Background: Surgical site infection (SSI) is a common complication among all surgical cases. It is the most common nosocomial infection identified in the developing world with pooled incidence of 11.8 per 100 surgical procedures. In our institution, the SSI rate in major obstetric and gynecologic cases in years 2000–2013 is 12.68%. Objective: To compare the efficacy of a single-dose cefazolin versus a single dose cefazolin plus 7-day mupirocin ointment wound application in preventing SSI among women undergoing major obstetric and gynecologic abdominal surgical procedures. Materials and Methods: The study included are 164 female participants, aged 18–65 years old who underwent major obstetric and gynecologic surgical procedures. Participants were randomly assigned to Groups A and B, wherein all participants were given single dose of 2 g cefazolin, intravenous, 30 min before skin incision. For the participants in Group B, an additional 7-day application of mupirocin ointment on incisional wound during the postoperative period was given. Assessment for occurrence of SSI and healing time using a standardized collection tool and Southampton wound scoring system, respectively, was done on the 8th, 15th, and 30th postoperative days. Results: The incidence of SSI is 2.45% (4 out of 164 participants). It was slightly higher in the Cefazolin only arm having three cases, while only one case in the Cefazolin plus mupirocin group. However, the difference of SSI occurrence between the two groups is not statistically significant. Wound healing time was also evaluated which was comparable between treatment groups. Conclusion Single dose Cefazolin plus 7-day once daily Mupirocin ointment application is comparable to single dose of cefazolin in preventing SSI in patients undergoing major low-risk obstetric and gynecologic surgeries. Therefore, the addition of mupirocin in uncomplicated major obstetric and gynecologic surgical cases is not cost-beneficial.
Cefazolin ; Gynecologic Surgical Procedures ; Mupirocin ; Obstetric Surgical Procedures ; Surgical Wound Infection

PURPOSE: This study aimed to investigate the molecular epidemiology of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak at a newborn nursery and neonatal intensive care unit (NICU).METHODS: During the outbreak, from August to September 2017, MRSA isolates collected from neonates and medical staff underwent genotyping and screened for virulence factors. Antibiotic susceptibilities were tested.RESULTS: During the study period, 41 neonates were admitted at the nursery (n=27) and NICU (n=14). Of these, 7 had MRSA infections (skin infection [n=6] and sepsis [n=1]) and 4 were colonized with MRSA. Associated medical staff (n=32) were screened; three were nasal MRSA carriers. Staphylococcal chromosomal cassette mec (SCCmec) type II, sequence type (ST) 89, spa type t375 was found to be the skin infection outbreak causing strain, with multi-drug resistance including low-level mupirocin resistance. SCCmec type IVa, ST 72, and a novel spa type designated t17879, was the cause of MRSA sepsis. Many different types of MRSA were colonized on the neonates; however, SCCmec type IVa, ST 72, spa type t664 was colonized in both neonates and a NICU nurse. All MRSA isolates from colonized infants were positive for the Panton-Valentine leukocidin (PVL) toxin gene.CONCLUSIONS: The strain causing an outbreak of skin infections had multi-drug resistance. Also, MRSA colonized in the neonates were found to carry the PVL toxin gene. Because different strains are present during an outbreak, molecular epidemiologic studies are important to identify the outbreak strain and colonized strains which aid in effective control and prevention of future MRSA outbreaks.
Colon ; Disease Outbreaks ; Drug Resistance, Multiple ; Epidemiologic Studies ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Leukocidins ; Medical Staff ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Molecular Epidemiology ; Mupirocin ; Nurseries ; Sepsis ; Skin ; Virulence Factors

OBJECTIVES: Staphylococcus aureus is a nosocomial pathogen that provides a major challenge in the healthcare environment, especially in burns units where patients are particularly susceptible to infections. In this study, we sought to determine molecular types of S. aureus isolates collected from burns patients, based on staphylococcal protein A and coagulase gene polymorphisms. METHODS: Antibiotic susceptibility testing of 89 S. aureus strains isolated from burn wounds of patients was assessed using the Kirby-Bauer disk diffusion method. Strains were characterized by spa typing, coa typing, and resistance and toxin gene profiling. RESULTS: A total of 12 different spa types were identified with the majority being t790 (18%). Panton-Valentine leucocidin encoding genes were identified in spa types t044 (5.6%), t852 (2.2%) and t008 (2.2%). The most commonly detected antibiotic resistance gene was ant (4′)-Ia (60.7%). Ten different coa types were detected and the majority of the tested isolates belonged to coa III (47.2%). All the high-level mupirocin-resistant and low-level mupirocin resistant strains belonged to coa type III. CONCLUSION: The present study illustrated that despite the high frequency of coa III and spa t790 types, the genetic background of S. aureus strains in Iranian burns patients was diverse. The findings obtained are valuable in creating awareness of S. aureus infections within burns units.
Ants ; Burns ; Coagulase ; Delivery of Health Care ; Diffusion ; Drug Resistance, Microbial ; Genetic Background ; Humans ; Leukocidins ; Methicillin Resistance ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Methods ; Microbial Sensitivity Tests ; Mupirocin ; Staphylococcal Protein A ; Staphylococcus aureus ; Staphylococcus ; Wounds and Injuries

Background: Superficial pyoderma is an infection most commonly caused by Staphyloccoccus aureus. The drug of choice is 2% mupirocin cream. However, high cost and emerging drug resistance affect compliance and overall cure. Tinospora rumphii has demonstrated antibacterial activity in vivo rendering it a potential cost-effective alternative treatment. Objectives: To determine the safety and efficacy of 25% T. rumphii cream versus 2% mupirocin cream in the treatment of superficial pyodermas caused by S. aureus. Methods: A randomized, double-blind, controlled study of 60 patients with superficial pyodermas caused by S aureus, aged 18-60, were given either 25% T. rumphii or 2% mupirocin cream for two weeks. Bactericidal activity, erythema, edema, induration and size of lesion were evaluated at baseline, days 3, 7, and 14. Participants Global Assessment (PGA) score and adverse events were noted. Statistical analysis was done using Mann-Whitney U and Pearson Chi square test. RESULTS: Fifty-one subjects (85%) completed the trial. There were no statistically significant differences between the two treatment groups for bactericial activity against Staphylococcus aureus (p=0.687) at day 14, for erythema (p=0.923, 0.5335, 0.3726, 0.6949), edema (p=0.0972, 0.5967, 0.2052, 0.2783), induration (p=0.0855, 0.3113, 0.281, 0.3161), and size of lesions (p=0.7262, 0.169, 0.15, 0.3988) at baseline, days 3, 7 and 14. There was no significant difference in PGA score (p=0.3086, 0.3483, 0.2234) at Days 3, 7 and 14 in both groups. No adverse events were noted. Conclusion Twenty five percent T. rumphii cream is equally safe and effective as 2% mupirocin cream for treatment of superficial pyodermas caused by S. aureus.
Mupirocin ; Staphylococcus aureus

PURPOSE: Staphylococcus aureus colonization exacerbates atopic dermatitis. Local or systemic antibiotics can increase difficulty in controlling skin colonization and the possibility of methicillin-resistant S. aureus (MRSA). Choosing appropriate antibiotics has become more challenging. We investigated the frequency of S. aureus and MRSA colonization and susceptibility to antimicrobial agents. METHODS: We collected and cultivated the skin colonization samples of atopic dermatitis children less than 20 years old from June 2006 to May 2016, and tested the antibiotic sensitivity. We also checked the severity of atopic dermatitis by SCORing Atopic Dermatitis (SCORAD) index and analyzed. RESULTS: Out of 2,355 subjects, 1,935 (82.2%) had S. aureus and 762 (39.4%) had MRSA. The frequency of MRSA increased from 13.3% in 2006 to 26.6% in 2007, 18.4% in 2008, 27.1% in 2009, 38.3% in 2010, 42.6% in 2011, 42.4% in 2012, 48.3% in 2013, 44.5% in 2014, 38.1% in 2015, and 37.5% in 2016. Mupirocin resistance started with 0% in 2009, and gradually increased annually to 13.7% in 2010, 14.7% in 2011, 25.4% in 2012, 35.2% in 2013, 34.9% in 2014, 39.8% in 2015, and 35.6% in 2016. The mupirocin resistant group has a higher SCORAD index than the other groups (P<0.05). CONCLUSION: MRSA frequency and mupirocin resistance tended to increase annually. We should choose the methods of managing bacterial colonization in atopic dermatitis carefully in order to prevent antibiotic resistance.
Anti-Bacterial Agents* ; Anti-Infective Agents ; Child* ; Colon* ; Dermatitis, Atopic* ; Drug Resistance ; Drug Resistance, Microbial ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin ; Skin ; Staphylococcus aureus* ; Staphylococcus*

Sea urchins are marine invertebrates commonly found in coastal areas around the world. The potential mechanisms of injury are primary puncture wounds, envenomation, and the foreign body reaction. A 20-year-old woman presented with multiple, 0.2 to 0.3 cm-sized, erythematous papules with central blackish particles accompanied by numbness and pain on the dorsum of the right foot and ankle for 7 days. She had been injured by a sea urchin 7 days prior at the seaside in Guam. A skin biopsy of the lesion showed inflammation with foreign body reaction. The attending physician removed all the blackish particles and applied mupirocin ointment. Although skin lesions improved over time, numbness and pain still remained. There have been only six reported cases of sea urchin granuloma in Korea, but no reports of sea urchin injury with neurologic symptoms. Herein, we report a rare case of sea urchin injury accompanied by paresthesia.
Ankle ; Biopsy ; Female ; Foot ; Foreign-Body Reaction ; Granuloma ; Guam ; Humans ; Hypesthesia ; Inflammation ; Invertebrates ; Korea ; Mupirocin ; Neurologic Manifestations ; Paresthesia* ; Punctures ; Sea Urchins* ; Skin ; Wounds and Injuries ; Young Adult

Skin and soft tissue infections (SSTIs) caused by community-associated (CA)-methicillin-resistant Staphylococcus aureus (MRSA) have become a worldwide concern. An otherwise healthy 16-month-old Korean girl was admitted because of skin abscess on the left chest wall with a history of recurrent SSTIs since the age of 6 months. Immunologic evaluation including serum immunoglobulin level and nitroblue-tetrazolium (NBT) test were normal. Pus and nasal swab cultures revealed CA-MRSA ST714-SCCmec type IV with the Panton-Valentine leukocidin (PVL) genes, which was initially reported in the Netherlands in 2006 and has not been previously reported in Korea. The skin abscesses were successfully treated by needle aspiration and the use of antibiotics. In addition, nasal mupirocin was applied as a decolonization method. No more episodes of SSTI were observed over a follow-up period of 10 months.
Abscess ; Anti-Bacterial Agents ; Child* ; Female ; Follow-Up Studies ; Humans ; Immunoglobulins ; Infant ; Korea* ; Leukocidins ; Mupirocin ; Needles ; Netherlands ; Skin* ; Soft Tissue Infections* ; Staphylococcus aureus ; Suppuration ; Thoracic Wall

PURPOSE: We aimed to assess the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU) by using various decolonization methods and to evaluate their efficacy. METHODS: Medical records of all neonates who were admitted to the NICU of Seoul National University Children's Hospital were retrospectively reviewed. Surveillance culture were obtained for all neonates in the NICU 48 hours after admission. Three periods with different decolonization methods were compared; Period 1 was without any decolonization measures (July 1, 2009 to August 26, 2010). In period 2, intranasal mupirocin and chlorhexidine gluconate bathing were administered to MRSA-colonized neonates (August 27, 2010 to September 6, 2011). In period 3, only chlorhexidine bathing was performed for MRSA-colonized infants (September 7, 2011 to August 31, 2012). RESULTS: A total of 1,378 infants were admitted to the NICU during the study period. Baseline demographic and clinical characteristics were similar among the 3 periods. The incidence of MRSA colonization per 1,000 patient-days was 6.27 for period 1, 7.02 for period 2, and 6.29 for period 3; however, these values were not significantly different. The incidence of MRSA infection was highest in period 3, with 0.69 cases per 1,000 patient-days; however, this finding was not significant. The MRSA infection/colonization ratio also did not differ significantly among the 3 study periods. CONCLUSION: Decolonization of MRSA in the NICU with the application of chlorhexidine gluconate bathing alone or in combination with intranasal mupirocin were not effective in decreasing the incidence of MRSA colonization and infection.
Baths ; Chlorhexidine ; Colon ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care, Neonatal* ; Medical Records ; Methicillin Resistance* ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin ; Retrospective Studies ; Seoul ; Staphylococcus aureus* ; Staphylococcus*

BACKGROUND: Mupirocin, a topical antimicrobial agent has been used for patients with methicillin-resistant Staphylococcus aureus and recently mupirocin resistance was issued in some studies. The objective of this study was to analyze prescription patterns of topical mupirocin, to evaluate appropriateness of prescriptions in the ambulatory setting, and to compare frequency of mupirocin usage in South Korea with that in United States. METHODS: Topical mupirocin prescription patterns (the number of prescription and a prescription period), and appropriateness of prescription (including a prescription rate over 10 days, a repeat prescription rate within 30 days and a prescription rate within labeled indications) were analyzed using the 2012 Health Insurance and Review and Assessment service-National Patient Sample dataset of South Korea. The National Ambulatory Medical Care Survey dataset was used to quantify topical mupirocin prescription in United States for comparison. RESULTS: In South Korea, the prescriptions rate for use over 10 days was 3%, the repeat prescription rate within 30 days was 8.87% and the prescription proportion within labeled indications was 33.84%. The most frequent diagnostic code was nonbacterial infection. The prescription rate per 1000 population of topical mupirocin in South Korea was calculated to be 46.07, whereas in United States was calculated to be 13.10. CONCLUSION: Topical mupirocin has been used frequently and inappropriately, so further studies are required to investigate the rationale behind such prescribing mupirocin patterns.
Ambulatory Care* ; Dataset ; Health Care Surveys ; Humans ; Insurance, Health ; Korea ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin* ; National Health Programs* ; Prescriptions* ; United States

BACKGROUND: Superficial bacterial infection is among the most common reasons for dermatologic consult. Numerous published articles suggest that the dried leaf of malunggay exhibits antibacterial property.
OBJECTIVES: To compare the effectiveness and safety of 15% malunggay ointment with 2% mupirocin ointment in treating localized pyoderma.
METHODS: Sixty-three patients with localized pyoderma (?10% of total body surface area) were enrolled in this randomized, double-blind study to apply either 15% malunggay or 2%  mupirocin ointment twice daily for 14 days. Clinical evaluation using the Global Assessment Score (GAS) for pruritus, pain, erythema, vesiculation, moistness and crusting were conducted at baseline and days 3, 7 and 14 of clinic visit.
RESULTS: Both malunggay and mupirocin groups showed significant decreases in GAS from baseline to days 3, 7 and 14 of treatment (p=0.000, Repeated measures, ANOVA). By days 7 and 14, median GAS of malunggay ointment was higher than mupirocin (1 vs. 0, p<0.05, Mann Whitney U Test). Cure rates were higher in the mupirocin arm comapred to the malunggay arm in Day 3 (53.13% vs. 38.71%), Day 7 (93.75% vs. 70.97%) and Day 14 (96.88% vs. 77.42%). No adverse events were noted after application of malunggay-based ointment at the end of the study period. There were no recurrence two weeks post treatment.
CONCLUSION: Patients in the mupirocin treatment arm had significantly lower global assessment scores and higher cure rates compared to those in the malunggay treatment arm.

Human ; Male ; Female ; Adult ; Child ; Ambulatory Care ; Anti-bacterial Agents ; Bacterial Infections ; Erythema ; Mupirocin ; Ointments ; Pain ; Pruritus ; Pyoderma