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Background The increasing use of chlorhexidine (CHG) for MRSA decolonization has raised concerns about the emergence of resistance or tolerance to these agents. Methods We evaluated the frequency and characteristics of qacA/B chlorhexidine tolerance genes among MRSA bloodstream infection (BSI) isolates at a tertiary hospital in Korea. MRSA BSI isolates collected from 2011 to 2016 was examined for carriage of qacA/B and smr genes and high-level mupirocin resistance. Staphylococcal cassette chromosome mec (SCCmec) and spa typing was also performed. Results Of the 203 MRSA BSI isolates, 57 (28.1%) were positive for qacA/B, 6 (3.0%) were positive for smr, and 15 (7.4%) were mupirocin resistant. Table 1 shows characteristics of qacA/B-positive vs. qacA/B-negative MRSA BSI. Patients with qacA/B-positive isolates were more often diagnosed with nosocomial BSI and catheter related BSI, but were less often diagnosed with bone and soft-tissue infections. The qacA/B-positive isolates were more often resistant to mupirocin, clindamycin, and ciprofloxacin and more often had a CHG MIC of >= 4mg/L. The qacA/B-positive isolates were more likely to belong to SCCmec II or III (84.2% vs. 38.5%, P < 0.001), which are common healthcare-associated (HA) MRSA strains in Korea. Most common spa types in qacA/B positive isolates were t2460 (64.9%) and t9353 (14.0%). Conclusion The qacA/B carriage among MRSA BSI isolates are not uncommon in this study and showed the features of HA-MRSA BSI.Table 1. Characteristics of qacA/B-positive vs. qacA/B-negative MRSA BSI. Characteristics qacA/B (+) (n = 57) qacA/B (-) (n = 146) P Age, median years(IQR) 72 (60–84) 69 (56–75) 0.062 Nosocomial BSI 44 (77.2) 61 (41.8) < 0.001 Catheter-related BSI 35 (61.4) 41 (28.1) < 0.001 Primary BSI 14 (24.6) 38 (26.0) 0.999 Bone and soft-tissue infections 4 (10.8) 33 (22.6) 0.009 Pneumonia 2 (3,5) 12 (8.2) 0.358 Other infections 2 (3.5) 13 (8.9) 0.242 Clindamycin resistant 56 (98.2) 96 (65.8) <0.001 Ciprofloxacin resistant 56 (98.2) 56 (38.4) <0.001 Vancomycin MIC >= 2mg/L 17 (29.8) 26 (17.8) 0.084 Chlorhexidine MIC >= 4mg/L 54 (94.7) 50 (34.2) <0.001 SCCmec II 37 (64.9) 39 (27.3) <0.001 SCCmec III 11 (19.3) 16 (11.2) 0.168 SCCmec IV 9 (15.8) 88 (61.5) <0.001 30 day mortality 14 (24.6) 35 (25.0) 0.999 Data are no. (%) of cases Disclosures All authors: No reported disclosures.

open forum infectious diseases

Prevalence and Characteristics of qacA/B-positive Methicillin-resistant Staphylococcus aureus (MRSA) Bloodstream Infection Isolates in a Tertiary Hospital