Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial

Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this qu...

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Bibliographic Details
Published in:Journal of clinical microbiology 2016-11, Vol.54 (11), p.2735-2742
Main Authors: Hayden, Mary K, Lolans, Karen, Haffenreffer, Katherine, Avery, Taliser R, Kleinman, Ken, Li, Haiying, Kaganov, Rebecca E, Lankiewicz, Julie, Moody, Julia, Septimus, Edward, Weinstein, Robert A, Hickok, Jason, Jernigan, John, Perlin, Jonathan B, Platt, Richard, Huang, Susan S
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents
Anti-Infective Agents, Local
Bacteriology
Carrier State - drug therapy
Carrier State - microbiology
Chlorhexidine - pharmacology
Drug Resistance, Bacterial
Genes, Bacterial
Humans
Methicillin-Resistant Staphylococcus aureus - drug effects
Methicillin-Resistant Staphylococcus aureus - isolation & purification
Microbial Sensitivity Tests
Mupirocin - pharmacology
Polymerase Chain Reaction
Selection, Genetic
Sequence Analysis, DNA
Staphylococcal Infections - drug therapy
Staphylococcal Infections - microbiology
Staphylococcus aureus
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Summary:Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening and isolation without decolonization, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization without screening to prevent MRSA infection in intensive-care unit (ICU) patients. Isolates from the baseline and intervention periods were collected and tested for susceptibility to chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility was tested by Etest. The presence of the qacA or qacB gene was determined by PCR and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were nonsusceptible to CHG (MICs, 8 μg/ml), and 5/814 (0.6%) carried qacA or qacB At baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and 7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized logistic regression model, the odds of mupirocin resistance among clinical MRSA isolates or MRSA isolates acquired in an ICU in intervention versus baseline periods did not differ across arms, although estimates were imprecise due to small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of mupirocin resistance were no different in the intervention versus baseline periods across arms, but the confidence limits were broad, and the results should be interpreted with caution.
ISSN:0095-1137
1098-660X
DOI:10.1128/JCM.01444-16