MOLECULAR CHARACTERIZATION AND ANTIMICROBIAL SUSCEPTIBILITY OF MRSA ISOLATED FROM CHRONIC HEMODIALYSIS OUTPATIENTS AND THEIR CORRELATION TO MRSA COLONIZATION AMONG HEALTHCARE WORKERS

Hadir Elmahallawy,Heba Mohamed,Salwa Afifi,Zeinab Helal

doi:10.36547/be.2019.2.4.70-75

Abstract

The carriage of methicillin-resistant Staphylococcus aureus (MRSA) among dialysis patients is remarkable not only in terms of the risks of developing infections, but also in playing a principle part in transmission among dialysis unit staff. The aim of this study was to detect the colonization of Methicillin-sensitive Staphylococcus aureus and MRSA carriage. Also, our aim was to determine the relatedness of MRSA isolates and the potential routes of transmission using PCR- Restriction Fragment Length Polymorphism (PCR-RFLP) in Hemodialysis Unit of El Zagazig General Hospital, a tertiary medical center in Sharqia, Egypt. This study was conducted on 150 chronic hemodialysis outpatients and 200 non clinical control samples including environmental and healthcare workers (HCWs). Antibiotic susceptibility by VITEK-2 and disc diffusion, PCR amplification of mecA, pvl and coa genes and RFLP-PCR were conducted during the study period. In this study 3.3% of the patients and 3.2% of HCWs colonized with pvl positive MRSA. Fifty percent of MRSA isolates showed a single band PCR product amplification of 810bp fragment corresponding to coa gene. Ten distinct MRSA RFLP banding patterns designated as H1-H10 were obtained. The majority of strains belonged to RFLP banding pattern H1 (33.33%).The prevalence of MRSA carriage among hemodialysis patients was 14% and 9.7 % among HCWs with similar polymorphism patterns. The presence of one major coa gene type confirmed the occurrence of hospital acquired-associated MRSA.

Highlights

Colonization and infection with multi-drug resistant (MDR) strains such as methicillin-resistant Staphylococcus aureus (MRSA) occurs with increasing frequency in hospitals worldwide
Among 284 chronic hemodialysis outpatients admitted to the hemodialysis unit at El Zagazig General Hospital from January to September 2014, only 150 patients agreed to participate in the study
Twenty one MRSA isolates recovered from hemodialysis patients

Summary

Introduction

Colonization and infection with multi-drug resistant (MDR) strains such as MRSA occurs with increasing frequency in hospitals worldwide (de Kraker et al, 2013). Plans to control the spread of MRSA in health care setting require standard data of the characteristics and prevalence of circulating MRSA strains and that can be obtained by active surveillance (Cirkovic et al, 2015). Hemodialysis (HD) patients may be at increased risk for MRSA infections and colonization (Johnson et al, 2009). Asymptomatic colonized patients and HCWs are the main sources of MRSA, in the health care settings. Of MRSA positive colonization and decolonizing of the patients, is one of the possible policies to prevent MRSA infections among HD patients This is difficult to determine without strain typing whether a newly identified case is the result of health-care associated acquisition. Limited data available about the epidemiology of Egyptian PVL -positive MRSA strains (Helal et al, 2012 and Hefzy et al, 2016)

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