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JAC Advance Access originally published online on May 13, 2008
Journal of Antimicrobial Chemotherapy 2008 62(3):514-517; doi:10.1093/jac/dkn208
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Longitudinal analysis of chlorhexidine susceptibilities of nosocomial methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan

Jann-Tay Wang1, Wang-Huei Sheng1, Jiun-Ling Wang1, Duckling Chen1, Mei-Ling Chen2, Yee-Chun Chen1 and Shan-Chwen Chang1,3,*

1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan 3 Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

Received 10 October 2007; returned 18 January 2008; revised 8 April 2008; accepted 23 April 2008

* Correspondence address. Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan. Tel: +886-2-23123456 ext. 5401; Fax: +886-2-23958721; E-mail: changsc{at}ntu.edu.tw

Background: Chlorhexidine has been widely used for hand hygiene to prevent transmission of nosocomial pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). However, data on longitudinal surveillance of the susceptibility of MRSA isolates to chlorhexidine are limited.

Methods: A total of 240 nosocomial MRSA isolates obtained in 1990, 1995, 2000 and 2005 at National Taiwan University Hospital (NTUH), a hospital where chlorhexidine gluconate was used for hand hygiene for more than 20 years, were included in the study. Chlorhexidine susceptibility, molecular typing using multilocus sequence typing and distribution of the qacA/B gene of these MRSA isolates were studied.

Results: The proportion of tested MRSA with a high MIC of chlorhexidine (≥4 mg/L) was 1.7% in 1990, 50% in 1995, 40% in 2000 and 46.7% in 2005. Among these 83 isolates with high chlorhexidine MICs, 55.4% carried the qacA/B gene. MRSA isolates carrying the qacA/B gene were first detected in 1995 and belonged to a single clone at that time. However, the qacA/B gene was detected in MRSA isolates belonging to seven different clones in 2005.

Conclusions: The proportion of tested MRSA isolates with high chlorhexidine MICs at NTUH increased from 1990 to 1995 and remained steady thereafter. The presence of the qacA/B gene may contribute to the spread of specific MRSA clones.

Keywords: MRSA , multilocus sequence typing , qacA/B , molecular typing


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