Introduction: Staphylococcus aureus (S. aureus) infections are associated with increased morbidity, mortality and health-care costs. Persistent nasal carriage of S. aureus found in 10-30% of the general population, constitutes a risk factor for these infections. Nasal decolonization is one of the used strategies to prevent this risk in some situations. Areas covered: Mupirocin nasal ointment has been used for the nasal decolonization and prevention of staphylococcal infections in various settings like surgeries. However, rising rates of resistance to mupirocin require the development of new decolonization agents. In this review, we will discuss mupirocin, its origins, studies that proved its efficacy and the associated resistance, as well as other decolonization agents under investigation. Expert opinion: As some limitations exist to mupirocin use, further research for alternatives is encouraged. Some old approved antiseptics (chlorhexidine, povidone-iodine) or antibiotics (rifampicin, bacitracin) have been investigated for their efficacy in this indication. Other new agents (tea tree oil, retapamulin, LTX-109, XF-73, phages, lysostaphin, squalamine analogues, etc.) are being studied. Some of them are still in preclinical phases, and others have reached clinical trials, but further research is needed. Special interest should be given to single dose decolonization strategies and to molecules that do not select resistant strains.
Keywords: nasal decolonization; Decolonization agents; mupirocin; prevention of infection; surgical site infections.
Ontario Health (Quality). Ontario Health (Quality). Ont Health Technol Assess Ser. 2022 Aug 23;22(4):1-165. eCollection 2022. Ont Health Technol Assess Ser. 2022. PMID: 36160757 Free PMC article. Review.
Ong C, Lucet JC, Bourigault C, Birgand G, Aho S, Lepelletier D. Ong C, et al. J Hosp Infect. 2020 Oct;106(2):332-334. doi: 10.1016/j.jhin.2020.08.008. Epub 2020 Aug 15. J Hosp Infect. 2020. PMID: 32805310
Buehlmann M, Frei R, Fenner L, Dangel M, Fluckiger U, Widmer AF. Buehlmann M, et al. Infect Control Hosp Epidemiol. 2008 Jun;29(6):510-6. doi: 10.1086/588201. Infect Control Hosp Epidemiol. 2008. PMID: 18510460
Septimus EJ, Schweizer ML. Septimus EJ, et al. Clin Microbiol Rev. 2016 Apr;29(2):201-22. doi: 10.1128/CMR.00049-15. Clin Microbiol Rev. 2016. PMID: 26817630 Free PMC article. Review.
Wertheim HF, Verveer J, Boelens HA, van Belkum A, Verbrugh HA, Vos MC. Wertheim HF, et al. Antimicrob Agents Chemother. 2005 Apr;49(4):1465-7. doi: 10.1128/AAC.49.4.1465-1467.2005. Antimicrob Agents Chemother. 2005. PMID: 15793127 Free PMC article. Clinical Trial.
Nazli A, Tao W, You H, He X, He Y. Nazli A, et al. Curr Med Chem. 2024;31(28):4425-4460. doi: 10.2174/0109298673249381231130111352. Curr Med Chem. 2024. PMID: 38310393 Review.
Ghaffary S, Javidnia A, Beheshtirouy S, Sadeghi J, Akbari AM, Hamishehkar H, Sarbakhsh P, Sanaat Z, Nikanfar A, Esfahani A, Chavoshi SH, Nejati B, Raeisi M, Gholami N. Ghaffary S, et al. Support Care Cancer. 2023 Dec 19;32(1):42. doi: 10.1007/s00520-023-08232-1. Support Care Cancer. 2023. PMID: 38110726 Clinical Trial.
Campos J, Pires MF, Sousa M, Campos C, da Costa CFFA, Sampaio-Maia B. Campos J, et al. Pathogens. 2023 May 26;12(6):765. doi: 10.3390/pathogens12060765. Pathogens. 2023. PMID: 37375455 Free PMC article.
Taki E, Jabalameli F, Tehrani MRM, Feizabadi MM, Halimi S, Sanjari M, Amini MR, Beigverdi R, Emaneini M. Taki E, et al. Curr Microbiol. 2023 Mar 24;80(5):147. doi: 10.1007/s00284-023-03262-8. Curr Microbiol. 2023. PMID: 36961628
Luo C, Chen M, Luo K, Yin X, Onchari MM, Wang X, Zhang J, Zhong H, Tian B. Luo C, et al. Curr Microbiol. 2023 Mar 13;80(5):135. doi: 10.1007/s00284-023-03196-1. Curr Microbiol. 2023. PMID: 36913050