Anti-Infective Agents; Chlorhexidine; Humans; Mupirocin; Orthopedics; Staphylococcal Infections; Staphylococcus aureus; Thoracic Surgery

To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU).. Prospective, randomized, controlled, parallel-group, nonblinded clinical trial.. Medical ICUs of 2 French university hospitals.. Five hundred adults with an expected length of stay in the ICU greater than 48 hours.. For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators.. MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions.. In the intent-to-treat analysis ([Formula: see text]), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups ([Formula: see text]). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group ([Formula: see text]), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%; [Formula: see text]). MRSA incidence rates were higher without isolation precautions (7.57‰) than with isolation precautions (2.36‰; [Formula: see text]).. Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation.. Clinicaltrials.gov identifier: NCT00151606.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Female; France; Guideline Adherence; Hospitals, Teaching; Humans; Infection Control; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nose; Patient Isolation; Staphylococcal Infections

Evaluate the feasibility of Staphylococcus aureus nasal colonization and bacteriuria screening in outpatients before realizing a decolonization treatment in S. aureus carriers and a bacteriuria treatment before hospitalization.. All patients undergoing hip, knee or back surgery in which prosthesis were implanted between October 2007 until the end of June 2008 were included. Microbiological studies were performed before hospitalization. Notice for S. aureus decolonization regimen was delivered to each patient and to the general practitioner only if the patient had nasal carriage.. Only 91.2% (240/263) of patients had microbiological results. Prevalence of S. aureus colonization was 21.4% (48 positives/224). Three patients were colonized with methicillin-resistant staphylococci. Decolonization regimen was applied before surgery to 70.8% (n=34) of the colonized patients. Among the patients, 8.9% (20/225) had bacteriuria, Escherichia coli being the most frequent micro-organism (n=16).. Preoperative search and management of S. aureus colonization and of bacteriuria in outpatients is possible. Monitoring record must be performed by a member of the hospital staff.

Topics: Aged; Arthroplasty, Replacement; Bacteriuria; Carrier State; Chlorhexidine; Community-Acquired Infections; Cross Infection; Decontamination; Escherichia coli; Feasibility Studies; Female; Forms and Records Control; Hospitalization; Humans; Male; Medical Records; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nasal Cavity; Preoperative Care; Skin; Staphylococcal Infections; Staphylococcus aureus

Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.. In a randomized, double-blind, placebo-controlled, multicenter trial, we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction (PCR) assay, followed by treatment with mupirocin nasal ointment and chlorhexidine soap, reduces the risk of hospital-associated S. aureus infection.. From October 2005 through June 2007, a total of 6771 patients were screened on admission. A total of 1270 nasal swabs from 1251 patients were positive for S. aureus. We enrolled 917 of these patients in the intention-to-treat analysis, of whom 808 (88.1%) underwent a surgical procedure. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin. The rate of S. aureus infection was 3.4% (17 of 504 patients) in the mupirocin-chlorhexidine group, as compared with 7.7% (32 of 413 patients) in the placebo group (relative risk of infection, 0.42; 95% confidence interval [CI], 0.23 to 0.75). The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21; 95% CI, 0.07 to 0.62). There was no significant difference in all-cause in-hospital mortality between the two groups. The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group (P=0.005).. The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission. (Current Controlled Trials number, ISRCTN56186788.)

Topics: Administration, Intranasal; Anti-Infective Agents; Carrier State; Cause of Death; Chlorhexidine; Cross Infection; Double-Blind Method; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Length of Stay; Logistic Models; Male; Middle Aged; Mupirocin; Nasal Cavity; Ointments; Polymerase Chain Reaction; Skin; Soaps; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity.. A randomized, investigator-blinded, placebo-controlled study was conducted with 31 patients, 6 months to 17 years of age, with moderate to severe atopic dermatitis and clinical signs of secondary bacterial infections. All patients received orally administered cephalexin for 14 days and were assigned randomly to receive intranasal mupirocin ointment treatment and sodium hypochlorite (bleach) baths (treatment arm) or intranasal petrolatum ointment treatment and plain water baths (placebo arm) for 3 months. The primary outcome measure was the Eczema Area and Severity Index score.. The prevalence of community-acquired methicillin-resistant S aureus in our study (7.4% of our S aureus-positive skin cultures and 4% of our S aureus-positive nasal cultures) was much lower than that in the general population with cultures at Children's Memorial Hospital (75%-85%). Patients in the group that received both the dilute bleach baths and intranasal mupirocin treatment showed significantly greater mean reductions from baseline in Eczema Area and Severity Index scores, compared with the placebo group, at the 1-month and 3-month visits. The mean Eczema Area and Severity Index scores for the head and neck did not decrease for patients in the treatment group, whereas scores for other body sites (submerged in the dilute bleach baths) decreased at 1 and 3 months, in comparison with placebo-treated patients.. Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections. Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus.

Topics: Administration, Intranasal; Adolescent; Anti-Bacterial Agents; Body Surface Area; Cephalexin; Child; Child, Preschool; Community-Acquired Infections; Dermatitis, Atopic; Humans; Infant; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Severity of Illness Index; Sodium Hypochlorite; Staphylococcal Infections

To examine the efficacy and tolerability of topical mupirocin for the management of surgically recalcitrant chronic rhinosinusitis (CRS) associated with Staphylococcus aureus infection.. Prospective open-label pilot study.. Patients with surgically recalcitrant CRS who had positive nasendoscopically guided cultures for Staphylococcus aureus were treated with twice daily nasal lavages containing 0.05% Mupirocin and lactated ringers salts. The duration of treatment was 3 weeks. Patients were assessed before and after treatment in terms of nasendoscopic findings, microbiology results, and Sinonasal Outcome Test (SNOT-20) and visual analogue scale questionnaires.. Fifteen of 16 patients had improved nasendoscopic findings after treatment. Twelve of 16 patients noted overall symptom improvement. Fifteen of 16 patients had negative swab results for Staphylococcus aureus after treatment. Only minimal adverse effects were experienced.. Nasal Lavage with 0.05% Mupirocin may represent an effective and well tolerated alternative treatment for postsurgical recalcitrant CRS.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Chronic Disease; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mupirocin; Otorhinolaryngologic Surgical Procedures; Pilot Projects; Prospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Therapeutic Irrigation; Treatment Outcome

The application of mupirocin to the exit-site in peritoneal dialysis (PD) patients decreases peritonitis and exit-site infection (ESI) considerably. However, long-term application of mupirocin may result in the development of methicillin- and mupirocin-resistant strains. In this study, we aimed to investigate the effect of once-a-week vs. thrice-a-week application of mupirocin on mupirocin and methicillin resistance in PD patients.. Thirty-six patients were divided into two groups based on frequency of weekly mupirocin application at the catheter exit-site. In group 1, patients were randomly assigned to apply mupirocin once a week (n = 18), while patients in group 2 applied mupirocin three times a week (n = 18). We obtained cultures from the nares, inguinal area, axillae, and the exit site. The microorganisms reproduced, and the resistance to mupirocin and methicillin were recorded. Three years of follow-up of these patients were also recorded.. During the three-year follow-up period, seven episodes (0.26 episodes/patient-years) of ESI and 13 episodes (0.36 episodes/patient-years) of peritonitis were determined in group 1, and one episode of ESI (0.11 episodes/patient-years) and six episodes (0.24 episodes/patient-years) of peritonitis were determined in group 2. The rate of peritonitis and ESI were, respectively, 56% and 92% lower in group 2 when compared to group I (p = 0.041 and p = 0.038, respectively). Throughout three years, a total of 1852 samples were analyzed. In group 1, S. aureus reproduction rate and mupirocin resistance were 2.11% and 0.2%, respectively. In group 2, S. aureus reproduction rate was 0.93%, and no mupirocin resistance was observed. Methicillin-resistant S. aureus was not observed in both groups. Coagulase-negative staphylococcus (CNS) reproduction rate was 70.56% (mupirocin resistance: 59.87% and methicillin resistance: 33.7%) and 72.56% (mupirocin resistance: 64.7% and methicillin resistance: 33.3%) in groups 1 and 2, respectively. No peritonitis and ESI secondary to S. aureus and fungal agents were observed in both groups.. The thrice-a-week application of mupirocin seems to be more efficient when compared to once-a-week application of mupirocin. Long-term application of mupirocin may cause the development of mupirocin- and methicillin-resistant strains, especially in CNS, which results in a difficulty for struggling against infections.

Topics: Administration, Topical; Aged; Catheters, Indwelling; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Therapy, Combination; Equipment Contamination; Female; Follow-Up Studies; Humans; Kidney Failure, Chronic; Long-Term Care; Male; Methicillin; Middle Aged; Mupirocin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Probability; Reference Values; Risk Assessment; Staphylococcal Infections; Statistics, Nonparametric; Treatment Outcome

Methicillin-resistant Staphylococcus aureus (MRSA) otorrhea has become an increasing problem with regard to infection through the tympanic membrane perforation and postsurgical infection. In particular, dry ear, at the preoperative stage, is considered to be a crucial factor in surgery. We evaluated how to control MRSA otorrhea before and after ear surgery.. Twenty-six patients having MRSA otorrhea were enrolled in the present study and randomly divided into 2 groups, namely, mupirocin ointment therapy for 16 patients and ofloxacin ear drops for 10 patients. Approximately 0.6 mg of mupirocin ointment was administered locally to the tympanic membrane and the promontory around and through the perforation with its adjacent external ear canal 1 to 4 times for 2 or 3 weeks at the clinic. On the other hand, ofloxacin ear drops were administered daily by the patients for 2 or 3 weeks at home.. Complete elimination of MRSA from the ear was obtained in all patients of the mupirocin group. This showed a significant improvement (p < 0.001) as compared with the ofloxacin group (improvement + cure rate, 40%). Local application of mupirocin did not aggravate hearing acuity of any patients who were evaluated by pure-tone audiometry before and after treatment.. The present findings first indicate that minimally essential application of mupirocin ointment is an extremely useful ototopical agent against MRSA otorrhea without ototoxicity.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cerebrospinal Fluid Otorrhea; Child; Female; Follow-Up Studies; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus (S. aureus) is an independent risk factor for orthopaedic surgical site infection (SSI). To determine whether a preoperative decolonization protocol reduces S. aureus SSIs, we conducted a prospective observational study of patients undergoing elective total joint arthroplasty (TJA) at our institution, with two control groups. The concurrent control group comprised patients of surgeons who did not participate in the intervention study. The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study. Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures. S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery. All 164 of 636 participants (26%) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup. In contrast, 1330 concurrent control patients had 12 S. aureus infections. If these infections had occurred in the 26% of patients expected to be nasal carriers of S. aureus at a given time, the infection rate would have been 3.5% (12 of 345) in the control group. In addition, the overall infection rate of the participating surgeons, including nonstaphylococcal infections, decreased from 2.6% during the preintervention period to 1.5% during the intervention period, translating to an adjusted economic gain of $231,741 for the hospital. The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA.. Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthroplasty, Replacement; Baths; Carrier State; Chlorhexidine; Cohort Studies; Cost-Benefit Analysis; Humans; Mupirocin; Nasal Cavity; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage may reduce the risk of MRSA infection and prevent transmission of the organism to other patients.. To determine the efficacy of decolonization therapy, patients colonized with MRSA were randomized (3:1 allocation) to receive treatment (2% chlorhexidine gluconate washes and 2% mupirocin ointment intranasally, with oral rifampin and doxycycline for 7 days), or no treatment. Follow-up samples for MRSA culture were obtained from the nares, perineum, skin lesions, and catheter exit sites monthly for up to 8 months. The primary outcome measure was detection of MRSA at 3 months of follow-up. Univariate and multivariable analyses were performed to identify variables associated with treatment failure.. Of 146 patients enrolled in the study, 112 patients (87 treated; 25 not treated) were followed up for at least 3 months. At 3 months of follow-up, 64 (74%) of those treated had culture results negative for MRSA, compared with 8 (32%) of those not treated (P=.0001). This difference remained significant at 8 months of follow-up, at which time, 54% of those treated had culture results negative for MRSA (chi2=64.4; P<.0001, by log-rank test). The results of the multivariable analysis indicated that having a mupirocin-resistant isolate at baseline was associated with treatment failure (relative risk, 9.4; 95% confidence interval, 2.8-31.9; P=.0003), whereas decolonization therapy was protective (relative risk, 0.1; 95% confidence interval, 0.04-0.4; P=.0002). Mupirocin resistance emerged in only 5% of follow-up isolates.. Treatment with topical mupirocin, chlorhexidine gluconate washes, oral rifampin, and doxycycline for 7 days was safe and effective in eradicating MRSA colonization in hospitalized patients for at least 3 months.

Topics: Administration, Intranasal; Aged; Aged, 80 and over; Carrier State; Chlorhexidine; Doxycycline; Drug Therapy, Combination; Female; Hand Disinfection; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that primarily manifests as uncomplicated skin and soft tissue infections. We conducted a cluster randomized, double-blind, placebo-controlled trial to determine whether targeted intranasal mupirocin therapy in CA-MRSA-colonized soldiers could prevent infection in the treated individual and prevent new colonization and infection within their study groups. We screened 3,447 soldiers comprising 14 training classes for CA-MRSA colonization from January to December 2005. Each training class was randomized to either the mupirocin or placebo study group, and the participants identified as CA-MRSA colonized were treated with either mupirocin or placebo. All participants underwent repeat screening after 8 to 10 weeks and were monitored for 16 weeks for development of infection. Of 3,447 participants screened, 134 (3.9%) were initially colonized with CA-MRSA. Five of 65 (7.7%; 95% confidence interval [95% CI], 4.0% to 11.4%) placebo-treated participants and 7 of 66 (10.6%; 95% CI, 7.9% to 13.3%) mupirocin-treated participants developed infections; the difference in the infection rate of the placebo- and mupirocin-treated groups was -2.9% (95% CI, -7.5% to 1.7%). Of those not initially colonized with CA-MRSA, 63 of 1,459 (4.3%; 95% CI, 2.7% to 5.9%) of the placebo group and 56 of 1,607 (3.5%; 95% CI, 2.6% to 5.2%) of the mupirocin group developed infections; the difference in the infection rate of the placebo and mupirocin groups was 0.8% (95% CI, -1.0% to 2.7%). Of 3,447 participants, 3,066 (89%) were available for the second sampling and completed follow-up. New CA-MRSA colonization occurred in 24 of 1,459 (1.6%; 95% CI, 0.05% to 2.8%) of the placebo group participants and 23 of 1,607 (1.4%; 95% CI, 0.05% to 2.3%) of the mupirocin group participants; the difference in the infection rate of the placebo and mupirocin groups was 0.2% (95% CI, -1.3% to 1.7%). Despite CA-MRSA eradication in colonized participants, this study showed no decrease in infections in either the mupirocin-treated individuals or within their study group. Furthermore, CA-MRSA eradication did not prevent new colonization within the study group.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Community-Acquired Infections; Culture Media; Double-Blind Method; Drug Delivery Systems; Female; Humans; Male; Methicillin Resistance; Military Personnel; Mupirocin; Specimen Handling; Staphylococcal Infections; Staphylococcus aureus

To determine whether the use of chlorhexidine bathing and intranasal mupirocin therapy among patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) would decrease the incidence of MRSA colonization and infection among intensive care unit (ICU) patients.. After a 9-month baseline period (January 13, 2003, through October 12, 2003) during which all incident cases of MRSA colonization or infection were identified through the use of active-surveillance cultures in a combined medical-coronary ICU, all patients colonized with MRSA were treated with intranasal mupirocin and underwent daily chlorhexidine bathing.. After the intervention, incident cases of MRSA colonization or infection decreased 52% (incidence density, 8.45 vs 4.05 cases per 1,000 patient-days; P=.048). All MRSA isolates remained susceptible to chlorhexidine; the overall rate of mupirocin resistance was low (4.4%) among isolates identified by surveillance cultures and did not increase during the intervention period.. We conclude that the selective use of intranasal mupirocin and daily chlorhexidine bathing for patients colonized with MRSA reduced the incidence of MRSA colonization and infection and contributed to reductions identified by active-surveillance cultures. This finding suggests that additional strategies to reduce the incidence of MRSA infection and colonization--beyond expanded surveillance--may be needed.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Baths; Carrier State; Chlorhexidine; Cross Infection; Female; Humans; Infection Control; Intensive Care Units; Male; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Whole-body washing with antiseptic solution has been widely used as part of eradication treatment for colonization with methicillin-resistant Staphylococcus aureus (MRSA), but evidence for the effectiveness of this measure is limited.. To study the efficacy of whole-body washing with chlorhexidine for the control of MRSA.. Randomized, placebo-controlled, double-blinded clinical trial.. University Hospital of Heidelberg and surrounding nursing homes.. MRSA carriers who were not treated concurrently with antibiotics effective against MRSA were eligible for the study.. Five days of whole-body washing with either 4% chlorhexidine solution (treatment group) or with a placebo solution. All patients received mupirocin nasal ointment and chlorhexidine mouth rinse. The outcome was evaluated 3, 4, 5, 9, and 30 days after treatment with swab samples taken from several body sites.. Of 114 patients enrolled in the study (56 in the treatment group and 58 in the placebo group), 11 did not finish treatment (8 from the treatment group and 3 from the placebo group [P=.02]). At baseline, the groups did not differ with regard to age, sex, underlying condition, site of MRSA colonization, or history of MRSA eradication treatment. Eleven patients were MRSA-free 30 days after treatment (4 from the treatment group and 7 from the placebo group [P=.47]). Only groin-area colonization was significantly better eradicated by the use of chlorhexidine. The best predictor for total eradication was a low number of body sites positive for MRSA. Adverse effects were significantly more frequent in the treatment group than in the placebo group (any symptom, 71% vs 33%) but were reversible in most cases.. Whole-body washing can reduce skin colonization, but it appears necessary to extend eradication measures to the gastrointestinal tract, wounds, and/or other colonized body sites if complete eradication is the goal.

Topics: Administration, Intranasal; Aged; Anti-Infective Agents, Local; Baths; Carrier State; Chlorhexidine; Cross Infection; Double-Blind Method; Female; Germany; Hospitals, University; Humans; Male; Methicillin Resistance; Mupirocin; Nursing Homes; Staphylococcal Infections; Staphylococcus aureus

Haemodialysis (HD) patients with meticillin-resistant Staphylococcus aureus (MRSA) infections face high morbidity and mortality. Nasal carriage of Staphylococcus aureus is known to play an important role as an endogenous source for HD-access-related infections that contribute significantly to morbidity, mortality and cost of end-stage renal disease (ESRD) management. This prospective investigation in regular out-clinic haemodialysis patients was undertaken to estimate the prevalence of S.aureus nasal carriage, to define patient groups at risk and to evaluate the effect of elimination on outcomes among outclinic haemodialysis patients.. 136 HD patients without signs of overt clinical infection (48 women, 88 men, age 22-88 years) were screened at least twice for the nasal carriage for meticillin-susceptible SA (MSSA) or meticillin-resistant SA (MRSA). Nasal carriage of S. aureus was related to demographic (age, gender, duration on HD), comorbidity (diabetes, malignancy) and exposure to health care (dialysis staff, hospitalisation). Nasal carriers for MRSA received standardized mupirocin therapy and were followed up for elimination and infections for 1 year.. The prevalence of nasal carriage for staphylococcus aureus was 53 % (41 % MSSA, 12 % MRSA). Compared with patients showing no colonization or with MSSA carriers, the 16 patients with nasal carriage for MRSA were older and more likely to have acquired the bacteria while hospitalised. Genotyping of MRSA isolates revealed different strains in patients and care-providers. Mupirocin eliminated MRSA in all patients, none of these patients experienced an infection caused by staphylococcus aureus, confirming the known value of MRSA elimination from other studies.. Elderly patients hospitalised for surgery constitute a high risk group for nasal carriage for MRSA. Early diagnosis may help prevent clinically relevant infection. Elimination of colonization by mupirocin appears to be an attractive preventive strategy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Carrier State; Female; Germany; Hemodialysis, Home; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nasal Cavity; Outpatients; Prevalence; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus is a common cause of postoperative wound infections, and nasal colonization by this organism is an important factor in the development of infections. Treatment with mupirocin can eradicate the organism in the short term, and prophylactic treatment of colonized patients may prevent postoperative S. aureus infections. A double-blind, randomized, placebo-controlled trial was performed to determine whether nasal mupirocin administered pre-operatively to S. aureus carriers reduces the rates of sternal and leg wound infections after cardiac surgery. The study enrolled 263 patients with nasal S. aureus undergoing elective cardiac surgery at St. Michael's Hospital, Toronto, Canada. Patients were assessed for infections in the immediate postoperative period and two months later. Two hundred and fifty-seven patients were included in the intention-to-treat analysis and re-analysed according to the actual treatment applied. Wound infections occurred in 17 (13.5%) mupirocin recipients and 11 (9.1%) placebo recipients (P=0.319), with seven (5.4%) and six (4.7%) sternal infections, respectively. Two (1.6%) wound infections were acquired postoperatively in the mupirocin group, neither of which were caused by S. aureus. The placebo group had three (2.4%) nosocomial wound infections, with two (1.6%) S. aureus bacteraemias (P=0.243). Among patients receiving mupirocin, 106 (81.5%) cleared S. aureus compared with 59 (46.5%) patients receiving placebo (P<0.0001). There was no significant difference between intention-to-treat and actual treatment groups. Prophylactic intranasal mupirocin administered to S. aureus carriers did not reduce the rates of overall surgical site infections by S. aureus, and only showed a trend towards decreased incidence of nosocomial S. aureus infections.

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Carrier State; Coronary Artery Bypass; Cross Infection; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Nose; Preoperative Care; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

Nasal carriage of Staphylococcus aureus is an important risk factor for S. aureus infections. Mupirocin nasal ointment is presently the treatment of choice for decolonizing the anterior nares. However, recent clinical trials show limited benefit from mupirocin prophylaxis in preventing nosocomial S. aureus infections, probably due to (re)colonization from extranasal carriage sites. Therefore, we studied the effectiveness of mupirocin nasal ointment treatment on the dynamics of S. aureus nasal and extranasal carriage. Twenty noncarriers, 26 intermittent carriers, and 16 persistent carriers had nasal, throat, and perineum samples taken 1 day before and 5 weeks after mupirocin treatment (twice daily for 5 days) and assessed for growth of S. aureus. The identities of cultured strains were assessed by restriction fragment length polymorphisms of the coagulase and protein A genes. The overall carriage rate (either nasal, pharyngeal, or perineal carrier or a combination) was significantly reduced after mupirocin treatment from 30 to 17 carriers (P = 0.003). Of the 17 carriers, 10 (60%) were still colonized with their old strain, 6 (35%) were colonized with an exogenous strain, and 1 (5%) was colonized with both. Two noncarriers became carriers after treatment. The acquisition of exogenous strains after mupirocin treatment is a common phenomenon. The finding warrants the use of mupirocin only in proven carriers for decolonization purposes. Mupirocin is effective overall in decolonizing nasal carriers but less effective in decolonizing extranasal sites.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Humans; Mupirocin; Nose; Ointments; Perineum; Pharynx; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Staphylococcus aureus nasal carriage is a major risk factor for nosocomial S. aureus infection. Studies show that intranasal mupirocin can prevent nosocomial surgical site infections. No data are available on the efficacy of mupirocin in nonsurgical patients.. To assess the efficacy of mupirocin prophylaxis in preventing nosocomial S. aureus infections in nonsurgical patients.. Randomized, double-blind, placebo-controlled trial.. 3 tertiary care academic hospitals and 1 nonacademic hospital.. 1602 culture-proven S. aureus carriers hospitalized in nonsurgical departments.. Therapy with mupirocin 2% nasal ointment (n = 793) or placebo ointment (n = 809), twice daily for 5 days, started 1 to 3 days after admission.. Nosocomial S. aureus infections according to defined criteria, in-hospital mortality, duration of hospitalization, and time to nosocomial S. aureus infection. Staphylococcus aureus isolates were genotyped to assess whether infection was caused by endogenous strains.. The mupirocin and placebo groups did not statistically differ in the rates of nosocomial S. aureus infections (mupirocin, 2.6%; placebo, 2.8%; risk difference, 0.2 percentage point [95% CI, -1.5 to 1.9 percentage points]), mortality (mupirocin, 3.0%; placebo, 2.8%; risk difference, -0.2 percentage point [CI, -1.9 to 1.5 percentage points]), or duration of hospitalization (median for both, 8 days). However, time to nosocomial S. aureus infection was decreased in the mupirocin group from 12 to 25 days (P > 0.2). A total of 77% of S. aureus nosocomial infections were endogenous.. A few infections in both groups may have been missed because investigators assessed a patient for infection only if microbiology culture results were positive for S. aureus.. Routine culture for S. aureus nasal carriage at admission and subsequent mupirocin application does not provide effective prophylaxis against nosocomial S. aureus infections in nonsurgical patients.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Double-Blind Method; Female; Genotype; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Two topical MRSA eradication regimes were compared in hospital patients: a standard treatment included mupirocin 2% nasal ointment, chlorhexidine gluconate 4% soap, silver sulfadiazine 1% cream versus a tea tree oil regimen, which included tea tree 10% cream, tea tree 5% body wash, both given for five days. One hundred and fourteen patients received standard treatment and 56 (49%) were cleared of MRSA carriage. One hundred and ten received tea tree oil regimen and 46 (41%) were cleared. There was no significant difference between treatment regimens (Fisher's exact test; P = 0.0286). Mupirocin was significantly more effective at clearing nasal carriage (78%) than tea tree cream (47%; P = 0.0001) but tea tree treatment was more effective than chlorhexidine or silver sulfadiazine at clearing superficial skin sites and skin lesions. The tea tree preparations were effective, safe and well tolerated and could be considered in regimens for eradication of MRSA carriage.

Topics: Administration, Topical; Anti-Bacterial Agents; Carrier State; Chlorhexidine; Humans; Infection Control; Methicillin Resistance; Mupirocin; Silver Sulfadiazine; Staphylococcal Infections; Staphylococcus aureus; Tea Tree Oil; Treatment Outcome

Staphylococcus aureus nasal carriage is a risk factor for surgical-site infections (SSIs) caused by S. aureus, and eradication of carriage reduces postoperative nosocomial infections caused by it. No study has compared large groups of preoperative carriers and non-carriers to identify factors that are linked to S. aureus nasal carriage.. While conducting a clinical trial evaluating whether mupirocin prevented S. aureus SSIs, we prospectively collected data on 70 patient characteristics that might be associated with S. aureus carriage. We performed stepwise logistic regression analysis.. Of the 4,030 patients, 891 (22%) carried S. aureus. Independent risk factors for S. aureus nasal carriage were obesity (odds ratio [OR], 1.29; 95% confidence interval [CI95], 1.11-1.50), male gender (OR, 1.29; CI95, 1.11-1.51), and a history of a cerebrovascular accident (OR, 1.53; CI95, 1.03-2.25) for all patients. Factors associated with nasal carriage varied somewhat by surgical specialty. In all groups, preoperative use of antimicrobial agents was independently associated with a lower risk of carrying S. aureus in the nares. Previously identified risk factors were not significantly associated with S. aureus nasal carriage in this large group of surgical patients.. Male gender, obesity, and a history of a cerebrovascular accident were identified as risk factors for S. aureus nasal carriage. It remains to be seen whether preoperative weight loss would reduce the rate of nasal carriage. In addition, the value of screening this patient population for S. aureus nasal carriage merits further investigation.

Topics: Adult; Age Factors; Aged; Anti-Bacterial Agents; Carrier State; Cross Infection; Female; Hospitals, University; Hospitals, Veterans; Humans; Iowa; Logistic Models; Male; Middle Aged; Mupirocin; Nasal Mucosa; Prospective Studies; Risk Assessment; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

In the present study, we prospectively investigated the effects of once- or thrice-weekly prophylactic application of mupirocin to catheter exit sites on Staphylococcus aureus carriage, methicillin and mupirocin resistance, and catheter-related infections in continuous ambulatory peritoneal dialysis (CAPD) patients. We enrolled 36 CAPD patients (men/women: 21/ 15; mean age: 55.1 +/- 1.4 years) in the study. At the start of the study, patients had been on once-weekly mupirocin treatment for 3.1 +/- 2.0 years. They were then randomly assigned to use mupirocin either once weekly (group I; n = 18; men/women: 10/8; age: 55.3 +/- 1.8 years) or thrice weekly (group II; n = 18; men/women: 11/7; age: 55.0 +/- 2.3 years). During the study period, swabs were taken monthly from nares, axillae, the inguinal area, and the catheter exit site. We evaluated a total of 806 samples in the first 6 months of the study. The two study groups were similar in terms of age and sex. In group I, 5 isolations of S. aureus in 3 patients came from initial S. aureus carriers. During the first 6 months of the study, only 2 new S. aureus carriers were detected in group I, for a total of 7 isolations. Mupirocin resistance (MuR) was present in only 1 isolate and methicillin resistance (MeR) was not observed. In group II, no S. aureus carriers were present at the initial evaluation, and we encountered only 1 new S. aureus carrier during the first 6 months of the study. During the same period, MuR and MeR were absent in group II. During the 6 months, we observed 1 exit-site infection and 1 peritonitis episode attributable to coagulase-negative staphylococcus (CNS) in group I. In group II, we observed 1 exit-site infection attributable to CNS. During the first 6 months of the study, once- or thrice-weekly application of mupirocin to the catheter exit site has not led to any significant change in S. aureus carriage, MeR and MuR, or catheter-related infection in our CAPD patients.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Catheters, Indwelling; Drug Administration Schedule; Drug Resistance, Microbial; Female; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus is the agent of community-acquired and nosocomial infections. Twenty to 35% of the population permanently carries it in the nose and oropharynx, and additional 50%, carries it intermittently. Topical calcium mupirocin is an antibacterial agent against Staphylococcus aureus recommended to eradicate nasal and hand colonization in patients and health care workers. The prevalence of nasal S. aureus was determined in patients undergoing cardiovascular surgery. In addition, the effect of mupirocine on the number of carriers and rate of nosocomial infections was evaluated. An experimental prospective study was undertaken with two groups of patients: one treated with mupirocin (n = 96), and the other without treatment (n = 95). Tests for presence of nasal S. aureus and nosocomial infections were conducted in all patients. A 34% prevalence of S. aureus carriers was found. A decrease of the prevalence was found in both treated (87%) and untreated patients (33%), but in significantly different proportions (p = 0.0002, RR = 0.22, 95%CI = 0.09-0.054). This result demonstrated the effectiveness of a mupirocin treatment program to decrease numbers of nasal carriers. With regard to nosocomial infection, S. aureus prevalence was 3.6%, occurring mostly in control patients (6 of 7). Total nosocomial infection prevalence was 17.3%, evenly distributed in treated and untreated patients. This suggested that mupirocin use did not decrease the number of nosocomial infections.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Mucosa; Nose; Prevalence; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

The object of this study was to investigate the efficacy of a methicillin-resistant Staphylococcus aureus (MRSA) multisite carriage decolonization in 32 hospitalized carriers--25 from surgical and seven from medical wards. Twenty-four of the patients had wounds (e.g. chronic ulcers, surgical sites) and 17 were spinal cord injury patients. Decolonization was performed by intranasal application of mupirocin, combined with an octenidine dihydrochloride bodywash over a period of five days. Samples from the nose, forehead, neck, axilla and groin were taken 24-48 h before beginning decolonization (sample point I, N=32) and 24-48 h afterwards (sample point II, N=32). Further samples, were taken seven to nine days after the procedure (sample point III, N=25). Contact sheep blood agar plates (24 cm2) were used to quantify MRSA colonies on forehead and neck. MRSA from other sample sites was determined semi-quantitatively. All patients were proven to be MRSA positive at one or more extranasal site(s); 18.8% did not have nasal carriage. The overall decolonization rate for all sites was 53.1% (sample point II) and 64% (sample point III), respectively. The reduction was significant for every site, showing a rate of 88.5% for nose (II, III) and of 56.3% (II) and 68% (III) for all extranasal sites together. Of 32 patients, a median of 6.5 cfu MRSA/24 cm2 was obtained for the forehead before decolonization and 0.5 cfu MRSA/24 cm2 for the neck. A significant reduction (0 cfu MRSA/24 cm2) from both sites was shown after treatment. Before decolonization procedures, median MRSA levels for the nose, groin and axilla were 55, 6 and 0 cfu/swab. After treatment, MRSA from each of these sites was significantly reduced. We conclude that nasal mupirocin combined with octenidine dihydrochloride whole-body wash is effective in eradicating MRSA from patients with variable site colonization.

Topics: Administration, Cutaneous; Administration, Intranasal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Colony Count, Microbial; Drug Resistance, Bacterial; Drug Therapy, Combination; Germany; Hospitals, University; Humans; Imines; Infection Control; Mass Screening; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Prevalence; Pyridines; Skin Care; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Compromised patients subjected to major digestive surgery frequently develop infective complications caused by methicillin-resistant Staphylococcus aureus (MRSA), which may have dangerous consequences. This was a prospective randomized study to determine whether intranasal mupirocin could reduce postoperative infective complications in patients having digestive surgery.. A total of 395 patients who underwent abdominal digestive surgery were assigned randomly into two groups: a treated group (193 patients) and controls (202). Patients in the treated group were given 30 mg mupirocin calcium hydrate ointment topically to each nostril three times a day on each of the 3 days before operation. The untreated group received no mupirocin treatment.. Most infections were due to Gram-negative bacteria in both groups. There were 21 Gram-positive infections detected at the surgical site, ten in the treated group and 11 in control patients. The incidence of pneumonia was significantly different between the groups (none in the treated group and five in control patients; P = 0.028). Four of five patients with pneumonia had a sputum culture containing MRSA.. Intranasal mupirocin treatment had no significant impact on surgical-site infection after digestive surgery.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Digestive System Diseases; Female; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Ointments; Preoperative Care; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Mupirocin has been used in nursing homes to prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA), despite the lack of controlled trials. In this double-blind, randomized study, the efficacy of intranasal mupirocin ointment versus that of placebo in reducing colonization and preventing infection was assessed among persistent carriers of S. aureus. Twice-daily treatment was given for 2 weeks, with a follow-up period of 6 months. Staphylococcal colonization rates were similar between residents at the Ann Arbor Veterans Affairs (VA) Extended Care Center, Michigan (33%), and residents at a community-based long-term care facility in Ann Arbor (36%), although those at the VA Center carried MRSA more often (58% vs. 35%; P=.017). After treatment, mupirocin had eradicated colonization in 93% of residents, whereas 85% of residents who received placebo remained colonized (P<.001). At day 90 after study entry, 61% of the residents in the mupirocin group remained decolonized. Four patients did not respond to mupirocin therapy; 3 of the 4 had mupirocin-resistant S. aureus strains. Thirteen (86%) of 14 residents who became recolonized had the same pretherapy strain; no strain recovered during relapse was resistant to mupirocin. A trend toward reduction in infections was seen with mupirocin treatment.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Double-Blind Method; Drug Resistance, Microbial; Female; Humans; Male; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Clinical efficacy of mupirocin ointment (dermatic and nasal) was evaluated in the treatment of oncologic patients with nosocomial infections of the staphylococcal etiology and carriers of S.aureus among the medical personnel. The use of dermatic ointment of mupirocin, a local antibiotic, in the treatment of the inpatients with nosocomial infections of the staphylococcal etiology allowed to lower at least 2.5 times the number of the prescriptions of vancomycin, a systemic antibiotic. The use of mupirocin nasal ointment provided absolute eradication of S.aureus strains in the carriers. Recolonization of the nasal passages with S.aureus in some carriers started only 3 months after the eradication. A 6-month observation of the carriers after the sanitation showed that the recolonization frequency by the end of the observation period amounted to 19%. A prolonged for more than 4 months effect of the treatment with mupirocin was stated in 81% of the cases. The monitoring of S.aureus circulation in the intrahospital environment revealed that its level during that period was 6 times lower than the initial one which was obviously due to the use of mupirocin (dermatic and nasal) for the carrier sanitation and the patient treatment.

Topics: Administration, Intranasal; Administration, Topical; Anti-Bacterial Agents; Carrier State; Cross Infection; Drug Administration Schedule; Environmental Monitoring; Humans; Infectious Disease Transmission, Professional-to-Patient; Medical Staff, Hospital; Mupirocin; Ointments; Primary Prevention; Staphylococcal Infections; Time Factors

The objective of this study was to determine whether use of mupirocin nasal ointment for perioperative eradication of Staphylococcus aureus nasal carriage is effective in preventing the development of surgical site infections (SSIs). A randomized, double-blind, placebo-controlled design was used. Either mupirocin or placebo nasal ointment was applied twice daily to 614 assessable patients from the day of admission to the hospital until the day of surgery. A total of 315 and 299 patients were randomized to receive mupirocin and placebo, respectively. Eradication of nasal carriage was significantly more effective in the mupirocin group (eradication rate, 83.5% versus 27.8%). In the mupirocin group, the rate of endogenous S. aureus infections was 5 times lower than in the placebo group (0.3% and 1.7%, respectively; relative risk, 0.19; 95% confidence interval, 0.02-1.62). Mupirocin nasal ointment did not reduce the SSI rate (by S. aureus) or the duration of hospital stay.

Topics: Anti-Bacterial Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Ointments; Orthopedics; Perioperative Care; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus

Central venous catheters are frequently needed for the provision of haemodialysis, but their clinical usefulness is severely limited by infectious complications. The risk of such infections can be reduced by topical application of mupirocin to the exit sites of non-cuffed catheters or by the use of tunnelled, cuffed catheters. Whether mupirocin offers any additional protection against infection in patients with tunnelled, cuffed haemodialysis catheters has not been studied.. An open-label, randomized controlled trial was performed comparing the effect of thrice-weekly exit site application of mupirocin (mupirocin group) vs no ointment (control group) on infection rates and catheter survival in patients receiving haemodialysis via a newly inserted, tunnelled, cuffed central venous catheter. All patients were followed until catheter removal and were monitored for the development of exit site infections and catheter-associated bacteraemias.. Fifty patients were enrolled in the study. Both the mupirocin (n=27) and control (n=23) groups were similar at baseline with respect to demographic characteristics, comorbid illnesses and causes of renal failure. Compared with controls, mupirocin-treated patients experienced significantly fewer catheter-related bacteraemias (7 vs 35%, P<0.01) and a longer time to first bacteraemia (log rank score 8.68, P<0.01). The beneficial effect of mupirocin was entirely attributable to a reduction in staphylococcal infection (log rank 10.69, P=0.001) and was still observed when only patients without prior nasal Staphylococcus aureus carriage were included in the analysis (log rank score 6.33, P=0.01). Median catheter survival was also significantly longer in the mupirocin group (108 vs 31 days, log rank score 5.9, P<0.05). Mupirocin use was not associated with any adverse patient effects or the induction of antimicrobial resistance.. Thrice-weekly application of mupirocin to tunnelled, cuffed haemodialysis catheter exit sites is associated with a marked reduction in line-related sepsis and a prolongation of catheter survival.

Topics: Administration, Topical; Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Drug Costs; Equipment Design; Humans; Infection Control; Mupirocin; Pseudomonas Infections; Renal Dialysis; Staphylococcal Infections

We assessed the incidence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) on admission, the rate of acquisition during the hospital stay and the relationship with subsequent infection in a digestive disease unit. The efficacy of a program of nasal carriage eradication with mupirocin was evaluated simultaneously. Over one year 484 patients were studied prospectively on admission for nasal and stool carriage of MRSA, then every week for nasal carriage. Nearly 70% (68.8%) of patients had chronic liver diseases. Nasal carriers were assigned to a five-day course of intranasal mupirocin ointment. One hundred and seventeen (24.2%) patients were MRSA positive, 57 (11.8%) of which were carriers on admission and 60 (12.4%) acquired carriage. Of these, 86 were treated with mupirocin with a success rate of 98.8% and 25.9% of them recolonized. Fourteen patients were retreated, to allow eradication in 71.4% of cases. Seventy percent of these became carriers again. One high-level mupirocin-resistant strain was isolated before treatment and seven during or after treatment. Hospital stay and stool carriage were independently associated with reacquisition (P = 0.0105 and P = 0.0462, respectively). Molecular analysis showed identity between the strains isolated from infection samples and from nasal swabs during the same week. For every patient who became recolonized, nasal strains isolated before and after eradication were the same in 70% of cases. Mortality during hospital stay was independently associated with age (P = 0.0081), MRSA nasal carriage (P = 0.02631), MRSA infection (P < 0.0001) and liver disease (P = 0.0017). This study did not show a change in the prevalence rate of infection in the unit during treatment with mupirocin. This treatment should only be attempted once due to the risk of emergence of high-level resistant strains.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Cross Infection; Drug Resistance, Bacterial; Feces; Female; Hospital Units; Humans; Incidence; Infection Control; Length of Stay; Liver Diseases; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nasopharynx; Paris; Prevalence; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Patients with nasal carriage of Staphylococcus aureus have an increased risk of surgical-site infections caused by that organism. Treatment with mupirocin ointment can reduce the rate of nasal carriage and may prevent postoperative S. aureus infections.. We conducted a randomized, double-blind, placebo-controlled trial to determine whether intranasal treatment with mupirocin reduces the rate of S. aureus infections at surgical sites and prevents other nosocomial infections.. Of 4030 enrolled patients who underwent general, gynecologic, neurologic, or cardiothoracic surgery, 3864 were included in the intention-to-treat analysis. Overall, 2.3 percent of mupirocin recipients and 2.4 percent of placebo recipients had S. aureus infections at surgical sites. Of the 891 patients (23.1 percent of the 3864 who completed the study) who had S. aureus in their anterior nares, 444 received mupirocin and 447 received placebo. Among the patients with nasal carriage of S. aureus, 4.0 percent of those who received mupirocin had nosocomial S. aureus infections, as compared with 7.7 percent of those who received placebo (odds ratio for infection, 0.49; 95 percent confidence interval, 0.25 to 0.92; P=0.02).. Prophylactic intranasal application of mupirocin did not significantly reduce the rate of S. aureus surgical-site infections overall, but it did significantly decrease the rate of all nosocomial S. aureus infections among the patients who were S. aureus carriers.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Many hospital-acquired purulent diseases and wound infections are due to multiresistant hospital strains of Staphylococcus aureus. The role of S. aureus nasal carriage in development of wound infections due to autoinfection is confirmed. Not only inpatients but also hospital staff can be highly colonized with coagulase positive staphylococci. The S. aureus persistence in hospital personnel results in distribution of the microorganisms in the environment. Therefore, detection of S. aureus carriers without signs of the infection among the hospital personnel and eradication of the pathogen make it possible to control outbreaks of S. aureus infection in hospitals. Clinical efficacy of nasal ointment of mupirocin in the treatment of S. aureus carriers among the intensive care personnel of the N. N. Blokhin Cancer Research Center was evaluated. S. aureus nasal carriage was diagnosed in 17 (26 per cent) out of 65 persons. All the isolates were susceptible to oxacillin. 5-7 days after discontinuation of the mupirocin nasal ointment use eradication of S. aureus was stated in 100 per cent of the cases. The effect was still observed in 94 per cent of the cases in 1 month, in 76 per cent of the cases in 5-6 months and in 60 per cent of the cases in 8-9 months. It is believed that mupirocin nasal ointment (Bactroban) is convenient to use, low toxic and highly active in the treatment of persons with S. aureus nasal carriage.

Topics: Anti-Bacterial Agents; Carrier State; Colony Count, Microbial; Humans; Medical Staff, Hospital; Microbial Sensitivity Tests; Mupirocin; Nose; Nose Diseases; Ointments; Staphylococcal Infections; Staphylococcus aureus; Time Factors

The action of mupirocin as a nasal ointment (Bactroban) was studied on intranasal carriers of the hospital staphylococcal strains. The study included 37 medical workers from different and mainly problem units of the large general hospital. The tolerability of the ointment was good. After the Bactroban use no complications of the patients were recorded. The efficacy of Bacroban by the microbiological criteria in total amounted to 100 per cent. The eradication of methicillin resistant Staphylococcus aureus (MRSA) was observed in 93 per cent of the cases. A decrease of the level of the nasal passages dissemination by MRSA and methicillin resistant coagulase-negative staphylococci (MRSC) up to such low titers as 100 and 90 per cent was stated. No difference in the action of Bactroban on MRSA, MSSA and MRSC was noted. The bacteriological monitoring for 3 to 4 months revealed a change of the staphylococcal strains in 94 per cent of the cases, recolonization by the same staphylococcal strain in 19 per cent, recolonization by some another staphylococcal strains in 33 per cent and no recolonization in 14 per cent. A stable decrease of staphylococcal strains was possible with simultaneous Bactroban sanitation of all the bacterial carriers of the hospital or its isolated unit.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Humans; Medical Staff, Hospital; Microbial Sensitivity Tests; Mupirocin; Nose; Nose Diseases; Staphylococcal Infections; Staphylococcus

Nasal carriage of MRSA is a significant risk-factor for the endogenous MRSA infection in immunocompromised patients. MRSA infection in ICU patients is thus mostly endogenous infection. To evaluate the impact of mupirocin use on the incidence of endogenous infection caused by MRSA in an intensive care unit, we prospectively treated all patients in the unit with mupirocin, 3 times daily for 3 days. This routine use of mupirocin led to eradication of nasal MRSA carriage in 81.8% of surveillance cultures and to a significant reduction in the total incidence of MRSA infection among MRSA carrier patients (0 episode in 11 patients) when compared to historical controls prior to the use of mupirocin (3 episodes in 7 patients). Mupirocin nasal ointment was significantly effective to prevent endogenous MRSA infection.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Cross Infection; Humans; Immunocompromised Host; Incidence; Intensive Care Units; Methicillin Resistance; Mupirocin; Ointments; Staphylococcal Infections

The objective of this study was to evaluate the effectiveness of mupirocin on Staphylococcus aureus with regard to peritoneal dialysis (PD)-catheter exit-site infections (ESI), tunnel infections (TI), and peritonitis episodes (PE). The study was performed on 42 continuous ambulatory peritoneal dialysis (CAPD) patients (group I) treated from April 1998 to July 1999. These patients were instructed to apply mupirocin daily at the catheter exit site as part of their exit-site care. The control was the same group's historical infection data. Results were also recorded for a second group of 16 patients (group II) with newly implanted PD catheters were also instructed to apply mupirocin at the exit site daily. During the control period (before daily mupirocin application), group I recorded 16 episodes of ESI (0.30 episodes per patient-year), 6 episodes of TI (0.11 episodes per patient-year), 15 episodes of PE (0.28 episodes per patient-year), and one case of catheter removal (0.019 episodes per patient-year) owing to S. aureus exit-site infection coexisting with peritonitis. The rate of S. aureus exit-site infection during this period was 0.11 episodes per patient-year; of S. aureus tunnel infection, 0.057 episodes per patient-year; and of S. aureus peritonitis, 0.076 episodes per patient-year. During the mupirocin period, infections and peritonitis owing to S. aureus dramatically decreased (p < 0.01 and p < 0.001 respectively). The rate of S. aureus exit-site infection was 0.02 episodes per patient-year, with no S. aureus tunnel infections, and no catheter removals owing to S. aureus peritonitis. Similarly, in group II, no episodes were recorded of any ESI, TI, or PE owing to S. aureus, although 4 episodes of ESI (0.37 episodes per patient-year, 2 with other gram-positive bacteria, and 2 with gram-negative bacteria) and 8 PEs (0.75 episodes per patient-year) were seen. We conclude that mupirocin application provides excellent prophylaxis for catheter-related infections owing to S. aureus, and that reduction of these infections may improve the long-term survival of patients on CAPD.

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

We determined risk factors associated with persistent carriage of methicillin-resistant Staphylococcus aureus (MRSA) among 102 patients enrolled in a double-blind, placebo-controlled trial of nasally administered mupirocin ointment. MRSA decolonization was unsuccessful in 77 (79%) of 98 patients who met the criteria for evaluation. By univariate analysis, 4 variables were found to be associated with persistent MRSA colonization (P < .1 for all 4): absence of mupirocin treatment, previous fluoroquinolone therapy, > or = 2 MRSA-positive body sites, and low-level mupirocin resistance. After multivariable Cox proportional hazards modeling, the presence of > or = 2 positive body sites (adjusted hazard ratio [AHR], 1.7; 95% confidence interval [CI], 1.0-2.9) and previous receipt of a fluoroquinolone (AHR, 1.8; 95% CI, 1.0-3.3) were independently associated with MRSA persistence, whereas nasal mupirocin tended to confer protection (AHR, 0.6; 95% CI, 0.4-1.0). Low-level mupirocin resistance was observed in 9 genotypically different MRSA strains and was not independently associated with chronic MRSA carriage (AHR, 1.5; 95% CI, 0.9-2.5). Our findings suggest that multisite MRSA carriage and previous receipt of a fluoroquinolone are independent risk factors for persistent MRSA colonization.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Double-Blind Method; Female; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Mupirocin has been widely used for the clearance of nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage during outbreaks, but no placebo-controlled trial has evaluated its value for eradicating MRSA carriage at multiple body sites in settings where MRSA is not epidemic. In a 1,500-bed teaching hospital with endemic MRSA, 102 patients colonized with MRSA were randomized into a double-blind, placebo-controlled trial and treated with either mupirocin (group M) or placebo (group P) applied to the anterior nares for 5 days; both groups used chlorhexidine soap for body washing. Follow-up screening, susceptibility testing, and genotyping were performed to evaluate treatment success, mupirocin or chlorhexidine resistance, and exogenous recolonization. At baseline, MRSA carriage was 60% in the nares, 38% in the groin, and 62% in other sites (skin lesions, urine). The MRSA eradication rate (all body sites) was 25% in group M (12 of 48 patients), compared to 18% in group P (9 of 50 patients; relative risk [RR], 0.72; 95% confidence interval [CI95], 0.33 to 1.55). At the end of follow-up, 44% of patients (19 of 43) were free of nasal MRSA in group M, compared to 23% (11 of 44) in group P (RR, 0.57; CI95, 0.31 to 1.04). Ten patients developed MRSA infections (three in group M and seven in group P). One mupirocin treatment failure was due to exogenous MRSA recolonization. No MRSA isolate showed chlorhexidine resistance or high-level mupirocin resistance; however, we observed an association (P = 0.003) between low-level mupirocin resistance at study entry (prevalence, 23%) and subsequent treatment failure in both study arms. These results suggest that nasal mupirocin is only marginally effective in the eradication of multisite MRSA carriage in a setting where MRSA is endemic.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Double-Blind Method; Drug Resistance, Microbial; Female; Genotype; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Staphylococcal Infections

We performed a randomized prospective study of 5-day treatment with topical mupirocin or bacitracin for the elimination of Staphylococcus aureus nasal colonization in healthcare workers (HCWs). Nasal cultures were obtained from 141 HCWs, 37 (26%) of whom showed S. aureus. After 72 to 96 hours of treatment, the organism was eradicated in 15 (94%) of 16 by mupirocin and in 8 (44%) of 18 by bacitracin (P = .0031). Similar efficacy was demonstrated at 30 days. Mupirocin may be more effective than bacitracin for eradication of S. aureus in healthy HCWs.

Topics: Adult; Anti-Bacterial Agents; Bacitracin; Carrier State; Cross Infection; Female; Humans; Infection Control; Infectious Disease Transmission, Professional-to-Patient; Male; Mupirocin; Nasal Mucosa; Prospective Studies; Single-Blind Method; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

The study objective was to measure the benefits of elimination of nasal carriage of Staphylococcus aureus by calcium mupirocin ointment in patients undergoing continuous ambulatory peritoneal dialysis. The design was a prospective, placebo-controlled, randomized clinical trial. The subjects were 267 patients recruited from nine renal units in Belgium, France and the UK. The main outcome measures were the rate of catheter exit site infection (ESI), rates of other infections and healthcare costs from the perspective of a hospital budget-holder. The rate of ESI caused by S. aureus was significantly reduced from one in 28.1 patient months to one in 99.3 patient months (P = 0.006) and there were also non-significant trends towards lower rates of ESI caused by any organism and peritonitis caused by S. aureus. In comparison with the placebo group, patients in the mupirocin group with ESI had lower antibiotic (P = 0.02) and hospitalization costs (P = 0.065). However, overall costs of antibiotic treatment, for all infections combined, were not significantly different (P = 0.2) and total antibiotic costs (including mupirocin) were significantly higher in the mupirocin group (P = 0.001). Mupirocin prophylaxis would have been cost-neutral if the rate of ESI increased to >75% in the placebo group, or if all healthcare costs increased by 40%, or if the cost of screening was reduced from Pound Sterling 15 to Pound Sterling 3 per patient, or if the cost of mupirocin treatment was reduced from Pound Sterling 93 to Pound Sterling 40 per patient year. In conclusion, savings in healthcare costs are unlikely to be sufficiently great to offset the cost of mupirocin and screening for nasal carriage of S. aureus. The decision about whether or not to implement mupirocin should depend on a local analysis of the value of preventing ESIs caused by S. aureus.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Belgium; Cost-Benefit Analysis; Female; France; Health Care Costs; Humans; Length of Stay; Male; Mass Screening; Middle Aged; Mupirocin; Peritoneal Dialysis; Staphylococcal Infections; Staphylococcus aureus; United Kingdom

Seventy-six human immunodeficiency virus (HIV)-infected patients with Staphylococcus aureus nasal carriage were randomized to treatment groups receiving intranasal mupirocin or placebo twice daily for 5 days. Nasal cultures for S. aureus were obtained at 1, 2, 6, and 10 weeks after therapy. At 1 week, 88% of mupirocin-treated patients had negative nasal cultures compared with 8% in placebo patients (P<.001). The percentage of mupirocin-treated patients with persistently negative nasal cultures decreased over time (63%, 45%, and 29% at 2, 6, and 10 weeks, respectively) but remained significantly greater than the placebo group (3% at 2, 6, and 10 weeks). In mupirocin-treated patients, most (16/19) instances of nasal recolonization were with pretreatment strains (determined by means of by pulsed field gel electrophoresis); mupirocin resistance was not observed. Five days of treatment with mupirocin eliminated S. aureus nasal carriage in HIV-infected patients for several weeks; however, since the effect waned over time, intermittent dosing regimens should be considered for long-term eradication.

Topics: Administration, Intranasal; Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Humans; Mupirocin; Nasal Lavage Fluid; Ointments; Placebos; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus from nasal discharge was identified in 37 (2.5%) cardiovascular patients operated between 1995 and 1997; 25 male and 12 female, ranging from 1 to 83 years (mean 63); 2 were excluded because of Arbekacin or Isodine-gel treatment. The first 17 were treated with Vancomycin inhalation (V group) and eradication was considered to have been achieved when 3 consecutive negative cultures were obtained; the subsequent 18 were treated with Mupirocin (M group) and eradication was determined by 1 negative culture. In post-eradication electively operated 13 V and 15 M, postoperative MRSA infection was observed in one M (wound infection); the interval from the first nasal culture to the operation was 68 +/- 58 in V and 32 +/- 12 days in M, respectively (p < 0.05). In the remaining 7 who had to undergo emergency surgery while waiting for eradication because of progression of symptoms (2 V) or prior to instituting treatment (2 V, and 3 M), postoperative MRSA infection was observed in 2 M (both pneumonia). No deaths from infection were observed. Though the time required for conversion of the nasal culture was longer in V (13 +/- 20) than in M (7 +/- 1 days) differences were not significant. Mupirocin is easier to use, eradication can be achieved generally within a week.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cardiac Surgical Procedures; Carrier State; Child; Child, Preschool; Female; Humans; Infant; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Staphylococcal Infections

From September 1997 to March 1998, forty patients with cerebral disorders were investigated. They were divided into two groups: one treated and the other untreated. Mupirocin calcium ointment (MCO) was applied three times a day for three days into the nasal cavities of the patients in the treated group. In order to check the growth of MRSA (methicillin-resistant Staphylococcus aureus), bacterial isolation culture from the nasal cavity was carried out on admission, one week after admission and one month after admission. MRSA was nor detected in isolation culture of any of the cases on admission. One week later MRSA was detected in isolation culture of one case of the 20 MCO treated patients and in three of the 20 untreated patients. There was no significant difference between treated and untreated groups. In isolation culture after one month, MRSA was recognized in four cases of 16 in the MCO treated group (three patients were discharged and one expired). On the other hand, it was recognized in eight cases of thirteen in the untreated group (seven cases were discharged). MRSA infection of the nasal cavity decreased significantly due to MCO treatment (p < 0.05). It is suggested that the nasal carriage of MRSA was prevented by intranasal application of MCO on admission.

Topics: Administration, Intranasal; Adult; Brain Diseases; Cross Infection; Female; Humans; Immunocompromised Host; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nasal Cavity; Ointments; Staphylococcal Infections; Staphylococcus aureus

To determine, among patients undergoing continuous ambulatory peritoneal dialysis (CAPD) who were Staphylococcus aureus nasal carriers, if periodic brief "pulses" of nasal mupirocin calcium ointment 2% after completion of a mupirocin eradication protocol would maintain these patients free of carriage.. Noncomparative, nonblinded study with historical controls.. A county medical center.. Patients in a CAPD program during the period April 1996 to May 1998.. All patients in the CAPD program had monthly nasal cultures for S. aureus. After informed consent, S. aureus nasal carriers were administered mupirocin to the nares twice a day for 5 days followed by nasal mupirocin twice monthly. Peritonitis and exit-site infection rates were monitored independently by CAPD nursing staff. Patients were monitored monthly for adverse effects of mupirocin and compliance with the maintenance regimen.. Twenty-four patients in the CAPD program were enrolled in the study and had a median duration of follow-up of 8.5 months. Fifteen (63%) of the 24 patients remained free of nasal carriage on follow-up cultures. Of the 9 patients with positive nasal cultures during the study, 8 had only one positive culture. There was no significant difference in the mean yearly peritonitis rate or S. aureus peritonitis rate (January 1995-May 1998). However, there was a significant decrease in the mean yearly exit-site infection rates both overall (from 8.8 episodes per 100 patients dialyzed per month in 1995 to 4.0 in 1998; P = .008) and due to S. aureus (from 5.6 in 1995 to 0.9 in 1998; P = .03). Adverse effects of nasal mupirocin were mild overall; 1 patient was removed from the study due to an allergic reaction to mupirocin.. Among CAPD patients who were S. aureus nasal carriers, periodic brief treatment with nasal mupirocin after an initial eradication regimen kept them free of carriage, for the most part, with few adverse effects. The pulse mupirocin regimen offers simplicity and possibly better compliance, as well as minimizing exposure to this agent, thereby possibly reducing the risk of resistance. Further studies are warranted to compare this regimen to other commonly used mupirocin maintenance regimens in dialysis patients.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Drug Administration Schedule; Humans; Middle Aged; Mupirocin; Nose; Ointments; Peritoneal Dialysis, Continuous Ambulatory; Staphylococcal Infections

Central venous catheterization is a common technique to establish rapid and temporary access for hemodialysis. However, it is a known risk factor for Staphylococcus aureus infection and bacteremia. Mupirocin is a topical antibiotic with high in vitro anti-staphylococcal activity. A randomized prospective trial was conducted to assess the effectiveness of mupirocin ointment in the prevention of Staphylococcus aureus skin and catheter colonization, and episodes of bacteremia in 136 end-stage renal disease patients. Of these, 67 received skin disinfection at the venous catheter insertion site with povidone iodine (control group), and 69 received the same treatment followed by application of 2% mupirocin ointment at the cannula site after catheter placement and at the end of each dialysis session. Patients were followed until catheter removal and were monitored for the development of Staphylococcus aureus skin/catheter colonization and episodes of bacteremia. Median duration of catheter use was greater in the mupirocin than in the control group (37 versus 20 d, P < 0.01). Patients in the mupirocin group had a significantly lower rate of Staphylococcus aureus isolation from the pericatheter skin (1.76 per 1000 versus 14.27 per 1000 patient-days, P < 0.001) and from the catheter surface (3.17 per 1000 versus 14.27 per 1000 patient-days, P < 0.001). The proportion of patients with Staphylococcus aureus skin infection at the insertion site was lower in the mupirocin group (4.3% versus 23.9%, P = 0.001). Staphylococcus aureus-associated bacteremia was observed in 17 patients (two in the mupirocin group [0.71 episodes per 1000 patient-days] and 15 in the control group [8.92 per 1000 patient-days], P < 0.001). The hazard ratio of developing Staphylococcus aureus bacteremia was 7.2 (95% confidence interval, 1.6 to 31.6) times greater in patients not receiving mupirocin. Mupirocin applied to the insertion site significantly reduces the risk of Staphylococcus aureus skin and catheter colonization, exit-site infection, and Staphylococcus aureus bacteremia in hemodialysis patients.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Catheterization; Catheterization, Central Venous; Equipment Contamination; Female; Humans; Male; Middle Aged; Mupirocin; Ointments; Prospective Studies; Renal Dialysis; Skin; Staphylococcal Infections; Staphylococcus aureus

We analyzed the effect of perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment on the reduction of the postoperative wound infection rate in orthopedics. In an unblinded intervention trial, we compared 1,044 patients treated with mupirocin (intervention group) with 1,260 historical controls (control group). From each group a random sample of 50 patients was taken. Risk factors were analyzed in these random samples and we found it unlikely that different distributions of risk factors might have influenced the results. The wound infection rates were 14/1,044 in the intervention group and 34/1,260 in the control group (p = 0.02). The rates of wound infections caused by S. aureus were subsequently 7/1,044 and 14/1,260 (p = 0.3). On checking the data we found that prophylaxis had unintentionally not been given to 172 patients in the intervention group. Correction of the data gave a comparable total infection rate, but a further reduced infection rate by S. aureus. Our findings suggest that prophylactic treatment with mupirocin in orthopedic surgery can reduce the infection rate.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Female; Humans; Infection Control; Male; Mupirocin; Nose; Ointments; Orthopedic Procedures; Risk Factors; Staphylococcal Infections; Surgical Wound Infection

The objective of this study was to compare prophylaxis for Staphylococcus aureus infections in peritoneal dialysis patients using 600 mg cyclic oral rifampin for 5 days every 3 months versus mupirocin calcium ointment 2% applied daily to the exit site. The study design was a prospective randomized trial, controlling for S aureus nasal carriage. Eighty-two continuous ambulatory and continuous cyclic peritoneal dialysis patients (54% male, 71 % white, 34% insulin-dependent, mean prestudy time on peritoneal dialysis 1.2 years) were randomly assigned to cyclic rifampin (n = 41 patients) or daily exit site mupirocin prophylaxis (n = 41 patients). Mean follow-up was 1 year. S aureus catheter infection rates were 0.13/yr with mupirocin and 0.15/yr with rifampin (P = NS). Both rates were significantly lower than the center's historical rate (the period between 1983 and 1992) of 0.46/yr prior to the study (P < 0.001). S aureus peritonitis rates were 0.04/yr with mupirocin and 0.02/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.16/yr (P < 0.02). Catheter loss due to S aureus infections was 0.02/yr with mupirocin and 0/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.12/yr (P < 0.001). There were no side effects in patients using mupirocin, but 12% were unable to continue rifampin due to side effects. We conclude that mupirocin ointment at the exit site and cyclic oral rifampin are equally effective in reducing S aureus catheter infections. In addition, rifampin or mupirocin significantly reduced S aureus peritonitis and catheter loss due to S aureus infections. Mupirocin at the exit site provides an excellent alternative prophylaxis for S aureus infections, particularly in patients who cannot tolerate oral rifampin therapy.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Catheters, Indwelling; Chemoprevention; Diabetes Mellitus, Type 1; Drug Administration Schedule; Equipment Contamination; Equipment Failure; Female; Follow-Up Studies; Humans; Male; Mupirocin; Nose; Ointments; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Catheterization; Double-Blind Method; Female; Humans; Incidence; Male; Middle Aged; Mupirocin; Ointments; Peritoneal Dialysis, Continuous Ambulatory; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

To test the hypothesis that perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment reduces the surgical-site infection (SSI) rate in cardiothoracic surgery.. Unblinded intervention trial with historical controls.. A university hospital, tertiary referral center for cardiothoracic surgery.. Consecutive patients undergoing cardiothoracic surgery between August 1, 1989, and February 1, 1991 (historical control group), and between March 1, 1991, and August 1, 1992 (intervention group).. The historical control group consisted of 928 patients and the intervention group of 868, of whom 752 actually were treated. The 116 patients who were unintentionally not treated were considered as a concurrent control group. In the intention-to-treat analysis, a significant reduction in SSI rate was observed after the intervention (historical-control group 7.3% and intervention group 2.8%; P < .0001). The SSI rate in the concurrent control group was significantly higher than in the treated group (7.8% and 2.0%, respectively; P = .0023). Resistance of S aureus to mupirocin was not observed.. The results of this study indicate that perioperative elimination of nasal carriage using mupirocin nasal ointment significantly reduces the SSI rate in cardiothoracic surgery patients and warrants a prospective, randomized, placebo-controlled efficacy trial. This preventive measure may be beneficial in other categories of surgical patients as well.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Female; Humans; Incidence; Infection Control; Male; Middle Aged; Mupirocin; Nasal Mucosa; Ointments; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Thoracic Surgery

To assess the cost-effectiveness of perioperative intranasal application of mupirocin calcium ointment in cardiothoracic surgery.. Cost-effectiveness analysis based on results of an intervention study with historical controls.. University Hospital Rotterdam, a tertiary referral center for cardiac and pulmonary surgery.. Consecutive patients undergoing cardiothoracic surgery between August 1, 1989, and February 1, 1991 (control group, n = 928), and between March 1, 1991, and August 1, 1992 (intervention group, n = 868).. Perioperative nasal application of mupirocin calcium ointment started on the day before surgery, continued for 5 days, twice daily.. Postoperative costs were increased significantly in patients with a surgical-site infection (SSI), compared with uninfected patients (P < .001). Mean SSI-attributable costs were estimated at $16,878 (95% confidence interval, $15,575-$18,181). The incidence of SSIs was 7.3% in the control group and 2.8% in the intervention group, mupirocin effectiveness being 62%. The costs of mupirocin were $11 per patient. Thus, the savings per SSI prevented were $16,633. To validate this comparative estimate of SSI-attributable costs, a noncomparative analysis of the postoperative length of stay (POLS) was performed, according to the Appropriateness Evaluation Protocol. Approximately 50% of the comparative SSI-attributable POLS were judged SSI-attributable in the noncomparative analysis. Sensitivity analyses, testing for the robustness of our conclusions, indicated that the presented model is rather insensitive to variations in the incidence of SSIs and for the effectiveness and costs of mupirocin. SSI-attributable costs were shown to be the only variable with substantial effect on the cost-effectiveness ratio. Perioperative mupirocin would result in net costs instead of savings only if SSI-attributable costs were less than $245.. SSIs in patients undergoing cardiothoracic surgery are associated with a substantial increase in postoperative costs. Provided that perioperative mupirocin reduces the SSI rate, this measure will be highly cost-effective in most centers providing cardiothoracic surgical services.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Cost-Benefit Analysis; Drug Costs; Female; Hospital Costs; Humans; Infection Control; Male; Middle Aged; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Thoracic Surgery

To study the efficacy of mupirocin for the elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients.. The efficacy of mupirocin was studied in a prospectively followed cohort. The effect of this intervention on the rate of S aureus bacteremia was evaluated using a historic control group.. Patients on the hemodialysis unit of the University Hospital Rotterdam, a tertiary referral center.. The study group consisted of consecutive patients on hemodialysis from February 1, 1992, until November 1, 1993. They were screened by taking nasal cultures monthly during their time on hemodialysis. If S aureus was isolated, treatment with mupirocin nasal ointment was initiated. The control group consisted of patients treated on the same hemodialysis unit from January 1, 1990, until January 1, 1992.. The study group consisted of 226 patients, of whom 172 were evaluated to determine the efficacy of mupirocin. Sixty-seven (39%) were identified as nasal carriers. Following the initial treatment, 66 nasal cultures (98.5%) became negative. After 3 months and 6 months, respectively, 63 (94%) and 61 (91%) of the treated carriers had negative cultures. The rate of bacteremia (defined as the number of episodes of S aureus bacteremia per patient-year on hemodialysis) was significantly lower among the 226 patients in the study group (0.04 per patient-year) than among the 273 patients in the control group (0.25 per patient year, P < .001). Development of resistance and adverse effects were not observed.. Mupirocin nasal ointment effectively eliminates nasal carriage of S aureus in patients on hemodialysis. This was associated with a significant reduction of the incidence of S aureus bacteremia, as compared to historic controls.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Mucosa; Ointments; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Fifteen of 20 hemodialysis patients who carried Staphylococcus aureus in their nares also carried the organism on their hands; 2 of 20 patients who did not carry S aureus in their nares carried S aureus on their hands (P < .001). Eighty-seven percent of patients who carried S aureus in their nares and on their hands carried the same strain at both sites. Intranasal mupirocin eliminated S aureus from both sites.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Follow-Up Studies; Humans; Infection Control; Mupirocin; Nasal Mucosa; Renal Dialysis; Skin; Staphylococcal Infections; Staphylococcus aureus

The therapeutic results of 41 cases of S. aureus infected burn wound (average 2.1% TBSA, approximately 200 cm2) treated with Mupirocin are reported in this paper. The effects of Mupirocin was obviously superior to that of SD-Ag used in control group. During the observation period the total effective rate of the studied group was 88.9% (control group: 70%, P < 0.05) and the bacterial clearance rate of S. aureus from the wound was 88.8% (control group: 40% P < 0.05). The sensitivity of 30 strains of S. aureus isolated from burn wounds to 11 varieties of antibiotics indicated that the sensitive rate to Mupirocin was as high as 92.68%, only lower that Vanconmycin. The bacteriological assay (MIC < or = 0.25 mg/L, MIC < or = 4 mg/L) also showed high sensitivity of S. aureus to Mupirocin. We suggest Mupirocin be the first choice of topical antibacterial agents for burn wound with S. aureus infection, especially for infection with MRSA.

Topics: Burns; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Ointments; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Mupirocin is a topically applied drug that is very active in the eradication of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, studies designed to compare mupirocin treatment with other antimicrobial regimens are lacking. We therefore conducted an open, prospective, randomized, controlled trial to compare the efficacy and safety of mupirocin versus those of oral co-trimoxazole plus topical fusidic acid (both regimens with a clorhexidine scrub bath) for the eradication of MRSA from nasal and extranasal carriers of MRSA. The eradication rates with mupirocin and co-trimoxazole plus fusidic acid at 2, 7, 14, 21, 28, and 90 days were 93 and of 93, 100 and 100, 97 and 94, 100 and 92, 96 and 95, and 78 and 71%, respectively, for nasal carriage. At 7, 14, and 28 days the eradication rates for extranasal carriage by the two regimens were 23 and 74, 83 and 76, and 45 and 69%, respectively. The efficacies and safety of both regimens were similar. The MRSA isolates were not resistant to the study drugs either at the baseline or at follow-up. These results suggest that mupirocin and co-trimoxazole plus fusidic acid, both used in conjunction with a chlorhexidine soap bath, are equally effective and safe for the eradication of MRSA from nasal and extranasal MRSA carriers. Mupirocin was easier to use but was more expensive.

Topics: Administration, Oral; Administration, Topical; Cross Infection; Drug Therapy, Combination; Female; Fusidic Acid; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nasal Cavity; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Sixty-eight health care workers were enrolled in a double-blind clinical trial and randomized to receive either mupirocin calcium ointment or placebo, intranasally bid for 5 days. Nasal cultures were taken immediately before starting treatment, 1 and 2 during treatment, at the end of treatment, 3 days later, weekly for 1-5 weeks and then monthly for 2-6 months after treatment. Mupirocin eliminated nasal carriage with Staphylococcus aureus in 58% of subjects within two days and 86.7% subjects by the end of therapy compared to 9.4% subjects at the end of treatment with placebo (P < 0.001). Post-treatment colonization rates of 43%, 56% and 67% were attained after 1 month, 2-4 and 6 months treatment with mupirocin respectively and recolonisation with the same strain of S. aureus that had been isolated before treatment was noted in 32%, 40% and 48%. No resistance to mupirocin developed and the drug was well tolerated. Mupirocin is safe and effective in suppressing nasal carriage of S. aureus.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Carrier State; Colony Count, Microbial; Double-Blind Method; Drug Evaluation; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nasal Cavity; Ointments; Personnel, Hospital; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Mupirocin ointment has been shown to be effective in eradicating Staphylococcus aureus nasal carriage in residents of a long-term care facility. Antiseptic soaps have been used as adjunct to this therapy. We compared the efficacy of short-term intranasal mupirocin ointment with and without chlorhexidine baths in the eradication of S. aureus nasal carriage with follow-up for 12 weeks.. Residents in four nursing homes known to have endemic methicillin-resistant S. aureus were screened for nasal carriage of S. aureus. Residents who had anterior nares cultures positive for S. aureus on two separate occasions were divided into two groups. Both groups received intranasal mupirocin ointment twice daily for 5 days and one group also received chlorhexidine baths for the first 3 days. Cultures of anterior nares, axilla, and groins were performed before treatment and 1 day and 1, 4, 8, and 12 weeks after treatment.. After treatment, S. aureus nasal carriage was eradicated in all residents. Recolonization with S. aureus had occurred at 12 weeks in 24% of residents receiving mupirocin ointment alone (6/25) and in 15% of residents receiving mupirocin ointment plus chlorhexidine baths (4/27).. A short course of mupirocin ointment was effective in eradicating nasal carriage of S. aureus in nursing home residents. There were no statistical differences in efficacy between the two regimens with respect to the eradication of nasal carriage and prevention of recolonization with S. aureus.

Topics: Administration, Intranasal; Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Cross Infection; Drug Therapy, Combination; Female; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nasal Cavity; Nursing Homes; Staphylococcal Infections; Treatment Outcome

Six double-blind, randomised placebo-controlled clinical trials in the United States have evaluated the elimination of Staphylococcus aureus carriage in healthcare workers with mupirocin ointment. Consistent data from the six centres demonstrated that calcium mupirocin ointment administered intranasally for five days is safe and effective in eliminating nasal carriage of S. aureus. Hand cultures were also performed at one centre, showing that hand carriage rates were significantly decreased 72 hours post-therapy and at six months. Additionally, molecular typing of all isolates obtained from the nares and hands found identical strains at both sites in the majority of subjects, implicating the nares as the primary reservoir of S. aureus colonisation.

Topics: Adolescent; Adult; Carrier State; Disease Reservoirs; Double-Blind Method; Female; Hand; Health Personnel; Humans; Infant, Newborn; Male; Middle Aged; Mupirocin; Nasal Mucosa; Ointments; Staphylococcal Infections; Staphylococcus aureus; United States

Whether nasal carriage of Staphylococcus aureus is associated with an increased risk of S. aureus exit-site infection remains controversial. We performed nasal cultures prior to peritoneal dialysis catheter placement in all of our patients beginning in September 1990. We also performed nasal cultures on a cohort of patients already on peritoneal dialysis. Patients with positive cultures received a prescription for a ten-day course of intranasal mupirocin. Exit-site and nasal cultures were performed on every subsequent office visit until the end of the study in April 1993. The initial visit and three widely-spaced subsequent visits were chosen for data analysis. There were 68 patients entered into the study. Data from a total of 272 visits were analyzed. The patients ranged in age from 18-80 years. There were 27 diabetics. We found no correlation between initial positive nasal cultures and the subsequent development of a S. aureus exit-site infection. All identified nasal carriers were treated with mupirocin. However, the subsequent development of a S. aureus exit-site infection could not be correlated to a prior S. aureus carrier state or lack thereof.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Cavity; Peritoneal Dialysis; Prospective Studies; Retrospective Studies; Skin; Staphylococcal Infections; Staphylococcus aureus

We investigated the long-term effect of a single 5-day application of intranasal mupirocin calcium ointment on Staphylococcus aureus nasal and hand colonization. The subjects were 68 healthy volunteers who were health care workers with stable S aureus nasal carriage and who had participated in a randomized, double-blind placebo-controlled clinical trial of intranasal mupirocin ointment.. A 1-year prospective cohort study of S aureus nasal carriers after treatment with active drug or placebo was performed. Cultures were obtained from all subjects 6 and 12 months after therapy. All subjects returned for the 6-month visit; 63 (93%) were examined at 1 year. The major outcome measure was the relative proportion of any S aureus cultured at either site at 6 and 12 months. The S aureus isolates were typed by restriction endonuclease analysis of plasmid DNA and by antibiotic susceptibility tests; the similarity of nasal and hand isolate "fingerprints" was compared.. At 6 months, nasal carriage was 48% in the treatment group vs 72% in controls (relative risk, 0.68; 95% confidence interval, 0.45 to 1.02; P = .054); at 1 year, nasal carriage was 53% vs 76%, respectively (relative risk, 0.70; 95% confidence interval, 0.48 to 1.02; P = .056). Hand carriage at 6 months was significantly reduced among mupirocin recipients relative to controls (15% and 48%; P = .04, adjusted for the baseline rate of hand carriage). Thirty-six percent of treated subjects were recolonized in the nares with a new strain at 1 year, whereas 34% had reisolation of the original strain after initially negative posttherapy cultures. During the year of follow-up, hand carriage was observed at least once in two thirds of the subjects. Nearly all of the hand isolates (87%) exactly matched the subjects' coincident nasal plasmid fingerprint and antibiogram type.. A single brief treatment course of intranasal mupirocin was effective in reducing nasal S aureus carriage for up to 1 year. When S aureus was recovered after nasal decolonization, the new isolate was as likely to represent colonization with a new strain as reisolation of the original strain. Staphylococcus aureus hand carriage was significantly decreased 6 months after therapy, further implicating the nares as the primary reservoir site for hand carriage.

Topics: Administration, Intranasal; Carrier State; Cohort Studies; Hand; Humans; Mupirocin; Nose; Ointments; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Treatment Outcome

Six double-blind, independently randomized studies evaluated the efficacy and safety of calcium mupirocin ointment in eliminating nasal carriage of Staphylococcus aureus among health care workers. Healthy volunteers with stable nasal carriage of S. aureus (n = 339) received either calcium mupirocin ointment (n = 170) or an identical placebo ointment (n = 169) intranasally for 5 days. Nasal carriage was eliminated 48-96 hours after completion of treatment in 130 (91%) of 143 evaluable volunteers receiving mupirocin but in only 8 (6%) of 142 evaluable volunteers receiving placebo. The 85% crude difference represents a 90% pooled (adjusted) estimate of the risk difference (95% confidence interval, 0.86-0.95) and a risk ratio of 16 (P < .0001). This effect of treatment with mupirocin was observed consistently (risk ratio, 8-32) in all six centers. In addition, 96 of the 130 mupirocin-treated volunteers and 1 of the 8 placebo-treated volunteers who were culture-negative at the end of therapy remained free of S. aureus 4 weeks after treatment. Adverse events in each treatment arm were mild and equally frequent. These data, consistent across six institutions, demonstrate that calcium mupirocin ointment administered intranasally for 5 days is safe and effective in eliminating stable nasal carriage of S. aureus.

Topics: Administration, Intranasal; Adolescent; Adult; Carrier State; Double-Blind Method; Female; Health Personnel; Humans; Male; Middle Aged; Mupirocin; Nasal Mucosa; Ointments; Staphylococcal Infections; Staphylococcus aureus

Twenty-six families with recurrent staphylococcal infections were treated with either mupirocin nasal ointment (group M) or chlorhexidine neomycin (Naseptin) cream (group N) to the anterior nares, each combined with chlorhexidine soap for washing and chlorhexidine powder applied to other possible carriage sites. Patients receiving mupirocin following failure with chlorhexidine/neomycin (group M/N) were also treated. Treatment was given for seven days to 99 patients, 32 index (infected) patients and 67 family members. Follow-up swabs were collected by a study nurse 8, 14, 28, and 91 days after starting treatment. The carriage of Staphylococcus aureus in the anterior nares was 67%, in the axillae 22%, in the groin 23%, and perianal 19%. The carriage rates in the index patients was higher than family members, in all sites. The eradication of S. aureus from the nasal carriage site after therapy at 8 days was 95% in group M, 85% in group M/N and 61% in group N. Recolonization during the follow-up period was much less in those treated with mupirocin: 57% of patients in group M and 42% in group M/N were not carriers at 91 days, whereas 89% of patients group N were again colonized. Assessment clinically and in terms of prevention of further infective lesions showed that there was a higher response to mupirocin than to chlorhexidine/neomycin. Mupirocin nasal is a successful therapy for removing nasal carriage of S. aureus and has a prolonged effect on recolonization.

Topics: Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Drug Combinations; Family Health; Humans; Mupirocin; Neomycin; Nose; Ointments; Recurrence; Staphylococcal Infections

To assess the impact of the use of mupirocin ointment on colonization, transmission, and infection with methicillin-resistant Staphylococcus aureus (MRSA) in a long-term-care facility.. All 321 residents of a Veterans Affairs long-term-care facility from June 1990 through June 1991 were studied for MRSA colonization and infection. MRSA-colonized patients received mupirocin ointment to nares in the first 7 months and to nares and wounds in the second 5 months. The effect of mupirocin use on MRSA colonization and infection was monitored. All S. aureus strains isolated were tested for the development of resistance to mupirocin.. A total of 65 patients colonized with MRSA received mupirocin ointment. Mupirocin rapidly eliminated MRSA at the sites treated in most patients by the end of 1 week. Weekly maintenance mupirocin was not adequate to prevent recurrences--40% of patients had recurrence of MRSA. Overall, MRSA colonization in the facility, which was 22.7% +/- 1% prior to the use of mupirocin, did not change when mupirocin was used in nares only (22.2% +/- 2.1%), but did decrease to 11.5% +/- 1.8% when mupirocin was used in nares and wounds. Although colonization decreased, roommate-to-roommate transmission and MRSA infection rates, low to begin with, did not change when mupirocin was used. Mupirocin-resistant MRSA strains were isolated in 10.8% of patients.. Mupirocin ointment is effective at decreasing colonization with MRSA. However, constant surveillance was required to identify patients colonized at admission or experiencing recurrence of MRSA during maintenance treatment. Long-term use of mupirocin selected for mupirocin-resistant MRSA strains. Mupirocin should be saved for use in outbreak situations, and not used over the long term in facilities with endemic MRSA colonization.

Topics: Aged; Carrier State; Cross Infection; Female; Humans; Incidence; Infection Control; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Prevalence; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

We have studied the efficacy of topical Mupirocin for elimination of Staphylococcus aureus (Staph. aureus) nasal carriage in CAPD patients. Staph. aureus nasal carriers in our CAPD program were randomized to one of two groups: Group 1, treated with Mupirocin, and Group 2, treated with neomycin sulphate nasal ointment. The prevalence of Staph. aureus nasal colonization was 44% for patients (24/54) and 17% for dialysis partners (5/29). Group 1 included 11 patients and 1 partner, and Group 2, 8 patients and 2 partners. In Group 1, the eradication rate was 100%, and the recolonization rate was 0, 8, 41, 55 and 66% at 1, 2, 3, 6 and 10 months. In Group 2, the eradication rate was 40%, with a recolonization rate of 0.25 and 75% at 1, 2 and 3 months. Re-treatment with mupirocin was successful in 66% of the cases, compared to 20% for neomycin. The MIC90 of mupirocin for Staph. aureus was 0.5 mcg/mL, with an increase to 4 mcg/mL towards the end of the study. During the study period, there was a very low incidence of Staph. aureus peritonitis or catheter-related infections in patients treated with mupirocin. Secondary effects of mupirocin were negligible. Mupirocin is more effective than neomycin sulphate for the elimination of Staph. aureus nasal colonization in patients undergoing CAPD. Periodic re-treatment is frequently necessary, given the significant recolonization rate.

Topics: Administration, Topical; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nasal Cavity; Neomycin; Peritoneal Dialysis, Continuous Ambulatory; Staphylococcal Infections; Staphylococcus aureus

Thirty patients commencing isotretinoin for acne were entered into a double-blind, randomized, placebo-controlled trial to investigate the effect of pulsed intra-nasal mupirocin ointment on Staphylococcus aureus colonization and isotretinoin-related side-effects. In both mupirocin and placebo groups there was an increase in isolation of S. aureus throughout the period of treatment with isotretinoin from the anterior nares, facial skin and lips. However, these increases were significantly less in the mupirocin-treated group. A high proportion of all patients suffered inflammatory side-effects of isotretinoin such as cheilitis and nasal vestibulitis, with their maximum severities being recorded 2 months after starting isotretinoin. In spite of the smaller increase in S. aureus colonization in the mupirocin-treated group no difference was demonstrated in either the incidence of specific S. aureus infections (e.g. furunculosis) or the prevalence of isotretinoin-related inflammatory side-effects. Furthermore, no relationship between the presence of S. aureus and the severity of inflammatory side-effects was shown. Streptococcus species were isolated on four separate occasions from four different patients during the study but their pathogenicity was unclear. These findings suggest that although pulsed intra-nasal mupirocin produces a significant reduction in isotretinoin-related staphylococcal colonization, its routine use cannot be justified on the basis of clinical benefit.

Topics: Acne Vulgaris; Administration, Intranasal; Adolescent; Adult; Double-Blind Method; Drug Administration Schedule; Female; Humans; Isotretinoin; Male; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Cutaneous; Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Carcinoma, Basal Cell; Cephalexin; Cetrimonium; Cetrimonium Compounds; Chlorhexidine; Drug Combinations; Female; Humans; Male; Middle Aged; Mupirocin; Premedication; Skin Neoplasms; Staphylococcal Infections; Surgical Wound Dehiscence; Surgical Wound Infection

The effectiveness and safety of mupirocin calcium ointment applied to the anterior part of the nares for 5 days in the eradication of nasal carriage of Staphylococcus aureus was investigated in a placebo-controlled, double-blind study. Subjects were healthy medical center staff who had two positive cultures of the anterior nares for S aureus. Antimicrobial susceptibility, phage typing, and restriction endonuclease analysis of plasmid DNA were used to monitor the identity of relapsing and persisting strains. Mupirocin eliminated 74% of S aureus at early follow-up and 91% of original strains. At 4 weeks, 78% of the original strains were eradicated, whereas all of the placebo group remained colonized. Recolonization with mupirocin-resistant strains occurred in six patients, but these were of different phage and plasmid types from the original isolates. None of the subjects had serious adverse effects. Applied intranasally for 5 days, a calcium preparation of mupirocin in a paraffin base is effective in eliminating S aureus nasal carriage and is well tolerated.

Topics: Adult; Carrier State; Double-Blind Method; Drug Resistance, Microbial; Female; Humans; Male; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

To determine the safety and efficacy of mupirocin calcium ointment in the elimination of Staphylococcus aureus nasal and hand carriage in healthy persons.. A double-blind, placebo-controlled, randomized trial.. Clinical research unit of a tertiary medical center.. Health care workers with stable S. aureus nasal carriage.. Subjects (n = 68) were randomly assigned to receive either mupirocin or placebo intranasally twice daily for 5 days.. Cultures of the hands and nares were obtained at baseline and 72 hours after therapy. The nares were also cultured 1, 2, 4, and 12 weeks after therapy. Antimicrobial susceptibility testing and restriction endonuclease analysis of plasmid DNA were used to confirm strain identity. There were no serious side effects. Mupirocin decreased the frequency of S. aureus nasal carriage at each time interval: At 3 months, 71% of subjects receiving mupirocin remained free of nasal S. aureus compared with 18% of controls. This difference (53%; 95% CI; 26% to 80%) was significant (P less than 0.0001). Additionally, analysis of plasmid patterns showed that 79% of subjects in the mupirocin group were free of the initial colonizing strain at 3 months. The proportion of hand cultures positive for S. aureus in the mupirocin group after therapy was lower than in the placebo group (2.9% compared with 57.6%). This difference (53%; 95 CI, 30% to 80%) was significant, after adjustment for the frequency of hand carriage at baseline (P less than 0.0001).. When applied intranasally for 5 days, mupirocin calcium ointment is safe and effective in eliminating S. aureus nasal carriage in healthy persons for up to 3 months and appears to have a corresponding effect on hand carriage at 72 hours after therapy.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Carrier State; Double-Blind Method; Fatty Acids; Female; Hand; Health Workforce; Humans; Male; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus

In a prospective study, 218 cardiothoracic patients, in whom 'Abbocath-T' cannulae had been inserted preoperatively into the internal jugular vein, were randomized to receive skin preparation of the insertion site with tincture of iodine (108 controls) or tincture of iodine followed by application of sterile 2% calcium mupirocin ointment (110 test patients). Cannulae were usually removed within 48 h of the operation. Patients receiving mupirocin were less likely to develop significant colonization of one or more of their cannulae as judged by Maki's criterion of a yield of greater than 15 colony forming units (cfu) from a cannula segment rolled on an agar plate (17% of mupirocin treated patients compared with 54% of the controls, P less than 0.001). Coagulase-negative staphylococci, micrococci, or both, were the commonest isolates and were cultured from 70% of the 186 control cannulae compared with 24% of 172 cannulae inserted through mupirocin-treated skin (P less than 0.001). A count of more than 15 cfu was found on the tips of 25% control cannulae compared with 5% of the cannulae from mupirocin-treated patients, an effect which was independent of in-situ time (P less than 0.001). For cannulae with colonized tips, the same species was isolated from the skin of the insertion site in 67%, from the exterior of the hub in 61% and from the lumen in only 15%. There were no side effects attributed to mupirocin or superinfection with resistant organisms. We conclude that in cardiothoracic patients the application of mupirocin after standard skin preparation with tincture of iodine significantly reduces the colonization of central venous cannulae by organisms derived from the skin insertion site.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteria; Catheterization, Central Venous; Colony Count, Microbial; Fatty Acids; Female; Humans; Jugular Veins; Male; Middle Aged; Mupirocin; Preoperative Care; Prospective Studies; Randomized Controlled Trials as Topic; Skin; Staphylococcal Infections

Mupirocin was used in haemodialysis patients in an attempt to eradicate nasal carriage of Staphylococcus aureus and to prevent infection caused by this microorganism. The effectiveness of calcium mupirocin as a 2% nasal ointment OB2 (16 patients for 104 patient-months) was compared to that of placebo (18 patients for 147 patient-months) in a double-blind study. Mupirocin or placebo were applied in both anterior nares thrice daily for 2 weeks and subsequently three times weekly for a total of 9 months. During therapy, S. aureus was recovered from only 6% of the nasal cultures in the mupirocin group compared to 58% in the placebo group (P less than or equal to 0.01). Only one S. aureus infection was documented in the mupirocin group compared to six in the placebo group (P less than or equal to 0.05). The S. aureus strain causing the single infection in the mupirocin group was of a different phage type to that of the original nasal strain. In contrast, at least four of the six strains causing infection in the placebo group were of similar phage type to the original nasal strain. All S. aureus isolates remained mupirocin sensitive (MIC less than or equal to 1 mg/l). In conclusion, mupirocin nasal ointment was effective in eradicating nasal carriage of S. aureus and in preventing S. aureus infections in patients on haemodialysis.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Carrier State; Clinical Trials as Topic; Double-Blind Method; Fatty Acids; Female; Humans; Male; Middle Aged; Mupirocin; Nose; Ointments; Random Allocation; Renal Dialysis; Staphylococcal Infections

Mupirocin eliminates nasal carriage of Staphylococcus aureus among medical and surgical personnel for periods varying from several weeks up to one year. In persons recolonized after therapy densities of S. aureus populations in nares were much lower than in the same persons before therapy.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Double-Blind Method; Fatty Acids; Humans; Mupirocin; Nose; Personnel, Hospital; Poland; Staphylococcal Infections

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

In a blind controlled trial 2% mupirocin ointment was applied four times a day for five days to the anterior nares of 32 healthy volunteers who were followed-up for at least five weeks. Mupirocin eliminated the persistent carriage of Staphylococcus aureus in all subjects within two days of starting mupirocin. Two weeks after the course S. aureus could not be detected, even in low numbers, in nose swabs from any of the 32 volunteers, and even after five weeks only six had resumed carriage. Of the 14 subjects who ultimately resumed carriage, 57% acquired a different phage type and 29% showed a relapse of colonisation with their pre-treatment strain. There was no evidence of overgrowth with Gram-negative organisms and pre- and post-treatment isolates of S. aureus were sensitive to mupirocin with MICs of 0.06 mg/l or less. There were no side-effects. We suggest that mupirocin may become the topical agent of choice for the elimination of S. aureus from the anterior nares.

Topics: Adult; Anti-Bacterial Agents; Carrier State; Clinical Trials as Topic; Fatty Acids; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nasal Cavity; Ointments; Random Allocation; Recurrence; Staphylococcal Infections

A trial was carried out in general practice in 200 patients presenting with skin infections to compare topical antibiotic treatment with mupirocin ointment with orally administered flucloxacillin or erythromycin. Patients were assigned at random to receive 4 to 10 days' treatment with either mupirocin applied 3-times daily or one of the oral antibiotics in the dosage normally used by the general practitioner for skin infections. The majority of infections were impetigo and infected wounds/lacerations; the main organisms isolated initially from 127 of the patients were either Staphylococcus aureus or beta-haemolytic Group A streptococci. Clinical response to mupirocin ointment (86% cured, 13% improved) was significantly better than that seen with erythromycin (47% cured, 26% improved) and similar to that with flucloxacillin (76% cured, 23% improved). Treatment outcome was not related to treatment duration with either the topical or oral preparations. Post-treatment samples from 76 patients showed that in the mupirocin group all the pathogens originally isolated were eliminated, including Gram-negative organisms.

Topics: Administration, Topical; Anti-Bacterial Agents; Child; Child, Preschool; Erythromycin; Fatty Acids; Female; Floxacillin; Humans; Infant; Male; Mupirocin; Random Allocation; Skin Diseases, Infectious; Staphylococcal Infections; Streptococcal Infections

The in-vitro activity of mupirocin ('pseudomonic acid') was determined against clinical isolates of Staphylococcus aureus with various antibiotic resistance patterns including resistance to methicillin. All 750 isolates were inhibited by 2 mg/l of mupirocin and the MICs for 200 isolates tested on DST agar at pH 7.2 with an inoculum of 10(4) cfu ranged from 0.015 to 0.06 mg/l. Inoculum size, pH, test agar and the method of dissolving mupirocin all influenced the MICs obtained. The minimum concentrations of mupirocin to obtain a 99, and 99.9 and 99.99% kill after 24 h in Iso-Sensitest broth at pH 7.2 were 2-4, 16 and 32 mg/l, respectively. Sterile cultures were obtained when each of five strains were exposed to 1.0 mg/l or more of mupirocin for 120 h. Resistant variants with MICs of up to 4 mg/l were detected at a frequency of approximately 1 X 10(-9) and produced chrome-yellow colonies. Each of five strains could be trained to grow in the presence of 40 mg/l of mupirocin. We conclude that although apparently bacteriostatic, mupirocin has slow bactericidal activity against Staph. aureus and that 2% mupirocin may well be effective for topical treatment of skin infections caused by Staph. aureus and contribute to the control of multiply-resistant strains during hospital outbreaks.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Fatty Acids; Humans; Hydrogen-Ion Concentration; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

To improve adherence with pre-surgical screening for Staphylococcus aureus nasal carriage and decolonization, we need more information about patients' experiences with these protocols.. We surveyed patients undergoing orthopedic, neurosurgical, or cardiac operations at Johns Hopkins Hospitals (JHH), the University of Iowa Hospitals and Clinics (UIHC) at MercyOne Northeast Iowa Neurosurgery (MONIN) to assess patients' experiences with decolonization protocols.. Five hundred thirty-four patients responded. Respondents at JHH were significantly more likely than those at the UIHC to report using mupirocin and were significantly more likely than those at the UIHC and MONIN to feel they received adequate information about surgical site infection (SSI) prevention and decolonization. Respondents at JHH were the least likely to not worry about SSI and they were more willing to do anything they could to prevent SSI. Few patients reported barriers to adherence and side effects of mupirocin or chlorhexidine.. Respondents did not report either major side effects or barriers to adherence. Patients varied in their level of concern about SSI, their willingness to invest effort in preventing SSI, and their assessments of preoperative information. To improve patients' adherence, clinicians and hospitals should assess their patients' needs and desires and tailor their preoperative processes, education, and prophylaxis accordingly.

Topics: Anti-Bacterial Agents; Carrier State; Chlorhexidine; Humans; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Nasal decolonization with mupirocin has been a common strategy for the prevention of surgical site infections (SSIs) and recurrent skin and soft tissue infections due to Staphylococcus aureus (SA). We recently noted an increase in SSIs due to SA, including a case of post-operative mupirocin-resistant methicillin-resistant SA (MRSA) infection despite attempted preoperative decolonization with mupirocin. We therefore evaluated the mupirocin susceptibility of SA at our hospital to determine the optimal regimen for decolonization.. SA isolates were recovered from clinical and screening samples received in the microbiology laboratory. Mupirocin susceptibility was determined using e-tests and isolates were categorized as susceptible or resistant using a breakpoint MIC value of 4mcg/ml.. 223 unique SA isolates from 218 patients were tested. Twenty-four SA isolates (10.8%) were resistant to mupirocin (20 MRSA and 4 methicillin-sensitive SA [MSSA]). MRSA strains were more likely to be resistant to mupirocin than MSSA strains (22.5% vs 3.0%, P < .001).. The emergence of drug resistance makes the policy of decolonization with nasal mupirocin a suboptimal strategy for the prevention of MRSA infections. In our study, less than 80% of MRSA strains were mupirocin susceptible. In patients colonized with MRSA at high risk for infection (eg, total joint replacement), other regimens such as intranasal povidone iodine may be preferable to mupirocin for patient decolonization.

Topics: Anti-Bacterial Agents; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Surgical Wound Infection

Academic hospital nurses were surveyed to assess adherence barriers to a universal povidone-iodine nasal decolonization protocol to prevent

Topics: Anti-Bacterial Agents; Carrier State; Humans; Inpatients; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Mupirocin, a topical antimicrobial agent, is an important component in the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization. The molecular characteristics of 46 mupirocin-resistant MRSA (MR-MRSA) clinical isolates were analyzed by multilocus sequence typing (MLST), staphylococcal cassette chromosome

Topics: Anti-Bacterial Agents; Canada; Genotype; Humans; Isoleucine-tRNA Ligase; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Mupirocin; Staphylococcal Infections

Decolonization of MRSA detected in the oral cavity and tracheal aspirates occurred in 85% and 58% of neonates, respectively, with nasal mupirocin treatment. Recurrent MRSA colonization occurred in 45% of neonates whose MRSA was detected in the oral cavity at a mean of 19 days. Recurrent MRSA colonization occurred in 58% of neonates whose MRSA was detected in tracheal aspirates at a mean of 23 days.

Topics: Anti-Bacterial Agents; Carrier State; Child; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Mupirocin-based decolonization of Staphylococcus aureus carriers undergoing haemodialysis is not widely implemented due to concerns of mupirocin resistance. In our haemodialysis unit, a strategy combining universal S. aureus screening with targeted mupirocin-based decolonization was introduced two decades ago. In this study of haemodialysis patients, mupirocin resistance was assessed in blood and colonizing S. aureus isolates during two periods. Mupirocin resistance in S. aureus was infrequent in both blood and colonizing isolates. Furthermore, in the years 2003-2021, a decreasing trend in the annual rate of S. aureus bloodstream infections was observed. Targeted mupirocin-based decolonization of S. aureus carriers undergoing haemodialysis is a sustainable measure for preventing healthcare-associated infections.

Topics: Anti-Bacterial Agents; Carrier State; Chlorhexidine; Humans; Longitudinal Studies; Mupirocin; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) infections are common in Far North Queensland (FNQ) and their incidence is increasing. Decolonisation regimens that include topical mupirocin are recommended in Australian guidelines to reduce recurrent infection. Mupirocin resistance was identified in 3,932/15,851 (24.8%) methicillin-sensitive Staphylococcus aureus (MSSA) isolates and in 533/5,134 (10.4%) MRSA isolates from FNQ between 1997 and 2016. Factors associated with mupirocin resistance in multivariate analysis were an MSSA isolate, age < 40 years, rural residence and female gender. These data support the use of mupirocin in MRSA decolonisation in FNQ, although addressing the underlying social determinants of health that drive the incidence of S. aureus infections remain a priority for local healthcare provision.

Topics: Adult; Australia; Female; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Queensland; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus haemolyticus is a coagulase-negative commensal organism of both people and companion animals. It has pathogenic potential and when cultured is often meticillin- and multidrug-resistant.. To characterise the clinical features of dogs and cats with clinical skin disease that had positive S. haemolyticus skin cultures, and to employ whole-genome sequencing (WGS) to identify resistance genes and characterise the genetic relatedness of strains.. Isolates were identified by the institutional clinical microbiology laboratory by routine aerobic culture and susceptibility from seven veterinary hospitals across the United States. Then, WGS and analysis of each isolate were performed and clinical data collected via a retrospective clinician questionnaire.. S. haemolyticus was identified from superficial (seven of 12) and deep (five of 12) cutaneous infections in our study. Most animals had received antimicrobials (10 of 12) and/or immunomodulatory drugs (nine of 12) within the six months before culture. WGS analysis revealed a variety of genetic lineages and a wide array of antimicrobial resistance genes. Meticillin resistance was identified in nine of 12 isolates and four of 12 isolates demonstrated mupirocin tolerance.. Staphylococcus haemolyticus may be an under-recognised pathogen in companion animals, and its demonstrated potential for multidrug-resistance, meticillin-resistance, and high-level mupirocin tolerance may create a therapeutic challenge. Further studies should evaluate the prior antimicrobial use and immunocompromised status as risk factors for infection with S. haemolyticus.. Staphylococcus haemolyticus est une bactérie à coagulase négative, commensale des humains et des animaux de compagnie. Elle possède un potentiel pathogène et, en culture, présente souvent des résistances à la méticilline et à plusieurs autres familles d’antibiotiques (bactérie multirésistante).. Étudier les caractéristiques cliniques des infections cutanées à S. haemolyticus canines et féline et utiliser le séquençage du génome entier (WGS) pour identifier les gènes de résistance et caractériser la parenté génétique des souches. MATÉRIELS ET MÉTHODES: Les isolats ont été identifiés par le laboratoire institutionnel de microbiologie clinique par culture aérobie de routine et antibiogramme dans sept hôpitaux vétérinaires américains. Ensuite, le WGS et l'analyse de chaque isolat ont été effectués et les données cliniques recueillies via un questionnaire clinique rétrospectif. RÉSULTATS: Dans notre étude Staphylococcus haemolyticus a été isolé dans des prélèvements provenant d'infections cutanées superficielles (sept sur 12) et profondes (cinq sur 12). La plupart des animaux ont reçu des antimicrobiens (10 sur 12) et/ou des médicaments immunomodulateurs (neuf sur 12) dans les six mois précédant la culture. L'analyse WGS révèle une variété de lignées génétiques et un large éventail de gènes de résistance aux antimicrobiens. La résistance à la méticilline a été identifiée dans neuf des 12 isolats et quatre des 12 isolats présentent une résistance élevée à la mupirocine.. Staphylococcus haemolyticus est un agent pathogène mal connu chez les animaux de compagnie, et son potentiel de multirésistance aux antibiotiques, de résistance à la méticilline et de résistance élevée à la mupirocine peut se révéler un défi thérapeutique. D'autres études devraient évaluer les facteurs de risque d'infection à S. haemolyticus tels que l’utilisation antérieure d'antimicrobiens et le statut immunodéprimé.. INTRODUCCIÓN: Staphylococcus haemolyticus es un organismo comensal coagulasa negativo tanto de personas como de animales de compañía. Tiene potencial patógeno y, cuando se cultiva, a menudo es resistente a la meticilina y a múltiples fármacos. OBJETIVOS: Caracterizar las características clínicas de perros y gatos con enfermedad clínica de la piel que tuviesen cultivos de piel positivos para S. haemolyticus y emplear la secuenciación del genoma completo (WGS) para identificar genes de resistencia y caracterizar la relación genética de las cepas. MATERIALES Y MÉTODOS: El laboratorio de microbiología clínica institucional identificó los aislamientos mediante cultivos aeróbicos de rutina y susceptibilidad de siete hospitales veterinarios en los Estados Unidos. Luego se realizó WGS y análisis de cada aislamiento y se recopilaron datos clínicos a través de un cuestionario clínico retrospectivo. RESULTADOS: Staphylococcus haemolyticus se identificó a partir de infecciones cutáneas superficiales (siete de 12) y profundas (cinco de 12) en nuestro estudio. La mayoría de los animales habían recibido antimicrobianos (10 de 12) y/o fármacos inmunomoduladores (nueve de 12) dentro de los seis meses anteriores al cultivo. El análisis WGS reveló una variedad de linajes genéticos y una amplia gama de genes de resistencia a los antimicrobianos. Se identificó resistencia a la meticilina en nueve de los 12 aislamientos y cuatro de los 12 aislamientos demostraron un alto nivel de resistencia a la mupirocina. CONCLUSIONES Y RELEVANCIA CLÍNICA: Staphylococcus haemolyticus puede ser un patógeno poco reconocido en los animales de compañía, y su potencial demostrado de resistencia a múltiples fármacos, resistencia a la meticilina y resistencia a la mupirocina de alto nivel puede crear un reto terapéutico. Estudios adicionales deberían evaluar el uso previo de antimicrobianos y un estado inmunocomprometido como factores de riesgo para la infección por S. haemolyticus.. Staphylococcus haemolyticus ist ein Koagulase-negativer Kommensale sowohl vom Menschen wie auch von Haustieren. Es handelt sich dabei um einen potenziellen Krankheitserreger, der bei Bakterienkultur oft Methicillin- und Multidrug Resistenz zeigt.. Eine Beschreibung der klinischen Merkmale von Hunden und Katzen mit einer klinischen Hauterkrankung, die eine positive S. haemolyticus Kultur der Haut aufwiesen. Eine Gesamt-Genom Sequenzierung (WGS) sollte eingesetzt werden, um die Resistenzgene zu identifizieren und die genetische Verwandtschaft der Stämme zu beschreiben.. Die Isolate wurden in institutionellen klinischen Mikrobiologie Laboratorien durch routinemäßige aerobe Kulturen und Empfindlichkeitstests in sieben Veterinärmedizinischen Kliniken, verteilt über die gesamten Vereinigten Staaten, identifiziert. Danach wurde eine WGS und Analyse eines jeden Isolates durchgeführt und die klinischen Daten mittels retrospektiver klinischer Fragebogen gesammelt.. Staphylococcus haemolyticus wurde in unserer Studie von oberflächlicher (sieben von 12) und tiefer (fünf von 12) Hautinfektionen identifiziert. Die meisten Tiere erhielten innerhalb der letzten sechs Monate vor der Kultur Antibiotika (10 von 12) und/oder immunmodulierende Medikamente (neun von 12). Die WGS-Analyse zeigte verschiedene genetische Linien und ein großes Ausmaß an antimikrobiellen Resistenzgenen. Eine Methicillin-Resistenz wurde bei neun von 12 Isolaten identifiziert und vier von 12 Isolaten zeigten ein hohes Level an Mupirocin Resistenz.. Bei Staphylococcus haemolyticus könnte es sich um ein zu wenig anerkanntes Pathogen bei Haustieren handeln und sein bewiesenes Potential für eine Multidrug Resistenz, Methicillin Resistenz und ein hohes Level an Mupirocin Resistenz können eine therapeutische Herausforderung darstellen. Weitere Studien sollten die vorherige Verabreichung von Antibiotika und einen Immunkompromittierten Status als Risikofaktoren für eine Infektion mit Staphylococcus haemolyticus evaluieren.. 背景: Staphylococcus haemolyticusは、人およびコンパニオンアニマルの両方に存在するコアグラーゼ陰性常在菌である。この菌は病原性を持ち、培養するとメチシリン耐性や多剤耐性を示すことが多い。 目的: 本研究の目的は、S. haemolyticusの皮膚培養が陽性であった臨床皮膚疾患の犬および猫の臨床的特徴を明らかにし、全ゲノム配列決定(WGS)を用いて耐性遺伝子を特定し、菌株の遺伝的近縁性を明らかにすることであった。 材料と方法: 分離株は、米国内の7つの動物病院から、施設の臨床微生物学研究所がルーチン好気性培養検査および薬剤感受性試験により同定した。その後、各分離株のWGSと解析を行い、レトロスペクティブな臨床医アンケートにより臨床データを収集した。 結果 本研究では、表在性(12例中7例)および深在性(12例中5例)皮膚感染症からStaphylococcus haemolyticusが確認された。ほとんどの動物が培養前6カ月以内に抗菌薬(12例中10例)および/または免疫調節薬(12例中9例)を投与されていた。WGS解析により、多様な遺伝子系統および抗菌薬耐性遺伝子が検出された。12株中9株でメチシリン耐性が確認され、12株中4株で高レベルのムピロシン耐性が確認された。 結論と臨床的関連性: Staphylococcus haemolyticusはコンパニオンアニマルにおいて十分に認存されていない病原体であり、多剤耐性、メチシリン耐性、高レベルのムピロシン耐性を示す可能性があることから、治療上の課題があると思われる。今後の研究では、S. haemolyticusに感染する危険因子として、抗菌薬の使用歴や免疫不全状態を評価する必要がある。.. 背景: 血葡萄球菌是人和伴侣动物的一种凝固酶阴性共生生物。它具有致病潜力，培养时通常对甲氧西林和多药耐药。 目的: 述具有溶血性链球菌皮肤培养阳性的临床皮肤病的犬和猫的临床特征，并采用全基因组测序(WGS)来鉴定耐药基因和鉴定菌株的遗传相关性。 材料和方法: 国七家兽医医院的机构临床微生物学实验室，通过常规需氧培养和敏感性鉴定分离物。然后进行WGS和每个分离物的分析，并通过回顾性临床医生问卷收集临床数据。 结果: 我们的研究中，从浅表(12个中的7个)和深层(12中的5个)皮肤感染中鉴定出溶血葡萄球菌。大多数动物在培养前六个月内接受了抗菌药物(12个中的10个)和/或免疫调节药物(12中的9个)。WGS分析揭示了多种遗传谱系和广泛的抗微生物基因。12株分离株中有9株对甲氧西林耐药，其中4株表现出高水平的莫匹罗星耐药性。 结论和临床相关性: 血葡萄球菌可能是伴侣动物中一种未被充分识别的病原体，其表现出的多药耐药性、甲氧西林耐药性和高水平莫匹罗星耐药性，这些可能会带来治疗挑战。进一步的研究应评估先前的抗菌药物使用情况和免疫功能低下状况，均应作为溶血性链球菌感染的危险因素。.. Staphylococcus haemolyticus é um microrganismo comensal coagulase-negativo de pessoas e animais de companhia. Possui potencial patogênico, e quando cultivado, é frequentemente resistente à meticilina e multirresistente.. Caracterizar as características clínicas de cães e gatos com doenças de pele com culturas de pele positivas para S. haemolyticus, e empregar o sequenciamento de genoma completo (WGS) para identificar genes de resistência e caracterizar o parentesco genético das cepas. MATERIAIS E MÉTODOS: Os isolados foram identificados pelo laboratório institucional de microbiologia clínica por cultura aeróbica de rotina e antibiograma de amostras oriundas de sete hospitais veterinários nos Estados Unidos. Posteriormente, WGS e análise de cada isolado foi realizada e os dados clínicos foram coletados por um questionário clínico retrospectivo.. Staphylococcus haemolyticus foi identificado de infecções cutâneas superficiais (sete de 12) e profundas (cinco de 12) do nosso estudo. A maioria dos animais recebeu antimicrobianos (10 de 12) e/ou medicamentos imunomoduladores (nove de 12) durante os seis meses antes da cultura. Resistência à meticilina foi detectada em nove dos 12 isolados e quatro dos 12 isolados demonstraram alto nível de resistência à mupirocina. CONCLUSÕES E RELEVÂNCIA CLÍNICA: Staphylococcus haemolyticus pode ser um patógeno subdiagnosticado em animais de companhia, e o seu demonstrado potencial para desenvolver multirresistência, resistência à meticilina e alto grau de resistência à mupirocina pode criar um desafio terapêutico. Estudos futuros devem avaliar a utilização prévia de antibióticos e o status de imunocomprometimento como fatores de risco para infecção por S. haemolyticus.

Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Dog Diseases; Dogs; Genomics; Methicillin; Microbial Sensitivity Tests; Mupirocin; Retrospective Studies; Staphylococcal Infections; Staphylococcus haemolyticus; United States

Staphylococcus aureus often leads to severe skin infections. However, S. aureus is facing a crisis of antibiotic resistance. The combination of phage and antibiotics is effective for drug-resistant S. aureus infections. Therefore, it is worth exploiting novel antibacterial agents to cooperate with antibiotics against S. aureus infections. Herein, a novel chimeric lysin ClyQ was constructed, which was composed of a cysteine- and histidine-dependent amidohydrolase/peptidase (CHAP) catalytic domain from S. aureus phage lysin LysGH15 and cell wall-binding domain (CBD) from Enterococcus faecalis phage lysin PlyV12. ClyQ had an exceptionally broad host range targeting streptococci, staphylococci, E. faecalis, and

Topics: Anti-Bacterial Agents; Bacteriophages; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Mupirocin is one of the most effective topically used antibiotic for the treatment of dermatitis, nasal carriage, decolonization of methicillin susceptible Staphylococcus aureus and eradication of methicillin resistant Staphylococcus aureus. Extensive use of this antibiotic has resulted in mupirocin resistance in Staphylococcus aureus which is a matter of concern. This study was conducted to evaluate the high and low level of mupirocin resistance in Staphylococcus aureus collected from various Indian hospitals. A total of 600 samples, of which 436 were pus specimens and 164 wound site swabs were collected from 30 Indian hospitals. Disc diffusion and agar dilution methods were used to test mupirocin susceptibility in methicillin resistant Staphylococcus aureus. Out of 600 Staphylococcus aureus isolates, 176 isolates (29.33%) were found to be methicillin resistant Staphylococcus aureus (MRSA). Out of 176 non-duplicate MRSA strains, 138 isolates were found to be mupirocin sensitive, 21 isolates had high level resistance whereas 17 isolates had low level resistance to mupirocin, which contributed 78.41%, 11.93% and 9.66% respectively. Multidrug resistant susceptibility was tested for all the MRSA with Cefuroxime, Cotrimoxazole and Vancomycin antibiotics. All the high and low level resistant strain were subjected to genome screening for mupA ileS gene respectively. mupA gene was found positive in all the high level resistant strain and out of 17 low level resistant strain, 16 strain were found point mutation in V588F of ileS gene. Overall, high rate of mupirocin resistance was found in the studied samples which might be a result of indiscriminate use of mupirocin in the population of studied region. This data emphasizes the urgent need for formulation of a well-defined and regulated guidelines for mupirocin use. Moreover, continuous surveillance is needed for the use of mupirocin and routine test should be performed to detect MRSA in patients and health care personnel to prevent MRSA infections.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Topics: Cross Infection; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Coagulase-Negative Staphylococci (CoNS) are opportunistic and nosocomial pathogens. The excessive use of antimicrobial agents, including antiseptics, represents one of the world's major public health problems. This study aimed to test the susceptibility of CoNS to antiseptics.. Out of 250 specimens collected from different sections of the hospital, 55 samples were identified as CoNS, categorized into three groups based on their sources: environmental samples (n = 32), healthcare worker carriers samples (n = 14), and clinical infection samples (n = 9). Isolates were examined for susceptibility to antibiotics and antiseptics, such as benzalkonium chloride (BC), cetyltrimethylammonium bromide (CTAB), and chlorhexidine digluconate (CHDG). Mupirocin and antiseptic resistance genes, as well as the mecA gene, were detected using polymerase chain reaction. CoNS isolates with notable resistance to antiseptics and antibiotics were identified using the API-Staph system.. A high frequency of multidrug resistance among CoNS clinical infection isolates was observed. Approximately half of the CoNS isolates from healthcare workers were susceptible to CHDG, but 93% were resistant to BC and CTAB. The frequency of antiseptics and antibiotics resistance genes in CoNS isolates was as follows: qacA/B (51/55; 92.7%), smr (22/55; 40.0%), qacG (1/55; 1.8%), qacH (6/55; 10.9%), qacJ (4/55; 7.3%), mecA (35/55; 63.6%), mupB (10/55; 18.2%), and mupA (7/55; 12.7%). A significant difference in the prevalence of smr gene and qacJ genes between CoNS isolates from healthcare workers and other isolates was reported (P value = 0.032 and ˂0.001, respectively). Four different CoNS species; S. epidermidis, S. chromogene, S. haemolyticus, and S. hominis, were identified by API.. CoNS isolates colonizing healthcare workers showed a high prevalence of antiseptic resistance genes, while clinical infection samples were more resistant to antibiotics. CHDG demonstrated greater efficacy than BC and CTAB in our hospital.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacterial Proteins; Benzalkonium Compounds; Cetrimonium; Coagulase; Humans; Mupirocin; Staphylococcal Infections; Staphylococcus; Staphylococcus epidermidis

Topics: Anti-Bacterial Agents; Chlorhexidine; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Staphylococcal Infections; Vancomycin

Methicillin-resistant

Topics: Animals; Anti-Bacterial Agents; Methicillin-Resistant Staphylococcus aureus; Mice; Microbial Sensitivity Tests; Oxadiazoles; Staphylococcal Infections; Staphylococcus aureus

Outbreaks of MRSA occur in NICUs and may be difficult to control. We describe an outbreak of mupirocin-resistant MRSA, molecular epidemiology of isolates and control.. Medical record review of personnel contact with infants. MRSA isolates were analyzed by whole genome sequencing (WGS); single nucleotide polymorphisms (SNPs) were identified.. A 31-month outbreak of MRSA infection occurred. Weekly colonization surveillance of infants was initiated; initial prevalence was 45%. Isolates exhibited high level mupirocin-resistance. There were 3 periods of increased colonization and new infections despite implementation of multiple infection prevention interventions. During the second period, an analysis identified a frontline staff member associated with newly colonized infants whose nasal culture grew the clonal MRSA. A marked reduction in colonization followed removal from patient contact. WGS of isolates from years 1-3 showed clonality with maximum SNP differences of 33. Importantly, the year 3 isolates were more closely related to the early year 1 isolates (15-20 SNP differences) than to the late year 1 or year 2 isolates (18-33 SNP differences).. During a recrudescent MRSA outbreak due to a clonal strain, both contact with a colonized staff member and a putative environmental or personnel reservoir were associated with MRSA acquisition.

Topics: Cross Infection; Disease Outbreaks; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Whole Genome Sequencing

Methicillin-resistant Staphylococcus aureus (MRSA) is the predominant cause of skin and soft tissue infections (SSTIs), which is a problem in prisons and jails. We conducted this study to understand MRSA molecular characteristics among inmates with SSTIs, and we chose MRSA isolates from a community hospital as a comparison.. A total of 219 MRSA isolates from three custodial facilities and 134 isolates from a community hospital in Taiwan were collected in the 2017 calendar year. MRSA isolates were investigated molecularly by staphylococcal chromosome cassette mec (SCCmec) type, mupirocin, and chlorhexidine genotypical resistance, and multi-locus sequence typing (ST).. ST59, ST8, and ST45 MRSA are the leading three MRSA strains causing SSTIs in Taiwan, 2017, but the molecular distribution varied distinctly between the custodial facilities and hospital settings. The genotypical mupirocin resistance rate is quite high in this study. The frequency of chlorhexidine resistance gene is relatively low, especially in MRSA isolates from custodial facilities.

Topics: Anti-Bacterial Agents; Chlorhexidine; Humans; Jails; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Mupirocin; Prisons; Soft Tissue Infections; Staphylococcal Infections; Staphylococcus; Taiwan

Periprosthetic joint infection (PJI) causes significant morbidity. Methicillin sensitive Staphylococcus aureus (MSSA) is the most frequent organism, and the majority are endogenous. Decolonisation reduces PJIs but there is a paucity of evidence comparing treatments. Aims; compare 3 nasal decolonisation treatments at (1) achieving MSSA decolonisation, (2) preventing PJI.. Our hospital prospectively collected data on our MSSA decolonisation programme since 2013, including; all MSSA carriers, treatment received, MSSA status at time of surgery and all PJIs. Prior to 2017 MSSA carriers received nasal mupirocin or neomycin, from August 2017 until August 2019 nasal octenidine was used.. During the study period 15,958 primary hip and knee replacements were performed. 3200 (20.1%) were MSSA positive at preoperative screening and received decolonisation treatment, 698 mupirocin, 1210 neomycin and 1221 octenidine. Mupirocin (89.1%) and neomycin (90.9%) were more effective at decolonisation than octenidine (50.0%, P < 0.0001). There was no difference in PJI rates (P = 0.452).. Mupirocin and neomycin are more effective than octenidine at MSSA decolonisation. There was poor correlation between the MSSA status after treatment (on day of surgery) and PJI rates. Further research is needed to compare alternative MSSA decolonisation treatments.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Cohort Studies; Drug Resistance, Bacterial; England; Imines; Joint Diseases; Methicillin; Mupirocin; Neomycin; Nose Diseases; Pyridines; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

Since the 1990s few new antibiotics have become available; during the same period the appearance and spread of bacteria no longer susceptible to first- and second-line antibiotics has accelerated; indeed some bacterial infections have become untreatable with existing antibiotics. Control of antibiotic resistance is multifactorial, and includes restrictive antibiotic use and good infection control. This lecture addresses three aspects of antibiotic resistance, with reference to the Netherlands, that illustrate the complexity of antibiotic resistance epidemiology. Initially selective decontamination of the digestive tract (SDD) was not adopted in the Netherlands because of concern about antibiotic resistance. However, three trials showed that SDD regimens, including four days of systemic cephalosporins, gave better clinical outcomes with no effect on antibiotic-resistant bacteria. Many predictions have been made about the impact of infections with antibiotic-resistant bacteria on human health. However, the situation is complex, because the risk factors for infection with multidrug-resistant bacteria are also risk factors for poor clinical outcome. A study in eight Dutch hospitals estimated the mortality attributable to antibiotic resistance as close to zero. Concern about the emergence of resistance in Staphylococcus aureus has limited the universal use of mupirocin to prevent surgical site infections. However, the risk may have been overstated, and universal decolonization with mupirocin and chlorhexidine has now become standard of care in patients undergoing cardiothoracic or orthopaedic surgery in many Dutch hospitals. Prophylactic antibiotics can improve patient outcomes with acceptable risks of promoting resistance.

Topics: Anti-Bacterial Agents; Chlorhexidine; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Humans; Intensive Care Units; Mupirocin; Staphylococcal Infections

Decolonization with topical antimicrobials is frequently prescribed in health care and community settings to prevent Staphylococcus aureus infection. However, effects on commensal skin microbial communities remains largely unexplored. Within a household affected by recurrent methicillin-resistant S. aureus skin and soft tissue infections (SSTI), skin swabs were collected from the anterior nares, axillae, and inguinal folds of 14 participants at 1- to 3-month intervals over 24 months. Four household members experienced SSTI during the first 12-months (observational period) and were prescribed a 5-day decolonization regimen with intranasal mupirocin and bleach water baths at the 12-month study visit. We sequenced the 16S rRNA gene V1-V2 region and compared bacterial community characteristics between the pre- and post-intervention periods and between younger and older subjects. The median Shannon diversity index was stable during the 12-month observational period at all three body sites. Bacterial community characteristics (diversity, stability, and taxonomic composition) varied with age. Among all household members, not exclusively among the four performing decolonization, diversity was unstable throughout the year post-intervention. In the month after decolonization, bacterial communities were changed. Although communities largely returned to their baseline states, relative abundance of some taxa remained changed throughout the year following decolonization (e.g., more abundant

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; RNA, Ribosomal, 16S; Staphylococcal Infections; Staphylococcus aureus; Water

The oxacillin- and cefoxitin-susceptible

Topics: Abscess; Anti-Bacterial Agents; Bacterial Proteins; Cefoxitin; Female; Genomics; Humans; Lactation; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Oxacillin; Penicillin-Binding Proteins; Staphylococcal Infections; Staphylococcus aureus

Surgical site infections (SSIs) are the most common and costly of all hospital-acquired infections, occurring in 5 percent of patients and accounting for 20% of all hospital-acquired infections. Preoperatively, we developed a protocol where patients were screened using hemoglobin A 1c (HbA1c) and nasal swabs. If HbA1c was greater than 9, patients were rescheduled for surgery when their HbA1c was less than 9. All patients then underwent nasal swabs to identify methicillin-sensitive Staphylococcus aureus/methicillin-resistant S. aureus in addition to standard chlorhexidine gluconate bathing. If positive, mupirocin ointment was used to treat the patients 5 days prior to surgery. We sought to measure the effectiveness of this protocol in reducing SSI in elective neurosurgical patients who were undergoing hardware implantation or had a procedure anticipated to last greater than 2 hours.. This was a retrospective review of patients undergoing elective neurosurgical procedures at Conemaugh Memorial Medical Center from 1/1/2014 to 06/30/2016. The intervention period was from 7/1/2016 to 12/20/2018, which included the patients undergoing the protocol.. The preintervention group consisted of 817 cases with a 2.7% infection rate (22 SSIs). The intervention group consisted of 822 cases with a 0.1% infection rate (1 SSI). This observed difference was statistically significant (P = 0.003).. This retrospective review of a presurgical protocol with measuring of HbA1c and nasal swabs revealed a significant decrease in the infection rate of patients undergoing elective neurosurgical procedures. Additional investigations are necessary; however, we recommend its use.

Topics: Anti-Bacterial Agents; Elective Surgical Procedures; Glycated Hemoglobin; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Neurosurgical Procedures; Staphylococcal Infections; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Chlorhexidine; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Carrier State; Chlorhexidine; Cornea; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Prospective Studies; Staphylococcal Infections; Surgeons

Chrysomycin A, a compound derived from marine microorganisms, proved to have a specific great in vitro inhibitory effect on methicillin-resistant

Topics: Aminoglycosides; Anti-Bacterial Agents; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Skin Diseases, Infectious; Staphylococcal Infections

Methicillin-susceptible Staphylococcus aureus (MSSA) is a more prevalent neonatal intensive care unit (NICU) pathogen than methicillin-resistant S. aureus (MRSA). However, the introduction and spread of MSSA, the role of systematic decolonization, and optimal infection prevention and control strategies remain incompletely understood. We previously screened infants hospitalized in a university-affiliated level III to IV NICU twice monthly over 18 months for S. aureus colonization and identified several prevalent staphylococcal protein A (

Topics: Genomics; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Methicillin; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Phylogeny; Staphylococcal Infections; Staphylococcus aureus

Nasal decolonization procedures against the opportunistic pathogen Staphylococcus aureus rely on topical antimicrobial drug usage, whose impact on the nasal microbiota is poorly understood. We examined this impact in healthy S. aureus carriers and noncarriers. This is a prospective interventional cohort study of 8 S. aureus carriers and 8 noncarriers treated with nasal mupirocin and chlorhexidine baths. Sequential nasal swabs were taken over 6 months. S. aureus was detected by quantitative culture and genotyped using spa typing. RNA-based 16S species-level metabarcoding was used to assess the living microbial diversity. The species Dolosigranulum pigrum, Moraxella nonliquefaciens and Corynebacterium propinquum correlated negatively with S. aureus carriage. Mupirocin treatment effectively eliminated S. aureus, D. pigrum and M. nonliquefaciens, but not corynebacteria. S. aureus recolonization in carriers occurred more rapidly than recolonization by the dominant species in noncarriers (median 3 vs. 6 months, respectively). Most recolonizing S. aureus isolates had the same spa type as the initial isolate. The impact of mupirocin-chlorhexidine treatment on the nasal microbiota was still detectable after 6 months. S. aureus recolonization predated microbiota recovery, emphasizing the strong adaptation of this pathogen to the nasal niche and the transient efficacy of the decolonization procedure.

Topics: Carrier State; Chlorhexidine; Cohort Studies; Humans; Microbiota; Mupirocin; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

Chronic rhinosinusitis (CRS) is a common condition negatively impacting a patient's quality of life. It has been hypothesized that bacterial biofilms are involved in the pathogenesis of CRS due to their persistence and difficulty to eradicate with conventional antibiotic therapy. Hence, the topical delivery of antibiotics via nasal rinse solution has gained a lot of attention due to the ability to deliver higher local concentrations, with less systemic absorption and side effects. This study investigates the efficacy of mupirocin dissolved in the 3 most commonly used sinus rinses in Australia Neilmed (isotonic saline), Flo Sinus Care (sodium chloride, sodium bicarbonate, potassium chloride, glucose anhydrous and calcium lactate and Pentahydrate) and FloCRS (sodium chloride, potassium chloride and xylitol).. Planktonic and biofilm cultures of S. aureus (ATCC25923, 2 methicillin-resistant S. aureus (MRSA) (C222 and C263), and 2 methicillin-susceptible S. aureus (MSSS) (C311 and C349) clinical isolates) were treated with mupirocin dissolved in three sinus rinses (Neilmed, Flo Sinus Care and FloCRS with different pH). To establish whether pH was a significant factor in determining antibiotic activity, experiments with Flo CRS were performed both at pH 5.64 and elevated pH 7.7. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined for planktonic cells. The biofilm biomass and metabolic activity were assessed by using crystal violet assay and alamarBlue assay respectively.. The combination of mupirocin in low pH (pH 5.64) sinus rinse (FloCRS) had the highest efficacy in reducing the growth of S. aureus in both the planktonic and biofilm forms. Mupirocin diluted in FloCRS (pH 5.64) showed a significantly higher reduction in both biomass and metabolic activity than that was observed when mupirocin was diluted in Neilmed, Flo Sinus Care or FloCRS (pH 7.7).. The choice of irrigant solution for topical mupirocin delivery appears to be important for antimicrobial activity. The delivery of mupirocin via low pH FloCRS could be useful in eliminating S. aureus biofilms present on the sinus mucosa of patients with CRS.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Humans; Hydrogen-Ion Concentration; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Quality of Life; Sinusitis; Staphylococcal Infections; Staphylococcus aureus

Preoperative methicillin-resistant Staphylococcus aureus (MRSA) testing and decolonization has demonstrated success for arthroplasty patients in surgical site infections (SSIs) prevention. Spine surgery, however, has seen varied results.. The purpose of this study was to determine the impact of nasal MRSA testing and operative debridement rates on surgical site infection after primary lumbar fusion.. Retrospective cohort study and/or Consolidated medical enterprise PATIENT SAMPLE: Adult patients undergoing primary instrumented lumbar fusions from January 2015 to December 2019 were reviewed.. The primary outcome was incision and drainage performed in the operating room within 90 days of surgery.. MRSA testing <90-day's before surgery, mupirocin prescription <30-day's before surgery, perioperative antibiotics, and Elixhauser comorbidity index were collected for each subject. Bivariate analysis used Wilcoxon rank-sum testing and logistic regression modeling Multivariable logistic regression modeling assessed for associations with MRSA testing, intravenous vancomycin use, and I&D rate.. The study included 1,884 patients for analysis, with mean age of 63.1 (SE 0.3) and BMI 29.5 (SE 0.1). MRSA testing was performed in 755 patients (40.1%) and was more likely to be performed in patients with lower Elixhauser index scores (OR 0.98, 95% CI 0.96-0.99, p=.021) on multivariable analysis. Vancomycin use increased significantly over time (OR 1.49 and/or year, 95% CI 1.3-1.8, p<.001) despite no change in mupirocin or I&D rates. MRSA testing, mupirocin prescriptions, perioperative parenteral vancomycin use, and intrawound vancomycin powder use had no impact on I&D rates. I&D risk was associated with higher BMI (OR 1.06, 95% CI 1.02-1.12, p=.009) and higher number of blood product units transfused (OR 1.23, 95% CI 1.03-1.46, p=.022).. The present study demonstrates no impact on surgical I&D rates from the use of preoperative MRSA testing. Increased BMI and transfusions were associated with operative I&D rates for surgical site infection. As a result of the hospital directive, vancomycin use increased over time with no associated change in infection rates, underscoring the need for focused interventions, and engagement with antibiotic stewardship programs.

Topics: Adult; Anti-Bacterial Agents; Humans; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection

Staphylococcus aureus as an opportunistic bacterial pathogen with intrinsic and acquired resistance to many antibiotics is a worldwide problem. The current study was undertaken to evaluate the resistance pattern, and determine the genetic types of multidrug-resistant S. aureus isolated from wound. This cross-sectional study was conducted over the period of two years (from December 2018 to November 2020) at the hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. In present study, 75 multidrug-resistant S. aureus isolates collected from wound infections were investigated. Phenotypic resistance was assessed by Kirby-Bauer disk diffusion method. Conventional PCR was performed for the detection of virulence encoding genes. Genotyping of strains was performed based on coa gene polymorphism using multiplex-PCR assay. SCCmec typing, spa typing and MLST were also used to characterize the genotype of the mupirocin, tigecycline and vancomycin resistant multidrug-resistant S. aureus isolates. All 75 multidrug-resistant S. aureus isolates in the study were confirmed as MRSA. Coagulase typing distinguished isolates into five genotypic patterns including III (40%), I (24%), IVb (16%), V (10.7%) and type X (9.3%). Resistance to tigecycline was detected in 4% of MDR-MRSA isolates and all belonged to CC8/ST239- SCCmec III/t421 lineage. According to our analysis, one VRSA strain was identified that belonged to coa type V and CC/ST22-SCCmec IV/t790 lineage. Resistance to mupirocin was detected in 9.3% of strains. All 7 mupirocin resistant MDR-MRSA isolates exhibited resistance to mupirocin in high level. Of these, 4 isolates belonged to CC/ST8-SCCmec IV/t008 (57.1%), 2 isolates belonged to CC/ST8-SCCmec IV/t064 (28.6%) and one isolate to CC/ST22-SCCmec IV/t790 (14.3%). Altogether, current survey provides a snapshot of the characteristics of S. aureus strains isolated from patients. Our observations highlighted type III as predominant coa type among multidrug-resistant MDR strains indicating low heterogeneity of these isolates. Our study also indicates the importance of continuous monitoring of the genotypes of MDR-MRSA isolates to prevent nosocomial outbreaks and the spread of MDR isolates.

Topics: Anti-Bacterial Agents; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Humans; Iran; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Tigecycline; Vancomycin-Resistant Staphylococcus aureus; Wounds and Injuries

Topics: Anti-Bacterial Agents; Chlorhexidine; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Neurosurgical Procedures; Staphylococcal Infections; Surgical Wound Infection

To investigate the genetic characteristics associated with eradication failure of Staphylococcus aureus in infants below 90 days old.. S. aureus isolated from clinical specimen cultures (blood, surgical tissue, or drainage, pus, etc.) and routine screening cultures in the neonatal intensive care unit (nasal and axillary skin swab) from patients below 90 days old were collected prospectively for 1 year, from August 2017 to July 2018. The isolates underwent typing and screening for genes associated with chlorhexidine (qacA/B), quaternary ammonium (smr), and mupirocin resistance (iles mutation, mupA, mupB), as well as Panton-Valentine leukocidin (PVL) toxin.. During the study period, 40 nonduplicate isolates were included for analyses, of which 70.0% were methicillin-resistant S. aureus (MRSA). Mupirocin resistance was found in 25% of the total isolates; 17.4% of the colonizers; and 35.3% of the pathogens (P = 0.196). Chlorhexidine resistance gene was found in 3 MRSA isolates colonized in the nares of preterm infants. All isolates harbored the disinfectant quaternary ammonium compound (QAC) resistance gene. PVL toxin gene was found in 57.5%, and the presence of PVL gene among colonizers and pathogens was similar (69.6% vs. 41.2%, P = 0.072).. Mupirocin, chlorhexidine, and QAC-resistant MRSAs harboring the PVL toxin gene were found in the nasal carriages of preterm infants. In this highly vulnerable patient population, one-fourth of the isolates harbored mupirocin-resistant genes, and all were resistant to QAC disinfectants. These strains are associated with persistence in both carriage and environmental reservoirs within the hospitals.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Drug Resistance, Bacterial; Female; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

Although in other groups Staphylococcus aureus eradication has proven to be an effective infection prevention measure, to our knowledge, no such studies have been performed in patients on home parenteral nutrition (HPN). The aim of this study was to investigate the efficacy of chronic nasal mupirocin use on S. aureus eradication and prevention of catheter related infections in patients on HPN.. This was a cohort study with data collected from adult patients on HPN who were screened for S. aureus carriage. In case of carriage, the patient was instructed to apply mupirocin nasal ointment monthly. Outcomes were the percentage of successful S. aureus eradication and the effect on the incidence of catheter-related infections and development of mupirocin resistance.. S. aureus nasal carriage was found in 54% of the patients. Eradication was successful in 66% (70 of 106) of patients treated with mupirocin. Overall S. aureus catheter-related infection rates decreased by 50% (P = 0.02). The decrease was mostly due to a drop in central line-associated bloodstream infection (CLABSI) rates (0.26versus 0.1 per 1000 central venous catheter days; P = 0.04). The overall CLABSI rates decreased as well (incidence ratio rate, 0.43; 95% confidence interval. 0.24-0.76; P < 0.01). Low-level mupirocin resistance was observed in four patients.. Findings from the present study highlighted the potential usefulness of mupirocin ointment prophylaxis to establish S. aureus eradication in patients on HPN. However, awareness for the development of mupirocin resistance is prudent. Further research needs to be carried out to validate these findings.

Topics: Adult; Anti-Bacterial Agents; Cohort Studies; Humans; Mupirocin; Parenteral Nutrition, Home; Staphylococcal Infections; Staphylococcus aureus

Patients with epidermolysis bullosa (EB) require care of wounds that are colonized or infected with bacteria. A subset of EB patients are at risk for squamous cell carcinoma, and bacterial-host interactions have been considered in this risk. The EB Clinical Characterization and Outcomes Database serves as a repository of information from EB patients at multiple centers in the United States and Canada. Access to this resource enabled broad-scale analysis of wound cultures.. A retrospective analysis of 739 wound cultures from 158 patients from 13 centers between 2001 and 2018.. Of 152 patients with a positive culture, Staphylococcus aureus (SA) was recovered from 131 patients (86%), Pseudomonas aeruginosa (PA) from 56 (37%), and Streptococcus pyogenes (GAS) from 34 (22%). Sixty-eight percent of patients had cultures positive for methicillin-sensitive SA, and 47%, methicillin-resistant SA (18 patients had cultures that grew both methicillin-susceptible and methicillin-resistant SA at different points in time). Of 15 patients with SA-positive cultures with recorded mupirocin susceptibility testing, 11 had mupirocin-susceptible SA and 6 patients mupirocin-resistant SA (2 patients grew both mupirocin-susceptible and mupirocin-resistant SA). SCC was reported in 23 patients in the entire database, of whom 10 had documented wound cultures positive for SA, PA, and Proteus species in 90%, 50%, and 20% of cases, respectively.. SA and PA were the most commonly isolated bacteria from wounds. Methicillin resistance and mupirocin resistance were reported in 47% and 40% of patients tested, respectively, highlighting the importance of ongoing antimicrobial strategies to limit antibiotic resistance.

Topics: Anti-Bacterial Agents; Canada; Epidermolysis Bullosa; Humans; Mupirocin; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

Skin and soft tissue infections commonly affect athletes and can lead to cluster outbreaks if not managed appropriately. We report the findings of an investigation into an outbreak of community-acquired Staphylococcus aureus infection in an Australian professional football team.. Retrospective cross-sectional study.. Nose, axilla, groin and throat swab were collected from 47 participants. MRSA and MSSA isolates underwent antibiotic susceptibility testing, binary typing and whole genome sequencing. Infection control practitioners (ICPs) investigated the training grounds for risk factors in the transmission of S. aureus.. Almost half of the participants (n=23, 48.9%) were found to be colonised with MSSA. An outbreak cluster of MRSA ST5 closely related to the fusidic acid-resistant New Zealand NZAK3 clone was identified in a group of four players. MSSA ST15 and MSSA ST291 strains were found to have colonised and spread between two and five players, respectively. All participants were advised to undergo decolonisation treatment consisting of 4% chlorhexidine body wash and mupirocin nasal ointment for ten days. The ICP team identified several unhygienic practices within the club's shared facilities that may have played a role in the transmission of S. aureus.. We report for the first time a community-associated S. aureus outbreak involving the highly successful fusidic acid-resistant MRSA ST5 clone in a professional football club associated with inadequate hygiene procedures. Management and prevention of S. aureus relies heavily on hygiene education and adherence to personal and environmental hygiene practices and policies.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Australia; Chlorhexidine; Community-Acquired Infections; Cross-Sectional Studies; Disease Outbreaks; Football; Fusidic Acid; Genome, Bacterial; Humans; Hygiene; Methicillin; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Ointments; Retrospective Studies; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

Methicillin-resistantStaphylococcus aureus (MRSA) remains a major human pathogen. MRSA decolonisation strategies frequently combine chlorhexidine baths and mupirocin nasal ointment. Although MRSA remains widespread in Portuguese hospitals, information regarding resistance to biocides and mupirocin is scarce. We evaluated the prevalence of biocide resistance genes and chlorhexidine and mupirocin non-susceptibility in a representative and well-characterised collection of MRSA isolated in Portuguese hospitals during a 31-year period (1985-2016).. Prevalence of five biocide resistance genes (lmrS, mepA, sepA, qacAB and smr) was determined by PCR. Antibiotic susceptibility was assessed by disk diffusion and by MIC determination using broth microdilution (chlorhexidine) and Etest (mupirocin).. Chromosomal genessepA and mepA were detected in all isolates, while lmrS was found in 87.1%. The prevalence of plasmid-borne genes was significant for qacAB (22.4%), associated with the Iberian (ST247-I/IA) clone (P < 0.0001), and low for smr (1.0%) detected among isolates belonging to the ST239-III/IIIvariant clone. Chlorhexidine non-susceptibility (MIC ≥ 4 mg/L) was observed in two isolates belonging to the EMRSA-15 clone (ST22-IV). Non-susceptibility to mupirocin (MIC > 1 mg/L) was significant (15.4%; n = 31) and mainly found among isolates of the EMRSA-15 clone (P < 0.0001; n = 29). One isolate presented low-level mupirocin resistance (MIC = 32 mg/L), and two missense mutations N213D (A637G) and V588F (G1762T) were identified in the ileS gene.. Concerningly, we detected a high prevalence of biocide resistance genes and an association of mupirocin and chlorhexidine non-susceptibility with the dominant EMRSA-15 clone in Portuguese hospitals.

Topics: Chlorhexidine; Disinfectants; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Portugal; Prevalence; Staphylococcal Infections

Staphylococcus aureus (S.aureus) is both a colonizer as well as a human pathogen that causes a variety of diseases. Mupirocin is a topical antimicrobial agent which is very effective against S.aureus infection. However, treating the S.aureus infection using mupirocin could be complicated due to biofilm formation. Consequently, resistance to mupirocin occurs and leads to chronic infection. The combination of mupirocin with a compound that has biofilm eradicating effect would be an ideal solution for effectively treating biofilm infections. Therefore, in this study, we have investigated the biofilm inhibitory and eradication effect of mupirocin with three essential oils (Cinnamon Oil (CO), Eugenol (EU) and Eucalyptus Oil (EO)) against sessile S.aureus. From these preliminary results, it was found that the mupirocin-CO (0.2 µg/ml-5.218 mg/ml) combination has a better synergistic antibiofilm effect against sessile S.aureus and the fractional inhibitory concentration index was found to be 0.458. The best combination of mupirocin with CO was loaded into a non-greasy O/W cream. The physico-chemical and microbiological evaluations were carried out for the prepared cream. The prepared cream has better biofilm eradication activity (40%) when compared to a marketed cream (20%).

Topics: Anti-Bacterial Agents; Biofilms; Drug Resistance, Bacterial; Eucalyptus Oil; Eugenol; Humans; Microbial Sensitivity Tests; Mupirocin; Oils, Volatile; Skin Cream; Staphylococcal Infections; Staphylococcus aureus

Although presurgical nasal decontamination with mupirocin (NDM) has been advocated as a measure for preventing postsurgical mediastinitis (PSM) due to Staphylococcus aureus, this strategy is not universally recommended due to lack of robust supporting evidence. We aimed to evaluate the role of preoperative NDM in the annual incidence of S. aureus PSM at our institution.. An interrupted time-series analysis, with an autoregressive error model, was applied to our single-center cohort by comparing preintervention (1990-2003) and postintervention (2005-2018) periods. Logistic regression was performed to analyze risk factors for S. aureus PSM.. 12 236 sternotomy procedures were analyzed (6370 [52.1%] and 5866 [47.9%] in the pre- and postintervention periods, respectively). The mean annual percentage adherence to NDM estimated over the postintervention period was 90.2%. Only 4 of 127 total cases of S. aureus PSM occurred during the 14-year postintervention period (0.68/1000 sternotomies vs 19.31/1000 in the preintervention period; P < .0001). Interrupted time-series analysis demonstrated a statistically significant annual reduction in S. aureus PSM of -9.85 cases per 1000 sternotomies (-13.17 to -6.5; P < .0001) in 2005, with a decreasing trend maintained over the following 5 years and an estimated relative reduction of 84.8% (95% confidence interval [CI], 89.25-74.09%). Chronic obstructive pulmonary disease was the single independent risk factor for S. aureus PSM (odds ratio, 3.7; 95% CI, 1.72-7.93) and was equally distributed in patients undergoing sternotomy during pre- or postintervention periods.. Our experience suggests the implementation of preoperative NDM significantly reduces the incidence of S. aureus PSM.

Topics: Anti-Bacterial Agents; Carrier State; Decontamination; Humans; Mediastinitis; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Sternotomy; Surgical Wound Infection

Fatty acid biosynthesis (FASII) enzymes are considered valid targets for antimicrobial drug development against the human pathogen

Topics: Adaptation, Physiological; Anti-Bacterial Agents; Fatty Acids; Guanosine Pentaphosphate; Guanosine Triphosphate; Humans; Malonyl Coenzyme A; Mupirocin; Phospholipids; Staphylococcal Infections; Staphylococcus aureus

Retapamulin activity against 53 isolates obtained from a mupirocin-resistant community-acquired methicillin-resistant Staphylococcus aureus pediatric disease cluster was evaluated using broth microdilution. All strains were susceptible to retapamulin with minimum inhibitory concentrations ≤ 0.5 μg/mL. DNA sequence analysis of rplC and cfr identified one rplC strain variant that did not demonstrate reduced phenotypic susceptibility to retapamulin. These results demonstrate that retapamulin may be a useful alternative therapy for mupirocin-resistant community-acquired methicillin-resistant S. aureus, especially in disease clusters.

Topics: Adolescent; Anti-Bacterial Agents; Bridged Bicyclo Compounds, Heterocyclic; Child; Child, Preschool; Community-Acquired Infections; Diterpenes; Humans; Infant; Infant, Newborn; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Sequence Analysis, DNA; Staphylococcal Infections

Chlorhexidine gluconate (CHG) and mupirocin are widely used to decolonize patients with methicillin-resistant Staphylococcus aureus (MRSA) and reduce risks associated with infection in hospitalized populations. Quantifying the association of an application of CHG alone or in combination with mupirocin with risk of MRSA infection is important for studies evaluating alternative decolonization strategies or schedules and for identifying whether there is room for improved decolonizing agents.. To estimate the proportion of patients with MRSA decolonized per application of CHG and mupirocin from existing population-level studies.. A stochastic mathematical model of an 18-bed intensive care unit (ICU) in an academic medical center operating over 1 year was used to estimate parameters for the proportion of simulated patients with MRSA decolonized per application of CHG and mupirocin. The model was conducted using approximate bayesian computation with data from an existing meta-analysis of studies conducted from February 2005 through January 2015. Data were analyzed from January 2018 through November 2019.. A universal decolonization protocol for colonized patients in the ICU using CHG or CHG and mupirocin in combination was simulated.. The proportion of patients with MRSA decolonized per application of CHG and mupirocin was estimated.. The estimated proportion of patients with MRSA decolonized per application of CHG was 0.15 (95% credible interval, 0.01-0.42), and the estimated proportion per application of mupirocin in conjunction with CHG was 0.15 (95% credible interval, 0.01-0.54). A lag in colonization detection was associated with decreases in the CHG estimate (0.11; 95% credible interval, 0.01-0.30) and mupirocin estimate (0.10; 95% credible interval, 0.00-0.34), which were sensitive to the value of the modeled contact rate between nurses and patients. A 1% increase in the value of this parameter was associated with a 0.73% increase in the estimated combined outcomes associated with CHG and mupirocin (95% CI: 0.71, 0.75). Gaps longer than 24 hours in the administration of decolonizing agents were associated with a decrease of within-ICU MRSA transmission. Compared with a mean (SD) of 1.23 (0.27) acquisitions per 1000 patient-days in scenarios with no decolonizing bathing, a bathing protocol administering CHG and mupirocin every 120 hours was associated with a mean (SD) acquisition rate of 1.03 (0.24) acquisitions per 1000 patient days, a 16.3% decrease (95% CI, 14.7%-18.0%; P > .001).. These findings suggest that there may be room for significant improvement in anti-MRSA disinfectants, including the compounds themselves and their delivery mechanisms. Despite the decolonization estimates found in this study, these agents are associated with robust outcomes after delays in administration, which may help in alleviating concerns over patient comfort and toxic effects.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Humans; Intensive Care Units; Methicillin-Resistant Staphylococcus aureus; Models, Theoretical; Mupirocin; Staphylococcal Infections

Current antimicrobial susceptibility/resistance data versus skin and soft tissue infection (SSTI) pathogens help to guide empirical treatment using topical antimicrobials.. To assess the in vitro activity and resistance rates of fusidic acid, mupirocin, ozenoxacin and comparator agents against pathogens isolated from patients with SSTIs in Canada.. SSTI isolates of MSSA (n = 422), MRSA (n = 283) and Streptococcus pyogenes (n = 46) obtained from CANWARD 2007-18 were tested using CLSI broth microdilution. Fusidic acid low-level resistance was defined as an MIC of ≥2 mg/L and high-level resistance as an MIC ≥512 mg/L. Mupirocin high-level resistance was defined as an MIC ≥512 mg/L and low-level resistance was an MIC of 2-256 mg/L.. Low-level and high-level fusidic acid resistance in MSSA was 10.9% and 1.7%, respectively. Low-level and high-level fusidic acid resistance in MRSA was 10.6% and 3.5%, respectively. High-level mupirocin resistance was identified in 1.4% of MSSA and 14.1% of MRSA, respectively. Versus MSSA, ozenoxacin demonstrated MIC50 and MIC90 of 0.004 and 0.25 mg/L, respectively. Against MRSA, ozenoxacin inhibited all isolates at an MIC of ≤0.5 mg/L, including isolates with ciprofloxacin MICs >2 mg/L, clarithromycin-resistant, clindamycin-resistant, high-level fusidic acid-resistant and high-level mupirocin-resistant isolates.. We conclude that fusidic acid low-level resistance exceeded 10% for both MSSA and MRSA while fusidic acid high-level resistance was ≤3.5%. Mupirocin high-level resistance exceeded 10% in MRSA. Ozenoxacin is active versus SSTI pathogens including MRSA resistant to fluoroquinolones, macrolides, clindamycin, fusidic acid and mupirocin.

Topics: Aminopyridines; Anti-Bacterial Agents; Canada; Fusidic Acid; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Quinolones; Soft Tissue Infections; Staphylococcal Infections; Staphylococcus aureus

Despite the widespread use of chlorhexidine (CHX) to prevent infection, data regarding the in vitro action of CHX against methicillin-resistant Staphylococcus aureus (MRSA) are limited. Clinical isolates from Hospital das Clinicas, Sao Paulo, Brazil, identified during 2002/2003 and 2012/2013 were studied to describe the susceptibility to CHX and mupirocin, molecular characteristics, and virulence profile of MRSA. Susceptibility test to Mupirocin was performed by the disk diffusion method and to CHX by the agar dilution technique. PCR for virulence genes, mecA gene and Staphylococcal Cassette Chromosome mec (SCCmec) types were investigated as well. Mupirocin- and CHX-resistant isolates were sequenced using the IlluminaTM plataform. Two hundred and sixteen MRSA clinical isolates were evaluated: 154 from infected and 62 from colonized patients. Resistance to mupirocin was observed in four isolates assigned as SCCmec type III and STs (ST05; ST239 and ST105) carrying mupA and blaZ, two of them co-harboring the ileS gene. Only one isolate assigned as SCCmec type III was resistant to CHX (MIC of 8.0 μg.mL-1) and harbored the qacA gene. Resistance to chlorhexidine and mupirocin were found in isolates carrying qacA and mupA in our hospital. Since these genes are plasmid-mediated, this finding draws attention to the potential spread of resistance to mupirocin in our hospital.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Brazil; Child; Child, Preschool; Chlorhexidine; DNA, Bacterial; Female; Hospitals, Teaching; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Sequence Analysis, DNA; Staphylococcal Infections; Virulence; Young Adult

To characterize the microbial communities of the anterior nares (nose) and posterior pharynx (throat) of adults dwelling in the community and in nursing homes before and after treatment with intranasal mupirocin.. Staphylococcus aureus-colonized adults were recruited from the community (n = 25) and from nursing homes (n = 7). S. aureus colonization was confirmed using cultures. Participants had specimens taken from nose and throat for S. aureus quantitation using quantitative PCR for the nuc gene and bacterial profiling using 16S rRNA gene sequencing over 12 weeks. After two baseline study visits 4 weeks apart, participants received intranasal mupirocin for 5 days with 3 further visits over a 8 week follow-up period.. We found a decrease in the absolute abundance of S. aureus in the nose for 8 weeks after mupirocin (1693 vs 141 fg/ul, p = 0.047). Mupirocin caused a statistically significant disruption in bacterial communities of the nose and throat after 1 week, which was no longer detected after 8 weeks. Bacterial community profiling demonstrated that there was a decrease in the relative abundance of S. aureus (8% vs 0.3%, p<0.01) 8 weeks after mupirocin and a transient decrease in the relative abundance of Staphylococcus epidermidis in the nose (21% vs 5%, p<0.01) 1 week after mupirocin.. Decolonization with mupirocin leads to a sustained effect on absolute and relative abundance of S. aureus but not for other bacteria in the nose. This demonstrates that a short course of mupirocin selectively decreases S. aureus in the nose for up to 8 weeks.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Female; Homes for the Aged; Humans; Male; Microbiota; Middle Aged; Mupirocin; Nose; Nursing Homes; Pharynx; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus protein A (spa) typing can be used to expand characterization of the epidemiology of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in neonatal intensive care units (NICU).. From January 2017 to June 2018, twice-monthly surveillance for S. aureus was performed in an academically affiliated NICU. Decolonization of infants colonized with S. aureus included chlorhexidine gluconate bathing and/or mupirocin for those with mupirocin-susceptible strains. Spa typing and mupirocin-resistance testing were performed. Demographic and clinical characteristics were compared between infants colonized with MSSA vs MRSA and infants with and without the most common MSSA spa type, MSSA-t279.. Overall, 14% and 2% of 1556 hospitalized infants had positive surveillance cultures for MSSA and MRSA, respectively. Thirty-six infants harbored unique MSSA spa types, 5 infants harbored unique MRSA spa types, and 30 MSSA and 6 MRSA spa types were identified in ≥2 infants. No outbreaks were identified during the study period. MSSA-t279 was isolated from 3% of infants and largely detected from infants hospitalized in one section of the NICU; 96% of t279 isolates were mupirocin resistant. Infection rates, length of hospitalization, and mortality were similar among infants initially colonized with t279 vs other MSSA spa types.. The MSSA colonization burden was 5-fold larger than that of MRSA. Numerous unique spa types were identified. The most common spa type, MSSA-t279, was not associated with increased morbidity or mortality but was mupirocin resistant and associated with clustered NICU beds. This suggests potential transmission from the environment, shared staff, and/or workflow issues requiring further study. Other decolonization strategies for S. aureus in the NICU are needed.

Topics: Anti-Bacterial Agents; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

High-level mupirocin resistance (HLMR) is determined by the plasmid-located ileS2 gene flanked by two copies of the insertion sequence 257 (IS257). The molecular epidemiology of high-level mupirocin-resistant isolates could be assessed by the determination of their IS257-ileS2 spacer regions conformation. In this study, 188 isolates of methicillin-resistant staphylococci were subjected to the detection of HLMR, and analysis of the conformation of the IS257-ileS2 spacer regions. Mupirocin resistance was detected in five (2,6%) isolates, among which two were recognized as Staphylococcus pseudintermedius, two as Staphylococcus haemolyticus, and one as Staphylococcus aureus. High-level mupirocin resistance was revealed by the agar disk diffusion method, and MIC values, and was confirmed by the detection of the ileS2 gene. The conformations of the IS257-ileS2 spacer regions were homologous in two S. haemolyticus strains tested. The remaining three isolates showed diverse IS257-ileS2 conformations. The results of this study indicate that HLMR occasionally occurs in staphylococci isolated from companion animals. The heterogeneity and the homogeneity of the IS257-ileS2 spacer regions confirm that the ileS2 gene spread among staphylococci of animal origin by the transfer of different as well as the same plasmids. Surveillance of the occurrence of mupirocin resistance and molecular characterization of resistant isolates are strongly recommended due to the possibility of plasmid-located resistance gene transfer between staphylococci.

Topics: Animals; Anti-Bacterial Agents; Cats; Coagulase; DNA Transposable Elements; Dogs; Drug Resistance, Multiple, Bacterial; Genes, Bacterial; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Pets; Plasmids; Staphylococcal Infections; Staphylococcus

Staphylococcus aureus causes various infections, including skin and soft tissue infections (SSTIs). In this study, methicillin-susceptible S. aureus (MSSA) from SSTIs among patients in three tertiary-care hospitals in Greece were studied in terms of antimicrobial resistance, clonal distribution, toxin and adhesin genes carriage.. During a five-year period (2014-2018), 6145 S. aureus were recovered from 13,244 patients with SSTIs and tested for antimicrobial susceptibility. MSSA were 4806 (78.21 %) including 1484 isolates with mupirocin minimum inhibitory concentration (MIC) > 64 mg/L (30.88 %). Two hundred and sixty representative mupirocin-resistant MSSA were analyzed for genes encoding Panton-Valentine leukocidin (PVL, lukS/lukF-PV), exfoliative toxins (eta, etb), adhesin FnbA (fnbA) and resistance genes mupA (high-level resistance to mupirocin), fusB (fusidic acid), aminoglycosides' modifying enzymes, ermA, ermC and msrA (macrolides/lincosamides) by PCRs. Strains were classified into clones by PFGE and MLST. All mupirocin-resistant MSSA were penicillin-resistant; 92.7 % expressed resistance to fusidic acid and 88.9 % to tobramycin. All 260 molecularly analyzed isolates were mupA-positive; all fusidic acid-resistant (241/260) carried fusB whereas, the tobramycin-resistant ones (230), ant(4')-Ia. The majority carried eta (93.85 %), etb (98.08 %) and fnbA (88.85 %). PFGE typing revealed a mostly unvarying population; 260 MSSA were grouped into three types. One major eta/etb-positive clone comprising of 258/260 strains (99.2 %), PFGE type 1, was classified as ST121, including nine strains co-carrying PVL. Another PVL-positive strain was identified as ST1, and one toxins-negative as ST21.. A mupirocin-resistant MSSA clone, ST121, carrying resistance, exfoliative toxins and adhesin genes, was spread and predominated in SSTIs from patients in Greece during the five-year studied period.

Topics: Adult; Anti-Bacterial Agents; Bacterial Toxins; Exotoxins; Genes, Bacterial; Greece; Humans; Leukocidins; Methicillin; Multilocus Sequence Typing; Mupirocin; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

This study surveys the clinical relevance of the nasal Staphylococcus aureus colonization status on intensive care unit (ICU)-acquired S. aureus infections and compares molecular characteristics of isolates from the nose and infectious sites. The 390 patients included comprised 278 non-carriers and 112 carriers. Among the carriers, 56 were decolonized with mupirocin. Decolonization was verified through a second (negative) culture. Spa typing and virulence gene profiling were performed for all isolates. Twenty six S. aureus infections were detected in the carriage group and 20 in the non-carriage group. Eighteen of these 26 (69.2%) infections were among carriers, and 8 of these 26 (30.8%) infections occurred among decolonized carriers (p = 0.02). Overall, 31/112 (27.7%) of the colonized patients and 25/46 (60.1%) of infection were due to methicillin-resistant S. aureus (MRSA). The highest frequency virulence genes were sea and hlg (both 100%) in nasal isolates and sea, hlg, fnb, and clf (100%) for infectious isolates. t030 was the most abundant spa type overall. S. aureus carriers were more likely to develop S. aureus infection compared with decolonized and non-carrying patients. The sources of ICU S. aureus infection appear to be exogenous mostly, and a predominant clone (spa type 030) plays an important role. We confirm that nasal mupirocin treatment prevents ICU infections even when there is an increased prevalence of nosocomial MRSA.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Carrier State; Humans; Intensive Care Units; Iran; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Mucosa; Prevalence; Staphylococcal Infections; Staphylococcus aureus; Virulence Factors

Nasal mucosa colonization by Staphylococcus aureus is a risk factor for hospital-acquired infections. This study examined the effectiveness of a decolonization strategy on orthopedic surgeons in a teaching hospital. S aureus colonization was detected in 43.2% of the surgeons, 25% of which were methicillin-resistant S aureus strains. Eradication was documented in 61.53% of the subjects who completed the decolonization strategy. Among orthopedic surgeons, mupirocin with or without chlorhexidine decolonization strategies was effective in eradicating S aureus colonization.

Topics: Anti-Bacterial Agents; Carrier State; Chlorhexidine; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Orthopedic Surgeons; Staphylococcal Infections; Staphylococcus aureus

Health care-associated infections (HAIs) are serious issues following lung cancer surgery, leading to an increased risk of morbidity and hospital cost burden. The aim of this study was to evaluate the impact on postoperative outcomes of a preoperative screening and decolonization strategy of nasal carriers for Staphylococcus aureus prior to lung cancer surgery.. We performed a retrospective study comparing 2 cohorts of patients undergoing major lung resection: a control group of patients from the placebo arm of the randomized Clinical Study to Evaluate the Efficacy of Chlorhexidine Mouthwashes operated on between July 2012 and April 2015 without any nasopharyngeal screening (N = 224); an experimental group, with preoperative screening for S. aureus of nasal carriers and selective 5-day decolonization in positive carriers using mupirocin ointment between January 2017 and December 2017 (N = 310). The 2 groups were matched according to a propensity score analysis with 1:1 matching. The primary outcome was the rate of postoperative HAIs, and the secondary outcome was the need for postoperative mechanical ventilation after surgery.. After matching, 2 similar groups of 108 patients each were obtained. In the experimental group, 26 patients had positive results for nasal carriage, and a significant decrease was observed in the rate of overall postoperative HAIs [control n = 19, 17.6%; experimental group n = 9, 8.3%; P = 0.043; relative risk 0.47 (0.22-1)] and in the rate of postoperative mechanical ventilation [control n = 12, 11.1%; experimental group n = 4, 3.7%; P = 0.038; relative risk 0.33 (0.11-1)]. After logistic regression and multivariable analysis, screening of S. aureus nasal carriers reduced the rate of HAIs [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.11-0.76; P = 0.01] and reduced the risk of the need for postoperative mechanical ventilation (OR 0.19, 95% CI 0.05-0.74; P = 0.02). There was no significant statistical difference between the 2 groups regarding the rate of postoperative S. aureus-associated infection (control group n = 6, 5.6%; experimental group n = 2, 1.9%; P = 0.28).. Identification of nasal carriers of S. aureus and selective decontamination using mupirocin appeared to have a beneficial effect on postoperative infectious events after lung resection surgery.

Topics: Aged; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Cross Infection; Female; Humans; Incidence; Lung Neoplasms; Male; Middle Aged; Mupirocin; Nasal Cavity; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Preoperative decolonization is recommended in Staphylococcus aureus nasal carriers scheduled for cardiac surgery. We aimed to evaluate the effectiveness of and compliance with mupirocin use in nasal S. aureus carriers in a real-life setting.. Prospective study including consecutive patients scheduled for cardiac surgery screened for S. aureus nasal carriage at preoperative consultation. Carriers were prescribed mupirocin nasal ointment, chlorhexidine shower and mouthwash. Effectiveness of decolonization was evaluated with a postoperative nasal sample. Compliance was evaluated objectively by determination of nasal mupirocin concentration using UPLC-MS/MS and self-reported by questionnaire.. Over 10 months, 361 patients were included, 286 had preoperative screening, 75 (26.2%) were S. aureus nasal carriers and 19 of them (25.3%) failed to be effectively decolonized. No resistance to mupirocin was documented. Preoperative and postoperative strains were identical in all cases. Declared good compliance was associated with decolonization success (OR = 24; 95% CI 4-143, P < 0.0001). Mupirocin detection was significantly associated with the level of compliance. Mupirocin was detected in 52.2% (24/46) of patients effectively decolonized and in 12.5% (2/16) of patients with decolonization failure (P < 0.01). In 2/19 patients, failure of decolonization was not associated with a compliance issue. Postoperative carriage was associated with an increased risk of S. aureus infection (OR = 9.8; 95% CI 1.8-53, P < 0.01).. In real life, decolonization is not always effective, hence there is a persisting risk of S. aureus endogenous infection. Mupirocin concentration measurement may help to understand compliance issues and failures in decolonization.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Chlorhexidine; Chromatography, High Pressure Liquid; Chromatography, Liquid; Humans; Mupirocin; Ointments; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Tandem Mass Spectrometry

Antimicrobial resistance is an increasingly serious problem in public health globally. Monitoring resistance levels within healthcare and community settings is critical to combat its ongoing increase. This study aimed to describe the rates and molecular mechanisms of mupirocin resistance in clinical Staphylococcus aureus isolates from Tygerberg Hospital, and to describe its association with strain types.. We retrospectively selected 212 S. aureus isolates which were identified from blood samples and pus swabs during the years 2009-2011 and 2015-2017. The isolates were identified using conventional microbiological methods and genotyping was done using spa typing. Cefoxitin (30 μg) disc diffusion and the two disc strategy (5 μg and 200 μg) were used to determine susceptibility to methicillin and mupirocin, respectively. Isolates with high-level resistance were screened for the plasmid mediated genes mupA and mupB by PCR, and sequencing of the ileS gene was done for all isolates exhibiting low-level resistance to describe the mutations associated with this phenotype. Chi-square test was used to assess the associations between mupirocin resistance and S. aureus genotypes.. Of 212 S. aureus isolates, 12% (n = 25) were resistant to mupirocin, and 44% (n = 93) were methicillin resistant. Strain typing identified 73 spa types with spa t045 being the most predominant constituting 11% of the isolates. High-level mupirocin resistance was observed in 2% (n = 5), and low-level resistance in 9% (n = 20) of the isolates. The prevalence of high-level mupirocin resistance amongst MRSA and MSSA was 4 and 1% respectively, while the prevalence of low-level mupirocin resistance was significantly higher in MRSA (18%) compared to MSSA (3%), (p = 0.032). mupA was the only resistance determinant for high-level resistance, and the IleS mutation V588F was identified in 95% of the isolates which showed low-level resistance. A significant association was observed between spa type t032 and high-level mupirocin resistance, and types t037 and t012 and low-level resistance (p <  0.0001).. The study reported higher rates of low-level mupirocin resistance compared to high-level resistance, and in our setting, mupirocin resistance was driven by certain genotypes. Our study advocates for the continuous screening for mupirocin resistance in S. aureus in clinical settings to better guide treatment and prescribing practices.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Blood; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Genotyping Techniques; Humans; Molecular Epidemiology; Mupirocin; Nuclear Proteins; Prevalence; Retrospective Studies; South Africa; Staphylococcal Infections; Staphylococcus aureus; Suppuration

In spinal surgery, incidence of surgical site infections (SSI) is estimated between 1 and 10%. It results in increased morbidity, mortality and cost of management. Individual Staphylococcus aureus (SA) decolonization has already proved efficiency to prevent those events in various surgical domains. The aim of this study was to evaluate a strategy of prevention of SSI and in particular the decolonization of the nasal carriage of SA by a protocol with Mupirocin application.. We conducted a bicentric observational study on 5314 spinal surgery patients over a seven-year period. In both center, we compared periods before and after implementation of two measures: modification of antibioprophylaxis and staphylococcus decolonization. Homogeneity of the different samples of patients was assessed through measure of individual and surgical variables. We measured monthly incidence of SSI and evaluated its evolution in order to assess efficiency of these interventions.. The incidence of SSI decreased by half, from 7.3% to 3% at the Beaujon Hospital and from 8.3% to 3.9% at the Georges-Pompidou European Hospital (GPEH). We do not observe any significant decrease of SA rate in these SSI.. We believe that Staphylococcus aureus decolonization should be recommended in spinal surgery, and should be combined with an overall improvement of the quality of care.

Topics: Anti-Bacterial Agents; Carrier State; Decontamination; Humans; Incidence; Mupirocin; Staphylococcal Infections; Surgical Wound Infection

Overall MRSA MUP, FA and RET resistance was low (5.1, 1.0 and 0.3%, respectively). MupA was the mechanism of high-level MUP resistance. All low-level MUP resistance isolates possessed an equivocal mutation N213D in IleS; of these, 2 reported an additional V588F mutation with an impact on the Rossman fold. FusA mutations, such as L461K, H457Q, H457Y and V90I were the primary FA mechanisms among high-level resistance isolates, most of which also contained fusC; however, all low-level resistance strains carried fusB. Except lsaE gene detected in one isolate, no other resistance mechanisms tested were found among RET-resistant isolates. Additionally, sixteen PFGE types (A-P) were observed, among which type B was the most common (49/76, 64.5%), followed by types E and G (4/76, 5.3% each) and types C and M (3/76, 3.9% each). All resistant strains were divided into 15 ST types by MLST. ST764 (24/76, 31.6%), ST630 (11/76, 14.5%), ST239 (9/76, 11.8%) and ST5 (7/76, 9.2%) were the major types. PFGE type B isolates with the aforementioned STs were mainly found in mupirocin resistant isolates.. MUP, FA and RET exhibited highly activity against the MRSA isolates. Acquired genes and chromosome-borne genes mutations were responsible for MUP and FA resistance; however, the mechanism for some RET-resistant isolates remains to be further elucidated. Also, the surveillance to MUP in MRSA should be strengthened to prevent elevated resistance due to the expansion of clones.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Bridged Bicyclo Compounds, Heterocyclic; China; Diterpenes; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Fusidic Acid; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Mupirocin; Mutation; Prevalence; Sequence Analysis, DNA; Staphylococcal Infections

The effects of subinhibitory concentrations (sub-MICs) of antibacterial agents on the biofilm-forming ability of Staphylococcus aureus require further study.. To investigate the effects of sub-MICs of chlorhexidine and mupirocin on biofilm formation in clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates.. MRSA isolates were collected from patients with bloodstream infections at a tertiary care hospital. The basal level of biofilm formation and biofilm induction by sub-MICs of chlorhexidine and mupirocin were evaluated by measuring biofilm mass stained with Crystal Violet.. Of the 112 MRSA isolates tested, 63 (56.3%) and 44 (39.3%) belonged to sequence type (ST)5 and ST72 lineages, respectively, which are the predominant healthcare- and community-associated clones in South Korea. ST5 isolates were more likely to have chlorhexidine MIC ≥4 (73.0% vs 29.5%), resistance to mupirocin (23.8% vs 0%), agr dysfunction (73.0% vs 9.1%), and qacA/B gene (58.7% vs 2.3%) compared to ST72 isolates. The basal level of biofilm formation ability was frequently stronger in ST72 isolates compared to ST5 isolates (77.3% vs 12.7%). Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in 56.3% and 53.6%, respectively, of all isolates. Biofilm induction was more prevalent in ST5 isolates (85.7% for chlorhexidine, 69.8% for mupirocin) than in ST72 isolates (15.9% for chlorhexidine, 27.3% for mupirocin).. Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in half of the clinical MRSA isolates. Our results suggest that ST5 MRSA biofilm can be induced together with some other bacterial virulent factors following exposure to chlorhexidine, which might confer a survival advantage to this clone in the healthcare environment.

Topics: Anti-Bacterial Agents; Biofilms; Carrier State; Chlorhexidine; Disinfectants; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Republic of Korea; Staphylococcal Infections; Tertiary Care Centers

Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is an effective measure to prevent clinical infection but resistance is a concern. We aim to evaluate the impact of mupirocin (MUP) ointment formulary removal, plateauing use of chlorhexidine gluconate (CHG), and hospital-wide introduction of octenidine (OCT)-based products on the minimum inhibitory concentration (MIC) of MRSA to MUP, CHG, and OCT in our hospital. A prevalence study was conducted at three time points (TP) on consecutive MRSA screening isolates to evaluate for their MICs to MUP, CHG, and OCT using broth microdilution sensititre plates and detection of the ileS-2 gene encoding high-level MUP resistance in 2013 (pre-intervention TP1; n = 160), 2016 (early post-intervention TP2; n = 99) and 2017 (late post-intervention TP3; n = 76). Statistical analyses were performed using Chi square test with reference from TP1. There was a significant improvement in MUP susceptibility (MIC < 4 mcg/ml) from 71.9% (TP1) to 86.9% (TP2; p = 0.006) to 88.2% (TP3; p = 0.007). The prevalence of MUP high-level resistance (MIC > 256 mcg/ml) reduced from 25.0% (TP1) to 12.1% (TP2; p = 0.014) to 5.3% (TP3; p = 0.001). Likewise, the prevalence of isolates harboring the ileS-2 gene decreased from 28.1% (TP1) to 18.2% (TP2; p = 0.072) to 9.2% (TP3; p = 0.002). OCT MIC range remains stable at 0.5 to 1 mcg/ml across all three TPs. The proportion of isolates with reduced CHG susceptibility (MIC ≥ 4 mcg/ml) increased over the three TPs from 23.1 to 27.2% (p = 0.45) to 42.1% (p = 0.003). Active formulary regulations have an impact on the resistance profile of MRSA and can be used as a strategy to preserve the MRSA decolonization armamentarium.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross-Sectional Studies; Drug Resistance, Bacterial; Genes, Bacterial; Humans; Imines; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Pyridines; Singapore; Staphylococcal Infections; Tertiary Care Centers

Topics: Adolescent; Adult; Anti-Bacterial Agents; Carrier State; Colony Count, Microbial; Gels; Healthy Volunteers; Humans; Laurates; Middle Aged; Monoglycerides; Mupirocin; Nasal Cavity; Staphylococcal Infections; Staphylococcus aureus; Young Adult

The objective was to describe French hospital nasal screening and decolonization procedures before clean surgery procedures. Information for participants was sent to the French Society for Infection Control members in June 2018. Seventy hospitals participated in the survey; 40% (N = 28) declared having institutional decolonization procedures: 64% (N = 18) in orthopaedic and 56% (N = 15) in cardiac surgeries. All hospitals used mupirocin for nasal decolonization and body decolonization with chlorhexidine (N = 16) or povidone iodine (N = 10). This study is the first to be performed in France giving information in this field. Screening/decolonization procedures are heterogeneous and the evaluation of their clinical impact remains complex.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Decontamination; France; Humans; Infection Control; Mupirocin; Nose; Orthopedic Procedures; Povidone-Iodine; Qualitative Research; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Surveys and Questionnaires; Thoracic Surgical Procedures

Colonization of methicillin-resistant Staphylococcus aureus (MRSA) can be detected via nasal screens. Evidence indicates that negative MRSA nasal screens may be used to de-escalate anti-MRSA antibiotics in pulmonary infections. In the ICU, universal decolonization with intranasal mupirocin is implemented to reduce MRSA infection risk. This study aimed to determine whether mupirocin administration affects the reliability of MRSA PCR nasal screens.. This retrospective study divided subjects based on timing of intranasal mupirocin administration-before and after MRSA screen. Subjects with confirmed pulmonary infection that received vancomycin, blood/respiratory cultures, and had MRSA PCR screen collected were included. Subjects with concurrent infection requiring vancomycin or MRSA infection in prior 30 days were excluded. Primary outcome of this non-inferiority study was the negative predictive value (NPV) of the screen. Secondary outcomes included the positive predictive value (PPV), sensitivity, and specificity of the screen and duration of vancomycin.. Ultimately, 125 subjects were included in each group. The NPV in the group receiving mupirocin before screen was 95.2%, whereas the NPV in the group receiving mupirocin after screen was 99%. The difference between groups was -3.8% (90% CI -7.8%-0.2%; p=0.31), which failed to meet non-inferiority criteria. The secondary outcomes of PPV, sensitivity and specificity of the screen were similar in both groups. The duration of vancomycin was significantly longer in subjects receiving mupirocin before screen (3 days vs. 2 days; p<0.05).. Intranasal mupirocin prior to the screen may reduce NPV in pulmonary infections. Approach de-escalation of vancomycin based on screen results with caution.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Cohort Studies; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nose; Polymerase Chain Reaction; Reproducibility of Results; Retrospective Studies; Staphylococcal Infections; Vancomycin

Topics: Cardiac Surgical Procedures; Delivery of Health Care; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Operating Rooms; Staphylococcal Infections; Staphylococcus aureus

Bacterial fatty acid synthases are promising antibacterial targets against multidrug-resistant pathogens. Platensimycin (PTM) is a potent FabB/FabF inhibitor, while its poor pharmacokinetics hampers the clinical development. In this study, a focused library of PTM derivatives was prepared through thiolysis of PTM oxirane (

Topics: Adamantane; Aminobenzoates; Anilides; Animals; Anti-Bacterial Agents; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mice; Mice, Inbred C57BL; Models, Molecular; Peritonitis; Small Molecule Libraries; Staphylococcal Infections; Staphylococcus

The aim of this study was to evaluate whether the establishment of a preoperative screening and decolonization protocol for Staphylococcus aureus carriers undergoing total knee arthroplasty (TKA) could decrease the incidence of periprosthetic joint infection (PJI) caused by this microorganism.. We conducted a retrospective study comparing a control group comprising 400 patients (134 men, and 266 women; mean age: 72.2 ± 6.8 years) who went through surgery between January 2009 and December 2013, with a second intervention group of 403 patients (125 men, and 278 women; mean age: 72.4 ± 6.9 years) in which the protocol of screening and decolonization of S. aureus nasal carriers was applied between January 2014 and December 2016. During this latter period patients were preoperatively screened and, if positive, treated with mupirocin nasal ointment and chlorhexidine soap, for 5 days prior to surgery.. In the control group, 17 of 400 patients (4.2%) had a SSI, 8 (2%) of them caused by S. aureus and 9 (2.2%) by other microorganisms. In the intervention group 20.6% of patients had a positive S. aureus nasal swab and were treated according to the protocol. 5 of 403 patients (1.2%) in this group had a SSI, 1 (0.2%) due to S. aureus and 4 (1%) to other microorganisms. When comparing surgical-site infection (SSI) rates between the two groups, we found a statistically significant reduction in both global SSI (p = 0.009) and specifically S. aureus SSI (p = 0.02), in the intervention group. No decolonized S. aureus nasal carrier presented a SSI.. In patients undergoing TKA a preoperative screening and decolonization protocol for S. aureus nasal carriers, using mupirocin nasal ointment and chlorhexidine soap, is an effective measure to reduce the rate of SSI caused by this microorganism.. Level III; Therapeutic Study.

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Carrier State; Chlorhexidine; Female; Humans; Incidence; Male; Mupirocin; Preoperative Care; Retrospective Studies; Spain; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Resistance to methicillin and mupirocin in coagulase-negative staphylococci (CoNS) is considered as one of the most important issues. Meanwhile, use of phenotypic methods in detecting the resistance to methicillin and mupirocin has a lower accuracy and speed compared to other molecular methods, such as High-Resolution Melting Analysis (HRM). In this study, HRM technique was used to identify CoNS resistance stains.. This experimental study was done on 86 isolates of CoNS strains isolated at Hamadan Hospital. Pheno-typic tests were used to identify Staphylococcus saprophyticus and S. epidermidis. Methicillin and Mupirocin resistant strains were tested using the MIC and HRM methods, and sensitivity and specificity of the primers were determined based on melting curve temperature range. In addition, data was analyzed by Applied Biosystems StepOne v 2.3 and Applied Biosystems HRM v 3.0.1 software.. Eighty-six (86) coagulase-negative isolates were isolated from different clinical specimens. Among these, 69 isolates of S. epidermidis and 17 isolates of S. saprophyticus were identified. Of the 69 S. epidermidis isolates, 19 isolates with oxacillin MIC ≥ 0.5 µg/mL and methicillin-resistant, and 11 isolates with mupirocin MIC ≥ 32 µg/mL and resistant to mupirocin. Of the 17 S. saprophyticus isolates, three isolates with oxacillin MIC ≥ 0.5 µg/mL were also methicillin-resistant, and one isolate with mupirocin MIC ≥ 32 µg/mL was resistant to mupirocin. Melting curve analysis for mecA and mupA primers was determined 81.7 ± 0.5°C and 74 ± 0.5°C, respectively. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HRM assay for detection of methicillin and mupirocin strains testing were 100%.. Identification of methicillin and mupirocin resistance in CoNSs using the HRM method has high sensitivity and specificity. Molecular methods are more accurate and faster than phenotypic methods and can identify a large number of resistant isolates in a short time.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Coagulase; DNA, Bacterial; Drug Resistance, Bacterial; Humans; Methicillin; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Nucleic Acid Denaturation; Species Specificity; Staphylococcal Infections; Staphylococcus

Staphylococcus aureus is a major cause of severe invasive infections. The increasing incidence of infections caused by antibiotic-resistant strains such as methicillin-resistant S. aureus (MRSA), calls for exploration of new approaches to treat these infections. Mupirocin is an antibiotic with a unique mode of action that is active against MRSA, but its clinical use is restricted to topical administration because of its limited plasma stability and rapid degradation to inactive metabolites. Mupirocin was identified by a machine learning approach to be suitable for nano-liposome encapsulation. The computational predictions were verified experimentally and PEGylated nano-liposomal formulation of mupirocin (Nano-mupirocin) was developed. The aim of this study was to investigate the efficacy of this formulation when administered parenterally for the treatment of S. aureus invasive infections. Nano-mupirocin exhibited prolonged half-life of active antibiotic and displayed superior antimicrobial activity against S. aureus than free mupirocin in the presence of plasma. Parenteral application of Nano-mupirocin in a murine model of S. aureus bloodstream infection resulted in improved antibiotic distribution to infected organs and in a superior therapeutic efficacy than the free drug. Parenterally administered Nano-mupirocin was also more active against MRSA than free mupirocin in a neutropenic murine lung infection model. In addition, Nano-mupirocin was very efficiently taken up by S. aureus-infected macrophages via phagocytosis leading to enhanced delivery of mupirocin in the intracellular niche and to a more efficient elimination of intracellular staphylococci. The outcome of this study highlights the potential of Nano-mupirocin for the treatment of invasive MRSA infections and support the further clinical development of this effective therapeutic approach.

Topics: Animals; Anti-Bacterial Agents; Female; Half-Life; Liposomes; Macrophages; Methicillin-Resistant Staphylococcus aureus; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Mupirocin; Nanostructures; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus carriage is a known risk factor for staphylococcal disease. However, the carriage rates vary by country, demographic group and profession. This study aimed to determine the S. aureus carriage rate in children in Eastern Uganda, and identify S. aureus lineages that cause infection in Uganda.. Nasopharyngeal samples from 742 healthy children less than 5 years residing in the Iganga/Mayuge Health and Demographic Surveillance Site in Eastern Uganda were processed for isolation of S. aureus. Antibiotic susceptibility testing based on minimum inhibitory concentrations (MICs) was determined by the BD Phoenix™ system. Genotyping was performed by spa and SCCmec typing.. The processed samples yielded 144 S. aureus isolates (one per child) therefore, the S. aureus carriage rate in children was 19.4% (144/742). Thirty one percent (45/144) of the isolates were methicillin resistant (MRSA) yielding a carriage rate of 6.1% (45/742). All isolates were susceptible to rifampicin, vancomycin and linezolid. Moreover, all MRSA were susceptible to vancomycin, linezolid and clindamycin. Compared to methicillin susceptible S. aureus (MSSA) isolates (68.8%, 99/144), MRSA isolates were more resistant to non-beta-lactam antimicrobials -trimethoprim/sulfamethoxazole 73.3% (33/45) vs. 27.3% (27/99) [p < 0.0001]; erythromycin 75.6% (34/45) vs. 24.2% (24/99) [p < 0.0001]; chloramphenicol 60% (27/45) vs. 19.2% (19/99) [p < 0.0001]; gentamicin 55.6% (25/45) vs. 25.3% (25/99) [p = 0.0004]; and ciprofloxacin 35.6% (16/45) vs. 2% (2/99) [p < 0.0001]. Furthermore, 42 MRSA (93.3%) were multidrug resistant (MDR) and one exhibited high-level resistance to mupirocin. Overall, 61 MSSA (61.6%) were MDR, including three mupirocin and clindamycin resistant isolates. Seven spa types were detected among MRSA, of which t037 and t064 were predominant and associated with SCCmec types I and IV, respectively. Fourteen spa types were detected in MSSA which consisted mainly of t645 and t4353.. S. aureus carriage rate in healthy children in Eastern Uganda is high and comparable to rates for hospitalized patients in Kampala. The detection of mupirocin resistance is worrying as it could rapidly increase if mupirocin is administered in a low-income setting. S. aureus strains of spa types t064, t037 (MRSA) and t645, t4353 (MSSA) are prevalent and could be responsible for majority of staphylococcal infections in Uganda.

Topics: Anti-Bacterial Agents; Antigens, Bacterial; Carrier State; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; Genotyping Techniques; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Molecular Typing; Mupirocin; Nasal Mucosa; Nose; Pharynx; Population Surveillance; Staphylococcal Infections; Staphylococcus aureus; Uganda

The evolution of antibiotics in the last century has revolutionized the field of medicine and led this field to higher level of success in treating mild to severe infections, but the inappropriate use of these life saving drugs has been accompanied with the appearance of resistant strains to these agents.. The aim of the study was to determine the prevalence rate of high and low-level mupirocin resistance in methicillin resistant staphylococcus,and to find out resistance to other antibiotics.. This study was conducted on 100 Staphylococcus isolates recovered from pus samples. Conventional disc diffusion tests were used for the detection of high and low level mupirocin resistance (mupirocin 5µg and 200µg discs) and for various other antimicrobials for example cephalexin, erythromycin, doxycycline, oxacillin, linezolid etc. Results: Outof 100 Staphylococcus isolates processed during the study period in the department of microbiology, 74 were Staphylococcus aureus (S.aureus) and 26 were Coagulase negative Staphylococcus (CoNS). Among S.aureus 43.4% were Methicillin resistant Staphylococcus aureus (MRSA) and 56.6% were Methicillin sensitive Staphylococcus aureus (MSSA), whereas among CoNS 42% were methicillin resistant and 58% were methicillin sensitive. We observed 6.75% of high level mupirocin resistance among Staphylococcus aureus and 19.23% among Coagulase negative staphylococcus.. It was concluded that an inappropriate excessive use of mupirocin leads to a rapid increase in high-level resistance to mupirocin and other antibiotics in CoNS, affecting the treatment lines and success rate of infection control in hospital settings.

Topics: Anti-Bacterial Agents; Coagulase; Drug Resistance, Multiple, Bacterial; Humans; India; Methicillin; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Prevalence; Prospective Studies; Staphylococcal Infections; Staphylococcus; Tertiary Care Centers

Mupirocin (Bactroban. Urine from three catheterised patients in two London hospitals during and after mupirocin medication, was passed through Waters Oasis cartridges to isolate organic acids. Sensitive LC-MS-MS analysis for monic acid A in methanolic eluate has been developed to identify ∼10 pg.. Monic acid A was quantified in all samples from one patient, translating into 6-46 ng from 12 mg mupirocin, assuming 1 L daily urine output. However, no urinary monic acid A was detected for two other patients.. Consistent occurrence of monic acid A in urine of one mupirocin patient shows for the first time that antibiotic distribution across nasal mucous membranes had generally been maintained during medication. In contrast, consistent absence in the two other patients requires wider study in hospital.

Topics: Biomarkers; Chromatography, Liquid; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Pyrans; Staphylococcal Infections; Tandem Mass Spectrometry

Between September 2013 and March 2016, 26 (1.95 %) of 1333 Staphylococcus aureus clinical isolates from a Chinese hospital were found to be resistant to mupirocin, including 18 (1.35 %) with high-level mupirocin resistance and 8 (0.6 %) with low-level mupirocin resistance. Among the 18 isolates with high-level mupirocin resistance, 17 were associated with plasmid-mediated mupA. Meanwhile, the 8 isolates with low-level mupirocin resistance were shown to have a V588F mutation in ileS. A total of 14 sequence types (STs) and 18 spa types were identified. All four isolates with t062 belonged to ST965. Three ST5-MRSA-SCCmec II were linked to t311, which was not previously reported. Furthermore, ST764-MRSA-SCCmec II-t002, exclusively found in Japan before, was identified in this study. In conclusion, we observed relatively low prevalence of mupirocin resistance among S. aureus with considerable heterogeneity in East China. Newly emerging MRSA clones with high-level mupirocin resistance should be of concern.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Blotting, Southern; China; Colony Count, Microbial; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; Methicillin-Resistant Staphylococcus aureus; Multilocus Sequence Typing; Mupirocin; Nuclear Proteins; Point Mutation; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus; Tertiary Care Centers

Methicillin-resistant Staphylococcus aureus (MRSA) is frequently implicated in health care-associated outbreaks in burn intensive care units, incurring substantial morbidity and mortality to these high-risk patients and excess costs to health care systems.. MRSA health care-associated infections (HAIs) were noted before and after the implementation of basic infection prevention measures and the subsequent implementation of universal decolonization with intranasal mupirocin. Pulsed-field gel electrophoresis was used to determine the relatedness of clinical isolates. A case-control study was conducted to characterize the risk factors for MRSA HAIs.. Basic interventions failed to decrease the rate of MRSA HAIs, although compliance with these interventions was high throughout the study. MRSA HAIs decreased from 8.53 HAIs per 1,000 patient days before the implementation of intranasal mupirocin to 3.61 HAIs per 1,000 patient days after the implementation of intranasal mupirocin (P = .033). Pulsed-field gel electrophoresis disclosed 10 unique clones with no large clusters. The case-control study revealed a significant association between MRSA HAIs and lengths of stay, body surface area burned, intubation, pressor requirement, leukocytosis, lactic acidosis, development of pneumonia, MRSA colonization, and death.. Basic environmental and behavioral interventions fell short of controlling a low-count, sporadic, and multiclonal MRSA outbreak in the burn intensive care unit of a tertiary medical center. However, the added implementation of universal decolonization with intranasal mupirocin was effective. Burn victims with greater disease severity were at higher risk for MRSA HAIs.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Burn Units; Burns; Cross Infection; Disease Outbreaks; Female; Humans; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Staphylococcal Infections; Tertiary Care Centers; Treatment Outcome; Young Adult

The past two decades have witnessed an alarming expansion of staphylococcal disease caused by community-acquired methicillin-resistant

Topics: Animals; Anti-Bacterial Agents; Child; Chlorhexidine; Community-Acquired Infections; Genome, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Mice; Microbial Sensitivity Tests; Mupirocin; Phylogeny; Plasmids; Staphylococcal Infections; Virulence

Nasal carriage of Staphylococcus aureus is very common among health care workers, and treatment with mupirocin is one of the choicest antibiotics available. But with the rampant usage of mupirocin like other antibiotics, the emergence of mupirocin resistance is also on rise. This resistance is both low level as well as high level among the isolated strains.. To screen for the high-level mupirocin resistance among the isolated Staphylococcus strains by Kirby Bauer disk diffusion method.. A total of 200 clinical isolates were tested for high level mupirocin resistance by disk diffusion method using Himedia disks.. Among the 200 nasal swabs, 26 (13%) showed growth of S. aureus, whereas 174 (87%) showed the growth of coagulase negative staphylococcus (CONS) spp. Mupirocin resistance was observed only among CONS spp, which was 15% for low-level mupirocin and 8% for high-level mupirocin resistance. No mupirocin resistance was observed among the Staphylococcus spp.. The identification of Mupirocin resistance will guide us to utilize the antibiotic in a judicious way to treat the nasal carriage effectively.

Topics: Anti-Bacterial Agents; Carrier State; Cross-Sectional Studies; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Female; Health Personnel; Humans; Male; Mupirocin; Nasal Cavity; Staphylococcal Infections; Staphylococcus

Preoperative colonization with Staphylococcus aureus (SA) increases risk of surgical site infection. Screening for SA followed by skin and nasal decolonization can help to reduce the risk of postoperative infections. Risk factors for colonization are, however, not completely understood.. A case-control study using questionnaires and patient demographics specifically designed to observe SA colonization risk factors in a presurgical orthopedic population. A total of 115 subjects with a positive preoperative screen for SA nasal colonization prior to orthopedic surgery completed a questionnaire to assess for SA risk factors: these subjects served as our cases. An additional 476 controls completed similar questionnaires. Data collected included demographic, health, and lifestyle information. Multivariable logistic regression was used to generate odds ratios (OR) for risk of SA colonization.. Several risk factors were identified. Male sex (OR 2.3; 95% confidence interval [CI], [1.4-3.8]) and diabetes (OR 3.8 [1.8-7.8]) significantly increased the risk of SA colonization. Older age, visiting public places (OR 0.2 [0.1-0.3]), recent antibiotic use (OR 0.2 [0.1-0.6]), and the presence of facial hair (OR 0.3 [0.1-0.6]) significantly lowered the risk of SA colonization.. By identifying patients who may be at greater risk of SA colonization, we can better streamline our presurgical techniques to help reduce risk of surgical site infections and improve patient outcomes.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Case-Control Studies; Child; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Mupirocin; Nose; Orthopedic Procedures; Preoperative Care; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Young Adult

Staphylococcus aureus is a microorganism, which is able to colonize the human body without any pathogenic effect, but it also can cause life-threatening infections (opportunistic pathogen). Asymptomatic colonization with both methicillin resistant (MRSA) and methicillin susceptible (MSSA) S.aureus strains state is an important predisposing factor for infections. The risk of infection for carriers of MSSA is even three-times higher than for non-colonized people, and in the case of MRSA it is even four-times higher than in MSSA carriers. Carriers can be also a source of infection for other people, especially those belonging to high-risk groups. The drug of choice used for the local eradication of S.aureus is mupirocin (Mup). In recent years, the failure of decolonization therapy has been observed. The aim of the study was to assess and compare the level of colonization of S.aureus (MRSA or MSSA) among medical students and to evaluate the sensitivity of the strains to mupirocin. For MRSA/MupRSA isolates the molecular mechanism of resistance phenotype was determined.. 955 swabs from 2014-2016 from pre-clinical students of medicine of the Medical University of Warsaw. The strains were identified using Pastorex-Staph-Plus (BioRad) and/or the VITEK-MS system (Biomerieux), according to manufacturer’s instructions. Susceptibility to methicillin and mupirocin was determined by disk diffusion and/or broth microdilution method, according to EUCAST. The presence of the mecA/mecC and mupA genes were detected with PCR technique.. Asymptomatic colonization with S.aureus strains was found in 245/955 (25,7%) students, in particular years in the range of 21,7-29,9%. 243 isolates expressed the MSSA/MupSSA phenotype, one strain was resistant to mupirocin MSSA/MupRSA (genotype mecA/mecC-negative, mupA-positive) and one showed simultaneous resistance to methicillin and mupirocin (mecA/mupA-positive genotype). The level of MRSA and MupRSA colonization was 0,1% and 0,2%, respectively.. The level of S.aureus colonization among surveyed students, didn’t differ from the norm for a generally healthy population, but showed an upward trend. The carriage of S.aureus, especially of multi-resistant strains among medical students at the beginning of their clinical activities, consist of a real threat to patients and other people.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Poland; Prevalence; Staphylococcal Infections; Staphylococcus aureus; Students, Medical; Universities; Young Adult

According to this study.

Topics: Anti-Bacterial Agents; Bacterial Load; Chlorhexidine; Cross Infection; Humans; Infection Control; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

The widespread of methicillin-resistant Staphylococcus aureus (MRSA) antimicrobial decolonization in the clinical setting may lead to an increase in the prevalence of multiresistance to coagulase-negative staphylococci (CoNS) owing to their selection. This study aimed to investigate the impact of MRSA decolonization strategies, using mupirocin and chlorhexidine, on their CoNS susceptibility.. A total of 312 CoNS isolates were collected before starting the decolonization protocols "baseline strains" (BLS) group, 330 isolates were collected after application of the targeted decolonization protocol "targeted decolonization strains" group, and 355 isolates were collected after application of the universal decolonization protocol "universal decolonization strains" group. Methicillin-resistant CoNS (MR-CoNS) were identified and tested for mupirocin and chlorhexidine susceptibilities. Heptaplex polymerase chain reaction assay was applied for simultaneous screening for chlorhexidine (CHX-R) and mupirocin resistance (Mu-R) genes.. Mu-R prevalence of MR-CoNS among the BLS group was considered moderate (9.1%); however, CHX-R in the BLS group was 5.8%, the rate of which significantly increased among the universal decolonization strains group.. Both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. The prevalence Mu-R rate didn't change significantly during either of the MRSA decolonization practices that may be due to the local nature of mupirocin application on the nasal mucosa only. In contrast CHX-R that was found to be significantly higher among the UDS group.. Our findings indicate that both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. Although the universal MRSA decolonization has superior efficacy in decolonization of CoNS, it may increase the risk of selecting CHX-R and Mu-R. In addition, other potential resistance genes should be studied.

Topics: Anti-Bacterial Agents; Carrier State; Chlorhexidine; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections

Mupirocin is one of the few antimicrobials active against methicillin-resistant Staphylococcus aureus (MRSA), and is frequently used for the eradication of MRSA nasal colonisation in humans. Initially, mupirocin resistance was recognised in human S. aureus, including MRSA isolates, then also among coagulase-negative staphylococci (CoNS). Nowadays, mupirocin resistance is occasionally observed in canine staphylococci, along with Staphylococcus pseudintermedius (MRSP) strains, as well as CoNS, which usually show methicillin resistance. In the current study, high-level mupirocin resistance in methicillin-resistant staphylococci isolated from diseased dogs and cats was investigated.. Among 140 methicillin-resistant staphylococci isolates from dogs and cats, three showed high-level mupirocin resistance in a screening test using the agar disk diffusion method. One was recognised as methicillin-resistant S. aureus, one as methicillin-resistant S. pseudintermedius, and one as methicillin-resistant Staphylococcus haemolyticus. S. pseudintermedius and S. aureus were isolated from dogs, S. haemolyticus was obtained from a cat. All isolates showed high-level mupirocin resistance, confirmed by minimum inhibitory concentration (MIC) values of above 1024 μg/ml and the presence of the plasmid-located gene ileS2. This is the first report on the detection of high-level mupirocin resistance (HLMR) in S. haemolyticus of feline origin.. This study revealed the occurrence of HLMR in three Staphylococcus isolates obtained from companion animals in Poland. The results of this study indicate that the monitoring of mupirocin resistance in staphylococci of animal origin, especially in methicillin-resistant isolates, is strongly recommended.

Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Dog Diseases; Dogs; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections

While decolonization of. Decision analytic models and a probabilistic sensitivity analysis were used for a cost-effectiveness analysis, with the effectiveness of decolonization based on a large published pre- and post- intervention trial. The primary outcomes of the models were infections prevented and health care costs. We modelled the cost-effectiveness of decolonization in a hypothetical cohort of adult patients undergoing hip and knee replacement in Alberta, Canada. Information on the incidence of complex surgical site infections (SSIs), as well as the cost of care for patients with and without SSIs was taken from a provincial infection control database, and health administrative data.. Decolonization for

Topics: Adult; Aged; Alberta; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chlorhexidine; Cost-Benefit Analysis; Decision Support Techniques; Female; Health Care Costs; Humans; Male; Middle Aged; Mupirocin; Preoperative Care; Standard of Care; Staphylococcal Infections; Surgical Wound Infection

The increasing use of chlorhexidine for methicillin-resistant Staphylococcus aureus (MRSA) decolonization has raised concerns about the emergence of resistance to or tolerance of this antiseptic. We examined the frequency and characteristics of qacA/B chlorhexidine tolerance genes among MRSA isolates in a surgical intensive care unit (ICU) where MRSA-colonized patients are decolonized by chlorhexidine bathing. The MRSA isolates were evaluated for chlorhexidine susceptibility, mupirocin resistance, molecular typing, agr functionality, and the heterogeneous vancomycin-intermediate S. aureus (hVISA) phenotype according to the presence of the qacA/B genes. Overall, 119 MRSA isolates were obtained from active surveillance cultures (93, 78.2%) and clinical cultures (26, 21.8%) between 2012 and 2014. Among these isolates, 39 (32.8%) carried the qacA/B genes, and 23 (19.3%) exhibited mupirocin resistance. Most qacA/B-positive isolates (36/39, 92.3%) were identified as ST5-SCCmecII (69.2%) and ST239-SCCmecIII (23.1%), which are common healthcare-associated (HA)-MRSA strains in Korea. Multivariate analysis found that qacA/B-positive MRSA isolates were associated with agr dysfunction (OR, 4.87; 95% CI, 1.71-13.87) and the hVISA phenotype (OR, 4.09; 95% CI, 1.48-11.34). In conclusion, our study showed that qacA/B carriage was common among MRSA isolates in an ICU where chlorhexidine is commonly used for decolonization. qacA/B carriage was significantly associated with agr dysfunction and the hVISA phenotype. These features may confer a selective advantage on HA-MRSA strains, including ST5-SCCmecII and ST239-SCCmecIII, in the ICU setting.

Topics: Aged; Anti-Infective Agents, Local; Bacterial Proteins; Chlorhexidine; Drug Resistance, Multiple, Bacterial; Female; Gene Expression Regulation, Bacterial; Humans; Intensive Care Units; Male; Membrane Transport Proteins; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Prevalence; Republic of Korea; Retrospective Studies; Staphylococcal Infections; Trans-Activators; Vancomycin

Topical antibiotics, such as mupirocin and fusidic acid, are commonly used in the prevention and treatment of skin infections, particularly those caused by staphylococci. However, the widespread use of these agents is associated with increased resistance to these agents, potentially limiting their efficacy. Of particular concern is the observation that resistance to topical antibiotics is often associated with multidrug resistance, suggesting that topical antibiotics may play a role in the emergence of multidrug-resistant (MDR) strains. New Zealand (NZ) has some of the highest globally recorded rates of topical antibiotic usage and resistance. Using a combination of Pacific Biosciences single-molecule real-time (SMRT) whole-genome sequencing, Illumina short-read sequencing, and Bayesian phylogenomic modeling on 118 new multilocus sequence type 1 (ST1) community

Topics: Administration, Topical; Anti-Bacterial Agents; Bayes Theorem; Drug Resistance, Multiple, Bacterial; Fusidic Acid; Genome, Bacterial; Humans; Microbial Sensitivity Tests; Mupirocin; New Zealand; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child, Preschool; Female; Furunculosis; Humans; Mupirocin; Nose Diseases; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

The use of nitric oxide (NO), a naturally occurring antimicrobial agent, as an alternative strategy to combat bacterial biofilms has recently gained considerable momentum in light of the global threat of emerging antibiotic resistance. While previous NO-based anti-biofilm approaches were aimed at killing bacterial cells within biofilms, NO has also been recently identified as a key mediator of biofilm dispersal, causing the release of cells from the biofilm community. This is of great interest towards the design of more effective anti-biofilm strategies but further studies are warranted to validate this concept. Therefore, in the present study we investigated whether a NO precursor, isosorbide mononitrate (ISMN) or its analogue D-isosorbide can induce bacteria cell dispersal from Staphylococcus aureus (S. aureus) biofilms and explored the potential synergy of ISMN and the antimicrobial compounds mupirocin and ciprofloxacin in biofilm eradication. This study demonstrate that ISMN causes dispersal of S. aureus biofilm bacteria, particularly when exposed to high levels of drug. ISMN at 60mg/mL increased the number of colony forming units (CFU) (~3log

Topics: Anti-Bacterial Agents; Biofilms; Ciprofloxacin; Isosorbide Dinitrate; Microbial Sensitivity Tests; Mupirocin; Nitric Oxide; Plankton; Staphylococcal Infections; Staphylococcus aureus

The incidence of multidrug-resistant (MDR) organisms, including methicillin-resistant Staphylococcus aureus (MRSA), is a serious threat to public health. Progress in developing new therapeutics is being outpaced by antibiotic resistance development, and alternative agents that rapidly permeabilize bacteria hold tremendous potential for treating MDR infections. A new class of glycopolymers includes polycationic poly-N (acetyl, arginyl) glucosamine (PAAG) is under development as an alternative to traditional antibiotic strategies to treat MRSA infections. This study demonstrates the antibacterial activity of PAAG against clinical isolates of methicillin and mupirocin-resistant Staphylococcus aureus. Multidrug-resistant S. aureus was rapidly killed by PAAG, which completely eradicated 88% (15/17) of all tested strains (6-log reduction in CFU) in ≤ 12-hours at doses that are non-toxic to mammalian cells. PAAG also sensitized all the clinical MRSA strains (17/17) to oxacillin as demonstrated by the observed reduction in the oxacillin MIC to below the antibiotic resistance breakpoint. The effect of PAAG and standard antibiotics including vancomycin, oxacillin, mupirocin and bacitracin on MRSA permeability was studied by measuring propidium iodide (PI) uptake by bacterial cells. Antimicrobial resistance studies showed that S. aureus developed resistance to PAAG at a rate slower than to mupirocin but similar to bacitracin. PAAG was observed to resensitize drug-resistant S. aureus strains sampled from passage 13 and 20 of the multi-passage resistance study, reducing MICs of mupirocin and bacitracin below their clinical sensitivity breakpoints. This class of bacterial permeabilizing glycopolymers may provide a new tool in the battle against multidrug-resistant bacteria.

Topics: Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Glucosamine; Glycosides; Humans; In Vitro Techniques; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Permeability; Polymers; Polysaccharides; Propidium; Staphylococcal Infections

In individuals with cystic fibrosis (CF), colonization with methicillin-resistant Staphylococcus aureus (MRSA) was reported to be associated with a deterioration of pulmonary disease as reflected by an accelerated decline in lung function. Thus, an early eradication of MRSA could be beneficial in these patients. Here, we report on an intensified MRSA eradication protocol.. Since 2012 a protocol for the eradication of newly acquired MRSA has been used in our CF Clinic, combining oral rifampicin and fusidic acid, inhaled vancomycin, nasal mupirocin, local antiseptic treatment and hygienic directives all of which are applied for only 7 days during an inpatient hospital stay.. Since 2012 seven patients (3 male, 4 female; age range 4 to 30 years) newly acquired MRSA. In 6 of the 7 patients (86%) successful eradication of MRSA was achieved upon first treatment using the protocol described above. In one patient a second course of treatment was performed which, however, also failed to eliminate the colonizing MRSA.. Our protocol led to an eradication rate of 86%. The impact of each individual component of the protocol remains to be determined.

Topics: Administration, Inhalation; Administration, Intranasal; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Baths; Child; Child, Preschool; Cystic Fibrosis; Drug Therapy, Combination; Female; Fusidic Acid; Hand Disinfection; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Retrospective Studies; Rifampin; Staphylococcal Infections; Treatment Outcome; Vancomycin; Young Adult

The incidence of refractory chronic rhinosinusitis (CRS) associated with methicillin-resistant Staphylococcus aureus (MRSA) is rising and remains a therapeutic challenge. The goal of this study is to demonstrate the efficacy of a non-invasive topical therapy against MRSA in these patients.. Seventeen patients with refractory CRS caused by MRSA were treated with a topical therapy protocol. Treatment consisted of weekly endoscopic sinus debridement followed by intra-sinus installation of a hydroxyl-ethylcellulose gel that releases mometasone and a culture-directed antibiotic for a period of 6 weeks, along with daily nasal nebulization of mometasone with the same antibiotic and saline rinses. Clinical outcome was assessed using the Lund-Kennedy (LK) symptom and endoscopic appearance scores. Sinus mucosal tissue was homogenized and cultured, and microbial biofilm burden was assessed based on colony forming units (CFUs) counts.. Rhinotopic therapy resulted in clearance of MRSA in 13 of 16 patients (81.2%). Treated patients also demonstrated significant improvement clinically as measured by the LK scores. In addition, a significant decrease in mucosal CFUs was observed post-therapy.. Our findings demonstrate that topical therapy is an effective method for treating MRSA-associated refractory CRS.

Topics: Administration, Intranasal; Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Cellulose; Culture Techniques; Debridement; Endoscopy; Female; Humans; Instillation, Drug; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mometasone Furoate; Mupirocin; Nebulizers and Vaporizers; Prospective Studies; Rhinitis; Saline Solution; Sinusitis; Staphylococcal Infections; Therapeutic Irrigation; Tobramycin; Treatment Outcome; Vancomycin

With increasing rates of virulent drug resistant organisms, MRSA (methicillin-resistant Staphylococcus aureus) decolonization has been demonstrated to decrease infection rates. Recent research has shown the antiseptic povidone-iodine to be equally effective and potentially cost saving compared to intranasal mupirocin. This study's purpose is to evaluate the incidence of MRSA colonization in a more rural community-based population, rates of infection on a mupirocin decolonization protocol, and develop a cost analysis model to compare costs of utilizing povidone-iodine.. Utilizing over 4 years of data, the incidence of MRSA decolonization of consecutive total knee and hip arthroplasties, as well as the rates of infection of patients uncolonized, colonized with successful decolonization, and unsuccessful decolonization were evaluated. Utilizing these data, cost data, and known infection rate utilizing povidone-iodine decolonization, a cost analysis model was developed.. Of the 5584 cases with MRSA data at a single institution, only 3.5% tested positive for intranasal MRSA. Of those patients, 69% were successfully decolonized. Of the 3864 cases with infection data, 21 sustained a surgical site infection within 90 days (0.54%). Of these patients, all tested negative for intranasal MRSA initially and therefore did not undergo the decolonization protocol. The cost analysis predicts a potential savings of $74.72 per patient at our institution to use a global intranasal povidone-iodine protocol prior to total joint arthroplasty.. Even with a lower incidence of MRSA than typically reported, utilization of intranasal povidone-iodine would potentially save $74.42 per patient.

Topics: Administration, Intranasal; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Arthroplasty, Replacement; Chlorhexidine; Cost-Benefit Analysis; Humans; Incidence; Methicillin; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Povidone-Iodine; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection

This article presents a break-even analysis for preoperative Staphylococcus aureus colonization screening and decolonization protocols in total hip arthroplasty (THA) and total knee arthroplasty (TKA).. Protocol costs, baseline infection rates after arthroplasty, and average revision costs were obtained from institutional records and the literature. The break-even analysis determined the absolute risk reduction (ARR) in infection rate required for cost-effectiveness.. S aureus nasal screening ($144.07) was cost effective when initial infection rates of TKA (1.10%) and THA (1.63%) had an ARR of 0.56% and 0.45%, respectively. The most inexpensive decolonization treatment ($5.09) was cost effective with an ARR of 0.02% for both TKA and THA. The most expensive decolonization option ($37.67) was cost effective with ARRs of 0.15% (TKA) and 0.12% (THA).. Preoperative S aureus decolonization can be highly cost effective, whereas colonization screening requires excessively high reductions in infection rate.

Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Humans; Mass Screening; Models, Economic; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Investigating microbial interactions from an ecological perspective is a particularly fruitful approach to unveil both new chemistry and bioactivity. Microbial predator-prey interactions in particular rely on natural products as signal or defense molecules. In this context, we identified a grazing-resistant

Topics: 4-Butyrolactone; Anti-Bacterial Agents; Bacterial Proteins; Biological Products; Dictyostelium; Drug Synergism; Genome, Bacterial; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Pseudomonas; Quorum Sensing; Staphylococcal Infections

The use of monthly intranasal mupirocin was associated with a significant reduction in the rate of methicillin-resistant Staphylococcus aureus transmission and Staphylococcus aureus invasive infection in a large neonatal intensive care unit. Resistance to mupirocin emerged over time, but it was rare and was not associated with adverse clinical outcomes.Infect Control Hosp Epidemiol 2018;39:741-745.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Interrupted Time Series Analysis; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Regression Analysis; Staphylococcal Infections

Our human model of nasal colonization and eradication of S. aureus is limited by safety issues. As rhesus macaques are closely related to humans and natural hosts for S. aureus, we developed an experimental decolonization and inoculation protocol in these animals. Animals were screened for nasal carriage of S. aureus and 20 carriers were selected. Decolonization was attempted using nasal mupirocin (10 animals) or mupirocin plus trimethoprim/sulfadiazine intramuscularly (10 animals) both once daily for 5 days, and checked by follow-up cultures for 10 weeks. Intranasal inoculation was performed with S. aureus strain 8325-4 in culture-negative animals. 11/20 animals, of which 5 received mupirocin and 6 the combination treatment, became culture-negative for S. aureus for 10 weeks and these 11 animals were subsequently inoculated. Swabs were taken once a week for 5 weeks to test for the presence of the inoculated strain. In 3 animals, strain 8325-4 was cultured from the nose 1 week after inoculation, indicating short-term survival of this strain only, a finding similar to that previously found in our human model. These data demonstrate that rhesus macaques may constitute a relevant animal model to perform S. aureus eradication and inoculation studies with relatively limited invasive handling of the animals.

Topics: Administration, Intranasal; Animals; Anti-Bacterial Agents; Carrier State; Disease Models, Animal; Drug Combinations; Female; Macaca mulatta; Male; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Sulfadiazine; Trimethoprim

Despite WHO recommendations, there is currently no national screening and eradication policy for the detection of methicillin-sensitive Staphylococcus aureus (MSSA) in the UK prior to elective orthopaedic surgery. This study aimed to evaluate the effectiveness of current standard methicillin-resistant S. aureus (MRSA) eradication therapies in the context of S. aureus (both MRSA and MSSA) decolonization in an elective orthopaedic population.. A total of 100 patients awaiting joint replacement surgery who were positive for S. aureus on PCR nasal screening underwent the current standard MRSA pre-operative decolonization regimen for 5 days. Prior to commencement of the eradication therapy, swabs of the anterior nares, throat and perineum were taken for culture. Further culture swabs were taken at 48-96 h following treatment, at hospital admission for surgery and at hospital discharge. Following the completion of treatment, patients were asked to provide feedback on their experience using Likert rating scales. The primary outcome of this study was S. aureus clearance 48-96 h following eradication treatment.Results/Key Findings. Clearance of S. aureus 48-96 h following treatment was 94 % anterior nares, 66 % throat and 88 % groin. Mean completion with nasal mupirocin was 98 %. There was no statistically significant recolonization effect between the end of the eradication treatment period and the day of surgery (P>0.05) at a median time of 10 days.. Current MRSA decolonisation regimens are well tolerated and effective for MSSA decolonization for the anterior nares and groin. The decolonization effect is preserved for at least 10 days following treatment.

Topics: Aged; Anti-Bacterial Agents; Carrier State; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Cavity; Nose; Orthopedics; Pharynx; Preoperative Care; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; United Kingdom

Resistance to mupirocin was analysed in Staphylococcus spp. isolated from healthy dogs (n=21) and dogs with pyoderma (n=47) or otitis externa (n=52). Isolates were identified to species level by MALDI-TOF and PCR-RFLP of the groEL gene. One isolate of Staphylococcus epidermidis from the skin of a healthy dog, which harboured a plasmid carrying the mupA gene, was resistant to mupirocin.

Topics: Animals; Bacterial Proteins; Chaperonin 60; Dog Diseases; Dogs; Drug Resistance, Bacterial; Mupirocin; Otitis Externa; Pyoderma; Skin; Staphylococcal Infections; Staphylococcus epidermidis

To demonstrate the safety and effectiveness of topical 2% mupirocin ointment as an adjunctive therapy for tympanostomy tube otorrhea (TTO) caused by methicillin-resistant Staphylococcus aureus (MRSA).. We treated children with community-acquired MRSA TTO by aural suctioning and culture-directed systemic antibiotics (+/- ototopical drops) alone (control group) or with the addition of single 1 ml dose of mupirocin ointment applied to the tube and ear canal (mupirocin group). Patient age, laterality, response to treatment, associate hearing loss, duration of follow-up, and recurrence of infection by MRSA or by other organisms were compared.. 29 children (37 ears) with MRSA TTO were included. 8 children (12 ears) received adjunctive topical mupirocin ointment - 21 children (25 ears) did not. 8 of 12 ears in the mupirocin group received concomitant systemic antibiotics - 4 ears were treated with topical mupirocin alone. The mean duration of follow-up of the mupirocin group was 7 months (with 95% C.I of 7 ± 7). The control group was 24 months (with 95% C.I of 24 ± 9). Recurrence of MRSA TTO in the mupirocin and control groups were 0/12; 0% and 10/25; 40%, by ear, respectively (p = 0.015). Recurrence of non-MRSA TTO in the mupirocin and control groups were 6/12; 50% and 9/25; 36%, by ear, respectively (p = 1.0). There were no sensorineural hearing losses in the mupirocin-treated children.. In this small series, a single application of topical mupirocin in combination with mechanical debridement, controlled infection by CA-MRSA without evidence of local reaction or subsequent hearing loss. Its role in treatment of MRSA TTO merits further investigation.

Topics: Administration, Topical; Anti-Bacterial Agents; Case-Control Studies; Cerebrospinal Fluid Otorrhea; Child, Preschool; Combined Modality Therapy; Community-Acquired Infections; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Ear Ventilation; Mupirocin; Ointments; Staphylococcal Infections

Sternal wound infection (SWI) after cardiac surgery is a severe complication. Among preventive measures, pre-operative decolonization of nasal carriage of Staphylococcus aureus has recently been shown to be beneficial. This quasi-experimental study assessed the effect of decolonization on the incidence of S. aureus-associated SWI based on 19 years of prospective surveillance.. Segmented negative binomial regression was used to analyse the change over time in the incidence of S. aureus mediastinitis requiring re-operation after cardiac surgery in a French university hospital between 1996 and 2014. Universal nasal decolonization with mupirocin was introduced in December 2001. The association between pre-operative nasal carriage and SWI due to S. aureus was analysed between 2006 and 2012.. Among 17,261 patients who underwent a cardiac surgical procedure, 565 developed SWI (3.3%), which was caused by S. aureus in 181 cases (1%). The incidence of mediastinitis caused by S. aureus decreased significantly over the study period (1.43% in 1996-2001 vs 0.61% and 0.64% in 2002-2005 and 2006-2014, respectively; P<0.001). In segmented analysis, there was a significant break in 2002, corresponding to the introduction of decolonization. Despite this intervention, pre-operative nasal carriage remained a significant risk factor for S. aureus mediastinitis (adjusted odds ratio 2.2; 95% confidence interval 1.2-4.2), as were obesity, critical pre-operative status, coronary artery bypass grafting (CABG), and combined surgery with valve replacement and CABG.. Universal nasal decolonization before cardiac surgery was effective in decreasing the incidence of mediastinitis caused by S. aureus. Nasal carriage of S. aureus remained a risk factor for S. aureus-associated SWI.

Topics: Administration, Topical; Aged; Anti-Bacterial Agents; Carrier State; Female; France; Hospitals, University; Humans; Incidence; Male; Middle Aged; Mupirocin; Non-Randomized Controlled Trials as Topic; Preoperative Care; Staphylococcal Infections; Surgical Wound Infection; Thoracic Surgery; Treatment Outcome

Surgical site infections (SSIs) cause considerable morbidity and deaths among patients undergoing vascular surgery. Pre-operative screening and subsequent treatment of nasal Staphylococcus aureus carriers with mupirocin and chlorhexidine reduces the risk of SSIs in cardiothoracic and orthopedic surgery. The aim of this study was to investigate the effect of this screen-and-treat strategy on the development of SSI in patients undergoing aortoiliac surgery.. A prospective study was performed that enrolled an intervention cohort comprising all patients undergoing aortoiliac surgery from February 2013 to December 2016. Before surgery, patients were screened for S. aureus nasal carriage and, if positive, were treated with mupirocin nasal ointment and chlorhexidine body washes. The presence of SSI was recorded on the basis of the criteria of the U.S. Centers for Disease Control and Prevention. A historic control group was used, consisting of aortoiliac surgery patients in 2010 who tested positive for S. aureus but received no treatment.. A total of 374 patients in the study cohort were screened of whom 75 (20.1%) tested positive for S. aureus. Of these patients, 68 were given eradication therapy. In the 2010 cohort, 22 patients (15.7%) were positive. The incidence of S. aureus infection was 0 of 75 in the treatment group versus 3 of 22 (13.6%) in the control group (p = 0.021). Both the 30-day mortality rate (1.3% vs. 13.6%; p = 0.035) and the rate of re-interventions (12.0% vs. 31.8%) were significantly lower in the treated group.. We conclude that S. aureus nasal screening and eradication with mupirocin and chlorhexidine reduces S. aureus SSI and its complications after aortoiliac surgery.

Topics: Aged; Anti-Infective Agents; Carrier State; Chlorhexidine; Female; Humans; Incidence; Male; Middle Aged; Mupirocin; Nasal Cavity; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome; United States; Vascular Surgical Procedures

Topics: Anti-Infective Agents, Local; Baths; Carrier State; Child; Cross Infection; Hand Disinfection; Humans; Infant, Newborn; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

There are very few articles in the literature describing continuous models of bacterial infections that mimic disease pathogenesis in humans and animals without using separate cohorts of animals at each stage of disease. In this work, we developed bioluminescent mouse models of partial-thickness scald wound infection and sepsis that mimic disease pathogenesis in humans and animals using a recombinant luciferase-expressing Staphylococcus aureus strain (Xen29). Two days post-scald wound infection, mice were treated twice daily with a 2% topical mupirocin ointment for 7 days. For sepsis experiments, mice were treated intraperitoneally with 6 mg/kg daptomycin 2 h and 6 h post-infection and time to moribund monitored for 72 h. Consistent bacterial burden data were obtained from individual mice by regular photon intensity quantification on a Xenogen IVIS Lumina XRMS Series III biophotonic imaging system, with concomitant significant reduction in photon intensities in drug-treated mice. Post-mortem histopathological examination of wounds and bacterial counts in blood correlated closely with disease severity and total flux obtained from Xen29. The bioluminescent murine models provide a refinement to existing techniques of multiple bacterial enumeration during disease pathogenesis and promote animal usage reduction. The models also provide an efficient and information-rich platform for preclinical efficacy evaluation of new drug classes for treating acute and chronic human and animal bacterial infections.

Topics: Animals; Anti-Bacterial Agents; Bacteremia; Burns; Disease Models, Animal; Luminescent Proteins; Male; Mice; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

To examine neonatal risk factors associated with recurrent Staphylococcus aureus colonization and to determine the genetic relatedness of S. aureus strains cultured from neonates before and after decolonization.Study designSingle-center retrospective cohort study of neonates admitted to the neonatal intensive care unit (NICU) from April 2013 to December 2015, during which weekly nasal cultures from hospitalized NICU patients were routinely obtained for S. aureus surveillance.. Johns Hopkins Hospital's 45-bed level IV NICU in Baltimore, Maryland.. Demographics and clinical data were collected on all neonates admitted to the NICU with S. aureus nasal colonization who underwent mupirocin-based decolonization during the study period. A decolonized neonate was defined as a neonate with ≥1 negative culture after intranasal mupirocin treatment. Pulsed-field gel electrophoresis was used for strain typing.. Of 2,060 infants screened for S. aureus, 271 (13%) were colonized, and 203 of these 271 (75%) received intranasal mupirocin. Of those treated, 162 (80%) had follow-up surveillance cultures, and 63 of these 162 infants (39%) developed recurrent colonization after treatment. The S. aureus strains were often genetically similar before and after decolonization. The presence of an endotracheal tube or nasal cannula/mask was associated with an increased risk of recurrent S. aureus colonization (hazard ratio [HR], 2.65; 95% confidence interval [CI], 1.19-5.90; and HR, 2.21; 95% CI, 1.02-4.75, respectively).. Strains identified before and after decolonization were often genetically similar, and the presence of invasive respiratory devices increased the risk of recurrent S. aureus nasal colonization in neonates. To improve decolonization efficacy, alternative strategies may be needed.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Baltimore; Carrier State; Cross Infection; Disinfection; Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Male; Mupirocin; Odds Ratio; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

We developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care-associated costs (HCACs), and deaths due to SSI.. Our model population comprised US adults undergoing elective surgery. We evaluated 3 self-administered preoperative strategies: (1) the standard of care (SOC) consisting of 2 disinfectant soap showers; (2) the "test-and-treat" strategy consisting of the decolonization bundle including chlorhexidine gluconate (CHG) soap, CHG mouth rinse, and mupirocin nasal ointment for 5 days) if S. aureus was found at any of 4 screened sites (nasal, throat, axillary, perianal area), otherwise the SOC; and (3) the "treat-all" strategy consisting of the decolonization bundle for all patients, without S. aureus screening. Model parameters were derived primarily from a randomized controlled trial that measured the efficacy of the decolonization bundle for eradicating S. aureus.. Under base-case assumptions, the treat-all strategy yielded the fewest SSIs and the lowest HCACs, followed by the test-and-treat strategy. In contrast, the SOC yielded the most SSIs and the highest HCACs. Consequently, relative to the SOC, the average savings per operation was $217 for the treat-all strategy and $123 for the test-and-treat strategy, and the average savings per per SSI prevented was $21,929 for the treat-all strategy and $15,166 for the test-and-treat strategy. All strategies were sensitive to the probability of acquiring an SSI and the increased risk if SSI if the patient was colonized with SA.. We predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Chlorhexidine; Cost-Benefit Analysis; Disinfection; Humans; Models, Economic; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; United States

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Child; Child, Preschool; Chlorhexidine; Drug Resistance, Bacterial; Drug Utilization; Female; Genes, Bacterial; Hospitals, Veterans; Humans; Incidence; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Multiplex Polymerase Chain Reaction; Mupirocin; Staphylococcal Infections; United States; Young Adult

We assessed the impact of preoperative Staphylococcus aureus screening and targeted decolonization on the incidence of postoperative methicillin-resistant S aureus (MRSA) colonization, intensive care unit MRSA transmission, and surgical site infections in cardiac surgery patients.. We reviewed medical records for all adult patients during two periods: preintervention (January 2007 to April 2010) and intervention (January 2011 to December 2014). In the intervention period, we performed nasal screening for methicillin-sensitive S aureus and MRSA using polymerase chain reaction within 30 days of the operation. Colonized patients received intranasal mupirocin twice daily and chlorhexidine baths daily for 5 days; patients colonized with MRSA also received prophylactic vancomycin plus cefazolin with contact isolation precautions. Nasal surveillance for MRSA was performed on intensive care unit admission and weekly thereafter. Multivariable logistic regression models were constructed to determine risk factors for postoperative MRSA colonization, and surgical site infections and the impact of our screening program was assessed in these models. Poisson regression was used to assess MRSA transmission.. Comparing 2,826 preintervention and 4,038 intervention patients, cases differed in age, diabetes mellitus, preoperative infection, preoperative length of stay, and bypass time (all p ≤ 0.03). Intervention patients had risk-adjusted reductions in MRSA colonization (odds ratio 0.53, 95% confidence interval [CI]: 0.37 to 0.76, p < 0.001), transmission (incidence rate ratio 0.29, 95% CI: 0.13 to 0.65, p = 0.002), and surgical site infections (odds ratio 0.58, 95% CI: 0.40 to 0.86, p = 0.007). Increased duration of preoperative decolonization therapy was associated with decreased postoperative MRSA colonization (odds ratio 0.73, 95% CI: 0.53 to 1.00, p = 0.05).. Preoperative S aureus screening with targeted decolonization was associated with reduced MRSA colonization, transmission, and surgical site infections. Duration of preoperative therapy correlated with decreased frequency of postoperative MRSA colonization.

Topics: Administration, Intranasal; Adult; Aged; Anti-Infective Agents; Cardiac Surgical Procedures; Carrier State; Chlorhexidine; Female; Humans; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

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

Staphylococcus aureus is the primary pathogen responsible for the majority of human skin infections, and meticillin-resistant S. aureus (MRSA) currently presents a major clinical concern. The overuse of Mupirocin, the first-line topical antibacterial drug over 30 years, has led to the emergence of Mupirocin-resistant MRSA, creating a clinical concern. The antimicrobial peptide Omiganan was touted to be a promising antibacterial drug candidate due to its rapid membrane-disrupting bactericidal mode of action, entering clinical trials in 2005 as a topical gel to prevent catheter site infections. However, drug development ceased in 2009 due to a lack of efficacy. We postulate this to be due to proteolytic degradation caused by endogenous human skin proteases. Herein, we tested our hypothesis using Omiganan and its all-D enantiomer in a human skin protease stability assay, followed by anti-MRSA activity assay against of a panel of clinical MRSA isolates, a bactericidal/static determination and a time-kill assay to gauge all-D Omiganan's potential for further topical antibacterial drug development.

Topics: Administration, Topical; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Peptide Hydrolases; Protein Stability; Skin Diseases; Staphylococcal Infections; Stereoisomerism

Staphylococcus aureus is the main causative agent of joint prosthesis infections. The decolonization of the carriers is effective in the prevention of the infections of the elective arthroplasties. The aim of this study is to evaluate if it is also in arthroplasties after hip fracture.. Study in patients with hip fracture who underwent joint prosthesis from January 2011 to December 2015 with a protocol of S. aureus detection-decolonization with intranasal mupirocin and chlorhexidine baths. Patients between January 2009 and December 2010 were the comparison group.. In the intervention period, the study of colonization of S. aureus was performed in 307 patients, of whom 87 were positive (28.3%). The study period was completed by 267 patients, of whom two developed S. aureus infection, compared to six of 138 in the control group (0.7% vs 4.3%, RR 0.1, p = 0.03).. In our study, S. aureus decolonization in patients with hip fracture decreased the incidence of joint prosthesis infection by this microorganism.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Carrier State; Chlorhexidine; Disinfectants; Female; Hip Fractures; Humans; Incidence; Male; Mupirocin; Nasal Cavity; Prosthesis-Related Infections; Staphylococcal Infections; Surgical Wound Infection

Mupirocin ointment is a widely used topical drug for the treatment of bacterial skin infections. However, ointments have some limitations which motivated the development of a film forming spray of mupirocin. Mupirocin spray (2%) was formulated with Eudragit E100 as a film forming agent and tested for its antibacterial and anti-biofilm activities against Escherichia coli, a skin pathogen causing wound and surgical site infections. Treatment with mupirocin spray resulted in significant antibacterial and anti-biofilm activities (inhibition and disruption) with single spray and sub-actual dose concentrations at par with the commercial ointment concentration. The spray formulation was found to be non-toxic to fibroblast cells and greatly resisted removal from the site of application upon washing, in contrast to the ointment which was significantly removed after a single wash. This is the first study to develop and evaluate a spray formulation for mupirocin that forms a stable thin film for sustained release of the drug.

Topics: Acrylates; Administration, Cutaneous; Aerosols; Anti-Bacterial Agents; Biofilms; Cell Line; Cell Survival; Drug Compounding; Escherichia coli; Humans; Mupirocin; Ointments; Polymers; Skin Diseases, Bacterial; Staphylococcal Infections; Wound Infection

Methicillin-resistant Staphylococcus aureus (MRSA) is globally endemic and is a leading cause of surgical site infection (SSI). The purpose of this study was to evaluate the incidence of SSI in MRSA carriers undergoing elective hip or knee arthroplasty, who had confirmed eradication and to compare it with incidence of SSI in non-MRSA carriers.. This is a retrospective analysis of 6613 patients who underwent elective total hip arthroplasty (THA; n = 3347) and total knee arthroplasty (TKA; n = 3266) at our institution. A cohort of patients who were preoperatively colonized with MRSA was identified. We compared the infection rates with non-MRSA carriers.. We had a colonization rate of 1.3% (83 patients). A total of 79 patients had confirmed eradication of carrier status before surgical intervention. Of these, 38 were THAs and 41 were TKAs. Five of 79 patients (6.32%; 95% confidence interval [CI]: 2.35%-14.79%) had "deep SSI" within 1 year of surgery. There were 2 MRSA infections in THAs (relative risk 4.46; 95% CI: 1.12-17.82). There were 2 MRSA and 1 methicillin-sensitive Staphylococcus aureus infections in TKAs (relative risk 5.61; 95% CI: 1.81-17.38). A significant statistical difference in infection rates from MRSA negative control group was noted, which had a deep sepsis rate of 1.17% in THAs and 1.3% in TKAs over the same period.. In spite of a selective treatment program for carriers and confirmed eradication, there is still a significantly increased risk of SSI in MRSA-colonized patients undergoing hip or knee arthroplasties.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chlorhexidine; Disinfectants; Elective Surgical Procedures; Female; Humans; Incidence; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Retrospective Studies; Risk; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; United Kingdom

The development of new synthetic antimicrobial peptides like LTX-109 provides a new class of drugs for the treatment of Staphylococcus aureus infections. We evaluated LTX-109 and mupirocin for pharmacodynamic parameters against 10 methicillin-resistant S. aureus isolates. The postantibiotic effect (PAE) is defined as the length of time that bacterial growth is suppressed following a brief exposure to an antibiotic. We also determined the sub-MIC effect (SME) which measures the direct effect of subinhibitory levels on strains that have not previously been exposed to antibiotics. The postantibiotic sub-MIC effect (PA-SME) is a combination of the PAE and SME. LTX-109 had an average PAE of 5·51 h vs 1·04 h for mupirocin. The PA-SME of LTX-109 ranged from 2·51 to 9·33 h as the concentration increased from 0·2 to 0·4 times the minimal inhibitory concentration (MIC). The PA-SME range for mupirocin was 0·93-2·58 h. LTX-109, as compared to mupirocin, demonstrated prolonged time of effect for these pharmacodynamic parameters, which supports persistent activity for several hours after the drug is no longer present or is below the MIC. The pharmacodynamic parameters studied here suggest that LTX-109 is less likely than mupirocin to generate resistance to S. aureus.. Resistant bacterial infections continue to be a challenge for clinicians. Identification of antibiotics with pharmacodynamic advantages may be beneficial in the treatment of these infections. An antibiotic with a longer postantibiotic effect may be able to be administered less frequently resulting in improved adherence. In this study, a new synthetic antimicrobial peptide, LTX-109, demonstrated a more prolonged time for LTX-109 than mupirocin against methicillin-resistant Staphylococcus aureus.

Topics: Anti-Bacterial Agents; Blood; Humans; Microbial Sensitivity Tests; Mupirocin; Oligopeptides; Staphylococcal Infections; Staphylococcus aureus

Our investigation of indoor-housed cynomolgus macaques (Macaca fascicularis) by using automated identification followed by antibiotic susceptibility testing revealed 1 of 7 immunocompetent animals and 2 of 9 immunosuppressed monkeys as carriers of methicillin-resistant Staphylococcus aureus (MRSA). Follow-up management involving mupirocin treatment resulted in the conversion of the 3 MRSA carriers into MRSA-negative cases. Prospective assessment of newly imported monkeys involving 24-h culture of nasal swabs on chromogenic agar revealed that 22% (18 of 82 animals) were MRSA-positive. Mupirocin treatment successfully converted all of the MRSA-positive macaques into non-carriers, suggesting the feasibility of this simple, one-step screening procedure for rapidly identifying MRSA carriers in large cohorts. In addition, 8 animals that had been diagnosed MRSA-positive and subsequently treated with mupirocin demonstrated no recolonization during follow-up, even under immunosuppressive conditions. We propose rapid screening using chromogenic agar followed by mupirocin treatment as a time- and cost-effective regimen for managing MRSA in cynomolgus monkeys.

Topics: Animals; Anti-Bacterial Agents; Feasibility Studies; Host-Pathogen Interactions; Immunocompetence; Immunocompromised Host; Macaca fascicularis; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Monkey Diseases; Mupirocin; Nasal Cavity; Staphylococcal Infections

An increase in the number of staphylococcal infections and carriers among medical staff has forced us to seek more and more effective antibacterial agents. Bacteria from the Staphylococcus genus possessing different mechanisms of resistance are the cause of nosocomial infections. The objective of our investigations was susceptibility of S. aureus strains isolated from nasal vestibule of medical students to fennel essential oil. The GC-MS analysis of fennel essential oil revealed eleven constituents among which a majority of trans-anethole (80%) was found. The D-tests showed iMLS

Topics: Anti-Bacterial Agents; Carrier State; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Drug Therapy, Combination; Foeniculum; Gas Chromatography-Mass Spectrometry; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Mupirocin; Oils, Volatile; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

This study aimed to investigate the clinical and molecular epidemiology and biofilm formation of Staphylococcus aureus (SA) isolated from pediatricians in China.. SA strains were isolated from Beijing Children's hospital from February 2016 to January 2017. Isolates were typed by multilocus sequence typing (MLST), spa and SCCmec typing (for Methicillin-resistant SA [MRSA] only). Antimicrobial susceptibility testing was performed by agar dilution method except sulphamethoxazole/trimethoprim (E-test method). Biofilm formation and biofilm associated genes were detected.. Totally 104 children (41 females and 63 males; median age, 5.2 months) were enrolled in this study, in which 60 patients suffered from MRSA infection. Among the 104 cases, 54.8% were categorized as community associated SA (CA-SA) infections. The children under 3 years were more likely to occur CA-SA infections compared with older ones (P = 0.0131). ST59-SCCmec IV-t437 (61.7%) was the most prevalent genotype of MRSA, and ST22-t309 (18.2%), ST5-t002 (9.1%), ST6-t701 (9.1%), ST188-t189 (9.1%) were the top four genotypes of methicillin-sensitive SA (MSSA). All the present isolates were susceptible to linezolid, vancomycin, trimethoprim-sulfamethoxazole, mupirocin, tigecyclin, fusidic acid. No erythromycin-susceptible isolate was determined, and only a few isolates (3.8%) were identified as susceptible to penicillin. Multi-drug resistant isolates were reponsible for 83.8% of the ST59-SCCmec IV-t437 isolates. The isolates with strong biofilm formation were found in 85% of MRSA and 53.2% of MSSA, and in 88.7% of ST59-SCCmec IV-t437 isolates. Biofilm formation ability varied not only between MRSA and MSSA (P = 0.0053), but also greatly among different genotypes (P < 0.0001). The prevalence of the biofilm associated genes among ST59-SCCmec IV-t437 clone was: icaA (100.0%), icaD (97.3%), fnbpA (100.0%), fnbpB (0), clfA (100%), clfB (100%), cna (2.7%), bbp (0), ebpS (88.5%), sdrC (78.4%), sdrD (5.4%), and sdrE (94.5%).. These results indicated strong homology of the MRSA stains isolated from Chinese children, which was caused by spread of multiresistant ST59-SCCmec IV-t437 clone with strong biofilm formation ability. The MSSA strains, in contrast, were very heterogeneity, half of which could produce biofilm strongly.

Topics: Adolescent; Biofilms; Child; Child, Preschool; China; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant; Infant, Newborn; Linezolid; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Mupirocin is a topical antibiotic for methicillin-resistant Staphylococcus aureus (MRSA) decolonization in hospital settings and nursing homes and is used as a highly effective antibiotic against MRSA. In this study, we aimed to evaluate the frequency of high-level mupirocin-resistant (HLMR) strains among the MRSA subtypes. A total of 188 clinical MRSA isolates were collected from 2011 to 2014, and their susceptibility to antimicrobial agents and vancomycin resistance was evaluated using disc diffusion method and micro-dilution method, respectively. Furthermore, the presence of mecA, SSCmec, mupA and mupB was assessed by PCR. All isolates were multi-drug resistant (MDR) but 2 strains (1.06%) were resistant to mupirocin. Minimum inhibitory concentration (MIC) of vancomycin for 8 strains (4.7%) was higher than 2 μg/ml. Of 188 isolates, 188 (100%), 64 (34.04%), 8 (4.3%), 150 (79.8%), 26 (13.8%), 2 (1.06) and 2 (1.06%) isolates possessed mecA, SCCmec types I, II, III, IV, mupA and mupB genes, respectively. Our data showed that despite infection control policy enforced by health care committee, the rate of mupirocin resistance among MRSA strains is continuously rising.

Topics: Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Humans; Iran; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Prevalence; Staphylococcal Infections

Staphylococcus aureus colonization has been identified as a key modifiable risk factor in the reduction of surgical site infections (SSI) related to elective total joint arthroplasty (TJA). We investigated the incidence of SSIs and cost-effectiveness of a universal decolonization protocol without screening consisting of nasal mupirocin and chlorhexidine before elective TJA compared to a program in which all subjects were screened for S aureus and selectively treated if positive.. We reviewed 4186 primary TJAs from March 2011 through July 2015. Patients were divided into 2 cohorts based on the decolonization regimen used. Before May 2013, 1981 TJA patients were treated under a "screen and treat" program while the subsequent 2205 patients were treated under the universal protocol. We excluded the 3 months around the transition to control for treatment bias. Outcomes of interest included SSI and total hospital costs.. With a universal decolonization protocol, there was a significant decrease in both the overall SSI rate (5 vs 15 cases; 0.2% vs 0.8%; P = .013) and SSIs caused by S aureus organisms (2 vs 10; 0.09% vs 0.5%; P = .01). A cost analysis accounting for the cost to administer the universal regimen demonstrated an actual savings of $717,205.59. TJA complicated by SSI costs 4.6× more to treat than that of an uncomplicated primary TJA.. Our universal decolonization paradigm for elective TJA is effective in reducing the overall rate of SSIs and promoting economic gains for the health system related to the downstream savings accrued from limiting future reoperations and hospitalizations.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Arthroplasty; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chlorhexidine; Cost-Benefit Analysis; Elective Surgical Procedures; Female; Hospital Costs; Humans; Incidence; Male; Middle Aged; Missouri; Mupirocin; Prosthesis-Related Infections; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

To investigate the efficacy of a potent novel antimicrobial protein of mass 6 kDa, epidermicin NI01, for eradicating the nasal burden of MRSA in a cotton rat ( Sigmodon hispidus ) model.. MRSA strain ATCC 43300 was used to establish a robust colonization of cotton rat nares. This model was used to evaluate the efficacy of topical 0.04% and 0.2% epidermicin NI01, administered twice daily for 3 days consecutively, and topical 0.8% epidermicin NI01 administered once, for reducing nasal MRSA burden. Control groups remained untreated or were administered vehicle only (0.5% hydroxypropylmethylcellulose) or 2% mupirocin twice daily for 3 days. The experiment was terminated at day 5 and MRSA quantitative counts were determined. Tissues recovered from animals treated with 0.2% epidermicin twice daily for 3 days were examined for histological changes.. Mupirocin treatment resulted in a reduction in burden of log 10 (log R) of 2.59 cfu/nares compared with vehicle ( P  < 0.0001). Epidermicin NI01 administered once at 0.8% showed excellent efficacy, resulting in a log R of 2.10 cfu/nares ( P  = 0.0004), which was equivalent to mupirocin. Epidermicin NI01 administered at 0.2% or 0.04% twice daily for 3 days did not have a significant impact on the tissue burden recovered from the nares. Mild to marked histological abnormalities were noted, but these were determined to be reversible.. A single dose of topical epidermicin NI01 was as effective as mupirocin administered twice daily for 3 days in eradication of MRSA from the nares of cotton rats. This justifies further development of epidermicin for this indication.

Topics: Administration, Topical; Animals; Antimicrobial Cationic Peptides; Bacterial Load; Bacteriocins; Dose-Response Relationship, Drug; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Rats; Sigmodontinae; Staphylococcal Infections

The healing of wounds has always provided challenges for the medical community whether chronic or acute. Modern and traditional medicine has proved that herbal medicine shown superiority over chemical drugs. Herein, we report an Entada phaseoloides (L.) Merr. extract with a total tannin content of 76.18% showed wound-healing promoting effect in rat model. We found significantly accelerated wound closure already on day 7 in animals treated with total Entada phaseoloides (L.) Merr. tannins (TEPT) as compared to vaseline treated controls (p<0.05). At day 15, histologically, the wounds in animals treated with TEPT were completely closed as compared to controls. In vitro, TEPT promotes fibroblast proliferation and migration into wounds of NIH3T3 with concentration range of 9.38-37.50μg/ml. TEPT also had an inhibitory action against Staphylococcus aureus with MBC of 1.5mg/ml and the result was further proved by transmission electron microscope. Thus, TEPT could promote wound shrinkage, improve healing rate and promote healing of infectious wounds in rats. And this effect may due to antibacterial activities and NIH3T3 cell pro-proliferative effect of the tannins compounds, which indicating that TEPT can be used as efficient treatment in traumatic injury.

Topics: Animals; Anti-Bacterial Agents; Cell Proliferation; Collagen; Emollients; Fabaceae; Male; Mice; Microscopy, Electron, Transmission; Mupirocin; NIH 3T3 Cells; Petrolatum; Plant Extracts; Rats; Rats, Sprague-Dawley; Skin; Staphylococcal Infections; Staphylococcus aureus; Tannins; Wound Healing; Wound Infection

In a controlled before-and-after study in a single centre, it was aimed to determine whether identification of Staphylococcus aureus nasal carriers followed by nasal mupirocin ointment and chlorhexidine soap reduced surgical site infections (SSIs) among 182 patients undergoing deep brain stimulation. In all, 119 patients were included in the control group and 63 in the screening group. There was a significant SSI decrease from 10.9% to 1.6% between the two groups (P<0.04; relative risk: 0.13; 95% confidence interval: 0.003-0.922). There were eight SSIs involving S. aureus in the control group, none in the screening group. No specific risk factors for SSI were identified.

Topics: Adult; Aged; Carrier State; Chlorhexidine; Controlled Before-After Studies; Deep Brain Stimulation; Disinfectants; Female; Humans; Infection Control; Male; Mass Screening; Middle Aged; Mupirocin; Preoperative Care; Soaps; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome

Topics: Administration, Topical; Anti-Bacterial Agents; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Folliculitis; Humans; Impetigo; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

To compare the presence of Staphylococcus aureus and pathogenic Gram-negative rods (GNR) in the anterior nares, posterior pharynx and three skin sites in community-based adults and nursing home-based adults before and after treatment with nasal mupirocin and topical chlorhexidine.. S. aureus-colonized adults were recruited from the community (n=26) and from nursing homes (n=8). Eligible participants were cultured for S. aureus and GNR during two study visits and then received intranasal mupirocin and topical chlorhexidine for 5days, with a 2-month follow-up period.. After decolonization, we found sustained decreases of S. aureus colonization in nose, throat and skin sites over 4-8weeks in both populations. Intranasal mupirocin did not increase GNR colonization in nose or throat. Chlorhexidine did not decrease GNR colonization in skin sites.. Decolonization with mupirocin and chlorhexidine leads to a sustained effect on S. aureus colonization without affecting GNR colonization.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Chlorhexidine; Community-Acquired Infections; Cross Infection; Female; Gram-Negative Bacterial Infections; Gram-Positive Asporogenous Rods; Humans; Male; Middle Aged; Mupirocin; Nose; Nursing Homes; Pharynx; Prospective Studies; Skin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Topics: Anti-Bacterial Agents; Bacterial Proteins; Belgium; Carrier State; Drug Resistance, Bacterial; Epidemiological Monitoring; Humans; Isoleucine-tRNA Ligase; Microbial Sensitivity Tests; Molecular Typing; Mupirocin; Mutation; Nuclear Proteins; Polymerase Chain Reaction; Prevalence; Staphylococcal Infections; Staphylococcus aureus

This was an observational study comparing methicillin-resistant Staphylococcus aureus (MRSA) transmission with no decolonization of medical patients to required decolonization of all MRSA carriers during two consecutive periods: baseline with no decolonization of medical patients (16 months) and universal MRSA carrier decolonization (13 months). The setting was a one-hospital, 156-bed facility with 9,200 annual admissions. Regression models were used to compare rates of MRSA acquisition. The chi-square test was used to compare event frequencies. We used rates of MRSA clinical disease as an outcome monitor of the program. Analysis was done on 15,666 patients who had admission and discharge tests; 27.9% of inpatient days were occupied by a MRSA-positive patient (colonized patient-days) who received decolonization while hospitalized during the baseline period (this 27.9% represented those who had planned surgery) compared to 76.0% during the intervention period (P < 0.0001). The rate of MRSA transmission was 97 events (1.0%) for 9,415 admissions (2.0 transmission events/1,000 patient-days) during baseline and was 87 (1.4%) for 6,251 admissions (2.7 transmission events/1,000 patient-days) during intervention (P = 0.06; rate ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00). The MRSA nosocomial clinical disease rate was 5.9 infections/10,000 patient-days in the baseline period and was 7.2 infections/10,000 patient-days for the intervention period (rate ratio, 0.82; 95% CI, 0.46 to 1.45; P = 0.49). Decolonization of MRSA patients does not add benefit when contact precautions are used for patients colonized with MRSA in acute (hospital) care.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Cross Infection; Female; Humans; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Patient Admission; Regression Analysis; Staphylococcal Infections; Treatment Outcome

OBJECTIVE To assess the clinical effectiveness of a universal screening program compared with a risk factor-based program in reducing the rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) among admitted patients at the Ottawa Hospital. DESIGN Quasi-experimental study. SETTING Ottawa Hospital, a multicenter tertiary care facility with 3 main campuses, approximately 47,000 admissions per year, and 1,200 beds. METHODS From January 1, 2006 through December 31, 2007 (24 months), admitted patients underwent risk factor-based MRSA screening. From January 1, 2008 through August 31, 2009 (20 months), all patients admitted underwent universal MRSA screening. To measure the effectiveness of this intervention, segmented regression modeling was used to examine monthly nosocomial MRSA incidence rates per 100,000 patient-days before and during the intervention period. To assess secular trends, nosocomial Clostridium difficile infection, mupirocin prescriptions, and regional MRSA rates were investigated as controls. RESULTS The nosocomial MRSA incidence rate was 46.79 cases per 100,000 patient-days, with no significant differences before and after intervention. The MRSA detection rate per 1,000 admissions increased from 9.8 during risk factor-based screening to 26.2 during universal screening. A total of 644 new nosocomial MRSA cases were observed in 1,448,488 patient-days, 323 during risk factor-based screening and 321 during universal screening. Secular trends in C. difficile infection rates and mupirocin prescriptions remained stable after the intervention whereas population-level MRSA rates decreased. CONCLUSION At Ottawa Hospital, the introduction of universal MRSA admission screening did not significantly affect the rates of nosocomial MRSA compared with risk factor-based screening. Infect. Control Hosp. Epidemiol. 2015;37(1):41-48.

Topics: Adult; Aged; Anti-Bacterial Agents; Canada; Clostridioides difficile; Clostridium Infections; Cross Infection; Female; Humans; Incidence; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Risk Factors; Staphylococcal Infections; Tertiary Care Centers

BACKGROUND Studies have suggested that contact precautions (CP) for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus may have risks that outweigh the benefits. These risks, coupled with more widespread use of horizontal interventions such as daily bathing with chlorhexidine gluconate, have brought into question the value of routine CP for these organisms. OBJECTIVE To assess the state of utilization of CP as well as adjunctive measures to reduce the risk of transmission in US hospitals. DESIGN Cross-sectional survey. PARTICIPANTS Total of 751 physician members of the Emerging Infections Network. METHODS An 8-question electronic survey distributed by email. RESULTS A total of 426/751 (57%) responded to the survey; 337/364 (93%) of respondents use routine CP for methicillin-resistant S. aureus and 335/364 (92%) use routine CP for vancomycin-resistant enterococcus. The most widely used trigger for initiation of CP for both pathogens was positive clinical culture. Practices for discontinuation of isolation varied widely. We found that 325/354 (92%) perform routine chlorhexidine gluconate bathing and 236/353 (67%) perform S. aureus decolonization with mupirocin for 1 or more subsets of inpatients, and 82/356 (23%) reported using either hydrogen peroxide vapor or ultraviolet-C room disinfection at discharge. Free text responses noted frustration and variation in the application, practice, and process for initiation and discontinuation of CP. CONCLUSIONS Use of CP for methicillin-resistant S. aureus and vancomycin-resistant enterococcus remains commonplace, although horizontal interventions such as chlorhexidine gluconate bathing are increasingly used. The heterogeneity of practices and policies was striking. Evidence-based guidelines regarding CP and horizontal interventions are needed. Infect. Control Hosp. Epidemiol. 2015;37(1):36-40.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Baths; Chlorhexidine; Cross-Sectional Studies; Disinfection; Gram-Positive Bacterial Infections; Humans; Hydrogen Peroxide; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Patient Isolation; Patients' Rooms; Staphylococcal Infections; Surveys and Questionnaires; Ultraviolet Rays; United States; Vancomycin-Resistant Enterococci

Topics: Anti-Bacterial Agents; Carrier State; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

One of the strategies utilized to decrease infections in the hospital setting relies on topical antimicrobials and antiseptics. While their use is beneficial, concerns arise over the potential to develop resistance or tolerance to these agents. We examined nosocomial Staphylococcus aureus isolates from 2007 to 2013 for the presence of genes associated with tolerance to chlorhexidine. Isolates and patients were identified from an S. aureus surveillance study at Texas Children's Hospital. Nosocomial S. aureus isolates (those causing infection at ≥72 h of hospitalization) were identified and underwent PCR for the qacA or qacB (qacA/B) and smr genes associated with elevated minimum bactericidal concentrations of chlorhexidine. Molecular typing with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and agr typing and a review of the medical record were performed. Two hundred forty-seven nosocomial S. aureus infections were identified. Overall, 111 isolates carried one or both genes (44.9%); 33.1% were positive for smr, 22.7% were positive for qacA/B, and 10.9% of the isolates possessed both genes. The smr-positive isolates were more often resistant to methicillin, ciprofloxacin, and/or clindamycin. The isolates positive for qacA/B were more often associated with indwelling central venous catheters and a vancomycin MIC of ≥2 μg/ml. Isolates carrying either smr or qacA/B were associated with a diagnosis of bacteremia. The smr-positive isolates more often belonged to sequence type 8 (ST8) than the isolates that were positive for qacA/B. Mupirocin resistance was detected in 2.8% of the isolates. Antiseptic-tolerant S. aureus strains are common in our children's hospital and are associated with decreased susceptibility to other systemic antimicrobials and with bloodstream infections. Further work is needed to understand the implications that these organisms have on the hospital environment and antiseptic use in the future.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Child; Child, Preschool; Chlorhexidine; Cross Infection; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Infant; Infection Control; Male; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Texas; Young Adult

Topics: Baths; Chlorhexidine; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Orthopedics; Soaps; Staphylococcal Infections; Surveys and Questionnaires

Staphylococcus aureus is a common cause of healthcare-associated infections in neonates.. To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance.. We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network's healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models.. Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19-0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74-0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10-0.79]). No mupirocin resistance was detected.. Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.

Topics: Anti-Bacterial Agents; Cross Infection; Female; Humans; Incidence; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Male; Maryland; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Regression Analysis; Retrospective Studies; Staphylococcal Infections; Tertiary Healthcare

The effect of decolonization on the control of methicillin-resistant Staphylococcus aureus (MRSA) may differ depending on intensive care unit (ICU) settings and the prevalence of antiseptic resistance in MRSA.. This study was conducted in a 14-bed surgical ICU over a 40-month period. The baseline period featured active surveillance for MRSA and institution of contact precautions. MRSA decolonization via chlorhexidine baths and intranasal mupirocin was implemented during a subsequent 20-month intervention period. Pre-post and interrupted time series analysis were used to evaluate changes in the clinical incidence of hospital-acquired MRSA colonization or infection. MRSA isolates were tested for the presence of qacA/B genes and mupirocin resistance.. In pre-post analysis, the clinical incidence of MRSA significantly decreased by 61.6% after implementation of decolonization (P < .001). Meanwhile, interrupted time series analysis showed decreases in both the level (β = -0.686; P = .210) and trend (β = -0.011; P = .819) of clinical MRSA incidence, but these changes were not statistically significant. Of 169 MRSA isolates, 64 (37.8%) carried the qacA/B genes, and 22 (13.0%) showed either low- (n = 20) or high-level (n = 2) resistance to mupirocin. Low-level mupirocin resistance significantly increased from 0%-19.4% during the study period.. Although decolonization using antiseptic agents was helpful to decrease hospital-acquired MRSA rates, the emergence of antiseptic resistance should be monitored.

Topics: Administration, Intranasal; Aged; Anti-Infective Agents, Local; Baths; Carrier State; Chlorhexidine; Critical Care; Cross Infection; Female; Humans; Incidence; Intensive Care Units; Interrupted Time Series Analysis; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Staphylococcal Infections

A recent trial showed that universal decolonization in adult intensive care units (ICUs) resulted in greater reductions in all bloodstream infections and clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) than either targeted decolonization or screening and isolation. Since regional health-care facilities are highly interconnected through patient-sharing, focusing on individual ICUs may miss the broader impact of decolonization. Using our Regional Healthcare Ecosystem Analyst simulation model of all health-care facilities in Orange County, California, we evaluated the impact of chlorhexidine baths and mupirocin on all ICU admissions when universal decolonization was implemented for 25%, 50%, 75%, and 100% of ICU beds countywide (compared with screening and contact precautions). Direct benefits were substantial in ICUs implementing decolonization (a median 60% relative reduction in MRSA prevalence). When 100% of countywide ICU beds were decolonized, there were spillover effects in general wards, long-term acute-care facilities, and nursing homes resulting in median 8.0%, 3.0%, and 1.9% relative MRSA reductions at 1 year, respectively. MRSA prevalence decreased by a relative 3.2% countywide, with similar effects for methicillin-susceptible S. aureus. We showed that a large proportion of decolonization's benefits are missed when accounting only for ICU impact. Approximately 70% of the countywide cases of MRSA carriage averted after 1 year of universal ICU decolonization were outside the ICU.

Topics: Adult; Anti-Infective Agents; Beds; California; Chlorhexidine; Computer Simulation; Cross Infection; Disinfection; Humans; Infection Control; Intensive Care Units; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Cost-Benefit Analysis; Humans; Mupirocin; Risk; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) infections cause significant morbidity and mortality in neonatal intensive care units (NICUs). We characterized the clinical and molecular epidemiology of MRSA strains colonizing NICU patients. Nasal MRSA isolates (n = 250, from 96 NICU patients) recovered through active surveillance from 2009 to 2014 were characterized with staphylococcal cassette chromosome mec (SCCmec) typing and detection of mupA (marker of high-level mupirocin resistance) and qacA/B (marker associated with chlorhexidine resistance). Factors associated with community-associated (CA-) or healthcare-associated (HA-) MRSA were evaluated. The overall prevalence of MRSA nasal colonization was 3.9%. Of 96 neonates in our retrospective cohort, 60 (63%) were colonized with CA-MRSA strains and 35 (36%) were colonized with HA-MRSA strains. Patients colonized with HA-MRSA were more likely to develop MRSA infections than patients colonized with CA-MRSA (13/35, 37% versus 8/60, 13%; p 0.007), although the interval from colonization to infection was shorter in CA-MRSA-colonized infants (median 0 days, range -1 to 4 versus HA-MRSA-colonized infants, 7 days, -1 to 43; p 0.005). Maternal peripartum antibiotics were associated with CA-MRSA colonization (adjusted odds ratio (aOR) 8.7; 95% CI 1.7-45.0); intubation and surgical procedures were associated with HA-MRSA colonization (aOR 7.8; 95% CI 1.3-47.6 and aOR 6.0; 95% CI 1.4-24.4, respectively). Mupirocin- and chlorhexidine-resistant MRSA was isolated from four and eight patients, respectively; carriage of a mupirocin-resistant strain precluded decolonization. CA-MRSA strains are prominent in the NICU and associated with distinct risk factors. Given community reservoirs for MRSA acquisition and transmission, novel infection prevention strategies are needed.

Topics: Anti-Infective Agents; Carrier State; Chlorhexidine; Disease Transmission, Infectious; Drug Resistance, Bacterial; Female; Genotype; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Male; Methicillin-Resistant Staphylococcus aureus; Molecular Typing; Mupirocin; Nasal Mucosa; Patient Safety; Prevalence; Retrospective Studies; Staphylococcal Infections

A high proportion of methicillin-resistant Staphylococcus aureus isolates recovered in one year period showed high-level mupirocin-resistance (HLMUPR-MRSA) in our environment (27.2%). HLMUPR-MRSA isolates were mainly collected from skin and soft tissue samples, and diabetes was the main related comorbidity condition. These isolates were more frequently found in vascular surgery. HLMUPR-MRSA was more resistant to aminoglycosides than mupirocin-susceptible MRSA, linked to the presence of bifunctional and/or nucleotidyltransferase enzymes with/without macrolide resistance associated with the msr(A) gene. Most of HLMUPR-MRSA isolates belonged to ST125/t067. Nine IS257-ileS2 amplification patterns (p3 was the most frequent) were observed in HLMUPR-MRSA isolates, suggesting the presence of several mupirocin-resistance-carrying plasmids in our environment and promoting the emergence of mupirocin resistance. The presence of the same IS257-ileS2 amplification pattern p3 in 65% of HLMUPR-MRSA, all of them ST125/t067, suggests a clonal spread in our hospital and community environment which could explain the high prevalence of HLMUPR-MRSA during the study period. An outbreak situation or an increase in mupirocin consumption was not observed.

Topics: Aged; Anti-Bacterial Agents; DNA Transposable Elements; Drug Resistance, Bacterial; Female; Genes, Bacterial; Genetic Variation; Genotype; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Plasmids; Retrospective Studies; Staphylococcal Infections

Coagulase-negative staphylococci are thought to act as reservoirs of antibiotic resistance genes that can be transferred to Staphylococcus aureus, thus hindering the combat of this bacterium. In this work, we analyzed the presence of plasmids conferring resistance to the antibiotic mupirocin-widely used to treat and prevent S. aureus infections in hospital environments-in nosocomial S. haemolyticus strains. About 12% of the 75 strains tested were resistant to mupirocin, and this phenotype was correlated with the presence of plasmids. These plasmids were shown to be diverse, being either conjugative or mobilizable, and capable of transferring mupirocin resistance to S. aureus Our findings reinforce that S. haemolyticus, historically and mistakenly considered as a less important pathogen, is a reservoir of resistance genes which can be transferred to other bacteria, such as S. aureus, emphasizing the necessity of more effective strategies to detect and combat this emergent opportunistic pathogen.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Conjugation, Genetic; DNA, Bacterial; Drug Resistance, Bacterial; Gene Order; Genome, Bacterial; Humans; Mupirocin; Nuclear Proteins; Plasmids; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus haemolyticus

Topics: Anti-Bacterial Agents; Epidemics; France; Humans; Imines; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Portugal; Pyridines; Staphylococcal Infections; Staphylococcus aureus; United States

The aim of this study was to detect mupirocin-resistant isolates from pus/wound swabs taken postoperatively in a tertiary centre in Egypt and to determine their ability to form biofilm in order to establish its correlation with mupirocin resistance. This was a prospective study including 513pus/wound swabs from patients suffering from postoperative surgical site infections over the period July 2013-January 2015. Samples were cultured and isolates were identified by coagulase activity, DNase test, mannitol fermentation by mannitol salt agar followed by API Staph 32. Oxacillin agar screen test, agar dilution test for mupirocin, and mupA gene detection by PCR were performed for all methicillin-resistant Staphylococcus aureus (MRSA) isolates. Biofilm detection was carried out by the microtitre plate and Congo red agar methods. Of the 161 S. aureus isolates identified, 73 (45.3%) were MRSA, among which 82.2% were mupirocin-susceptible and 17.8% were mupirocin-resistant. Among the resistant isolates, 38.5% showed low-level resistance and 61.5% were high-level mupirocin-resistant. The mupA gene was detected in 75.0% of high-level mupirocin-resistant strains and in none of the low-level mupirocin-resistant strains. Among the mupirocin-susceptible isolates, 95.0% were biofilm-producers and 5.0% did not produce biofilm. All mupirocin-resistant isolates produced biofilm. Moreover, 15.3% of high-level mupirocin-resistant strains were negative for the mupA gene but showed evidence of biofilm formation. In conclusion, biofilm formation may be suggested to play a role in mupirocin resistance besides the presence of a genetic element encoding abnormal isoleucyl-tRNA synthetase, however further studies are needed to confirm these findings.

Topics: Anti-Bacterial Agents; Biofilms; Drug Resistance, Bacterial; Egypt; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Prospective Studies; Staphylococcal Infections; Surgical Wound Infection; Tertiary Care Centers

Chlorhexidine and mupirocin have been increasingly used in healthcare facilities to eradicate methicillin-resistant Staphylococcus aureus (MRSA) carriage. The aim of this study was to determine the prevalence and mechanisms of chlorhexidine and mupirocin resistance in MRSA from invasive infections and colonisation. MRSA isolates obtained from blood and nasal samples between 2012 and 2014 were analysed. Susceptibility to mupirocin was determined by disk diffusion and Etest and susceptibility to chlorhexidine by broth microdilution. The presence of mupA and qac (A/B and C) genes was investigated by PCR. Molecular typing was performed in high-level mupirocin-resistant (HLMR) isolates. Mupirocin resistance was identified in 15.6% of blood isolates (10.9% HLMR) and 15.1% of nasal isolates (12.0% HLMR). Presence of the mupA gene was confirmed in all HLMR isolates. For blood isolates, chlorhexidine minimum inhibitory concentrations (MICs) ranged from ≤0.125 to 4mg/L and minimum bactericidal concentrations (MBCs) from ≤0.125 to 8mg/L. In nasal isolates, chlorhexidine MICs and MBCs ranged from ≤0.125 to 2mg/L. The qacA/B gene was detected in 2.2% of MRSA isolates (chlorhexidine MIC range 0.25-2mg/L) and the qacC gene in 8.2% (chlorhexidine MIC range ≤0.125-1mg/L). The prevalence of qacC was 18.9% in HLMR isolates and 3.6% in mupirocin-susceptible isolates (P=0.009). Most of the HLMR isolates (97.1%) belonged to ST125 clone. These results suggest that chlorhexidine has a higher potential to prevent infections caused by MRSA. In contrast, mupirocin treatment should be used cautiously to avoid the spread of HLMR MRSA.

Topics: Anti-Bacterial Agents; Bacteremia; Carrier State; Chlorhexidine; Drug Resistance, Bacterial; Genes, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nose; Spain; Staphylococcal Infections

Methicillin-resistant Staphylococcus aureus (MRSA) is a public health problem worldwide. The aim of the present study was to investigate the molecular epidemiology and antimicrobial susceptibilities of MRSA strains in Stockholm, Sweden in 2014. Pulsed-field gel electrophoresis (PFGE) was used to characterise the strains. Antimicrobial susceptibilities to ceftaroline, linezolid and mupirocin were determined by the disc diffusion method. Etest was used to determine vancomycin susceptibility and to confirm resistance to ceftaroline, mupirocin and linezolid in non-susceptible strains. High-level ceftaroline-resistant strains [minimum inhibitory concentration (MIC)≥4mg/L] were confirmed by the broth microdilution method. spa typing was carried out on strains that were non-susceptible to the antibiotics tested. In total, 743 consecutive non-duplicate MRSA strains recovered in Stockholm in 2014 were investigated. PFGE analysis of the isolates revealed a population with 271 different PFGE patterns and three non-typeable strains. No PFGE type accounted for >10% of all strains. The most common PFGE types were MRSA-00-02 (6.9%) and MRSA-05-02 (4.6%). MRSA-05-02 is a USA300-like strain. The antimicrobial susceptibilities of the strains were as follows: ceftaroline, 98.5%; linezolid, 100%; mupirocin, 99.3%; and vancomycin, 100%. Two strains with spa t001 displayed ceftaroline MICs of 4mg/L. Three strains with spa types t002, t064 and t437 showed high-level mupirocin resistance (MIC>1024mg/L). In conclusion, there was a diverse genetic population among the MRSA isolates and no predominant genotype was found. This study identified a few strains with high-level ceftaroline resistance, high-level mupirocin resistance and high-risk genotypes.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Ceftaroline; Cephalosporins; Genotype; Linezolid; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Molecular Epidemiology; Mupirocin; Staphylococcal Infections; Sweden; Vancomycin

Topics: Adult; Anti-Bacterial Agents; Combined Modality Therapy; Conservative Treatment; Cotton Fiber; Female; Granulation Tissue; Humans; Mupirocin; Nails, Ingrown; Remission Induction; Staphylococcal Infections; Staphylococcus aureus; Suppuration; Treatment Outcome

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Cross Infection; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

Topical antimicrobials are often employed for decolonization and infection prevention and may alter the endogenous microbiota of the skin. The objective of this study was to compare the microbial communities and levels of richness and diversity in community-dwelling subjects and intensive care unit (ICU) patients before and after the use of topical decolonization protocols. We enrolled 15 adults at risk for Staphylococcus aureus infection. Community subjects (n = 8) underwent a 5-day decolonization protocol (twice daily intranasal mupirocin and daily dilute bleach-water baths), and ICU patients (n = 7) received daily chlorhexidine baths. Swab samples were collected from 5 anatomic sites immediately before and again after decolonization. A variety of culture media and incubation environments were used to recover bacteria and fungi; isolates were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry. Overall, 174 unique organisms were recovered. Unique communities of organisms were recovered from the community-dwelling and hospitalized cohorts. In the community-dwelling cohort, microbial richness and diversity did not differ significantly between collections across time points, although the number of body sites colonized with S. aureus decreased significantly over time (P = 0.004). Within the hospitalized cohort, richness and diversity decreased over time compared to those for the enrollment sampling (from enrollment to final sampling, P = 0.01 for both richness and diversity). Topical antimicrobials reduced the burden of S. aureus while preserving other components of the skin and nasal microbiota.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Female; Humans; Intensive Care Units; Male; Microbiota; Middle Aged; Mupirocin; Nose; Skin; Sodium Hypochlorite; Staphylococcal Infections; Staphylococcus aureus

Topics: Chlorhexidine; Drug Resistance, Bacterial; Humans; India; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Renal Dialysis; Staphylococcal Infections; Tertiary Care Centers

Saline irrigation of the nasal cavity is a classic and effective treatment for acute or chronic rhinosinusitis. Topical antibiotics such as mupirocin have been widely used for recalcitrant chronic rhinosinusitis. Therefore, the purpose of this study was to evaluate the effect of saline irrigation using mupirocin.. A systematic literature review and meta-analysis of mupirocin saline irrigation were performed using EMBASE, MEDLINE, and Cochrane library through December 2015. Data were analyzed with R 3.2.2 software. A random effects model was used because of the diversity of included studies. Sensitivity analysis of particular tested groups and single proportion tests were also performed. The main outcome measure was residual staphylococcal infection, as confirmed by culture or PCR.. Two RCTs, two prospective studies and two retrospective studies were included. A random effects model meta-analysis of the pooled data identified a relative risk of residual infection of 0.13 (95% CI: 0.06-0.26, p<0.05) with low heterogeneity (I2 = 0%). The proportion of residual staphylococcal infections after 1 month was 0.08 (95% CI: 0.04-0.16). However, this proportion increased to 0.53 at 6 months (95% CI: 0.27-0.78).. The short-term use of mupirocin has a strongly reductive effect on staphylococcal infection in chronic rhinosinusitis. Although there is currently a lack of clear evidence, future studies with well-designed inclusion criteria and randomized controlled trials are needed to examine mupirocin's long-term effect on chronic rhinosinusitis.

Topics: Administration, Intranasal; Humans; Mupirocin; Nasal Cavity; Nasal Lavage; Paranasal Sinuses; Randomized Controlled Trials as Topic; Retrospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Therapeutic Irrigation

Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S.aureus carriers helps to reduce the incidence of PJI by S.aureus.. An S.aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010.. A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S.aureus compared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P=.04).. In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Carrier State; Chlorhexidine; Female; Humans; Incidence; Male; Mupirocin; Nose; Prosthesis-Related Infections; Staphylococcal Infections; Staphylococcus aureus

Whether decolonization following incision and drainage (I&D) for methicillin-resistant Staphylococcus aureus (MRSA) abscess decreases repeat I&D and MRSA-positive cultures in children is unknown.. Referral to the Pediatric Infectious Disease Service (PIDS) for decolonization was determined for eligible children (2003-2010), with outcomes studied over 12 months.. We identified 653 children; 54 had been seen by PIDS. In the PIDS group, no patients (0/54, 0%) had a repeat I&D. In the no PIDS group 36/599 (6%) had a repeat I&D, P = .06. Logistic regression modeling for repeat I&D showed no significant effect, odds ratio = 0.29; 95% confidence interval = 0.04-2.15; P = .23. In the PIDS group, 3 patients (3/54, 5.6%) had a repeat MRSA-positive culture. In the no PIDS group, 58/599 (9.7%) had a positive repeat culture, P = .46. Logistic regression modeling for positive culture showed no significant effect (odds ratio = 0.55; 95% confidence interval = 0.17-1.81; P = .32).. We detected no statistically significant association between decolonization and repeat I&D or MRSA-positive culture.

Topics: Abscess; Administration, Intranasal; Anti-Bacterial Agents; Baths; Child; Child, Preschool; Cohort Studies; Disinfectants; Drainage; Female; Humans; Longitudinal Studies; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Retrospective Studies; Risk Factors; Sodium Hypochlorite; Staphylococcal Infections; Treatment Outcome

Intranasal carrier status of Methicillin-sensitive Staphylococcus aureus (MSSA), and Methicillin-resistant Staphylococcus aureus (MRSA) has been shown to be a significant risk factor for developing surgical site infections. To determine if current treatment protocol for positive nasal screen was effective at decolonizing carriers 289 consecutive patients undergoing primary or revision total joint arthroplasty were screened preoperatively. Those patients with positive cultures were treated with a 5-day course of intranasal mupirocin. Preoperatively 44 (15.2%) patients tested positive for MSSA colonization, and 12 (4.2%) patients for MRSA. Testing on the day of surgery revealed 15 (5.2%) patients with MSSA positive cultures, and 1 (0.35%) patient with a MRSA positive culture. Reduction of MSSA and MRSA colonization was statistically significant (P=0.0341, P=0.0073 respectively). Our overall results indicate that our current decolonization protocol with nasal mupirocin was effective in reducing MSSA and MRSA colonization, although a significant number of patients remained positive for MSSA.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement; Carrier State; Clinical Protocols; Cross-Sectional Studies; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nasal Cavity; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Young Adult

The association between mupirocin use and plasmid-based high-level resistance development mediated through mupA in CoNS has not been quantified. We determined acquisition of mupirocin resistance in Staphylococcus aureus and CoNS in surgery patients treated peri-operatively with mupirocin.. Patients admitted for surgery were treated with nasal mupirocin ointment and chlorhexidine soap for 5 days, irrespective of S. aureus carrier status. Nasal swabs were obtained before decolonization (T1) and 4 days after surgery (T2) and were inoculated onto agars containing 8 mg/L mupirocin. Staphylococci were identified by MALDI-TOF MS and mupirocin resistance was confirmed by Etest.. Among 1578 surgical patients, 936 (59%) had nasal swabs obtained at T1 and T2; 192 (21%) patients carried mupirocin-resistant CoNS at T1 and 406 (43%) at T2 (P<0.001). Of 744 patients not colonized at T1, 277 acquired resistance (37%), corresponding to an acquisition rate of 7.4/100 patient days at risk. In all, 588 (97%) of 607 mupirocin-resistant CoNS had an MIC >256 mg/L (high level) and 381 of 383 (99.5%) were mupA positive. No acquisition of mupirocin resistance was observed in S. aureus.. Acquisition of mupirocin resistance following decolonization was widespread in CoNS and absent in S. aureus. As almost all isolates harboured the mupA gene, monitoring resistance development in S. aureus when decolonization strategies containing mupirocin are used is recommended.

Topics: Cohort Studies; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Mupirocin; Nasal Cavity; Plasmids; Prospective Studies; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Staphylococcal Infections; Staphylococcus

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Population Surveillance; Staphylococcal Infections

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Drug Resistance, Multiple, Bacterial; Hospitals, Veterans; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nose; Population Surveillance; Staphylococcal Infections; Surgical Wound Infection

The 'soak and smear' regimen is a highly effective method for localised topical therapy employed by dermatologists for widespread inflammatory skin conditions. The regimen involves application of topical medication under occlusion after soaking in water. Complications from this treatment method are rare. We present a case of multiple, generalised methicillin-resistant Staphylococcus aureus (MRSA)-positive furuncles arising in a patient as an unexpected consequence of therapy. The case highlights an unanticipated risk of a commonly employed treatment amid an epidemic of MRSA in the community.

Topics: Aged; Anti-Bacterial Agents; Chlorhexidine; Clobetasol; Diagnosis, Differential; Doxycycline; Eczema; Furunculosis; Glucocorticoids; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Water

To evaluate whether topical mupirocin treatment can effectively decolonize methicillin-resistant Staphylococcus aureus (MRSA) carriage and reduce subsequent MRSA infection in neonates.. During a 1-year period, the infants admitted to our neonatal intensive care units (NICUs)-1 and NICU-2 were included, and specimens from the nares and umbilicus were obtained within 24 hours, and specimen collection was repeated weekly for 2 weeks. Mupirocin was administered for 5 days to the infants with MRSA colonization in NICU-1 during the first half of the year and then switched to those in NICU-2 during the second half of the year.. A total of 525 infants were recruited: 257 infants in the treatment group and 268 in the control group. MRSA colonization was detected in 130 infants (25%) during NICU stay, which is a similar rate in both groups. Twenty-two (4.2%) episodes of MRSA infection were identified. The rate of MRSA infection was significantly higher in infants with prior colonization than in those without (10.2% vs. 2.3%, P<0.001). Among the infants with prior colonization, the rate of MRSA infection in the treatment group was significantly lower than that in the control group (3.2% vs. 16%, P=0.014), and the rate in the treatment group was comparable to that in those without colonization (P=0.7804). Of the 15 infants with both clinical and colonizing isolates, indistinguishable strains between the paired isolates from the same infant by molecular methods were identified in 14 infants (93%).. Administering mupirocin topical therapy to MRSA-colonized infants in NICUs might reduce subsequent MRSA infections during hospitalization in these infants. A large-scale study should be conducted.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Disinfection; Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Odds Ratio; Risk Factors; Staphylococcal Infections; Taiwan

Topical mupirocin is used widely to treat skin and soft tissue infections and to eradicate nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). Few studies to date have characterized the rates of S. aureus mupirocin resistance in pediatric populations. We retrospectively studied 358 unique S. aureus isolates obtained from 249 children seen in a predominantly outpatient setting by the Division of Pediatric Dermatology at a major academic center in New York City between 1 May 2012 and 17 September 2013. Mupirocin resistance rates and the associated risk factors were determined using a logistic regression analysis. In our patient population, 19.3% of patients had mupirocin-resistant S. aureus isolates at the time of their first culture, and 22.1% of patients with S. aureus infection had a mupirocin-resistant isolate at some time during the study period. Overall, 31.3% of all S. aureus isolates collected during the study period were resistant to mupirocin. Prior mupirocin use was strongly correlated (odds ratio [OR] = 26.5; P = <0.001) with mupirocin resistance. Additional risk factors for mupirocin resistance included methicillin resistance, atopic dermatitis (AD), epidermolysis bullosa (EB), immunosuppression, and residence in northern Manhattan and the Bronx. Resistance to mupirocin is widespread in children with dermatologic complaints in the New York City area, and given the strong association with mupirocin exposure, it is likely that mupirocin use contributes to the increased resistance. Routine mupirocin testing may be important for MRSA decolonization strategies or the treatment of minor skin infections in children.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant; Infant, Newborn; Logistic Models; Male; Microbial Sensitivity Tests; Mupirocin; Prevalence; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Young Adult

Methicillin-resistant Staphylococcus aureus (MRSA) is a leading pathogen of healthcare-associated infections in intensive care units (ICUs). Prior studies have shown that decolonization of MRSA carriers is an effective method to reduce MRSA infections in ICU patients. However, there is currently a lack of data on its effect on mortality and medical cost.. Using a quasi-experimental, interrupted time-series design with re-introduction of intervention, we evaluated the impact of active screening and decolonization on MRSA infections, mortality and medical costs in the surgical ICU of a university hospital in Taiwan. Regression models were used to adjust for effects of confounding variables.. MRSA infection rate decreased from 3.58 (baseline) to 0.42‰ (intervention period) (P <0.05), re-surged to 2.21‰ (interruption period) and decreased to 0.18‰ (re-introduction of intervention period) (P <0.05). Patients admitted to the surgical ICU during the intervention periods had a lower in-hospital mortality (13.5% (155 out of 1,147) versus 16.6% (203 out of 1,226), P = 0.038). After adjusting for effects of confounding variables, the active screening and decolonization program was independently associated with a decrease in in-hospital MRSA infections (adjusted odds ratio: 0.3; 95% CI: 0.1 to 0.8) and 90-day mortality (adjusted hazard ratio: 0.8; 95% CI: 0.7 to 0.99). Cost analysis showed that $22 medical costs can be saved for every $1 spent on the intervention.. Active screening for MRSA and decolonization in ICU settings is associated with a decrease in MRSA infections, mortality and medical cost.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Cross Infection; Disinfection; Female; Hospital Mortality; Humans; Infection Control; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nasal Cavity; Staphylococcal Infections; Taiwan

Little is known about the natural course of patients with chronic stable illnesses colonized with methicillin-resistant Staphylococcus aureus (MRSA). The aim is to determine the impact of MRSA colonization in mortality among long-term health care facility (LTHCF) residents.. A multicenter, prospective, observational study was designed. Residents in 4 LTHCFs were classified according to MRSA carriage status and followed for 12 months. Treatment consisted of 5 days of nasal mupirocin in MRSA carriers.. Ninety-three MRSA-carriers among 413 residents were identified. Thirty-one MRSA-colonized patients died during the study period, 11 of whom from an infectious disease. Independent predictors of their higher mortality rates included heart failure, current neoplasm, MRSA carriage and COPD at 3 months and these same factors plus stroke, Bar-thel index <40, pressure ulcers, and older age at 12 months. MRSA-persistence was 35% and 62.5% at 3 and 12 months, respectively.. MRSA colonization among frail LTHCFs residents is highly prevalent, and is associated with higher mortality. Despite treatment of MRSA carriers, many remained colonized. Factors that promote persistence of MRSA colonization, and the impact of their modification on mortality rates in these patients, need further investigation.

Topics: Administration, Intranasal; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Female; Health Surveys; Humans; Long-Term Care; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Prospective Studies; Risk Factors; Spain; Staphylococcal Infections; Survival Analysis

Mupirocin is a topical antibiotic largely used to eradicate staphylococcal nasal carriage. Here, we investigated the prevalence of mupirocin-resistant Staphylococcus aureus and coagulase-negative staphylococcal isolates recovered from patients in different wards in a hospital (Lyon, France), which were determined both phenotypically with an Epsilometer test (Etest) and genetically by PCR for mupA and mupB.

Topics: Anti-Bacterial Agents; Carrier State; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; France; Genes, Bacterial; Genotype; Humans; Mupirocin; Nasal Mucosa; Phenotype; Polymerase Chain Reaction; Prevalence; Staphylococcal Infections; Staphylococcus; Tertiary Care Centers

Novel antimicrobials and new approaches to developing them are urgently needed. Repurposing already-approved drugs with well-characterized toxicology and pharmacology is a novel way to reduce the time, cost, and risk associated with antibiotic innovation. Ebselen, an organoselenium compound, is known to be clinically safe and has a well-known pharmacology profile. It has shown potent bactericidal activity against multidrug-resistant clinical isolates of staphylococcus aureus, including methicillin- and vancomycin-resistant S. aureus (MRSA and VRSA). We demonstrated that ebselen acts through inhibition of protein synthesis and subsequently inhibited toxin production in MRSA. Additionally, ebselen was remarkably active and significantly reduced established staphylococcal biofilms. The therapeutic efficacy of ebselen was evaluated in a mouse model of staphylococcal skin infections. Ebselen 1% and 2% significantly reduced the bacterial load and the levels of the pro-inflammatory cytokines tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and monocyte chemo attractant protein-1 (MCP-1) in MRSA USA300 skin lesions. Furthermore, it acts synergistically with traditional antimicrobials. This study provides evidence that ebselen has great potential for topical treatment of MRSA skin infections and lays the foundation for further analysis and development of ebselen as a potential treatment for multidrug-resistant staphylococcal infections.

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Azoles; Bacterial Toxins; Biofilms; Cell Survival; Cells, Cultured; Daptomycin; Drug Repositioning; Drug Synergism; Female; Host-Pathogen Interactions; Humans; Isoindoles; Keratinocytes; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Mice, Inbred BALB C; Microbial Sensitivity Tests; Mupirocin; Organoselenium Compounds; Skin; Staphylococcal Infections

Both low-level mupirocin resistance (LMR) and high-level mupirocin resistance (HMR) have been identified. The aim of this study was to determine the epidemiology of LMR and HMR in MRSA isolates at five hospitals that have used mupirocin for targeted decolonization as part of successful institutional control programmes.. All MRSA identified in three microbiology laboratories serving five central and south-east London hospitals and surrounding communities between November 2011 and February 2012 were included. HMR and LMR were determined by disc diffusion testing. WGS was used to derive multilocus sequence types (MLSTs) and the presence of HMR and LMR resistance determinants.. Prevalence of either HMR or LMR amongst first healthcare episode isolates from 795 identified patients was 9.69% (95% CI 7.72-11.96); LMR was 6.29% (95% CI 4.70-8.21) and HMR was 3.40% (95% CI 2.25-4.90). Mupirocin resistance was not significantly different in isolates identified from inpatients at each microbiology laboratory, but was more common in genotypically defined 'hospital' rather than 'community' isolates (OR 3.17, 95% CI 1.36-9.30, P = 0.002). LMR was associated with inpatient stay, previous history of MRSA and age ≥65 years; HMR was associated with age ≥65 years and residential postcode outside London. LMR and HMR varied by clone, with both being low in the dominant UK MRSA clone ST22 compared with ST8, ST36 and ST239/241 for LMR and with ST8 and ST36 for HMR. V588F mutation and mupA carriage had high specificity (>97%) and area under the curve (>83%) to discriminate phenotypic mupirocin resistance, but uncertainty around the sensitivity point estimate was large (95% CI 52.50%-94.44%). Mutations in or near the mupA gene were found in eight isolates that carried mupA but were not HMR.. Mupirocin resistance was identified in <10% of patients and varied significantly by clone, implying that changes in clonal epidemiology may have an important role in determining the prevalence of resistance in conjunction with selection due to mupirocin use.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Local; Cohort Studies; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Female; Genetic Variation; Genome, Bacterial; Genotype; Humans; London; Male; Methicillin-Resistant Staphylococcus aureus; Molecular Epidemiology; Multilocus Sequence Typing; Mupirocin; Prevalence; Sequence Analysis, DNA; Staphylococcal Infections

The incidence of prosthesis infections after breast reconstruction is of the order of 4% to 13% according to the literature. In surgical patients, Staphylococcus aureus (S. aureus) is the bacterial species most often responsible for surgical site infections. In cardiac surgery, screening for carriage of S. aureus and preoperative decontamination are carried out routinely before prosthetic surgery. We retrospectively reviewed data from patients at our institution between January 2011 and December 2013. Our series showed that the prosthesis infection rates were in the range of 5.92% in 2008 with an ISO rate of S. aureus 3.61%. Routine screening for prosthetic reconstructions was performed to assess the impact of preoperative decontamination patients in carriers of S. aureus. This screening was done in 381 patients: 17.8% of patients were carriers of S. aureus ; 11 patients have an ISO (or an incidence rate of 2.88%) ; 5 patients have an ISO S. aureus (an incidence of S. aureus ISO 1.3%). The introduction of the screening process, allowed a drop of 5.92% ISO rate at 1.46% with a passage of S. aureus SSI rates of 3, 60% to 0.72%. In the near future, studies are needed to confirm these encouraging results, to demonstrate the efficacy of preoperative decontamination in carriers of S. aureus patients before laying prosthesis.

Topics: Anti-Bacterial Agents; Female; Humans; Mammaplasty; Mupirocin; Nasal Cavity; Preoperative Care; Prospective Studies; Prosthesis-Related Infections; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Nasal furunculosis is a deep infection of hair follicle within the nasal vestibule. In this report, the authors presented a 49-year-old woman with 4-day history of focal red area and tender swelling on the tip of her nose. On physical examination, together with a swelling at nasal vestibulum, erythema, and edema on the skin of nasal tip were observed, which is called the Rudolph Sign. The patient was treated with intranasal topical mupirocin and oral sodium fusidate. Because nasal furunculosis may lead to serious complications such as ophthalmic vein thrombosis and cavernous sinus thrombosis, early diagnosis and effective treatment is essential.

Topics: Administration, Intranasal; Administration, Oral; Animals; Anti-Bacterial Agents; Edema; Female; Furunculosis; Fusidic Acid; Humans; Middle Aged; Mupirocin; Nose Diseases; Staphylococcal Infections

Leclercia adecarboxylata is a rarely described motile, aerobic, gram-negative bacillus reported to cause clinically significant solitary infections in immunocompromised patients and polymicrobial wound infections in immunocompetent patients [1-5]. We present a case of a polymicrobial infection including L. adecarboxylata in a healthy female patient with a subungual splinter, to increase awareness and aid in the diagnosis and treatment of cutaneous L. adecarboxylata infections. To our knowledge, this is the first reported case of trauma-related subungual L. adecarboxylata infection reported in the dermatology literature.

Topics: Adult; Anti-Bacterial Agents; Bambusa; Cephalexin; Coinfection; Doxycycline; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Finger Injuries; Foreign Bodies; Humans; Immunocompetence; Mupirocin; Nails; Staphylococcal Infections; Wound Infection

The emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA), including strains resistant to current antibiotics, has contributed to an increase in the number of skin infections reported in humans in recent years. New therapeutic options are needed to counter this public health challenge. The aim of the present study was to examine the potential of thiazole compounds synthesized by our research group to be used topically to treat MRSA skin and wound infections. The broth microdilution method confirmed that the lead thiazole compound and four analogues are capable of inhibiting MRSA growth at concentrations as low as 1.3 μg/mL. Additionally, three compounds exhibited a synergistic relationship when combined with the topical antibiotic mupirocin against MRSA in vitro via the checkerboard assay. Thus the thiazole compounds have potential to be used alone or in combination with mupirocin against MRSA. When tested against human keratinocytes, four derivatives of the lead compound demonstrated an improved toxicity profile (were found to be non-toxic up to a concentration of 20 μg/mL). Utilizing a murine skin infection model, we confirmed that the lead compound and three analogues exhibited potent antimicrobial activity in vivo, with similar capability as the antibiotic mupirocin, as they reduced the burden of MRSA present in skin wounds by more than 90%. Taken altogether, the present study provides important evidence that these thiazole compounds warrant further investigation for development as novel topical antimicrobials to treat MRSA skin infections.

Topics: Administration, Topical; Animals; Drug Therapy, Combination; Humans; Keratinocytes; Methicillin-Resistant Staphylococcus aureus; Mice; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcal Skin Infections; Thiazoles

Mupirocin is a topical antimicrobial used to decolonize patients who carry methicillin-resistant Staphylococcus aureus (MRSA), and the topical agent retapamulin may be a potential alternative therapy. The goal of this study was to determine the in vitro activity of retapamulin as well as a panel of 15 antimicrobial agents, including mupirocin, for 403 MRSA isolates collected longitudinally from a naive population at the Veterans Affairs Puget Sound Health Care System. The MICs for retapamulin had a unimodal distribution, ranging from 0.008 to 0.5 μg/ml. One isolate had an MIC of >16 μg/ml, was also resistant to clindamycin and erythromycin, and was recovered from the nares of a patient undergoing hemodialysis. Twenty-four isolates (6%) and 11 isolates (3%) demonstrated low-level resistance (MICs of 8 to 64 μg/ml) and high-level resistance (MICs of ≥ 512 μg/ml), respectively, to mupirocin. Isolates were recovered from 10 patients both before and after mupirocin therapy. Of those, isolates from 2 patients demonstrated MIC changes postmupirocin therapy; in both cases, however, strain typing demonstrated that the pre- and postmupirocin strains were different. A total of 386 isolates (96%) had vancomycin MICs of ≤ 1.0 μg/ml; 340 isolates (84%) were resistant to levofloxacin, 18 isolates (4.5%) were resistant to trimethoprim-sulfamethoxazole, and 135 isolates (33%) had elevated MICs of 4 μg/ml for linezolid. The baseline levels of resistance were low for mupirocin (9%) and even lower for retapamulin (0.25%) Although the use of mupirocin is currently the standard therapy for decolonization practices, the activity of retapamulin warrants its consideration as an alternative therapy in MRSA decolonization regimens.

Topics: Anti-Bacterial Agents; ATP-Binding Cassette Transporters; Bacterial Proteins; Bridged Bicyclo Compounds, Heterocyclic; Diterpenes; Humans; Linezolid; Longitudinal Studies; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; United States; Veterans

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) patients in the United States is approximately 25%. Little is known about the relative proportion of hospital- versus community-associated strains or the antimicrobial susceptibility of MRSA in different CF centers. We hypothesized that the majority of MRSA isolates obtained from children with CF are those endemic in the hospital and that those associated with community acquisition (SCCmec IV) would be more resistant than typically seen in non-CF MRSA isolates.. We studied MRSA strains from seven pediatric CF centers to determine the clonal distribution based on DNA sequencing of the staphylococcal protein A gene (spa typing), the type of staphylococcal chromosomal cassette mec (SCCmec), and the proportion of strains with Panton-Valentine leukocidin (PVL). Antimicrobial susceptibility to systemic and topical antibiotics was compared between different MRSA types.. We analyzed 277 MRSA isolates from unique patients (mean age 11.15 ± 4.77 years, 55% male). Seventy % of isolates were SCCmec II PVL negative and the remainder SCCmec IV. Overall 17% MRSA strains were PVL positive (all SCCmec IV). Spa typing of 118 isolates showed most of the SCCmec II strains being t002, while SCCmec IV PVL positive isolates were t008, and SCCmec IV PVL negative isolates represented a variety of spa-types. The proportions of SCCmec II strains and spa-types were similar among centers. Overall rates of resistance to trimethoprim-sulfamethoxazole (4%), tetracycline (7%), tigecycline (0.4%), linezolid (0.4%) as well as fosfomycin (0.4%), fusidic acid (3%), and mupirocin (1%) were low. No strains were resistant to vancomycin. SCCmec II strains had higher rates of resistance to ciprofloxacin and clindamycin (P < 0.001) than SCCmec IV strains.. In this U.S. study, most MRSA isolates in the pediatric CF population were SCCmec II PVL negative. Rates of resistance were low, including to older and orally available antibiotics such as trimethoprim-sulfamethoxazole.

Topics: Acetamides; Adolescent; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Bronchoscopy; Child; Child, Preschool; Cohort Studies; Cystic Fibrosis; DNA, Bacterial; Exotoxins; Female; Fosfomycin; Fusidic Acid; Humans; Leukocidins; Linezolid; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Minocycline; Molecular Typing; Mupirocin; Oxazolidinones; Penicillin-Binding Proteins; Pharynx; Pneumonia, Staphylococcal; Sequence Analysis, DNA; Sputum; Staphylococcal Infections; Staphylococcal Protein A; Tetracycline; Tigecycline; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Forty-two medical centers from throughout the United States participating in a longitudinal surveillance program were asked to submit 100 consecutive Staphylococcus aureus isolates during July to December 2011. Susceptibility testing using CLSI broth microdilution and mecA detection by PCR analysis was performed on the 4,131 isolates collected. Methods employing Etest glycopeptide resistance detection (GRD; bioMérieux) and brain heart infusion agar containing 4 μg/ml vancomycin (BHIV) were used to screen methicillin-resistant S. aureus (MRSA) isolates for heterogeneous intermediate-level resistance to vancomycin (hVISA). Isolates with positive hVISA screen results were confirmed by population analysis profiling-area under the curve (PAP-AUC) determinations. The genetic relatedness of hVISA, ceftaroline-nonsusceptible, or high-level (HL) mupirocin resistance MRSA isolates was assessed by pulsed-field gel electrophoresis (PFGE). Among 2,093 MRSA isolates, the hVISA screen results were positive with 47 isolates by Etest GRD and 30 isolates by BHIV agar screen. Twenty-five of the GRD- or BHIV screen-positive isolates were confirmed as hVISA by PAP-AUC testing. Results of the current study were compared to results obtained from prior surveillance performed in 2009. The prevalence of hVISA among MRSA isolates was higher in 2011 than in 2009 (1.2% versus 0.4%, P = 0.003), especially for isolates with a vancomycin MIC of 2 (45.4% versus 14.3%, P = 0.01). The overall rate of ceftaroline susceptibility in the current study was 99.4% (one hVISA isolate had an intermediate ceftaroline MIC). HL mupirocin resistance increased from 2.2% in 2009 to 3.2% in 2011 (P = 0.006). Although overall rates of hVISA and HL mupirocin resistance are low, they have increased since 2009.

Topics: Anti-Bacterial Agents; Ceftaroline; Cephalosporins; Electrophoresis, Gel, Pulsed-Field; Epidemiological Monitoring; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; United States; Vancomycin; Vancomycin Resistance

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Arthroplasty, Replacement; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Oral Hygiene; Prosthesis-Related Infections; Risk Factors; Staphylococcal Infections; Surgical Wound Infection

In the United States, veterinary use of mupirocin is primarily limited to the treatment of canine pyoderma caused by methicillin-resistant Staphylococcus pseudintermedius (MRSP). In this study, only 1 of 581 S. pseudintermedius isolates tested was resistant to mupirocin and carried the high-level mupirocin resistance gene, ileS2, on a plasmid.

Topics: Animals; Anti-Bacterial Agents; DNA, Bacterial; Dogs; Drug Resistance, Bacterial; Genes, Bacterial; Molecular Sequence Data; Mupirocin; Polymerase Chain Reaction; Prevalence; Pyoderma; Sequence Analysis, DNA; Staphylococcal Infections; Staphylococcus; United States

Methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most significant pathogens affecting global public health and health care systems. In Canada and the United States, the spread of MRSA is primarily attributed to a single dominant epidemic clone: CMRSA10/USA300. Despite this, the CMRSA7/USA400 epidemic clone has been reported to be the predominate epidemic clone in several Canadian provinces and some parts of the United States. This study examined the epidemiology of CMRSA7/USA400 MRSA in Alberta, Canada, from June 2005 to December 2012. Molecular characterization of CMRSA7/USA400 isolates was done using spa, SCCmec, PVL, and PFGE typing and identified two predominant spa types in Alberta: t128 and t1787. Although closely related, these spa types have distinct geographic distributions. From 2010 to 2012, the number of t128 infections has remained stable while there has been a nearly 3-fold increase in the number of provincial t1787 infections, accompanied by 10-fold increases in t1787 infection rates in some communities. Most t128 and t1787 patients were First Nations or Inuit people, and isolates were usually from skin and soft tissue infections in outpatients. t128 patients were significantly older than t1787 patients. Antimicrobial susceptibility testing showed higher mupirocin resistance in t1787 than in t128 MRSA. Improved strategies to reduce or stabilize t1787 infections in Alberta are needed.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alberta; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Bacterial; Female; Genotype; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Molecular Typing; Mupirocin; Prevalence; Staphylococcal Infections; Young Adult

We describe a new, efficient, sensitive, and fast single-tube multiple-PCR protocol for the identification of the most clinically significant Staphylococcus spp. and the simultaneous detection of the methicillin and mupirocin resistance loci. The protocol identifies at the species level isolates belonging to S. aureus, S. epidermidis, S. haemolyticus, S. hominis, S. lugdunensis, and S. saprophyticus.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Methicillin; Molecular Diagnostic Techniques; Multiplex Polymerase Chain Reaction; Mupirocin; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus; Time Factors

The prevalence and spread of mupirocin and antiseptic resistance among colonizing and infectious Staphylococcus aureus were determined. S. aureus isolated from anterior nares and infection sites of patients hospitalized in the largest tertiary care referral hospital in Malaysia was investigated for mupirocin and antiseptic susceptibility testing, and for PCR detection of mupA, qacA/B, and smr genes. Twelve isolates showed resistance to mupirocin by disk diffusion, of which 10 (3.8%) harbored the mupA gene. Minimum inhibitory concentrations (MICs) ranged from 64 to 768 μg/ml for mupA positive and below 46 μg/ml for negative isolates. The mupA was more common among ST239 isolates (70%). The qacA/B was carried in 67 out of 95 methicillin-resistant Staphylococcus aureus (MRSA) (70.5%) and 3 out of 164 methicillin-susceptible Staphylococcus aureus (MSSA) (1.8%), while smr was carried in 6 out of 95 MRSA (6.3%) strains. MICs ranged from 3.9 to 15.6 μg/ml for benzethonium chloride (BTC) and benzalkonium chloride (BKC), and from 10.3 to 20.7 μg/ml for chlorhexidine digluconate (CHG). Isolates with qacA/B and smr or qacA/B alone showed higher MIC (20.7 μg/ml for CHG and 15.6 μg/ml for BTC and BKC) than the isolates that lacked antiseptic resistance genes (10.3 μg/ml for CHG and 3.9 μg/ml for BTC and BKC). In 16 cases, ST239 was isolated from the infection site and the nares simultaneously, and shared identical resistance patterns (qacAB or qacAB+smr), suggesting possible endogenous infection. Spread of low-level mupirocin resistance expressing ST239 MRSA and high-level resistance expressing emerging ST1, co-existing with antiseptic-resistant genes showing elevated MICs, should be monitored for effective infection control.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacterial Proteins; Benzalkonium Compounds; Benzethonium; Chlorhexidine; Gene Expression; Genotype; Humans; Malaysia; Membrane Transport Proteins; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nuclear Proteins; Prevalence; Staphylococcal Infections; Tertiary Healthcare

Active surveillance systems are effective in reducing health care-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Nonetheless, some patients develop MRSA infection despite control measures. We tried to identify risk factors related to the appearance of MRSA at sites other than the nasal fossa in patients who were nasal carriers of MRSA.. A retrospective case-control study was conducted in an active surveillance program for MRSA between January 2009 and December 2010 at a Spanish teaching hospital. Cases were patients with MRSA in the anterior nares and a length of stay of at least 5 days who developed MRSA-positive clinical culture after decolonization treatment had started. Controls were patients with the same characteristics as the case group, except that they did not develop MRSA-positive clinical culture as verified by negative clinical cultures.. After intrinsic and extrinsic risk factors were analyzed, the emergence of mupirocin-resistant MRSA clones after decolonization treatment, and residence in a nursing home were marginally significant in the univariate analysis. The detection of the emergence of mupirocin-resistant MRSA clones was independently associated with the detection of MRSA in other clinical locations.. In an active surveillance program for MRSA it is important to determine the mupirocin susceptibility of the isolates to determine appropriate treatment and to verify negativity after decolonizing treatment has been completed.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents; Carrier State; Case-Control Studies; Drug Resistance, Bacterial; Female; Hospitals, Teaching; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Retrospective Studies; Risk Factors; Spain; Staphylococcal Infections; Young Adult

Inmates of Rikers Island jail potentially introduce Staphylococcus aureus into New York State prisons upon transfer. In this study, methicillin-resistant Staphylococcus aureus isolates (n = 452), collected from infected inmates (2009 to 2013), were characterized. spa type t008 was the predominant clone identified, accounting for 82.3% of the isolates, with no evidence of mupirocin or chlorhexidine resistance.

Topics: Chlorhexidine; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Molecular Epidemiology; Molecular Typing; Mupirocin; New York; Prisoners; Prisons; Staphylococcal Infections

Staphylococcus aureus (S. aureus) continues to be a leading cause of outbreaks and health-care-associated infections in neonatal intensive care units. In the first few months of life, many neonates acquire S. aureus as part of their delicate and evolving microbiota. Neonates that asymptomatically acquire S. aureus colonization are at increased risk of developing a subsequent S. aureus infection. This review discusses the epidemiology and prevention of S. aureus disease in neonates and how decolonization to eradicate S. aureus may decrease S. aureus transmission and infections in the neonatal intensive care unit.

Topics: Anti-Bacterial Agents; Asymptomatic Diseases; Carrier State; Cross Infection; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Mupirocin; Risk Assessment; Staphylococcal Infections

The in vitro and in vivo antimicrobial activity of primary ammonium ethyl methacrylate homopolymers (AEMPs) was investigated. AEMPs with different degrees of polymerization (DP = 7.7-12) were prepared by reversible addition-fragmentation chain-transfer (RAFT) polymerization. The AEMPs showed higher inhibitory effects against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), than Gram-negative bacteria. The AEMPs also showed potent anti-S. aureus activity in the presence of fetal bovine serum, whereas the activity of the antibiotic mupirocin was reduced under the same conditions. The AEMPs showed very little or no hemolytic activity. The cytotoxicity of AEMPs against mammalian cells HEp-2 and COS-7 was concentration-dependent, and the cell viability significantly decreased at higher polymer concentrations. The AEMPs significantly reduced the number of viable S. aureus cells in the nasal environment of cotton rats when compared to that of the control. This study demonstrates that AEMPs have potential for use in treating topical S. aureus infections.

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Cattle; Chlorocebus aethiops; COS Cells; Gram-Negative Bacteria; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose Diseases; Polymethacrylic Acids; Rats; Sigmodontinae; Staphylococcal Infections

Nasal carriers not only pose serious threat to themselves but also to the community by playing an active role in the dissemination of serious and life threatening S. aureus especially MRSA strains. The present study focuses on the use of broad spectrum lytic phage as decolonising agent. In addition, the combined use of lytic phage with mupirocin has also been investigated as an effective decolonising regimen. The effect of phage on the adherence, invasion and cytotoxic effect of MRSA strains on nasal epithelial cells was studied in an ex-vivo model of cultured murine nasal epithelial cells. This was followed by demonstration of therapeutic potential of phage along with mupirocin in decolonising the nares of BALB/c mice using a nasal model of MRSA colonisation.. Phage was able to significantly reduce the in vitro adherence, invasion and cytotoxicity of MRSA 43300 as well as other clinical MRSA strains on murine nasal epithelial cells as compared to untreated control. Also, the frequency of emergence of spontaneous mutants decreased to negligible levels when both the agents (phage and mupirocin) were used together.. Phage MR-10, given along with mupirocin showed an additive effect and the combination was able to effectively eradicate the colonising MRSA population from the nares of mice by day 5.

Topics: Animals; Anti-Bacterial Agents; Bacterial Adhesion; Biological Therapy; Carrier State; Cell Survival; Combined Modality Therapy; Endocytosis; Epithelial Cells; Female; Methicillin-Resistant Staphylococcus aureus; Mice, Inbred BALB C; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Staphylococcus Phages; Treatment Outcome

TXA497 is representative of a new class of guanidinomethyl biaryl compounds that exhibit potent bactericidal behavior against methicillin-resistant Staphylococcus aureus (MRSA). In this study, we compared the anti-staphylococcal, skin deposition, and skin permeation properties of TXA497 and the topical anti-MRSA antibiotic mupirocin. The results of minimum inhibitory concentration (MIC) assays revealed that TXA497 retains potent activity against MRSA that is highly resistant to mupirocin. Using Franz diffusion cells, compound deposition into human cadaver skin was evaluated, and the results showed the skin deposition of TXA497 to be significantly greater than that of mupirocin. Moreover, unlike mupirocin, TXA497 does not pass through the entire skin layer, suggesting a minimal potential for the systemic absorption of the compound upon topical administration. Additionally, antibacterial concentrations of TXA497 showed no significant toxicity to primary human keratinocytes. Given the rising levels of mupirocin resistance among MRSA populations, our results are significant in that they highlight TXA497 as a potentially useful alternative therapy for treating MRSA skin infections that are resistant to mupirocin.

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Biphenyl Compounds; Drug Resistance, Bacterial; Guanidines; Humans; In Vitro Techniques; Keratinocytes; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Skin; Skin Absorption; Staphylococcal Infections

Topics: Adrenal Cortex Hormones; Animals; Anti-Bacterial Agents; Biofilms; Disease Models, Animal; Humans; In Situ Hybridization, Fluorescence; Mupirocin; Rhinitis; Sheep; Sinusitis; Staphylococcal Infections; Staphylococcus aureus

In neonatal intensive care units, topical agents represent an increasing part of the infection control armamentarium. Fifty-one coagulase-negative staphylococci (CNS) isolated from catheter-associated bloodstream infections in very preterm neonates were investigated in this study: 41.2% exhibited decreased susceptibility to at least one antiseptic (chlorhexidine 12%, benzalkonium 24%, acriflavine 33%) and 61% were resistant to mupirocin. QacA/B, mupA and both genes were detected by polymerase chain reaction in 59%, 63% and 49% of CNS, respectively. Seventy-six percent of Staphylococcus epidermidis (5/5 pulsed-field-gel electrophoresis subgroups) and 11% of Staphylococcus capitis (1/3 subgroups) were multi-resistant. Skin antisepsis using low-concentration aqueous formulations and off-label mupirocin indications should benefit from a stewardship programme.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteremia; Catheter-Related Infections; DNA, Bacterial; Drug Resistance, Bacterial; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Intensive Care Units, Neonatal; Male; Mupirocin; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus

Hospital-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a source of morbidity and mortality. S. aureus is the most common pathogen in prosthetic joint infections and the incidence of MRSA is increasing.. The purposes of this study were (1) to determine the MRSA prevalence density rate at a specialty orthopaedic hospital before and after the implementation of a screening and decolonization protocol,(2) to compare our prevalence density to that of an affiliated university hospital, to control for changes in MRSA prevalence density that might have been independent of the decolonization protocol, and (3) to measure the admission prevalence density rate of MRSA in an elective orthopaedic surgery population and the compliance rate of 26 patients with the protocol [corrected].. In October 2008, we implemented a MRSA screening and decolonization protocol for patients undergoing elective orthopaedic surgery. Nasal swabs were used for screening and mupirocin nasal ointment and chlorhexidine skin antisepsis where prescribed for decolonization to all patients. At the surgical visit, compliance was measured and the patients who were MRSA positive received vancomycin for antibiotic prophylaxis. Institution wide surveillance for multidrug-resistant organisms, including MRSA provided a comparison of the change in MRSA burden at the orthopaedic hospital versus the university hospital.. Before implementation of the preoperative staphylococcal decolonization protocol there were 79 MRSA-positive cultures in 64,327 patient-days for a prevalence density rate of 1.23 per 1000 patient-days. After protocol implementation, 53 MRSA-positive cultures were identified in 63,860 patient-days for a rate of 0.83 per 1000 patient-days. Before the protocol, the MRSA prevalence density at the specialty hospital was similar to that of the university hospital; after implementation of the protocol, the prevalence density at the specialty hospital was 33% lower than that of the university hospital. The MRSA admission prevalence was 3.02%. The compliance rate was greater than 95%.. Implementation of a staphylococcal decolonization protocol at a single specialty orthopaedic hospital decreased the prevalence density of MRSA.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Chi-Square Distribution; Chlorhexidine; Community-Acquired Infections; Cross Infection; Elective Surgical Procedures; Hospitals, University; Humans; Incidence; Infection Control; Mass Screening; Medication Adherence; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Mucosa; Orthopedic Procedures; Patient Admission; Prevalence; Program Evaluation; Staphylococcal Infections; Time Factors; Treatment Outcome; Vancomycin

Although testing and treatment for Staphylococcus aureus colonization before total joint arthroplasty (TJA) are well described and understood, the durability of decolonization has not been studied extensively.. The purpose of this pilot study is to determine the percentage of arthroplasty patients with S. aureus colonization despite previous decolonization at the time of TJA.. Over a 2-year period, all patients having TJA by one surgeon were screened and treated for nasal S. aureus. Of 634 patients, 139 had methicillin-sensitive S. aureus (15%) or methicillin-resistant S. aureus (6.6%) colonization before TJA. Fifty-eight of these 139 patients (42%) were retested at 3 to 30 months for persistent colonization by nasal culture. Data collection included age at time of TJA, type of TJA, and time from TJA to repeat testing. We performed no clonal analysis for strains.. Thirty-nine of the 58 patients (67%) decolonized before surgery were negative on retesting and 19 (33%) were again positive for S. aureus colonization. Of the 19 patients who retested positive for colonization, 17 (89%) were colonized by bacteria with unchanged antibiotic sensitivity.. We demonstrate that 33% (19 of 58) of postoperative arthroplasty patients test positive for S. aureus colonization at 3 to 30 months after surgery despite preoperative decolonization. Arthroplasty surgeons must be aware that a decolonization treatment does not guarantee that a patient will remain decolonized in the future. Although unchanged antibiotic sensitivity in 89% of these patients suggests a substantial role for persistence as opposed to eradication and repeat colonization, we were unable to retrospectively perform clonal analysis to confirm this conclusion. This group of patients demonstrating continued colonization with S. aureus after arthroplasty deserves further study, because it remains unclear whether there is a higher risk of late infection in this population.. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement; Disinfection; Female; Humans; Male; Middle Aged; Mupirocin; Pilot Projects; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

The rate of the MRSA strains, particularly at burn centers, is increasing worldwide. Detection of mupirocin resistance MRSA strains in the burn centers particularly from personnel will help to control these strains. For this purpose, a total of 116 Staphylococcus aureus isolates from the patients (burns) and personnel (nostrils) in Ahvaz Taleghani hospital (Iran) were investigated. The methicillin and mupirocin resistant isolates were detected by multiplex amplification of the mecA and ileS-2 genes. The mecA was found among 80% of isolates. The rates of mupirocin resistant strains among personnel and patients were 70% and 6%, respectively. The carriage rates of the S. aureus, MRSA and MRSA with high-level mupirocin resistance in the personnel were 40%, 34% and 28%, respectively. In conclusions, the high prevalence of MRSA strains in the patients showed the potential outbreak of the MRSA in the burn center and highlighted the need of antibiotic susceptibility monitoring of MRSA. Moreover being personnel as a main reservoir in terms of MRSA strains with high-level mupirocin resistance emphasizes the screening of the personnel in terms of the MRSA in the healthcare system especially in the burn center.

Topics: Anti-Bacterial Agents; Burns; Drug Resistance, Bacterial; Humans; Iran; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Personnel, Hospital; Prevalence; Staphylococcal Infections

Hospital roommates are cohorted with similarly colonized patients to decrease methicillin-resistant Staphylococcus aureus (MRSA) transmission risk. However, little is known about differences in S aureus nasal and extranasal carriage between hospital roommates who are in MRSA or non-MRSA designated rooms.. Patients sharing hospital rooms were cultured for S aureus in the nose, throat, and other body sites. Differences in S aureus methicillin and mupirocin susceptibility and USA300 type were evaluated.. Eighty-two patients comprising 48 roommate pairs were studied. Among 6 roommate pairs in MRSA rooms, 3 (50%) had differences in carriage based on having methicillin-susceptible S aureus at an extranasal body site. In non-MRSA rooms, 19 (45%) roommate pairs had differences in S aureus carriage. Extranasal colonization was significantly associated with discordance between roommates, P < .001. Antibiotic exposure, ward type, and the duration of room sharing were not associated with discordance.. Patients have almost a 50% chance of having differences in S aureus colonization compared with their hospital roommate, even in MRSA-designated rooms. Cohorting by MRSA status at the time of admission may not be as effective a control strategy as horizontal measures that do not rely on known colonization with S aureus or other pathogens.

Topics: Anti-Bacterial Agents; Asymptomatic Infections; Cross Infection; Hospitalization; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Patients' Rooms; Risk Factors; Staphylococcal Infections

Mupirocin is the cornerstone of decolonization regimens, a successful strategy to prevent healthcare-associated staphylococcal infections. Several recent studies have reported alarming results: (i) an extending reservoir of mupA, the ancestral mobile resistance gene, among coagulase-negative staphylococci (CoNS); (ii) the emergence of a new resistance gene (mupB); and (iii) a growing number of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MRSA), including highly pathogenic clones. We performed a nationwide prospective study in France to detect such trends among invasive staphylococci.. Between October 2011 and February 2012, 367 MRSA and 708 CoNS invasive isolates were collected from 37 hospitals and analysed centrally. Mupirocin MICs were determined using the broth microdilution method. mupA/B PCR was performed for resistant isolates (MIC >1 mg/L). Genetic relatedness between mupirocin-resistant MRSA isolates was determined by PFGE analysis and related isolates were tested by microarray.. Among MRSA isolates 2.2% (n = 8) were classified as mupirocin resistant; 1.4% (n = 5) showing low-level resistance (MIC ≤256 mg/L) and 0.8% (n = 3) high-level resistance (MIC >256 mg/L). Only the latter isolates carried mupA. A clonal relationship was identified between two mupA-negative MRSA from the same hospital and three mupA-positive MRSA from three distant towns; these three isolates belonged to the Lyon clone. Mupirocin resistance was identified in 10.3% of CoNS, mainly highly resistant mupA-positive isolates (5.6%). The mupB gene was not detected in mupirocin-resistant MRSA or CoNS.. This first large national study indicates the need for thorough epidemiological monitoring and a stewardship programme to prevent and detect mupirocin resistance in staphylococci.

Topics: Anti-Bacterial Agents; Bacterial Proteins; DNA, Bacterial; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; France; Microarray Analysis; Microbial Sensitivity Tests; Molecular Epidemiology; Molecular Typing; Mupirocin; Nuclear Proteins; Polymerase Chain Reaction; Prospective Studies; Staphylococcal Infections; Staphylococcus

Mupirocin is used for the decolonization of methicillin-resistant Staphylococcus aureus (MRSA). High-level mupirocin resistance (Hi-Mup(R)) is of concern, having been associated with therapeutic failure. Our main objective was to assess the emergence and mode/s of spread of Hi-Mup(R) in the MRSA population recovered between 2002 and 2009 in four health care settings in the Pontevedra province, northwest Spain. Five hundred and fifty consecutive clinical MRSA isolates were obtained and screened for antimicrobial susceptibility. Isolates were stratified into multidrug-resistant (MDR) and non-MDR. High-level mupirocin resistant MRSA were characterized by genotyping and plasmid analysis. Thirty-one MRSA (5.6%) exhibited Hi-Mup(R). No association was detected between Hi-Mup(R) and MDR but isolates displaying Hi-Mup(R) were more likely to be resistant to gentamicin and tobramycin. Four main MRSA clones were identified: ST125/t067/PFGE A, ST36/t018/PFGE D, ST8/t008/PFGE B, and ST72/t148 or t3092/PFGE B. Each isolate carried the Hi-Mup(R)ileS2-encoding gene on plasmids and ten plasmid types were distinguished based on unique IS257-ileS2 configurations. Some plasmid types were successfully disseminated among the MRSA clones. Remarkably, six plasmid types were acquired by the predominant genotype ST125/t067/PFGE A. In conclusion, molecular characterization of MRSA isolates combined with the rapid typing of ileS2-encoding plasmids through determination of IS257-ileS2 configurations have proved to be a powerful strategy to address the molecular epidemiology of Hi-Mup(R). The transmission of a diverse set of ileS2-carrying plasmids promoted the emergence of the resistance, with a limited role of clonal expansion in its dispersion.

Topics: Anti-Bacterial Agents; Community Health Centers; Drug Resistance, Bacterial; Gene Transfer, Horizontal; Genes, Bacterial; Genotype; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Molecular Epidemiology; Molecular Typing; Mupirocin; Plasmids; Spain; Staphylococcal Infections

Chronic airway infection with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis (CF) is an increasing clinical problem, and therapeutic options are limited. Because chronic infection with MRSA can be associated with accelerated decline in lung function, eradication of MRSA is attempted in most CF centres today. The aim of this observational prospective cohort study was to determine whether it is possible to eradicate MRSA from airways of CF patients using prolonged oral antibiotic combination therapy together with topical decolonization measures.. Eleven CF patients, (median age: 9 years (range 1-43); median FEV1: 91%pred (95%CI 74%-100%pred)) who were chronically infected with MRSA, were treated daily for six months with rifampicin and fusidic acid orally. This study did not include a patient control group. Two patients had to switch to an alternative schedule, using rifampicin and clindamycin, due to the resistance pattern of MRSA. Topical decolonization measures were applied to all patients and included mupirocin-containing nasal ointment in both nostrils three times daily for five days and chlorhexidine hair and body wash once daily for five days. Microbiological eradication was achieved in all patients at the end of the six-month eradication protocol, even when significant time (range 18 months to 9 years) had elapsed since initial isolation. In only one patient MRSA reappeared in the six-month follow-up period after the initial study period. Side-effects, like nausea, vomiting and diarrhoea were seen in five out of eleven patients, but did not lead to therapy cessation.. Chronic MRSA infection can be eradicated from respiratory tract samples using a six month dual antibiotic regimen and topical MRSA decolonization measures.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Child, Preschool; Chronic Disease; Cystic Fibrosis; Disease Eradication; Female; Forced Expiratory Volume; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Mucosa; Nucleic Acid Synthesis Inhibitors; Ointments; Prospective Studies; Rifampin; Staphylococcal Infections; Young Adult

The aim of this study was to investigate the genotypes of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MR-MRSA) isolates in our neonatal intensive care unit (NICU) and their potential source.. One hundred one MRSA isolates obtained from 59 inborn and 42 outborn infants were identified and their antimicrobial susceptibility determined. Using pulse-field gel electrophoresis (PFGE) analysis, MR-MRSA isolates obtained from the neonatal patients in the NICU were compared with those from adult hospitalized in the same hospital and with community-associated MRSA (CA-MRSA) isolates recovered from different hospitals in Korea.. Overall, 47% of CA-MRSA and 79% of healthcare-associated MRSA isolates exhibited high-level mupirocin resistance (HLMR). Forty-five percent of the outborn infants were considered to have CA-MRSA at the time of admission to our NICU. Most HLMR-MRSA isolates from neonates were grouped into a single cluster by PFGE analysis, and which included CA-MRSA isolates with HLMR recovered from outborn infants who were already colonized when they were transferred to our NICU. They belonged to the same PFGE group as the community-genotype strains isolated from different hospitals in Korea. HLMR-MRSA isolates from adults patients were classified as different clones. None of the attending staff in the NICU were nasal carriers.. Community-genotype strains of MRSA with HLMR may be imported to our NICU through obstetrics clinics and contribute to MRSA colonization or infection in facilities with a high rate of admission of outborn infants.

Topics: Adult; Anti-Bacterial Agents; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Female; Genotype; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Male; Methicillin; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Republic of Korea; Staphylococcal Infections

The treatment of recurrent furunculosis is poorly documented and represents a public health challenge. The medical care of this disease is often disappointing, especially as the disease evolution is uncertain and relapses occur. We report the efficacy and safety of our CMC regimen: skin disinfection (chlorhexidine), local nasal antibiotic (mupirocin), and systemic antibiotic (clindamycin).. Patients attending our institution during the period 2006-2012 for recurrent furunculosis (≥ 4 episodes/y) were enrolled in the study. Clinical and bacteriological data were collected. Staphylococcus aureus colonization was also investigated in close contacts, and carriers were treated. Patients were treated with the CMC regimen: skin disinfection with chlorhexidine for 21 days, nasal mupirocin ointment for 5 days, and oral clindamycin 1800-2400 mg for 21 days.. Nineteen patients were included. Their mean age was 36 ± 14.5 y and the male to female sex ratio was 1.1. Screening swabs from all sites were S. aureus-positive in 63% (n = 12), including 4 methicillin-resistant S. aureus (MRSA). Before the CMC regimen, the median time to relapse was 31 days (mean 52 days). The mean number of recurrences was 5.5 ± 2.4/y. After the CMC regimen, among 16 patients who had a complete follow-up, 14 were healed beyond 9 months. Two recurrences occurred, 1 in an MRSA carrier and 1 in a patient with an insufficiently treated dermatosis. No serious side effect occurred that required the cessation of treatment.. There are 2 major routes involved in recurrent furunculosis: risk factors and staphylococcal colonization of close contacts. Our procedure is safe and effective, with 87% remission beyond 9 months. It merits testing on larger numbers of participants.

Topics: Adult; Anti-Bacterial Agents; Carrier State; Chlorhexidine; Clindamycin; Disinfectants; Female; Furunculosis; Humans; Male; Middle Aged; Mupirocin; Nasal Cavity; Retrospective Studies; Secondary Prevention; Skin; Staphylococcal Infections; Young Adult

Staphylococcus decolonization prior to surgery is used to prevent surgical site infections (SSIs) after total joint arthroplasty (TJA). To determine if current treatment protocols result in successful decolonization of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA), 106 consecutive patients were screened for nasal MSSA/MRSA colonization pre-operatively and on the day of surgery. Colonized patients used intranasal mupirocin twice a day and chlorhexidine showers daily 5 days prior to surgery. Pre-operatively, 24 joints (22.0%) were positive for MSSA colonization and 5 joints (4.6%) were positive for MRSA colonization. On the day of surgery, 3 joints (2.8%) who underwent decolonization were positive for MSSA colonization and 0 joints were positive for MRSA colonization. The reduction in MSSA colonization was significant (P<0.001), while the eradication of MRSA colonization approached statistical significance (P=0.063). Current decolonization protocols using intranasal mupirocin and chlorhexidine washes are effective for reducing MRSA/MSSA colonization.

Topics: Administration, Intranasal; Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Baths; Chlorhexidine; Female; Humans; Incidence; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Preoperative Care; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

Topics: Anti-Bacterial Agents; Arthroplasty, Replacement; Disinfection; Female; Humans; Male; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

We describe a real-time PCR-based assay capable of simultaneously detecting femA (Staphylococcus aureus-specific), mecA (methicillin resistance), qacA/B (chlorhexidine tolerance), and mupA (high-level mupirocin resistance) from bacterial cells in less than 90 minutes. The assay was validated with 1968 clinical MRSA submitted to a surveillance network.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Chlorhexidine; Drug Resistance, Bacterial; Humans; Membrane Transport Proteins; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nuclear Proteins; Polymerase Chain Reaction; Staphylococcal Infections; Time Factors

As the number of CA-MRSA skin and soft tissue infections continues to grow, it's important to know which patients are at greatest risk and which evidence-based treatment protocols to turn to when needed.

Topics: Acetamides; Administration, Topical; Anti-Bacterial Agents; Clindamycin; Community-Acquired Infections; Continuity of Patient Care; Cross Infection; Ethnicity; Humans; Linezolid; Medical History Taking; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Oxazolidinones; Patient Education as Topic; Physical Examination; Practice Guidelines as Topic; Rifampin; Risk Factors; Secondary Prevention; Skin; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Treatment of patients with burn wound infections may become complicated by the presence of antibiotic resistant bacteria and biofilms. Herein, we demonstrate an in vitro thermal wound infection model using human skin equivalents (HSE) and biofilm-forming methicillin-resistant Staphylococcus aureus (MRSA) for the testing of agents to combat such infections. Application of a liquid nitrogen-cooled metal device on HSE produced reproducible wounds characterized by keratinocyte death, detachment of the epidermal layer from the dermis, and re-epithelialization. Thermal wounding was accompanied by up-regulation of markers for keratinocyte activation, inflammation, and antimicrobial responses. Exposure of thermal wounded HSEs to MRSA resulted in significant numbers of adherent MRSA/HSE after 1 hour, and multiplication of these bacteria over 24-48 hours. Exposure to MRSA enhanced expression of inflammatory mediators such as TLR2 (but not TLR3), IL-6 and IL-8, and antimicrobial proteins human β-defensin-2, -3 and RNAse7 by thermal wounded as compared to control HSEs. Moreover, locally applied mupirocin effectively reduced MRSA counts on (thermal wounded) HSEs by more than 99.9% within 24 hours. Together, these data indicate that this thermal wound infection model is a promising tool to study the initial phase of wound colonization and infection, and to assess local effects of candidate antimicrobial agents.

Topics: Animals; Anti-Infective Agents; Biofilms; Collagen; Disease Models, Animal; Fibroblasts; Gene Expression Regulation; Hot Temperature; Humans; Inflammation; Interleukin-1alpha; Interleukin-1beta; Methicillin-Resistant Staphylococcus aureus; Models, Biological; Mupirocin; Rats; Staphylococcal Infections; Toll-Like Receptor 2; Toll-Like Receptor 3; Wound Infection

Previously, we have proposed mupirocin-in-liposomes-in-hydrogel delivery system as advanced delivery system with the potential in treatment of burns. In the current studies, we evaluated the system for its cytotoxicity, ability to prevent biofilm formation, act on the mature biofilms, and finally determined its potential as wound treatment in in vivo mice burn model. The system was found to be nontoxic against HaCaT cells, that is, keratinocytes. It was safe for use and exhibited antibiofilm activity against S. aureus biofilms, although the activity was more significant against planktonic bacteria and prior to biofilm formation than against mature biofilms as shown in the resazurin and the crystal violet assays. An in vivo mice burn model was used to evaluate the biological potential of the system and the healing of burns observed over 28 days. The in vivo data suggest that the delivery system enhances wound healing and is equally potent as the marketed product of mupirocin. Histological examination showed no difference in the quality of the healed scar tissue, whereas the healing time for the new delivery system was shorter as compared to the marketed product. Further animal studies and development of more sophisticated in vivo model are needed for complete evaluation.

Topics: Animals; Anti-Bacterial Agents; Biofilms; Burns; Disease Models, Animal; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Liposomes; Mice; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Wound Healing

Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is a widely established, though controversial part of many MRSA controlling strategies. The aim of this study was to evaluate our decolonization success rate, identify the risk factors for decolonization failure and determine the optimal duration of follow-up in our low MRSA prevalence setting (2.6 % of isolates).. Every patient with newly detected MRSA colonization or infection between January 2007 and December 2009 was recruited to the study. The MRSA strategy of our institution (a 700 bed tertiary hospital in eastern Switzerland) consists of a 5-day regimen of nasal mupirocin ointment, chlorhexidin mouth rinse and whole body wash with didecyldimonium chloride. Systemic antibiotics are usually not added to the regimen.. We determined a MRSA decolonization success rate of 65 % (33/51) after a median follow-up of 13 months [i.e. a tripling of the spontaneous clearance rate of 22 % (6/27) in the non-decolonized group]. The most important risk factor for decolonization failure was colonization of the respiratory tract [odds risk (OR) 9.1, 95 % confidence interval (CI) 1.2-66.7], as well as isolation of MRSA spa-type 002 ([R 5.8, 95 % CI 1.0-33.3). Of all the episodes of MRSA recurrence, 88 % (14/16) were detected within 270 days after decolonization.. High MRSA decolonization success rates can be achieved without the routine use of oral antibiotics. A time period of 1 year after decolonization seems to be a reasonable duration of follow-up in our setting. We encourage other institutions to take into account local MRSA epidemiology (e.g. predominance of certain subtypes) for the management of MRSA patients.

Topics: Adult; Aged; Anti-Bacterial Agents; Cross Infection; Disinfection; Female; Humans; Infection Control; Inpatients; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Risk Factors; Staphylococcal Infections; Switzerland; Tertiary Care Centers

Nasal decolonization in methicillin-resistant Staphylococcus aureus (MRSA) carriers using mupirocin (MUP) is a strategy that complements barrier precautions and contact isolation. However, eradication failure cases have been observed despite isolates being susceptible to MUP. This would suggest that the minimum inhibitory concentration (MIC) alone is not the only determinant of successful eradication. In this study, we undertook a comparative analysis of MRSA isolates from cases of successful and unsuccessful MUP-eradication treatment. The analyses we carried out were: determination of mupirocin MICs, sequencing of the isoleucyl-tRNA synthetase (ileS) gene, staphylococcal cassette chromosome mec typing, and the assessment of slime production. MICs for all 14 of the successful nasal decolonization cases showed susceptibility to MUP, whereas 21 (87.5 %) of the 24 unsuccessful cases were MUP-susceptible, with low-level resistance seen in 3 (12.5 %) strains. In the analysis of mutations in the ileS gene, one strain with an MIC of 4 μg/ml exhibited a G1778A point mutation that has not been previously reported. In the 14 successful nasal decolonization cases, only 1 strain (7.1 %) was an MRSA slime-producer, compared with 19 (79.7 %) of the 24 MRSA strains that could not be eradicated after MUP treatment (p < 0.05). For the eradication of MRSA by MUP, it is possible that slime may affect drug penetration. In conclusion, slime production was the only significant difference between isolates recovered from successful and unsuccessful eradication cases.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; DNA Mutational Analysis; DNA, Bacterial; Humans; Infant; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nasal Cavity; Ointments; Staphylococcal Infections; Treatment Failure

To examine the use of long-term prophylactic mupirocin as part of a comprehensive strategy in reducing Staphylococcus aureus colonization and infection in a neonatal intensive care unit (NICU).. Twice daily mupirocin was applied to all infants admitted to the NICU throughout hospitalization starting in 2004. S. aureus surveillance was implemented in 2008. The efficacy of these practices was evaluated with a retrospective review of infants admitted from 2004 to 2010 found to be colonized or infected with S. aureus.. During the study period, 66 of 6283 NICU infants had a S. aureus infection with 67% methicillin resistance. There were three distinctive S. aureus outbreaks, the first being a methicillin-resistant strain July 2004. After implementation of daily mupirocin, the outbreak was eradicated and the rate of S. aureus infection significantly decreased (1.82 to 0.40/1000 patient-days-at-risk, P=0.0049). Mupirocin was discontinued March 2005 followed by a methicillin-sensitive S. aureus outbreak November 2005. In December 2005, mupirocin was reinstituted and has continued to present day, again significantly reducing S. aureus infections (1.42 to 0.33/1000 patient-days-at-risk, P<0.0001) with zero isolates resistant to mupirocin. In the pre-mupirocin period, S. aureus colonization was upwards of 60% now with rates typically <5%. S. aureus colonization strongly predicted later invasive infection (P<0.0001).. Although controversial, prophylactic mupirocin in all NICU infants has acted as a barrier to colonization and markedly decreased S. aureus infection rates over a 5-year period.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Medical Records; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Retrospective Studies; Staphylococcal Infections; Time; Treatment Outcome; United States

Chlorhexidine and mupirocin are used in health care facilities to eradicate methicillin-resistant Staphylococcus aureus (MRSA) carriage. The objective of this study was to assess the frequency of chlorhexidine and mupirocin resistance in isolates from nares carriers in multiple nursing homes and to examine characteristics associated with resistance. Nasal swab samples were collected from approximately 100 new admissions and 100 current residents in 26 nursing homes in Orange County, CA, from October 2008 to May 2011. MRSA isolates were tested for susceptibility by using broth microdilution, disk diffusion, and Etest; for genetic relatedness using pulsed-field gel electrophoresis; and for qac gene carriage by PCR. Characteristics of the nursing homes and their residents were collected from the Medicare Minimum Data Set and Long-Term Care Focus. A total of 829 MRSA isolates were obtained from swabbing 3,806 residents in 26 nursing homes. All isolates had a chlorhexidine MIC of ≤4 μg/ml. Five (0.6%) isolates harbored the qacA and/or qacB gene loci. Mupirocin resistance was identified in 101 (12%) isolates, with 78 (9%) isolates exhibiting high-level mupirocin resistance (HLMR). HLMR rates per facility ranged from 0 to 31%. None of the isolates with HLMR displayed qacA or qacB, while two isolates carried qacA and exhibited low-level mupirocin resistance. Detection of HLMR was associated with having a multidrug-resistant MRSA isolate (odds ratio [OR], 2.69; P = 0.004), a history of MRSA (OR, 2.34; P < 0.001), and dependency in activities of daily living (OR, 1.25; P = 0.004). In some facilities, HLMR was found in nearly one-third of MRSA isolates. These findings may have implications for the increasingly widespread practice of MRSA decolonization using intranasal mupirocin.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Carrier State; Chlorhexidine; Disinfectants; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Long-Term Care; Male; Membrane Transport Proteins; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nasal Cavity; Nursing Homes; Polymerase Chain Reaction; Staphylococcal Infections

Antibiotic irrigations are occasionally used during endoscopic sinus surgery when gross mucosal infection is present. These irrigations are thought to flush out pathogenic bacteria and decrease the bacterial load within the mucosal surfaces. This treatment, however, has not been studied in vivo and it is unknown whether antibiotic rinses produce a quantitative reduction in pathologic bacteria within the sinus mucosa. The objective of this study was to determine the relative abundance of Staphylococcus aureus within the maxillary sinus and to evaluate the impact of intraoperative mupirocin irrigation on bacterial burden.. Sixteen patients with symmetric maxillary chronic rhinosinusitis were prospectively enrolled. After bilateral maxillary antrostomies, biopsies were taken of the maxillary sinus mucosa on both sides. In each patient, the right side was irrigated with 240 mL of normal saline (NS) and the left side was irrigated with 240 mL of NS mixed with 60 mg mupirocin. Repeat maxillary sinus mucosal biopsies were taken from each side 7 to 10 days postsurgery. Each biopsy was analyzed using quantitative polymerase chain reaction to determine the presence and relative amount of S. aureus.. Mupirocin irrigations were found to significantly reduce the amount of S. aureus found within the maxillary sinus mucosa compared to NS alone. The average fold change between the pre- and posttreatment biopsies on the right and left was 9.05 and 97.42, respectively (p < 0.01).. Intraoperative mupirocin irrigations significantly reduce the amount of S. aureus detected within the diseased sinus mucosa at up to 10 days postoperatively.

Topics: Anti-Bacterial Agents; Chronic Disease; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mupirocin; Nasal Lavage; Nasal Polyps; Polymerase Chain Reaction; Prospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infected wounds and ulcers. Uncomplicated CA-MRSA skin infections are typically managed in an outpatient setting with oral and topical antibiotics and/or incision and drainage, whereas complicated skin infections often require hospitalization, intravenous antibiotics, and sometimes surgery. The aim of this study was to develop a mouse model of CA-MRSA wound infection to compare the efficacy of commonly used systemic and topical antibiotics. A bioluminescent USA300 CA-MRSA strain was inoculated into full-thickness scalpel wounds on the backs of mice and digital photography/image analysis and in vivo bioluminescence imaging were used to measure wound healing and the bacterial burden. Subcutaneous vancomycin, daptomycin, and linezolid similarly reduced the lesion sizes and bacterial burden. Oral linezolid, clindamycin, and doxycycline all decreased the lesion sizes and bacterial burden. Oral trimethoprim-sulfamethoxazole decreased the bacterial burden but did not decrease the lesion size. Topical mupirocin and retapamulin ointments both reduced the bacterial burden. However, the petrolatum vehicle ointment for retapamulin, but not the polyethylene glycol vehicle ointment for mupirocin, promoted wound healing and initially increased the bacterial burden. Finally, in type 2 diabetic mice, subcutaneous linezolid and daptomycin had the most rapid therapeutic effect compared with vancomycin. Taken together, this mouse model of CA-MRSA wound infection, which utilizes in vivo bioluminescence imaging to monitor the bacterial burden, represents an alternative method to evaluate the preclinical in vivo efficacy of systemic and topical antimicrobial agents.

Topics: Acetamides; Administration, Oral; Administration, Topical; Animals; Anti-Bacterial Agents; Bacterial Load; Bridged Bicyclo Compounds, Heterocyclic; Clindamycin; Community-Acquired Infections; Daptomycin; Diabetes Mellitus, Type 2; Disease Models, Animal; Diterpenes; Doxycycline; Linezolid; Luminescent Measurements; Male; Methicillin-Resistant Staphylococcus aureus; Mice; Mice, Inbred C57BL; Mupirocin; Oxazolidinones; Skin; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Wound Healing

Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital-acquired pathogen, with transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff as the main mode of transmission.. Investigation of a cluster of new cases of MRSA resistant to mupirocin and fusidic acid, using epidemiological and microbiological resources.. From September 2010 to February 2012, sixteen patients had at least one culture positive for MRSA resistant to mupirocin and fusidic acid. Some not apparently related cases and outbreaks appeared. By analysing cultures taken from patients and staff using pulsed-field gel electrophoresis, it was demonstrated that most likely this situation was started by an auxiliary nurse who was a carrier of the MRSA. Healthcare worker decontamination using oral antibiotic therapy was unsuccessful. Eventually, the situation was controlled by placing the carrier in a different job, with no further cases to date (September, 2012).. This report illustrates the risk of nosocomial transmission linked to care delivered by healthcare workers.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Carrier State; Cross Infection; Disease Outbreaks; Disease Reservoirs; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Fusidic Acid; Humans; Incidence; Infectious Disease Transmission, Professional-to-Patient; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Nursing Assistants; Ointments; Personnel, Hospital; Retrospective Studies; Spain; Staphylococcal Infections; Tertiary Care Centers

Surgical site infections (SSIs) associated with methicillin-resistant Staphylococcus aureus (MRSA) are a major complication of surgery. This study is part of a large infection control quality improvement effort to eliminate MRSA SSIs.. This is an Institutional Review Board-approved, case-control study examining MRSA SSI rates before and after implementation of a facility-wide MRSA SSI prevention protocol in 2007. The protocol involved a 5-day course of intranasal mupirocin and nonrinse 2% chlorhexidine gluconate cloths.. In 2006, a total of 39 MRSA SSIs occurred after 9,976 procedures in patients who underwent orthopedic, vascular, cardiac, or neurosurgical procedures (rate = 0.39 per 100 procedures). The highest incidence occurred after cardiac surgery (rate = 1.24/100 procedures), and the lowest occurred after orthopedic surgery (rate = 0.28/100 procedures). In 2007, the MRSA SSI rate decreased to 20 of 9,818 procedures (rate = 0.20/100 procedures) in the 4 categories (P = .016; odds ratio, 1.92). In 2008, the MRSA SSI rate dropped again to 13 of 10,068 procedures (rate = 0.13/100 procedures) in the 4 categories (P = .0003; odds ratio, 3.04).. A 5-day course of intranasal mupirocin and nonrinse 2% chlorhexidine gluconate cloths may be beneficial in preventing MRSA SSIs in the non-general surgery population.

Topics: Adult; Anti-Bacterial Agents; Case-Control Studies; Chlorhexidine; Female; Florida; Humans; Incidence; Infection Control; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Surgical Wound Infection

In this study, we determined the prevalence of mupirocin and antiseptics resistance in methicillin-resistant Staphylococcus aureus (MRSA) at a secondary- and a tertiary-care hospital in Korea. Mupirocin susceptibility test, ileS gene sequencing, and polymerase chain reaction for mupA, qacA/B, and smr gene were performed with 456 nonduplicated MRSA isolates collected from 2 hospitals in Korea. Genetic relatedness was determined by spa typing and multilocus sequence typing (MLST). The rates of low-level and high-level mupirocin resistance were 7% and 2% in the secondary-care hospital and 17% and 2% in the tertiary-care hospital, respectively. The positive rate of qacA/B and smr gene in mupirocin-resistant MRSA was 65% and 71%, respectively. In spa typing, most mupirocin-resistant MRSA showed genetic relatedness and some of the highly resistant isolates were ST239 and ST5 in MLST analysis. The distribution of low-level and high-level mupirocin resistance and the coexistence of antiseptic resistance in MRSA can result in failure of decolonization in Korea.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antiporters; Bacterial Proteins; Bacterial Typing Techniques; Drug Resistance, Multiple, Bacterial; Genes, Bacterial; Humans; Incidence; Membrane Transport Proteins; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Mupirocin; Nuclear Proteins; Republic of Korea; Staphylococcal Infections; Tertiary Care Centers

In the present study, we analyzed the response of S. aureus to mupirocin, the drug of choice for nasal decolonization. Mupirocin selectively inhibits the bacterial isoleucyl-tRNA synthetase (IleRS), leading to the accumulation of uncharged isoleucyl-tRNA and eventually the synthesis of (p)ppGpp. The alarmone (p)ppGpp induces the stringent response, an important global transcriptional and translational control mechanism that allows bacteria to adapt to nutritional deprivation. To identify proteins with an altered synthesis pattern in response to mupirocin treatment, we used the highly sensitive 2-dimensional gel electrophoresis technique in combination with mass spectrometry. The results were complemented by DNA microarray, Northern blot, and metabolome analyses. Whereas expression of genes involved in nucleotide biosynthesis, DNA metabolism, energy metabolism, and translation was significantly downregulated, expression of isoleucyl-tRNA synthetase, the branched-chain amino acid pathway, and genes with functions in oxidative-stress resistance (ahpC and katA) and putative roles in stress protection (the yvyD homologue SACOL0815 and SACOL1759 and SACOL2131) and transport processes was increased. A comparison of the regulated genes to known regulons suggests the involvement of the global regulators CodY and SigB in shaping the response of S. aureus to mupirocin. Of particular interest was the induced transcription of genes encoding virulence-associated regulators (i.e., arlRS, saeRS, sarA, sarR, sarS, and sigB), as well as genes directly involved in the virulence of S. aureus (i.e., fnbA, epiE, epiG, and seb).

Topics: Anti-Bacterial Agents; Bacterial Proteins; Electrophoresis, Gel, Two-Dimensional; Gene Expression Profiling; Gene Expression Regulation, Bacterial; Humans; Isoleucine-tRNA Ligase; Mass Spectrometry; Microbial Sensitivity Tests; Mupirocin; Oligonucleotide Array Sequence Analysis; Staphylococcal Infections; Staphylococcus aureus; Transcriptome; Virulence

A total of 299 nares and 194 blood isolates of methicillin-resistant Staphylococcus aureus (MRSA), each recovered from a unique patient, were collected from 23 U.S. hospitals from May 2009 to March 2010. All isolates underwent spa and staphylococcal cassette chromosome mec element (SCCmec) typing and antimicrobial susceptibility testing; a subset of 84 isolates was typed by pulsed-field gel electrophoresis (PFGE) using SmaI. Seventy-six spa types were observed among the isolates. Overall, for nasal isolates, spa type t002-SCCmec type II (USA100) was the most common strain type (37% of isolates), while among blood isolates, spa type t008-SCCmec type IV (USA300) was the most common (39%). However, the proportion of all USA100 and USA300 isolates varied by United States census region. Nasal isolates were more resistant to tobramycin and clindamycin than blood isolates (55.9% and 48.8% of isolates versus 36.6% and 39.7%, respectively; for both, P < 0.05). The USA300 isolates were largely resistant to fluoroquinolones. High-level mupirocin resistance was low among all spa types (<5%). SCCmec types III and VIII, which are rare in the United States, were observed along with several unusual PFGE types, including CMRSA9, EMRSA15, and the PFGE profile associated with sequence type 239 (ST239) isolates. Typing data from this convenience sample suggest that in U.S. hospitalized patients, USA100 isolates of multiple spa types, while still common in the nares, have been replaced by USA300 isolates as the predominant MRSA strain type in positive blood cultures.

Topics: Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; Bacterial Typing Techniques; Clindamycin; Cross Infection; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nasal Cavity; Prevalence; Retrospective Studies; Staphylococcal Infections; Tobramycin; United States

Despite limited evidence of meticillin-resistant Staphylococcus aureus (MRSA) decolonization efficacy, the practice of decolonization for both pre-admission and on-admission patients is growing. Recent research within National Health Service (NHS) Scotland revealed low rates of treatment and consequent low efficacy in home-based decolonization. As no national guidelines on home-based decolonization currently exist, practices within NHS Scotland may be variable.. To establish current pre-admission MRSA home-based decolonization protocols and patient advice within NHS Scotland. Similarities and differences were identified to determine possible sources of variability.. Cross-sectional survey distributed electronically to MRSA Screening Project Managers within each NHS geographical region in Scotland (N = 15).. Thirteen out of 15 NHS regions responded; one region reported no standard protocol. From the remaining 12 regions, 100% recommended use of mupirocin and antiseptic bodywash daily for five days; this was the only consistent aspect of practice across responding regions. Variation was noted in advice regarding method of mupirocin application, bodywash product and volume of bodywash recommended. Six regions (50%) specified bodywash skin contact time, yet these times varied across regions. Mouth care was advocated by three regions (25%). Daily change of facecloths and clothes was endorsed by five regions (41.7%); four regions (33.3%) promoted daily towel changes. Only one region (8.3%) suggested daily bedroom cleaning; three regions (25%) advised changing bed linen daily.. Variation in protocols and patient advice may influence efficacy of home-based decolonization and further research may inform the development of evidence-based clinical guidelines.

Topics: Anti-Infective Agents, Local; Carrier State; Cross-Sectional Studies; Home Care Services, Hospital-Based; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Scotland; Staphylococcal Infections; Treatment Outcome

To perform a cost-effectiveness analysis to evaluate preoperative use of mupirocin in patients with total joint arthroplasty (TJA).. Simple decision tree model.. Outpatient TJA clinical setting.. Hypothetical cohort of patients with TJA.. A simple decision tree model compared 3 strategies in a hypothetical cohort of patients with TJA: (1) obtaining preoperative screening cultures for all patients, followed by administration of mupirocin to patients with cultures positive for Staphylococcus aureus; (2) providing empirical preoperative treatment with mupirocin for all patients without screening; and (3) providing no preoperative treatment or screening. We assessed the costs and benefits over a 1-year period. Data inputs were obtained from a literature review and from our institution's internal data. Utilities were measured in quality-adjusted life-years, and costs were measured in 2005 US dollars.. Incremental cost-effectiveness ratio.. The treat-all and screen-and-treat strategies both had lower costs and greater benefits, compared with the no-treatment strategy. Sensitivity analysis revealed that this result is stable even if the cost of mupirocin was over $100 and the cost of SSI ranged between $26,000 and $250,000. Treating all patients remains the best strategy when the prevalence of S. aureus carriers and surgical site infection is varied across plausible values as well as when the prevalence of mupirocin-resistant strains is high.. Empirical treatment with mupirocin ointment or use of a screen-and-treat strategy before TJA is performed is a simple, safe, and cost-effective intervention that can reduce the risk of SSI. S. aureus decolonization with nasal mupirocin for patients undergoing TJA should be considered.. Level II, economic and decision analysis.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Decision Support Techniques; Decision Trees; Health Care Costs; Humans; Infection Control; Mupirocin; Preoperative Care; Quality-Adjusted Life Years; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; United States

To describe the dynamics of colonization by methicillin resistant Staphylococcus aureus (MRSA) detected in the Haemodialysis Unit (UHD) of the Hospital San Pedro de Alcantara of Caceres due to the detection of catheter-associated infections. Additionally, we attempt to evaluate the effectiveness of preventive strategies introduced.. Nasal swab tests were performed in order to detect MRSA colonization in patients and health professionals from August 2008 to January 2009, according to the Consensus GEIH-SEIMC Y SEMPSPH Consensus. An active surveillance was performed with treatment and control of the carriers until negative results were achieved. A consensus document was drawn up in the UHD with registered preventive measures and work systems were reviewed. Prevalence, cumulative incidence, colonization pressure (carrier ratio per day/total patients or experts per day) were calculated. A chi-square test was performed, as well as a Z test for the comparison ratio.. The nasal swabs of 54 acute and chronic patients on haemodialysis showed an initial carrier prevalence of 29.6%; cumulative incidence in patients of 42.6%. Nasal swabs of 48 professionals had a cumulative incidence of 39.5%. There was a parallel decrease in colonization pressure in patients and specialists. After five months A smear was performed 5 months later on 40 patients and 26 specialists, which showed no carriers among the patients, and one among the health professionals.. We detected a high number of MRSA carriers among patients and Health professionals from the Haemodialysis Unit. Screening and treatment measures were effective for the decolonization of this population. It is important to adopt long-term strategies for active surveillance for the rapid detection of alert situations.

Topics: Adult; Algorithms; Bacterial Load; Carrier State; Cross Infection; Disease Reservoirs; Endemic Diseases; Fusidic Acid; Hemodialysis Units, Hospital; Humans; Infection Control; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Patients; Personnel, Hospital; Prevalence; Risk; Staphylococcal Infections

Preoperative screening and decolonization of methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA, respectively) are advocated to reduce surgical site infections. We determined the rate and duration of decolonization in patients undergoing elective orthopedic surgery. Patients undergoing elective orthopedic surgery were seen in our preoperative testing program (PAT) and had their anterior nares cultured for MRSA and MSSA. All patients were treated with intranasal mupirocin and a topical chlorhexidine solution. A cohort of patients returned to PAT before a subsequent elective procedure and were recultured. All culture results and time between PAT visits were recorded, and the rates of successful initial and persistent decolonization were determined. Six hundred ten patients visited PAT 1290 times. Overall, 94 (70.1%) of 134 patients with initially MRSA- or MSSA-positive cultures remained decolonized at a mean time of 156 days (SD=140), whereas 40 patients (29.9%) were not decolonized by the time of repeat testing at a mean time of 213 days (SD=187). At repeat testing, there were 2 newly MRSA-positive and 35 newly MSSA-positive patients. Staphylococcus aureus decolonization with intranasal mupirocin and topical chlorhexidine was effective but not persistent in a significant proportion of patients. A small number of previously uncolonized patients became colonized. Staphylococcus aureus screening and decolonization protocols must be repeated before any readmission, regardless of prior colonization status.

Topics: Administration, Intranasal; Administration, Topical; Aged; Chlorhexidine; Cohort Studies; Dose-Response Relationship, Drug; Drug Therapy, Combination; Elective Surgical Procedures; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

We report a case of a 55 year-old male who was transferred to a Danish hospital from Central America. A routine screening revealed a methicillin resistant Staphylococcus aureus (MRSA) isolate sensitive to mupirocin (minimal inhibitory concentration (MIC) 0.094 mg/L) and eradication treatment was initiated. Three weeks later the patient developed MRSA bacteraemia with the same strain, though now resistant to mupirocin (MIC 8 mg/l). The incidence of mupirocin resistance is low in Denmark compared to other countries with a heavier burden of MRSA, but there is reason to be concerned due to the increasing reliance on this drug for treatment of MRSA carriage.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Staphylococcal Infections; Travel

This study aimed to correlate the multidrug resistance (MDR) and sequence type (ST) clones of community-associated (CA) meticillin-resistant Staphylococcus aureus (MRSA) to identify the genes responsible for clindamycin and mupirocin resistance in S. aureus isolates from paediatric hospitals in mainland China. A total of 435 S. aureus isolates were collected. Compared with CA meticillin-susceptible S. aureus (MSSA), the resistance rates of CA-MRSA to ciprofloxacin, chloramphenicol, gentamicin and tetracycline were higher (19.0 vs 2.6 %, P<0.001; 14.7 vs 3.1 %, P<0.001; 14.7 vs 3.1 %, P<0.01; and 46.0 vs 13.3 %, P<0.001, respectively). Compared with hospital-associated (HA)-MRSA, the resistance rates of CA-MRSA to ciprofloxacin, gentamicin, rifampicin, tetracycline and trimethoprim-sulfamethoxazole were lower (19 vs 94.8 %, P<0.001; 14.7 vs 84.4 %, P<0.001; 5.5 vs 88.3 %, P<0.001; 46 vs 94.8 %, P<0.001; and 1.8 vs 9.1 %, P<0.01, respectively). The resistance rates of CA-MRSA, HA-MRSA and CA-MSSA to clindamycin (92.0, 77.9 and 64.1 %, respectively) and erythromycin (85.9, 77.9 and 63.1 %, respectively) were high. The MDR rates (resistance to three or more non-β-lactams) were 49.6, 100 and 14 % in the CA-MRSA, HA-MRSA and CA-MSSA isolates, respectively. Five of seven ST clones in the CA-MRSA isolates, namely ST59, ST338, ST45, ST910 and ST965, had MDR rates of >50 % (67.9, 87.5, 100, 50 and 83.3 %, respectively). The constitutive phenotype of macrolide-lincosamide-streptogramin B (MLS(B)) resistance (69 %) and the ermB gene (38.1 %) predominated among the MLS(B)-resistant CA S. aureus strains. The resistance rate to mupirocin was 2.3 % and plasmids carrying the mupA gene varied in size between 23 and 54.2 kb in six strains with high-level resistance as determined by Southern blot analysis. The present study showed that resistance to non-β-lactams, especially to clindamycin, is high in CA-MRSA isolates from Chinese children and that the profile of resistance is related to clonal type. This study revealed distinctive patterns of MLS(B)-resistant genes among CA S. aureus isolates.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; China; Clindamycin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Humans; Infant; Infant, Newborn; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Sequence Analysis, DNA; Staphylococcal Infections; Staphylococcus aureus

Infections with methicillin-resistant Staphylococcus aureus (MRSA) are an ever growing problem in the community, hospitals, and for orthopedic surgeons in particular. A conscious effort must be made to deal with this pathogen prior to total joint arthroplasty procedures. The drastic increase in prevalence of surgical-site infections (SSIs) after total joint replacement surgery has proved to be a major health care burden for both patients and surgeons from both a medical and financial standpoint. The development of screening techniques for detection of MRSA colonization in patients being admitted to hospitals is steadily increasing popularity. Particularly nasal swab rapid polymerase chain reaction detection of MRSA allows surgeons to identify patients at high risk for postoperative SSI. A variety of treatment regimens for eradication of MRSA colonization from the nares of surgical patients have surfaced, such as topical mupirocin prior to undergoing surgery. Decolonization of MRSA in patients undergoing joint arthroplasty procedures has demonstrated encouraging initial results in preventing SSIs and should be a serious focus of the future for orthopedic surgeons.

Topics: Administration, Topical; Anti-Bacterial Agents; Arthroplasty, Replacement; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Prosthesis-Related Infections; Staphylococcal Infections; Surgical Wound Infection

In our hospital, mupirocin has increasingly been used for peri-operative decolonization of Staphylococcus aureus. The target for mupirocin is isoleucyl tRNA synthetase (ileS). High-level resistance to mupirocin is conferred by acquisition of plasmids expressing a distinct ileS gene (ileS2). Here we evaluated the longitudinal trends in high-level mupirocin resistance in coagulase-negative staphylococci (CoNS) and linked this to the presence of ileS2 genes and mupirocin use. We assessed mupirocin resistance in CoNS bloodstream isolates from 2006 to 2011 tested by Phoenix automated testing (PAT). We evaluated the reliability of PAT results using Etest. PAT species determination was confirmed by MALDI-TOF (matrix-assisted laser desorption ionization-time of flight) mass spectrometry. We investigated the presence of ileS2 in the first 100 consecutive CoNS bloodstream isolates of each year using RT-PCR. Mupirocin use increased from 3.6 kg/year in 2006 to 13.3 kg/year in 2010 and correlated with the increase in the percentage of CoNS isolates carrying ileS2 (8% in 2006 to 22% in 2011; Spearman's rho, 0.137; P = 0.01). The sensitivity and specificity of PAT for detecting high-level mupirocin resistance were 0.97 and 0.97, respectively. ileS2 was detected in 81 of 82 phenotypically highly mupirocin-resistant strains and associated with resistance to ciprofloxacin, erythromycin, and clindamycin. In conclusion, we found a rapid increase in high-level resistance to mupirocin and resistance to other antibiotics in CoNS associated with an increase in mupirocin use. The associated resistance to other antibiotics may result in a reduction of oral antibiotic options for prolonged treatment of prosthetic infections with CoNS.

Topics: Anti-Bacterial Agents; Bacteremia; Blood; Coagulase; Drug Resistance, Bacterial; Humans; Isoleucine-tRNA Ligase; Microbial Sensitivity Tests; Mupirocin; Plasmids; Sensitivity and Specificity; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Staphylococcal Infections; Staphylococcus

We aimed to determine whether additional molecular and microbiological evaluations of methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients newly identified as nasal carriers were useful for control strategies and whether longitudinal testing during the same or repeat hospitalization changed MRSA status. Nasal swabs from patients positive by Xpert MRSA PCR and not known to be colonized in the previous year were cultured for S. aureus. Isolates were tested for resistance to a variety of antibiotics, including high-level mupirocin resistance (HLMR) and low-level mupirocin resistance (LLMR) and the presence of genes mecA and mupA and those for Panton-Valentine leukocidin (PVL), USA300, and USA400. Repeat nasal screens during the 6-month study were tested for continued presence of MRSA. Among 130 patients, cultures revealed MRSA in 85 (65.4%), methicillin-susceptible S. aureus in 19 (14.6%), and no growth in 26 (20%). MRSA isolates were USA300 positive in 13/85 (15.3%) and LLMR in 8/85 (9.4%) patients. No isolates were HLMR or mupA positive. mecA dropout was detected in 9/130 (6.9%) patients. The rate of subsequent MRSA infections in USA300-positive versus -negative patients was not different. MRSA nasal status remained concordant in 69/70 (98.6%) patients who had follow-up testing. The findings do not support expanding MRSA surveillance to include routine detection of genes for USA300, PVL, or mupA, all of which were either of low frequency or not significantly associated with MRSA infection risk in our population of newly identified nasal carriers. Repeat nasal screening for MRSA during the same or subsequent hospitalizations over 6 months could also be deferred, reducing costs associated with screening.

Topics: Aged; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Boston; Carrier State; Drug Resistance, Multiple, Bacterial; Exotoxins; Female; Humans; Leukocidins; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Molecular Epidemiology; Molecular Typing; Mupirocin; Nasal Mucosa; Nuclear Proteins; Penicillin-Binding Proteins; Staphylococcal Infections

High-level resistance to mupirocin in meticillin-resistant Staphylococcus aureus (MRSA) jeopardizes its role in nasal decolonization protocols. We carried out a study in 2010 to determine the prevalence of high-level mupirocin resistance in our tertiary-care hospital. The prevalence of high-level resistance to mupirocin in MRSA in this hospital was 11%. There was also complete agreement between the genotypic and phenotypic methods of detection of high-level mupirocin resistance in 24 of the screening isolates.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Genotype; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Phenotype; Prevalence; Singapore; Staphylococcal Infections; Tertiary Care Centers

Topics: Anti-Bacterial Agents; Clindamycin; Cross Infection; Drug Resistance, Multiple, Bacterial; Genotype; Humans; India; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Molecular Typing; Mupirocin; Staphylococcal Infections; Tertiary Care Centers

Our objective was to determine the prevalence of methicillin-resistant Staphylococcus aureus in workers who had direct contact with oncologic patients infected with MRSA and admitted to the intensive care unit of the Valencian Institute of Oncology. A study of prevalence of MRSA colonization of 62 workers was performed. Samples were taken from nose and pharynx in each of the workers. After 24 hours of incubation in Amies transport medium Viscose (Eurotubo®), 124 samples were seeded (N = 124) in chocolate agar agar, MRSA II and BHI broth (Brain Heart Infusion). Those colonies that were identified by Gram stain gram-positive cocci in clusters available, catalase positive and coagulase positive were processed for study of sensitivity by Kirby-Bauer method and screening test for methicillin (10μg of Oxoid®) on Mueller-Hinton (Becton-Dickinson®, BD), supplemented with NaCl (2%). Those confirmed MRSA isolates, he returned to perform sensitivity study by microdilution (MicroScan®, Siemens) to determine the MIC (mg/L). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 1.61% (1) and 12.90% (8) for methicillin-sensitive Staphylococcus aureus (MSSA), from nostrils. The measures implemented were: nasal application of mupirocin to the worker colonized control isolation measures in infected patients and indoctrination of the personnel involved.

Topics: Administration, Intranasal; Cancer Care Facilities; Carrier State; Cross Infection; Culture Media; Hand Disinfection; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Infectious Disease Transmission, Professional-to-Patient; Intensive Care Units; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nasal Cavity; Neoplasms; Oncology Service, Hospital; Personnel, Hospital; Pharynx; Staphylococcal Infections

Nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA) was evaluated after a mupirocin treatment in a family previously colonized by MRSA sequence type ST398 and ST1, who lived close to a pig farm. Eight nasal samples were swabbed from each of the four family members on different moments after mupirocin treatment. The efficacy of treatment was low in those family members who worked in the farm, and higher in the remaining two family members with sporadic contact with pigs. In addition, nasal and skin swabs from randomly selected pigs of the farm were taken. MRSA were detected in 33% of pigs tested. All MRSA isolates obtained were characterized by Staphylococcal-Cassette-Chromosome mec (SCCmec) determination, Multilocus-Sequence-Typing (MLST), spa- and agr-typing, Pulsed-field-gel-electrophoresis (PFGE), antimicrobial susceptibility, detection of antimicrobial resistance genes, and toxin gene profiling. Spa-types t011, t1255 and t1197 were detected in humans and animals, with indistinguishable PFGE patterns, suggesting animal to human MRSA transmission. Each spa-type was ascribed to a specific pulsotype. Spa-types t127 and t108 were only detected in MRSA isolates obtained from humans, and t012 only in those from animals. MRSA ST1-t127 isolates and some ST398-t011 and ST398-t1197 isolates presented a multiantimicrobial-resistance phenotype. None of them harbored lukF/lukS, tst, eta and etb virulence genes. This study showed that the efficacy of nasal MRSA decolonization in healthy people with very close contact with pigs is especially low.

Topics: Animals; Anti-Bacterial Agents; Drug Resistance, Bacterial; Family; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Molecular Typing; Mupirocin; Prevalence; Spain; Staphylococcal Infections; Swine; Swine Diseases

Methicillin-resistant Staphylococcus aureus (MRSA) wound infections after cardiac surgery have increased in recent years and carry significant morbidity and mortality. In our hospital, MRSA accounted for 56% of postoperative infections.. Postoperative wound infection rates were compared for the 3 years before (baseline period) and after (intervention period) introduction of a comprehensive MRSA intervention program. The intervention included preoperative screening for MRSA colonization, administration of intravenous vancomycin prophylaxis for identified carriers, administration of intranasal mupirocin calcium ointment to all patients regardless of colonization status for 5 days beginning the day before surgery, and application of mupirocin to chest tube sites at the time of removal.. Postoperative MRSA wound infections decreased by 93% (32 infections per 2767 cases in the baseline period vs 2 infections per 2496 cases in the intervention period; relative risk, 0.069; P < .001). Overall wound infection rates decreased from 2.1% to 0.8% (59 infections per 2769 cases vs 20 infections per 2496 cases; P < .001). During the intervention period, there was no change in the number of MRSA infections after noncardiac surgery.. This MRSA intervention program, in which all patients receive intranasal mupirocin and patients colonized with MRSA receive vancomycin prophylaxis, has resulted in a near-complete and sustained elimination of MRSA wound infections after cardiac surgery.

Topics: Administration, Intranasal; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cardiac Surgical Procedures; Confounding Factors, Epidemiologic; Female; Humans; Incidence; Infection Control; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; New York; Ointments; Research Design; Risk Assessment; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; Vancomycin

Mupirocin is a topical antimicrobial used to eradicate methicillin-resistant Staphylococcus aureus (MRSA) colonization, usually in the absence of susceptibility testing. We hypothesized that high-level (HL) mupirocin resistance was associated with multidrug resistance (MDR). To this end, unique patient isolates identified at our institution during 2008 were stratified into those resistant to ≥ 3 non-β-lactam antimicrobial classes (MDR) and non-MDR MRSA. HL mupirocin resistance was screened by mupA PCR on all MDR isolates (n = 191) and a 20% random sample (n = 130) of non-MDR isolates; E-testing confirmed HL resistance. We found that among MDR isolates, 13 (6.8%) carried mupA, whereas none of the non-MDR isolates did (P = 0.001). Thus, although the overall prevalence of HL mupirocin resistance is low among MRSA isolates at our institution, an association exists between mupA carriage and MDR. Using genotyping and antimicrobial susceptibility profiling, we identified nine HL mupirocin-resistant clones. Whereas the majority of mupA-negative MDR isolates had a health care-associated MRSA (HA-MRSA) genotype (multilocus sequence type 5 [ST5] or SCCmec type II), the majority of mupA-positive MDR isolates had a community-associated MRSA (CA-MRSA) genotype (ST8 or SCCmec type IV). However, CA- and HA-MRSA genotypes were more evenly distributed among mupA-positive isolates compared to mupA-negative MDR isolates. Thus, in Chicago, mupA is circulating among both CA- and HA-MRSA backgrounds.

Topics: Academic Medical Centers; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Chicago; Child; Child, Preschool; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Female; Genotype; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nuclear Proteins; Polymerase Chain Reaction; Staphylococcal Infections; Young Adult

In our recent experience with methicillin-resistant Staphylococcus aureus (MRSA) infections in 488 patients undergoing thoracic cardiovascular surgery, we found only 2 MRSA infections (one sternal and one graft site). Both patients received preoperative bacitracin and had a negative nares culture for MRSA before the initiation of bacitracin therapy. We conclude that preoperative MRSA screening cultures and bacitracin prophylaxis are neither clinically efficacious nor cost-effective in predicting or preventing MRSA in patients undergoing thoracic cardiovascular surgery.

Topics: Administration, Topical; Anti-Bacterial Agents; Carrier State; Cost-Benefit Analysis; Humans; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Preoperative Care; Prevalence; Staphylococcal Infections; Thoracic Surgical Procedures

The coagulase-negative staphylococci are known for their ability to acquire resistance genes, which limits the choice of therapeutic options for the treatment of infections caused by these microorganisms. In this study, the diversity of high-level mupirocin resistance plasmids (Mup(R) ) was investigated in four strains of Staphylococcus haemolyticus belonging to different pulsed-field gel electrophoresis (PFGE) types or subtypes, isolated in a Brazilian hospital. These strains harbor the mupA gene in large plasmids. In addition, the presence of IS257 sequences flanking the mupA gene was also shown. Two isolates belonging to two different PFGE types exhibited a similar polymorphism for a fragment of the mupA gene and the closest proximal flanking copies of the IS257, suggesting horizontal transmission of S. haemolyticus mupirocin resistance plasmids in the environment and a role of this species as a reservoir of the mupA gene.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Bacterial Typing Techniques; Brazil; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Gene Transfer, Horizontal; Genotype; Hospitals; Humans; Molecular Typing; Mupirocin; Nuclear Proteins; Plasmids; Polymorphism, Genetic; Staphylococcal Infections; Staphylococcus haemolyticus

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cardiac Surgical Procedures; Humans; Infection Control; Medical Staff; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nursing Staff; Ointments; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; Vancomycin

Topics: Anti-Bacterial Agents; Carrier State; Drug Resistance, Bacterial; Drug Utilization; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with increased mortality, costs and length of stay compared to non-MRSA infections. This observational 4-year study analyses the impact of screening and treating orthopaedic healthcare workers for MRSA colonisation. A total of 1,011 swabs were taken from 566 healthcare workers. Positive healthcare workers were treated with topical mupirocin to both anterior nares. The prevalence of MRSA colonisation on initial testing was 4.77%. The rate of positive MRSA colonisation of those tested on more than one occasion fell from 5.88% to 2.71% (p = 0.055) on subsequent screening. All healthcare workers receiving treatment were successfully cleared of colonisation; however, some required more than one course of treatment. These results show that there could be a role for screening and treating orthopaedic staff for MRSA colonisation as part of a strategy to reduce the prevalence of MRSA infections in orthopaedic units.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Bacteriological Techniques; Carrier State; Female; Health Personnel; Humans; Ireland; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Prevalence; Staphylococcal Infections; Young Adult

Topics: Anti-Infective Agents; Catheter-Related Infections; Chlorhexidine; Drug Resistance, Bacterial; Hemodialysis Units, Hospital; Humans; Infection Control; Microbial Sensitivity Tests; Mupirocin; Prevalence; Staphylococcal Infections; Staphylococcus

Although infrequent, postoperative methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection (SSI) is associated with significant morbidity and cost. Previous studies have identified the importance of MRSA screening to diminish the risk of postoperative MRSA SSI. The current study quantifies the importance of eradication of the MRSA carrier state to prevent MRSA SSI. Beginning February 2007, all admissions to an 800-bed tertiary care hospital were screened for MRSA by nasal swab using rapid polymerase chain reaction-based testing. Patients found to be nasal carriers of MRSA were treated with 2 per cent mupirocin nasal ointment and 4 per cent chlorhexidine soap before surgery. The subset of patients undergoing procedures that are part of the Surgical Care Improvement Project (SCIP) were followed for MRSA SSI (n = 8980). The results of preoperative MRSA screening and eradication of the carrier state were analyzed. Since the initiation of universal MRSA screening, 11 patients undergoing SCIP procedures have developed MRSA SSI (0.12%). Of these, six patients (55%) had negative preoperative screens. Of the five patients with positive preoperative screens, only one received treatment to eradicate the carrier state. In patients who develop MRSA SSI, failure to treat the carrier state before surgery results in MRSA SSI.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Carrier State; Cohort Studies; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nasal Cavity; Preoperative Care; Prognosis; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Risk Assessment; Sensitivity and Specificity; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Gloves, Protective; Humans; Infection Control; Masks; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Population Surveillance; Prospective Studies; Protective Clothing; Saudi Arabia; Staphylococcal Infections

Staphylococcus aureus with high-level mupirocin resistance has rarely been isolated in Japan. We detected methicillin-resistant S. aureus (MRSA) with high-level mupirocin resistance (HLMR-MRSA; MIC ≥1,024 μg/ml) in a surveillance program of invasive MRSA infection in the Minami Ibaraki Area of Japan. The other 177 strains surveyed in the program showed susceptibility or low-level resistance to mupirocin. The HLMR-MRSA strain, named 115, was isolated from the blood of a patient with peripheral venous catheter-associated infection. The patient had not received administration of mupirocin before the isolation of strain 115. Another HLMR-MRSA strain, named 257, was recovered from the patient's sputum obtained 1 year after the infection. Close relatedness between genotypes of strains 115 and 257 indicated persistent colonization of strain 115 on the patient. In contrast, no HLMR-MRSA was detected in materials submitted from other inpatients treated in the same wards during the same period, demonstrating that horizontal transmission of HLMR-MRSA did not occur.

Topics: Aged; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections

We quantified surgical site infections (SSIs) after preoperative screening/selective decolonization before elective total joint arthroplasty (TJA) with 2-year follow-up and 2 controls. Concurrent controls (n = 2284) were patients of surgeons not participating in screening/decolonization. Preintervention controls (n = 741) were patients of participating surgeons who underwent TJA the previous year. Staphylococcus aureus nasal carriers (321/1285 [25%]) used intranasal mupirocin and chlorhexidine baths as outpatients. Staphylococcal SSIs occurred in no intervention patients (0/321) and 19 concurrent controls. If all SSIs occurred in carriers and 25% of controls were carriers, staphylococcal SSI rate would have been 3.3% in controls (19/571; P = .001). Overall SSI rate decreased from 2.7% (20/741) in preintervention controls to 1.2% (17/1440) in intervention patients (P = .009). Preoperative screening/selective decolonization was associated with fewer SSIs after elective TJA.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chlorhexidine; Cohort Studies; Follow-Up Studies; Hip Joint; Humans; Knee Joint; Mass Screening; Mupirocin; Preoperative Care; Prevalence; Prospective Studies; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The clinical importance of low-level mupirocin resistance and genotypic chlorhexidine resistance remains unclear. We aimed to determine whether resistance to these agents increases the risk of persistent methicillin-resistant Staphylococcus aureus (MRSA) carriage after their use for topical decolonization therapy.. A nested case-control study was conducted of MRSA carriers who received decolonization therapy from 2001 through 2008. Cases, patients who remained colonized, were matched by year to controls, those in whom MRSA was eradicated (follow-up, 2 years). Baseline MRSA isolates were tested for mupirocin resistance by Etest and chlorhexidine resistance by qacA/B polymerase chain reaction. MRSA carriers with high-level mupirocin resistance were excluded. The effect of the primary exposure of interest, low-level mupirocin and genotypic chlorhexidine resistance, was evaluated with multivariate conditional logistic regression analysis.. The 75 case patients and 75 control patients were similar except that those persistently colonized were older (P = .007) with longer lengths of hospital stay (P = .001). After multivariate analysis, carriage of combined low-level mupirocin and genotypic chlorhexidine resistance before decolonization independently predicted persistent MRSA carriage (odds ratio [OR], 3.4 [95% confidence interval {CI}, 1.5-7.8]). Other risk factors were older age (OR, 1.04 [95% CI, 1.02-1.1]), previous hospitalization (OR, 2.4 [95% CI, 1.1-5.7]), presence of a skin wound (OR, 5.7 [95% CI, 1.8-17.6]), recent antibiotic use (OR, 3.1 [95% CI, 1.3-7.2]), and central venous catheterization (OR, 5.7 [95% CI, 1.4-23.9]).. Combined low-level mupirocin and genotypic chlorhexidine resistance significantly increases the risk of persistent MRSA carriage after decolonization therapy. Institutions with widespread use of these agents should monitor for resistance and loss of clinical effectiveness.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Carrier State; Case-Control Studies; Chlorhexidine; DNA, Bacterial; Drug Resistance, Bacterial; Female; Genes, Bacterial; Genotype; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Polymerase Chain Reaction; Staphylococcal Infections; Treatment Outcome

Piperine, a trans-trans-isomer of 1-piperoyl-piperidine, was tested in combination with mupirocin for antimicrobial activity against Staphylococcus aureus strains including meticillin-resistant S. aureus. The combination markedly reduced the MIC of mupirocin and also lowered the mutation frequency. Enhanced accumulation and efflux of ethidium bromide from wild-type and mutant (Mup(r)-1) strains in the presence of piperine indicated that inhibition of efflux could be a possible mechanism of potentiation of mupirocin activity by piperine. The combination of piperine with mupirocin in a dermal infection model of mice showed better in vivo efficacy when compared with the commercially available formulation of 2 % mupirocin.

Topics: Alkaloids; Animals; Anti-Bacterial Agents; Bacterial Proteins; Benzodioxoles; Disease Models, Animal; Drug Synergism; Enzyme Inhibitors; Ethidium; Female; Membrane Transport Proteins; Methicillin-Resistant Staphylococcus aureus; Mice; Microbial Sensitivity Tests; Mupirocin; Piperidines; Polyunsaturated Alkamides; Rodent Diseases; Staphylococcal Infections; Treatment Outcome

Using data from an observational study in which the effectiveness of a guideline for eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage was evaluated, we identified variables that were associated with treatment failure.. A multivariate logistic regression model was performed with subgroup analyses for uncomplicated and complicated MRSA carriage (the latter including MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and for those treated according to the guideline (i.e. mupirocin nasal ointment and chlorhexidine soap solution for uncomplicated carriage, in combination with two oral antibiotics for complicated carriage).. Six hundred and thirteen MRSA carriers were included, of whom 333 (54%) had complicated carriage; 327 of 530 patients (62%) with known complexity of carriage were treated according to the guideline with an absolute increase in treatment success of 20% (95% confidence interval 12%-28%). Among those with uncomplicated carriage, guideline adherence [adjusted odds ratio (OR(a)) 7.4 (1.7-31.7)], chronic pulmonary disease [OR(a) 44 (2.9-668)], throat carriage [OR(a) 2.9 (1.4-6.1)], perineal carriage [OR(a) 2.2 (1.1-4.4)] and carriage among household contacts [OR(a) 5.6 (1.2-26)] were associated with treatment failure. Among those with complicated carriage, guideline adherence was associated with treatment success [OR(a) 0.2 (0.1-0.3)], whereas throat carriage [OR(a) 4.4 (2.3-8.3)] and dependence in activities of daily living [OR(a) 3.6 (1.4-8.9)] were associated with failure.. Guideline adherence, especially among those with complicated MRSA carriage, was associated with treatment success. Adding patients with extranasal carriage or dependence in daily self-care activities to the definition of complicated carriage, and treating them likewise, may further increase treatment success.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Asymptomatic Infections; Carrier State; Chlorhexidine; Female; Guideline Adherence; Humans; Logistic Models; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Practice Guidelines as Topic; Staphylococcal Infections; Treatment Failure

We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The guideline distinguishes complicated (defined as the presence of MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and uncomplicated carriage (not meeting criteria for complicated carriage). Mupirocin nasal ointment and chlorhexidine soap solution are recommended for uncomplicated carriers and the same treatment in combination with two oral antibiotics for complicated carriage.. A prospective cohort study was performed in 18 Dutch centres from 1 October 2006 until 1 October 2008.. Six hundred and thirteen MRSA carriers underwent one or more decolonization treatments during the study period, mostly after hospital discharge. Decolonization was achieved in 367 (60%) patients with one eradication attempt and ultimately 493 (80%) patients were decolonized, with a median time until decolonization of 10 days (interquartile range 7-43 days). Three hundred and twenty-seven (62%) carriers were treated according to the guideline, which was associated with an absolute increase in treatment success of 20% [from 45% (91/203) to 65% (214/327)].. Sixty percent of MRSA carriers were successfully decolonized after the first eradication attempt and 62% were treated according to the guideline, which was associated with an increased treatment success.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Asymptomatic Infections; Carrier State; Chlorhexidine; Cohort Studies; Cross Infection; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Netherlands; Practice Guidelines as Topic; Staphylococcal Infections; Treatment Outcome

Nasal carriage of Staphylococcus aureus may be responsible for some serious infections among hemodialyzed patients. Its pathogenic potential and commensal nature allows for an easy transmission both in and out of hospital environment.. This study was to assess the prevalence of S. aureus nasal carriage, to determine its frequency and nature in hemodialyzed patients of the Rabat Ibn Sina University hospital, in Morocco.. The study began in March 2008 according to the following protocol: screening of nasal carriage with five samplings, performed once a month three times, then once a month two times again after an interruption period of three months. Screening was performed weekly during the first month in hemodialyzed patients treated with mupirocin (Bactroban(®) 2%), and then monthly, to monitor the kinetics of S. aureus eradication.. The study included 54 hemodialyzed patients with a mean 44.16±14 years of age, sex ratio of 0.54, and mean hemodialysis duration of 118.7±67 months. Permanent and intermittent S. aureus carriage was found in respectively 18.52% and 25.92% of patients. Eighty-one strains of S. aureus were identified, 14.81% of which were methicillin resistant. Eradication was sustained beyond 20 months in patients treated with mupirocin.. This investigation allowed us to identify hemodialyzed patients at risk, so as to implement the rules of individual and collective hygiene, and to extend mupirocin antibiotic prophylaxis in our hemodialysis unit.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Carrier State; Comorbidity; Drug Resistance, Multiple, Bacterial; Female; Hospitals, University; Humans; Kidney Failure, Chronic; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Morocco; Mupirocin; Nasal Cavity; Prevalence; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Chlorhexidine; Drug Resistance, Bacterial; Female; Hexachlorophene; Humans; Male; Medication Adherence; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nose; Postoperative Complications; Staphylococcal Infections; Surveys and Questionnaires

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Child; Child, Preschool; Chlorhexidine; Female; Hong Kong; Humans; Infant; Infant, Newborn; Interviews as Topic; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Regression Analysis; Staphylococcal Infections; Young Adult

The rate of mupirocin resistance in meticillin-resistant Staphylococcus aureus (MRSA) in Besançon University Hospital is low with a decreasing trend, from 10% in 2004 to 3% in 2009. This trend in resistance paralleled mupirocin consumption. Genotyping results showed that this decrease was not linked to a change in MRSA clones. It appears that the way in which the mupirocin is used, rather than the volume, plays a role in the emergence of resistance and that its cautious use is likely to maintain the mupirocin resistance at a low level, thus preserving its efficacy.

Topics: Cross Infection; Drug Resistance, Bacterial; Drug Utilization; Genotype; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Molecular Typing; Mupirocin; Staphylococcal Infections

Topics: Administration, Intranasal; Anti-Bacterial Agents; Cross Infection; Humans; Mass Screening; Medication Adherence; Mupirocin; Pharmacy Service, Hospital; Staphylococcal Infections; Staphylococcus aureus

Although the effect of Staphylococcus aureus (SA) decolonization on surgical site infection (SSI) rates has been studied, patient tolerance and acceptance of these regimens has not been assessed. Surgical patients at our hospital's Pre-Admission Testing Clinic (PAT) receive SA reduction protocols instructing the preoperative use of chlorhexidine gluconate (CHG) soap and intranasal mupirocin ointment (MO). Certain insurers do not cover MO costs resulting in out of pocket (OOP) expenses for some patients.. This study assessed patient attitudes and compliance with our hospital's SA decolonization regimen.. One-hundred-forty-six patients received surveys. Descriptive statistics were used for analysis.. Of respondents fitting inclusion criteria, 81% followed the MO protocol (MO users) while 89% followed the CHG protocol (CHG users). Fifty-four percent of MO users reported OOP expenses and 13% reported a hard or very hard financial burden. Ninety-three percent of CHG users reported the protocol was easy or very easy to follow.. Eighty-one percent of patients receiving the SA protocol were fully compliant despite cost or difficulty obtaining MO. Given these barriers and some difficulty with CHG application, we hypothesize compliance may be improved if MO is provided to patients without OOP expenses and if the CHG application method is simplified.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chlorhexidine; Female; Hand Disinfection; Health Care Costs; Health Expenditures; Health Knowledge, Attitudes, Practice; Humans; Infection Control; Insurance, Health, Reimbursement; Male; Middle Aged; Mupirocin; New York City; Nose; Patient Compliance; Program Evaluation; Soaps; Spine; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome; Young Adult

To evaluate the trend of mupirocin resistance in MRSA, isolated at the Clinical Microbiology Laboratory of a tertiary care hospital.. A total of 200 MRSA strains recovered over a 2 year period from various body sites were tested using the 5 and 200 microg discs of mupirocin to detect its resistance.. High level and low level mupirocin resistance were detected in zero and 1% of MRSA strains, respectively. Resistance to other non beta lactam antibiotics was also high. No MRSA strains were found to be resistant to vancomycin and tegicycline.. Mupirocin resistance was found to be very low among local clinical isolates of MRSA. Its judicious use to decolonize nasal carriers should be promoted among hospitalized patients to avoid further transmission and infections due to prevalent endemic MRSA strains in any health care setting. Concomitantly, regular surveillance and effective infection control initiatives are desirable to reduce the incidence of health care associated infections due to MRSA and also of mupirocin resistance.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Hospitals, Teaching; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Pakistan; Prevalence; Staphylococcal Infections

Four community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) isolates expressing high-level mupirocin resistance (MIC >1024 mg l(-1)) were isolated from four sites of a diabetic patient and characterized for the genetic location of their resistance determinants and typed using PFGE, staphylococcal cassette chromosome mec (SCCmec), the coagulase gene and multilocus sequence typing to ascertain their relatedness. The presence of genes for resistance to high-level mupirocin (mupA), tetracycline (tetK) and fusidic acid (far1), Panton-Valentine leukocidin (PVL), accessory gene regulators (agr) and capsular polysaccharide (cap) were detected in PCR assays. The isolates were resistant to kanamycin, streptomycin, tetracycline, fusidic acid and cadmium acetate, and harboured mupA, tetK, far1, PVL, agr3 and cap8. They had identical PFGE patterns and coagulase gene type, possessed the type IV SCCmec element and belonged to sequence type 80 (ST80). However, they had three different plasmid profiles: (i) 28.0 and 26.0 kb; (ii) 28.0, 21.0 and 4.0 kb; and (iii) 41.0 and 4.0 kb. Genetic studies located the resistance to tetracycline, fusidic acid and cadmium acetate on the 28 kb plasmid and mupA on the related non-conjugative 26 and 21 kb plasmids. One of the 21 kb mupirocin-resistance plasmids was derived from the approximately 41 kb plasmid during transfer experiments. The emergence of high-level mupirocin resistance in the ST80-SCCmec IV MRSA clone demonstrates the increasing capacity of CA-MRSA clones to acquire resistance to multiple antibacterial agents. The presence of different plasmid profiles in genetically identical isolates creates difficulty in the interpretation of typing results and highlights the weakness of using plasmid analysis as the sole method for strain typing.

Topics: Anti-Bacterial Agents; Community-Acquired Infections; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Plasmids; Staphylococcal Infections

High-level mupirocin resistance results from the acquisition of a mupirocin resistance (Mupr) plasmid carrying the mupA gene. In this study, we investigated the heterogeneous location of the mupA gene as well as sequence variations in mupA restriction fragment length polymorphism (RFLP) types of high-level mupirocin-resistant (MuH) staphylococci isolated from tertiary hospitals and long-term care facilities in South Korea. RFLP patterns of the mupA gene were investigated in 14 MuH staphylococci isolates, and sequence variations of the cassette-like construction composed of the transfer gene complex (trs), an insertion sequence (IS257-like) and the mupA gene of the Mupr plasmid were also studied. Among the 14 isolates, four different EcoRI/HindIII banding patterns were observed, which were determined to be caused by sequence deletion between the mupA gene and trsLM of the trs gene complex. Four different sequence types were also identified for the trsLM-IS257-like-mupA cassette. The IS257-like sequence of all MuH staphylococci showed two base pair substitutions and one base deletion compared with the sequence of IS257. The heterogeneous location of the mupA gene was caused by sequence deletion adjacent to the IS257-like sequence of the trsLM-IS257-like-mupA cassette construction, and the IS257-like sequence was found in all MuH staphylococci.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Cross Infection; DNA Transposable Elements; Drug Resistance, Bacterial; Genotype; Hospitals; Humans; Long-Term Care; Methicillin-Resistant Staphylococcus aureus; Molecular Sequence Data; Mupirocin; Nuclear Proteins; Polymorphism, Restriction Fragment Length; Republic of Korea; Sequence Analysis; Staphylococcal Infections

A total of 803 clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates obtained from Shanghai and Wenzhou in China were subjected to a screening test by disk diffusion for detection of mupirocin resistance. Among the 803 strains, 53 (6.6%) were mupirocin-resistant. Of these 53 strains, all were discovered by the agar dilution method and polymerase chain reaction (PCR) to be high-level mupirocin-resistant and to harbour the mupA gene. Plasmid DNA hybridisation and curing experiments disclosed that mupA was located on a large plasmid varying in size between 23.0kb and 52.4kb in all strains. Susceptibility testing of 10 antibiotics revealed that resistance rates between the Shanghai isolates and the Wenzhou isolates to trimethoprim/sulfamethoxazole and rifampicin differed significantly. Molecular typing by pulsed-field gel electrophoresis (PFGE), staphylococcal chromosomal cassette mec (SCCmec) and staphylococcal protein A (spa) revealed that PFGE A-SCCmec IIIA-spa t030 and PFGE B-SCCmec IIIA-spa t030 represented all of the Wenzhou strains, whereas PFGE N-SCCmec I-spa t318, PFGE P-SCCmec III-spa t037, PFGE I-SCCmec III-spa t037 and PFGE M-SCCmec IIIA-spa t002 were the predominant profiles among Shanghai isolates. These findings indicated that high-level mupirocin resistance mediated by plasmids prevailed in the clinical mupirocin-resistant MRSA from Shanghai and Wenzhou and was mainly related to the transmission of clones.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Bacterial Typing Techniques; China; Cluster Analysis; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Bacterial; Genotype; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nuclear Proteins; Plasmids; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Staphylococcal Infections

Topics: 2-Propanol; Anti-Infective Agents; Carrier State; Chlorhexidine; Cross Infection; Humans; Mupirocin; Nasal Cavity; Povidone-Iodine; Skin; Staphylococcal Infections; Surgical Wound Infection

In most bacteria, nutrient limitations provoke the stringent control through the rapid synthesis of the alarmones pppGpp and ppGpp. Little is known about the stringent control in the human pathogen Staphylococcus aureus, partly due to the essentiality of the major (p)ppGpp synthase/hydrolase enzyme RSH (RelA/SpoT homolog). Here, we show that mutants defective only in the synthase domain of RSH (rsh(syn)) are not impaired in growth under nutrient-rich conditions. However, these mutants were more sensitive toward mupirocin and were impaired in survival when essential amino acids were depleted from the medium. RSH is the major enzyme responsible for (p)ppGpp synthesis in response to amino acid deprivation (lack of Leu/Val) or mupirocin treatment. Transcriptional analysis showed that the RSH-dependent stringent control in S. aureus is characterized by repression of genes whose products are predicted to be involved in the translation machinery and by upregulation of genes coding for enzymes involved in amino acid metabolism and transport which are controlled by the repressor CodY. Amino acid starvation also provoked stabilization of the RNAs coding for major virulence regulators, such as SaeRS and SarA, independently of RSH. In an animal model, the rsh(syn) mutant was shown to be less virulent than the wild type. Virulence could be restored by the introduction of a codY mutation into the rsh(syn) mutant. These results indicate that stringent conditions are present during infection and that RSH-dependent derepression of CodY-regulated genes is essential for virulence in S. aureus.

Topics: Animals; Anti-Bacterial Agents; Biosynthetic Pathways; Colony Count, Microbial; Culture Media; Female; Gene Expression Profiling; Gene Expression Regulation, Bacterial; Guanosine Pentaphosphate; Ligases; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Microbial Viability; Mupirocin; Mutation; Staphylococcal Infections; Staphylococcus aureus; Virulence; Virulence Factors

Topics: Carrier State; Chlorhexidine; Disinfectants; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Treatment Outcome; United Kingdom

Topics: Anti-Bacterial Agents; Carrier State; Cohort Studies; Female; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Infection Control; Intensive Care Units, Neonatal; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Treatment Outcome

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance, Bacterial; Hospitals, Community; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nursing Homes; Staphylococcal Infections; United Kingdom

Topics: Administration, Intranasal; Anti-Infective Agents; Antibiotic Prophylaxis; Carrier State; Chlorhexidine; Cross Infection; Humans; Mupirocin; Risk Factors; Staphylococcal Infections; Surgical Wound Infection

Buttonhole (constant-site) cannulation (BHC) continues to gain popularity with home and in-center dialysis programs worldwide. However, long-term safety data are lacking. This paper reports the authors' single-center experience with Staphylococcus aureus bacteremia (SAB) and the efficacy of topical mupirocin prophylaxis (MP).. This study was a retrospective prepost comparison of SAB rates after establishing MP. Fifty-six consecutive patients on home nocturnal hemodialysis via arteriovenous fistulae, mean age 51.5 +/- 10.6 years, 38% women, and vintage 44.5 +/- 34.5 months were observed for a total of 93.4 (pre-MP) and 193.5 (post-MP) patient-years.. Ten episodes of SAB were observed, with metastatic complications in four cases, including pneumonia (n = 2), septic arthritis, and a fatal C3 epidural abscess. When analyzed by observation period, the odds ratio (OR) for SAB before versus after the introduction of MP was 6.4 [95% confidence interval (CI) = 1.3 to 32.3; P = 0.02]. Two SAB episodes occurred after the MP started. Both patients had discontinued the MP for 3 weeks (nonadherent) preceding infection; hence, no SAB episodes were observed on treatment. In an as-treated analysis, the OR for SAB in the absence of MP was 35.3 (95% CI = 2.0 to 626.7; P = 0.01).. BHC is associated with a significant risk of SAB with metastatic complications. In this prepost comparison of SAB rates, no infections were observed with MP. While awaiting more definitive studies, this simple intervention should be considered for patients using BHC.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arteriovenous Shunt, Surgical; Bacteremia; Catheterization, Peripheral; Female; Hemodialysis, Home; Humans; Male; Middle Aged; Mupirocin; Odds Ratio; Ontario; Retrospective Studies; Risk Assessment; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Carrier State; Chlorhexidine; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Surgical Wound Infection

Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Carrier State; Chlorhexidine; Humans; Infection Control; Mupirocin; Patient Isolation; Staphylococcal Infections; Surgical Wound Infection

We investigated the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates from pediatric patients demonstrating mupirocin resistance related to mupirocin use at our institution. No mupirocin resistance was found in 98% of isolates, whereas mupirocin prescriptions increased by 110%. Resistance rates remained low despite the increasing use of mupirocin.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Bacterial; Female; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

Topics: Administration, Topical; Adolescent; Anti-Bacterial Agents; Antibiotic Prophylaxis; Catheter-Related Infections; Catheters, Indwelling; Child; Disinfectants; Humans; Kidney Failure, Chronic; Mupirocin; Peritoneal Dialysis; Peritonitis; Pseudomonas Infections; Risk Factors; Skin Care; Sodium Hypochlorite; Staphylococcal Infections; Treatment Outcome

To evaluate the effects of an active surveillance program for Staphylococcus aureus linked to a decolonization protocol on the incidence of healthcare-associated infection and new nasal colonization due to S. aureus.. Retrospective quasi-experimental study.. An 18-bed medical intensive care unit at a tertiary care center in Cleveland, Ohio.. From January 1, 2006, through December 31, 2007, all patients in the medical intensive care unit were screened for S. aureus nasal carriage at admission and weekly thereafter. During the preintervention period, January 1 through September 30, 2006, only surveillance occurred. During the intervention period, January 1 through December 31, 2007, S. aureus carriers received mupirocin intranasally. Beginning in February 2007, carriers also received chlorhexidine gluconate baths.. During the preintervention period, 604 (73.7%) of 819 patients were screened for S. aureus nasal carriage, yielding 248 prevalent carriers (30.3%). During the intervention period, 752 (78.3%) of 960 patients were screened, yielding 276 carriers (28.8%). The incidence of S. aureus carriage decreased from 25 cases in 3,982 patient-days (6.28 cases per 1,000 patient-days) before intervention to 18 cases in 5,415 patient-days (3.32 cases per 1,000 patient-days) (P=.04; relative risk [RR], 0.53 [95% confidence interval {CI}, 0.28-0.97]) and from 9.57 to 4.77 cases per 1,000 at-risk patient-days (P=.02; RR, 0.50 [95% CI, 0.27-0.91]). The incidence of S. aureus hospital-acquired bloodstream infection during the 2 periods was 2.01 and 1.11 cases per 1,000 patient-days, respectively (P=.28). The incidence of S. aureus ventilator-associated pneumonia decreased from 1.51 to 0.18 cases per 1,000 patient-days (P=.03; RR, 0.12 [95% CI, 0.01-0.83]). The total incidence of S. aureus hospital-acquired infection decreased from 3.52 to 1.29 cases per 1,000 patient-days (P=.03; RR, 0.37 [95% CI, 0.14-0.90]).. Active surveillance for S. aureus nasal carriage combined with decolonization was associated with a decreased incidence of S. aureus colonization and hospital-acquired infection.

Topics: Anti-Bacterial Agents; Bacteremia; Carrier State; Cross Infection; Humans; Incidence; Intensive Care Units; Methicillin; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Ohio; Pneumonia, Ventilator-Associated; Population Surveillance; Prevalence; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Baths; Carrier State; Chlorhexidine; Cross Infection; Humans; Infection Control; Intensive Care Units; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Surgical site infection has been identified as one of the most important preventable sources of morbidity and mortality associated with medical treatment. The purpose of the present study was to evaluate the feasibility and efficacy of an institutional prescreening program for the preoperative detection and eradication of both methicillin-resistant and methicillin-sensitive Staphylococcus aureus in patients undergoing elective orthopaedic surgery.. Data were collected prospectively during a single-center study. A universal prescreening program, employing rapid polymerase chain reaction analysis of nasal swabs followed by an eradication protocol of intranasal mupirocin and chlorhexidine showers for identified carriers, was implemented. Surgical site infection rates were calculated and compared with a historical control period immediately preceding the start of the screening program.. During the study period, 7019 of 7338 patients underwent preoperative screening before elective surgery, for a successful screening rate of 95.7%. One thousand five hundred and eighty-eight (22.6%) of the patients were identified as Staphylococcus aureus carriers, and 309 (4.4%) were identified as methicillin-resistant Staphylococcus aureus carriers. A significantly higher rate of surgical site infection was observed among methicillin-resistant Staphylococcus aureus carriers (0.97%; three of 309) compared with noncarriers (0.14%; seven of 5122) (p = 0.0162). Although a higher rate of surgical site infection was also observed among methicillin-sensitive Staphylococcus aureus carriers (0.19%; three of 1588) compared with noncarriers, this difference did not achieve significance (p = 0.709). Overall, thirteen cases of surgical site infection were identified during the study period, for an institutional infection rate of 0.19%. This rate was significantly lower than that observed during the control period (0.45%; twenty-four cases of surgical site infection among 5293 patients) (p = 0.0093).. Implementation of an institution-wide prescreening program for the identification and eradication of methicillin-resistant and methicillin-sensitive Staphylococcus aureus carrier status among patients undergoing elective orthopaedic surgery is feasible and can lead to significant reductions in postoperative rates of surgical site infection.. Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cefazolin; Chlorhexidine; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nasal Cavity; Ointments; Orthopedics; Polymerase Chain Reaction; Prospective Studies; Staphylococcal Infections; Surgical Wound Infection; Vancomycin

Mupirocin is used topically to treat skin infection caused by methicillin-resistant Staphylococcus aureus (MRSA). One hundred eighty-eight strains (isolated in 2003, 2004, 2007, and 2008) were tested for mupirocin susceptibility using disk diffusion method and minimum inhibitory concentration (MIC). Mupirocin resistance was detected in 10 (5%) strains with 2 of them showing MIC of 256 mg/l. PCR detection using gene-specific primers showed that all 10 mupirocin-resistant strains harbored ileS2 gene whereas mupA gene was detected in 2 mupirocin-resistant strains with MIC of 256 mg/l. Amplification of agr grouping and SCCmec typing showed that all 10 strains were agr group I and SCCmec type III. Sequence analysis of region X of the spa gene yielded 4 distinct spa types (t037, t363, t421, and t6405) which were clonally related. In conclusion, the rate of mupirocin resistance in Malaysia is still low but is much higher than previous reports in Malaysia.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Bacterial Typing Techniques; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Bacterial; Genes, Bacterial; Genotype; Hospitals; Humans; Malaysia; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nuclear Proteins; Polymerase Chain Reaction; Prevalence; Sequence Analysis, DNA; Staphylococcal Infections; Trans-Activators

We compared the cost-effectiveness of a methicillin-resistant Staphylococcus aureus (MRSA) programme of active surveillance plus decolonization with the current Veterans Health Administration (VHA) strategy of active surveillance alone, as well as a common strategy of no surveillance. A decision-analytical model was developed for an inpatient stay time horizon, using the VHA's perspective. Model inputs were taken from published literature where available, and supplemented with expert opinion when necessary. Effectiveness outcomes were hospital-acquired MRSA infections and deaths avoided. One-way and two-way sensitivity analyses and Monte Carlo simulations were performed. In the base-case analysis, the strategy of active surveillance plus decolonization dominated (i.e. lower cost and greater effectiveness) both the comparison strategies of active surveillance and no surveillance. In addition, the active surveillance strategy dominated the strategy of no surveillance. One-way and two-way sensitivity analyses demonstrated that at low levels of direct benefit of decolonization (1-4%), the strategy of active surveillance plus decolonization would no longer be dominant. In the probabilistic sensitivity analysis, active surveillance plus decolonization dominated both the other two strategies, and the active surveillance strategy dominated no surveillance in all of 1000 Monte Carlo simulations. These results provide a strong economic argument for adding an MRSA decolonization protocol to the current VHA active surveillance strategy.

Topics: Carrier State; Chlorhexidine; Cost-Benefit Analysis; Cross Infection; Data Interpretation, Statistical; Disinfectants; Hospitalization; Humans; Length of Stay; Methicillin-Resistant Staphylococcus aureus; Monte Carlo Method; Mupirocin; Sentinel Surveillance; Staphylococcal Infections; Veterans Health

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Cavity; Orthopedics; Physicians; Prevalence; Staphylococcal Infections; Surgical Wound Infection

Topics: Administration, Intranasal; Administration, Topical; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Comparative Effectiveness Research; Humans; Methicillin-Resistant Staphylococcus aureus; Mohs Surgery; Mupirocin; Nose; Prospective Studies; Research Design; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection

Colonization with methicillin-resistant Staphylococcus aureus (MRSA) places patients at risk for postoperative MRSA wound infections.. To determine the effect of a decontamination and prophylaxis protocol on postoperative MRSA wound infections in patients with nasal MRSA.. Wound cultures over a 23-month period were reviewed before and 11 months after implementation of a screening and decontamination protocol. After preoperative MRSA screening with nasal swabs, carriers were instructed to use intranasal mupirocin for 5 to 7 days before surgery and 5 to 7 days of trimethoprim-sulfamethoxazole starting the day before surgery.. During the 23 months before prescreening evaluation, we performed 3,633 Mohs surgical cases, and 12 postoperative MRSA wound infections (0.3%) occurred. Subsequently, 963 patients underwent screening for MRSA, and 23 MRSA carriers were identified (2.4%). Of the 22 who underwent the decontamination and treatment protocol, none developed postoperative wound infections. One MRSA carrier did not receive preoperative treatment and subsequently developed a MRSA wound infection. There were no other MRSA infections.. Preoperative MRSA screening and implementation of a decontamination protocol appears to decrease postoperative MRSA wound infections after Mohs surgery. Although an interesting observation, controlled studies of clinical and cost effectiveness are required before general implementation. The authors have indicated no significant interest with commercial supporters.

Topics: Administration, Topical; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Decontamination; Hospitals, Veterans; Humans; Infection Control; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Mohs Surgery; Mupirocin; Preoperative Care; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection

Implementation of meticillin-resistant Staphylococcus aureus (MRSA) decolonisation programmes has been increasing and the emergence of mupirocin resistance has been reported. However, the patient-level risk factors associated with mupirocin resistance are not clear. In this study, independent predictors of mupirocin resistance in MRSA among Providence Veterans Affairs Medical Center patients with MRSA-positive culture dates between 1 July 2004 and 30 June 2008 were identified using a frequency-matched case-control study. Forty cases (mupirocin-resistant) were matched on culture date quarter and year to 270 controls (mupirocin-susceptible). The adjusted conditional logistic regression model identified three significant independent predictors associated with mupirocin resistance in MRSA: (1) exposure to mupirocin in the year prior to the culture date [odds ratio (OR): 9.84; 95% confidence interval (CI): 2.93-33.09]; (2) Pseudomonas aeruginosa infection in the year before the culture-related admission (4.85; 1.20-19.61); and (3) cefepime use in the year prior to culture (2.80; 1.03-7.58). In sensitivity analyses, previous mupirocin exposure was associated with low-level [minimum inhibitory concentration (MIC) 8-128mg/L; 23 cases, 202 controls; OR: 6.32; 95% CI: 1.58-25.33] and high-level (MIC ≥256mg/L; 17 cases, 151 controls; OR: 11.18; 95% CI: 1.89-66.30) mupirocin resistance. To our knowledge, this is the first case-control study to reveal a strong association between previous mupirocin exposure and subsequent mupirocin resistance in MRSA, with demonstrated robustness in low- and high-level mupirocin resistance. Mupirocin susceptibility monitoring is critical for facilities instituting decolonisation with mupirocin as increased use may reduce effectiveness through resistance.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Case-Control Studies; Drug Resistance, Bacterial; Female; Hospitals, Veterans; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Rhode Island; Risk Factors; Staphylococcal Infections

The objectives of this study were to determine the susceptibility of Methicillin Resistant Staphylococcus aureus (MRSA) isolates to Mupirocin and other antimicrobial agents and to record the prevalence and distribution of this organism at the University Hospital of the West Indies (UHWI).. MRSA isolates collected between January 1, 2008 and December 31, 2008, were tested for low and high level resistance to Mupirocin. Susceptibility testing to other antibiotics including cotrimoxazole, minocycline, tetracycline, clindamycin, erythromycin, gentamicin and vancomycin was also done. Laboratory records for all patients from whom MRSA was recovered were reviewed and data on type and source of isolates, clinical diagnosis, history of previous hospitalization and use of mupirocin were extracted. In addition, the laboratory records for 2004 and 2005 were also reviewed to determine prevalence during these periods.. Seven per cent of Staphylococcus aureus isolates were resistant to methicillin (MRSA) and of these, 30% and 24% showed low level and high level resistance to mupirocin, respectively. Ninety-four per cent of MRSA strains were resistant to erythromycin while 52% showed resistance to clindamycin. Resistance to tetracycline, co-trimoxazole and minocycline was 27%, 12% and 6%, respectively, while about one-third of the isolates were resistant to gentamicin. There was no resistance to vancomycin. More than half (58%) of the isolates were from skin and soft tissue specimens while isolates from respiratory and urinary tracts and the bloodstream accounted for 19%, 13% and 4%, respectively. There has been a steady increase in prevalence from 4% in 2004 to 5% in 2007 and 7% in 2008.. Resistance of MRSA to mupirocin appears to be an emerging problem at the UHWI and must be monitored carefully. There is also significant resistance to commonly used antimicrobial agents and strict adherence to antibiotic policy is required to preserve the usefulness of these agents.

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance, Multiple, Bacterial; Hospitals; Humans; Jamaica; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Prevalence; Staphylococcal Infections

To examine the efficacy of preoperative Staphylococcus aureus screening on postoperative methicillin-resistant S aureus (MRSA) infection rates in otolaryngology.. Chart review.. Postoperative MRSA infection rates in unscreened patients during a 1-year period were compared with infection rates in patients after preoperative S aureus screening was initiated. Colonized patients were treated with mupirocin and chlorhexidine preoperatively.. Records of 420 patients were reviewed. In the 241 patients without screening, nine patients had S aureus infections, and there were two (0.8%) postoperative MRSA surgical-site infections. Of 179 patients after screening was initiated, 24 patients (13.4%) were colonized with S aureus and underwent preoperative treatment. There were no MRSA infections in the postoperative period.. Early results show the potential benefit of preoperative S aureus screening in MRSA infection rate reduction. Although larger studies are needed, screening and treatment of MRSA colonized patients preoperatively may reduce infectious complications in otolaryngology.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Otorhinolaryngologic Surgical Procedures; Postoperative Complications; Preoperative Care; Staphylococcal Infections

Mupirocin is a topical antimicrobial agent which is used for the treatment of skin and postoperative wound infections, and the prevention of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, the prevalence of mupirocin resistance in S. aureus, particularly in MRSA, has increased with the extensive and widespread use of this agent in hospital settings. This study characterized low- and high-level mupirocin-resistant S. aureus isolates obtained from Nigeria and South Africa.. A total of 17 mupirocin-resistant S. aureus isolates obtained from two previous studies in Nigeria and South Africa, were characterized by antibiogram, PCR-RFLP of the coagulase gene and PFGE. High-level mupirocin resistant isolates were confirmed by PCR detection of the mupA gene. The genetic location of the resistance determinants was established by curing and transfer experiments.. All the low-level mupirocin resistant isolates were MRSA and resistant to gentamicin, tetracycline and trimethoprim. PFGE identified a major clone in two health care institutions located in Durban and a health care facility in Pietermaritzburg, Greytown and Empangeni. Curing and transfer experiments indicated that high-level mupirocin resistance was located on a 41.1 kb plasmid in the South African strain (A15). Furthermore, the transfer of high-level mupirocin resistance was demonstrated by the conjugative transfer of the 41.1 kb plasmid alone or with the co-transfer of a plasmid encoding resistance to cadmium. The size of the mupirocin-resistance encoding plasmid in the Nigerian strain (35 IBA) was approximately 35 kb.. The emergence of mupirocin-resistant S. aureus isolates in Nigeria and South Africa should be of great concern to medical personnel in these countries. It is recommended that methicillin-susceptible S. aureus (MSSA) and MRSA should be routinely tested for mupirocin resistance even in facilities where the agent is not administered. Urgent measures, including judicious use of mupirocin, need to be taken to prevent clonal dissemination of the mupirocin/methicillin resistant S. aureus in KZN, South Africa and the transfer of the conjugative plasmid encoding high-level mupirocin resistance identified in this study.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Drug Resistance, Bacterial; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nigeria; Nuclear Proteins; Phenotype; South Africa; Staphylococcal Infections; Staphylococcus aureus

Various strategies for controlling methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in neonatal intensive care units (NICUs) have been tried, with varying levels of success. We report a MRSA outbreak occurring between April 2004 and August 2007 in a 24-bed NICU in a large university hospital. We describe the difficulties involved in implementing measures to control the MRSA outbreak and the possible contribution of each measure.. Cases were defined as neonates with MRSA obtained from either clinical cultures or surveillance cultures (from the anterior nares). Systematic screening of neonates for colonization was performed only between February and December 2005. Successive control strategies included barrier precaution and isolation in individual rooms, mupirocine ointment for neonates and health care workers, cohort isolation, hand hygiene observation, and staff training.. During the routine surveillance culture period (February to December 2005; 48 weeks), 46 neonates were found to be positive for MRSA and were treated with mupirocin. After December 2005, the outbreak was controlled, but the ongoing spread was not eradicated; 9 sporadic MRSA cases were detected by clinical culture up to August 2007.. The widespread use of mupirocine in staff and patients did not control the outbreak and is not recommended. The later control appeared to coincide with increased hand hygiene audits and training for staff, along with appropriate cohort isolation of neonates and cohort nursing.

Topics: Anti-Bacterial Agents; Cross Infection; Disease Outbreaks; Education; France; Hand Disinfection; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Patient Isolation; Sentinel Surveillance; Staphylococcal Infections

Topics: Bacterial Proteins; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nuclear Proteins; Polymerase Chain Reaction; Spain; Staphylococcal Infections

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Typing Techniques; Cluster Analysis; DNA Fingerprinting; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Genotype; Hospitals; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Spain; Staphylococcal Infections

Seventy-eight staphylococcal strains were isolated from surgical-site, blood-stream and other hospital-acquired infections. Eighteen isolates were determined as methicillin (MET)-resistant S. aureus (MRSA), while the remaining were MET-resistant coagulase-negative staphylococci (CoNS). Fifty percent of CoNS strains were multiresistant, while 10 % of isolates were resistant only to beta-lactams. Clinical isolates of CoNS were generally more resistant to antimicrobial agents than S. aureus strains. Thirty-nine % of S. aureus strains were resistant only to beta-lactams. None of the MRSA strains carried ileS-2 gene; this gene was found in two strains of S. epidermidis.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Coagulase; Drug Resistance, Bacterial; Humans; Isoleucine-tRNA Ligase; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus

Persistent nasal carriers have an increased risk of Staphylococcus aureus infection, whereas intermittent carriers and noncarriers share the same low risk. This study was performed to provide additional insight into staphylococcal carriage types.. Fifty-one volunteers who had been decolonized with mupirocin treatment and whose carriage state was known were colonized artificially with a mixture of S. aureus strains, and intranasal survival of S. aureus was compared between carriage groups. Antistaphylococcal antibody levels were also compared among 83 carriage-classified volunteers.. Persistent carriers preferentially reselected their autologous strain from the inoculum mixture (P=.02). They could be distinguished from intermittent carriers and noncarriers on the basis of the duration of postinoculation carriage (154 vs. 14 and 4 days, respectively; P=.017, by log-rank test). Cultures of swab samples from persistent carriers contained significantly more colony-forming units per sample than did cultures of swab samples from intermittent carriers and noncarriers (P=.004). Analysis of serum samples showed that levels of immunoglobulin G and immunoglobulin A to 17 S. aureus antigens were equal in intermittent carriers and noncarriers but not in persistent carriers.. Along with the previously described low risk of infection, intermittent carriers and noncarriers share similar S. aureus nasal elimination kinetics and antistaphylococcal antibody profiles. This implies a paradigm shift; apparently, there are only 2 types of nasal carriers: persistent carriers and others. This knowledge may increase our understanding of susceptibility to S. aureus infection.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Carrier State; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Mucosa; Ointments; Staphylococcal Infections; Staphylococcus aureus; Young Adult

All patients admitted to our tertiary care hospital from 1 December 2007 to 10 June 2008 were screened for methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) nasal colonization, and the isolates were tested for mupirocin susceptibility by using Etest. Mupirocin resistance (MR) was noted to occur in 3.4% of MRSA carriers, and high-level MR was noted to occur in 0.62% of carriers.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Drug Resistance, Bacterial; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Young Adult

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Randomized Controlled Trials as Topic; Staphylococcal Infections; Treatment Outcome

We evaluated the usefulness of topical decolonization therapy for reducing the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among MRSA-colonized inpatients.. Retrospective cohort study.. Three hospitals with universal surveillance for MRSA; at their physician's discretion, colonized patients could be treated with a 5-day course of nasal mupirocin calcium 2%, twice daily, plus chlorhexidine gluconate 4% every second day.. MRSA carriers were later retested for colonization (407 subjects; study 1) or followed up for development of MRSA infection (933 subjects; study 2). Multivariable methods were used to determine the impact of decolonization therapy on the risks of sustained colonization (in study 1) and MRSA infection (in study 2).. Independent risk factors for sustained colonization included residence in a long-term care facility (odds ratio [OR], 1.8 [95% confidence interval [CI], 1.1-3.2]) and a pressure ulcer (OR, 2.3 [95% CI, 1.2-4.4]). Mupirocin at any dose decreased this risk, particularly during the 30-60-day period after therapy; mupirocin resistance increased this risk (OR, 4.1 [95% CI, 1.6-10.7]). Over a median follow-up duration of 269 days, 69 (7.4%) of 933 patients developed infection. Independent risk factors for infection were length of stay (hazard ratio [HR], 1.2 per 5 additional days [95% CI, 1.0-1.4]), chronic lung disease (HR, 1.7 [95% CI, 1.0-2.8]), and receipt of non-MRSA-active systemic antimicrobial agents (HR, 1.8 [95% CI, 1.1-3.1]). Receipt of mupirocin did not affect the risk of infection, although there was a trend toward delayed infection among patients receiving mupirocin (median time to infection, 50 vs 15.5 days; P=.06).. Mupirocin-based decolonization therapy temporarily reduced the risk of continued colonization but did not decrease the risk of subsequent infection.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Child; Child, Preschool; Chlorhexidine; Cohort Studies; Drug Therapy, Combination; Female; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Risk Factors; Staphylococcal Infections; Treatment Outcome; Young Adult

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Ireland; Mupirocin; Prevalence; Staphylococcal Infections; Staphylococcus

Since methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most prevalent nosocomial pathogens and a frequent cause of mortality and morbidity, there is an increasing tendency to use topical mupirocin for eradication of MRSA carriage. However, there have been recent reports of resistance against mupirocin among MRSA isolates. This study was conducted to investigate the presence of mupirocin resistance in a population of 595 nosocomial MRSA isolates by phenotypic and genotypic methods. In 35 (5.9%) of 595 isolates, mupirocin resistance was detected by disc diffusion and E-test methods. High-level mupirocin resistance was detected in 23 (65.8%) isolates and low-level mupirocin resistance in 12 (34.2%) isolates by E-test method. The molecular analysis of 35 mupirocin resistant MRSA isolates showed the presence of both mecA and mupA genes by polymerase chain reaction. While in 23 high-level mupirocin resistant MRSA isolates a 38 kb plasmid was detected, none of the low-level mupirocin-resistant MRSA isolates revealed the presence of this plasmid. Thirty-two of 35 mupirocin resistant MRSA isolates were genotyped with pulsed-field gel electrophoresis and 24 isolates were typed as identical (genotype A) and 8 as genetically-related (genotype A1), according to Tenover criteria. These data revealed that mupirocin resistant MRSA isolates in our hospital were of the same genotype or closely related.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Carrier State; Cross Infection; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Nuclear Proteins; Penicillin-Binding Proteins; Phenotype; Staphylococcal Infections

We investigated whether methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) isolates with low-level mupirocin resistance can serve as recipients of a pSK41-like plasmid conferring high-level mupirocin resistance without substantial fitness cost. Our results suggest that acquisition of the plasmid conferring high-level mupirocin resistance was not necessarily associated with fitness cost in some MRSA recipients with low-level mupirocin resistance.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Conjugation, Genetic; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Plasmids; Staphylococcal Infections

Peritoneal dialysis (PD) is a common maintenance renal replacement modality for children with ESRD frequently compromised by infectious peritonitis and catheter exit site and tunnel infections (ESI/TI). The effect of topical mupirocin (Mup) and sodium hypochlorite (NaOCl) solution was evaluated as part of routine daily exit site care on peritonitis and ESI/TI rates, causative microorganisms, and catheter survival rates.. Retrospective chart review of children on home continuous cycling PD between April 1, 2001 and June 30, 2007 was performed. Infection rates were examined based on exit site protocol used in two different periods: Mup alone, April 1, 2001 to November 17, 2004; and Mup and NaOCl (Mup+NaOCl), November 18, 2004 to June 30, 2007.. Eighty-three patients (mean PD initiation age: 12.1 +/- 5.8 yr) received home PD over 2009 patient months. Annualized rates (ARs) for peritonitis decreased from 1.2 in the Mup period to 0.26 in the Mup+NaOCl period (P < 0.0001). ARs for ESI/TI decreased from 1.36 in the Mup period to 0.33 in the Mup+NaOCl period (P < 0.0001). No infections with Mup-resistant organisms were observed when either Mup or Mup+NaOCl was used for prophylaxis. Gram-negative-organism associated peritonitis decreased from an AR of 0.31 in the Mup period to 0.07 in the Mup+NaOCl period (P < 0.001). Infection-related catheter removal rates decreased from 1 in 38.9 catheter-months in the Mup period to 1 in 94.2 in the Mup+NaOCl period (P = 0.01). Catheter survival rates were longer in the Mup+NaOCl period (Kaplan-Meier, P < 0.009).. The combination Mup+NaOCl in daily exit site care was very effective to reduce PD catheter-associated infections and prolong catheter survival in pediatric patients.

Topics: Administration, Topical; Adolescent; Anti-Bacterial Agents; Catheterization; Child; Disinfectants; Drug Therapy, Combination; Female; Humans; Kaplan-Meier Estimate; Kidney Failure, Chronic; Male; Mupirocin; Peritoneal Dialysis; Peritonitis; Pseudomonas Infections; Retrospective Studies; Skin Care; Sodium Hypochlorite; Staphylococcal Infections; Treatment Outcome

Linezolid resistance has dominantly been mediated by mutations in 23S rRNA or ribosomal protein L4 genes. Recently, cfr has demonstrated the ability to produce a phenotype of resistance to not only oxazolidinones, but also other antimicrobial classes (phenicols, lincosamides, pleuromutilins, and streptogramin A). We describe the first detection of cfr-mediated linezolid resistance in Staphylococcus aureus and Staphylococcus epidermidis recovered from human infection cases monitored during the 2007 LEADER Program.

Topics: Acetamides; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Proteins; Drug Resistance, Bacterial; Humans; Linezolid; Methyltransferases; Microbial Sensitivity Tests; Molecular Sequence Data; Oxazolidinones; Sequence Analysis, DNA; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis

To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers and to identify factors influencing decolonization treatment failure.. Prospective cohort study from January 2002 to April 2007, with a mean follow-up period of 36 months.. University hospital with 750 beds and 27,000 admissions/year.. Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.. Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites.. The mean age (+/- standard deviation [SD]) age of the 62 patients was 66.2 +/- 19 years. The most frequent locations of MRSA colonization were the nose (42 patients [68%]), the throat (33 [53%]), perianal area (33 [53%]), rectum (36 [58%]), and inguinal area (30 [49%]). Decolonization was completed in 87% of patients after a mean (+/-SD) of 2.1 +/- 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.. This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course.

Topics: Aged; Aged, 80 and over; Anal Canal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Female; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Pharynx; Povidone-Iodine; Rectum; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

We determined the in vitro activity of retapamulin, a novel pleuromutilin antibiotic, against 664 Staphylococcus aureus isolates from the UK, including many resistant to fusidic acid and/or highly resistant to mupirocin.. MICs were determined on Mueller-Hinton agar in accordance with the CLSI guidelines. Susceptibility was categorized using CLSI criteria, where available; otherwise the European Committee for Antimicrobial Susceptibility Testing (EUCAST)/BSAC criteria were used (for mupirocin and fusidic acid). Mutations in the rplC gene, which encodes ribosomal protein L3, were sought by PCR and DNA sequencing.. The S. aureus included 488 (73%) methicillin-resistant isolates (oxacillin MICs >2 mg/L), 336 isolates (51%) resistant to fusidic acid (MICs >1 mg/L) and 254 (38%) with high-level mupirocin resistance (MICs >256 mg/L); 103 (16%) isolates were resistant both to fusidic acid and to high levels of mupirocin. Retapamulin inhibited 663 (99.9%) isolates at < or =0.25 mg/L. A single methicillin-resistant S. aureus isolate, also with high-level mupirocin resistance, required a retapamulin MIC of 2 mg/L, but its reduced susceptibility to retapamulin was not associated with any mutation in ribosomal protein L3.. Retapamulin demonstrated excellent activity in vitro against S. aureus isolates, irrespective of their level of resistance to other antibacterials. These results support the EUCAST epidemiological cut-off value for retapamulin of < or =0.5 mg/L against S. aureus.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Bridged Bicyclo Compounds, Heterocyclic; Diterpenes; DNA Mutational Analysis; Drug Resistance, Bacterial; Fusidic Acid; Humans; Microbial Sensitivity Tests; Mupirocin; Ribosomal Protein L3; Ribosomal Proteins; Staphylococcal Infections; Staphylococcus aureus; United Kingdom

Although there has been a dramatic decrease in the incidence of peritonitis in continuous ambulatory peritoneal dialysis (CAPD), rates > 0.5 episodes per patient per year are still common, with a very high rate of relapse. The nasal, pharyngeal, and skin carriage of Staphylococcus aureus (S. aureus) has been reported to be one of the most important of predisposing factors for peritonitis. Mupirocin application has been introduced to combat S. aureus carriage state with some degree of success. To evaluate the benefits of combining ablution for prayer with mupirocin in eliminating the carrier state of S. aureus and thus preventing peritonitis in CAPD patients, we randomized prospectively 65 patients on CAPD into two groups; group (1) used mupirocin intranasal application alone, and group (2) were instructed, in addition to application of mupirocin, to perform the proper ablution technique. The main outcome measures were the state of nasal, skin and pharyngeal S. aureus carriage state, the incidence of peritonitis, and mal-function-free PD catheter survival. After 3 months of CAPD initiation, S. aureus carrier state was detected in 11 (33.3%) patients in group (1), and in 2 (6.25%) patients in group (2) (p aureus carriers (p aureus peritonitis occurred in 19 occasions in 10 patients of group (1) versus 4 occasions in 3 patients of group (2) (p S aureus carriage and hence it decreases the incidence of continuous ambulatory peritoneal dialysis-associated S. aureus peritonitis.

Topics: Adult; Anti-Bacterial Agents; Blood Urea Nitrogen; Carrier State; Creatinine; Female; Hematocrit; Humans; Male; Middle Aged; Mupirocin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Saudi Arabia; Skin Care; Staphylococcal Infections; Staphylococcus aureus

Topics: Austria; Cross Infection; Drug Contamination; Hospitals, University; Humans; Methicillin Resistance; Mupirocin; Ointments; Pantothenic Acid; Staphylococcal Infections; Staphylococcus aureus

Staphylococcal hospital isolates (n = 166) were tested in a touchdown multiplex-polymerase chain reaction assay for the identification of methicillin and mupirocin resistance and discrimination of S. aureus (femA gene) from coagulase negative staphylococci and other bacteria. All isolates harbored the 16SrDNA (Staphylococcus genus specific internal control) gene, and 130 (78 %) the mecA (methicillin resistance) gene. Fifty-seven (44 %) of these were determined as methicillin-resistant S. aureus, while the remaining 73 (56 %) were methicillin-resistant coagulase-negative staphylococci. Seventy-five (45 %) isolates harbored the ileS-2 (high-level mupirocin resistance) gene and were determined as mupirocin-resistant. This assay represents a simple, rapid, reliable approach for the detection and discrimination of methicillin-and mupirocin-resistant staphylococci.

Topics: Anti-Bacterial Agents; Bacterial Proteins; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Hospitals; Humans; Methicillin; Methicillin Resistance; Mupirocin; Polymerase Chain Reaction; RNA, Ribosomal, 16S; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus

Topics: Anti-Bacterial Agents; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Humans; Methicillin Resistance; Mupirocin; Prevalence; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) and multiresistant Staphylococcus pseudintermedius (MRSP) have emerged as important pathogens in animal infections. Associated therapeutic problems and the zoonotic potential of staphylococci have renewed interest in topical antibiotics for treatment and carrier decolonization. Fusidic acid and mupirocin are used topically in humans and animals but resistant strains isolated from people are increasing. This study investigates the in vitro activity of fusidic acid and mupirocin against coagulase-positive staphylococci from pets.. A collection of 287 staphylococci was examined, comprising 102 MRSA, 102 methicillin-susceptible S. aureus, 71 S. pseudintermedius and 12 MRSP from canine and feline infections and carrier sites isolated in the UK and Germany. MICs were determined by the agar dilution method according to CLSI (formerly NCCLS) standards.. The majority (89.7%) of all MICs were

Topics: Animals; Animals, Domestic; Anti-Bacterial Agents; Carrier State; Cats; Coagulase; Dogs; Fusidic Acid; Germany; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus; United Kingdom

There are two important routes for the transmission of Staphylococcus aureus to the burn wound. In the endogenous route, patients naturally carrying S. aureus colonize their own wounds, whereas in the exogenous route burn wounds are cross-infected from other sources. In this study we evaluated the effect of blocking the endogenous route on S. aureus burn wound colonization by mupirocin application in the nose of patients at the time of admission.. From September 2000 to January 2002 all patients with burns admitted to a single dedicated Burn Centre received nasal mupirocin upon admission. This period was compared to two control periods (C1: July 1999 to July 2000 and C2: January 2002 to January 2003) for S. aureus burn wound colonization. The colonization risk was analysed, adjusting for confounding, with Cox proportional hazard regression.. A total of 98 patients did not have S. aureus burn wound colonization at the time of admission and were, thus, considered at risk for S. aureus acquisition during their stay. As compared to C1, the relative risk of acquiring S. aureus in their wound was 0.48 (95% CI: 0.24-0.97) in the mupirocin period and 0.55 (95% CI: 0.28-1.1) during the C2 period. S. aureus nasal/pharyngeal colonization was a significant independent risk factor for wound colonization (RR: 2.3; 95% CI: 1.2-4.2).. Nasal mupirocin may contribute to risk reduction of S. aureus wound colonization in patients with burns.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Burns; Cross Infection; Drug Administration Routes; Female; Humans; Male; Mupirocin; Nasal Mucosa; Nose; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Topics: Administration, Intranasal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Carrier State; Chlorhexidine; Doxycycline; Humans; Iodine; Methicillin Resistance; Mupirocin; Nasal Mucosa; Orthopedic Procedures; Preoperative Care; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The effect of large-scale expanded surveillance for methicillin-resistant Staphylococcus aureus (MRSA) on health care-associated MRSA disease is not known.. To examine the effect of 2 expanded surveillance interventions on MRSA disease.. Observational study comparing rates of MRSA clinical disease during and after hospital admission in 3 consecutive periods: baseline (12 months), MRSA surveillance for all admissions to the intensive care unit (ICU) (12 months), and universal MRSA surveillance for all hospital admissions (21 months).. A 3-hospital, 850-bed organization with approximately 40,000 annual admissions.. Polymerase chain reaction-based nasal surveillance for MRSA followed by topical decolonization therapy and contact isolation of patients who tested positive for MRSA.. Poisson and segmented regression models were used to compare prevalence density of hospital-associated clinical MRSA disease (bloodstream, respiratory, urinary tract, and surgical site) in each period. Rates of bloodstream disease with methicillin-susceptible S. aureus were used as a control.. The prevalence density of aggregate hospital-associated MRSA disease (all body sites) per 10,000 patient-days at baseline, during ICU surveillance, and during universal surveillance was 8.9 (95% CI, 7.6 to 10.4), 7.4 (CI, 6.1 to 9.0; P = 0.15 compared with baseline), and 3.9 (CI, 3.2 to 4.7; P < 0.001 compared with baseline and ICU surveillance), respectively. During universal surveillance, the prevalence density of MRSA infection at each body site had a statistically significant decrease compared with baseline. The methicillin-susceptible S. aureus bacteremia rate did not statistically significantly change during the 3 periods. In a segmented regression model, the aggregate hospital-associated MRSA disease prevalence density changed by -36.2% (CI, -65.4% to 9.8%; P = 0.17) from baseline to ICU surveillance and by -69.6% (CI, -89.2% to -19.6%]; P = 0.03) from baseline to universal surveillance. During universal surveillance, the MRSA disease rate decreased during hospitalization and in the 30 days after discharge; no further reduction occurred thereafter. Surveillance with clinical cultures would have identified 17.8% of actual MRSA patient-days, and ICU-based surveillance with polymerase chain reaction would have identified 33.3%.. The findings rely on observational data.. The introduction of universal admission surveillance for MRSA was associated with a large reduction in MRSA disease during admission and 30 days after discharge.

Topics: Anti-Bacterial Agents; Chlorhexidine; Cross Infection; Disinfectants; Humans; Infection Control; Intensive Care Units; Methicillin Resistance; Mupirocin; Patient Admission; Poisson Distribution; Polymerase Chain Reaction; Population Surveillance; Prevalence; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; United States; Universal Precautions

Surgical site infections (SSIs) with Staphylococcus aureus are a recognized adverse event of hip and knee replacements. We evaluated the impact of a program to detect S. aureus nasal carriers before surgery with preoperative decolonization (using mupirocin twice daily for 5 days prior to surgery) of carriers. Nasal swab samples were obtained from patients prior to surgery from 8/1/2003 through 2/28/2005. Samples were tested using real-time PCR technology to detect S. aureus. The group that developed S. aureus SSI was compared to a combined concurrent and historical control for one year following the operation. S. aureus caused 71% of SSIs in the combined control groups. Of the 1495 surgical candidates evaluated, 912 (61.0%) were screened for S. aureus; 223 of those screened (24.5%) were positive and then decolonized with mupirocin. Among the 223 positive and decolonized patients, three (1.3%) developed a SSI. Among the 689 screen-negative patients, four (0.6%) developed SSIs for an overall rate of 0.77%. Among the 583 control patients who were not screened or decolonized, 10 (1.7%) developed S. aureus SSIs. SSIs from other organisms were 0.44% and 0.69%, respectively.. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthroplasty, Replacement; Carrier State; Cohort Studies; Cost-Benefit Analysis; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Cavity; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The objective of the study was to investigate the trend of mupirocin resistance among methicillin-resistant Staphylococcus aureus (MRSA) in Trinidad. No premarketing susceptibility surveillance was ever done following the introduction of mupirocin in 1986. A total of 188 MRSA strains recovered over a 2-year period from various body sites were tested for mupirocin resistance via the disc diffusion method. The major sources of MRSA were surgical site infections (74.0%) and bloodstream infections (8.0%). High-level and low-level mupirocin resistance were detected in 26.1 and 44.1% of MRSA stains, respectively. Resistances to other non-beta-lactam antibiotics were also high. Ninety-eight percent of all MRSA were resistant to erythromycin. This was followed by resistance rates of 96.8, 95.2, 94.1, 93.6, and 93.1%, for gentamicin, ciprofloxacin, amikacin and tobramycin, co-trimoxazole, and tetracycline, respectively. No MRSA strains were found to be resistant to vancomycin, linezolid, and quinupristin-dalfopristin. The study showed that mupirocin resistance among Trinidadian MRSA strains was relatively high compared to that seen in other countries. Because of the increasing prevalence of MRSA at the San Fernando General Hospital (SFGH) and the apparently increasing resistance to mupirocin, frequent monitoring of MRSA susceptibility patterns and infection control initiatives may be helpful in reducing the incidence of MRSA with a concomitant decrease in mupirocin resistance. This report is the first after 20 years of continuous use of the drug at the SFGH.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Prevalence; Staphylococcal Infections; Staphylococcus aureus; Trinidad and Tobago

We report a significant reduction in the number of surgical site infections (SSIs) due to meticillin-resistant Staphylococcus aureus (MRSA) in patients undergoing cardiac surgery after the introduction of preoperative screening using a same-day polymerase chain reaction (PCR) test. This was an observational cohort study set in a cardiac surgery unit based in southwest England. We studied 1462 patients admitted for cardiac surgery between October 2004 and September 2006. The IDI MRSA PCR test was used preoperatively to screen 765 patients between October 2005 and September 2006. Patients identified as carriers were treated with nasal mupirocin ointment and topical triclosan for five days, with single-dose teicoplanin instead of flucloxacillin as perioperative antibiotic prophylaxis. The rate of SSI following cardiac surgery in this group was compared to 697 patients who underwent surgery without screening between October 2004 and September 2005. After introduction of PCR screening, the overall rate of SSI fell from 3.30% to 2.22% with a significant reduction in the rate of MRSA infections (relative risk reduction: 0.77; 95% confidence interval: 0.056-0.95). PCR screening combined with suppression of MRSA at the time of cardiac surgery is feasible in routine clinical practice and is associated with a significant reduction in subsequent MRSA SSIs.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Carrier State; Cohort Studies; Cross Infection; England; Humans; Mass Screening; Methicillin Resistance; Mupirocin; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Teicoplanin; Thoracic Surgery; Triclosan

Topics: Communicable Diseases, Emerging; Disease Outbreaks; Humans; Incidence; Ireland; Methicillin Resistance; Mupirocin; Population Surveillance; Risk Assessment; Risk Factors; Staphylococcal Infections

Current treatment for serious infections caused by methicillin-resistant Staphylococcus aureus relies heavily upon the glycopeptide antibiotic vancomycin. Unfortunately, this practice has led to an intermediate resistance phenotype that is particularly difficult to treat in invasive staphylococcal diseases, such as septicemia and its metastatic complications, including endocarditis. Although the vancomycin-intermediate resistance phenotype has been linked to abnormal cell wall structures and autolytic rates, the corresponding genetic changes have not been fully elucidated. Previously, whole-genome array studies listed numerous genes that are overexpressed in vancomycin-intermediate sensitive strains, including graRS (SACOL0716 to -0717), encoding a two-component regulatory system (TCRS), as well as the adjacent vraFG (SACOL0718 to -0720), encoding an ATP-binding cassette (ABC) transporter; but the exact contribution of these genes to increased vancomycin resistance has not been defined. In this study, we showed that isogenic strains with mutations in genes encoding the GraRS TCRS and the VraFG ABC transporter are hypersensitive to vancomycin as well as polymyxin B. Moreover, GraRS regulates the expression of the adjacent VraFG pump, reminiscent of gram-positive bacteriocin-immunity regulons. Mutations of graRS and vraFG also led to increased autolytic rates and a more negative net surface charge, which may explain, in part, to their increased sensitivity to cationic antimicrobial peptides. Taken together, these data reveal an important genetic mediator to the vancomycin-intermediate S. aureus phenotype and may hold clues to the selective pressures on staphylococci upon exposure to selective cationic peptide antibiotics used in clinical practice.

Topics: Anti-Bacterial Agents; ATP-Binding Cassette Transporters; Bacterial Proteins; Gene Expression Regulation, Bacterial; Humans; Microbial Sensitivity Tests; Polymyxin B; Signal Transduction; Staphylococcal Infections; Staphylococcus aureus; Vancomycin; Vancomycin Resistance

Mupirocin resistance in Staphylococcus aureus is increasingly being reported in many parts of the world. This study describes the epidemiology and laboratory characterization of mupirocin-resistant methicillin-resistant S. aureus (MRSA) strains in Canadian hospitals. Broth microdilution susceptibility testing of 4,980 MRSA isolates obtained between 1995 and 2004 from 32 Canadian hospitals was done in accordance with CLSI guidelines. The clinical and epidemiologic characteristics of strains with high-level mupirocin resistance (HLMup(r)) were compared with those of mupirocin-susceptible (Mup(s)) strains. MRSA strains were characterized by pulsed-field gel electrophoresis (PFGE) and typing of the staphylococcal chromosomal cassette mec. PCR was done to detect the presence of the mupA gene. For strains with mupA, plasmid DNA was extracted and subjected to Southern blot hybridization. A total of 198 (4.0%) HLMup(r) MRSA isolates were identified. The proportion of MRSA strains with HLMup(r) increased from 1.6% in the first 5 years of surveillance (1995 to 1999) to 7.0% from 2000 to 2004 (P < 0.001). Patients with HLMup(r) MRSA strains were more likely to have been aboriginal (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5 to 9.4; P = 0.006), to have had community-associated MRSA (OR, 2.2; 95% CI, 1.0 to 5.0; P = 0.05), and to have been colonized with MRSA (OR, 1.7; 95% CI, 1.0 to 3.0; P = 0.04). HLMup(r) MRSA strains were also more likely to be resistant to fusidic acid (21% versus 4% for mupirocin-susceptible strains; P < 0.001). All HLMup(r) MRSA strains had a plasmid-associated mupA gene, most often associated with a 9-kb HindIII fragment. PFGE typing and analysis of the plasmid profiles indicate that both plasmid transmission and the clonal spread of HLMup(r) MRSA have occurred in Canadian hospitals. These results indicate that the incidence of HLMup(r) is increasing among Canadian strains of MRSA and that HLMup(r) MRSA is recovered from patients with distinct clinical and epidemiologic characteristics compared to the characteristics of patents with Mup(s) MRSA strains.

Topics: Aged; Anti-Bacterial Agents; Canada; Cross Infection; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Hospitals; Humans; Male; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

The aim of this study was to determine the risk factors for the recovery of low-level mupirocin-resistant (mup(r)) or -susceptible (mup(s)) MRSA from patients in intensive care units (ICUs).. A case-case-control study was conducted from November 2003 to April 2004. Two case groups consisted of patients with low-level mup(r) MRSA and mup(s) MRSA. A control group was frequency matched.. Mup(r) MRSA and mup(s) MRSA were isolated from 20 to 51 patients, respectively, during a six-month period. Risk factors identified for mup(r) MRSA were as follows: exposure to piperacillin-tazobactam (odds ratio [OR] 13.8; 95% confidence intervals [CI], 1.8-105.0), third-generation cephalosporins (OR, 5.0; 95% CI, 1.6-15.5) and quinolones (OR, 3.4; 95% CI, 1.1-10.7). Risk factors identified for mup(s) MRSA were as follows: length of ICU stay (OR, 1.1; 95% CI, 1.0-1.1), surgery (OR, 3.7; 95% CI, 1.5-9.0), exposure to third-generation cephalosporins (OR, 8.4; 95% CI, 3.3-21.7) and quinolones (OR, 7.7; 95% CI, 2.8-21.3).. Our results suggest that nosocomial isolation of low-level mup(r) MRSA may be affected by piperacillin-tazobactam.

Topics: Adult; Aged; Anti-Bacterial Agents; Case-Control Studies; Cephalosporins; Drug Resistance, Bacterial; Female; Humans; Intensive Care Units; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Quinolones; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Colonization of methicillin-resistant Staphylococcus aureus (MRSA) commonly leads to infection by the same strain. We examined the activity of lysostaphin, mupirocin, and tea tree oil against clinical MRSA (n = 98) isolates. MIC(50) (range) were as follows: lysostaphin, 0.125 mg/L (0.125-0.25); mupirocin, 0.5 mg/L (0.19-1024); tea tree oil, 1024 mg/L (512-2048). High- and low-level mupirocin resistance was noted in 9.2% of our MRSA isolates. Time kill results indicate MRSA activity at 24 h was lysostaphin = gentamicin = vancomycin (P mupirocin > tea tree oil (P >or= .05). Checkerboard testing indicated a synergistic relationship between lysostaphin and mupirocin in combination with gentamicin. Antagonism was observed with the combination of vancomycin and tea tree oil; time kill studies confirmed this result. Decolonization options are limited and resistance to mupirocin exists. Lysostaphin and tea tree oil may offer additional therapeutic options for the decolonization of MRSA where current treatment alternatives are limited.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Drug Antagonism; Drug Resistance, Bacterial; Drug Synergism; Humans; Lysostaphin; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Tea Tree Oil

Two hundred Staphylococcus aureus strains collected from an Indian hospital were tested for mupirocin susceptibility using disc diffusion method and E-test. High-level and low-level mupirocin resistance was detected in 10 (5%) and 2 (1%) S. aureus strains, respectively. Pulsed-field gel electrophoresis analysis of the high-level mupirocin-resistant methicillin-resistant S. aureus isolates revealed the presence of 2 clones with the majority of strains belonging to 1 clone, suggesting clonal dissemination.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; Hospitals; Humans; India; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Cross Infection; Decontamination; Humans; Methicillin Resistance; Mupirocin; Soaps; Staphylococcal Infections; Staphylococcus aureus

Mupirocin is an antimicrobial agent commonly used to treat staphylococcal infection or to eliminate persistent carriage. To date, interpretive criteria have not been established to define susceptibility or resistance when performing mupirocin susceptibility testing. In this evaluation, using CLSI guidelines, a total of 502 staphylococci comprising 219 methicillin-sensitive Staphylococcus aureus, 222 methicillin-resistant S. aureus and 61 coagulase-negative staphylococci are tested by broth microdilution, disc diffusion and E-test. Disc diffusion using 5 microg mupirocin discs was found to be a reliable method to distinguish susceptible and resistant strains. Minimum inhibitory concentration (MIC) determination was required to differentiate low-level and high-level resistance to mupirocin. E-test was found to be an accurate alternative to broth microdilution for the routine determination of MIC values of staphylococci to mupirocin. Broth microdilution and disc-diffusion results were plotted on a scattergram, and error rates were calculated. No errors were found using susceptibility criteria of < 4 microg/mL (MIC) and > 19 mm (zone diameter).

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Ireland; Microbial Sensitivity Tests; Multicenter Studies as Topic; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

This study reports an investigation of outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization involving 17 newborns in the neonatal unit of a teaching hospital. A neonatal specialist colonized with MRSA that eventually became mupirocin-resistant was implicated as a recurrent source of transmission of MRSA to newborns.

Topics: Academic Medical Centers; Anti-Bacterial Agents; Carrier State; Cross Infection; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; France; Humans; Infant, Newborn; Infectious Disease Transmission, Professional-to-Patient; Methicillin Resistance; Middle Aged; Mupirocin; Nasal Mucosa; Neonatology; Staphylococcal Infections; Staphylococcus aureus; Umbilical Cord

Meticillin-resistant Staphylococcus aureus isolates were classified into three mupirocin susceptibility groups by the disc diffusion method using 5 and 200 microg mupirocin discs. The zone diameter observed for a 5 microg disc distinguished Mup(S) from the resistant strains (either Mup(RL) or Mup(RH)). On the other hand, a 200 microg disc distinguished the high-resistance Mup(RH) strains from the other two (Mup(S) or Mup(RL)). Thus, the concomitant use of 5 and 200 microg mupirocin discs allowed the clear distinction among the three mupirocin susceptibility groups, Mup(S), Mup(RL) or Mup(RH).

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

The in vivo efficacy of the novel polymeric guanidine AKACID Plus was evaluated in a guinea pig model of experimental skin infection with methicillin-resistant Staphylococcus aureus (MRSA). Topical application of AKACID Plus at concentrations of > or =0.5% was as effective as mupirocin 2% cream in the treatment of superficial skin infection with MRSA.

Topics: Animals; Anti-Bacterial Agents; Colony Count, Microbial; Dose-Response Relationship, Drug; Female; Guanidines; Guinea Pigs; Male; Methicillin Resistance; Mupirocin; Polymers; Skin; Skin Diseases, Infectious; Staphylococcal Infections

To prevent transmission of MRSA, eradication by antiseptic washings and nasal ointment is recommended. There are few studies, which investigated the success of eradication of MRSA carriage during everyday clinical working conditions and results are controversial. We wanted to assess the effectiveness of MRSA eradication procedures--especially octenidine whole body washings and mupirocin nasal ointment--under conditions of everyday life.. We retrospectively analyzed the files of all patients who were admitted to the medical department of a tertiary care hospital between 1999 and 2004 and who were infected or colonized by MRSA. According to hospital's standards of care patients should have been washed with octenidine and should have got mupirocin nasal ointment only in case of nasal carriage. Patients were regarded as MRSA-eradicated when swabs taken on three consecutive days, earliest, three days after discontinuation of antiseptic and antiinfective procedures were without proof of MRSA.. Only 6% of patients were eradicated. MRSA could be cultured from swabs taken on dismissal of 60% of patients. Fifteen percent of patients had only one or two negative series of swabs. In 19% of patients success of eradication remained unknown. Besides we found that under every day clinical working conditions compliance with several tasks of the eradication protocol was insufficient.. Under every day clinical working conditions MRSA eradication is successful only in few patients. Whole body washings should be tested in detailed studies before they should become a recommendation for eradication of MRSA.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Baths; Carrier State; Critical Pathways; Cross Infection; Decontamination; Disinfection; Female; Germany; Guideline Adherence; Hospitals, University; Humans; Imines; Infection Control; Male; Methicillin Resistance; Middle Aged; Mupirocin; Pyridines; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) can be a precursor to serious infection, and decolonization with topical mupirocin has been studied as a means of preventing clinical infection. Mupirocin resistance in patients with MRSA has been reported, usually in the context of widespread mupirocin use.. Patients admitted to a surgical intensive care unit (SICU) had nasal swab cultures for MRSA performed at admission, weekly, and at discharge in an active surveillance program. Collected MRSA isolates were tested for mupirocin resistance, and molecular analysis was performed. Clinical data on the characteristics and outcomes of the patients who stayed in the SICU for >48 h were collected prospectively.. Of the 302 MRSA isolates available for testing, 13.2% were resistant to mupirocin, with 8.6% having high-level resistance (minimum inhibitory concentration, >or=512 microg/mL) and 4.6% having low-level resistance (minimum inhibitory concentration, 8-256 microg/mL). Patients admitted to the SICU for >48 h who were colonized with mupirocin-resistant MRSA were more likely to have been admitted to our hospital during the previous year (P=.016), were older (P=.009), and had higher in-hospital mortality (16% vs. 33%; P=.027), compared with patients colonized with mupirocin-susceptible MRSA. Molecular analysis of the mupirocin-resistant isolates revealed that 72.5% of isolates contained staphylococcal cassette chromosome mec II. Repetitive sequence polymerase chain reaction typing revealed that high-level mupirocin resistance was present in multiple clonal groups. The rate of mupirocin use hospital-wide during the study period was 6.08 treatment-days per 1000 patient-days.. We documented a high rate of mupirocin resistance in MRSA isolates from SICU patients, despite low levels of in-hospital mupirocin use.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Drug Resistance, Multiple, Bacterial; Female; Hospitals, Private; Humans; Intensive Care Units; Male; Methicillin Resistance; Middle Aged; Missouri; Mupirocin; Nose; Phylogeny; Risk Factors; Sentinel Surveillance; Staphylococcal Infections; Staphylococcus aureus

To compare the sensitivity of various protocols for methicillin-resistant Staphylococcus aureus (MRSA) surveillance, active surveillance for detecting MRSA nasal colonization was performed on 97 members of the medical staff and 218 patients in the Intensive Care Unit (ICU) of a university hospital. Duplicate nasal swabs were collected from each participant. One was plated directly on a blood agar plate (D-BAP) and observed at 24 and 48 hr. Another was incubated overnight in tryptic soy broth (TSB) with 6.5% NaCl, and subcultured on both BAP (B-BAP) and mannitol salt agar with 4 mg/L of oxacillin (B-MSAOXA). The MRSA colonization rate was similar in the medical staff and patient samples (16.5% vs 11.9%, p = 0.285). Among the medical staff members, the sensitivity of MRSA detection was the same (93.8%) in D-BAP and B-BAP. In the ICU patients, which are a high-risk group, the sensitivity of MRSA detection was improved by adding a pre-enrichment step (73.1% on D-BAP vs 96.2% on B-BAP). The simple direct plating protocol was sufficiently sensitive for the medical staff members, but pre-enrichment was an essential step to increase detection of MRSA in the ICU patients.

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Carrier State; Clinical Protocols; Culture Media; Humans; Intensive Care Units; Medical Staff, Hospital; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Nasal Cavity; Population Surveillance; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

We report the largest documented healthcare-associated outbreak of Panton-Valentine leucocidin-positive meticillin-resistant Staphylococcus aureus (PVL(+) MRSA) in Europe. Six index patients from three long-term care facilities (LTCFs) were screened positive for PVL(+) MRSA in 2004 on admission to a community hospital in Germany. The purpose of this prospective study was to describe the prevalence of PVL(+) MRSA in the LTCFs before and after infection control interventions. Screening for MRSA with or without PVL was performed in all three LTCFs in 2004 [453 residents, 240 healthcare workers (HCWs)] and 2005 (440 residents, 192 HCWs). Swabs from anterior nares and wounds, if applicable, were collected. Colonised residents and staff were treated with mupirocin nasal ointment and topical antiseptics, and staff were provided with hygiene education. Total MRSA carrier rate of residents and HCWs in 2004 was 11.3% (PVL(+) MRSA 9.1%, PVL(-) MRSA 2.2%). There were comparable carrier rates between residents and HCWs in each LTCF. All PVL(+) MRSA isolates were of clonal origin (MLST 22) representing a novel spa sequence type t310. A decrease in total MRSA prevalence (from 11.3 to 5.5%) and PVL(+) MRSA (from 9.1 to 3.3%) was observed in 2005. The rate of PVL(-) MRSA remained unaffected. No symptomatic skin infections were noted among residents or HCWs. In this outbreak incomplete control of PVL(+) MRSA presumably resulted from difficult and delayed detection and decolonisation of carriers, incomplete compliance with control measures and lack of enforcement by public health authorities.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Toxins; Carrier State; Cross Infection; Disease Outbreaks; Exotoxins; Female; Germany; Guideline Adherence; Health Personnel; Humans; Infection Control; Leukocidins; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Patients; Staphylococcal Infections; Staphylococcus aureus; Wounds and Injuries

The aim of the present study was to investigate the activity of the propolis and its combinations with mupirocin against methicillin-resistant Staphylococcus aureus (MRSA) in nasal carriage.. This study was carried out between June and August 2005. To infect nares of the rabbits, MRSA (ATCC 33591) strain was used. Minimum inhibitory concentration was determined according to National Committee for Clinical Laboratory Standards. Each inoculum was prepared in the same medium at a density adjusted to a 0.5 McFarland turbidity standard (10(5) colony-forming units [cfu]/mL) and diluted 1:100 for the broth microdilution procedure. Ten microliters (10 microL) (10(5) cfu/mL) of the bacterial suspension containing approximately 1000 cfu of MRSA was administered with sterile microsyringe through both nostrils of each rabbit. Ninety-six (96) hours after inoculation, the presence of infection was confirmed by using bacterial cultures. Twenty-six young New Zealand rabbits were randomly divided into 4 groups. Each treatment group (1, 2, and 3) included 7 rabbits and control group (group 4) included 5 rabbits. Group 1 was treated with topical mupirocin + ethanolic extract of propolis drops, group 2 received topical mupirocin, group 3 was administered ethanolic extract of propolis drops, and the control group (group 4) was only treated with phosphate-buffered solution drops for 7 days. At the end of study, nasal cultures and smears were obtained for bacterial count and cytologic examination.. The colony numbers of bacteria in group 1 were determined to be significantly lower than in group 2 (p = 0.0001), group 3 (p = 0.0001), and group 4 (p = 0.0001). The mean bacterial cell counts of groups 1-4 were 360.2 +/- 52.4 cfu/mL, 4120.6 +/- 860.4 cfu/mL, 5980.8 +/- 1240.6 cfu/mL, and 11500.0 +/- 2568.4 cfu/mL, respectively. Mupirocin + propolis administration (group 1) resulted in a significant reduction in the polymorphonuclear leukocyte (PMNL) count in the mucous membranes of rabbits compared with the other treatment groups (p < 0.05).. Propolis addition to mupirocin regimen was found to result in more profound reduction in bacterial cell count and inflammatory response compared with the rest of the treatment modalities.

Topics: Administration, Intranasal; Animals; Anti-Infective Agents; Colony Count, Microbial; Disease Models, Animal; Drug Synergism; Mupirocin; Nasal Mucosa; Propolis; Rabbits; Random Allocation; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important pathogen in community-acquired and nosocomial infections. The unique bactericidal action of mupirocin makes it one of the few antibiotics still effective against MRSA. The purpose of this study was to investigate the mupirocin resistance in MRSA strains isolated from wound infections of in- and out-patients of two distinct hospitals located in Ankara and Istanbul. A total of 143 MRSA strains were included in the study. Mupirocin resistance was investigated by Kirby-Bauer disk diffusion method and the results were confirmed by determination of the MIC values by E-test strips. Among 143 MRSA isolates, mupirocin resistance was detected by none of the methods, and overall mupirocin sensitivity was detected as 100 percent. The majority of mupirocin resistant MRSA is isolated from wound infections. The aetiology mostly depends on the increased topical use of the agent. The method used in the detection of mupirocin resistance and interpretation of the results are important parameters in the determination of mupirocin resistance in MRSA strains. Since there was no resistant strain among 143 clinical isolates obtained from two different hospitals, it was concluded that, mupirocin resistance is not an important problem in these regions currently, and mupirocin may be safely used in treating wound infections.

Topics: Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Turkey; Wound Infection

Elimination of methicillin-resistant Staphylococcus aureus (MRSA) is of critical importance in oral and maxillofacial surgery because control is very difficult once infection of an oral tumor or oral wound with MRSA is established.. We retrospectively investigated the risk factors for acquiring MRSA in 518 patients with oral cancer among 1,877 inpatients in our department between 1984 and 2005.. The patients with oral cancer demonstrated a high rate of MRSA colonization and infection (77.8%) relative to the population as a whole with MRSA isolated percentage in our department after 1991. The risk factors for MRSA in oral cancer patients are also related to systemic diseases and physiological and iatrogenic conditions, including cerebrovascular diseases (77.8%), peripheral arterial catheterization (69.2%), diabetes (50.0%), tracheotomy (50.0%), renal failure (50.0%), long-term broad-spectrum antibiotic use (45.7%), and malnutrition (43.3%). However, the highest risk of MRSA seems to be related to poor hygienic care.. Beginning in 1999, we implemented a strategy for reducing infection by MRSA that included nasal mupirocin ointment for patients at high risk of MRSA; since then, the detection rate has decreased. We suggest that the administration of nasal mupirocin ointment and provision of scrupulous hygienic care for high-risk patients are useful and effective measures for decreasing the incidence of MRSA infection.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Catheterization, Peripheral; Cerebrovascular Disorders; Colony Count, Microbial; Diabetes Complications; Follow-Up Studies; Humans; Hygiene; Malnutrition; Methicillin Resistance; Mouth Neoplasms; Mupirocin; Ointments; Renal Insufficiency; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Tracheotomy

Germany has witnessed increasing national methicillin-resistant Staphylococcus aureus (MRSA) rates during the past 2 decades. In our 900-bed tertiary care community hospital, a similar increase was noted during the period from 1994 to 2002, although single-room isolation and decolonization therapy were the standard of care.. An intensified infection control program aimed at the reduction of nosocomial MRSA transmissions was developed in 2002 and translated into clinical practice in 2003. Essential components of the program were a detailed written MRSA standard, acquisition of signal-colored isolation gowns and storage carts facilitating the use of separate supplies for MRSA patients, intensified surveillance and feedback of MRSA data, "flagging" of formerly positive MRSA patients, and a general MRSA screening policy for all newly admitted patients on the surgical intensive care unit (ICU). The effect of the program was monitored by continuous surveillance of MRSA cases on all wards. The transmission index was defined as the ratio between secondary and "imported" MRSA cases.. Comparing the preintervention (2002) and postintervention (2005-2006) periods, the total number of MRSA patients, MRSA rates on the ICUs, and invasive MRSA infections on the ICUs were reduced. The MRSA transmission index fell from 2.1 (2002) to 0.8 (2006). The rate of deep incisional and organ/space infections due to MRSA occurring after orthopedic surgery was lowered from 0.74 to 0.15%.. Our data indicate that the efficacy of single-room isolation and decolonization therapy can be strongly enhanced by means of a multicomponent, comprehensive MRSA control program. The program was effective despite an increasing "import" of new MRSA cases. Programs of this type may be suited to achieve a downward turn of MRSA figures in Germany.

Topics: Anti-Infective Agents, Local; Carrier State; Cross Infection; Disinfection; Germany; Hospitals, Community; Hospitals, Teaching; Humans; Infection Control; Methicillin Resistance; Mupirocin; Patient Isolation; Staphylococcal Infections; Universal Precautions

The authors have previously described the successful use of a five-day peri-operative prophylaxis regimen using nasal mupirocin and topical triclosan (PPNMTT) to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection. The present article describes the results of repeated point-prevalence surveillance for four years to determine whether mupirocin resistance has emerged in surgical units using empirical, short-term, peri-operative prophylaxis with nasal mupirocin. Before starting PPNMTT and every six months thereafter for four years, point-prevalence surveillance was performed for nasal S. aureus carriage in all patients on five orthopaedic surgery wards, one vascular surgery ward and one elderly medicine control ward. S. aureus screening and clinical isolates (surgical patients) were undertaken for low- [minimum inhibitory concentration (MIC) 8-128 mg/L] and high-level (MIC > 128 mg/L) mupirocin resistance. All isolates were phage typed to determine whether there was evidence of the spread of clonal mupirocin-resistant strains. Of 593, 139 and 206 nasal screening swabs (taken after the regimen had started) from orthopaedic, vascular and control patients, 28%, 24% and 48% (orthopaedic/vascular surgery vs elderly medicine, P < 0.001) yielded S. aureus isolates, respectively, and 12%, 11% and 30% (P < 0.001) were MRSA positive, respectively. Of the S. aureus nasal screen isolates from orthopaedic/vascular surgery and control patients, 5% and 4%, respectively, were low-level mupirocin resistant (P > 0.1). Of 286 (orthopaedic/vascular surgery) and 68 (elderly medicine) clinical S. aureus isolates obtained after the regimen had started, 7% and 9% (P > 0.1), respectively, were low-level mupirocin resistant. No high-level mupirocin-resistant isolates were isolated from mupirocin (orthopaedic/vascular surgery) or elderly medicine control ward patients. There was no trend towards increasing prevalence of low-level mupirocin resistance during the four-year study period. The results of phage typing did not support the clonal spread of resistant strains. Long-term follow-up confirmed the efficacy of PPNMTT in reducing the prevalence of nasal carriage of S. aureus and MRSA in orthopaedic and vascular surgery patients. Despite four years of use of PPNMTT, there was no evidence of sustained emergence or spread of mupirocin resistance.

Topics: Administration, Intranasal; Administration, Topical; Anti-Infective Agents; Antibiotic Prophylaxis; Carrier State; Drug Resistance, Bacterial; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Orthopedic Procedures; Prevalence; Sentinel Surveillance; Staphylococcal Infections; Staphylococcus aureus; Triclosan

We identified 25 high-level mupirocin-resistant (MuH) and 21 low-level mupirocin-resistant (MuL) Staphylococcus aureus isolates from eight long-term-care facilities (LTCFs). The pulsed-field gel electrophoresis patterns of 19 MuH and 19 MuL isolates from two facilities were identical for 18 and 15 isolates, respectively. The most predominant mupA restriction fragment length polymorphism type was found in 21 MuH isolates. We conclude that clonal transmission of MuH and MuL S. aureus strains occurred in these LTCFs. This is the first report of clonal transfer of mupirocin resistance in LTCFs.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Cross Infection; DNA, Bacterial; Drug Resistance, Bacterial; Humans; Korea; Long-Term Care; Mupirocin; Nuclear Proteins; Polymorphism, Genetic; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious nosocomial problem, globally distributed. Decolonization with mupirocin can be used to control its dissemination.. To determine the incidence of mupirocin resistance among MRSA carriers from an intensive care unit.. We obtained 2723 nasal swabs during 3 years. Resistance to methicillin and mupirocin were verified (agar diffusion and the E test) and confirmed by polymerase chain reaction (PCR) (mecA for methicillin; ileS-2 and mupA for mupirocin). Plasmid-curing procedure and pulsed-field gel electrophoresis (PFGE) were employed in isolates exhibiting high resistance to mupirocin (HR-Mup) and in other selected organisms.. The overall incidence of HR-Mup among MRSA carriers during the studied period was 4.84% (8/165); however, the incidence decreased from 13.04% (6/46) in the first year to 3.5% (2/57) in the second year and was 0% in the last year (P = .02). LR-Mup, in contrast, increased significantly (P = .01).. Plasmid-curing procedure showed the plasmid location of genes responsible for HR-Mup. PFGE demonstrated that most MRSA, including the isolates with HR-Mup, were genetically related. The decline in HR-Mup may be attributable to the plasmid location of genes (ileS-2/mupA) and to the fact that all patients colonized with HR-Mup MRSA died or were discharged in a relatively short period of time.

Topics: Bacterial Proteins; Carrier State; Cross Infection; DNA, Bacterial; Drug Resistance, Bacterial; Genes, Bacterial; Humans; Incidence; Intensive Care Units; Methicillin Resistance; Microbial Sensitivity Tests; Molecular Epidemiology; Mupirocin; Nose; Nuclear Proteins; Penicillin-Binding Proteins; Plasmids; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus (S aureus) is the major cause of surgical site infections (SSI). At The Christ Hospital, Cincinnati, OH, S aureus accounted for over 80% of sternal wound infections in cardiac surgery patients. Approximately 700 cardiac surgeries are performed each year, with an associated infection rate of 1.8% per 100 procedures performed. In an attempt to reduce S aureus sternal wound infections, the use of prophylactic intranasal mupirocin was examined.. Each patient undergoing cardiac surgery was nasally cultured before entering the operating room, and then intranasal mupirocin was applied and continued every 12 hours. Culture results were finalized within 48 hours. Mupirocin was discontinued when the culture returned negative and continued for 7 days when the culture returned positive for S aureus.. Cultures showed a S aureus carrier rate of 21%. These patients received mupirocin for 7 days. A decrease in S aureus-associated SSI rates was observed from a case rate of 1.68% to 0.37% per 100 procedures over a 17-month period.. Identifying and treating S aureus carriers with a full course of mupirocin does impact the rate of S aureus surgical site infections.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cardiac Surgical Procedures; Female; Humans; Incidence; Male; Middle Aged; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

After the introduction of routine treatment for every nasal carrier of methicillin-resistant Staphylococcus aureus, active follow-up surveillance for nosocomial methicillin-resistant S. aureus infection was conducted for 5 years in an intensive care unit of a tertiary-care teaching hospital. There was a significant decrease in the incidence of nosocomial methicillin-resistant S. aureus infection during the later years of follow-up. Decolonization of nasal carriers of methicillin-resistant S. aureus is probably associated with such findings.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Brazil; Chlorhexidine; Cross Infection; Humans; Infection Control; Intensive Care Units; Methicillin Resistance; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Carrier State; Humans; Iran; Methicillin Resistance; Mupirocin; Nasal Mucosa; Personnel, Hospital; Prevalence; Staphylococcal Infections; Staphylococcus aureus

Indiscriminate antibiotic use may lead to development of antibiotic resistance. Preoperative mupirocin treatment decreases Staphylococcus aureus carriage and may reduce subsequent surgical site infection, but is unlikely to benefit noncarriers. This study was undertaken to evaluate whether avoiding mupirocin in noncarriers places them at increased risk for subsequent postoperative infection.. We conducted a retrospective cohort study examining incidence of postoperative infection in patients undergoing cardiac surgery at the Cleveland Clinic after introduction of a protocol of polymerase chain reaction screening for nasal S aureus carriage, and avoiding mupirocin treatment of noncarriers.. Between August 1, 2002, and May 31, 2004, 6,334 patients were screened for nasal carriage of S aureus before undergoing cardiac surgery. There was no significant difference in infection rates between carriers and noncarriers when examining the incidence of all infections (5.6% and 5.0%; relative risk [RR] 1.11 [95% confidence interval (CI): 0.86 to 1.43]), infections caused specifically by S aureus (1.04% and 0.80%; RR 1.30 [95% CI: 0.71 to 2.39]), any surgical site infection (3.1% and 3.2%; RR 0.97 [95% CI: 0.69 to 1.36]), S aureus surgical site infection (0.82% and 0.58%; RR 1.41 [95% CI: 0.71 to 2.82]), any bloodstream infection (3.1% and 2.5%; RR 1.21 [95% CI: 0.86 to 1.71]), and S aureus bloodstream infection (0.37% and 0.48%; RR 0.77 [95% CI: 0.30 to 2.03]). Mupirocin use declined substantially after introduction of the protocol.. A strategy of targeting perioperative mupirocin treatment to carriers leads to significant reduction in mupirocin use without increasing early postoperative infectious complications in noncarriers.

Topics: Aged; Antibiotic Prophylaxis; Bacteremia; Cardiac Surgical Procedures; Carrier State; Cohort Studies; Comorbidity; Disease Susceptibility; Female; Humans; Incidence; Male; Middle Aged; Mupirocin; Nasal Cavity; Ohio; Patient Selection; Polymerase Chain Reaction; Preanesthetic Medication; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Unnecessary Procedures

The long-term efficacy (55 months) of eradication of nasal carriage of meticillin-resistant Staphylococcus aureus (MRSA) by mupirocin was assessed for MRSA infections in a gastroenterology unit receiving patients for long hospital stays. In total, 2242 patients were included in the study; 92% had been hospitalized in another hospital before admission to the study department, 64% had chronic liver diseases (LD), 25% had miscellaneous medical conditions and 11% were admitted following gastroenterological surgery. Three consecutive periods were considered in the analysis. Nasal carriage at admission was similar in all three periods (10.9 vs 7.5 vs 8.6% in Periods 1, 2 and 3, respectively), while acquired nasal carriage decreased in the whole population (14.3 vs 16.2 vs 10.2% in Periods 1, 2 and 3, respectively, P=0.006) and in LD patients (15.8 vs 18.7 vs 11.9% in Periods 1, 2 and 3, respectively, P=0.018). The incidence of MRSA infections (N per total number of hospitalization-days) was 1.41 per 1000 in the year before initiation of eradication, 1.40 in Period 1, 0.74 in Period 2 and 0.59 in Period 3 (P=0.022). The incidence of MRSA infections among patients was 7.0% in Period 1, 3.7% in Period 2 and 3.1% in Period 3 in LD patients (P=0.0062). The corresponding figures were 5.5, 3.0 and 2.4% for the whole population (P=0.0024). The mortality caused by MRSA was 0.31, 0.19 and 0.13% (P=0.035) in Periods 1, 2 and 3, respectively. The numbers of resistant strains among those acquired during hospitalization were 12 in Period 1, four in Period 2 and six in Period 3. Long-term intranasal mupirocin treatment in MRSA carrier patients with long hospital stay is associated with a decrease in acquired carriage and MRSA infections, while resistance of the strains to mupirocin does not increase provided that colonized patients are only treated once.

Topics: Adult; Aged; Anti-Bacterial Agents; Carrier State; Cross Infection; Disease Reservoirs; Female; Humans; Infection Control; Length of Stay; Liver Diseases; Male; Mass Screening; Methicillin Resistance; Middle Aged; Multivariate Analysis; Mupirocin; Nasal Cavity; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Topics: Anti-Bacterial Agents; Humans; Infectious Disease Transmission, Patient-to-Professional; Medical Laboratory Personnel; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

The methicillin-resistant Staphylococcus aureus (MRSA) population in the Hospital Universitario Nuestra Señora de Candelaria over a 5-year period (1998 to 2002) was marked by shifts in the circulation of pandemic clones. Here, we investigated the emergence of high-level mupirocin resistance (Hi-Mup(r)). In addition to clonal spread, transfer of ileS2-carrying plasmids played a significant role in the dissemination of Hi-Mup(r) among pandemic MRSA lineages.

Topics: Anti-Bacterial Agents; Conjugation, Genetic; Disease Outbreaks; Humans; Methicillin Resistance; Molecular Sequence Data; Mupirocin; Plasmids; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Clinical Competence; Health Care Surveys; Humans; Infection Control; Infection Control Practitioners; Methicillin Resistance; Mupirocin; Nasal Cavity; Pediatrics; Staphylococcal Infections; Staphylococcus aureus

We report the effectiveness of preemptive enhanced barrier precautions in containing a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a university hospital burn unit and further controlling endemic nosocomial MRSA infection in the unit during the succeeding 27 months.. During a 6-month period, 12 patients in a 7-bed burn unit were found to be colonized (7) or infected (5) by MRSA. An epidemiologic study was undertaken.. Seven of the 10 strains of MRSA from patients that were available for DNA typing were clonally identical. Early in the outbreak, a health care worker was found to be a concordant nasal carrier and was successfully decolonized with nasal mupirocin. However, despite stringent compliance with isolation of MRSA-positive patients (targeted precautions), new cases of MRSA colonization or infection continued to occur. The outbreak was rapidly terminated after implementing preemptive barrier precautions with all patients in the unit: a new, clean gown and gloves for any physical contact with the patient or their environment. Although 25% of all nosocomial S aureus isolates in our hospital are resistant to methicillin, the incidence of endemic MRSA colonization and infection in the burn unit has remained very low since implementing barrier precautions unit wide (baseline rate, 2.2 [95% CI: 1.0-4.2] cases per 1000 patient-days; outbreak rate, 7.2 [95% CI: 4.4-11.0] cases per 1000 patient-days; post-outbreak termination endemic rate, 1.1 (95% CI: 0.4-2.3) cases per 1000 patient-days). The rate ratio comparing the outbreak and the baseline period was 3.20 (95% CI: 1.40-7.95, P = .002); the rate ratio comparing the post-outbreak period with the baseline period was 0.48 (95% CI: 0.14-1.53, P = .10), and it has not been necessary to screen personnel for MRSA carriage to prevent nosocomial MRSA infections in this highly vulnerable population.. Preemptive barrier precautions were highly effective in controlling the outbreak and, most notably, have also been highly effective in maintaining a very low incidence of nosocomial MRSA infection endemically in the succeeding 27 months of follow-up. Use of clean gloves, with or without a gown, bears consideration for all high-risk hospitalized patients to prevent cross transmission of all multiresistant nosocomial pathogens.

Topics: Burn Units; Carrier State; Cross Infection; Deoxyribonucleases, Type II Site-Specific; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; Incidence; Infection Control; Infectious Disease Transmission, Professional-to-Patient; Methicillin Resistance; Molecular Epidemiology; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Wisconsin

The effect of topically applied retapamulin ointment was evaluated using various dosing regimens in the Staphylococcus aureus and Streptococcus pyogenes wound infection model. Retapamulin (1%, wt/wt) was efficacious using twice-daily (b.i.d.) applications for 4 or 5 days. These data underpinned the decision to evaluate 1% retapamulin b.i.d. in clinical trials.

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bridged Bicyclo Compounds, Heterocyclic; Colony Count, Microbial; Diterpenes; Drug Resistance, Bacterial; Methicillin Resistance; Mice; Mupirocin; Ointments; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The preoperative intranasal application of mupirocin significantly decreases the rate of nosocomial S. aureus infections among patients who are S. aureus carriers. However, it remains unclear whether the routine preoperative use of mupirocin would reduce postoperative S. aureus infections, especially methicillin-resistant Staphylococcus aureus (MRSA) infections, and who would benefit from the prophylactic use of mupirocin. Ninety-six consecutive patients who had undergone elective radical esophagectomy with right thoracotomy and laparotomy were evaluated. Fifty-one patients were given 2% mupirocin calcium ointment 3 times daily over 3 consecutive days before surgery. Uni- and multivariate analyses were performed to identify factors affecting the following three issues: postoperative MRSA infection, postoperative pneumonia, and the length of postoperative hospital stay. In univariate analyses, the preoperative application of mupirocin significantly reduced MRSA infection, postoperative pneumonia, and length of postoperative hospital stay. Multivariate analyses indicated significant associations between mupirocin administration and reductions in both MRSA infection and postoperative pneumonia, but not in length of postoperative hospital stay. Radical esophagectomy with right thoracotomy and laparotomy for esophageal carcinoma warranted the preoperative prophylactic administration of mupirocin in order to reduce postoperative infectious complications from MRSA. Its routine use for such a high-risk procedure is entirely reasonable.

Topics: Administration, Intranasal; Aged; Antibiotic Prophylaxis; Cross Infection; Esophagectomy; Female; Humans; Length of Stay; Male; Methicillin Resistance; Middle Aged; Mupirocin; Pneumonia; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus is the most common cause of healthcare-associated infections. Intranasal mupirocin treatment probably decreases S. aureus infections among colonized surgical patients. Using cost-effectiveness analysis, we evaluated the cost-effectiveness of preoperative use of mupirocin for the prevention of healthcare-associated S. aureus infections.. Three strategies were compared: (1) screen with nasal culture and give treatment to carriers, (2) give treatment to all patients without screening, and (3) neither screen nor treat. A societal perspective was taken. Adverse outcomes included bloodstream infection, pneumonia, surgical site infection, death due to underlying illness or infection, readmission, and the need for home health care. Data inputs were obtained from an extensive MEDLINE review and from publicly available government data sources. The following base-case data inputs (and ranges) for sensitivity analysis were used: rate of S. aureus carriage, 23.1% (19%-55%); efficacy of mupirocin treatment, 51% (8%-75%); mupirocin treatment cost, 48.36 US Dollars (24.18-57.74 US Dollars); and hospital costs of bloodstream infection, 25,128 US Dollars (6,194-40,211 US Dollars), pneumonia, 18,366 US Dollars (5,574-28,952 US Dollars), and surgical site infection 16,256 US Dollars (5,119-22,553 US Dollars). Widespread use of mupirocin has been associated with high levels of mupirocin resistance; therefore, a broad range of estimates for efficacy was tested in the sensitivity analysis.. The target population included patients undergoing nonemergent surgery requiring postoperative hospitalization.. Both the screen-and-treat and treat-all strategies were cost saving, saving 102 US Dollars per patient screened and 88 US Dollars per patient treated, respectively. In 1-way sensitivity analyses, the model was robust with respect to all data inputs except for the efficacy of mupirocin treatment. If the efficacy is less than 16.1%, then the screen-and-treat strategy is cost incurring. A treat-all strategy was more cost saving if the rate of S. aureus carriage was greater than 42.7%, the mupirocin cost was less than 29.87 US Dollars, or nursing compensation was greater than 64.21 US Dollars per hour.. Administration of mupirocin before surgery is cost saving, primarily because healthcare-associated infections are very expensive. The level of mupirocin efficacy is critical to the cost-effectiveness of this intervention.

Topics: Anti-Bacterial Agents; Cost Savings; Cost-Benefit Analysis; Cross Infection; Decision Trees; Mupirocin; Nose; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

To describe, during a 6-year period, multidrug-resistant bacterial carriage in an intensive care unit (ICU).. Prospective survey of 2235 ICU patients with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E).. A surgical ICU in a tertiary-care teaching hospital.. All admitted patients.. Nasal and rectal swabs were performed at admission and weekly thereafter. There was nasal application of mupirocin for MRSA carriers and selective digestive decontamination with local antibiotics for ESBL-E carriers.. The swab compliance rate was 82% at admission and 51% during ICU stay. The rates of MRSA carriage or infection were 4.2 new cases per 100 admissions and 7.9 cases per 1000 patient-days during ICU stay. The rates of ESBL-E carriage or infection were 0.4 new case per 100 admissions and 3.9 cases per 1000 patient-days during ICU stay. Importation of MRSA increased significantly over time from 3.2 new cases per 100 admissions during the first 3 years to 5.5 during the last 3 years. The rate of ICU-acquired ESBLE decreased from 5.5 cases per 1000 patient-days during the first 3 years to 1.9 cases during the last 3 years. Nasal and digestive decontamination had low efficacy in eradicating carriage.. MRSA remained poorly controlled throughout the hospital and was not just a problem in the ICU. MRSA thus requires more effective measures throughout the hospital. ESBL-E was mainly an ICU pathogen and our approach resulted in a clear decrease in the rate of acquisition in the ICU over time.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; France; Humans; Infection Control; Intensive Care Units; Length of Stay; Methicillin Resistance; Mupirocin; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Time Factors

Peritonitis and exit-site infections (ESI) are major causes of technique failure and morbidity in peritoneal dialysis (PD) patients. Topical mupirocin on the exit-site has been shown to reduce such complications and prolong life in PD. Since the year 2000, such an approach has been adopted for our new incident PD population. We now report the results of this new protocol. We also studied the effect of co-morbidity on peritonitis occurrence.. A total of 740 incident PD patients were studied. Patients were divided into two groups based on year of entry into PD (Group 1 from January 1998-December 1999 without topical mupirocin and Group 2 from January 2000-March 2004 with topical mupirocin). Variables studied included gender, age, diabetic status, ischaemic heart disease, peripheral vascular disease, cerebrovascular disease and serum albumin.. Topical mupirocin at the exit-site has led to a significant reduction in peritonitis rate (0.443 vs 0.339 episodes/patient-year; P<0.0005) and ESI (0.168 vs 0.156 episodes/patient-year; P<0.005) attributed primarily to the significant reduction in Staphylococcus aureus infections. There was an unexpected finding of lower Pseudomonas aeruginosa peritonitis in the mupirocin group (P<0.005). Stepwise multiple logistic regression analysis revealed that only mupirocin application and serum albumin were significant predictors of peritonitis.. Our study, although limited by its retrospective nature, demonstrated that topical mupirocin was associated with a significant reduction in ESI and peritonitis with unexpected findings of lower Pseudomonas peritonitis. Serum albumin prior to 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 incident PD patients.

Topics: Administration, Topical; Anti-Bacterial Agents; Cardiovascular Diseases; Catheters, Indwelling; Cohort Studies; Diabetes Mellitus; Humans; Incidence; Middle Aged; Mupirocin; Ointments; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Retrospective Studies; Singapore; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Heart Diseases; Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Surgical Wound Infection

Methicillin-resistant Staphylococcus aureus (MRSA) causes severe morbidity and mortality in intensive care units (ICUs) worldwide. The purpose of this study was to determine whether intranasal mupirocin prophylaxis is useful to prevent ICU-acquired infections with MRSA.. We conducted a 4-year observational retrospective study in a 15-bed adult medical ICU. During the first 2-year period mupirocin ointment was included in the MRSA control programme; during the second, mupirocin was not used. The main endpoint was the number of endogenous ICU-acquired infections with MRSA.. The number of endogenous acquired infections was significantly higher during the second period than during the first (11 versus 1; P = 0.02), although there was no significant difference in the total number of patients infected with MRSA between the two periods. We also observed that nasal MRSA decolonisation was significantly higher in the mupirocin period than in mupirocin-free period (P = 0.002).. Our findings suggest that intranasal mupirocin can prevent endogenous acquired MRSA infection in an ICU. Further double-blind, randomised, placebo-controlled studies are needed to demonstrate its cost-effectiveness and its impact on resistance.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Cross Infection; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Methicillin Resistance; Mupirocin; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

In a retrospective study, Dr Muller and colleagues have assessed the efficacy of mupirocin nasal ointment alongside hygienic measures in methicillin-resistant Staphylococcus aureus (MRSA)-positive patients admitted to the intensive care unit (ICU). Their findings, which suggest that intranasal mupirocin can prevent ICU-related MRSA infections, need confirmation in a well-designed clinical trial. In general: early identification, isolation and treatment of all MRSA carriers, including health care workers, and disinfection of contaminated environments, are the main 'ingredients' of an effective MRSA 'search and destroy' program.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Cross Infection; Humans; Intensive Care Units; Methicillin Resistance; Mupirocin; Staphylococcal Infections

Topics: Administration, Intranasal; Hospitals, University; Humans; Incidence; Medication Errors; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

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

Due to increasing mupirocin resistance, alternatives for Staphylococcus aureus nasal decolonization are needed. Lauric acid monoesters combined with lactic, mandelic, malic, or benzoic acid are being evaluated as possible alternatives. We determined the in vitro activity of 13 lauric acid monoester (LAM) formulations and mupirocin against 30 methicillin-susceptible S. aureus (MSSA) isolates and 30 methicillin-resistant S. aureus (MRSA) isolates. We then used a murine model of MRSA nasopharyngeal colonization to compare the in vivo activity of mupirocin with three LAM formulations. MSSA and MRSA MIC(90) values were 0.25 microg/ml for mupirocin and

Topics: Animals; Anti-Bacterial Agents; Carrier State; Disease Models, Animal; Esters; Humans; Lauric Acids; Methicillin; Methicillin Resistance; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests; Mupirocin; Nasopharynx; Ointments; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Mupirocin MICs and mupA presence were determined in 108 staphylococci causing prosthetic joint infection. Zero of 35 isolates (0%) of methicillin-susceptible Staphylococcus aureus, 4/15 (27%) methicillin-resistant S. aureus isolates, 3/16 (19%) methicillin-susceptible coagulase-negative staphylococci, and 11/42 (26%) methicillin-resistant coagulase-negative staphylococci were mupirocin resistant. mupA was detected in all five high-level mupirocin-resistant staphylococci and one mupirocin-susceptible staphylococcus.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Resistance, Bacterial; Female; Genotype; Humans; Joint Prosthesis; Male; Methicillin Resistance; Middle Aged; Mupirocin; Phenotype; Staphylococcal Infections; Staphylococcus

From 1990 to 1995 at Hospital Universitário Clementino Fraga Filho, patients colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA) were treated with mupirocin to eliminate MRSA carriage. In 1995, 65% of MRSA patients at this hospital had mupirocin-resistant isolates. Starting in 1996, mupirocin use was restricted to patients colonized, but not infected, with MRSA.. To describe the use of mupirocin for controlling MRSA over a decade and to analyze the molecular epidemiology of mupirocin-resistant MRSA infections at this hospital.. A 490-bed, tertiary-care university hospital.. The incidence densities of patients with MRSA and acquisition of mupirocin by the hospital were calculated for the period 1992-2001. S. aureus isolates from 1999-2000 were analyzed by pulsed-field gel electrophoresis. Mupirocin-resistant MRSA isolates from 1994-1995 and 1999-2000 were analyzed for ileS-2 gene background polymorphisms.. The incidence density of MRSA patients increased slightly over time, whereas the purchase of mupirocin decreased dramatically. Mupirocin-resistant MRSA infections decreased from 65% in 1994-1995 to 15% in 1999-2000. The MRSA Brazilian clone, detected in 1992, was still highly prevalent. The same ileS-2 encoding plasmid found in 1994-1995 persisted in three identical MRSA isolates from 1999-2000 belonging to the Brazilian clone.. After mupirocin use decreased, the ileS-2 encoding plasmid persisted in only a few Brazilian clone isolates. Our data on mupirocin-resistant MRSA incidence and mupirocin use strongly suggested that restricted use was related to decreased rates of mupirocin resistance at our hospital.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Brazil; Cross Infection; DNA, Bacterial; Hospitals, University; Humans; Incidence; Infection Control; Methicillin Resistance; Mupirocin; Polymorphism, Genetic; Staphylococcal Infections; Staphylococcus aureus

A retrospective review of an outbreak of community-acquired methicillin-resistant Staphylococcus aureus soft tissue infections in a high school football team was conducted. Thirteen players had 20 infections. Available community-acquired methicillin-resistant S. aureus isolates showed identical antibiotic susceptibility and field inversion gel electrophoresis analysis band patterns. Nasal cultures and mupirocin were ineffective at predicting and controlling infection, respectively. Infections treated with beta-lactam antibiotics were at risk for recurrence.

Topics: Adolescent; Child; Community-Acquired Infections; Confidence Intervals; Disease Outbreaks; Follow-Up Studies; Football; Humans; Incidence; Male; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Odds Ratio; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Treatment Refusal

We executed a blanket-use program of intranasal application of mupirocin ointment to control the propagation of methicillin-resistant Staphylococcus aureus (MRSA) that occurred in a thoracic surgery ward of a university hospital. During an intervention of 14 weeks, all patients admitted to the ward for scheduled surgery received the ointment to their nares three times daily for 3 days before surgery, once on return to the ward, and three times weekly for the following 2 weeks. None of 84 patients was newly colonized with MRSA, and the daily rates of patients with MRSA in a recovery room in the ward significantly decreased in the period. We consider that the unselective application of mupirocin ointment is one of the effective measures to control MRSA propagation in a thoracic surgery unit.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Female; Hospital Units; Hospitals, University; Humans; Infant; Infant, Newborn; Infection Control; Japan; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus; Thoracic Surgery; Tokyo

We examined the molecular basis of the emergence of mupirocin resistance in a methicillin-resistant Staphylococcus aureus (MRSA) strain colonizing a nursing home resident undergoing mupirocin prophylaxis.. A persistent carrier of mupirocin-susceptible MRSA participated in a trial of mupirocin for nasal decolonization among nursing home residents. During prophylaxis a high-level mupirocin-resistant MRSA emerged in the nasal isolates from this patient. S. aureus and coagulase-negative staphylococci were isolated prior to, during and after 14 days of mupirocin treatment. The staphylococcal isolates and their plasmids were examined by molecular genetic methods.. All mupirocin-susceptible and -resistant MRSA isolates possessed the same genotype. The patient was also colonized by a single mupirocin-resistant Staphylococcus epidermidis strain. The mupirocin-resistant MRSA and S. epidermidis strains harboured identical plasmids that carried the mupA determinant and genes for conjugative DNA transfer in staphylococci. These plasmids could be transferred in vitro from both clinical isolates to S. aureus RN2677.. The MRSA strain contained a conjugative plasmid expressing mupA that was identical with that found in the S. epidermidis strain which colonized the patient. These findings suggest that transfer of mupA from S. epidermidis to MRSA probably occurred during mupirocin prophylaxis.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Proteins; Carrier State; Conjugation, Genetic; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Gene Transfer, Horizontal; Humans; Male; Methicillin Resistance; Mupirocin; Nuclear Proteins; Nursing Homes; R Factors; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis

Topics: Administration, Intranasal; Anti-Bacterial Agents; Environment, Controlled; Hair Removal; Hemorrhage; Humans; Infection Control; Mupirocin; Protective Clothing; Staphylococcal Infections; Surgical Procedures, Operative; Surgical Wound Infection

To determine the rates of mupirocin resistance in staphylococci during a 4 year period (1999-2002) in Greece.. A total of 1200 Staphylococcus aureus and 2760 coagulase-negative staphylococci (CoNS), consecutively collected from four Greek hospitals located in different geographical areas, were tested for susceptibility to mupirocin using the Etest and a reference agar dilution method.. Twenty-four S. aureus (2%) and 532 CoNS (19.2%) were found to be mupirocin-resistant during the study period. High-level mupirocin resistance was detected in 20 S. aureus (1.6%) and in 440 CoNS (15.9%), respectively. No variations in the rates of mupirocin-resistant S. aureus in relation to the year of collection were observed. In contrast, the rate of mupirocin-resistant CoNS increased dramatically from 9% in 1999, to 14% in 2000, 20% in 2001 and reached 33% in 2002. PFGE analysis revealed the presence of one main clone (A) among mupirocin-resistant S. aureus and two main clones (i and a) among Staphylococcus epidermidis isolates.. In Greece, the rate of mupirocin-resistant S. aureus has remained low and steady since 1999. The high rate of mupirocin-resistant CoNS (33%) in 2002 was due mainly to clonal dissemination of epidemic hospital clones.

Topics: Anti-Bacterial Agents; Coagulase; Cross Infection; Drug Resistance, Bacterial; Genotype; Greece; Humans; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus

Staphylococcus aureus is a common pathogen in neonatal intensive care departments, causing significant morbidity, mortality, and cost. Frequently, S aureus outbreaks may last for months or years. After a cluster of 4 clinically significant S aureus infections in a 7-day period in our 35-bed neonatal intensive care department, we immediately introduced standard outbreak control measures. Unique to our approach was the addition of immediate nasal mupirocin treatment of all staff members and selected patients.. Patients were screened for S aureus colonization and were cohorted with separate caregivers. S aureus isolates were submitted to a reference laboratory for pulse-field gel electrophoretic typing. Infection control practices were emphasized and education was provided for staff, physicians, and parents of patients. All caregivers and selected patients were treated immediately with nasal mupirocin. Cohorting was maintained until all patients who were colonized or infected were discharged.. A total of 5 patients were found to be infected and 4 of 19 patients tested were found to be colonized during the study period. Patients who were infected were successfully treated. Secondary colonization and infection did not occur after implementation of controls.. Rapid and comprehensive implementation of standard outbreak controls along with immediate treatment of direct care staff and patients with nasal mupirocin successfully controlled this outbreak within 4 weeks and no further cases have been noted.

Topics: Administration, Inhalation; Adult; Anti-Bacterial Agents; Disease Outbreaks; Humans; Infant, Newborn; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Intensive Care Units, Neonatal; Minnesota; Mupirocin; Staphylococcal Infections

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Humans; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Double-Blind Method; Female; Genotype; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection is difficult to control. Due to a dramatic increase in the nosocomial MRSA infection rate at our hospital from 2000 to 2001, this study was conducted to identify the source of these infections and the effectiveness of control measures.. 179 healthcare workers (HCWs) were screened for carriage of MRSA. Starting in April 2001, all patients with MRSA infection or colonization were put in strict contact and cohort isolation. The bacterial isolates of HCW carriers and patients with MRSA infection from April 2001 to September 2001 were subjected to antimicrobial susceptibility testing by disk-diffusion method and molecular typing by pulsed-field gel electrophoresis (PFGE).. Fifteen HCWs were found to be carriers of MRSA. They were all given topical mupirocin treatment. After these interventions, the nosocomial MRSA infection rate decreased from 1.23 to 0.53 per 1000 patient-days. All 61 MRSA isolates available for antimicrobial susceptibility testing and molecular typing were multidrug resistant. PFGE study revealed 2 predominant types, type C and type Y, comprising 36 and 12 isolates, respectively.. The current study demonstrates the importance of measures to control nosocomial MRSA infections in hospitals that already have a high incidence of endemic MRSA infection. Elimination of carriage by healthcare workers, and strict contact and cohort isolation are the main effective measures.

Topics: Anti-Bacterial Agents; Cross Infection; Hospitals, Teaching; Humans; Infection Control; Infectious Disease Transmission, Professional-to-Patient; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Taiwan

Mupirocin and amoxicillin-clavulanate were synergistic against 9 of 49 (18%) strains of methicillin-resistant and methicillin-susceptible Staphylococcus aureus and coagulase-negative staphylococci (CNS). A pattern of enhanced killing was also found using time-kill studies. Time-kill assays were more discriminatory than chequerboard titration assays in demonstrating synergy. These results suggest that combinations of amoxicillin-clavulanate and mupirocin may have therapeutic benefits in prophylaxis against staphylococcal infections.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Coagulase; Drug Synergism; Drug Therapy, Combination; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus

A multicentre surveillance study comprising 26 laboratories located in Austria, Germany, and Switzerland was carried out in November 2001. A total of 787 isolates of Staphylococcus aureus and 456 isolates of Staphylococcus epidermidis mainly recovered from hospitalised patients, were tested. MICs for mupirocin were determined using the broth microdilution procedure. Breakpoints were < or = 4 mg/l (susceptible), 8-256 mg/l (low-level resistance) and > or = 512 mg/l (high-level resistance). Rates of low- and high-level resistances were 2.9 and 0.9% in S. aureus, and 9.4 and 3.3% in S. epidermidis, respectively. Mupirocin resistance was almost exclusively observed in oxacillin-resistant isolates of S. aureus (MRSA) and S. epidermidis (MRSE). High-level mupirocin resistance was detected in 3.1 and 4.5% of MRSA and MRSE, respectively.

Topics: Anti-Bacterial Agents; Austria; Drug Resistance, Bacterial; Germany; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Oxacillin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Switzerland

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Cardiovascular Surgical Procedures; Female; Hospitals, Teaching; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Risk Factors; Sentinel Surveillance; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Turkey

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cross Infection; Hospitals; Humans; Infection Control; Methicillin Resistance; Middle Aged; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; United States

We sought to investigate the anti-staphylococcal activity of indolmycin, with particular emphasis on comparing its activity with fusidic acid and mupirocin.. Established procedures were used to examine the activity of indolmycin against a range of clinical isolates, including strains resistant to fusidic acid and mupirocin. Indolmycin-resistant mutants were recovered and characterized phenotypically and genotypically.. Indolmycin was bacteriostatic and demonstrated good activity against MSSA (methicillin-susceptible Staphylococcus aureus), MRSA (methicillin-resistant S. aureus) and VISA (vancomycin-intermediate S. aureus), including strains resistant to mupirocin or fusidic acid. Spontaneous indolmycin-resistant mutants occurred at a lower frequency than those selected by mupirocin or fusidic acid and exhibited no cross-resistance with the comparative drugs. High-level resistance (indolmycin MIC 128 mg/L) that was associated with an H43N mutation in tryptophanyl-tRNA synthetase (TrpS), the target enzyme of indolmycin, resulted in loss of bacterial fitness. However, the locus responsible for low-level indolmycin resistance (indolmycin MICs 8-32 mg/L) was not identified.. Indolmycin is a potent anti-staphylococcal agent, which exhibits activity against mupirocin- and fusidic acid-resistant strains. Indolmycin might be a candidate for development as a topical agent in the treatment of staphylococcal infections and nasal carriage of MRSA.

Topics: Anti-Infective Agents, Local; Drug Resistance, Bacterial; Fusidic Acid; Geobacillus stearothermophilus; Indoles; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Tryptophan-tRNA Ligase

A total of 1,346 Staphylococcus aureus (SA) and 498 coagulase-negative staphylococcal (CoNS) strains isolated from 11 Latin American medical centers between 2000 and 2001 were tested against mupirocin and other antimicrobial agents by reference broth microdilution method as part of the SENTRY Antimicrobial Surveillance Program. Oxacillin resistance (OR) was detected in 38.6% of S. aureus and in 78.1% of CoNS. The overall resistance rate to mupirocin was low among S. aureus (3.1%; MIC > or =8 microd/ml) but significantly higher among ORSA compared to oxacillin-susceptible SA (5.4% versus 1.7%; p <0.001). Mupirocin-resistant S. aureus strains were detected in 9 of 11 centers, with individual center rates varying between 1.8 and 15.7%. Mupirocin resistance rates were high among CoNS (27.5%) and varied widely (10.0 to 48.9%) among the monitored Latin American medical centers. Mupirocin resistance rates appear to be increasing and routine monitoring for potential resistance seems prudent.

Topics: Academic Medical Centers; Anti-Bacterial Agents; Chi-Square Distribution; Drug Resistance, Bacterial; Humans; Latin America; Microbial Sensitivity Tests; Mupirocin; Prevalence; Probability; Sampling Studies; Staphylococcal Infections; Staphylococcus aureus

We performed a prospective study of Staphylococcus aureus nasal carriage in patients on chronic haemodialysis to determine the role of cutaneous colonization in the aetiology of recurrent nasal colonization. From February 2000 to September 2001, 71 patients on chronic haemodialysis in the dialysis unit at a university hospital were screened monthly for S. aureus nasal carriage. Carriers received nasal mupirocin for five days and were tested for nasal and cutaneous carriage two days later and monthly thereafter. Using genotyping results, recurrence was defined as relapse if pretreatment and subsequent nasal isolates were clonally identical; if the isolates were different, it was considered recolonization. Thirty-nine patients (55%) were nasal carriers: 11 initially and 28 during follow-up. Among the mupirocin-treated patients, the eradication of S. aureus nasal carriage rate was 88.5%. Nasal recurrence was documented in 17 patients (43.5%), and S. aureus nasal strains were available for molecular typing in 14 patients with a total of 23 recurrence episodes. On the basis of pulsed-field gel electrophoresis analysis, 16 (70%) recurrence episodes were considered relapses and seven were considered (30%) recolonizations. Among the episodes of relapse, prior cutaneous colonization was detected in only three cases. In haemodialysis patients, the majority of nasal carriage recurrences after mupirocin therapy were due to relapses. Cutaneous colonization does not appear to be relevant in the development of these relapses.

Topics: Anti-Bacterial Agents; Carrier State; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mupirocin; Nose Diseases; Recurrence; Renal Dialysis; Skin Diseases; Spain; Staphylococcal Infections

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Mupirocin; Ointments; Orthopedic Procedures; Preoperative Care; Staphylococcal Infections; Surgical Wound Infection

The purpose of this study (the third in a series of similar studies) is to evaluate the prevalence of Staphylococcus aureus (SA), methicillin-resistant SA (MRSA) and mupirocin-resistant SA (MuRSA) carriers in a peritoneal dialysis centre where patients have been instructed to use prophylactic mupirocin ointment at the catheter exit site over the last 7 years.. Swabs were taken from catheter exit site, nares, axillae and groin in 147 chronic peritoneal dialysis out-patients between November 2003 and January 2004. Axillae/groin and nasal samples were pooled and cultured in the same medium, whereas exit site swabs were cultured separately. All SA isolated were tested for methicillin and mupirocin resistance using oxacillin screening plates and E-test strips.. Sixteen of 147 patients (10.9%) were found to be SA carriers: of these 13 (8.8%) had a positive nasal/axillae/groin culture; two (1.4%) had both nasal/axillae/groin- and exit site-positive culture; and one (0.7%) had only exit site-positive culture. In these 16 SA carriers, we found mupirocin-resistant strains (MuRSA) in four patients (25%) and MRSA in two patients (12.5%). Among the four MuRSA carriers, one had both nasal/axillae/groin- and exit site-positive culture and three had only nasal/axillae/groin-positive culture. Three high-level resistance and one low-level resistance MuRSA carriers were isolated. One MuRSA strain was also methicillin resistant. All MRSA strains were sensitive to vancomycin and rifampicin.. After 7 years' routine use of prophylactic mupirocin ointment at the catheter exit site in non-selected chronic peritoneal dialysis patients, MuRSA was found in 25% of SA strains isolated or in 2.7% of the patients. Compared with our previous study, 3 years earlier, there is no significant increase in the MuRSA prevalence in peritoneal dialysis patients who routinely apply mupirocin ointment at the catheter exit site.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Catheters, Indwelling; Drug Resistance, Bacterial; Female; Follow-Up Studies; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Peritoneal Dialysis; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Time Factors

Topics: Anti-Bacterial Agents; Humans; Impetigo; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Sweden

We report a patient who underwent implantation of a DeBakey left-ventricular assist device and developed a methicillin-resistant Staphylococcus aureus drive line infection on postoperative day 304. The patient was forwarded to urgent heart transplantation with a successful outcome.

Topics: Adolescent; Azathioprine; Cardiomyopathy, Dilated; Cyclosporine; Equipment Contamination; Heart Transplantation; Heart-Assist Devices; Humans; Immunosuppressive Agents; Male; Methicillin Resistance; Methylprednisolone; Mupirocin; Patient Isolation; Postoperative Complications; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Nasal carriage is an important reservoir of oxacillin-resistant Staphylococcus aureus (ORSA). Mupirocin is a topical drug used to remove S. aureus from nares. However, isolates resistant to mupirocin have been reported all over the world. Silver sulphadiazine (SSD) is a topical agent, which when associated with cerium nitrate (CN), has been shown to be useful in the treatment of burn infections and could be an alternative drug for patient decolonization. Susceptibility to oxacillin in 203 S. aureus isolates was evaluated by the agar diffusion test, while the agar diffusion and agar dilution methods were used for mupirocin. A PCR-multiplex method was performed to detect the mecA and ileS-2 genes. Minimum inhibitory concentration (MICs) to SSD and CN, used alone or in association, were determined by the agar dilution method. One hundred and sixty-three (80.3%) strains were oxacillin-resistant, and 37 (18.2%) were mupirocin resistant. The MIC of SSD alone or in association with CN was 64 microg/mL, while for CN alone was 2048 microg/mL for all isolates. SSD presented anti-staphylococcal activity at concentrations (64 microg/mL) much lower than those commonly used in commercial preparations (10 mg/g) and had good activity against mupirocin-resistant strains, showing that this drug could be used for nasal decolonization in ORSA carries.

Topics: Anti-Infective Agents, Local; Bacterial Proteins; Brazil; Cerium; Cross Infection; DNA Primers; DNA, Bacterial; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Mupirocin; Oxacillin; Penicillin-Binding Proteins; Polymerase Chain Reaction; Silver Sulfadiazine; Staphylococcal Infections; Staphylococcus aureus

Occurrence of high-level mupirocin resistant coagulase-negative staphylococci in 5 hospitals in the region of Gdansk was determined. The study was carried out on 192 staphylococcal strains isolated from patients and medical staff. The mupirocin resistant strains were detected by 5 microgram mupirocin disc. The minimal inhibitory concentration (MIC) for mupirocin was estimated by E-tests. The mupirocin resistant strains were characterised by antibiotic sensitivity, including MIC for glycopeptides and oxacillin. Biotypes of resistant strains were also determined. Eight high-level mupirocin resistant strains (4.7%) were found. Only one strain expressed low-level resistance. All but one of high-level mupirocin resistant strains were resistant to methicillin. Six of them belonged to the S. epidermidis species but differences in the biotypes and antibiotic resistance patterns of these strains suggest they did not have a common origin.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Drug Resistance, Multiple, Bacterial; Humans; Incidence; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Poland; Staphylococcal Infections; Staphylococcus; Staphylococcus epidermidis

Recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection in a patient with diabetes and in his wife is described. Culture of nares samples from the family dog grew mupirocin-resistant (minimum inhibitory concentration >1024 microg/mL) MRSA that had a pulsed-field gel electrophoresis chromosomal pattern identical to the MRSA isolated from the patient's nares and his wife's wound. Further recurrence of MRSA infection and nasal colonization in the couple was prevented only after successful eradication of MRSA from the family dog's nares.

Topics: Animals; Animals, Domestic; Anti-Bacterial Agents; Carrier State; Dogs; Family Characteristics; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nasal Cavity; Staphylococcal Infections; Staphylococcus aureus

Infections with Staphylococcus aureus are a significant problem in patients in liver transplant units. An association between prior nasal carriage with and subsequent infections has been documented previously in liver transplant recipients and patients with cirrhosis. However, the role of decolonization with mupirocin applied intranasally for the prevention of S. aureus infections in these patients has not been determined.. S. aureus nasal carriage was prospectively sought in 70 consecutive liver transplant candidates. Mupirocin two times per day for 5 days was administered to the carriers. Follow-up nasal cultures to document decolonization were performed 5 days after the final application of mupirocin. The primary endpoint was the development of S. aureus infections.. Thirty-one of 70 patients (44%) were found to be nasal carriers and 27 of 31 nasal carriers (87%) were successfully decolonized. However, 12 of 27 patients (37%) successfully decolonized became recolonized with S. aureus, and an additional nine patients who were initially noncarriers became newly colonized with S. aureus during the study period. Despite the use of mupirocin, 16 of 70 patients (23%) developed an infection with S. aureus. No isolate was found to be mupirocin resistant.. Elimination of S. aureus nasal carriage by mupirocin did not prevent S. aureus infections in patients in our liver transplant unit.

Topics: Adult; Aged; Anti-Bacterial Agents; Carrier State; Female; Humans; Liver Transplantation; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus (SA) isolates (n = 255) from outpatients with skin and soft-tissue infections were collected in 3 different areas in Norway. Group A streptococci (GAS, n = 68) were isolated from skin or pharyngotonsillar specimens from outpatients. Minimum inhibitory concentrations (MIC) of bacitracin, fusidic acid and mupirocin were tested using the E-test. Pulsed field gel electrophoresis (PFGE) patterns of fusidic acid-sensitive (FusS) and -resistant (FusR) SA were compared. All GAS isolates showed MIC of bacitracin of < or = 1.0 mg/l, of mupirocin of < or = 0.125 mg/l and of fusidic acid 1.0-4.0 mg/l. All the SA showed MIC of mupirocin < or = 0.5 mg/l and of bacitracin of > or = 2.0 mg/l, 91% with MIC > or = 16 mg/l. FusR was shown by 32.5% of the SA strains with similar prevalence rates in 3 different geographical areas of Norway. One particular PFGE pattern (type 1) was shown by 76% of the FusR SA. SA of type 1 belonged to phage group II and produced exfoliative toxins. Thus, the results demonstrated a high prevalence of FusR among SA causing skin infections and that this was mainly due to dissemination of clonally related FusR SA.

Topics: Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Bacitracin; Child; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Fusidic Acid; Genes, Bacterial; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Probability; Sensitivity and Specificity; Skin Diseases, Bacterial; Soft Tissue Infections; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes

The extent of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MRSA) in countries using mupirocin only for the eradication of nasal carriage of MRSA is unknown.. During 1997, 1998, 1999, 2000, and 2001, 1368 strains of MRSA were isolated from 15 general hospitals in the Tohoku area of Japan and tested for susceptibility to mupirocin.. The isolation of low-level mupirocin resistance was 0.8% in 1997, 1.1% in 1998, 0.7% in 1999, 4.0% in 2000, and 2.4% in 2001. For the first 3 years it was about 1%. However, the isolation rate of low-level mupirocin resistance in MRSA increased dramatically in 2000. High-level mupirocin resistance was not detected during these years.. Most patients from whom low-level mupirocin resistant MRSA were found in 2000 and 2001 had previously received mupirocin treatment for eradicating nasal carriage of MRSA, and these strains were isolated from sputum or the pharynx. This result indicates that mupirocin treatment is likely to be one of the causes of mupirocin resistance and, therefore, the development of low-level mupirocin resistance in MRSA isolated from sputum or the pharynx should be considered when using mupirocin in order to improve the control of the spread of MRSA in hospitals.

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance, Multiple, Bacterial; Hospitals, General; Humans; Japan; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Nasal Cavity; Pharynx; Population Surveillance; Sputum; Staphylococcal Infections; Staphylococcus aureus; Suppuration; Urine

Interpretation of the mupirocin E-test for low-level mupirocin-resistant Staphylococcus aureus strains has been improved by adding the indicator dye tetrazolium. E-tests were compared with agar dilution methods for assessing mupirocin susceptibility. MICs obtained by the agar dilution method and E-tests showed 89.3% agreement within 2 log(2) dilution criteria. The agreement between MICs increased to 100% in the 1 log(2) dilution definition when the indicator dye tetrazolium was added to the E-test. The use of the E-test with tetrazolium reduction is more accurate for determining mupirocin MICs for S. aureus strains.

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance, Bacterial; Humans; Indicators and Reagents; Microbial Sensitivity Tests; Mupirocin; Nitroblue Tetrazolium; Observer Variation; Reproducibility of Results; Staphylococcal Infections; Staphylococcus aureus

Topics: Aged; Carrier State; Drug Resistance, Multiple, Bacterial; Glycopeptides; Humans; Intensive Care Units; Male; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Respiratory Insufficiency; Sensitivity and Specificity; Severity of Illness Index; Staphylococcal Infections; Staphylococcus aureus

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).. Prospective evaluation in which patients colonized with MRSA were treated twice daily with 2% topical mupirocin ointment for 5 days.. James H. Quillen Veterans' Affairs Medical Center.. Forty hospitalized patients with two anterior nares cultures positive for MRSA within a 7-day period.. 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.. 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 HLMR 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.. 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.

Topics: Administration, Topical; Anti-Bacterial Agents; Drug Resistance; Hospitals, Veterans; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Nasal Cavity; Staphylococcal Infections; Staphylococcus aureus; Tennessee

Two hospital staff, women aged 20 and 22 years, were inadvertently found to be positive for methicillin-resistant Staphylococcus aureus (MRSA). Both had been in a hospital outside of the Netherlands, but due to the long period of time that had elapsed since then, they did not fall under the standard protocol for MRSA screening. After the usual wash procedure with chlorhexidine and mupirocin nasal ointment treatment, they remained positive for MRSA in the throat culture. Both patients still had their pharyngeal tonsils and were suffering from throat complaints. After systemic treatment with two antibiotics, they both became MRSA-free. Throat carriership of MRSA might be a reason why MRSA eradication fails in the case of apparently healthy healthcare workers. The addition of a throat culture to the screening of healthcare workers would therefore be useful.

Topics: Administration, Intranasal; Adult; Carrier State; Chlorhexidine; Cross Infection; Female; Humans; Infectious Disease Transmission, Professional-to-Patient; Methicillin Resistance; Mupirocin; Nasopharynx; Netherlands; Staphylococcal Infections; Staphylococcus aureus; Treatment Failure

We describe a case of toxic epidermal necrolysis after intranasal application of mupirocin in a 76-year-old woman. The drug was given for eradication of methicillin-resistant Staphylococcus aureus.

Topics: Administration, Intranasal; Aged; Anti-Bacterial Agents; Fatal Outcome; Female; Humans; Methicillin Resistance; Mupirocin; Nose; Staphylococcal Infections; Stevens-Johnson Syndrome

We have examined whether topical perioperative prophylaxis can reduce the incidence of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections (SSIs). Using a controlled before and after approach on patients from four orthopaedic wards, undergoing orthopaedic surgery involving insertion of metal prostheses and/or fixation, received perioperative prophylaxis with nasal mupirocin for five days, and a shower or bath with 2% (v/v) triclosan before surgery (PPNMT). After introduction of PPNMT there was a marked decrease in incidence of MRSA SSIs (per 1000 operations) from 23 in the six months beforehand (period A) to 3.3 (P<0.001) and 4 (P<0.001) in subsequent consecutive six-month periods (B and C, respectively). Of 11 MRSA SSI cases that occurred during periods B and C, only one had actually received PPNMT, and 10 occurred after acute, as opposed to elective, surgery (P<0.001). Point prevalence nasal MRSA carriage decreased from 38% before PPNMT to 23% immediately after, and 20%, 7%, 10% and 8% (P<0.001) at six-monthly intervals post-intervention. Conversely, the prevalence of nasal MRSA carriage in a control elderly medicine ward did not change significantly. Vancomycin usage, in terms of defined daily doses, declined by 23%. Low-level mupirocin resistance was found in 2.3% of S. aureus isolates from orthopaedic patients before PPNMT, and in 3.9%, 6.1%, 10% and 0% in subsequent six month periods. No S. aureus isolates with high-level mupirocin resistance were found. PPNMT can reduce the incidence of MRSA SSls after orthopaedic surgery, probably by reducing nasal MRSA carriage in the endemic setting, without selecting for mupirocin resistance.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Arthroplasty, Replacement; Baths; Carrier State; Fracture Fixation; Humans; Methicillin Resistance; Mupirocin; Orthopedic Procedures; Perioperative Care; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Triclosan

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization occurred from November 2001 in the neonatal intensive care unit (NICU) of our hospital. Since the establishment of our NICU in 1991, some MRSA has been detected in NICU patients. For MRSA infection preventive measures, utilization of the following items was implemented: mupirocin ointment, diluted povidone iodine, methylrosaniline chloride, and disposable rubber gloves. Patients in whom MRSA was detected received intranasal administration of the mupirocin ointment three times daily and were bathed in, or their entire body was wiped with diluted povidone iodine once daily for the first 3 days in each week. In addition, they received an intraoral application of methylrosaniline chloride daily. All therapy was done until MRSA strains were undetectable for 3 continuous weeks. Genotypes of 13 MRSA strains isolated from eight inpatients and one mother were analyzed by pulsed-field gel electrophoresis (PFGE). All PFGE patterns were identical, except for one, which had one distinct migrating fragment. These data suggested that this MRSA outbreak was caused by the same strain, which was derived from the mother of a low-birth-weight infant born on October 30, 2001. Gradually, the number of inpatients carrying MRSA decreased, until finally MRSA was no longer observed, in April 2002. Fortunately, we controlled the MRSA outbreak immediately, and none of the inpatients developed severe MRSA infection. We think that in our NICU, which is isolated from other hospital wards, it is important to prevent the entrance of MRSA-carrying mothers.

Topics: Cross Infection; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Female; Gentian Violet; Gloves, Protective; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Japan; Male; Methicillin Resistance; Mupirocin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Nosocomial and surgical-site infections are significant burdens to the health care system that account for $5 billion and $1.6 billion each year in the United States, respectively. These infections are associated with significant morbidity and mortality rates, increased length of hospitalization, and increased treatment costs that are often not reimbursed by third-party payers. Approximately 40% of sternal wound infections in cardiac surgery patients are caused by Staphylococcus aureus and the prevalence of methicillin-resistant S aureus (MRSA) has risen dramatically in the past 2 to 3 decades. The economic burden that is associated with MRSA is significant; infections caused by MRSA cost approximately $3700 more to treat than infections caused by methicillin-sensitive S aureus, and the death rate for MRSA infection is nearly 3 times that of methicillin-sensitive S aureus. Thus, interventions to prevent nosocomial infection in patients who undergo cardiac surgery may improve outcomes and decrease costs. Advances in diagnostic testing may help to target intranasal antibiotic therapy to those patients who are most likely to receive a benefit. The LightCycler System is a fast and effective polymerase chain reaction-based diagnostic test that may be used to identify patients with nasal colonization of S aureus. Carrier status can be determined in a matter of hours rather than days as is the case with traditional culture techniques.

Topics: Carrier State; Cost-Benefit Analysis; Humans; Mupirocin; Polymerase Chain Reaction; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Sternum; Surgical Wound Infection

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

The E test and broth microdilution showed comparable accuracy for the susceptibility testing of methicillin-resistant S. aureus (MRSA). All of the 109 primary clinical MRSA isolates were fully susceptible to the glycopeptides vancomycin and teicoplanin, the oxazolidinone linezolid, and the streptogramin quinupristin-dalfopristin. Nine out of the 109 MRSA isolates (8.3 percent) demonstrated resistance to moxifloxacin and 5 out of the 109 strains (4.6 percent) were resistant to the topical agent mupirocin. Linezolid and quinupristin-dalfopristin may prove useful alternatives for the treatment of patients with MRSA infections. MRSA isolates should be screened for in vitro susceptibility against mupirocin prior to the topical application.

Topics: Acetamides; Anti-Bacterial Agents; Aza Compounds; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Linezolid; Methicillin Resistance; Microbial Sensitivity Tests; Moxifloxacin; Mupirocin; Oxazolidinones; Quinolines; Staphylococcal Infections; Staphylococcus aureus; Teicoplanin; Vancomycin; Virginiamycin

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Drug Resistance, Bacterial; Humans; Mupirocin; Nose; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Humans; Mupirocin; Selection Bias; Staphylococcal Infections; Staphylococcus aureus; Statistics, Nonparametric; Surgical Wound Infection

The objective of this study was to assess the efficacy and safety of a short course of oral vancomycin and intranasal mupirocin ointment in the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization. During an outbreak of MRSA, the colonized subjects received oral vancomycin and topical mupirocin. They were screened for MRSA 1, 3, 6 and 12 months after decolonization. A questionnaire was developed to evaluate the side-effects of oral vancomycin. Thirty-five subjects were treated. Clearance was achieved in all cases, in 24 (69%) subjects after one course of therapy. Twenty-eight (80%) subjects experienced some side-effects, including six (17%) who did not tolerate oral vancomycin. Although oral vancomycin, in combination with topical mupirocin, is effective in the elimination of MRSA colonization, there is a need for further studies to confirm our results and to evaluate the safety of oral vancomycin.

Topics: Administration, Oral; Administration, Topical; beta-Lactam Resistance; Drug Evaluation; Humans; Methicillin Resistance; Mupirocin; Ointments; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin

The purpose of this study was to determine the effectiveness of mupirocin and polymyxin B, alone and in combination, in vitro and in vivo using rabbit models of, and keratitis.. Rabbit eyes were intrastromally injected with 1,000 colony-forming units (CFUs) of or or 100 CFUs of Rabbits were then treated with 2.7 mg/mL mupirocin, 10,000 U/mL polymyxin B, a mupirocin:polymyxin B combination, or 0.3% ciprofloxacin. Vehicle and untreated controls were also included. Treatment schedules depended on the strain injected. The number of CFUs was determined for all eyes after treatment.. The mupirocin:polymyxin B combination was effective for all three genera both in vitro and in vivo. For keratitis, the mupirocin:polymyxin B combination was more effective than either drug alone and significantly reduced the log number of bacteria in the cornea by more than 3 logs compared with the vehicle or untreated controls (p

Topics: Animals; Anti-Bacterial Agents; Colony Count, Microbial; Cornea; Disease Models, Animal; Drug Therapy, Combination; Eye Infections, Bacterial; Keratitis; Microbial Sensitivity Tests; Mupirocin; Ophthalmic Solutions; Polymyxin B; Pseudomonas aeruginosa; Pseudomonas Infections; Rabbits; Serratia Infections; Serratia marcescens; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

In an attempt to reduce sternal infections caused by Staphylococcus aureus, a protocol was introduced that included the administration of intranasal mupirocin calcium 2% before surgery to patients undergoing cardiothoracic surgery. Surveillance data indicated a 55% reduction in the rate of deep sternal wound infections caused by S aureus and superficial sternal wound infections have declined from 25 to 6 since the adoption of the protocol. At the study institution, this protocol is now an ongoing process to reduce the incidence of sternal infections caused by S aureus among cardiothoracic patients.

Topics: Administration, Intranasal; Clinical Protocols; Coronary Artery Bypass; Humans; Incidence; Infection Control; Mupirocin; Quality Assurance, Health Care; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Humans; Mupirocin; Staphylococcal Infections; Surgical Wound Infection

Mupirocin (Mup) has been used extensively to prevent Staphylococcus aureus (SAu) infections in patients undergoing peritoneal dialysis (PD). Resistance to Mup has been reported, but its relevance after long-term use of this drug in PD is unknown. Colonization by SAu was treated with topic Mup in our unit between September 1990 and December 2000. Sensitivity to Mup was tested in 437 strains of SAu isolated from 155 PD patients and 62 dialysis partners. Resistance to Mup was classified as low (minimal inhibitory concentration [MIC] > or = 8 microg/mL) or high (MIC > or = 512 microg/mL) degree. MIC90 was 0.125 microg/mL in 1990 to 1996 (5% low, 0% high-degree resistance), 64 microg/mL in 1997 to 1998 (6.6% low, 8.3% high-degree resistance), and 1,024 microg/mL in 1999 to 2000 (2.3% low, 12.4% high-degree resistance). Mup-resistant SAu were isolated from 25 patients and 13 partners a median of 15 months after starting PD. Resistance was associated frequently with repeated treatments of SAu recolonization, but was detected in 3 cases at the start of PD therapy. The accumulated incidence of SAu exit-site infection in the period 1997 to 2000 was 32.3% in patients colonized by Mup-resistant SAu as compared with 14.5% in those colonized by Mup-sensitive SAu (P = 0.03). Mup-resistant SAu have emerged in a significant proportion of our PD patients and dialysis partners. This emergence has resulted in a moderate, but significant, increase in the risk of SAu exit-site infection and raises concerns about the future of Mup as the therapy of choice for SAu colonization in patients undergoing chronic PD.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Mupirocin; Nose; Peritoneal Dialysis; Peritonitis; Staphylococcal Infections; Staphylococcus aureus

Patient-to-patient transmission of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs) has been well described. We report the first documented outbreak of probable transmission of MRSA from a mother to 3 of her preterm quadruplet infants postnatally.. Routine surveillance of clinical microbiologic laboratory reports revealed an increased incidence of MRSA infections in our NICU, including 3 of 4 preterm quadruplets. Surveillance cultures of the anterior nares of all patients and the quadruplets' parents were performed to detect MRSA carriage. The isolates were typed by pulsed-field gel electrophoresis with the restriction endonuclease SmaI. Infection control strategies included mupirocin treatment and contact isolation precautions for infected/colonized infants.. Clinical cultures from infants A, C, and D and surveillance cultures of the quadruplets' mother and 2 additional unrelated infants grew the same clone of MRSA. The mother's only identified risk factors for MRSA acquisition were 2 prepartum hospitalizations related to the multiple gestation and previous treatment with antibiotics. All anterior nares cultures were negative for MRSA after mupirocin treatment.. Use of gowns and gloves by the family members of women with multiple gestations should be recommended to prevent transmission of potential pathogens in the NICU.

Topics: Adult; Amino Acid Sequence; Carrier State; Cross Infection; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Infection Control; Intensive Care Units, Neonatal; Methicillin Resistance; Mupirocin; Pregnancy; Pregnancy Complications; Quadruplets; Staphylococcal Infections; Staphylococcus aureus

Staphylococci cause one-third of all serious invasive infections in the SENTRY Antimicrobial Surveillance Program including bacteremias and lower respiratory tract infections. Staphylococci are also commensals of the skin and nasal passages; therefore, topical agents active against these organisms are valuable in preventing infections or transfer of the organisms between patients and/or health care workers. Mupirocin is a potent topical anti-staphylococcal compound, but its effectiveness has been compromised by emerging resistance. In early 2000, the SENTRY Program detected 302 mupirocin-resistant isolates (131 Staphylococcus aureus, and 171 coagulase-negative staphylococci [CoNS]) from the United States (19/25 medical centers), Canada (4/5), Latin America (3/9) and Europe (7/18). One hundred sixty-eight mupirocin-resistant and 59 susceptible isolates were tested further by reference MIC, Etest (AB BIODISK, Solna, Sweden) and disk diffusion (5-microg) methods. Mupirocin resistance rates for blood stream infections varied by geographic area: for S. aureus from 1.9 to 5.6%, and for CoNS from 12.8 to 39.9%. Using elevated mupirocin MIC results, two resistant populations were noted: low-level resistance at 8-128 microg/mL and high-level resistance at > or = 1024 microg/mL. Acceptable correlation was observed between Etest and disk diffusion results (r = 0.84) without serious intermethod interpretive errors. High-level resistant isolates had heavy growth with no visible zone around the disk; low-level resistant isolates produced hazy zones of inhibition, and susceptible strains had clear zones of inhibition at > or = 17 mm. As mupirocin resistance can be plasmid-mediated, the prudent and appropriate use of this topical agent is important to minimize the ongoing development of resistance. Local surveillance for emerging mupirocin resistance appears warranted particularly in the United States and Canada, pragmatically using a disk diffusion test screening. Where more precise data are needed, the Etest is a very accurate method for distinguishing mupirocin low-level from high-level resistance patterns.

Topics: Anti-Bacterial Agents; Canada; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Europe; Humans; Latin America; Microbial Sensitivity Tests; Mupirocin; Population Surveillance; Ribotyping; Staphylococcal Infections; Staphylococcus aureus; United States

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Drug Resistance, Bacterial; Humans; Mupirocin; Nose; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

A total of 1785 Staphylococcus aureus clinical isolates were collected in our hospital during 1998 (526), 1999 (564) and 2000 (695). Among them, one hundred and thirty (39, 33 and 58, respectively) were phenotypically assigned as methicillin-resistant Staphylococcus aureus (MRSA); sixteen of these isolates (3, 2 and 11, respectively) were detected as highly mupirocin-methicillin resistant Staphylococcus aureus (MMRSA). In this work, our goal was to characterize MRSA and MMRSA clinical isolates by co-application of phenotypic and genotypic methods in order to determine the MMRSA incidence in our hospital during the period 1998-2000. With this purpose we compared and integrated the results obtained using conventional microbiology methods with those obtained using a multiplex polymerase chain reaction (PCR) assay. Our results showed a good complementation between these two approximations to determine the incidence of MMRSA clinical isolates and permitted to estimate that such incidence increased from 7.7% in 1998 to 19% in 2000.

Topics: Bacterial Proteins; Carrier Proteins; Genetic Markers; Genotype; Hexosyltransferases; Hospitals; Humans; Methicillin Resistance; Mupirocin; Muramoylpentapeptide Carboxypeptidase; Penicillin-Binding Proteins; Peptidyl Transferases; Phenotype; Polymerase Chain Reaction; Spain; Staphylococcal Infections; Staphylococcus aureus

The objective of this study was to investigate the state of mupirocin resistance in methicillin-resistant Staphylococcus aureus (MRSA) in a community hospital in Japan. Ninety strains of MRSA were isolated from the respiratory tract of 56 patients (group I, Jun 1990-Aug 1996) before introduction of mupirocin in Japan, which were compared with 168 strains from 48 patients (group II, Sept 1996-Jan 1998) and 146 strains from 85 patients (group III, Feb 1999-Dec 1999) isolated after introduction of mupirocin. Comparisons were made by determining the minimum inhibitory concentrations (MIC) against nine antibiotics. Fifty-five MRSA isolates from 27 patients [13 (27.1%) of 48 in group II and 14 (16.5%) of 85 in group III] after introduction of mupirocin showed low-level resistance to mupirocin (MIC, 6.25 to 50 microg/ml) but the remaining isolates were sensitive to mupirocin (MIC < or =3.13 microg/ml). Most patients colonized with low-level mupirocin-resistant MRSA were elderly (> or =65 years of age), on total parenteral nutrition or nasal feeding and had other underlying diseases. The proportion of patients colonized with low-level mupirocin-resistant MRSA following repeated use of mupirocin was higher in patients of group II than those of group III. Molecular typing by pulsed-field gel electrophoresis (PFGE) demonstrated that the pattern of 13 MRSA isolates from 13 patients of group II consisted of three patterns (A, B, C) with predominance of pattern A, while the pattern of 13 MRSA isolates from 13 patients of group III consisted of three patterns (A, C, D) with predominance of patterns A and D. Our results indicated that resistance of MRSA to mupirocin remains at a low level at present in Japan. However, we should be aware of the possible emergence of MRSA highly resistant to mupirocin in the future.

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance, Microbial; Electrophoresis, Gel, Pulsed-Field; Hospitals, Community; Humans; Japan; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

A total of 128 MRSA isolates from a burns unit in 1992 and 1997 was studied by resistotyping, plasmid analysis and pulsed-field gel electrophoresis (PFGE) of SmaI-digested chromosomal DNA to ascertain whether a clone of MRSA had persisted in the unit or whether different clones had been introduced at different times. All the MRSA isolates produced beta-lactamase and had high MICs to methicillin (>256 mg/L). All were resistant to tetracycline, kanamycin, cadmium acetate and mercuric chloride. Most were resistant to gentamicin, neomycin, erythromycin, chloramphenicol, trimethoprim, ciprofloxacin, propamidine isethionate and ethidium bromide, and were susceptible to minocycline, vancomycin and teicoplanin. None of the 1992 isolates was resistant to mupirocin, but 56% and 19% of the 1997 isolates expressed high- and low-level mupirocin resistance, respectively. Many of the 1997 isolates had acquired a 38-kb plasmid encoding high-level mupirocin resistance. The 1992 isolates had two main PFGE patterns; 82% of them belonged to PFGE pattern 1. The 1997 isolates had PFGE pattern 1, the same as the majority of the 1992 isolates. All MRSA isolates from both years carried the mecA gene in the same SmaI fragment. These findings demonstrated that a clone of MRSA that was prevalentin the burns unit in 1992 had persisted and became the predominant clone in 1997.

Topics: beta-Lactamases; Burn Units; DNA, Bacterial; Drug Resistance, Microbial; Drug Resistance, Multiple; Electrophoresis, Gel, Pulsed-Field; Genes, Bacterial; Humans; Kuwait; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Plasmids; Staphylococcal Infections; Staphylococcus aureus

A rat model was used to investigate the efficacy of mupirocin in the prevention of vascular prosthetic graft infections. The effect of mupirocin-soaked Dacron was compared with the effect of rifampin-soaked, collagen-sealed Dacron in the rat model of graft infection caused by methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus. Graft infections were established in the back subcutaneous tissue of 195 adult male Wistar rats by implantation of 1-cm(2) Dacron prostheses followed by topical inoculation with 5 x 10(7) colony-forming units of S. aureus. The study included a control group (no graft contamination), two contaminated groups that did not receive any antibiotic prophylaxis, two contaminated groups in which perioperative intraperitoneal amoxicillin clavulanate prophylaxis (50 mg/kg) was administered, four contaminated groups that received mupirocin- or rifampin-soaked graft, and four contaminated groups that received mupirocin- or rifampin-soaked graft and perioperative intraperitoneal amoxicillin clavulanate prophylaxis (50 mg/kg). The grafts were sterilely removed 7 days after implantation and the infection was evaluated by using sonication and quantitative agar culture. Data analysis showed that the efficacy of mupirocin against both strains was significantly different from that of the untreated control. In addition, mupirocin was more effective than rifampin against the methicillin-resistant strain. Finally, only the combination of mupirocin and amoxicillin clavulanate produced complete suppression of growth of all strains.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Blood Vessel Prosthesis; Collagen; Drug Therapy, Combination; Male; Methicillin Resistance; Mupirocin; Polyethylene Terephthalates; Rats; Rats, Wistar; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Clinical strains of methicillin-resistant Staphylococcus aureus (MRSA) expressing high- and low-level mupirocin resistance were studied to determine the genetic location of mupirocin and other resistance determinants. Mupirocin resistance was confirmed by MIC determination with E-test strips. Curing and transfer experiments were used to establish the genetic location of the resistance determinants and the PCR with mupA-specific primers was used to detect the presence of mupA genes. High-level mupirocin-resistant isolates had MICs >1024 mg/L, whereas the low-level resistant isolates had MICs of 32-128 mg/L. The isolates carried plasmids ranging from 2.8 to 38 kb in size. All of them carried 26- and 3.0-kb plasmids, but only the high-level mupirocin-resistant isolates carried a 38-kb plasmid. Curing and transfer experiments revealed that the 26-kb plasmid encoded resistance to cadmium, mercuric chloride, propamidine isethionate and ethidium bromide and the 38-kb plasmid was a conjugative plasmid encoding high-level mupirocin resistance. One isolate, IBN287, carried both plasmid-borne high-level and chromosomal low-level mupirocin resistance. The mupA gene was detected on the 38-kb plasmid DNA but not in the genomic DNA of the low-level mupirocin-resistant isolates. The genomic DNA of strain IBN287 cured of the 38-kb mupirocin resistance plasmid did not contain mupA. The results suggest that different genes encoded low- and high-level mupirocin resistance in these isolates.

Topics: Anti-Bacterial Agents; beta-Lactamases; Conjugation, Genetic; DNA, Bacterial; Drug Resistance, Microbial; Drug Resistance, Multiple; Humans; Methicillin Resistance; Mupirocin; Plasmids; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus

High-level mupirocin- and methicillin-resistant Staphylococcus aureus (MRSA) isolated from five hospitals in Kuwait were studied by pulsed-field gel electrophoresis (PFGE) to determine their relatedness to one another and to high-level mupirocin-resistant MRSA isolated previously in a Burns Unit. The genetic location of mupirocin resistance determinant was also determined. All of the isolates were resistant to gentamicin, kanamycin, streptomycin, tetracycline and cadmium, and contained plasmids of 38, 26 and 2.8 kb. Two isolates contained additional 4.4-kb plasmids. Transfer experiments demonstrated that the 38-kb plasmid encoded high-level mupirocin resistance and the 4.4-kb plasmid encoded chloramphenicol resistance. PFGE typing of representative isolates from the five hospitals demonstrated that the majority of them had identical or closely related pulsed-field patterns suggesting that they had a common origin. However, they differed from high-level mupirocin-resistant MRSA isolated previously in the Burns Unit in their resistance and pulsed-field patterns. Whereas the majority of the previous isolates were susceptible to ciprofloxacin and resistant to trimethoprim and chloramphenicol, the majority of the current isolates were susceptible to trimethoprim and chloramphenicol, and resistant to ciprofloxacin. Only one of the current isolates had identical pulsed-field pattern to the majority of isolates obtained previously in the Burns Unit. The results suggested that a previously dominant clone of high-level mupirocin-resistant MRSA has been replaced in the Burns Unit by a new clone, which also spread in four other hospitals.

Topics: Anti-Bacterial Agents; Conjugation, Genetic; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Hospitals; Humans; Kuwait; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Plasmids; Staphylococcal Infections; Staphylococcus aureus

In this work, we describe a multiplex PCR assay for the detection of clinically relevant antibiotic resistance genes harbored by some Staphylococcus aureus isolates and for the simultaneous identification of such isolates at the species level. Conditions were optimized for the simultaneous detection of the 310-, 456-, and 651-bp regions of the mecA (encoding high-level methicillin resistance), ileS-2 (encoding high-level mupirocin resistance), and femB (encoding a factor essential for methicillin resistance) genes, respectively, from a single colony in a single reaction tube. The femB PCR fragment allows the specific identification of S. aureus. Validation of the method was performed using 50 human isolates of methicillin-resistant S. aureus (MRSA) and the appropriate control strains. This assay offers a rapid, simple, feasible, specific, sensitive, and accurate identification of mupirocin-resistant MRSA clinical isolates and could be systematically applied as a diagnostic test in clinical microbiology laboratories, facilitating the design and use of antibiotic therapy.

Topics: Anti-Bacterial Agents; Bacterial Proteins; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus

Topics: Drug Resistance, Bacterial; Greece; Hospitals; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Topical mupirocin was able to interrupt colonization of 52% and 68% of methicillin-resistant Staphylococcus aureus (MRSA)-colonized patients carrying mupirocin-resistant and -sensitive strains, respectively, including 44.4% and 85.7% of those colonized only in the nares. Although a trend to decreased effectiveness was seen for clearing mupirocin-resistant MRSA, this agent can decolonize many patients with resistant strains.

Topics: Administration, Topical; Anti-Bacterial Agents; Hospitals, Community; Humans; Infection Control; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Quebec; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Contraindications; Humans; Liver Transplantation; Methicillin Resistance; Mupirocin; Nose; Risk; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Vancomycin

A new cream formulation of mupirocin developed to improve patient compliance was compared with systemic and topical antibiotics commonly used to treat primary and secondary skin infections. A mouse surgical wound model infected with Staphylococcus aureus or Streptococcus pyogenes was used. Topical treatment was applied at 4 and 10 h postinfection or oral treatment at a clinically relevant dose was administered 4, 8, and 12 h postinfection; treatments were continued three times daily for a further 3 days. Mupirocin cream was significantly more effective than (P < 0.01; two of eight studies) or not significantly different from (six of eight studies) mupirocin ointment in reducing bacterial numbers. Mupirocin cream was similar in efficacy to oral flucloxacillin but significantly more effective (P < 0.001) than oral erythromycin. It was also similar in efficacy to cephalexin against S. pyogenes but superior against S. aureus (P < 0.01). Mupirocin cream had a similar efficacy to fusidic acid cream against S. aureus but was significantly superior against S. pyogenes (P < 0.01). A hamster impetigo model infected with S. aureus was also used. Topical or oral treatment was administered at 24 and 30 h postinfection (also 36 h postinfection for oral therapy) and then three times daily for a further 2 days. On day 5, mupirocin cream was significantly more effective than mupirocin ointment in one study (P < 0.01) and of similar efficacy in the other two studies. Mupirocin cream was not significantly different from fusidic acid cream or neomycin-bacitracin cream, but it was significantly superior (P < 0.01) to oral erythromycin and cephalexin. Mupirocin cream was as effective as, or superior to, oral and other topical agents commonly used for skin infections.

Topics: Administration, Oral; Administration, Topical; Animals; Anti-Bacterial Agents; Bacitracin; Cephalexin; Chemistry, Pharmaceutical; Cricetinae; Erythromycin; Female; Floxacillin; Fusidic Acid; Impetigo; Male; Mice; Mupirocin; Neomycin; Penicillins; Skin Diseases, Bacterial; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Wound Infection

Nasal carriage of Staphylococcus aureus including methicillin-resistant S. aureus (MRSA) is associated with an increased risk for postoperative staphylococcal infection. This study was conducted to investigate the effect of preoperative nasal mupirocin treatment on the postoperative infections in patients undergoing upper gastrointestinal surgery. The intervention group consisted of 141 consecutive patients who underwent upper gastrointestinal surgery between March 1, 1997, and February 28, 1998. The patients in the intervention group were treated with intranasal mupirocin three times a day for 3 consecutive days before surgery. The incidence of postoperative staphylococcal infections in the intervention group was then compared with that of the historical control group. The control group consisted of 128 consecutive patients who underwent upper gastrointestinal surgery without mupirocin treatment between January 1, 1996 and December 31, 1996. The postoperative staphylococcal infection rate in the control group (11.7%) was significantly higher (P < 0.001) than in the intervention group (0.71%). The postoperative MRSA infection rate was significantly reduced by the intervention (control group 7.0% and intervention group 0%; P < 0.01). These results suggest that preoperative nasal eradication of S. aureus with mupirocin thus appears to be an effective measure to prevent postoperative staphylococcal infection in patients undergoing upper gastrointestinal surgery.

Topics: Administration, Intranasal; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Digestive System Surgical Procedures; Female; Humans; Incidence; Male; Methicillin Resistance; Middle Aged; Mupirocin; Ointments; Postoperative Complications; Staphylococcal Infections

Nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in infants has become a serious concern and a new means of preventing the transmission of MRSA in the community needs to be considered.. We performed nasal mupirocin treatment on 10 infants who were MRSA-positive either in the nose or the pharynx and evaluated the effect of mupirocin on the eradication of MRSA.. Eradication of MRSA from the nose was successful in two cases and eradication from the pharynx in six (66.6%) of nine cases. The number of treatments required to achieve eradication varied; within three courses for nose carriers and from one to seven courses for pharynx carriers. Eradication was unsuccessful even after five to seven treatments in three pharynx-limited carriers.. These data suggest that the effect of nasal mupirocin treatment on pharynx-colonized MRSA is limited and that repetitive treatment is necessary in some cases. However, in view of the possibility of preferential pharyngeal colonization of Staphylococcus aureus in infancy, nasal mupirocin treatment deserves further evaluation for eradication not only of nose- but also of pharynx-colonized MRSA.

Topics: Administration, Intranasal; Carrier State; Cross Infection; Female; Humans; Infant, Newborn; Male; Methicillin Resistance; Mupirocin; Nose; Pharyngeal Diseases; Pharynx; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance, Microbial; Hospitals; Humans; Mupirocin; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Drug Resistance, Multiple; Humans; Methicillin Resistance; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

Due to the emergence of mupirocin-resistance in some epidemic strains of methicillin resistant Staphylococcus aureus (EMRSA) and the appearance of EMRSA with intermediate resistance to vancomycin, we evaluated the in-vitro activity of 5% povidone-iodine ('Betadine') cream as a possiblealternative to mupirocin for the elimination of nasal carriage of S. aureus. As judged by enrichment culture, povidone-iodine was bactericidal against three mupirocin-sensitive strains of S. aureus from nasal carriers, and against mupirocin-resistant and -sensitive strains of EMRSA types 3, 15 and 16, after incubation with povidone-iodine for 1.0 min at 32 degrees C. Mupirocin nasal ointment did not prevent growth after 180 min incubation. In a quantitative suspension test, 1:100 dilution of povidone-iodine cream completely eliminated an inoculum of 10(8)cfu/mL of all nine test organisms after incubation at 32 degrees C for 1.0 min, and 1:1000 dilution reduced cfu, by a factor of 10(5). After direct inoculation of the povidone-iodine cream to give 10(5)cfu/g, none of the test strains were recoverable after 30 s, giving a killing rate of approximately 10(4)cfu/s; for mupirocin nasal ointment, the maximum reduction of mupirocin-sensitive strains was ten fold after 3 h. Povidone-iodine activity was not detectable in sensitivity-testing agar, although 0.025% of povidone-iodine was detectable in a 15% nutrient strength tryptone soya agar. Using this minimal medium, the addition of nasal secretions (from any of 11 samples) reduced the activity of povidone-iodine by 80-90%, but mupirocin activity was unaffected. One millilitre of nasal secretions inactivated the equivalent of approximately 22.5 mg of povidone-iodine. These results suggest that povidone-iodine cream may have a role in the prevention of colonization and infection caused by MRSA, including mupirocin-resistant strains.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Biological Availability; Carrier State; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Mupirocin; Nasal Mucosa; Nose; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

To describe the clinical and molecular epidemiology of mupirocin-resistant (MR) and mupirocin-susceptible (MS) methicillin-resistant Staphylococcus aureus (MRSA) at a Veterans' Affairs hospital and to assess risk factors associated with the acquisition of MR MRSA.. All clinical MRSA isolates for the period October 1990 through March 1995 underwent susceptibility testing to mupirocin. Mupirocin resistance trends were measured, and MS MRSA and MR MRSA isolates underwent typing by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted to evaluate risk factors for having MR versus MS MRSA.. The James H. Quillen Veterans' Affairs Medical Center in Mountain Home, Tennessee, included a 324-bed acute-care hospital, a 120-bed nursing home, and a 525-bed domiciliary. Colonizations and infections with MRSA were endemic, and mupirocin ointment was commonly used.. Inpatients and outpatients at the facility.. 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.

Topics: Administration, Topical; Anti-Bacterial Agents; Cross Infection; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Hospitals, Veterans; Humans; Methicillin Resistance; Mupirocin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

A rat model was used to investigate the efficacy of mupirocin in the prevention of vascular prosthetic graft infection due to Staphylococcus epidermidis strains with different susceptibility patterns (methicillin susceptible, methicillin resistant, and with intermediate resistance to vancomycin). The effect of mupirocin-soaked Dacron was compared to that of perioperative intraperitoneal prophylaxis with vancomycin. Graft infections were established in the back subcutaneous tissue of adult male Wistar rats by implantation of Dacron prostheses (1 cm(2)) followed by topical inoculation with 5 x 10(7) CFU of one staphylococcal strain. The study included a control group (no graft contamination), three contaminated groups that did not receive any antibiotic prophylaxis, three contaminated groups that received mupirocin-soaked grafts, three contaminated groups in which perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg of body weight) was administered, and three contaminated groups that received mupirocin-soaked grafts and perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were sterilely removed 7 days after implantation, and the infection was evaluated by using sonication and quantitative agar culture. Data analysis showed the efficacy of mupirocin against all three strains, with growth of the strains in treated rats significantly different than that in the untreated control. In addition, mupirocin was more effective than vancomycin against the strain with intermediate susceptibility to the glycopeptide. Finally, the combination of mupirocin and vancomycin produced complete suppression of the growth of all of the strains.

Topics: Aminoglycosides; Animals; Anti-Bacterial Agents; Blood Vessels; Male; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Rats; Rats, Wistar; Staphylococcal Infections; Staphylococcus epidermidis; Vancomycin; Vancomycin Resistance

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Isoleucine-tRNA Ligase; Methicillin Resistance; Mupirocin; Polymerase Chain Reaction; Sequence Analysis, DNA; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus nasal carriage (SANC) is a risk factor for development of S. aureus dialysis-related infections. Reported here are results of a SANC surveillance and treatment program employed by our dialysis unit over a two-year period. Surveillance nasal cultures were performed at 3-month intervals in 129 peritoneal dialysis patients. Those with SANC applied mupirocin ointment intranasally 3 times daily for 5 consecutive days for 3 consecutive months. Treatment was repeated only when subsequent cultures showed SANC. Infection and catheter loss rates were compared to 63 historical controls, and between SANC and non SANC patients of the study group. Patients who were initially non carriers showed increasing probability for acquiring SANC throughout the study period. Following treatment, the probability for recurrence of SANC was 26%, 41%, 58%, and 62% at 1, 3, 6, and 12 months. The rates of S. aureus exit-site or tunnel infection (p = 0.36), peritonitis (p = 0.0002), and catheter loss (p = 0.01) were lower in the study group as compared to controls. Despite treatment, SANC patients demonstrated a twofold increase in exit-site/tunnel infection rate (p = 0.03) and a threefold increase in catheter loss rate (p = 0.1) as compared to non SANC patients. The high rate of SANC recurrence and the long interval between surveillance cultures may explain the failure of the current protocol to completely eliminate the risk for S. aureus infections. The results support a change in the treatment plan to that of continuing the monthly mupirocin regimen indefinitely once SANC has been identified.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Mupirocin; Nose; Peritoneal Dialysis; Peritonitis; Prospective Studies; Recurrence; Staphylococcal Infections; Staphylococcus aureus

In September 1996, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization occurred in the neonatal intensive care unit (NICU) of our hospital. After failing to control the outbreak by conventional methods we implemented an intranasal blanket use programme of mupirocin ointment from the beginning of November 1997. In the programme, patients who had been carrying MRSA received intranasal administration of the ointment three times daily for the first three days and consecutively three times weekly, while newly admitted patients and those who had not been colonized were prophylactically medicated three times weekly. This blanket administration was executed for one month. Methicillin-resistant Staphylococcus aureus colonization became undetectable in all but one intubated inpatient who had already been colonized before the start of the programme, and no new acquisitions occurred until the middle of January 1998, seven weeks after the termination of the blanket use programme. The rate of colonized patients in the unit also decreased. During and after the programme, neither an increase in minimum inhibitory concentration for the antibiotic nor apparent adverse reactions in any of the treated patients were observed. We concluded that this procedure is an effective method of controlling an MRSA outbreak in an NICU when the outbreak cannot be managed with conventional measures.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Cross Infection; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Nasal Mucosa; Ointments; Program Evaluation; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Tokyo

Routine use of mupirocin to prevent staphylococcal infections is controversial. We assessed attitudes and practices of healthcare professionals attending the Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections regarding mupirocin prophylaxis. Eighty percent of participants did not use mupirocin routinely. At the end of the session, 58% indicated they would consider increased use of mupirocin.

Topics: Anti-Bacterial Agents; Attitude of Health Personnel; Cross Infection; Humans; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Two distinct strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients in a dermatology ward were also resistant to mupirocin. The mupirocin resistance plasmids from both strains were indistinguishable by EcoRI and HindIII restriction digest analysis, except for the presence of genes apparently mediating penicillinase production in some transconjugants. Conjugative transfer of the plasmid mediating mupirocin resistance from one of these strains to a recipient S. aureus was accompanied in some cases by co-transfer of plasmids mediating resistance to tetracycline or erythromycin; in some instances a plasmid which possessed no apparent resistance markers was also transferred. The second strain demonstrated conjugative transfer of penicillin and mupirocin resistance as well as transfer of a plasmid mediating gentamicin resistance, but transfer of erythromycin resistance was not apparently plasmid-mediated.

Topics: Anti-Bacterial Agents; Conjugation, Genetic; Drug Resistance, Microbial; Drug Resistance, Multiple; Humans; Methicillin Resistance; Mupirocin; Penicillin Resistance; Plasmids; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Humans; Lip Diseases; Male; Middle Aged; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Mupirocin resistance could be transferred from highly resistant clinical isolates of Staphylococcus aureus to highly sensitive recipients of Staph. aureus, Staph. epidermidis and Staph. haemolyticus. Transconjugants of the latter two organisms could transfer this resistance into mupirocin-sensitive Staph. aureus. Moderately resistant strains did not transfer this resistance to sensitive recipients, nor did strains with high-level mupirocin resistance developed by serial transfer or habituation. The inhibitory effects of mupirocin on crude isoleucyl-tRNA synthetases (IRS) isolated from mupirocin-sensitive and -resistant strains of Staph. aureus have been determined. Drug concentrations needed to produce 50% inhibition, I50 values, were very low against IRS from a highly sensitive strain, somewhat higher against IRS from moderately resistant strains, much higher against enzyme from strains trained in vitro to high-level resistance, and considerably higher still against IRS extracted from clinical isolates possessing high-level mupirocin resistance and from the transconjugates of such strains resulting from crosses with mupirocin-sensitive strains. It is concluded that high-level resistance in clinical isolates is plasmid-mediated involving a second, mupirocin-resistant IRS whereas in moderately resistant strains, and in strains trained in vitro to high-level resistance, chromosomal mutations are likely to be responsible for decreasing IRS sensitivity.

Topics: Anti-Bacterial Agents; Conjugation, Genetic; Drug Resistance, Microbial; Genes, Bacterial; Humans; Isoleucine-tRNA Ligase; Microbial Sensitivity Tests; Mupirocin; Plasmids; Staphylococcal Infections; Staphylococcus aureus

Mupirocin is a topical antimicrobial agent that has been successfully used to eradicate methicillin-resistant Staphylococcus aureus from the anterior nares and other sites of patients and health care personnel. This report describes the acquisition of a novel mupirocin resistance gene (ileS) by an epidemic MRSA clone that is geographically widespread in Brazil.

Topics: Anti-Bacterial Agents; Brazil; Cross Infection; Disease Outbreaks; DNA, Bacterial; Drug Resistance, Microbial; Drug Resistance, Multiple; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Physical Chromosome Mapping; Staphylococcal Infections; Staphylococcus aureus

The presence of the ileS-2 gene, responsible for mupirocin resistance, in clinical isolates of methicillin-resistant Staphylococcus aureus was determined by multiplex polymerase chain reaction. Three pairs of primers were used, which yielded specific fragments of femA (encoding a unique feature of S. aureus), mecA (encoding resistance to methicillin) and ileS-2 genes. The multiplex polymerase chain reaction system is an easy and time-saving technique that, together with a rapid method for DNA extraction by boiling, may be incorporated as a routine analysis in clinical diagnostic laboratories.

Topics: Anti-Bacterial Agents; Bacterial Proteins; DNA Primers; Drug Resistance, Microbial; Genes, Bacterial; Humans; Methicillin Resistance; Mupirocin; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus

An outbreak of mupirocin-resistant (MuR) staphylococci was investigated in two wards of a large hospital in Warsaw, Poland. Fifty-three MuR isolates of Staphylococcus aureus, S. epidermidis, S. haemolyticus, S. xylosus, and S. capitis were identified over a 17-month survey which was carried out after introduction of the drug for the treatment of skin infections. The isolates were collected from patients with infections, environmental samples, and carriers; they constituted 19.5% of all staphylococcal isolates identified in the two wards during that time. Almost all the MuR isolates were also resistant to methicillin (methicillin-resistant S. aureus and methicillin-resistant coagulase-negative staphylococci). Seven of the outbreak isolates expressed a low-level-resistance phenotype (MuL), whereas the remaining majority of isolates were found to be highly resistant to mupirocin (MuH). The mupA gene, responsible for the MuH phenotype, has been assigned to three different polymorphic loci among the strains in the collection analyzed. The predominant polymorph, polymorph I (characterized by a mupA-containing EcoRI DNA fragment of about 16 kb), was located on a specific plasmid which was widely distributed among the entire staphylococcal population. All MuR S. aureus isolates were found to represent a single epidemic strain, which was clonally disseminated in both wards. The S. epidermidis population was much more diverse; however, at least four clusters of closely related isolates were identified, which suggested that some strains of this species were also clonally spread in the hospital environment. Six isolates of S. epidermidis were demonstrated to express the MuL and MuH resistance mechanisms simultaneously, and this is the first identification of such dual MuR phenotype-bearing strains. The outbreak was attributed to a high level and inappropriate use of mupirocin, and as a result the dermatological formulation of the drug has been removed from the hospital formulary.

Topics: Anti-Bacterial Agents; Chromosome Mapping; Cross Infection; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Humans; Microbial Sensitivity Tests; Mupirocin; Plasmids; Polymorphism, Restriction Fragment Length; Random Amplified Polymorphic DNA Technique; Staphylococcal Infections; Staphylococcus

Patients who are infected or colonised by MRSA should be isolated. However, isolation is very costly in terms of time and work. In order to shorten the period of isolation, attempts are being made to eradicate this organism from patients by means of whole-body washing in addition to nasal mupirocin treatment. The effectiveness of such washes has not yet been adequately confirmed by studies. From September 1997 to August 1998, therefore, in a clinical trial of MRSA eradication, 28 patients were washed for a period of five days with a 1:1 diluted preparation based on octenidine dihydrochloride. At the same time, the nose was treated with mupirocin. Before washing was begun, on day 4 during washing and on days 1, 4 and 7 after washing was completed, smears were taken from each patient from the nose, pharynx, forehead hairline, groin, axilla and wounds, and in the case of women from the sub-mammary area. Elimination of the MRSA was achieved in 21 out of 28 cases; in four cases the washing was discontinued on account of skin redness, in three cases no elimination could be achieved during the control period. In order to ensure the success of eradication and to minimise skin reactions due to the washing, the wash procedure must be standardised, and decontamination controlled microbiologically. The study confirms that MRSA can be eradicated by means of washing with an antiseptic combined with mupirocin treatment.

Topics: Administration, Topical; Anti-Bacterial Agents; Baths; Carrier State; Cross Infection; Decontamination; Female; Humans; Imines; Male; Methicillin Resistance; Mupirocin; Nasal Cavity; Ointments; Pyridines; Staphylococcal Infections; Staphylococcus aureus

The incidence of cutaneous bacterial infection after carbon dioxide (CO2 laser resurfacing is increasing. Patients with staphylococcal colonization of their anterior nares may be at greater risk for postoperative cutaneous colonization and/or infection, which can potentially cause scarring.. We present a case report of methicillin-resistant Staphylococcus aureus secondary infection of the skin after CO2 laser resurfacing. We discuss the possible etiologies of this patient's infection, her postoperative management, and preoperative suggestions for possibly preventing infection.. A 49-year-old woman was treated with CO2 laser resurfacing for moderate actinic damage and facial rhytides. She developed a cutaneous infection with methicillin-resistant S. aureus, which caused diffuse linear scarring on her cheeks and upper lip.. The patient was successfully treated with oral minocycline, rifampin, and topical mupiricin ointment to her cutaneous erosions.. We propose that it would be helpful for patients undergoing CO2 laser resurfacing to have their nares cultured to see if they are staphylococcal carriers. If a patient is found to be a carrier, mupiricin ointment can be used preoperatively treat to the nares, to help decrease the risk of infection of the skin from this potential source.

Topics: Dermatologic Surgical Procedures; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Laser Therapy; Methicillin Resistance; Middle Aged; Minocycline; Mupirocin; Rifampin; Skin Aging; Skin Diseases, Bacterial; Staphylococcal Infections; Staphylococcus aureus; Surgery, Plastic; Surgical Wound Infection

An epidemic methicillin-resistant Staphlococcus aureus (EMRSA-3) appeared in a District hospital in June 1989 as part of a regional outbreak. The dynamics of the outbreak were complex and involved patient transfer between hospitals and wards. Control measures followed UK guidelines and included the use of nasal mupirocin. During these efforts a mupirocin-resistant MRSA [MuMRSA: mupirocin minimum inhibitor concentration (MIC) > 256 mg/L] emerged, probably in a patient who had been given eight mupirocin courses over nine months. The MuMRSA had a narrower phage-typing pattern than EMRSA-3, but was indistinguishable by pulsed-field gel electrophoresis of SmaI chromosomal restriction enzyme digests and its susceptibility pattern to other antibiotics. The results of in vitro curing and gene probing indicated that mupirocin resistance was encoded on a 48 Md plasmid. MuMRSA spread occurred in 12 patients and 11 staff. The affected patients were nursed on the same ward. The strain was eradicated from patients with oral ciprofloxacin and rifampicin, triclosan skin treatment and nasal fusidic acid and bacitracin cream. The control of the outbreak had significant medical, social and financial implications. Fortunately, there were alternative topical agents to mupirocin, an agent which has played such a key role in MRSA eradication in recent years.

Topics: Aged; Anti-Bacterial Agents; Bacteriophage Typing; Cross Infection; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Humans; Infectious Disease Transmission, Patient-to-Professional; London; Male; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Topics: Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Female; Humans; Male; Methicillin; Methicillin Resistance; Mupirocin; Penicillins; Staphylococcal Infections; Staphylococcus aureus; Teicoplanin; Vancomycin

Topics: Anti-Bacterial Agents; Carrier State; Drug Resistance, Microbial; Drug Resistance, Multiple; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Spain; Staphylococcal Infections; Staphylococcus aureus

Topics: Adult; Aged; Anti-Bacterial Agents; Brazil; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Female; Hospitals, University; Humans; Infection Control; Intermediate Care Facilities; Male; Methicillin Resistance; Middle Aged; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

The topical agent mupirocin plays a crucial role in strategies designed to control outbreaks of methicillin-resistant Staphylococcus aureus. The extent of high- or low-level mupirocin resistance amongst S. aureus from European hospitals is not known. Six hundred and ninety-nine S. aureus and 249 coagulase-negative staphylococci (CNS) derived from blood, hospital-acquired pneumonia or skin and soft tissue infections from 19 European hospitals were tested for susceptibility to mupirocin and oxacillin. Methicillin sensitivity was found in 72% and 32% of S. aureus and CNS, respectively. High-level mupirocin resistance was detected in 1.6% of S. aureus and 5.6% of CNS isolates, while low-level mupirocin resistance was detected in 2.3% of S. aureus and 7.2% of CNS isolates. Amongst S. aureus, methicillin-resistant isolates were twice as likely to have high- or low-level mupirocin resistance. This difference was less pronounced in CNS. No relationship was found between the site of infection and prevalence of mupirocin resistance. High- and low-level mupirocin resistance was detected amongst staphylococci from 10 and 16 of the hospitals studied, respectively. To maintain the relatively low prevalence of mupirocin resistance in Europe amongst both S. aureus and CNS, the prudent use of mupirocin restricted to defined infection control strategies should be emphasized.

Topics: Anti-Bacterial Agents; Coagulase; Drug Resistance, Microbial; Europe; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus

The susceptibilities to mupirocin of 102 selected clinical isolates of Staphylococcus aureus and of control strain S. aureus NCTC 6571 were determined by disc diffusion (using discs containing 5, 15, 25, 30, 50 and 200 microg of mupirocin) and Etest and the results were compared with MICs determined using an agar incorporation method. On the basis of agar incorporation MICs, 42 isolates were sensitive to mupirocin (MIC < or = 4 mg/L), 39 showed low-level resistance (MICs = 8-128 mg/L) and 22 were highly resistant (MICs > or = 256 mg/L) and contained the mupA resistance gene. Using Stokes' criteria, none of the discs used gave major errors (sensitive isolates classified as highly resistant) or very major errors (highly resistant isolates classified as sensitive) in assigning a category of susceptibility, but minor errors (a difference of one category) were noted with all strengths. The best correlation with agar incorporation MIC was obtained with 25 microg mupirocin discs, which classified correctly 98 (95%) isolates, while worse correlations were noted with 5 microg and 200 microg discs which are the only types currently available commercially, for which there were 47 and 30 minor errors, respectively. The MICs found by Etest were the same as, or lower than, those determined by agar incorporation. Etests classified correctly all 42 mupirocin-sensitive isolates, 19 (49%) low-level resistant isolates and 16 (73%) highly resistant isolates. Two isolates that contained the mupA gene and showed agar incorporation MICs of 256 mg/L and 512 mg/L were not classified as highly resistant by any of the diffusion methods used. Agar incorporation MIC determination, possibly supported by detection of the mupA gene, offers the most effective means of identifying high-level mupirocin resistance in S. aureus, although the Etest also proved to be reproducible. However, we conclude that 25 microg discs warrant further evaluation for possible use in clinical laboratories, as they appear to be more reliable than the discs currently available.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Evaluation Studies as Topic; Genes, Bacterial; Humans; Microbial Sensitivity Tests; Mupirocin; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus

Antimicrobial agents are generally tested against bacteria in the log phase of multiplication to produce the maximal bactericidal effect. In case of foreign body infections, bacteria may multiply less optimally. We examined the effects of several classes of lipophilic antistaphylococcal agents to determine their antimicrobial activity towards coagulase-positive and coagulase-negative staphylococci during the non-growing and slowly growing phases. Only two-fold combinations containing rifampicin were bactericidal (3-log kill) against Staphylococcus aureus. This was in contrast to growing bacteria in the log phase, in which a variety of antibiotics produced relevant killing. Concerning the staphylococci examined, antibiotic killing was greatly dependent on the growth rate. Most of the two-fold combinations containing rifampicin showed additive and synergistic antibacterial activity both in growth and stationary states as measured by the killing kinetics. The theoretical and clinical implications of delayed killing by chemotherapeutic agents for established bacterial infections and infections involving foreign bodies are discussed. Antimicrobial combinations including rifampicin and a second lipophilic antistaphylococcal drug may be most promising and appropriate as coating substances for intravascular devices or for clinical application in cases of implant infections.

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Erythromycin; Fusidic Acid; Humans; Microbial Sensitivity Tests; Mupirocin; Prostheses and Implants; Rifampin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Staphylococcus epidermidis

Twelve strains of methicillin-resistant Staphylococcus aureus with high-level resistance to mupirocin were studied. The MIC of methicillin was 16 to 128 mg/l and the MIC of mupirocin > or = 512 mg/l. All of the isolates carried a plasmid of about 30 MDa, and one strain lost resistance to mupirocin when the plasmid was cured. Three different resistance patterns were found: six strains were resistant to ciprofloxacin, kanamycin, and 10 mg/l of cadmium sulfate; two strains were resistant to these agents as well as to gentamicin, erythromycin, clindamycin, mercury chloride, and ethidium bromide; and four strains were resistant to the previously named agents as well as to rifampicin and tetracycline. The use of this valuable topical antibiotic, especially in long-term-care facilities, should be monitored to avoid dissemination of resistance.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Plasmids; Spain; Staphylococcal Infections; Staphylococcus aureus

Topics: Antibiotic Prophylaxis; Disease Outbreaks; Humans; Methicillin Resistance; Mupirocin; Spain; Staphylococcal Infections; Surgical Wound Infection

The frequency of Staphylococcus aureus (SA) nasal carriage and the impact of antibiotic therapy remain undefined in children receiving long-term peritoneal dialysis (PD). We obtained a nasal culture for SA every 4-12 weeks in 21 children (mean age 7.03 +/- 5.8 years) receiving PD from January 1992 to August 1996 (total of 35.3 patient-years). In each case, SA nasal carriage (NSA+) was treated with intranasal mupirocin for 7 days. NSA+ was detected in 13 patients (61.9%) who received dialysis for 28.9 patient-years. Eight (61.5%) of 13 patients became NSA+ during the initial 3 months of dialysis. Seven (53.8%) of the NSA+ patients had 11 exit-site infections (ESI) and one episode of peritonitis (0.42 total infections/patient-year) due to SA. The 8 patients without SA nasal carriage (NSA-) received dialysis for 6.4 patient-years. None of the NSA-patients had an ESI or peritonitis with SA. Finally, the incidence of non-SA infections in the NSA+ and NSA- groups was not different (0.62 vs 0.31 total infections/patient-year, p > 0.05). In conclusion, there appears to be an association between SA nasal carriage and SA ESI in children on PD. The risk of SA peritonitis in NSA+ patients treated with mupirocin may be minimal. The risk of SA nasal carriage may increase with time on dialysis.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Catheters, Indwelling; Child; Female; Humans; Male; Mupirocin; Nose; Peritoneal Dialysis; Peritonitis; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Humans; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

This study was performed to determine the clinical and economic consequences of alternative strategies of preventing Staphylococcus aureus infection in chronic hemodialysis patients by use of intranasal mupirocin calcium to clear nasal carriage of S aureus. Decision analysis evaluated clinical outcomes and cost-effectiveness of three likely management strategies to address S aureus nasal carriage and prevent subsequent infection in chronic ambulatory hemodialysis patients: (1) screen for S aureus nasal carriage every 3 months and treat those with a positive test result with mupirocin calcium; (2) treat all patients weekly with mupirocin calcium; or (3) no prevention strategy, treat infection only. Rates of nasal carriage of S aureus, S aureus infection rates, proportion of infections attributable to nasal carriage, efficacy of mupirocin, natural history of infection, and patient management strategies were derived from the published literature and supplemented by a panel of experts. Actual payments for medical services were obtained from Medicare parts A and B. Incremental cost-effectiveness was calculated from the perspective of Medicare and subjected to sensitivity analyses. Assuming that 75% of S aureus infections are attributable to nasal carriage in hemodialysis patients, eliminating nasal carriage of S aureus with mupirocin calcium (with or without screening) markedly reduces the number of infections (45% to 55%) and also reduces health care expenditures relative to treating infections when they occur. Annual savings to Medicare are $784,000 to $1,117,000 per 1,000 hemodialysis patients, depending on the prevention strategy. Preventing S aureus infection by eradicating nasal carriage in chronic hemodialysis patients reduces morbidity while simultaneously reducing medical care costs. The decision to eliminate nasal carriage on a regular basis or use a screening test to guide antibiotic therapy is dependent on the tradeoff between improved short-term clinical and cost benefits and the potential for bacterial resistance that may arise from widespread use of mupirocin calcium.

Topics: Administration, Intranasal; Ambulatory Care; Anti-Bacterial Agents; Chemoprevention; Clinical Protocols; Cohort Studies; Cost Savings; Cost-Benefit Analysis; Decision Support Techniques; Decision Trees; Drug Costs; Drug Resistance, Microbial; Follow-Up Studies; Health Expenditures; Humans; Medicare Part A; Medicare Part B; Mupirocin; Nose; Renal Dialysis; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; United States

The synthesis, antibacterial activities, murine pharmacokinetic and infection model data for a range of aryl and heteroaryl ketone derivatives of monic acid (2a) are reported. The best results were found for the 3-furyl and 2-methoxy thiazol-5-yl analogues.

Topics: Animals; Anti-Bacterial Agents; Humans; Ketones; Male; Mice; Mice, Inbred Strains; Microbial Sensitivity Tests; Mupirocin; Sepsis; Staphylococcal Infections; Structure-Activity Relationship; Thiazoles

In December 1992, a thoracic ward in a Melbourne teaching hospital experienced an increase in patients infected with methicillin-resistant Staphylococcus aureus (MRSA). It was decided to attempt to control the outbreak by cohorting positive patients (infected and colonized), as well as nurse cohorting, emphasis on handwashing, and use of intranasal mupirocin initially three times a day for three days, then thrice weekly, for all patients in the ward (with or without MRSA). The campaign comprised for phases of 53, 45, 92 and 365 days, respectively. Patient and nurse cohorting stopped at the end of phase I. In phases I and II, surveillance nose swabs were taken on admission, then twice weekly; in phase III, on admission and weekly and in phase IV, on admission until the end of 1993. In phases I and II (98 days), only one patient acquired MRSA. When the frequency of mupirocin prophylaxis was decreased to once weekly (phase III), two patients acquired MRSA in 92 days (no significant difference): thrice weekly administration resumed (phase IV), during which there were three acquisitions in 365 days. The rates of nose colonization of admissions were 6.4%, 6.3%, 9.7% and 3.1% in phase I-IV, respectively. Only three patients were treated with vancomycin between July 1993 and June 1994 (significantly lower than historical rates, P = 0.0086). No mupirocin resistance was seen in MRSA isolates from this ward during phases I, II and III. In areas of low-level endemic MRSA, the blanket use of thrice-weekly intranasal mupirocin may be effective in decreasing serious infections with MRSA, and does not necessarily elicit mupirocin resistance.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Cross Infection; Disease Outbreaks; Hand Disinfection; Humans; Incidence; Infection Control; Methicillin Resistance; Mupirocin; Nursing Staff, Hospital; Program Evaluation; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Humans; Methicillin Resistance; Mupirocin; Nasal Cavity; Respiratory Tract Infections; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Topical; Anti-Bacterial Agents; Bacitracin; Drug Interactions; Drug Resistance, Microbial; Fusidic Acid; Humans; Methicillin Resistance; Mupirocin; Polymyxin B; Staphylococcal Infections; Staphylococcus aureus

To describe the epidemiology and the interventions used to control two methicillin-resistant Staphylococcus aureus (MRSA) epidemics involving 46 infants with two fatalities in a neonatal intensive care unit (NICU).. A 50-bed, level III NICU in a university hospital.. After traditional interventions failed to stop the first epidemic, an intensive microbiologic surveillance (IMS) program was developed. Cultures were obtained on all infants each week, and those colonized with MRSA were isolated. When an infant was found to be colonized with MRSA, cultures immediately were obtained on all surrounding infants. This was continued until no MRSA-colonized infants were found in the area. During the first epidemic, mupirocin was used in an attempt to eradicate the organism from the unit.. All infants, colonized and noncolonized, and parents of and personnel working with colonized infants were treated simultaneously with 5 days of mupirocin. This failed to eradicate MRSA in colonized infants. The spread of MRSA ceased in the unit, but a second epidemic occurred 4 months later. This time, IMS alone was successful in quickly containing the epidemic, and MRSA disappeared from the unit after all colonized infants were discharged. Plasmid analysis demonstrated that the same strain was responsible for both outbreaks.. IMS and isolation are effective in containing the spread of MRSA in an NICU. The use of mupirocin failed to eradicate the organism.

Topics: Anti-Bacterial Agents; Cross Infection; Humans; Infant, Newborn; Infection Control; Intensive Care, Neonatal; Methicillin Resistance; Mupirocin; Ohio; Staphylococcal Infections; Staphylococcus aureus

Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) was implemented in Rio de Janeiro and Uberlândia University Hospitals, which had different policies on use of mupirocin. One hundred fourteen multiresistant MRSA strains were isolated from 62 patients. Mupirocin resistance was observed in 63% of strains in Rio de Janeiro, where there was extensive use of topical mupirocin, and 6.1% in Uberlândia, where its use was rare.

Topics: Anti-Bacterial Agents; Brazil; Cross Infection; Drug Resistance, Microbial; Hospitals, University; Humans; Infection Control; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

All methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from colonized or infected patients in a 625-bed public teaching hospital during an epidemic, and for 3 years thereafter, underwent susceptibility testing to mupirocin. Mupirocin resistance among MRSA increased markedly over this period (1990, 2.7%; 1991, 8.0%; 1992, 61.5%; 1993, 65%) in association with increased use of mupirocin ointment as an adjunct to infection control measures.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Cross Infection; Drug Resistance, Microbial; Humans; Infection Control; Methicillin Resistance; Mupirocin; Prevalence; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

Several countries have achieved considerable success in the control of epidemic methicillin-resistant Staphylococcus aureus (MRSA). However, in several hospitals in the UK, MRSA strains of enhanced epidemicity, notably EMRSA-16, are becoming endemic. Our inability to eliminate the cause of a single-strain outbreak is unfamiliar and unnerving. Factors in 'market-led' health care delivery that hinder control of MRSA include a shortage of inpatient beds, patients moving from ward to ward, and more mixed-specialty wards. Increasing use of day treatments leaves an inpatient hospital population with more risk factors for infection. Early discharge of infected patients to convalescent homes, or to homes for the elderly, has created a new reservoir of infected and colonized patients. The emergence of high-level mupirocin resistance may soon also contribute to failure of control. The transfer of vancomycin resistance from Enterococcus faecium to a laboratory strain of S. aureus suggests that, especially in hospitals with both vancomycin-resistant enterococci and MRSA, there is the opportunity for the emergence of vancomycin-resistant MRSA for which there may be no effective antimicrobial prophylaxis or treatment. It is increasingly important to persuade hospital managers that even partial control of MRSA, whilst expensive, is still cost-effective and is a quality issue for individual hospitals. The control of EMRSA-16 in one hospital has recently been estimated to have saved more than 629,000 pounds extra costs. MRSA continues to be at the forefront of those organisms that seriously challenge modern technological medicine and surgery.

Topics: Anti-Bacterial Agents; Cross Infection; Disease Reservoirs; Drug Resistance, Microbial; Hospital Costs; Humans; Infection Control; Methicillin Resistance; Mupirocin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

We retrospectively reviewed hospital discharge diagnoses of septic arthritis over an 11-year period (1982 through 1992) at 3 medical centers; 11 episodes of septic arthritis were identified in patients on hemodialysis treatment. Of the 11 episodes, 9 were caused by Staphylococcus aureus; in 8 of 9, the blood cultures were positive for the organism and the infection was monoarticular. Concurrent infection of the dialysis access site occurred in 4 cases. Two patients died (22%). We postulate that repeated skin trauma and contact with health care personnel and facilities result in a high rate of nasal carriage of S aureus and, hence, an increased risk of bacteremia with its attendant complications such as septic arthritis. The use of mupirocin nasal ointment is reported to eradicate or suppress carriage in a high percentage of patients; some studies report that long-term suppressive therapy reduces the frequency of S aureus bacteremia.

Topics: Administration, Intranasal; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthritis, Infectious; Female; Humans; Male; Middle Aged; Mupirocin; Renal Dialysis; Risk Factors; Staphylococcal Infections

We studied conjugative plasmids encoding high-level mupirocin resistance. These plasmids were found in Staphylococcus aureus isolates from two geographic locations in the United States. Transfer genes on three mupirocin resistance plasmids with different restriction endonuclease profiles were indistinguishable by DNA hybridization from those on pG01, a conjugative aminoglycoside resistance plasmid representative of similar plasmids that are prevalent in the United States. One mupirocin resistance plasmid, pG0400 (34 kb), was smaller than pG01 (52 kb) because of the absence from pG0400 of DNA, found on pG01, that contained genes encoding resistance to aminoglycosides, trimethoprim, and quaternary ammonium compounds flanked by directly repeated copies of the insertion sequence (IS)-like element IS431-IS257. The plasmids pG0400 and pG01 were otherwise indistinguishable except for the presence in pG0400 of a 4.5-kb HinDIII fragment encoding mupirocin resistance. The added mupirocin resistance gene was flanked by two directly repeated copies of IS431/257. The nucleotide sequence of DNA contiguous to the outside of the IS elements, as well as those of the elements themselves, was identical in both pG01 and pG0400, and there were no target site duplications flanking either copy of the element. We conclude that the mupirocin resistance gene was added to an existing conjugative plasmid in conjunction with the deletion of other resistance genes by recombination at IS elements. The construction of conjugative plasmids carrying a mupirocin resistance gene may be a model for the mobility of other resistance genes newly acquired by staphylococci.

Topics: Base Sequence; Chromosome Mapping; Conjugation, Genetic; Connecticut; Disease Transmission, Infectious; DNA Transposable Elements; Drug Resistance, Microbial; Humans; Molecular Sequence Data; Mupirocin; Plasmids; Staphylococcal Infections; Staphylococcus aureus

A six month prospective study was carried out in a surgical intensive care unit (SICU) of a university hospital to assess the incidence and routes of exogenous colonization by Staphylococcus aureus. A total of 157 patients were included in the study. One thousand one hundred and eleven specimens (nasal, surgical wound swabs, tracheal secretions obtained on admission and once a week thereafter, and all clinical specimens) were collected over a four month period from patients without nasal decontamination (A). They were compared with 729 specimens collected over a two month period from patients treated with nasal mupirocin ointment (B). All S. aureus strains were typed by restriction fragment length polymorphism (RFLP) pulsed-field gel electrophoresis after SmaI macrorestriction. The nasal colonization rates on admission were 25.5 and 32.7% in groups A and B, respectively. Thirty-one untreated patients (31.3%) and three patients (5.1%) treated with nasal ointment, acquired the nasal S. aureus in the SICU (P = 0.00027). Nasal carriers were more frequently colonized in the bronchopulmonary tract (Bp) and surgical wound (Sw) (62%) than patients who were not nasal carriers (14%) (P < 0.00001). The patterns were identical for nasal, Bp and Sw strains from the same patient. RFLP analysis characterized seven epidemic strains of methicillin-resistant S. aureus (MRSA) which colonized 60% of group A and 9% of group B patients (P < 0.00001). The bronchopulmonary tract infection rate was reduced in group B (P = 0.032). In conclusion, in an SICU, nasal carriage of S. aureus appeared to be the source of endogenous and cross-colonization. The use of nasal mupirocin ointment reduced the incidence of Bp and Sw colonization, as well as the MRSA infection rate.

Topics: Administration, Intranasal; Bacterial Typing Techniques; Carrier State; Colony Count, Microbial; Cross Infection; Hospitals, University; Humans; Intensive Care Units; Methicillin Resistance; Mupirocin; Nasal Mucosa; Ointments; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

Twenty-two isolates of Staphylococcus aureus, recovered from patients over a period of about one year, exhibited low level resistance to mupirocin, developed a salmon pink colour on culture and 21 had the same phage-type. However the plasmid profiles and associated antibiotic resistances differed. Digestion of cellular DNA with SmaI showed that two isolates from a single patient had a markedly different pattern to the remainder, and that six others differed by one band, though these formed groups of one and five isolates. This episode apparently represents a small outbreak of colonization or infection, which would have been missed but for the unusual pigmentation of the isolates recovered, and illustrates the difficulties of relying on a single typing system.

Topics: Anti-Bacterial Agents; Bacteriophage Typing; Cross Infection; Disease Outbreaks; DNA, Bacterial; Drug Resistance, Microbial; Female; Humans; Infection Control; Male; Microbial Sensitivity Tests; Mupirocin; Pigmentation; R Factors; Restriction Mapping; Staphylococcal Infections; Staphylococcus aureus

Semisynthetic analogues of pseudomonic acid A have been prepared containing a heterocyclyl substituted oxazole. Derivatives in which the heterocycle was thiophene, furan, pyridine, or isoxazole showed good antibacterial potency and were further evaluated in vivo. Both pharmacokinetic parameters and oral activity against an experimental intraperitoneal sepsis were superior to results obtained from previously described pseudomonic acid A derivatives.

Topics: Animals; Anti-Bacterial Agents; Furans; Humans; Isoxazoles; Mice; Mupirocin; Oxazoles; Pyrazoles; Pyridines; Sepsis; Staphylococcal Infections; Thiazoles; Thiophenes

Staphylococcus aureus is the most frequently (42%) isolated micro-organism during bacteraemic episodes in haemodialysis patients. Nasal carriage of S. aureus is of major importance in determining the risk of subsequent infections. Indeed, nasal carriage of S. aureus is highly prevalent in uraemic patients from the onset of maintenance dialysis therapy. The strains isolated simultaneously from the nares and the hands are usually the same. Likewise, infecting S. aureus strains and those isolated from nasal surveillance cultures obtained in the same patient are usually similar. S. aureus infections in haemodialysis patients are thus mostly to be considered as auto-infections. The nares are therefore an elective site for the prevention of S. aureus infections in haemodialysis patients. This has been demonstrated with oral rifampin, and more recently with nasal mupirocin, which is highly effective. Long-term application of nasal mupirocin (e.g. once per week) is cost-effective and is only rarely associated with the emergence of mupirocin-resistance in S. aureus.

Topics: Anti-Bacterial Agents; Humans; Mupirocin; Nose; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Topics: Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Intranasal; Carrier State; Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Six mupirocin-resistant Staphylococcus aureus were isolated from patients living in the northern part of Western Australia (WA). They were all resistant to methicillin, tetracycline, trimethoprim and cadmium and harboured similar 41.4 kb plasmids. Transfer and curing experiments with one of the isolates, WBG7569, demonstrated that the 41.4 kb plasmid encoded resistance to mupirocin, tetracycline, trimethoprim and cadmium. The isolates were compared by pulsed-field gel electrophoresis with methicillin-resistant S. aureus (MRSA) previously isolated from the Kimberley region in the northern-most part of WA (WA MRSA). The mupirocin-resistant isolates were found to be closely related to WA MRSA suggesting that they were WA MRSA which had acquired a new multiple-resistance plasmid encoding high-level mupirocin resistance.

Topics: Cadmium; Conjugation, Genetic; Deoxyribonuclease EcoRI; DNA, Bacterial; Drug Resistance, Microbial; Humans; Methicillin Resistance; Mupirocin; R Factors; Staphylococcal Infections; Staphylococcus aureus; Tetracycline Resistance; Trimethoprim Resistance; Western Australia

Staphylococcus aureus strains resistant to mupirocin (MIC > 4000 mg l-1) were recovered from children and staff at a school for children with eczema and/or asthma or cystic fibrosis after mupirocin had been used to treat eczematous lesions. At least three distinct strains of S. aureus were involved and resistance was shown to be due in most isolates to a transmissible plasmid. The need for monitoring the extended use of this valuable antibiotic is emphasized.

Topics: Adolescent; Asthma; Bacteriophage Typing; Carrier State; Child; Cystic Fibrosis; Drug Resistance, Microbial; Eczema; Female; Humans; Male; Mupirocin; Plasmids; Schools; Staphylococcal Infections; Staphylococcus aureus; Tetracycline

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

Three hundred isolates of Staphylococcus aureus from wound swabs were examined for the production of toxic shock syndrome toxin 1 (TSST-1). The isolates were collected from community patients, surgical inpatients and from patients in the Regional Burns Unit, Booth Hall Children's Hospital, Manchester. The overall incidence of toxin production was 17% and there was no significant variation between the sources of the strains. All 55 TSST-1-producing strains were grown in sublethal concentrations of five topical antimicrobial compounds and the level of toxin produced was determined and compared with the amount produced in a control broth after incubation for 24 h. The effects of sublethal concentrations of the compounds on TSST-1 production were strain dependent; some compounds tended to increase production (at least four-fold) and some tended to decrease production (at least four-fold). Some of the strains showed an increase in toxin production in the presence of chlorhexidine gluconate/cetrimide solution and silver sulphadiazine cream whereas 18%, 42% and 47% of the strains showed a decrease in toxin production in the presence of povidone iodine solution, stabilised hydrogen peroxide cream and mupirocin ointment, respectively. Preliminary results suggest that silver sulphadiazine cream induces toxin formation earlier in the growth cycle.

Topics: Anti-Infective Agents, Local; Bacterial Toxins; Cetrimonium; Cetrimonium Compounds; Chlorhexidine; Colony Count, Microbial; Enterotoxins; Humans; Hydrogen Peroxide; Mupirocin; Povidone-Iodine; Shock, Septic; Silver Sulfadiazine; Staphylococcal Infections; Staphylococcus aureus; Superantigens

Mupirocin resistance was determined in consecutive oxacillin-resistant and borderline oxacillin-resistant Staphylococcus aureus clinical isolates collected over 14 months at a university hospital during 1991 and 1992. Twenty of 86 (23%) oxacillin-resistant and borderline oxacillin-resistant S. aureus isolates were mupirocin resistant; 80% were high-level resistant. Prior mupirocin use was a significant risk factor (relative risk, 6.08; 95% confidence interval, 3.7 to 9.99). Seven of 20 resistant isolates were distinct strains, as determined by pulsed-field gel electrophoresis typing. Two instances of clonal dissemination of a single strain occurred, but several other distinct mupirocin-resistant strains were documented. Mupirocin resistance was unexpectedly common among these isolates.

Topics: DNA, Bacterial; Drug Resistance, Microbial; Hospitals, University; Humans; Mupirocin; Oxacillin; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; United States

Topics: Drug Resistance, Microbial; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Population Surveillance; Staphylococcal Infections; Staphylococcus aureus; Western Australia

Following the introduction in 1988 of a regimen of selective decontamination of the digestive tract (SDD) for extensively injured patients in our burns centre, colonization rates with Gram-negative organisms declined significantly, but colonization with Staphylococcus aureus was unaffected. In an effort to reduce staphylococcal colonization, the SDD regimen has been supplemented with intranasal mupirocin since 1991. In this paper, 33 consecutive patients with burns of > 30 per cent TBSA who were treated with the supplemental regimen (SDD + M) in 1991 and 1992, were compared with 34 consecutive patients admitted in the previous 2 years who were treated with SDD only. Staph. aureus colonization of wounds, sputum and gastric aspirates was significantly reduced in the SDD + M group. Gram-negative colonization rates and the incidence of clinical infections remained low in both groups. Our experience suggests that decontamination of endogenous bacterial reservoirs, in combination with isolation measures to prevent exogenous colonization, effectively prevents infectious complications in patients with severe burns.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Burns; Child; Child, Preschool; Digestive System; Drug Therapy, Combination; Female; Humans; Infant; Male; Middle Aged; Mupirocin; Ointments; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Topics: Disease Outbreaks; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Nasal Mucosa; Staphylococcal Infections; Staphylococcus aureus

To describe the spectrum of clinical infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers.. Case series.. Two Veterans Affairs hospitals in which methicillin-resistant S aureus (MRSA) is endemic.. Five employees presenting to employee health or infectious disease clinic.. All employees had had direct exposure to patients colonized with MRSA. Employee infections included cellulitis, impetigo, folliculitis, paronychia, and conjunctivitis. MRSA was isolated from all clinically infected sites and from the anterior nares of two employees. Three employees received a variety of ineffective oral antimicrobials before MRSA was recognized as the causative agent. All infections responded to appropriate therapy.. Employees of hospitals with endemic MRSA may acquire MRSA infection. Presentation in our employees was that of relatively uncomplicated soft tissue infection, but several employees received inappropriate therapy before bacteriologic diagnosis. We recommend that culture and susceptibility testing be obtained prior to institution of therapy when hospital employees present with soft tissue infection.

Topics: Adult; Female; Hospitals, Veterans; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Pennsylvania; Personnel, Hospital; Rifampin; Staphylococcal Infections; Staphylococcus aureus

We present the clinical results of a prospective protocol of the treatment of Staphylococcus aureus nasal carriers (SANCs) in our continuous ambulatory peritoneal dialysis unit with mupirocin (Bactroban, SmithKline Beecham Pharmaceuticals, Philadelphia, PA). We monitored the incidence of peritonitis and catheter exit-site infection, the rate of infection-related catheter loss, and the degree of association between SANC state and S aureus infection. The study group included 94 patients with a follow-up of 1,097 patient-months (phase B). The same information was retrospectively collected among 74 continuous ambulatory peritoneal dialysis patients treated during the 24 months preceding the study period (follow-up of 1,043 patient-months) (phase A). S aureus nasal carriage was observed in 47.5% of the patients. Mupirocin was very effective in eradicating S aureus from the nares, but most patients required periodic retreatment. The incidence of S aureus peritonitis decreased from 1 episode/58 patient-months in phase A to 1 episode/548 patient-months in phase B, and the incidence of exit-site infection decreased from one episode/55 patient-months in phase A to 1 episode/137 patient-months in phase B. However, there was a simultaneous increase in the incidence of infections by other gram-positive and -negative bacteria. The rate of catheter loss after peritonitis (P = not significant) or exit-site infection (P < 0.05) tended to decrease from phase A to phase B. Seventy-seven percent of the peritonitis infections and 74% of the exit-site infections by S aureus occurred in SANCs.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Intranasal; Adult; Aged; Carrier State; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Staphylococcal Infections

Fourteen mupirocin-resistant Staphylococcus aureus strains were isolated over 18 months; 12 exhibited low-level resistance, while two showed high-level resistance. Highly mupirocin-resistant strains contained a large plasmid which transferred mupirocin resistance to other S. aureus strains and to Staphylococcus epidermidis. This plasmid and pAM899-1, a self-transferable gentamicin resistance plasmid, have molecular and biologic similarities.

Topics: Conjugation, Genetic; DNA, Bacterial; Drug Resistance, Microbial; Electrophoresis, Polyacrylamide Gel; Humans; Microbial Sensitivity Tests; Mupirocin; Phenotype; Plasmids; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis

To investigate a cluster of mupirocin-resistant Staphylococcus aureus on a dermatology ward.. An outbreak of mupirocin-resistant S aureus was noted on the dermatology ward during a prospective epidemiologic study of methicillin-resistant S aureus (MRSA) and borderline methicillin-susceptible S aureus (BMSSA). Pulsed-field gel electrophoresis (PFGE) of whole-cell DNA digested with Sma I was used as a marker of strain identity.. An 850-bed university hospital with a 12-bed inpatient dermatology ward. Most patients have severe, exfoliating dermatologic disorders.. MRSA or BMSSA were isolated from 13 patients on the dermatology ward over a 14-month period. Eleven of these isolates (84.6%) were mupirocin-resistant. Nine isolates were present on admission (81.8%); 8 of these patients had been hospitalized on the same ward within the last two months. Nasal and hand cultures from 36 personnel were negative for mupirocin-resistant MRSA or BMSSA. Extensive environmental culturing revealed that a blood pressure cuff and the patients' communal shower were positive for mupirocin-resistant BMSSA. PFGE of all mupirocin-resistant isolates demonstrated that the nine patients and both environmental sources had identical DNA typing patterns.. Changing of blood pressure cuffs between patients and more stringent cleaning of communal areas was initiated. Repeat environmental cultures were negative.. S aureus is not usually associated with an environmental reservoir; however, these patients all had severe desquamation, which may have prolonged environmental contamination.

Topics: Blood Pressure Determination; Connecticut; Cross Infection; Dermatology; Disease Outbreaks; Disease Reservoirs; Drug Resistance, Microbial; Equipment Contamination; Hospital Units; Hospitals, University; Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Topics: Germany; Humans; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus

The incidence of S. aureus bacteraemia in a haemodialysis unit was studied over 2 years (167.75 patient-years of follow-up) during which nasal calcium mupirocin was used to eradicate nasal S. aureus carriage; this incidence was compared to that previously observed in the same unit before the use of nasal mupirocin (185.8 patient-years). Nasal mupirocin led to eradication of nasal S. aureus carriage in 96.3% of surveillance cultures and to a fourfold reduction in the incidence of S. aureus bacteraemia per patient-year, from 0.097 before mupirocin to 0.024 with mupirocin use (P = 0.008). Once or thrice weekly maintenance regimens of mupirocin were equally efficacious. The incidence of bacteraemia caused by other micro-organisms was not significantly affected. One single mupirocin-resistant isolate was identified in a nasal surveillance culture. Eradication of S. aureus from the nares did not lead to overgrowth by other micro-organisms. Chemoprophylaxis with nasal mupirocin in haemodialysis patients is cost-effective.

Topics: Administration, Intranasal; Adult; Aged; Bacteremia; Carrier State; Cost-Benefit Analysis; Humans; Middle Aged; Mupirocin; Nose; Ointments; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Topics: Carrier State; Catheters, Indwelling; Humans; Infections; Mupirocin; Nasal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topics: Cross Infection; Humans; Infection Control; Mupirocin; Staphylococcal Infections

Topics: Drug Resistance, Microbial; Female; Humans; Male; Mupirocin; New Zealand; Staphylococcal Infections; Staphylococcus aureus

Topics: Drug Resistance, Microbial; Humans; Mupirocin; Species Specificity; Staphylococcal Infections; Staphylococcus aureus

Topics: Carrier State; Coagulase; Cross Infection; Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Topics: Bacitracin; Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

The evaluation of health care workers role in methicillin-resistant Staphylococcus aureus outbreaks and the efficacy of mupirocin as a topical agent for nasal carriers.. Microbiologic study of nasal microflora of 1547 health care workers from the San Carlos University Hospital and 108 health care workers from related hospitals while an outbreak of methicillin-resistant Staphylococcus aureus nosocomial infections is in progress at San Carlos University Hospital. Assessment of the efficacy of mupirocin nasal ointment for nasal carriers using microbiologic controls of nasal and pharyngeal swabs at the end of treatment and two weeks after.. In San Carlos University Hospital a total of 53 health care workers with nasal carriage of methicillin-resistant Staphylococcus aureus were found. That figure represents a 3.4% of all health care workers studied and also a 15.4% of methicillin-resistance among all S. aureus isolated. Among health care workers from related hospitals, only one nasal carrier was found. Forty-seven of all 53 methicillin-resistant Staphylococcus aureus isolated from San Carlos University Hospital health care workers and the strain isolated from the related hospitals health care worker were similar to the epidemic strain responsible for the outbreak. Mupirocin, as nasal ointment, was useful in eliminating nasal colonization in all cases.. When a nosocomial outbreak of methicillin-resistant Staphylococcus aureus infections is detected, health care workers are one of the most important reservoirs. Topical treatment with mupirocin (nasal ointment) is useful for eliminating the nasal carrier status.

Topics: Administration, Intranasal; Carrier State; Cross Infection; Disease Outbreaks; Hospitals, University; Methicillin; Methicillin Resistance; Mupirocin; Nasal Cavity; Ointments; Personnel, Hospital; Spain; Staphylococcal Infections; Staphylococcus aureus

Staphylococci are still a leading cause of hospital infection. The success of nasal mupirocin for the control of epidemic methicillin-resistant Staphylococcus aureus (EMRSA), the prevention of colonization of central venous cannulae, and the prevention of septicaemia in haemodialysis patients should encourage the use of minimal dose regimens to minimize the emergence of mupirocin resistance. Mupirocin applied to the anterior nares 4-times daily usually eliminates S. aureus, including EMRSA, within 48 h. Elimination is sustained for several weeks in patients and staff. We recently found that a single dose, or a regimen of 4-times daily for 2 days, eliminated nasal carriage of S. aureus within 24 h; 7 days after a single dose, 92% of the subjects were still cleared; 7 days after the 2-day course, 96% remained free of nasal S. aureus. Ward personnel who are nasal carriers of EMRSA can, provided that other carriage sites are negative, return to work after 2 days of a 4-times daily intranasal regimen. The UK guidelines, recently published in this Journal, recommend an aggressive approach to identifying and eliminating EMRSA, including the elimination of nasal carriage. This approach is increasingly associated with the control of EMRSA in the UK and elsewhere.

Topics: Administration, Intranasal; Carrier State; Cross Infection; Dose-Response Relationship, Drug; Humans; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Nasal carriage of Staphylococcus aureus is a risk factor for the development of infections caused by S. aureus in haemodialysis patients. This study compared the incidence of bacteraemia caused by S. aureus during 6 months of use of nasal 2% calcium mupirocin ('Nasal Bactroban') 3-times a week for nasal carriers with the incidence observed previously in the same dialysis unit without the use of mupirocin. Nasal mupirocin led to the total eradication of nasal carriage of S. aureus, a 4.26-fold reduction in the incidence of S. aureus bacteraemia, and a substantial cost saving. After a cumulative experience of nasal mupirocin in haemodialysis patients of more than 43 patient-years, the development of mupirocin resistance was not observed.

Topics: Administration, Intranasal; Adult; Aged; Bacteremia; Cost-Benefit Analysis; Cross Infection; Humans; Middle Aged; Mupirocin; Prospective Studies; Renal Dialysis; Staphylococcal Infections

In an open, non-comparative clinical study conducted at 102 hospitals in the UK and Ireland, 1,510 subjects were treated with 2% calcium mupirocin in a white soft paraffin/Softisan 649 base (Bactroban 'Nasal') during hospital outbreaks of methicillin-resistant Staphylococcus aureus (MRSA). In most subjects treatment was applied two or three times daily to both anterior nares for three to eight days. Of the 766 assessable subjects, nasal carriage of S aureus was cleared in 744 (97.1%). Initially, MRSA was present in 628 cases (79.4%), and the organism was eliminated in 609 of these (97.0%). Isolates of S aureus were tested for susceptibility to a variety of antibiotics by disc test: of 523 nasal isolates tested against mupirocin, 516 (98.7%) were sensitive. Treatment was very well tolerated. Adverse events were reported by 22 subjects (1.5%); these were mostly mild local effects and necessitated withdrawal of treatment only in three subjects. The results indicate that topical calcium mupirocin is a highly effective and well tolerated treatment for the eradications of nasal carriage of S aureus, including MRSA.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carrier State; Child; Child, Preschool; Cross Infection; Female; Humans; Infant; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose Diseases; Staphylococcal Infections

We report the case of a 54-year-old, quadriplegic woman with a methicillin-resistant Staphylococcus aureus (MRSA) vaginal infection. After failing a five-day course of intravenous vancomycin therapy, the patient was treated for ten days with mupirocin ointment applied intravaginally twice daily, which resulted in eradication of the infection. This report details a novel approach in treating MRSA vaginal infections.

Topics: Administration, Intravaginal; Female; Humans; Methicillin Resistance; Middle Aged; Mupirocin; Ointments; Quadriplegia; Staphylococcal Infections; Vaginosis, Bacterial

In an attempt to control the spread of methicillin-resistant Staphylococcus aureus (MRSA) within a spinal cord injury unit, we investigated the mode of transmission and implemented a multidisciplinary approach for control that consisted of grouping of patients into cohorts, contact isolation, and antibiotics. Surveillance cultures of patients and nose and hand cultures of medical personnel were performed. Of 11 colonized patients, 6 had MRSA isolates that shared a similar plasmid profile and antibiogram, raising the possibility of interpatient spread of the organism. Medical personnel had no evident role in transmitting MRSA. All patients' pretherapy MRSA isolates were susceptible to minocycline and, except for one, to rifampin. Time-kill studies showed an indifferent interaction of these two antibiotics. Ten colonized patients received a 2-week oral course of 100 mg of minocycline twice daily and 600 mg of rifampin once daily, while the 11th patient was treated for only 1 week. Patients with colonization of the nares also had twice daily nasal application of 2% mupirocin for 5 days. Colonization with MRSA cleared in 10 of 11 patients (91%) and 20 of 21 sites (95%). When the individual circumstances of a medical facility justify eradication of MRSA colonization, a multidisciplinary approach that includes antibiotic therapy with oral minocycline and rifampin, along with topical mupirocin for those with nasal carriage, may be successful.

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Cross Infection; Drug Therapy, Combination; Humans; Infection Control; Methicillin Resistance; Microbial Sensitivity Tests; Minocycline; Mupirocin; Plasmids; Rifampin; Staphylococcal Infections; Staphylococcus aureus

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred in two adjacent orthopaedic wards following the admission of a known carrier. The outbreak was not contained by ward closure or by standard infection control measures. Eventually several nasal carriers were identified and treated with nasal mupirocin, following which the outbreak ended.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Cross Infection; Disinfection; England; Fatty Acids; Female; Hospital Units; Humans; Male; Methicillin; Mupirocin; Orthopedics; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Topical; Anti-Bacterial Agents; Drug Resistance, Microbial; Fatty Acids; Humans; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Time Factors

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Fatty Acids; Humans; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Recent reports have emphasized an increase in both infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) in institutionalized older patients. We studied whether or not local treatment with mupirocin ointment could eliminate nasal colonization with S aureus. A total of 102 patients in a Veterans Administration nursing home were screened for S aureus nasal colonization. Thirty-nine patients (38.2%) were colonized, 18 with methicillin-sensitive Saureus (MSSA) and 21 with MRSA. Almost half of all colonized patients were in the most dependent functional category and there was a significant association of MRSA colonization, but not MSSA colonization, with poor functional status. Colonized patients were treated with mupirocin ointment applied to the anterior nares twice daily for seven days. After treatment, MSSA persisted in only two patients and MRSA in only one patient; thus, nasal colonization was eliminated in 91.4% of colonized patients. At one month and two months follow-up, 11 patients became transiently recolonized and three became persistently recolonized with S aureus. Mupirocin was well tolerated with no side effects noted. Mupirocin ointment may be useful in controlling nasal colonization with S aureus in the nursing home setting.

Topics: Activities of Daily Living; Administration, Topical; Aged; Anti-Bacterial Agents; Carrier State; Drug Resistance, Microbial; Fatty Acids; Homes for the Aged; Humans; Mupirocin; Nose; Nursing Homes; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Topical; Anti-Bacterial Agents; Fatty Acids; Humans; Mupirocin; Nose; Ointments; Staphylococcal Infections

Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Female; Methicillin Resistance; Mice; Mice, Inbred Strains; Mupirocin; Ointments; Staphylococcal Infections; Wound Infection

The spread of two strains of Staphylococcus aureus with high level resistance to mupirocin is described. The resistance proved to be easily transferred to other S. aureus strains by filter mating experiments and on the skin of mice. No plasmid band corresponding to the resistance could be demonstrated by agarose gel electrophoresis or by caesium chloride gradient centrifugation but cleavage of 'chromosomal' DNA from resistant recipients showed bright bands of DNA absent from sensitive controls.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Dermatology; Disease Outbreaks; Drug Resistance, Microbial; Fatty Acids; Hospital Departments; Humans; Microbial Sensitivity Tests; Mupirocin; Prospective Studies; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

Colonization of a patient by methicillin-resistant Staphylococcus aureus (MRSA) of a single phage-type for over four years is described. During this period we observed the appearance and disappearance of resistance to erythromycin, clindamycin, gentamicin, kanamycin, tobramycin, neomycin and mupirocin. We also saw stepwise increases in methicillin resistance and reversible changes in physical appearance and the colonizer pathogen role. Correlation of clinical observations, details of antibiotic therapy and laboratory studies demonstrated that adaptation of MRSA during antibiotic therapy favoured MRSA establishment and predominance.

Topics: Anti-Bacterial Agents; Bacteriophage Typing; beta-Lactamases; Child; Fatty Acids; Humans; Male; Methicillin; Microbial Sensitivity Tests; Mupirocin; Mutation; Penicillin Resistance; Plasmids; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus strains (MRSA) have become increasingly prevalent as nosocomial pathogens, especially in burn wounds. MRSA constituted 38% of all S. aureus isolates in our 25-bed burns unit despite the utilization of a combination of 1% silver sulfadiazine and 0.2% chlorhexidine as topical therapy. Mupirocin, a new antibiotic, has proved in vitro and in vivo to be highly effective in the treatment of MRSA infections. A prospective clinical trial with mupirocin ointment in MRSA burn wound infection was untertaken. Forty-five children with 59 discrete burn wounds and from whom MRSA were isolated were treated with 2% mupirocin ointment under occlusive dressings, applied twice daily for 5 days. The average burned area treated was 8% (range, 2 to 20%) of the total body surface area. The burn wounds were assessed clinically and bacteriologically daily. Mupirocin eliminated MRSA in all 59 wounds treated, with the maximum therapeutic response seen within 4 days. In three wounds, gram-negative organisms persisted after 5 days of topical therapy. Treatment was well tolerated by all children. We recommend that mupirocin in its present polyethylene glycol base should be used only on a selective basis, when current prophylactic topical therapy has failed to control MRSA infection in burns of less than 20% of the total body surface area, and that it should be applied only for a limited period of 5 days. The safety and the efficacy of mupirocin in burns exceeding 20% of the total body surface area need to be established.

Topics: Anti-Bacterial Agents; Burns; Child; Child, Preschool; Fatty Acids; Female; Humans; Infant; Male; Methicillin; Mupirocin; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Wound Infection

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Fatty Acids; Humans; Mupirocin; Nose Diseases; Staphylococcal Infections; Time Factors

2% mupirocin ointment applied intra-nasally for 5 days was assessed for elimination of nasal carriage of Staphylococcus aureus in 31 staff members in a children's hospital. Three volunteers failed to complete the trial because of side effects, i.e. buccal reddening and swelling, and unpleasant taste. During treatment staphylococcal nasal carriage was not found in any case; of the 24 post-treatment nasal swabs taken 4 days after treatment 22 were still negative. Re-colonization with S. aureus of different phage types occurred in the remaining two cases.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Child; Cross Infection; Fatty Acids; Female; Hospitalization; Humans; Male; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

An outbreak with a strain of methicillin-resistant Staphylococcus aureus began in The London Hospital in 1982 and continues to be associated with significant morbidity and mortality. This particular strain, termed epidemic methicillin-resistant S. aureus, is recognized by its characteristic antibiogram, phage-type and plasmid profile. In this outbreak various means of control have been attempted. Sideroom isolation did not curtail spread of the organism and containment was only achieved with the combination of extended screening, mupirocin for treatment of carriage and the use of an isolation ward.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Fatty Acids; Hospitals, Teaching; Humans; London; Methicillin; Mupirocin; Patient Isolation; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Child, Preschool; Dermatitis, Atopic; Fatty Acids; Humans; Male; Mupirocin; Ointments; Penicillin Resistance; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus

During a hospital outbreak of methicillin-resistant Staphylococcus aureus (MRSA), involving more than 200 patients, 40 patients and 32 hospital staff who were stable nasal carriers of MRSA received topical application of 2% mupirocin, formulated in a white soft paraffin and lanolin ointment, to their anterior nares for five days. Nasal carriage was eliminated in all patients and staff, usually within the first 48 h of treatment. Of the 40 patients, 36 remained clear of nasal MRSA for the duration of their follow-up (mean = 2 weeks) and four became re-colonized one to five weeks after their course. Immediately after the course, the number of patients with MRSA isolated from wounds and wrists fell from 16 to 7, and from 16 to 3, respectively. Of the 32 staff, all were negative one week after the course, and of the 22 still available for follow-up at eight weeks, all were consistently negative (mean period of follow-up = 7.8, range = 1-20 weeks). Four patients and five staff were re-colonized with MRSA between one to five, and two to twelve weeks, respectively, after treatment. Overall, in the post-treatment follow-up, 98.6% of the staff-weeks and 90.1% of the patient-weeks were free of nasal MRSA. MICs of mupirocin for both pre and post treatment isolates were all 0.03 or 0.06 mg/l. The elimination of nasal MRSA by mupirocin, and the introduction of isolation facilities, were associated with the control of the outbreak.

Topics: Adult; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Fatty Acids; Follow-Up Studies; Humans; Methicillin; Mupirocin; Nasal Cavity; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Fatty Acids; Female; Humans; Mupirocin; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus

This report deals with the problems associated with a high incidence rate of methicillin-resistant Staphylococcus aureus in low birth weight infants in a regional special care baby unit. Strict isolation facilities were not used and the outbreak was promptly brought under control by the use of intensive traditional methods of infection control and the use of topical mupirocin in a paraffin base.

Topics: Administration, Topical; Anti-Bacterial Agents; Cross Infection; Disease Outbreaks; Fatty Acids; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Intensive Care Units, Neonatal; Methicillin; Microbial Sensitivity Tests; Mupirocin; Ointments; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Cross Infection; Disease Reservoirs; Fatty Acids; Humans; Methicillin; Mupirocin; Patient Isolation; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Transportation of Patients

Topics: Carrier State; Cross Infection; Disease Outbreaks; Fatty Acids; Humans; Methicillin; Mupirocin; Nasal Cavity; Penicillin Resistance; Perineum; Personnel, Hospital; Skin; Staphylococcal Infections; Staphylococcus aureus

The efficacy of topically-applied mupirocin was evaluated against an experimental surgical staphylococcal wound infection in the guinea-pig. A suture impregnated with Staphylococcus aureus was inserted into a superficial wound, and topical therapy with mupirocin ointment was started 24 h after infection. In non-treated wounds, the bacterial counts increased to greater than 10(6) organisms/wound in the majority of animals at 24 h, remaining at this level for up to seven days. Therapy with placebo ointment (polyethylene glycol base) was ineffective, whereas twice daily application of mupirocin ointment resulted in elimination of the staphylococci. Mupirocin was as effective as topically-applied fusidic acid cream in reducing the bacterial counts of infected wounds.

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Fatty Acids; Female; Guinea Pigs; Mupirocin; Staphylococcal Infections; Surgical Wound Infection; Time Factors

A preliminary trial is reported studying the effectiveness of pseudomonic acid in primary superficial skin infections in 20 patients. Staphylococcus aureus was isolated in 18 patients and beta-haemolytic streptococci group A in two. Only on one occasion was a pathogenic organism, Staph. aureus, isolated post-treatment and clinical cure or improvement was achieved in 19/20 (95%) of patients. All isolates were found to have pseudomonic acid MICs of between 0.06 and 0.25 mg/l.

Topics: Administration, Topical; Anti-Bacterial Agents; Fatty Acids; Humans; Mupirocin; Skin Diseases, Infectious; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Carrier State; Fatty Acids; Gentamicins; Humans; Methicillin; Mupirocin; Nose; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Fatty Acids; Humans; Methicillin; Mupirocin; Penicillin Resistance; Staphylococcal Infections