Mupirocin Resistance

Abstract

With increasing pressure to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection, it is possible that there will be increased use of mupirocin for nasal decolonization of MRSA. Understanding the mechanisms, clinical significance, and epidemiology of mupirocin resistance is important for predicting how changes in mupirocin use may affect bacterial populations and MRSA control. High-level mupirocin resistance in S. aureus is mediated by a plasmid-encoded mupA gene. This gene can be found on conjugative plasmids that carry multiple resistance determinants for other classes of antimicrobial agents. High-level resistance has been associated with decolonization failure, and increased resistance rates have been associated with increased mupirocin use. Low-level mupirocin resistance is mediated via mutation in the native ileS gene, and the clinical significance of this resistance is unclear. Laboratory tests to detect and distinguish between these types of resistance have been described but are not widely available in the United States. Institutions that are considering the implementation of widespread mupirocin use should consider these resistance issues and develop strategies to monitor the impact of mupirocin use.

Evolution of Multidrug-ResistantStaphylococcus aureusInfections in Horses and Colonized Personnel in an Equine Clinic Between 2005 and 2010

“…26,38 Additionally, repeated decolonization with mupirocin may select for a mupirocin-resistant MRSA-population. 32 Persistent staphylococci carriage and intermittent staphylococci colonization in humans is well described and occurs in about 30% and 60% of the population, respectively. 21 Intermittently, colonized people are colonized with different S. aureus strains at varying frequencies.…”

Staphylococcus aureus Contamination during Food Preparation, Processing and Handling

“…Although it was reported that the elimination of nasal S. aureus by 63% with mupirocin, the emergence of resistant strains to this antibiotic from infected individuals is possible [28]. The increase of mupirocin resistant S. aureus as an attempt to eliminate methicillin resistant strains [29].…”

“…The increase of mupirocin resistant S. aureus as an attempt to eliminate methicillin resistant strains [29].…”

“…Although it was reported that the elimination of nasal S. aureus by 63% with mupirocin, the emergence of resistant strains to this antibiotic from infected individuals is possible [28]. The increase of mupirocin resistant S. aureus as an attempt to eliminate methicillin resistant strains [29].The aim of this study is to analyze the frequency of infection among food handlers and to relate S. aureus virulence factors, such as SEs, blood hemolysis, DNase and antibiotic resistance to food industries and food handlers. …”

Mechanism of Action of a Membrane-Active Quinoline-Based Antimicrobial on Natural and Model Bacterial Membranes

“…Although the protein synthesis inhibitor mupirocin is currently widely used for anti-MRSA nasal decolonisation, it is not active against non-multiplying persister bacteria which constitute a reservoir for recolonisation [5] . In addition to this, an increased prevalence of mupirocin resistant MRSA [6] has led to the development of more effective alternatives, including the experimental antimicrobials LTX-109 [7] and XF-73 [8] in addition to HT61 [1] .The mode of action of HT61 has not hitherto been thoroughly investigated, however initial cell-based assays showed that HT61 is capable of depolarising the cytoplasmic membrane ofGram positives with further evidence from electron microscopy suggesting that HT61 causes lysis of either the membrane or cell wall [1,4] . The putative membrane-targeting of HT61 may provide some explanation for its potency against non-multiplying MRSA [9] , and suggests that its mechanism of action may be similar to those of other membrane-active antibiotics such as daptomycin [10] , cationic antibiotics such as polymyxins B and E (colistin), gramicidin S [11] and cationic antimicrobials, for example chlorhexidine [12] and ceragenins [13] .…”