Susceptibility to chlorhexidine and mupirocin among methicillin-resistant Staphylococcus aureus clinical isolates from a teaching hospital

Bes, Taniela Marli; Neto, Lauro Vieira Perdigão; Martins, Roberta Ruedas; Heijden, Inneke M. van der; Trindade, Priscila de Arruda; Camilo, Gaspar; Nagano, Debora Satie; Mongelos, Diego; Marchi, Ana Paula; Tomaz, Mariama; Oliveira, Larissa Marques de; Rossi, Flávia; Levin, Anna Sara Shafferman; Costa, Sílvia Figueiredo

doi:10.1590/s1678-9946202163027

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…The high resistance to fusidic acid (46.2%) exceeds by far that observed among MRSA globally (2.6%) (Hajikhani et al 2021). The resistance rate to mupirocin (15.4%) was higher than the 3.1% revealed in a previous multicenter surveillance study (Kresken et al 2004); this is of crucial importance since resistance to mupirocin could potentially diminish the e cacy of MRSA decolonizing strategies (Bes et al 2021). For both antimicrobials (fusidic acid and mupirocin) further studies are needed to elucidate the genetic background of the increased resistance (whether it is due to mutation(s) and/or acquired resistance genes).…”

Section: Discussionmentioning

confidence: 75%

Spa diversity and genetic characterization of t127 methicillin-resistant Staphylococcus aureus in a tertiary Greek hospital

Tsergouli

Κarampatakis

Kontopoulou

et al. 2022

AMicr

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Introduction Methicillin-resistant Staphy lococcus aureus (MRSA) causes severe community and hospital acquired infections. Identification of staphylococcal cassette chromosome mec (SCCmec), multilocus-sequence typing, and sequencing of S. aureus protein A (spa) gene are used for MRSA typing. The aim was to investigate the spa types of MRSA isolates in a tertiary hospital in Greece and analyse the whole genome sequences of two t127 MRSA isolates. Methods Totally, 39 MRSA isolates collected from July 2019 to June 2020 in “Georgios Gennimatas” General Hospital of Thessaloniki, Greece, were included in the study. Identification and antimicrobial susceptibility testing were performed using VITEK II automated system, and spa typing was performed. A minimum spanning tree was used to display the spa type frequencies and the genetic distances among them. Two t127-MRSA isolates (IM-MRSA and PD-MRSA) were selected for WGS. Results Six isolates (15.4%) were resistant to mupirocin, 18 (46.2%) to fusidic acid, three (7.7%) to vancomycin and two (5.1%) to teicoplanin. Twenty-two different spa types were detected, with t002, t003, and t422 being the most frequent (5/39, 12.8% each), followed by t1994 (4/39, 10.3%). The isolates presented high genetic diversity and, taking into account the time between hospital admission and sampling, intrahospital spread did not occur. Even the two t127 isolates were assigned to different sequence types, ST9-XII-t127 and ST1-IVa-t127. Plasmids and genes conferring antimicrobial resistance and virulence were also identified. Conclusions Various spa types were identified and together with the information about the time between hospital admission and sampling supports polyclonal MRSA spread in the hospital excluding a nosocomial infection. WGS provides a more detailed analysis distinguishing even the isolates belonging to the same spa type.

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Section: Discussionmentioning

confidence: 75%

Spa diversity and genetic characterization of t127 methicillin-resistant Staphylococcus aureus in a tertiary Greek hospital

Tsergouli

Κarampatakis

Kontopoulou

et al. 2022

AMicr

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“…It should be emphasized that this conclusion is limited to bacterial isolates exhibiting a chlorhexidine tolerance equal to or less than 32 µg mL −1 ; however, recent studies investigating the in situ development of chlorhexidine resistance in bacterial isolates obtained from HCAI-patient wounds and patient-care fomites have provided evidence supporting the extent of healthcare-associated chlorhexidine resistance to be ≤8 µg mL −1 . [52] While the majority of antimicrobial technologies used in infrastructure materials work by leaching antimicrobials from the surface, [53] the chlorhexidine used in the technology reported here is bonded to the surface, and leaching of the chlorhexidine was not observed. This lack of leaching from the surface could potentially enhance the duration of antimicrobial efficacy against bacteria, especially resistant strains, which often rely on efflux pumps to remove antimicrobials.…”

Section: Discussionmentioning

confidence: 98%

Development of biocide coated polymers and their antimicrobial efficacy

et al. 2023

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Microbial contamination of plastic surfaces is a significant source of hospitalacquired infections. To produce antimicrobial surfaces, chlorhexidine was attached to nitrided acrylonitrile butadiene styrene (ABS). The uniformity of chlorhexidine distribution on the plastic surfaces was revealed by time-of-flight secondary ion mass spectrometry (TOF-SIMS) imaging. Its antimicrobial efficacy was established against model pathogenic Gram-positive and Gram-negative bacteria, fungi, and viruses. The stability of the bonded chlorhexidine was evaluated via a leaching test. The surfaces rapidly killed microbes: no viable colonies of Escherichia coli, Staphylococcus aureus, or Candida albicans were recoverable after 45 minutes. It was effective against SARS-COV-2, with no viable virions found after 30 minutes. Additionally, the surfaces were as effective in killing chlorhexidine-resistant strains of bacteria as they were in killing naïve strains.The surface was stable; after 2 weeks of leaching, no detectable chlorhexidine was found in the leachate. We believe that the technology is widely applicable to prevent the spread of fomite infection.

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“…A recent review by Dadashi et al (2020) has shown that the global prevalence of mupirocin resistance may be as little as 1.0% in some regions (for studies performed in certain areas of Australia, India, France and Iran, for example) to more than 50% (studies from the United States of America, Egypt and other areas from India). Recent studies with Brazilian Staphylococcus strains from hospitals have reported mupirocin resistance frequencies ranging from 2% (Bes et al 2021) to 33% (Chamon et al 2017). In Staphylococcus isolated from domestic animals from Brazil, these frequencies were considerably lower, from 0.8% in strains isolated from dogs (Rossi et al 2018) to 1% in strains isolated from cats (Rossi et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Brazilian methicillin-resistant Staphylococcus aureus (MRSA) strains carrying a diversity of mupirocin-resistance plasmids

Giambiagi-deMarval

Cardozo

Coimbra-e-Souza

et al. 2022

Preprint

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Methicillin-resistant Staphylococcus aureus (MRSA) are widespread causative agents of hard-to-treat infections in the nosocomial environment, with increasingly narrower treatment possibilities. Mupirocin is an antibiotic commonly used to promote nasal decolonization and prevent transmission of MRSA in hospitals. Resistance to high levels of mupirocin is emerging globally, being mainly conferred by the product of the mupA gene. In this study, we analyzed the levels of resistance to mupirocin, the presence of the mupA gene, the transmissibility and diversity of plasmids among Staphylococcus isolated from nosocomial infections. Five mupA-carrying and mupirocin-resistant MRSA strains were studied in terms of the plasmidial origin of mupA, which was confirmed by curing during heat stress, plasmid extraction and PCR. Resistance was associated with high-molecular weight plasmids, which were transferred by conjugation to methicillin-sensitive S. aureus, and then to a MRSA strain. The plasmids were shown to be diverse by analysis of the presence, orientation, and distance of the insertion sequence IS257 from the mupA gene, and by their restriction patterns. This study reinforces that, given the decline of possibilities to treat MRSA infections and the easy transfer of mupirocin-resistance plasmids among Staphylococcus, the use of this antibiotic must be carefully monitored.

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Susceptibility to chlorhexidine and mupirocin among methicillin-resistant Staphylococcus aureus clinical isolates from a teaching hospital

Abstract: This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Cited by 6 publications

References 29 publications

Spa diversity and genetic characterization of t127 methicillin-resistant Staphylococcus aureus in a tertiary Greek hospital

Spa diversity and genetic characterization of t127 methicillin-resistant Staphylococcus aureus in a tertiary Greek hospital

Development of biocide coated polymers and their antimicrobial efficacy

Brazilian methicillin-resistant Staphylococcus aureus (MRSA) strains carrying a diversity of mupirocin-resistance plasmids

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