Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term-care facility with the use of mupirocin ointment.
OBJECTIVE
To assess the impact of the use of mupirocin ointment on colonization, transmission, and infection with methicillin-resistant Staphylococcus aureus (MRSA) in a long-term-care facility.


METHODS
All 321 residents of a Veterans Affairs long-term-care facility from June 1990 through June 1991 were studied for MRSA colonization and infection. MRSA-colonized patients received mupirocin ointment to nares in the first 7 months and to nares and wounds in the second 5 months. The effect of mupirocin use on MRSA colonization and infection was monitored. All S. aureus strains isolated were tested for the development of resistance to mupirocin.


RESULTS
A total of 65 patients colonized with MRSA received mupirocin ointment. Mupirocin rapidly eliminated MRSA at the sites treated in most patients by the end of 1 week. Weekly maintenance mupirocin was not adequate to prevent recurrences--40% of patients had recurrence of MRSA. Overall, MRSA colonization in the facility, which was 22.7% +/- 1% prior to the use of mupirocin, did not change when mupirocin was used in nares only (22.2% +/- 2.1%), but did decrease to 11.5% +/- 1.8% when mupirocin was used in nares and wounds. Although colonization decreased, roommate-to-roommate transmission and MRSA infection rates, low to begin with, did not change when mupirocin was used. Mupirocin-resistant MRSA strains were isolated in 10.8% of patients.


CONCLUSIONS
Mupirocin ointment is effective at decreasing colonization with MRSA. However, constant surveillance was required to identify patients colonized at admission or experiencing recurrence of MRSA during maintenance treatment. Long-term use of mupirocin selected for mupirocin-resistant MRSA strains. Mupirocin should be saved for use in outbreak situations, and not used over the long term in facilities with endemic MRSA colonization.
Kauffman
C A
CA
Division of Infectious Diseases, Department of Veterans Affairs Medical Center, Ann Arbor, Michigan 48105.
Terpenning
M S
MS
He
X
X
Zarins
L T
LT
Ramsey
M A
MA
Jorgensen
K A
KA
Sottile
W S
WS
Bradley
S F
SF
D000368:Aged; D002353:Carrier State / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods / Q000592:standards; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D016712:Mupirocin / Q000494:pharmacology / Q000627:therapeutic use*; D009666:Nose / Q000382:microbiology*; D015995:Prevalence; D012008:Recurrence; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects*; D014946:Wound Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission
D016712:Mupirocin