Universal decolonization study slashes BSI rates, but will mupirocin resistance be the Achilles heel?

January 12th, 2015

A controversial MRSA study that showed universal decolonization of patients with mupirocin and chlorhexi­dine was much more effective than active detection and isolation (ADI) has been both commended and criticized, reveal­ing a sharp divide in the infection control community between advocates of so-called “horizontal” and “vertical” interven­tions.

The overriding concern among many epidemiologists and infection preven­tionists is that widespread adoption of the decolonization approach will create mupirocin-resistant strains of methicillin-resistant Staphylococcus aureus (MRSA).

“I expect that if we start using mupiro­cin like vaseline and chlorhexidene like water — bugs being bugs — this is only going to last a little while,” says Martin Evans, MD, associate direc­tor of the MRSA Prevention Program in the Veterans Health Administration (VHA) hospital system. “That is not just my concern, but a concern of a lot but a concern of a lot of other people as well.”

Susan Huang, MD, lead author of the decolonization study notes that the protocol prevented serious infections in critically ill ICU patients, adding “For whom else would we be saving these products?”

For our in-depth coverage of this important debate see the October 2013 issue of Hospital Infection Control & Prevention