Eradication of Staphylococcus aureus and MRSA in the Nares: A Historical Perspective of the Ecological Niche, with Suggestions for Future Therapy Considerations

Nasal colonization with pathogenic bacteria continues to present challenges for patients undergoing surgical procedures, and for the physicians that treat them. Even as molecular medicine produces ever faster and improved data sets for clinicians, it would benefit all medical personnel attempting to decolonize the nose to better understand the historical nasal decolonization data with specific reference to the ecological niche for these bacteria, as it has been recorded for more than a century. Much of the historical data points to the largest ecological niche for nasal Staphylococcus aureus as the vibrissae of the vestibulum nasi. A careful study shows that any topical antimicrobial preparation needs to successfully penetrate the deepest recesses of these specialized nasal hair follicles, if decolonization is to be adequately accomplished. This review highlights the most relevant data of the last 140 years concerning the staphylococcal ecological niche of the vibrissae. Also to be discussed will be a historical review of topical Mupirocin. Almost thirty years after its FDA approval, Mupirocin is still the most widely used topical antibiotic for decolonization therapy around the word. Correspondingly, new experimental in vitro data will be presented showing the differing efficacy of Mupirocin against multiple strains of HA-MRSA and CAMRSA, based solely on the commercial topical formulation (non Mupirocin ingredients) that acts synergistically with the Mupirocin. Finally, the review will discuss why an understanding of these historical data is a vital component to integrate into any new or augmented nasal decolonization therapy.