Sustained Reduction in Methicillin-Resistant Staphylococcus aureus Wound Infections After Cardiothoracic Surgery

Walsh, Edward E.; Greene, Linda; Kirshner, Ronald L.

doi:10.1001/archinternmed.2010.326

Cited by 70 publications

(65 citation statements)

References 21 publications

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“…Indeed, mupirocin-mediated nasal decolonization has been shown to be effective in reducing infections in burn wound, dialysis, and surgical patient populations, as well as S. aureus transmission among health care workers and intensive care unit patients (15)(16)(17)(18)(19)(20)(21). In addition to nasal decolonization, topical mupirocin has been used to successfully treat hemodialysis central venous catheter exit sites, impetigo, eczema, surgical wound sites, skin and soft tissue wounds, the breasts of breast-feeding mothers, and tympanic membrane lesions (22)(23)(24)(25)(26)(27). However, the emergence of S. aureus mupirocin resistance has reduced the agent's efficacy both as a nasal decolonization agent and as a treatment option for skin and wound infections.…”

mentioning

confidence: 99%

Neomycin Sulfate Improves the Antimicrobial Activity of Mupirocin-Based Antibacterial Ointments

Blanchard

Brooks

Beckley

et al. 2016

Antimicrob Agents Chemother

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In the midst of the current antimicrobial pipeline void, alternative approaches are needed to reduce the incidence of infection and decrease reliance on last-resort antibiotics for the therapeutic intervention of bacterial pathogens. In that regard, mupirocin ointment-based decolonization and wound maintenance practices have proven effective in reducing Staphylococcus aureus transmission and mitigating invasive disease. However, the emergence of mupirocin-resistant strains has compromised the agent's efficacy, necessitating new strategies for the prevention of staphylococcal infections. Herein, we set out to improve the performance of mupirocin-based ointments. A screen of a Food and Drug Administration (FDA)-approved drug library revealed that the antibiotic neomycin sulfate potentiates the antimicrobial activity of mupirocin, whereas other library antibiotics did not. Preliminary mechanism of action studies indicate that neomycin's potentiating activity may be mediated by inhibition of the organism's RNase P function, an enzyme that is believed to participate in the tRNA processing pathway immediately upstream of the primary target of mupirocin. The improved antimicrobial activity of neomycin and mupirocin was maintained in ointment formulations and reduced S. aureus bacterial burden in murine models of nasal colonization and wound site infections. Combination therapy improved upon the effects of either agent alone and was effective in the treatment of contemporary methicillin-susceptible, methicillin-resistant, and high-level mupirocin-resistant S. aureus strains. From these perspectives, combination mupirocin-and-neomycin ointments appear to be superior to that of mupirocin alone and warrant further development.

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mentioning

confidence: 99%

Neomycin Sulfate Improves the Antimicrobial Activity of Mupirocin-Based Antibacterial Ointments

Blanchard

Brooks

Beckley

et al. 2016

Antimicrob Agents Chemother

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“…Intranasal use of mupirocin has been shown to be helpful in decreasing nasal colonization with methicillin-resistant S. aureus (MRSA) (19,20) and in decreasing HAIs, including postoperative infections, in select patient populations (21,22). Some centers, however, have reported increasing in vitro resistance to mupirocin when used in closed inpatient populations (23).…”

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confidence: 99%

Clinical and Molecular Features of Decreased Chlorhexidine Susceptibility among Nosocomial Staphylococcus aureus Isolates at Texas Children's Hospital

McNeil

Kok

Vallejo

et al. 2016

Antimicrob Agents Chemother

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One of the strategies utilized to decrease infections in the hospital setting relies on topical antimicrobials and antiseptics. While their use is beneficial, concerns arise over the potential to develop resistance or tolerance to these agents. We examined nosocomial Staphylococcus aureus isolates from 2007 to 2013 for the presence of genes associated with tolerance to chlorhexidine. Isolates and patients were identified from an S. aureus surveillance study at Texas Children's Hospital. Nosocomial S. aureus isolates (those causing infection at >72 h of hospitalization) were identified and underwent PCR for the qacA or qacB (qacA/B) and smr genes associated with elevated minimum bactericidal concentrations of chlorhexidine. Molecular typing with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and agr typing and a review of the medical record were performed. Two hundred forty-seven nosocomial S. aureus infections were identified. Overall, 111 isolates carried one or both genes (44.9%); 33.1% were positive for smr, 22.7% were positive for qacA/B, and 10.9% of the isolates possessed both genes. The smr-positive isolates were more often resistant to methicillin, ciprofloxacin, and/or clindamycin. The isolates positive for qacA/B were more often associated with indwelling central venous catheters and a vancomycin MIC of >2 g/ml. Isolates carrying either smr or qacA/B were associated with a diagnosis of bacteremia. The smr-positive isolates more often belonged to sequence type 8 (ST8) than the isolates that were positive for qacA/B. Mupirocin resistance was detected in 2.8% of the isolates. Antiseptictolerant S. aureus strains are common in our children's hospital and are associated with decreased susceptibility to other systemic antimicrobials and with bloodstream infections. Further work is needed to understand the implications that these organisms have on the hospital environment and antiseptic use in the future.

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“…In one study, it was observed that MRSA infection rates decreased by 93% in cardiac surgical wounds after a program was initiated that not only screened patients, but also included additional interventions such as decolonizing hospital staff who screen positive, providing vancomycin prophylaxis for patients who screen positive, and administering mupirocin calcium nasal ointment for all patients regardless of screening status. 14 Strict implementation of preventive measures such as hand hygiene, monitoring of device utilization and adherence to the bundles for prevention of healthcare associated infection are detrimental in reducing MRSA infection rate. Medical practitioners can play a crucial role in identification and control of MRSA infections by active screening of patients for MRSA, contact isolation of patients, and patients and healthcare staff education.…”

Section: Resultsmentioning

confidence: 99%

Incidence of Methicillin-Resistant Staphylococcus aureus (MRSA) infection among patients and hospital staff and impact of preventive measures in reduction of MRSA infection rate: a prospective observational study

Nadimpalli

Bhamare

Rao

et al. 2016

Int J Basic Clin Pharmacol

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Sustained Reduction in Methicillin-Resistant Staphylococcus aureus Wound Infections After Cardiothoracic Surgery

Abstract: This MRSA intervention program, in which all patients receive intranasal mupirocin and patients colonized with MRSA receive vancomycin prophylaxis, has resulted in a near-complete and sustained elimination of MRSA wound infections after cardiac surgery.

Cited by 70 publications

References 21 publications

Neomycin Sulfate Improves the Antimicrobial Activity of Mupirocin-Based Antibacterial Ointments

Neomycin Sulfate Improves the Antimicrobial Activity of Mupirocin-Based Antibacterial Ointments

Clinical and Molecular Features of Decreased Chlorhexidine Susceptibility among Nosocomial Staphylococcus aureus Isolates at Texas Children's Hospital

Incidence of Methicillin-Resistant Staphylococcus aureus (MRSA) infection among patients and hospital staff and impact of preventive measures in reduction of MRSA infection rate: a prospective observational study

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