Abstract
Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of nosocomial infections. One of the potential risk factors for nosocomial staphylococcal infections is colonization of the anterior nares of healthcare workers (HCWs). Our study aimed to determine the rate of nasal carriage MRSA among HCWs at Manmohan Memorial Medical College and Teaching Hospital, Kathmandu. Methods Two hundred and thirty-two nasal swabs were collected from HCWs of Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal, within six months (February 2018–July 2018). Nasal swabs were cultured, and S. aureus isolates were subjected to the antimicrobial susceptibility test by the modified Kirby–Bauer disc diffusion method. MRSA and iMLSB (inducible macrolide lincosamide streptogramin B) resistance was screened using the cefoxitin disc (30 μg) and D-test (clindamycin and erythromycin sensitivity pattern), respectively, following CLSI (Clinical and Laboratory Standard Institute) guidelines. Risk factors for MRSA colonization were determined using the chi-square test considering the p value ˂0.05 as significant. Results A total of 34/232 (14.7%) S. aureus were isolated, out of which 12 (35.3%) were MRSA. The overall rate of nasal carriage MRSA among HCWs was 5.2% (12/232). Colonization of MRSA was higher in males (8.7%) than in females (4.3%). MRSA colonization was found to be at peak among the doctors (11.4%). HCWs of the postoperative ward were colonized highest (18.2%). All MRSA isolates were sensitive to linezolid and tetracycline. iMLSB resistance was shown by 7(20.6%) of the isolates. MRSA strains showed higher iMLSB resistance accounting for 33.3% (4/12) in comparison to methicillin-susceptible strains with 13.6% (3/22). Smoking was found to be significantly associated with MRSA colonization (p=0.004). Conclusion Rate of nasal carriage MRSA is high among HCWs and hence needs special attention to prevent HCW-associated infections that may result due to nasal colonization.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of nosocomial infections
A total of 232 nasal swabs were collected from healthcare workers (HCWs), of which 34 (14.7%) were found to be carriers of S. aureus, and among them, 12/34 (35.3%) HCWs were found to be MRSA carriers
Our study showed higher iMLSB resistance in MRSA strains with 33.3% (4/12) in comparison to methicillin-sensitive Staphylococcus aureus (MSSA) strains with 13.6% (3/ 22)
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of nosocomial infections. Our study aimed to determine the rate of nasal carriage MRSA among HCWs at Manmohan Memorial Medical College and Teaching Hospital, Kathmandu. S. aureus isolates were subjected to the antimicrobial susceptibility test by the modified Kirby–Bauer disc diffusion method. Rate of nasal carriage MRSA is high among HCWs and needs special attention to prevent HCW-associated infections that may result due to nasal colonization. The incidence of hospital-acquired infection caused by methicillin-resistant Staphylococcus aureus (MRSA) is increasing worldwide, resulting in longer hospital stay, prolonged antibiotic administration, and higher costs [2]. Penicillin was introduced in the 1940s to treat staphylococcal infections; in 1945, strains of S. aureus developed resistance to it. Since the incidence of inducible clindamycin resistance is high, accurate identification of inducible clindamycin resistance is important to prevent therapeutic failure in infections caused by these strains [10]
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