title: Long-term efficacy of mupirocin in the prevention of infections with meticillin-resistant Staphylococcus aureus in a gastroenterology unit.
abstract: The long-term efficacy (55 months) of eradication of nasal carriage of meticillin-resistant Staphylococcus aureus (MRSA) by mupirocin was assessed for MRSA infections in a gastroenterology unit receiving patients for long hospital stays. In total, 2242 patients were included in the study; 92% had been hospitalized in another hospital before admission to the study department, 64% had chronic liver diseases (LD), 25% had miscellaneous medical conditions and 11% were admitted following gastroenterological surgery. Three consecutive periods were considered in the analysis. Nasal carriage at admission was similar in all three periods (10.9 vs 7.5 vs 8.6% in Periods 1, 2 and 3, respectively), while acquired nasal carriage decreased in the whole population (14.3 vs 16.2 vs 10.2% in Periods 1, 2 and 3, respectively, P=0.006) and in LD patients (15.8 vs 18.7 vs 11.9% in Periods 1, 2 and 3, respectively, P=0.018). The incidence of MRSA infections (N per total number of hospitalization-days) was 1.41 per 1000 in the year before initiation of eradication, 1.40 in Period 1, 0.74 in Period 2 and 0.59 in Period 3 (P=0.022). The incidence of MRSA infections among patients was 7.0% in Period 1, 3.7% in Period 2 and 3.1% in Period 3 in LD patients (P=0.0062). The corresponding figures were 5.5, 3.0 and 2.4% for the whole population (P=0.0024). The mortality caused by MRSA was 0.31, 0.19 and 0.13% (P=0.035) in Periods 1, 2 and 3, respectively. The numbers of resistant strains among those acquired during hospitalization were 12 in Period 1, four in Period 2 and six in Period 3. Long-term intranasal mupirocin treatment in MRSA carrier patients with long hospital stay is associated with a decrease in acquired carriage and MRSA infections, while resistance of the strains to mupirocin does not increase provided that colonized patients are only treated once.
authors.affiliation: Service de Bactériologie-Virologie-Hygiène, Hôpital Henri Mondor, Assistance Publique-Hopitaux de Paris, Créteil, France. catherine.dupeyron@hmn.ap-hop-paris.fr
authors.forename: C
authors.initials: C
authors.lastname: Dupeyron
authors.forename: B
authors.initials: B
authors.lastname: Campillo
authors.forename: J-P
authors.initials: JP
authors.lastname: Richardet
authors.forename: C-J
authors.initials: CJ
authors.lastname: Soussy
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002353:Carrier State / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D004197:Disease Reservoirs; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000150:complications / Q000382:microbiology; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D016106:Methicillin Resistance; D008875:Middle Aged; D015999:Multivariate Analysis; D016712:Mupirocin / Q000008:administration & dosage*; D009296:Nasal Cavity / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin