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Staphylococcus aureus Nasal Colonization in a Nursing Home: Eradication With Mupirocin

Published online by Cambridge University Press:  21 June 2016

Jean E. Cederna ,
Margaret S. Terpenning ,
Mark Ensberg ,
Suzanne F. Bradley  and
Carol A. Kauffman
Jean E. Cederna
Affiliation:
Divisions of Infectious Diseases and Geriatrics and Department of Internal Medicine, University of Michigan Medical School, and the Veterans Administration Medical Center, Ann Arbor, Michigan
Margaret S. Terpenning
Affiliation:
Divisions of Infectious Diseases and Geriatrics and Department of Internal Medicine, University of Michigan Medical School, and the Veterans Administration Medical Center, Ann Arbor, Michigan
Mark Ensberg
Affiliation:
Divisions of Infectious Diseases and Geriatrics and Department of Internal Medicine, University of Michigan Medical School, and the Veterans Administration Medical Center, Ann Arbor, Michigan
Suzanne F. Bradley
Affiliation:
Divisions of Infectious Diseases and Geriatrics and Department of Internal Medicine, University of Michigan Medical School, and the Veterans Administration Medical Center, Ann Arbor, Michigan
Carol A. Kauffman*
Affiliation:
Divisions of Infectious Diseases and Geriatrics and Department of Internal Medicine, University of Michigan Medical School, and the Veterans Administration Medical Center, Ann Arbor, Michigan
*
Veterans Administration Medical Center, 2215 Fuller Rd., Ann Arbor, Michigan 48105
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Abstract

Recent reports have emphasized an increase in both infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) in institutionalized older patients. We studied whether or not local treatment with mupirocinointment could eliminate nasal colonization with S aureus. A total of 102 patients in a Veterans Administration nursing home were screened for S aureus nasal colonization. Thirty-nine patients (38.2%) were colonized, 18 with methicillin-sensitive Saureus (MSSA) and 21 with MRSA. Almost half of all colonized patients were in the most dependent functional category and there was a significant association of MRSA colonization, but not MSSA colonization, with poor functional status. Colonized patients were treated with mupirocin ointment applied to the anterior nares twice daily for seven days. After treatment, MSSA persisted in only two patients and MRSA in only one patient; thus, nasal colonization was eliminated in 91.4% of colonized patients. At one month and two months follow-up, 11 patients became transiently recolonized and three became persistently recolonized with S aureus. Mupirocin was well tolerated with no side effects noted. Mupirocin ointment may be useful in controlling nasal colonization with S aureus in the nursing home setting.

Type
Original articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 1 , January 1990 , pp. 13 - 16
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

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References

1. Peacock, JE, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med. 1980;93:526–532.CrossRefGoogle Scholar
2. Standiford, HC. Methicillin resistant Staphylococcus aureus infections: it's time to get tough. Infect Control. 1987; 8:187–189.CrossRefGoogle ScholarPubMed
3. Storch, GA, Radcliff, JL, Meyer, PL, Hinrichs, JH. Methicillin resistant Staphylococcus aureus in a nursing home. Infect Control. 1987;8:24–29.CrossRefGoogle ScholarPubMed
4. Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med. 1982;97:309–317.CrossRefGoogle ScholarPubMed
5. Bacon, AE, Jorgensen, KA, Wilson, KH, Kauffman, CA. Emergence of nosocomial methicillin-resistant Staphylococcus aureus and therapy of colonized personnel during a hospital-wide outbreak. Infect Control. 1987;8:145–150.CrossRefGoogle ScholarPubMed
6. Bartzokas, CA, Paton, JH, Gibson, MF, Graham, R, McLoughlin, GA; Croton, RS. Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med. 1984;311:1422–1425.10.1056/NEJM198411293112207CrossRefGoogle ScholarPubMed
7. Hsu, CCS, Macaluso, CP, Special, L, Hubble, RH. High rate of methicillin resistance of Staphyhcoccus aureus isolated from hospitalized nursing home patients. Arch Intern Med. 1988;148:569–570.CrossRefGoogle Scholar
8. Thomas, JC, Bridge, J, Waterman, S, et al. Transmission and control of methicillin resistant Staphylococcus aureus in a skilled nursing facility. Infect Control Hosp Epidemiol. 1989;10:106–110.CrossRefGoogle Scholar
9. Gaynes, RP, Weinstein, RA, Chamberlin, W, Kabins, SA. Antibiotic-resistant flora in nursing home patients admitted to the hospital. Arch Intern Med. 1985;145:1804–1807.CrossRefGoogle ScholarPubMed
10. Ellison, RT, Judson, FN, Peterson, LC, Cohn, DL, Ehret, JM. Oral rifampin and trimethoprim/sulfamethoxazole therapy in asymptomatic carriers of methicillin-resistant Staphylococcus aureus infections. West J Med..1984;140:735–740.Google ScholarPubMed
11. McAnally, TP, Lewis, MR, Brown, DR. Effect of rifampin and bacitracin on nasal carriers of Staphylococcus aureus. Antimicrob Agents Chemother.1984;25:422–426.10.1128/AAC.25.4.422CrossRefGoogle ScholarPubMed
12. Bryan, CS, Wilson, RS, Meade, P Sill, LG. Topical antibiotic ointments for staphylococcal nasal carriers: survey of current practices and comparisons ofbacitracin and vancomycin ointments. Infect Control. 1980;1:153–156.CrossRefGoogle Scholar
13. Ward, TT, Winn, RE, Hartstein, AI, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control, Infect Control. 1981;2:453–459.10.1017/S0195941700055715CrossRefGoogle Scholar
14. Hospital Infection Society and British Society for Antimicrobial Chemotherapy. Guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus. J Hosp Infect. 1986;7:193–201.CrossRefGoogle Scholar
15. Mupirocin. Med Lett Drugs Ther. 1988;30:55–56.Google Scholar
16. Thornsberry, C, McDougal, LK. Successful use of broth microdilution in susceptibility tests for methicillin-resistant (heteroresistant) staphylococci. J Clin Microbiol. 1983;18:1084–1091.CrossRefGoogle ScholarPubMed
17. Bitar, CM, Mayhall, CG, Lamb, VA, Bradshaw, TJ, Spadora, AC, Dalton, HP. Outbreak due to methicillin and rifampin resistant Staphylococcus aureus: epidemiology and eradication of the resistant strain from the hospital. Infect Control. 1987;8:15–23.10.1017/S0195941700066935CrossRefGoogle ScholarPubMed
18. Parenti, MA, Hatfield, SM, Leyden, JJ. Mupirocin: a topical antibiotic with a unique structure and mechanism of action, Clin Pharm. 1987;6:761–770.Google ScholarPubMed
19. Dux, PH, Fields, L., Pollock, D. 2% topical mupirocin versus systemic erythromycin and cloxacillin in primary and secondary skin infections. Current Ther Res. 1986;40:933–940.Google Scholar
20. Casewell, MW, Hill, RLR. Mupirocin (pseudomonic acid)—a promising new topical antimicrobial agent. J Antimicrob Chemother. 1987;19:1–5.CrossRefGoogle ScholarPubMed
21. Dacre, JE, Emmerson, AM, Jenner, EA. Nasal carriage of gentamicin and methicillin resistant Staphylococcus aureus treated with topical pseudomonic acid. Lancet. 1983;2:1036.CrossRefGoogle ScholarPubMed
22. Hill, RLR, Duckworth, GJ, Casewell, MW. Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother. 1988;22:377–384.10.1093/jac/22.3.377CrossRefGoogle ScholarPubMed
23. Boelaert, J, Desmet, R, Debaere, Y, et al. Can mupirocin nasal ointment prevent Staphylococcus aureus infections in hemodialysis patients? Twenty-eighth Interscience Conference on Antimicrobial Agents and Chemotherapy, 1988;Abstr. #929.Google Scholar
24. Denning, DW, Haiduvan-Griffiths, D. Eradication of low-level methicillin resistant Staphylococcus aureus skin colonization with topical mupirocin. Infect Control Hosp Epidemiol. 1988;9:261–263.10.2307/30144179CrossRefGoogle ScholarPubMed
25. Rahman, M, Noble, WC, Cookson, B. Transmissible mupirocin resistance in Staphylococcus aureus. Epidemiol Infect. 1989;102:261–270.CrossRefGoogle ScholarPubMed
26. Zervos, MJ, Terpenning, MS, Schaberg, DR, Therasse, PM, Medendorp, SV, Kauffman, CA. High-level aminoglycoside-resistant enterococci. Colonization of nursing home and acute care hospital patients. Arch Intern Med. 1987;145:1591–1594.CrossRefGoogle Scholar