Resistance mupirocin

Other pseudomonic acids (B, C, D) are also produced. Mupirocin is active predominantly against staphylococci and most streptococci, but Enterococcus faecalis and Gramnegative bacilli are resistant There is also evidence of plasmid-mediated mupirocin resistance in some chnical isolates of Staph, aureus. 

Gilbart J., Perry CR. Slocombe B. (1993) High-level mupirocin resistance in Staphylococcus aureus evidence for two distinct isoleucyl-tRNA synthetases. Antimicrob Agents Chemother, 31, 32-38. Godfrey A.J. Bryan L.E. (1984) Intrinsic resistance and whole cell factors contributing to antibiotic resistance, hv. Antimicrobial Drug Resistance (ed. L.E. Bryan), pp. 113-145. New York Academic Press. 

Intranasal S. aureus increases the risk of S. aureus exit-site infections, tunnel infections, peritonitis, and subsequent catheter loss.49 Several measures have been used to decrease the risk of peritonitis caused by S. aureus, including mupirocin cream applied daily around the exit site, intranasal mupirocin cream twice daily for 5 days each month, or rifampin 300 mg orally twice daily for 5 days, repeated every 3 months.49 Mupirocin use is preferred over rifampin to prevent the development of resistance to rifampin, although mupirocin resistance has also been reported.49 Other measures that have been used to decrease both S. aureus and P. aeruginosa infections include gentamicin cream applied twice daily and ciprofloxacin otic solution applied daily to the exit site.49... 

Mupirocin is indicated for topical treatment of minor skin infections, such as impetigo. Topical application over large infected areas, such as decubitus ulcers or open surgical wounds, has been identified as an important factor leading to emergence of mupirocin-resistant strains and is not recommended. Mupirocin is also indicated for intranasal application for elimination of methicillin-resistant S aureus carriage by patients or health care workers. 

Production of second, Mupirocin Plasmid-mediated mupirocin-resistant... 

Of 36 patients undergoing continuous ambulatory peritoneal dialysis (mean age 55 years 21 men), who had been applying mupirocin to the catheter exit site once weekly for an average of 3.1 years before the start of the study, three were nasal carriers of S. aureus, and there was only one mupirocin-resistant organism (5). Once-weekly application of mupirocin at catheter exit sites led to comparable rates of colonization by mupirocin-resistant S. aureus as did thrice-weekly or more frequent application. 

Cookson, B. Failure of mupirocin-resistant staphylococci to inactivate mupirocin. Eur.J.Clin. Microbiol.In feet.Dis., 1989, 8, 1038-1040... 

Farmer, T.H. Gilbart, J. Elson, S.W. Biochemical basis of mupirocin resistance in strains of Staphylococcus aureus. J.Antimicrob.Chemother., 1992, 30, 587-596... 

In conclusion, evidence exists for the topical use of mupirocin, polysporin B, and to a lesser degree PVI for CLABSI prevention. The potential for mupirocin resistance development has to be considered. Currently, while gramicidin is not available in the US, a similar preparation in the form of bacitracin/neomycin/ polymyxin B is commonly used. 

Mupirocin is employed topically in eradicating nasal and skin carriage of staphylococci, including methicilhn-resistantS to/)/ , colonization. 

Mupirocin is a topical antibiotic that inhibits isoleucyl tRNA synthetase with the subsequent inhibition of protein synthesis. Mupirocin has become a mainstay in the treatment of Staph, aureus infection and colonization during hospital outbreaks, and it is in this organism that acquired resistance has arisen (Gilbart etal. 1993). 

MUPF resins, 75 779 Mupirocin, bacterial resistance mechanisms, 3 32t... 

Mupirocin is an antibiotic agent available only for topical use. It is indicated for use in Gram-positive skin infections. Mupirocin should not be used for more than 10 days, to prevent the emergence of resistance. 

Mupirocin is not related to any of the sys-temically used antibiotics. It is an inhibitor of bacterial protein synthesis and is especially active against gram-positive aerobic bacteria, e.g. methicillin-resistant S. aureus and group A beta-hemolytic streptococci. Absorption through the skin is minimal. Intranasal application may be associated with irritation of mucous membranes. 

Mupirocin (pseudomonic acid A) is structurally unrelated to other currently available topical antibacterial agents. Most gram-positive aerobic bacteria, including methicillin-resistant S aureus (MRSA), are sensitive to mupirocin (see Chapter 50). It is effective in the treatment of impetigo caused by S aureus and group A -hemolytic streptococci. 

Mupirocin (Bactroban) inhibits a specific enzyme responsible for tRNA synthesis in susceptible bacteria. This drug is used topically to treat skin infections caused by Staphylococcus aureus or Streptococcus pyogenes. Likewise, mupirocin can be administered by nasal spray to treat local colonization of S. aureus in the nasal mucosa. This idea may be especially helpful in preventing systemic infection in individuals such as health care workers who are exposed to an outbreak of resistant strains of S. aureus. Local/topical administration of this drug is well tolerated, although some irritation of the skin may occur during topical use, and cough and respiratory irritation can occur when mupirocin is administered by nasal spray. 

Octenidine is an antiseptic with proven antimicrobial qualities, which is frequently used as a disinfectant in surgery as well as antiseptic mouthwash with excellent tolerance especially when used on mucous membranes.23,24 It has even been shown to be effective in eradicating MRSA when used as an octenidine dihydrochloride whole-body wash combined with nasal mupirocin treatment.25 Due to the low irritant and allergic potential as well a low resistance rate, octenidine seems to be a substance with a promising future. 

Although the incidence of adverse reactions to mupirocin is typically low (occurring in less than 1.5% of patients), several local side effects such as burning, stinging, pain, erythema, and contact dermatitis have been reported. Resistance to mupirocin has been reported but is not common. Some strains of bacteria have a low level of resistance but succumb to high-dose of mupirocin.14 Due to this fact, it should be handled with extreme care, especially as prophylactic use, in order to prevent further resistance. 

Topical Antibiotic Monotherapy Localized impetiginized eczema lesions can be treated successfully with topical fusidic acid or mupirocin, whereas topical application of other antibiotics (neomycin as obsolete aminoglycosid, tetracyclines, or polymyxines) should be avoided.84 Especially in children with AD, fusidic acid resistance seems to be a particular problem reflecting the chronicity and the extent of the disease (see Section 30.2.2). 

Fusidic acid and mupirocin has been proven to be equal in clinical efficacy 85-87 The risk of allergic contact dermatitis to fusidic acid in patients with AD can be considered very low. In an analysis of multicenter surveillance data in Germany, fusidic acid did not cause any case of sensitization in the subgroup of atopies.29 Topical neomycin, however, is rarely indicated not only because of inefficacy and high resistance rates, but also because of frequent development of allergic contact dermatitis.88,89... 

Rohr, U. et al., Methicillin-resistant Staphylococcus aureus whole-body decolonization among hospitalized patients with variable site colonization by using mupirocin in combination with octenidine dihydrochloride. J. Hosp. Infect. 54, 305-309, 2003. 

Ravenscroft, J.C. et al., Short-term effects of topical fusidic acid or mupirocin on the prevalence of fusidic acid resistant (FusR) Staphylococcus aureus in atopic eczema. Br. J. Dermatol. 148, 1010— 1017, 2003. 

Mupirocin is primarily active against Gram-positive organisms including those commonly associated with skin infections. It is available as an ointment for use, e.g. in folliculitis and impetigo, and to eradicate nasual staphylococci, e.g. in carriers of resistant staphylococci. It is rapidly hydrolysed in the tissues. 

Topical/wsidic add and mupirocin are preferred (as they are not ordinarily used for systemic infections and therefore development of drug resistant strains is less likely to have any serious consequences). Framycetin and polymjodns are also used. Absorption of neomycin from all topical preparations can cause serious injury to the eighth cranial nerve. It is also a contact sensitiser. 

Mupirocin is an antibiotic that inhibits bacterial protein synthesis by binding to isoleucyl transfer RNA synthetase. It is primarily bacteriostatic at low concentrations, but is bactericidal in the high concentrations and can have activity against organisms reported to be relatively resistant in vitro. 

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