Abstract
ObjectivesThere is a paucity of data on methicillin-resistant Staphylococcus aureus (MRSA) epidemiology among Balkan countries. The aim of our study was to determine the prevalence of nasal and pharyngeal carriages and diversity of MRSA among patients and healthcare workers (HCWs) in the major referral centre in Serbia, and to evaluate performance of three different media for MRSA screening.MethodsNasal and pharyngeal swabs were obtained from 195 patients and 105 HCWs in Emergency Department (ED), Surgical Department (SD) and Medical Department (MD). After broth enrichment, samples were inoculated onto MRSA-ID, ORSA and oxacillin-MSA and incubated for 24/48 hours. Characterisation of isolated MRSA strains was determined by MLVA, spa, SCCmec and agr typing, PVL genes detection and antimicrobial susceptibility.ResultsMRSA carriage prevalence was 11.8% in patients and 7.6% in HCWs. Introduction of pharyngeal swabs in screening procedure increased MRSA carriage rate by over 30%. Variable found to be independently associated with an increased risk for MRSA carriage was ED (odd ratio (OR) = 4.45, 95% confidence interval (CI) 1.78-11.14). A higher risk of multidrug-resistant MRSA carriage was observed among patients (OR = 22; 95% CI 1.92-251.54). CC5-MRSA-SCCmecI was the dominant clone among patients and HCWs in ED and MD, while high genetic diversity of community-associated MRSA (CA-MRSA) was shown in SD especially among HCWs. MRSA-ID was superior to the other tested media with a sensitivity/specificity of 95.2% and 99.6% after 48 hours of incubation.ConclusionsThese results indicate high MRSA carriage rate in the hospital and emergence of CA-MRSA through HCWs in these settings. MRSA-ID was the optimal available choice for MRSA screening.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most significant healthcareassociated (HA) and community-associated (CA) pathogen, causing a wide range of infections, from mild skin and soft tissue infections to life-threatening invasive diseases
Variable found to be independently associated with an increased risk for MRSA carriage was Emergency Department (ED) (odd ratio (OR) = 4.45, 95% confidence interval (CI) 1.78-11.14)
A higher risk of multidrugresistant MRSA carriage was observed among patients (OR = 22; 95% confidence intervals (95% CI) 1.92-251.54)
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most significant healthcareassociated (HA) and community-associated (CA) pathogen, causing a wide range of infections, from mild skin and soft tissue infections to life-threatening invasive diseases. The MRSA infections are associated with higher morbidity, mortality, prolonged length of hospital stay and higher healthcare costs as compared to methicillin-susceptible staphylococci [1]. Strategies to control the transmission of MRSA in hospitals require baseline knowledge of the prevalence and characteristics of circulating MRSA strains, which can be obtained by active surveillance. Screening and rapid identification of MRSA carriage among patients and healthcare workers (HCWs) are essential steps in controlling MRSA spread in hospitals. Many studies have evaluated the performance of chromogenic media in detecting MRSA [4,5,6,7,8,9,10], but several of these are laboratory based studies [4,5], i.e. well-defined collections of staphylococci were used for testing, whereas testing of primary specimens may be of more importance [6,7,10]
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