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Efficacy of mupirocin in methicillin-resistant Staphylococcus aureus burn wound infection
1Department of Paediatric Surgery, University of Cape Town, Rondebosch, South Africa.
Abstract:
Methicillin-resistant Staphylococcus aureus strains (MRSA) have become increasingly prevalent as nosocomial pathogens, especially in burn wounds. MRSA constituted 38% of all S. aureus isolates in our 25-bed burns unit despite the utilization of a combination of 1% silver sulfadiazine and 0.2% chlorhexidine as topical therapy. Mupirocin, a new antibiotic, has proved in vitro and in vivo to be highly effective in the treatment of MRSA infections. A prospective clinical trial with mupirocin ointment in MRSA burn wound infection was untertaken. Forty-five children with 59 discrete burn wounds and from whom MRSA were isolated were treated with 2% mupirocin ointment under occlusive dressings, applied twice daily for 5 days. The average burned area treated was 8% (range, 2 to 20%) of the total body surface area. The burn wounds were assessed clinically and bacteriologically daily. Mupirocin eliminated MRSA in all 59 wounds treated, with the maximum therapeutic response seen within 4 days. In three wounds, gram-negative organisms persisted after 5 days of topical therapy. Treatment was well tolerated by all children. We recommend that mupirocin in its present polyethylene glycol base should be used only on a selective basis, when current prophylactic topical therapy has failed to control MRSA infection in burns of less than 20% of the total body surface area, and that it should be applied only for a limited period of 5 days. The safety and the efficacy of mupirocin in burns exceeding 20% of the total body surface area need to be established.
Insights
Mupirocin ointment effectively treated Methicillin-resistant Staphylococcus aureus (MRSA) burn wound infections in children. This antibiotic eliminated MRSA in all treated wounds within four days, showing good tolerance.
Area of Science:
- Infectious Diseases
- Dermatology
- Clinical Microbiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is a growing nosocomial pathogen, particularly in burn wound infections.
- Current topical therapies (silver sulfadiazine and chlorhexidine) were insufficient, with MRSA comprising 38% of S. aureus isolates in a burns unit.
- Mupirocin demonstrates in vitro and in vivo efficacy against MRSA.
Purpose of the Study:
- To evaluate the efficacy and safety of 2% mupirocin ointment for treating MRSA burn wound infections in children.
- To determine the optimal duration and application criteria for mupirocin in pediatric burn care.
Main Methods:
- A prospective clinical trial involving 45 children with 59 discrete MRSA-positive burn wounds.
- Treatment involved twice-daily application of 2% mupirocin ointment under occlusive dressings for 5 days.
- Wounds were assessed clinically and bacteriologically daily; average treated area was 8% of total body surface area.
Main Results:
- Mupirocin successfully eradicated MRSA from all 59 treated burn wounds.
- Complete MRSA elimination was observed within a maximum of 4 days.
- Gram-negative organisms persisted in three wounds after 5 days of treatment.
- Mupirocin treatment was well-tolerated by all pediatric patients.
Conclusions:
- Topical mupirocin is highly effective for MRSA burn wound infections in children, clearing infections rapidly.
- Mupirocin should be selectively used for burns <20% total body surface area after standard therapy failure, applied for 5 days.
- Further studies are needed to establish the safety and efficacy of mupirocin for burns exceeding 20% total body surface area.