• Nu S-Au Găsit Rezultate

View of Mupirocin Resistance among Methicillin Resistant Staphylococcus Aureus Nasal Isolates from Health Care Workers; An Egyptian Single Centre Study

N/A
N/A
Protected

Academic year: 2022

Share "View of Mupirocin Resistance among Methicillin Resistant Staphylococcus Aureus Nasal Isolates from Health Care Workers; An Egyptian Single Centre Study"

Copied!
11
0
0

Text complet

(1)

Mupirocin Resistance among MethicillinResistant Staphylococcus Aureus Nasal Isolates from Health Care Workers; An Egyptian Single Centre Study

Ayman Abd El-Rahman Allam1, Mai Essam Mahmoud*2, Ahmed Elsadek Fakhr3 and Lobna Abdelaziz El-Korashi4

1,3,4

Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

3Pathology Laboratory and Blood Bank, International Medical Center, Jeddah, Saudi Arabia

2 Department of Infection Control, Al-Ahrar Hospital, Zagazig, Egypt.

Corresponding author: Mai Essam Mahmoud E-mail : [email protected] Abstract:

Back ground: Methicillin-resistant Staphylococcus aureus (MRSA) is a major health concern in hospital environment. The isolates resistance to most previously used antibiotics is clearly escalating. In many hospitals, MRSA became mostly universal in the hospital environment.

Health care workers (HCWs) can transmit MRSA from patient to patient by their contaminated hands, gloves, aprons and other instruments.

Aim of the Study:Our objective was to evaluate mupirocin resistance in nasal carriage of Staphylococcus Aureus resistant to methicillin among HCWsat Al-Ahrar Teaching Hospital.

Methods: A cross-sectional study was focusedon 163 HCWs. Nasal swabs were collected for detection of mupirocin and methicillin resistant isolates and their antimicrobial susceptibility pattern by standard bacteriological procedures. Then molecular detection of resistant genes by PCR was done.

Results: The whole nasal carriage ofStaphylococcus Aureus resistant toMupirocin in our study was 1.2%. The prevalence of resistance tomupirocin amongMRSA isolates was 4.4%.

Conclusion:As the resistance rate to mupirocin was not high, so it can be used in nasal decolonization of MRSA among medical staff and patients.

Keywords:

Mupirocin, resistance, MRSA, antibiotics, Health Care Workers.

Introduction:

Staphylococcus aureus (S.aureus) is a one of commensal microflora in many body areas such as axillae, hands, rectum, perineum, gastrointestinal tract, vagina and skin. But the highest reservoir of S. aureus is the nares.S.aureus and MRSA are members of the most common hospital

(2)

acquired pathogens which not only cause increased mortality and morbidity rates but also increase the duration of hospital stay and cost. HCWs act as carriers, reservoirs, or victims of cross-transmission ofMRSA. Eradication of staphylococcal colonization is considered as an important strategy to prevent infection and transmission of these strains. 1Mupirocin (MUP), pseudomonic acid or Bactroban is a derivative drug of crotonic acid which was extracted in 1971from Pseudomonas fluorescens. It was first presented in 1976 as a favorable remedy against Gram-positive bacteria. Since then, MUP has become available as an antimicrobial agent that hinderscreationof proteins through competitive inhibition of bacterial isoleucyl-tRNA synthetaseand is used to decolonize the anterior nares. However, the prolonged use of MUP has directed to itsresistance among isolates ofS. aureus. 2Therefore, we aimed to evaluateMUP resistance in the nasal carriage ofStaphylococcus Aureus resistant to methicillinbetween HCWs in an Egyptian Tertiary Care Hospital, so we can develop a better MRSA control and apolicy forinfection control by instituting the use of different options to prevent the colonization and spread of infection in case of resistance.

Subject and Method:

A Cross-sectional study was done at Al Ahrar Teaching Hospital, a tertiary care hospital,

Zagazig, Sharkia governorate, Egypt. This study was done in the period from November 2018 to June 2019.

Subjects:

This study included 163HCWs (doctors, nurses, pharmacist, housekeeping, technician, and security guards) at Al Ahrar Teaching Hospital. Their demographic data (name, age, sex, residence, occupation) were collected.

Sample collection:

Samples were taken from both nostrils of HCWs by disposable sterile cotton swab after moistening it with sterile distilled water. The swabs were rubbed very well three times over the inner wall of ala nasi and nasal septum. The swabs were transmitted to the laboratory of the Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University within one hour to process it.

Sample processing:

We cultured the samples on Mannitol salt Agar (Oxoid, UK) , they were incubated for 48 hoursat 37C. Mannitol-positive colonies were re-cultured on plates ofnutrient agar for 24 hours at 37C.

Isolated colonies were identified by Gram stain . S.aureus suspected Colonies were tested for catalase, coagulase and deoxyribonuclease (DNase) by typical microbiological procedures.3Catalase-positive, Coagulase-positive and DNase-positive Isolates were considered

(3)

S.aureus.Antibiotic susceptibility test for all isolated strains were detected by standardized disk diffusion on Müeller Hinton Agar (Becton-Dickinson, Sparks, USA) by Kirby–Bauer disc diffusion technique.4The antibiotics used in this study included: Mup (20μg), Mup (5μg), cefoxitin (30μg), clindamycin (2 µg), ciprofloxacin (5 µg), penicillin (10 units), rifampin (5 µg).

All of these discs are manufactured by BD BBL™sensi disc™, USAexcept Mup 20µg and Mup 5µg are manufactured by Oxoid, UK. Diameters of inhibition zones were measured with a ruler on the under surface of the Petri-dishes and dissected incope with thestandards of the Clinical Laboratory Standards Institute (CLSI) 2018.5Isolates having a zone diameter ≥ 22 mm against 30μg cefoxitin disc were considered susceptible to Methicillin, while those having a zone diameter ≤ 21 mm against 30μg cefoxitin disc were considered Methicillin resistant. S.aureus isolates were considered sensitive to Mup 5 μg when having a zone diameter ≥14 mm, while isolates having a zone diameter <14 mm were considered resistant. S.aureus isolates were considered sensitive to mupirocin 20 μg when having a zone diameter ≥17 mm. Isolates ofS.aureus with a zone diameter 6-16 mm were deemed as low-level resistant, while those with no inhibition zone were deemed as high-level resistant. 6.7

Molecular detection:

Multiplex PCR Assay was used for MRSA and MUPRSA isolates to identify S.aureus gene (nuc), methicillin resistant gene (mecA) and mupirocin resistant gene (MupA and Mup B) as following: Extraction was done using Thermo Scientific Gene JET Genomic DNA Purification Kit, from USA, according to manufacturer's instructions. We used Platinum™ SuperFi II PCR Master Mix(Invitrogen, Thermo Fisher Scientific, USA) for amplification which was done according to manufacturer's instructions. Primers used are shown in table (1).8 The amplification reaction was done in a 0.2mL, thin-walled, nuclease-free PCR tube on ice. The total 50 lvolume PCR mix was formed from 5 l template DNA, 25 l 2X Platinum™ SuperFi™ II PCR Master Mix, 0.2 M of each forward and reverse primer, and autoclaved distilled water to the rest of volume. . The reaction was placed in the pre-heated thermal cycler with amplification conditions were as following: the initial denaturation was achieved by one cycle of 98°C for 1 min. DNA amplification was achieved by: 40cycles each lastsfor 10 sec at 98°C, for 30 sec at57°C and for 1min at 72°C. The final extension consists of one cycle at 72 °C for 5 min. The products of amplified PCR were visualized by electrophoresis by 2 % agarose gel. 9 The band of Nuc gene was at 279 bp, the band of MecA gene was at 112bp, The band of MupA gene was at 456 bp and the band of Mup B gene was at 674bp (Table1).

Table 1: Used Primers in multiplex PCR

Primer Sequence Relevant product size

Nuc F-GCGATTGATGGTGATACGGTT

279bp R- AGCCAAGCCTTGACGAACTAAAGC

MecA F-GTGAAGATATACCAAGTGATT 112bp

(4)

R-ATCAGTATTTCACCTTGTCCG MupA F-TATATTATGCGATGGAAGGTTGG

456bp R- AATAAAATCAGCTGGAAAGTGTTG

MupB F-CTAGAAGTCGATTTTGGAGTAG 674bp

R-AGTGTCTAAAATGATAAGACGATC

Statistical analysis:

The Statistical Package for Social Science (SPSS) version 11.0 (IBM, USA)was used for performing the statistical analyses.For quantitative variables:data were stated as means ± standard deviation and range. For categorical data:data were stated as number and percentage.

Independent t-test was for comparing means of two independent samples of normally distributed data whileChi-square test (X2) was used to assess the relation among the qualitative data.P- values of <0.05 were supposed significant.

Results:

The prevalence of MRSA was (45/163) 27.6% from all isolates while the prevalence of MRSA isolates in S.aureus isolates was (45/48) 93.8%. The prevalence of Mup resistance was (2/163) 1.2% from all isolates. The prevalence of Mup resistance in MRSA isolate was (2/45) 4.4%. For antibiotic susceptibility testing, the Mup RSA isolates among MRSA strains (2) have higher sensitivity to ciprofloxacin (100%), while Mup SSA isolates among MRSA strains (43) show higher sensitivity to MUP (100%), rifampicin (100%) and clindamycin (90.7%) (Table2).There is a considerable relation between presence of MUP resistant isolates and working in ICU (p-value equals 0.02) (Table 3).The detection of PCR product was done by using gel electrophoresis, and only one sample shows 3 bands (photo1).Regarding risk factors of MUP resistant isolates in MRSA isolates, history of prior pseudomonas infection (within 1 year) and prior cefepime use (within 1 year) increased significantly the risk of MUP resistant MRSA isolates by 87 folds (P-value=

0.015) while prior exposure to mupirocin (1 year) did not increase that risk.By discdiffusion method, two MRSA isolates were mupirocin resistant, one of them showed high-level resistant and the other showed low-level resistant. By PCR only high level mupirocin resistant strain showed MupA gene .Using disc concentration (Mup 5 µg, Mup 20g, and both Mup 5 µg& Mup 20g) showed the same sensitivity 95.6%, specificity 93.8%, same positive predictive value 93.5% and same negative predictive value 95.7% with the same accuracy 94.6% in prediction of mupirocin resistance.

(5)

Photo1: The detection of PCR product by gel electrophoresis shows the 279 bp band for nuc, the 112 bp band for mecA and the 456 bp band for mupA. Only sample in lane 1 showed the 3 bands specific for mecA, nuc and mupA genes.

Table 2: Antibiotic susceptibility pattern of Mup RSA isolates among MRSA strains:

*N: number, †MupRSA: mupirocin resistant S.aureus, ‡Mup SSA: mupirocin sensitive S.aureus

Variable MupRSA †(N*=2) MupSSA ‡ (N*=43)

Antibiotic conc (ug\ml) Sensitive Resistant Sensitive Resistant

N* % N* % N* % N* %

Cefoxitin 30 0 0 2 100 3 7 40 93

Clindamycin 2 0 0 2 100 39 90.7 4 9.3

Rifampicin 5 1 50 1 50 43 100 0 0

Ciprofloxacin 5 2 100 0 0 33 76.7 10 23.3

Penicillin 10 u 0 0 2 100 1 2.3 42 97.7

Mupirocin 20 0 0 0 0 43 100 0 0

Mupirocin 5 0 0 2 100 43 100 0 0

(6)

Table 3: Nasal carriage of Mup RSA and Mup SSA among MRSA (n=45) isolates:

Variable

MupRSA† MupSSA ‡

P-Value Odds Ratio (95%

Confidence Interval) N=2 % N=43 %

Age in years

<30 30–40

>40

0 1 1

0 50 50

18 15 10

41.8 34.9 23.3

0.468

1.87(0.11-32.1) 3.3 (0.19-57.67)

Sex Female Male

2 0

100 0

35 8

81.4 18.6

1

1.2 (0.05-27.31)

Years of working 0–9

9–15 15–29

0 1 1

0 50 50

25 12 6

58.1 27.9 14

0.214

2.59(0.15 – 44.7) 6.17 (0.3 – 112.41)

Occupation Doctors pharmacists Nurses

House keeping

0 0 1 1

0 0 50 50

6 1 24 9

14 2.3 55.8 20.9

1 1 1 0.399

1.15 (0.05-26.89) 5.67 (0.18 – 177.69) 0.79 (0.05 – 13.5) 3.78 (0.21 – 66.47)

(7)

Technicians Security guards

0 0

0 0

2 1

4.7 2.3

1 1

3.32 (0.12 – 89.46) 5.67 (0.18 – 177.69) Department

Intensive care unit Pediatric

Gastro intestinal tract Gynaecology

Surgery Laboratory

Out patients clinics Neurology

Nephrology

2 0 0 0 0 0 0 0 0

100 0 0 0 0 0 0 0 0

5 7 3 5 8 3 6 3 3

11.6 16.2 7 11.6 18.6 7 14 7 7

0.02*

1 1 1 1 1 1 1 1

3.32(1.48 – 829.22) 0.97 (0.04 - 22.48) 2.31 (0.09 – 58.32) 0 (0 – 29.77) 0.84 (0.04 – 19.06) 2.31 (0.09 – 58.32) 1.15 (0.05-26.89) 2.31 (0.09 – 58.32) 2.31 (0.09 – 58.32)

†MupRSA: mupirocin resistant S.aureus, ‡Mup SSA: mupirocin sensitive S.aureus Discussion:

MRSA has been considered as one of the prevalent causes of nosocomial infections, that it is resistant to various classes of antibiotics. 10The magnitude of the problem in Egypt is massive with estimates of more than 75% of Health care associated Staph. aureus infections to be MRSA strains. 11Mup is a topical antibiotic which intervenes with bacterial protein synthesis that can be used for suppression of staphylococcal nasal colonization and control of MRSA transmission in Health Care setting. The increase in non-rationalized use of antibiotics may result in the expansion of MupRSA, leaving the clinicians with few choices to prevent the MRSAspread .12In the current study, the prevalence of Mup resistance among all our nasal isolates was 1.2%

(2/163); one was ahigh level of resistance and the other was a low level of resistance. This result was in consistence with the prevalence of Mup resistance reported byOthman. (2013) which was 2%(6/300). The six isolates were of high level resistance.12Gadepalli et al. found that the prevalence of Mup resistance in an Indian hospital was 6% (12/200); 10/200 were of HLR and 2/200 were of LLR.In this study, the low percentage of mupirocin resistance may be due to the lack of the use of Mup as a routine decolonize of S. aureus at Al- Ahrar Teaching Hospital and due to small sample size.13Inthis study,the Prevalence of Mup resistant isolates in MRSA isolate

(8)

was 4.4%.In Egypt 2013, Othmanreported that the Prevalence of isolates resistant to Mup in MRSA isolate was 3.7%. 12 On the other hand, in a study done byJones et al. revealed a high rate of mup resistance was 13.2% among MRSA isolates.14 While in Spain, Perez-Roth et al., showed that around 12% of MRSA isolates possessed Mup resistance. In the current study, Mup RSA among MRSA isolates were 2 isolates, while Mup SSA among MRSA cases were 43. Mup RSA was resistant to cefoxitin, clindamycin and penicillin by (100%) as well, while it was sensitive to rifampicin (50%) and ciprofloxacin (100%). 15 Another study were done by Simor et al.where Mup RSA isolates showed, 85% resistant to clindamycin, 4% resistant toRifampicin and 75%

resistant tociprofloxacin.16 MupSSA isolates in our study, showed 100% sensitivity to rifampicin in addition to Mup. Similar results reported by a previous study. 16In the current study, there was a significant relation between the presence of Mup resistant isolates and working in ICU (P- value

=0.02). There was non-significant relation between nasal carriage of Mup resistant MRSA isolates and either age, gender, years of working, occupation or department of the studied patients other than ICU. These findings disagreed with a previous study where theyfound no effect of working in ICU and Mup resistance asall HCWS in the study were sensitive to Mup in spite of working in ICU.17 In current study, history of prior Pseudomonas infection (within 1 year) and prior cefepime use (within 1 year) increased significantly risk of mupirocin resistant MRSA isolates by 87 folds. These results are almost in agreement with another study where they reported that MRSA isolates from infected patients with Pseudomonasaeruginosa in the year before the cultures were 4.85 times prospective to show Mup resistance compared to cultures from patients with no history of this infection and previous use of cefepime to be a liberated predictor of Mup resistance.18The association between Pseudomonas infection and Mup resistance is attributed to Mupirocin which is produced by Pseudomonas fluorescensbacterium. Also, Pseudomonas is insensitive to Mup resulting from its innate resistance to its produced antibiotic. 19We found that Mup resistance was not related toprior exposure to Mup . In contrast, other studiesidentified that long, extensive or unplanned use and various courses of Mup are all relatedto the increase of Mup resistance. 16, 20 By disc diffusion method, we isolated only two isolates with Mup resistance. One of them revealed high level of resistance and the other revealed low level of resistance. This result is in consistence with a study done byKaur &Narayanwho reported that two isolates resistant to Mup among 20 MRSA isolates using disc diffusion method, one was high-level resistance and the other was low-level Mup resistance. 21 on the other hand, Boncompain et al.reported all MRSA cases were susceptible to Mup by disc diffusion method.22Low level of Mup resistancecomes from point mutations inside the host ileS gene and is of controversial clinical significance, while a high level of Mupresistance results from gaining of a transferable plasmid enclosing the MupA (or ileS-2) gene, encoding an additional isoleucyl- tRNA synthetase that is not Mup bound. 23, 24Using disc concentration of Mup 5 µg and Mup 20

g predict presence of mupirocin resistant with sensitivity 95.6%, specificity 93.8%, 93.5%

positive predictive value and 95.7% negative predictive value with accuracy 94.6%. These findings were in agreement with previous studies.6, 12Nuc and Mec A genes were present in all

(9)

our isolates, but MupA gene was found only in one isolate. The Mup B gene was not found in any of our isolates. Similar findingswere detected by other studies. 8, 25

Conclusion and recommendations:

The current study concluded that the rate of resistance to Mup was low at Al Ahrar Hospital, so Mupointment is still reliable to be used in MRSA nasal decolonization for HCWs.

Acknowledgments:

Authors present their sincere appreciation of all participants in the study.

Ethics declarations

Approval of Ethics and consent to participate

The study was agreed by Institutional Review Board (IRB) Committee of Zagazig Faculty of Medicine (approval no. Zu-IRB # 4422/1-4-2018). An informed consent form was signed by each participant.

Publication Consent

This research was consented for publication by all the authors and respondents in this paper and it will be available on the internet.

Authors' contributions:

AA: designing draft, data collectingand analysing thisdata and paper writing.ME: data collecting and paper writing. AF: data collecting, paper revising. LA: designingdraft, data collecting, analysing thisdata andpaper writing. All authors have critically reviewed, approved the final draft and are responsible for the content and similarity index of the manuscript.

References:

1- Albrich WC and Harbarth S. Health-care workers. source, vector, or victim of MRSA?

Lancet Infect Dis.2008; 8(5):289-301.http://dx.doi.org/10.1016/s1473-3099(08)70097-5.

2- Pierce R, Bryant K, Elward A, Lessler J and Milstone AM. Gram-negative and fungal infections following mupirocin-based methicillin-resistant Staphylococcus aureus decolonization in neonates. Open Forum Infectious Diseases. 2016; 3, (suppl_1), 694.http://dx.doi.org/10.1093/ofid/ofw172.557.

3- Brown DF, Edwards DI, Hawkey PM, Morrison D, Ridgway GL, Towner K J, et al.

Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). Joint Working Party of the British Society for Antimicrobial Chemotherapy; Hospital Infection Society and Infection Control Nurses Association. J Antimicrob Chemother. 2005; 56:1000–1018.

http://dx.doi.org/10.1093/jac/dki372.

(10)

4- Bauer AW, Kirby WM, Sherris JC and Turck M. Antibiotic susceptibility testing by a standardized single disk method. American Journal of Clinical Pathol.1966;45(4):493- 496. http://dx.doi.org/10.1093/ajcp/45.4_ts.493.

5- CLSI-Clinical and Laboratory Standards Institute (2018). Performance standards for antimicrobial susceptibility testing; 28th informational supplement (M100-S28). Wayne, PA, USA.https://clsi.org/media/1930/m100ed28.

6- Malaviolle X, Nonhoff C, Denis O, Rottiers S and Struelens MJ. Evaluation of disc diffusion methods and Vitek 2 automated system for testing susceptibility to mupirocin in Staphylococcus aureus.Journal of Antimicrobial Chemotherapy. 2008; 62: 1018–

1 0 2 3 . h t t p : / / d x . d o i . o r g / 1 0 . 1 0 9 3 / j a c / d k n 3 4 5 . 7- Fuchs PC, Jones RN and Barry AL. Interpretive criteria for disk diffusion susceptibility testing of mupirocin, a topical antibiotic. J Clin Microbiol. 1990; 28: 608–

609.http://dx.doi.org/10.1128/jcm.28.3.608-609.

8- McClure JA, ZaalDeLongchamp J, Conly JM and ZhangK. Novel Multiplex PCR Assay for Detection of Chlorhexidine-Quaternary Ammonium, Mupirocin, and Methicillin Resistance Genes, with Simultaneous Discrimination of Staphylococcus aureus from Coagulase- Negative Staphylococci.J ClinMicrobiol. 2017; 55(6):1857- 1864.https://pubmed.ncbi.nlm.nih.gov/28381601.

9- Sambrook J, Fritsch E and Maniatis T (1989). Molecular cloning. A laboratory manual (2nd ed). Cold Spring Harbor Laboratory Press, (3 vols; 1659 pages)ISBN 0 87969 309 6. http://dx.doi.org/10.1016/0167-7799(91)90068-s.

10- Enright MC, Robinson DA, Randle G, Feil EJ, Grundmann H and Spratt BG. The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proc Natl Acad Sci USA. 2020; 99: 7687–7692.https://pubmed.ncbi.nlm.nih.gov/12032344.

11- Abdel-Maksoud M, El-Shokry M, Ismail G, Hafez S, El-Kholy A, Attia E, et al.

Methicillin-Resistant Staphylococcus aureus Recovered from Healthcare- and Community-Associated Infections in Egypt. International journal of bacteriology.2016;

5751785.https://pubmed.ncbi.nlm.nih.gov/27433480.

12- Othman H. Detection of Susceptibility of Staphylococcus aureus to Mupirocin Using Disc Diffusion Method. researchgate.2013.https://www.researchgate.net/publication/318646083.

13- Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK, Chaudhry R, et al.Mupirocin resistance in Staphylococcus aureus in an Indian hospital.DiagnMicrobiol Infect Dis. 2007;

58(1):125-127.http://dx.doi.org/10.1016/j.diagmicrobio.2006.10.012.

14- Jones JC, Rogers TJ, Brookmeyer P, Dunne WM Jr, Storch GA, Coopersmith CM, et al.

Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin. Infect. Dis. 2007; 45(5):541–54. https://doi.org/10.1086/520663.

15- Perez-Roth E, Lopez-Aguilar C, Alcoba-Florez J and Méndez-Álvarez S. High-level mupirocin resistance within methicillin-resistant Staphylococcus aureus pandemic

(11)

lineages. Antimicrob AgentsChemother.2006; 50 (9) 3207–

3211.https://pubmed.ncbi.nlm.nih.gov/16940133.

16- Simor AE, Stuart TL, Louie L, Watt C, Ofner-Agostini M, Gravel D, et al and the Canadian Nosocomial Infection Surveillance Program. Mupirocin-Resistant, Methicillin- ResistantStaphylococcus aureus Strains in Canadian Hospitals. Antimicrob Agents Chemother. 2007; 51(11): 3880–3886.https://pubmed.ncbi.nlm.nih.gov/17724154.

17- Rashad SS, Ismail GA and El- Shafei M. Mupirocin Resistance in Surgical Intensive Care Unit. Int.J.Curr.Microbiol.App.Sci. 2014; 3(4): 685-693.ISSN: 2319-7706 Volume 3https://www.ijcmas.com.

18- Caffrey AR, Quilliam BJ and LaPlante KL. Risk factors associated with mupirocin resistance in meticillin-resistant Staphylococcus aureus.J HospInfect. 2010 ;76(3):206-210.

http://dx.doi.org/10.1016/j.jhin.2010.06.023.

19- Sutherland R, Boon RJ, Griffin KE, Masters PJ, Slocombe B and White AR.

Antibacterial activity of mupirocin (pseudomonic acid), a new antibiotic for topical use.

Antimicrob Agents Chemother. 1985; 27: 495-

498.https://pubmed.ncbi.nlm.nih.gov/3923922.

20- Fawley WN, Parnell P, Hall J and Wilcox MH. Surveillance for mupirocin resistance following introduction of routine peri-operative prophylaxis with nasal mupirocin.J Hosp Infect. 2006; 62(3):327-332. http://dx.doi.org/10.1016/j.jhin.2005.09.022.

21- Kaur DC and Narayan PA. Mupirocin resistance in nasal carriage of Staphylococcus aureus among healthcare workers of a tertiary care rural hospital.Indian J Crit Care Med. 2014;

18(11):716-721.https://pubmed.ncbi.nlm.nih.gov/25425838.

22- Boncompain CA, Suárez CA and Morbidoni HR. Staphylococcus aureusnasal carriage in health care workers: First report from a major public hospital in Argentina. Rev Argent Microbiol. 2017; 49(2):125-131.http://dx.doi.org/10.1016/j.ram.2016.12.007.

23- Hodgson JE, Curnock SP, Dyke KG, Morris R, Sylvester DR, and Gross MS. Molecular characterization of the gene encoding high level mupirocin resistance in Staphylococcus aureus J2870. Antimicrob.Agents Chemother.1994; 38:1205–

1208.https://pubmed.ncbi.nlm.nih.gov/8067768.

24- Farmer TH, Gilbart J, and Elson SW. Biochemical basis of mupirocin resistance in strains of Staphylococcus aureus. J. Antimicrob. Chemother. 1992; 30 (5): 587–

596.http://dx.doi.org/10.1093/jac/30.5.587.

25- Ohadian-Moghadam S, Pourmand MR and Davoodabadi A. The Detection of Mupirocin Resistance and Nasal Carriage of Methicillin Resistant Staphylococcus aureus among Healthcare Workers at University Hospitals of Tehran, Iran.Iran J Public Health. 2015;

44 (3): 361-368.PMID: 25905079; PMCID: PMC4402414.

Referințe

DOCUMENTE SIMILARE

A total of 100 clinical isolates of Staphylococcus aureus was collected from indoor patients of Khyber Teaching Hospital Peshawar.. The isolation and identification of

Antimicrobial sensitivity of Gram bacteria positives and negatives isolated from patients with foot diabetic.. Antibiotics Staphylococcus aureus

Detection of ica ABCD genes and biofilm formation in clinical isolates of methicillin resistant Staphylococcus aureus .Iranian jornal of

To assess the knowledge of management of second wave of Corona Virus (COVID - 19) among Health care Workers at public health facilities at Barona zone,

Molecular Detection of AmpC Family Genes Encoding Antibiotic Resistance among Escherichia coli isolated from Patients with Urinary Tract Infection (UTI) in Najaf

Detection of Chromosomal and Plasmid-Mediated Quinolone Resistance Among Escherichia coli Isolated from Urinary Tract Infection Cases; Zagazig University Hospitals, Egypt.

This study was conducted to isolate and detect methicillin-resistant staphylococci (MRS) in healthy broilers in Nsukka Southeast, Nigeria and determine the antibiogram of

The purpose of the present study was to enumerate, isolate and evaluate the resistance profile of Staphylococcus aureus and Escherichia coli in grilled meat consumed in