Contribution of efflux to antibiotic resistance in Campylobacter isolated from poultry in Senegal.

a level of 12.2% LMR in the previous study. It is tempting to suggest that the efficacy of mupirocin against LMR MRSA may have helped to reduce the incidence of LMR in the intervening period, as the usage of mupirocin in CUH increased by $80% over the period 2003 – 06, inclusive. A subset of 25 MRSA isolates (including the HMR strains) demonstrated nine distinct antimicrobial profiles when tested against a panel of nine agents using CLSI testing methods (data not shown); however, SCCmec typing showed that these isolates all belonged to type IV, indicative of EMRSA-15. While HMR has been associated with SCCmec type IV previously, there is also evidence that HMR is associated with multiple clonal groups. 7 This is unsurprising, as HMR is plasmid-borne. The clonality of the MRSA isolates investigated may also explain the lack of LMR S. aureus in this study. The figures of the current Irish study also contrast with a multicentre European study of isolates collected during 2001, 8 where the total mupirocin resistance among MRSA isolates was 3.1% and 13.5% for HMR and LMR, respectively. However, the HMR and LMR levels for the CoNS subset of isolates in the European study were 3.3% and 9.4%, respectively, indicating a much lower level of HMR than that found in our study. Although, the prevalence of LMR CoNS in the current study may have been biased by the presence of a local S. epidermidis clone. The findings of this Irish study indicate a comparatively high level of HMR among blood culture CoNS isolates (notably among S. epidermidis), which may provide a hospital reservoir from which transfer of HMR to S. aureus can occur. Despite the concurrently low incidence of HMR among MRSA and MSSA, these findings indicate the need to monitor the incidence of HMR, particularly among nosocomial isolates of staphylococci.