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2017 ; 4
(2
): ofx093
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Antimicrobial Stewardship Lessons From Mupirocin Use and Resistance in
Methicillin-Resitant Staphylococcus Aureus
#MMPMID28702468
Peterson LR
; Samia NI
; Skinner AM
; Chopra A
; Smith B
Open Forum Infect Dis
2017[Spr]; 4
(2
): ofx093
PMID28702468
show ga
BACKGROUND: The quantitative relationship between antimicrobial agent consumption
and rise or fall of antibiotic resistance has rarely been studied. We began all
admission surveillance testing for methicillin-resistant Staphylococcus aureus
(MRSA) in August 2005 with subsequent contact isolation and decolonization using
nasally applied mupirocin ointment for those colonized. In October 2012, we
discontinued decolonization of medical (nonsurgical service) patients. METHODS:
We conducted a retrospective study from 2007 through 2014 of 445680 patients;
35235 were assessed because of mupirocin therapy and positive test results for
MRSA. We collected data on those patients receiving 2% mupirocin ointment for
decolonization to determine the defined daily doses (DDDs). A nonparametric
regression technique was used to quantitate the effect of mupirocin consumption
on drug resistance in MRSA. RESULTS: Using regressive modeling, we found that,
when consumption was consistently >25 DDD/1000 patient-days, there was a
statistically significant increase in mupirocin resistance with a correlating
positive rate of change. When consumption was ?25 DDD/1000 patient-days, there
was a statistically significant decrease in mupirocin resistance with a
correlating negative rate of change. The scatter plot of fitted versus observed
mupirocin resistance values showed an R(2) value of 0.89-a high correlation
between mupirocin use and resistance. CONCLUSIONS: Use of the antimicrobial agent
mupirocin for decolonization had a threshold of approximately 25 DDD/1000
patient-days that separated a rise and fall of resistance within the acute-care
setting. This has implications for how widely mupirocin can be used for
decolonization, as well as for setting consumption thresholds when prescribing
antimicrobials as part of stewardship programs.