MRSA Nasal Carriage Research Articles

Prevalence of High and Low-Level Mupirocin Resistance in Clinical Isolates of Staphylococcus Aureus from Skin and Soft Tissue Infection

The skin has an extremely diverse ecology of organisms that may produce infection. The clinical manifestations of skin and soft tissue infection(SSTIs) culminate in a two-step process involving invasion and the interaction of bacteria with host defenses. Approximately 7% to 10% of hospitalized patientsare affected by SSTIs. Mupirocin has been used to treat skin infections and eradicate the nasal carriage of MRSA. Our aim is to estimate the prevalence of lowand high-level Mupirocin resistance among the clinical isolates of Staphylococcus aureus from skin and soft tissue infection. The study was conducted in theDepartment of Microbiology, Krishna Institute of Medical Sciences, Krishna Hospital and Medical Research Centre, Karad, District- Satara. Specimen collectionand processing of samples were performed as per standards. The Kirby -Bauer disc diffusion method was used for the sensitivity to common antibioticsrecommended Clinical and Laboratory Standard Institute (CLSI 2021). Mupirocin resistance was detected using 5μg and 200μg Mupirocin discs to determineLow and High -level resistance. 135 Staphylococcus aureus isolates were obtained from patients admitted to various medical, surgical, and intensive care unitsand patients attending outpatient departments. Out of 415 clinically suspected cases of skin and soft tissue infection, 91.33% were culture positive, and 8.67%were culture negative. Out of 379 microorganisms, 44.06% were Gram-positive cocci, 27.44% were Gram negative bacilli, 24.27% were Gram negative cocci,and 14.22% were Gram-positive bacilli. Out of 167 Gram positive cocci, 135 (80.84%) were Staphylococcus aureus, 22 (13.17%) were Coagulase NegativeStaphylococcus and 10 (5.99%) were Micrococcus. We conclude that the prevalence of Staphylococcus aureus was 32.53%, among which Mupirocin high and lowlevelresistance was 5.92% and 7.41%, respectively.

To Study the Carriage and Antimicrobial Sensitivity Profile of MRSA among Nursing Staff of Rural Tertiary Health Care Centre of North India

The present study is carried to determine nasal carriage of MRSA among nursing staff posted in Medicine and allied wards of a rural tertiary healthcare center in North India and antibiotic sensitivity profile of the isolated MRSA strains. Many of the carriers of MRSA harbour pathogen in areas like nares, hand surfaces, axilla and are generally asymptomatic. Colonisation in healthcare workers has increased the incidence of serious nosocomial infection wherein healthcare workers act as vectors for transmission of infection in already immuno-compromised patients. The study undertaken was a cross sectional type where in nursing staff was analysed for nasal carriage of MRSA and antibiotic sensitivity profile of MRSA. A total of A total of 60 nursing staff members posted in medicine and allied wards were recruited in this study. A total of 34 (56.6%) were females and 26 (43.3%) were males. our study showed considerable MRSA carriage among the nurses and also reported a decreased sensitivity to commonly used drugs. Also, no resistance was detected against higher antibiotics like Vancomycin, Teicoplanin and Linezolid which points to their use in eradication of infection caused by MRSA. There is a need to strictly implement and follow the hospital infection control guidelines so as to reduce the spread of MRSA to susceptible persons.

Prevalence of Methicillin-Resistant and Methicillin Sensitive Staphylococcus aureus Nasal Carriage and their Antibiotic Resistant Patterns in Kirkuk City, Iraq

The carriage of community-acquired methicillin-resistant S. aureus (CA-MRSA) has become a source of community-associated infections, particularly in the anterior nares of people worldwide. This study was aimed at determining the prevalence of community-acquired S. aureus (CA-SA) and CA-MRSA nasal carriage among healthy individuals of various ages in Kirkuk City and evaluating the susceptibility of isolates to various antibiotics. A total of 597 healthy individuals were recruited in the community between December 1, 2021, and December 30, 2022. Nasal swabs obtained from participants were taken to the laboratory, where bacteria were isolated and identified using phenotypic characteristics. The MRSA isolates were identified by applying the modified Kirby Bauer disc diffusion technique. The results showed that the prevalence of CA-SA and CA-MRSA nasal carriers was 16.6 and 4.5%, respectively. The average age of the participants was 33.2 years, with a male-to-female ratio of 1.1: 1. The highest resistance of the isolates was observed against oxacillin (27.3%), followed by penicillin G (24.3%), amoxicillin (15.2%), erythromycin (12.1%), and tetracycline (6.1%). There was a 9.1% resistance rate to clindamycin, rifampin, gentamycin, and ciprofloxacin. However, all CA-MRSA isolates were multi-drug resistant. However, all the isolates were sensitive (100 %) to vancomycin, linezolid, and mupirocin. The findings of the present study highlight the potential for CA-SA and CA-MRSA acquisition in this population, which may be related to antibiotic abuse or overuse as well as poor hygiene. To lessen the impact of community-associated strains of MRSA nasal carriage, this necessitates the probable need for infection prevention measures and adequate antibiotic therapy.

The Clinical Importance of Preoperative Rectal Swabs in Patients after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Background: Surgical site infections are among the most common healthcare-associated infections, especially in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this retrospective study was to examine postoperative infectious complications according to preoperative screening findings of nasal and rectal swabs. Methods: Two hundred four consecutive patients received nasal and rectal swab examination for multidrug-resistant (MDR) bacteria within 30 days before the operation in patients where CRS and HIPEC were planned. Inclusion criteria were as follows: confirmed peritoneal metastases (histologically and/or cytologically); age under 85 years; adequate renal, liver, and bone marrow function; no sign of infection preoperatively; resectable disease; and CRS and HIPEC procedure. If surgical site infection occurred, the microbial spectrum of the site was assessed. One hundred twenty-one patients (63 female [52.1%] and 58 male [47.9%]) met the criteria and were further analyzed retrospectively. Statistical correlations between postoperative complications and risk factors were investigated by univariate and multivariate analysis. Results: Postoperative complications in total were observed in 57 patients (47.1%) with major complications (Clavien-Dindo grades 3–4) in 15 patients (12.4%) and infectious complications in 37 (30.6%) patients. The overall prevalence of nasal MRSA carriage was 3.28%, and the overall prevalence of rectal MDR bacteria carriage was 10.7%. In propensity score analysis, colonized patients compared to noncolonized patients showed increased total complications (CD1–5, p = 0.025), infectious complications (p = 0.028), surgical site infections (p = 0.022) as well as pneumonia (p = 0.016). Multivariate analysis showed that in addition to preoperative rectal colonization, American Society of Anesthesiologists score was a risk factor for postoperative complications. Conclusions: Preoperative 3-MRGN and vancomycin-resistant enterococcus colonization were associated with increased complications and surgical site infections. Special antimicrobial treatment pathways are necessary for these patients to reduce postoperative complications due to colonization.

Methicillin-resistant Staphylococcus aureus antibiotic susceptibility profile and associated factors among hospitalized patients at Hawassa University Comprehensive Specialized Hospital, Ethiopia

IntroductionMethicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital-acquired infection, which is difficult to treat because of antibiotic resistance. There is scant data on MRSA from southern parts of Ethiopia. ObjectiveThe aim of this study was to determine the prevalence of MRSA nasal carriage, antibiotic susceptibility profiles, and associated factors among hospitalized patients attending Hawassa University Comprehensive Specialized Hospital (HUCSH), Hawassa, Ethiopia. MethodsA hospital-based cross-sectional study was conducted from December 11, 2019 to February 15, 2020. Background and clinical data were captured by an interviewer-administered questionnaire. Nasal swabs were collected aseptically and inoculated onto mannitol salt agar and sheep blood agar, which was incubated for 24 hours at 37°C. S. aureus was confirmed using standard bacteriological methods. MRSA was identified using the cefoxitin Kirby-Bauer disk diffusion method. ResultsOf the 280 included hospitalized patients, 38 (13.6%) were colonized with S. aureus. The prevalence of MRSA carriage was 9.3% (95% CI 6.1‒12.2). Twenty-six (68.4%) of the S. aureus isolates were methicillin resistant. Participants with a monthly income > 4000 Ethiopian Birr were four times more likely to be colonized with MRSA (p = 0.022). A high proportion of patients with a history of admission to the surgical ward was colonized with MRSA. Over 10% of MRSA isolates were resistant to all antibiotics except clindamycin and erythromycin. Of the 26 MRSA isolates, 88.5% showed multidrug resistance. ConclusionsThe prevalence of MRSA was relatively high among hospitalized patients at HUCSH. Factors such as weight and monthly income were significantly associated with the occurrence of MRSA.

Nasal carriage of Methicillin-Resistant Staphylococcus aureus among sympatric free-ranging domestic pigs and wild Chlorocebus pygerythrus in a rural African setting.

BackgroundMethicillin Resistant Staphylococcus aureus (MRSA) nasal carriage in domestic pigs and vervet monkeys is a risk factor for subsequent severe infections in domestic pigs and for dissemination to the human population. This study assessed nasal carriage of MRSA in domestic pigs and sympatric vervet monkeys in a rural African village during an outbreak of a virus hemorrhagic fever suspected to be contracted from wild primates.This study was conducted during the 2012 Ebola outbreak to determine nasal carriage of MRSA in free-ranging domestic pigs and sympatric freely roaming vervet monkeys using conventional methods. Staphylococcus aureus (S. aureus) isolated from the anterior nares were tested for susceptibility to commonly used antibiotics and conventional PCR was used to confirm methicillin resistance. The MRSA strains were then genotyped using SCCmec typing.ResultsOverall, there was a high level of resistance to tetracycline [90% (63/70) in pigs and 67% (10/15) in vervet monkeys], trimethoprim/sulphamethoxazole [90% (63/70) in pigs and 67% (10/15) in vervet monkeys], and penicillin [83% (58/70) in pigs and 67% (10/15) in vervet monkeys]. Most of the MRSA strains (91.6%, 11/12) were of the SCCmec type I [1B] genotype.ConclusionThe nasal carriage of drug resistant S. aureus in freely roaming domestic and wild animals presents a risk for widespread environmental spread of antimicrobial resistance thus presenting a risk for treatment failure in domestic animals, wild animals, and humans.

Methicillin Resistant <i>Staphylococcus aureus</i> in Pigs and Pig Breeders in Three Regions of Cameroon

The spread of antibiotic resistance, whether in the community or in the hospital, has recently become a major public health problem. Moreover, livestock seems to be a reservoir of resistant microorganisms such as porcine methicillin resistant Staphylococcus aureus (P-MRSA) whose carriage and transmission was mainly demonstrated in persons with occupational exposure to pigs. Much uncertainty remains about the public health implications of P-MRSA. To address concerns that exist regarding the zoonotic risk that pig carriers pose to breeders, the prevalence of P-MRSA in pigs and pig breeders was determined among 152 pig breeders in three regions of Cameroon. Materials and Method: Participants in this study came from Adamawa, Far North and Littoral regions of Cameroon. A total of 152 pig breeders or farm workers participated in this study. After having collected some social and cultural data with the aid of a questionnaire, nasal swabs were collected from pigs (n = 275) and their breeders using the standard collection procedures and placed in cooler containing cold accumulators. For each sample, microbiological assays were done as well as antibiotic susceptibility tests. Results: MRSA was isolated from 25 out of 275 pigs sampled (9.09%) and from 32 out of 152 (21.05%) pig breeders sampled; 33 breeders (21.71%) were carriers of S. aureus including 32 MRSA and one MSSA. The prevalence of MRSA nasal carriage was 21.05% ± 6.48. A significant negative association between body protection and nasal carriage of MRSA (OR = 0.29, 95% CI [0.093; 0.93]; p = 0.04) was observed. In each region, similar strains of MRSA were isolated both in pigs and their breeders with the same antibiotic resistant profile. Conclusion: The prevalence of MRSA though not high compared to European countries warrants further research as data on this zoonosis is scarce in our context. As such, transmission of MRSA from pigs to pig breeders or vice-versa constitutes a real danger, and this relationship may be a starting point for MRSA contamination in the community. Moreover, proper use of body protections and antibiotic medications as recommended will be a better protective measure against nasal MRSA carriage.

Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage among patients with diabetes at the Korle Bu Teaching Hospital.

AimTo investigate the epidemiology of S. aureus and MRSA nasal carriage among people with diabetes at the Korle Bu Teaching Hospital in Accra, including the prevalence, predictors of carriage, and antibiotic resistance.MethodologyThis study was cross-sectional, involving 300 diabetes patients and 106 non-diabetic individuals. Swab specimens of the nares were obtained from the participants and bacteriologically-cultured. Identification and characterization of S. aureus and MRSA were based on standard bacteriological methods; antimicrobial susceptibility testing was by the Kirby-Bauer method.ResultsThe prevalence of staphylococcal carriage, the diabetes group relative to the non-diabetes group, were 31.0% and 10.4% (S. aureus), and 3.3% and 0.0% (MRSA). Presence of diabetes predisposed to S. aureus carriage, but not MRSA nor coagulase-negative staphylococci (CoNS) carriage (OR = 3.88; p < 0.0001). Colonization with CoNS was protective of S. aureus (OR = 0.039, p < 0.001) and MRSA (OR = 0.115, p = 0.043) colonization among the diabetics. The antimicrobial resistance patterns recorded among the S. aureus isolated from the diabetic individuals relative to the non-diabetics were as follows: penicillin (95% vs. 91%), tetracycline (37% vs. 27%), cotrimoxazole (30% vs. 36%), erythromycin (17% vs. 0%), norfloxacin (13% vs. 0%), clindamycin (12% vs. 0%), gentamicin (9% vs. 0%), fusidic acid (10% vs. 9%), linezolid (4% vs. 0%), and rifampicin (5% vs. 0%). The proportion of multidrug resistant S. aureus was 41% (n = 38) in the diabetes group and 0% in the non-diabetes group; this difference was statistically significant (p = 0.01).ConclusionsThe presence of diabetes predisposed the participants to S. aureus carriage by almost four folds, but not MRSA carriage. Colonization with CoNS was protective of S. aureus and MRSA carriage in the diabetes group. Finally, linezolid remains a good therapeutic agent for anti-MRSA therapy.

Nasal Carriage of MRSA in Healthcare Workers: A Pivotal Role in Controlling Hospital-Acquired Infections

Nasal Carriage of MRSA in Healthcare Workers: A Pivotal Role in Controlling Hospital-Acquired Infections

High prevalence nasal carriage of methicillin-resistant Staphylococcus aureus among long term care facility healthcare workers in relation to patient contact

SummaryBackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a major public health concern worldwide. Healthcare workers (HCWs) are an important source of transmission of MRSA. We conducted a prospective study to define the frequency of S. aureus nasal colonization with emphasis on the carriage of MRSA in HCWs in relation to the intensity of patient contact.MethodsOut-of-hospital care emergency medical technicians and students, and HCWs in the emergency department, intensive care unit and a long-term care facility (LTCF) were enrolled to compare the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) nasal colonization. The MRSA isolates were further identified by their microbiological and molecular characteristics.FindingsS. aureus was isolated from 63 of 248 HCWs (25.4%). The overall MRSA nasal carriage rate was 15/248, 6%, and the prevalence was higher in the HCWs who had worked for 5–10 years (12.8%), and among female HCWs (10.3%) than male HCWs (0.9%). LTCFs had the highest prevalence (12%). In contrast, the overall carriage of MSSA was 48/248, 19.4%, and most carriers worked for ≥5 years (52.1%). Hospital nurses had the highest rate of MSSA carriage (21.4%). Most of the MRSA isolates were SCCmec IV/ST59 or ST45 (60%), and were resistant to erythromycin and clindamycin (53%).ConclusionsHospital nurses have highest S. aureus nasal carriage, whereas HCWs in the LTCFs comprise a significant reservoir of MRSA colonization. The differences in the characteristics of MRSA and MSSA nasal carriage among HCWs highlights the importance on long-term nasal screening of S. aureus in healthcare facilities.

Methicillin-resistant Staphylococcus aureus nasal carriage among janitors working in hospital and non-hospital areas: a comparative cross-sectional study

BackgroundNasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of both healthcare-associated and community-acquired MRSA infections in various populations. Screening of MRSA nasal colonization is important in the prevention and control of infection and may provide useful information to guide antimicrobial therapy. This study aimed to determine nasal carriage of MRSA, its antimicrobial susceptibility pattern, and associated factors among janitors working in hospital & non-hospital areas at the University of Gondar, Northwest Ethiopia.MethodsA comparative cross-sectional study was carried out in a total of 436 study participants (221 hospital and 215 non-hospital janitors) from January to May 2019. The study participants were sampled using a simple random sampling technique. Data on socio-demographic characteristics and associated factors were collected through face to face interviews using a structured questionnaire. Nasal swabs were collected and inoculated into Mannitol salt agar. MRSA was detected using cefoxitin (30 µg) disc and an antibiotic susceptibility test was done using the disc diffusion method. Data were entered and analyzed using SPSS version 20 statistical package. P value ≤ 0.05 was considered as statistically significant.ResultsThe overall prevalence of S. aureus was 101/436 [23.2%, (95% CI: 19.3–27.8)], of which, 29.4% (65/221) were isolated from hospital and 16.7% (36/215) non-hospital janitors. The prevalence of MRSA was 4.8% (21/436) [95% CI: 3.0–6.9]; of these, 8.1% (18/221) of the isolates were from the hospital and 1.4% (3/215) non-hospital janitors, while methicillin-sensitive S. aureus (MSSA) in hospital & non-hospital janitors were 49 (22.2%) and 31 (14.4%), respectively. Among the MRSA isolates, 52.4% (11/21) were multi-drug resistant. Of these, 42.9% (9/18) were isolated from hospital and 66.7% (2/3) non-hospital janitors. Hence, nasal carriage of MRSA was significantly associated with hospitalization within the preceding year (AOR = 3.15, CI = 1.13–8.71).ConclusionThe present study revealed that high MSSA and MRSA were isolated from the hospital as compared to non-hospital janitors and high rates of antibiotics resistance were recorded in the hospital janitors. Consequently, hospitalizations were significantly associated with MRSA. Accordingly, regular screening of carriers in apparently healthy janitors is required for the prevention of nosocomial infections.

SCCmec Genotypes of Methicillin-Resistant Staphylococcus aureus in Nasal Carriage of Multiple Sclerosis Patients in Iran

Asymptomatic nasal colonization of Methicillin-Resistant Staphylococcus aureus is common in Multiple Sclerosis patients. SCCmec types I to III are mainly attributed to HA-MRSA strains whereas SCCmec types IV and V have commonly been reported in CA-MRSA infections. Here, we assessed the frequency of nasal carriage of MRSA in MS patients. This study aimed to evaluate MRSA SCCmec typing in MS nasal carriage. A cross-sectional descriptive study was conducted from Feb and Jun 2017 in MS Research Center, Tehran University of Medical Sciences (TUMS), Iran. Overall, 620 nasal swabs were collected (325 from MS patients and 295 from control group). Antimicrobial susceptibility test was performed using the disk diffusion and E-test method. Presence of mecA gene was confirmed by PCR assay and multiplex PCR was performed for SCCmec typing of MRSA isolates. The frequency of MRSA among the MS patients and control group was almost equal (9.2% and 10.1%, respectively). SCCmec typing detected only types III, IV and V in both groups and type IV was the most predominant type in MS patients and control group. SCCmec type III was more prevalent in control group than MS patients (40% vs. 20%). Moreover, the frequency of SCCmec type V in MS patients was significantly higher than control group (36.7% vs. 3.3%). Although most MRSA isolates were collected from inpatients, interestingly there is a high frequency of SCCmec types IV and V in MS group. Moreover, MRSA isolates were not resistant to more antibiotics in SCCmec type III than types IV-V.

Detection of Methicillin Susceptible and Resistant Staphylococcus aureus Nasal Carriage and Its Antibiotic Sensitivity among Basic and Clinical Years Medical Students.

Background: Healthcare workers (HCWs) and medical students can be asymptomatic carriers in transmitting methicillin resistant and susceptible Staphylococcus aureus (MRSA and MSSA). Studying epidemiological and antibiotic susceptibility data is necessary to limit the spread of infections, help with treatment and understand the transmission dynamics of MSSA and MRSA. Our study assessed the rate of MSSA and MRSA nasal carriage and its antibiogram among medical students in basic and clinical years at the University of Jordan. Methods: A total of 210 nasal swabs were randomly collected from participants. MSSA and MRSA were identified by culture, biochemical and other phenotypical analysis methods. Antibiotic susceptibility was determined by the disc diffusion method. Results: The nasal carriage of MSSA was 6.6% and 11.4% and that of MRSA was 1.9% and 2.8% among basic and clinical years, respectively. There was no significant difference for the nasal carriage of MSSA and MRSA among basic and clinical year students (p value ≥ 0.05). MSSA resistance ranged between 25% and 33% for trimethoprim-sulfamethoxazole, tetracycline and ciprofloxacin. For MRSA, the highest resistance was to trimethoprim-sulfamethoxazole and tetracycline (67% to 100%), followed by gentamicin and ciprofloxacin (33% to 67%), in all participants in the study. Conclusion: The difference in the carriage rates of MSSA and MRSA among basic and clinical students was statistically insignificant. The continuous awareness and implementation of infection control procedures and guided patient contact are recommended. The results might also suggest that healthcare workers could be victims in the cycle of MRSA nasal carriage, a theory that needs further study.

Prevalence and antimicrobial susceptibility patterns of Staphylococcus aureus/methicillin-resistant Staphylococcus aureus nasal carriage among Kabul University students

Nasal carriage of Staphylococcus aureus/Methicillin-resistant Staphylococcus aureus (S. aureus/MRSA) poses a major risk for the transmission and infection of this pathogen especially in hospital setting. The main objective of this study was to investigate the colonization of S. aureus/MRSA among healthy individuals and determine their susceptibility patterns to common antibiotics in Kabul. A total of 150 healthy participants have been included and nasal swabs were collected from all. Samples were cultured on appropriate and selective media for proper identification of S. aureus. Antibiotic susceptibility profiles were determined by the disc diffusion method and interpreted according to the Clinical &amp; Laboratory Standards Institute (CLSI) protocols. The prevalence of S. aureus nasal colonization was 33.3% with 12.7% MRSA nasal carriage. The prevalence of S. aureus/MRSA colonization was not statistically significant according to gender (p=0.84) and age (0.18). All MRSA isolates were sensitive to rifampicin, linezolid and acid fusidic. Thirty-two percent of the S. aureus isolates were multi-drug resistant. Multi-drug resistance varied from resistance to at least three classes of antibiotics (14%) to maximum six classes of antibiotics (4%). This study revealed a high prevalence of S. aureus/MRSA nasal carriage among healthy individuals when compared to similar studies conducted elsewhere and is a reason of concern. Identifying and treating MRSA carriers, as well as responsible use of antibiotics is recommended.

Nasal Carriage of MRSA among Healthy College Students and Livestock

Nasal Carriage of MRSA among Healthy College Students and Livestock

Prevalence and molecular characteristics of MRSA nasal carriage among hospital care workers in a tertiary hospital in the Philippines.

Hospital-care workers (HCWs) are at risk for MRSA carriage, subsequent infection and potential transmission of nosocomial infection. Epidemiological typing of MRSA among HCWs would provide data that can be used for control measures. This is a cross sectional study that involved 92 participants from pediatric and surgery department of a tertiary hospital. Nasal swabs were collected and inoculated onto MRSASelect Chromogenic Media. Samples characterized as MRSA underwent SCCmec typing and detection of Panton Valentine leucocidin (PVL) by PCR. The overall prevalence of MRSA was 13%. Six were from Pediatrics and another six were from Surgery. Seven out of 12 MRSA isolates carried SCCmec type I gene and five isolates carried SCCmec type IV gene. Six samples were found positive for PVL, four of which PVL-SSCmec IV, while the other two isolates were PVL-SCCmec I. The isolates were grouped into four main sequence types (STs) namely ST 1147, ST30, ST5 and ST97. Two samples from both departments were found to be PVL-positive SCCmec I ST 30; PVL-positive SCCmec IV ST 97 was found in two MRSA samples from Pediatrics and PVL-positive SCCmec IV ST 30 from Surgery. Data collected from a non-outbreak setting suggest the presence of different clones of MRSA from nasal swabs of HCWs belonging to the Department of Pediatrics and Surgery. The data collected by this study can be used as reference for other succeeding studies on the surveillance of MRSA among HCWs.

Prevalence, molecular epidemiology, and antimicrobial resistance of methicillin-resistant Staphylococcus aureus from swine in southern Italy

BackgroundColonization by livestock-associated MRSA (LA-MRSA) has increasingly been reported in the swine population worldwide. The aim of this study was to assess the prevalence of MRSA nasal carriage in healthy pigs, including the black (Calabrese) breed, from farms in the Calabria Region (Southern Italy). Between January and March 2018, a total of 475 healthy pigs reared in 32 farms were sampled by nasal swabbing. MRSA isolates were characterized by spa, MLST and SCCmec typing, and susceptibility testing to 17 antimicrobials.Results22 of 32 (66.8%) pig farms resulted positive for MRSA. The prevalence of MRSA was 46.1% (219 MRSA culture-positive out of 475 samples). MRSA colonization was significantly higher in intensive farms and in pigs with a recent or ongoing antimicrobial treatment. All 219 MRSA isolates were assigned to ST398. The most common spa types were t011 (37.0%), t034 (22.4%) and t899 (15.1%). A novel spa type (t18290) was detected in one isolate. An insertion of IS256 in the ST398-specific A07 fragment of the SAPIG2195 gene was detected in 10 out of 81 t011 isolates. Nearly all isolates carried the SCCmec type V element, except 11 isolates that carried the SCCmec type IVc. None of the isolates was positive for the Panton-Valentine leukocidin. All isolates were resistant to tetracycline. High resistance rates were also found for clindamycin (93.1%), trimethoprim/sulfamethoxazole (68.4%), fluoroquinolones (47.9–65.3%) and erythromycin (46.1%). None of the isolates was resistant to vancomycin and fusidic acid. Overall, a multidrug resistant phenotype was observed in 88.6% of isolates.ConclusionsWe report a high prevalence of MRSA among healthy swine in Southern Italy farms, with higher isolation frequency associated with intensive farming. The epidemiological types identified in our study reflect those reported in other European countries. Our findings underscore the importance of monitoring the evolution of LA-MRSA in pig farms in order to implement control measures and reduce the risk of spread in the animal population.

Prevalence of carriage of community-acquired Methicillin-resistant Staphylococcus aureus among children attending the pediatric OPD at a tertiary care hospital

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are commonly recognized in persons without traditional risk factors. Nasal carriage of MRSA is an important risk factor for subsequent MRSA infection and transmission of this pathogen. The aim of this study was to estimate the prevalence of carriage of community acquired MRSA and to describe its antibiotic susceptibility pattern among the pediatric population.Methods: A prospective longitudinal study was conducted in our hospital for a period of 6 months. All pediatric patients age less than 15 years attending the pediatric OPD were included in the study. A total of 325 children were included in the study based on our inclusion and exclusion criteria. Nasal smear was collected by tilting back the child’s head and gently inserting a sterile cotton swabs pre-wetted with sterile saline and slowly rotating against the turbinate of both anterior nares. The following antibiotics were tested for sensitivity pattern: penicillin, pipercillin, erythromycin, clindamycin, cotrimoxazole, vancomycin, linezolid, rifampin, ciprofloxacin and daptomycin. Any S. aureus that is resistant to Cefoxitin was defined as MRSA.Results: The prevalence of Staphylococcus aureus was found to be 26.7% of the entire microorganism detected and 6.4% (n = 21) of the entire study subjects had methicillin resisitant Staphylococcus aureus. Of testing the susceptibility of the various antibiotics vancomycin was the only drug found to be 100% sensitive followed by linezolid and pipericillin (90%). 50% sensitivity was seen with erythromycin and very poor sensitivity was seen in cefuroxime and ciprofloxacin (&lt;50%).Conclusions: CA-MRSA strains tend to replace HA-MRSA in health-care settings, making infection control measures less effective. Hospital based antibiotic policy has to be created and strictly followed to minimize the burden of antibiotic resistance.

Nasal colonisation, antimicrobial susceptibility and genotypic pattern of Staphylococcus aureus among agricultural biotechnology students in Besut, Terengganu, east coast of Malaysia.

This study aimed to profile the antimicrobial susceptibility and presence of resistance and virulence genes of methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA nasal carriage, by means of genotypic analyses, in students of a tertiary institution in the state of Terengganu, east coast of Malaysia. A total of 370 agricultural biotechnology students from Universiti Sultan Zainal Abidin in Besut, Terengganu, were enrolled in this study. Antimicrobial susceptibility profiles were evaluated by standard methods. PCR detection of resistance and virulence genes was performed on S. aureus that were methicillin-resistant, macrolide-lincosamide-streptogramin B (MLSB )-positive phenotype and/or positive for the leukocidin (pvl) gene followed by staphylococcal cassette chromosome mec (SCCmec), staphylococcal protein A (spa) and accessory gene regulator (agr) typing. One hundred and nineteen of 370 students carried S. aureus (32%); 18 of the isolates were MRSA (15%). Erythromycin resistance was detected in 20% (24/119) of which 15% (18/119) were MRSA and 5% (6/119) MSSA. Among the 24 erythromycin-resistant isolates, D-test was positive in 29% (7/24) displaying inducible MLSB , whereas the remaining 71% (17/24) showed constitutive MLSB phenotypes. Nine (7.6%) of 119 isolates were pvl positive: 44% MRSA (4/9) and 56% MSSA (5/9). Staphylococcal surface protein sasX gene was present in 92% of MRSA and 8% of MSSA isolates. The majority of MRSA isolates were agr type I (15/18; 83%). Five spa types identified with spa t037 were predominant, followed by spa types (t304 and t8696) as newly reported Malaysian MRSA in a community setting. The presence of MRSA with SCCmec of hospital-associated features and globally recognised spa types in community setting is worrisome. Furthermore, the presence of MLSB strains among multidrug-resistant (MDR) S. aureus with sasX as well as pvl-positive isolates highlights the potential risk of a community setting in facilitating the dissemination of both virulence and resistance determinants.

High prevalence of mupirocin resistance in methicillin resistant staphylococci and its clinical significance

Background: With the increasing pressure to prevent MRSA infections, it is possible that there will be increased use of Mupirocin for nasal decolonization of MRSA. Mupirocin is bacteriostatic at low concentration near the MIC for staphylococcus aureus but it is bactericidal at concentrations achieved by topical administration (20,000ug/ml) with the 2% formulation. Earlier reported High level Mupirocin resistance strain is associated with decolonization failure. The present study was carried out to determine the rates of high level and low level Mupirocin resistance (MuH and MuL) in methicillin resistant Staphylococcus aureus and methicillin resistant coagulase negative staphylococci. Materials and methods: A prospective study was carried out on 104 non-duplicate Staphylococcal isolates from various clinical specimens were tested for Mupirocin resistance using 5µg and 200µg discs. Detection of Mupirocin resistance was done by the disk diffusion method using 5 μg and 200 μg Mupirocin disks to determine low- and high-level resistance, respectively. Results: Mupirocin resistance was 7.8%, and 4.6% in MRSA and 40% and 20% in MR-CONS for 5 µg and 200 µg disc respectively. Conclusion: Institutions that are considering the implementation of widespread Mupirocin use should consider these resistance issues and develop strategies to monitor the impact of Mupirocin use. Perioperative prophylaxis with nasal mupirocin therapy (PPNMT) can reduce the incidence of MRSA SSls after orthopaedic surgery, probably by reducing nasal MRSA carriage in the endemic setting, without selecting for mupirocin resistance.