|Year : 2015 | Volume
| Issue : 1 | Page : 13-15
Prevalence and antibiogram of hospital acquired-methicillin resistant Staphylococcus aureus and community acquired-methicillin resistant Staphylococcus aureus at a tertiary care hospital National Institute of Medical Sciences
Ameer Abbas, PS Nirwan, Preeti Srivastava
Department of Microbiology, National Institute of Medical Sciences Medical College, Jaipur, Rajasthan, India
|Date of Web Publication||25-Mar-2015|
P S Nirwan
Department of Microbiology, National Institute of Medical Sciences Medical College, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
Background and Aims: Since 1959, treatment of infections caused by S. aureus included semi synthetic penicillin drugs such as Methicillin. Sooner a year later in 1960 Methicillin resistant S. aureus came into existence. Decade after decade the MRSA strains increased and these bacteria were marked as major cause of nosocomial infections in early 1980s. The invasion of MRSA into community is now day's matter of concern for microbiologist. This study was conducted to detect the prevalence of MRSA resistance and to prepare antibiogram of HA-MRSA and CA-MRSA isolates at our hospital. Materials and Methods: A total of 201 staphylococcus isolates were detected as MRSA. They were then separated into two categories i.e. community acquired MRSA (CA-MRSA) and hospital acquired MRSA (HA-MRSA) according prescribed criteria. Antibiogram was prepared by Kirby- Bauer disk diffusion method. Results: Out of 201 isolates, HA-MRSA prevalence was 143(28.6%) and CA-MRSA was 58(11.6%). The HA-MRSA isolates showed were 10- 30% more resistant when compared to CA-MRSA. All isolates were 100 % sensitive to Vancomycin and Linezolid. Conclusion: We strongly suggest that time to time monitoring of MRSA should be done and proper hand wash must be done to avoid spread of MRSA.
Keywords: Community acquired-methicillin resistant Staphylococcus aureus, hospital acquired-methicillin resistant Staphylococcus aureus, methicillin resistant Staphylococcus aureus, Staphylococcus aureus
|How to cite this article:|
Abbas A, Nirwan P S, Srivastava P. Prevalence and antibiogram of hospital acquired-methicillin resistant Staphylococcus aureus and community acquired-methicillin resistant Staphylococcus aureus at a tertiary care hospital National Institute of Medical Sciences. Community Acquir Infect 2015;2:13-5
|How to cite this URL:|
Abbas A, Nirwan P S, Srivastava P. Prevalence and antibiogram of hospital acquired-methicillin resistant Staphylococcus aureus and community acquired-methicillin resistant Staphylococcus aureus at a tertiary care hospital National Institute of Medical Sciences. Community Acquir Infect [serial online] 2015 [cited 2021 Dec 1];2:13-5. Available from: http://www.caijournal.com/text.asp?2015/2/1/13/153857
| Introduction|| |
Staphylococcus aureus is one of the most common human pathogens with ability to cause a wide range of infections. On an average 20-40% of the adults are carriers of S. aureus in the anterior nares. 
The emergence of community-acquired (CA) and hospital acquired (HA) methicillin resistant S. aureus (MRSA) has led to increasing in cases of invasive infections. ,
In 1965 first case of MRSA infection recorded in Australia, (Sydney) , and in 1980 first case of a CA-MRSA infection in the United States was reported. Both HA-MRSA and CA-MRSA strains are transmitted by skin to skin contact although they have distinct clinical characteristics.
We determined the prevalence of MRSA resistance among S. aureus and reported antibiotic susceptibility pattern of HA-MRSA and CA-MRSA at our tertiary care hospital.
| Materials and Methods|| |
The present study was carried out for a period of 1 year. Five hundred S. aureus were isolated from different clinical samples such as pus, ear swab, sputum, urine, blood, throat, nares, etc., by the standard laboratory procedures  in the Department of Microbiology, National Institute of Medical Sciences, Jaipur, Rajasthan, India.
Antibiotic susceptibility test
Antibiotic susceptibility test was performed by Kirby-Bauer disk diffusion method. Fourteen antibiotics were used including erythromycin (15 μg), clindamycin (2 μg), ciprofloxacin (5 μg), cefoxitin (30 μg), tetracycline (30 μg), amikacin (30 μg), gentamicin (10 μg), (co-trimoxazole 25 μg), norfloxacin (10 μg), chloramphenicol (30 μg), teicoplanin (30 μg), nitrofurontine (300 μg), vancomycin (30 μg) and linezolid (30 μg) (Hi-Media Pvt. Ltd., Mumbai, Maharashtra, India).
Detection of methicillin resistant Staphylococcus aureus
Methicillin resistant Staphylococcus aureus detection was done using cefoxitin 30 μg. Those isolates showed zone of inhibition <21 mm considered as MRSA. 
Categorization of methicillin resistant Staphylococcus aureus isolates into hospital acquired-methicillin resistant Staphylococcus aureus and community acquired-methicillin resistant Staphylococcus aureus
Based on the history of the patient, the MRSA isolates were categorized into CA or HA. Basically if an infection occurs among the out patients or inpatients with an MRSA isolate earlier than 48 h of hospitalization, is considered as CA-MRSA, and if MRSA strain isolated after 48 h of hospitalization or from a patient with a history of hospitalization for surgery or dialysis, or of a residence in a long-term care facility within 1 year of the MRSA culture date will come under HA-MRSA.
| Results|| |
Prevalence of HA-MRSA and CA-MRSA is shown in [Table 1]. Antibiotic sensitivity pattern of HA-MRSA and CA-MRSA is depicted in [Table 2].
| Discussion|| |
We observed no significant difference observed between males and females patients. Male were 277 (56%) and females were 223 (44%). The age groups that were seen to be highly infected with S. aureus were 0-20 and 21-40 at a percentage of 38.40% each.
A total of 201 (40.20%) MRSA were detected from various clinical samples using cefoxitin disc diffusion technique. These results are in accordance with Mittal et al. (India)  40.38%, Seifi et al. (Iran)  41.7%, and Mohanasoundaram (India)  39.16%, although high prevalence of MRSA have been reported by Venkata et al. (India)  75.27%. Unfavorable point is there is a tremendous increase in the methicillin-resistant isolates in our hospital, when compared with the study by Sharma et al. conducted during February 2011-March 2012,  this observation might be because Sharma et al. used oxacillin disc diffusion method for detection of MRSA on the other hand we used cefoxitin disc diffusion for the detection of MRSA isolates which far superior method as compared to oxacillin disc diffusion method.
The isolation rate of MRSA among different clinical samples were as follows, high prevalence was seen among pus sample, that is, 43.80% followed by swabs from different sites 41.59%, blood 39.47%, urine 38.73% and sputum 33.33%. High prevalence of MRSA among pus samples was also reported by Tiwari et al. 71.20% of MRSA were from pus samples.  Deepak et al. also reported high percentage of MRSA among pus samples 43.10%. 
This study revealed that all MRSA isolates were 100% sensitive to vancomycin and linezolid. About 61.19% of MRSA isolates were resistant to erythromycin, 52.73% to ciprofloxacin, 38.80% to clindamycin, 37.81% to gentamicin, 29.35% to co-trimoxazole and 19.40% to tetracycline. Contrary to the reports by Qureshi et al.  who reported 98.9% resistance to ciprofloxacin and 97.8% to gentamicin, Sharma et al.  reported 87.3% of MRSA strains were resistant to co-trimoxazole and 58.3% to tetracycline that is much higher when compared to our study.
In our study among 144 HA-MRSA isolates majority of resistance was shown to norfloxacin (88.88%) followed by erythromycin (62.93%), ciprofloxacin (54.54%), clindamycin (46.15%), gentamicin (46.15%), co-trimoxazole (32.16%), tetracycline (21.67%) and teicoplanin (16.08%). Amikacin (13.98%), chloramphenicol (9.79%), nitrofurontine (5.55%) were least resistant drug among hospital-associated MRSA isolates.
Of the 58 CA-MRSA isolates, 16 (84.21%) were resistant to norfloxacin, 33 (56.89%) to erythromycin, 28 (48.27%) to ciprofloxacin. Good sign was CA-MRSA isolates did not show higher resistant to drugs of choice like co-trimoxazole (22.41%), clindamycin (20.68%), gentamicin (17.24%), teicoplanin (15.51%) and tetracycline (13.79%) chloramphenicol (6.89%) and amikacin (5.17%) were least resistant drugs. All CA-MRSA isolates was 100% sensitive to nitrofurontine, vancomycin and linezolid.
The resistance patterns of the HA-MRSA were higher when compared to those of the CA-MRSA. This correlated with the results of Huang et al. and Vysakh and Jeya. , Both HA-MRSA and CA-MRSA possess different gene like mecA gene and PVL gene respectively, which enhance resistance to antibiotics and inappropriate use of antibiotics also promotes resistance that could be a possible reason for the difference in resistance pattern of HA-MRSA and CA-MRSA.
Antibiotics such as clindamycin, amikacin, chloramphenicol and teicoplanin can be alternative for reserved drugs such as vancomycin and linezolid which can be used for life-threatening infections. Clindamycin is still a reliable drug among CA infections.
| Conclusion|| |
Methicillin resistant Staphylococcus aureus is one of most common cause of therapeutic problems in many hospitals. Misuse of antibiotics can be a main reason for the spread of MRSA. HA-MRSA is always a worry for health care workers. Further spread of MRSA among community, that is, CA-MRSA is a current challenging problem. Rational use of antibiotics, institutional antibiotic policy, proper hand hygiene and washing are the answer of it.
| References|| |
Collee JG, Franser AG, Marmion BP, Simmons A. Mackie and McCartney Medical Microbilogy. Vol. 6. Ch. 6. Tata McGraw Hill Publications; 1996. p. 380-8.
Frank AL, Marcinak JF, Mangat PD, Tjhio JT, Kelkar S, Schreckenberger PC, et al.
Clindamycin treatment of methicillin-resistant Staphylococcus aureus
infections in children. Pediatr Infect Dis J 2002;21:530-4.
Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH. Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus
and coagulase-negative staphylococci. J Clin Microbiol 2003;41:4740-4.
Fey PD, Saïd-Salim B, Rupp ME, Hinrichs SH, Boxrud DJ, Davis CC, et al
. Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus
. Antimicrob Agents Chemother 2003;47:196-203.
Fluit AC, Wielders CL, Verhoef J, Schmitz FJ. Epidemiology and susceptibility of 3,051 Staphylococcus aureus
isolates from 25 university hospitals participating in the European SENTRY study. J Clin Microbiol 2001;39:3727-32.
Baird D. Staphylococcus
. Cluster forming gram-positive cocci. Mackie and McCartney Practical Medical Microbiology. 14 th
ed. 1996. p. 245-58.
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Susceptibility Tests. Approved Standard M2-A7. Clinical and Laboratory Standards Institute (CLSI); 2005. p. 768-800.
Mittal V, Kishor S, Siddique ME. Prevalence of inducible clindamycin resistance among clinical isolates of Staphylococcus aureus
detect by phenotypic method: A prilimanary report. J Infect Dis Immun 2013;5:10-2.
Seifi N, Kahani N, Askari E, Mahdipour S, Naderi NM. Inducible clindamycin resistance in Staphylococcus aureus
isolates recovered from Mashhad, Iran. Iran J Microbiol 2012;4:82-6.
Mohanasoundaram KM. The prevalence of inducible clindamycin resistance among gram-positive cocci which were isolated from various clinical specimens. J Clin Diagn Res 2011;5:38-40.
Venkata A, Rao AR, Kavita K, Seetha S. Prevalence of inducible clindamycin resistance among clinical isolates of staphylococci. Natl J Basic Med Sci 2012;3:68-71.
Sharma M, Pathak S, Srivastava P. Prevalence and antibiogram of methicillin resistant Staphylococcus aureus
at a tertiary care hospital in Jaipur, Rajasthan. Int J Pharm Res Biosci 2013; 2:139-47.
Tiwari HK, Das AK, Sapkota D, Sivrajan K, Pahwa VK. Methicillin resistant Staphylococcus aureus
: Prevalence and antibiogram in a tertiary care hospital in Western Nepal. J Infect Dev Ctries 2009;3:681-4.
Deepak S, Samant SA, Urhekar AD. Study of coagulase positive and negative Staphylococci in clinical samples. Indian J Med Sci 1999;53:425-8.
Qureshi AH, Rafi S, Qureshi SM, Ali AM. The current susceptibility patterns of methicillin resistant Staphylococcus aureus
to conventional anti Staphylococcus
antimicrobials at Rawalpindi. Pak J Med Sci 2004;20:361-4.
Sharma NK, Garg R, Baliga S, Bhat KG. Nosocomial infections and drug susceptibility patterns in methicillin sensitive and methicillin resistant Staphylococcus aureus
. J Clin Diagn Res 2013;7:2178-80.
Huang H, Flynn NM, King JH, Monchaud C, Morita M, Cohen SH. Comparisons of community-associated methicillin-resistant Staphylococcus aureus
(MRSA) and hospital-associated MSRA infections in Sacramento, California. J Clin Microbiol 2006;44:2423-7.
Vysakh PR, Jeya M. A comparative analysis of community acquired and hospital acquired methicillin resistant Staphylococcus aureus
. J Clin Diagn Res 2013;7:1339-42.
[Table 1], [Table 2]