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JAC Advance Access originally published online on May 18, 2009
Journal of Antimicrobial Chemotherapy 2009 64(1):9-15; doi:10.1093/jac/dkp159
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Review

Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects

T. Coates1, R. Bax2 and A. Coates3,*

1 University College London, Gower Street, London, WC1E 6BT, UK 2 Churt House, Sandrock Road, Westcott, Dorking, Surrey, RH4 3LE, UK 3 Medical Microbiology, Department of Cellular and Molecular Medicine, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK

* Corresponding author. Tel: 020-8725-5725; Fax: 020-8672-0234; E-mail: acoates{at}sgul.ac.uk

Staphylococcus aureus in the nose is a risk factor for endogenous staphylococcal infection. UK guidelines recommend the use of mupirocin for nasal decolonization in certain groups of patients colonized with methicillin-resistant S. aureus (MRSA). Mupirocin is effective at removing S. aureus from the nose over a few weeks, but relapses are common within several months. There are only a few prospective randomized clinical trials that have been completed with sufficient patients, but those that have been reported suggest that clearance of S. aureus from the nose is beneficial in some patient groups for the reduction in the incidence of nosocomial infections. There is no convincing evidence that mupirocin treatment reduces the incidence of surgical site infection. New antibiotics are needed to decolonize the nose because bacterial resistance to mupirocin is rising, and so it will become less effective. Furthermore, a more bactericidal antibiotic than mupirocin is needed, on the grounds that it might reduce the relapse rate, and so clear the patient of MRSA for a longer period of time than mupirocin.

Keywords: antimicrobials , infection control , MRSA , nosocomial , surgical


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