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JAC Advance Access originally published online on June 29, 2007
Journal of Antimicrobial Chemotherapy 2007 60(3):665-668; doi:10.1093/jac/dkm235
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Macrolide-resistant Staphylococcus aureus colonization in cystic fibrosis patients: is there transmission to household contacts?

Gerdien A. Tramper-Stranders1,*, Cornelis K. van der Ent1, Susan A. M. Gerritsen1, André Fleer2, Jan L. L. Kimpen3 and Tom F. W. Wolfs3

1 Department of Paediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands 2 Department of Medical Microbiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands 3 Department of Paediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands

Received 28 February 2007; returned 11 April 2007; revised 21 May 2007; accepted 6 June 2007

* Corresponding author. Tel: +31-30-2504757; Fax: +31-30-2504747; E-mail: g.tramper{at}umcutrecht.nl

Objectives: Patients with cystic fibrosis (CF) are frequently colonized by macrolide-resistant Staphylococcus aureus, a result of maintenance macrolide therapy. As transmission of S. aureus between household contacts is common, we examined the prevalence of macrolide-resistant S. aureus colonization in CF patients on maintenance azithromycin therapy and their household contacts and compared this with the S. aureus macrolide resistance prevalence in the community.

Patients and methods: Sixty-five CF patients on maintenance macrolide therapy and 194 household contacts were screened for S. aureus colonization by culturing sputa, cough swabs and nasal swabs. Resistance to macrolide, lincosamide and methicillin was determined by disc diffusion tests. The prevalence of macrolide-resistant S. aureus colonization in both groups was compared with figures from a nationwide study into S. aureus carriership and resistance. To assess possible transmission, genotyping of S. aureus was performed using the spa-typing method.

Results: Macrolide resistance among CF patients with S. aureus colonization was 69.6%; 75% of these isolates displayed lincosamide resistance too. Among household contacts, macrolide resistance prevalence did not differ significantly from resistance prevalence in the community (9.6% versus 6.3%; P = 0.358). No methicillin resistance was observed. No identical (macrolide-resistant and -susceptible) S. aureus genotypes were observed between CF patients and their household contacts except for one household, suggesting a probable transmission.

Conclusions: No significant increase in macrolide-resistant S. aureus colonization was observed among household contacts of CF patients on long-term azithromycin therapy. Transmission of macrolide-resistant S. aureus could not be proved by genotyping in the majority of households.

Keywords: macrolide resistance , S. aureus , staphylococcal transmission


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