scholarly journals Outbreak of Mupirocin-Resistant Staphylococci in a Hospital in Warsaw, Poland, Due to Plasmid Transmission and Clonal Spread of Several Strains

1999 ◽  
Vol 37 (9) ◽  
pp. 2781-2788 ◽  
Author(s):  
Tomasz A. Łe˛ski ◽  
Marek Gniadkowski ◽  
Anna Skoczyńska ◽  
Elz˙bieta Stefaniuk ◽  
Krzysztof Trzciński ◽  
...  
Keyword(s):  
Resistance Mechanisms ◽  
Hospital Environment ◽  
Coagulase Negative Staphylococci ◽  
Large Hospital ◽  
Methicillin Resistant ◽  
Inappropriate Use ◽  
Clonal Spread ◽  
High Level ◽  
Almost All ◽  
Level Resistance

An outbreak of mupirocin-resistant (MuR) staphylococci was investigated in two wards of a large hospital in Warsaw, Poland. Fifty-three MuR isolates of Staphylococcus aureus, S. epidermidis, S. haemolyticus, S. xylosus, and S. capitis were identified over a 17-month survey which was carried out after introduction of the drug for the treatment of skin infections. The isolates were collected from patients with infections, environmental samples, and carriers; they constituted 19.5% of all staphylococcal isolates identified in the two wards during that time. Almost all the MuR isolates were also resistant to methicillin (methicillin-resistant S. aureus and methicillin-resistant coagulase-negative staphylococci). Seven of the outbreak isolates expressed a low-level-resistance phenotype (MuL), whereas the remaining majority of isolates were found to be highly resistant to mupirocin (MuH). The mupA gene, responsible for the MuH phenotype, has been assigned to three different polymorphic loci among the strains in the collection analyzed. The predominant polymorph, polymorph I (characterized by a mupA-containingEcoRI DNA fragment of about 16 kb), was located on a specific plasmid which was widely distributed among the entire staphylococcal population. All MuR S. aureus isolates were found to represent a single epidemic strain, which was clonally disseminated in both wards. The S. epidermidis population was much more diverse; however, at least four clusters of closely related isolates were identified, which suggested that some strains of this species were also clonally spread in the hospital environment. Six isolates of S. epidermidis were demonstrated to express the MuL and MuH resistance mechanisms simultaneously, and this is the first identification of such dual MuR phenotype-bearing strains. The outbreak was attributed to a high level and inappropriate use of mupirocin, and as a result the dermatological formulation of the drug has been removed from the hospital formulary.

scholarly journals Prevalence and molecular characterization of methicillin-resistant Staphylococcus aureus with mupirocin, fusidic acid and/or retapamulin resistance

2020 ◽  
Author(s):  
Wenjing Chen ◽  
Chunyan He ◽  
Han Yang ◽  
Wen Shu ◽  
Zelin Cui ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Fusidic Acid ◽  
Resistance Mechanisms ◽  
Antibiotics Resistance ◽  
Genetic Characteristics ◽  
Methicillin Resistant ◽  
Low Level ◽  
High Level ◽  
Level Resistance

Abstract Data on the prevalence of resistance to mupirocin (MUP), fusidic acid (FA) and retapamulin (RET) in methicillin-resistant Staphylococcus aureus (MRSA) from China are still limited. In this study we examined these three antibiotics resistance pheno and geno-typically in 1206 MRSA clinical isolates. Phenotypic MUP, FA and RET resistance was determined by MICs, and genotypically by PCR and DNA sequencing examining genes mupA / B , fusB - D , cfr and vgaA / Av , and mutations in ileS , fusA / E , rplC , and 23S RNA V domain. The genetic characteristics of resistance isolates were conducted by PFGE and MLST. Overall MRSA MUP, FA and RET resistance was low (5.1%, 1.0% and 0.3%, respectively). The mupA was the mechanism of high-level MUP resistance. All low-level MUP resistance isolates possessed an equivocal mutation N213D in IleS, and 2 of them additionally had the reported V588F mutation impacting the Rossman fold. FusA mutations, such as L461K, H457Q, H457Y and V90I, were the primary FA resistance mechanisms among high-level resistance isolates, most of which contained fusC ; however, all low-level resistance strains carried fusB . No resistance mechanisms detected were found among RET resistance isolates. Genetic analysis demonstrated clone spread for MUP resistance isolates. In conclusion, MUP, FA and RET exhibited highly activity against MRSA isolates. Acquired genes and chromosome-borne genes mutations were responsible for MUP and FA resistance, and further investigation is needed to uncover the RET resistance mechanisms. Moreover, the surveillance to MUP in MRSA should be strengthened to prevent resistance increase due to the expansion of clones.

scholarly journals Species-Specific Sensitivity of Coagulase-Negative Staphylococci to Single Antibiotics and Their Combinations

2011 ◽  
Vol 60 (2) ◽  
pp. 155-161 ◽  
Author(s):  
GRAŻYNA SZYMAŃSKA ◽  
MAGDALENA SZEMRAJ ◽  
ELIGIA M. SZEWCZYK
Keyword(s):  
University Hospital ◽  
Hospital Environment ◽  
Beta Lactam ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Beta Lactam Antibiotics ◽  
Resistant Strains ◽  
Staphylococcus Hominis ◽  
Species Specific

The activity of beta-lactam antibiotics (oxacillin, cloxacillin, cephalotin), vancomycin, gentamicin and rifampicin applied in vitro individually and in combination against 37 nosocomial methicillin-resistant strains of coagulase-negative staphylococci (CNS) was assessed to demonstrate the heterogeneity of this group of bacteria and estimate the chance of the efficacy of such therapy. The strains belonged to four species: Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus cohnii, Staphylococcus hominis. They originated from a hospital environment and from the skin of medical staff of the intensive care unit of a paediatric ward at a university hospital. All strains were methicillin-resistant, according to CLSI standards, but individual strains differed in MIC(ox) values. Susceptibility to other tested antibiotics was also characteristic for the species. The increased susceptibility to antibiotics in combinations, tested by calculating the fractional inhibitory concentration (FIC) index, concerned 26 out of 37 investigated strains and it was a feature of a particular species. Combinations of vancomycin and cephalotin against S. epidermidis and oxacillin with vancomycin were significant, as well as cephalotin and rifampicin in growth inhibition of multiresistant S. haemolyticus strains.

scholarly journals Association of two resistance mechanisms in a clinical isolate of Enterobacter cloacae with high-level resistance to imipenem.

1991 ◽  
Vol 35 (6) ◽  
pp. 1093-1098 ◽  
Author(s):  
E H Lee ◽  
M H Nicolas ◽  
M D Kitzis ◽  
G Pialoux ◽  
E Collatz ◽  
...  
Keyword(s):  
Clinical Isolate ◽  
Enterobacter Cloacae ◽  
Resistance Mechanisms ◽  
High Level ◽  
Level Resistance

scholarly journals Multidrug Resistance: An Emerging Crisis

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Jyoti Tanwar ◽  
Shrayanee Das ◽  
Zeeshan Fatima ◽  
Saif Hameed
Keyword(s):  
Multidrug Resistance ◽  
Resistance Mechanisms ◽  
Natural Phenomenon ◽  
Infection Prevention And Control ◽  
Antimicrobial Drugs ◽  
Inappropriate Use ◽  
Risk Of Death ◽  
Microbial Response ◽  
Microbial Infections ◽  
Almost All

The resistance among various microbial species (infectious agents) to different antimicrobial drugs has emerged as a cause of public health threat all over the world at a terrifying rate. Due to the pacing advent of new resistance mechanisms and decrease in efficiency of treating common infectious diseases, it results in failure of microbial response to standard treatment, leading to prolonged illness, higher expenditures for health care, and an immense risk of death. Almost all the capable infecting agents (e.g., bacteria, fungi, virus, and parasite) have employed high levels of multidrug resistance (MDR) with enhanced morbidity and mortality; thus, they are referred to as “super bugs.” Although the development of MDR is a natural phenomenon, the inappropriate use of antimicrobial drugs, inadequate sanitary conditions, inappropriate food-handling, and poor infection prevention and control practices contribute to emergence of and encourage the further spread of MDR. Considering the significance of MDR, this paper, emphasizes the problems associated with MDR and the need to understand its significance and mechanisms to combat microbial infections.

scholarly journals Emergence of Resistant Staphylococci on the Hands of New Graduate Nurses

2004 ◽  
Vol 25 (5) ◽  
pp. 431-435 ◽  
Author(s):  
Jeannie P. Cimiotti ◽  
Fann Wu ◽  
Phyllis Della-Latta ◽  
Mirjana Nesin ◽  
Elaine Larson
Keyword(s):  
New York ◽  
Microbial Flora ◽  
Hospital Environment ◽  
Full Time ◽  
Graduate Nurses ◽  
Coagulase Negative Staphylococci ◽  
New Graduate Nurses ◽  
Methicillin Resistant ◽  
Experienced Nurses ◽  
New Graduate

AbstractObjective:To describe the aerobic microbial flora on the hands of experienced and new graduate nurses over time.Design:A prospective cohort design that examined the relationship between duration of employment in an intensive care unit (ICU) and the microbial flora on the hands of experienced and new graduate nurses during a 23-month period.Setting:A 50-bed, level III-IV neonatal ICU in New York City.Participants:Twelve experienced nurses and 9 new graduate nurses working full time in the NICU.Intervention:One hundred fifty samples were obtained from the clean, dominant hands of the nurses. Cultures were performed at baseline and then quarterly for each experienced and new graduate nurse. Baseline and final cultures ofStaphylococcus epidermidiswere further examined using pulsed-field gel electrophoresis.Results:At baseline, a significantly larger proportion of the experienced nurses had methicillin-resistant, coagulase-negative staphylococci isolated from their hands compared with the new graduate nurses (95% and 33%, respectively;P= .0004). For a second culture, performed 1 to 4 months later, there were no longer significant differences between the two groups (82% and 54%, respectively;P= .12). By the last culture, all staphylococcal isolates were methicillin resistant in both groups of nurses; 3 were methicillin-resistantS. aureus.Conclusions:Colonization with methicillin-resistant staphylococci occurred after brief exposure to the hospital environment, despite the use of antiseptic hand hygiene agents. Furthermore, at final culture, the two groups shared one dominant hospital-acquired strain ofS. epidermidis.

scholarly journals Prevalence of Resistance Mechanisms against Macrolides and Lincosamides in Methicillin-Resistant Coagulase-Negative Staphylococci in the Czech Republic and Occurrence of an Undefined Mechanism of Resistance to Lincosamides

2005 ◽  
Vol 49 (8) ◽  
pp. 3586-3589 ◽  
Author(s):  
Gabriela Novotna ◽  
Václava Adamkova ◽  
Jiri Janata ◽  
Oto Melter ◽  
Jaroslav Spizek
Keyword(s):  
Czech Republic ◽  
Resistance Genes ◽  
Staphylococcus Epidermidis ◽  
Resistance Mechanisms ◽  
Coagulase Negative Staphylococci ◽  
The Czech Republic ◽  
Methicillin Resistant ◽  
High Occurrence ◽  
Mechanism Of Resistance ◽  
Staphylococcus Haemolyticus

ABSTRACT High occurrence of the non-macrolide-lincosamide-streptogramin B resistance genes msrA (53%) and linA/linA′ (30%) was found among 98 methicillin-resistant coagulase-negative staphylococci additionally resistant to macrolides and/or lincosamides. The gene msrA predominated in Staphylococcus haemolyticus (43 of 62 isolates). In Staphylococcus epidermidis, it was present in 7 of 27 isolates. A novel mechanism of resistance to lincosamides appears to be present in 10 genetically related isolates of S. haemolyticus in the absence of ermA, ermC, msrA, and linA/linA′.

scholarly journals 1192. Identification of a Novel Enterobacter cloacae Isolate Producing an IMP-13 Metallo-β-Lactamase

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S360-S361
Author(s):  
Muhammad Bilal Abid ◽  
Blake Buchan ◽  
Nathan Ledeboer ◽  
L Silvia Munoz-Price ◽  
Mary Beth Graham
Keyword(s):  
Clinical Success ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Stage Iiic ◽  
Travel History ◽  
Healthcare Settings ◽  
High Level ◽  
Culture Positive ◽  
Broth Dilution ◽  
Level Resistance

Abstract Background Metallo-β-lactamases (MBLs) have been identified as emerging resistance determinants in Enterobacteriaceae, A. baumanii, and P. aeruginosa. Early identification of carbapenemase-producing organisms (CPOs) is essential to prevent dissemination within healthcare settings. We report a case of a patient who was blood culture positive for a multidrug-resistant E. cloacae which was subsequently found to be positive for the MBL blaIMP-13. Methods A 74-year-old female, with no significant past medical or travel history, developed sepsis 2 days after undergoing debulking surgery for stage IIIc ovarian carcinoma. Blood cultures were positive for Gram-negative bacilli and the organisms identified as Enterobacter spp. with blaIMP MBL (Verigene). Antimicrobial susceptibility testing demonstrated high-level resistance to all penicillins, ureidopenicillins, cephalosporins, and β-lactam/inhibitor antibiotics, and susceptibility to colistin, tigecycline, and monobactams. Results Further testing using micro-broth dilution, BD phoenix, and Etest, demonstrated susceptible MICs to meropenem and imipenem, with intermediate to resistant MICs to ertapenem. The patient was treated with a combination therapy of amikacin, aztreonam, and ceftazidime-avibactam and responded clinically. Per standard protocol, the organism was sent to WI Laboratory of Hygiene for further characterization. Phenotypic testing using the modified carbapenem inactivation test (mCIM) was positive, indicating the presence of a carbapenemase; however, results using Xpert CarbaR (Cepheid) were negative. Subsequent sequencing of the isolate confirmed the presence of blaIMP-13. Conclusion This was an important case for several reasons. First, blaIMP-13 is historically reported in Pseudomonas aeruginosa. Indeed, this was the first report of Enterobacteriaceae harboring blaIMP in WI. Second, it had unique susceptibility pattern to carbapenems and was not detected by the CarbaR. Third, these data demonstrate clinical success in treating an MBL CPO with a combination anti-microbial regimen, based on an understanding of resistance mechanisms involved. This report calls for more vigilant screening for CPO using both phenotypic and genotypic methods. Disclosures N. Ledeboer, Luminex: Consultant, Consulting fee.

scholarly journals Screening of methicillin-resistant Staphylococcus aureus in healthcare workers and students and its susceptibility to mupirocin in a tertiary care teaching hospital in South India

2017 ◽  
Vol 9 (04) ◽  
pp. 239-242 ◽  
Author(s):  
Jutang Babat Ain Tiewsoh ◽  
Meena Dias
Keyword(s):  
Staphylococcus Aureus ◽  
Healthcare Workers ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Tertiary Care ◽  
Carrier State ◽  
Coagulase Negative Staphylococcus ◽  
Methicillin Resistant ◽  
Mupirocin Resistance ◽  
High Level ◽  
Level Resistance

Abstract BACKGROUND: Staphylococcus is the most common pathogen causing infection in hospitals. They also colonize the healthcare workers who serve as reservoir of infection. Emergence of methicillin-resistant Staphylococcus aureus (MRSA) is a burning issue throughout the world contributing to significant morbidity and mortality. Use of mupirocin to eradicate the carrier state is the need of the hour. OBJECTIVES: To screen healthcare workers (HCWs) and medical students for MRSA and to know the susceptibility of mupirocin in this group. MATERIALS AND METHODS: A total of 432 students, nursing staff, doctors and house-keeping staff were screened for MRSA for 4 months. The MRSA and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS) isolates were then tested for mupirocin resistance. RESULTS: Out of 432 samples, 24 (5.55%) were MRSA and 104 (24.07%) were MRCoNS. Only 4.16% (n = 1) showed high-level resistance to mupirocin among the MRSA isolates, while resistance among MRCoNS was higher at 6.7% (n = 7) for low-level resistance and 17.30% (n = 18) for high-level resistance. CONCLUSION: MRSA colonization of HCWs may serve as a source of infection and mupirocin resistance should be screened for all whether working in Intensive Care Units or not and if detected, alternative treatment should be used which will result in appropriate use of this antibiotic for decolonization.

scholarly journals High diversity of vancomycin-resistant Enterococcus faecium isolated in Southern Brazil

2019 ◽  
Author(s):  
Renata O Soares ◽  
Gabriela R Cunha ◽  
Vinicius P Perez ◽  
Jussara L Siqueira ◽  
Gustavo E Sambrano ◽  
...  
Keyword(s):  
Profile Analysis ◽  
Southern Brazil ◽  
Porto Alegre ◽  
Vancomycin Resistant Enterococci ◽  
Antimicrobial Susceptibility Profile ◽  
Vancomycin Resistant ◽  
Clonal Spread ◽  
High Level ◽  
Relationship Of ◽  
Level Resistance

Background. Vancomycin-resistant enterococci (VRE) are common in some hospital settings and their clonal spread has been described in different regions of the world. We determined the antimicrobial susceptibility profile and the clonal relationship of VRE isolates recovered from inpatients at three general hospitals of Porto Alegre, Brazil. Results. Ninety-four VRE were characterized as Enterococcus faecium and exhibited resistance to teicoplanin, ampicillin, ciprofloxacin, and susceptibility to linezolid, quinupristin-dalfopristin and daptomycin. High level resistance to gentamicin was detected in 13.8% of them. All VREfm harbored vanA gene, while 85.1% and 94.7% harbored respectively esp and acm virulence genes. PFGE profile analysis revealed 23 clonal types including 79 isolates, while 15 isolates exhibited unique pattern type, showing a polyclonal distribution of VREfm in Southern Brazil. Conclusion. These findings contribute to the local understanding regarding the characteristics of the circulating VREs in the region.

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