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. 2024 May;29(19):2300668.
doi: 10.2807/1560-7917.ES.2024.29.19.2300668.

Emergence and spread of a mupirocin-resistant variant of the European epidemic fusidic acid-resistant impetigo clone of Staphylococcus aureus, Belgium, 2013 to 2023

Nicolas Yin  1 , Charlotte Michel  1 , Nadia Makki  2 , Ariane Deplano  1 , Alisha Milis  2 , Benoit Prevost  1 , Veronique Yvette Miendje-Deyi  3 , Marie Hallin  4   5   6 , Delphine Martiny  1   7   6
Affiliations

Emergence and spread of a mupirocin-resistant variant of the European epidemic fusidic acid-resistant impetigo clone of Staphylococcus aureus, Belgium, 2013 to 2023

Nicolas Yin et al. Euro Surveill. 2024 May.

Abstract

BackgroundAntimicrobial resistance to mupirocin and fusidic acid, which are used for treatment of skin infections caused by Staphylococcus aureus, is of concern.AimTo investigate resistance to fusidic acid and mupirocin in meticillin-susceptible S. aureus (MSSA) from community-acquired skin and soft tissue infections (SSTIs) in Belgium.MethodsWe collected 2013-2023 data on fusidic acid and mupirocin resistance in SSTI-associated MSSA from two large Belgian laboratories. Resistant MSSA isolates sent to the Belgian Staphylococci Reference Centre were spa-typed and analysed for the presence of the eta and etb virulence genes and the mupA resistance gene. In addition, we whole genome sequenced MSSA isolates collected between October 2021 and September 2023.ResultsMupirocin resistance increased between 2013 and 2023 from 0.5-1.5% to 1.7-5.6%. Between 2018 and 2023, 91.4% (64/70) of mupirocin-resistant isolates were co-resistant to fusidic acid. By September 2023, between 8.9% (15/168) and 10.1% (11/109) of children isolates from the two laboratories were co-resistant. Of the 33 sequenced isolates, 29 were sequence type 121, clonal and more distantly related to the European epidemic fusidic acid-resistant impetigo clone (EEFIC) observed in Belgium in 2020. These isolates carried the mupA and fusB genes conferring resistance to mupirocin and fusidic acid, respectively, and the eta and etb virulence genes.ConclusionWe highlight the spread of a mupirocin-resistant EEFIC in children, with a seasonal trend for the third quarter of the year. This is of concern because this variant is resistant to the two main topical antibiotics used to treat impetigo in Belgium.

Keywords: Belgium; Child; Exfoliatins; Fusidic Acid; Impetigo; Mupirocin; Staphylococcus aureus; Virulence; Whole Genome Sequencing.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Resistance to fusidic acid and mupirocin in meticillin-susceptible Staphylococcus aureus isolates from skin and soft tissue infections, Belgium, October 2013–September 2023 (n = 32,503)
Figure 2
Figure 2
Resistance to fusidic acid and mupirocin in meticillin-susceptible Staphylococcus aureus isolates from skin and soft tissue infections in children, Belgium, July–September 2014–2023 (n = 2,038)
Figure 3
Figure 3
spa types and dendrogram of whole genome multilocus sequence typing results of meticillin-susceptible Staphylococcus aureus sequence type 121 reference genomes (n = 30), sequence type 121 isolates from Belgium, October 2021–September 2023 (n = 30) and sequence type 123 isolate from Belgium, 2020 (n = 1)
See this image and copyright information in PMC

References

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