Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians 2014; 6(02): 091-095
DOI: 10.4103/0974-2727.141505
Original Article

Resistance pattern of mupirocin in methicillin-resistant Staphylococcus aureus in trauma patients and comparison between disc diffusion and E-test for better detection of resistance in low resource countries

Nonika Rajkumari
Department of Laboratory Medicine, Microbiology Division, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Purva Mathur
Department of Laboratory Medicine, Microbiology Division, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Nidhi Bhardwaj
Department of Laboratory Medicine, Microbiology Division, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Gunjan Gupta
Department of Laboratory Medicine, Microbiology Division, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Rajrani Dahiya
Department of Laboratory Medicine, Microbiology Division, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Bijayini Behera
Department of Microbiology, Yashoda Superspeciality Hospital, Secunderabad, Andhra Pradesh, India
,
Mahesh Chandra Misra
Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Source of Support: Nil
› Further Information
Also available at
  PDF Download Permissions and Reprints

ABSTRACT

Introduction: Mupirocin is an effective antibiotic for elimination of methicillin-resistant Staphylococcus aureus (MRSA) from nasal colonization and has been used to control outbreaks. Current reports show an increasing trend of resistance to this antibiotic.

Objective: This study was conducted to analyze the resistance pattern of MRSA to mupirocin among the patients admitted following trauma to an apex trauma care center of India and to compare the efficacy between two methods of antimicrobial sensitivity testing.

Materials and Methods: A total of 150 isolates of MRSA from various clinical samples of trauma patients over a period of 2 years were included in this study. These strains were confirmed for MRSA using VITEK ® 2 Compact and the Clinical Laboratory Standard Institute disc diffusion methods. The mupirocin susceptibility of the strains was tested by using E-test and 5 μg mupirocin disc in parallel each time, and the results were compared.

Results: Clear zones of inhibition were observed in both tests. Though, good correlation was observed between the disc diffusion and E-tests in >98%, E-test showed a tendency to show lower minimum inhibitory concentration (MIC) in the remaining. These finding did not affect the final interpretation or outcomes. Of the total 150 strains, 138 (92%) showed sensitivity with the zone size in the range of 30-45 mm by 5 μg disc; rest (8%) showed sensitivity with the zone in the range of 18-30 mm by 5 μg disc, but 143 (95%) showed MIC ≤ 0.094 μg/ml and 8 (5%) gave MIC ≤ 0.75 μg/ml but ≥0.094 μg/ml by E-test. However, when both tests were compared, 5 (3.3%) showed zone size between 14 and 25 mm with ≤0.75 but >0.25 μg/ml MIC; 7 (5%) falling between 25 and 30 mm zone with MIC of ≤0.25 but >0.094 μg/ml and 138 (92%) showed zone >30 mm with MIC ≤0.094 but >0.064 μg/ml.

Conclusions: All the MRSA isolates in our study were sensitive to mupirocin which is an encouraging finding. Though good screening for sensitivity can be done with 5 μg mupirocin disc, E-test provides a much clear and accurate results in clinical set-up. Hence, disc test can be used in resource poor countries and supplemented with E-test when needed.

Keywords

Antibiotic resistance - disc diffusion - E-test - methicillin-resistant Staphylococcus aureus - mupirocin


Publication History

Article published online:
19 April 2020

© 2014.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • REFERENCES

  • 1 Finlay JE, Miller LA, Poupard JA. Interpretive criteria for testing susceptibility of staphylococci to mupirocin. Antimicrob Agents Chemother 1997;41:1137-9.
  • 2 Doebbeling BN, Breneman DL, Neu HC, Aly R, Yangco BG, Holley HP Jr, et al. Elimination of Staphylococcus aureus nasal carriage in health care workers: Analysis of six clinical trials with calcium mupirocin ointment. The Mupirocin Collaborative Study Group. Clin Infect Dis 1993;17:466-74.
  • 3 Naguib MH, Naguib MT, Flournoy DJ. Mupirocin resistance in methicillin-resistant Staphylococcus aureus from a veterans hospital. Chemotherapy 1993;39:400-4.
  • 4 Fuchs PC, Jones RN, Barry AL. Interpretive criteria for disk diffusion susceptibility testing of mupirocin, a topical antibiotic. J Clin Microbiol 1990;28:608-9.
  • 5 Barry AL, Pfaller MA, Fuchs PC. Ramoplanin susceptibility testing criteria. J Clin Microbiol 1993;31:1932-5.
  • 6 Eltringham I. Mupirocin resistance and methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect 1997;35:1-8.
  • 7 Mondino PJ, Dos Santos KR, de Freire Bastos Mdo C, Giambiagi-deMarval M. Improvement of mupirocin E-test for susceptibility testing of Staphylococcus aureus. J Med Microbiol 2003;52:385-7.
  • 8 Udo EE, Jacob LE, Mathew B. Genetic analysis of methicillin-resistant Staphylococcus aureus expressing high- and low-level mupirocin resistance. J Med Microbiol 2001;50:909-15.
  • 9 Yun HJ, Lee SW, Yoon GM, Kim SY, Choi S, Lee YS, et al. Prevalence and mechanisms of low- and high-level mupirocin resistance in staphylococci isolated from a Korean hospital. J Antimicrob Chemother 2003;51:619-23.
  • 10 Cookson BD. The emergence of mupirocin resistance: A challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998;41:11-8.
  • 11 Seah C, Alexander DC, Louie L, Simor A, Low DE, Longtin J, et al. MupB, a new high-level mupirocin resistance mechanism in Staphylococcus aureus. Antimicrob Agents Chemother 2012;56:1916-20.
  • 12 Clinical and Laboratory Standard Institute. Performance standards for Antimicrobial Susceptibility Testing; Twentieth Informational Supplement (June 2010 update).Vol. 30, No. 15. Pennsylvania, USA: CLSI; 2010.
  • 13 Clinical and Laboratory Standard Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. Clinical and Vol. 32, No. 3. Pennsylvania, USA; CLSI; 2012. Available from: http://antimicrobianos.com.ar/ATB/wp-content/uploads/2012/11/M100S22E.pdf [Last assessed on 2014 May 15].
  • 14 Jones JC, Rogers TJ, Brookmeyer P, Dunne WM Jr, Storch GA, Coopersmith CM, et al. Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin Infect Dis 2007 1;45:541-7.
  • 15 Daskalaki M, Otero JR, Chaves F. Molecular characterization of resistance to mupirocin in methicillin-resistant Staphylococcus aureus isolates in a tertiary hospital in Spain. J Antimicrob Chemother 2009;63:826-8.
  • 16 Liu QZ, Wu Q, Zhang YB, Liu MN, Hu FP, Xu XG, et al. Prevalence of clinical meticillin-resistant Staphylococcus aureus (MRSA) with high-level mupirocin resistance in Shanghai and Wenzhou, China. Int J Antimicrob Agents 2010;35:114-8.
  • 17 Sareyyüpoglu B, Ozyurt M, Haznedaroglu T, Ardiç N. Detection of methicillin and mupirocin resistance in staphylococcal hospital isolates with a touchdown multiplex polymerase chain reaction. Folia Microbiol (Praha) 2008;53:363-7.
  • 18 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;58:125-7.
  • 19 Orrett FA. The emergence of mupirocin resistance among clinical isolates of methicillin-resistant Staphylococcus aureus in Trinidad: A first report. Jpn J Infect Dis 2008;61:107-10.
  • 20 Walker ES, Levy F, Shorman M, David G, Abdalla J, Sarubbi FA. A decline in mupirocin resistance in methicillin-resistant Staphylococcus aureus accompanied administrative control of prescriptions. J Clin Microbiol 2004;42:2792-5.
  • 21 Oommen SK, Appalaraju B, Jinsha K. Mupirocin resistance in clinical isolates of staphylococci in a tertiary care centre in south India. Indian J Med Microbiol 2010;28:372-5.
  • 22 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;50:3412-3.
  • 23 Jayakumar S, Meerabai M, Banu SS, Mathew R, Kalyani M, Lal Y B. Prevalence of high- and low level mupirocin resistance among staphylococcal isolates from skin infection in a tertiary care hospital. J Clin Diagn Res 2013;7:238-42.
  • 24 Acuna-Villaorduna C, Hardwick MJ, Goucher S, Waga M, Shoham S. Evaluation of mupA Evigene in comparison to disk diffusion for detection of high-level mupirocin resistance in clinical isolates of Staphylococcus aureus. J Clin Microbiol 2010;48:2953-4.
  • 25 Palepou MF, Johnson AP, Cookson BD, Beattie H, Charlett A, Woodford N. Evaluation of disc diffusion and E-test for determining the susceptibility of Staphylococcus aureus to mupirocin. J Antimicrob Chemother 1998;42:577-83.