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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
12:18

Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)

Published on: February 9, 2011

Emergence of mupirocin-resistant Staphylococcus aureus in chronic peritoneal dialysis patients using mupirocin

R Annigeri1, J Conly, S Vas

  • 1Division of Nephrology, University Health Network and University of Toronto, Ontario, Canada.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|January 11, 2002
PubMed
Abstract

Insights

High-level mupirocin resistance emerged in Staphylococcus aureus (SA) among chronic peritoneal dialysis patients after 4 years of prophylactic mupirocin use. This finding has implications for preventing exit-site infections in these patients.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Microbiology

Background:

  • Chronic peritoneal dialysis (CPD) patients are susceptible to exit-site infections.
  • Prophylactic mupirocin application is a common strategy to prevent these infections.
  • The long-term impact of continuous mupirocin use on bacterial resistance is a concern.

Purpose of the Study:

  • To determine the prevalence of Staphylococcus aureus (SA), methicillin-resistant SA (MRSA), and mupirocin-resistant SA (MuRSA) carriage in CPD patients.
  • To assess the impact of 4 years of prophylactic mupirocin application on bacterial resistance.
  • To evaluate the clinical significance of emerging resistance.

Main Methods:

  • Collected swabs from nares, axillae/groin, and exit sites of 149 CPD patients.
  • Cultured isolates on mannitol salt agar and broth.
  • Tested SA for methicillin resistance (oxacillin screening) and mupirocin resistance (E-test), defining high-level MuRSA as MIC ≥ 256 mg/mL.

Main Results:

  • Staphylococcus aureus was isolated from 17% of patients, primarily from nares/axilla/groin.
  • High-level MuRSA was detected in 3% of patients (15% of SA isolates).
  • No MRSA was detected; one patient with high-level MuRSA experienced treatment failure for peritonitis.

Conclusions:

  • Continuous, long-term prophylactic mupirocin use in CPD patients can lead to the emergence of high-level MuRSA.
  • This resistance has significant clinical implications, potentially compromising the effectiveness of mupirocin for preventing exit-site infections.
  • Further research is needed to guide optimal prophylactic strategies in CPD patients.

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