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Darlene Miller, Jorge Maestre, Edith Perez, Ben David Wilson, Harry W Flynn, Eduardo C Alfonso; Molecular and Mupirocin Profiles of MSSA and MRSA Isolates Associated with Chronic/Recalcitrant Ocular Disease. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):271.
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© ARVO (1962-2015); The Authors (2016-present)
To document the molecular characteristics and mupirocin profiles of Staphylococcus aureus isolates recovered from chronic and or recalcitrant ocular disease.
We used three separate multiplex PCR reactions to characterize molecular profiles for SCCmec, Panton Valentine leukocidin (PVL) toxin and the global accessory gene regulator (ARG) for 135 isolates recovered (2011-2014) from 52 patients with chronic staphylococcal disease (persistent colonization/recovery of S. aureus after a treatment course of at least 14 days). Mupirocin MIC profiles (N=60) were documented using E tests. Resistance was categorized as high level (HL), >512 ug/ml, low level (LL), 8-256 ug/ml and susceptible (SL), less than 8 ug/ml.
.The average number of repeat isolates per patient averaged 2.9 with an average time interval of 174 days (range 10-810 days). Reservoirs for repeat infections included conjunctiva (38.5%), cornea (16.3%), lacrimal system (11.1%), lids (10.4%), socket (9.6%) and ocular other (14.1%). Methicillin susceptible isolates were recovered from 25.9% (n=35) of patients.. The majority of the MRSA isolates were healthcare associated (n=66/75, 88%). SCCmec profiles included SCCmec I (4.5%), SCCmec II-95.5% (N= 66/75, 88%,) . Community associated MRSA profiles (n=28) were all SCCmec IV, (IVa-39.3%, IVd-60.7%). 4,4% of isolates were untypable. The PVL toxin was present in 94.8% of isolates. ARG type 2(51.8%, n=70) was the most common ARG genotype followed by ARG 1 (29.6%), ARG 3 (14.8%), ARG 4 (0.07%) and nontyable (3%). Isolates with genotype: SSCmec II, ARG2 and PVL + (50.3%, n=68) served as markers for chronic ocular disease. High level mupirocin resistance was found in 6.7% (4/60) of isolates (conjunctiva-2, cornea-2). Low level resistance was document in 2 (3.3%-conjunctiva, lids). Resistance occurred more frequently in MRSA isolates (5/6, 83.3%). General in vitro susceptibility for mupirocin was 90% (n=54/60).
Unique molecular profiles may serve as markers for chronic ocular staphylococcal disease and high level resistance to mupirocin. Mupirocin could be useful in decolonizing and reducing ocular surface reservoirs.
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