Eradication of Staphylococcus aureus colonization by chronic use of mupirocin in patients on home parenteral nutrition
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Published on: February 9, 2011
Michelle Gompelman1, Heiman F L Wertheim2, Chantal P Bleeker-Rovers3
1Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Objectives:
Although in other groups Staphylococcus aureus eradication has proven to be an effective infection prevention measure, to our knowledge, no such studies have been performed in patients on home parenteral nutrition (HPN). The aim of this study was to investigate the efficacy of chronic nasal mupirocin use on S. aureus eradication and prevention of catheter related infections in patients on HPN.
Methods:
This was a cohort study with data collected from adult patients on HPN who were screened for S. aureus carriage. In case of carriage, the patient was instructed to apply mupirocin nasal ointment monthly. Outcomes were the percentage of successful S. aureus eradication and the effect on the incidence of catheter-related infections and development of mupirocin resistance.
Results:
S. aureus nasal carriage was found in 54% of the patients. Eradication was successful in 66% (70 of 106) of patients treated with mupirocin. Overall S. aureus catheter-related infection rates decreased by 50% (P = 0.02). The decrease was mostly due to a drop in central line-associated bloodstream infection (CLABSI) rates (0.26versus 0.1 per 1000 central venous catheter days; P = 0.04). The overall CLABSI rates decreased as well (incidence ratio rate, 0.43; 95% confidence interval. 0.24-0.76; P < 0.01). Low-level mupirocin resistance was observed in four patients.
Conclusions:
Findings from the present study highlighted the potential usefulness of mupirocin ointment prophylaxis to establish S. aureus eradication in patients on HPN. However, awareness for the development of mupirocin resistance is prudent. Further research needs to be carried out to validate these findings.
Insights
Chronic nasal mupirocin effectively eradicated Staphylococcus aureus in home parenteral nutrition patients. This reduced catheter-related infections, including CLABSI, though mupirocin resistance requires monitoring.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Parenteral Nutrition
Background:
- Staphylococcus aureus eradication is a key infection control strategy in many patient groups.
- Its efficacy in patients receiving home parenteral nutrition (HPN) remains understudied.
- Catheter-related infections (CRIs) are a significant complication for HPN patients.
Purpose of the Study:
- To evaluate the effectiveness of chronic nasal mupirocin in eradicating S. aureus carriage in HPN patients.
- To assess the impact of mupirocin prophylaxis on the incidence of CRIs among HPN patients.
- To monitor the development of mupirocin resistance.
Main Methods:
- A cohort study design was employed.
- Adult HPN patients were screened for S. aureus nasal carriage.
- Carriage was treated with monthly mupirocin nasal ointment application.
Main Results:
- S. aureus nasal carriage was identified in 54% of patients.
- Successful eradication was achieved in 66% of treated patients.
- Overall S. aureus CRI rates decreased by 50% (P=0.02), with a significant reduction in central line-associated bloodstream infections (CLABSI) (P=0.04).
Conclusions:
- Nasal mupirocin prophylaxis shows promise for S. aureus eradication in HPN patients.
- A reduction in CRIs, particularly CLABSIs, was observed.
- Vigilance regarding potential mupirocin resistance development is necessary.
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