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564. A Five-Year Evolutionary Study of the Minimum Inhibitory Concentrations of Methicillin-resistant Staphylococcus aureus to Mupirocin, Chlorhexidine, and Octenidine in a Singaporean Tertiary Institution

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infection. Eradication of MRSA carriage reduces clinical infection and prevents transmission. In Singapore General Hospital, a series of hospital-wide measures were instituted over three years (...

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Autores principales: Zheng, Shuwei, Jasmine Chung, Shimin, Chiak James Sim, Heng, Zhu, Xiaoyi, Xuan Tan, Si, Chlebicka, Tara M, Huak Chan, Yiong, Peng Lim, Tze, Hoon Andrea Kwa, Lay, Piotr Chlebicki, Maciej
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810281/
http://dx.doi.org/10.1093/ofid/ofz360.633
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author Zheng, Shuwei
Jasmine Chung, Shimin
Chiak James Sim, Heng
Zhu, Xiaoyi
Xuan Tan, Si
Chlebicka, Tara M
Huak Chan, Yiong
Peng Lim, Tze
Hoon Andrea Kwa, Lay
Piotr Chlebicki, Maciej
author_facet Zheng, Shuwei
Jasmine Chung, Shimin
Chiak James Sim, Heng
Zhu, Xiaoyi
Xuan Tan, Si
Chlebicka, Tara M
Huak Chan, Yiong
Peng Lim, Tze
Hoon Andrea Kwa, Lay
Piotr Chlebicki, Maciej
author_sort Zheng, Shuwei
collection PubMed
description BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infection. Eradication of MRSA carriage reduces clinical infection and prevents transmission. In Singapore General Hospital, a series of hospital-wide measures were instituted over three years (Figure 1) to reduce mupirocin (MUP) resistance, and to decrease the bioburden of MRSA colonization amongst inpatients using octenidine (OCT)-based products. METHODS: A prevalence study was conducted at three time points (TPs) on consecutive MRSA screening isolates to evaluate for their minimum inhibitory concentrations (MICs) to CHG, OCT and MUP using broth microdilution sensitive plates and the presence of the ileS-2 gene, in 2013 (pre-intervention TP, TP1; n = 160), 2016 (early post-intervention TP, TP2; n = 99) and 2017 (late post-intervention TP, TP3; n = 76). Statistical analyses were performed using the Chi-square test with reference from TP1. RESULTS: A significant improvement in MUP susceptibility by MIC (256 µg/mL) and ileS-2 testing reduced from 25.0% (TP1) to 12.1% (TP2; P = 0.014) to 5.3% (TP3; P = 0.001) and 30.0% (TP1) to 18.2% (TP2; P = 0.036) to 9.2% (TP3; P = 0.001), respectively. OCT MIC range remained stable at 0.5 to 1 across all three TPs. The number of isolates with reduced CHG susceptibility (MIC ≥4 mg/L) increased over the three TPs from 23.1% to 27.2% (P = 0.45) to 42.1% (P = 0.003), despite decreasing CHG prescription. CONCLUSION: A restrictive MUP usage policy can improve MUP susceptibility amongst MRSA isolates over time. Widespread OCT use did not appear to result in a rise of OCT MIC over the intervention period. Although the clinical significance of reduced susceptibility to CHG remains uncertain, this worrying trend in our institution deserves further studies to better understand mechanisms of CHG resistance. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68102812019-10-28 564. A Five-Year Evolutionary Study of the Minimum Inhibitory Concentrations of Methicillin-resistant Staphylococcus aureus to Mupirocin, Chlorhexidine, and Octenidine in a Singaporean Tertiary Institution Zheng, Shuwei Jasmine Chung, Shimin Chiak James Sim, Heng Zhu, Xiaoyi Xuan Tan, Si Chlebicka, Tara M Huak Chan, Yiong Peng Lim, Tze Hoon Andrea Kwa, Lay Piotr Chlebicki, Maciej Open Forum Infect Dis Abstracts BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infection. Eradication of MRSA carriage reduces clinical infection and prevents transmission. In Singapore General Hospital, a series of hospital-wide measures were instituted over three years (Figure 1) to reduce mupirocin (MUP) resistance, and to decrease the bioburden of MRSA colonization amongst inpatients using octenidine (OCT)-based products. METHODS: A prevalence study was conducted at three time points (TPs) on consecutive MRSA screening isolates to evaluate for their minimum inhibitory concentrations (MICs) to CHG, OCT and MUP using broth microdilution sensitive plates and the presence of the ileS-2 gene, in 2013 (pre-intervention TP, TP1; n = 160), 2016 (early post-intervention TP, TP2; n = 99) and 2017 (late post-intervention TP, TP3; n = 76). Statistical analyses were performed using the Chi-square test with reference from TP1. RESULTS: A significant improvement in MUP susceptibility by MIC (256 µg/mL) and ileS-2 testing reduced from 25.0% (TP1) to 12.1% (TP2; P = 0.014) to 5.3% (TP3; P = 0.001) and 30.0% (TP1) to 18.2% (TP2; P = 0.036) to 9.2% (TP3; P = 0.001), respectively. OCT MIC range remained stable at 0.5 to 1 across all three TPs. The number of isolates with reduced CHG susceptibility (MIC ≥4 mg/L) increased over the three TPs from 23.1% to 27.2% (P = 0.45) to 42.1% (P = 0.003), despite decreasing CHG prescription. CONCLUSION: A restrictive MUP usage policy can improve MUP susceptibility amongst MRSA isolates over time. Widespread OCT use did not appear to result in a rise of OCT MIC over the intervention period. Although the clinical significance of reduced susceptibility to CHG remains uncertain, this worrying trend in our institution deserves further studies to better understand mechanisms of CHG resistance. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810281/ http://dx.doi.org/10.1093/ofid/ofz360.633 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Zheng, Shuwei
Jasmine Chung, Shimin
Chiak James Sim, Heng
Zhu, Xiaoyi
Xuan Tan, Si
Chlebicka, Tara M
Huak Chan, Yiong
Peng Lim, Tze
Hoon Andrea Kwa, Lay
Piotr Chlebicki, Maciej
564. A Five-Year Evolutionary Study of the Minimum Inhibitory Concentrations of Methicillin-resistant Staphylococcus aureus to Mupirocin, Chlorhexidine, and Octenidine in a Singaporean Tertiary Institution
title 564. A Five-Year Evolutionary Study of the Minimum Inhibitory Concentrations of Methicillin-resistant Staphylococcus aureus to Mupirocin, Chlorhexidine, and Octenidine in a Singaporean Tertiary Institution
title_full 564. A Five-Year Evolutionary Study of the Minimum Inhibitory Concentrations of Methicillin-resistant Staphylococcus aureus to Mupirocin, Chlorhexidine, and Octenidine in a Singaporean Tertiary Institution
title_fullStr 564. A Five-Year Evolutionary Study of the Minimum Inhibitory Concentrations of Methicillin-resistant Staphylococcus aureus to Mupirocin, Chlorhexidine, and Octenidine in a Singaporean Tertiary Institution
title_full_unstemmed 564. A Five-Year Evolutionary Study of the Minimum Inhibitory Concentrations of Methicillin-resistant Staphylococcus aureus to Mupirocin, Chlorhexidine, and Octenidine in a Singaporean Tertiary Institution
title_short 564. A Five-Year Evolutionary Study of the Minimum Inhibitory Concentrations of Methicillin-resistant Staphylococcus aureus to Mupirocin, Chlorhexidine, and Octenidine in a Singaporean Tertiary Institution
title_sort 564. a five-year evolutionary study of the minimum inhibitory concentrations of methicillin-resistant staphylococcus aureus to mupirocin, chlorhexidine, and octenidine in a singaporean tertiary institution
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810281/
http://dx.doi.org/10.1093/ofid/ofz360.633
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