Antimicrobial Resistance to Agents Used for Staphylococcus aureus Decolonization: Is There a Reason for Concern?

  • Gregory R. Madden
  • Costi D. Sifri
Antimicrobial Development and Drug Resistance (A Pakyz, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Antimicrobial Development and Drug Resistance


Purpose of Review

Chlorhexidine gluconate (CHG) and mupirocin are increasingly used for Staphylococcus aureus decolonization to prevent healthcare-associated infections; however, increased use of these agents has led to concerns for growing resistance and reduced efficacy. In this review, we describe current understanding of reduced susceptibility to CHG and mupirocin in S. aureus and their potential clinical implications.

Recent Findings

While emergence of S. aureus tolerant or resistant to topical antimicrobial agents used for decolonization is well described, the clinical impact of reduced susceptibility is not clear. Important challenges are that standardized methods of resistance testing and interpretation are not established, and the risk for selection for co- or cross-resistance using universal, as opposed to targeted decolonization, is unclear.


Evidence continues to support S. aureus decolonization in certain patient groups, although further studies are needed to determine the long-term impact of CHG and mupirocin resistance on efficacy. Strategies to mitigate further development of reduced susceptibility and the consequences of selection pressures through universal decolonization on resistance will benefit from further investigation.


Antimicrobial resistance Antiseptic Chlorhexidine Mupirocin Decolonization Staphylococcus aureus 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Division of Infectious Diseases & International Health, Department of MedicineUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Office of Hospital Epidemiology/Infection Prevention & ControlUniversity of Virginia Health SystemCharlottesvilleUSA

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