Improvement of mupirocin E-test for susceptibility testing of Staphylococcus aureus

Mondino, Pedro Juan José; Santos, Kátia Regina Netto dos; Bastos, Maria do Carmo de Freire; Giambiagi-deMarval, Márcia

doi:10.1099/jmm.0.05011-0

Cited by 9 publications

(6 citation statements)

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“…An MIC falling between 8 and 256 μg/ml was taken a low or intermediate resistance, those showing ≥512 μg/ml as highly resistant and those isolates showing MIC <4 μg/ml were interpreted as sensitive. [ 6 7 ]…”

Section: Methodsmentioning

confidence: 99%

“…[ 4 5 ] Resistance of MRSA to mupirocin is categorized into two types: Low-level or intermediate resistance (MupI), with MICs of 8-256 μg/ml, and high-level resistance (MupR), with MICs ≥512 μg/ml. [ 6 7 ] A plasmid-mediated mupA gene appears to be associated with high-level resistance, while low-level resistance is associated with chromosomal point mutations. [ 8 9 10 ] Another novel gene, mupB is also responsible for high-level of mupirocin resistance.…”

Section: Introductionmentioning

confidence: 99%

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Resistance pattern of mupirocin in methicillin-resistant Staphylococcus aureus in trauma patients and comparison between disc diffusion and E-test for better detection of resistance in low resource countries

et al. 2014

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Introduction:Mupirocin is an effective antibiotic for elimination of methicillin-resistant Staphylococcus aureus (MRSA) from nasal colonization and has been used to control outbreaks. Current reports show an increasing trend of resistance to this antibiotic.Objective:This study was conducted to analyze the resistance pattern of MRSA to mupirocin among the patients admitted following trauma to an apex trauma care center of India and to compare the efficacy between two methods of antimicrobial sensitivity testing.Materials and Methods:A total of 150 isolates of MRSA from various clinical samples of trauma patients over a period of 2 years were included in this study. These strains were confirmed for MRSA using VITEK® 2 Compact and the Clinical Laboratory Standard Institute disc diffusion methods. The mupirocin susceptibility of the strains was tested by using E-test and 5 μg mupirocin disc in parallel each time, and the results were compared.Results:Clear zones of inhibition were observed in both tests. Though, good correlation was observed between the disc diffusion and E-tests in >98%, E-test showed a tendency to show lower minimum inhibitory concentration (MIC) in the remaining. These finding did not affect the final interpretation or outcomes. Of the total 150 strains, 138 (92%) showed sensitivity with the zone size in the range of 30-45 mm by 5 μg disc; rest (8%) showed sensitivity with the zone in the range of 18-30 mm by 5 μg disc, but 143 (95%) showed MIC ≤ 0.094 μg/ml and 8 (5%) gave MIC ≤ 0.75 μg/ml but ≥0.094 μg/ml by E-test. However, when both tests were compared, 5 (3.3%) showed zone size between 14 and 25 mm with ≤0.75 but >0.25 μg/ml MIC; 7 (5%) falling between 25 and 30 mm zone with MIC of ≤0.25 but >0.094 μg/ml and 138 (92%) showed zone >30 mm with MIC ≤0.094 but >0.064 μg/ml.Conclusions:All the MRSA isolates in our study were sensitive to mupirocin which is an encouraging finding. Though good screening for sensitivity can be done with 5 μg mupirocin disc, E-test provides a much clear and accurate results in clinical set-up. Hence, disc test can be used in resource poor countries and supplemented with E-test when needed.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Resistance pattern of mupirocin in methicillin-resistant Staphylococcus aureus in trauma patients and comparison between disc diffusion and E-test for better detection of resistance in low resource countries

et al. 2014

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“…Until recently, methods for testing topical agents have not been included in susceptibility testing documents published by the Clinical and Laboratory Standards Institute (CLSI; formerly NCCLS), although guidelines for testing by various methods have been suggested by others (9,10,12,13,16,17). The British Society for Antimicrobial Chemotherapy has formal recommendations for the testing of mupirocin (www.bsac .org.uk) that include testing of a 5-g and a 20-g mupirocin disk.…”

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confidence: 99%

Multicenter Study To Determine Disk Diffusion and Broth Microdilution Criteria for Prediction of High- and Low-Level Mupirocin Resistance in Staphylococcus aureus

et al. 2010

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Mupirocin susceptibility testing of Staphylococcus aureus has become more important as mupirocin is used more widely to suppress or eliminate S. aureus colonization and prevent subsequent health care-and community-associated infections. The present multicenter study evaluated two susceptibility testing screening methods to detect mupirocin high-level resistance (HLR), broth microdilution (BMD) MICs of >512 g/ml, and a 6-mm zone diameter for a disk diffusion (DD) test with a 200-g disk. Initial testing indicated that with Clinical and Laboratory Standards Institute methods for BMD and DD testing, the optimal conditions for the detection of mupirocin HLR were 24 h of incubation and reading of the DD zone diameters with transmitted light. Using the presence or absence of mupA as the "gold standard" for HLR, the sensitivity and specificity of a single-well 256 g/ml BMD test were 97 and 99%, respectively, and those for the 200-g disk test were 98 and 99%, respectively. Testing with two disks, 200 g and 5 g, was evaluated for its ability to distinguish HLR isolates (MICs > 512 g/ml), low-level-resistant (LLR) isolates (MICs ‫؍‬ 8 to 256 g/ml), and susceptible isolates (MICs < 4 g/ml). Using no zone with both disks as an indication of HLR and no zone with the 5-g disk plus any zone with the 200-g disk as LLR, only 3 of the 340 isolates were misclassified, with 3 susceptible isolates being classified as LLR. Use of standardized MIC or disk tests could enable the detection of emerging high-and low-level mupirocin resistance in S. aureus.

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“…We analysed a total of 124 S. aureus isolates and found 20 Mup RH , 19 Mup RL and 85 Mup S . We established the criteria using 45 S. aureus strains (16 Mup RH , 16 Mup RL and 13 Mup S ) that had been well characterized by the agar dilution method and PFGE (Santos et al, 1999), PCR (Nunes et al, 1999) and Etest (Mondino et al, 2003). We validated the criteria by analysing another 79 S. aureus nosocomial strains.…”

Section: Discussionmentioning

confidence: 99%

“…The dilution method is considered the 'gold standard' for the determination of mupirocin-resistance levels. We have recently shown that the mupirocin Etest (AB Biodisk) with tetrazolium reduction is more accurate, thus bringing the Etest closer to the gold standard agar dilution method for determining the mupirocin MICs for S. aureus strains (Mondino et al, 2003). However, both agar dilution and Etest are too expensive and laborious for routine application.…”

Section: Introductionmentioning

confidence: 99%

Interpretive criteria to differentiate low- and high-level mupirocin resistance in Staphylococcus aureus

Oliveira

Cardozo

Marques

et al. 2007

Journal of Medical Microbiology

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Meticillin-resistant Staphylococcus aureus isolates were classified into three mupirocin susceptibility groups by the disc diffusion method using 5 and 200 μg mupirocin discs. The zone diameter observed for a 5 μg disc distinguished MupS from the resistant strains (either MupRL or MupRH). On the other hand, a 200 μg disc distinguished the high-resistance MupRH strains from the other two (MupS or MupRL). Thus, the concomitant use of 5 and 200 μg mupirocin discs allowed the clear distinction among the three mupirocin susceptibility groups, MupS, MupRL or MupRH.

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Improvement of mupirocin E-test for susceptibility testing of Staphylococcus aureus

Cited by 9 publications

References 9 publications

Resistance pattern of mupirocin in methicillin-resistant Staphylococcus aureus in trauma patients and comparison between disc diffusion and E-test for better detection of resistance in low resource countries

Resistance pattern of mupirocin in methicillin-resistant Staphylococcus aureus in trauma patients and comparison between disc diffusion and E-test for better detection of resistance in low resource countries

Multicenter Study To Determine Disk Diffusion and Broth Microdilution Criteria for Prediction of High- and Low-Level Mupirocin Resistance in Staphylococcus aureus

Interpretive criteria to differentiate low- and high-level mupirocin resistance in Staphylococcus aureus

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