Prevalence Of Mupirocin Resistance Research Articles

Prevalence of mupirocin resistance in methicillin resistant staphylococcus aureus (MRSA) at tertiary care teaching hospital, Tamil Nadu

Prevalence of mupirocin resistance in methicillin resistant staphylococcus aureus (MRSA) at tertiary care teaching hospital, Tamil Nadu

Prevalence of Mupirocin Resistance in Staphylococci Isolated from Skin and Soft Tissue Infections

Prevalence of Mupirocin Resistance in Staphylococci Isolated from Skin and Soft Tissue Infections

2303. Differential Effects on MRSA and MSSA Epidemiology in a Neonatal Intensive Care Unit (NICU) During a Year-Long Surveillance and Decolonization Effort

Background Staphylococcus aureus (SA) causes morbidity and mortality in the NICU. While surveillance, with decolonization, is recommended for MRSA outbreak control, the impact of such strategies on endemic MSSA infections is less known. We compare the impact of a year-long surveillance and decolonization effort on MRSA and MSSA colonization dynamics and invasive infection rates in the NICU.MethodsAll infants hospitalized in our academically affiliated, regional perinatal NICU (1032 annual admissions) between January and December 2017 were screened twice monthly for SA colonization by culturing the anterior nares and three skin sites. Eligible patients with positive SA cultures underwent decolonization with mupirocin and/or chlorhexidine bathing. The following parameters for MRSA and MSSA were compared using frequencies and Fisher’s exact tests: 1) Colonization density (proportion of positive surveillance cultures; 2) rates of effective decolonization (proportion of successful decolonization efforts); 3) rates of invasive infections; and 4) mupirocin resistance.ResultsOverall, 25 twice monthly surveillance efforts were undertaken from which 1351/1375 (98%) screening cultures were obtained. Screening identified newly detected MSSA vs. MRSA in 145 vs. 20 infants, respectively. Colonization density decreased more for MRSA (Q1 vs. Q4 decrease of 67%) vs, MSSA (Q1 vs. Q4 decrease of 5%). Decolonization was more effective for MRSA (78%) vs. MSSA (71%). Compared with 2016, rates of invasive infections decreased more for MRSA (2.4 vs. 1.6 /10,000 patient-days, 33%) than MSSA (9.4 vs. 7.8 /10,000 patient-days, 17%). Prevalence of mupirocin resistance through study period was higher for MSSA (24% vs. 10%). No outbreaks were detected.ConclusionA year- long surveillance and decolonization effort was more successful in decreasing MRSA colonization density and invasive infections compared with MSSA. These results are likely due to continual importation of MSSA into the NICU from the community. Since MSSA caused more invasive infections than MRSA, strategies primarily aimed to decrease the burden of MRSA need to be modified to decrease the burden of MSSA in NICUs.Disclosures All authors: No reported disclosures.

Prevalence of Mupirocin Resistance in Patients Colonized with Staphylococcus Aureusin A Tertiary Care Rural Hospital

Introduction: Nasal carriage of Staphylococcus aureus plays a key role in the epidemiology and pathogenesis of infection and is a major risk factor for the development of both community-acquired and nosocomial infections. A causal relationship between S. aureus nasal carriage and infection is supported by the fact that the nasal strain and the infecting strain share the same genotype. Nasal mupirocin, a nasal formulation is approved by the United States Food and Drug Administration for eradicating nasal carriage in patients as well as in health care personnel. The increasing prevalence of mupirocin resistance among Staphylococcus aureus & coagulase-negative Staphylococcus (CoNS) species could be an important threat to the future use of mupirocin against MRSA. Thus this study was carried out with the aimsto know the prevalence of mupirocin resistance in Patients colonized with Staphylococcus spp. Methodology: A total of 229 hospitalised patients were randomly selected. S. aureus &CoNS isolates were tested for mupirocin resistance by the disk diffusion method using 5µg and 200µg mupirocin discs. Results: Out of 229 hospitalised patients, MRSA was isolated in 21(9.17%) and MRCoNS in 27(11.79 %). 5(2.18%) isolates were Mupirocin resistance. Low-Level Mupirocin resistance (MuL) was seen in 1(0.44%) of MRSA and High-Level mupirocin resistance (MuH) was noted in 4(1.74%) isolates of MRCoNS Conclusion: The presence of mupirocin resistance in 1(0.44%) of MRSA and 4(1.74%) of MRCoNS is a cause of concern. Hence it is recommended that routine testing of MRSA for mupirocin resistance be conducted. Keyword- Nasal carriage, MRSA, MRCoNS, Mupirocin resistance.

Low prevalence of mupirocin resistance in MRSA isolates from a tertiary care center in north India

Low prevalence of mupirocin resistance in MRSA isolates from a tertiary care center in north India

High prevalence of mupirocin resistance associated with resistance to other antimicrobial agents inStaphylococcus aureusisolated from patients in private health care, Western Cape

AbstractStaphylococcus aureus is an opportunistic pathogen which results in high morbidity and mortality. Decolonisation of the carriers by the intranasal administration of mupirocin is frequently prescribed in infection control practice. The aim of this study was to establish the prevalence of mupirocin resistance in our setting and to investigate the association between mupirocin resistance and resistance to other antimicrobial agents. We simultaneously evaluated laboratory procedures for the sensitivity testing of mupirocin. Standardised disc sensitivity testing for high-level resistance to mupirocin was performed on a prospective sample of 997 unique clinical isolates of S. aureus. The results were confrmed with molecular testing. We also evaluated the reliability of automated sensitivity testing by Vitek® 2. Statistical methods were used to estimate associations between high-level resistance to mupirocin and resistance to other antimicrobial agents. High-level mupirocin resistance prevalence was 23.3...

Prevalence of mupirocin resistance among invasive coagulase-negative staphylococci and methicillin-resistant Staphylococcus aureus (MRSA) in France: emergence of a mupirocin-resistant MRSA clone harbouring mupA

Mupirocin is the cornerstone of decolonization regimens, a successful strategy to prevent healthcare-associated staphylococcal infections. Several recent studies have reported alarming results: (i) an extending reservoir of mupA, the ancestral mobile resistance gene, among coagulase-negative staphylococci (CoNS); (ii) the emergence of a new resistance gene (mupB); and (iii) a growing number of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MRSA), including highly pathogenic clones. We performed a nationwide prospective study in France to detect such trends among invasive staphylococci. Between October 2011 and February 2012, 367 MRSA and 708 CoNS invasive isolates were collected from 37 hospitals and analysed centrally. Mupirocin MICs were determined using the broth microdilution method. mupA/B PCR was performed for resistant isolates (MIC >1 mg/L). Genetic relatedness between mupirocin-resistant MRSA isolates was determined by PFGE analysis and related isolates were tested by microarray. Among MRSA isolates 2.2% (n = 8) were classified as mupirocin resistant; 1.4% (n = 5) showing low-level resistance (MIC ≤256 mg/L) and 0.8% (n = 3) high-level resistance (MIC >256 mg/L). Only the latter isolates carried mupA. A clonal relationship was identified between two mupA-negative MRSA from the same hospital and three mupA-positive MRSA from three distant towns; these three isolates belonged to the Lyon clone. Mupirocin resistance was identified in 10.3% of CoNS, mainly highly resistant mupA-positive isolates (5.6%). The mupB gene was not detected in mupirocin-resistant MRSA or CoNS. This first large national study indicates the need for thorough epidemiological monitoring and a stewardship programme to prevent and detect mupirocin resistance in staphylococci.

Prevalence and Clinical Characteristics of Mupirocin-Resistant Staphylococcus aureus

Background: Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a known risk factor for nosocomialtransmission and infection. In an effort to mitigate this problem, topical mupirocin has been widely used for clearing nasal carriage of MRSA. However, mupirocin resistance has become a worldwide concern due to increased use of the antibiotic. The aims of this study were to evaluate the clinical characteristics and prevalence of mupirocin resistance among clinical isolates of staphylococci and to investigate antimicrobial susceptibility. Methods: A total of 175 S. aureus specimens recovered over a 4-month period from various body sites were tested for resistance to mupirocin and other antibiotics using the Vitek2 automated system. The presence of the mupA gene was assessed in isolates exhibiting resistance to mupirocin and in other selected organisms. The clinical characteristics of the isolates were also reviewed. Results: Of the 175 S. aureus isolates, 9.1% (16/175) were resistant to mupirocin, with 1.7% (3/175) having high-level resistance (HR) and 7.4% (13/175) having low-level resistance (LR). Patients with HR-mupirocinresistant S. aureus had a longer duration of hospitalization (P=0.026). Of the 13 LR-mupirocin-resistant S. aureus strains, 11 had identical antibiogram patterns. The mupA gene was detected only among HR isolates. Conclusion: The rate of mupirocin resistance in the S. aureus isolates was high. The spread of mupirocinresistant S. aureus may be due to nosocomial infection. (Korean J Clin Microbiol 2011;14:18-23)

Phenotypic and molecular characterization of Staphylococcus aureus isolates expressing low- and high-level mupirocin resistance in Nigeria and South Africa.

BackgroundMupirocin is a topical antimicrobial agent which is used for the treatment of skin and postoperative wound infections, and the prevention of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, the prevalence of mupirocin resistance in S. aureus, particularly in MRSA, has increased with the extensive and widespread use of this agent in hospital settings. This study characterized low- and high-level mupirocin-resistant S. aureus isolates obtained from Nigeria and South Africa.MethodsA total of 17 mupirocin-resistant S. aureus isolates obtained from two previous studies in Nigeria and South Africa, were characterized by antibiogram, PCR-RFLP of the coagulase gene and PFGE. High-level mupirocin resistant isolates were confirmed by PCR detection of the mupA gene. The genetic location of the resistance determinants was established by curing and transfer experiments.ResultsAll the low-level mupirocin resistant isolates were MRSA and resistant to gentamicin, tetracycline and trimethoprim. PFGE identified a major clone in two health care institutions located in Durban and a health care facility in Pietermaritzburg, Greytown and Empangeni. Curing and transfer experiments indicated that high-level mupirocin resistance was located on a 41.1 kb plasmid in the South African strain (A15). Furthermore, the transfer of high-level mupirocin resistance was demonstrated by the conjugative transfer of the 41.1 kb plasmid alone or with the co-transfer of a plasmid encoding resistance to cadmium. The size of the mupirocin-resistance encoding plasmid in the Nigerian strain (35 IBA) was approximately 35 kb.ConclusionThe emergence of mupirocin-resistant S. aureus isolates in Nigeria and South Africa should be of great concern to medical personnel in these countries. It is recommended that methicillin-susceptible S. aureus (MSSA) and MRSA should be routinely tested for mupirocin resistance even in facilities where the agent is not administered. Urgent measures, including judicious use of mupirocin, need to be taken to prevent clonal dissemination of the mupirocin/methicillin resistant S. aureus in KZN, South Africa and the transfer of the conjugative plasmid encoding high-level mupirocin resistance identified in this study.

New approaches to prevention of staphylococcal infection in surgery

The present review describes the literature about the prevention of Staphylococcus aureus infections in surgery, published from August 2006 to January 2008, and puts it into perspective. To prevent Staphylococcus aureus infections after surgical procedures, three methods were described, that is, isolation precautions after methicillin-resistant Staphylococcus aureus screening, vancomycin as an antibiotic prophylaxis in patients at risk for methicillin-resistant Staphylococcus aureus, and topical decolonization of carriage. Identified methicillin-resistant Staphylococcus aureus carriers can be treated with the appropriate antibiotic prophylaxis to prevent infection with methicillin-resistant Staphylococcus aureus. Topical decolonization with chlorhexidine gluconate resulted in a reduced overall nosocomial infection rate, but no effect was found on the Staphylococcus aureus infection rate. Topical decolonization with mupirocin reduced the overall Staphylococcus aureus infection rate after surgery in Staphylococcus aureus nasal carriers. The treatment of proven carriers of Staphylococcus aureus with mupirocin is an effective method to prevent Staphylococcus aureus nosocomial infections after surgery. Cost-analysis studies show that this screen-and-treat approach is cost saving as long as the prevalence of mupirocin resistance in Staphylococcus aureus is low. The effect of chlorhexidine gluconate on the Staphylococcus aureus infection rate in carriers should be determined in future studies.