The Emergence of Mupirocin Resistance among Staphylococcus aureus in a Tertiary Care Hospital in South India: The Necessity for Routine Susceptibility Testing
DOI:
https://doi.org/10.31964/mltj.v8i2.516Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is difficult to treat, causing considerable morbidity and mortality. Nasal carriage of MRSA can occur both in healthcare workers and patients. Mupirocin is used as a topical agent for the eradication of such isolates. The present study aims to study the prevalence of mupirocin resistance among the MRSA and MSSA (Methicillin-sensitive Staphylococcus aureus) isolates. A total of 148 Staphylococcus aureus isolates were tested. Antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method for amoxicillin, penicillin, cotrimoxazole, clindamycin, mupirocin(5 µg and 200 µg discs for low and high-level resistance), erythromycin, gentamicin and linezolid. MRSA isolates were detected by cefoxitin disc diffusion and Mec A detection by PCR (Polymerase Chain Reaction). MRSA was detected among 44 (29.7%) of the isolates. Among MSSA, good susceptibility was observed for cotrimoxazole 89 (85.5%) and clindamycin 92 (88.4%). An overall mupirocin resistance of 12(8.1%) was observed, with high-level resistance at 4 (2.7%) and low-level resistance at 8 (5.4%).The mupirocin resistance pattern between MRSA and MSSA was not statistically significant (p=0.1833). The emergence of mupirocin resistance highlights the necessity for creating cognizance among clinicians before prescribing mupirocin. In eradicating nasal carriage of MRSA, all the isolates should always be tested for mupirocin susceptibility to prevent the selection and spread of drug-resistant isolates.References
Abdul Gader,S.M.,Lentswe,T.,Whitelaw,A., & Newton foot M.(2020). The prevalence and molecular mechanisms of mupirocin resistance in Staphylococcus aureus isolates from a Hospital in Cape Town, South Africa.Antimicrobial Resistance and Infection Control, 9, 47.https://doi.org/10.1186/s13756-020-00707-8
Anand ,K.B., Agrawal, P., Kumar, S., Kapila, K. (2009). Comparison of the cefoxitin disc diffusion test, the oxacillin screen agar test and PCR for the Mec A gene for detection of MRSA. Indian J Med Microbiol, 27, 27-29.
Antonov, N.K., Garzon, M.C., Morel, K.D., Whittier, S., Planet ,P.J., Lauren, CT. (2015). High prevalence of mupirocin resistance in Staphylococcus aureus isolates from a pediatric population. Antimicrob Agents Chemother, 59(6), 3350–3356 doi:10.1128/AAC.00079-15.
Baek ,Y.S., Jeon ,J., Ahn, J.W., Song, H.J. (2016). Antimicrobial resistance of Staphylococcus aureus isolated from skin infections and its implications in various clinical conditions in Korea. Int J Dermatol, 55(4), e191–e197 DOI: 10.1111/ijd.13046
Cavalcante, F.S.,Abad, E.D., Lyra, Y.C., Saintive S.B., Ribeiro, M., Ferreira D.C., Santos, K.R. (2015). High prevalence of methicillin resistance and PVL genes among Staphylococcus aureus isolates from the nares and skin lesions of pediatric patients with atopic dermatitis. Braz J Med Biol Res, 48(7), 588–594. doi: 10.1590/1414-431X20154221
Clinical and Laboratory Standards Institute (CLSI). 2018. Performance standards for antimicrobial susceptibility testing. Clinical Laboratory Standards Institute. Wayne, PA, USA; M100S 28, 28th edition 2018.
Dadashia, M., Hajikhanic, B., Darban-Sarokhalild,D., Belkume,A. , Goudarzic, M. (2020). Mupirocin resistance in Staphylococcus aureus: A systematic review and meta-analysis. Journal of Global Antimicrobial Resistance, 20, 238–247. doi: 10.1016/j.jgar.2019.07.032
Emaneini, M., Khoramrooz, S.S., Taherikalani, M., Jabalameli, F., Aligholi, M. (2011). Molecular characterization of Staphylococcus aureus isolated from children with adenoid hypertrophy: emergence of new spa types t7685 and t7692. Int J Pediatr Otorhinolaryngol, 75(11), 1446–1449. doi: 10.1016/j.ijporl.2011.08.013
Fritz, S.A., Hogan, P.G., Camins, B.C., Ainsworth, A.J., Patrick, C., Martin ,M.S., Krauss, M.J., Rodriguez, M., Burnham, C.A. (2013). Mupirocin and chlorhexidine resistance in Staphylococcus aureus in patients with community onset skin and soft tissue infections. Antimicrob Agents Chemother, 57(1), 559–568. doi: 10.1128/AAC.01633-12
Hayden, M.K., Lolans,K., Haffenreffer, K., Avery,T.R., Kleinman, K., Li, H., Kaganov, R.E., Lankiewicz, J., Moody, J., Septimus, E., Weinstein, R.A., Hickok, J., Jernigan ,J., Perlin, J.B., Platt ,R., Huang, S.S. (2016). Chlorhexidine and mupirocin susceptibility of methicillin-resistant Staphylococcus aureus isolates in the REDUCE-MRSA trial. J Clin Microbiol, 54(11), 2735–2742. doi: 10.1128/JCM.01444-16
Hetem, D.J.,Bonten, M.J. (2013). Clinical relevance of mupirocin resistance in Staphylococcus aureus. J Hosp Infect, 85(4), 249-56. doi: 10.1016/j.jhin.2013.09.006.
Hogue, J.S., Buttke,P., Braun, L.E., Fairchok, M.P. (2010). Mupirocin resistance related to increasing mupirocin use in clinical isolates of methicillin-resistant Staphylococcus aureus in a pediatric population. J Clin Microbiol, 48(7), 2599–2600. doi: 10.1128/JCM.02118-09
Jung, M.Y., Chung, J.Y., Lee ,H.Y., Park, J., Lee, D.Y., Yang ,JM. (2015). Antibiotic susceptibility of Staphylococcus aureus in atopic dermatitis: current prevalence of methicillin-resistant staphylococcus aureus in Korea and treatment strategies. Ann Dermatol, 27(4), 398–403. doi: 10.5021/ad.2015.27.4.398
Kavitha, E., Srikumar, R. (2019). High-level mupirocin resistance in Staphylococcus spp. among health care workers in a tertiary care hospital. International Journal of Experimental and Clinical Pharmacology,103(5-6), 320-23. doi: 10.1159/000499022
Khan, A., Tewari ,R., Shree, N. (2020). Mupirocin resistant methicillin-resistant Staphylococcus aureus – Are these strains wrongly reported and treated?. Int J Med Sci Public Health, 9(6), 363-367. doi: 10.5455/ijmsph.2020.06092202029062020
Kumar, D., Bisht, D., Faujdar, S.S. (2020). Incidence of mupirocin resistance in Staphylococcus aureus isolated from rural population: A new emerging challenge. Int J Cur Res Rev, 12(22), 82-85. doi:10.31782/IJCRR.2020.12225
Mackie and Mccartney. (2006). Practical Medical Microbiology (14 th edition). (2006). Elsiever, 245-249.
Mahmoudi, S.,Mamishi, S., Mohammadi, M., Banar. M., Taghi Haghi Ashtiani, M., Mahzari, M.,Bahador, A., Pourakbari, B. (2019). Phenotypic and genotypic determinants of mupirocin resistance among Staphylococcus aureus isolates recovered from clinical samples of children: an Iranian hospital-based study. Infection and Drug Resistance, 12, 137–143. doi: 10.2147/IDR.S185610
Mcneil, J.C., Hulten ,K.G., Kaplan, S.L., Mason, E.O. (2011). Mupirocin resistance in Staphylococcus aureus causing recurrent skin and soft tissue infections in children. Antimicrob Agents Chemother, 55(5), 2431–2433. doi: 10.1128/AAC.01587-10
Pereira, M.F., Berezin, E.N., Carvalho, R.L., Scheffer, D.K., Mimica, M.J. (2014). Mupirocin susceptibility in Staphylococcus aureus nasal and oropharyngeal isolates from Brazilian children. J Chemother, 26(6), 373–374 doi: 10.1179/1973947813Y.0000000151
Perumal, G., Kannan, S., Appalaraju, B. (2022). Detection and Distribution of Low Level and High Level Mupirocin Resistance among Clinical Methicillin-Resistant Staphylococcus aureus Isolate. Journal of Clinical and Diagnostic Research,16(5), DC06-DC10. doi: 10.7860/JCDR/2022/55943.16298
Pourakbari, B., Sadr, A., Ashtiani, MT.H. (2011). Five-year evaluation of the antimicrobial susceptibility patterns of bacteria causing bloodstream infections in Iran, J Infect Develop Countries, 6(2), 120–125. doi: 10.3855/jidc.1517
Rudresh, M.S., Ravi, G.S., Motagi, A., Alex, A.M., Sandhya, P., Navaneeth, B.V. (2015). Prevalence of Mupirocin Resistance Among Staphylococci, its Clinical Significance and Relationship to Clinical use. Journal of Laboratory Physicians, 7, 103-107. doi: 10.4103/0974-2727.163127
Shivanna, J., Dasegowda,V. (2023). Comparison of Disk Diffusion and Agar Dilution Method for the Detection of Mupirocin Resistance in Staphylococcal Isolates from Skin and Soft Tissue Infections. J Lab Physicians, 1-5. https://doi.org/ 10.1055/s-0042-1760672.
Vázquez, N.M., Cáceres Guido, P., Fiorilli, G., Moreno ,S. (2019). Emerging mupirocin resistance in methicillin-resistant Staphylococcus aureus isolates at a tertiary care children’s hospital in Argentina. Arch Argent Pediatr, 117(1), 48-52. doi: 10.5546/aap.2019.eng.48
Wu, D., Wang, Q., Yang ,Y., Geng, W., Wang, Q., Yu, S.,Yao, K., Yuan, L., Shen,X. (2010). Epidemiology and molecular characteristics of community-associated methicillin-resistant and methicillin-susceptible Staphylococcus aureus from skin/soft tissue infections in a children’s hospital in Beijing, China. Diagn Microbiol Infect Dis, 67(1), 1–8. doi: 10.1016/j.diagmicrobio.2009.12.006
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