1887

Abstract

Purpose. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of nosocomial infections. A thorough understanding of the epidemiology and distribution of MRSA allows the development of better preventive measures and helps to control or reduce the rate of infection among the general population.

Methodology. A retrospective survey was performed on 511 cases of MRSA infections from inpatient, outpatient and nursing home populations over a 12-month period. To study the relationships between two continuous quantitative variables (patient age vs resistance percentage), a simple linear regression was calculated for each antibiotic to predict the antibiotic resistance percentage with respect to patient age.

Results/Key findings. The pattern of antibiotic resistance with respect to the age of patients depended on the antibiotic mode of action. Antibiotics that target DNA synthesis (i.e. fluoroquinolones) display a direct correlation with the age of patients, with higher rates of resistance among the older population, while antibiotics that target ribosomal functions (i.e. aminoglycosides) or cell wall synthesis (i.e. cephalosporin) do not display an age-dependent pattern and have a consistent degree of resistance across all age classes.

Conclusion. Antibiotics that target DNA synthesis result in a progressively higher number of resistant isolates among the older population. The results emphasize the importance of patient age on antibiotic selection as a preventive measure to reduce the rate of resistant infections in each susceptible population. This pattern suggests that physicians should take into consideration patient age as another factor in determining the best antibiotic regiment with the aim of curtailing the emergence of newer resistant phenotypes in the future.

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2017-11-08
2019-09-22
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References

  1. Reygaert WC. Antimicrobial resistance mechanisms of Staphylococcus aureus. Microb Pathog Strateg Combat them Sci Technol Educ 2013; 1: 297– 305
    [Google Scholar]
  2. Gould IM, Bal AM. New antibiotic agents in the pipeline and how they can help overcome microbial resistance. Virulence 2013; 4: 185– 191 [CrossRef] [PubMed]
    [Google Scholar]
  3. Martinez JL, Baquero F. Mutation frequencies and antibiotic resistance. Antimicrob Agents Chemother 2000; 44: 1771– 1777 [CrossRef] [PubMed]
    [Google Scholar]
  4. Martínez JL, Alonso A, Gómez-Gómez JM, Baquero F. Quinolone resistance by mutations in chromosomal gyrase genes. Just the tip of the iceberg?. J Antimicrob Chemother 1998; 42: 683– 688 [CrossRef] [PubMed]
    [Google Scholar]
  5. Hooper DC. Mechanisms of fluoroquinolone resistance. Drug Resist Updat 1999; 2: 38– 55 [CrossRef] [PubMed]
    [Google Scholar]
  6. Köhler T, Michea-Hamzehpour M, Plesiat P, Kahr AL, Pechere JC. Differential selection of multidrug efflux systems by quinolones in Pseudomonas aeruginosa. Antimicrob Agents Chemother 1997; 41: 2540– 2543 [PubMed]
    [Google Scholar]
  7. Maisnier-Patin S, Andersson DI. Adaptation to the deleterious effects of antimicrobial drug resistance mutations by compensatory evolution. Res Microbiol 2004; 155: 360– 369 [CrossRef] [PubMed]
    [Google Scholar]
  8. Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clin Proc 2011; 86: 156– 167 [CrossRef] [PubMed]
    [Google Scholar]
  9. Hawkey PM. The origins and molecular basis of antibiotic resistance. BMJ 1998; 317: 657– 660 [CrossRef] [PubMed]
    [Google Scholar]
  10. Poole K. Efflux-mediated antimicrobial resistance. In: Antibiotic Discovery and Development 2014; pp. 349– 395
    [Google Scholar]
  11. Otero LH, Rojas-Altuve A, Llarrull LI, Carrasco-López C, Kumarasiri M et al. How allosteric control of Staphylococcus aureus penicillin binding protein 2a enables methicillin resistance and physiological function. Proc Natl Acad Sci USA 2013; 110: 16808– 16813 [CrossRef] [PubMed]
    [Google Scholar]
  12. Fishovitz J, Hermoso JA, Chang M, Mobashery S. Penicillin-binding protein 2a of methicillin-resistant Staphylococcus aureus. IUBMB Life 2014; 66: 572– 577 [CrossRef] [PubMed]
    [Google Scholar]
  13. Jain A, Agarwal A, Verma RK. Cefoxitin disc diffusion test for detection of meticillin-resistant staphylococci. J Med Microbiol 2008; 57: 957– 961 [CrossRef] [PubMed]
    [Google Scholar]
  14. Grundmann H, Aires-de-Sousa M, Boyce J, Tiemersma E. Emergence and resurgence of meticillin-resistant Staphylococcus aureus as a public-health threat. Lancet 2006; 368: 874– 885 [CrossRef] [PubMed]
    [Google Scholar]
  15. Klein EY, Sun L, Smith DL, Laxminarayan R. The changing epidemiology of methicillin-resistant Staphylococcus aureus in the United States: a national observational study. Am J Epidemiol 2013; 177: 666– 674 [CrossRef] [PubMed]
    [Google Scholar]
  16. Delorme T, Garcia A, Nasr P. A longitudinal analysis of methicillin-resistant and sensitive Staphylococcus aureus incidence in respect to specimen source, patient location, and temperature variation. Int J Infect Dis 2017; 54: 50– 57 [CrossRef] [PubMed]
    [Google Scholar]
  17. CDC Antibiotic Resistance Threats in the United States, 2013 Antibiotic/Antimicrobial Resistance | CDCCDC 2013
    [Google Scholar]
  18. Tessier JM, Scheld WM. Principles of antimicrobial therapy. Handb Clin Neurol 2010; 96: 17– 29 [CrossRef] [PubMed]
    [Google Scholar]
  19. Saag M, Balu R, Phillips E, Brachman P, Martorell C et al. High sensitivity of human leukocyte antigen-b*5701 as a marker for immunologically confirmed abacavir hypersensitivity in white and black patients. Clin Infect Dis 2008; 46: 1111– 1118 [CrossRef] [PubMed]
    [Google Scholar]
  20. Yoshida H, Nakamura M, Bogaki M, Nakamura S. Proportion of DNA gyrase mutants among quinolone-resistant strains of Pseudomonas aeruginosa. Antimicrob Agents Chemother 1990; 34: 1273– 1275 [CrossRef] [PubMed]
    [Google Scholar]
  21. Balcazar JL. Bacteriophages as vehicles for antibiotic resistance genes in the environment. PLoS Pathog 2014; 10: e1004219 [CrossRef] [PubMed]
    [Google Scholar]
  22. Jimenez-Truque N, Tedeschi S, Saye EJ, McKenna BD, Langdon W et al. Relationship between maternal and neonatal Staphylococcus aureus colonization. Pediatrics 2012; 129: e1252-e1259 [CrossRef]
    [Google Scholar]
  23. Bennett PM. Plasmid encoded antibiotic resistance: acquisition and transfer of antibiotic resistance genes in bacteria. Br J Pharmacol 2008; 153: S347– S357 [CrossRef] [PubMed]
    [Google Scholar]
  24. Jumbe NL, Louie A, Miller MH, Liu W, Deziel MR et al. Quinolone efflux pumps play a central role in emergence of fluoroquinolone resistance in Streptococcus pneumoniae. Antimicrob Agents Chemother 2006; 50: 310– 317 [CrossRef] [PubMed]
    [Google Scholar]
  25. Boyd LB, Atmar RL, Randall GL, Hamill RJ, Steffen D et al. Increased fluoroquinolone resistance with time in Escherichia coli from >17,000 patients at a large county hospital as a function of culture site, age, sex, and location. BMC Infect Dis 2008; 8: 4 [CrossRef] [PubMed]
    [Google Scholar]
  26. Yokota S, Ohkoshi Y, Sato K, Fujii N. Emergence of fluoroquinolone-resistant Haemophilus influenzae strains among elderly patients but not among children. J Clin Microbiol 2008; 46: 361– 365 [CrossRef] [PubMed]
    [Google Scholar]
  27. Lautenbach E, Fishman NO, Bilker WB, Castiglioni A, Metlay JP et al. Risk factors for fluoroquinolone resistance in nosocomial Escherichia coli and Klebsiella pneumoniae infections. Arch Intern Med 2002; 162: 2469– 2477 [CrossRef] [PubMed]
    [Google Scholar]
  28. Ho PL, Yung RW, Tsang DN, Que TL, Ho M et al. Increasing resistance of Streptococcus pneumoniae to fluoroquinolones: results of a Hong Kong multicentre study in 2000. J Antimicrob Chemother 2001; 48: 659– 665 [PubMed] [Crossref]
    [Google Scholar]
  29. Chen CR, Malik M, Snyder M, Drlica K. DNA gyrase and topoisomerase IV on the bacterial chromosome: quinolone-induced DNA cleavage. J Mol Biol 1996; 258: 627– 637 [CrossRef] [PubMed]
    [Google Scholar]
  30. Karlowsky JA, Thornsberry C, Jones ME, Evangelista AT, Critchley IA et al. Factors associated with relative rates of antimicrobial resistance among Streptococcus pneumoniae in the United States: results from the TRUST Surveillance Program (1998–2002). Clin Infect Dis 2003; 36: 963– 970 [CrossRef] [PubMed]
    [Google Scholar]
  31. Vila J, Ruiz J, Goñi P, Jimenez de Anta T. Quinolone-resistance mutations in the topoisomerase IV parC gene of Acinetobacter baumannii. J Antimicrob Chemother 1997; 39: 757– 762 [CrossRef] [PubMed]
    [Google Scholar]
  32. Nakano M, Deguchi T, Kawamura T, Yasuda M, Kimura M et al. Mutations in the gyrA and parC genes in fluoroquinolone-resistant clinical isolates of Pseudomonas aeruginosa. Antimicrob Agents Chemother 1997; 41: 2289– 2291 [PubMed]
    [Google Scholar]
  33. Zhao X, Xu C, Domagala J, Drlica K. DNA topoisomerase targets of the fluoroquinolones: a strategy for avoiding bacterial resistance. Proc Natl Acad Sci USA 1997; 94: 13991– 13996 [CrossRef] [PubMed]
    [Google Scholar]
  34. Andersson DI. The ways in which bacteria resist antibiotics. Int J Risk Saf Med 2005; 17: 111– 116
    [Google Scholar]
  35. Lysnyansky I, Mikula I, Gerchman I, Levisohn S. Rapid detection of a point mutation in the parC gene associated with decreased susceptibility to fluoroquinolones in Mycoplasma bovis. Antimicrob Agents Chemother 2009; 53: 4911– 4914 [CrossRef] [PubMed]
    [Google Scholar]
  36. Redgrave LS, Sutton SB, Webber MA, Piddock LJ. Fluoroquinolone resistance: mechanisms, impact on bacteria, and role in evolutionary success. Trends Microbiol 2014; 22: 438– 445 [CrossRef] [PubMed]
    [Google Scholar]
  37. Ng EY, Trucksis M, Hooper DC. Quinolone resistance mediated by norA: physiologic characterization and relationship to flqB, a quinolone resistance locus on the Staphylococcus aureus chromosome. Antimicrob Agents Chemother 1994; 38: 1345– 1355 [PubMed] [Crossref]
    [Google Scholar]
  38. Mao EF, Lane L, Lee J, Miller JH. Proliferation of mutators in A cell population. J Bacteriol 1997; 179: 417– 422 [CrossRef] [PubMed]
    [Google Scholar]
  39. Leclerc JE, Li B, Payne WL, Cebula TA. High mutation frequencies among Escherichia coli and Salmonella pathogens. Science 1996; 274: 1208– 1211 [CrossRef] [PubMed]
    [Google Scholar]
  40. Matic I, Radman M, Taddei F, Picard B, Doit C et al. Highly variable mutation rates in commensal and pathogenic Escherichia coli. Science 1997; 277: 1833– 1834 [CrossRef] [PubMed]
    [Google Scholar]
  41. de Visser JA. The fate of microbial mutators. Microbiology 2002; 148: 1247– 1252 [CrossRef] [PubMed]
    [Google Scholar]
  42. CLSI Performance Standards for Antimicrobial Susceptibility Testing, 27th ed. Clinical and Laboratory Standards Institute; 2017
    [Google Scholar]
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