The Clinical Utility of Analysis High Resolution Melting Curve Assay for Simultaneous Identification of Methicillin and Mupirocin Resistant in Coagulase-Negative Staphylococci

Background: Resistance to methicillin and mupirocin in coagulase-negative staphylococci (CoNS) is considered as one of the most important issues. Meanwhile, use of phenotypic methods in detecting the resistance to methicillin and mupirocin has a lower accuracy and speed compared to other molecular methods, such as High-Resolution Melting Analysis (HRM). In this study, HRM technique was used to identify CoNS resistance stains. Methods: This experimental study was done on 86 isolates of CoNS strains isolated at Hamadan Hospital. Phenotypic tests were used to identify Staphylococcus saprophyticus and S. epidermidis. Methicillin and Mupirocin resistant strains were tested using the MIC and HRM methods, and sensitivity and specificity of the primers were determined based on melting curve temperature range. In addition, data was analyzed by Applied Biosystems Step-One v 2.3 and Applied Biosystems HRM v 3.0.1 software. Results: Eighty-six (86) coagulase-negative isolates were isolated from different clinical specimens. Among these, 69 isolates of S. epidermidis and 17 isolates of S. saprophyticus were identified. Of the 69 S. epidermidis isolates, 19 isolates with oxacillin MIC >= 0.5 mu g/mL and methicillin-resistant, and 11 isolates with mupirocin MIC >= 32 mu g/mL and resistant to mupirocin. Of the 17 S. saprophyticus isolates, three isolates with oxacillin MIC >= 0.5 mu g/mL were also methicillin-resistant, and one isolate with mupirocin MIC >= 32 mu g/mL was resistant to mupirocin. Melting curve analysis for mecA and mupA primers was determined 81.7 +/- 0.5 degrees C and 74 +/- 0.5 degrees C, respectively. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HRM assay for detection of methicillin and mupirocin strains testing were 100%. Conclusions: Identification of methicillin and mupirocin resistance in CoNSs using the HRM method has high sensitivity and specificity. Molecular methods are more accurate and faster than phenotypic methods and can identify a large number of resistant isolates in a short time.