Efficacy of mupirocin in methicillin-resistant Staphylococcus aureus burn wound infection.
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.
Rode
H
H
Department of Paediatric Surgery, University of Cape Town, Rondebosch, South Africa.
Hanslo
D
D
de Wet
P M
PM
Millar
A J
AJ
Cywes
S
S
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005227:Fatty Acids / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D016712:Mupirocin; D010403:Penicillin Resistance; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects; D013997:Time Factors; D014946:Wound Infection / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005227:Fatty Acids; D016712:Mupirocin; D008712:Methicillin