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Prevalence of qacA/B Genes and Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates in the Setting of Chlorhexidine Bathing Without Mupirocin
  • Published Date:
    Feb 02 2016
  • Source:
    Infect Control Hosp Epidemiol. 37(5):590-597.


Public Access Version Available on: May 01, 2017 information icon
Please check back on the date listed above.
Details:
  • Pubmed ID:
    26828094
  • Pubmed Central ID:
    PMC4833605
  • Funding:
    U54 CK000162/CK/NCEZID CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    OBJECTIVE

    We aimed to determine the frequency of qacA/B chlorhexidine tolerance genes and high-level mupirocin resistance among MRSA isolates before and after the introduction of a chlorhexidine (CHG) daily bathing intervention in a surgical intensive care unit (SICU).

    DESIGN

    Retrospective cohort study (2005–2012)

    SETTING

    A large tertiary-care center

    PATIENTS

    Patients admitted to SICU who had MRSA surveillance cultures of the anterior nares

    METHODS

    A random sample of banked MRSA anterior nares isolates recovered during (2005) and after (2006–2012) implementation of a daily CHG bathing protocol was examined for qacA/B genes and high-level mupirocin resistance. Staphylococcal cassette chromosome mec (SCCmec) typing was also performed.

    RESULTS

    Of the 504 randomly selected isolates (63 per year), 36 (7.1%) were qacA/B positive ( + ) and 35 (6.9%) were mupirocin resistant. Of these, 184 (36.5%) isolates were SCCmec type IV. There was a significant trend for increasing qacA/B (P= .02; highest prevalence, 16.9% in 2009 and 2010) and SCCmec type IV (P< .001; highest prevalence, 52.4% in 2012) during the study period. qacA/B( + ) MRSA isolates were more likely to be mupirocin resistant (9 of 36 [25%] qacA/B( + ) vs 26 of 468 [5.6%] qacA/B(−); P= .003).

    CONCLUSIONS

    A long-term, daily CHG bathing protocol was associated with a change in the frequency of qacA/B genes in MRSA isolates recovered from the anterior nares over an 8-year period. This change in the frequency of qacA/B genes is most likely due to patients in those years being exposed in prior admissions. Future studies need to further evaluate the implications of universal CHG daily bathing on MRSA qacA/B genes among hospitalized patients.

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