 Bacterial strain typing: 1. understanding the epidemiology of MRSA 2. evaluating the effectiveness of infection control 3. evaluating.

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Presentation transcript:

 Bacterial strain typing: 1. understanding the epidemiology of MRSA 2. evaluating the effectiveness of infection control 3. evaluating the effectiveness of antimicrobial prescribing measures.

CHEF DR III

PFGE results using the standardized European protocol

PFGE results using the standardized European protocol and Matushek electrophoresis parameters

PFGE results using the standardized Canadian protocol

PFGE results for some isolates using the Matushek protocol. M= lambda concatemers, numbers represent the isolates. M M

Number and percentage of the PFGE types (designated M1-M6 and uniques) PFGE type Number of isolates (%) M1187 (36.5) M2105 (20.5) M3 27 (5.3) M473 (14.3) M529 (5.7) M67 (1.4) Unique84 (16.4)

Figure shows the positive bands at 309 bp with 100 bp molecular weight markers. Isolate identification codes are indicated for each lane. MRSA ATCC (positive control) and MSSA ATCC 6538 (negative control) are included in the last 2 lanes of the gel.

PCR mecA detection No. of isolates No. (%) of isolates with the indicated result Ox-salt agar screen Ox disk diffusion Fox disk diffusion Fox E-test MIC of (µg/ml) PBP2' latex agglutination Growth No growth ResistantSensitiveResistantSensitive<8<8>32PositiveNegative Positive (92.3 § ) 3 (7.7) 33 (84.6 § ) 6 (15.4) 33 (84.6 § ) 6 (15.4) 26 (66.7) 13 (33.3 § ) 36 (92.3 § ) 3 (7.7) Negative (54.2) 11 (45.8 ¶ ) 5 (20.8) 19 (79.2 ¶ ) 3 (12.5) 21 (87.5 ¶ ) 18 (75 ¶ ) 6 (25) 5 (20.8) 19 (79.2 ¶ ) Evaluation of oxacillin-salt agar screen test, oxacillin and cefoxitin disk diffusion tests, cefoxitin E-test, and PBP2' latex agglutination methods for detection of methicillin resistance in 63 S. aureus isolates Ox=oxacillin, Fox=cefoxitin, PBP2'= penicillin binding protein 2' § = Sensitivity, ¶ = Specificity

PCR mecA detection No. of isolates No. (%) of isolates with the indicated result Modified Fox disk diffusion Modified Fox E-test MIC of (µg/ml) Resistant <21 Sensitive >22 <4<4>6>6 Positive 39 35(89.7 § )4(10.3) 35(89.7 § ) Negative 24 3(12.5)21(87.5 ¶ )22(91.7 ¶ )2(8.3) Evaluation of the revised cefoxitin disk diffusion and revised cefoxitin E-test breakpoints for detection of methicillin resistance in the 63 S. aureus isolates Ox=oxacillin, Fox=cefoxitin, PBP2'= penicillin binding protein 2‘ § = Sensitivity, ¶ = Specificity

AntibioticTotal susceptibility No. (%) (512) Inpatient isolates No. (%) (397) Outpatient isolates No. (%) (115) VAN512(100)397(100)115(100) Q/D512(100)397(100)115(100) LZD491(95.9)386(97.2)105(91.3) CHL413(80.7)302(76.1)111(96.5) GAT404(78.9)299(75.3)105(91.3) MUP394(77.0)292(73.6)102(88.7) GEN203(39.6)118(29.7)85(73.9) SXT173(33.8)85(21.4)88(76.5) FD22(4.3)15(3.8)7(6.1) FD = fusidic acid, GAT = gatifloxacin, GEN = gentamicin, LZD = linezolid, MUP = mupirocin, Q/D = quinupristin/dalfopristin, SXT = sulfa/trimethoprim, CHL = chloramphenicol, VAN = vancomycin

FD = fusidic acid, GAT = gatifloxacin, GEN = gentamicin, LZD = linezolid, MUP = mupirocin, Q/D = quinupristin/dalfopristin, SXT = sulfa/trimethoprim, CHL = chloramphenicol HospitalFDGATGENLZDMUPQ/DSXTCHL A (179) B (72) C (69) D (64) E (74) F (54)

The numbers above the columns are the diameters of the zones

The numbers above the columns are the MICs in µg/mL

VAN= vancomycin, MIN= minocycline, GAT= gatifloxacin, GEN= gentamicin, LZD= linezolid, MUP= mupirocin, Q/D= quinupristin/dalfopristin, SXT= sulfamethoxazole/trimethoprim

Antibiotic Susceptibility PatternA (179)B (72)C (69)D (64)E (74)F (54) 1 GAT/LZD/MUP/QD/CHL GAT/LZD/QD GAT/LZD/MUP/QD LZD/MUP/QD/CHL GAT/GEN/LZD/MUP/QD/C GAT/GEN/LZD/MUP/QD/SXT/CHL FD = fusidic acid, GAT = gatifloxacin, GEN = gentamicin, LZD = linezolid, MUP = mupirocin, Q/D = quinupristin/dalfopristin, SXT = sulfamethoxazole/trimethoprim, CHL = chloramphenicol. A-F represent the hospital codes

FD = fusidic acid, GAT = gatifloxacin, GEN = gentamicin, LZD = linezolid, MUP = mupirocin, Q/D = quinupristin/dalfopristin, SXT = Sulfamethoxazole/trimethoprim, CHL = chloramphenicol. Isolation period (No.) FDGATGENLZDMUPQ/DSXTCHL 1 (55) (206) (210) (41)