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Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit.
Clin Infect Dis. 2007 Sep 01; 45(5):541-7.CI

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

We documented a high rate of mupirocin resistance in MRSA isolates from SICU patients, despite low levels of in-hospital mupirocin use.

Authors+Show Affiliations

Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA. jcjones@im.wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

17682986

Citation

Jones, Jeffrey C., et al. "Mupirocin Resistance in Patients Colonized With Methicillin-resistant Staphylococcus Aureus in a Surgical Intensive Care Unit." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 45, no. 5, 2007, pp. 541-7.
Jones JC, Rogers TJ, Brookmeyer P, et al. Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin Infect Dis. 2007;45(5):541-7.
Jones, J. C., Rogers, T. J., Brookmeyer, P., Dunne, W. M., Storch, G. A., Coopersmith, C. M., Fraser, V. J., & Warren, D. K. (2007). Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 45(5), 541-7.
Jones JC, et al. Mupirocin Resistance in Patients Colonized With Methicillin-resistant Staphylococcus Aureus in a Surgical Intensive Care Unit. Clin Infect Dis. 2007 Sep 1;45(5):541-7. PubMed PMID: 17682986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. AU - Jones,Jeffrey C, AU - Rogers,Theodore J, AU - Brookmeyer,Peter, AU - Dunne,William Michael,Jr AU - Storch,Gregory A, AU - Coopersmith,Craig M, AU - Fraser,Victoria J, AU - Warren,David K, Y1 - 2007/07/13/ PY - 2007/01/18/received PY - 2007/05/23/accepted PY - 2007/8/9/pubmed PY - 2007/9/7/medline PY - 2007/8/9/entrez SP - 541 EP - 7 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 45 IS - 5 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: We documented a high rate of mupirocin resistance in MRSA isolates from SICU patients, despite low levels of in-hospital mupirocin use. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/17682986/Mupirocin_resistance_in_patients_colonized_with_methicillin_resistant_Staphylococcus_aureus_in_a_surgical_intensive_care_unit_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/520663 DB - PRIME DP - Unbound Medicine ER -