Use Of Mupirocin Research Articles

Reduction of peritoneal dialysis associated infections using a novel exit-site care practice.

Peritoneal dialysis (PD) related infections are a significant obstacle leading to PD discontinuation. Since catheter related infections (CRI), defined as exit site infections and/or tunnel infection, can progress to peritonitis, vigorous efforts are implemented in CRI prevention. Following an increased CRI rate in our institution, partially related to environmental organisms found in water distribution systems, we hypothesized that exit site care that includes prevention of water exposure-related pathogens may reduce CRI. In this prospective single center study, we compared a contemporary cohort consisting of PD patients who implemented the modified exit-site care protocol, mainly including water avoidance during shower with stoma bag usage and local Mupirocin ointment against a historical control group before the protocol implementation. The historical cohort was allowed water exposure and used local gentamicin ointment. The primary outcome was the development of a CRI. Secondary outcomes were PD associated peritonitis and infection related outcomes. There were 55 patients in contemporary cohort and 58 in historical group. The CRI rate was significantly lower in study group (0.11/episodes per patient year [EPP]) compared to control group (0.71 EPP), p < 0.001. A multivariate Cox regression analysis demonstrated a protective effect of being in the contemporary cohort compared to historical group (HR for first CRI = 12.0 95%CI: 4.0-35.7, p < 0.001). Peritonitis rate was significantly lower in contemporary cohort (0.19/EPP) compared to the historical group (0.40/EPP), p = 0.011. Transfer to hemodialysis was significantly lower in contemporary cohort than historical group (7.3% vs 31.0% in contemporary and historical group respectively, HR = 0.2, 95%CI; 0.05-0.6, p = 0.001). An exit site care protocol that includes water avoidance and local Mupirocin use reduced substantially both CRI and peritonitis rate in patients treated with PD.

New insights: mupirocin resistance among methicillin-resistant Staphylococcus aureus (MRSA) infection in southern Indian region

: Methicillin-resistant (MRSA) remains to be the most concerned pathogen with enhanced multi-drug resistance in clinical set-ups. With an immediate need to control MRSA infection, there is a steep rise in the use of mupirocin as a decolonization regime.: A total of 65 MRSA samples were analysed in the present study. infection identified by standard conventional phenotypic methods. The antibiotic susceptibility pattern of mupirocin (5 μg/ml) was found using Kirby Bauer’s disc diffusion method and the minimum inhibitory concentration (MIC) determined using MIC E-test strips of mupirocin.: All the bacterial strains presented with MIC value less than 4 μg/ml, 23 isolates falls in the range of 0.05 μg/ml and 0.19 μg/ml, 12 strains MIC ranged between 0.125 and 0.640 μg/ml. However, five MRSA isolates showed no zone against mupirocin E-strip.: In present study, 92% of isolates were sensitive to mupirocin, this gives hope that mupirocin can be promising in the elimination of MRSA strains, a major concern in clinical practice. Also, the use of 5µg mupirocin discs is economical as compared to mupirocin E-strips, mupirocin discs can be used in a low resourceful clinical setups. However, our study revealed no difference in sensitivity for both the E-strip and disc method.

Exploring mechanisms of mupirocin resistance and hyper-resistance.

Mupirocin is a broad-spectrum antibiotic that acts predominantly against Gram-positive bacteria. It is produced by Pseudomonas fluorescens NCIMB 10586 and has been clinically used to treat primary and secondary skin infections and to eradicate nasal colonisation of methicillin-resistant Staphylococcus aureus strains. Mupirocin inhibits protein synthesis by blocking the active site of isoleucyl-tRNA synthetase (IleRS), which prevents the enzyme from binding isoleucine and ATP for Ile-tRNAIle synthesis. Two types of IleRS are found in bacteria - while IleRS1 is susceptible to mupirocin inhibition, IleRS2 provides resistance to cells. These two types belong to distinct evolutionary clades which likely emerged from an early gene duplication in bacteria. Resistance in IleRS2 is based on the loss of interactions that govern mupirocin binding to IleRS1, such as hydrogen bonding to the carboxylate moiety of mupirocin. IleRS2 enzymes with Ki in the millimolar range have recently been discovered. These hyper-resistant IleRS2 variants surprisingly have a non-canonical version of the catalytic motif, which serves as a signature motif of class I aminoacyl-tRNA synthetases to which IleRS belongs. The non-canonical motif, in which the 1st and 3rd positions are swapped, is key for hyper-resistance and can be accommodated without abolishing enzyme activity in IleRS2 but not in IleRS1. Clinical use of mupirocin led to the emergence of resistance in S. aureus. Low-level resistance arises by mutations of the housekeeping IleRS1, while high-level resistance develops by the acquisition of the resistant IleRS2 on a plasmid. There is no evidence that hyper-resistant variants have been found in clinical isolates.

A retrospective claims analysis of US pediatricians prescribing practices for the treatment of Molluscum Contagiosum

Introduction: Molluscum Contagiosum (MC), a common viral skin infection affects mostly children, is caused by Molluscipoxvirus. MC is characterized by flesh-colored, round, dome-shaped, umbilicated bumps. Pediatricians are often the first to diagnose MC. Objective: To examine US pediatrician’s MC treatment management using claims data. Methods: Syneos used the Compile Claims database to collect all medical and pharmacy claims for pediatric patients diagnosed with molluscum (ICD10 Code B081) in 2019-2020. Pediatric patients with a Molluscum (B081) claim from a pediatrician practice were calculated along with patients prescribed a prescription by the same pediatrician within 30 days of a molluscum claim. Practitioners were categorized as “wait and see,” “treater” or “referrer.” Frequency data were captured. Results: From 2019-2020, 260,788 molluscum patients ≤ 19 years were diagnosed by 56,026 healthcare providers. Pediatricians were responsible for a majority of molluscum diagnoses: 72% of patients (187,228) diagnosed by 35,017 pediatricians. Most pediatricians initially managed MC with a “wait and see” approach (91%). If a “wait and see” pediatrician initiated treatment, half managed by prescription, whereas “treaters” used in-office procedures (81%) and prescriptions (23%). Mupirocin (45%) and triamcinolone (23%) were preferred prescriptions. Conclusion: Mupirocin and triamcinolone were likely used to treat signs of inflammation indicative of MC resolution known as Beginning of the End (BOTE) sign. Neither are FDA approved for MC nor antiviral; mupirocin use without secondary bacterial infection may contribute to resistance. Newly approved MC indicated therapies should be considered and a better understanding of BOTE is essential to distinguish MC resolution from secondary infection.

Mupirocin–Induced Allergic Contact Dermatitis: A Case Report and a Review of the Literature

Background: Mupirocin, an antibiotic, is frequently used to treat special traumatic infected skin lesions, such as impetigo, methicillin-resistant Staphylococcus aureus (MRSA), burn, scratch after operation, etc. Topical use of mupirocin can lead to some adverse drug reactions (ADR). Objectives: To report a case of mupirocin-induced contact dermatitis and a review of the literature to identify the causative factors and clinical characteristics. Methods: We report a case of contact dermatitis in a 39-year-old woman which happened 2 days after mupirocin ointment application on her hand. Also, a review of the literature was done according to PRISMA guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched. Time or language filters were not used and all related reports were included. Results: In the mentioned case, mupirocin has a causative role in dermatitis. The review showed 10 cases of mupirocin-induced allergy. The clinical presentations included serum sickness, diffuse urticaria, fever, arthralgias, toxic epidermal necrolysis, pruritus, rash, breathlessness, palpitations, flushing, redness all over the body, low blood pressure, severe allergic contact dermatitis, pruritic papular eruption, extensive contact dermatitis, allergic contact hypersensitivities. All cases were improved after anti-allergic treatments except one who had been tracheostomy and was in serious condition. Conclusions: this is the first review of mupirocin-induced allergy. Although these incidences are rare, clinicians should be aware to prevent severe reactions with serious consequences.

Mupirocin resistance patterns in staphylococcus isolates causing cutaneous and soft-tissue infections: An epidemiological study in a tertiary health-care facility, Dhule, Maharashtra, India

Background: Skin and soft-tissue infections (SSI) caused by Staphylococcus aureus remain a significant concern in both community and hospital settings. Mupirocin resistance among these isolates poses challenges for infection management and control strategies. Aims and Objectives: The aim of this study was to determine the prevalence and patterns of mupirocin resistance among staphylococcus isolates responsible for cutaneous and soft-tissue infections in patients attending a tertiary health-care facility. Along with that, the study investigated into mupirocin resistance prevalence and identified risk factors. Materials and Methods: A prospective study was conducted at a medical college, including 256 non-consecutive staphylococcal isolates from SSI. Antibiotic susceptibility testing was performed using Clinical and Laboratory Standards Institute recommended methods. Mupirocin resistance was determined through disk diffusion testing using 5 μg and 200 μg Mupirocin disks for low-level and high-level resistance, respectively. Results: Among the samples, 16.4% were methicillin-resistant S. aureus (MRSA) and 9.37% were methicillin-resistant coagulase-negative staphylococci. Mupirocin high-level resistance was found in 16.6% of S. aureus isolates, and mupirocin low-level resistance in 19% of MRSA isolates. The prevalence of resistance was lower in inpatient departments compared to outpatient departments. Associations were observed between resistance and patient demographics, history of mupirocin use, surgical site infections, hospitalization history, and diabetes. Conclusion: Mupirocin resistance presents a multifaceted challenge in the context of both patient demographics and clinical settings. The prevalence of resistance was influenced by factors such as patient age, gender, and prior mupirocin usage.

Chronicity of high and low level mupirocin resistance in Staphylococcus aureus from 30 Indian hospitals

Mupirocin is one of the most effective topically used antibiotic for the treatment of dermatitis, nasal carriage, decolonization of methicillin susceptible Staphylococcus aureus and eradication of methicillin resistant Staphylococcus aureus. Extensive use of this antibiotic has resulted in mupirocin resistance in Staphylococcus aureus which is a matter of concern. This study was conducted to evaluate the high and low level of mupirocin resistance in Staphylococcus aureus collected from various Indian hospitals. A total of 600 samples, of which 436 were pus specimens and 164 wound site swabs were collected from 30 Indian hospitals. Disc diffusion and agar dilution methods were used to test mupirocin susceptibility in methicillin resistant Staphylococcus aureus. Out of 600 Staphylococcus aureus isolates, 176 isolates (29.33%) were found to be methicillin resistant Staphylococcus aureus (MRSA). Out of 176 non-duplicate MRSA strains, 138 isolates were found to be mupirocin sensitive, 21 isolates had high level resistance whereas 17 isolates had low level resistance to mupirocin, which contributed 78.41%, 11.93% and 9.66% respectively. Multidrug resistant susceptibility was tested for all the MRSA with Cefuroxime, Cotrimoxazole and Vancomycin antibiotics. All the high and low level resistant strain were subjected to genome screening for mupA ileS gene respectively. mupA gene was found positive in all the high level resistant strain and out of 17 low level resistant strain, 16 strain were found point mutation in V588F of ileS gene. Overall, high rate of mupirocin resistance was found in the studied samples which might be a result of indiscriminate use of mupirocin in the population of studied region. This data emphasizes the urgent need for formulation of a well-defined and regulated guidelines for mupirocin use. Moreover, continuous surveillance is needed for the use of mupirocin and routine test should be performed to detect MRSA in patients and health care personnel to prevent MRSA infections.

Methicillin-resistant Staphylococcus aureus mupirocin resistance rates in a large healthcare system

Methicillin-resistant Staphylococcus aureus (MRSA) is a common etiology of hospital-acquired infections (HAIs). One strategy to reduce HAIs due to MRSA involves a multistep decolonization process. This often involves nasal application of mupirocin 2% ointment. In our institution, when individuals meet criteria for decolonization, we recommend 5 days of treatment given twice daily. High levels of mupirocin resistance have been reported in some hospital systems, with &gt;80% of tested isolates being resistant. To better understand our resistance levels, we selected 238 MRSA isolates from blood cultures to be tested for mupirocin resistance to correlate the presence of resistance and use of mupirocin for decolonization. We choose to assess MRSA blood isolates rather than nasal swabs given that we aim to prevent invasive MRSA infections, including blood stream infections, with decolonization. The blood cultures were collected from 11 acute-care facilities within our system from March 2021 through June 2022. High-level resistance was defined as an MIC &gt;1,024 μg/mL according to Clinical and Laboratory Standards Institute guidelines. Of those, 7.14% showed high level resistance, and 76.47% occurred in those who were exposed to mupirocin and 23.53% occurred in those without mupirocin exposure (P = .0094). On average, those with high-level resistance had had more recent exposure to mupirocin compared to those without resistance, which was statistically significant. Also, those with high resistance, on average, received more doses of mupirocin, although this was not statistically significant. Conclusions: More recent and higher number of doses of mupirocin were associated with the development of resistance, which is consistent with what we know from pharmacodynamics of antibiotic resistance with other agents. These findings may be particularly important for those patients who have frequent hospitalizations and often require decolonization. Understanding baseline mupirocin resistance levels in an institution can assist with determining decolonization strategies.Disclosures: None

MINIMUM INHIBITORY CONCENTRATION LEVELS OF MUPIROCIN BY E-TEST AMONG STAPHYLOCOCCUS AUREUS ISOLATES AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERN

Objective: This study was done to evaluate the susceptibility of Staphylococcus aureus to mupirocin and to determine the antimicrobial susceptibility pattern of Staphylococcus aureus among various clinical isolates. Methods: All the consecutive, non-duplicative Staphylococcus aureus isolates collected during the year 2020 were subjected to the disk diffusion method to evaluate the antimicrobial susceptibility pattern and were stocked. Mupirocin susceptibility for all stocked Staphylococcus aureus was detected by Minimal inhibitory concentration (MIC) determination by Epsilometer test (E-test). Results: The total number of Staphylococcus aureus was 52. The maximum number of Staphylococcus aureus was isolated from pus sample 40 (76.9%). Among the 52 isolates, 26 (50%) were found to be methicillin-resistant Staphylococcus aureus (MRSA). All the isolates were susceptible to tetracycline (100%), vancomycin (100%), teicoplanin (100%), and linezolid (100%). By E-test, the overall prevalence of mupirocin resistance was 63.5%. Low-level Mupirocin resistance (MupRL) of 8-256 µg/ml was 59.6% and high-level mupirocin resistance (MupRH) of ≥512 µg/ml was 3.9%. Conclusion: The present study shows a high prevalence of mupirocin resistance (63.5%) which is a serious concern. Therefore, indiscriminate use of topical mupirocin in carriers is not advisable. It may be recommended only in case of an outbreak of skin and soft tissue infection attributed to Staphylococcus aureus.

Quality improvement study on the effectiveness of intranasal povidone-iodine decolonization on surgery patients

Surgical site infection prevention and treatment remains a challenge in healthcare settings globally. The routine use of intranasal mupirocin for decolonization has challenges and preoperative intranasal povidone-iodine decolonization is another option. The purpose of this quality improvement study was to assess if a one-time preoperative intranasal povidone-iodine application could reduce the risk of the likelihood of nasal carriage of Staphylococcus aureus after surgery. Ambulatory Surgery Center patients were enrolled in an intranasal povidone-iodine decolonization quality improvement study as they reported at the pre-operative holding area. Pre-decolonization intranasal samples were collected, followed by intranasal application of povidone-iodine. Patients waited for a minimum of 20 minutes after application before proceeding with surgery. Nasal samples were again collected after surgery. Each sample was tested for S.aureus colonization using the 16S rRNA-mecA-nuc triplex polymerase chain reaction, standard biochemical tests, and qualitative culturing. In the 98 patients enrolled, 36% of these patients had intranasal colonization with S.aureus by 16S rRNA-mecA-nuc triplex polymerase chain reaction before surgery. Using a qualitative culture technique, 28% of patients tested positive for S.aureus before surgery and 20% of patients tested positive for S.aureus after surgery (P= 0.039). Intranasal preoperative povidone-iodine is an effective strategy in the decolonization of S.aureus from the nares if properly implemented.

THE ROLE OF ANTIBACTERIAL THERAPY IN THE TREATMENT OF ATOPIC DERMATITIS IN CHILDREN

Background. Atopic dermatitis is one of the most common chronic inflammatory skin diseases. In atopic dermatitis, the diversity of the normal microflora decreases, so that the number of S. aureus prevails and the number of bacteria with antistaphylococcal activity decreases. The aim of this study was to evaluate the effectiveness of mupirocin 2% cream in the treatment of atopic dermatitis in children as an additional therapy, and the effect of the rs4696480 polymorphism in the TLR2 gene on the effectiveness of the treatment.Materials and methods. The study included patients with atopic dermatitis (n = 37), aged 1-18 years (7.9±4.9) from the Department of Allergy at Kyiv City Children Clinical Hospital №2. All children included in the study with atopic dermatitis had a positive S. aureus culture. Patients were randomized into two groups: a group receiving mupirocin 2% cream on the affected skin areas 2 times a day 10 days (group A) and a control group (group B). Children of the control group received only symptomatic therapy. The SCORAD score and CDLQI (children's dermatology life quality index) questionnaire score was recorded before and after the treatment, side effects were recorded during the study. Skin swab cultures were taken before and after treatment. Genotyping for TLR2 rs4696480 was performed by using Real-time PCR.This study was approved by the ethical committee of the O.Bogomolets National Medical University; all patients/parents of the children gave an informed consent to participate. Statistical processing of the obtained data was carried out using the statistical package IBM SPSS Statistics Base (version 22) and the software EZR version 1.32 (graphical interface of the R environment (version 2.13.0). The difference in the effectiveness of therapy between the two subgroups and the influence of genotype on the effectiveness of therapy was determined using the Student criterion for parametric data (T) and Wilcoxon W-test for nonparametric data (W). The dynamics of indicators in each group before and after treatment were evaluated using the Wilcoxon T-test (T-W). Eeffectiveness of S. aureus eradication was estimated using the odds ratio (OR) with a 95% confidence interval (CI). Results were considered statistically significant at the level of p &lt; 0.05.Results. In both groups of children, improvement was observed in 10 days after the treatment. In group A, the improvement in ΔSCORAD was found to be 13.8 (T-W=190.0, p&lt;0.001). In group B, there was also an improvement: ΔSCORAD 8.5 (T-W=153.0, p&lt;0.001). The difference in ΔSCORAD scores between groups A and B was statistically significant (T=2.70, p=0.011). The decrease in CDLQI score after treatment was 31.3% in group A (T-W=190.0, p&lt;0.001), and 18.3% in group B (T-W=171.0, p&lt;0.001). The difference between these two groups was not statistically significant (W=334.0, p=0.409).After the treatment, the skin culture showed that in group A, 57.9% of patients were S. aureus-negative, in group B, only 22.2% of children had a negative culture (OR= 5.50, CI 1.32-22.86).We compared ΔSCORAD depending on the genotype of the rs4696480 polymorphism in TLR2 gene and found no difference in the two subgroups: In the subgroup with the AA genotype, ΔSCORAD was found to be 12.6±3.7; in the subgroup with the TT genotype ‒ 14.4±5.1 (T=0.84, p=0.413).Conclusions. Our results demonstrate the effectiveness of the use of topical mupirocin in the treatment of atopic dermatitis as an additional therapy.

The utility of empirical mupirocin for eradication of methicillin-resistant Staphylococcus aureus colonisation in Far North Queensland, Australia.

Methicillin-resistant Staphylococcus aureus (MRSA) infections are common in Far North Queensland (FNQ) and their incidence is increasing. Decolonisation regimens that include topical mupirocin are recommended in Australian guidelines to reduce recurrent infection. Mupirocin resistance was identified in 3,932/15,851 (24.8%) methicillin-sensitive Staphylococcus aureus (MSSA) isolates and in 533/5,134 (10.4%) MRSA isolates from FNQ between 1997 and 2016. Factors associated with mupirocin resistance in multivariate analysis were an MSSA isolate, age < 40 years, rural residence and female gender. These data support the use of mupirocin in MRSA decolonisation in FNQ, although addressing the underlying social determinants of health that drive the incidence of S. aureus infections remain a priority for local healthcare provision.

Intranasal Mupirocin to Reduce Surgical Site Infection Post Cardiac Surgery: A Review of the Literature.

Sternal wound infections after cardiac surgery are associated with high rates of morbidity and mortality. One of the known risk factors of sternal wound infection is Staphylococcus aureus colonisation. Intranasal mupirocin decolonisation therapy implemented pre-operatively appears to be an effective preventative measure in reducing sternal wound infections post-cardiac surgery. Therefore, the main aim of this review is to evaluate the current literature regarding the use of intranasal mupirocin before cardiac surgery and its impact on sternal wound infection rates.

Dissemination of Methicillin-Resistant Staphylococcus aureus Sequence Type 764 Isolates with Mupirocin Resistance in China.

Mupirocin, a topical antimicrobial agent, is an important component in the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization. The molecular characteristics of 46 mupirocin-resistant MRSA (MR-MRSA) clinical isolates were analyzed by multilocus sequence typing (MLST), staphylococcal cassette chromosome mec element (SCCmec) typing, spa typing, and analysis of virulence genes. All 26 MRSA isolates with low-level mupirocin resistance possessed a V588F mutation in ileS. Among 20 MRSA isolates with high-level resistance to mupirocin, all carried mupA; 2 isolates also possessed the V588F mutation in ileS, and 1 possessed the V631F mutation in ileS (isoleucyl-tRNA synthetase). The majority of MR-MRSA isolates were resistant to erythromycin, clindamycin, tetracycline, ciprofloxacin, and gentamicin, but the rates of resistance to rifampin and fusidic acid were 8.7% and 6.5%, respectively. Eight sequence types (STs) were found among the 46 MR-MRSA isolates, of which ST764 was the most prevalent (76.1%). The most frequent spa type identified was t1084 (52.2%). The SCCmec type most frequently found was type II (80.4%). The most common clone among low-level MR-MRSA isolates was ST764-MRSA-SCCmec type II-t1084 (23 isolates), while ST764-MRSA-SCCmec type II-t002 (9 isolates) was the most common clone among high-level MR-MRSA isolates. Additionally, all toxin genes except the seb gene were not identified among ST764 isolates. Among clonal complex 5 (CC5) isolates, immune evasion cluster (IEC)-associated genes (chp, sak, and scn) and seb were present in ST764 but absent in ST5, while sec, sel1, tsst-1, and hlb genes were identified in ST5 but absent in ST764. In conclusion, the spread of CC5 clones, especially a novel ST764-MRSA-SCCmec type II-t1084 clone with high-level resistance to mupirocin, was responsible for the increase in mupirocin resistance. These findings indicated that the emergence of the ST764 MR-MRSA clone involves a therapeutic challenge for treating serious MRSA infections. IMPORTANCE Mupirocin, a topical antibiotic that is commonly used for the nasal decolonization of MRSA and methicillin-sensitive Staphylococcus aureus in hospital settings and nursing homes, was introduced as a highly effective antibiotic against MRSA. Mupirocin acts by competitively binding isoleucyl-tRNA synthetase, thereby disrupting protein synthesis. This drug shows bacteriostatic and bactericidal activity at low and high concentrations, respectively. However, with the increase in mupirocin use, low-level and high-level resistance during nasal mupirocin treatment has been reported. In a previous study, the proportion of MRSA strains with high-level mupirocin resistance in a Canadian hospital increased from 1.6% in the first 5 years of surveillance (1995 to 1999) to 7.0% (2000 to 2004).

1326. Mupirocin Resistance in Staphylococcus aureus in Pediatric Patients for Ten Years

Abstract Background Mupirocin has been recommended for decolonization in methicillin-resistant Staphylococcus aureus (MRSA) carriers for recurrent skin and soft tissue infections and treatment for impetigo. However, the indiscriminate use of mupirocin causes mupirocin resistance, associated with decolonization failure. The aim of the study was to investigate the epidemiology of mupirocin resistance and to identify clinical characteristics among children in a single center. Methods From January 2011 to October 2020, we retrospectively analyzed the epidemiology of antibiotic resistance and clinical characteristics of pediatric patients under 19 years old in whom S. aureus was firstly isolated at any body site. Results Of the 3,414 S. aureus isolates, 46% (1569/3414) were methicillin-resistant, and 20.3% (692/3414) were mupirocin resistant. Among MRSA, Mupirocin-resistant (MupR) was 22.6% (354/1569), and among methicillin-sensitive S. aureus (MSSA), MupR was 18.3% (338/1845) (P&amp;lt; 0.001). The median age of MupR MRSA patients was 0.14 years (interquartile range 0.04-0.79), and the median age of MupR MSSA patients was 5.0 years (interquartile range 2.0-8.1) (P=0.000). Of 692 MupR S. aureus, 94.2% (652/692) were mainly detected in the skin. MupR MRSA was most frequently isolated in the neonatal intensive care unit (40.1%, 142/354), but MupR MSSA was most frequently isolated in the outpatient setting (81.4%, 275/338) (P&amp;lt; 0.001). Of these, 43% (119/275) patients were diagnosed with atopic dermatitis. By age, mupR MRSA was the more commonly isolated in infants younger than one year (77.4%, 274/354), and MupR MSSA was more commonly isolated in children older than three years old (65.4%, 221/338) (P&amp;lt; 0.001). The frequency of MupR MRSA and MSSA showed an increase in trend over time (P&amp;lt; 0.001). Among other topical agents, 6.5% (102/1569) of MRSA was resistant to fusidic acid. Conclusion As mupirocin resistance gradually increases, a test for mupirocin susceptibility should be performed before applying the skin lesions or decolonization for MRSA. In addition, clinicians should carefully prescribe mupirocin to prevent the development of MupR S. aureus. Disclosures Yae-Jean Kim, MD, PhD, Janssen: Grant/Research Support|Korean Society of Pediatric Infectious Diseases: Grant/Research Support|Ministry of Trade, Industry and Energy: Grant/Research Support|MSD: Grant/Research Support.

1232. Mupirocin Susceptibility of Staphylococcus aureus (SA), 2022: Is It Time for Change in MRSA Decolonization?

Abstract Background Nasal decolonization with mupirocin has been a commonly used strategy for the prevention of surgical site infections (SSIs) due to SA. We recently noted an increase in SSIs due to SA despite the use of mupirocin, including a case of post-operative mupirocin-resistant MRSA infection despite intranasal mupirocin. We therefore evaluated the mupirocin susceptibility of SA at Stamford Hospital to determine the optimal regimen for decolonization. Methods SA isolates were recovered from clinical and screening samples received in the microbiology laboratory from 8/1/2020 to 2/28/2022. Mupirocin susceptibility was determined using e-tests and a standardized inoculum on Mueller-Hinton agar. Isolates were categorized as “susceptible” (MuS) with minimum inhibitory concentrations (MIC) ≤4 mcg/ml or resistant (MuR) with MIC values ≥8mcg/ml. Resistant strains were further divided into low-level resistance, with MIC values from 8 to 256 mcg/ml, and high-level resistance, with MIC values &amp;gt;256/ml. SA isolates were identified and tested for susceptibility by usual Clinical Laboratory Standards Institute (CLSI) criteria. Results 223 unique SA isolates from 218 patients were tested. Patients ranged in age from newborn to 94 years. Twenty-four SA isolates (10.8%) were resistant to mupirocin (20 MRSA and 4 MSSA). Of the 24 MuR strains, 19 (79.2%) isolates demonstrated high-level resistance. MRSA strains were more likely to be resistant (22.5% were MuR) than MSSA strains (3.0% were MuR) (p&amp;lt; 0.001). MuR strains did not differ from MuS strains with respect to patient age, sex, race, site of isolation, infected versus colonized, community-acquired versus hospital-acquired or inpatient/out-patient location. Conclusion Preventing surgical site infections is challenging. Decolonization with mupirocin nasal ointment has been a common component of preoperative optimization. However, the emergence of resistance would render mupirocin suboptimal and other regimens might be preferred. In our study, less than 80% of MRSA strains were MuS. These findings are concerning and have led us to reevaluate our current decolonization strategy. In patients colonized with MRSA at high risk for infection (e.g. total joint replacement), intranasal povidone iodine may be preferable to mupirocin. Disclosures All Authors: No reported disclosures.

2315. Impact of MSSA Surveillance and Decolonization on Invasive Infection in the Neonatal ICU

Abstract Background Invasive methicillin-susceptible Staphylococcus aureus (MSSA) infections are an important cause of morbidity and mortality in neonatal intensive care unit (NICU) infants. MSSA colonization (asymptomatic carriage in the nose, skin, or gut) is a risk factor for subsequent invasive infection (e.g., pneumonia, bone infections, bloodstream infections, etc). Active surveillance programs coupled with decolonization measures for MSSA-colonized infants have been associated with decreased invasive MSSA infection rates in the NICU setting. Methods In June 2020, an active surveillance program was implemented to detect MSSA nasal colonization for infants admitted to the St. Louis Children’s Hospital NICU, a 140-bed quaternary NICU. MSSA-colonized infants were decolonized with a 7 day course of intranasal mupirocin twice daily plus topical chlorhexidine baths on days 1, 4, and 7 (for infants greater than 30 weeks postmenstrual age). MSSA bloodstream infection (BSI) rates were followed quarterly pre- (September 2018-May 2020) and post- (June 2020-March 2022) implementation of MSSA surveillance and decolonization. Mean MSSA BSI rates pre- and post-implementation were compared via paired T-test. The number of infants treated with mupirocin was calculated pre- and post-implementation. Results After implementing MSSA surveillance and decolonization there was no significant change in the mean MSSA BSI rate (Figure): 0.22 per 1000 patient-days pre-implementation, 0.16 per 1000 patient-days post-implementation (p=0.37). Since initiating MSSA decolonization in June 2020, the number of NICU infants exposed to mupirocin increased nearly fourfold: mean 10 infants treated per month pre-implementation, mean 38 infants treated per month post-implementation. Conclusion Implementing an MSSA surveillance and decolonization program in the NICU was not associated with a sustained decrease in invasive MSSA infections. However, mupirocin use in the NICU nearly quadrupled following implementation. Additional investigation is warranted to identify potential contributing factors for unchanged invasive MSSA infection rates despite active surveillance and decolonization (e.g., emerging mupirocin resistance). Disclosures All Authors: No reported disclosures.

Creation of data application to facilitate device-monitoring safety for infection prevention

Background: Efficient monitoring of devices to ensure timely removal is an ongoing challenge. There is a need for data visualization products that can aggregate disparate data streams to support device reviews, increase consistency across changes in caregiver teams, and synergize with people and operational processes within and across regional acute-care facilities. Methods: A data display application was developed to provide data from nearly any source in a consistent visual representation that could be used in real time. The infection prevention (IP) overlay combined data related to urinary catheters, central vascular catheters, and femoral vascular catheters from the electronic health record system. Clinical and data experts collaborated to develop data definitions, inclusion criteria, and report components. The application display indicated the current catheter or device status of each patient facility-wide, organized by service unit (Fig. 1). Additional patient information could be accessed from within the application, and a comment feature allowed caregivers to communicate directly through the tool (Fig. 2). Results: Pilot implementation began February 2021, and the NATE IP application was live for all users (unit and facility leaders, providers, infection preventionists, etc) as of July 2021. The tool is currently available for use at 171 acute-care hospitals within the HCA healthcare system, and it accommodated 3 different electronic medical record systems. Usage peaked in August 2021, with an average of 1,700 views per day. Daily utilization maximum ranges from 1,100 to 1,500 views per day, with an average of ~1,300 views per day. The tool is used during daily patient safety rounds, including weekends and holidays. User feedback was overwhelmingly positive, with users reporting an increase in communication, streamlined documentation, improved tracking of reasons to retain, and increased accountability for daily updates. During the proof-of-concept implementation, zero bugs were identified and several feature enhancements were implemented, including addition of port status and device-day reporting counts. Planned enhancements include mupirocin and chlorhexidine bathing use, isolation precaution use, and blood cultures ordered &gt;3 days after admission. Conclusions: The NATE IP tool brings together data related devices into a single view for use by direct caregivers and all levels of leadership. Development of this or similar tools to consolidate various data streams into a central tool facilitates improved communication and consistency between caregiver teams. It also drives operational efficiencies and improves safety. Expansion to incorporate notifications related to potential issue will expand the proactive utility of this tool.Funding: NoneDisclosures: None

Lowbury Lecture 2021: tales of the unexpected in antibiotic resistance

Since the 1990s few new antibiotics have become available; during the same period the appearance and spread of bacteria no longer susceptible to first- and second-line antibiotics has accelerated; indeed some bacterial infections have become untreatable with existing antibiotics. Control of antibiotic resistance is multifactorial, and includes restrictive antibiotic use and good infection control. This lecture addresses three aspects of antibiotic resistance, with reference to the Netherlands, that illustrate the complexity of antibiotic resistance epidemiology. Initially selective decontamination of the digestive tract (SDD) was not adopted in the Netherlands because of concern about antibiotic resistance. However, three trials showed that SDD regimens, including four days of systemic cephalosporins, gave better clinical outcomes with no effect on antibiotic-resistant bacteria. Many predictions have been made about the impact of infections with antibiotic-resistant bacteria on human health. However, the situation is complex, because the risk factors for infection with multidrug-resistant bacteria are also risk factors for poor clinical outcome. A study in eight Dutch hospitals estimated the mortality attributable to antibiotic resistance as close to zero. Concern about the emergence of resistance in Staphylococcus aureus has limited the universal use of mupirocin to prevent surgical site infections. However, the risk may have been overstated, and universal decolonization with mupirocin and chlorhexidine has now become standard of care in patients undergoing cardiothoracic or orthopaedic surgery in many Dutch hospitals. Prophylactic antibiotics can improve patient outcomes with acceptable risks of promoting resistance.

Epidemiology and Risk Factors for Hemodialysis Access–Associated Infections in Children: A Prospective Cohort Study From the SCOPE Collaborative

Infections cause significant morbidity and mortality for children receiving maintenance hemodialysis (HD). The Standardizing Care to Improve Outcomes inPediatric End-Stage Kidney Disease (SCOPE) Collaborative is a quality-improvement initiativeaimed at reducing dialysis-associated infections by implementing standardized care practices. This study describes patient-level risk factors for catheter-associated bloodstream infections (CA-BSIs) and examines the association between dialysis center-level compliance with standardized practices and risk of CA-BSI. Prospective cohort study. Children enrolled in SCOPE between June 2013 and July2019. Data were collected on patient characteristics and center-level compliance with HD catheter care practices across the study period. Centers were categorized as consistent, dynamic (improved compliance over the study period), or inconsistent performers based on frequency of compliance audit submission and changes in compliance with HD care practices over time. CA-BSIs. Generalized linear mixed models were used to evaluate (1) patient-level risk factors for CA-BSI and (2) associations between change in center-level compliance and CA-BSIs. The cohort included 1,277 children from 35 pediatric dialysis centers; 1,018 (79.7%) had a catheter and 259 (20.3%) had an arteriovenous fistula or graft. Among children with a catheter, mupirocin use at the catheter exit site was associated with an increased rate of CA-BSIs (rate ratio [RR], 4.45; P= 0.004); the use of no antibiotic agent at the catheter exit site was a risk factor of borderline statistical significance (RR, 1.79; P= 0.05). Overall median compliance with HD catheter care practices was 87.5% (IQR, 77.3%-94.0%). Dynamic performing centers showed a significant decrease in CA-BSI rates over time (from 2.71 to 0.71 per 100 patient-months; RR, 0.98; P< 0.001), whereas no significant change in CA-BSI rates was detected among consistent or inconsistent performers. Lack of data on adherence to HD care practices on the individual patient level. Improvement in compliance with standardized HD care practices over time may lead to a reduction in dialysis-associated infections.