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Bactroban

Mupirocin (pseudomonic acid A, or Bactroban) is an antibiotic originally isolated from Pseudomonas fluorescens. It is used topically, and is primarily effective against Gram-positive bacteria. more...

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It has a unique mechanism of action, which is selective binding to bacterial isoleucyl-tRNA synthetase, which halts the incorporation of isoleucine into bacterial proteins. Because this mechanism of action is not shared with any other antibiotic, mupirocin has few problems of antibiotic cross-resistance. It is a topical treatment for bacterial skin infections, for example, furuncle, open wounds etc. It is also useful in the treatment of methicillin-resistant Staphyolococcus aureus (MRSA), which is a significant cause of death in hospitalized patients who have received systemic antibiotic therapy. It is suggested, however, that mupirocin not be used for extended periods of time, or indiscriminately, as resistance does develop, and could, if it becomes widespread, destroy mupirocin's value as a treatment for MRSA. It may also result in overgrowth of non-susceptible organisms.

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Microbe of the month: Staphylococcus aureus
From Nursing, 9/1/01 by Sheff, Barbara

Type of microbe: bacteria (Gram-positive cocci in bean-shaped pairs)

Infections commonly caused: cellulitis, impetigo, postoperative wound infections, bacteremia, osteomyelitis, pneumonia, pericarditis, cervicitis, meningitis, acute endocarditis, and abscesses.

Signs and symptoms of bacteremia: The disease usually begins with chills and sometimes rigors and pleuritic chest pain. The patient is acutely ill, febrile, and listless and may complain of joint pain. Physical exam may reveal petechiae or necrotic, necropuralent, hemorrhagic lesions on the extremities; subconjunctival hemorrhages; and tachycardia.

Lab tests: As ordered, draw blood specimens for culture at timed intervals. Send swabs of skin lesions, purulent exudates, and urine for culture and sensitivity testing before administering antibiotics. If a patient's I.V. line or other catheter is suspected of causing infection, remove and culture it. Culture the patient's nostrils to see if he's colonized with methicillin-resistant Staphylococcus aureus (MRSA).

Nursing interventions: Check for allergies to penicillin. Treat uncomplicated bacteremia with a beta-lactam antibiotic (such as nafcillin, oxacillin, or a cephalosporin). If the patient is colonized with MRSA or has a documented, serious allergic reaction to beta-lactam agents, vancomycin is the drug of choice.

Prevention: Because 30% to 50% of adults are colonized with staphylococcal bacteria, infection can occur whenever normal skin or mucosal barriers are breached. Hand washing is the first defense against transmission. Nasal application of mupirocin (Bactroban) may help prevent infection in high-risk colonized patients. Practice sterile technique for all catheter care. Antimicrobial and antiseptic agents bonded to I.V. devices and a new modified catheter hub may help prevent infection.

This department offers key clinical points about a particular microbe. Because of space constraints, it's not comprehensive.

BY BARBARA SHEFF, RN, CPH, HNC, MT(ASCP), MA Microbiology Consultant * Boston, Mass.

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