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Dissemination of high-level mupirocin-resistant CC22-MRSA-IV in Saxony
Stefan Monecke1,2,3, Antje Ruppelt-Lorz2, Elke Müller1,3
1Alere Technologies GmbH (Abbott Rapid Diagnostics), Jena, Germany.
Abstract:
Mupirocin is used for eradicating methicillin-resistant S. aureus (MRSA) in nasal colonization. A plasmid-borne gene, mupA, is associated with high-level mupirocin resistance. Despite the fact that, among all MRSA from a tertiary care center in the German state of Saxony, the prevalence of mupA, encoding high-level mupirocin resistance, was approximately 1% over a 15-year period from 2000-2015, a sharp increase to nearly 20% was observed in 2016/2017. DNA microarray profiling revealed that this was due to the dissemination of a variant of CC22-MRSA-IV ("Barnim Epidemic Strain" or "UK-EMRSA-15"), which, in addition to mecA, harbors mupA, aacA-aphD, qacA, and - in most isolates - erm(C). In order to prevent therapy failures and a further spread of this strain, the use of mupirocin should be more stringently controlled as well as guided by susceptibility testing. In addition, MRSA decolonization regimens that rely on other substances, such as betaisodona, polyhexanide or octenidine, should be considered.
Insights
High-level mupirocin resistance in methicillin-resistant Staphylococcus aureus (MRSA) dramatically increased due to a specific MRSA strain. This necessitates stricter mupirocin use and alternative decolonization strategies.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Mupirocin is a key agent for eradicating nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA).
- High-level mupirocin resistance is primarily mediated by the plasmid-borne *mupA* gene.
- A stable, low prevalence of *mupA* in MRSA was observed in Saxony, Germany, from 2000-2015.
Purpose of the Study:
- To investigate the cause of a recent sharp increase in high-level mupirocin resistance among MRSA isolates.
- To identify the specific MRSA strain responsible for the rise in resistance.
- To provide recommendations for preventing therapy failures and further dissemination.
Main Methods:
- Retrospective analysis of MRSA isolates from a tertiary care center in Saxony.
- DNA microarray profiling to determine the genetic makeup of resistant strains.
- Epidemiological surveillance over a 17-year period (2000-2017).
Main Results:
- A significant surge in *mupA* prevalence, from approximately 1% to nearly 20%, was observed in 2016/2017.
- The increase was linked to the dissemination of a CC22-MRSA-IV variant (UK-EMRSA-15/Barnim Epidemic Strain).
- This strain frequently carried *mupA* along with other resistance genes, including *mecA*, *aacA-aphD*, *qacA*, and *erm*(C).
Conclusions:
- The emergence and spread of a specific MRSA strain carrying *mupA* is driving increased mupirocin resistance.
- Stricter control and susceptibility testing for mupirocin use are crucial.
- Alternative MRSA decolonization agents like betaisodona, polyhexanide, or octenidine should be considered.
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