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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)...

Abstract

Background:

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.

Objectives:

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.

Setting:

A 490-bed, tertiary-care university hospital.

Methods:

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.

Results:

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.

Conclusions:

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)

Copyright

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, Brazil.bmeurera@alternex.com.br

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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