Document Type : Original Article
Authors
1 Department of Microbiology, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
2 Department of Physiology, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
Abstract
Objective: Methicillin‑resistant Staphylococcus aureus (MRSA) ranks top among the
nosocomial pathogens. Nasal formulation of mupirocin is found to eradicate MRSA from
colonized individuals, but the emergence of resistant strains is a matter of concern.
Methods: Nasal swabs were collected from 200 health care workers (HCWs) who were
screened for MRSA. Kirby–Bauer disc diffusion method was used to perform antibiotic
susceptibility test. MRSA detection was done using a cefoxitin 30 µg disc and interpreted
according to the Clinical and Laboratory Standards Institute guidelines. Determination of
mupirocin resistance was performed using Epsilometer test (E‑test).
Findings: About 14% of HCWs showed nasal carriage of MRSA. Nursing orderlies were
the predominant carriers. E‑test showed four mupirocin resistant isolates. The antibiogram
of the MRSA isolates revealed the higher resistance to antibiotics as compared to
methicillin‑sensitive Staphylococcus aureus. All the MRSA isolates were sensitive to linezolid.
Conclusion: HCWs in our hospital showed high nasal carriage rate of MRSA, particularly
the nursing orderlies which is statistically significant. It is advisable to detect mupirocin
resistance among the isolates obtained from the HCWs so that in case of resistance,
alternative treatment should be sought.
Keywords
The impact of surgical‑site infections in the 1990s: Attributable
mortality, excess length of hospitalization, and extra costs.
Infect Control Hosp Epidemiol 1999;20:725‑30.
2. Köck R, Becker K, Cookson B, van Gemert‑Pijnen JE,
Harbarth S, Kluytmans J, et al. Methicillin‑resistant
Staphylococcus aureus (MRSA): Burden of disease and control
challenges in Europe. Euro Surveill 2010;15:19688.
3. Albrich WC, Harbarth S. Health‑care workers: Source, vector,
or victim of MRSA? Lancet Infect Dis 2008;8:289‑301.
4. Solberg CO. Spread of Staphylococcus aureus in hospitals:
Causes and prevention. Scand J Infect Dis 2000;32:587‑95.
5. Mathanraj S, Sujatha S, Sivasangeetha K, Parija SC. Screening
for methicillin‑resistant Staphylococcus aureus carriers among
patients and health care workers of a tertiary care hospital in
South India. Indian J Med Microbiol 2009;27:62‑4.
6. Paul M, Bishara J, Yahav D, Goldberg E, Neuberger A,
Ghanem‑Zoubi N, et al. Trimethoprim‑sulfamethoxazole
versus vancomycin for severe infections caused by methicillin
resistant Staphylococcus aureus: Randomised controlled trial.
BMJ 2015;350:h2219.
7. Lally RT, Lanz E, Schrock CG. Rapid control of an outbreak of
Staphylococcus aureus on a neonatal intensive care department
using standard infection control practices and nasal
mupirocin. Am J Infect Control 2004;32:44‑7.
8. Chaturvedi P, Singh AK, Singh AK, Shukla S, Agarwal L.
Prevalence of mupirocin resistant Staphylococcus aureus isolates
among patients admitted to a tertiary care hospital. N Am J
Med Sci 2014;6:403‑7.
9. Clinical and Laboratory Standards Institute. Performance
Standards for Antimicrobial Disk Susceptibility Tests;
Approved Standard‑Eleventh Edition and Performance
Standards for Antimicrobial Susceptibility Testing:
Twenty‑ Third Informational Supplement. CLSI Document
M02‑A11 and M100‑S23. Wayne, PA: Clinical and Laboratory
Standard Institute; 2013.
10. Truong H, Shah SS, Ludmir J, Twananana EO, Bafana M,
Wood SM, et al. Staphylococcus aureus skin and soft tissue
infections at a tertiary hospital in Botswana. S Afr Med J
2011;101:413‑6.
11. Yazgi H, Ertek M, Ozbek A, Kadanali A. Nasal carriage of
Staphylococcus aureus in hospital personnel and the normal population and antibiotic resistance of the isolates. Mikrobiyol
Bul 2003;37:137‑42.
12. SinghAK, Gupta M, AgarwalA, Gupta P, Singh M. Prevalence
of methicillin‑resistant Staphylococcus aureus colonisation and
its antibiotic susceptibility profile among healthcare personnel
in a tertiary care setup of Northern India. Int J Curr Microbiol
Appl Sci 2013;2:293‑9.
13. Al‑Abdli NE, Baiu S. Nasal carriage of Staphylococcus in
health care workers in Benghazi hospitals. Am J Microbiol
Res 2014;2:110‑2.
14. Norazah A, Koh YT, Kamel AG, Alias R, Lim VK. Mupirocin
resistance among Malaysian isolates of methicillin‑resistant
Staphylococcus aureus. Int J Antimicrob Agents 2001;17:411‑4.
15. Mulqueen J, Cafferty F, Cormican M, Keane JD, Rossney A.
Nasal carriage of meticillin‑resistant Staphylococcus aureus in
GPs in the West of Ireland. Br J Gen Pract 2007;57:811‑3.
16. Eveillard M, Martin Y, Hidri N, Boussougant Y,
Joly‑Guillou ML. Carriage of methicillin‑resistant
Staphylococcus aureus among hospital employees: Prevalence,
duration, and transmission to households. Infect Control
Hosp Epidemiol 2004;25:114‑20.
17. Akoua Koffi C, Dje K, Toure R, Guessennd N, Acho B,
Faye Kette H, et al. Nasal carriage of meticillin‑resistant
Staphylococcus aureus among health care personnel in
Abidjan (Côte d’lvoire). Dakar Med 2004;49:70‑4.
18. Cesur S, Cokça F. Nasal carriage of methicillin‑resistant
Staphylococcus aureus among hospital staff and outpatients.
Infect Control Hosp Epidemiol 2004;25:169‑71.
19. Shrestha B, Pokhrel BM, Mohapatra TM. Staphylococcus aureus
nasal carriage among health care workers in a Nepal Hospital.
Braz J Infect Dis 2009;13:322.
20. Pulimood TB, Lalitha MK, Jesudason MV, PandianR, Selwyn J,
John TJ. The spectrum of antimicrobial resistance among
methicillin resistant Staphylococcus aureus(MRSA) in a tertiary
care centre in India. Indian J Med Res 1996;103:212‑5.
21. Qureshi AH, Rafi S, Qureshi SM, Ali AM. The
current susceptibility patterns of methicillin resistant
Staphylococcus aureus to conventional anti Staphylococcus
antimicrobials at Rawalpindi. Pak J Med Sci 2004;20:361‑4.
22. Shittu AO, Lin J, Kolawole D. Antimicrobial susceptibility
patterns of Staphylococcus aureus and characterization of MRSA
in Southwestern Nigeria. Wounds 2006;18:77‑84.
23. Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK,
ChaudhryR, et al. Mupirocin resistance in Staphylococcus aureus
in an Indian hospital. Diagn Microbiol Infect Dis 2007;58:125‑7.
24. Hudson IR. The efficacy of intranasal mupirocin in the
prevention of staphylococcal infections: A review of recent
experience. J Hosp Infect 1994;27:81‑98.
25. Singh AK, Venkatesh V, Singh M. Mupirocin resistance in
clinical isolates of Staphylococcus aureus in a tertiary care
hospital set up in North India. Int J Med Res Health Sci
2013;2:840‑7.
26. Walker ES, Vasquez JE, Dula R, Bullock H, Sarubbi FA.
Mupirocin‑resistant, methicillin‑resistant Staphylococcus aureus:
Does mupirocin remain effective? Infect Control Hosp
Epidemiol 2003;24:342‑6
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