Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects

• Published in: Journal of antimicrobial chemotherapy Vol. 64; no. 1; pp. 9 - 15
• Main Authors: Coates, T., Bax, R., Coates, A.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.2009; Oxford Publishing Limited (England)
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; antimicrobials; Bacterial diseases; Biological and medical sciences; Carrier State - drug therapy; Carrier State - microbiology; Clinical Trials as Topic; Cross Infection - prevention & control; General aspects; Guidelines as Topic; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; infection control; Infectious diseases; Medical sciences; Methicillin-Resistant Staphylococcus aureus - drug effects; MRSA; Mupirocin - therapeutic use; Nasal Cavity - microbiology; Nose; nosocomial; Nosocomial infections; Pharmacology. Drug treatments; Review; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus infections; Surgery; surgical; United Kingdom; surgical; infection control; antimicrobials; nosocomial; MRSA; Nosocomial infection; Check; Mupirocin; Nasopharynx; Intranasal administration; Antimicrobial agent; Infection; Antibiotic; Surgery; Nose; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Antibacterial agent; Staphylococcal infection; Strength; Staphylococcus aureus
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkp159

Staphylococcus aureus in the nose is a risk factor for endogenous staphylococcal infection. UK guidelines recommend the use of mupirocin for nasal decolonization in certain groups of patients colonized with methicillin-resistant S. aureus (MRSA). Mupirocin is effective at removing S. aureus from the nose over a few weeks, but relapses are common within several months. There are only a few prospective randomized clinical trials that have been completed with sufficient patients, but those that have been reported suggest that clearance of S. aureus from the nose is beneficial in some patient groups for the reduction in the incidence of nosocomial infections. There is no convincing evidence that mupirocin treatment reduces the incidence of surgical site infection. New antibiotics are needed to decolonize the nose because bacterial resistance to mupirocin is rising, and so it will become less effective. Furthermore, a more bactericidal antibiotic than mupirocin is needed, on the grounds that it might reduce the relapse rate, and so clear the patient of MRSA for a longer period of time than mupirocin.