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Kim, Lee, Park, Kim, Kim, Choi, Park, Hwang, Shin, Shim, Kwon, Kwon, Hur, Kim, Lim, and Chong: Genotype, Coagulase Type and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolated from Dermatology Patients and Healthy Individuals in Korea
Original Article

J Bacteriol Virol 2009;39(4):307-316.

Published online: 18 January 2009

DOI: https://doi.org/10.4167/jbv.2009.39.4.307

Genotype, Coagulase Type and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolated from Dermatology Patients and Healthy Individuals in Korea

Shin-Moo Kim∗, 1, ∗, Dong-Cho Lee2, Seok-Don Park†, 2, Bo-Suk Kim2, Jin-Kyung Kim3, Mi-Rae Choi1, Se-Young Park2, Soo-Myung Hwang4, Na-Young Shin5, Eun-Sook Shim1, Pil-Seung Kwon1, Dong-Yeul Kwon6, Sung-Ho Hur7, Ho-Jun Kim8, Hyo-Bin Lim9, Yunsop Chong10

1Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan, Korea

2Department of the Dermatology, Wonkwang University Hospital, Iksan, Korea

3Vestibulocochlear Research Center & Department of Microbiology, College of Medicine, Wonkwang University, Iksan, Korea

4Department of Clinical Laboratory Science, Catholic University of Pusan, Busan, Korea

5Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, The Catholic University of Korea, Seoul, Korea

6College of Pharmacy and Wonkwang-Oriental Medicines Research Institute, Wonkwang University, Iksan, Korea

7Department of Clinical Laboratory Science, Dong-eui Institute of Technology University, Busan, Korea

8Department of Biology, Sunchon National University, Sunchon, Korea

9Division of Life-Environment, College of Life Science and Natural Resources, Wonkwang University, Iksan, Korea

10Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea

†Co-corresponding author: Seok-Don Park. Department of Dermatology, Wonkwang University Hospital, Iksan 570-711, Korea. Phone: +82-63-850-1601, Fax: +82-63-842-1895, e-mail: sdpark@wonkwang.ac.kr

∗Corresponding author: Shin-Moo Kim. Department of Clinical Laboratory Science. Wonkwang Health Science University, Iksan 570-750, Korea. Phone: +82-63-840-1211, Fax: +82-63-840-1211, e-mail: smkim1211@hanmail.net

∗∗ This study was supported by a research fund from Wonkwang Health Science University, 2009.

      Revised 7 October 200920 October 2009       Accepted 4 November 2009

Copyright © 2009 Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent dermatology pathogens in hospitals and increasingly recognized in communities. We determined PFGE pattern of SmaI-restricted genomic DNA, coagulase type, and antimicrobial susceptibility of MRSA isolated in 2008 from dermatology inpatients and healthy hospital employees in A Hospital and from primary school children in Iksan city, Korea. Overall, the isolation rate of MRSA was 3.8% from the 788 normal persons: 4.9% from hospital employees and 1.1% from primary school children. MRSA was isolated in six of 13 (46.2%) family members of four school children with MRSA. The most prevalent coagulase serotype was II from patients and V from healthy individuals. Ten of twenty and six of twenty MRSA isolates from patients and from healthy personnel, respectively, had identical PFGE patterns, suggesting that these are originated from identical clones. Against MRSA from patients, only vancomycin was the most active (MIC range ≤2 μg/ml), whereas the resistance rates were 35% to rifampin and 65% to mupirocin. The resistance rates of patient isolates were ≥90% to amikacin, clindamycin, ciprofloxacin, erythromycin, fusidic acid, gentamicin and tetracycline. In conclusion, the MRSA carriage rates of healthy hospital workers were relatively high, 2.3~7.7%, depending on groups. Family members of a few primary school children with MRSA showed a high carriage rate, suggesting that intrafamily transmission occurred. MRSAs isolated from dermatology inpatients were relatively more resistant to various antimicrobial agents, including mupirocin, but all isolates were susceptibility to vancomycin.

Keywords: Genotype, Coagulase type, MRSA, Antimicrobial susceptibility

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Figure 1.
PFGE dendrogram of SmaI-restricted DNA of MRSA isolates from dermatology patients and healthy persons. PFGE banding patterns were analyzed using the Dice coefficient and the unweighted pair group method with arithmetic averages (UPGMA). The coagulase type and presence of mecA gene are also shown.
jbv-39-307f1.tif
Table 1.
Isolation rates of MRSA from nasal swab of healthy individuals
Subject No. of specimens cultured No. (%) of specimen MRSA positive
A Hospital worker    
Doctor 65 5 (7.7)
Nurse 210 12 (5.7)
Non-medical personnel 128 3 (2.3)
Primary school pupil 372 4 (1.1)
Family membera 13 6 (46.2)
Total 788 30 (3.8)

a Member of four pupils with MRSA

Table 2.
Distribution of coagulase serotypes of MRSA strains isolated from dermatology patients and healthy individuals
Source (No. tested) No. (%) of isolates with coagulase serotypes
I II III IV V VI VII VIII NTa
Dermatology patients (30) 0 22 (73) 0 4 (13) 3 (11) 0 1 (3) 0 0
Healthy individuals (30) 1 (3) 2 (7) 0 0 17 (57) 0 8 (26) 0 2 (7)
Total (60) 1 (2) 24 (40) 0 4 (7) 20 (33) 0 9 (15) 0 2 (3)

a NT, not typable

Table 3.
Antimicrobial susceptibility of MRSA isolates determined by the CLSI disk diffusion test
Antimicrobial agents % of MRSA isolates from
Patients (n = 20)a Healthy individuals (n = 20)
Sb I R S I R
Amikacin 0 0 100 20 50 30
Chloramphenicol 90 0 10 100 0 0
Ciprofloxacin 0 0 100 90 0 10
Clindamycin 5 0 95 90 5 5
Erythromycin 5 0 95 35 20 45
Gentamicin 5 0 95 50 10 40
Mupirocin 35 0 65 100 0 0
Tetracycline 0 0 100 65 0 35
Tobramycin 5 0 95 10 5 85
Vancomycin 100 0 0 100 0 0
Cotrimoxazole 85 0 15 95 0 5

a No. of isolates tested.

b S, susceptible; I, intermediate; R, resistant

Table 4.
Antimicrobial susceptibilities of MRSA isolated from dermatology patients and healthy individuals determined by the CLSI agar dilution method
Source of MRSA (No. tested) Antimicrobial agents MIC (μg/ml) % Resistant
Range 50% 90%
Patient (n = 20) Ciprofloxacin 16~128 32 64 100
  Clindamycin ≤0.5~≥128 ≥128 ≥128 95
  Erythromycin ≥128 ≥128 ≥128 100
  Fusidic acid 0.125~≥64 ≥64 ≥64 90
  Gentamicin 1~≥128 128 ≥128 95
  Mupirocin 0.125~32 16 16 65
  Rifampin ≤0.5~4 1 4 35
  Tetracycline 6 4 ~≥128 64 64 100
  Vancomycin 2 2 2 0
Healthy individua (n = 20) Ciprofloxacin ≤0.5~128 ≤0.5 ≤0.5 10
  Clindamycin ≤0.5~≥128 ≤0.5 ≤0.5 5
  Erythromycin ≤0.5~64 ≤0.5 64 50
  Fusidic acid 0.06~≥64 0.06 32 15
  Gentamicin ≤0.5~≥128 4 ≥128 50
  Mupirocin 0.125~0.25 0.125 0.25 0
  Rifampin ≤0.5 ≤0.5 ≤0.5 0
  Te t ra cy c li n e ≤0.5~64 ≤0.5 32 35
  Vancomycin 0.125~2 0.5 2 0
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