Publication: Impact of mupirocin resistance on the transmission and control of healthcare-associated MRSA
Issued Date
2015-12-01
Resource Type
ISSN
14602091
Other identifier(s)
2-s2.0-84949574795
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Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
The Journal of antimicrobial chemotherapy. Vol.70, No.12 (2015), 3366-3378
Suggested Citation
Sarah R. Deeny, Colin J. Worby, Olga Tosas Auguet, Ben S. Cooper, Jonathan Edgeworth, Barry Cookson, Julie V. Robotham Impact of mupirocin resistance on the transmission and control of healthcare-associated MRSA. The Journal of antimicrobial chemotherapy. Vol.70, No.12 (2015), 3366-3378. doi:10.1093/jac/dkv249 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/36245
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Title
Impact of mupirocin resistance on the transmission and control of healthcare-associated MRSA
Abstract
© The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. OBJECTIVES: The objectives of this study were to estimate the relative transmissibility of mupirocin-resistant (MupR) and mupirocin-susceptible (MupS) MRSA strains and evaluate the long-term impact of MupR on MRSA control policies.METHODS: Parameters describing MupR and MupS strains were estimated using Markov chain Monte Carlo methods applied to data from two London teaching hospitals. These estimates parameterized a model used to evaluate the long-term impact of MupR on three mupirocin usage policies: 'clinical cases', 'screen and treat' and 'universal'. Strategies were assessed in terms of colonized and infected patient days and scenario and sensitivity analyses were performed.RESULTS: The transmission probability of a MupS strain was 2.16 (95% CI 1.38-2.94) times that of a MupR strain in the absence of mupirocin usage. The total prevalence of MupR in colonized and infected MRSA patients after 5 years of simulation was 9.1% (95% CI 8.7%-9.6%) with the 'screen and treat' mupirocin policy, increasing to 21.3% (95% CI 20.9%-21.7%) with 'universal' mupirocin use. The prevalence of MupR increased in 50%-75% of simulations with 'universal' usage and >10% of simulations with 'screen and treat' usage in scenarios where MupS had a higher transmission probability than MupR.CONCLUSIONS: Our results provide evidence from a clinical setting of a fitness cost associated with MupR in MRSA strains. This provides a plausible explanation for the low levels of mupirocin resistance seen following 'screen and treat' mupirocin usage. From our simulations, even under conservative estimates of relative transmissibility, we see long-term increases in the prevalence of MupR given 'universal' use.