scholarly journals Mupirocin Resistance in Staphylococcus aureus Causing Recurrent Skin and Soft Tissue Infections in Children

2011 ◽  
Vol 55 (5) ◽  
pp. 2431-2433 ◽  
Author(s):  
J. Chase McNeil ◽  
Kristina G. Hulten ◽  
Sheldon L. Kaplan ◽  
Edward O. Mason
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Trna Synthetase ◽  
Soft Tissue Infections ◽  
Methicillin Resistant ◽  
Content Type ◽  
Plasmid Gene ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Mupirocin Resistance

ABSTRACTStaphylococcus aureusresistance to mupirocin is often caused by acquisition of a novel isoleucyl-tRNA synthetase encoded on the plasmid genemupA. We testedS. aureusisolates from children at Texas Children's Hospital with recurrent skin and soft tissue infections for mupirocin resistance andmupA. Of 136 isolates, 20 were resistant to mupirocin (14.7%). Fifteen isolates (11%) carriedmupA, and the gene was more common in methicillin-susceptibleS. aureus(21.4%) than methicillin-resistantS. aureus(8.3%;P= 0.03). Seven of 20 mupirocin-resistant isolates displayed clindamycin resistance.

scholarly journals Clinical and Molecular Features of Decreased Chlorhexidine Susceptibility among Nosocomial Staphylococcus aureus Isolates at Texas Children's Hospital

2015 ◽  
Vol 60 (2) ◽  
pp. 1121-1128 ◽  
Author(s):  
J. Chase McNeil ◽  
Eric Y. Kok ◽  
Jesus G. Vallejo ◽  
Judith R. Campbell ◽  
Kristina G. Hulten ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Setting ◽  
Bloodstream Infections ◽  
Hospital Environment ◽  
Content Type ◽  
Children's Hospital ◽  
Molecular Features ◽  
Children’S Hospital ◽  
Topical Antimicrobials ◽  
Mupirocin Resistance

ABSTRACTOne of the strategies utilized to decrease infections in the hospital setting relies on topical antimicrobials and antiseptics. While their use is beneficial, concerns arise over the potential to develop resistance or tolerance to these agents. We examined nosocomialStaphylococcus aureusisolates from 2007 to 2013 for the presence of genes associated with tolerance to chlorhexidine. Isolates and patients were identified from anS. aureussurveillance study at Texas Children's Hospital. NosocomialS. aureusisolates (those causing infection at ≥72 h of hospitalization) were identified and underwent PCR for theqacAorqacB(qacA/B) andsmrgenes associated with elevated minimum bactericidal concentrations of chlorhexidine. Molecular typing with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), andagrtyping and a review of the medical record were performed. Two hundred forty-seven nosocomialS. aureusinfections were identified. Overall, 111 isolates carried one or both genes (44.9%); 33.1% were positive forsmr, 22.7% were positive forqacA/B, and 10.9% of the isolates possessed both genes. Thesmr-positive isolates were more often resistant to methicillin, ciprofloxacin, and/or clindamycin. The isolates positive forqacA/Bwere more often associated with indwelling central venous catheters and a vancomycin MIC of ≥2 μg/ml. Isolates carrying eithersmrorqacA/Bwere associated with a diagnosis of bacteremia. Thesmr-positive isolates more often belonged to sequence type 8 (ST8) than the isolates that were positive forqacA/B. Mupirocin resistance was detected in 2.8% of the isolates. Antiseptic-tolerantS. aureusstrains are common in our children's hospital and are associated with decreased susceptibility to other systemic antimicrobials and with bloodstream infections. Further work is needed to understand the implications that these organisms have on the hospital environment and antiseptic use in the future.

Epidemiology of Methicillin-Resistant Staphylococcus aureus at a Children's Hospital

2003 ◽  
Vol 24 (6) ◽  
pp. 427-430 ◽  
Author(s):  
Andrew L. Campbell ◽  
Kristina A. Bryant ◽  
Beth Stover ◽  
Gary S. Marshall
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Risk Factor ◽  
Soft Tissue ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Categorical Variables ◽  
Methicillin Resistant ◽  
Children's Hospital ◽  
Children’S Hospital

AbstractObjective:To describe the relative contribution of and risk factors for both community-acquired and nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections.Design:Retrospective cohort study.Setting:270-bed, tertiary-care children's hospital.Participants:All MRSA-infected children from whom MRSA was recovered between October 1, 1999, and September 30, 2001.Methods:Demographic, clinical, and risk factor data were abstracted from medical records. Categorical variables were analyzed using the chi-square or Fisher's exact test and continuous variables were analyzed using the Mann-Whitney test.Results:Of the 62 patients with new MRSA infection, 37 had community-acquired MRSA and 25 had nosocomial MRSA. Most community-acquired MRSA infections were of the skin and soft tissue, the middle ear, and the lower respiratory tract. Nosocomial MRSA infections occurred in the lower respiratory tract, the skin and soft tissue, and the blood. Risk factors for infection, including underlying medical illness, prior hospitalization, and prior surgery, were similar for patients with community-acquired MRSA and nosocomial MRSA. History of central venous catheterization and previous endotracheal intubation was more common in patients with nosocomial MRSA. Only 3 patients with community-acquired MRSA had no identifiable risk factor other than recent antibiotic use. Resistance for clindamycin, erythromycin, and levofloxacin was similar between strains of community-acquired MRSA and nosocomial MRSA.Conclusions:Similarities in patient risk factors and resistance patterns of isolates of both community-acquired and nosocomial MRSA suggest healthcare acquisition of most MRSA. Thus, classifying MRSA as either community acquired or nosocomial underestimates the amount of healthcare-associated MRSA.

scholarly journals Origin and Evolution of European Community-Acquired Methicillin-Resistant Staphylococcus aureus

mBio ◽  
2014 ◽  
Vol 5 (5) ◽  
Author(s):  
Marc Stegger ◽  
Thierry Wirth ◽  
Paal S. Andersen ◽  
Robert L. Skov ◽  
Anna De Grassi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Middle East ◽  
North Africa ◽  
Fusidic Acid ◽  
Sub Saharan Africa ◽  
Soft Tissue Infections ◽  
Methicillin Resistant ◽  
Content Type ◽  
Sub Saharan

ABSTRACT Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) was recognized in Europe and worldwide in the late 1990s. Within a decade, several genetically and geographically distinct CA-MRSA lineages carrying the small SCCmec type IV and V genetic elements and the Panton-Valentine leukocidin (PVL) emerged around the world. In Europe, the predominant CA-MRSA strain belongs to clonal complex 80 (CC80) and is resistant to kanamycin/amikacin and fusidic acid. CC80 was first reported in 1993 but was relatively rare until the late 1990s. It has since been identified throughout North Africa, the Middle East, and Europe, with recent sporadic reports in sub-Saharan Africa. While strongly associated with skin and soft tissue infections, it is rarely found among asymptomatic carriers. Methicillin-sensitive S. aureus (MSSA) CC80 strains are extremely rare except in sub-Saharan Africa. In the current study, we applied whole-genome sequencing to a global collection of both MSSA and MRSA CC80 isolates. Phylogenetic analyses strongly suggest that the European epidemic CA-MRSA lineage is derived from a PVL-positive MSSA ancestor from sub-Saharan Africa. Moreover, the tree topology suggests a single acquisition of both the SCCmec element and a plasmid encoding the fusidic acid resistance determinant. Four canonical SNPs distinguish the derived CA-MRSA lineage and include a nonsynonymous mutation in accessory gene regulator C (agrC). These changes were associated with a star-like expansion into Europe, the Middle East, and North Africa in the early 1990s, including multiple cases of cross-continent imports likely driven by human migrations. IMPORTANCE With increasing levels of CA-MRSA reported from most parts of the Western world, there is a great interest in understanding the origin and factors associated with the emergence of these epidemic lineages. To trace the origin, evolution, and dissemination pattern of the European CA-MRSA clone (CC80), we sequenced a global collection of strains of the S. aureus CC80 lineage. Our study determined that a single descendant of a PVL-positive methicillin-sensitive ancestor circulating in sub-Saharan Africa rose to become the dominant CA-MRSA clone in Europe, the Middle East, and North Africa. In the transition from a methicillin-susceptible lineage to a successful CA-MRSA clone, it simultaneously became resistant to fusidic acid, a widely used antibiotic for skin and soft tissue infections, thus demonstrating the importance of antibiotic selection in the success of this clone. This finding furthermore highlights the significance of horizontal gene acquisitions and underscores the combined importance of these factors for the success of CA-MRSA.

scholarly journals Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus in Patients with Community-Onset Skin and Soft Tissue Infections

2012 ◽  
Vol 57 (1) ◽  
pp. 559-568 ◽  
Author(s):  
Stephanie A. Fritz ◽  
Patrick G. Hogan ◽  
Bernard C. Camins ◽  
Ali J. Ainsworth ◽  
Carol Patrick ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Routine Care ◽  
Soft Tissue Infections ◽  
Content Type ◽  
Before And After ◽  
Intranasal Mupirocin ◽  
Mupirocin Resistance ◽  
High Level ◽  
Community Onset

ABSTRACTDecolonization measures, including mupirocin and chlorhexidine, are often prescribed to preventStaphylococcus aureusskin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level mupirocin and chlorhexidine resistance inS. aureusstrains recovered from patients with SSTI before and after mupirocin and chlorhexidine administration and to determine whether carriage of a mupirocin- or chlorhexidine-resistant strain at baseline precludedS. aureuseradication. We recruited 1,089 patients with community-onset SSTI with or withoutS. aureuscolonization. In addition to routine care, 483 patients were enrolled in a decolonization trial: 408 received intranasal mupirocin (with or without antimicrobial baths), and 258 performed chlorhexidine body washes. Patients were followed for up to 12 months with repeat colonization cultures. AllS. aureusisolates were tested for high-level mupirocin and chlorhexidine resistance. At baseline, 23/1,089 (2.1%) patients carried a mupirocin-resistantS. aureusstrain and 10/1,089 (0.9%) patients carried chlorhexidine-resistantS. aureus. Of 4 patients prescribed mupirocin, who carried a mupirocin-resistantS. aureusstrain at baseline, 100% remained colonized at 1 month compared to 44% of the 324 patients without mupirocin resistance at baseline (P= 0.041). Of 2 patients prescribed chlorhexidine, who carried a chlorhexidine-resistantS. aureusstrain at baseline, 50% remained colonized at 1 month compared to 48% of the 209 patients without chlorhexidine resistance at baseline (P= 1.0). The overall prevalence of mupirocin and chlorhexidine resistance is low inS. aureusisolates recovered from outpatients, but eradication efforts were less successful in patients carrying a mupirocin-resistantS. aureusstrain at baseline.

An Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit

2003 ◽  
Vol 24 (5) ◽  
pp. 317-321 ◽  
Author(s):  
Lisa Saiman ◽  
Alicia Cronquist ◽  
Fann Wu ◽  
Juyan Zhou ◽  
David Rubenstein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Methicillin Resistant ◽  
Children's Hospital ◽  
Surveillance Cultures ◽  
Children’S Hospital ◽  
Incident Cases

AbstractObjective:To describe the epidemiologic and molecular investigations that successfully contained an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal intensive care unit (NICU).Design:Isolates of MRSA were typed by pulsed-field gel electrophoresis (PFGE) and S. aureus protein A (spa).Setting:A level III-IV, 45-bed NICU located in a children's hospital within a medical center.Patients:Incident cases had MRSA isolated from clinical cultures (eg, blood) or surveillance cultures (ie, anterior nares).Interventions:Infected and colonized infants were placed on contact precautions, cohorted, and treated with mupirocin. Surveillance cultures were performed for healthcare workers (HCWs). Colonized HCWs were treated with topical mupirocin and hexachlorophene showers.Results:From January to March 2001, the outbreak strain of MRSA PFGE clone B, was harbored by 13 infants. Three (1.3%) of 235 HCWs were colonized with MRSA. Two HCWs, who rotated between the adult and the pediatric facility, harbored clone C. One HCW, who exclusively worked in the children's hospital, was colonized with clone B. From January 1999 to November 2000, 22 patients hospitalized in the adult facility were infected or colonized with clone B. Spa typing and PFGE yielded concordant results. PFGE clone B was identified as spa type 16, associated with outbreaks in Brazil and Hungary.Conclusions:A possible route of MRSA transmission was elucidated by molecular typing. MRSA appears to have been transferred from our adult facility to our pediatric facility by a rotating HCW. Spa typing allowed comparison of our institution's MRSA strains with previously characterized outbreak clones.

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