Skip to main content
SpringerLink
Log in

Comparative analysis of MRSA strains isolated from cases of mupirocin ointment treatment in which eradication was successful and in which eradication failed

  • Original Article
  • Published:
Journal of Infection and Chemotherapy

Abstract

Nasal decolonization in methicillin-resistant Staphylococcus aureus (MRSA) carriers using mupirocin (MUP) is a strategy that complements barrier precautions and contact isolation. However, eradication failure cases have been observed despite isolates being susceptible to MUP. This would suggest that the minimum inhibitory concentration (MIC) alone is not the only determinant of successful eradication. In this study, we undertook a comparative analysis of MRSA isolates from cases of successful and unsuccessful MUP-eradication treatment. The analyses we carried out were: determination of mupirocin MICs, sequencing of the isoleucyl-tRNA synthetase (ileS) gene, staphylococcal cassette chromosome mec typing, and the assessment of slime production. MICs for all 14 of the successful nasal decolonization cases showed susceptibility to MUP, whereas 21 (87.5 %) of the 24 unsuccessful cases were MUP-susceptible, with low-level resistance seen in 3 (12.5 %) strains. In the analysis of mutations in the ileS gene, one strain with an MIC of 4 μg/ml exhibited a G1778A point mutation that has not been previously reported. In the 14 successful nasal decolonization cases, only 1 strain (7.1 %) was an MRSA slime-producer, compared with 19 (79.7 %) of the 24 MRSA strains that could not be eradicated after MUP treatment (p < 0.05). For the eradication of MRSA by MUP, it is possible that slime may affect drug penetration. In conclusion, slime production was the only significant difference between isolates recovered from successful and unsuccessful eradication cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kluytmans JA, Mouton JW, Ijzerman EP, Vandenbroucke-Grauls CM, Maat AW, Wagenvoort JH, et al. Nasal carriage of Staphylococcus aureus as a major risk factor for wound infection after cardiac surgery. J Infect Dis. 1995;171:216–9.

    Article  PubMed  CAS  Google Scholar 

  2. Peterson LR. To screen or not to screen for methicillin-resistant Staphylococcus aureus. J ClinMicrobiol. 2010;48:683–9.

    Google Scholar 

  3. Cimochowski GE, Harostock MD, Brown R, Bernardi M, Alonzo N, Coyle K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg. 2001;71:1572–8.

    Article  PubMed  CAS  Google Scholar 

  4. Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002;346:1871–7.

    Article  PubMed  CAS  Google Scholar 

  5. Patel JB, Gorwitz RJ, Jernigan JA. Mupirocin resistance. Clin Infect Dis. 2009;49:935–41.

    Article  PubMed  CAS  Google Scholar 

  6. Babu T, Rekasius V, Parada JP, Schreckenberger P, Challapalli M. Mupirocin resistance among methicillin-resistant Staphylococcus aureus-colonized patients at admission to a tertiary care medical center. J Clin Microbiol. 2009;47:2279–80.

    Article  PubMed  CAS  Google Scholar 

  7. Kikuchi K. Mupirocin resistant staphylococci. Lab Test Tech. 2000;28:1561–3.

    Google Scholar 

  8. Antonio M, McFerran N, Pallen MJ. Mutations affecting Rossman fold of isoleucyl-tRNA synthetase are correlated with low-level mupirocin resistance in Staphylococcus aureus. Antimicrob Agents Chemother. 2002;46:438–42.

    Article  PubMed  CAS  Google Scholar 

  9. Yang JA, Park DW, Sohn JW, Yang IS, Kim KH, Kim MJ. Molecular analysis of isoleucyl-tRNA synthetase mutation in clinical isolates of methicillin-resistant Staphylococus aureus with low level mupirocin resistance. J Korean Med Sci. 2006;21:827–32.

    Article  PubMed  CAS  Google Scholar 

  10. Fujimura S, Tokue Y, Watanabe A. Isoleucyl-tRNA synthetase mutation in Staphylococcus aureus clinical isolates and in vitro selection of low-level mupirocin-resistant strains. Antimicrob Agents Chemother. 2003;47:3373–4.

    Article  PubMed  CAS  Google Scholar 

  11. Walker ES, Vasquez JE, Dula R, Bullock H, Sarubbi FA. Mupirocin-resistant, methicillin-resistant Staphylococcus aureus: does mupirocin remain effective? Infect Control Hosp Epidemiol. 2003;24:342–6.

    Article  PubMed  Google Scholar 

  12. Kiedrowski MR, Kavanaugh JS, Malone CL, Mootz JM, Voyich JM, Smeltzer MS, et al. Nuclease modulates biofilm formation in community-associated methicillin-resistant Staphylococcus aureus. PLoS One. 2011;6:e26714.

    Article  PubMed  CAS  Google Scholar 

  13. Williams I, Venables WA, Lloyd D, Paul F, Critchley I. The effects of adherence to silicone surfaces on antibiotic susceptibility in Staphylococcus aureus. Microbiology. 1997;143:2407–13.

    Article  PubMed  CAS  Google Scholar 

  14. Manisha M, Gehua W, Wendym J. Multiplex PCR for detection of genes for Staphylococcus aureus enterotoxins, exfoliative toxins, toxic shock syndrome toxin 1, and methicillin resistance. J ClinMicrobiol. 2000;38:1032–5.

    Google Scholar 

  15. Smith CL, Cantor CR. Purification, specific fragmentation, and separation of large DNA molecules. Methods Enzymol. 1987;155:449–67.

    Article  PubMed  CAS  Google Scholar 

  16. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis (criteria for bacterial strain typing). J ClinMicrobiol. 1995;33:2233–9.

    CAS  Google Scholar 

  17. Chalker AF, Ward JM, Fosberry AP, Hodgson JE. Analysis and toxic overexpression in Escherichia coli of a staphylococcal gene encoding isoleucyl-tRNA synthetase. Gene. 1994;141:103–8.

    Article  PubMed  CAS  Google Scholar 

  18. Zhang K, McClure J-A, Elsayed S, Louie T, Conly JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin resistant Staphylococcus aureus. J ClinMicrobiol. 2005;43:5026–33.

    CAS  Google Scholar 

  19. Christensen GD, Simpson WA, Bisno AL, Beachey EH. Adherence of slime-producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun. 1982;37:318–26.

    PubMed  CAS  Google Scholar 

  20. Giamarellou H, Souli M. Effects of slime produced by clinical isolates of coagulase-negative staphylococci on activities of various antimicrobial agents. Antimicrob Agents Chemother. 1998;42:939–41.

    PubMed  Google Scholar 

  21. Suci PA, Mittelman MW, Yu FP, Geesey GG. Investigation of ciprofloxacin penetration into Pseudomonas aeruginosa biofilms. Antimicrob Agents Chemother. 1994;38:2125–33.

    Article  PubMed  CAS  Google Scholar 

  22. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002;15:167–93.

    Article  PubMed  CAS  Google Scholar 

  23. Hammond AA, Miller KG, Kruczek CJ, Dertien J, Colmer-Hamood JA, Griswold JA, et al. An in vitro biofilm model to examine the effect of antibiotic ointments on biofilms produced by burn wound bacterial isolates. Burns. 2011;37:312–21.

    Article  PubMed  Google Scholar 

  24. Huang YC, Chou YH, Su LH, Lien RI, Lin TY. Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units. Pediatrics. 2006;118:469–74.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Infection Control and Prevention Committee, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan

    Masamichi Ogura

  2. Department of Infection Control and Prevention Nursing, Nagoya City University Graduate School of Nursing, Nagoya, Japan

    Hisako Yano

  3. Division of Infection Control and Prevention, Nagoya City University Hospital, Nagoya, Japan

    Atsushi Nakamura

  4. Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Mikinori Sato

  5. Infection Control and Prevention Committee, Nagoya City University Hospital, Nagoya, Japan

    Yukio Wakimoto

  6. Department of Microbiology, Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine, Gifu, Japan

    Masamichi Ogura, Kiyofumi Ohkusu & Takayuki Ezaki

Authors
  1. Masamichi Ogura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hisako Yano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikinori Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atsushi Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukio Wakimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kiyofumi Ohkusu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takayuki Ezaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masamichi Ogura.

About this article

Cite this article

Ogura, M., Yano, H., Sato, M. et al. Comparative analysis of MRSA strains isolated from cases of mupirocin ointment treatment in which eradication was successful and in which eradication failed. J Infect Chemother 19, 196–201 (2013). https://doi.org/10.1007/s10156-012-0445-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10156-012-0445-0

Keywords

Search

Navigation