Clonal dissemination of mupirocin-resistant staphylococci in Greek hospitals

Petinaki, Efthimia; Spiliopoulou, Iris; Kontos, Fanourios; Maniati, Matina; Bersos, Z; Stakias, N; Malamou-Lada, H.; Koutsia-Carouzou, C.; Maniatis, Antonios N.

doi:10.1093/jac/dkh028

Cited by 38 publications

(27 citation statements)

References 9 publications

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“…In the present study, of 29 isolates (30.5%) that presented mupirocin resistance phenotype, of which 41.4% harbored the mupA gene as confirmed as high-level mupirocin resistant MRSA that is lower than the previous rate reported by Abbasi-Montazeri et al (31) from the south-west of Iran (34%) and is higher than India (5%) (32), and Greece (1.6%) (8). In this survey, the resistance of the isolates was confirmed by the amplification of mupA.…”

Section: Discussionsupporting

confidence: 63%

“…In a study conducted by Shahsavan et al (33), it was shown that 25% of mupirucin resistant MRSA isolates carried the mupA gene. Unrestricted policies that allow the improper and widespread use of mupirocin for long periods in hospitals and health care settings and the origin of the isolates and clinical samples are the most important causes of variation in the incidence rate of resistance to mupirocin in MRSA isolates (8,32,33).…”

Section: Discussionmentioning

confidence: 99%

“…Mupirocin is an analogue of isoleucine that binds to isoleucyl-tRNA synthetase and blocks protein synthesis. Mupirocin resistance is classified in two categories: a) high-level mupirocin resistance that is encoded by plasmid-borne mupA genes, b) low level mupirocin resistance (mupL) that is encoded by the genes located on the bacterial chromosome (8). Nowadays, in spite of the introduction of newer antibiotics, due to the emergence and spread of various types of antibacterial resistance genes, the treatment of infections caused by MRSA strains has become problematic (3).…”

Section: Introductionmentioning

confidence: 99%

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Molecular Characterization and Resistance Profile of Methicillin Resistant Staphylococcus aureus Strains Isolated from Hospitalized Patients in Intensive Care Unit, Tehran-Iran

Nezhad

Meybodi

Rezaee

et al. 2017

Jundishapur J Microbiol

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Background: Staphylococcus aureus is an important opportunistic pathogen and can cause a wide range of infections. The ability of this pathogen to successfully persist within the hospital and the community is largely due to its remarkable ability to acquire resistance against various antimicrobial agents. Objectives: The aim of this study was to determine the carriage of antibacterial resistance genes and virulence markers of S. aureus isolates from hospitalized patients in intensive care units in Tehran, the capital of Iran. Methods: In this cross-sectional study that was conducted during an 11-month period since March 2015 to January 2016, a total of 105 S. aureus strains were investigated. MRSA screening was performed by phenotypic and genotypic methods. The Kirby-Bauer disk diffusion method was used to assess the sensitivity of S. aureus strains. The strains were typed based on the polymorphisms in SCCmec types. The presence of resistance (ermA, ermB, ermC, mupA, msrA, msrB, tetM, ant (4´)-Ia, aac (6´)-Ie/aph (2˝), aph (3´)-IIIa) and toxin (etb, eta, pvl, tst) encoding genes were investigated by the polymerase chain reaction (PCR) technique. Results: In this study, 105 isolates of S. aureus were obtained from 299 various clinical specimens. Ninety five (90.5%) strains were confirmed as methicillin-resistant S. aureus. The lowest levels of resistance were related to quinupristin-dalfopristin (16.8%) while the highest levels of resistance were related to penicillin (94.7%). Multi-drug resistance was observed in 91.5% of the isolates. Type IV was the most prevalent SCCmec type (57.9%), followed by type III (22.1), type V (12.6%), I (5.3%), and II (2.1%). Overall, 25 isolates (26.3%) harbored PVL-encoding genes, and all of them belonged to SCCmec type IV. The presence of resistance genes ant(4´) ermA, ermB, ermC, msrA, msrB, and tetM was detected in 94.7%, 81.1%, 31.6%, 31.6%, 15.9%, 18.9%, 47.3%, 21.1%, 56.8%. The frequency of the etb, eta, and tst genes were 1.1%, 4.2%, and 32.6%, respectively. Conclusions:The results illustrated the diversity of antibacterial resistance and virulence gene profiles among different SCCmec types of S. aureus. The increased prevalence of methicillin-resistant S. aureus isolates containing different toxin and antibiotic resistance genes is a serious threat for the hospitalized patients in the intensive care units.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Molecular Characterization and Resistance Profile of Methicillin Resistant Staphylococcus aureus Strains Isolated from Hospitalized Patients in Intensive Care Unit, Tehran-Iran

Nezhad

Meybodi

Rezaee

et al. 2017

Jundishapur J Microbiol

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“…Conversely, many other studies from India (25), Greek (26), and Jordan (27) reported low resistance rates of mupirocin among MRSA isolates examined. The high mupirocin resistance rate in burn patients, as demonstrated in the current study, supports the concern that using mupirocin in clinical practice should be revised.…”

Section: Discussionmentioning

confidence: 73%

Distribution of SCCmec Types in Methicillin-Resistant Staphylococcus aureus Isolated from Burn Patients

Afshari

Sepahi

Goudarzi

et al. 2017

Arch Clin Infect Dis

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Background: Methicillin resistance Staphylococcus aureus (MRSA) isolates have been recognized as one of the most important causes of infection in burn patients that have recently shown a frequent and rapid development of antibiotic resistance. Objectives: The present study described the distribution of different SCCmec types and antibiotic resistance pattern among MRSA strains isolated from burn patients in a referral burn center in Tehran, Iran. Methods: During a 12-month study, 189 MRSA isolates were obtained from burn patients. Standard culture and biochemical tests were used for identification of MRSA isolates. The antibiotic susceptibility testing was performed using disc diffusion method and the presence of mecA, nucA, pvl, and tst encoding genes was determined using PCR method. In addition, the different SCCmec types were determined using multiplex PCR. Results: All the MRSA isolates were observed to be resistant to amoxicillin and penicillin and sensitive to linezolid, teicoplanin, and vancomycin. The rates of resistance to other antibiotics varied from 86.2% for amikacin to 17.5% for quinupristin-dalfopristin. MDR was observed in all the isolates. Six different antimicrobial resistance patterns were observed among our isolates. Based on the multiplex PCR assay, the two different SCCmec types were detected as 71.4% type III and 28.6% type IV. In total, 8.5% of isolates harbored pvl toxin encoding gene all of which belonging to SCCmec type IV. Furthermore, 33 isolates (17.5%) harbored tst encoding gene. Conclusions:The results showed low diversity of SCCmec type among circulating MRSA in the burn center with relatively high prevalence of SCCmec III. These findings support the need for more studies to elucidate distribution of different SCCmec types among MRSA isolated from burn patients.

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“…Low prevalence of HLMUPR MRSA strains was previously reported in Korea (1.8%) (35). Unrestricted policies that allow improper and widespread utilization of mupirocin for long periods in hospitals and health care settings and the origin of the isolates and clinical samples are the most important causes of variation in the incidence rate of resistance to mupirocin in MRSA isolates (30)(31)(32). In all, the high resistance rate of mupirocin presented in the current study emphasized that using mupirocin in clinical practice should be modified.…”

Section: Discussionmentioning

confidence: 92%

Distribution of Genes Encoding Toxin, Adhesion, and Antibacterial Resistance Among Various SCCmec Types of Methicillin-Resistant Staphylococcus aureus Isolated From Intensive Care Unit, Tehran, Iran

Abiri

Sepahi

Goudarzi

et al. 2017

Jundishapur J Microbiol

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Background: Most methicillin-resistant Staphylococcus aureus (MRSA) infections occur in health care settings; therefore, it is important to know about antimicrobial susceptibility, and carriage of virulence genes in S. aureus isolates. Objectives: The current study aimed at determining the prevalence of genes coding antimicrobial resistance, toxins, and adhesion factors among various SCCmec types of MRSA isolated from intensive care units (ICUs). Methods: From April 2016 to March 2017, a total of 200 MRSA species were isolated from various clinical samples of patients hospitalized in ICUs. The Kirby-Bauer disk diffusion method was employed to determine resistance pattern. Conventional polymerase chain reaction (PCR) assay was utilized to demonstrate antimicrobial resistance, toxins, and adhesion genes. Different SCCmec types of MRSA strains were determine by the multiplex PCR assay. Results: Antibiotic susceptibility testing revealed that all the isolates were sensitive to linezolid, teicoplanin, and vancomycin. The frequency of high-level mupirocin-resistant MRSA was 5.5%. The presence of resistance genes ant(4')-Ia, aac(6')-Ie/aph(2"), tetM, msrA, ph(3')-IIIa, ermA, msrB, ermB, ermC, and mupA were detected 73.5%, 60.5%, 57.5%, 37%, 36.5%, 34.5%, 24%, 17%, 15% and 5.5%, respectively. The most prevalent adhesion genes were clfA (93.5%) followed by clfB (90%), fnbA (81.5%), fnbB (77%), can (51%), ebp (46.5%), and bbp (2.5%). The frequency of etb, eta, pvl, and tst genes were 4.5%, 9.5%, 21.5%, and 61.5%, respectively. Inducible macrolide-lincosamidestreptogramin B (inducible MLSB resistance; iMLSB), and constitutive MLSB (cMLSB) phenotypes were observed in 88 (44%) and 26 (13%) isolates. Different SCCmec types comprising type III (56.5%), type IV (25%), type II (11%) and type I (7.5%) were identified among the MRSA strains. Conclusions: Results of the current study showed a high prevalence of resistance to commonly used antibiotics that can be a serious threat to patients hospitalized in ICUs. Also, the current study findings showed that different SCCmec types causing nosocomial infections were associated with specific antimicrobial resistance, adhesion, and toxin gene profiles.

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Clonal dissemination of mupirocin-resistant staphylococci in Greek hospitals

Abstract: In Greece, the rate of mupirocin-resistant S. aureus has remained low and steady since 1999. The high rate of mupirocin-resistant CoNS (33%) in 2002 was due mainly to clonal dissemination of epidemic hospital clones.

Cited by 38 publications

References 9 publications

Molecular Characterization and Resistance Profile of Methicillin Resistant Staphylococcus aureus Strains Isolated from Hospitalized Patients in Intensive Care Unit, Tehran-Iran

Molecular Characterization and Resistance Profile of Methicillin Resistant Staphylococcus aureus Strains Isolated from Hospitalized Patients in Intensive Care Unit, Tehran-Iran

Distribution of SCCmec Types in Methicillin-Resistant Staphylococcus aureus Isolated from Burn Patients

Distribution of Genes Encoding Toxin, Adhesion, and Antibacterial Resistance Among Various SCCmec Types of Methicillin-Resistant Staphylococcus aureus Isolated From Intensive Care Unit, Tehran, Iran

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