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Yin N, Michel C, Makki N, Deplano A, Milis A, Prevost B, Miendje-Deyi VY, Hallin M, Martiny D. Emergence and spread of a mupirocin-resistant variant of the European epidemic fusidic acid-resistant impetigo clone of Staphylococcus aureus, Belgium, 2013 to 2023. Euro Surveill 2024; 29:2300668. [PMID: 38726693 PMCID: PMC11083972 DOI: 10.2807/1560-7917.es.2024.29.19.2300668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 05/12/2024] Open
Abstract
BackgroundAntimicrobial resistance to mupirocin and fusidic acid, which are used for treatment of skin infections caused by Staphylococcus aureus, is of concern.AimTo investigate resistance to fusidic acid and mupirocin in meticillin-susceptible S. aureus (MSSA) from community-acquired skin and soft tissue infections (SSTIs) in Belgium.MethodsWe collected 2013-2023 data on fusidic acid and mupirocin resistance in SSTI-associated MSSA from two large Belgian laboratories. Resistant MSSA isolates sent to the Belgian Staphylococci Reference Centre were spa-typed and analysed for the presence of the eta and etb virulence genes and the mupA resistance gene. In addition, we whole genome sequenced MSSA isolates collected between October 2021 and September 2023.ResultsMupirocin resistance increased between 2013 and 2023 from 0.5-1.5% to 1.7-5.6%. Between 2018 and 2023, 91.4% (64/70) of mupirocin-resistant isolates were co-resistant to fusidic acid. By September 2023, between 8.9% (15/168) and 10.1% (11/109) of children isolates from the two laboratories were co-resistant. Of the 33 sequenced isolates, 29 were sequence type 121, clonal and more distantly related to the European epidemic fusidic acid-resistant impetigo clone (EEFIC) observed in Belgium in 2020. These isolates carried the mupA and fusB genes conferring resistance to mupirocin and fusidic acid, respectively, and the eta and etb virulence genes.ConclusionWe highlight the spread of a mupirocin-resistant EEFIC in children, with a seasonal trend for the third quarter of the year. This is of concern because this variant is resistant to the two main topical antibiotics used to treat impetigo in Belgium.
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Affiliation(s)
- Nicolas Yin
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
| | - Charlotte Michel
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
| | - Nadia Makki
- Department of microbiology, Algemeen Medisch Laboratorium (AML), Antwerp, Belgium
| | - Ariane Deplano
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
| | - Alisha Milis
- Department of microbiology, Algemeen Medisch Laboratorium (AML), Antwerp, Belgium
| | - Benoit Prevost
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
| | | | - Marie Hallin
- Centre for environmental health and occupational health, Public health school, Université libre de Bruxelles, Brussels, Belgium
- European Plotkin institute for vaccinology (EPIV), Faculty of medicine, Université libre de Bruxelles, Brussels, Belgium
- These authors contributed equally to the work and share the last authorship
| | - Delphine Martiny
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
- Faculty of medicine and pharmacy, Université de Mons, Mons, Belgium
- These authors contributed equally to the work and share the last authorship
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Mirhaj M, Varshosaz J, Labbaf S, Emadi R, Seifalian AM, Sharifianjazi F, Tavakoli M. Mupirocin loaded core-shell pluronic-pectin-keratin nanofibers improve human keratinocytes behavior, angiogenic activity and wound healing. Int J Biol Macromol 2023; 253:126700. [PMID: 37673152 DOI: 10.1016/j.ijbiomac.2023.126700] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/11/2023] [Accepted: 09/02/2023] [Indexed: 09/08/2023]
Abstract
In the current study, a core-shell nanofibrous wound dressing based on Pluronic-F127 (F127) containing 2 wt% mupirocin (Mup) core and pectin (Pec)-keratin (Kr) shell was fabricated through coaxial electrospinning technique, and the blended nanofibers were also fabricated from the same materials. The fiber diameter and specific surface area of the blended nanofibers were about 101.56 nm and 20.16 m2/g, while for core-shell nanofibers they were about 97.32 nm and 25.26 m2/g, respectively. The resultant blended and core-shell nanofibers experienced a degradation of 27.65 % and 32.28 % during 7 days, respectively. The drug release profile of core-shell nanofibers revealed a sustained release of Mup over 7 days (87.66 %), while the blended F127-Pec-Kr-Mup nanofibers had a burst release within the first few hours (89.38 % up to 48 h) and a cumulative release of 91.36 % after 7 days. Due to the controlled release of Mup, the core-shell structure significantly improved the human keratinocytes behavior, angiogenic potential and wound healing in a rat model compared to the blended structure. In conclusion, the F127-Mup/Pec-Kr core-shell nanofibrous wound dressing appears to be a promising candidate for the prevention of infection, and can potentially accelerate the recovery and healing of chronic and ischemic wounds.
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Affiliation(s)
- Marjan Mirhaj
- Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran
| | - Jaleh Varshosaz
- Novel Drug Delivery Systems Research Centre, Department of Pharmaceutics, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sheyda Labbaf
- Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran.
| | - Rahmatollah Emadi
- Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran.
| | - Alexander Marcus Seifalian
- Nanotechnology & Regenerative Medicine Commercialization Centre (NanoRegMed Ltd, Nanoloom Ltd, Liberum Health Ltd), London BioScience Innovation Centre, London, United Kingdom
| | - Fariborz Sharifianjazi
- Department of Natural Sciences, School of Science and Technology, University of Georgia, Tbilisi 0171, Georgia.
| | - Mohamadreza Tavakoli
- Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran
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3
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Ghaffary S, Javidnia A, Beheshtirouy S, Sadeghi J, Akbari AM, Hamishehkar H, Sarbakhsh P, Sanaat Z, Nikanfar A, Esfahani A, Chavoshi SH, Nejati B, Raeisi M, Gholami N. Comparison of global decolonization efficacy with mupirocin nasal drop and chlorhexidine mouthwash in acute leukemia patients: randomized clinical trial. Support Care Cancer 2023; 32:42. [PMID: 38110726 DOI: 10.1007/s00520-023-08232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/03/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE Neutropenic fever remains a major complication in acute leukemia. Decolonization is assumed as a promising intervention for eradicating causative agents of infection. METHODS In this randomized clinical trial, 96 patients with acute leukemia were assigned randomly to mupirocin nasal drop 2% (n = 32), chlorhexidine mouthwash 0.2% (n = 33), and control group (n = 31). In control group, patients did not receive any medication for decolonization. All patients received treatment for 5 days (2 days prior to chemotherapy until 3 days after chemotherapy). Pharynx and nasal swabs were taken prior to the intervention and at the end of decolonization period in all groups. Antibiotic susceptibility testing was performed by the disc diffusion method in order to identify bacterial isolates. RESULTS Bacterial recovery of both nasal and pharynx swabs was observed after global decolonization with mupirocin nasal drop. Decolonization with mupirocin significantly eradicated Coagulase-negative staphylococci (CONS) in both nasal and pharynx swabs (p-value = 0.000). Moreover, mupirocin decreased Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) species. Chlorhexidine mouthwash significantly eradicated CONS in pharynx swabs (p-value = 0.000). In addition, both decolonization strategies decreased both antibiotic use and frequency of fever in leukemic patients. CONCLUSION Global decolonization with mupirocin nasal drop not only eradicates both nasal and pharynx microorganisms, but also reduces antibiotic requirement and frequency of fever in patients with acute leukemia. The protocol of the present study was approved on December 2016 (registry number: IRCT20160310026998N6).
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Affiliation(s)
- Saba Ghaffary
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Aref Javidnia
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Javid Sadeghi
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hamed Hamishehkar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zohreh Sanaat
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Nikanfar
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Esfahani
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Hadi Chavoshi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Nejati
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mortaza Raeisi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Gholami
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Whelan L, Leal J, Barkema HW, Leslie M, McClure JA, Zhang K, May ER. Baseline prevalence of antimicrobial resistance in patients who develop a surgical site infection in hip and knee replacements: A brief report. Am J Infect Control 2023; 51:1449-1451. [PMID: 37353054 DOI: 10.1016/j.ajic.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
Prior to clean surgeries, decolonization with topical antimicrobials may lead to an increase in antimicrobial resistance. To provide a baseline prevalence of resistance to topical antimicrobials, in Alberta, specimens were collected from surgical site infections following hip and knee replacements. Among 81 samples with complex surgical site infections, in 43 specimens Staphylococcus species were isolated. Only coagulase-negative staphylococci isolates carried resistance genes with 10 carrying the gene qac and 6 carrying the MupA gene.
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Affiliation(s)
- Lindsay Whelan
- Departments of Community Health Sciences, University of Calgary, Strategic Clinical Network, Alberta Health Services, AMR-One Health Consortium, Calgary, Alberta, Canada.
| | - Jenine Leal
- Departments of Community Health Sciences, and Microbiology Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, O'Brien Institute for Public Health, University of Calgary, AMR-One Health Consortium, Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Herman W Barkema
- Department of Production Animal Health Faculty of Veterinary Medicine and Cumming School of Medicine, University of Calgary, AMR-One Health Consortium, One Health at UCalgary, University of Calgary Biostatistics Centre, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, and School of Public Policy, University of Calgary, AMR-One Health Consortium, Calgary, Alberta, Canada
| | - Myles Leslie
- Department of Community Health Sciences, Cumming School of Medicine, and School of Public Policy, University of Calgary, AMR-One Health Consortium, Calgary, Alberta, Canada
| | - Jo-Ann McClure
- Departments of Medicine, Centre for Antimicrobial Resistance, Alberta Health Services, Calgary/Alberta Provincial Laboratories/University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Departments of Medicine, Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Provincial Laboratories /University of Calgary, Calgary, Alberta, Canada; Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine, The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Elissa Rennert May
- Departments of Medicine, and Community Health Sciences, and Microbiology Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, University of Calgary, Calgary, Alberta, Canada; Departments of Medcine, O'Brien Institute for Public Health and Snyder Institute for Chronic Diseases, AMR-One Health Consortium, Calgary, Alberta, Canada
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5
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Winter AJ, Khanizeman RN, Barker‐Mountford AMC, Devine AJ, Wang L, Song Z, Davies JA, Race PR, Williams C, Simpson TJ, Willis CL, Crump MP. Structure and Function of the α-Hydroxylation Bimodule of the Mupirocin Polyketide Synthase. Angew Chem Int Ed Engl 2023; 62:e202312514. [PMID: 37768840 PMCID: PMC10953402 DOI: 10.1002/anie.202312514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 09/30/2023]
Abstract
Mupirocin is a clinically important antibiotic produced by a trans-AT Type I polyketide synthase (PKS) in Pseudomonas fluorescens. The major bioactive metabolite, pseudomonic acid A (PA-A), is assembled on a tetrasubstituted tetrahydropyran (THP) core incorporating a 6-hydroxy group proposed to be introduced by α-hydroxylation of the thioester of the acyl carrier protein (ACP) bound polyketide chain. Herein, we describe an in vitro approach combining purified enzyme components, chemical synthesis, isotopic labelling, mass spectrometry and NMR in conjunction with in vivo studies leading to the first characterisation of the α-hydroxylation bimodule of the mupirocin biosynthetic pathway. These studies reveal the precise timing of hydroxylation by MupA, substrate specificity and the ACP dependency of the enzyme components that comprise this α-hydroxylation bimodule. Furthermore, using purified enzyme, it is shown that the MmpA KS0 shows relaxed substrate specificity, suggesting precise spatiotemporal control of in trans MupA recruitment in the context of the PKS. Finally, the detection of multiple intermodular MupA/ACP interactions suggests these bimodules may integrate MupA into their assembly.
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Affiliation(s)
| | | | | | | | - Luoyi Wang
- Institute of MicrobiologyChinese Academy of SciencesBeijing100101China
| | - Zhongshu Song
- School of ChemistryUniversity of BristolBristolBS8 1TSUK
| | | | - Paul R. Race
- School of BiochemistryUniversity of BristolBristolBS8 1TDUK
- current addressSchool of Natural and Environmental SciencesNewcastle UniversityNewcastle upon TyneNE1 7RUUK
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6
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Winter AJ, Khanizeman RN, Barker‐Mountford AMC, Devine AJ, Wang L, Song Z, Davies JA, Race PR, Williams C, Simpson TJ, Willis CL, Crump MP. Structure and Function of the α-Hydroxylation Bimodule of the Mupirocin Polyketide Synthase. Angew Chem Weinheim Bergstr Ger 2023; 135:e202312514. [PMID: 38515435 PMCID: PMC10952193 DOI: 10.1002/ange.202312514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Indexed: 03/23/2024]
Abstract
Mupirocin is a clinically important antibiotic produced by a trans-AT Type I polyketide synthase (PKS) in Pseudomonas fluorescens. The major bioactive metabolite, pseudomonic acid A (PA-A), is assembled on a tetrasubstituted tetrahydropyran (THP) core incorporating a 6-hydroxy group proposed to be introduced by α-hydroxylation of the thioester of the acyl carrier protein (ACP) bound polyketide chain. Herein, we describe an in vitro approach combining purified enzyme components, chemical synthesis, isotopic labelling, mass spectrometry and NMR in conjunction with in vivo studies leading to the first characterisation of the α-hydroxylation bimodule of the mupirocin biosynthetic pathway. These studies reveal the precise timing of hydroxylation by MupA, substrate specificity and the ACP dependency of the enzyme components that comprise this α-hydroxylation bimodule. Furthermore, using purified enzyme, it is shown that the MmpA KS0 shows relaxed substrate specificity, suggesting precise spatiotemporal control of in trans MupA recruitment in the context of the PKS. Finally, the detection of multiple intermodular MupA/ACP interactions suggests these bimodules may integrate MupA into their assembly.
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Affiliation(s)
| | | | | | | | - Luoyi Wang
- Institute of MicrobiologyChinese Academy of SciencesBeijing100101China
| | - Zhongshu Song
- School of ChemistryUniversity of BristolBristolBS8 1TSUK
| | | | - Paul R. Race
- School of BiochemistryUniversity of BristolBristolBS8 1TDUK
- current addressSchool of Natural and Environmental SciencesNewcastle UniversityNewcastle upon TyneNE1 7RUUK
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7
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Smith M, Herwaldt L. Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU. Am J Infect Control 2023; 51:A64-A71. [PMID: 37890955 DOI: 10.1016/j.ajic.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units. METHODS We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited. DISCUSSION/CONCLUSIONS Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.
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Affiliation(s)
- Matthew Smith
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA.
| | - Loreen Herwaldt
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
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8
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Galal MM, Abdullah SA, Mohamed OY, Moustafa AA. Greenness assessment of two chromatographic methods developed for the determination of Mupirocin in two binary mixtures along with its impurity. BMC Chem 2023; 17:145. [PMID: 37891646 PMCID: PMC10612294 DOI: 10.1186/s13065-023-01055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Two simple, accurate and precise chromatographic methods have been developed and validated for estimating Mupirocin (MUP) in two binary mixtures. Mixture (1); with Fluticasone propionate (FLU) together with two of their impurities, namely; Pseudomonic acid-D (Pseud-D) and Fluticasone impurity C (FIC). Mixture (2); with Mometasone furoate (MF) along with Pseud-D impurity. High performance thin layer chromatography (HPTLC-densitometry) and high performance liquid chromatography (RP-HPLC) were the two proposed methods. In the HPTLC method, good separation of both mixtures was achieved by using HPTLC plates pre-coated with silica gel 60 F254 as stationary phase and the mobile phase consisted of toluene: chloroform: ethanol at a ratio of (5: 4: 2, by volume). The detection was carried out at 220 nm for MUP and 254 nm for FLU, MF, Pseud-D and FIC. In the HPLC method, chromatographic separation was carried out using Agilent Eclipse XDB (250 mm×4.6 mm, 5 μm) C18 column. For mixture (1), a mobile phase of methanol: sodium di-hydrogen phosphate (pH 3.0) was applied in stepwise gradient elution starting at ratios of (50: 50, v/v) and then switching to (80: 20, v/v) after 7 min at a flow rate of 1 mL.min- 1. Detection was performed using diode array detector at 220 nm for MUP and Pseud-D and 240 nm for FLU and FIC. For mixture (2), the same mobile phase was used, but in isocratic elution in the ratio (80: 20, v/v) at flow rate of 1 mL.min- 1 and detection at 220 nm for MUP and Pseud-D and 248 nm for MF. The two methods successfully separated the cited drugs and were used to determine the drugs in pure form as well as pharmaceutical dosage forms. Validation was done as per International Council on Harmonization guidelines. Furthermore, the greenness of the proposed methods compared to the reported method, was evaluated as per the National Environmental Method Index, analytical Eco scale, Green Analytical Procedure Index and Analytical Greenness metric approaches.
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Affiliation(s)
- Maha M Galal
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini street, Cairo, 11562, Egypt.
| | - Shaaban A Abdullah
- Egyptian Drug Authority-Central Administration for Drug Control (EDA-CADC), Cairo, Egypt
| | - Ola Y Mohamed
- Egyptian Drug Authority-Central Administration for Drug Control (EDA-CADC), Cairo, Egypt
| | - Azza A Moustafa
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini street, Cairo, 11562, Egypt
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9
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Mirhaj M, Varshosaz J, Labbaf S, Emadi R, Marcus Seifalian A, Sharifianjazi F. An antibacterial Multi-Layered scaffold fabricated by 3D printing and electrospinning methodologies for skin tissue regeneration. Int J Pharm 2023; 645:123357. [PMID: 37647978 DOI: 10.1016/j.ijpharm.2023.123357] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/26/2023] [Indexed: 09/01/2023]
Abstract
A multi-layered scaffold can mimic the hierarchical structure of the skin, accelerate the wound healing, and protect the skin against contamination and infection. In this study, a three-layered (3L) scaffold was manufactured through a combination of 3D printing and electrospinning technique. A top layer of polyurethane (PU) nanofibrous coating for the prevention of micro-organism penetration was created through electrospining. The middle layer was prepared through the 3D printing of Pluronic F127-quaternized chitosan-silver nitrate nanoparticles (F127-QCS-AgNO3), as the porous absorbent and antibacterial layer. A bottom layer of core-shell nanofibrous structure of F127-mupirocin/pectin-keratin (F127-Mup/Pec-Kr) for tissue regeneration and enable antibacterial activity was coated onto the middle layer. A range of techniques were applied to fully characterize the resultant structure. The average tensile strength and elastic modulus of the 3L scaffold were measured as 0.65 ± 0.08 MPa and 9.37 ± 2.33 MPa, respectively. The release of Ag ions, mupirocin (Mup), and the antibacterial activity of the dressings was investigated. According to the results, the highest rate of cell adhesion and viability, and angiogenic potential among the studied samples were related to the 3L scaffold, which was also found to significantly accelerate the wound healing.
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Affiliation(s)
- Marjan Mirhaj
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran.
| | - Jaleh Varshosaz
- Novel Drug Delivery Systems Research Centre, Department of Pharmaceutics, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sheyda Labbaf
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran.
| | - Rahmatollah Emadi
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran.
| | - Alexander Marcus Seifalian
- Nanotechnology & Regenerative Medicine Commercialization Centre (NanoRegMed Ltd, Nanoloom Ltd, Liberum Health Ltd), London BioScience Innovation Centre, London, United Kingdom.
| | - Fariborz Sharifianjazi
- Department of Natural Sciences, School of Science and Technology, University of Georgia, Tbilisi, Georgia.
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10
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Wang B, Zhan Q, Xiao Y, Xu Y, Zhao H, Rao L, Wang X, Zhang J, Shen L, Zhou Y, Guo Y, Wu X, Yu J, Yu F. Mupirocin enhances the biofilm formation of Staphylococcus epidermidis in an atlE-dependent manner. Int J Antimicrob Agents 2023; 62:106904. [PMID: 37385560 DOI: 10.1016/j.ijantimicag.2023.106904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/27/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023]
Abstract
The pathogenicity of Staphylococcus epidermidis is largely attributed to its exceptional ability to form biofilms. Here, we report that mupirocin, an antimicrobial agent widely used for staphylococcal decolonization and anti-infection, strongly stimulates the biofilm formation of S. epidermidis. Although the polysaccharide intercellular adhesin (PIA) production was unaffected, mupirocin significantly facilitated extracellular DNA (eDNA) release by accelerating autolysis, thereby positively triggering cell surface attachment and intercellular agglomeration during biofilm development. Mechanistically, mupirocin regulated the expression of genes encoding for the autolysin AtlE as well as the programmed cell death system CidA-LrgAB. Critically, through gene knockout, we found out that deletion of atlE, but not cidA or lrgA, abolished the enhancement of biofilm formation and eDNA release in response to mupirocin treatment, indicating that atlE is required for this effect. In Triton X-100 induced autolysis assay, mupirocin treated atlE mutant displayed a slower autolysis rate compared with the wild-type strain and complementary strain. Therefore, we concluded that subinhibitory concentrations of mupirocin enhance the biofilm formation of S. epidermidis in an atlE dependent manner. This induction effect could conceivably be responsible for some of the more unfavourable outcomes of infectious diseases.
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Affiliation(s)
- Bingjie Wang
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qing Zhan
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China; Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanghua Xiao
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yanlei Xu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Huilin Zhao
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lulin Rao
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xinyi Wang
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiao Zhang
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Shen
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Zhou
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yinjuan Guo
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaocui Wu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jingyi Yu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fangyou Yu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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11
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Saffari PS, Lee C, Acharya H. Extensive Non-Bullous Facial Impetigo in an Adult. Vis J Emerg Med 2023; 32:101754. [PMID: 37901479 PMCID: PMC10601362 DOI: 10.1016/j.visj.2023.101754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Persiana S. Saffari
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carol Lee
- West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA
| | - Hemang Acharya
- West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA
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12
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Zubairi MB, Abd AH, Al-lami MS. Formulation and Characterization of Mupirocin Nanomicelles in Insulin-Based Gel for Dermatological Application. J Pharm Bioallied Sci 2023; 15:S1178-S1181. [PMID: 37694028 PMCID: PMC10485479 DOI: 10.4103/jpbs.jpbs_172_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 09/02/2023] Open
Abstract
Aim To produce and analyze mupirocin nanomicelle (MP-NM) in insulin-based gel. Procedures MP-NM was prepared using solvent evaporation with Tween 80 as a surfactant. HPMC polymer prepared gel. MP-NM was characterized by globular diameter, polydispersity index (PDI), pH, entrapment efficiency (EE), and transmission electron microscopy (TEM). NM MP release was studied in vitro. Results The revolutionary MP-NM in insulin-based gel dissolves MP completely without precipitation due to its unique physical and chemical properties. MP had 8.64 ± 0.2 nm globular diameter, high EE (98.85 ± 0.01%), and normal homogeneous dispersion (PDI, 0.143 ± 0.003) in NM. MP's formula showed rapid first-order kinetics release. Conclusion To our knowledge, this is the first MP-NM nano-drug delivery system employing insulin-based gel. It has promising pre-clinical and clinical uses.
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Affiliation(s)
- Maysaa B. Zubairi
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Basra, Basra, Iraq
| | - Abdulkareem H. Abd
- Department of Pharmacology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | - Mohammed S. Al-lami
- Department of Pharmaceutics, College of Pharmacy, University of Basra, Basra, Iraq
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13
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Kobayashi T, Ishikawa T, Katsuragi J, Ota M, Omae T, Sasaki Y, Tsurumi Y, Nomoto T, Ohtori S. Effective screening methods to prevent surgical site infections in orthopedic surgery: an observational study. BMC Musculoskelet Disord 2023; 24:356. [PMID: 37149570 PMCID: PMC10163806 DOI: 10.1186/s12891-023-06471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/27/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The bacterial source of surgical-site infections (SSIs) can have either endogenous and/or exogenous origins, and some studies have revealed that endogenous transmission is an important pathway for SSIs in orthopedic surgery. However, since the frequency of SSIs is low (0.5-4.7%), screening all surgery patients is labor-intensive and cost-prohibitive. The goal of this study was to better understand how to improve the efficacy of nasal culture screening in preventing SSIs. METHODS Nasal cultures for 1616 operative patients over a 3-year period were evaluated for the presence of nasal bacterial microbiota and the species identity. We also investigated the medical factors that influence colonization and evaluated the ratio of agreement between nasal cultures and SSI-causing bacteria. RESULTS In a survey of 1616 surgical cases, 1395 (86%) were normal microbiota (NM), 190 (12%) were MSSA carriers, and 31 (2%) were MRSA carriers. The risk factors for MRSA carriers were significantly higher than the NM group in patients with a history of hospitalization (13 [41.9%], p = 0.015), patients who had been admitted to a nursing facility (4 [12.9%], p = 0.005), and patients who were > 75 years of age (19 [61.3%], p = 0.021). The incidence of SSIs was significantly higher in the MSSA group (17/190 [8.4%]) than the NM group (10/1395 [0.7%], p = 0.00). The incidence of SSIs in the MRSA group (1/31 [3.2%]) tended to be higher than that in the NM group, but there was no statistically significant difference (p = 0.114). The concordance rate between causative bacteria of SSI and species present in nasal cultures was 53% (13/25 cases). CONCLUSIONS The results of our study suggest screening patients with a history of past hospitalization, a history of admission in a long-term care facility, and older than 75 to reduce SSIs. TRIAL REGISTRATION This study was approved by the institutional review board of the authors' affiliated institutions (the ethics committee of Sanmu Medical Center, 2016-02).
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Affiliation(s)
- Tatsuki Kobayashi
- Orthopedic Surgery, Sanmu Medical Center, 167 Naruto, 289-1326, Chiba, Sanmu city, Chiba, Japan.
| | - Tetsuhiro Ishikawa
- Orthopedic Surgery, Sanmu Medical Center, 167 Naruto, 289-1326, Chiba, Sanmu city, Chiba, Japan
| | - Joe Katsuragi
- Orthopedic Surgery, Sanmu Medical Center, 167 Naruto, 289-1326, Chiba, Sanmu city, Chiba, Japan
| | - Mitsutoshi Ota
- Orthopedic Surgery, Sanmu Medical Center, 167 Naruto, 289-1326, Chiba, Sanmu city, Chiba, Japan
| | - Takanori Omae
- Orthopedic Surgery, Sanmu Medical Center, 167 Naruto, 289-1326, Chiba, Sanmu city, Chiba, Japan
| | - Yasuhito Sasaki
- Orthopedic Surgery, Sanmu Medical Center, 167 Naruto, 289-1326, Chiba, Sanmu city, Chiba, Japan
| | - Yousuke Tsurumi
- Orthopedic Surgery, Sanmu Medical Center, 167 Naruto, 289-1326, Chiba, Sanmu city, Chiba, Japan
| | - Takashi Nomoto
- Orthopedic Surgery, Sanmu Medical Center, 167 Naruto, 289-1326, Chiba, Sanmu city, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670, Chiba, Japan
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14
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Sun MC, Chen YF, Liu D, Xu XL, You YC, Lu W, Shi YJ, Ren MY, Fan YB, Du YZ, Tao XH. Effective decolonization strategy for mupirocin-resistant Staphylococcus aureus by TPGS-modified mupirocin-silver complex. Mater Today Bio 2023; 18:100534. [PMID: 36686036 PMCID: PMC9850068 DOI: 10.1016/j.mtbio.2022.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/11/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023]
Abstract
The widespread utilization of mupirocin to treat methicillin-resistant Staphylococcus aureus (MRSA)-caused infectious diseases has led to the emergence of mupirocin-resistant Staphylococcus aureus (MuRSA), posing a serious global medical threat. In order to counteract MuRSA, we develop a d-α-tocopherol polyethylene glycol 1000 succinate (TPGS) modified mupirocin and silver complex (TPGS/Mup-Ag) to combat MuRSA. The surfactivity of TPGS endows Mup-Ag with a homogeneous and small particle size (∼16 nm), which significantly enhances bacterial internalization. Silver ions are released from the mupirocin-Ag complex (Mup-Ag) to exert a synergistic antibacterial activity with mupirocin. Results manifest that our strategy reduces the concentration of mupirocin that induces 50% bacterial death from about 1000 μmol/mL to about 16 μmol/mL. In vitro bacterial infection model suggests that TPGS/Mup-Ag can not only eliminate both intracellular and inhibit bacterial adhesion, but also living cells are not affected. Results of in vivo experiments demonstrate that TPGS/Mup-Ag can effectively inhibit the progression of skin infection and accelerate wound healing, as well as alleviate systemic inflammation in both the subcutaneous infection model and the wound infection model. Furthermore, this study may contribute to the development of therapeutic agents for antibiotic-resistant bacteria and offer ideas for silver-based bactericides.
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Affiliation(s)
- Ming-Chen Sun
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, China,Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Ying-Fang Chen
- HangZhou Xiaoshan District Skin Disease Hospital, Hangzhou, 311200, China
| | - Di Liu
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Xiao-Ling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, 310015, China
| | - Yu-Chan You
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Wei Lu
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, China
| | - Yun-Juan Shi
- Department of Graduate School, Bengbu Medical College, Bengbu, 233030, China
| | - Ming-Yang Ren
- Department of Graduate School, Bengbu Medical College, Bengbu, 233030, China
| | - Yi-Bin Fan
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, China
| | - Yong-Zhong Du
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China,Corresponding author. Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, 866 Yu-Hang-Tang Road, Hangzhou, 310058, China.
| | - Xiao-Hua Tao
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, China,Corresponding author. Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People’s Hospital, 158 Shangtang Road, Hangzhou, 310014, China.
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15
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Wilson E, Marra AR, Ward M, Chapin L, Boulden S, Ryken TC, Jones LC, Herwaldt LA. Patients' experiences and compliance with preoperative screening and decolonization. Am J Infect Control 2023; 51:78-82. [PMID: 35339622 DOI: 10.1016/j.ajic.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND To improve adherence with pre-surgical screening for Staphylococcus aureus nasal carriage and decolonization, we need more information about patients' experiences with these protocols. METHODS We surveyed patients undergoing orthopedic, neurosurgical, or cardiac operations at Johns Hopkins Hospitals (JHH), the University of Iowa Hospitals and Clinics (UIHC) at MercyOne Northeast Iowa Neurosurgery (MONIN) to assess patients' experiences with decolonization protocols. RESULTS Five hundred thirty-four patients responded. Respondents at JHH were significantly more likely than those at the UIHC to report using mupirocin and were significantly more likely than those at the UIHC and MONIN to feel they received adequate information about surgical site infection (SSI) prevention and decolonization. Respondents at JHH were the least likely to not worry about SSI and they were more willing to do anything they could to prevent SSI. Few patients reported barriers to adherence and side effects of mupirocin or chlorhexidine. CONCLUSION Respondents did not report either major side effects or barriers to adherence. Patients varied in their level of concern about SSI, their willingness to invest effort in preventing SSI, and their assessments of preoperative information. To improve patients' adherence, clinicians and hospitals should assess their patients' needs and desires and tailor their preoperative processes, education, and prophylaxis accordingly.
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Affiliation(s)
- Ethan Wilson
- University of Iowa College of Public Health, Department of Epidemiology, Iowa City, IA, USA
| | - Alexandre R Marra
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA; Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Melissa Ward
- University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, IA, USA
| | - Laura Chapin
- MercyOne Northeast Iowa Neurosurgery, Iowa City, IA, USA
| | | | - Timothy C Ryken
- MercyOne Northeast Iowa Neurosurgery, Iowa City, IA, USA; Dartmouth-Hitchcock Medical Center, Department of Neurosurgery, Lebanon, NH, USA
| | - Lynne C Jones
- Johns Hopkins School of Medicine, Department of Orthopaedic Surgery, Baltimore, MD, USA
| | - Loreen A Herwaldt
- University of Iowa College of Public Health, Department of Epidemiology, Iowa City, IA, USA; University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, IA, USA.
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16
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Winter AJ, Rowe MT, Weir ANM, Akter N, Mbatha SZ, Walker PD, Williams C, Song Z, Race PR, Willis CL, Crump MP. Programmed Iteration Controls the Assembly of the Nonanoic Acid Side Chain of the Antibiotic Mupirocin. Angew Chem Weinheim Bergstr Ger 2022; 134:e202212393. [PMID: 38505625 PMCID: PMC10947060 DOI: 10.1002/ange.202212393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Mupirocin is a clinically important antibiotic produced by Pseudomonas fluorescens NCIMB 10586 that is assembled by a complex trans-AT polyketide synthase. The polyketide fragment, monic acid, is esterified by a 9-hydroxynonanoic acid (9HN) side chain which is essential for biological activity. The ester side chain assembly is initialised from a 3-hydroxypropionate (3HP) starter unit attached to the acyl carrier protein (ACP) MacpD, but the fate of this species is unknown. Herein we report the application of NMR spectroscopy, mass spectrometry, chemical probes and in vitro assays to establish the remaining steps of 9HN biosynthesis. These investigations reveal a complex interplay between a novel iterative or "stuttering" KS-AT didomain (MmpF), the multidomain module MmpB and multiple ACPs. This work has important implications for understanding the late-stage biosynthetic steps of mupirocin and will be important for future engineering of related trans-AT biosynthetic pathways (e.g. thiomarinol).
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Affiliation(s)
| | | | | | - Nahida Akter
- School of ChemistryUniversity of BristolBristolBS8 1TSUK
| | | | - Paul D. Walker
- School of ChemistryUniversity of BristolBristolBS8 1TSUK
| | | | - Zhongshu Song
- School of ChemistryUniversity of BristolBristolBS8 1TSUK
| | - Paul R. Race
- School of BiochemistryUniversity of BristolBristolBS8 1TDUK
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17
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Lee CY, Fang YP, Wu TH, Chang YF, Sung CH. Sequence types 8, 59, and 45 methicillin resistant Staphylococcus aureus as the predominant strains causing skin and soft tissue infections in Taiwan's prisons and jails. J Microbiol Immunol Infect 2022; 55:1239-1245. [PMID: 34635424 DOI: 10.1016/j.jmii.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is the predominant cause of skin and soft tissue infections (SSTIs), which is a problem in prisons and jails. We conducted this study to understand MRSA molecular characteristics among inmates with SSTIs, and we chose MRSA isolates from a community hospital as a comparison. METHODS A total of 219 MRSA isolates from three custodial facilities and 134 isolates from a community hospital in Taiwan were collected in the 2017 calendar year. MRSA isolates were investigated molecularly by staphylococcal chromosome cassette mec (SCCmec) type, mupirocin, and chlorhexidine genotypical resistance, and multi-locus sequence typing (ST). RESULTS Of the 219 MRSA isolates from custodial facilities, SCCmec IV was the most prevalent type (65.3%), followed by type VT (32.4%) and type V (1.8%). Regarding sequence types, ST59 (36.4%), 8 (35.3%), and 45 (17.9%) were the leading three predominant types out of 184 selected MRSA isolates, and ST45 MRSA was more prevalent in custodial facilities (p = 0.019). The antimicrobial resistance rates varied for different MRSA strains, with ST45 MRSA having the lowest rates of resistance to most antimicrobials. Overall, 91.5% of isolates carried mupA gene and 25.8% were positive for qacA/B gene, this was independent of the MRSA sequence types. CONCLUSIONS ST59, ST8, and ST45 MRSA are the leading three MRSA strains causing SSTIs in Taiwan, 2017, but the molecular distribution varied distinctly between the custodial facilities and hospital settings. The genotypical mupirocin resistance rate is quite high in this study. The frequency of chlorhexidine resistance gene is relatively low, especially in MRSA isolates from custodial facilities.
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Affiliation(s)
- Chun Yi Lee
- Department of Pediatrics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.
| | - Yu Ping Fang
- Department of Pediatrics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Tsung Hua Wu
- Department of Pediatrics, Changhua Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yu Feng Chang
- Department of Clinical Laboratory, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chia Hsing Sung
- Department of Clinical Laboratory, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
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18
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Yan BX, Chen XY, Wang ZY, Cui YZ, Landeck L, Fu NC, Yang XY, Xu F, Zhou Y, Chen JQ, Man XY. Mupirocin blocks imiquimod-induced psoriasis-like skin lesion by inhibiting epidermal isoleucyl-tRNA synthetase. Cell Commun Signal 2022; 20:185. [PMID: 36419191 PMCID: PMC9682813 DOI: 10.1186/s12964-022-00995-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/22/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Isoleucyl-tRNA synthetase (IARS) catalyzes isoleucine to the corresponding tRNA, maintaining the accuracy of gene translation. Its role in psoriasis has been not investigated so far. In this study, we aimed to investigate the mechanisms underlying the efficacy of IARS inhibitor, mupirocin, treatment for psoriasis. METHODS The expression of IARS was determined by immunofluorescence, Western blot and qRT-PCR in normal healthy control- and psoriatic human skin. An imiquimod (IMQ) -induced psoriasis-like skin disease model was used to study the phenotypes changed by an IARS inhibitor, mupirocin (MUP). Endotypes were analyzed by RNA-seq, R&D Luminex multi-factor technique, ELISA, immunofluorescence and flow cytometry. Additionally, the effect of MUP on epidermal keratinocytes (KCs) were conducted in-vitro in primary cultured human KCs. RESULTS We found the expression of IARS was higher in psoriatic skin than in healthy controls. In IMQ-induced psoriasis-like C57BL/6 J mouse model, MUP reversed IMQ-induced keratinocytes proliferation, expression of inflammatory cytokines and infiltration of immune cells. Furthermore, in cultured human keratinocytes, MUP inhibited proliferation, but promoted apoptosis, which may be related with STAT3 signaling pathway. CONCLUSION Our finding of blocking the infiltration of immune cells by inhibiting the formation of IARS, could be one mechanism to explain the effect of MUP in the treatment of psoriasis. Developing strategies targeting suppression IARS should open new perspectives for the treatment of psoriasis. Video Abstract.
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Affiliation(s)
- Bing-Xi Yan
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Xue-Yan Chen
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Zhao-Yuan Wang
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Ying-Zhe Cui
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Lilla Landeck
- Ernst Von Bergmann General Hospital, Teaching Hospital of Charité, University Medicine Berlin–Humboldt University Berlin, Potsdam, Germany
| | - Ni-Chang Fu
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Xing-Yu Yang
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Fan Xu
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Yuan Zhou
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Jia-Qi Chen
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
| | - Xiao-Yong Man
- grid.412465.0Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88Th Jiefang Road, Hangzhou, 310009 China
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Orillac C, Patel A, Dastagirzada Y, Benjamin C, Lieberman S, Lebowitz R, Golfinos JG, Pacione D. Comparing Rates of Postoperative Meningitis After Endoscopic Endonasal Procedures Based on Methicillin-Resistant Staphylococcus aureus/Methicillin-Sensitive Staphylococcus aureus Colonization and Antibiotic Prophylaxis. World Neurosurg 2022; 167:e858-64. [PMID: 36041718 DOI: 10.1016/j.wneu.2022.08.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Endoscopic endonasal approach (EEA) procedures are inherently contaminated due to direct access through the nasopharyngeal mucosa. The reported rate of postoperative meningitis in EEA procedures is 0.7%-3%. A variety of methods exist to minimize the risk of meningitis with antibiotic prophylaxis, although their value is not completely understood. This study investigated whether there is a difference in rates of postoperative meningitis based on Staphylococcus aureus colonization and use of preoperative antibiotic prophylaxis. METHODS All adult patients who underwent EEA resection at our institution from 2013 to 2021 were retrospectively reviewed. Patients with preoperative cerebrospinal fluid infections were excluded. Data including recent preoperative infections, preoperative colonization status, antibiotic administration, and postoperative outcomes were recorded for each patient. RESULTS Of 483 patients identified (mean age, 51 years; range, 18-90 years; 274 [56.7%] female), 80 (16.6%) had a positive preoperative methicillin-resistant Staphylococcus aureus (MRSA)/methicillin-sensitive Staphylococcus aureus (MSSA) screening swab. Twenty-one (26.3%) colonized patients were treated with preoperative decolonizing antibiotics. Within 30 days of surgery, 13 (2.7%) patients developed culture-positive meningitis. There was no significant difference in meningitis rates based on MRSA/MSSA colonization status. Among colonized patients, there was no significant difference in rates of MRSA/MSSA meningitis based on preoperative antibiotic decolonization. CONCLUSIONS Postoperative rates of meningitis after EEA surgery were not significantly changed based on MRSA/MSSA colonization status of the patient or preoperative decolonization. The utility of preoperative testing of MRSA/MSSA status and antibiotics for decolonization to prevent postoperative meningitis should be further investigated.
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20
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Labrecque S, Shah S, Fergus D, Parry MF. Mupirocin Susceptibility of Staphylococci 2022: Is it time for a change in MRSA decolonization protocols? Am J Infect Control 2022:S0196-6553(22)00657-5. [PMID: 36116681 DOI: 10.1016/j.ajic.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Nasal decolonization with mupirocin has been a common strategy for the prevention of surgical site infections (SSIs) and recurrent skin and soft tissue infections due to Staphylococcus aureus (SA). We recently noted an increase in SSIs due to SA, including a case of post-operative mupirocin-resistant methicillin-resistant SA (MRSA) infection despite attempted preoperative decolonization with mupirocin. We therefore evaluated the mupirocin susceptibility of SA at our hospital to determine the optimal regimen for decolonization. METHODS SA isolates were recovered from clinical and screening samples received in the microbiology laboratory. Mupirocin susceptibility was determined using e-tests and isolates were categorized as susceptible or resistant using a breakpoint MIC value of 4mcg/ml. RESULTS 223 unique SA isolates from 218 patients were tested. Twenty-four SA isolates (10.8%) were resistant to mupirocin (20 MRSA and 4 methicillin-sensitive SA [MSSA]). MRSA strains were more likely to be resistant to mupirocin than MSSA strains (22.5% versus 3.0%, p<0.001). CONCLUSIONS The emergence of drug resistance makes the policy of decolonization with nasal mupirocin a suboptimal strategy for the prevention of MRSA infections. In our study, less than 80% of MRSA strains were mupirocin susceptible. In patients colonized with MRSA at high risk for infection (e.g., total joint replacement), other regimens such as intranasal povidone iodine may be preferrable to mupirocin for patient decolonization.
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Affiliation(s)
- Sophie Labrecque
- Departments of Microbiology and Infectious Diseases, Stamford Health, Stamford, CT
| | - Sonia Shah
- Departments of Microbiology and Infectious Diseases, Stamford Health, Stamford, CT
| | - Diedre Fergus
- Departments of Microbiology and Infectious Diseases, Stamford Health, Stamford, CT
| | - Michael F Parry
- Departments of Microbiology and Infectious Diseases, Stamford Health, Stamford, CT; Division of Infectious Diseases, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
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Massart N, Reizine F, Fillatre P, Seguin P, La Combe B, Frerou A, Egreteau PY, Hourmant B, Kergoat P, Lorber J, Souchard J, Canet E, Rieul G, Fedun Y, Delbove A, Camus C. Multiple-site decontamination regimen decreases acquired infection incidence in mechanically ventilated COVID-19 patients. Ann Intensive Care 2022; 12:84. [PMID: 36053369 PMCID: PMC9438389 DOI: 10.1186/s13613-022-01057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background Among strategies that aimed to prevent acquired infections (AIs), selective decontamination regimens have been poorly studied in the COVID-19 setting. We assessed the impact of a multiple-site decontamination (MSD) regimen on the incidence of bloodstream infections (BSI) and ventilator-associated pneumonia (VAP) in COVID-19 patients receiving mechanical ventilation. Methods We performed an ancillary analysis of a multicenter retrospective observational study in 15 ICUs in western France. In addition to standard-care (SC), 3 ICUs used MSD, a variant of selective digestive decontamination, which consists of the administration of topical antibiotics four times daily in the oropharynx and the gastric tube, chlorhexidine body wash and a 5-day nasal mupirocin course. AIs were compared between the 3 ICUs using MSD (MSD group) and the 12 ICUs using SC. Results During study period, 614 of 1158 COVID-19 patients admitted in our ICU were intubated for at least 48 h. Due to missing data in 153 patients, 461 patients were finally included of whom 89 received MSD. There were 34 AIs in the MSD group (2117 patient-days), as compared with 274 AIs in the SC group (8957 patient-days) (p < 0.001). MSD was independently associated with a lower risk of AI (IRR = 0.56 [0.38–0.83]; p = 0.004) (Table 2). When the same model was used for each site of infection, MSD remained independently associated with a lower risk of VAP (IRR = 0.52 [0.33–0.89]; p = 0.005) but not of BSI (IRR = 0.58, [0.25–1.34], p = 0.21). Hospital mortality was lower in the MSD group (16.9% vs 30.1%, p = 0.017). Conclusions In ventilated COVID-19 patients, MSD was independently associated with lower AI incidence. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01057-x.
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Affiliation(s)
- Nicolas Massart
- Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France.
| | - Florian Reizine
- Service de Réanimation Médicale CHU de Rennes, 2, rue Henri le Guilloux, 35000 , Rennes, France.,Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
| | - Pierre Fillatre
- Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Philippe Seguin
- Service de Réanimation Chirugicale, CHU de Rennes, 2, rue Henri le Guilloux, 35000, Rennes, France
| | - Béatrice La Combe
- Service de Réanimation, CH Bretagne SUD, LORIENT, 5 avenue de Choiseul, 56322, Lorient, France
| | - Aurélien Frerou
- Service de Réanimation, Centre Hospitalier de Saint-Malo, 1 rue de la Marne, 35400, Saint-Malo, France
| | - Pierre-Yves Egreteau
- Service de Réanimation, Centre Hospitalier de Morlaix, 15 rue de kersaint gilly, 29600, Morlaix, France
| | - Baptiste Hourmant
- Service de Réanimation Médicale CHU de Brest, 2 avenue Foch, 29200, Brest, France
| | - Pierre Kergoat
- Service de Réanimation, CH de QUIMPER, 14bis Avenue Yves Thépot, 29107, Quimper , France
| | - Julien Lorber
- Service de Médecine Intensive Réanimation, CH de Saint-Nazaire, 11 bd Georges Charpak, 44600, Saint-Nazaire, France
| | - Jerome Souchard
- Service de Réanimation Médicale CHU de Rennes, 2, rue Henri le Guilloux, 35000 , Rennes, France.,Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
| | - Emmanuel Canet
- Service de Réanimation médicale, CHU de nantes, 1 place Alexis Ricordeau, 44093, Nantes , France
| | - Guillaume Rieul
- Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
| | - Yannick Fedun
- Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
| | - Agathe Delbove
- Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
| | - Christophe Camus
- Service de Réanimation Médicale CHU de Rennes, 2, rue Henri le Guilloux, 35000 , Rennes, France
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22
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Chen G, Zhou Y, Dai J, Yan S, Miao W, Ren L. Calcium alginate/PNIPAAm hydrogel with body temperature response and great biocompatibility: Application as burn wound dressing. Int J Biol Macromol 2022; 216:686-697. [PMID: 35817237 DOI: 10.1016/j.ijbiomac.2022.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/16/2022] [Accepted: 07/03/2022] [Indexed: 11/05/2022]
Abstract
Deep burns often do not heal easily, because the dermis of the skin is severely damaged, leading to severe inflammation and bacterial infection. Therefore, it is of great clinical significance to develop a dressing that promotes the healing process of deep burn wound. In this study, we used N-isopropyl acrylamide, sodium alginate and calcium chloride as the main materials, a series of calcium alginate/ poly (N-isopropyl acrylamide)(NIPAAm) hydrogel (CAPH) with different component ratios were synthesized. Its swelling properties, temperature response properties, rheological properties, biocompatibility properties, and in vitro drug release properties were investigated. Based on the above conditions, the CAPH(sodium alginate:NIPAAm = 2:15) with the best comprehensive performance was selected, which has a good biocompatibility. In addition, 0.02 % (w/v) mupirocin was loaded in CAPH. The temperature-responsive property of PNIPAAm in CAPH at 34 °C not only allowed the CAPH to rapidly release the drug under to prevent infection, but also to assist in wound contraction. Application of CAPH to localized wounds of deep second-degree burns in mice showed a faster healing rate and tissue regeneration. At the same time, collagen recovery was enhanced, collagen bundles were arranged in an orderly manner, and the scarring was not obvious after 16 days. Therefore, this research prepared a new safe and effective biomaterial.
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Affiliation(s)
- Guoguang Chen
- School of pharmacy, Nanjing Tech University, 30th South Puzhu Road, Nanjing 211816, China
| | - Yaxin Zhou
- School of pharmacy, Nanjing Tech University, 30th South Puzhu Road, Nanjing 211816, China
| | - Jie Dai
- School of pharmacy, Nanjing Tech University, 30th South Puzhu Road, Nanjing 211816, China
| | - Shiyu Yan
- School of pharmacy, Nanjing Tech University, 30th South Puzhu Road, Nanjing 211816, China
| | - Wenjun Miao
- School of pharmacy, Nanjing Tech University, 30th South Puzhu Road, Nanjing 211816, China
| | - Lili Ren
- School of pharmacy, Nanjing Tech University, 30th South Puzhu Road, Nanjing 211816, China.
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23
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Najm MB, Rawas-Qalaji M, Assar NH, Yahia R, Hosary RE, Ahmed IS. Optimization, Characterization and In Vivo Evaluation of Mupirocin Nanocrystals for Topical Administration. Eur J Pharm Sci 2022;:106251. [PMID: 35788029 DOI: 10.1016/j.ejps.2022.106251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022]
Abstract
Treatment of infectious skin conditions resulting from wounds and burns with topical antibiotics is challenging, particularly those caused by methicillin-resistant Staphylococcus aureus bacteria (MRSA). This is due to the formation of bacterial biofilms characterized by antimicrobial resistance. Mupirocin (MP), a widely used topical antibiotic, is active against gram-positive bacteria including MRSA. However, MP suffers from sub-optimal therapeutic efficacy due to its poor water-solubility and the significant rise in MP-resistant S. aureus. In this study, the physico-chemical characteristics of MP were modified through nanocrystallization to improve its therapeutic efficacy for the treatment of skin infections. Mupirocin-nanocrystals (MP-NC) were prepared using a nanoprecipitation technique and optimized using a D-optimal response surface design. The optimization of MP-NC produced ultra-small monodisperse spherical particles with a mean diameter of 70 nm and a polydispersity index of 0.2. The design resulted in two optimal MP-NC formulations that were evaluated by performing series of in vitro, ex vivo, microbiological, and in vivo studies. In-vitro results showed a 10-fold increase in the saturation solubility and a 9-fold increase in the dissolution rate of MP-NC. Ex vivo permeation studies, using pig ears skin, showed a 2-fold increase in the dermal deposition of MP-NC with the highest drug deposition occurring at 500-µm skin depth. Moreover, the optimal MP-NC formulations were lyophilized and incorporated into a 2% w/w cream. Microbiological studies revealed a 16-fold decrease in the minimum inhibitory concentration and the minimum bactericidal concentration of MP-NC. In vivo studies, using a rat excision burn wound model, demonstrated rapid and complete healing of infected burn wounds in rats treated with MP-NC cream in comparison to marketed Avoban ointment. Our results suggest that nanocrystallization of MP may provide an avenue through which higher levels of a topically applied MP can be permeated into the skin to reach relevant infectious areas and exert potential local antibacterial effects.
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24
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Minhas MU, Ahmad S, Khan KU, Sohail M, Abdullah O, Khalid I, Malik NS. Synthesis And Evaluation of Polyethylene Glycol-4000-Co-Poly (AMPS) Based Hydrogel Membranes for Controlled Release of Mupirocin for Efficient Wound Healing. Curr Drug Deliv 2022; 19:1102-1115. [PMID: 35301948 DOI: 10.2174/1567201819666220317112649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/11/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic wound healing is a major challenge for health care system around the globe. Current study was conducted to develop and characterize chemically cross-linked polyethylene glycol-co-poly (AMPS) hydrogel membranes to enhanced the wound healing efficiency of antibiotic mupirocin (MP). METHODS Free radical polymerization technique was used for the development of hydrogel membranes. In aqueous medium, polymer PEG-4000 cross-linked with the monomer 2-acrylamido-2-methylpropane sulfonic acid (AMPS) in the presence of initiators ammonium peroxide sulfate (APS) and sodium hydrogen sulfite (SHS). N, N-Methylenebisacrylamide (MBA) was used as cross-linker in the preparation of hydrogel membranes. Developed membranes were spherical, transparent, and elastic. FTIR, TGA/DSC, and SEM were used to characterize the polymeric system. Swelling behavior, drug loading, and its release pattern at pH of 5.5 and 7.4, irritation study, ex vivo drug permeation, and deposition study was also evaluated. RESULTS Formed membranes were spherical, transparent and elastic. The formation of a stable polymeric network was confirmed by structural and thermal analysis. Permeation of the drug its deposition in the skin showed good permeation and retention. No irritancy to the skin was observed. CONCLUSION On the basis of results obtained, the present study concluded that it may be an ideal network for the delivery of mupirocin in skin infections.
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Affiliation(s)
- Muhammad Usman Minhas
- College of Pharmacy, University of Sargodha, University Road Sargodha City, Punjab, Pakistan
| | - Sarfaraz Ahmad
- Department of Pharmaceutics, Faculty of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan
| | - Kifayat Ullah Khan
- Department of Pharmaceutics, Faculty of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan
| | - Muhammad Sohail
- Department of Pharmacy, COMSATS Institute of Information Technology, Abbottabad 22060, KPK, Pakistan
| | - Orva Abdullah
- Hamdard Institute of Pharmaceutical Science Hamdard University Islamabad, Pakistan
| | - Ikrima Khalid
- Faculty of Pharmaceutical Sciences, GC University Faisalabad, Punjab- Pakistan
| | - Nadia Shamshad Malik
- Department of Pharmacy, Capital University of Science and Technology, Islamabad, Pakistan
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25
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Sundaramoorthy M, Karuppaiah A, Nithyanth M, Baberoselin R, Ramesh S, Geetha N, Veintramuthu S. Formulation development of cream with mupirocin and essential oils for eradication of biofilm mediated antimicrobial resistance. Arch Microbiol 2021; 203:1707-1715. [PMID: 33459816 DOI: 10.1007/s00203-020-02175-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/02/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
Staphylococcus aureus (S.aureus) is both a colonizer as well as a human pathogen that causes a variety of diseases. Mupirocin is a topical antimicrobial agent which is very effective against S.aureus infection. However, treating the S.aureus infection using mupirocin could be complicated due to biofilm formation. Consequently, resistance to mupirocin occurs and leads to chronic infection. The combination of mupirocin with a compound that has biofilm eradicating effect would be an ideal solution for effectively treating biofilm infections. Therefore, in this study, we have investigated the biofilm inhibitory and eradication effect of mupirocin with three essential oils (Cinnamon Oil (CO), Eugenol (EU) and Eucalyptus Oil (EO)) against sessile S.aureus. From these preliminary results, it was found that the mupirocin-CO (0.2 µg/ml-5.218 mg/ml) combination has a better synergistic antibiofilm effect against sessile S.aureus and the fractional inhibitory concentration index was found to be 0.458. The best combination of mupirocin with CO was loaded into a non-greasy O/W cream. The physico-chemical and microbiological evaluations were carried out for the prepared cream. The prepared cream has better biofilm eradication activity (40%) when compared to a marketed cream (20%).
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Affiliation(s)
- Mahalakshmi Sundaramoorthy
- Department of Pharmaceutics, PSG College of Pharmacy, Coimbatore, India, 641 004.,Affiliated to The Tamilnadu Dr.M.G.R Medical University, Chennai, India
| | - Arjunan Karuppaiah
- Department of Pharmaceutics, PSG College of Pharmacy, Coimbatore, India, 641 004.,Affiliated to The Tamilnadu Dr.M.G.R Medical University, Chennai, India
| | - Munusamy Nithyanth
- Department of Pharmaceutics, PSG College of Pharmacy, Coimbatore, India, 641 004.,Affiliated to The Tamilnadu Dr.M.G.R Medical University, Chennai, India
| | - Rajandurai Baberoselin
- Department of Pharmaceutics, PSG College of Pharmacy, Coimbatore, India, 641 004.,Affiliated to The Tamilnadu Dr.M.G.R Medical University, Chennai, India
| | - Santhanam Ramesh
- Department of Pharmaceutics, Ratnam Institute of Pharmacy, Nellore, India, 524 346
| | - Natesan Geetha
- Department of Botany, Bharathiar University, Coimbatore, India, 641046
| | - Sankar Veintramuthu
- Department of Pharmaceutics, PSG College of Pharmacy, Coimbatore, India, 641 004. .,Affiliated to The Tamilnadu Dr.M.G.R Medical University, Chennai, India.
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26
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Conceição T, de Lencastre H, Aires-de-Sousa M. Prevalence of biocide resistance genes and chlorhexidine and mupirocin non-susceptibility in Portuguese hospitals during a 31-year period (1985-2016). J Glob Antimicrob Resist 2021; 24:169-74. [PMID: 33373736 DOI: 10.1016/j.jgar.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/15/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Methicillin-resistantStaphylococcus aureus (MRSA) remains a major human pathogen. MRSA decolonisation strategies frequently combine chlorhexidine baths and mupirocin nasal ointment. Although MRSA remains widespread in Portuguese hospitals, information regarding resistance to biocides and mupirocin is scarce. We evaluated the prevalence of biocide resistance genes and chlorhexidine and mupirocin non-susceptibility in a representative and well-characterised collection of MRSA isolated in Portuguese hospitals during a 31-year period (1985-2016). METHODS Prevalence of five biocide resistance genes (lmrS, mepA, sepA, qacAB and smr) was determined by PCR. Antibiotic susceptibility was assessed by disk diffusion and by MIC determination using broth microdilution (chlorhexidine) and Etest (mupirocin). RESULTS Chromosomal genessepA and mepA were detected in all isolates, while lmrS was found in 87.1%. The prevalence of plasmid-borne genes was significant for qacAB (22.4%), associated with the Iberian (ST247-I/IA) clone (P < 0.0001), and low for smr (1.0%) detected among isolates belonging to the ST239-III/IIIvariant clone. Chlorhexidine non-susceptibility (MIC ≥ 4 mg/L) was observed in two isolates belonging to the EMRSA-15 clone (ST22-IV). Non-susceptibility to mupirocin (MIC > 1 mg/L) was significant (15.4%; n = 31) and mainly found among isolates of the EMRSA-15 clone (P < 0.0001; n = 29). One isolate presented low-level mupirocin resistance (MIC = 32 mg/L), and two missense mutations N213D (A637G) and V588F (G1762T) were identified in the ileS gene. CONCLUSION Concerningly, we detected a high prevalence of biocide resistance genes and an association of mupirocin and chlorhexidine non-susceptibility with the dominant EMRSA-15 clone in Portuguese hospitals.
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27
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Fourdrain A, Bouabdallah I, Gust L, Cassir N, Brioude G, Falcoz PE, Alifano M, Le Rochais JP, D'Annoville T, Trousse D, Loundou A, Leone M, Papazian L, Thomas PA, D'Journo XB. Screening and topical decolonization of preoperative nasal Staphylococcus aureus carriers to reduce the incidence of postoperative infections after lung cancer surgery: a propensity matched study. Interact Cardiovasc Thorac Surg 2020; 30:552-558. [PMID: 31886854 DOI: 10.1093/icvts/ivz305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Health care-associated infections (HAIs) are serious issues following lung cancer surgery, leading to an increased risk of morbidity and hospital cost burden. The aim of this study was to evaluate the impact on postoperative outcomes of a preoperative screening and decolonization strategy of nasal carriers for Staphylococcus aureus prior to lung cancer surgery. METHODS We performed a retrospective study comparing 2 cohorts of patients undergoing major lung resection: a control group of patients from the placebo arm of the randomized Clinical Study to Evaluate the Efficacy of Chlorhexidine Mouthwashes operated on between July 2012 and April 2015 without any nasopharyngeal screening (N = 224); an experimental group, with preoperative screening for S. aureus of nasal carriers and selective 5-day decolonization in positive carriers using mupirocin ointment between January 2017 and December 2017 (N = 310). The 2 groups were matched according to a propensity score analysis with 1:1 matching. The primary outcome was the rate of postoperative HAIs, and the secondary outcome was the need for postoperative mechanical ventilation after surgery. RESULTS After matching, 2 similar groups of 108 patients each were obtained. In the experimental group, 26 patients had positive results for nasal carriage, and a significant decrease was observed in the rate of overall postoperative HAIs [control n = 19, 17.6%; experimental group n = 9, 8.3%; P = 0.043; relative risk 0.47 (0.22-1)] and in the rate of postoperative mechanical ventilation [control n = 12, 11.1%; experimental group n = 4, 3.7%; P = 0.038; relative risk 0.33 (0.11-1)]. After logistic regression and multivariable analysis, screening of S. aureus nasal carriers reduced the rate of HAIs [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.11-0.76; P = 0.01] and reduced the risk of the need for postoperative mechanical ventilation (OR 0.19, 95% CI 0.05-0.74; P = 0.02). There was no significant statistical difference between the 2 groups regarding the rate of postoperative S. aureus-associated infection (control group n = 6, 5.6%; experimental group n = 2, 1.9%; P = 0.28). CONCLUSIONS Identification of nasal carriers of S. aureus and selective decontamination using mupirocin appeared to have a beneficial effect on postoperative infectious events after lung resection surgery.
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Affiliation(s)
- Alex Fourdrain
- Service de Chirurgie Thoracique, Aix-Marseille Université, CNRS, INSERM, Centre de Recherche en Cancérologie de Marseille (CRCM), Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Ilies Bouabdallah
- Service de Chirurgie Thoracique, Aix-Marseille Université, CNRS, INSERM, Centre de Recherche en Cancérologie de Marseille (CRCM), Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Lucile Gust
- Service de Chirurgie Thoracique, Aix-Marseille Université, CNRS, INSERM, Centre de Recherche en Cancérologie de Marseille (CRCM), Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Nadim Cassir
- Aix-Marseille Université, IHU, MEPHI, CLIN, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Geoffrey Brioude
- Service de Chirurgie Thoracique, Aix-Marseille Université, CNRS, INSERM, Centre de Recherche en Cancérologie de Marseille (CRCM), Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Pierre-Emmanuel Falcoz
- Service de Chirurgie Thoracique, Nouvel Hôpital Civil, Strasbourg Université, Strasbourg, France
| | - Marco Alifano
- Service de Chirurgie Thoracique, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris Descartes Université, Paris, France
| | | | - Thomas D'Annoville
- Service de Chirurgie Thoracique, Hôpital Arnaud de Villeneuve, Montpellier Université, Montpellier, France
| | - Delphine Trousse
- Service de Chirurgie Thoracique, Aix-Marseille Université, CNRS, INSERM, Centre de Recherche en Cancérologie de Marseille (CRCM), Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Anderson Loundou
- Unité d'aide méthodologique, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Marc Leone
- Aix-Marseille Université, IHU, MEPHI, CLIN, Assistance-Publique Hôpitaux de Marseille, Marseille, France.,Service d'Anesthésie-Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Laurent Papazian
- Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Pascal Alexandre Thomas
- Service de Chirurgie Thoracique, Aix-Marseille Université, CNRS, INSERM, Centre de Recherche en Cancérologie de Marseille (CRCM), Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Xavier Benoit D'Journo
- Service de Chirurgie Thoracique, Aix-Marseille Université, CNRS, INSERM, Centre de Recherche en Cancérologie de Marseille (CRCM), Assistance-Publique Hôpitaux de Marseille, Marseille, France
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28
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Zheng S, Chung SJ, Sim HCJ, Chlebicka TM, Chan YH, Lim TP, Kwa LHA, Chlebicki MP. Impact of formulary interventions on the minimum inhibitory concentration of methicillin-resistant Staphylococcus aureus to mupirocin, chlorhexidine, and octenidine in a Singapore tertiary institution. Eur J Clin Microbiol Infect Dis 2020; 39:2397-2403. [PMID: 32712737 DOI: 10.1007/s10096-020-03995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is an effective measure to prevent clinical infection but resistance is a concern. We aim to evaluate the impact of mupirocin (MUP) ointment formulary removal, plateauing use of chlorhexidine gluconate (CHG), and hospital-wide introduction of octenidine (OCT)-based products on the minimum inhibitory concentration (MIC) of MRSA to MUP, CHG, and OCT in our hospital. A prevalence study was conducted at three time points (TP) on consecutive MRSA screening isolates to evaluate for their MICs to MUP, CHG, and OCT using broth microdilution sensititre plates and detection of the ileS-2 gene encoding high-level MUP resistance in 2013 (pre-intervention TP1; n = 160), 2016 (early post-intervention TP2; n = 99) and 2017 (late post-intervention TP3; n = 76). Statistical analyses were performed using Chi square test with reference from TP1. There was a significant improvement in MUP susceptibility (MIC < 4 mcg/ml) from 71.9% (TP1) to 86.9% (TP2; p = 0.006) to 88.2% (TP3; p = 0.007). The prevalence of MUP high-level resistance (MIC > 256 mcg/ml) reduced from 25.0% (TP1) to 12.1% (TP2; p = 0.014) to 5.3% (TP3; p = 0.001). Likewise, the prevalence of isolates harboring the ileS-2 gene decreased from 28.1% (TP1) to 18.2% (TP2; p = 0.072) to 9.2% (TP3; p = 0.002). OCT MIC range remains stable at 0.5 to 1 mcg/ml across all three TPs. The proportion of isolates with reduced CHG susceptibility (MIC ≥ 4 mcg/ml) increased over the three TPs from 23.1 to 27.2% (p = 0.45) to 42.1% (p = 0.003). Active formulary regulations have an impact on the resistance profile of MRSA and can be used as a strategy to preserve the MRSA decolonization armamentarium.
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Affiliation(s)
- Shuwei Zheng
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore.
| | - S J Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - H C J Sim
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - T M Chlebicka
- University of New South Wales, Medicine, Sydney, Australia
| | - Y H Chan
- Biostatistics Unit, National University of Singapore, Singapore, Singapore
| | - T P Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - L H A Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - M P Chlebicki
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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29
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Park KH, Jung M, Kim DY, Lee YM, Lee MS, Ryu BH, Hong SI, Hong KW, Bae IG, Cho OH. Effects of subinhibitory concentrations of chlorhexidine and mupirocin on biofilm formation in clinical meticillin-resistant Staphylococcus aureus. J Hosp Infect 2020; 106:295-302. [PMID: 32679053 DOI: 10.1016/j.jhin.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The effects of subinhibitory concentrations (sub-MICs) of antibacterial agents on the biofilm-forming ability of Staphylococcus aureus require further study. AIM To investigate the effects of sub-MICs of chlorhexidine and mupirocin on biofilm formation in clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates. METHODS MRSA isolates were collected from patients with bloodstream infections at a tertiary care hospital. The basal level of biofilm formation and biofilm induction by sub-MICs of chlorhexidine and mupirocin were evaluated by measuring biofilm mass stained with Crystal Violet. FINDINGS Of the 112 MRSA isolates tested, 63 (56.3%) and 44 (39.3%) belonged to sequence type (ST)5 and ST72 lineages, respectively, which are the predominant healthcare- and community-associated clones in South Korea. ST5 isolates were more likely to have chlorhexidine MIC ≥4 (73.0% vs 29.5%), resistance to mupirocin (23.8% vs 0%), agr dysfunction (73.0% vs 9.1%), and qacA/B gene (58.7% vs 2.3%) compared to ST72 isolates. The basal level of biofilm formation ability was frequently stronger in ST72 isolates compared to ST5 isolates (77.3% vs 12.7%). Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in 56.3% and 53.6%, respectively, of all isolates. Biofilm induction was more prevalent in ST5 isolates (85.7% for chlorhexidine, 69.8% for mupirocin) than in ST72 isolates (15.9% for chlorhexidine, 27.3% for mupirocin). CONCLUSION Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in half of the clinical MRSA isolates. Our results suggest that ST5 MRSA biofilm can be induced together with some other bacterial virulent factors following exposure to chlorhexidine, which might confer a survival advantage to this clone in the healthcare environment.
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Affiliation(s)
- K-H Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - M Jung
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - D Y Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Y-M Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - M S Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - B-H Ryu
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - S I Hong
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - K-W Hong
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - I-G Bae
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - O-H Cho
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
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Chen W, He C, Yang H, Shu W, Cui Z, Tang R, Zhang C, Liu Q. Prevalence and molecular characterization of methicillin-resistant Staphylococcus aureus with mupirocin, fusidic acid and/or retapamulin resistance. BMC Microbiol 2020; 20:183. [PMID: 32600253 PMCID: PMC7325228 DOI: 10.1186/s12866-020-01862-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
Background The data on the prevalence of resistance to mupirocin (MUP), fusidic acid (FA) and retapamulin (RET) in methicillin-resistant Staphylococcus aureus (MRSA) from China are still limited. This study aimed to examine these three antibiotics resistance in 1206 MRSA clinical isolates from Eastern China. Phenotypic MUP, FA and RET resistance was determined by minimum inhibitory concentrations (MICs), and genotypic by PCR and DNA sequencing of the mupA/B, fusB-D, cfr, vgaA/Av/ALC/B/C/E, lsaA-C/E and salA and mutations in ileS, fusA/E, rplC, and 23S RNA V domain. The genetic characteristics of resistance isolates were conducted by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Results Overall MRSA MUP, FA and RET resistance was low (5.1, 1.0 and 0.3%, respectively). MupA was the mechanism of high-level MUP resistance. All low-level MUP resistance isolates possessed an equivocal mutation N213D in IleS; of these, 2 reported an additional V588F mutation with an impact on the Rossman fold. FusA mutations, such as L461K, H457Q, H457Y and V90I were the primary FA mechanisms among high-level resistance isolates, most of which also contained fusC; however, all low-level resistance strains carried fusB. Except lsaE gene detected in one isolate, no other resistance mechanisms tested were found among RET-resistant isolates. Additionally, sixteen PFGE types (A-P) were observed, among which type B was the most common (49/76, 64.5%), followed by types E and G (4/76, 5.3% each) and types C and M (3/76, 3.9% each). All resistant strains were divided into 15 ST types by MLST. ST764 (24/76, 31.6%), ST630 (11/76, 14.5%), ST239 (9/76, 11.8%) and ST5 (7/76, 9.2%) were the major types. PFGE type B isolates with the aforementioned STs were mainly found in mupirocin resistant isolates. Conclusions MUP, FA and RET exhibited highly activity against the MRSA isolates. Acquired genes and chromosome-borne genes mutations were responsible for MUP and FA resistance; however, the mechanism for some RET-resistant isolates remains to be further elucidated. Also, the surveillance to MUP in MRSA should be strengthened to prevent elevated resistance due to the expansion of clones.
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Affiliation(s)
- Wenjing Chen
- Department of Clinical Laboratory, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Chunyan He
- Department of Clinical Laboratory, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Han Yang
- Department of Clinical Laboratory, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Wen Shu
- Department of Clinical Laboratory, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Zelin Cui
- Department of Clinical Laboratory, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Rong Tang
- Department of Clinical Laboratory, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Chuanling Zhang
- Department of Clinical Laboratory, Xiaoshan Hospital, Hangzhou, Zhejiang Province, China
| | - Qingzhong Liu
- Department of Clinical Laboratory, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China.
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Hakimi Alni R, Tavasoli F, Barati A, Shahrokhi Badarbani S, Salimi Z, Babaeekhou L. Synergistic activity of melittin with mupirocin: A study against methicillin-resistant S. Aureus (MRSA) and methicillin-susceptible S. Aureus (MSSA) isolates. Saudi J Biol Sci 2020; 27:2580-2585. [PMID: 32994714 PMCID: PMC7499389 DOI: 10.1016/j.sjbs.2020.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 01/06/2023] Open
Abstract
Methicillin-Resistant Staphylococcus aureus (MRSA) biofilms are involved in various nosocomial infections, being in the limelight of academic research. The current study aimed to determine the antimicrobial effects of melittin on planktonic and biofilm forms of S. aureus. Following the identification of MRSA and SCCmec types (using PCR method), Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC), and fractional inhibitory concentration index (FICi), for melittin and mupirocin were determined by broth microdilution assay. Melittin anti-biofilm activity was determined, using a microtiter-plate test (MtP) and scanning electron microscope (SEM) methods. The quorum sensing inhibitory activity of ½ MIC melittin was examined using a quantitative real-time RT-PCR method, and melittin cytotoxicity on Vero cells was examined by tetrazolium-based colorimetric (MTT) test. The Results of our study showed that Geometric means of MIC values of the melittin and mupirocin were 4.4 and 14.22 μg/ml respectively. The geometric mean of the FICi for both melittin-mupirocin was 0.75. No S. aureus biofilm was formed and hld gene (as a biofilm regulator) expression down-regulated. It seems that melittin can be useful in the treatment of S. aureus infections (especially MRSA) by reducing the hld expression. Furthermore, synergistic growth-inhibitory effects of mupirocin with melittin could be considered as a promising approach in the treatment of MRSA isolates.
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Affiliation(s)
- Reza Hakimi Alni
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Tavasoli
- Department of Biology, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
| | - Amirhomayoon Barati
- Department of Biology, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
| | | | - Zahra Salimi
- Department of Biology, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
| | - Laleh Babaeekhou
- Department of Biology, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
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Vázquez NM, Cáceres Guidó P, Fiorilli G, Moreno S. Emerging mupirocin resistance in methiciüin-resistant Staphylococcus aureus isolates at a tertiary care children's hospital in Argentina. ARCH ARGENT PEDIATR 2020; 117:48-51. [PMID: 30652446 DOI: 10.5546/aap.2019.eng.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/30/2018] [Indexed: 11/12/2022]
Abstract
In Latin America, few studies have been done in mupirocin resistance and biofilm formation in methicillin-resistant Staphylococcus aureus (MRSA). This study investigated mupirocin-resistance in MRSA isolates from pediatric patients with bacteremia and their ability to form biofilm. Antibiotic resistance was analyzed with the Kirby-Bauer test and the broth microdilution method. Bacterial biofilm formation was measured using the crystal violet assay. Among MRSA isolates, 2.3 % (5/217) exhibited a high level of mupirocin-resistance with a minimum inhibitory concentration of >512 μg/mL, in addition to cross-resistance with clindamycin, erythromycin, gentamicin, and ciprofloxacin. Remarkably, biofilm formation in such isolates was moderate to high. This is the first report published in Argentina on clinical isolates of mupirocin-resistant MRSA and it is critical for following its evolution over time at a local level and in the Latin American region.
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Affiliation(s)
- Nicolás M Vázquez
- Laboratorio de Farmacología de Activos Vegetales, Centro de Estudios Biomédicos, Biotecnológicos, Ambientales y de Diagnóstico (CEBBAD), CONICET, carreras de Farmacia y Bioquímica. Universidad Maimónides
| | - Paulo Cáceres Guidó
- Grupo de Medicina Integradora. Hospital de Pediatría Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Graciela Fiorilli
- Servicio de Microbiología. Hospital de Pediatría Garrahan. Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvia Moreno
- Laboratorio de Farmacología de Activos Vegetales, Centro de Estudios Biomédicos, Biotecnológicos, Ambientales y de Diagnóstico (CEBBAD), CONICET, carreras de Farmacia y Bioquímica. Universidad Maimónides.
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Abdulgader SM, Lentswe T, Whitelaw A, Newton-Foot M. The prevalence and molecular mechanisms of mupirocin resistance in Staphylococcus aureus isolates from a Hospital in Cape Town, South Africa. Antimicrob Resist Infect Control 2020; 9:47. [PMID: 32169102 PMCID: PMC7071584 DOI: 10.1186/s13756-020-00707-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022] Open
Abstract
Background Antimicrobial resistance is an increasingly serious problem in public health globally. Monitoring resistance levels within healthcare and community settings is critical to combat its ongoing increase. This study aimed to describe the rates and molecular mechanisms of mupirocin resistance in clinical Staphylococcus aureus isolates from Tygerberg Hospital, and to describe its association with strain types. Methods We retrospectively selected 212 S. aureus isolates which were identified from blood samples and pus swabs during the years 2009–2011 and 2015–2017. The isolates were identified using conventional microbiological methods and genotyping was done using spa typing. Cefoxitin (30 μg) disc diffusion and the two disc strategy (5 μg and 200 μg) were used to determine susceptibility to methicillin and mupirocin, respectively. Isolates with high-level resistance were screened for the plasmid mediated genes mupA and mupB by PCR, and sequencing of the ileS gene was done for all isolates exhibiting low-level resistance to describe the mutations associated with this phenotype. Chi-square test was used to assess the associations between mupirocin resistance and S. aureus genotypes. Results Of 212 S. aureus isolates, 12% (n = 25) were resistant to mupirocin, and 44% (n = 93) were methicillin resistant. Strain typing identified 73 spa types with spa t045 being the most predominant constituting 11% of the isolates. High-level mupirocin resistance was observed in 2% (n = 5), and low-level resistance in 9% (n = 20) of the isolates. The prevalence of high-level mupirocin resistance amongst MRSA and MSSA was 4 and 1% respectively, while the prevalence of low-level mupirocin resistance was significantly higher in MRSA (18%) compared to MSSA (3%), (p = 0.032). mupA was the only resistance determinant for high-level resistance, and the IleS mutation V588F was identified in 95% of the isolates which showed low-level resistance. A significant association was observed between spa type t032 and high-level mupirocin resistance, and types t037 and t012 and low-level resistance (p < 0.0001). Conclusion The study reported higher rates of low-level mupirocin resistance compared to high-level resistance, and in our setting, mupirocin resistance was driven by certain genotypes. Our study advocates for the continuous screening for mupirocin resistance in S. aureus in clinical settings to better guide treatment and prescribing practices.
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Affiliation(s)
- Shima M Abdulgader
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS, Tygerberg Hospital, Francie van Zijl Drive, PO Box 241; Cape Town, Tygerberg, 8000, South Africa.
| | - Tshepiso Lentswe
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS, Tygerberg Hospital, Francie van Zijl Drive, PO Box 241; Cape Town, Tygerberg, 8000, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS, Tygerberg Hospital, Francie van Zijl Drive, PO Box 241; Cape Town, Tygerberg, 8000, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Mae Newton-Foot
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS, Tygerberg Hospital, Francie van Zijl Drive, PO Box 241; Cape Town, Tygerberg, 8000, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Alcantara KP, Zulfakar MH, Castillo AL. Development, characterization and pharmacokinetics of mupirocin-loaded nanostructured lipid carriers (NLCs) for intravascular administration. Int J Pharm 2019; 571:118705. [PMID: 31536765 DOI: 10.1016/j.ijpharm.2019.118705] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/04/2019] [Accepted: 09/15/2019] [Indexed: 02/06/2023]
Abstract
Mupirocin is a promising broad-spectrum antibiotic that is effective in treating MRSA infections. However, due to its rapid elimination and hydrolysis following injection and high protein binding, current therapeutic use is limited to topical administration. Nanotechnology-driven innovations provide hope for patients and practitioners in overcoming the problem of drug degradation by encapsulation. The objective of this research is to develop and characterize Mupirocin-Loaded Nanostructured Lipid Carriers (M-NLC) for intravascular administration. The MNLC was produced by a combination of high shear homogenization and high pressure homogenization of solid (cetyl palmitate) and liquid (caprylic/caprylic acid) biocompatible lipids in 5 different ratios. The mean particle size, polydispersity index (PDI) and the zeta potential (ZP) of the MNLC formulations were between 99.8 and 235 nm, PDI lower than 0.164, ZP from -25.96 to -19.53 and pH ranging from 6.28-6.49. The MNLC formulation also enhances the anti-bacterial activity of mupirocin. All formulation showed sustained drug release and good physical characteristics for three months storage under 25 °C. It also revealed that the MNLC 1 is safe at 250 mg/kg dose in rats. The MNLC 1 also showed a significant increase in plasma concentration in rabbits following IV administration thus, demonstrating an enhancement on its pharmacokinetic profile as compared to free mupirocin.
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Affiliation(s)
- Khent P Alcantara
- The Graduate School, University of Santo Tomas, Manila, Philippines; Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines; College of Pharmacy, Our Lady of Fatima University, Antipolo City, Rizal, Philippines.
| | - Mohd Hanif Zulfakar
- Center for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Agnes L Castillo
- The Graduate School, University of Santo Tomas, Manila, Philippines; Faculty of Pharmacy, University of Santo Tomas, Manila, Philippines; Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines
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Dadashi M, Hajikhani B, Darban-Sarokhalil D, van Belkum A, Goudarzi M. Mupirocin resistance in Staphylococcus aureus: A systematic review and meta-analysis. J Glob Antimicrob Resist 2019; 20:238-247. [PMID: 31442624 DOI: 10.1016/j.jgar.2019.07.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Staphylococcus aureus is one of the most common pathogens causing nosocomial and community-acquired infections associated with high morbidity and mortality. Mupirocin has been increasingly used for treatment of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) infections. The aim of this study was to determine the prevalence of mupirocin-resistant S. aureus (MuRSA), mupirocin-resistant MRSA (MuRMRSA), high-level MuRSA (HLMuRSA) and high-level MuRMRSA (HLMuRMRSA) worldwide. METHODS Online databases including Medline, Embase and Web of Science were searched (2000-2018) to identify studies addressing the prevalence of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA. STATA v. software was used to interpret the data. RESULTS Of the 2243 records identified from the databases, 30 and 63 studies fulfilled the eligibility criteria for MuRSA and MuRMRSA, respectively. Finally, 27 and 60 studies were included separately for HLMuRSA and HLMuRMRSA, respectively. The analyses revealed pooled and averaged prevalences of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA of 7.6% [95% confidence interval (CI) 6.2-9.0%], 13.8% (95% CI 12.0-15.6%), 8.5% (95% CI 6.3-10.7%) and 8.1% (95% CI 6.8-9.4%), respectively. CONCLUSION Overall, these results show a global increase in the prevalence of HLMuRSA and HLMuRMRSA among clinical S. aureus isolates over time. However, there was only a significant increase in the prevalence of MuRMRSA compared with the other categories, especially MuRSA. Since mupirocin remains the most effective antibiotic for MSSA and MRSA decolonisation both in patients and healthcare personnel, a reduction of its effectiveness presents a risk for invasive infection. Monitoring of mupirocin resistance development remains critical.
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Affiliation(s)
- Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Non Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alex van Belkum
- Data Analytics Unit, bioMérieux 3, La Balme-les-Grottes, France
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common health care-associated infections. Staphylococcus aureus remains the most common etiologic agent causing SSIs. Studies confirm S aureus carriage increases the risk of S aureus SSIs. The purpose of this article is to review the strategies to reduce SSIs due to S aureus focusing on nasal decolonization. RESULTS Published studies indicate screening patients for S aureus nasal carriage and decolonizing carriers during the preoperative period decreases the risk of S aureus SSIs in cardiac and orthopedic surgery. Mupirocin remains the best topical agent at eradicating nasal S aureus however, concerns over resistance have led to development of alternative agents. Nasal povidone-iodine, alcohol-based nasal antiseptic, and photodynamic therapy are promising new interventions, but more studies are needed. CONCLUSIONS Short term nasal mupirocin is still the most studied and effective topical agent in eradicating S aureus nasal colonization. However, increasing mupirocin resistance remains an ongoing concern and newer agents are needed. Currently, preoperative S aureus decolonization often uses combination chlorhexidine gluconate bathing and nasal mupirocin considering that colonization of multiple body sites is commonly seen.
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Affiliation(s)
- Edward J Septimus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Division of Internal Medicine, Texas A&M College of Medicine, Houston, TX.
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Üstündağ Okur N, Hökenek N, Okur ME, Ayla Ş, Yoltaş A, Siafaka PI, Cevher E. An alternative approach to wound healing field; new composite films from natural polymers for mupirocin dermal delivery. Saudi Pharm J 2019; 27:738-752. [PMID: 31297030 PMCID: PMC6598503 DOI: 10.1016/j.jsps.2019.04.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/19/2019] [Indexed: 01/31/2023] Open
Abstract
In this study, novel adhesive films were prepared for Mupirocin dermal delivery. Natural polymers as chitosan, sodium alginate and carbopol were used for films development to evaluate possible interactions and drug release properties. Solvent evaporation method was used for films preparation. Preliminary studies involved FT-IR spectroscopy and Scanning Electron Microscopy to specify interactions and morphology. Thickness, tensile strength and water uptake in phosphate buffer saline were evaluated whereas in vitro release studies were also performed. In vitro drug release studies demonstrated that mupirocin release was improved. Ex vivo bioadhesion and permeation studies using Balb-c mice were performed to check the suitability of the films. Antimicrobial ability was evaluated by agar well diffusion tests. Finally, excisional wound model applied to test the wound healing effect and evaluated macroscopic and histopathologically. One formulation was found more effective compared to the market product for wound healing at Balb-c mice.
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Affiliation(s)
- Neslihan Üstündağ Okur
- University of Health Sciences, Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul, Turkey
| | - Nesrin Hökenek
- Istanbul Medipol University, School of Pharmacy, Department of Pharmaceutical Technology, Istanbul, Turkey
| | - Mehmet Evren Okur
- University of Health Sciences, Faculty of Pharmacy, Department of Pharmacology, İstanbul, Turkey
| | - Şule Ayla
- Istanbul Medipol University, School of Medicine, Department of Histology and Embryology, Beykoz, Istanbul, Turkey
| | - Ayşegül Yoltaş
- Ege University, Faculty of Science, Department of Biology, Fundamental and Industrial Microbiology Division, Bornova, Izmir, Turkey
| | - Panoraia I Siafaka
- Istanbul Medipol University, School of Pharmacy, Department of Pharmaceutical Technology, Istanbul, Turkey.,Aristotle University of Thessaloniki, Department of Chemistry, Thessaloniki, Greece
| | - Erdal Cevher
- Istanbul University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul, Turkey
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Abstract
Mupirocin is an antibiotic from monocarboxylic acid class used as antibacterial agent against methicillin-resistant Staphylococcus aureus (MRSA) and can be obtained as a mixture of four pseudomonic acids by Pseudomonas fluorescens biosynthesis. Nowadays improving antibiotics occupies an important place in the pharmaceutical industry as more and more resistant microorganisms are developing. Mupirocin is used to control the MRSA outbreaks, for infections of soft tissue or skin and for nasal decolonization. Due to its wide use without prescription, the microorganism's resistance to Mupirocin increased from up to 81%, thus becoming imperative its control or improvement. As the biotechnological production of Mupirocin has not been previously reviewed, in the present paper we summarize some consideration on the biochemical process for the production of pseudomonic acids (submerged fermentation and product recovery). Different strains of Pseudomonas, different culture medium and different conditions for the fermentation were analysed related to the antibiotics yield and the product recovery step is analysed in relation to the final purity. However, many challenges have to be overcome in order to obtain pseudomonic acid new versions with better properties related to antibacterial activity.
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Affiliation(s)
- Alexandra Tucaliuc
- Faculty of Chemical Engineering and Environmental Protection "Cristofor Simionescu", "Gheorghe Asachi" Technical University of Iasi, Iasi, Romania
| | - Alexandra Cristina Blaga
- Faculty of Chemical Engineering and Environmental Protection "Cristofor Simionescu", "Gheorghe Asachi" Technical University of Iasi, Iasi, Romania.
| | - Anca Irina Galaction
- Faculty of Medical Bioengineering, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Dan Cascaval
- Faculty of Chemical Engineering and Environmental Protection "Cristofor Simionescu", "Gheorghe Asachi" Technical University of Iasi, Iasi, Romania
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Abstract
The recent demonstration for the first time of urinary monic acid A as a clinical urinary biomarker of exposure to intra-nasal mupirocin during medication for methicillin-resistant Staphylococcus aureus (MRSA) offers a way of verifying adherence to the regimen. However, absence of the biomarker in some patients needs explanation, to ensure that efficient decolonisation has not been compromised by confounding circumstances, and that additional resistance to mupirocin has not unwittingly been encouraged.
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Affiliation(s)
- Peter Mantle
- Faculty of Natural Sciences, Imperial College London, South Kensington, London SW7 2AZ, UK.
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Mittal S, Sayal P, Yadav P, Kumar A, Rajian M. Mupirocin Resistance Among Methicillin Resistant Staphylococcus Isolates in a Tertiary Health Care Center. Infect Disord Drug Targets 2019; 19:128-132. [PMID: 29714149 DOI: 10.2174/1871526518666180501104525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/11/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The evolution of antibiotics in the last century has revolutionized the field of medicine and led this field to higher level of success in treating mild to severe infections, but the inappropriate use of these life saving drugs has been accompanied with the appearance of resistant strains to these agents. AIMS & OBJECTIVES The aim of the study was to determine the prevalence rate of high and low-level mupirocin resistance in methicillin resistant staphylococcus,and to find out resistance to other antibiotics. MATERIALS & METHODS This study was conducted on 100 Staphylococcus isolates recovered from pus samples. Conventional disc diffusion tests were used for the detection of high and low level mupirocin resistance (mupirocin 5µg and 200µg discs) and for various other antimicrobials for example cephalexin, erythromycin, doxycycline, oxacillin, linezolid etc. Results: Outof 100 Staphylococcus isolates processed during the study period in the department of microbiology, 74 were Staphylococcus aureus (S.aureus) and 26 were Coagulase negative Staphylococcus (CoNS). Among S.aureus 43.4% were Methicillin resistant Staphylococcus aureus (MRSA) and 56.6% were Methicillin sensitive Staphylococcus aureus (MSSA), whereas among CoNS 42% were methicillin resistant and 58% were methicillin sensitive. We observed 6.75% of high level mupirocin resistance among Staphylococcus aureus and 19.23% among Coagulase negative staphylococcus. CONCLUSION It was concluded that an inappropriate excessive use of mupirocin leads to a rapid increase in high-level resistance to mupirocin and other antibiotics in CoNS, affecting the treatment lines and success rate of infection control in hospital settings.
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Affiliation(s)
- Seema Mittal
- Department of Microbiology, Assistant Professor, Bhagat Phool Singh Government Medical College, Khanpurkalan- 131305, Sonepat, Haryana, India
| | - Pallavi Sayal
- Department of Microbiology, Assistant Professor, Bhagat Phool Singh Government Medical College, Khanpurkalan- 131305, Sonepat, Haryana, India
| | - Priyanka Yadav
- Department of Microbiology, Assistant Professor, Bhagat Phool Singh Government Medical College, Khanpurkalan- 131305, Sonepat, Haryana, India
| | - Ashok Kumar
- Department of Microbiology, Assistant Professor, Bhagat Phool Singh Government Medical College, Khanpurkalan- 131305, Sonepat, Haryana, India
| | - Manisha Rajian
- Department of Microbiology, Assistant Professor, Bhagat Phool Singh Government Medical College, Khanpurkalan- 131305, Sonepat, Haryana, India
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Ahmad HF, Kallies KJ, Shapiro SB. The effect of mupirocin dressings on postoperative surgical site infections in elective colorectal surgery: A prospective, randomized controlled trial. Am J Surg 2018; 217:1083-1088. [PMID: 30528317 DOI: 10.1016/j.amjsurg.2018.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 10/31/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are the most common nosocomial infection among surgical patients. We hypothesized that mupirocin ointment would decrease SSI rates compared to standard surgical dressings in patients undergoing colorectal surgery. METHODS A prospective randomized controlled trial was performed, including patients undergoing elective open and minimally invasive colorectal surgery. Patients were randomized 1:1 to receive standard gauze dressings or mupirocin ointment (2%) dressings. The primary outcome was incisional SSI at 30 days postoperative. RESULTS A total of 192 patients were enrolled; 150 underwent randomization: 75 to the mupirocin arm, and 75 to the standard gauze dressing arm. Three SSIs occurred; one (1%) in the mupirocin group, and two (3%) in the standard gauze group (P = 0.560). There was no significant difference between standard gauze dressings and mupirocin dressings. CONCLUSION Mupirocin (2%) ointment failed to show a benefit compared to standard dressings for postoperative SSI.
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Affiliation(s)
- Humera F Ahmad
- Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Kara J Kallies
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Stephen B Shapiro
- Department of General Surgery, Gundersen Health System, La Crosse, WI, USA.
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Khoshnood S, Heidary M, Asadi A, Soleimani S, Motahar M, Savari M, Saki M, Abdi M. A review on mechanism of action, resistance, synergism, and clinical implications of mupirocin against Staphylococcus aureus. Biomed Pharmacother 2018; 109:1809-1818. [PMID: 30551435 DOI: 10.1016/j.biopha.2018.10.131] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 12/20/2022] Open
Abstract
Mupirocin (MUP), bactroban, or pseudomonic acid is a natural crotonic acid derivative drug extracted from Pseudomonas fluorescens which is produced by modular polyketide synthases. This antibiotic has a unique chemical structure and mechanism of action. It is a mixture of A-D pseudomonic acids and inhibits protein synthesis through binding to bacterial isoleucyl-tRNA synthetase. MUP is often prescribed to prevent skin and soft tissue infections caused by S. aureus isolates and where the MRSA isolates are epidemic, MUP may be used as a choice drug for nasal decolonization. It is also used for prevention of recurring infections and control the outbreaks. The emergence of MUP resistance has been increasing particularly among methicillin-resistant Staphylococcus aureus (MRSA) isolates in many parts of the world and such resistance is often related with MUP widespread uses. Although both low-level and high-level MUP resistance were reported among MRSA isolates, the rate of resistance is different in various geographic areas. In this review, we will report the global prevalence of MUP resistance, discuss synergism and mechanism of action of MUP, and provide new insights into the clinical use of this antibiotic.
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Affiliation(s)
- Saeed Khoshnood
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Heidary
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Arezoo Asadi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saleh Soleimani
- Department of Biology, Payame Noor University, Isfahan, Iran
| | - Moloudsadat Motahar
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Savari
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Saki
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahtab Abdi
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Hadadi M, Heidari H, Ebrahim-Saraie HS, Motamedifar M. Molecular Characterization of Vancomycin, Mupirocin and Antiseptic Resistant Staphylococcus aureus Strains. Mediterr J Hematol Infect Dis 2018; 10:e2018053. [PMID: 30210746 DOI: 10.4084/MJHID.2018.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/18/2018] [Indexed: 01/25/2023] Open
Abstract
Background Staphylococcus aureus is a common cause of nosocomial infections leading to a broad spectrum of diseases. Increasing antibiotic resistance among S. aureus strains, particularly methicillin-resistant S. aureus (MRSA), is a serious concern. In addition, the emergence of antiseptics resistance in MRSA helps the organism to persist and spread in healthcare environments easily. The aim of this study was to determine the molecular characteristics of vancomycin, mupirocin, and antiseptic resistant S. aureus strains. Materials and Methods This cross-sectional study was performed on a total of 120 MRSA isolates collected from two major hospitals in Shiraz, Iran. Minimum inhibitory concentrations (MICs) of vancomycin and mupirocin were determined by E-test method according to CLSI and Eucast guidelines. Presence of resistance genes was investigated by PCR method. Results Antibacterial susceptibility tests for MRSA isolates showed that three isolates (2.5%) were vancomycin-intermediate S. aureus (VISA), seven isolates (5.8%) were vancomycin-resistant S. aureus (VRSA), and 15 isolates (12.5%) were high-level mupirocin-resistant (MuH). None of the isolates had vancomycin resistance gene (vanA), but the frequency of mupirocin resistance gene was significant, and 55 (45.8%) isolates carried the mupA gene. Moreover, norA, smr and qacA/B genes were detected in 110 (91.7%), 55 (45.8%) and 36 (30%) strains, respectively. Conclusion This study showed the existence of VISA and VRSA strains in our region, and we also found a high frequency of mupirocin and biocide resistance genes among them.
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Shittu AO, Kaba M, Abdulgader SM, Ajao YO, Abiola MO, Olatimehin AO. Mupirocin-resistant Staphylococcus aureus in Africa: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2018; 7:101. [PMID: 30147868 PMCID: PMC6094907 DOI: 10.1186/s13756-018-0382-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mupirocin is widely used for nasal decolonization of Staphylococcus aureus to prevent subsequent staphylococcal infection in patients and healthcare personnel. However, the prolonged and unrestricted use has led to the emergence of mupirocin-resistant (mupR) S. aureus. The aim of this systematic review was to investigate the prevalence, phenotypic and molecular characteristics, and geographic spread of mupR S. aureus in Africa. Methods We examined five electronic databases (EBSCOhost, Google Scholar, ISI Web of Science, MEDLINE, and Scopus) for relevant English articles on screening for mupR S. aureus from various samples in Africa. In addition, we performed random effects meta-analysis of proportions to determine the pooled prevalence of mupR S. aureus in Africa. The search was conducted until 3 August 2016. Results We identified 43 eligible studies of which 11 (26%) were obtained only through Google Scholar. Most of the eligible studies (28/43; 65%) were conducted in Nigeria (10/43; 23%), Egypt (7/43; 16%), South Africa (6/43; 14%) and Tunisia (5/43; 12%). Overall, screening for mupR S. aureus was described in only 12 of 54 (22%) African countries. The disk diffusion method was the widely used technique (67%; 29/43) for the detection of mupR S. aureus in Africa. The mupA-positive S. aureus isolates were identified in five studies conducted in Egypt (n = 2), South Africa (n = 2), and Nigeria (n = 1). Low-level resistance (LmupR) and high-level resistance (HmupR) were both reported in six human studies from South Africa (n = 3), Egypt (n = 2) and Libya (n = 1). Data on mupR-MRSA was available in 11 studies from five countries, including Egypt, Ghana, Libya, Nigeria and South Africa. The pooled prevalence (based on 11 human studies) of mupR S. aureus in Africa was 14% (95% CI =6.8 to 23.2%). The proportion of mupA-positive S. aureus in Africa ranged between 0.5 and 8%. Furthermore, the frequency of S. aureus isolates that exhibited LmupR, HmupR and mupR-MRSA in Africa were 4 and 47%, 0.5 and 38%, 5 and 50%, respectively. Conclusions The prevalence of mupR S. aureus in Africa (14%) is worrisome and there is a need for data on administration and use of mupirocin. The disk diffusion method which is widely utilized in Africa could be an important method for the screening and identification of mupR S. aureus. Moreover, we advocate for surveillance studies with appropriate guidelines for screening mupR S. aureus in Africa.
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Affiliation(s)
- Adebayo O. Shittu
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shima M. Abdulgader
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Yewande O. Ajao
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Mujibat O. Abiola
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Ayodele O. Olatimehin
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
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Madden GR, Sifri CD. Antimicrobial Resistance to Agents Used for Staphylococcus aureus Decolonization: Is There a Reason for Concern? Curr Infect Dis Rep 2018; 20:26. [PMID: 29882094 DOI: 10.1007/s11908-018-0630-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Chlorhexidine gluconate (CHG) and mupirocin are increasingly used for Staphylococcus aureus decolonization to prevent healthcare-associated infections; however, increased use of these agents has led to concerns for growing resistance and reduced efficacy. In this review, we describe current understanding of reduced susceptibility to CHG and mupirocin in S. aureus and their potential clinical implications. RECENT FINDINGS While emergence of S. aureus tolerant or resistant to topical antimicrobial agents used for decolonization is well described, the clinical impact of reduced susceptibility is not clear. Important challenges are that standardized methods of resistance testing and interpretation are not established, and the risk for selection for co- or cross-resistance using universal, as opposed to targeted decolonization, is unclear. Evidence continues to support S. aureus decolonization in certain patient groups, although further studies are needed to determine the long-term impact of CHG and mupirocin resistance on efficacy. Strategies to mitigate further development of reduced susceptibility and the consequences of selection pressures through universal decolonization on resistance will benefit from further investigation.
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Yankey H, Isaacson G. Efficacy of topical 2% mupirocin ointment for treatment of tympanostomy tube otorrhea caused by community-acquired methicillin resistant Staphylococcus aureus. Int J Pediatr Otorhinolaryngol 2018; 109:36-39. [PMID: 29728181 DOI: 10.1016/j.ijporl.2018.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To demonstrate the safety and effectiveness of topical 2% mupirocin ointment as an adjunctive therapy for tympanostomy tube otorrhea (TTO) caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS We treated children with community-acquired MRSA TTO by aural suctioning and culture-directed systemic antibiotics (+/- ototopical drops) alone (control group) or with the addition of single 1 ml dose of mupirocin ointment applied to the tube and ear canal (mupirocin group). Patient age, laterality, response to treatment, associate hearing loss, duration of follow-up, and recurrence of infection by MRSA or by other organisms were compared. RESULTS 29 children (37 ears) with MRSA TTO were included. 8 children (12 ears) received adjunctive topical mupirocin ointment - 21 children (25 ears) did not. 8 of 12 ears in the mupirocin group received concomitant systemic antibiotics - 4 ears were treated with topical mupirocin alone. The mean duration of follow-up of the mupirocin group was 7 months (with 95% C.I of 7 ± 7). The control group was 24 months (with 95% C.I of 24 ± 9). Recurrence of MRSA TTO in the mupirocin and control groups were 0/12; 0% and 10/25; 40%, by ear, respectively (p = 0.015). Recurrence of non-MRSA TTO in the mupirocin and control groups were 6/12; 50% and 9/25; 36%, by ear, respectively (p = 1.0). There were no sensorineural hearing losses in the mupirocin-treated children. CONCLUSION In this small series, a single application of topical mupirocin in combination with mechanical debridement, controlled infection by CA-MRSA without evidence of local reaction or subsequent hearing loss. Its role in treatment of MRSA TTO merits further investigation.
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Affiliation(s)
- Hilary Yankey
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, USA
| | - Glenn Isaacson
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, USA; Department of Pediatrics, Lewis Katz School of Medicine at Temple University, USA.
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Lounsbury N, Eidem T, Colquhoun J, Mateo G, Abou-Gharbia M, Dunman PM, Childers WE. Novel inhibitors of Staphylococcus aureus RnpA that synergize with mupirocin. Bioorg Med Chem Lett 2018; 28:1127-31. [PMID: 29463447 DOI: 10.1016/j.bmcl.2018.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/10/2018] [Accepted: 01/14/2018] [Indexed: 11/23/2022]
Abstract
We recently discovered RnpA as a promising new drug discovery target for methicillin-resistant S. aureus (MRSA). RnpA is an essential protein that is thought to perform two required cellular processes. As part of the RNA degrasome Rnpa mediates RNA degradation. In combination with rnpB it forms RNase P haloenzymes which are required for tRNA maturation. A high throughput screen identified RNPA2000 as an inhibitor of both RnpA-associated activities that displayed antibacterial activity against clinically relevant strains of S. aureus, including MRSA. Structure-activity studies aimed at improving potency and replacing the potentially metabotoxic furan moiety led to the identification of a number of more potent analogs. Many of these new analogs possessed overt cellular toxicity that precluded their use as antibiotics but two derivatives, including compound 5o, displayed an impressive synergy with mupirocin, an antibiotic used for decolonizing MSRA whose effectiveness has recently been jeopardized by bacterial resistance. Based on our results, compounds like 5o may ultimately find use in resensitizing mupirocin-resistant bacteria to mupirocin.
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Ruiz-Tovar J, Llavero C, Morales V, Gamallo C. Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery. Surg Endosc 2018; 32:3495-501. [PMID: 29349539 DOI: 10.1007/s00464-018-6069-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Surgical site infection (SSI) prevention bundles include the simultaneous use of different measures, which individually have demonstrated an effect on prevention of SSI. The implementation of bundles can yield superior results to the implementation of individual measures. The aim of this study was to address the effect of the application of a bundle including intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, on the surgical site infection after elective laparoscopic colorectal cancer surgery. METHODS A prospective, randomized study was performed, including patients with diagnosis of colorectal neoplasms and plans to undergo an elective laparoscopic surgery. The patients were randomized into two groups: those patients following standard bundles (Group 1) and those ones following the experimental bundle with three additional measures, added to the standard bundle. Incisional and organ space SSI were investigated. The study was assessor-blinded. RESULTS A total of 198 patients were included in the study, 99 in each group. The incisional SSI rate was 16% in Group 1 and 2% in Group 2 [p = 0.007; RR = 5.6; CI 95% (1.4-17.8)]. The organ-space SSI rate was 4% in Group 1 and 0% in Group 2 [p = 0.039; RR = 1.7; CI 95% (1.1-11.6)]. Median hospital stay was 5.5 days in Group 1 and 4 days in Group 2 (p = 0.028). CONCLUSIONS The addition of intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, to a standard bundle of SSI prevention, reduces the incisional and organ-space SSI and consequently the hospital stay, after elective laparoscopic colorectal cancer surgery (ClinicalTrials.gov Identifier: NCT03081962).
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Salih L, Tevell S, Månsson E, Nilsdotter-Augustinsson Å, Hellmark B, Söderquist B. Staphylococcus epidermidis isolates from nares and prosthetic joint infections are mupirocin susceptible. J Bone Jt Infect 2018; 3:1-4. [PMID: 29291157 PMCID: PMC5744189 DOI: 10.7150/jbji.22459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/22/2017] [Indexed: 01/24/2023] Open
Abstract
The objective of the present study was to investigate the antibiotic susceptibility including mupirocin among Staphylococcus. epidermidis isolated from prosthetic joint infections (PJIs) (n=183) and nasal isolates (n=75) from patients intended to undergo prosthetic joint replacements. Susceptibility to mupirocin (used for eradication of nasal carriership of Staphylococcus aureus) was investigated by gradient test, and susceptibility to various other antimicrobial agents was investigated by disc diffusion test. All isolates, except three from PJIs and one from the nares, were fully susceptible to mupirocin. Multi-drug resistance (≥3 antibiotic classes) was found in 154/183 (84.2%) of the PJI isolates but only in 2/75 (2.7%) of the nares isolates, indicating that S. epidermidis causing PJIs do not originate from the nares.
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Affiliation(s)
- Lavin Salih
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Staffan Tevell
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Infectious Diseases, Karlstad Hospital, Sweden
| | - Emeli Månsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,RegionVästmanland - Uppsala University, Centre for Clinical Research, Hospital of Västmanland, Västerås, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, and Department of Infectious Diseases, County Council of Östergötland, Linköping, Sweden
| | - Bengt Hellmark
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Stirton J, Herron JS, Nandi S. Empiric treatment is less costly than Staphylococcus aureus screening and decolonization in total joint arthroplasty patients. Arthroplast Today 2017; 4:323-324. [PMID: 30186914 PMCID: PMC6123317 DOI: 10.1016/j.artd.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022] Open
Abstract
The aim of our study was to compare the cost of preoperative empiric mupirocin treatment of all total joint arthroplasty patients with a standard Staphylococcus aureus screening and decolonization protocol. The cost of empiric mupirocin treatment is $24.65 per patient, whereas the cost of a standard S. aureus screening and decolonization protocol is $60.32 per patient. Given that more than 1,051,000 total joint arthroplasties are performed annually, the cost savings with empiric treatment is nearly $40 million per year. Empiric treatment allows for more efficient workflow, minimizes potential for clerical error, eliminates risk of undertreatment, and has not been shown to increase antibiotic resistance.
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Affiliation(s)
- Jacob Stirton
- Department of Orthopaedic Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Joseph Scott Herron
- Department of Orthopaedic Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Sumon Nandi
- Department of Orthopaedic Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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