Impact of Combined Low-Level Mupirocin and Genotypic Chlorhexidine Resistance on Persistent Methicillin-Resistant Staphylococcus aureus Carriage After Decolonization Therapy: A Case-control Study

Lee, Andie S.; Macedo-Viñas, Marina; François, Patrice; Renzi, Gesuèle; Schrenzel, Jacques; Vernaz, Nathalie; Pittet, Didier; Harbarth, Stéphan Juergen

doi:10.1093/cid/cir233

Cited by 170 publications

(104 citation statements)

References 38 publications

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“…The higher frequency of low-level mupirocin resistance in MRSA strains compared to MSSA strains has been noted in previous clinical studies (12,19). However, previous studies of low-level mupirocin resistance have not stratified the strains by acquisition location or identified newly positive patients (13,14). Our data provide some insight into the epidemiology of these strains, as none of the isolates were USA300 and none of the patients were inpatients known to have received mupirocin ointment in the previous year.…”

Section: Discussionmentioning

confidence: 80%

Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolates from Patients Newly Identified as Nasal Carriers

Weir¹,

Fram²,

Berg³

et al. 2012

J Clin Microbiol

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We aimed to determine whether additional molecular and microbiological evaluations of methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients newly identified as nasal carriers were useful for control strategies and whether longitudinal testing during the same or repeat hospitalization changed MRSA status. Nasal swabs from patients positive by Xpert MRSA PCR and not known to be colonized in the previous year were cultured for S. aureus. Isolates were tested for resistance to a variety of antibiotics, including high-level mupirocin resistance (HLMR) and low-level mupirocin resistance (LLMR) and the presence of genes mecA and mupA and those for Panton-Valentine leukocidin (PVL), USA300, and USA400. Repeat nasal screens during the 6-month study were tested for continued presence of MRSA. Among 130 patients, cultures revealed MRSA in 85 (65.4%), methicillin-susceptible S. aureus in 19 (14.6%), and no growth in 26 (20%). MRSA isolates were USA300 positive in 13/85 (15.3%) and LLMR in 8/85 (9.4%) patients. No isolates were HLMR or mupA positive. mecA dropout was detected in 9/130 (6.9%) patients. The rate of subsequent MRSA infections in USA300-positive versus -negative patients was not different. MRSA nasal status remained concordant in 69/70 (98.6%) patients who had follow-up testing. The findings do not support expanding MRSA surveillance to include routine detection of genes for USA300, PVL, or mupA, all of which were either of low frequency or not significantly associated with MRSA infection risk in our population of newly identified nasal carriers. Repeat nasal screening for MRSA during the same or subsequent hospitalizations over 6 months could also be deferred, reducing costs associated with screening.

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Section: Discussionmentioning

confidence: 80%

Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolates from Patients Newly Identified as Nasal Carriers

Weir¹,

Fram²,

Berg³

et al. 2012

J Clin Microbiol

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“…The high rate of qac gene carriage in ST 239 associated with an MRSA outbreak has been noted previously in an ICU in the United Kingdom, where the initiation of daily chlorhexidine bathing for all patients was associated with greatly reduced transmission of endemic UK clones but no reduction in the transmission of ST 239 Cooper et al 2012). Recent studies have determined that carriage of plasmid borne qac genes can confer at least tolerance, and possibly resistance, to widely used antiseptics such as chlorhexidine gluconate, and may provide a selective advantage in the nosocomial environment (Smith et al 2008;Batra et al 2010;Lee et al 2011;Otter et al 2013). Where there are no broadly available means of phenotypic identification of resistance, such as with quaternary ammonium compounds, WGS allows for the detection of genetic elements associated with resistance.…”

Section: Discussionmentioning

confidence: 83%

Genome sequencing defines phylogeny and spread of methicillin-resistant Staphylococcus aureus in a high transmission setting

et al. 2014

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Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial infection. Whole-genome sequencing of MRSA has been used to define phylogeny and transmission in well-resourced healthcare settings, yet the greatest burden of nosocomial infection occurs in resource-restricted settings where barriers to transmission are lower. Here, we study the flux and genetic diversity of MRSA on ward and individual patient levels in a hospital where transmission was common. We repeatedly screened all patients on two intensive care units for MRSA carriage over a 3-mo period. All MRSA belonged to multilocus sequence type 239 (ST 239). We defined the population structure and charted the spread of MRSA by sequencing 79 isolates from 46 patients and five members of staff, including the first MRSA-positive screen isolates and up to two repeat isolates where available. Phylogenetic analysis identified a flux of distinct ST 239 clades over time in each intensive care unit. In total, five main clades were identified, which varied in the carriage of plasmids encoding antiseptic and antimicrobial resistance determinants. Sequence data confirmed intra-and interwards transmission events and identified individual patients who were colonized by more than one clade. One patient on each unit was the source of numerous transmission events, and deep sampling of one of these cases demonstrated colonization with a ''cloud'' of related MRSA variants. The application of whole-genome sequencing and analysis provides novel insights into the transmission of MRSA in under-resourced healthcare settings and has relevance to wider global health.

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“…Concern regarding increased resistance of nosocomial bacteria to biocides and disinfectants like chlorhexidine has tempered enthusiasm for wider adoption of their use in hospitals for skin antisepsis. [27][28][29][30][31][32][33][34] The potential for the emergence of resistance to chlorhexidine remains a substantial concern and should be monitored over time. 35 Identifying simple, cost-effective, and safe strategies for the prevention of health care-associated infection is essential.…”

Section: Discussionmentioning

confidence: 99%

Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection

2013

N Engl J Med

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Impact of Combined Low-Level Mupirocin and Genotypic Chlorhexidine Resistance on Persistent Methicillin-Resistant Staphylococcus aureus Carriage After Decolonization Therapy: A Case-control Study

Abstract: Combined low-level mupirocin and genotypic chlorhexidine resistance significantly increases the risk of persistent MRSA carriage after decolonization therapy. Institutions with widespread use of these agents should monitor for resistance and loss of clinical effectiveness.

Cited by 170 publications

References 38 publications

Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolates from Patients Newly Identified as Nasal Carriers

Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolates from Patients Newly Identified as Nasal Carriers

Genome sequencing defines phylogeny and spread of methicillin-resistant Staphylococcus aureus in a high transmission setting

Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection

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