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Kwak, Kwon, Jeong, Kang, Cheun, Lee, Kim, Choi, Na, Kwon, and Son: Molecular Epidemiology and Antimicrobial Resistance of Methicillin-resistant Staphylococcus aureus Isolated from Nasal Swab at Intensive Care Unit
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 65(2): 91-98.

Published online: 31 August 2008

DOI: https://doi.org/10.4046/trd.2008.65.2.91

Molecular Epidemiology and Antimicrobial Resistance of Methicillin-resistant Staphylococcus aureus Isolated from Nasal Swab at Intensive Care Unit

Om Sub Kwak, M.D.1, Mee Hye Kwon, M.D.1, Ji Hyun Jeong, M.D.1, Mi-il Kang, M.D.1, Ji Young Cheun, M.D.1, Go Eun Lee, M.D.1, Young Keun Kim, M.D.1, Eu Gene Choi, M.D.1, Moon Jun Na, M.D.1, Hee Uk Kwon, M.D.2, Ji Woong Son, M.D.1

1Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea.

2Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.

Address for correspondence: Ji Woong Son, M.D. Department of Internal Medicine, College of Medicine, Konyang University, 685, Gasuwon-dong, Seo-gu, Daejeon 302-718, Korea. Phone: 82-42-600-9100, Fax: 82-42-545-9103, sk1609@hanmail.net

Received 12 March 2008       Accepted 18 June 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is the most common organism associated with nosocomial infections. MRSA infections are becoming increasing important because they have emerged no only as healthcare-associated (HA) infections but also as community-associated (CA) ones. This study examined the moleculo-epidemiology of MRSA, which was isolated from nasal swabs in the intensive care unit (ICU) at Konyang University Hospital. MRSA are classified into HA-MRSA and CA-MRSA.

Methods

From June to September 2006, 353 patients who were admitted to the ICU in Konyang University Hospital were enrolled in this study. Single nasal swabs were obtained for culture in the ICU on the 1st day. Pulsed-field gel electrophoresis and the antimicrobial resistant patterns were analyzed between HA- and CA-MRSA. An antimicrobial sensitivity test was also performed.

Results

Forty two strains of MRSA were isolated from 353 patients (11.9%). Among the 42 isolates, HA-MRSA and CA-MRSA were found in 33 (78.6%), and 9 (21.4%), respectively. Eleven different PFGE types (type A to K) were identified. Types A (n=9) and B (n=7) were the most common for HA-MRSA, and types A (n=2) and B (n=2) were identified in CA-MRSA. The proportion of types A and B in CA-MRSA (44.4%) was similar to that in HA-MRSA (48.5%). The rates of resistance rates to erythromycin and ciprofloxacin were higher in HA-MRSA than in CA-MRSA.

Conclusion

The rate of isolation of MRSA in an ICU setting was 11.9%. HA-MRSA was isolated more frequently than CA-MRSA. The rate of resistance of HA-MRSA to erythromycin and ciprofloxacin was higher than that of CA-MRSA. Despite the small number of subjects, the main isolates (type A and B) of CA-MRSA were similar to those of HA-MRSA.

Keywords: Methicillin-resistance, Staphylococcus aureus, Pulsed-field gel electrophoresis

Figures and Tables

Figure 1
Classification of 42 MRSA isolates at Konyang University Hospital. IR: isolates rate.
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Figure 2
PFGE image of MRSA strains with enzyme SmaI-macrorestriction. Lane 1, type D; lane 2, 4, 5, 7, type A; lane 3, type C; lane 6, type I; lane 9, type H.
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Figure 3
Prevalence according to PFGE types of CA-MRSA and HA-MRSA.
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Table 1
Clinical characteristics of patients with CA-MRSA and HA-MRSA
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Data are numbers (%) of patients unless stated otherwise.

Table 2
Healthcare-associated risk factors for acquisition of MRSA
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Data are numbers (%) of patients unless stated otherwise.

Table 3
Antimicrobial resistance rates between CA-MRSA and HA-MRSA
trd-65-91-i003

Data are numbers (%) of patients unless stated otherwise.

*trimethoprim-sulfamethoxazole.

Table 4
Antimicrobial resistance rates between PFGE types (Except type C, D, E, F, G, J and K because number of each type is less than 3)
trd-65-91-i004

Data are numbers (%) of patients unless stated otherwise.

*trimethoprim-sulfamethoxazole.

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