Efficacy of mupirocin in methicillin-resistant Staphylococcus aureus burn wound infection

Abstract

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 undertaken. 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.

Burn Wound Infections

“…Mupirocin (pseudomonic acid A) is a fermentation product of Pseudomonas fluorescens (189,330). This antibiotic has potent inhibitory activity against gram-positive skin flora such as coagulase-negative staphylococci and Staphylococcus aureus, including MRSA (287,366,367,420). Although primarily marketed for nasal decontamination, mupirocin has increasingly been used as a burn wound topical agent in burn units in North America, where MRSA has become a problem (126,287).…”

LL-37-Derived Peptides Eradicate Multidrug-Resistant Staphylococcus aureus from Thermally Wounded Human Skin Equivalents

“…For example, topical antibiotics, like mupirocin (6) and Neosporin (7), are ineffective when resistant bacteria colonize the wound (8,9). Furthermore, these antimicrobials are not effective because bacteria in biofilms can be up to 1,000-fold less sensitive to antibiotics than their planktonic counterparts (10)(11)(12).…”

Randomized double-blinded trial of rifampin with either novobiocin or trimethoprim-sulfamethoxazole against methicillin-resistant Staphylococcus aureus colonization: prevention of antimicrobial resistance and effect of host factors on outcome

“…However, despite the relative efficacy of vancomycin for treating serious MRSA infections, there is a need for reliable and safe oral regimens for those with less serious infections and, in some cases, for the eradication of MRSA colonization in order to reduce the hospital reservoir. A number of local and systemic antimicrobial agents have been used for decolonization; these include trimethoprim-sulfamethoxazole (T/S), rifampin, the combination of these two agents, ciprofloxacin, mupirocin, bacitracin, and hexachlorophene (5,7,8,13,18,21,25,26,36,38,40,41,43,51,55,56). The results of such approaches are variable, and results of carefully controlled randomized studies are seldom available.…”