title: High prevalence of mupirocin resistance in Staphylococcus aureus isolates from a pediatric population.
abstract: Topical mupirocin is used widely to treat skin and soft tissue infections and to eradicate nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). Few studies to date have characterized the rates of S. aureus mupirocin resistance in pediatric populations. We retrospectively studied 358 unique S. aureus isolates obtained from 249 children seen in a predominantly outpatient setting by the Division of Pediatric Dermatology at a major academic center in New York City between 1 May 2012 and 17 September 2013. Mupirocin resistance rates and the associated risk factors were determined using a logistic regression analysis. In our patient population, 19.3% of patients had mupirocin-resistant S. aureus isolates at the time of their first culture, and 22.1% of patients with S. aureus infection had a mupirocin-resistant isolate at some time during the study period. Overall, 31.3% of all S. aureus isolates collected during the study period were resistant to mupirocin. Prior mupirocin use was strongly correlated (odds ratio [OR] = 26.5; P = <0.001) with mupirocin resistance. Additional risk factors for mupirocin resistance included methicillin resistance, atopic dermatitis (AD), epidermolysis bullosa (EB), immunosuppression, and residence in northern Manhattan and the Bronx. Resistance to mupirocin is widespread in children with dermatologic complaints in the New York City area, and given the strong association with mupirocin exposure, it is likely that mupirocin use contributes to the increased resistance. Routine mupirocin testing may be important for MRSA decolonization strategies or the treatment of minor skin infections in children.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York, USA.
authors.forename: Nina K
authors.initials: NK
authors.lastname: Antonov
authors.affiliation: Department of Dermatology, Columbia University Medical Center, New York, New York, USA Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Garzon
authors.affiliation: Department of Dermatology, Columbia University Medical Center, New York, New York, USA Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Morel
authors.affiliation: Department of Clinical Microbiology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Whittier
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York, USA Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, New York, USA pjp23@cumc.columbia.edu cat35@cumc.columbia.edu.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Planet
authors.affiliation: Department of Dermatology, Columbia University Medical Center, New York, New York, USA Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.
authors.forename: Christine T
authors.initials: CT
authors.lastname: Lauren
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D016712:Mupirocin / Q000627:therapeutic use*; D015995:Prevalence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000378:metabolism*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin
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