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The Epidemiology of Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus at a Veterans' Affairs Hospital

  • Jose E. Vasquez (a1), Elaine S. Walker (a1), Bettylene W. Franzus (a1), Barbara K. Overbay (a1), David R. Reagan (a1) and Felix A. Sarubbi (a1)...



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] ≥4 to 256 μg/mL), and 42% showed high-level mupirocin resistance (MIC ≥512 μg/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.


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.


Corresponding author

Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614


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1. Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725737.
2. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, Standiford, HC, John, JF, Korvick, JA, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313328.
3. Muder, RR, Brennen, C, Wagener, MM, Vickers, RM, Rihs, JD, Hancock, GA et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107112.
4. Spindel, SJ, Strausbaugh, LJ, Jacobson, C. Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a 5-year experience. Infect Control Hosp Epidemiol 1995;16:217223.
5. Meier, PA, Carter, CD, Wallace, SE, Hollis, RJ, Pfaller, MA, Herwaldt, LA. A prolonged outbreak of methicillin-resistant Staphylococcus aureus in the burn unit of a tertiary medical center. Infect Control Hosp Epidemiol 1996;17:798802.
6. Nicolle, LE, Dyck, B, Thompson, G, Roman, S, Kabani, A, Plourde, P, et al. Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 1999;20:202205.
7. Murray-Leisure, KA, Geib, S, Graceley, D, Rubin-Slutsky, AB, Saxena, N, Muller, HA, et al. Control of epidemic methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 1990;11:343350.
8. Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998;27:543550.
9. Reagan, DR, Doebbling, BN, Pfaller, MA, Sheetz, CT, Houston, AK, Hollis, RJ, et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin ointment. Ann Intern Med 1991;114:101106.
10. Bradley, SF. Effectiveness of mupirocin in the control of methicillin-resistant Staphylococcus aureus . Infect Med 1993;10:2331.
11. Kauffman, CA, Terpenning, MS, He, X, Zarins, LT, Ramsey, MA, Jorgensen, KA, et al. Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term-care facility with the use of mupirocin ointment. Am J Med 1993;94:371378.
12. Bradley, SF, Ramsey, MA, Morton, TM, Kauffman, CA. Mupirocin resistance: clinical and molecular epidemiology. Infect Control Hosp Epidemiol 1995;16:354358.
13. Miller, MA, Dascal, A, Portnoy, J, Mendelson, J. Development of mupirocin resistance among methicillin-resistant Staphylococcus aureus after widespread use of nasal mupirocin ointment. Infect Control Hosp Epidemiol 1996;17:811813.
14. Santos, KRN, Fonseca, LS, Filho, PPG. Emergence of high level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated from Brazilian university hospitals. Infect Control Hosp Epidemiol 1996;17:813816.
15. Kavi, J, Andrews, JM, Wise, R. Mupirocin resistant Staphylococcus aureus . Lancet 1987;2:1472.
16. Rahman, M, Noble, WC, Cookson, B. Mupirocin resistant Staphylococcus aureus . Lancet 1987;2:387.
17. Neu, HC. The use of mupirocin in controlling methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 1990;11:1112.
18. Fuchs, PC, Jones, RN, Barry, AL. Interpretive criteria for disk diffusion susceptibility testing of mupirocin, a topical antibiotic. J Clin Microbiol 1990;28:608609.
19. National Committee for Clinical Laboratory Standards. ethods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Approved standard. 4th ed. Vol 17, No. 2. Villanova, PA 1997:M7A4.
20. Gilbart, J, Perry, CR, Slocombe, B. High level mupirocin resistance in Staphylococcus aureus: evidence for two distinct isoleucyl-tRNA synthetases. Antimicrob Agents Chemother 1993;37:3238.
21. Morton, TM, Johnston, JL, Patterson, J, Archer, GL. Characterization of a conjugative staphylococcal mupirocin resistance plasmid. Antimicrob Agents Chemother 1995;39:12721280.
22. Maslow, JN, Slutsky, AM, Arbeit, RD. Application of pulsed-field electrophoresis to molecular epidemiology. In: Persing, DH, Smith, TF, White, TJ, eds. Diagnostic Molecular Microbiology Principles and Practice. Washington, DC: American Society for Microbiology; 1993:563572.
23. Tenover, FC, Arbeit, RD, Goering, RV, Mickelsen, PA, Murray, BE, Persing, DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed field gelelectrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
24. Gaynes, RP, Horan, TC. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA Lippincott Williams & Wilkins; 1999:12961307.
25. Hodgson, JE, Curnock, SP, Dyke, KGH, Morris, R, Sylvester, DR, Gross, MS. Molecular characterization of the gene encoding high-level mupirocin resistance in Staphylococcus aureus J2870. Antimicrob Agents Chemother 1994;38:12051208.
26. Boyce, JM. Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 1991;12:4654.
27. Harbarth, S, Dharan, S, Liassine, N, Herrault, P, Auckenthaler, R, Pittet, D. Randomized, placebo-controlled, double blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 1999;43:14121416.


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