Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 675       

   Table of Contents      
CORRESPONDENCE
Year : 2016  |  Volume : 143  |  Issue : 6  |  Page : 824-825

High occurrence of high-level mupirocin & chlorhexidine resistant genes in methicillin resistant staphylococcal isolates from dialysis unit of a tertiary care hospital


1 Department of Microbiology, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, India
2 Nephrology Unit, Billroth Hospital, Chennai 600 018, Tamil Nadu, India

Date of Web Publication12-Oct-2016

Correspondence Address:
Padma Krishnan
Department of Microbiology, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.192078

Rights and Permissions

How to cite this article:
Perumal N, Murugesan S, Ramanathan V, Krishnan P. High occurrence of high-level mupirocin & chlorhexidine resistant genes in methicillin resistant staphylococcal isolates from dialysis unit of a tertiary care hospital. Indian J Med Res 2016;143:824-5

How to cite this URL:
Perumal N, Murugesan S, Ramanathan V, Krishnan P. High occurrence of high-level mupirocin & chlorhexidine resistant genes in methicillin resistant staphylococcal isolates from dialysis unit of a tertiary care hospital. Indian J Med Res [serial online] 2016 [cited 2019 Sep 15];143:824-5. Available from: http://www.ijmr.org.in/text.asp?2016/143/6/824/192078

Sir,

Chronic hemodialysis (CHD) patients are vulnerable to infections, including infections by methicillin-resistant staphylococci (MRS) because they are repeatedly exposed to the hospital environment and often receive prolonged courses of antibiotics, besides being immunocompromised [1] . Nasal carriage of MRS in hospital personnel also adds to the colonization pressure in healthcare facilities, acting as reservoirs for transmission to these patients [1] . Routine use of mupirocin and chlorhexidine in healthcare settings has contributed to acquisition of resistance to these antimicrobial agents among microbes which cause outbreaks in these settings [2] . Resistance to mupirocin is of low-level (mutations in the chromosomal ileS gene) or high-level [by a plasmid-mediated mupA (ileS2) gene, encoding a novel IleS] [3] . Chlorhexidine resistance is conferred by the plasmid- mediated qacA/B genes which encode proton-dependent multidrug efflux pumps [4]. We conducted a cross-sectional study to detect the presence of mupirocin and chlorhexidine resistance among methicillin resistant staphylococcal isolates obtained from the dialysis unit of a tertiary care hospital.

A total of 83 non-duplicate methicillin resistant coagulase negative staphylococcal (MRCoNS) isolates from anterior nares of CHD patients (n=124) and hospital personnel (n=30) from dialysis unit of Billroth Hospital, a tertiary care centre in Chennai, Tamil Nadu, India, were included in this study. Phenotypic detection of low- and high-level mupirocin resistance was carried out using mupirocin discs [5 and 200 μg (Hi-Media, Mumbai)] and minimum inhibitory concentration (MIC) for mupirocin was determined by agar dilution method [5],[6] . Staphylococcus aureus ATCC 25923 was used as quality control strain and results were interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines and British Society for Antimicrobial Chemotherapy (BSAC) guidelines [5],[6] . Isolates resistant to 5 and 200 μg mupirocin discs were further subjected to mupA gene detection [7] . All isolates were screened for the presence of chlorhexidine resistance gene (qacA/B) by PCR [8] .

Of the 83 MRCoNS isolates, 68 (81.9%) were from CHD patients and 15 (18%) from dialysis unit staff members. Mupirocin resistance was observed in 26 (31.3%) isolates, of which, 22 (26.5%) exhibited high-level mupirocin resistance (HLMR) and were also positive for mupA gene. In our study, mupirocin resistance was slightly higher than that reported from another study from south India [9] . Majority of the isolates showing HLMR (n=16, 19.2%) were isolated from CHD patients. Six of 22 (27.3%) isolates with HLMR displayed qacA/B. The distribution of chlorhexidine resistance genes among high- and low-level mupirocin resistant and mupirocin sensitive isolates are shown in the [Table 1]. In this study, mupirocin sensitive isolates (12/83, 14.4%) were found to harbour higher percentage of qacA/B genes compared to mupirocin resistant isolates (8/83, 9.6%). {Table 1}

In conclusion, our findings indicate that the routine use of chlorhexidine and mupirocin prophylaxis may increase the prevalence of chlorhexidine- and mupirocin-resistance genes in staphylococci in a hospital setting.

 
   References Top

1.
Lai CF, Liao CH, Pai MF, Chu FY, Hsu SP, Chen HY, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all-cause mortality in hemodialysis patients. Clin J Am Soc Nephrol 2011; 6 : 167-74.  Back to cited text no. 1
[PUBMED]    
2.
Fritz SA, Hogan PG, Camins BC, Ainsworth AJ, Patrick C, Martin MS, et al. Mupirocin and chlorhexidine resistance in Staphylococcus aureus in patients with community-onset skin and soft tissue infections. Antimicrob a0 gents c0 hemother 2013; 57 : 559-68.  Back to cited text no. 2
    
3.
Patel JB, Gorwitz RJ, Jernigan JA. Mupirocin resistance. Clin i0 nfect d0 is 2009; 49 : 935-41.  Back to cited text no. 3
    
4.
Horner C, Damien M, Mark W. Reduced susceptibility to chlorhexidine in staphylococci: is it increasing and does it matter? J Antimicrob Chemother 2012; 67 : 547-59.  Back to cited text no. 4
    
5.
Clinical and l0 aboratory Standard Institute (CLSI). Performance standards for antimicrobial susceptibility testing; 23 rd Informational Supplement. CLSI document M100-S23. Wayne PA: CLSI; 2013.   Back to cited text no. 5
    
6.
British Society for Antimicrobial Chemotherapy (BSAC). Methods for antimicrobial susceptibility testing, version 12. Birmingham, England: BSAC; May 2013.  Back to cited text no. 6
    
7.
Yun H, 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.  Back to cited text no. 7
    
8.
Noguchi N, Suwa J, Narui K, Sasatsu M, Ito T, Hiramatsu K, et al. Susceptibilities to antiseptic agents and distribution of antiseptic-resistance genes qacA/B and smr of methicillin-resistant Staphylococcus aureus isolated in Asia during 1998 and 1999. J Med Microbiol 2005; 54 : 557-65.  Back to cited text no. 8
[PUBMED]    
9.
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.  Back to cited text no. 9
[PUBMED]    



 
 
    Tables

  [Table 1]IndianJMedRes_2016_143_6_824_192078_t1.jpg


This article has been cited by
1 Design of Melting Curve Analysis (MCA) by Real-Time Polymerase Chain Reaction Assay for Rapid Distinction of Staphylococci and Antibiotic Resistance
Narges Heydari,Mohammad Yousef Alikhani,Hamed Tahmasebi,Babak Asghari,Mohammad Reza Arabestani
Archives of Clinical Infectious Diseases. 2019; In Press(In Press)
[Pubmed] | [DOI]
2 A review on mechanism of action, resistance, synergism, and clinical implications of mupirocin against Staphylococcus aureus
Saeed Khoshnood,Mohsen Heidary,Arezoo Asadi,Saleh Soleimani,Moloudsadat Motahar,Mohammad Savari,Morteza Saki,Mahtab Abdi
Biomedicine & Pharmacotherapy. 2019; 109: 1809
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Tables

 Article Access Statistics
    Viewed506    
    Printed4    
    Emailed0    
    PDF Downloaded170    
    Comments [Add]    
    Cited by others 2    

Recommend this journal