The Effectiveness of the Mupirocin Ointment in Treatment of Nasal Carriers of Staphylococcus aureus in Medical Staffs in Ali Ebne Abitaleb Hospital, Rafsanjan (Southeast of Iran)
Staphylococcus aureus nasal carriers in medical staffs are one of the important causes of nosocomial infections. They can easily be treated by Mupirocin ointment. We studied the effect of the Mupirocin ointment in the treatment of Staphylococcus aurous nasal carriers in clinical wards staffs. This cross-sectional study was done on 18 cases. One week and 1 to 3 months after Mupirocin application in their anterior nasal vestibules, nasal cultures were done. Between them, 83.3% after one week of their treatment had negative cultures. Ninty three percent of the above group after one month had negative cultures and 86% of them after 3 months had negative cultures. All of the isolates were sensitive to vancomycin. It seems that Mupirocin is effective in treatment of nasal carriers of Staphylococcus aureus.
to cite this article:
N.Z. Sheikholeslami, M. Tashakori and M. Bahsoun, 2011. The Effectiveness of the Mupirocin Ointment in Treatment of Nasal Carriers of Staphylococcus aureus in Medical Staffs in Ali Ebne Abitaleb Hospital, Rafsanjan (Southeast of Iran). Trends in Medical Research, 6: 191-194.
August 03, 2011; Accepted: November 19, 2011;
Published: January 04, 2012
Hospital infections occur during admission of patients and can develop complications.
So according to the potential effects of hospital infections, the occurrence
rate, complications, mortality rate and high economic costs, recognition of
correlated factors are very important (Taylor and Lillis,
2008). Many factors correlate to hospital infections and one of them is
the presence of Staphylococcus aureus nasal carrier among hospital personnel.
Staphylococcus is the most common strain causing hospital infections.
In humans and especially in adults, Staphylococcus aureus desire to colonize
in anterior nasal mucosa temporarily or permanently and about 10-40% of individuals
and hospital personnel are Staphylococcus aureus nasal carriers and act
as the important source of infection (Laupland et al.,
2003). The resistance of Staphylococcus to various antibiotics is
one of the most important health problems. In order to overcome this problem,
the detection methods to control and eradicate the Staphylococcus aureus
nasal carriers are essential. Mupirocine is one of these methods of treatments
(Dupeyron et al., 2006). For example, the study
of long-term (55 months) of Dupeyron in a GI ward during the three rounds, showed
reduction in the rate of nasal carriers of Staphylococcus aureus carriers
and also reduction of the prevalence of Staphylococcus aureus after Mupirocine
treatment (Dupeyron et al., 2006). This study
reveals the effectiveness of Mupirocin in the treatment of nasal carriers of
Staphylococcus aureus in medical staffs in Ali Ebne Abitaleb Hospital,
Rafsanjan (IRAN) that had not been performed before in this area.
MATERIALS AND METHODS
In this clinical interventional study, the subjects were 240 cases of hospital
personnel of Ali Ibn Abi Talib, Rafsanjan. All of them were screened in order
to recognize the Staphylococcus aureus nasal carriers. The results showed
that 44 cases had positive nasal cultures. They were identified in Sheikholeslami
study performed in 2009 (Shekholeslami et al., 2009).
Twenty six cases were excluded from the project (5 cases left the center, in
19 cases initial tests were negative and 2 cases did not accompany). All of
the cases filled the initial questionnaire included demographic details: age,
sex, sector of residence, usage of antibiotics in the recent 48 h, the result
and the antibiogram of their nasal cultures. Samples were obtained by sterile
swabs from deep tissue of anterior nasal and then cultured on Blood-Agar media.
After Mupirocine application 2 times daily for 1 week, nasal cultures were done
after 1 week, 1 and 3 months. If any one used antibiotics in the past 48 h,
the initial sampling was postponed for 48 h. Antibiogram tests were done by
Standard Agar Diffusion method. For identification of Staphylococcus aureus,
the major tests of catalase, coagolase and DNase were done. Disks of penicillin,
cefixim, vancomycin, oxacillin, erythromycin, clindamycin, cefazolin, nitrofurantion,
co-trimoxozole, ciprofloxacin, cephalothin and doxycyclin were used for antibiogram.
Data were analyzed by using SPSS software, applying Chi-Square and t-tests.
In all analysis, the significant level of p-value has been set on less then 0.05. All of the imformation were secret. The limitations of research were: (1) lack of cooperation of personnel although we gave them confidence that no social problem will be created for them and (2) low number of samples so we were forced to eliminate the age and sex separations. Also we could not use placebo because the participants did not agree.
Educational degrees of cases were elementary cycle, diploma, associate, bachelor, master and doctoral which elementary cycle and MS respectively had 33/3 and 5/6% frequency.
According to personal titles; they were divided into different groups such as physician, metro nurse, auxiliary nurse and hospital workers which auxiliary nurse and metro respectively had 33/3 and 5/6% frequency.
According to wards where cases were working, they were divided into different wards such as CCU, internal ward, ICU, pediatric, surgery and between them, the CCU had the highest frequency rate (27/58%) of positive nasal cultures. After the initial cultures, antibiogram analysis in 18 cases showed the highest sensitivity to Vancomycin (100%) (Table 1). Participants that had positive nasal cultures, were treated with topical ointment of Mupirocin twice daily for one week. One week after treatment, 16/7% of the cases had positive cultures and 83/3% had negative cultures. Following 1 month later after treatment 93/3% and three months after treatment 85/1% still had negative cultures. Totally, we studied 18 cases that their nasal cultures were positive. Between them, 83.3% after one week of their treatment had negative cultures. Ninty three percent of the above group after one month had negative cultures and 86% of them after 3 months had negative cultures.
Recent years the resistant strains of Staphylococcus caused severe epidemics
in the hospitals in all over the world (Dupeyron et al.,
2006). In many cases, infection is transferred to the patient through the
hospital personnel and they act as potential reservoir of infection. One of
the best ways in order to control this problem is the eradicatation of nasal
carriers of Staphylococcus aureus between hospital personnel by using
the Mupirocin ointment (Van Rijen, 2008). We studied totally
18 cases that the results of their nasal cultures due to Staphylococcus aureus
were positive. The efficacy of Mupirocin ointment in the eradication of Staphylococcus
aureus nasal carriers on 339 cases in Doebbeling and colleagues study was
91% (Doebbeling et al., 1993). Their results
are similar to our findings. In another study by Dimitrov
et al. (2003) that was performed on the ICU staff; the response rate
to treatment after 6 days application of Mupirocin ointment was 100%. After
1, 5 and 8 months alternatively, 94, 76 and 60% of cases had still negative
cultures. Although, in our study the rate of response to treatment after 1 week
was lower than the Demitrieva study (83/3% versus 100%) but after one month
follow-up our result was similar to this research (93/3% versus 94%) and after
three-months follow-up 86% of our cases remained negative culture results but
after 7 months 60% of the cases in the Demitrieva study had negative cultures.
This dissimilarity may be due to the differences in the period of final follow-up
between our studies (7 months in the Demitrieva study versus 3 months in this
Wertheim et al. (2005) revealed that the efficacy
of Mupirocin ointment in permanent nasal carriers after 5 weeks was 69% and
in the alternative nasal carriers 58% and the reviews showed Mupirocin. The
result of our study showed the better efficacy of Mupirocin ointment in comparison
to the Wertheim study and more likely we can emphasize on the efficacy of this
In addition, after the initial culture; antibiogram results showed that between all of the antibiotics, no resistance against Vancomycin was reported.
The following suggestions have been made:
||We suggest to perform another study with additional cases
in order to obtain more exact results and also to determine and compare
the prevalence of nosocomial infections before and after of this treatment
||We suggest to screen and treat Staphylococcus aureus nasal carriers
among hospital personnel prior to employ in health centers and hospitals
||As our study has shown the highest sensitivity to Vancomycin (100%), we
recommend to use this antibiotic correctly in order to avoid construction
of the resistant strains
||The lack of cooperation of some personnel was a problem for us, so it
seems some additional educational efforts should be done in order to clear
the significance of nosocomial infections for health personnel
It seems the efficacy of Muphrocine ointment in the treatment of nasal Staphylococcus carriers among hospital personnel in this study is optimal.
Thanks and appreciations: the authors appreciate the efforts of Mr. Karami in the Rafsanjan Laboratory Hospital and Dr Resaeian epidemiologist of Rafsanjan Medical University.
Dimitrov, T., E.E. Udo and S. Grover, 2003. Point surveillance of Staphlococcus aureus carriage among medical staff in infectious diseases hospital, Kuwait. Med. Princ. Pract., 12: 139-144.
Doebbeling, B.N., D.L. Breneman, H.C. Neu, R. Aly and B.G. Yangco et al., 1993. Elimination of Staphylococcus aureus nasal carriage in health care workers: Analysis of six clinical trials whit calcium mupirocin ointment. The mupirocin collaborative study group. Clin. Infect. Dis., 17: 466-474.
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Dupeyron, C., B. Campillo, J.P. Richardet and C.J. Soussy, 2006. Long-term efficacy of mupirocin in the prevention of infectios with meticillin-resistant staphylococcus aureus in a gastroenterology unit. J. Hosp. Infect., 63: 385-392.
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Direct Link |
Shekholeslami, Z.N., M. Rezaeian and M. Tashakori, 2009. Determination of the prevalence of Staphylococcus aureus nasal carriers and antibiotic resistance pattern in clinical wards staff of Ali- Ebne Abitaleb Hospital, Rafsanjan. J. Rafsenjan Univ. Med. Sci., 8: 27-36.
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Van Rijen, M., M. Bonten, R. Wenzel and J. Kluytmans, 2008. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database Syst. Rev., Vol. 4,
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