Mupirocin-resistant, methicillin-resistant Staphylococcus aureus strains in Canadian hospitals

被引:132
作者
Simor, Andrew E.
Stuart, Tammy L.
Louie, Lisa
Watt, Christine
Ofner-Agostini, Marianne
Gravel, Denise
Mulvey, Michael
Loeb, Mark
McGeer, Allison
Bryce, Elizabeth
Matlow, Anne
机构
[1] Sunnybrook Hlth Sci Ctr, Dept Microbiol, Toronto, ON M4N 3M5, Canada
[2] Univ Toronto, Dept Lab Med & Pathol, Toronto, ON, Canada
[3] Publ Hlth Agcy Canada, Ottawa, ON, Canada
[4] Natl Microbiol Lab, Winnipeg, MB, Canada
[5] McMaster Univ, Hamilton, ON, Canada
[6] Mt Sinai Hosp, Toronto, ON M5G 1X5, Canada
[7] Univ British Columbia, Vancouver Gen Hosp, Vancouver, BC V5Z 1M9, Canada
[8] Hosp Sick Children, Toronto, ON M5G 1X8, Canada
关键词
D O I
10.1128/AAC.00846-07
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
Mupirocin resistance in Staphylococcus aureus is increasingly being reported in many parts of the world. This study describes the epidemiology and laboratory characterization of mupirocin-resistant methicillin-resistant S. aureus (MRSA) strains in Canadian hospitals. Broth microdilution susceptibility testing of 4,980 MRSA isolates obtained between 1995 and 2004 from 32 Canadian hospitals was done in accordance with CLSI guidelines. The clinical and epidemiologic characteristics of strains with high-level mupirocin resistance (HLMUp(r)) were compared with those of mupirocin-susceptible (Mup(s)) strains. MRSA strains were characterized by pulsed-field gel electrophoresis (PFGE) and typing of the staphylococcal chromosomal cassette mec. PCR was done to detect the presence of the mupA gene. For strains with mupA, plasmid DNA was extracted and subjected to Southern blot hybridization. A total of 198 (4.0%) HLMup(r) MRSA isolates were identified. The proportion of MRSA strains with HLMUpr increased from 1.6% in the first 5 years of surveillance (1995 to 1999) to 7.0% from 2000 to 2004 (P < 0.001). Patients with HLMUpr MRSA strains were more likely to have been aboriginal (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5 to 9.4; P = 0.006), to have had community-associated MRSA (OR, 2.2; 95% C1, 1.0 to 5.0; P = 0.05), and to have been colonized with MRSA (OR, 1.7; 95% CI, 1.0 to 3.0; P = 0.04). HLMup(r) MRSA strains were also more likely to be resistant to fusidic acid (21% versus 4% for mupirocin-susceptible strains; P < 0.001). All HLMUpr MRSA strains had a plasmid-associated mupA gene, most often associated with a 9-kb HindIII fragment. PFGE typing and analysis of the plasmid profiles indicate that both plasmid transmission and the clonal spread of HLMUpr MRSA have occurred in Canadian hospitals. These results indicate that the incidence of HLMUpr is increasing among Canadian strains of MRSA and that HLMupr MRSA is recovered from patients with distinct clinical and epidemiologic characteristics compared to the characteristics of patents with Mup(r) MRSA strains.
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页码:3880 / 3886
页数:7
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