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JAC Advance Access published online on November 7, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki387
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Published by Oxford University Press 2005
Received July 24, 2005
Revised September 26, 2005
Accepted September 28, 2005

Brief report

In vivo transfer of high-level mupirocin resistance from Staphylococcus epidermidis to methicillin-resistant Staphylococcus aureus associated with failure of mupirocin prophylaxis

Julian G. Hurdle 1, Alex J. O'Neill 1, Lona Mody 2, Ian Chopra 1, and Suzanne F. Bradley 3*

1 School of Biochemistry and Microbiology, University of Leeds, Leeds LS2 9JT, UK
2 Division of Geriatric Medicine, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, The University of Michigan Medical School, Ann Arbor, MI, USA
3 Division of Geriatric Medicine, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, The University of Michigan Medical School, Ann Arbor, MI, USA; Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, The University of Michigan Medical School, Ann Arbor, MI, USA

* To whom correspondence should be addressed.
Suzanne F. Bradley, E-mail: sbradley{at}umich.edu


  Abstract

Objectives: We examined the molecular basis of the emergence of mupirocin resistance in a methicillin-resistant Staphylococcus aureus (MRSA) strain colonizing a nursing home resident undergoing mupirocin prophylaxis.

Patient and methods: A persistent carrier of mupirocin-susceptible MRSA participated in a trial of mupirocin for nasal decolonization among nursing home residents. During prophylaxis a high-level mupirocin-resistant MRSA emerged in the nasal isolates from this patient. S. aureus and coagulase-negative staphylococci were isolated prior to, during and after 14 days of mupirocin treatment. The staphylococcal isolates and their plasmids were examined by molecular genetic methods.

Results: All mupirocin-susceptible and -resistant MRSA isolates possessed the same genotype. The patient was also colonized by a single mupirocin-resistant Staphylococcus epidermidis strain. The mupirocin-resistant MRSA and S. epidermidis strains harboured identical plasmids that carried the mupA determinant and genes for conjugative DNA transfer in staphylococci. These plasmids could be transferred in vitro from both clinical isolates to S. aureus RN2677.

Conclusions: The MRSA strain contained a conjugative plasmid expressing mupA that was identical with that found in the S. epidermidis strain which colonized the patient. These findings suggest that transfer of mupA from S. epidermidis to MRSA probably occurred during mupirocin prophylaxis.

Keywords: MRSA; nasal decolonization; coagulase-negative; staphylococci.
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