Mupirocin resistance in nasal carriage ofStaphylococcus aureusamong healthcare workers of a tertiary care rural hospital

Abstract

Introduction:Mupirocin (pseudomonic acid A) is a topical antimicrobial agent with excellent antistaphylococcal and antistreptococcal activity. A nasal formulation is approved by the United States Food and Drug Administration for eradicating nasal carriage in adult patients as well as in health care personnel. Resistance to mupirocin has already been reported worldwide. The increasing prevalence of mupirocin resistance among Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) species could be an important threat to the future use of mupirocin against methicillin-resistant S. aureus (MRSA). Thus, this study was carried out to find the prevalence of mupirocin resistance in S. aureus and CoNS by disc diffusion and to determine the rates of high-level and low-level mupirocin resistance in S. aureus and CoNS by disc diffusion.Materials and Methods:A total of 140 healthcare workers (HCWs) (doctor, nursing staff, housekeeping staff) were randomly selected. S. aureus and CoNS isolates were tested for mupirocin resistance by the disk diffusion method using 5 μg and 200 μg mupirocin discs. MRSA isolates were tested for antibiotics by Kirby-Bauer disc-diffusion method as per Clinical and Laboratory Standards Institute guidelines.Results:Out of 140 nasal swabs collected from HCWs, S. aureus was isolated in 38 (27.14%), and CoNS was isolated in 73 (52.14%). MRSA was isolated in 20 (14.28%) and methicillin-resistant coagulase-negative Staphylococci (MRCoNS) in 34 (24.29%. Methicillin-sensitive S. aureus (MSSA) and MSCoNS isolates were 100% sensitive to mupirocin, but two isolates from MRSA (1.43%) and five from MRCoNS (3.57%) were mupirocin resistant.Conclusion:The presence of mupirocin resistance in MRSA and MRCoNS is a cause for concern. It could be limited by regular surveillance and effective infection control initiatives so to inform health care facilities to guide therapeutic and prophylactic use of mupirocin.

Mupirocin Resistance in Isolates of Staphylococcus spp. from Nasal Swabs in a Tertiary Hospital in France

“…This recommendation is further supported by several studies reporting high rates of mupirocin resistance or clonal dissemination of mupirocin-resistant MRSA and CoNS in hospital settings (7). Together, these findings highlight the importance of performing regular sentinel studies in different parts of the world to rapidly identify the emergence and dissemination of mupirocin-resistant staphylococci (7,11,21,22).…”

A Prospective Study Estimating the Mupirocin Resistance in Health Care Providers with MRSA Nasal Carriage in a Tertiary Care Hospital in Rural South India

“…Both of which were similar to the study conducted by Thilakavathy et al, (2015) and Goyal et al, (2002). The highest prevalence was among the nurses from the wards (50%) followed by housekeeping staff (25%) and technologist (25%) which was similar to the study conducted by Thilakavathy et al, (2015), Kaur and Narayan (2014) and Agarwal et al, (2015). Total no of S.aureus isolated 5(2.68%) 13(6.98%) 18(9.68%)…”

“…All the 8 MRSA were Mupirocin sensitive which was similar to study conducted by Kaur and Narayan (2014), Thilakavathy et al, (2015), and Oommen et al, (2010).…”

“…The S. aureus and MRSA colonisation rate is much less compared to other studies (Kaur and Narayan, 2014;Agarwal et al, 2015;Mathanraj et al, 2009) in India which could be because of the low local prevalence of MRSA in rural area, which was estimated to be only 5.03% (MRSA infection rate) in a recent study conducted by Thomas et al, (2016) in the same hospital in 2015-2016. The prevalence was probably more in nurses from the wards as they are the personnel closely associated with infected patients.…”

“…Mupirocin to treat Staphylococcal infections and colonisation has led to the emergence of resistant strains. Mupirocin resistance is categorised into two types: Low-level or intermediate resistance (MupL or MupI), with minimum inhibitory concentration (MICs) of 8-256 μg/ml, and high-level resistance (MupH), with MICs ≥512 μg/ml (Kaur and Narayan, 2014).Various studies have suggested that MupL nasal isolates can be controlled with Mupirocin therapy. Whereas, high-level resistant strains are frequently associated with failure of decolonization (Hudson, 1994;Agarwal et al, 2015).…”