Mupirocin for Controlling Methicillin-ResistantStaphylococcus Aureus: Lessons From a Decade of Use at a University Hospital

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Abstract
Background: From 1990 to 1995 at Hospital Universitario dementino Fraga Filho, patients colonized or infected with methicillin-resistantStaphylococcus aureus(MRSA) were treated with mupirocin to eliminate MRSA carriage. In 1995, 65% of MRSA patients at this hospital had mupirocin-resistant isolates. Starting in 1996, mupirocin use was restricted to patients colonized, but not infected, with MRSA.Objectives: To describe the use of mupirocin for controlling MRSA over a decade and to analyze the molecular epidemiology of mupirocin-resistant MRSA infections at this hospital.Setting: A 490-bed, tertiary-care university hospital.Methods: The incidence densities of patients with MRSA and acquisition of mupirocin by the hospital were calculated for the period 1992–2001.S. aureusisolates from 1999–2000 were analyzed by pulsed-field gel electrophoresis. Mupirocin-resistant MRSA isolates from 1994–1995 and 1999–2000 were analyzed forileS-2gene background polymorphisms.Results: The incidence density of MRSA patients increased slightly over time, whereas the purchase of mupirocin decreased dramatically. Mupirocin-resistant MRSA infections decreased from 65% in 1994–1995 to 15% in 1999–2000. The MRSA Brazilian clone, detected in 1992, was still highly prevalent. The sameileS-2 encoding plasmid found in 1994–1995 persisted in three identical MRSA isolates from 1999–2000 belonging to the Brazilian clone.Conclusions: After mupirocin use decreased, theileS-2 encoding plasmid persisted in only a few Brazilian clone isolates. Our data on mupirocin-resistant MRSA incidence and mupirocin use strongly suggested that restricted use was related to decreased rates of mupirocin resistance at our hospital. (Infect Control Hosp Epidemiol 2005;26:662-667)

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