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Biomedical subjects

I Eltringham

Publications and source records attributed to I Eltringham.

5 recordsLinked to original sources
PubMed1998

Control of an outbreak of an epidemic methicillin-resistant Staphylococcus aureus also resistant to mupirocin.

An epidemic methicillin-resistant Staphlococcus aureus (EMRSA-3) appeared in a District hospital in June 1989 as part of a regional outbreak. The dynamics of the outbreak were complex and involved patient transfer between hospitals and wards. Control measures followed UK guidelines and included the use of nasal mupirocin. During these efforts a mupirocin-resistant MRSA [MuMRSA: mupirocin minimum inhibitor concentration (MIC) > 256 mg/L] emerged, probably in a patient who had been given eight mupirocin courses over nine months. The MuMRSA had a narrower phage-typing pattern than EMRSA-3, but was indistinguishable by pulsed-field gel electrophoresis of SmaI chromosomal restriction enzyme digests and its susceptibility pattern to other antibiotics. The results of in vitro curing and gene probing indicated that mupirocin resistance was encoded on a 48 Md plasmid. MuMRSA spread occurred in 12 patients and 11 staff. The affected patients were nursed on the same ward. The strain was eradicated from patients with oral ciprofloxacin and rifampicin, triclosan skin treatment and nasal fusidic acid and bacitracin cream. The control of the outbreak had significant medical, social and financial implications. Fortunately, there were alternative topical agents to mupirocin, an agent which has played such a key role in MRSA eradication in recent years.

Aged↗
PubMed1997

Mupirocin resistance and methicillin-resistant Staphylococcus aureus (MRSA).

Mupirocin has become the topical agent of choice for the elimination of methicillin-resistant Staphylococcus aureus (MRSA) carriage. The increased use of this antibiotic has been followed by reports of outbreaks due to MRSA with both low- and high-level resistance. Whilst low-level resistance is becoming more widespread, it is unlikely to have a major impact upon current practice. High-level resistance is plasmid borne, and although uncommon, can lead to problems with elimination especially in an outbreak situation. Alternatives are available but uncertainty exists as to their efficacy and safety. Any strategy to limit the increase of mupirocin resistance in MRSA should emphasize the importance of controlled antibiotic use both for mupirocin and other agents.

Anti-Bacterial Agents↗