Abstract
Resistance to mupirocin in methicillin-resistant Staphylococcus aureus (MRSA) have increased with wide use of mupirocin in many countries, but the prevalence in Korea is not well-known. The aim of this study was to determine the prevalence, antimicrobial susceptibility, and clonality of mupirocin-resistant (MUP-R) isolates from three Korean hospitals. A total of 175 MRSA isolates were collected from three university hospitals in 2009–2010. Antimicrobial susceptibility was tested by the disk diffusion and the agar dilution methods. femA, mecA and mupA genes were detected by polymerase chain reactions. Pulsed-filed gel electrophoresis (PFGE) pattern of genomic DNA was determined after digestion with SmaI. Overall, 12 among the 175 MRSA isolates were resistant to mupirocin, with prevalence ranging from 0 to 10% depending on hospitals. Three high-level (HL) and nine low-level (LL) MUR-R isolates were obtained from two hospitals. All MUP-R isolates were susceptible to rifampin and vancomycin, but were resistant to ciprofloxacin, clindamycin, and erythromycin. Eight LL and one HL MUP-R isolates were also resistant to fusidic acid. PFGE analysis showed three HL MUP-R isolates belonged to arbitrary cluster 3, 5 and 6 with 60∼90% similarity compared to LL MUP-R isolates. In conclusion, the HL resistance to mupirocin was detected in two hospitals, but HL MUP-R isolates were clonally not related.
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Figure 1.
A dendrogram generated with Fingerprinting II informatix software showing the PFGE types (1–6) of SmaI-restricted chromosome DNA of 12 mupirocin-resistant MRSA isolates. No. 03, 07, and 08 isolates with high-level resistance to mupirocin; No. 01∼02, 4∼6, 9∼12 isolates with low-level resistance to mupirocin.
![jbv-41-279f1.tif](/upload/SynapseXML/0079jbv/thumb/jbv-41-279f1.gif)
Table 1.
Mupirocin-resistant MRSA isolates detected in three Korean hospitals
Table 2.
Antimicrobial susceptibility of high- and low-level mupirocin-resistant MRSA isolates determined by disk diffusion
Antimicrobial agents |
HL MUP-R MRSAa (n = 3)b |
LL MUP-R MRSA (n = 9) | ||||
---|---|---|---|---|---|---|
Sc | I | R | S | I | R | |
Amikacin | 0 | 33 | 67 | 33 | 11 | 56 |
Gentamicin | 0 | 0 | 100 | 22 | 0 | 78 |
Tobramycin | 0 | 0 | 100 | 22 | 0 | 78 |
Chloramphenicol | 100 | 0 | 0 | 100 | 0 | 0 |
Ciprofloxacin | 0 | 0 | 100 | 0 | 0 | 100 |
Clindamycin | 0 | 0 | 100 | 0 | 0 | 100 |
Erythromycin | 0 | 0 | 100 | 0 | 0 | 100 |
Mupirocin | 0 | 0 | 100 | 0 | 0 | 100 |
Tetracycline | 33 | 0 | 67 | 11 | 0 | 89 |
Vancomycin | 100 | 0 | 0 | 100 | 0 | 0 |
Table 3.
MICs of high- and low-level mupirocin-resistant MRSA isolates against antimicrobial agents