Journal of Antimicrobial Chemotherapy, Vol 42, 67-73, Copyright © 1998 by The British Society for Antimicrobial Chemotherapy
T Gottlieb and D Mitchell
Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in teaching
hospitals in eastern Australian states, with prevalence rates averaging
25-30% of all S. aureus. Between 1990 and 1995, 1467 non- duplicate MRSA
isolates from clinically infected sites were tested in Sydney, Melbourne,
and Brisbane as part of a national survey of staphylococcal susceptibility.
We reviewed the differing evolution of resistance to ciprofloxacin,
rifampicin, and fusidic acid. Despite similarities in community and
hospital antibiotic use and MRSA prevalence rates, trends in resistance to
the oral antibiotics in these cities have progressed independently of each
other. In the 1995 survey in individual hospitals in Melbourne, 16-24% of
strains were ciprofloxacin-resistant, compared with 80-100% in Sydney and
30-44% in Brisbane. There was great diversity of phage type patterns for
ciprofloxacin-resistant strains, suggesting heterogeneous development of
resistance. Rifampicin resistance was more closely associated with distinct
dominant epidemic phage types, common to institutions in the same city, but
without spread to the other cites. Between 1990 and 1995, these comprised
30-60% of all MRSA in Brisbane, compared with 5- 10% in Melbourne and <
25% in Sydney. Fusidic acid resistance was uncommon and sporadic (< 5%),
and was distributed equally between methicillin-resistant and
methicillin-susceptible strains. Resistance to the oral agents in MRSA is
due to a complex mix of antibiotic selection pressures and cross-infection
with local and epidemic strains in closely related institutions. Each of
these mechanisms can predominate, dependent on local factors and the
antibiotics used.
ORIGINAL ARTICLES
The independent evolution of resistance to ciprofloxacin, rifampicin, and fusidic acid in methicillin-resistant Staphylococcus aureus in Australian teaching hospitals (1990-1995). Australian Group for Antimicrobial Resistance (AGAR)
Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, New South Wales. tom@micr.crg.cs.nsw.gov.au
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