At VCU Medical Center we recently began universal staphylococcal decolonization for elective procedures in cardiac, neurosurgery and orthopedic surgery. Here is an article on the clinical significance of mupirocin resistance in Staphylococcus aureus published in the Journal of Hospital Infection.
Resistance to mupirocin, both high- and low-level, reduces the effectiveness of decolonizing strategies for S. aureus or MRSA. Low-level resistant isolates may initially be eradicated as effectively as susceptible isolates, but recolonization appears to be more usual. Increased use of mupirocin is associated with emergence of resistance through enhanced selective pressure and cross-transmission, however, emergence of mupirocin resistance following increased use has not been reported consistently,
We plan to be selective with our use of mupirocin. Our decolonization strategy also includes the use of chlorhexidine body wash and Peridex gargles.
We will be watching our infection rates very closely.
