Mupirocin for Controlling Methicillin-Resistant<i>Staphylococcus Aureus</i>: Lessons From a Decade of Use at a University Hospital

Vivoni, Adriana Marcos; Santos, Kátia Regina Netto dos; de-Oliveira, Márcia P.; Giambiagi-deMarval, Márcia; Ferreira, A.; Riley, Lee W.; Moreira, Beatriz Meurer

doi:10.1086/502599

Cited by 64 publications

(34 citation statements)

References 35 publications

(29 reference statements)

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“…S. aureus isolates were typed by PFGE after SmaI digestion as previously described (30). Banding patterns were analyzed by visual inspection and by computer-assisted analysis with GelCompar II (version 1.5) software (Applied Maths, Kortrijk, Belgium) using 0.40% optimization and 1% position tolerance.…”

Section: Methodsmentioning

confidence: 99%

Clonal Composition of Staphylococcus aureus Isolates at a Brazilian University Hospital: Identification of International Circulating Lineages

Vivoni¹,

et al. 2006

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In only a few instances has the clonal composition of Staphylococcus aureus collections that include methicillinsusceptible S. aureus (MSSA) been extensively characterized. In order to investigate the clonal composition of MSSA and methicillin-resistant S. aureus (MRSA) and examine whether the infections diagnosed at our hospital were related to internationally distributed S. aureus lineages, we collected 89 clinical S. aureus isolates from patients at a public university hospital in Rio de Janeiro, Brazil, from September 1999 to June 2000. All S. aureus isolates were genotyped by pulsed-field gel electrophoresis and multilocus restriction fragment typing (MLRFT), and a subset (n ‫؍‬ 17) was further characterized by multilocus sequence typing (MLST). The 34 MRSA isolates were additionally characterized by SCCmec typing. The MSSA population (n ‫؍‬ 55) was grouped into 18 restriction fragment types (RFTs); of these, five RFTs accounted for 67% (37) of the MSSA isolates. MRSA isolates were clustered into only three RFTs (P ‫؍‬ 0.02). The majority of MSSA RFTs were related to sequence type 30 (ST30) (12 isolates, 22%), ST1, ST188, and ST432 (6 isolates, 11% each). The predominant MRSA RFT comprised 31 (91%) of 34 isolates; four randomly selected isolates of this RFT were ST239, the previously described widely disseminated Brazilian clone. However, a fifth isolate belonging to this RFT was the ST644, a new single locus variant of ST239. By applying MLRFT and MLST, we found evidence for a clonal structure in MSSA isolates and detected the dissemination of MSSA clonal complexes 1, 5, 8, 30, and 45.

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Section: Methodsmentioning

confidence: 99%

Clonal Composition of Staphylococcus aureus Isolates at a Brazilian University Hospital: Identification of International Circulating Lineages

Vivoni¹,

et al. 2006

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“…Analysis of genetic relatedness and characterization of isolates using pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with SmaI were carried out as previously described (20). Banding patterns were determined by visual inspection and by using Bionumerics software, version 6.0 (Applied Maths) using the Dice index and the unweighted-pair group method with arithmetic average.…”

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Staphylococcus haemolyticus as an Important Hospital Pathogen and Carrier of Methicillin Resistance Genes

et al. 2012

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Phenotypic and molecular methods were used to characterize the antibiotic resistance of 64 clinical isolates of Staphylococcus haemolyticus. By PCR of the mecA gene, 87% were found to be methicillin resistant. Approximately 55% harbored staphylococcal cassette chromosome mec element (SCCmec) type V, and only one SCCmec type IV. Many isolates (75%) displayed multiresistance, and pulsotype analysis showed a high diversity.A mong coagulase-negative staphylococci (CoNS), Staphylococcus haemolyticus is the second most frequently isolated from human blood cultures (18) and has the highest level of antimicrobial resistance (3,8). Methicillin resistance is conferred by the mecA gene, carried on the staphylococcal cassette chromosome mec element (SCCmec) (12). Eight types (I to VIII) of SCCmec have been assigned for Staphylococcus aureus (11), and SCCmec type V has already been found in CoNS, particularly in S. haemolyticus (13). The increase in the frequency of methicillinresistant S. haemolyticus as the causal agent of hospital infections and the possibility of emergence of resistance to other antibiotics demand trustworthy characterization of the isolates and an investigation of clonal spreading within hospitals.In the studies reported here, 64 clinical strains were isolated from patients at Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil, between 2006 and 2008. The strains were isolated from the following clinical infections or sources in 31 males and 33 females: bacteremia (n ϭ 45), skin (n ϭ 2), urine (n ϭ 13), and unknown source (n ϭ 4). The isolates were identified at the hospital laboratory as S. haemolyticus by using the MicroScan WalkAway PC21 panel, and their identification was confirmed by specific PCR (17).The resistance profiles of the strains for the main antibiotics used in Brazil were determined by disc diffusion tests according to CLSI guidelines (5). However, the mupirocin susceptibility testing was not preconized by CLSI, so the results for this antibiotic were interpreted as previously described (7, 9). The methicillin resistance was also evaluated by other phenotypic methods, such as the MIC for oxacillin (5), the MicroScan, and PCR of the mecA gene (6). The SCCmec type was determined in a multiplex PCR as previously described (14), except that the pair of primers mecI P2 and mecI P3 used as the internal control were replaced by MRS1 and MRS2 (6), which amplify a 154-bp fragment of the mecA gene.Analysis of genetic relatedness and characterization of isolates using pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with SmaI were carried out as previously described (20). Banding patterns were determined by visual inspection and by using Bionumerics software, version 6.0 (Applied Maths) using the Dice index and the unweighted-pair group method with arithmetic average. Similar PFGE genotypes were defined using a coefficient of similarity of up to 80%, and the subtypes were those with less than five-band variants, as recommended by van Belkun et al. (19).As shown in Table 1, there wa...

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“…44 Multiple studies have reported the arrival (or development) and spread of mupirocinresistant strains in settings where mupirocin is in frequent use, 45,46 including multiple reports of resistant strains spreading in Brazilian hospitals. 47,48 Mupirocin has also rarely been associated with toxic epidermal necrolysis after topical intranasal application, so a decision to apply it with great frequency would have to take this risk into account. 49 One recent meta-analysis of studies reporting the results of therapy for eradication of MRSA reported much conflicting evidence and concluded, "There is insufficient evidence to support use of topical or systemic antimicrobial therapy for eradicating nasal or extranasal MRSA.…”

Section: Several Studies In This Issue Of Infection Control and Hospitalmentioning

confidence: 99%

Methicillin-ResistantStaphylococcus aureusControl: We Didn't Start the Fire, but It's Time to Put It Out

Muto

2006

Infect. Control Hosp. Epidemiol.

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The prevalence of healthcare-associated infections (HAIs) caused by multidrug-resistant organisms has significantly increased over the past decade, according to the measurements of the Centers for Disease Control and Prevention, and will likely continue to climb. 1 ' 2 Currently, more than 70% of HAIs are caused by bacteria that are resistant to at least 1 of the drugs most commonly used to treat these infections. 3 These HAIs have been associated with increased cost and mortality, compared with infections due to antibiotic-susceptible strains of the same bacterial species. 4,5 Nevertheless, despite decades of studies confirming increased rates of adverse events related to these organisms and ongoing evidence of increased prevalence of multidrug-resistant organisms, 2 as well as the emergence of new antimicrobial-resistant organisms, 6 few coordinated effective efforts exist across the United States and most parts of the world to prevent MRSA transmission and reduce the number of MRSA HAIs. 7 Despite evidence of efficacy for control of multidrug-resistant organisms with active surveillance cultures and barrier precautions 8 " 10 and despite documented failure to control MRSA in studies lacking methods to fully identify the MRSA reservoir, 8 most healthcare systems have not elected to implement methods to identify and contain MRSA, and so MRSA continues to spread and to colonize and infect patients. Several studies in this issue of Infection Control and HospitalEpidemiology describe efforts to control methicillin-resistant S. aureus (MRSA). I comment here on 3 of them. 11 " 13 Interestingly, the investigators in these 3 studies believe that colonized patients represented a significant portion of the MRSA reservoir and elected to implement a program of active surveillance cultures to better identify MRSA-colonized patients. In two of the studies, that of Salgado and Farr 11 and that of Eveillard et al., 12 barrier precautions were implemented for all patients identified as being MRSA colonized, as recommended by the recent Society for Healthcare Epidemiology of America (SHEA) guideline. 8 The third study, by Sandri et al., 13 discusses the utility of MRSA decolonization of the nares by administration of topical mupirocin therapy and chlorhexidine baths to all patients identified as having MRSA colonization of the nares.The study by Salgado and Farr" reports the proportion of patients identified by active surveillance culture on admission as being MRSA colonized who later had an MRSA-positive clinical microbiology culture, the number and type of clinical microbiology cultures done, and the number and type of MRSA-positive clinical microbiology cultures. Their study demonstrates that only 15% of all patients identified as being colonized with MRSA on admission would have been so identified subsequently via clinical microbiology culture. When data for patients in the intensive care unit (ICU) and in other units (non-ICU patients) were analyzed separately, the investigators found that 21.4% of ICU patients had a subse...

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Mupirocin for Controlling Methicillin-ResistantStaphylococcus Aureus: Lessons From a Decade of Use at a University Hospital

Abstract: After mupirocin use decreased, the ileS-2 encoding plasmid persisted in only a few Brazilian clone isolates. Our data on mupirocin-resistant MRSA incidence and mupirocin use strongly suggested that restricted use was related to decreased rates of mupirocin resistance at our hospital.

Cited by 64 publications

References 35 publications

Clonal Composition of Staphylococcus aureus Isolates at a Brazilian University Hospital: Identification of International Circulating Lineages

Clonal Composition of Staphylococcus aureus Isolates at a Brazilian University Hospital: Identification of International Circulating Lineages

Staphylococcus haemolyticus as an Important Hospital Pathogen and Carrier of Methicillin Resistance Genes

Methicillin-ResistantStaphylococcus aureusControl: We Didn't Start the Fire, but It's Time to Put It Out

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