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Journal of Clinical Microbiology, September 1999, p. 2781-2788, Vol. 37, No. 9
Sera & Vaccines Central Research Laboratory,
00-725 Warsaw, Poland
Received 1 March 1999/Returned for modification 22 May
1999/Accepted 9 June 1999
An outbreak of mupirocin-resistant (MuR) staphylococci was
investigated in two wards of a large hospital in Warsaw, Poland. Fifty-three MuR isolates of Staphylococcus aureus, S. epidermidis, S. haemolyticus, S. xylosus,
and S. capitis were identified over a 17-month survey which
was carried out after introduction of the drug for the treatment of
skin infections. The isolates were collected from patients with
infections, environmental samples, and carriers; they constituted
19.5% of all staphylococcal isolates identified in the two wards
during that time. Almost all the MuR isolates were also resistant to
methicillin (methicillin-resistant S. aureus and
methicillin-resistant coagulase-negative staphylococci). Seven of the
outbreak isolates expressed a low-level-resistance phenotype (MuL),
whereas the remaining majority of isolates were found to be highly
resistant to mupirocin (MuH). The mupA gene, responsible
for the MuH phenotype, has been assigned to three different polymorphic
loci among the strains in the collection analyzed. The predominant
polymorph, polymorph I (characterized by a mupA-containing
EcoRI DNA fragment of about 16 kb), was located on a
specific plasmid which was widely distributed among the entire staphylococcal population. All MuR S. aureus isolates were
found to represent a single epidemic strain, which was clonally
disseminated in both wards. The S. epidermidis population
was much more diverse; however, at least four clusters of closely
related isolates were identified, which suggested that some strains of
this species were also clonally spread in the hospital environment. Six
isolates of S. epidermidis were demonstrated to express the
MuL and MuH resistance mechanisms simultaneously, and this is the first
identification of such dual MuR phenotype-bearing strains. The outbreak
was attributed to a high level and inappropriate use of mupirocin, and
as a result the dermatological formulation of the drug has been removed
from the hospital formulary.
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Outbreak of Mupirocin-Resistant Staphylococci in a
Hospital in Warsaw, Poland, Due to Plasmid Transmission and Clonal
Spread of Several Strains
ski,*
ska,
bieta
Stefaniuk,ski, and
*
Corresponding author. Mailing address: Sera & Vaccines
Central Research Laboratory, ul. Chelmska 30/34, 00-725 Warsaw, Poland. Phone: 48 (22) 841 40 71, ext. 230. Fax: 48 (22) 841 29 49. E-mail: leski{at}urania.il.waw.pl.
Journal of Clinical Microbiology, September 1999, p. 2781-2788, Vol. 37, No. 9
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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