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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
12:18

Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)

Published on: February 9, 2011

Control of an outbreak of an epidemic methicillin-resistant Staphylococcus aureus also resistant to mupirocin

D Irish1, I Eltringham, A Teall

  • 1Department of Microbiology, Greenwich Hospital, London, UK.

The Journal of Hospital Infection
|June 9, 1998
PubMed

Insights

A mupirocin-resistant MRSA strain emerged during an epidemic methicillin-resistant Staphylococcus aureus outbreak, complicating control efforts. Alternative treatments were successfully used for eradication.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Hospital Epidemiology

Background:

  • An epidemic methicillin-resistant Staphylococcus aureus (EMRSA-3) outbreak occurred in a district hospital in June 1989.
  • The outbreak dynamics were complex, involving inter-hospital and inter-ward patient transfers.
  • Standard control measures included nasal mupirocin application.

Purpose of the Study:

  • To investigate the emergence and characteristics of mupirocin-resistant MRSA (MuMRSA) during an EMRSA-3 outbreak.
  • To understand the genetic basis and transmission of MuMRSA.
  • To evaluate eradication strategies for MuMRSA.

Main Methods:

  • Epidemiological investigation of outbreak dynamics.
  • Molecular typing including phage-typing and pulsed-field gel electrophoresis (PFGE).
  • In vitro plasmid curing experiments and gene probing to identify resistance mechanisms.

Main Results:

  • Mupirocin resistance emerged in MRSA (MuMRSA) during control efforts, likely in a patient with repeated mupirocin exposure.
  • MuMRSA was plasmid-mediated (48 Md plasmid) and spread to 12 patients and 11 staff members.
  • MuMRSA was successfully eradicated using a combination of oral antibiotics (ciprofloxacin, rifampicin), topical treatments (triclosan, fusidic acid, bacitracin).

Conclusions:

  • The emergence of mupirocin resistance poses a significant challenge to MRSA control strategies.
  • Effective multi-drug regimens are crucial for eradicating resistant strains.
  • Alternative topical agents are vital when resistance to primary agents develops.

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