Efficacy of Skin and Nasal Povidone-Iodine Preparation against Mupirocin-Resistant Methicillin-Resistant Staphylococcus aureus and S. aureus within the Anterior Nares

Abstract

[BN]) or left untreated. One hour posttreatment, explants were washed with phosphate-buffered saline (PBS) plus 2% mucin. One, 6, or 12 h later, bacteria were recovered and enumerated. Alternatively, following baseline sampling, human subjects applied two consecutive applications of SNP or saline to their anterior nares. One, 6, and 12 h after application of the preparation (postprep), nasal swabs were obtained, and S. aureus was enumerated. We observed that treatment of infected PM or human skin explants with SNP resulted in >2.0 log 10 CFU reduction in MRSA, regardless of mupirocin sensitivity, which was significantly different from the values for BN-and Bet-treated explants and untreated controls 1 h, 6 h, and 12 h after being washed with PBS plus mucin. Swabbing the anterior nares of human subjects with SNP significantly reduced resident S. aureus compared to saline 1, 6, and 12 h postprep. Finally, pretreatment of PM explants with SNP, followed by a mucin rinse prior to infection, completely prevented MRSA infection. We conclude that SNP may be an attractive alternative for reducing the bioburden of anterior nares prior to surgery.

Prevention of periprosthetic joint infection

“…The future for S. aureus decolonisation may be improved by the use of effective iodine or chlorhexidine based agents, that avoid the potential for the emergence of antibiotic resistance, and can be used as a single application. 16 Guidelines: While both the WHO and the CDC provide no recommendations regarding the pre-operative screening for S. aureus, the WHO recommend using mupirocin 2% for treating known nasal carriers (strong recommendation). 6 They do not recommend for or against the use of a chlorhexidene body wash for the purpose of decolonisation.…”

Clinical Issues—September 2017

“…One implementation challenge is monitoring both patient compliance with the mupirocin treatment regimen and patient tolerance of the application 12 . In studies on high‐level mupirocin resistance, widespread use of mupirocin repeatedly applied to wounds (eg, dialysis catheter exit sites, decubitus ulcers) has been associated with mupirocin resistance and treatment failures 2,13 . Deeny et al 14 studied mupirocin resistance in MRSA strains in clinical‐use scenarios and found that the prevalence of mupirocin resistance increased 50% to 75% during universal decolonization and increased 10% during targeted decolonization.…”

“…An alternative to nasal decolonization is the use of an antiseptic such as 5% povidone‐iodine 13,16‐18 or an alcohol‐based antiseptic (eg, 70% ethanol) 19,20 . Use of an antiseptic may be advantageous for universal decolonization because there is less concern for antibiotic resistance.…”

“…12 In studies on high-level mupirocin resistance, widespread use of mupirocin repeatedly applied to wounds (eg, dialysis catheter exit sites, decubitus ulcers) has been associated with mupirocin resistance and treatment failures. 2,13 Deeny et al 14 studied mupirocin resistance in MRSA strains in clinical-use scenarios and found that the prevalence of mupirocin resistance increased 50% to 75% during universal decolonization and increased 10% during targeted decolonization. These researchers urge caution when implementing protocols that promote widespread mupirocin use.…”

“…6 The antimicrobial stewardship team, including microbiology and pharmacy personnel, also should be consulted to assist with the evaluation of local mupirocin and CHG resistance patterns when deciding whether to decolonize patients without active surveillance testing results. 10 An alternative to nasal decolonization is the use of an antiseptic such as 5% povidone-iodine 13,[16][17][18] or an alcohol-based antiseptic (eg, 70% ethanol). 19,20 Use of an antiseptic may be advantageous for universal decolonization because there is less concern for antibiotic resistance.…”