Mupirocin-Resistant Staphylococcus aureus in Iran: A Biofilm Production and Genetic Characteristics

The spread of mupirocin-resistant Staphylococcus aureus strains in hospitals and communities is a universal challenge. Limited data is available on the genetic features of high-level mupirocin resistant- (HLMUPR-) S. aureus isolates in Tehran. In the present research, we investigated 48 high-level mupirocin resistance S. aureus by antimicrobial activity, virulence analysis, biofilm formation, multilocus sequence typing (MLST), and staphylocoagulase (SC) typing. All the HLMUPR strains were positive for mupA gene. The frequency of multidrug resistance was 97.9%. Twenty-one (43.8%) were toxinogenic with 14 producing pvl (29.2%), 5 tst (10.4%), and two eta (4.2%). Among the HLMUPR isolates, biofilm production was detected in 45 (89.6%) isolates with complete dominance clfB, clfA genes, and a noticeably high frequency fnbA (95.8%), followed by fnbB (93.8%), eno and icaD (each 83.3%), sdrC (81.3%), ebps (79.2%), icaA (75%), sdrD (66.7%), fib (60.4%), sdrE (50%), cna (41.7%), and bap (4.2%). Coagulase typing distinguished isolates into four genotypic patterns including III (50%), II (27.1%), and type IVa (22.9%). A total of three clonal complexes (CCs) and 4 sequence types (STs) including CC/ST22 as the most prevalent (52.1%), CC8/ST239 (20.8%), CC/ST8 (16.7%), and CC/ST5 (10.4%) were identified in current work. According to our analysis, nonbiofilm producer isolates belonged to CC8/ST239 (6.3%) and CC/ST8 (4.2%). Fusidic acid-resistant isolates belonged to CC/ST45 ( n = 3 ) and CC8/ST239 ( n = 1 ). Observations highlighted the circulation of the CC/ST22 HLMUPR S. aureus strains with strong biofilm-production ability in our hospitals, indicating the possibility of transmission of this type between community and hospital.

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Prevalence of Chlorhexidine-Resistant Methicillin-Resistant Staphylococcus aureus following Prolonged Exposure

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02419-14 ◽

2014 ◽

Vol 58 (8) ◽

pp. 4404-4410 ◽

Cited By ~ 32

Author(s):

Carey D. Schlett ◽

Eugene V. Millar ◽

Katrina B. Crawford ◽

Tianyuan Cui ◽

Jeffrey B. Lanier ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Molecular Analysis ◽

Prolonged Exposure ◽

Controlled Trial ◽

Epidemiological Data ◽

Methicillin Resistant ◽

Content Type ◽

Mupirocin Resistance ◽

High Level ◽

Study Participants

ABSTRACTChlorhexidine has been increasingly utilized in outpatient settings to control methicillin-resistantStaphylococcus aureus(MRSA) outbreaks and as a component of programs for MRSA decolonization and prevention of skin and soft-tissue infections (SSTIs). The objective of this study was to determine the prevalence of chlorhexidine resistance in clinical and colonizing MRSA isolates obtained in the context of a community-based cluster-randomized controlled trial for SSTI prevention, during which 10,030 soldiers were issued chlorhexidine for body washing. We obtained epidemiological data on study participants and performed molecular analysis of MRSA isolates, including PCR assays for determinants of chlorhexidine resistance and high-level mupirocin resistance and pulsed-field gel electrophoresis (PFGE). During the study period, May 2010 to January 2012, we identified 720 MRSA isolates, of which 615 (85.4%) were available for molecular analysis, i.e., 341 clinical and 274 colonizing isolates. Overall, only 10 (1.6%) of 615 isolates were chlorhexidine resistant, including three from the chlorhexidine group and seven from nonchlorhexidine groups (P> 0.99). Five (1.5%) of the 341 clinical isolates and five (1.8%) of the 274 colonizing isolates harbored chlorhexidine resistance genes, and four (40%) of the 10 possessed genetic determinants for mupirocin resistance. All chlorhexidine-resistant isolates were USA300. The overall prevalence of chlorhexidine resistance in MRSA isolates obtained from our study participants was low. We found no association between extended chlorhexidine use and the prevalence of chlorhexidine-resistant MRSA isolates; however, continued surveillance is warranted, as this agent continues to be utilized for infection control and prevention efforts.

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Prevalence of clinical meticillin-resistant Staphylococcus aureus (MRSA) with high-level mupirocin resistance in Shanghai and Wenzhou, China

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2009.09.018 ◽

2010 ◽

Vol 35 (2) ◽

pp. 114-118 ◽

Cited By ~ 26

Author(s):

Qing-Zhong Liu ◽

Qiong Wu ◽

Yi-Bo Zhang ◽

Mei-Na Liu ◽

Fu-Pin Hu ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Mupirocin Resistance ◽

High Level

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Emerging high-level mupirocin resistance among MRSA isolates in Ireland

Eurosurveillance ◽

10.2807/ese.13.14.08084-en ◽

2008 ◽

Vol 13 (14) ◽

pp. 1-2

Author(s):

Angela Rossney ◽

S O'Connell

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Blood Stream ◽

Reference Laboratory ◽

Methicillin Resistant ◽

Mupirocin Resistance ◽

High Level

High-level mupirocin resistance was detected among 37 of 2,586 (1.4%) methicillin-resistant Staphylococcus aureus (MRSA) blood-stream isolates sent to the Ireland's National MRSA Reference Laboratory between 1 January 1999 and 31 December 2005, compared with 29 of 997 isolates (2.9%) sent between 1 January 2006 and 31 December 2007.

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Evaluation of mupA EVIGENE Assay for Determination of High-Level Mupirocin Resistance in Staphylococcus aureus

Journal of Clinical Microbiology ◽

10.1128/jcm.00088-10 ◽

2010 ◽

Vol 48 (11) ◽

pp. 4253-4255 ◽

Cited By ~ 2

Author(s):

A. K. I. Rasmussen ◽

R. L. Skov ◽

R. A. Venezia ◽

J. K. Johnson ◽

H. Stender

Keyword(s):

Staphylococcus Aureus ◽

Mupirocin Resistance ◽

High Level

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Assessment of Mupirocin Resistance among Clinical Isolates of Methicillin Resistant Staphylococcus aureus

10.51429/ejmm30114 ◽

2021 ◽

Vol 30 (1) ◽

pp. 109-114

Author(s):

Nancy M. Attia ◽

Abeer Abd El Rahim Ghazal ◽

Omnia M. Khaleel ◽

Ahmed Gaballah

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Methicillin Resistant ◽

Mupirocin Resistance ◽

High Level ◽

Research Institute Hospital ◽

Low Prevalence ◽

Mrsa Colonization

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization is considered a major risk factor for nosocomial infections and its decolonization has reduced these infections. Mupirocin (MUP) is the topical antibiotic of choice for decolonization. MUP decolonization failure is attributed to MUP resistance. Objective: The aim of the current study is to assess MUP resistance among MRSA isolates phenotypically and genotypically. Methodology: Fifty MRSA isolates were identified in Microbiology Department in the Medical Research Institute hospital, Alexandria University. Antibiotic susceptibility to different classes of antibiotics by disk diffusion method was done. MUP minimum inhibitory concentration (MIC) was determined phenotypically by MUP Ezy MIC™ Strips. MUP resistance was determined genetically by multiplex PCR detection of mupA and mupB. Results: Of all MRSA isolates, 6% exhibited high level and none showed low level MUP resistance. Only mupA was detected in all resistant isolates. Conclusion: Despite low prevalence of MUP resistance, it is appropriate to test MUP resistance prior nasal decolonization

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Genetic analysis of high-level mupirocin resistance in the ST80 clone of community-associated meticillin-resistant Staphylococcus aureus

Journal of Medical Microbiology ◽

10.1099/jmm.0.013268-0 ◽

2010 ◽

Vol 59 (2) ◽

pp. 193-199 ◽

Cited By ~ 13

Author(s):

Edet E. Udo ◽

Eiman Sarkhoo

Keyword(s):

Staphylococcus Aureus ◽

Fusidic Acid ◽

Capsular Polysaccharide ◽

Cadmium Acetate ◽

Accessory Gene ◽

Type Iv ◽

Plasmid Profiles ◽

Plasmid Analysis ◽

Mupirocin Resistance ◽

High Level

Four community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) isolates expressing high-level mupirocin resistance (MIC >1024 mg l−1) were isolated from four sites of a diabetic patient and characterized for the genetic location of their resistance determinants and typed using PFGE, staphylococcal cassette chromosome mec (SCCmec), the coagulase gene and multilocus sequence typing to ascertain their relatedness. The presence of genes for resistance to high-level mupirocin (mupA), tetracycline (tetK) and fusidic acid (far1), Panton–Valentine leukocidin (PVL), accessory gene regulators (agr) and capsular polysaccharide (cap) were detected in PCR assays. The isolates were resistant to kanamycin, streptomycin, tetracycline, fusidic acid and cadmium acetate, and harboured mupA, tetK, far1, PVL, agr3 and cap8. They had identical PFGE patterns and coagulase gene type, possessed the type IV SCCmec element and belonged to sequence type 80 (ST80). However, they had three different plasmid profiles: (i) 28.0 and 26.0 kb; (ii) 28.0, 21.0 and 4.0 kb; and (iii) 41.0 and 4.0 kb. Genetic studies located the resistance to tetracycline, fusidic acid and cadmium acetate on the 28 kb plasmid and mupA on the related non-conjugative 26 and 21 kb plasmids. One of the 21 kb mupirocin-resistance plasmids was derived from the ∼41 kb plasmid during transfer experiments. The emergence of high-level mupirocin resistance in the ST80-SCCmec IV MRSA clone demonstrates the increasing capacity of CA-MRSA clones to acquire resistance to multiple antibacterial agents. The presence of different plasmid profiles in genetically identical isolates creates difficulty in the interpretation of typing results and highlights the weakness of using plasmid analysis as the sole method for strain typing.

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1213. Evaluation of an Alcohol-Based Antiseptic for Nasal Decolonization of Methicillin-Resistant Staphylococcus aureus (MRSA)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1046 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S367-S368

Author(s):

Anubhav Kanwar ◽

Jennifer L Cadnum ◽

Thriveen Sankar Chittoor Mana ◽

Scott Gestrich ◽

Annette Jencson ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Limited Data ◽

Higher Alcohol ◽

Methicillin Resistant ◽

Alcohol Dose ◽

Repeated Applications ◽

Mupirocin Resistance ◽

The Mean ◽

Triple Dose

Abstract Background Due to concerns for emergence of mupirocin resistance, there is an interest in use of topical antiseptics for nasal decolonization of Staphylococcus aureus. Alcohol-based nasal antiseptics have recently been developed as an alternative to mupirocin, but there is limited data on efficacy, particularly among patients where the burden of carriage is often high. Methods We evaluated the effectiveness of a one-time application of a commercial alcohol-based nasal sanitizer for reduction in nasal methicillin-resistant Staphylococcus aureus (MRSA) in MRSA-colonized patients. Patients received either a single dose or triple dose over 3 minutes; the triple dose is recommended for preoperative dosing. Swabs were used for quantitative culture of MRSA from the anterior nares and vestibule prior to and 10 minutes, 2 hours, and 6 hours after application. For a subset of patients, cultures for MRSA were collected from hands, clothing, groin, and chest/axilla. Results Of 34 MRSA carriers enrolled, 27 (79%) had MRSA detected in nares, 32 (94%) were male, and the mean age was 65. Of the 27 carriers positive for nasal MRSA, 15 (56%) received a single alcohol dose and 12 (44%) received a triple dose over 3 minutes. As shown in the figure, the single and triple dose applications significantly reduced MRSA concentrations at 2 hours post-treatment when the initial burden was low (i.e., <2 log10colonies per swab), but there was no significant reduction at 6 hours; there was no significant reduction with either dose when the initial burden was high (≥2 log10colonies per swab). Conclusion A single application of an alcohol nasal sanitizer significantly reduced nasal MRSA at 2 hours post-application when the initial burden of colonization was low, but not when a high burden of carriage was present. Additional studies are needed to determine whether higher alcohol doses or repeated applications might result in improved efficacy. Disclosures All authors: No reported disclosures.

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

Journal of Medical Microbiology ◽

10.1099/jmm.0.46965-0 ◽

2007 ◽

Vol 56 (7) ◽

pp. 937-939 ◽

Cited By ~ 24

Author(s):

Naira Elane Moreira de Oliveira ◽

Ana Paula Couto Marques Cardozo ◽

Elizabeth de Andrade Marques ◽

Kátia Regina Netto dos Santos ◽

Marcia Giambiagi deMarval

Keyword(s):

Staphylococcus Aureus ◽

High Resistance ◽

The Other ◽

Diffusion Method ◽

Disc Diffusion ◽

Disc Diffusion Method ◽

Zone Diameter ◽

Resistant Strains ◽

Mupirocin Resistance ◽

High Level

Meticillin-resistant Staphylococcus aureus isolates were classified into three mupirocin susceptibility groups by the disc diffusion method using 5 and 200 μg mupirocin discs. The zone diameter observed for a 5 μg disc distinguished MupS from the resistant strains (either MupRL or MupRH). On the other hand, a 200 μg disc distinguished the high-resistance MupRH strains from the other two (MupS or MupRL). Thus, the concomitant use of 5 and 200 μg mupirocin discs allowed the clear distinction among the three mupirocin susceptibility groups, MupS, MupRL or MupRH.

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Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial

Journal of Clinical Microbiology ◽

10.1128/jcm.01444-16 ◽

2016 ◽

Vol 54 (11) ◽

pp. 2735-2742 ◽

Cited By ~ 45

Author(s):

Mary K. Hayden ◽

Karen Lolans ◽

Katherine Haffenreffer ◽

Taliser R. Avery ◽

Ken Kleinman ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Cluster Randomized Trial ◽

Confidence Limits ◽

Methicillin Resistant ◽

Content Type ◽

Mrsa Infection ◽

Mupirocin Resistance ◽

Cluster Randomized ◽

High Level

Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening and isolation without decolonization, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization without screening to prevent MRSA infection in intensive-care unit (ICU) patients. Isolates from the baseline and intervention periods were collected and tested for susceptibility to chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility was tested by Etest. The presence of the qacA or qacB gene was determined by PCR and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were nonsusceptible to CHG (MICs, 8 μg/ml), and 5/814 (0.6%) carried qacA or qacB . At baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and 7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized logistic regression model, the odds of mupirocin resistance among clinical MRSA isolates or MRSA isolates acquired in an ICU in intervention versus baseline periods did not differ across arms, although estimates were imprecise due to small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of mupirocin resistance were no different in the intervention versus baseline periods across arms, but the confidence limits were broad, and the results should be interpreted with caution.

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