Susceptibility to and resistance determinants of fusidic acid in Staphylococcus aureus isolated from Chinese children with skin and soft tissue infections

Liu, Yingchao; Geng, Wenjing; Yang, Yonghong; Zheng, Yaojie; Shang, Yunxiao; Wu, Dejing; Li, Xiangmei; Wang, Limin; Yu, Sangjie; Yao, Kaihu; Shen, Xuzhuang

doi:10.1111/j.1574-695x.2011.00887.x

Cited by 17 publications

(16 citation statements)

References 30 publications

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“…This study showed that all four FA-resistant strains carried the acquired low-level resistance gene fusB, whilst no fusA mutation or fusC gene was found. Both fusB (2/186) and fusC (2/186) were responsible for the FA resistance in S. aureus isolates from Chinese paediatric patients studied previously (Liu et al, 2012). In central Taiwan region, the most common resistance determinant was fusC, which was found in 25 of 34 MRSA isolates (Chen et al, 2011).…”

Section: Discussionmentioning

confidence: 98%

Prevalence of fusB in Staphylococcus aureus clinical isolates

Huang

Ding

et al. 2013

Journal of Medical Microbiology

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Fusidic acid (FA) resistance in Staphylococcus aureus markedly varied among different regions. Few data for FA resistance are available in China. In this study, FA susceptibility testing was performed, and the prevalence of fusB and fusC in 116 clinical isolates of S. aureus was investigated by PCR. Mutations in fusA were also determined by sequencing of PCR products. Molecular typing of fusB-positive strains was based on multilocus sequence typing (MLST), spa typing and pulsed-field gel electrophoresis (PFGE). A DNA fragment flanking fusB was sequenced. Transformation experiments were carried out in fusB-positive S. aureus. Of 116 S. aureus including 19 meticillin-resistant S. aureus (MRSA) and 97 meticillin-susceptible S. aureus (MSSA), four (3.5 %) were resistant to FA with MICs of 6-12 mg ml "1 , including one MRSA from blood and three MSSA from wound exudates. All four FA-resistant isolates were found to be fusB gene positive. Three FA-resistant MSSA strains had the same MLST profile of ST630 and spa type of t377, whilst the MRSA strain belonged to ST630-t4549. Only one PFGE pattern was recognized for these four strains. No fusC and fusA mutations were detected in any of the isolates. FA resistance in fusB-positive clinical isolates could be transferred to S. aureus RN4220. The fusB gene was located in a transposon-like element, which had 99 % identity with that found in pUB101. In conclusion, the FA resistance rate is low in S. aureus, and the fusB gene is responsible for the resistance. INTRODUCTIONFusidic acid (FA) is a bacteriostatic antibiotic that blocks bacterial protein synthesis by locking elongation factor G (EF-G) to the ribosome (O'Neill et al., 2007), and is considered a useful antibiotic for meticillin-resistant Staphylococcus aureus (MRSA) infections (Tsuji et al., 2011). It is listed as the treatment of choice for skin and soft tissue infections (SSTIs), acute and chronic osteomyelitis, vertebral infection, septic arthritis and other device-related infections caused by S. aureus (Schöfer & Simonsen, 2010;Whitby, 1999).FA-resistant S. aureus has been reported in many countries, and the prevalence of resistance was remarkably different among different countries , with resistance rates relatively low (,10 %) in Asian countries except for Kuwait, Pakistan and South Korea. In Kuwait, resistance rates dramatically increased from 22 % in 1994 to 92 % in 2004. The overall FA resistance rates were 10.7 % in 13 European countries; 1.4-3.1 % in Italy, Poland, Spain and Sweden; 62.4 % in Greece; and 19.9 % in Ireland (Castanheira et al., 2010b). In the last decade, there has been an increase in the prevalence of FA-resistant staphylococci in a number of northern European countries. This has been particularly striking among strains of S. aureus causing impetigo due to clonal expansion of a strain called the epidemic European FA-resistant impetigo clone (EEFIC). This clone has been reported in the UK, France, Sweden, Norway and other European countries (O'Neill et al., 2007a). FA resistance rates in S...

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Section: Discussionmentioning

confidence: 98%

Prevalence of fusB in Staphylococcus aureus clinical isolates

Huang

Ding

et al. 2013

Journal of Medical Microbiology

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“…However, resistance to fusidic acid in China was reported after 2007. 15, 16 Therefore, selective pressure from antibiotic use likely led to increased resistance to fusidic acid. Similarly, initial reports on mupirocin-resistant S. aureus emerged shortly after the introduction of mupirocin into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Characterization of community-associated Staphylococcus aureus from skin and soft-tissue infections: a multicenter study in China

Liu

Yang

et al. 2016

Emerging Microbes & Infections

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We evaluated the epidemiological and molecular features of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and methicillin-sensitive S. aureus (MSSA) from children and adult patients with skin and soft-tissue infections (SSTIs) in China. Prospective community-acquired S. aureus SSTI surveillance was conducted in 23 hospitals over a 24-month period. Susceptibility to 16 antimicrobials was evaluated using the agar dilution method. StatApriori was used to determine statistically significant association trends. The genotypic characteristics of CA-MRSA isolates were tested by staphylococcal cassette chromosome mec (SCCmec) typing, staphylococcal protein A (spa) typing, and multilocus sequence typing. The presence of Panton–Valentine leukocidin (pvl) genes was determined. Overall, 71.6% (1946/2716) of cases were community-associated S. aureus. CA-MRSA accounted for 2.6% (51). Out of 1895 methicillin-sensitive S. aureus strains, 97.3% were resistant to erythromycin, 96.6% to penicillin and 89.1% to clindamycin. No S. aureus strains were resistant to vancomycin. Thirteen sequence types (STs) and 17 spa types were detected among the CA-MRSA strains. The most prevalent sequence type was ST121 (19/51, 37.3%), followed by ST59 (13/51, 25.5%). In addition, t437 was predominant, accounting for 43.1% (22/51). Only five (9.8%) of the CA-MRSA strains harbored pvl genes. There were no significant differences in antibiotic sensitivity profiles between ST121 and non-ST121 MRSA isolates. However, ST121 strains tended to be more resistant to cefazolin, whereas non-ST121 strains were more resistant to chloramphenicol. In conclusion, CA-MRSA infections are rare among Chinese SSTI patients. MRSA strains in China have diverse genetic backgrounds, with ST121 being the predominant clone. Fusidic acid and mupirocin remain effective for topical treatment.

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“…fusB may be chromosomal or plasmid borne and typically confers low-level fusidic acid resistance. In S. aureus, fusB has been found on pUB101, a ubiquitous 21.9-kb plasmid that encodes ␤-lactamase and cadmium resistance (132)(133)(134), and recent work has described fusB in association with a highly clonal p11819-97 plasmid among isolates of the dominant European CA-MRSA CC80 clone (135). The fusB gene has also been described as being present on the chromosome of a European fusidic acid-resistant S. aureus impetigo clone (EEFIC) (136).…”

Section: Fusidic Acidmentioning

confidence: 99%

Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns

2017

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Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.

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Susceptibility to and resistance determinants of fusidic acid in Staphylococcus aureus isolated from Chinese children with skin and soft tissue infections

Cited by 17 publications

References 30 publications

Prevalence of fusB in Staphylococcus aureus clinical isolates

Prevalence of fusB in Staphylococcus aureus clinical isolates

Characterization of community-associated Staphylococcus aureus from skin and soft-tissue infections: a multicenter study in China

Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns

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