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Abstract Bioequivalence (BE) assessment of topical drug products is a long-standing challenge. Agencies such as the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have published several drafts in recent years suggesting different approaches as alternative to evaluate the BE. A proposed Topical Classification System (TCS) has even been discussed. Given the above, the objective of this research was to use in vitro and in vivo BE approaches to evaluate Brazilian marketed mupirocin (MPC) ointments, previously classified as TCS class The in vitro permeation test (IVPT) was performed by applying formulations to pig skin by Franz cells. The in vivo methodology was dermatopharmacokinetic (DPK). These approaches (in vivo tape stripping and IVPT) demonstrated capability of distinguishing among different formulations, thus making them useful methodologies for BE evaluation.
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Pomadas/análise , Técnicas In Vitro/métodos , Equivalência Terapêutica , Mupirocina/análise , Pesquisa/instrumentação , Pele , United States Food and Drug Administration , Preparações Farmacêuticas/análise , Metodologia como AssuntoRESUMO
RESUMEN Objetivo: describir el porcentaje de resistencia a la mupirocina y a otros antibióticos en aislados de Staphylococcus aureus que colonizan pacientes en hemodiálisis. Métodos: estudio descriptivo en el que se incluyeron pacientes en hemodiálisis en una unidad renal de Medellín. La colonización por S. aureus fue evaluada en las fosas nasales y en la piel. La identificación bacteriana se realizó por PCR y la sensibilidad antibiótica se determinó por el sistema automatizado VITEK-2 y por el método E-test. Las características clínicas de los pacientes fueron evaluadas con la historia clínica. Resultados: se incluyeron 210 pacientes, de estos el 50,5 % (n = 106) fueron mujeres, con una mediana para la edad de 62 años (RIC 51,87-71,13). De las características clínicas se destacó el uso frecuente de antibióticos: 59 % (n = 124) y la historia de hospitalización: 69 % (n = 145). El porcentaje de colonización por S. aureus fue de 33,8 % (n = 71) y el sitio más frecuente de colonización fue las fosas nasales (19 %; n = 40). Todos los aislados fueron sensibles a la mupirocina por el método de VITEK-2. Sin embargo, un aislado presentó resistencia de bajo nivel a la mupirocina por E-test. La colonización por aislados resistentes a meticilina (SARM) fue de 4,8 % (n = 10) y estos presentaron, principalmente, resistencia solamente a la oxacilina (58,3 %; n = 7). Conclusión: la alta sensibilidad a la mupirocina en aislados de S. aureus colonizantes sugiere su uso como terapia profiláctica en pacientes en hemodiálisis con alto riesgo de infección. Es importante fortalecer los programas de uso racional de antibióticos para evitar la diseminación de mecanismos de resistencia a estos y a otros en las unidades renales.
SUMMARY Objective: To describe the resistance percentage to mupirocin and other antibiotics in Staphylococcus aureus isolates colonizing hemodialysis patients. Methods: A descriptive study was conducted at an outpatient dialysis center in Medellín and hemodialysis patients with catheter were included. Colonization by S. aureus was evaluated in nostrils and skin. Bacterial identification was performed by PCR and antibiotic susceptibility was determined by the Vitek-2 automated system and by E-test. Clinical information was obtained from medical records. Results: Two hundred and ten patients were included, of which 50.5% (n=106) were women, with a median for the age of 62 years (IQR 51,87-71,13). Among the clinical characteristics, the frequent use of antibiotics 59% (n=124) and the history of hospitalization 69% (n=145) were highlighted. The percentage of colonization by S. aureus was 33.8% (n=71) and the most frequent site of colonization was nostrils (19%; n=40). All isolates were susceptible to mupirocin by the method of Vitek-2. However, one isolate showed low level resistance to mupirocin by E-test. Colonization by methicillinresistant isolates (MRSA) was 4.8% (n=10); which presented mainly resistance only to oxacillin (58,3%; n = 7). Conclusion: The high susceptibility to mupirocin in isolates of colonizing S. aureus suggests its use as prophylactic therapy in hemodialysis patients with high risk of infection. It is important to strengthen programs for the rational use of antibiotics to prevent the spread of mechanisms of resistance to this and other antibiotics at dialysis units.
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Humanos , Diálise Renal , Mupirocina , DiáliseRESUMO
Resumen Antecedentes: Las infecciones nosocomiales ocasionadas por cepas de Staphylococcus aureus resistentes a meticilina (SARM) son un problema de salud importante en todo el mundo. Este microorganismo produce una gran variedad de infecciones incluyendo osteomielitis, endocarditis invasora, artritis séptica y septicemia. S. aureus se encuentra habitualmente en piel y cavidad nasal, se disemina fácilmente a través de fómites, contacto piel-piel o contacto con fluidos nasales. Los discentes de la EMM están en contacto continuo con pacientes del Hospital Central Militar y pueden adquirir o diseminar este tipo de microorganismos. De aquí la importancia de la medicina preventiva, con el fin de valorar la frecuencia de este microorganismo y utilizar medidas sanitarias que puedan evitar su diseminación. Objetivo: Determinar la frecuencia de portadores de Staphylococcus aureus resistentes a meticilina (SARM) en discentes de la Escuela Militar de Medicina. Metodología: Muestras de mucosa de la cavidad nasal de discentes de la Escuela Militar de Medicina del 2do a 5to año, fueron cultivadas en agar sangre y agar sal-manitol, se seleccionaron cepas con morfología colonial y microscópica correspondiente S. aureus, se realizó pruebas de catalasa y coagulasa, cepas positivas a S. aureus fueron sometidas a antibiograma utilizando sensidiscos de oxacilina y la resistencia fue determinada a partir del diámetro en el halo de inhibición. Los discentes portadores recibieron tratamiento erradicador con mupirocina al 5% intranasal por 7 días y se tomaron nuevamente muestras para determinar la persistencia de S. aureus en la cavidad nasal. Resultados: De los 110 discentes de la Escuela Militar de Medicina a quienes se le tomó muestras 51 pacientes (46.36%) resultaron portadores positivos a S. aureus, el antibiograma con discos de oxacilina mostró una resistencia a meticilina de 12 pacientes correspondiente al 10.9%, mientras que con la terapia antibiótico erradicador con mupirocina al 5% intranasal, la presencia de S. aureus resistente a meticilina disminuyo al 0%. Conclusiones: Se obtuvo un 10.9% de discentes portadores de S. aureus resistente a meticilina, mismo que fue erradicado en su totalidad con mupirocina al 5% intranasal.
Abstract Background: Nosocomial infections caused by strains of methicillin-resistant Staphylococcus aureus (MRSA) are a major health problem throughout the world. This microorganism produces a wide variety of infections including osteomyelitis, invasive endocarditis, septic arthritis, and septicemia. S. aureus is usually found in the skin and nasal cavity, it is easily spread through fomites, skin-skin contact or contact with nasal fluids. The students of the EMM are in continuous contact with patients of the Hospital Central Militar and can acquire or disseminate this type of microorganisms. Hence the importance of preventive medicine, in order to assess the frequency of this microorganism and use sanitary measures that can prevent its spread. Objective: To determine the frequency of resistant methicillin-resistant Staphylococcus aureus (MRSA) carriers in students of the Escuela Militar de Medicina. Methodology: Mucosa samples from the nasal cavity of students of the Escuela Militar de Medicina from the 2nd to 5th year, were cultured on blood agar and salt-mannitol agar, strains with corresponding colonial and microscopic morphology were selected S. aureus, tests were performed of catalase and coagulase, positive strains of S. aureus were subjected to antibiogram using oxacillin sensitives and the resistance was determined from the diameter in the inhibition zone. Student carriers received eradicating treatment with intranasal 5% mupirocin for 7 days and samples were taken again to determine the persistence of S. aureus in the nasal cavity. Results: Of the 110 students of the Escuela Militar de Medicina who were sampled 51 patients (46.36%) were positive carriers to S. aureus, the antibiogram with oxacillin discs showed a resistance to methicillin of 12 patients corresponding to 10.9%, while that with antibiotic eradication therapy with 5% intranasal mupirocin, the presence of resistant S. aureus Methicillin decreased to 0%. Conclusions: A 10.9% of students carriers of resistant S. aureus methicillin were obtained, which was eradicated in its entirety with 5% intranasal mupirocin.
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Objective To establish a RP-HPLC method for determination of ketoconazole, mupirocin and mometasone furoate in compound ketoconazole ointment. Methods RP-HPLC was conducted on a Intersil ODS-3 column (250 mm×4.6 mm, 5 μm), with methanol-PBS with pH 5.5 (65:35) as the mobile phase and the column temperature was 45 ℃. The flow rate was 1.0 ml/min, and the detection wavelength was 248 nm. Results The methodological verification showed that ketoconazole, mupirocin and mometasone furoate had a good linearity (r≥0.9995). The inter/intra-day precisions were less than 3.0%, The recovery rates were between 90% and 108%. The stability and repeatability of RSD were also less than 3.0%, which met the requirements of method validation. The contents of the three components in three batches were determined by the new method. Conclusion The method is simple and reliable. It can provide a basis for the quality control of compound ketoconazole ointment and lay a foundation for its quality standard research.
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CoNS when exposed to repeated or prolonged treatment with mupirocin ointment, may become a reservoir of high-level resistance determinants and then pass on this resistance to S. aureus. CoNS usually tends to be reservoirs of antimicrobial resistance factors, hence they generally lead to recurrence of multi-drug resistance. Hence, it is imperative to identify and discriminate the strains of S. aureus and CoNS. We wanted to analyse mupirocin resistance in coagulase negative Staphylococcus isolated from a rural population. METHODSThis study was performed in the Department of Microbiology, SMCH (Ghaziabad) among indoor as well as OPD patients of a tertiary care hospital. All coagulase negative Staphylococcus strains were taken from patient’s clinical specimens visiting the OPD or from patients getting treatment from the hospital. CoNS were identified by standard biochemical tests. An inhibition zonal area < 21 mm was considered as resistant. RESULTSMupirocin resistance was found to be 7 % in MRCoNS and 5 % in MSCoNS. MupRH and MupRL were 5 % and 7 % respectively. Only 5 (5 %) isolates showed MIC more than 512 µg / mL as described. CONCLUSIONSIn case of emergence of mupirocin resistance, other decolonization options ought to be considered.
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Background: Mupirocin is an antibacterial drug and it is used for topical application either alone or along with other antiseptics, in areas where ever infections or colonization of methicillin-resistant Staphylococcus aureus (MRSA) are found. Enhanced use of mupirocin ointment these days for local application has led to the rise in data of its resistance. Many carriers and patients are treated inappropriately due to lack of sensitivity testing and improper reporting for mupirocin and development of different levels of resistance in these strains. Due to the lack of next level treatment possibilities, we need to report sensitivity accurately, record prevalence of resistant strains, and figure out the cause of resistance. Objective: We carried out this study to demonstrate levels of mupirocin resistance in MRSA strains isolated from patients samples and to check the resistance pattern of these strains to other antibacterial, in our hospital located in Delhi, North India. Materials and Methods: The study is framed as prospective type and performed on the strains of MRSA collected from the different samples from outpatient departments and inpatient departments from January 2017 to December 2017. Out of 221 Staphylococcus aureus collected from different clinical specimens, 113 isolates were confirmed as MRSA strains. Two of the suggested methods were selected to detect mupirocin resistance: Disk diffusion method by 5 μg disc and microbroth dilution method. Results: From our 113 MRSA isolates, resistance for mupirocin was noted in 16 (14.15%) isolates when subjected to disk diffusion and microbroth dilution test. These 16 strains showed varied level of resistance. High-level resistance was shown by 4 (3.5%) isolates and 12 (10.6%) isolates were found as low-level resistant (MuL). Mupirocin resistant MRSA isolates showed higher antibiotic resistance to erythromycin (81.26% vs. 78.76%), clindamycin (56.25% vs. 42.47%), linezolid (12.50% vs. 7.90%), and tigecycline (6.25% vs. 6.19%) as compared to MRSA strains. Not even single MRSA isolates were identified as vancomycin-resistant strain. Conclusion: Both high- and low-level mupirocin-resistant MRSA was found in high numbers from these patients. It is recommended that routine test must be performed to detect resistance for mupirocin subsequent to the detection of MRSA colonization among visitors, patients, and health care workers and its isolation from local sites. Treatment and decolonization of mupirocin-resistant strains are mandatory to reduce infection and spread in hospital after having done proper sensitivity testing only.
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Introducción. Staphylococcus aureus resistente a la meticilina (SARM) es un microorganismo que coloniza las fosas nasales y diferentes partes del cuerpo, lo cual se considera un factor de riesgo para adquirir infecciones invasivas, especialmente en pacientes sometidos a cirugía cardiovascular. Objetivo. Determinar la colonización nasal por SARM y establecer las características clínicas en pacientes programados para cirugía cardiovascular. Materiales y métodos. Se hizo un estudio descriptivo entre febrero y diciembre de 2015. Se incluyeron pacientes adultos programados para cirugía cardiovascular en el Hospital Universitario San Ignacio de Bogotá. La colonización se identificó mediante reacción en cadena de la polimerasa (Polymerase Chain Reaction, PCR) en tiempo real en muestras obtenidas mediante hisopados nasales. Los pacientes fueron descolonizados con mupirocina al 2,0 % intranasal dos veces al día y baños con gluconato de clorhexidina al 4 % del cuello hacía abajo durante cinco días, al cabo de lo cual se hizo una PCR de control. Resultados.Se incluyeron 141 pacientes, 52 hospitalizados y 89 ambulatorios. Del total, 19 (13,4 %) tenían colonización nasal por SARM, correspondientes a 9 (17,3 %) de los 52 hospitalizados y 10 (11,2 %) de los 89 ambulatorios. Todos los pacientes sometidos a descolonización tuvieron resultado negativo en la PCR al final del proceso y ninguno presentó infección del sitio operatorio por S. aureus. Conclusiones.Se demostró colonización nasal por SARM tanto en los pacientes hospitalizados como en los ambulatorios. La descolonización con mupirocina fue efectiva para erradicar el estado de portador a corto plazo, lo que podría tener efecto en las tasas de infección del sitio operatorio en las cirugías cardiovasculares.
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a microorganism that colonizes nostrils and different parts of the body, which is considered a risk factor to acquire invasive infections, especially in cardiovascular surgery patients. Objective: To determine the frequency of nasal colonization by MRSA and to establish the clinical characteristics in patients scheduled for cardiovascular surgery. Materials and methods: This was a descriptive study conducted between February and December, 2015. We included adult patients scheduled for cardiovascular surgery at the Hospital Universitario San Ignacio in Bogotá, Colombia. Colonization was identified by real-time PCR from nasal swabs. Colonized patients were treated with mupirocin 2.0% intranasally twice a day and bathed with chlorhexidine 4% from the neck downwards for five days. At the end of this treatment, PCR control was carried out. Results: We included 141 patients with a percentage of nasal colonization of 13.4% (19/141). There were 52 hospitalized patients and 89 outpatients with a percentage of nasal colonization of 17.3% (9/52), and 11.2% (10/89), respectively. All colonized patients who received treatment had a negative PCR at the end of the regime and none of the participating patients had a surgical site infection by S. aureus at the end of the study. Conclusions: Nasal colonization was observed both in hospitalized patients and outpatients. Decolonization treatment with mupirocin was effective to eradicate the carrier state in the short term, which could impact the rates of surgical wound infection associated with cardiovascular surgery.
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Infecção Hospitalar , Staphylococcus aureus Resistente à Meticilina , Infecção da Ferida Cirúrgica , Portador Sadio , Mupirocina , Mucosa NasalRESUMO
@#Objective: To determine the efficacy of carragelose® nasal spray versus mupirocin ointment impregnated nasal packs on postoperative mucosal healing among chronic rhinosinusitis with nasal polyposis (CRSwNP) patients after endoscopic sinus surgery (ESS). Methods: Design: Double-Blind, Non-Randomized, Right-Left Side Comparison Setting: Tertiary Government Training Hospital Participants: Fifteen (15) patients diagnosed with chronic rhinosinusitis with nasal polyposis (CRSwNP) who had ESS were included in the study. Nasal packs (Netcell®) impregnated with carragelose® nasal spray or mupirocin ointment were respectively applied in right and left nostrils. Postoperative mucosal healing was graded by a blinded consultant using the Lund-Kennedy Endoscopic Scoring System and Perioperative Sinus Endoscopy (POSE) scoring system. Results: Six patients (12 nasal sides) completed the study. Comparing nasal packs impregnated with carragelose® nasal spray mupirocin ointment, the carragelose® group had lower Lund- Kennedy median scores than the mupirocin group on the 7th post-operative day; and this was statistically significant (p = .027). There were no significant differences in Lund-Kennedy postoperative scores on days 4 (p = .217), 14 (p = .171) and 28 (p = .151). Conclusion: Carragelose® nasal spray impregnated nasal packs may be comparable with, and may be an alternative to mupirocin ointment impregnated nasal packs in terms of postoperative mucosal healing among ESS patients with CRSwNP.
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Objective To evaluate the pharmacodynamics and safety of the self-made compound ketoconazole ointment. Methods Using the disk diffusion test, 6 kinds of fungi and 2 kinds of bacteria were selected to investigate the effect of the self-made ointment and 3 commercial products on the diameter of the bacteriostatic circle. In addition, the skin irritation and skin allergies of the single and multiple applications were used to evaluate the safety of the self-made ointment. Results The self-made ointment was similar to the commercial products containing ketoconazole. They all showed remarkable bacteriostatic circle against the 6 kinds of fungi. For pseudomonas aeruginosa, none of the preparations contributed to visible bacteriostatic circle. For staphylococcus aureus, the bacteriostatic circle of the self-made ointment was similar to that of commercial mupirocin ointment and was significantly larger than other commercial products. After the treatment with the self-made ointment, the score of the skin irritation was below 0.5 and the sensitization rate was 0. There was no difference in tissue structure between treated and normal skin. Conclusion The self-made compound ketoconazole ointment has better safety and better antibacterial property than the commercial products. It is expected to be used for the treatment of superficial skin fugle infections.
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En América Latina, existen escasos estudios sobre la resistencia a mupirocina y producción de biofilm en Staphylococcus aureus resistente a la meticilina (SARM). En este trabajo, se investigó la resistencia a mupirocina en SARM aislados de pacientes pediátricos con bacteremia y su capacidad para producir biofilm. Se estudió la resistencia a antibióticos por Kirby-Bauer y microdilución en caldo. Se cuantificó el biofilm bacteriano por ensayo de cristal violeta. El 2,3 % (5/217) de los aislados de SARM presentaron un alto nivel de resistencia a mupirocina con una concentración inhibitoria mínima de >512 μ/ml, además de resistencia cruzada con clindamicina, eritromicina, gentamicina y ciprofloxacina. Notablemente, dichos aislados formaron biofilm en un nivel moderado-alto. Este primer reporte en Argentina de aislados clínicos de SARM resistentes a la mupirocina es clave para seguir su evolución en el tiempo a nivel local y en la región de América Latina.
In Latin America, few studies have been done in mupirocin resistance and biofilm formation in methicillin-resistant Staphylococcus aureus (MRSA). This study investigated mupirocin-resistance in MRSA isolates from pediatric patients with bacteremia and their ability to form biofilm. Antibiotic resistance was analyzed with the Kirby-Bauer test and the broth microdilution method. Bacterial biofilm formation was measured using the crystal violet assay. Among MRSA isolates, 2.3 % (5/217) exhibited a high level of mupirocin-resistance with a minimum inhibitory concentration of > 512 μg/mL, in addition to cross-resistance with clindamycin, erythromycin, gentamicin, and ciprofloxacin. Remarkably, biofilm formation in such isolates was moderate to high. This is the first report published in Argentina on clinical isolates of mupirocin-resistant MRSA and it is critical for following its evolution over time at a local level and in the Latin American region.
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Humanos , Pediatria , Staphylococcus aureus , Resistência a Medicamentos , Mupirocina , BiofilmesRESUMO
Objective To observe the effect of Kangfuxin liquid combined with mupirocin on exit -site granulation tissue hyperplasia in peritoneal dialysis patients. Methods From January 2012 to December 2017, 35 peritoneal dialysis patients with exit-site granulation tissue hyperplasia in the People's Hospital of Huadu District were selected and randomly assigned into treatment group (15 cases) and control group(20 cases). The control group was given conventional treatment, the treatment group received a sterile dressing moistened with Kangfuxin liquid. Before and after treatment,the exit-site granulation tissue outcome and the incidence of complications were recorded and compared. Results The recovery time of the control group was (8. 58 ± 1. 36)d,which was longer than (3. 43 ± 0. 85)d of the treatment group (t=3. 57,P<0. 05). Exit-site exudation was found in 3 patients of the control group. No complications were observed in the treatment group. Conclusion Kangfuxin liquid combined with mupiro-cin can shorter the recovery time of exit-site granulation tissue hyperplasia in peritoneal dialysis patients,and reduce the side effect,which is worthy of clinical application.
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Objective To prepare, investigate and optimize the drug stability of compound adapalene ointment.Methods The ointment containing adapalene and mupirocin were prepared with PEG400and PEG3350as matrix.Stress test was usedto evaluate and optimize the stability of drugs in the ointment.The drug stability was further tested by the acceleration test and long-term test.Results The raw adapalene was stable under high temperature, high humidity and strong light irradiation.The raw mupirocin was stable under high humidity and strong light irradiation, but was highly unstable under high temperature condition.Degradation of adapalene and mupirocin was found with pH≤7.At pH 7.5, the best stability was achieved, with over95％of the drugs remaining at day 10.Favorable ointment was prepared with PEG400∶PEG3350=2∶1.The drug stability was promoted by addition of 0.2％triethanolamine significantly.In the acceleration test and long-term test, the percentages of adapalene and mupirocin were above 95％.Conclusion The compound adapalene ointment was successfully prepared and the drug stability was excellent.
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Objective To compare the percutaneous absorption of experimentally prepared mupirocin ointment and commercially sold mupirocin ointment, and to study the dynamics mode of transdermal absorption of mupirocin ointment. Methods Inerstil ODS-SP column (4.6 mm× 150 mm,5 μm) was used with a mixture of 0.1 mol·L-1 sodium dihydrogen phosphate buffer solution (pH value was adjusted to 6.3 by 0.1 mol·L-1 sodium hydroxide solution) and acetonitrile (75:25) as a mobile phase by HPLC.The detection wavelength was set at 230 nm.The flow rate was 1.0 mL·min-1 .Improved Franz type diffusion cells were used for in vitro permeation studies and excised Obama Suckling pig skins in vitro were used as the transdermal barrier.The concentration of the receptor solution was determined by HPLC to investigate its cumulative permeation quantities at different time and the two sets of ointment were compared. Results The average recovery rate of hydrophilic medium was 99.4％,and RSD was 1.2％(n= 9).The average recovery rate of lipophilic medium was 99.0％,and RSD was 1.3％(n= 9).There was no significant difference of the concentration between two ointment within 12 h.The osmotic release of the drug of the sample and the reference preparation, which were in hydrophilic medium, was similar to that of the Zero equation, and roughly Higuchi equation in the lipophilic medium. Conclusion The results showed that the release behavior of mupirocin ointment followed Zero equation in the hydrophilic medium,and Higchi equation in the lipophilic medium.
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Objective:To observe the clinical efficacy and safety of topical ozone therapy for patients with herpes zoster by reflectance confocal microscopy (RCM).Methods:A total of 60 patients with herpes zoster were divided into a control group and an ozone treatment group (n=30).In the control group,patients took oral valacyclovir tablets or granules (0.3 g per day,three times a day) and they were subjected to local weak laser irradiation treatment plustopical 2％ mupirocin ointment twice a day.In the ozone group,the treatment is same as the control group except mupirocin ointment was replaced with topical ozone treatment (hydrotherapy every day plus ozonated oil twice a day).The clinical symptoms,discoid cell and adverse reactions were observed and taken records at day 0,3,7 and 14.Statistical analysis was performed to compare the clinical efficacy between the 2 groups.Results:On the seventh day of treatment,the discoid cells of the ozone group disappeared,and the difference between the control group and the ozone group was statistically significant (P＜0.05).The difference of decreased percentage of pain scores at each time point between the 2 groups was statistically significant (P＜0.05).The clinical efficacy was 100％ in the ozone group and 86.7％ in the control group,with significant difference between the 2 groups (P＜0.05).Conclusion:Topical ozone therapy in patients with herpes zoster is helpful in relieving pain,shortening the course as well as improving the clinical efficacy without obvious adverse reactions.It is worth to be popularized.
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Abstract Staphylococcus aureus is an important cause of bloodstream infections. Therefore, the main purpose of this work was to characterize a collection of 139 S. aureus isolates from bloodstream infections in two public hospitals in relation to their antimicrobial susceptibility profile, staphylococcal cassette chromosome mec types, and clonal relationship. Methicillin resistance and resistance to other 12 agents were accessed by the disk diffusion test. Minimum inhibitory concentration to mupirocin was also determined. The SCCmec types were accessed by multiplex PCR, and the clonal relationship was determined by pulsed field gel electrophoresis method and restriction modification system characterization. Besides, multilocus sequence typing was performed for representative methicillin-resistant S. aureus isolates. The military hospital showed a dissemination of the New York/Japan (USA100/ST5/CC5/SCCmecII) lineage associated to multidrug resistance, including mupirocin resistance, and the teaching hospital presented polyclonal and non-multidrug resistant MRSA isolates. Complete substitution of the Brazilian endemic clone by other lineages was found in both hospitals. These findings can highlight differences in policy control and prevention of infections used in the hospitals and a change in the epidemiological profile of MRSA in Brazilian hospitals, with the replacement of BEC, a previously well-established clone, by other lineages.
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Humanos , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Antibacterianos/farmacologia , Brasil , DNA Bacteriano/genética , Técnicas de Tipagem Bacteriana , Mupirocina/farmacologia , Eletroforese em Gel de Campo Pulsado , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Staphylococcus aureus Resistente à Meticilina/genética , Tipagem de Sequências Multilocus , Genótipo , Hospitais PúblicosRESUMO
Objective:To study the preparation and in vitro release and transdermal absorption of compound film forming gel. Methods:The compound film forming gel was made from new types of film-forming materials. The in vitro release rate was determined by Franz diffusion cells. Results:The in vitro release rate of mupirocin and dyclonine from the compound film forming gel was 81.34% and 88.46%,the transdermal cumulative release amount was(192.73 ± 0.45) μg·cm-2and(103.58 ± 0.66) μg·cm-2,and the skin retention was (419.81 ± 1.48) μg·cm-2and (212.07 ± 1.81) μg·cm-2, respectively. Conclusion: The release of drug is nearly complete. The transdermal absorption test shows that about 30.26% mupirocin and 32.53% dyclonine can pass through skin, and about 65.91% mupirocin and 66.59% dyclonine are stored in skin. The preparation not only plays the role of bacteriostasis,but also promotes wound healing and analgesia.
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Objective To analyze clinical effects of Mupirocin ointment combined with topical glucocorticoid drugs in treating eczema/atopic dermatitis. Methods 100 patients with eczema / atopic dermatitis patients treated in our hospital from March 2015 to August 2016 were selected and randomly divided into the control group and the experimental group, 50 patients in each group. The control group were treated with glucocorticoid therapy, the experimental group were treated with topical corticosteroids combined with Mupirocin ointment drug. Compared the clinical effect between two groups. Results After treatment, 7 cases relapsed in the experimental group and 17 relapsed in the control group.The recurrence rate of the control group(34.0%)was significantly higher than that of the experimental group (14.0%),there was significantly statistical difference(P<0.05). There were no obvious adverse reactions in two groups. In the experimental group, 8 cases were ineffective, and the total effective number was 42 cases. In the control group, 20 cases were ineffective, and the total effective number was 30 cases. The effective rate of the control group (60.0%) was significantly lower than that of the experimental group(84.0%), there was significantly statistical difference (P<0.05). Conclusion Mupirocin ointment combined with topical glucocorticoid drugs was good clinical effect and low adverse reactions.
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Objective To analyze clinical effects of Mupirocin ointment combined with topical glucocorticoid drugs in treating eczema/atopic dermatitis. Methods 100 patients with eczema / atopic dermatitis patients treated in our hospital from March 2015 to August 2016 were selected and randomly divided into the control group and the experimental group, 50 patients in each group. The control group were treated with glucocorticoid therapy, the experimental group were treated with topical corticosteroids combined with Mupirocin ointment drug. Compared the clinical effect between two groups. Results After treatment, 7 cases relapsed in the experimental group and 17 relapsed in the control group.The recurrence rate of the control group(34.0%)was significantly higher than that of the experimental group (14.0%),there was significantly statistical difference(P<0.05). There were no obvious adverse reactions in two groups. In the experimental group, 8 cases were ineffective, and the total effective number was 42 cases. In the control group, 20 cases were ineffective, and the total effective number was 30 cases. The effective rate of the control group (60.0%) was significantly lower than that of the experimental group(84.0%), there was significantly statistical difference (P<0.05). Conclusion Mupirocin ointment combined with topical glucocorticoid drugs was good clinical effect and low adverse reactions.
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Objective To evaluate the methicillin-resistant Staphylococcus aureus (MRSA) colonization in infants at neonatal intensive care unit (NICU) by active surveillance cultures (ASC) and the effects of mupirocin decolonization on MRSA infection. Methods Neonates adimitted to NICU of Ruian People's Hospital of Zhejiang Province, China between October 1, 2013 and September 30, 2014 underwent ASC within 24 hours of admission (ASC group). The samples from nasal vestibule and umbilicus were cultured for MRSA, and positive cultures were considered as MRSA colonization. These with negative cultures underwent repeated culture of MRSA by ASC at the 1st and 2nd week after NICU admission. Neonates admitted to NICU between October 1, 2014 and September 30, 2015 with MRSA colonization based on ASC were decolonized with mupirocin at both nasal vestibule and umbilicus twice daily for five consecutive days (decolonization group). Culture samples were obtained one day and one week after decolonization to repeat ASC. ASC was stopped if the subsequent culture was negative twice successively; and a second mupirocin decolonizaton was performed if the culture was positive. Chi-square test was used to compare the rates of colonization and infection between the two groups. Results (1) MRSA colonization and infection in ASC group: MRSA colonization rates within 24 hours, and in the 1st and 2nd week after NICU admission in ASC group were 2.2% (9/418), 3.7% (15/402) and 3.6% (13/361), respectively. Compared with those without MRSA colonization, neonates with MRSA colonization had a higher incidence of MRSA infection [13.5% (5/37) vs 3.7% (14/381), χ2=7.524, P=0.006]. (2) MRSA colonization and infection in decolonization group: MRSA colonization rates within 24 hours, and at the 1st and 2nd week after NICU admission in decolonization group were 2.8% (12/435), 2.9% (12/414) and 1.3% (5/373), respectively. The MRSA colonization rate at the 2nd week was significantly lower than that in ASC group (χ2=3.919, P=0.048). Twenty-nine cases had MRSA colonization, among which, 27 cases were decolonized once and two cases were decolonized twice, and all were successful. The rate of MRSA infection in decolonization group was 2.1% (9/435), which was significantly lower than in ASC group [4.5% (19/418)] (χ2=4.118, P=0.042). Conclusions Rate of MRSA colonization is high at NICU. Mupirocin can decolonize MRSA carriage and reduce MRSA infection in neonates.
RESUMO
Objective: To investigate the molecular epidemiology and antimicrobial resistance patterns of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers and patients. Methods: MRSA isolates were recovered from nasal swabs collected at a tertiary care hospital of Nepal and confirmed on the basis of Gram staining, conventional biochemical tests, and PCR amplification of mecA gene. PCRs were also used for detection of the different resistance genes and staphylococcal cassette chromosome (SCC) mec types. Antibiotic susceptibility patterns of isolates were assessed by disc diffusion method and minimum inhibitory concentrations were determined by E-test. Results: A total of 29 MRSA were isolated from 536 nasal swabs (5.4%) of health care workers and patients at a tertiary care hospital in Nepal. All isolates were susceptible to amikacin, gentamicin, vancomycin (minimal inhibitory concentrations1024μg/mL). Fourteen isolates were found harboring the mupA gene and one isolate was found carrying the novel mupB gene. High prevalence (68%) of SCCmec I type was found, followed by SCCmec V (13%) and SCCmec III (3%) among all the MRSA isolates. Conclusions: We found the emergence of SCCmec type Ⅰ with high-level mupirocin resistance among MRSA in Nepal. Data also suggest that MRSA SCCmec type V strain has spread from the community to the hospital.