Mupirocin-Based Decolonization Regimen Safe in S aureus Carriers on Hemodialysis

After 2 decades of a protocol for mupirocin-based decolonization of Staphylococcus aureus carriers undergoing hemodialysis, mupirocin resistance was infrequent. These study findings were published in the Journal of Hospital Infection.

Mupirocin-based decolonization of S aureus is not widely performed in hemodialysis units due to fears of resistance. In 2001, a screen-and-treat decolonization program was implemented at University of Geneva Hospitals, the largest tertiary health care center in Switzerland. In this retrospective cohort study, patients undergoing hemodialysis were tested for S aureus via nare and groin swab specimens. Patients who tested positive for S aureus underwent mupirocin-based decolonization on the basis of methicillin-resistant S aureus (MRSA) or methicillin-susceptible S aureus (MSSA) carrier status.

For this study, the rates of health care-associated bloodstream infections (BSIs) and mupirocin resistance were evaluated.

Between 2003 and 2021, 92 BSIs associated with S aureus were observed, with more BSIs caused by MSSA (n=62) than MRSA (n=30). Among patients with BSIs, the mean (SD) age was 64.7 (15.4) years, and 68.5% were men.

The overall annual incidence rate (IR) of BSIs ranged between 0.037 and 0.881 per 100 patient-hemodialysis-months, with incident BSI rates decreasing by 9.8% each year (P <.001).

The rate of catheter-associated BSIs caused by S aureus was also observed to decrease by 11.9% (P <.001) annually during the study period.

Of 24 MSSA and 3 MRSA blood isolates tested between 2013 and 2021, 1 had intermediate susceptibility to mupirocin and 3 were resistant to mupirocin, respectively. All other isolates testing during this period were susceptible to mupirocin.

Among 46 patients who were screened for S aureus at least twice in the hemodialysis unit, 28.3% were S aureus carriers. A total of 15 MSSA isolates and 2 MRSA isolates were collected. Further analysis showed 1 MSSA sample with resistance to mupirocin, but the patient who carried the resistant strain was subsequently found to carry a susceptible strain.

The findings of this study may not be generalizable to other centers or regions, particularly those with higher MRSA rates or clonal spread of mupirocin-resistant MRSA strains.

“We were able to show that long-term application of a ‘screen-and-treat’ mupirocin-based decolonization regimen in HD [hemodialysis] patients is a safe practice,” the researchers noted. “This approach should be considered as a sustainable strategy for preventing S. aureus infections in this high-risk patient population,” the researchers concluded.