Transcript ICAAC 2011 K948

Mupirocin Resistance in
Staphylococci After Three
Years of Universal MRSA
Admission Screening
Rosy Reynolds, Shazad Mushtaq, Angela Kidney
on behalf of
The BSAC Working Party on Resistance Surveillance
O347
23rd ECCMID, Berlin, 27-30th Apr 2013
[email protected]
England - MRSA screening and decolonisation
“From April 2009, all elective admissions must be
screened for MRSA in line with Department of Health
guidance. This should be extended to cover emergency
admissions as soon as possible and definitely no later than
2011.”
Operational Guidance 2, Department of Health, December 2008
and 2009/10 Operating Framework
“We expect all patients who test positive for MRSA on
screening prior to admission to be effectively decolonised,
as indicated in previous guidance.”
Operational Guidance 2, Department of Health, December 2008
BSAC Resistance Surveillance Project
2012
• Bacteraemia (2007-2011)
• Hospital-onset lower respiratory
infection (2008/09 - 2010/11)
• Blood S. aureus: 500/yr (250 in 2007)
• LRTI S. aureus : 250/yr
• Blood coagulase-negative
staphylococci: 250 /yr
UK & Ireland
40 laboratories
(25 up to 2009, 2009/10)
• BSAC agar dilution MICs &
BSAC/EUCAST breakpoints.
• mecA, mupA tested by PCR
PHE, London;
Quotient Bioresearch,
Fordham.
www.bsacsurv.org
RTI
S. aureus
2008/09
2010/11
685
Blood
S. aureus
2007
2011
2189
Blood
CoNS
2007
2011
1020
Hospital*
100%
49%
63%
ICU
42%
7%
14%
44 →26%
37 →14%
78 →68%
From
To
N
Methicillin
resistant
* >48 hours
Mupirocin MICs in 1020 CoNS
40
Low-level
Low-level resistant
resistant
High-level
High-level
resistant
resistant
30
20
10
Mupirocin MIC, mg/L
mupA-positive
High-level resistance =
MIC>256 mg/L and/or mupA-positive
>=2048
1024
512
256
128
64
32
16
8
4
2
1
0.5
0.25
0.12
0
<=0.06
Isolates, %
Susceptible
Susceptible
Mupirocin MICs in 2874 S. aureus
50
Susceptible
Low-level resistant
High-level
resistant
30
20
10
Mupirocin MIC, mg/L
mupA-positive
High-level resistance =
MIC>256 mg/L and/or mupA-positive
>=2048
1024
512
256
128
64
32
16
8
4
2
1
0.5
0.25
0.12
0
<=0.06
Isolates, %
40
Mupirocin vs methicillin resistance
%mup-R
(N)
LRTI
S. aureus
Methicillin
susceptible
Methicillin
resistant
0.2%
13%
(439)
(246)
Blood
S. aureus
0.6%
10%
(1704)
(489)
7%
35%
(268)
(752)
Blood
CoNS
Mupirocin resistance in MRSA
20
high-level resistance
low-level resistance
N = 731
11% R
15
34%
10
5
0
2007
2008
2009
2010
2011
Mupirocin resistance in MSSA
10
high-level resistance
low-level resistance
N = 2143
0.5% R
8
6
4
2
0
2007
2008
2009
2010
2011
Mupirocin
Mupirocinresistance
resistanceininMRCoNS
MRSA
50
high-level resistance
low-level resistance
N = 752
35% R
40
30
80%
20
10
0
2007
2008
2009
2010
2011
Mupirocin resistance in MSCoNS
25
high-level resistance
low-level resistance
N = 268
8% R
20
15
10
5
80%
0
2007
2008
2009
2010
2011
Mupirocin resistance 2007-2011
50
40
30
20
10
0
2007
2009 
2008
MRCoNS
MRSA
MSCoNS
2010
2011
MSSA
Mupirocin resistance in staphylococci
from blood and hospital-onset LRTI in the UK and Ireland:
• Has not increased significantly since
mandatory screening / decolonisation.
• Is common in methicillin-resistant
isolates:
• MRSA - 11% (mostly low-level)
• MRCoNS - 35% (mostly high-level)
• Remains under selective pressure.
ACKNOWLEDGEMENTS
BSAC Resistance Surveillance Project 2007-11
Central Laboratories
Sponsors 2007-2011
HPA Colindale
•
•
•
•
•
•
•
•
•
•
• Shazad Mushtaq
• David Livermore
... and many others
Quotient Bioresearch
• Angela Kidney
• Regina Janes
... and many others
Collecting Laboratories
Astellas
AstraZeneca
Basilea
Cerexa / Forest
Cubist
J&J / Janssen
Merck / MSD
Novartis (Chiron)
Pfizer (Wyeth)
Theravance