Methicillin-Resistant Staphylococcus Aureus (MRSA) Epidemiology and Antibiotics Susceptibility Profile Isolated from Different Clinical Samples in Tertiary Care Hospital: MRSA Epidemiology and Antibiotics Susceptibility Profile

Wajid  Ali; Shah  Zaman; Zakia  Subhan; Abdur Razaq; Muhammad  Nabi; Maria  Khattak; Nabiha  Naeem; Dua-E-Jamila  Khurrum; Sudhair  Abbas Bangash; Irfan  Ullah

doi:10.54393/pbmj.v5i5.455

Authors

Wajid Ali Department of Pharmacology, Ayub Medical College Abbottabad
Shah Zaman Department of Pharmacology, Peshawar Medical College
Zakia Subhan Department of Pharmacology, KMU-IMS Kohat
Abdur Razaq Department of Pharmacology, Institute of Basic Medical Sciences, Khyber Medical University Peshawar
Muhammad Nabi Institute of Pharmaceutical Sciences Khyber Medical university (IPS.KMU)
Maria Khattak Department of Pharmacology, Khyber Medical University
Nabiha Naeem Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore, Pakistan
Dua-E-Jamila Khurrum Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore, Pakistan
Sudhair Abbas Bangash Faculty of Life Science, Department of Pharmacy, Sarhad University of Science and Information Technology, Peshawar, Pakistan
Irfan Ullah Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v5i5.455

Keywords:

Methicillin-Resistant, Staphylococcus aureus, Antibiotics, Susceptibility, Tertiary Care

Abstract

Staphylococcus aureus is a versatile bacterium that causes a wide range of diseases in humans and animals. Objective: To determine the occurrence and antibiotic sensitivity profiles of Methicillin-Resistant Staphylococcus aureus (MRSA) isolates directly from the clinical samples. Methods: Individuals from various subgroups of the District Peshawar provided three different clinical specimens that are pus, body fluids and blood. Plasma, Macconkey and Cysteine Lactose Electrolyte Deficient agar (CLED) agar were used to prepare each specimen in the usual method. Gram staining test, catalase, and coagulase were used to identify and confirm S. aureus. The conventional "Kirby-Bauer disc" diffusion method was used to confirm MRSA antibiotic resistance patterns to several antibiotics. Results: A maximum of 750 diagnostic samples were evaluated and 50 (6.37%) were found to be positive for MRSA, with 33 (72%) coming from pus samples, 9 (19%) from fluid samples, and 6 (12%) from blood samples. Males had a higher prevalence of MRSA strains (69%) than females (31%). Most MRSA strains were completely resistant to different type of antibiotics e.g. penicillin, oxacillin, and ampicillin, while remaining completely susceptible to linezolid, teicoplanin, & vancomycin. Other anti-microbials to which MRSA strains were resistant are ceftriaxone (78.88%), cefoxitin (65.55%), erythromycin (83.33%), clindamycin (72.22%), co-amoxiclav (76.66%), fusidic acid (67.77%), and gentamycin (83.33%) (74.4%). Conclusions: This study found that the frequency of MRSA in Pakhtunkhwa is lower in comparison to that reported in other regions of Pakistan. Moreover, because MRSA is multi-drug-resistant, culture sensitivity testing should be conducted to determine the best antibiotic to use to treat MRSA infection

References

Thati V, Shivannavar CT, Gaddad SM. Vancomycin resistance among methicillin resistant Staphylococcus aureus isolates from intensive care units of tertiary care hospitals in Hyderabad. Indian J Med Res. 2011 Nov;134(5):704-8. doi: 10.4103/0971-5916.91001.

Waitayangkoon P, Thongkam A, Benjamungkalarak T, Rachayon M, Thongthaisin A, Chatsuwan T et al. Hospital epidemiology and antimicrobial susceptibility of isolated methicillin-resistant Staphylococcus aureus: a one-year retrospective study at a tertiary care center in Thailand. Pathog Glob Health. 2020 May 18;114(4):212-217. doi: 10.1080/20477724.2020.1755550.

Shahkarami F, Rashki A, Rashki Ghalehnoo Z. Microbial Susceptibility and Plasmid Profiles of Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus. Jundishapur J Microbiol. 2014 Jul;7(7):e16984. doi: 10.5812/jjm.16984.

Indian Network for Surveillance of Antimicrobial Resistance (INSAR) group, India. Methicillin resistant Staphylococcus aureus (MRSA) in India: prevalence & susceptibility pattern. Indian J Med Res. 2013 Feb;137(2):363-9.

Amorim ML, Faria NA, Oliveira DC, Vasconcelos C, Cabeda JC, Mendes AC et al. Changes in the clonal nature and antibiotic resistance profiles of methicillin-resistant Staphylococcus aureus isolates associated with spread of the EMRSA-15 clone in a tertiary care Portuguese hospital. J Clin Microbiol. 2007 Sep;45(9):2881-8. doi: 10.1128/JCM.00603-07.

Tiwari HK, Das AK, Sapkota D, Sivrajan K, Pahwa VK. Methicillin resistant Staphylococcus aureus: prevalence and antibiogram in a tertiary care hospital in western Nepal. J Infect Dev Ctries. 2009 Oct 22;3(9):681-4. doi: 10.3855/jidc.86.

Hussain MS, Naqvi A, Sharaz M. Methicillin Resistant Staphylococcus aureus (MRSA);: Prevalence And Susceptibility Pattern Of Methicillin Resistant Staphylococcus aureus (MRSA) Isolated From Pus In Tertiary Care Of District Hospital Of Rahim Yar Khan. The Professional Medical Journal. 2019 Jan 10;26(01):122-7. doi.org/10.29309/TPMJ/2019.26.01.2510.

Rongpharpi SR, Hazarika NK, Kalita H. The prevalence of nasal carriage of Staphylococcus aureus among healthcare workers at a tertiary care hospital in assam with special reference to MRSA. J Clin Diagn Res. 2013 Feb;7(2):257-60. doi: 10.7860/JCDR/2013/4320.2741.

Rahimi F. Characterization of Resistance to Aminoglycosides in Methicillin-Resistant Staphylococcus aureus Strains Isolated From a Tertiary Care Hospital in Tehran, Iran. Jundishapur J Microbiol. 2016 Jan 2;9(1):e29237. doi: 10.5812/jjm.29237.

Inomata S, Yano H, Tokuda K, Kanamori H, Endo S, Ishizawa C et al. Microbiological and molecular epidemiological analyses of community-associated methicillin-resistant Staphylococcus aureus at a tertiary care hospital in Japan. J Infect Chemother. 2015 Oct;21(10):729-36. doi: 10.1016/j.jiac.2015.07.005.

Rajaduraipandi K, Mani KR, Panneerselvam K, Mani M, Bhaskar M, Manikandan P. Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus: a multicentre study. Indian J Med Microbiol. 2006 Jan;24(1):34-8. doi: 10.4103/0255-0857.19892.

Bhatt MP, Bhalla GS, Kundan T, Jindamwar P, Chaudhari CN, Sahni NG. Antimicrobial susceptibility profile of methicillin-resistant Staphylococcus aureus at a tertiary care centre. Archives Of Clinical Microbiology. 2015;6(3):0-.

Khan RA, Rahman AU, Ahmad A, Jaseem M, Jabbar A, Khan SA et al. Prevalence and antibiotic susceptibility profile of methicillin-resistant Staphylococcus aureus (MRSA) isolated from different clinical samples in district Peshawar. J Appl Environ Biol Sci. 2014;4(8S):40-6.

Khan AA, Ali A, Tharmalingam N, Mylonakis E, Zahra R. First report of mecC gene in clinical methicillin resistant S. aureus (MRSA) from tertiary care hospital Islamabad, Pakistan. J Infect Public Health. 2020 Oct;13(10):1501-1507. doi: 10.1016/j.jiph.2020.05.017.

Bari F, Wazir R, Haroon M, Ali S, Ali I, Rahman H et al. Frequency and antibiotic susceptibility profile of MRSA at lady reading hospital, Peshawar. Gomal Journal of Medical Sciences. 2015 Mar 31;13(1).

Preeja PP, Kumar SH, Shetty V. Prevalence and Characterization of Methicillin-Resistant Staphylococcus aureus from Community- and Hospital-Associated Infections: A Tertiary Care Center Study. Antibiotics (Basel). 2021 Feb 18;10(2):197. doi: 10.3390/antibiotics10020197.

Shittu AO, Lin J. Antimicrobial susceptibility patterns and characterization of clinical isolates of Staphylococcus aureus in KwaZulu-Natal province, South Africa. BMC Infect Dis. 2006 Jul 28;6:125. doi: 10.1186/1471-2334-6-125.

Omuse G, Kabera B, Revathi G. Low prevalence of methicillin resistant Staphylococcus aureus as determined by an automated identification system in two private hospitals in Nairobi, Kenya: a cross sectional study. BMC Infect Dis. 2014 Dec 14;14:669. doi: 10.1186/s12879-014-0669-y.

Fatholahzadeh B, Emaneini M, Gilbert G, Udo E, Aligholi M, Modarressi MH et al. Staphylococcal cassette chromosome mec (SCCmec) analysis and antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus (MRSA) isolates in Tehran, Iran. Microb Drug Resist. 2008 Sep;14(3):217-20. doi: 10.1089/mdr.2008.0822.

Mahmood K, Tahir M, Jameel T, Ziauddin A, Aslam HF. Incidence of Methicillin-resistant Staphylococcus aureus (MRSA) causing nosocomial infection in a Tertiary Care Hospital. Annals of King Edward Medical University. 2010;16(2):91-.doi.org/10.21649/akemu.v16i2.188.

Pai V, Rao VI, Rao SP. Prevalence and Antimicrobial Susceptibility Pattern of Methicillin-resistant Staphylococcus aureus [MRSA] Isolates at a Tertiary Care Hospital in Mangalore, South India. J Lab Physicians. 2010 Jul;2(2):82-4. doi: 10.4103/0974-2727.72155.

Taj Y, Abdullah FE, Kazmi SU. Current pattern of antibiotic resistance in Staphylococcus aureus clinical isolates and the emergence of vancomycin resistance. J Coll Physicians Surg Pak. 2010 Nov;20(11):728-32.

Kim HB, Jang HC, Nam HJ, Lee YS, Kim BS, Park WB et al. In vitro activities of 28 antimicrobial agents against Staphylococcus aureus isolates from tertiary-care hospitals in Korea: a nationwide survey. Antimicrob Agents Chemother. 2004 Apr;48(4):1124-7. doi: 10.1128/AAC.48.4.1124-1127.2004.

Alfouzan W, Udo EE, Modhaffer A, Alosaimi A. Molecular Characterization of Methicillin- Resistant Staphylococcus aureus in a Tertiary Care hospital in Kuwait. Sci Rep. 2019 Dec 6;9(1):18527. doi: 10.1038/s41598-019-54794-8.

Tiemersma EW, Bronzwaer SL, Lyytikäinen O, Degener JE, Schrijnemakers P, Bruinsma N et al. Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002. Emerg Infect Dis. 2004 Sep;10(9):1627-34. doi: 10.3201/eid1009.040069.

Sharma S, Mall A. The prevalence, antibiogram and characterisation of methicillin resistant Staphylococcus aureus among the patients from the Doon Valley hospitals. African Journal of Microbiology Research. 2011 Oct 9;5(21):3446-51. doi.org/10.5897/AJMR11.600.