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Kim, Park, and Park: Isolation and Antimicrobial Susceptibility of Mupirocin-Resistant and Methicillin-Resistant Staphylococcus aureus from Clinical Samples
Original Article

J Bacteriol Virol 2011;41(4):279-286.

Published online: 9 February 2011

DOI: https://doi.org/10.4167/jbv.2011.41.4.279

Isolation and Antimicrobial Susceptibility of Mupirocin-Resistant and Methicillin-Resistant Staphylococcus aureus from Clinical Samples

Shin-Moo Kim1, *, Se-Young Park2, Seok-Don Park2, 3

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

2Department of the Dermatology, Wonkwang University School of Medicine, Iksan, Korea

3Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea

*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 research fund from Wonkwang Health Science University, 2011.

Received 1 November 20112 December 2011       Accepted 14 December 2011

Copyright © 2011 Journal of Bacteriology and Virology

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

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.

Keywords: Antimicrobial susceptibility, Mupirocin-resistant MRSA, mupA gene

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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
Table 1.
Mupirocin-resistant MRSA isolates detected in three Korean hospitals
Hospital No. of MRSA isolates tested No.(%) of mupirocin-resistant isolates
High-level/low-level Total
A university 115 2/7 (1.7/6.0) 9 (7.8)
B university 30 1/2 (3.3/6.7) 3 (10.0)
C university 30 0 (0) 0 (0)
Total 175 3/9 (1.7/5.1) 12 (6.9)
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

a HL MUP-R MRSA, high-level mupirocin-resistant MRSA; LL MUP-R MRSA, low-level mupirocin-resistant MRSA.

b No. of isolates tested.

c S, susceptible; I, intermediate; R, resistant.

Table 3.
MICs of high- and low-level mupirocin-resistant MRSA isolates against antimicrobial agents
Level of MUP-R (No. tested) Antimicrobial agents MIC (μg/ml)
 Resistance (%)
Range MIC50 MIC90
Low level (n = 9) Ciprofloxacin 128 ∼ ≥128 128 ≥128 100
Clindamycin ≥128 ≥128 ≥128 100
Erythromycin ≥128 ≥128 ≥128 100
Fusidic acid ≤0.25 ∼ ≥128 ≥128 ≥128 89
Mupirocin 64 ∼ 128 64 128 100
Rifampin ≤0.5 ≤0.5 ≤0.5 0
Tetracycline ≤0.5 ∼ 64 64 64 67
Vancomycin 1 1 1 0
High level (n = 3) Ciprofloxacin 128 ∼ ≥128 128 ≥128 100
Clindamycin ≥128 ≥128 ≥128 100
Erythromycin ≥128 ≥128 ≥128 100
Fusidic acid ≤0.25 ∼ ≥64 ≤0.25 ≥64 33
Mupirocin ≥1,024 ≥1,024 ≥1,024 100
Rifampin ≤0.5 ≤0.5 ≤0.5 0
Tetracycline ≤ 0.5 ∼ 64 64 64 78
Vancomycin 0.5 ∼ 1 1 1 0
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