Mupirocin resistance in Staphylococcus aureus in an Indian hospital

Gadepalli, Ravisekhar; Dhawan, Benu; Mohanty, Srujana; Kapil, Arti; Das, Bimal Kumar; Chaudhry, Rama; Samantaray, Jyotish Chandra

doi:10.1016/j.diagmicrobio.2006.10.012

Cited by 53 publications

(35 citation statements)

References 12 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%

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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%

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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“…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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“…These plasmids also carry resistance genes to other antimicrobial agents, such as the macrolides, gentamicin, tetracycline and trimethoprim. Although sensitivity to mupirocin is not affected by the same genetic elements as resistance to beta-lactam agents, such as cloxacillin, an association between MRSA and mupirocin resistance has been noted in the literature (Ravisekhar Gadepalli et al, 2007;Wasserman et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Mupirocin Resistance in Methicillin Resistant Staphylococcus aureus Strains isolated from a Tertiary Care Hospital

Madhumati¹,

Rajendran²,

K³

2018

Int.J.Curr.Microbiol.App.Sci

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Mupirocin is a topical antibiotic that has been used extensively for treating methicillin resistant Staphylococcus aureus (MRSA) associated infections. However, the prevalence of resistance to mupirocin is being increasingly found due to its irrational and widespread use. Retapamulin: a pleuromutilin antibacterial agent is an effective topical antibiotic against these resistant strains. This study was carried out to determine the rates of resistance to mupirocin in MRSA isolates in our patient population, and to estimate the association of such resistance and resistance to other classes of antimicrobial agents in order to consider the effect of the use of mupirocin on the selection of antimicrobial resistant strains. This prospective study was conducted in the Department of Microbiology at VIMS & RC, Bengaluru. 200 Staphylococcus aureus isolates were recovered from various clinical specimens from out patients and in patients admitted into various wards and intensive care units. Isolation and identification of isolates S. aureus isolated from clinical specimens were identified according to the standard laboratory operating procedures. Antimicrobial sensitivity was determined by the Vitek 2 K automated system. All tests and quality assurance procedures were performed and interpreted according to the standards set by the Clinical and Laboratory Standards Institute (CLSI). For fusidic acid and retapamulin The European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria was used. For the macrolide-lincosamide streptogramin B (MLSB) phenotype (inducible clindamycin resistance encoded by the plasmid-borne gene, erm) was determined by the disc approximation test, clindamycin was reported to be resistant. Mupirocin resistance testing was done by disc diffusion with disc concentration of 5μg and 200μg. Among the 200 Staphylococcus aureus isolates 108 (54%) were MRSA, highest percentage of MRSA strains were from blood isolates (62%), followed by aspirated fluids and pus (59 % and 56 % respectively). Of the 108 MRSA strains, 26 (24%) were mupirocin resistant Staphylococcus aureus (MupRSA). Mupirocin resistance was not detected in methicillin sensitive Staphylococcus aureus (MSSA) isolates. High-level mupirocin resistance was observed in 11% and low-level resistance in 13% of the 108 isolates. Higher prevalence of high level mupirocin resistance was from blood isolates followed by pus (45% and 36.3% respectively), low level mupirocin resistance was maximum seen in the isolates from respiratory secretions (46%). MupRSA was more frequently isolated from ICUs and surgical wards. The mupirocin resistant MRSA strains exhibited resistance to other class of antibiotics also: ampicillin (90%), ciprofloxacin (88%), erythromycin (86%), co trimoxazole (73%). However fusidic acid, vancomycin and linezolid showed sensitivity of 99%, 96% and 96% respectively. All the strains were sensitive to retapamulin. Increase in mupirocin resistance among MRSA isolates is a matter of concern. Antimicrobial stewardship programmes are i...

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Mupirocin resistance in Staphylococcus aureus in an Indian hospital

Cited by 53 publications

References 12 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 Genes Encoding Toxin, Adhesion, and Antibacterial Resistance Among Various SCCmec Types of Methicillin-Resistant Staphylococcus aureus Isolated From Intensive Care Unit, Tehran, Iran

Prevalence of Mupirocin Resistance in Methicillin Resistant Staphylococcus aureus Strains isolated from a Tertiary Care Hospital

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