Ann Dermatol.  2012 Feb;24(1):32-38. 10.5021/ad.2012.24.1.32.

The Prevalence, Genotype and Antimicrobial Susceptibility of High- and Low-Level Mupirocin Resistant Methicillin-Resistant Staphylococcus aureus

• Park SY
• Kim SM
• Park SD

• KMID: 2156853
• DOI: http://doi.org/10.5021/ad.2012.24.1.32

Abstract

BACKGROUND
Mupirocin has been used for the treatment of skin infections and eradication of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). The increased use of this antibiotic has been accompanied by outbreaks of MRSA that are resistant to mupirocin.
OBJECTIVE
This study aims to determine the prevalence, genotype and antimicrobial susceptibility of mupirocin-resistant MRSA from 4 Korean hospitals.
METHODS
A total 193 MRSA clinical isolates were collected from four university hospitals. Antimicrobial susceptibility tests, including mupirocin, and pulsed-field gel electrophoresis (PFGE) pattern analysis were performed.
RESULTS
Overall, 27 of the 193 (14.1%) MRSA isolates were resistant to mupirocin. All of the (A) hospital isolates showed high-level (HL) mupirocin resistance and the low-level (LL) mupirocin resistant strains were from three other hospitals. The PFGE patterns of 16 mupirocin-resistant isolates were divided into 5 clusters (1-5), and the nine HL mupirocin-resistant isolates belonged to cluster 1. Both the HL and LL mupirocin-resistant MRSA isolates were susceptible to vancomycin and rifampin, but they were resistant to ciprofloxacin, clindamycin and tetracycline. The erythromycin and fusidic acid resistance rates were different between the HL and LL resistant isolates.
CONCLUSION
HL mupirocin-resistant isolates that could transfer this resistance to other bacteria were detected and these isolates were clonally related. The emergence of mupirocin resistant isolates emphasizes the importance of using antibiotics judiciously and carefully monitoring the prevalence of mupirocin resistance.

Keyword

Antimicrobial susceptibility; MRSA; Mupirocin; Pulsed field gel electrophoresis

MeSH Terms

Anti-Bacterial Agents
Bacteria
Ciprofloxacin
Clindamycin
Disease Outbreaks
Electrophoresis, Gel, Pulsed-Field
Erythromycin
Fusidic Acid
Genotype
Hospitals, University
Methicillin Resistance
Methicillin-Resistant Staphylococcus aureus
Mupirocin
Prevalence
Rifampin
Skin
Tetracycline
Vancomycin
Anti-Bacterial Agents
Ciprofloxacin
Clindamycin
Erythromycin
Fusidic Acid
Mupirocin
Rifampin
Tetracycline
Vancomycin

Figure

• 

  Fig. 1 Agarose gel electrophoresis of the amplified 372-bp DNA fragments of the femA gene. The samples are lane M: a 100 bp size marker, lanes 1-9: mupirocin resistant MRSA, PC: femA-positive control (S. aureus ATCC 33591) and NC: femA-negative control (S. epidermidis ATCC 2228). MRSA: methicillin-resistant Staphylococcus aureus.

• 

  Fig. 2 Agarose gel electrophoresis of the amplified 554-bp DNA fragments of the mecA gene. The samples are lane M: a 100 bp size marker, lanes 1-9: mupirocin resistant MRSA, PC: mecA-positive control (ATCC 33591) and NC: mecA-negative control (ATCC 25923). MRSA: methicillin-resistant Staphylococcus aureus.

• 

  Fig. 3 Agarose gel electrophoresis of the amplified 1.6 kb DNA fragments of the mupA gene. The samples are lane M: a 1-kb size marker, lanes 1-2, 4-5, 9-11: high-level mupirocin resistant MRSA, PC: mupA-positive control (KCKC 6129), and NC: mupA-negative control (ATCC 25923). MRSA: methicillin-resistant Staphylococcus aureus.

• 

  Fig. 4 Agarose gel electrophoresis of the amplified 1.6 kb DNA fragments of the mupA gene. The samples are lane M: a 1-kb size marker, lanes 15, 21-26: low-level mupirocin resistant MRSA, PC: mupA-positive control (KCKC 6129) and NC: mupA-negative control (ATCC 25923). MRSA: methicillin-resistant Staphylococcus aureus.

• 

  Fig. 5 A dendrogram generated with the Gelcompar II program showing the five PFGE types (1-5) of SmaI-restricted chromosome DNA of the 16 mupirocin-resistant MRSA isolates. H1-H10: isolates with high-level mupirocin resistance, L16-21: isolates with low-level mupirocin resistance. PFGE: pulsed-field gel electrophoresis, MRSA: methicillin-resistant Staphylococcus aureus.

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