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Mupirocin and Staphylococcus aureus: a recent paradigm of emerging antibiotic resistance
1Department of Infectious Diseases, Auckland Hospital, Private Bag 92024, Auckland, New Zealand. ArloU@adhb.govt.nz
Objectives:
To describe trends in mupirocin resistance among Staphylococcus aureus in New Zealand (NZ), following the availability of mupirocin in 1986.
Patients And Methods:
Data from a variety of sources were used for this study: susceptibility data collected annually from diagnostic laboratories throughout NZ; a local survey of mupirocin-resistant S. aureus in the Auckland area in 1997; a national survey of S. aureus antimicrobial susceptibility in 1999; and the national methicillin-resistant S. aureus (MRSA) surveillance programme.
Results:
All data sources show that there was a steady increase in mupirocin resistance among S. aureus throughout the 1990s, and rates in NZ are now markedly higher than those reported in most other comparable countries. By 1999, resistance averaged 28%, with higher rates among community-acquired compared with hospital-acquired isolates, and with a wide geographical variation in resistance. Resistance was more common among S. aureus generally than MRSA.
Conclusion:
We postulate that the steady rise in mupirocin resistance among S. aureus in NZ throughout the 1990s may be due, at least in part, to the over the counter availability of mupirocin from 1991 to 2000. The current patterns of mupirocin consumption need to be reviewed and its use rationalized to maximize the chances of this antibiotic retaining beneficial antistaphylococcal activity.
Insights
Mupirocin resistance in Staphylococcus aureus steadily increased in New Zealand during the 1990s, reaching 28% by 1999. This rise may be linked to over-the-counter mupirocin availability, necessitating a review of its use.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Mupirocin, an antibiotic, became available in New Zealand in 1986.
- Staphylococcus aureus is a common bacterium that can cause various infections.
Purpose of the Study:
- To track the prevalence of mupirocin resistance in Staphylococcus aureus in New Zealand.
- To investigate factors contributing to the rise in resistance.
Main Methods:
- Analysis of annual susceptibility data from diagnostic laboratories across New Zealand.
- Inclusion of data from local and national surveys on S. aureus resistance.
- Examination of the national methicillin-resistant S. aureus (MRSA) surveillance program.
Main Results:
- A consistent increase in mupirocin resistance among S. aureus was observed throughout the 1990s.
- By 1999, resistance rates in New Zealand were significantly higher than in comparable countries, averaging 28%.
- Higher resistance rates were noted in community-acquired isolates compared to hospital-acquired ones, with significant geographical variations.
Conclusions:
- The widespread availability of mupirocin over-the-counter from 1991 to 2000 is a potential driver for the observed increase in resistance.
- Rationalizing mupirocin use is crucial to preserve its effectiveness against Staphylococcus aureus infections.