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[Mupirocin resistant MRSA in Japan]
1Department of Infectious Diseases, Tokyo Women's Medical University.
Abstract:
Mupirocin is a unique antibiotic that is produced by Pseudomonas fluorescens, and is available for elimination of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, there have been many reports that high level mupirocin resistant S. aureus were discovered in Europe, South or North American countries. In Japan, mupirocin has been only available for nasal ointment of MRSA eradication since 1996. After introduction of mupirocin, we have screened mupirocin resistance routinely in our hospital. On January 1998, we had high level mupirocin-resistant MRSA isolated from a nose of a neonate with severe nephrotic syndrome. The mupA was detected by PCR and the mupirocin-resistance could transfer to S. aureus RN2677 by filter-mating with co-transfer of gentamicin, tobramycin, kanamycin and erythromycin. This strain was eradicated after prophylactic use of vancomycin for her nephrectomy. To our knowledge, this is the first isolate of high level mupirocin-resistant MRSA in Japan.
Insights
High-level mupirocin resistance in methicillin-resistant Staphylococcus aureus (MRSA) has been identified in Japan. This discovery highlights the need for ongoing surveillance of antibiotic resistance in clinical settings.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Context:
- Mupirocin is an antibiotic used to eradicate nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA).
- High-level mupirocin resistance in S. aureus has been reported globally, but not previously in Japan.
- Routine screening for mupirocin resistance was implemented in a Japanese hospital following mupirocin's introduction in 1996.
Purpose:
- To report the first isolation of high-level mupirocin-resistant MRSA in Japan.
- To characterize the genetic basis and transferability of mupirocin resistance.
Summary:
- A neonate in Japan presented with severe nephrotic syndrome and was found to carry high-level mupirocin-resistant MRSA.
- The resistance was confirmed to be mediated by the mupA gene, which was transferable via filter-mating along with resistance to other antibiotics.
- The MRSA strain was successfully eradicated using vancomycin prophylaxis.
Impact:
- This finding represents the first documented case of high-level mupirocin-resistant MRSA in Japan.
- It underscores the importance of continuous monitoring for antibiotic resistance to guide effective treatment strategies.
- Highlights potential challenges in MRSA eradication in clinical practice due to emerging resistance mechanisms.