| Autor: |
McNeil, J. Chase, Kok, Eric Y., Vallejo, Jesus G., Campbell, Judith R., Hulten, Kristina G., Mason, Edward O., Kaplan, Sheldon L. |
| Zdroj: |
Antimicrobial Agents and Chemotherapy; November 2015, Vol. 60 Issue: 2 p1121-1128, 8p |
| Abstrakt: |
ABSTRACTOne of the strategies utilized to decrease infections in the hospital setting relies on topical antimicrobials and antiseptics. While their use is beneficial, concerns arise over the potential to develop resistance or tolerance to these agents. We examined nosocomial Staphylococcus aureusisolates from 2007 to 2013 for the presence of genes associated with tolerance to chlorhexidine. Isolates and patients were identified from an S. aureussurveillance study at Texas Children's Hospital. Nosocomial S. aureusisolates (those causing infection at ≥72 h of hospitalization) were identified and underwent PCR for the qacAor qacB(qacA/B) and smrgenes associated with elevated minimum bactericidal concentrations of chlorhexidine. Molecular typing with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and agrtyping and a review of the medical record were performed. Two hundred forty-seven nosocomial S. aureusinfections were identified. Overall, 111 isolates carried one or both genes (44.9%); 33.1% were positive for smr, 22.7% were positive for qacA/B, and 10.9% of the isolates possessed both genes. The smr-positive isolates were more often resistant to methicillin, ciprofloxacin, and/or clindamycin. The isolates positive for qacA/Bwere more often associated with indwelling central venous catheters and a vancomycin MIC of ≥2 μg/ml. Isolates carrying either smror qacA/Bwere associated with a diagnosis of bacteremia. The smr-positive isolates more often belonged to sequence type 8 (ST8) than the isolates that were positive for qacA/B. Mupirocin resistance was detected in 2.8% of the isolates. Antiseptic-tolerant S. aureusstrains are common in our children's hospital and are associated with decreased susceptibility to other systemic antimicrobials and with bloodstream infections. Further work is needed to understand the implications that these organisms have on the hospital environment and antiseptic use in the future. |
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