First Report of Clinical and Microbiological Failure in the Eradication of Glycopeptide-Intermediate Methicillin-Resistant Staphylococcus aureus Carriage by Mupirocin

Excerpt

Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of nosocomial colonization and infection. Recently, strains with decreased susceptibility to glycopeptides (glycopeptide-intermediate Staphylococcus aureus; GISA) have been reported and classified as homogenous or heterogenous resistant mutants [1]. Local outbreaks of infection caused by GISA have been reported in France [2]. In the course of 2002, highly vancomycin-resistant strains of MRSA were identified in the USA; these strains carried the vanA gene [3]. To limit the spread of MRSA, nasal decolonization with mupirocin can be added to infection control measures [4]. High-level (MIC≥512 mg/l) and low-level (MIC=8–256 mg/l) mupirocin resistance resulting from different mechanisms has been described in Staphylococcus aureus [5]. We report here the first case of clinical and microbiological failure of mupirocin to eradicate GISA carriage. …