Skip to main content Accessibility help

Mupirocin for Controlling Methicillin-Resistant Staphylococcus Aureus: Lessons From a Decade of Use at a University Hospital

  • Adriana M. Vivoni (a1), Kátia R. N. Santos (a1), Márcia P. de-Oliveira (a2), Marcia Giambiagi-deMarval (a1), Adriana L. P. Ferreira (a2), Lee W. Riley (a3) and Beatriz M. Moreira (a1)...



From 1990 to 1995 at Hospital Universitario dementino 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. (Infect Control Hosp Epidemiol 2005;26:662-667)


Corresponding author

Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Centro de Cièncias Da Saúde, Bloco I, sala 12-28, Cidade Universitária, Rio de Janeiro, RJ 21941-590,


Hide All
1.Boyce, JM, Jackson, MM, Pugliese, G, et al.Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105115.
2.Janssen, DA, Zarins, LT, Schaberg, DR, et al.Detection and characterization of mupirocin resistance in Staphylococcus aureus. Antimicrob Agents Chemother 1993;37:20032006.
3.Udo, EE, Pearman, JW, Grubb, WB. Emergence of high-level mupirocin resistance in methicillin-resistant Staphylococcus aureus in Western Australia. J Hosp Infect 1994;26:157165.
4.Ramos, RL, Teixeira, LA, Ormonde, LR, et al.Emergence of mupirocin resistance in multiresistant Staphylococcus aureus clinical isolates belonging to Brazilian epidemic clone III::B:A. J Med Microbiol 1999;48:303307.
5.Alarcon, T, Sanz, JC, Blanco, F, Domingo, D, Lopez-Brea, M. High-level mupirocin resistance among Spanish methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1998;17:877879.
6.Leski, TA, Gniadkowski, M, Skoczynska, A, et al.Outbreak of mupirocin-resistant staphylococci in a hospital in Warsaw, Poland, due to plasmid transmission and clonal spread of several strains. J Clin Microbiol 1999;37:27812788.
7.Yun, HJ, Lee, SW, Yoon, GM, et al.Prevalence and mechanisms of low-and high-level mupirocin resistance in staphylococci isolated from a Korean hospital. J Antimicrob Chemother 2003;51:619623.
8.Vasquez, JE, Walker, ES, Franzus, BW, et al.The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a Veterans' Affairs hospital. Infect Control Hosp Epidemiol 2000;21:459464.
9.Kauffman, CA, Terpenning, MS, He, X, 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.
10.Walker, ES, Levy, F, Shorman, M, et al.A decline in mupirocin resistance in methicillin-resistant Staphylococcus aureus accompanied administrative control of prescriptions. J Clin Microbiol 2004;42:27922795.
11.Upton, A, Lang, S, Heffernan, H. Mupirocin and Staphylococcus aureus: a recent paradigm of emerging antibiotic resistance. J Antimicrob Chemother 2003;51:613617.
12.Farmer, TH, Gilbart, J, Elson, SW. Biochemical basis of mupirocin resistance in strains of Staphylococcus aureus. J Antimicrob Chemother 1992;30:587596.
13.Udo, EE, Al-Sweih, N, Noronha, BC. A chromosomal location of the mupA gene in Staphylococcus aureus expressing high-level mupirocin resistance. J Antimicrob Chemother 2003;51:12831286.
14.Rahman, M, Noble, WC, Dyke, KG. Probes for the study of mupirocin resistance in staphylococci. J Med Microbiol 1993;39:446449.
15.Woodford, N, Watson, AP, Patel, S, et al.Heterogeneous location of the muph high-level mupirocin resistance gene in Staphylococcus aureus. J Med Microbiol 1998;47:829835.
16.Teixeira, LA, Resende, CA, Ormonde, LR, et al.Geographic spread of epidemic multiresistant Staphylococcus aureus clone in Brazil. J Clin Microbiol 1995;33:24002404.
17.Aires, DS, Miragaia, M, Sanches, IS, et al.Three-year assessment of methicillin-resistant Staphylococcus aureus clones in Latin America from 1996 to 1998. J Clin Microbiol 2001;39:21972205.
18.Bastos, MC, Mondino, PJ, Azevedo, ML, Santos, KR, Giambiagi-deMarval, M. Molecular characterization and transfer among Staphylococcus strains of a plasmid conferring high-level resistance to mupirocin. Eur J Clin Microbiol Infect Dis 1999;18:393398.
19.Netto dos Santos, KR, de Souza, FL, Gontijo Filho, PP. Emergence of high-level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated from Brazilian university hospitals. Infect Control Hosp Epidemiol 1996;17:813816.
20.Santos, KR, Teixeira, LM, Leal, GS, Fonseca, LS, Gontijo Filho, PP. DNA typing of methicillin-resistant Staphylococcus aureus: isolates and factors associated with nosocomial acquisition in two Brazilian university hospitals. J Med Microbiol 1999;48:1723.
21.Oliveira, DC, Tomasz, A, de Lencastre, H. The evolution of pandemic clones of methicillin-resistant Staphylococcus aureus: identification of two ancestral genetic backgrounds and the associated mec elements. Microb Drug Resist 2001;7:349361.
22.National Committee for Clinical Laboratory Standards. Methods far Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, ed. 5. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000. Approved standard M7-A5.
23.Finlay, JE, Miller, LA, Poupard, JA. Interpretive criteria for testing susceptibility of staphylococci to mupirocin. Antimicrob Agents Chemother 1997;41:11371139.
24.Nunes, EL, dos Santos, KR, Mondino, PJ, Bastos, MC, Giambiagi-de Marval, M. Detection of ileS-2 gene encoding mupirocin resistance in methicillin-resistant Staphylococcus aureus by multiplex PCR. Diagn Microbiol Infect Dis 1999;34:7781.
25.Del Vecchio, VG, Petroziello, JM, Gress, MJ, et al.Molecular genotyp-ing of methicillin-resistant Staphylococcus aureus via fluorophore-en-hanced repetitive-sequence PCR. J Clin Microbiol 1995;33:21412144.
26.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
27.Bignardi, GE, Woodford, N, Chapman, A, Johnson, AP, Speller, DC. Detection of the mec-A gene and phenotypic detection of resistance in Staphylococcus aureus isolates with borderline or low-level methicillin resistance. J Antimicrob Chemother 1996;37:5363.
28. Roche Diagnostics, Inc. Roche Applied Science. Indianapolis, IN: Roche Diagnostics, Inc.; 2003 Available at Accessed August 2003.
29.Boyce, JM. Preventing staphylococcal infections by eradicating nasal carriage of Staphylococcus aureus: proceeding with caution. Infect Control Hosp Epidemiol 1996;17:775779.
30.Schmitz, FJ, Lindenlauf, E, Hofmann, B, et al.The prevalence of low-and high-level mupirocin resistance in staphylococci from 19 European hospitals. J Antimicrob Chemother 1998;42:489495.
31.Riley, TV, Carson, CF, Bowman, RA, et al.Mupirocin-resistant methicillin-resistant Staphylococcus aureus in Western Australia. Med J Aust 1994;161:397398.
32.Torvaldsen, S, Roberts, C, Riley, TV. The continuing evolution of methicillin-resistant Staphylococcus aureus in Western Australia. Infect Control Hosp Epidemiol 1999;20:133135.
33.Harbarth, S, Dharan, S, Liassine, N, et al.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.
34.Laupland, KB, Conly, JM. Treatment of Staphylococcus aureus colonization and prophylaxis for infection with topical intranasal mupirocin: an evidence-based review. Clin Infect Dis 2003;37:933938.
35.Chambers, HF. The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis 2001;7:178182.
36.Eguia, JM, Chambers, HF. Community-acquired methicillin-resistant Staphylococcus aureus: epidemiology and potential virulence factors. Curr Infect Dis Rep 2003;5:459466.
37.Vandenesch, F, Naimi, T, Enright, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003;9:978984.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed