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Title: Comparison of prevalence of antiseptic resistance genes in staphylococcus aureus and coagulase-negative staphylococci from nurses and the general population in Hong Kong
Authors: Zhang, M
Boost, M
O'Donoghue, M 
Tong, E
Hiramatsu, K
Issue Date: 2010
Source: 20th European Congress of Clinical Microbiology & Infectious Diseases, Vienna, Austria, 10-13 April, 2010 How to cite?
Abstract: Objective: Widespread use of antiseptic agents has led to the emergence of Staphylococcus aureus and coagulase-negative staphylococci (CNS) with decreased antiseptic susceptibility. This has been associated with the presence of several genes including qacA/B and smr. This study determined and compared the prevalence of antiseptic resistance genes in S. aureus and CNS from nurses and the general population and investigated risk factors for carriage by nurses of qacA/B or smr positive S. aureus and CNS.
Methods: Nasal swabs were collected from 235 nurses and cultured for the presence S. aureus and CNS. The nurses completed a questionnaire providing demographics and data on antiseptic use, contact with MRSA positive patients, and recent antibiotic therapy. 200 recent carriage isolates of S. aureus and CNS from the general population were used for comparison. PCR was used to detect mecA, qacA/B and smr genes. Univariate and multivariate analysis were used to investigate associations between presence of antiseptic resistance genes and potential risk factors.
Results: A significant difference was noted in the prevalence from nurses and the general public of both qacA/B and smr in CNS isolates and of qacA/B in S. aureus (see table). Overall MRSA carriage was low (3% nurses; 0.5% general public). There was a significantly higher prevalence of qacA/B in MRCNS strains than in MSCNS isolates (p<0.001), but, whilst the rate was higher in MRSA than MSSA, this did not reach significance. Contact with MRSA patients increased risk of carriage of strains with antiseptic resistance genes (OR 2.26; p=0.031). Presence of mecA in an isolate increased the risk of harbouring antiseptic resistance genes (OR 2.78; p<0.001).
Conclusions: The increased prevalence of antiseptic resistance genes in isolates from nurses indicates that the hospital environment exerts selective pressure for carriage of these strains. The increased proportion of antiseptic resistance gene positivity in mecA positive isolates suggests co-selection of these genes, as does the increased risk of carriage of antiseptic resistance gene positive strains by those in recent contact with MRSA positive patients. Although qacA/B and smr do not confer antiseptic resistance at concentrations used, they may pose an infection control risk by persisting in areas with low level antiseptic residues. The association between mecA and qacA/B/smr may contribute to survival of MRSA in the hospital environment.
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