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Impact of combined low-level mupirocin and genotypic chlorhexidine resistance on persistent methicillin-resistant

Andie S Lee1, Marina Macedo-Vinas, Patrice François

  • 1Infection Control Program, Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 2, 2011
PubMed
Abstract

Insights

Low-level mupirocin and chlorhexidine resistance predict persistent MRSA carriage. Monitoring resistance is crucial for effective decolonization therapy and preventing MRSA spread.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • The clinical significance of low-level mupirocin resistance and genotypic chlorhexidine resistance in Staphylococcus aureus (MRSA) is not well understood.
  • Topical decolonization therapy is used to treat MRSA carriage, but resistance may impact its effectiveness.

Purpose of the Study:

  • To investigate if resistance to mupirocin and chlorhexidine increases the risk of persistent MRSA carriage after decolonization therapy.
  • To identify risk factors associated with persistent MRSA colonization.

Main Methods:

  • A nested case-control study of MRSA carriers undergoing decolonization therapy (2001-2008).
  • Cases (persistent colonization) were matched to controls (MRSA eradication).
  • Baseline MRSA isolates were tested for low-level mupirocin resistance and genotypic chlorhexidine resistance (qacA/B PCR).

Main Results:

  • Combined low-level mupirocin and genotypic chlorhexidine resistance independently predicted persistent MRSA carriage (OR, 3.4).
  • Other risk factors included older age, previous hospitalization, skin wounds, recent antibiotic use, and central venous catheterization.
  • Persistent colonization was associated with older age and longer hospital stays.

Conclusions:

  • Combined low-level mupirocin and genotypic chlorhexidine resistance significantly elevates the risk of persistent MRSA carriage post-decolonization.
  • Healthcare institutions should monitor for these resistance mechanisms to ensure the clinical effectiveness of decolonization strategies.

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