Prevalence and Clinical Characteristics of Mupirocin-Resistant Staphylococcus aureus

A-jin Lee; Hun-Suk Suh; Chang-Ho Jeon; Sang-Gyung Kim

doi:10.5145/KJCM.2011.14.1.18

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Lee, Suh, Jeon, and Kim: Prevalence and Clinical Characteristics of Mupirocin-Resistant Staphylococcus aureus

Original Article

Korean J Clin Microbiol 2011;14(1):18-23.

Published online: 21 March 2011

DOI: https://doi.org/10.5145/KJCM.2011.14.1.18

Prevalence and Clinical Characteristics of Mupirocin-Resistant Staphylococcus aureus

A-jin Lee, Hun-Suk Suh, Chang-Ho Jeon, Sang-Gyung Kim

Department of Laboratory Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea

Correspondence: Hun-Suk Suh, Department of Laboratory Medicine, Catholic University of Daegu School of Medicine, 3056-6 Daemyeong 4-dong, Nam-gu, Daegu 705-718, Korea. (Tel) 82-53-650-4143, (Fax) 82-53-653-8672, (E-mail) hssuh@cu.ac.kr

Received 4 May 2010 Revised 28 June 2010 Accepted 20 July 2010

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

Background

Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a known risk factor for nosocomialtransmission and infection. In an effort to mitigate this problem, topical mupirocin has been widely used for clearing nasal carriage of MRSA. However, mupirocin resistance has become a worldwide concern due to increased use of the antibiotic. The aims of this study were to evaluate the clinical characteristics and prevalence of mupirocin resistance among clinical isolates of staphylococci and to investigate antimicrobial susceptibility.

Methods

A total of 175 S. aureus specimens recovered over a 4-month period from various body sites were tested for resistance to mupirocin and other antibiotics using the Vitek2 automated system. The presence of the mupA gene was assessed in isolates exhibiting resistance to mupirocin and in other selected organisms. The clinical characteristics of the isolates were also reviewed.

Results

Of the 175 S. aureus isolates, 9.1% (16/175) were resistant to mupirocin, with 1.7% (3/175) having high-level resistance (HR) and 7.4% (13/175) having low-level resistance (LR). Patients with HR-mupirocin-resistant S. aureus had a longer duration of hospitalization (P=0.026). Of the 13 LR-mupirocin-resistant S. aureus strains, 11 had identical antibiogram patterns. The mupA gene was detected only among HR isolates.

Conclusion

The rate of mupirocin resistance in the S. aureus isolates was high. The spread of mupirocin-resistant S. aureus may be due to nosocomial infection.

Keywords: Mupirocin, Staphylococcus aureus, Drug resistance

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Fig. 1.

Bands of mupA gene in 3 high-level resistance of mupirocin. Lane 1, patient No. 162; Lane 2, patient No. 192; Lane 3, patient No. 195; Lane 4, PCR size marker.

Table 1.

Distribution of mupirocin MICs among 175 strains of Staphylococcus aureus

Mupirocin resistance	MIC (μg/mL)	No. of isolate (%)
Susceptible	＜2	150 (85.7)
	4	9 (5.1)
Low-level resistant	64	13 (7.4)
High-level resistant	≥512	3 (1.7)
Total		175 (100)

Abbreviation: MIC, minimal inhibitory concentration.

Table 2.

Clinical characteristics of 175 strains of Staphylococcus aureus

		Mupirocin susceptible (N=159)	Mupirocin LR (N=13)	Mupirocin HR (N=3)
Hospital stay, median days (range)		6 (1∼1,670)	6 (2∼60)	55 (24∼222)
Specimens, N (%)
Sputum	69 (39.4)	59 (85.5)	9 (13.0)	1 (1.4)
Urine	17 (9.7)	17 (100.0)	0 (0.0)	0 (0.0)
Blood	30 (17.1)	28 (93.3)	1 (3.3)	1 (3.3)
Wound	38 (21.7)	35 (92.1)	2 (5.3)	1 (2.6)
Others	21 (12.0)	20 (95.2)	1 (4.8)	0 (0.0)
Total	175 (100.0)	159 (90.9)	13 (7.4)	3 (1.7)
Place, N (%)
ICU	48 (27.4)	44 (91.7)	3 (6.2)	1 (2.1)
GW	95 (54.3)	84 (88.4)	9 (9.5)	2 (2.1)
OPD	11 (6.3)	11 (100.0)	0 (0.0)	0 (0.0)
ED	21 (12.0)	20 (95.2)	1 (7.7)	0 (0.0)
Total	175 (100.0)	159 (90.9)	13 (7.4)	3 (1.7)

Abbreviations: LR, low-level resistant; HR, high-level resistant; ICU, intensive care unit; GW, general ward; OPD, outpatient department; ED, emergency department.

Table 3.

Antimicrobial resistance profile of 108 MRSA strain

Antimicrobial	No. (%)
Ciprofloxacin	88 (81.5)
Clindamycin	95 (87.9)
Erythromycin	96 (88.9)
Fusidic acid	74 (68.5)
Nitrofurantoin	6 (5.6)
Gentamicin	89 (82.4)
Arbekacin	0 (0.0)
Linezolid	0 (0.0)
Penicillin G	108 (100)
Quinupristin-Dafopristin	0 (0.0)
Rifampin	7 (6.5)
Teicoplanin	0 (0.0)
Tetracycline	92 (85.2)
Trimethoprim-sulfamethoxazole	9 (8.3)
Telithromycin	87 (80.6)
Tigecycline	0 (0.0)
Vancomycin	0 (0.0)

Table 4.

Epidemiologic and clinical features of the sixteen mupirocin-resistant Staphylococcus aureus

No.	MR	Antibiogram^∗	Specimen	Place	Hospita stay (days)	Primary diagnosis
4	HR	LQVT	Blood	ICU	222	COPD
8	LR	LQRTsVT	Sputum	GW	6	COPD
10	LR	LQRTsVT	Ascitic fluid	GW	24	Duodenal ulcer
15	LR	GLQRTsVT	Sputum	ICU	5	SAH
55	LR	LQRTsVT	Sputum	ED	2	COPD
65	LR	LQRTsVT	Sputum	GW	30	Gangrene of toe
66	LR	LQRTsVT	Wound	GW	2	Sacral sore
79	LR	LQRTsVT	Sputum	GW	4	ESRD
92	LR	LQVT	Sputum	GW	9	Pneumothorax
99	LR	LQRTsVT	Sputum	GW	60	Aplastic anemia
100	LR	LQRTsVT	Sputum	ICU	4	Septic shock
106	LR	LQRTsVT	Blood	GW	4	ESRD
107	HR	CLQRTsV	T Wound	GW	24	Sacral sore
109	HR	CiCELQRTs TeVT	Sputum	GW	55	SAH
153	LR	LQRTsVT	Wound	GW	35	Open wound of ankle and foot
169	LR	LQRTsVT	Sputum	ICU	23	Spine fracture

^∗ Type of antibiogram: LQVT (susceptible to linezolid, quinupristin-dafopristin, vancomycin, teicoplanin), LQRTsVT (susceptible to linezolid, quinupristin-dafopristin, rifampin, trimethoprim-sulfamethoxazole, vancomycin, teicoplanin), GLQRTsVT (susceptible to gentamicin, linezolid, quinupristin-dafopristin, rifampin, trimethoprim-sulfamethoxazole, vancomycin, teicoplanin), CiCELQRTsTeVT (susceptible to ciprofloxacin, clindamycin, erythromycin, linezolid, quinupristin-dafopristin, rifampin, trimethoprim-sulfamethoxazole, tetracycline, vancomycin, teicoplanin).

Abbreviations: MR, mupirocin resistance; LR, low-level resistant, HR, high-level resistant; ICU, intensive care unit; GW, general word; ED, emergency department; COPD, chronic obstructive pulmonary disease; SAH, subarachnoidal hemorrhage; ESRD, end-stage renal disease.

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