Korean J Urol.  2014 May;55(5):349-353. 10.4111/kju.2014.55.5.349.

Unexpected Multidrug Resistance of Methicillin-Resistant Staphylococcus aureus in Urine Samples: A Single-Center Study

• Lunacek A
• Koenig U
• Mrstik C
• Radmayr C
• Horninger
• Plas E

• KMID: 1988413
• DOI: http://doi.org/10.4111/kju.2014.55.5.349

Abstract

PURPOSE
Infections of methicillin-resistant Staphylococcus aureus (MRSA) are becoming an increasingly concerning clinical problem. The aim of this study was to assess the development of MRSA in urine cultures in a major public university-affiliated hospital and the therapeutical and hygiene-related possibilities for reducing resistance.
MATERIALS AND METHODS
This study included 243 samples from patients diagnosed with MRSA infection over a period of 6 years. An agar diffusion test measured the effects of antimicrobial agents against bacteria grown in culture. The analyses were based on the guidelines of the Clinical and Laboratory Standards Institute.
RESULTS
A regression analysis was performed, which showed 100% resistance to the following antibiotics throughout the entire testing period: carbapenem, cephalosporin (1st-4th generation), penicillin G, aminopenicillin, beta-lactamase, and isoxazolyl penicillin. However, a significant decrease in resistance was found for amikacin, gentamicin, clindamycin, levofloxacin, erythromycin, and mupirocin.
CONCLUSIONS
MRSA showed a decreasing trend of antimicrobial resistance, except against carbapenem, cephalosporin (1st-4th generation), penicillin G, aminopenicillin, beta-lactamase, and isoxazolyl penicillin, for which complete resistance was observed.

Keyword

Methicillin-resistant Staphylococcus aureus; Multidrug resistance; Urine

MeSH Terms

Agar
Amikacin
Anti-Bacterial Agents
Anti-Infective Agents
Bacteria
beta-Lactamases
Clindamycin
Diffusion
Drug Resistance, Multiple*
Erythromycin
Gentamicins
Humans
Levofloxacin
Methicillin-Resistant Staphylococcus aureus*
Mupirocin
Penicillin G
Penicillins
Agar
Amikacin
Anti-Bacterial Agents
Anti-Infective Agents
Clindamycin
Erythromycin
Gentamicins
Mupirocin
Penicillin G
Penicillins
beta-Lactamases

Figure

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  FIG. 1 Increase of methicillin-resistant Staphylococcus aureus (MRSA) infections during the time period from 2004 to 2009. Furthermore the exponential trend (black line) is delineated on the diagram.

• 

  FIG. 2 Decrease in the methicillin-resistant Staphylococcus aureus resistance within a time period of 6 years on the basis of amikacin use.

• 

  FIG. 3 Decrease in the methicillin-resistant Staphylococcus aureus resistance on the basis of gentamicin use within the same period as amikacin in Fig. 2.

Reference

1. Mehndiratta PL, Gur R, Saini S, Bhalla P. Staphylococcus aureus phage types and their correlation to antibiotic resistance. Indian J Pathol Microbiol. 2010; 53:738–741.

2. Loomba PS, Taneja J, Mishra B. Methicillin and vancomycin resistant S. aureus in hospitalized patients. J Glob Infect Dis. 2010; 2:275–283.

3. Chihara S, Popovich KJ, Weinstein RA, Hota B. Staphylococcus aureus bacteriuria as a prognosticator for outcome of Staphylococcus aureus bacteremia: a case-control study. BMC Infect Dis. 2010; 10:225.

4. Lee BK, Crossley K, Gerding DN. The association between Staphylococcus aureus bacteremia and bacteriuria. Am J Med. 1978; 65:303–306.

5. Muder RR, Brennen C, Rihs JD, Wagener MM, Obman A, Stout JE, et al. Isolation of Staphylococcus aureus from the urinary tract: association of isolation with symptomatic urinary tract infection and subsequent staphylococcal bacteremia. Clin Infect Dis. 2006; 42:46–50.

6. Pfaller MA, Acar J, Jones RN, Verhoef J, Turnidge J, Sader HS. Integration of molecular characterization of microorganisms in a global antimicrobial resistance surveillance program. Clin Infect Dis. 2001; 32:Suppl 2. S156–S167.

7. Stevens DL, Herr D, Lampiris H, Hunt JL, Batts DH, Hafkin B. Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. 2002; 34:1481–1490.

8. Diller R, Sonntag AK, Mellmann A, Grevener K, Senninger N, Kipp F, et al. Evidence for cost reduction based on pre-admission MRSA screening in general surgery. Int J Hyg Environ Health. 2008; 211:205–212.

9. Ando E, Monden K, Mitsuhata R, Kariyama R, Kumon H. Biofilm formation among methicillin-resistant Staphylococcus aureus isolates from patients with urinary tract infection. Acta Med Okayama. 2004; 58:207–214.

10. Abe Y, Shigemura K, Yoshida H, Fujisawa M, Arakawa S. Risk factors for anti-MRSA drug resistance. Int J Antimicrob Agents. 2012; 40:423–426.

11. Orrett FA, Land M. Methicillin-resistant Staphylococcus aureus prevalence: current susceptibility patterns in Trinidad. BMC Infect Dis. 2006; 6:83.

12. Riedl CR, Plas E, Hubner WA, Zimmerl H, Ulrich W, Pfluger H. Bacterial colonization of ureteral stents. Eur Urol. 1999; 36:53–59.

13. Gotz F. Staphylococcus and biofilms. Mol Microbiol. 2002; 43:1367–1378.

14. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002; 15:167–193.

15. Hall-Stoodley L, Costerton JW, Stoodley P. Bacterial biofilms: from the natural environment to infectious diseases. Nat Rev Microbiol. 2004; 2:95–108.

16. Currie K, Knussen C, Price L, Reilly J. Methicillin-resistant Staphylococcus aureus screening as a patient safety initiative: using patients' experiences to improve the quality of screening practices. J Clin Nurs. 2014; 23:221–231.