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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 (...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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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. |
format | Online Article Text |
id | pubmed-6810281 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
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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