Related Experiment Videos
Mupirocin resistance after long-term use for Staphylococcus aureus colonization in patients undergoing chronic
Miguel Pérez-Fontán1, Miguel Rosales, Ana Rodríguez-Carmona
1Division of Nephrology, Hospital Juan Canalejo, Coruña, Spain. mfontan@canalejo.cesga.es
Abstract:
Mupirocin (Mup) has been used extensively to prevent Staphylococcus aureus (SAu) infections in patients undergoing peritoneal dialysis (PD). Resistance to Mup has been reported, but its relevance after long-term use of this drug in PD is unknown. Colonization by SAu was treated with topic Mup in our unit between September 1990 and December 2000. Sensitivity to Mup was tested in 437 strains of SAu isolated from 155 PD patients and 62 dialysis partners. Resistance to Mup was classified as low (minimal inhibitory concentration [MIC] > or = 8 microg/mL) or high (MIC > or = 512 microg/mL) degree. MIC90 was 0.125 microg/mL in 1990 to 1996 (5% low, 0% high-degree resistance), 64 microg/mL in 1997 to 1998 (6.6% low, 8.3% high-degree resistance), and 1,024 microg/mL in 1999 to 2000 (2.3% low, 12.4% high-degree resistance). Mup-resistant SAu were isolated from 25 patients and 13 partners a median of 15 months after starting PD. Resistance was associated frequently with repeated treatments of SAu recolonization, but was detected in 3 cases at the start of PD therapy. The accumulated incidence of SAu exit-site infection in the period 1997 to 2000 was 32.3% in patients colonized by Mup-resistant SAu as compared with 14.5% in those colonized by Mup-sensitive SAu (P = 0.03). Mup-resistant SAu have emerged in a significant proportion of our PD patients and dialysis partners. This emergence has resulted in a moderate, but significant, increase in the risk of SAu exit-site infection and raises concerns about the future of Mup as the therapy of choice for SAu colonization in patients undergoing chronic PD.
Insights
Mupirocin resistance in Staphylococcus aureus (SAu) is increasing in peritoneal dialysis (PD) patients. This resistance is linked to higher rates of SAu exit-site infections, questioning mupirocin
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Mupirocin (Mup) is widely used to prevent Staphylococcus aureus (SAu) infections in peritoneal dialysis (PD) patients.
- Concerns exist regarding the long-term efficacy of Mup due to potential resistance development.
Purpose of the Study:
- To investigate the emergence and clinical relevance of Mup resistance in SAu among PD patients and their dialysis partners.
- To assess the impact of Mup resistance on the incidence of SAu exit-site infections.
Main Methods:
- Longitudinal study analyzing SAu strains isolated from PD patients and dialysis partners between 1990 and 2000.
- Sensitivity testing to Mup using minimal inhibitory concentration (MIC) breakpoints for low and high-degree resistance.
- Comparison of SAu exit-site infection rates between patients colonized with Mup-resistant and Mup-sensitive strains.
Main Results:
- Mupirocin resistance in SAu strains significantly increased from 1997 to 2000, with high-degree resistance rising notably.
- Mup-resistant SAu were isolated from a considerable number of PD patients and dialysis partners, often after repeated Mup treatments.
- Patients colonized with Mup-resistant SAu exhibited a significantly higher accumulated incidence of exit-site infections (32.3%) compared to those with Mup-sensitive SAu (14.5%).
Conclusions:
- Mupirocin-resistant SAu strains have emerged in a significant proportion of the PD population.
- The rise in Mup resistance is associated with an increased risk of SAu exit-site infections.
- The findings raise concerns about the continued effectiveness of mupirocin for SAu colonization prophylaxis in chronic PD.