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

Oliveira, Naira Elane Moreira de; Cardozo, Ana Paula Couto Marques; Marques, Elizabeth de Andrade; Santos, Kátia Regina Netto dos; Giambiagi-deMarval, Márcia

doi:10.1099/jmm.0.46965-0

Cited by 38 publications

(22 citation statements)

References 11 publications

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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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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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“…However, the mupirocin susceptibility testing was not preconized by CLSI, so the results for this antibiotic were interpreted as previously described (7,9). The methicillin resistance was also evaluated by other phenotypic methods, such as the MIC for oxacillin (5), the MicroScan, and PCR of the mecA gene (6).…”

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Staphylococcus haemolyticus as an Important Hospital Pathogen and Carrier of Methicillin Resistance Genes

et al. 2012

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Phenotypic and molecular methods were used to characterize the antibiotic resistance of 64 clinical isolates of Staphylococcus haemolyticus. By PCR of the mecA gene, 87% were found to be methicillin resistant. Approximately 55% harbored staphylococcal cassette chromosome mec element (SCCmec) type V, and only one SCCmec type IV. Many isolates (75%) displayed multiresistance, and pulsotype analysis showed a high diversity.A mong coagulase-negative staphylococci (CoNS), Staphylococcus haemolyticus is the second most frequently isolated from human blood cultures (18) and has the highest level of antimicrobial resistance (3,8). Methicillin resistance is conferred by the mecA gene, carried on the staphylococcal cassette chromosome mec element (SCCmec) (12). Eight types (I to VIII) of SCCmec have been assigned for Staphylococcus aureus (11), and SCCmec type V has already been found in CoNS, particularly in S. haemolyticus (13). The increase in the frequency of methicillinresistant S. haemolyticus as the causal agent of hospital infections and the possibility of emergence of resistance to other antibiotics demand trustworthy characterization of the isolates and an investigation of clonal spreading within hospitals.In the studies reported here, 64 clinical strains were isolated from patients at Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil, between 2006 and 2008. The strains were isolated from the following clinical infections or sources in 31 males and 33 females: bacteremia (n ϭ 45), skin (n ϭ 2), urine (n ϭ 13), and unknown source (n ϭ 4). The isolates were identified at the hospital laboratory as S. haemolyticus by using the MicroScan WalkAway PC21 panel, and their identification was confirmed by specific PCR (17).The resistance profiles of the strains for the main antibiotics used in Brazil were determined by disc diffusion tests according to CLSI guidelines (5). However, the mupirocin susceptibility testing was not preconized by CLSI, so the results for this antibiotic were interpreted as previously described (7, 9). The methicillin resistance was also evaluated by other phenotypic methods, such as the MIC for oxacillin (5), the MicroScan, and PCR of the mecA gene (6). The SCCmec type was determined in a multiplex PCR as previously described (14), except that the pair of primers mecI P2 and mecI P3 used as the internal control were replaced by MRS1 and MRS2 (6), which amplify a 154-bp fragment of the mecA gene.Analysis of genetic relatedness and characterization of isolates using pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with SmaI were carried out as previously described (20). Banding patterns were determined by visual inspection and by using Bionumerics software, version 6.0 (Applied Maths) using the Dice index and the unweighted-pair group method with arithmetic average. Similar PFGE genotypes were defined using a coefficient of similarity of up to 80%, and the subtypes were those with less than five-band variants, as recommended by van Belkun et al. (19).As shown in Table 1, there wa...

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“…Palepou et al [8] 25 /xg de Oliveira et al [9] 5 /"g 200 /*g Zone-of-inhibition diameter, by susceptibility level zone-of-inhibition diameter, but were also classified as being mupirocin susceptible, on the basis of MICs using the Etest. Our study demonstrated that there was a high prevalence of mupirocin resistance among MRSA clinical isolates, compared with other surveillance studies that found a geographic variation in the prevalence of mupirocin resistance among MRSA isolates that ranged from 4% to 17%.…”

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confidence: 99%

Surveillance for Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus Clinical Isolates

Mongkolrattanothai

Mankin

Raju

et al. 2008

Infect. Control Hosp. Epidemiol.

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

Cited by 38 publications

References 11 publications

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

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

Staphylococcus haemolyticus as an Important Hospital Pathogen and Carrier of Methicillin Resistance Genes

Surveillance for Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus Clinical Isolates

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