耐甲氧西林凝固酶阴性葡萄球菌在耐甲氧西林金黄色葡萄球菌去定植策略中分离的莫匹罗星和洗必泰耐药率。
Prevalence of mupirocin and chlorhexidine resistance among methicillin-resistant coagulase-negative staphylococci isolated during methicillin-resistant Staphylococcus aureus decolonization strategies.
机构信息
Department of Medical Microbiology and Immunology, College of Medicine, Menoufia University, Menoufia, Egypt; Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.
Department of Medical Microbiology and Immunology, College of Medicine, Menoufia University, Menoufia, Egypt; Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.
出版信息
Am J Infect Control. 2019 Nov;47(11):1319-1323. doi: 10.1016/j.ajic.2019.05.004. Epub 2019 Jun 13.
BACKGROUND
The widespread of methicillin-resistant Staphylococcus aureus (MRSA) antimicrobial decolonization in the clinical setting may lead to an increase in the prevalence of multiresistance to coagulase-negative staphylococci (CoNS) owing to their selection. This study aimed to investigate the impact of MRSA decolonization strategies, using mupirocin and chlorhexidine, on their CoNS susceptibility.
METHODS
A total of 312 CoNS isolates were collected before starting the decolonization protocols "baseline strains" (BLS) group, 330 isolates were collected after application of the targeted decolonization protocol "targeted decolonization strains" group, and 355 isolates were collected after application of the universal decolonization protocol "universal decolonization strains" group. Methicillin-resistant CoNS (MR-CoNS) were identified and tested for mupirocin and chlorhexidine susceptibilities. Heptaplex polymerase chain reaction assay was applied for simultaneous screening for chlorhexidine (CHX-R) and mupirocin resistance (Mu-R) genes.
RESULTS
Mu-R prevalence of MR-CoNS among the BLS group was considered moderate (9.1%); however, CHX-R in the BLS group was 5.8%, the rate of which significantly increased among the universal decolonization strains group.
DISCUSSION
Both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. The prevalence Mu-R rate didn't change significantly during either of the MRSA decolonization practices that may be due to the local nature of mupirocin application on the nasal mucosa only. In contrast CHX-R that was found to be significantly higher among the UDS group.
CONCLUSIONS
Our findings indicate that both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. Although the universal MRSA decolonization has superior efficacy in decolonization of CoNS, it may increase the risk of selecting CHX-R and Mu-R. In addition, other potential resistance genes should be studied.
背景
耐甲氧西林金黄色葡萄球菌（MRSA）在临床环境中的广泛抗菌去定植可能导致凝固酶阴性葡萄球菌（CoNS）的多药耐药性增加，因为它们会被选择。本研究旨在调查使用莫匹罗星和洗必泰的 MRSA 去定植策略对其 CoNS 敏感性的影响。
方法
在开始去定植方案前共收集了 312 株 CoNS 分离株（“基线菌株”[BLS]组），在应用靶向去定植方案后收集了 330 株（“靶向去定植菌株”[TDS]组），在应用通用去定植方案后收集了 355 株（“通用去定植菌株”[UDS]组）。鉴定耐甲氧西林 CoNS（MR-CoNS）并测试其对莫匹罗星和洗必泰的敏感性。应用七重聚合酶链反应检测同时筛选洗必泰（CHX-R）和莫匹罗星耐药（Mu-R）基因。
结果
BLS 组中 MR-CoNS 的 Mu-R 流行率被认为是中度（9.1%）；然而，BLS 组中的 CHX-R 为 5.8%，而 UDS 组中 CHX-R 的比例显著增加。
讨论
两种 MRSA 去定植策略都有助于降低 MR-CoNS 的流行率。在任何一种 MRSA 去定植实践中，Mu-R 率都没有显著变化，这可能是由于莫匹罗星仅应用于鼻黏膜的局部性质。相比之下，UDS 组中 CHX-R 明显更高。
结论
我们的研究结果表明，两种 MRSA 去定植策略都有助于降低 MR-CoNS 的流行率。虽然通用 MRSA 去定植在去定植 CoNS 方面具有更好的效果，但它可能会增加选择 CHX-R 和 Mu-R 的风险。此外，还应研究其他潜在的耐药基因。
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