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[A. Zannier, MD, MSc]

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Risk factors associated with mupirocin resistance in meticillin-resistant Staphylococcus aureus


A.R. Caffreya, b, B.J. Quilliamb and K.L. LaPlantea, b, c, 

 


a Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, Rhode Island, USAb University of Rhode Island, Department of Pharmacy Practice, Kingston, Rhode Island, USAc Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, Rhode Island, USA 




Received 26 March 2010;  accepted 24 June 2010.  Available online 16 September 2010.  



SummaryImplementation of meticillin-resistant Staphylococcus aureus
 (MRSA) decolonisation programmes has been increasing and the emergence 
of mupirocin resistance has been reported. However, the patient-level 
risk factors associated with mupirocin resistance are not clear. In this
 study, independent predictors of mupirocin resistance in MRSA among 
Providence Veterans Affairs Medical Center patients with MRSA-positive 
culture dates between 1 July 2004 and 30 June 2008 were identified using
 a frequency-matched case¨Ccontrol study. Forty cases 
(mupirocin-resistant) were matched on culture date quarter and year to 
270 controls (mupirocin-susceptible). The adjusted conditional logistic 
regression model identified three significant independent predictors 
associated with mupirocin resistance in MRSA: (1) exposure to mupirocin 
in the year prior to the culture date [odds ratio (OR): 9.84; 95% 
confidence interval (CI): 2.93¨C33.09]; (2) Pseudomonas aeruginosa
 infection in the year before the culture-related admission (4.85; 
1.20¨C19.61); and (3) cefepime use in the year prior to culture (2.80; 
1.03¨C7.58). In sensitivity analyses, previous mupirocin exposure was 
associated with low-level [minimum inhibitory concentration (MIC) 
8¨C128 mg/L; 23 cases, 202 controls; OR: 6.32; 95% CI: 1.58¨C25.33] and 
high-level (MIC ¡Ý256 mg/L; 17 cases, 151 controls; OR: 11.18; 95% CI: 
1.89¨C66.30) mupirocin resistance. To our knowledge, this is the first 
case¨Ccontrol study to reveal a strong association between previous 
mupirocin exposure and subsequent mupirocin resistance in MRSA, with 
demonstrated robustness in low- and high-level mupirocin resistance. 
Mupirocin susceptibility monitoring is critical for facilities 
instituting decolonisation with mupirocin as increased use may reduce 
effectiveness through resistance. 


Keywords: Meticillin-resistant Staphylococcus aureus Mupirocin resistance; Risk factors