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Suzanne F Bradley - One of the best experts on this subject based on the ideXlab platform.
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in vivo transfer of high level Mupirocin resistance from staphylococcus epidermidis to methicillin resistant staphylococcus aureus associated with failure of Mupirocin prophylaxis
Journal of Antimicrobial Chemotherapy, 2005Co-Authors: Julian G Hurdle, Alex J Oneill, Lona Mody, Ian Chopra, Suzanne F BradleyAbstract:OBJECTIVES: We examined the molecular basis of the emergence of Mupirocin resistance in a methicillin-resistant Staphylococcus aureus (MRSA) strain colonizing a nursing home resident undergoing Mupirocin prophylaxis. PATIENT AND METHODS: A persistent carrier of Mupirocin-susceptible MRSA participated in a trial of Mupirocin for nasal decolonization among nursing home residents. During prophylaxis a high-level Mupirocin-resistant MRSA emerged in the nasal isolates from this patient. S. aureus and coagulase-negative staphylococci were isolated prior to, during and after 14 days of Mupirocin treatment. The staphylococcal isolates and their plasmids were examined by molecular genetic methods. RESULTS: All Mupirocin-susceptible and -resistant MRSA isolates possessed the same genotype. The patient was also colonized by a single Mupirocin-resistant Staphylococcus epidermidis strain. The Mupirocin-resistant MRSA and S. epidermidis strains harboured identical plasmids that carried the mupA determinant and genes for conjugative DNA transfer in staphylococci. These plasmids could be transferred in vitro from both clinical isolates to S. aureus RN2677. CONCLUSIONS: The MRSA strain contained a conjugative plasmid expressing mupA that was identical with that found in the S. epidermidis strain which colonized the patient. These findings suggest that transfer of mupA from S. epidermidis to MRSA probably occurred during Mupirocin prophylaxis.
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Mupirocin based decolonization of staphylococcus aureus carriers in residents of 2 long term care facilities a randomized double blind placebo controlled trial
Clinical Infectious Diseases, 2003Co-Authors: Lona Mody, Carol A Kauffman, Suzanne F Bradley, Shelly Mcneil, Andrzej T GaleckiAbstract:Mupirocin has been used in nursing homes to prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA), despite the lack of controlled trials. In this double-blind, randomized study, the efficacy of intranasal Mupirocin ointment versus that of placebo in reducing colonization and preventing infection was assessed among persistent carriers of S. aureus. Twice-daily treatment was given for 2 weeks, with a follow-up period of 6 months. Staphylococcal colonization rates were similar between residents at the Ann Arbor Veterans Affairs (VA) Extended Care Center, Michigan (33%), and residents at a community-based long-term care facility in Ann Arbor (36%), although those at the VA Center carried MRSA more often (58% vs. 35%; P = .017). After treatment, Mupirocin had eradicated colonization in 93% of residents, whereas 85% of residents who received placebo remained colonized (P < .001). At day 90 after study entry, 61% of the residents in the Mupirocin group remained decolonized. Four patients did not respond to Mupirocin therapy; 3 of the 4 had Mupirocin-resistant S. aureus strains. Thirteen (86%) of 14 residents who became recolonized had the same pretherapy strain; no strain recovered during relapse was resistant to Mupirocin. A trend toward reduction in infections was seen with Mupirocin treatment.
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Mupirocin resistance: clinical and molecular epidemiology.
Infection control and hospital epidemiology, 1995Co-Authors: Suzanne F Bradley, Mary A Ramsey, Teresa M. Morton, Carol A KauffmanAbstract:The antistaphylococcal activity of topical Mupirocin has made it an attractive agent for the treatment of asymptomatic colonization with Staphylococcus aureus. Increasing use has been associated with the emergence of Mupirocin resistance in staphyloccoci, and failure of therapy has been associated with the isolation of strains exhibiting high-level resistance (MIC > 500 micrograms/mL). Fortunately, low-level Mupirocin resistance (MIC < 100 micrograms/mL) occurs most commonly. Because a novel gene encoding for Mupirocin resistance resides in both low-level and high-level resistant strains, the emergence of low-level Mupirocin resistance may not be as epidemiologically insignificant as previously thought.
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Detection and characterization of Mupirocin resistance in Staphylococcus aureus.
Antimicrobial agents and chemotherapy, 1993Co-Authors: David A. Janssen, Margaret S Terpenning, Lidija T Zarins, Suzanne F Bradley, Dennis R. Schaberg, Carol A KauffmanAbstract:Fourteen Mupirocin-resistant Staphylococcus aureus strains were isolated over 18 months; 12 exhibited low-level resistance, while two showed high-level resistance. Highly Mupirocin-resistant strains contained a large plasmid which transferred Mupirocin resistance to other S. aureus strains and to Staphylococcus epidermidis. This plasmid and pAM899-1, a self-transferable gentamicin resistance plasmid, have molecular and biologic similarities. Images
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attempts to eradicate methicillin resistant staphylococcus aureus from a long term care facility with the use of Mupirocin ointment
The American Journal of Medicine, 1993Co-Authors: Carol A Kauffman, Margaret S Terpenning, Lidija T Zarins, Mary A Ramsey, Karen A Jorgensen, William S Sottile, Suzanne F BradleyAbstract:Abstract purpose: To assess the impact of the use of Mupirocin ointment on colonization, transmission, and infection with methicillin-resistant Staphylococcus aureus (MRSA) in a long-termcare facility. patients and 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 strahis. Mupirocin should be saved for use in outbreak situations, and not used over the long term in facilities with endemic MRSA colonization.
Careyann D Burnham - One of the best experts on this subject based on the ideXlab platform.
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Mupirocin and chlorhexidine resistance in staphylococcus aureus in patients with community onset skin and soft tissue infections
Antimicrobial Agents and Chemotherapy, 2013Co-Authors: Stephanie A Fritz, Patrick G Hogan, Bernard Camins, Ali J Ainsworth, Carol Patrick, Madeline S Martin, Melissa J Krauss, Marcela Rodriguez, Careyann D BurnhamAbstract:Decolonization measures, including Mupirocin and chlorhexidine, are often prescribed to prevent Staphylococcus aureus skin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level Mupirocin and chlorhexidine resistance in S. aureus strains recovered from patients with SSTI before and after Mupirocin and chlorhexidine administration and to determine whether carriage of a Mupirocin- or chlorhexidine-resistant strain at baseline precluded S. aureus eradication. We recruited 1,089 patients with community-onset SSTI with or without S. aureus colonization. In addition to routine care, 483 patients were enrolled in a decolonization trial: 408 received intranasal Mupirocin (with or without antimicrobial baths), and 258 performed chlorhexidine body washes. Patients were followed for up to 12 months with repeat colonization cultures. All S. aureus isolates were tested for high-level Mupirocin and chlorhexidine resistance. At baseline, 23/1,089 (2.1%) patients carried a Mupirocin-resistant S. aureus strain and 10/1,089 (0.9%) patients carried chlorhexidine-resistant S. aureus. Of 4 patients prescribed Mupirocin, who carried a Mupirocin-resistant S. aureus strain at baseline, 100% remained colonized at 1 month compared to 44% of the 324 patients without Mupirocin resistance at baseline (P = 0.041). Of 2 patients prescribed chlorhexidine, who carried a chlorhexidine-resistant S. aureus strain at baseline, 50% remained colonized at 1 month compared to 48% of the 209 patients without chlorhexidine resistance at baseline (P = 1.0). The overall prevalence of Mupirocin and chlorhexidine resistance is low in S. aureus isolates recovered from outpatients, but eradication efforts were less successful in patients carrying a Mupirocin-resistant S. aureus strain at baseline.
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effectiveness of measures to eradicate staphylococcus aureus carriage in patients with community associated skin and soft tissue infections a randomized trial
Infection Control and Hospital Epidemiology, 2011Co-Authors: Stephanie A Fritz, Bernard Camins, Careyann D Burnham, Kimberly A Eisenstein, Joseph M Fritz, Emma K Epplin, Jonathan Dukes, Gregory A StorchAbstract:background. Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI). objective. Compare the effectiveness of 4 regimens for eradicating S. aureus carriage. design. Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months. setting. Barnes-Jewish and St. Louis Children’s Hospitals, St. Louis, Missouri, 2007–2009. participants. Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds. interventions. Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% Mupirocin ointment applied to the nares twice daily, intranasal Mupirocin plus daily 4% chlorhexidine body washes, or intranasal Mupirocin plus daily dilute bleach water baths. results. Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the Mupirocin group ( vs controls), 55% of those P p .03 in the Mupirocin and chlorhexidine group ( ), and 63% off those in the Mupirocin and bleach group ( ). Of 229 participants P p .05 P p .006 with 4-month colonization data, eradication rates were 48% in the control group, 56% in the Mupirocin only group ( vs controls), P p .40 54% in the Mupirocin and chlorhexidine group ( ), and 71% in the Mupirocin and bleach group ( ). At 1 and 4 months,
Stephanie A Fritz - One of the best experts on this subject based on the ideXlab platform.
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Mupirocin and chlorhexidine resistance in staphylococcus aureus in patients with community onset skin and soft tissue infections
Antimicrobial Agents and Chemotherapy, 2013Co-Authors: Stephanie A Fritz, Patrick G Hogan, Bernard Camins, Ali J Ainsworth, Carol Patrick, Madeline S Martin, Melissa J Krauss, Marcela Rodriguez, Careyann D BurnhamAbstract:Decolonization measures, including Mupirocin and chlorhexidine, are often prescribed to prevent Staphylococcus aureus skin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level Mupirocin and chlorhexidine resistance in S. aureus strains recovered from patients with SSTI before and after Mupirocin and chlorhexidine administration and to determine whether carriage of a Mupirocin- or chlorhexidine-resistant strain at baseline precluded S. aureus eradication. We recruited 1,089 patients with community-onset SSTI with or without S. aureus colonization. In addition to routine care, 483 patients were enrolled in a decolonization trial: 408 received intranasal Mupirocin (with or without antimicrobial baths), and 258 performed chlorhexidine body washes. Patients were followed for up to 12 months with repeat colonization cultures. All S. aureus isolates were tested for high-level Mupirocin and chlorhexidine resistance. At baseline, 23/1,089 (2.1%) patients carried a Mupirocin-resistant S. aureus strain and 10/1,089 (0.9%) patients carried chlorhexidine-resistant S. aureus. Of 4 patients prescribed Mupirocin, who carried a Mupirocin-resistant S. aureus strain at baseline, 100% remained colonized at 1 month compared to 44% of the 324 patients without Mupirocin resistance at baseline (P = 0.041). Of 2 patients prescribed chlorhexidine, who carried a chlorhexidine-resistant S. aureus strain at baseline, 50% remained colonized at 1 month compared to 48% of the 209 patients without chlorhexidine resistance at baseline (P = 1.0). The overall prevalence of Mupirocin and chlorhexidine resistance is low in S. aureus isolates recovered from outpatients, but eradication efforts were less successful in patients carrying a Mupirocin-resistant S. aureus strain at baseline.
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effectiveness of measures to eradicate staphylococcus aureus carriage in patients with community associated skin and soft tissue infections a randomized trial
Infection Control and Hospital Epidemiology, 2011Co-Authors: Stephanie A Fritz, Bernard Camins, Careyann D Burnham, Kimberly A Eisenstein, Joseph M Fritz, Emma K Epplin, Jonathan Dukes, Gregory A StorchAbstract:background. Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI). objective. Compare the effectiveness of 4 regimens for eradicating S. aureus carriage. design. Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months. setting. Barnes-Jewish and St. Louis Children’s Hospitals, St. Louis, Missouri, 2007–2009. participants. Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds. interventions. Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% Mupirocin ointment applied to the nares twice daily, intranasal Mupirocin plus daily 4% chlorhexidine body washes, or intranasal Mupirocin plus daily dilute bleach water baths. results. Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the Mupirocin group ( vs controls), 55% of those P p .03 in the Mupirocin and chlorhexidine group ( ), and 63% off those in the Mupirocin and bleach group ( ). Of 229 participants P p .05 P p .006 with 4-month colonization data, eradication rates were 48% in the control group, 56% in the Mupirocin only group ( vs controls), P p .40 54% in the Mupirocin and chlorhexidine group ( ), and 71% in the Mupirocin and bleach group ( ). At 1 and 4 months,
Gregory A Storch - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of measures to eradicate staphylococcus aureus carriage in patients with community associated skin and soft tissue infections a randomized trial
Infection Control and Hospital Epidemiology, 2011Co-Authors: Stephanie A Fritz, Bernard Camins, Careyann D Burnham, Kimberly A Eisenstein, Joseph M Fritz, Emma K Epplin, Jonathan Dukes, Gregory A StorchAbstract:background. Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI). objective. Compare the effectiveness of 4 regimens for eradicating S. aureus carriage. design. Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months. setting. Barnes-Jewish and St. Louis Children’s Hospitals, St. Louis, Missouri, 2007–2009. participants. Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds. interventions. Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% Mupirocin ointment applied to the nares twice daily, intranasal Mupirocin plus daily 4% chlorhexidine body washes, or intranasal Mupirocin plus daily dilute bleach water baths. results. Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the Mupirocin group ( vs controls), 55% of those P p .03 in the Mupirocin and chlorhexidine group ( ), and 63% off those in the Mupirocin and bleach group ( ). Of 229 participants P p .05 P p .006 with 4-month colonization data, eradication rates were 48% in the control group, 56% in the Mupirocin only group ( vs controls), P p .40 54% in the Mupirocin and chlorhexidine group ( ), and 71% in the Mupirocin and bleach group ( ). At 1 and 4 months,
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Mupirocin resistance in patients colonized with methicillin resistant staphylococcus aureus in a surgical intensive care unit
Clinical Infectious Diseases, 2007Co-Authors: Jeffrey C Jones, Theodore J Rogers, Peter Brookmeyer, William Michael Dunne, Gregory A Storch, Craig M Coopersmith, Victoria J Fraser, David K WarrenAbstract:BACKGROUND Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) can be a precursor to serious infection, and decolonization with topical Mupirocin has been studied as a means of preventing clinical infection. Mupirocin resistance in patients with MRSA has been reported, usually in the context of widespread Mupirocin use. METHODS Patients admitted to a surgical intensive care unit (SICU) had nasal swab cultures for MRSA performed at admission, weekly, and at discharge in an active surveillance program. Collected MRSA isolates were tested for Mupirocin resistance, and molecular analysis was performed. Clinical data on the characteristics and outcomes of the patients who stayed in the SICU for >48 h were collected prospectively. RESULTS Of the 302 MRSA isolates available for testing, 13.2% were resistant to Mupirocin, with 8.6% having high-level resistance (minimum inhibitory concentration, >or=512 microg/mL) and 4.6% having low-level resistance (minimum inhibitory concentration, 8-256 microg/mL). Patients admitted to the SICU for >48 h who were colonized with Mupirocin-resistant MRSA were more likely to have been admitted to our hospital during the previous year (P=.016), were older (P=.009), and had higher in-hospital mortality (16% vs. 33%; P=.027), compared with patients colonized with Mupirocin-susceptible MRSA. Molecular analysis of the Mupirocin-resistant isolates revealed that 72.5% of isolates contained staphylococcal cassette chromosome mec II. Repetitive sequence polymerase chain reaction typing revealed that high-level Mupirocin resistance was present in multiple clonal groups. The rate of Mupirocin use hospital-wide during the study period was 6.08 treatment-days per 1000 patient-days. CONCLUSIONS We documented a high rate of Mupirocin resistance in MRSA isolates from SICU patients, despite low levels of in-hospital Mupirocin use.
David J. Hetem - One of the best experts on this subject based on the ideXlab platform.
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Prevention of Surgical Site Infections: Decontamination with Mupirocin Based on Preoperative Screening for Staphylococcus aureus Carriers or Universal Decontamination?
Clinical Infectious Diseases, 2016Co-Authors: David J. Hetem, Martin C. J. Bootsma, Marc J. M. Bonten, Robert A WeinsteinAbstract:Peri-operative decolonization of Staphylococcus aureus nasal carriers with Mupirocin together with chlorhexidine body washing reduces the incidence of S. aureus surgical site infection (SSI). A targeted strategy, applied in S. aureus carriers only, is costly and implementation may reduce effectiveness. Universal decolonization is more cost-effective, but increases exposure of non-carriers to Mupirocin, and the risk of resistance to Mupirocin in staphylococci. High-level Mupirocin resistance in S. aureus can emerge through horizontal gene transfer originating from coagulase-negative staphylococci (CoNS) and through clonal transmission. The current evidence on the occurrence of high-level Mupirocin resistance in S. aureus and CoNS, in combination with the results of mathematical modelling, strongly suggest that the increased selection of high-level Mupirocin resistance in CoNS does not constitute an important risk for high-level Mupirocin resistance in S. aureus.As compared to a targeted strategy, universal decolonization seems associated with an equally low risk of Mupirocin resistance in S. aureus.
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Acquisition of high-level Mupirocin resistance in CoNS following nasal decolonization with Mupirocin
The Journal of antimicrobial chemotherapy, 2014Co-Authors: David J. Hetem, H. Charles Vogely, Tim T Severs, Annet Troelstra, Johannes G. Kusters, Marc J. M. BontenAbstract:OBJECTIVES: The association between Mupirocin use and plasmid-based high-level resistance development mediated through mupA in CoNS has not been quantified. We determined acquisition of Mupirocin resistance in Staphylococcus aureus and CoNS in surgery patients treated peri-operatively with Mupirocin. PATIENTS AND METHODS: Patients admitted for surgery were treated with nasal Mupirocin ointment and chlorhexidine soap for 5 days, irrespective of S. aureus carrier status. Nasal swabs were obtained before decolonization (T1) and 4 days after surgery (T2) and were inoculated onto agars containing 8 mg/L Mupirocin. Staphylococci were identified by MALDI-TOF MS and Mupirocin resistance was confirmed by Etest. RESULTS: Among 1578 surgical patients, 936 (59%) had nasal swabs obtained at T1 and T2; 192 (21%) patients carried Mupirocin-resistant CoNS at T1 and 406 (43%) at T2 (P 256 mg/L (high level) and 381 of 383 (99.5%) were mupA positive. No acquisition of Mupirocin resistance was observed in S. aureus. CONCLUSIONS: Acquisition of Mupirocin resistance following decolonization was widespread in CoNS and absent in S. aureus. As almost all isolates harboured the mupA gene, monitoring resistance development in S. aureus when decolonization strategies containing Mupirocin are used is recommended.
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Emergence of High-Level Mupirocin Resistance in Coagulase-Negative Staphylococci Associated with Increased Short-Term Mupirocin Use
Journal of clinical microbiology, 2012Co-Authors: Erik Bathoorn, David J. Hetem, Johannes G. Kusters, Jeriela Alphenaar, Marc J. M. BontenAbstract:In our hospital, Mupirocin has increasingly been used for peri-operative decolonization of Staphylococcus aureus. The target for Mupirocin is isoleucyl tRNA synthetase (ileS). High-level resistance to Mupirocin is conferred by acquisition of plasmids expressing a distinct ileS gene (ileS2). Here we evaluated the longitudinal trends in high-level Mupirocin resistance in coagulase-negative staphylococci (CoNS) and linked this to the presence of ileS2 genes and Mupirocin use. We assessed Mupirocin resistance in CoNS bloodstream isolates from 2006 to 2011 tested by Phoenix automated testing (PAT). We evaluated the reliability of PAT results using Etest. PAT species determination was confirmed by MALDI-TOF (matrix-assisted laser desorption ionization–time of flight) mass spectrometry. We investigated the presence of ileS2 in the first 100 consecutive CoNS bloodstream isolates of each year using RT-PCR. Mupirocin use increased from 3.6 kg/year in 2006 to 13.3 kg/year in 2010 and correlated with the increase in the percentage of CoNS isolates carrying ileS2 (8% in 2006 to 22% in 2011; Spearman's rho, 0.137; P = 0.01). The sensitivity and specificity of PAT for detecting high-level Mupirocin resistance were 0.97 and 0.97, respectively. ileS2 was detected in 81 of 82 phenotypically highly Mupirocin-resistant strains and associated with resistance to ciprofloxacin, erythromycin, and clindamycin. In conclusion, we found a rapid increase in high-level resistance to Mupirocin and resistance to other antibiotics in CoNS associated with an increase in Mupirocin use. The associated resistance to other antibiotics may result in a reduction of oral antibiotic options for prolonged treatment of prosthetic infections with CoNS.
