Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects

Abstract

Staphylococcus aureus in the nose is a risk factor for endogenous staphylococcal infection. UK guidelines recommend the use of mupirocin for nasal decolonization in certain groups of patients colonized with methicillin-resistant S. aureus (MRSA). Mupirocin is effective at removing S. aureus from the nose over a few weeks, but relapses are common within several months. There are only a few prospective randomized clinical trials that have been completed with sufficient patients, but those that have been reported suggest that clearance of S. aureus from the nose is beneficial in some patient groups for the reduction in the incidence of nosocomial infections. There is no convincing evidence that mupirocin treatment reduces the incidence of surgical site infection. New antibiotics are needed to decolonize the nose because bacterial resistance to mupirocin is rising, and so it will become less effective. Furthermore, a more bactericidal antibiotic than mupirocin is needed, on the grounds that it might reduce the relapse rate, and so clear the patient of MRSA for a longer period of time than mupirocin.

Descolonização de portadores de Staphylococcus aureus: indicações, vantagens e limitações

“…[10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]33 Nasal mupirocin is considered the best topical agent for the eradication of gram-positive bacteria immediately following the treatment, when the adherence to this protocol is high. 35 As shown in chart 1, 68.8% of the studies that used topical mupirocin for patient decolonization achieved an effective outcome. 12,[14][15][16][19][20]22,25,31,33 Corroborating this result, it is found that topical treatment using mupirocin is indicated by most international health guidelines, including those of the CDC and WHO.…”

“…35 Poor adherence can be avoided by making the nursing team or research professionals accountable for conducting the decolonization, or by establishing a protocol supervision scheme, as reported in many of the analyzed studies.…”

“…41 It is important to highlight that another reason for the contraindication of mupirocin concerns bacterial resistance to this agent, considering that the increase in resistance has a direct relationship to repeated treatments with the same antibiotic. 35 There are two types of mupirocin-resistant Staphylococcus aureus: high-and low-level resistance. Both are related to the failure to completely eradicate the microrganism.…”

“…Both are related to the failure to completely eradicate the microrganism. 35 Furthermore, in cases of resistance to mupirocin, four weeks after the treatment has ended there is a high risk of endogenous re-colonization. 9 Nevertheless, resistance to mupirocin is still considered low (approximately 4.0% in a Canadian hospital), but is steadily increasing: 1.6% between 1995 and 1999 and 7.0% between 2000 and 2004.…”

Therapeutic Potential of Staphylococcal Bacteriophages for Nasal Decolonization of <i>Staphylococcus aureus</i> in Mice

“…In the UK, it is recommended that MRSA carriers who are receiving prophylaxis for an operation should undergo nasal decolonization with mupirocin, the most commonly used antibiotic for Grampositive bacteria [6]. Because nasal relapses are common within several months [7], and mupirocin resistant S. aureus strains have recently been reported [8], alternate treatments are being pursued by various groups.…”