Related Experiment Videos
Reduction in the colonization of central venous cannulae by mupirocin
1Department of Medical Microbiology, King's College School of Medicine and Dentistry, London, UK.
Abstract:
In an in-vitro simulation of an intravascular cannula enclosed in a fibrin sheath, 0.03 mg1(-1) of mupirocin prevented significant colonization [greater than 15 colony forming units (cfu)] by two clinical isolates of Staphylococcus epidermidis and one each of S. saprophyticus, S. hominis and S. haemolyticus. This suggests that in vivo, where protein binding of mupirocin is 95-97%, 1 mg 1(-1) of mupirocin at the cannula surface would be required to prevent colonization. These results support the findings of our previously published prospective controlled trial, in which mupirocin applied to the insertion sites of 172 internal jugular cannulae reduced the rate of colonization of cannula tips to 5%, compared with 25% for the 186 controls (P less than 0.001). Of the 46 colonized cannula tips from 110 control patients, the same species was isolated from the skin of the insertion site in 67% and from the lumen flush in only 15%. Analysed by patient, mupirocin reduced the proportion of patients with colonized tips from 17% to 3% after 24 h of infection, and from 35 to 10% after 48 h (P = 0.002). The use of agar containing charcoal, as a mupirocin neutralizer, and the incubation of tip-culture plates flooded with the Oxford staphylococcus, gave no evidence of carry over of mupirocin onto cannulae removed from mupirocin-treated patients.
Insights
Mupirocin effectively prevents Staphylococcus colonization on intravascular cannulae. This topical antibiotic significantly reduces cannula tip colonization rates in clinical settings, enhancing patient safety.
Area of Science:
- Infectious Diseases
- Medical Microbiology
- Clinical Pharmacy
Background:
- Intravascular cannulae are prone to bacterial colonization, primarily by Staphylococcus species.
- Colonization of cannulae can lead to serious bloodstream infections.
- Mupirocin is a topical antibiotic with known efficacy against Gram-positive bacteria.
Purpose of the Study:
- To evaluate the efficacy of mupirocin in preventing Staphylococcus colonization of intravascular cannulae.
- To determine the required concentration of mupirocin for effective in vivo prevention.
- To support previous findings on mupirocin's role in reducing cannula-associated infections.
Main Methods:
- In vitro simulation of intravascular cannulae with fibrin sheaths.
- Testing mupirocin concentrations against clinical isolates of Staphylococcus species.
- Analysis of data from a prospective controlled trial involving internal jugular cannulae.
Main Results:
- 0.03 mg/L mupirocin prevented significant colonization in vitro.
- An estimated 1 mg/L mupirocin is needed at the cannula surface in vivo.
- Mupirocin reduced cannula tip colonization from 25% to 5% in a clinical trial.
- Mupirocin decreased the proportion of patients with colonized tips from 17% to 3% at 24 hours and 35% to 10% at 48 hours.
Conclusions:
- Mupirocin demonstrates significant potential in preventing Staphylococcus colonization of intravascular cannulae.
- Topical mupirocin application at insertion sites is effective in reducing cannula colonization rates.
- These findings support the use of mupirocin as a prophylactic measure against cannula-associated infections.