Daniel Diekema, MD
Potential Financial Conflicts of Interest: None disclosed.
Diekema D. Benefits and Drawbacks of Universal Surveillance of Methicillin-Resistant Staphylococcus aureus. Ann Intern Med. 2008;149:67. doi: 10.7326/0003-4819-149-1-200807010-00024
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Published: Ann Intern Med. 2008;149(1):67.
TO THE EDITOR:
I read with interest the ambitious and informative study by Robicsek and colleagues (1). The authors have clearly articulated the positive effect of their methicillin-resistant Staphylococcus aureus (MRSA) control strategy, but they ignore the potential unintended consequences of this approach.
First, the title of the study is misleading because this intervention involved much more than universal MRSA surveillance. A key component of their second intervention period was decolonization with mupirocin and chlorhexidine. Among several reasons that routine decolonization of asymptomatic MRSA carriers is not recommended, the emergence of mupirocin resistance is among the most important. A recent Annals article describes the emergence of a community-associated MRSA strain bearing the plasmid pUSA03, which carries a gene conferring high-level resistance to mupirocin (2). Widespread use of mupirocin will likely facilitate the rapid spread of this resistance determinant. Did the authors monitor the MRSA strains for mupirocin resistance during the course of this study?
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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