Mupirocin Resistance
Mupirocin Resistance
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DOI：
10.1086/605495
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发表时间：
2009-09-15
影响因子：
11.8
通讯作者：
Jernigan, John A.
中科院分区：
文献类型：
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作者：
Patel, Jean B.;Gorwitz, Rachel J.;Jernigan, John A.
随着预防耐甲氧西林金黄色葡萄球菌（MRSA）感染的压力越来越大，可能会增加莫匹罗星用于MRSA的鼻腔去殖民化。了解莫匹罗星耐药的机制、临床意义和流行病学对于预测莫匹罗星使用的变化如何影响细菌种群和MRSA控制非常重要。S.金黄色葡萄球菌是由质粒编码的mupA基因介导的。这种基因可以在接合质粒上发现，这些质粒携带其他类别抗菌剂的多个耐药决定簇。高水平耐药与去殖民化失败相关，耐药率增加与莫匹罗星使用增加相关。低水平的莫匹罗星耐药是通过天然ileS基因突变介导的，这种耐药的临床意义尚不清楚。已经描述了检测和区分这些类型的耐药性的实验室测试，但在美国还没有广泛使用。正在考虑实施广泛使用莫匹罗星的机构应考虑这些耐药性问题，并制定策略以监测莫匹罗星使用的影响。
With increasing pressure to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection, it is possible that there will be increased use of mupirocin for nasal decolonization of MRSA. Understanding the mechanisms, clinical significance, and epidemiology of mupirocin resistance is important for predicting how changes in mupirocin use may affect bacterial populations and MRSA control. High-level mupirocin resistance in S. aureus is mediated by a plasmid-encoded mupA gene. This gene can be found on conjugative plasmids that carry multiple resistance determinants for other classes of antimicrobial agents. High-level resistance has been associated with decolonization failure, and increased resistance rates have been associated with increased mupirocin use. Low-level mupirocin resistance is mediated via mutation in the native ileS gene, and the clinical significance of this resistance is unclear. Laboratory tests to detect and distinguish between these types of resistance have been described but are not widely available in the United States. Institutions that are considering the implementation of widespread mupirocin use should consider these resistance issues and develop strategies to monitor the impact of mupirocin use.