Mupirocin resistance in clinical isolates of methicillin sensitive and resistant Staphylococcus aureus in a tertiary care centre of North India
Keywords:
MRSA, Mupirocin, Staphylococcus aureus
Abstract
Background: Staphylococcus aureus continues to be major healthcare problem worldwide as therapeutic options for its management are limited. Decolonisation regimes using mupiroicin are aimed at reducing the burden of infection due to this microorganism. However resistance to mupirocin poses a threat to the current standard eradication protocols.
Aims: To find out the type and extent of mupirocin resistance in clinical isolates of S. aureus.
Material and methods: This cross-sectional study was carried out at a tertiary care centre of North India for a period of 6 months. S. aureus recovered by standard microbiological procedures form various clinical samples such as blood, urine, pus and other body fluids was subjected to antimicrobial susceptibility testing along with detection of mupirocin resistance using 5 and 200µg discs. Minimum inhibitory concentration (MIC) of mupirocin was determined using E -test strips. Fisher’s exact test was done to determine the statistical significance. A P-value of <0.05 was considered as statistically significant.
Results: A total of 247 S. aureus isolates were recovered of which 81 (32.8%) were resistant to methicillin (MRSA) whereas 166 (67.2%) were sensitive to this antibiotic (MSSA). Low level resistance to mupirocin was seen in 7 (8.6%) MRSA and 3 (1.8%) MSSA isolates. Prior use of this topical antibiotic and previous hospitalisation were found to be the risk factors associated with mupirocin resistance.
Conclusion: Low level mupirocin resistance was seen in S. aureus isolates which if left unchecked could in future pave way for high level resistance and subsequent treatment failures.
Downloads
Download data is not yet available.
References
1.de Kraker ME, Davey PG, Grundmann H. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med 2011; 8:e1001104.
2.Datta R, Huang SS. Risk of infection and death due to methicillin- resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis 2008; 47:176–81.
3. Grunden N. MRSA: a short history of a monster microbe. Pittsburgh Regional Healthcare Initiative. Reprinted from PRHI Executive Summary, December 2003. Available: http:// www.prhi.org/docs/MRSA
4. Calfee DP, Salgado CD, Milstone AM et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35:772-96.
5. National Clinical Effectiveness Committee. Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA), National Clinical Guideline No. 2. 2013. Department of Health, Ireland.
6. Coia JE, Duckworth GJ, Edwards DI et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in health- care facilities. J Hosp Infect 2006; 63(1):1-44.
7.Cookson D. The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998; 41:11-18.
8. Patel JB, Gorwitz RJ, Jernigan JA. Mupirocin resistance. Clin Infect Dis 2009; 49:935-41.
9. Fuller AT, Mellows G, Woolford M, Banks GT, Barrow KD, Chain EB. Pseudomonic acid: an antibiotic produced by Pseudomonas fluorescens. Nature. 1971; 234:416-17.
10. Gilbart J, Perry CR, Slocombe B. High-level mupirocin resistance in Staphylococcus aureus: evidence for two distinct isoleucyl-tRNA synthetases. Antimicrob Agents Chemother. 1993; 37:32-38.
11. Schmitz FJ, Jones ME. Antibiotics for treatment of infections caused by MRSA and elimination of MRSA carriage. What are the choices? Int J Antimicrob Agents 1997; 9:1-19.
12. SK Oommen, B Appalaraju, K Jinsha . Mupirocin resistance in clinical isolates of staphylococci in a tertiary care centre in south India Mupirocin resistance in clinical isolates of staphylococci in a tertiary care centre in south India. Indian Journal of Medical Microbiology. 2010; 28(4): 372-75.
13.Jean B. Patel, Rachel J. Gorwitz, and John A. Jernigan. Mupirocin Resistance Antimicrobial resistance. CID 2009; 49:935-41.
14.Oliveira NE, Cardozo AP, Marques EA, Santos KR, de-Marval GBM. Interpretive criteria to differentiate low- and high- level mupirocin resistance in Staphylococcus aureus. J Med Microbiol 2007; 56:937-39.
15.Creagh S, Lucey B. Interpretive criteria for mupirocin susceptibility testing of Staphylococcus spp. using CLSI guidelines. Br J Biomed Sci 2007; 64:1-5.
16. Koneman EW, Procop GW, Allen S, Allen SD, Schreckenberger PC, Janda WM, Winn WC, Woods GL, editors. Koneman's Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2005
17. Clinical and Laboratory Standards Institute (CLSI). M100. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. 27th ed. Wayne, PA: CLSI; 2017.
18. Rahman M, Noble WC, Cookson B. Mupirocin resistant Staphylococcus aureus. Lancet. 1987; 330:387-88.
19.Hughes J, Stabler R, Gaunt M, Karadag T, Desai N, Betley J et al. Clonal variation in high- and low-level phenotypic and genotypic mupirocin resistance of MRSA isolates in south-East London. J Antimicrob Chemother. 2015; 70:3191-99.
20. Boswihi SS, Udo EE, Al-Sweih N. Shifts in the clonal distribution of methicillin-resistant Staphylococcus aureus in Kuwait hospitals: 1992-2010. PLoS One. 2016; 11:e0162744.
21. Hayden MK, Lolans K, Haffenreffer K, Avery TR, Kleinman K, Li H et al. Chlorhexidine and mupirocin susceptibility of methicillin-resistant Staphylococcus aureus isolates in the REDUCE-MRSA trial. J Clin Microbiol. 2016; 54:2735–42.
22. Gostev V, Kruglov A, Kalinogorskaya O, Dmitrenko O, Khokhlova O, Yamamoto T et al. Molecular epidemiology and antibiotic resistance of methicillin-resistant Staphylococcus aureus circulating in the Russian Federation. Infect Genet Evol. 2017; 53:189-94.
23. Chaturvedi P, Singh AK, Singh AK, Shukla S, Agarwal L. Prevalence of mupirocin resistant Staphylococcus aureus isolates among patients admitted to a tertiary care hospital. N Am J Med Sci 2014; 6:403-07.
24. Murugesan PN, Ramanathan V, Krishnan P. High occurrence of high level muprirocin and chlorhexidine resistant genes in methicillin resistant Staphylococcal isolates from dialysis unit of a tertiary care hospital. Indian J Med Res. 2016; 143:824-25
25. Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK, Chaudhry R, et al. Mupirocin resistance in Staphylococcus aureus in an Indian hospital. Diagn Microbiol Infect Dis 2007; 58:125-27.
26. Abimanyu N, Murugesan S, Krishnan P. Emergence of methicillin‐resistant Staphylococcus aureus ST239 with high‐level mupirocin and inducible clindamycin resistance in a tertiary care center in Chennai, South India. J Clin Microbiol 2012; 50:3412‐13.
27. Rudresh MS. Giriyapur SR, Motagi A, Alex AM, Sandhya P, Navaneeth BV. Prevalence of mupirocin resistance among Staphylococci, its clinical significance and relationship to clinical use. J Lab Physicians 2015; 7(2):103-07.
28. Caffrey AR, Quilliam BJ and Laplante KL. "Risk Factors Associated With Mupirocin Resistance in methicillin resistant Staphylococcus aureus." Journal of Hospital Infection. 2010; 76(3):206-10.
29. Fomda BA, Thokar MA, G Bashir, Khan A, Kour A, Zahoor D, Ray P. Prevalence and genotypic relatedness of methicillin resistant staphylococcus aureus in a tertiary care hospital. J Postgrad Med. 2014; 60:386-89.
30. Ahmad BF, Ahmad PM, Zahoor D, Ahmad MT, Ahmad NR. Phenotypic detection of constitutive and inducible clindamycin resistance in clinical isolates of Staphylococcus aureus and coagulase negative Staphylococcus on routine susceptibility plate. J Common Dis 2010; 42(1):19-26.
2.Datta R, Huang SS. Risk of infection and death due to methicillin- resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis 2008; 47:176–81.
3. Grunden N. MRSA: a short history of a monster microbe. Pittsburgh Regional Healthcare Initiative. Reprinted from PRHI Executive Summary, December 2003. Available: http:// www.prhi.org/docs/MRSA
4. Calfee DP, Salgado CD, Milstone AM et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35:772-96.
5. National Clinical Effectiveness Committee. Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA), National Clinical Guideline No. 2. 2013. Department of Health, Ireland.
6. Coia JE, Duckworth GJ, Edwards DI et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in health- care facilities. J Hosp Infect 2006; 63(1):1-44.
7.Cookson D. The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998; 41:11-18.
8. Patel JB, Gorwitz RJ, Jernigan JA. Mupirocin resistance. Clin Infect Dis 2009; 49:935-41.
9. Fuller AT, Mellows G, Woolford M, Banks GT, Barrow KD, Chain EB. Pseudomonic acid: an antibiotic produced by Pseudomonas fluorescens. Nature. 1971; 234:416-17.
10. Gilbart J, Perry CR, Slocombe B. High-level mupirocin resistance in Staphylococcus aureus: evidence for two distinct isoleucyl-tRNA synthetases. Antimicrob Agents Chemother. 1993; 37:32-38.
11. Schmitz FJ, Jones ME. Antibiotics for treatment of infections caused by MRSA and elimination of MRSA carriage. What are the choices? Int J Antimicrob Agents 1997; 9:1-19.
12. SK Oommen, B Appalaraju, K Jinsha . Mupirocin resistance in clinical isolates of staphylococci in a tertiary care centre in south India Mupirocin resistance in clinical isolates of staphylococci in a tertiary care centre in south India. Indian Journal of Medical Microbiology. 2010; 28(4): 372-75.
13.Jean B. Patel, Rachel J. Gorwitz, and John A. Jernigan. Mupirocin Resistance Antimicrobial resistance. CID 2009; 49:935-41.
14.Oliveira NE, Cardozo AP, Marques EA, Santos KR, de-Marval GBM. Interpretive criteria to differentiate low- and high- level mupirocin resistance in Staphylococcus aureus. J Med Microbiol 2007; 56:937-39.
15.Creagh S, Lucey B. Interpretive criteria for mupirocin susceptibility testing of Staphylococcus spp. using CLSI guidelines. Br J Biomed Sci 2007; 64:1-5.
16. Koneman EW, Procop GW, Allen S, Allen SD, Schreckenberger PC, Janda WM, Winn WC, Woods GL, editors. Koneman's Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2005
17. Clinical and Laboratory Standards Institute (CLSI). M100. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. 27th ed. Wayne, PA: CLSI; 2017.
18. Rahman M, Noble WC, Cookson B. Mupirocin resistant Staphylococcus aureus. Lancet. 1987; 330:387-88.
19.Hughes J, Stabler R, Gaunt M, Karadag T, Desai N, Betley J et al. Clonal variation in high- and low-level phenotypic and genotypic mupirocin resistance of MRSA isolates in south-East London. J Antimicrob Chemother. 2015; 70:3191-99.
20. Boswihi SS, Udo EE, Al-Sweih N. Shifts in the clonal distribution of methicillin-resistant Staphylococcus aureus in Kuwait hospitals: 1992-2010. PLoS One. 2016; 11:e0162744.
21. Hayden MK, Lolans K, Haffenreffer K, Avery TR, Kleinman K, Li H et al. Chlorhexidine and mupirocin susceptibility of methicillin-resistant Staphylococcus aureus isolates in the REDUCE-MRSA trial. J Clin Microbiol. 2016; 54:2735–42.
22. Gostev V, Kruglov A, Kalinogorskaya O, Dmitrenko O, Khokhlova O, Yamamoto T et al. Molecular epidemiology and antibiotic resistance of methicillin-resistant Staphylococcus aureus circulating in the Russian Federation. Infect Genet Evol. 2017; 53:189-94.
23. Chaturvedi P, Singh AK, Singh AK, Shukla S, Agarwal L. Prevalence of mupirocin resistant Staphylococcus aureus isolates among patients admitted to a tertiary care hospital. N Am J Med Sci 2014; 6:403-07.
24. Murugesan PN, Ramanathan V, Krishnan P. High occurrence of high level muprirocin and chlorhexidine resistant genes in methicillin resistant Staphylococcal isolates from dialysis unit of a tertiary care hospital. Indian J Med Res. 2016; 143:824-25
25. Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK, Chaudhry R, et al. Mupirocin resistance in Staphylococcus aureus in an Indian hospital. Diagn Microbiol Infect Dis 2007; 58:125-27.
26. Abimanyu N, Murugesan S, Krishnan P. Emergence of methicillin‐resistant Staphylococcus aureus ST239 with high‐level mupirocin and inducible clindamycin resistance in a tertiary care center in Chennai, South India. J Clin Microbiol 2012; 50:3412‐13.
27. Rudresh MS. Giriyapur SR, Motagi A, Alex AM, Sandhya P, Navaneeth BV. Prevalence of mupirocin resistance among Staphylococci, its clinical significance and relationship to clinical use. J Lab Physicians 2015; 7(2):103-07.
28. Caffrey AR, Quilliam BJ and Laplante KL. "Risk Factors Associated With Mupirocin Resistance in methicillin resistant Staphylococcus aureus." Journal of Hospital Infection. 2010; 76(3):206-10.
29. Fomda BA, Thokar MA, G Bashir, Khan A, Kour A, Zahoor D, Ray P. Prevalence and genotypic relatedness of methicillin resistant staphylococcus aureus in a tertiary care hospital. J Postgrad Med. 2014; 60:386-89.
30. Ahmad BF, Ahmad PM, Zahoor D, Ahmad MT, Ahmad NR. Phenotypic detection of constitutive and inducible clindamycin resistance in clinical isolates of Staphylococcus aureus and coagulase negative Staphylococcus on routine susceptibility plate. J Common Dis 2010; 42(1):19-26.
Published
2019-11-28
How to Cite
1.
Bali N, Peer M, Kour R, Ahmad S, Koul P. Mupirocin resistance in clinical isolates of methicillin sensitive and resistant Staphylococcus aureus in a tertiary care centre of North India. jms [Internet]. 2019Nov.28 [cited 2026Oct.2];22(3):4-11. Available from: http://ano.jmsskims.org/index.php/jms/article/view/446
Section
Original Articles
