Abstract
BackgroundTo analyze the molecular epidemiology and to compare between the major methicillin resistant Staphylococcus aureus biotypes for association with patient characteristics who had an implant for closed fracture and developed early post-operative wound infections (POWI) in a tertiary care hospital of India.MethodsPulsed-field gel electrophoresis (PFGE), antimicrobial resistance, accessory gene regulator (agr) and staphylococcal cassette chromosome mec (SCCmec) types, Paton–Valentine leukocidin (PVL) gene, toxin gene profiling, biofilm formation and patient demographics were correlated with MLST clonal complexes (CC).FindingsOverall eight different sequence types (STs) were detected with a predominance of ST239 (66%), ST22 (18%) and some minor types ST772, ST30 (4% each) ST1, ST642, ST6, ST107 (2% each). All ST239 isolates belong to CC239 and SCCmec III whereas ST22 isolates belong to CC22 and SCCmec IV. The isolates varied in the distribution of various toxin genes. With 63.63% biofilm formers ST239 were all multidrug resistant with frequent resistance to erythromycin, clindamycin, gentamicin, cefuroxime, amoxyclav and ciprofloxacin indicating doxycycline, amikacin, vancomycin and linezolid can be the drug of choice.ConclusionThis study shows that ST239 MRSA is still most prevalent strain with new emergence of ST642 and ST107 isolates in association with orthopedic implant based POWI. As compare to other ST types ST239 strain was associated with adverse treatment outcomes. This highlights the importance of improving nosocomial infection control measures in this unit.
Highlights
Staphylococcus aureus is the leading cause of early postoperative wound infections (POWI) in patients undergoing implant based orthopedic procedures [1, 2]
This study shows that ST239 methicillin resistant S. aureus (MRSA) is still most prevalent strain with new emergence of ST642 and ST107 isolates in association with orthopedic implant based post-operative wound infections (POWI)
The most common Sequence types (STs) found in the present study were ST239 (n = 33; 66%) and ST22 (n = 9; 18%), ST772 and ST30 were detected in two isolates each and three other STs were found (ST1, ST642, ST6, ST107), each corresponding to one isolate
Summary
Staphylococcus aureus is the leading cause of early postoperative wound infections (POWI) in patients undergoing implant based orthopedic procedures [1, 2]. Symptom associated S. aureus infections are caused by typical toxins [5] which are regulated by accessory gene regulator (agr) [6]. The first methicillin resistant S. aureus (MRSA) infections appeared in 1961 and have since become a major worldwide nosocomial pathogen. Epidemiology of MRSA changed with the first report of community-associated MRSA (CA-MRSA) occurred in 1981 [7]. To analyze the molecular epidemiology and to compare between the major methicillin resistant Staphylococcus aureus biotypes for association with patient characteristics who had an implant for closed fracture and developed early post-operative wound infections (POWI) in a tertiary care hospital of India
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