Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 18 , ISSUE 11 ( November, 2014 ) > List of Articles


Mupirocin resistance in nasal carriage of Staphylococcus aureus among healthcare workers of a tertiary care rural hospital

Dardi Kaur, Pandey Narayan

Keywords : Antibiotic resistance, methicillin-resistant coagulase-negative Staphylococci, methicillin-resistant Staphylococcus aureus, mupirocin resistance

Citation Information : Kaur D, Narayan P. Mupirocin resistance in nasal carriage of Staphylococcus aureus among healthcare workers of a tertiary care rural hospital. Indian J Crit Care Med 2014; 18 (11):716-721.

DOI: 10.4103/0972-5229.144013

License: CC BY-ND 3.0

Published Online: 01-09-2008

Copyright Statement:  Copyright © 2014; The Author(s).


Introduction: Mupirocin (pseudomonic acid A) is a topical antimicrobial agent with excellent antistaphylococcal and antistreptococcal activity. A nasal formulation is approved by the United States Food and Drug Administration for eradicating nasal carriage in adult patients as well as in health care personnel. Resistance to mupirocin has already been reported worldwide. The increasing prevalence of mupirocin resistance among Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) species could be an important threat to the future use of mupirocin against methicillin-resistant S. aureus (MRSA). Thus, this study was carried out to find the prevalence of mupirocin resistance in S. aureus and CoNS by disc diffusion and to determine the rates of high-level and low-level mupirocin resistance in S. aureus and CoNS by disc diffusion. Materials and Methods: A total of 140 healthcare workers (HCWs) (doctor, nursing staff, housekeeping staff) were randomly selected. S. aureus and CoNS isolates were tested for mupirocin resistance by the disk diffusion method using 5 μg and 200 μg mupirocin discs. MRSA isolates were tested for antibiotics by Kirby-Bauer disc-diffusion method as per Clinical and Laboratory Standards Institute guidelines. Results: Out of 140 nasal swabs collected from HCWs, S. aureus was isolated in 38 (27.14%), and CoNS was isolated in 73 (52.14%). MRSA was isolated in 20 (14.28%) and methicillin-resistant coagulase-negative Staphylococci (MRCoNS) in 34 (24.29%. Methicillin-sensitive S. aureus (MSSA) and MSCoNS isolates were 100% sensitive to mupirocin, but two isolates from MRSA (1.43%) and five from MRCoNS (3.57%) were mupirocin resistant. Conclusion: The presence of mupirocin resistance in MRSA and MRCoNS is a cause for concern. It could be limited by regular surveillance and effective infection control initiatives so to inform health care facilities to guide therapeutic and prophylactic use of mupirocin.

PDF Share
  1. Yazgi H, Ertek M, Ozbek A, Kadanali A. Nasal carriage of Staphylococcus aureus in hospital personnel and the normal population and antibiotic resistance of the isolates. Mikrobiyol Bul 2003;37:137-42.
  2. Sousa-Junior FC, Silva-Carvalho MC, Fernandes MJ, Vieira MF, Pellegrino FL, Figueiredo AM, et al. Genotyping of methicillin-resistant Staphylococcus aureus isolates obtained in the Northeast region of Brazil. Braz J Med Biol Res 2009;42:877-81.
  3. Heininger U, Datta F, Gervaix A, Schaad UB, Berger C, Vaudaux B, et al. Prevalence of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) in children a multicenter cross-sectional study. Pediatr Infect Dis J 2007;26:544-6.
  4. Morange-Saussier V, Giraudeau B, van der Mee N, Lermusiaux P, Quentin R. Nasal carriage of methicillin-resistant Staphylococcus aureus in vascular surgery. Ann Vasc Surg 2006;20:767-72.
  5. Creech CB 2 nd, Kernodle DS, Alsentzer A, Wilson C, Edwards KM. Increasing rates of nasal carriage of methicillin-resistant Staphylococcus aureus in healthy children. Pediatr Infect Dis J 2005;24:617-21.
  6. Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751-62.
  7. Halablab MA, Hijazi SM, Fawzi MA, Araj GF. Staphylococcus aureus nasal carriage rate and associated risk factors in individuals in the community. Epidemiol Infect 2010;138:702-6.
  8. Peacock JE Jr, Moorman DR, Wenzel RP, Mandell GL. Methicillin-resistant Staphylococcus aureus: Microbiologic characteristics, antimicrobial susceptibilities, and assessment of virulence of an epidemic strain. J Infect Dis 1981;144:575-82.
  9. Goyal R, Das S, Mathur M. Colonisation of methicillin resistant Staphylococcus aureus among health care workers in a tertiary care hospital of Delhi. Indian J Med Sci 2002;56:321-4.
  10. Palepou MF, Johnson AP, Cookson BD, Beattie H, Charlett A, Woodford N. Evaluation of disc diffusion and Etest for determining the susceptibility of Staphylococcus aureus to mupirocin. J Antimicrob Chemother 1998;42:577-83.
  11. Laupland KB, Conly JM. Treatment of Staphylococcus aureus colonization and prophylaxis for infection with topical intranasal mupirocin: An evidence-based review. Clin Infect Dis 2003;37:933-8.
  12. Rahaman M, Noble WC, Cookson B. Mupirocin-resistant Staphylococcus aureus. Lancet 1987;2:387-8.
  13. Moorhouse E, Fenelon L, Hone R, Smyth E, McGahon J, Dillon M. Staphylococcus aureus sensitivity to various antibiotics-a national survey in Ireland 1993. Ir J Med Sci 1996;165:40-3.
  14. Upton A, Lang S, Heffernan H. Mupirocin and Staphylococcus aureus: Recent paradigm of emerging antibiotic resistance. J Antimicrob Chemother 2003;51:613-7.
  15. Vasquez JE, Walker ES, Franzus BW, Overbay BK, Reagan DR, Sarubbi FA. The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a Veterans′ Affairs hospital. Infect Control Hosp Epidemiol 2000;21:459-64.
  16. Orrett FA. The emergence of mupirocin resistance among clinical isolates of methicillin-resistant Staphylococcus aureus in Trinidad: A first report. Jpn J Infect Dis 2008;61:107-10.
  17. Udo EE, Jacob LE, Mathew B. Genetic analysis of methicillin-resistant Staphylococcus aureus expressing high- and low-level mupirocin resistance. J Med Microbiol 2001;50:909-15.
  18. Seah C, Alexander DC, Louie L, Simor A, Low DE, Longtin J, et al. MupB, a new high-level mupirocin resistance mechanism in Staphylococcus aureus. Antimicrob Agents Chemother 2012;56:1916-20.
  19. Hurdle JG, O′Neill AJ, Mody L, Chopra I, Bradley SF. In vivo transfer of high-level mupirocin resistance from Staphylococcus epidermidis to methicillin-resistant Staphylococcus aureus associated with failure of mupirocin prophylaxis. J Antimicrob Chemother 2005;56:1166-8.
  20. Clinical and Laboratory Standard Institute. Performance standards for antimicrobial disc susceptibility tests, twentieth supplement. 2012;32:M100-S21.
  21. Finlay JE, Miller LA, Poupard JA. Interpretive criteria for testing susceptibility of Staphylococci to mupirocin. Antimicrob Agents Chemother 1997;41:1137-9.
  22. Golia S, Hittinahalli V, Kamath AS, Nirmala AR. A study of nasal carriage of MRSA among the health care workers of a tertiary care hospital, Bangalore. Int J Basic Appl Med Sci 2013; 3:3-7.
  23. Rongpharpi SR, Hazarika NK, Kalita H. The prevalence of nasal carriage of Staphylococcus aureus among healthcare workers at a tertiary care hospital in Assam with special reference to MRSA. J Clin Diagn Res 2013;7:257-60.
  24. Vinodhkumaradithyaa A, Uma A, Shirivasan M, Ananthalakshmi I, Nallasivam P, Thirumalaikolundusubramanian P. Nasal carriage of methicillin-resistant Staphylococcus aureus among surgical unit staff. Jpn J Infect Dis 2009;62:228-9.
  25. Shakya B, Shrestha S, Mitra T. Nasal carriage rate of methicillin resistant Staphylococcus aureus among at National Medical College Teaching Hospital, Birgunj, Nepal. Nepal Med Coll J 2010;12:26-9.
  26. Silva EC, Antas Md, Monteiro B Neto A, Rabelo MA, Melo FL, Maciel MA. Prevalence and risk factors for staphylococcus aureus in health care workers at a university hospital of Recife-PE. Braz J Infect Dis 2008;12:504-8.
  27. Oommen SK, Appalaraju B, Jinsha K. Mupirocin resistance in clinical isolates of Staphylococci in a tertiary care centre in south India. Indian J Med Microbiol 2010;28:372-5.
  28. Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK, Chaudhry R, et al. Mupirocin resistance in Staphylococcus aureus in an Indian hospital. Diagn Microbiol Infect Dis 2007;58:125-7.
  29. Schmitz FJ, Jones ME. Antibiotics for treatment of infections caused by MRSA and elimination of MRSA carriage. What are the choices? Int J Antimicrob Agents 1997;9:1-19.
  30. O′Neill AJ, McLaws F, Kahlmeter G, Henriksen AS, Chopra I. Genetic basis of resistance to fusidic acid in Staphylococci. Antimicrob Agents Chemother 2007;51:1737-40.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.