Program Schedule

279
Prevalence and Epidemiology of Mupirocin Resistance Among Those Colonized with Methicillin-resistant Staphylococcus aureus in the Community

Session: Poster Abstract Session: MRSA and VRE
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • mupirocin_IDWeekposter_print.pdf (4.6 MB)
  • Background: Mupirocin ointment is often used to attempt eradication of colonization with methicillin-resistant Staphylococcus aureus (MRSA). However, mupirocin resistance, particularly among community-onset MRSA strains, has been increasing. This study sought to describe the prevalence and epidemiology of mupirocin resistance among community-dwelling subjects and their colonized household members. 

    Methods: Over a three year time period, surveillance cultures for MRSA colonization were obtained from patients presenting to an ambulatory setting with an acute MRSA skin and soft tissue infection (i.e. index case) and their household members. All MRSA isolates obtained from subjects were evaluated for mupirocin minimum inhibitory concentration (MIC) using Etest®. Isolates with high-level mupirocin resistance (MIC >512 µg/ml) were compared to susceptible isolates on the basis of SCCmec type, spa typing and susceptibilities to other commonly tested antimicrobials.  

    Results: Four hundred thirty-four isolates were included in the analysis. Nineteen (4.4%) isolates demonstrated high-level mupirocin resistance (HLMR). Approximately half of these (47.4%) were isolated from index cases.  The results are demonstrated in the table. Clindamycin resistance was seen more commonly among isolates with HLMR(42.1% vs. 9.2%; P<0.001). No isolates demonstrated resistance to trimethoprim-sulfamethoxazole. No differences were seen by SCCmec type. The predominant spa type seen in both susceptible and HLMR isolates was t008. However, this was more commonly seen in susceptible isolates.

    Characteristic

    Susceptible

    N=413

    High-level Resistance

    N=19

    P-value

    Clindamycin resistance

    38 (9.2)

    8 (42.1)

    <0.001

    SCCmec type

          IV

          II

    235 (56.7)

    180 (43.3)

    11 (57.9)

    8 (42.1)

    0.91

    0.90

    spa type

         t008

         t002

         t024

         other

    297 (71.9)

    11 (2.7)

    11 (2.7)

    45 (10.9)

    8 (42.1)

    1 (5.3)

    0 (0)

    8 (42.1)

    0.005

    0.50

    0.47

    <0.001

     Conclusion: HLMR is associated with clindamycin resistance in MRSA surveillance culture isolates. Future studies should determine the rate of development of cross-resistance to other antimicrobials with mupirocin use.

    Valerie C. Cluzet, MD1, Pam Tolomeo, MPH1, Ebbing Lautenbach, MD, MPH, MSCE2 and The CDC Prevention Epicenters Program, (1)University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, (2)University of Pennsylvania School of Medicine, Philadelphia, PA

    Disclosures:

    V. C. Cluzet, None

    P. Tolomeo, None

    E. Lautenbach, None

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