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The Epidemiology of Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus at a Veterans' Affairs Hospital

Published online by Cambridge University Press:  02 January 2015

Jose E. Vasquez ,
Elaine S. Walker ,
Bettylene W. Franzus ,
Barbara K. Overbay ,
David R. Reagan  and
Felix A. Sarubbi
Jose E. Vasquez
Affiliation:
James H. Quillen Veterans' Affairs Medical Center andEast Tennessee State University College of Medicine, Johnson City, Tennessee
Elaine S. Walker
Affiliation:
James H. Quillen Veterans' Affairs Medical Center andEast Tennessee State University College of Medicine, Johnson City, Tennessee
Bettylene W. Franzus
Affiliation:
James H. Quillen Veterans' Affairs Medical Center andEast Tennessee State University College of Medicine, Johnson City, Tennessee
Barbara K. Overbay
Affiliation:
James H. Quillen Veterans' Affairs Medical Center andEast Tennessee State University College of Medicine, Johnson City, Tennessee
David R. Reagan
Affiliation:
James H. Quillen Veterans' Affairs Medical Center andEast Tennessee State University College of Medicine, Johnson City, Tennessee
Felix A. Sarubbi*
Affiliation:
James H. Quillen Veterans' Affairs Medical Center andEast Tennessee State University College of Medicine, Johnson City, Tennessee
*
Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614
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Abstract

Objective:

To describe the clinical and molecular epidemiology of mupirocin-resistant (MR) and mupirocin-susceptible (MS) methicillin-resistant Staphylococcus aureus (MRSA) at a Veterans' Affairs hospital and to assess risk factors associated with the acquisition of MR MRSA.

Design:

All clinical MRSA isolates for the period October 1990 through March 1995 underwent susceptibility testing to mupirocin. Mupirocin resistance trends were measured, and MS MRSA and MR MRSA isolates underwent typing by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted to evaluate risk factors for having MR versus MS MRSA.

Setting:

The James H. Quillen Veterans' Affairs Medical Center in Mountain Home, Tennessee, included a 324-bed acute-care hospital, a 120-bed nursing home, and a 525-bed domiciliary. Colonizations and infections with MRSA were endemic, and mupirocin ointment was commonly used.

Patients:

Inpatients and outpatients at the facility.

Results:

MS MRSA was recovered from 506 patients and MR MRSA from 126. Among MR MRSA isolates, 58% showed low-level mupirocin resistance (minimum inhibitory concentration [MIC] ≥4 to 256 μg/mL), and 42% showed high-level mupirocin resistance (MIC ≥512 μg/mL). A significant increase (P=.002) in the number of high-level MR isolates occurred during the 1993 to 1995 period. A case-control study showed that presence of a decubitus ulcer correlated with high-level resistant isolates (P<.05). The distribution of PFGE patterns did not differ for MR and MS MRSA.

Conclusions:

Use of mupirocin ointment in a program aimed at managing endemic MRSA infection or colonization resulted in a significant increase in the recovery of high-level MR MRSA isolates. These isolates appeared to emerge from our existing MRSA pool. A case-control study provided few clues concerning patients likely to harbor MR MRSA We confirmed the position that the extended use of mupirocin ointment should be avoided in settings where MRSA is endemic.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 7 , July 2000 , pp. 459 - 464
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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