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Mupirocin Resistance in Staphylococci After Three Years of Universal MRSA Admission Screening

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 23 rd ECCMID, Berlin, 27-30 th Apr 2013 rosy.reynolds@nbt.nhs.uk.

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Mupirocin Resistance in Staphylococci After Three Years of Universal MRSA Admission Screening

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  1. Mupirocin Resistance in Staphylococci After Three Years of Universal MRSA Admission Screening Rosy Reynolds, Shazad Mushtaq, Angela Kidney on behalf ofThe BSAC Working Party on Resistance Surveillance O347 23rd ECCMID, Berlin, 27-30th Apr 2013 rosy.reynolds@nbt.nhs.uk

  2. 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

  3. 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 • BSAC agar dilution MICs & BSAC/EUCAST breakpoints. • mecA, mupA tested by PCR www.bsacsurv.org BSAC Resistance Surveillance Project UK & Ireland 40 laboratories (25 up to 2009, 2009/10) PHE, London; Quotient Bioresearch, Fordham.

  4. * >48 hours

  5. Susceptible Susceptible Low-level resistant Low-level resistant High-level resistant High-level resistant mupA-positive High-level resistance = MIC>256 mg/L and/or mupA-positive

  6. Susceptible Susceptible Low-level resistant Low-level resistant High-level resistant High-level resistant mupA-positive High-level resistance = MIC>256 mg/L and/or mupA-positive

  7. Mupirocin vs methicillin resistance

  8. N = 731 11% R 34%

  9. N = 2143 0.5% R

  10. N = 752 35% R 80%

  11. N = 268 8% R 80%

  12. Mupirocin resistance in staphylococci from blood and hospital-onset LRTI in the UK and Ireland: • Has not increased significantlysince mandatory screening / decolonisation. • Is common in methicillin-resistant isolates: • MRSA - 11% (mostly low-level) • MRCoNS - 35% (mostly high-level) • Remains under selective pressure.

  13. ACKNOWLEDGEMENTS BSACResistance Surveillance Project 2007-11

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