Multidrug-resistant clones of community-associated meticillin-resistant Staphylococcus aureus isolated from Chinese children and the resistance genes to clindamycin and mupirocin

Abstract

This study aimed to correlate the multidrug resistance (MDR) and sequence type (ST) clones of community-associated (CA) meticillin-resistant Staphylococcus aureus (MRSA) to identify the genes responsible for clindamycin and mupirocin resistance in S. aureus isolates from paediatric hospitals in mainland China. A total of 435 S. aureus isolates were collected. Compared with CA meticillinsusceptible S. aureus (MSSA), the resistance rates of CA-MRSA to ciprofloxacin, chloramphenicol, gentamicin and tetracycline were higher (19.0 vs 2.6 %, P,0.001; 14.7 vs 3.1 %, P,0.001; 14.7 vs 3.1 %, P,0.01; and 46.0 vs 13.3 %, P,0.001, respectively). Compared with hospital-associated (HA)-MRSA, the resistance rates of CA-MRSA to ciprofloxacin, gentamicin, rifampicin, tetracycline and trimethoprim-sulfamethoxazole were lower (19 vs 94.8 %, P,0.001; 14.7 vs 84.4 %, P,0.001; 5.5 vs 88.3 %, P,0.001; 46 vs 94.8 %, P,0.001; and 1.8 vs 9.1 %, P,0.01, respectively). The resistance rates of CA-MRSA, HA-MRSA and CA-MSSA to clindamycin (92.0, 77.9 and 64.1 %, respectively) and erythromycin (85.9, 77.9 and 63.1 %, respectively) were high. The MDR rates (resistance to three or more non-b-lactams) were 49.6, 100 and 14 % in the CA-MRSA, HA-MRSA and CA-MSSA isolates, respectively. Five of seven ST clones in the CA-MRSA isolates, namely ST59, ST338, ST45, ST910 and ST965, had MDR rates of .50 % (67.9, 87.5, 100, 50 and 83.3 %, respectively). The constitutive phenotype of macrolide-lincosamide-streptogramin B (MLS B ) resistance (69 %) and the ermB gene (38.1 %) predominated among the MLS B -resistant CA S. aureus strains. The resistance rate to mupirocin was 2.3 % and plasmids carrying the mupA gene varied in size between 23 and 54.2 kb in six strains with high-level resistance as determined by Southern blot analysis. The present study showed that resistance to non-b-lactams, especially to clindamycin, is high in CA-MRSA isolates from Chinese children and that the profile of resistance is related to clonal type. This study revealed distinctive patterns of MLS B -resistant genes among CA S. aureus isolates.

Molecular and Clinical Characteristics of Clonal Complex 59 Methicillin-Resistant Staphylococcus aureus Infections in Mainland China

“…Plasmid of 23.4 kb to 50 kb was the most common which accounted for 90.6%. Previously we showed that the position of mup A gene in high level mupirocin resistant MRSA was present in the plasmid of 23.4 kb to 50 kb [52]. Further studies are needed to explain the relationship between antibiotic resistant genes and plasmids.…”

Molecular Epidemiology and Antibiotic Resistance Profiles of Methicillin-Resistant Staphylococcus aureus Strains in a Tertiary Hospital in China

“…In addition, the ST59 isolates had less antibiotic resistance than ST239 and ST5 isolates. Clones harboring SCC mec IV or V and carrying PVL are usually reported in the context of community-onset infections, and ST59 is known to be the most common CA-MRSA clone among Chinese children (Geng et al, 2010; Wang et al, 2012). In Hong Kong and Taiwan, CA-MRSA clones, including ST59, have spread to hospital settings (Song et al, 2011).…”

Could chloramphenicol be used against ESKAPE pathogens? A review ofin vitrodata in the literature from the 21st century

“…Indeed, Livermore et al recently reported that the susceptibility to chloramphenicol among 20 carbapenemase-producing Enterobacter strains was only 20% [7]. According to this observation, we could speculate that the Enterobacter phenotype is similar to that of K. pneumoniae, where resistance to [60] 2009 Pakistan 501 KB 90 [61] 2010 Pakistan 139 KB 93 [62] 2010 India 69 KB 60 [63] 2010 USA 21 MicroScan 91 [64] 2010 Pakistan 174 KB; E-test 7 [65] 2011 Greece 44 KB 70 [66] 2011 USA 170 -96 [67] 2011 Canada 51 Sensititre 98 [68] 2011 Iran 140 KB 100 [69] 2011 Libya 62 KB 61 [70] 2011 Nigeria 16 KB 0 [71] 2012 Turkey 34 -94 [72] 2012 Nigeria 46 KB 20 [73] 2012 Spain 204 KB 99 [74] 2012 India 135 KB 94 [75] 2012 Brazil 1998 (Y): 48 KB 4 [76] 2008 (Y): 56 70 2012 USA 270 -100 [77] 2012 China 163 CA -85 [78] 77 HA 87 † All the strains belonged to a single clone. ‡…”