TY - JOUR
T1 - The independent evolution of resistance to ciprofloxacin, rifampicin, and fusidic acid in methicillin-resistant Staphylococcus aureus in Australian teaching hospitals (1990-1995)
AU - Gottlieb, Thomas
AU - Mitchell, David
AU - Collignon, Peter
AU - Halliday, Linda
AU - Gottlieb, Thomas
AU - Funnell, Glenn
AU - Munro, Rosemary
AU - Daley, Denise
AU - Fernandes, Clarence
AU - Benn, Richard
AU - Vickery, Alison
AU - Yan, Barbara
AU - Mitchell, David
AU - Nimmo, Graeme
AU - Schooneveldt, Jacqueline
AU - Faoagali, Joan
AU - George, Narelle
AU - Pruul, Hendrik
AU - Lim, Irene
AU - Ott, Keith
AU - Spicer, John
AU - Franklin, Clare
AU - Turnidge, John
AU - Bell, Jan
AU - Olden, Dianne
AU - Hogg, Geoffrey
AU - Easton, Marion
AU - Andrew, John
AU - Waters, Mary Jo
AU - Joyce, Linda
AU - McGechie, David
AU - Francis, Graham
AU - Toohey, Michael
AU - Pearman, John
AU - Christiansen, Keryn
AU - Coombs, Geoffrey
AU - Mulgrave, Leigh
PY - 1998/7
Y1 - 1998/7
N2 - Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in teaching hospitals in eastern Australian states, with prevalence rates averaging 25-30% of all S.aureus. Between 1990 and 1995, 1467 non-duplicate MRSA isolates from clinically infected sites were tested in Sydney, Melbourne, and Brisbane as part of a national survey of staphylococcal susceptibility. We reviewed the differing evolution of resistance to ciprofloxacin, rifampicin, and fusidic acid. Despite similarities in community and hospital antibiotic use and MRSA prevalence rates, trends in resistance to the oral antibiotics in these cities have progressed independently of each other. In the 1995 survey in individual hospitals in Melbourne, 16-24% of strains were ciprofloxacin-resistant, compared with 80-100% in Sydney and 30-44% in Brisbane. There was great diversity of phage type patterns for ciprofloxacin-resistant strains, suggesting heterogeneous development of resistance. Rifampicin resistance was more closely associated with distinct dominant epidemic phage types, common to institutions in the same city, but without spread to the other cities. Between 1990 and 1995, these comprised 30-60% of all MRSA in Brisbane, compared with 5-10% in Melbourne and < 25% in Sydney. Fusidic acid resistance was uncommon and sporadic (< 5%), and was distributed equally between methicillin-resistant and methicillin-susceptible strains. Resistance to the oral agents in MRSA is due to a complex mix of antibiotic selection pressures and cross-infection with local and epidemic strains in closely related institutions. Each of these mechanisms can predominate, dependent on local factors and the antibiotics used.
AB - Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in teaching hospitals in eastern Australian states, with prevalence rates averaging 25-30% of all S.aureus. Between 1990 and 1995, 1467 non-duplicate MRSA isolates from clinically infected sites were tested in Sydney, Melbourne, and Brisbane as part of a national survey of staphylococcal susceptibility. We reviewed the differing evolution of resistance to ciprofloxacin, rifampicin, and fusidic acid. Despite similarities in community and hospital antibiotic use and MRSA prevalence rates, trends in resistance to the oral antibiotics in these cities have progressed independently of each other. In the 1995 survey in individual hospitals in Melbourne, 16-24% of strains were ciprofloxacin-resistant, compared with 80-100% in Sydney and 30-44% in Brisbane. There was great diversity of phage type patterns for ciprofloxacin-resistant strains, suggesting heterogeneous development of resistance. Rifampicin resistance was more closely associated with distinct dominant epidemic phage types, common to institutions in the same city, but without spread to the other cities. Between 1990 and 1995, these comprised 30-60% of all MRSA in Brisbane, compared with 5-10% in Melbourne and < 25% in Sydney. Fusidic acid resistance was uncommon and sporadic (< 5%), and was distributed equally between methicillin-resistant and methicillin-susceptible strains. Resistance to the oral agents in MRSA is due to a complex mix of antibiotic selection pressures and cross-infection with local and epidemic strains in closely related institutions. Each of these mechanisms can predominate, dependent on local factors and the antibiotics used.
UR - http://www.scopus.com/inward/record.url?scp=15144353146&partnerID=8YFLogxK
U2 - 10.1093/jac/42.1.67
DO - 10.1093/jac/42.1.67
M3 - Article
C2 - 9700530
AN - SCOPUS:15144353146
SN - 0305-7453
VL - 42
SP - 67
EP - 73
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 1
ER -