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Minimal dose requirements for nasal mupirocin and its role in the control of epidemic MRSA
1Department of Medical Microbiology, King's College School of Medicine & Dentistry, Denmark Hill, London, UK.
Abstract:
Staphylococci are still a leading cause of hospital infection. The success of nasal mupirocin for the control of epidemic methicillin-resistant Staphylococcus aureus (EMRSA), the prevention of colonization of central venous cannulae, and the prevention of septicaemia in haemodialysis patients should encourage the use of minimal dose regimens to minimize the emergence of mupirocin resistance. Mupirocin applied to the anterior nares 4-times daily usually eliminates S. aureus, including EMRSA, within 48 h. Elimination is sustained for several weeks in patients and staff. We recently found that a single dose, or a regimen of 4-times daily for 2 days, eliminated nasal carriage of S. aureus within 24 h; 7 days after a single dose, 92% of the subjects were still cleared; 7 days after the 2-day course, 96% remained free of nasal S. aureus. Ward personnel who are nasal carriers of EMRSA can, provided that other carriage sites are negative, return to work after 2 days of a 4-times daily intranasal regimen. The UK guidelines, recently published in this Journal, recommend an aggressive approach to identifying and eliminating EMRSA, including the elimination of nasal carriage. This approach is increasingly associated with the control of EMRSA in the UK and elsewhere.
Insights
Minimal dose nasal mupirocin effectively eradicates Staphylococcus aureus, including epidemic methicillin-resistant Staphylococcus aureus (EMRSA), from nasal passages. Shorter treatment regimens significantly reduce nasal carriage, aiding hospital infection control.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Staphylococci are a primary cause of hospital-acquired infections.
- Nasal mupirocin has shown success in controlling epidemic methicillin-resistant Staphylococcus aureus (EMRSA) and preventing infections in specific patient groups.
- Minimizing mupirocin dosage is crucial to prevent the development of antimicrobial resistance.
Purpose of the Study:
- To evaluate the efficacy of reduced-dose and single-dose mupirocin regimens for eliminating nasal Staphylococcus aureus carriage.
- To determine the duration of Staphylococcus aureus clearance after minimal mupirocin treatment.
- To assess the feasibility of rapid return to work for healthcare personnel carrying EMRSA.
Main Methods:
- Administration of intranasal mupirocin in single doses or for 2-day courses (4 times daily).
- Monitoring of Staphylococcus aureus nasal carriage status before and after treatment.
- Assessment of sustained clearance rates at 7 days post-treatment.
Main Results:
- A single dose or a 2-day regimen of mupirocin eliminated nasal Staphylococcus aureus within 24 hours.
- Sustained clearance was observed in 92% of subjects 7 days after a single dose and 96% after the 2-day course.
- Nasal EMRSA carriers could return to work after 2 days of treatment if other carriage sites were negative.
Conclusions:
- Minimal dose intranasal mupirocin is highly effective for rapid and sustained elimination of Staphylococcus aureus nasal carriage.
- Shorter treatment regimens offer a viable strategy for controlling EMRSA in healthcare settings.
- This approach aligns with guidelines for aggressive EMRSA identification and elimination, contributing to infection control.