1232. Mupirocin Susceptibility of <i>Staphylococcus aureus</i> (SA), 2022: Is It Time for Change in MRSA Decolonization?

Abstract Background Nasal decolonization with mupirocin has been a commonly used strategy for the prevention of surgical site infections (SSIs) due to SA. We recently noted an increase in SSIs SA despite use mupirocin, including case post-operative mupirocin-resistant MRSA infection intranasal mupirocin. therefore evaluated susceptibility at Stamford Hospital determine optimal regimen decolonization. Methods isolates were recovered from clinical and screening samples received microbiology laboratory 8/1/2020 2/28/2022. Mupirocin was determined using e-tests standardized inoculum on Mueller-Hinton agar. Isolates categorized as “susceptible” (MuS) minimum inhibitory concentrations (MIC) ≤4 mcg/ml or resistant (MuR) MIC values ≥8mcg/ml. Resistant strains further divided into low-level resistance, 8 256 mcg/ml, high-level &amp;gt;256/ml. identified tested by usual Clinical Laboratory Standards Institute (CLSI) criteria. Results 223 unique 218 patients tested. Patients ranged age newborn 94 years. Twenty-four (10.8%) (20 4 MSSA). Of 24 MuR strains, 19 (79.2%) demonstrated resistance. more likely be (22.5% MuR) than MSSA (3.0% (p&amp;lt; 0.001). did not differ MuS respect patient age, sex, race, isolation, infected versus colonized, community-acquired hospital-acquired inpatient/out-patient location. Conclusion Preventing is challenging. Decolonization nasal ointment common component preoperative optimization. However, emergence resistance would render suboptimal other regimens might preferred. In our study, less 80% MuS. These findings are concerning have led us reevaluate current strategy. colonized high risk (e.g. total joint replacement), povidone iodine may preferable Disclosures All Authors: No reported disclosures.