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. 2019 Feb 12;14(2):e0212029.
doi: 10.1371/journal.pone.0212029. eCollection 2019.

A decade of antimicrobial resistance in Staphylococcus aureus: A single center experience

Claudia P Vicetti Miguel  1 , Asuncion Mejias  1   2 , Amy Leber  3 , Pablo J Sanchez  4
Affiliations

A decade of antimicrobial resistance in Staphylococcus aureus: A single center experience

Claudia P Vicetti Miguel et al. PLoS One. .

Abstract

Background: The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) resulted in the recommended use of clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) for suspected S. aureus infections. The objective of this study was to determine the resistance to methicillin, clindamycin, and TMP-SMX in S. aureus isolates during a 10-year period.

Methods: Retrospective review of the antimicrobial susceptibilities of all S. aureus isolates in the outpatient and inpatient settings at Nationwide Children's Hospital from 1/1/2005 to 12/31/2014. Duplicate isolates from the same site and year and those obtained for MRSA surveillance or from patients with cystic fibrosis were excluded.

Results: Of the 57,788 S. aureus isolates from 2005-2014, 40,795 (71%) were included. In the outpatient setting, methicillin resistance decreased from 54% to 44% (p<0.001) while among inpatient isolates, no significant change was observed. From 2009-2014, resistance to clindamycin among outpatient isolates increased from 16% to 17% (p = 0.002) but no significant trend was observed among inpatient isolates (18% to 22%). Similarly, TMP-SMX resistance increased in outpatient S. aureus isolates from 2005-2014 (0.9% to 4%, p<0.001) but not among inpatient isolates. Among both inpatient and outpatient isolates, methicillin-susceptible S. aureus (MSSA) exhibited higher resistance to both clindamycin and TMP-SMX than MRSA. In addition, resistance to methicillin, clindamycin and TMP-SMX varied widely according to the site of specimen collection.

Conclusion: In a decade where >40,000 S. aureus isolates were identified at a large pediatric hospital, substantial changes in methicillin, clindamycin, and TMP-SMX resistance occurred. These findings highlight the importance of ongoing surveillance of the local antimicrobial resistance in S. aureus in order to guide empiric antimicrobial therapy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Methicillin resistance by year (2005–2014) in outpatient (A) and inpatient (B) S. aureus isolates from NCH.
NCH indicates Nationwide Children’s Hospital. aNumber of outpatient S. aureus isolates (n = 31,760). bNumber of inpatient S. aureus isolates (n = 7,760). cp-value determined using the χ2 test for trends.
Fig 2
Fig 2. Clindamycin resistance by year (2009–2014) in outpatient (A) and inpatient (B) S.aureus isolates from NCH.
NCH indicates Nationwide Children’s Hospital; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible S. aureus. aNumber of outpatient S. aureus isolates (n = 20,450). bNumber of inpatient S. aureus isolates (n = 5,317). cp-value determined using the χ2 test for trends.
Fig 3
Fig 3. Inducible and constitutive clindamycin resistance by year (2009–2014) in outpatient (A) and inpatient (B) S. aureus isolates from NCH.
NCH indicates Nationwide Children’s Hospital. aNumber of outpatient S. aureus isolates (n = 20,450). bNumber of inpatient S. aureus isolates (n = 5,317). *p<0.05, determined using the χ2 test for trends.
Fig 4
Fig 4. TMP-SMX resistance by year (2005–2014) in outpatient (A) and inpatient (B) S.aureus isolates from NCH.
TMP-SMX indicates trimethoprim-sulfamethoxazole; NCH, Nationwide Children’s Hospital; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible S. aureus. aNumber of outpatient S. aureus isolates (n = 31,760). bNumber of inpatient S. aureus isolates (n = 7,760). cp-value determined using the χ2 test for trends.
See this image and copyright information in PMC

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