Information

How does Mupirocin affect in staphylococcal infection?


I found this sentence confusing

Transitor carriers of staphylococcal infections 70% because of mupirocin i/n.

Mupirocin is drug which affects some way. I am not sure if the statement means inner neuronal.

I am little confused by the abbreviation i/n. What is the point of the sentence?


This comes from the usage of the Mupirocin: Its an antibiotic, which is used topically (on the skin, its not taken in form of pills). It binds specifically to the isoleucyl t-RNA synthetase in gram positive bacteria and Streptoccus and Staphylococcus and is used to fight intranasally (that what i/n stands for) infections with these bacteria. It inhibts the introduction of isoleucine into proteins. More informations can be found here.


Type of medicineAn antibacterial skin preparation
Used forBacterial skin infections in adults and children
Also calledBactroban®
Available asCream and ointment

Mupirocin is an antibacterial cream/ointment which is used to treat small areas of skin infection. It is sometimes used to treat infections such as impetigo in children. It works by killing the germs (bacteria) causing the infection.

Mupirocin is used in particular to treat infections caused by bacteria called meticillin-resistant Staphylococcus aureus (MRSA). Infection with MRSA bacteria mainly occurs in people who are already ill in hospital. The infection can be difficult to treat and it can also spread to other people.

There is also a nasal ointment which contains mupirocin. It is prescribed for people who have been in contact with people with MRSA infection. It helps to stop the infection from spreading to other people. See separate medicine leaflet called Mupirocin nasal ointment which gives more information about this preparation.


Trends

Staphylococcus aureus cells are effective in exchanging mobile genetic elements, including antibiotic-resistance genes.

During colonization or infection of host organisms, the exchange appears to be particularly effective.

Bacteriophage-mediated transfer involves both transduction and autotransduction, which may enable lysogenic S. aureus cells to acquire antibiotic-resistance genes.

Conjugation is more promiscuous than previously anticipated, with transfer of apparently nonconjugative plasmids.

Greater understanding of the habitats and the conditions that promote transfer of antibiotic resistance is critical for limiting the spread of resistance.

Video Abstract

Staphylococcus aureus is a serious human pathogen with remarkable adaptive powers. Antibiotic-resistant clones rapidly emerge mainly by acquisition of antibiotic-resistance genes from other S. aureus strains or even from other genera. Transfer is mediated by a diverse complement of mobile genetic elements and occurs primarily by conjugation or bacteriophage transduction, with the latter traditionally being perceived as the primary route. Recent work on conjugation and transduction suggests that transfer by these mechanisms may be more extensive than previously thought, in terms of the range of plasmids that can be transferred by conjugation and the efficiency with which transduction occurs. Here, we review the main routes of antibiotic resistance gene transfer in S. aureus in the context of its biology as a human commensal and a life-threatening pathogen.


What drugs and food should I avoid while taking Bactroban (Mupirocin Topical) ?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Avoid getting this medicine in your eyes, mouth, or nose. A separate product called mupirocin nasal is made for use in the nose. Mupirocin topical is for use only on the skin.

Avoid using other medications on the areas you treat with mupirocin topical unless your doctor tells you to.


Results

S. aureus infection

During the 7-year study period, there were 66 patients with 96 S. aureus infections. The characteristics of the infants with S. aureus infection are described in Table 1. Ninety-one per cent of infants with S. aureus infection were premature and 68% had a birth weight of <1500 g. S. aureus infection was significantly associated with extremely low birth weight (P<0.0001, OR 17.58 with 95% confidence interval (CI): 8.49, 36.41) and extreme prematurity (P<0.0001, OR 25.10 with 95% CI: 9.6, 65.6). When adjusting for time to infection, these results remained highly significant. The most common site of S. aureus infection was skin and soft tissue at 42% (40/96) as demonstrated in Supplementary Information 1. BSI accounted for the second most common site at 27% (26/96) with 25 of 26 being central line-associated BSI. The S. aureus strains that caused bacteremia proved to be difficult to treat with a median time to a negative repeat blood culture of 4 days (range 2 to 9 days). Forty-six per cent of infants with BSI had metastatic complications with a median time to metastasis of <24 h (range 0 to 5 days). S. aureus was considered to have contributed to an infant’s mortality when it occurred within 1 week of death and no other reason for death was evident. Overall mortality of S. aureus bacteremia was 31% with eight infants dying of overwhelming S. aureus sepsis.

There were three distinctive S. aureus outbreaks during the 7-year study period (Figure 1). There was a MRSA outbreak in 2004 involving seven BSI with two fatal cases and an incidence of 1.88 per 1000 patient-days-at-risk in this pre-mupirocin time. This outbreak involved one primary MRSA strain with an antibiogram reflecting antibiotic resistance to clindamycin, ciprofloxacin and penicillin. The rate of S. aureus infection significantly decreased to 0.40 per 1000 patient-days-at-risk after implementation of intranasal mupirocin in August 2004. Mupirocin was discontinued in February 2005, after which S. aureus infections again increased culminating in another outbreak with a methicillin-sensitive S. aureus strain involving 10 BSI with four fatal cases and a rate of 1.42 per 1000 patient-days-at-risk. Mupirocin was reinstated in December 2005 along with other aspects of the comprehensive infection control strategy as previously described, and the rate of S. aureus infection again significantly decreased to 0.33 per 1000 patient-days-at-risk from December 2005 to December 2010. There was a smaller MRSA outbreak involving two BSI at the beginning of 2009 during the mupirocin prophylactic period, which may have been from a mupirocin resistant strain although this was not tested at the time. Overall when comparing the mupirocin prophylactic period with the control period, we had a significant reduction in the rate of S. aureus infection (P<0.0001) with a number needed to treat of 49 and an incidence rate ratio of 0.29 (95% CI: 0.166 to 0.512).

Number of cases of Staphylococous aureus and rate of infection during each intervention period with and without universal mupirocin. (A) August 2004. Prophylactic mupirocin alone without surveillance culture was started with the 2004 outbreak. Only infants with positive infection cultures were placed in isolation. (B) December 2005. Prophylactic mupirocin and the Institute of Healthcare Improvement (IHI) bundle were implemented. (C) April 2008. Bimonthly and then weekly active surveillance cultures were started. The early 2009 outbreak coincided with rising S. aureus colonization rates and therefore in February 2009 (D) we added active surveillance cultures on admission to our already weekly S. aureus surveillance in order to isolate infants who were colonized at birth.

Using the statistical process control U-chart, the outbreaks revealed special cause variation with rates greater than three s.d. above the mean (Figure 2). With escalating infection control measures including prophylactic mupirocin and surveillance cultures, our infection rate has exhibited common cause variation with rates below the upper control limit over the last 2 years with a mean rate of infection of 0.2 per 1000 patient-days-at-risk.

Statistical process control U-chart: Monthly Staphylococus aureus infection rate. The three outbreaks revealed special cause variation with rates greater than 3 s.d. above the mean. (A) August 2004. Prophylactic mupirocin alone without surveillance cultures was started with the 2004 outbreak. Only infants with positive infection cultures were placed in isolation. (B) December 2005. Prophylactic mupirocin and the Institute of Healthcare Improvement (IHI) bundle were implemented. (C) April 2008. Bimonthly and then weekly active surveillance cultures were started. The early 2009 outbreak coincided with rising S. aureus colonization rates and therefore in February 2009 (D) we added active surveillance cultures on admission to our already weekly S. aureus surveillance in order to isolate infants who were colonized at birth. With these escalating infection control measures, our infection rate has exhibited common cause variation with rates below the upper control limt over the last 2 years with a mean rate of infection of 0.2 per 1000 patient-days-at-risk.

S. aureus colonization

After routine active surveillance cultures were implemented in April 2008, there were 77 infants found to be colonized with S. aureus. Table 2 summarizes the demographic data of colonized infants. Being outborn or readmitted from home was a highly significant risk factor for colonization (P=0.0003, OR=2.64 with 95% CI: 1.54, 4.55). Although historic colonization data during the 2002 outbreak obtained from hospital generated infection control reports revealed an average time to colonization of 3 weeks (data not included), we found that within our study period, more than 50% of the inborn infants who were ever colonized were found to be colonized on admission including a set of twins and a set of triplets with an average time to colonization being 9 days. Half of the infants who were colonized at birth were delivered via cesarean section most with intact membranes. Colonization was significantly associated with extremely low birth weight (P=0.009, OR=3.28 with 95% CI: 1.35, 8.00) and extreme prematurity (P=0.0009, OR=2.93 with 95% CI: 1.56, 5.52). When adjusting for time to colonization, these results remained highly significant. Of the 77 infants who were found to be colonized, 11 infants developed a S. aureus infection, whereas only 5 infants developed a S. aureus infection in the non-colonized group. Therefore, colonized infants were 82 times more likely to become infected with S. aureus than non-colonized infants.

After starting routine surveillance screening in April 2008, the number of children screened generally varied between 40 and 70 depending on the census of the NICU at that time. We found S. aureus colonization rates initially at 5 to 10% but then as high as 20% (90% MRSA) November 2008 through March 2009. This high level of colonization first proceeded and then coincided with a MRSA outbreak. The S. aureus colonization rate again increased to 10% (50% MRSA) in Feb 2010 which coincided with two episodes of S. aureus bacteremia. Despite these peaks in colonization, over the past 2.5 years we have been able to maintain low S. aureus colonization rates with 1.1% for new positive colonization and 4.8% for overall positive colonization (Supplementary Information 2).

Mupirocin susceptibility

In May 2010, we started testing for mupirocin resistance. Of the 19 positive infection and colonization S. aureus isolates detected from May 2010 to December 2010, not a single isolate was resistant to mupirocin.


Mupirocin (Bactroban, Centany)

Mupirocin is an antibiotic that is used topically (on the skin) for the treatment of impetigo, a bacterial disease of the skin caused by Staphylococcus aureus, beta-hemolytic streptococcus and Streptococcus pyogenes. It also is used intranasally (inside the nose) by patients and some people who work in healthcare centers to eliminate methicillin-resistant Staphylococcus aureus (MRSA) that have colonized the inside of the nose.

Unlike most other antibiotics that act on either bacterial DNA or the walls of bacteria, mupirocin blocks the activity of an enzyme called isoleucyl-tRNA synthetase within the bacteria. This enzyme is necessary in order for the bacteria to make proteins. Without the ability to make proteins, the bacteria die. Because of its unique mechanism of action, there is little chance that bacteria will have become resistant to mupirocin because of exposure to other antibiotics.

Mupirocin topical cream was approved by the FDA in December, 1987. The intranasal form was approved in October 1995.

What are the uses for mupirocin?

  • Mupirocin is a drug used for the treatment of impetigo and infections of the skin caused by Staphylococcus aureus, beta-hemolytic streptococcus, or Streptococcus pyogenes.
  • Mupirocin is not recommended for use on the skin in serious burns because more of the inactive ingredient used for the ointment, polyethylene glycol (Miralax), may be absorbed and can damage the kidneys.
  • The nasal ointment is used for the elimination of multi-drug resistant nasal Staphylococcus aureus infection in people who are colonized by Staphylococcus aureus. Mupirocin also may be used for secondary infections as determined by your doctor.

What are the side effects of mupirocin?

Side effects are uncommon and mild with mupirocin. The most frequent side effects are:

Other side effects caused by the intranasal use of mupirocin include:

What is the dosage for mupirocin?

For the treatment of impetigo, a small amount of the ointment is applied to the affected area, usually three times daily (every 8 hours). The area may be covered with a sterile gauze dressing. If there is no improvement in 3-5 days the doctor should be contacted to re-examine the infected area.

For other skin infections, the cream is applied to the affected area 3 times a day for 10 days, and the doctor should be contacted as well if there is no improvement after 3-5 days.

When mupirocin is used for treating intranasal Staphylococcus aureus that are resistant to other antibiotics, patients who are age 12 years and older require the application of about half of the ointment from a single-use tube of ointment into one nostril and the other half into the other nostril. This treatment is repeated twice daily for 5 days. Currently, there is not enough information to recommend use of mupirocin for the treatment of intranasal Staphylococcus aureus in children younger than 12 years of age.

QUESTION

Which drugs or supplements interact with mupirocin?

There are no known drug interactions with mupirocin however, it should not be used at the same time with other drugs that are applied inside the nose.


Notes

Acknowledgments. We thank all authors contacted for acquisition of data for ongoing or partially published (abstract only) studies. We sincerely acknowledge the efforts of Dr Hannah Day at the US Food and Drug Administration and Elizabeth Carroll at the University of Iowa for their assistance with translation of non-English articles. We also acknowledge Dr Paul Casella for providing editorial review on the manuscript, and thank the Iowa City VA Healthcare System for its support.

Author contributions. R. N. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: M. L. S., E. N. P. Acquisition of data: M. L. S., R. N., A. E. B. Analysis and interpretation of data: R. N., M. L. S., E. N. P. Drafting of the manuscript: R. N., M. L. S. Critical revision of the manuscript for important intellectual content: All authors. Data analyses: R. N., M. L. S. Obtained funding: M. L. S., E. N. P. Administrative, technical, or material support: M. L. S., A. E. B., R. N. Study supervision: M. L. S.

Disclaimer. The sponsors had no role in the design and conduct of the study collection, management, analysis and interpretation of data or in the preparation, review, and approval of the manuscript and decision to submit the manuscript for publication.

Financial support. This project was funded under the Veterans Affairs Health Services and Research Career Development Award (CDA 11-215) awarded to M. L. S.

Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.


What is Infantigo?

Infantigo is a contagious superficial skin infection. Most cases are caused by staphylococcal bacteria (staph, for short). A lower percentage of cases involve streptococcal bacteria (strep for short).

Any break in the skin (such as a cut, scrape or insect bite) can potentially become infected with the germs that cause Infantigo. Because cuts, abrasions and insect bites occur more often in the summer, it tends to be more common during that time of the year. Most children will pick and scratch at the lesions and, in that manner, inoculate the skin with bacteria. Infantigo can also occur when a pre-existing skin disease such as eczema, scabies or chickenpox becomes infected from severe itching and scratching.

Types of Infantigo

There are two kinds of Infantigo: Non-bullous and Bullous.

Non-bullous – is more common and is caused by both staph and strep bacteria. Small blisters or scabs appear then form yellow or honey-colored crusts. Non-bullous Infantigo usually starts around the nose and on the face, causing swollen glands, but can also affect arms and legs.

Bullous – is caused by staph a bacterium that produces a toxin, causing a break between the top and bottom layers of the skin, forming a blister. These blisters can appear in various areas, especially in the buttock area. These blisters are fragile and break, leaving red, raw skin.

How does it occur?

As we mentioned, the condition is caused mainly by two bacteria’s which lives in the normal skin. The two organisms are the staphylococcus aureus and streptococcus pyogens although the former is responsible for most of the infections. The organisms usually do not cause any infections unless they are allowed to penetrate into the skin through a cut wound or any kind of skin breech.

What does Infantigo look like?

At first the sores look like small red bumps that quickly become small blisters that eventually progress to oozing sores covered by a yellow-brown crust. Obvious pus may drain from the lesions. In the bullous form of the infection, you’ll see larger blisters that flatten out when fluid drains out. The roof of the flattened blister then sloughs off leaving a raw area. Diagnosis is made by the visual appearance of the sores and laboratory tests are usually unnecessary.

Infantigo Pictures:


What is the sequel of the condition?

Children are more susceptible or more prone to being injured as they play and run around. The resulting tiny breeches appearing on the skin would be enough for the organisms to cause an episode of Infantigo. The result of this penetration would be a reddened skin area with blister formation and later on giving rise to pus discharge. The condition will disappear within few weeks but sometimes it can lead to other complications as well.

How does it spread?

The characteristic feature of this condition is its contagiousness which will make the sufferer himself to spread it from one part of the skin to another by touching or scratching around the wound. A second person can be infected with the disease when submitted to direct contact with the wound or being in contact with a contaminated object or a cloth used by the infected person. Thus, prevention of the disease would have to look at breaking the transmission of the disease from one person to another.


Bactroban Cream (mupirocin) Side Effects, Warnings, and Interactions

Bactroban cream (mupirocin) is an antibiotic used topically (on the skin) to treat impetigo and infections of the skin caused by Staphylococcus aureus, beta-hemolytic streptococcus, or Streptococcus pyogenes.

The nasal ointment is used for the elimination of multi-drug resistant nasal Staphylococcus aureus infection in people who are colonized by Staphylococcus aureus. Mupirocin also may be used for other secondary infections.

Common side effects of mupirocin include application site reactions (burning, stinging, pain, and itching).

Other side effects caused by the intranasal use of mupirocin include headache, runny nose, congestion, sore throat, dry skin, swelling (edema), changes in taste, nasal irritation, and cough.

There are no known drug interactions with mupirocin however, it should not be used at the same time with other drugs that are applied inside the nose.

There are no adequate studies of mupirocin in pregnant women. Studies in animals suggest no important effects on the fetus. Mupirocin may be used in pregnancy if the physician feels it is necessary. There is no information on the safety of mupirocin in nursing infants. It is unknown if any of the small amount of mupirocin that is absorbed from the skin into the blood of the mother concentrates in breast milk. It is advisable not to nurse while using mupirocin.

What are the important side effects of Bactroban cream (mupirocin)?

Side effects are uncommon and mild with mupirocin. The most frequent side effects are:

Other side effects caused by the intranasal use of mupirocin include:

Bactroban cream (mupirocin) side effects list for healthcare professionals

The following adverse reactions are discussed in more detail in other sections of the labeling:

  • Severe Allergic Reactions
  • Eye Irritation
  • Local Irritation
  • Clostridium difficile-Associated Diarrhea

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In 2 randomized, double-blind, double-dummy trials, 339 subjects were treated with topical Bactroban cream plus oral placebo. Adverse reactions occurred in 28 (8.3%) subjects. The following adverse reactions were reported by at least 1% of subjects in connection with the use of Bactroban cream in clinical trials: headache (1.7%), rash (1.1%), and nausea (1.1%).

Other adverse reactions which occurred in less than 1% of subjects were: abdominal pain, burning at application site, cellulitis, dermatitis, dizziness, pruritus, secondary wound infection, and ulcerative stomatitis.

In a supportive trial in the treatment of secondarily infected eczema, 82 subjects were treated with Bactroban cream. The incidence of adverse reactions was as follows: nausea (4.9%), headache and burning at application site (3.6% each), pruritus (2.4%), and 1 report each of abdominal pain, bleeding secondary to eczema, pain secondary to eczema, hives, dry skin, and rash.

Postmarketing Experience

In addition to adverse reactions reported from clinical trials, the following reactions have been identified during postmarketing use of Bactroban cream. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These reactions have been chosen for inclusion due to a combination of their seriousness, frequency of reporting, or potential causal relationship to Bactroban cream.

Immune System Disorders

Systemic allergic reactions, including anaphylaxis, urticaria, angioedema, and generalized rash.


Bacitracin vs Mupirocin (Bactroban) – Which Is Better For Staphylococcus Aureus Infections?

Bacitracin is an antibiotic that inhibits the growth of bacteria mainly by altering membrane permeability and by preventing the formation of peptidoglycan chains required for cell wall synthesis.

However, the incidence of allergy to this antibiotic has considerably increased over the last decade, most likely due to more frequent use.

Mupirocin is an antibiotic used to treat infections caused by bacteria called methicillin-resistant Staphylococcus aureus. This type of infection usually happens in people who are already ill in the hospital.

According to studies, it is more efficient than bacitracin for the eradication of Staphylococcus aureus.

Good Home Remedies For The Eradication Of S. aureus

#1 Turmeric

Turmeric (scientific name – Curcuma longa) is a good natural remedy to fight this bacterium. It has potent antibacterial, antioxidant, wound-healing, and anti-inflammatory attributes which help fight the infection successfully and quickly.

Also, consuming turmeric gives a boost to the immune system. In addition, it is recommended to consume turmeric combined with black pepper.

To treat bacterial infections, you just need to mix water with freshly ground turmeric to make a fine paste. Then, apply this paste topically on the affected skin area. Let it sit for 10 minutes and rinse off with water. Repeat this process two times per day until you get relief from the skin infection.

Note – benefits of turmeric include so many healing characteristics that currently there are more than 10,300 peer-reviewed articles published.

#2 Aloe Vera

Aloe vera has potent antibiotic properties and when applied to the skin infection, it can cure it over time. For instance, researchers have concluded that this medicinal plant could be an alternative for antibiotics to treat bacterial infections, according to a 2015 study.

Also, aloe vera prevents cell death around the skin infection, hence, it lowers the risk of infection.

#3 Coconut Oil

Coconut oil has antimicrobial and antifungal activity and works as an effective natural remedy for any type of fungal infection, most likely due to the presence of medium-chain fatty acids.

These essential fatty acids work as fungicides to kill the fungi that cause the infection. To use it, you just need to apply the coconut oil to the affected skin area three times per day.

Note – if you have a history of allergies, use caution when using coconut oil.

#4 Tea Tree Oil

Due to its strong and effective anti-inflammatory and antimicrobial properties, tea tree essential oil is effective for treating bacterial skin infections. In addition, tea tree essential oil relieves skin discomforts caused by the infection.

Mix equal amounts of sweet almond oil and tea tree essential oil and use this solution topically on the affected skin area.

#5 Probiotics

Probiotics are live yeasts and bacteria which are beneficial for your health, particularly your digestive system. Also, the good gut bacteria is responsible for:

  • stimulating the secretion of IgA
  • creating enzymes which destroy harmful bacteria
  • producing vitamin B12.

Regular intake of probiotics will also boost your immunity to fight against any type of bacterial infection.