Antimicrobial Susceptibility StudyGenotypic and phenotypic characterization of methicillin-resistant Staphylococcus aureus (MRSA) clones with high-level mupirocin resistance
Introduction
Mupirocin, also known as pseudomonic acid A, is a topical antibiotic that was originally isolated from Pseudomonas fluorescens. It is used for decolonization of nasal carriers of methicillin-resistant Staphylococcus aureus (MRSA) (Sutherland et al., 1985). The increased use of this antibiotic has been accompanied by outbreaks of mupirocin-resistant MRSA (Schmitz and Jones, 1997, Simor et al., 2007).
Mupirocin is an analogue of isoleucine that inhibits protein synthesis by competitively binding to the enzyme isoleucyl-tRNA synthetase (Yanagisawa et al., 1994). The high-level mupirocin-resistant isolates show a MIC greater than 512 mg/L. This resistance is mediated by the acquisition of a plasmid containing the ileS2 gene that encodes an alternative isoleucyl-tRNA synthetase enzyme and is generally flanked by copies of the insertion sequence IS257 (Pérez-Roth et al., 2010, Woodford et al., 1998).
The objective of the study was to identify the prevalence, clonal lineages, resistance mechanisms and virulence genes of high-level mupirocin-resistant MRSA (HLMUPR-MRSA) isolates recovered from inpatients and outpatients in our institution during one year.
Section snippets
Material and methods
One hundred forty-seven MRSA isolates were collected from clinical samples in the University Teaching Hospital “Lozano Blesa” (Zaragoza, Spain) from July 2009 to July 2010. Only one isolate per patient was included. The study was conducted retrospectively. Clinical records of all patients were reviewed. For each patient the following data were collected: gender, age, medical service, source of the culture sample and comorbid conditions during the year prior to MRSA isolation (dialysis,
Results and discussion
During the course of this study, MRSA prevalence in our hospital was 30.9%, consistent with other resistance rates found in different Spanish hospitals (Cuevas et al., 2008, González-Domínguez et al., 2015, Lozano et al., 2013). Forty MRSA isolates showed HLMUPR, representing 27.2% of the studied isolates (mupirocin MICs ≥ 256 mg/L). This percentage is higher than that found in other Spanish hospital (Daskalaki et al., 2009). Other isolates were mupirocin-susceptible (i.e. MIC, <8 mg/L).
Conclusions
Most of HLMUPR-MRSA isolates that are circulating in our environment belonged to ST125/t067. This specific lineage is predominant in our area and it is associated with resistance to aminoglycosides, and to a lesser extent, to macrolides. The presence of the same IS257-ileS2 amplification pattern p3 in 65% of HLMUPR-MRSA, all of them ST125/t067, suggests a clonal spread in our hospital and community environment which could explain the high prevalence of HLMUPR-MRSA during the study period. An
Funding
This work was supported by Departamento de Ciencia, Tecnología and Universidad del Gobierno de Aragón, Spain (Project DGA-FSE/Grupos consolidados, B24-211130). MGD received a grant from the S.E.I.M.C (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica).
Conflict of interest
None.
Acknowledgments
We are grateful to Dr. E. Pérez-Roth for his technical assistance in the rapid typing method for strain characterization based on the heterogeneous IS257-ileS2 spacer regions and Dr. J Pintado for his helping with the GelCompar II® software.
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2021, Infection, Genetics and EvolutionCitation Excerpt :The present research showed a 20% prevalence of mupA among tested isolates. However, much higher rates were also reported by researches from Spain (27.2%) (González-Domínguez et al., 2016) and Iran (34%) (Abbasi-Montazeri et al., 2013). Conversely, a study conducted in Korea reported a 1.8% prevalence of mupA gene among MRSA isolates (Park et al., 2015).
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2020, Gene ReportsCitation Excerpt :Our analysis indicated a 23.1% prevalence of mupA in examined isolates which all exhibited HLMUPR phenotype. Different rates of this gene were observed in data published from Korea (1.8%) (Park et al., 2015), Belgium (3.1%) (Nagant et al., 2016), Spain (27.2%) (González-Domínguez et al., 2016), and Iran (34%) (Abbasi-Montazeri et al., 2013). Our findings regarding distribution of mupA gene was in line with Antonov et al. (2015), Mahmoudi et al. (2019) and Nagant et al. (2016)'s studies that reported the presence of this gene in both MRSA and MSSA strains while different result comes of Goudarzi et al.'s study that mupA was only detected in MRSA strains (Goudarzi et al., 2017).
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2020, Journal of Global Antimicrobial ResistanceCitation Excerpt :Based on title and abstract evaluation in a secondary screening, 1043 and 850 of the chosen articles were excluded, respectively (see Fig. 1, which also includes the reasons for exclusion). In the next step, upon full-text review 30 and 63 articles were included (out of 350) for MuRSA and MuRMRSA, respectively [4,10,11,19–84]. Finally, articles containing sufficient data regarding HLMuRSA (27 studies) and HLMuRMRSA (60 studies) were included (Fig. 1).