1. Mupirocin Resistance in Staphylococci After Three Years of Universal MRSA Admission Screening Rosy Reynolds, Shazad Mushtaq, Angela Kidney on behalf of The BSAC Working Party on Resistance Surveillance O347 23 rd ECCMID, Berlin, 27-30 th Apr 2013 rosy.reynolds@nbt.nhs.uk

2. England - MRSA screening and decolonisation “From April 2009, all elective admissions must be screened for MRSA in line with Department of Health guidance. This should be extended to cover emergency admissions as soon as possible and definitely no later than 2011.” Operational Guidance 2, Department of Health, December 2008 and 2009/10 Operating Framework “We expect all patients who test positive for MRSA on screening prior to admission to be effectively decolonised, as indicated in previous guidance.” Operational Guidance 2, Department of Health, December 2008

3. BSAC Resistance Surveillance Project UK & Ireland 40 laboratories (25 up to 2009, 2009/10) Bacteraemia (2007-2011) Hospital-onset lower respiratory infection (2008/09 - 2010/11) Blood S. aureus: 500/yr (250 in 2007) LRTI S. aureus : 250/yr Blood coagulase-negative staphylococci: 250 /yr BSAC agar dilution MICs & BSAC/EUCAST breakpoints. mecA, mupA tested by PCR www.bsacsurv.org 2012 PHE, London; Quotient Bioresearch, Fordham.

4. RTI S. aureus Blood S. aureus Blood CoNS From To 2008/09 2010/11 2007 2011 2007 2011 N68521891020 Hospital*100%49%63% ICU42%7%14% Methicillin resistant 44 →26%37 →14%78 →68% * >48 hours

5. SusceptibleLow-level resistantHigh-level resistant SusceptibleLow-level resistantHigh-level resistant mupA-positive High-level resistance = MIC>256 mg/L and/or mupA-positive

6. SusceptibleLow-level resistantHigh-level resistant SusceptibleLow-level resistantHigh-level resistant mupA-positive High-level resistance = MIC>256 mg/L and/or mupA-positive

7. %mup-R (N) Methicillin susceptible Methicillin resistant LRTI S. aureus 0.2% (439) 13% (246) Blood S. aureus 0.6% (1704) 10% (489) Blood CoNS 7% (268) 35% (752) Mupirocin vs methicillin resistance

8. N = 731 11% R 34%

9. N = 2143 0.5% R

10. 80% N = 752 35% R

11. N = 268 8% R 80%

13. Mupirocin resistance in staphylococci from blood and hospital-onset LRTI in the UK and Ireland: Has not increased significantly since mandatory screening / decolonisation. Is common in methicillin-resistant isolates: MRSA - 11% (mostly low-level) MRCoNS - 35% (mostly high-level) Remains under selective pressure.

14. Central Laboratories HPA Colindale Shazad Mushtaq David Livermore... and many others Quotient Bioresearch Angela Kidney Regina Janes... and many others Collecting Laboratories Sponsors 2007-2011 Astellas AstraZeneca Basilea Cerexa / Forest Cubist J&J / Janssen Merck / MSD Novartis (Chiron) Pfizer (Wyeth) Theravance ACKNOWLEDGEMENTS BSAC Resistance Surveillance Project 2007-11