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CORRESPONDENCE
Year : 2016  |  Volume : 34  |  Issue : 1  |  Page : 114-115
 

High level mupirocin resistance among CoNS from nasal carriers of End stage renal disease patients and hospital personnel from tertiary care centre, Chennai


1 Department of Microbiology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, India
2 Department of Nephrology, Billroth Hospitals, Chennai, Tamil Nadu, India

Date of Submission28-May-2014
Date of Acceptance22-Feb-2015
Date of Web Publication15-Jan-2016

Correspondence Address:
P Krishnan
Department of Microbiology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.167672

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How to cite this article:
Murugesan S, Singh U, Perumal N, Ramanathan V, Krishnan P. High level mupirocin resistance among CoNS from nasal carriers of End stage renal disease patients and hospital personnel from tertiary care centre, Chennai. Indian J Med Microbiol 2016;34:114-5

How to cite this URL:
Murugesan S, Singh U, Perumal N, Ramanathan V, Krishnan P. High level mupirocin resistance among CoNS from nasal carriers of End stage renal disease patients and hospital personnel from tertiary care centre, Chennai. Indian J Med Microbiol [serial online] 2016 [cited 2020 Apr 7];34:114-5. Available from: http://www.ijmm.org/text.asp?2016/34/1/114/167672


Dear Editor,

End-stage renal disease (ESRD) patients have a significantly high risk for bacterial infections because they are repeatedly exposed to the health-care environment and often receive prolonged courses of antibiotics, besides being immunocompromised.[1] High-level resistance to mupirocin is conferred by the plasmid mediated ileS gene (ileS2) also known as mupA gene.[2] Previous studies suggested that mupirocin resistant coagulase negative staphylococci (CoNS) might be an important source of the mupA determinant for Methicilin-resistant Staphylococcus aureus (MRSA).[3] Since ESRD patients have constant interaction with both the hospital and community settings, the current study was designed to detect nasal carriage of methicillin and mupirocin resistant CoNS amongst both ESRD patients and hospital personnel in a tertiary care hospital.

A total of 145 nasal swabs were collected from ESRD patients (N = 115) and hospital personnel (N = 30) from a Dialysis unit in Chennai during the period September 2013 to October 2013. Initial isolation and identification of CoNS was done by standard biochemical methods.[4] Screening of CoNS for methicillin resistance was done by cefoxitin disc (30 μg) diffusion, MIC (agar dilution method) and interpreted as per CLSI guidelines (2012). High-level mupirocin resistance was detected by using mupirocin (200 μg) disc diffusion test, MIC (agar dilution method) and ileS2 gene PCR.[5] Among 135 CoNS, 79 (59%) isolates were found to be high level methicillin resistant (MIC = 256 µg/ml). 35 (26%) isolates were found to be high-level mupirocin resistant (MIC > 512 µg/ml/mupA+) [Table 1]. The mupA gene PCR product was sequenced and submitted to NCBI database (Accession no: KJ002644) and used as a positive control.
Table 1: Distribution of methicillin and mupirocin resistance amongst CoNS isolated from ESRD patients and hospital personnel

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The present study indicates increasing prevalence of high level mupirocin resistance mediated by mobile elements among CoNS which substantiates their role as a putative reservoir of mupA resistance gene for MRSA. Thus, continued surveillance for mupirocin resistance among staphylococci in the anterior nares of ESRD patients and hospital personnel is needed xxxxin order to avoid decolonization and treatment failure using mupirocin.


 ~ Acknowledgement Top


We thank all the patients and hospital personnel who participated in this study.

 
 ~ 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
    
2.
Driscoll DG, Young CL, Ochsner UA. Transient loss of high-level mupirocin resistance in Staphylococcus aureus due to MupA polymorphism. Antimicrob Agents Chemother 2007;51:2247-8.  Back to cited text no. 2
    
3.
Bathoorn E, Hetem DJ, Alphenaar J, Kusters JG, Bonten MJ. Emergence of high-level mupirocin resistance in coagulase-negative staphylococci associated with increased short-term mupirocin use. J Clin Microbiol 2012;50:2947-50.  Back to cited text no. 3
    
4.
Bannerman TL. Staphylococcus, Micrococcus and other catalase positive cocci that grow aerobically, Chapter 28. In: Manual of Clinical Microbiology, 8th ed. Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH, editors. ASM Press: Washington DC; 2003. p. 384.  Back to cited text no. 4
    
5.
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. 5
    



 
 
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