John Hughes1, Richard Stabler2, Michael Gaunt2, Tacim Karadag3, Nergish Desai4, Jason Betley5, Avgousta Ioannou5, Anna Aryee1, Pasco Hearn1, Helene Marbach1, Amita Patel1, Jonathan A Otter1, Jonathan D Edgeworth1, Olga Tosas Auguet6. 1. Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK. 2. Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. 3. Department of Microbiology, Lewisham and Greenwich NHS Trust, London, UK. 4. Department of Microbiology, King's College Hospital NHS Foundation Trust, London, UK. 5. Illumina Cambridge Limited, Chesterford Research Park, Little Chesterford, Essex, UK. 6. Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK olga.tosas@gstt.nhs.uk.
Abstract
OBJECTIVES: Both low-level mupirocin resistance (LMR) and high-level mupirocin resistance (HMR) have been identified. The aim of this study was to determine the epidemiology of LMR and HMR in MRSA isolates at five hospitals that have used mupirocin for targeted decolonization as part of successful institutional control programmes. METHODS: All MRSA identified in three microbiology laboratories serving five central and south-east London hospitals and surrounding communities between November 2011 and February 2012 were included. HMR and LMR were determined by disc diffusion testing. WGS was used to derive multilocus sequence types (MLSTs) and the presence of HMR and LMR resistance determinants. RESULTS: Prevalence of either HMR or LMR amongst first healthcare episode isolates from 795 identified patients was 9.69% (95% CI 7.72-11.96); LMR was 6.29% (95% CI 4.70-8.21) and HMR was 3.40% (95% CI 2.25-4.90). Mupirocin resistance was not significantly different in isolates identified from inpatients at each microbiology laboratory, but was more common in genotypically defined 'hospital' rather than 'community' isolates (OR 3.17, 95% CI 1.36-9.30, P = 0.002). LMR was associated with inpatient stay, previous history of MRSA and age ≥65 years; HMR was associated with age ≥65 years and residential postcode outside London. LMR and HMR varied by clone, with both being low in the dominant UK MRSA clone ST22 compared with ST8, ST36 and ST239/241 for LMR and with ST8 and ST36 for HMR. V588F mutation and mupA carriage had high specificity (>97%) and area under the curve (>83%) to discriminate phenotypic mupirocin resistance, but uncertainty around the sensitivity point estimate was large (95% CI 52.50%-94.44%). Mutations in or near the mupA gene were found in eight isolates that carried mupA but were not HMR. CONCLUSIONS: Mupirocin resistance was identified in <10% of patients and varied significantly by clone, implying that changes in clonal epidemiology may have an important role in determining the prevalence of resistance in conjunction with selection due to mupirocin use.
OBJECTIVES: Both low-level mupirocin resistance (LMR) and high-level mupirocin resistance (HMR) have been identified. The aim of this study was to determine the epidemiology of LMR and HMR in MRSA isolates at five hospitals that have used mupirocin for targeted decolonization as part of successful institutional control programmes. METHODS: All MRSA identified in three microbiology laboratories serving five central and south-east London hospitals and surrounding communities between November 2011 and February 2012 were included. HMR and LMR were determined by disc diffusion testing. WGS was used to derive multilocus sequence types (MLSTs) and the presence of HMR and LMR resistance determinants. RESULTS: Prevalence of either HMR or LMR amongst first healthcare episode isolates from 795 identified patients was 9.69% (95% CI 7.72-11.96); LMR was 6.29% (95% CI 4.70-8.21) and HMR was 3.40% (95% CI 2.25-4.90). Mupirocin resistance was not significantly different in isolates identified from inpatients at each microbiology laboratory, but was more common in genotypically defined 'hospital' rather than 'community' isolates (OR 3.17, 95% CI 1.36-9.30, P = 0.002). LMR was associated with inpatient stay, previous history of MRSA and age ≥65 years; HMR was associated with age ≥65 years and residential postcode outside London. LMR and HMR varied by clone, with both being low in the dominant UK MRSA clone ST22 compared with ST8, ST36 and ST239/241 for LMR and with ST8 and ST36 for HMR. V588F mutation and mupA carriage had high specificity (>97%) and area under the curve (>83%) to discriminate phenotypic mupirocin resistance, but uncertainty around the sensitivity point estimate was large (95% CI 52.50%-94.44%). Mutations in or near the mupA gene were found in eight isolates that carried mupA but were not HMR. CONCLUSIONS:Mupirocin resistance was identified in <10% of patients and varied significantly by clone, implying that changes in clonal epidemiology may have an important role in determining the prevalence of resistance in conjunction with selection due to mupirocin use.
Authors: Olga Tosas Auguet; Richard A Stabler; Jason Betley; Mark D Preston; Mandeep Dhaliwal; Michael Gaunt; Avgousta Ioannou; Nergish Desai; Tacim Karadag; Rahul Batra; Jonathan A Otter; Helene Marbach; Taane G Clark; Jonathan D Edgeworth Journal: Clin Infect Dis Date: 2018-03-05 Impact factor: 9.079
Authors: Adebayo O Shittu; Mamadou Kaba; Shima M Abdulgader; Yewande O Ajao; Mujibat O Abiola; Ayodele O Olatimehin Journal: Antimicrob Resist Infect Control Date: 2018-08-15 Impact factor: 4.887
Authors: Nina Van Goethem; Tine Descamps; Brecht Devleesschauwer; Nancy H C Roosens; Nele A M Boon; Herman Van Oyen; Annie Robert Journal: Implement Sci Date: 2019-08-13 Impact factor: 7.327
Authors: Sarah R Deeny; Colin J Worby; Olga Tosas Auguet; Ben S Cooper; Jonathan Edgeworth; Barry Cookson; Julie V Robotham Journal: J Antimicrob Chemother Date: 2015-09-03 Impact factor: 5.790
Authors: Olga Tosas Auguet; Jason R Betley; Richard A Stabler; Amita Patel; Avgousta Ioannou; Helene Marbach; Pasco Hearn; Anna Aryee; Simon D Goldenberg; Jonathan A Otter; Nergish Desai; Tacim Karadag; Chris Grundy; Michael W Gaunt; Ben S Cooper; Jonathan D Edgeworth; Theodore Kypraios Journal: PLoS Med Date: 2016-01-26 Impact factor: 11.069
Authors: N Van Goethem; M J Struelens; S C J De Keersmaecker; N H C Roosens; A Robert; S Quoilin; H Van Oyen; B Devleesschauwer Journal: BMC Public Health Date: 2020-08-31 Impact factor: 3.295