Article

Staphylococcus aureus Mupirocin and Chlorhexidine Resistance in Patients with Community-Onset Skin and Soft Tissue Infections.

From the Departments of Pediatrics.
Antimicrobial Agents and Chemotherapy (Impact Factor: 4.57). 11/2012; 57(1). DOI: 10.1128/AAC.01633-12
Source: PubMed

ABSTRACT Decolonization measures, including mupirocin and chlorhexidine, are often prescribed to prevent Staphylococcus aureus skin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level mupirocin and chlorhexidine resistance in S. aureus strains recovered from patients with SSTI before and after mupirocin and chlorhexidine administration, and to determine whether carriage of a mupirocin- or chlorhexidine-resistant strain at baseline precluded S. aureus eradication. We recruited 1089 patients with community-onset SSTI ± S. aureus colonization. In addition to routine care, 483 patients were enrolled in a decolonization trial: 408 received intranasal mupirocin (with or without antimicrobial baths), and 258 performed chlorhexidine body washes. Patients were followed for up to 12 months with repeat colonization cultures. All S. aureus isolates were tested for high-level mupirocin and chlorhexidine resistance. At baseline, 23/1089 (2.1%) patients carried a mupirocin-resistant S. aureus strain and 10/1089 (0.9%) patients carried chlorhexidine-resistant S. aureus. Of 4 patients prescribed mupirocin who carried a mupirocin-resistant S. aureus strain at baseline, 100% remained colonized at 1 month, compared to 44% of the 324 patients without mupirocin resistance at baseline (p=0.041). Of 2 patients prescribed chlorhexidine who carried a chlorhexidine-resistant S. aureus strain at baseline, 50% remained colonized at 1 month, compared to 48% of the 209 patients without chlorhexidine resistance at baseline (p=1.0). The overall prevalence of mupirocin and chlorhexidine resistance is low in S. aureus isolates recovered from outpatients but eradication efforts were less successful in patients carrying a mupirocin-resistant S. aureus strain at baseline.

1 Bookmark
 · 
167 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to investigate the observation of daptomycin resistance in Corynebacterium striatum, both in vivo and in vitro. We describe a case of C. striatum bacteremia in a patient with a left ventricular assist device (LVAD); the initial isolate recovered was daptomycin susceptible with a minimum inhibitory concentration (MIC) of 0.125 μg/ml. Two months later, and after daptomycin therapy, the individual became bacteremic with an isolate of C. striatum with a daptomycin MIC of >256 μg/ml. To study the prevalence of daptomycin resistance in C. striatum, clinical isolates of C. striatum were grown in broth culture containing daptomycin to investigate the emergence of resistance to this antimicrobial. Molecular typing was used to evaluate serial isolates from the index patient and the clinical isolates of C. striatum we assayed. In vitro analysis of isolates from the index patient and 7 of 11 additional C. striatum isolates exhibited the emergence of high-level daptomycin resistance, despite initially demonstrating low MICs to this antimicrobial agent. This phenotype was persistent even after serial subculture in the absence of daptomycin. Together, these data demonstrate that caution should be taken when using daptomycin to treat high-inoculum infections and/or infections of indwelling medical devices with C. striatum. To our knowledge, this is the first report characterizing the emergence of daptomycin resistance in C. striatum.
    European Journal of Clinical Microbiology 06/2014; 33(12). DOI:10.1007/s10096-014-2188-6 · 2.54 Impact Factor
  • Infection Control and Hospital Epidemiology 09/2014; 35(9):1192-1194. DOI:10.1086/677627 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The REDUCE MRSA Trial (Randomized Evaluation of Decolonization vs Universal Clearance to Eliminate Methicillin-Resistant Staphylococcus aureus), a large multicenter, randomized controlled trial in adult intensive care units (ICUs), found universal decolonization to be more effective than surveillance and isolation procedures with or without targeted decolonization for reducing rates of MRSA-positive clinical cultures. The Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention subsequently published protocols for implementing universal decolonization in ICUs based on the trial's methods. Caution should be exercised before widely adopting these procedures in neonatal intensive care units (NICUs), particularly strategies that involve bathing with chlorhexidine and mupirocin application due to the potential for adverse events in their unique patient population, especially preterm infants. Large multicenter trials in the NICUs are needed to evaluate the efficacy, short- and long-term safety, and cost effectiveness of these strategies prior to their widespread implementation.Journal of Perinatology advance online publication, 10 July 2014; doi:10.1038/jp.2014.125.
    Journal of perinatology: official journal of the California Perinatal Association 07/2014; 34(9). DOI:10.1038/jp.2014.125 · 1.59 Impact Factor

Full-text (2 Sources)

Download
13 Downloads
Available from
Nov 25, 2014