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Maharjan S, Ansari M, Maharjan P, Rai KR, Sabina KC, Kattel HP, Rai G, Rai SK. Phenotypic detection of methicillin resistance, biofilm production, and inducible clindamycin resistance in Staphylococcus aureus clinical isolates in Kathmandu, Nepal. Trop Med Health 2022; 50:71. [PMID: 36131351 PMCID: PMC9490977 DOI: 10.1186/s41182-022-00460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Methicillin resistance, inducible clindamycin resistance (ICR), biofilm production, and increased minimum inhibitory concentration (MIC) of vancomycin in Staphylococcus aureus are major causes of antibiotic treatment failure and increased morbidity and mortality. The surveillance of such isolates and the study of their antimicrobial pattern are essential in managing the infections caused by these isolates. This study aimed to determine methicillin resistance, biofilm production, and ICR in S. aureus isolates from a tertiary care hospital in Kathmandu, Nepal. MATERIALS AND METHODS A total of 217 S. aureus isolated from different samples were processed following standard laboratory procedures. Antibiotic susceptibility testing was performed by the Kirby-Bauer disk diffusion technique. Methicillin-resistant S. aureus (MRSA) were identified by the cefoxitin disk diffusion test, and biofilm producers were examined using the microtiter plate technique. D-test and E-test were performed to determine inducible clindamycin resistance and minimum inhibitory concentration of vancomycin, respectively. RESULTS Among the 217 S. aureus isolates, 78.3% were multidrug-resistant (MDR), 47.0% were MRSA, 62.2% were biofilm producers, and 50.7% showed ICR. All MRSA isolates exhibited MIC levels of vancomycin within the susceptible range. Biofilm producers and MRSA isolates showed elevated antimicrobial resistance. MRSA was significantly associated with MDR. Biofilm-producing and multidrug-resistant MRSA isolates showed significantly higher MIC levels of vancomycin (p = 0.0013 and < 0.0001, respectively), while ICR was significantly higher in MDR (p = 0.0001) isolates. CONCLUSION High multidrug resistance, MRSA, and ICR in this study call for routine evaluation of antibiotic susceptibility patterns of S. aureus. Vancomycin can be used to treat serious staphylococcal infections. Clindamycin should be prescribed only after performing the D-test. Drugs like teicoplanin, chloramphenicol, doxycycline, amikacin, and levofloxacin can treat MRSA infections.
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Affiliation(s)
- Sujina Maharjan
- Department of Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal
| | - Mehraj Ansari
- Department of Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal.
| | - Pawan Maharjan
- Phect-Nepal Model Hospital School of Medical Laboratory Sciences, Kathmandu, Nepal
| | - Kul Raj Rai
- Department of Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal.,Key Laboratory of Fujian-Taiwan Animal Pathogen Biology, College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, China
| | - K C Sabina
- Department of Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal
| | - Hari Prasad Kattel
- Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Ganesh Rai
- Department of Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal
| | - Shiba Kumar Rai
- Department of Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal.,Department of Microbiology, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal
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Zhou K, Sun F, Xu XL, Hao XK, Liu JY. Prevalences and characteristics of cultivable nasal bacteria isolated from preclinical medical students. J Int Med Res 2021; 48:300060520961716. [PMID: 33103543 PMCID: PMC7607144 DOI: 10.1177/0300060520961716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Commensal bacteria in the nasal cavity may act as opportunistic pathogens that cause infections under certain conditions. Screening for commensal bacteria in the nasal cavity may aid in understanding their roles in microbiota balance and preventing potential infections. METHODS Nasal samples were collected from healthy preclinical medical students and used to inoculate various bacterial culture media, by means of the WaspLab microbiology automated system. Bacterial colonies were then identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antibiotic resistance phenotypes of Staphylococcus aureus were determined by antibiotic susceptibility tests. RESULTS In total, 549 bacterial strains were isolated from 161 participants. These strains included the following genera: Staphylococcus, Streptococcus, Corynebacterium, Dolosigranulum, Bacillus, Micrococcus, Haemophilus, Neisseria, Moraxella, Pseudomonas, and members of Enterobacteriaceae (e.g., Escherichia, Klebsiella, Citrobacter, Enterobacter, and Serratia). Approximately 25.5% of students were carriers of S. aureus; most S. aureus isolates were resistant to penicillin, erythromycin, and clindamycin. The prevalence of methicillin-resistant S. aureus in nasal samples was 4.3%. CONCLUSIONS A diverse group of nasal commensal bacteria inhabited our population of healthy volunteers. These data can improve comprehension of the potential roles of these nasal commensal bacteria in regulating microbiota balance and promoting or mitigating potential future infections.
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Affiliation(s)
- Ke Zhou
- Center of Clinical Laboratory Medicine of PLA, Department of Laboratory Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fei Sun
- Department of Otolaryngology Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiu-Li Xu
- Center of Clinical Laboratory Medicine of PLA, Department of Laboratory Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiao-Ke Hao
- Center of Clinical Laboratory Medicine of PLA, Department of Laboratory Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jia-Yun Liu
- Center of Clinical Laboratory Medicine of PLA, Department of Laboratory Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Molecular characteristics of Staphylococcus aureus strains isolated from nasal samples of sixth year medical students during their pediatric services practices. Ann Clin Microbiol Antimicrob 2021; 20:25. [PMID: 33865424 PMCID: PMC8053271 DOI: 10.1186/s12941-021-00429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare services. Medical students are at risk for MRSA carriage, subsequent infection and potential transmission of nosocomial infection.Few studies have examined MRSA carriage among medical students. Methods In this prospective cohort study, between July 2016 and June 2017, two nasal swab samples were taken per student 4 weeks apart during their pediatric internship. MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine leukocidin (PVL) encoding genes. Results A total of 239 sixth year medical students, 164 (68.6%) male (M/F:2.1),with median age 25 years (min–max; 23–65 years) were included in this prospective cohort study. Among 239 students, 17 students (7.1%) were found to be colonized with methicillin-sensitive S. aureus (MSSA) at the beginning of pediatric internship. After 4 weeks, at the end of pediatric internship totally 52 students were found to be S. aureus colonized (21.8%). Three of 52 S. aureus isolates were MRSA (1.3%) and the rest was MSSA (20.5%), all were PVL gen negative. Two of three MRSA isolates were characterized as SCCmec type IV, one isolate was untypeable SCCmec. Nasal carriage of S. aureus increased from 7.1% to 21.5% (p < 0.001). Nasal S. aures colonization ratio was higher in students working in pediatric infectious disease service (p = 0.046). Smoking was found to be associated with a 2.37-fold [95% CI (1.12–5.00); p = 0.023] and number of patients in pediatric services was 2.66-fold [95% CI (1.13–6.27); p = 0.024] increase the risk of nasal S. aureus colonization. Gender was not found to increase risk of MRSA carriage. Conclusion MSSA nasal carriage increased at the end of pediatric internship and significantly high in students working in pediatric infectious diseases services. Smoking and high number of patients in pediatric services significantly increase S.aureus colonization.
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Prevalence of Staphylococcus aureus Nasal Carriage and Methicillin-resistant S. aureus Among Medical Students: A Systematic Review and Meta-analysis. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.111125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Evaluating the prevalence of Staphylococcus aureus nasal carriage and methicillin-resistant S. aureus (MRSA) that are sources of nosocomial infection among medical students. Evidence Acquisition: Electronic databases were searched by preferred subject headings and free-text keywords. After omitting duplicates, retrieved articles were screened by two independent reviewers in a three-step process based on inclusion criteria. Then, reviewers critically appraised the selected studies by JBI checklists and extracted the required data. Finally, the pooled prevalence rates of S. aureus nasal carriage and MRSA were meta-analyzed by Stata V.16 software. The heterogeneity of included studies was calculated by I2 and chi-square. Subgroup analysis was carried out according to study designs, as well as the continent origin of clinical and preclinical students. Results: Of 858 retrieved studies, 15 were included in the meta-analysis. The results showed that the pooled prevalence of nasal S. aureus carriage was 28% [prevalence rate: 0.028, 95% CI: 0.21 - 0.34, P < 0.001, I2: 96.40%, chi2: 360.98 (df = 14)]. The prevalence of S. aureus among clinical students was 33% (pooled prevalence rate: 0.33, 95% CI: 0.18 - 0.47) whereas, in preclinical students, it was 25% (pooled prevalence rate: 0.25, 95% CI: 0.23 - 0.28). Also, in a subgroup analysis of continents, Australia (Oceania) had the highest prevalence rate. According to an evaluation of publication bias, the distribution of studies was very high. Moreover, pooled MRSA prevalence among medical students was 2% (prevalence rate: 0.02 95% CI: 0.01 - 0.03, P < 0.001). Conclusions: In this meta-analysis, S. aureus and MRSA prevalence rates among medical students were estimated at 28% and 2%, respectively. More attention should be given to the prevention of MRSA colonization and screening strategies among medical students across the world.
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de Oliveira EMN, de Carvalho ARB, Ferreira AM, Moura LKB, Valle ARMDC, de Freitas DRJ, Moura MEB. Colonization of methicillin-resistant Staphylococcus aureus among healthcare students: an integrative review. SAO PAULO MED J 2021; 139:607-614. [PMID: 34787295 PMCID: PMC9634839 DOI: 10.1590/1516-3180.2020.0564.r2.22042021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) infection is a worldwide concern given its presence even in non-hospitalized healthy individuals, such as university students. OBJECTIVE To identify in the literature the prevalence of colonization by MRSA among healthcare students. DESIGN AND SETTING Integrative review of the literature conducted in Universidade Federal do Piauí. METHOD A search for primary studies was performed in the following databases: Medical Literature Analysis and Retrieval System on-line; Cumulative Index to Nursing and Allied Health Literature; Web of Science; Scopus; and LILACS. RESULTS This review included 27 studies that demonstrated MRSA infection prevalence ranging from 0.0 to 15.3% among students. CONCLUSION The prevalence of colonization of MRSA among healthcare students is high, and the nasal cavity was cited as an important reservoir location for these microorganisms.
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Affiliation(s)
| | | | - Adriano Menis Ferreira
- PhD. Nurse and Professor, Nursing Postgraduate Program, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil.
| | - Luana Kelle Batista Moura
- PhD. Dentist and Professor, Department of Dentistry, Centro Universitário Santo Agostinho, Teresina (PI), Brazil.
| | | | | | - Maria Eliete Batista Moura
- PhD. Nurse and Professor, Nursing Postgraduate Program, Universidade Federal do Piauí (UFPI), Teresina (PI), Brazil.
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Orlin I, Rokney A, Onn A, Glikman D, Peretz A. Hospital clones of methicillin-resistant Staphylococcus aureus are carried by medical students even before healthcare exposure. Antimicrob Resist Infect Control 2017; 6:15. [PMID: 28138384 PMCID: PMC5260124 DOI: 10.1186/s13756-017-0175-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community. Few studies have examined MRSA carriage among medical students. The aim of this study is to examine Staphylococcus aureus (SA) carriage, and particular MRSA, over time in cohort medical students Methods Prospective collection of nasal swabs from medical students in Israel and assessment of SA carriage. Three samples were taken per student in preclinical and clinical parts of studies. Antibiotic susceptibilities were recorded and MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine Leukocidin (PVL) encoding genes, and spa types. Clonality was assessed by pulsed-field gel electrophoresis. Results Among 58 students, SA carriage rates increased from 33% to 38% to 41% at baseline (preclinical studies), 13 and 19 months (clinical studies), respectively (p = 0.07). Methicillin-susceptible SA (MSSA) carriage increased in the clinical studies period (22 to 41%, p = 0.01). Overall, seven students (12%) carried 13 MRSA isolates. MRSA isolates were PVL negative and were characterized as SCCmecII-t002, SCCmecIV-t032, or t12435 with untypable SCCmec. MRSA carriage during the pre-clinical studies was evident in 4/7 students. Two students carried different MRSA clones at various times and persistent MRSA carriage was noted in one student. Simultaneous carriage of MRSA and MSSA was not detected. Conclusions MSSA carriage increased during the clinical part of studies in Israeli medical students. Compared with previous reports, higher rates of MRSA carriage were evident. MRSA strains were genotypically similar to Israeli healthcare-associated clones; however, carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains.
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Affiliation(s)
- Ido Orlin
- The Faculty of Medicine in the Galilee, Bar-Ilan University, Galilee, Israel
| | - Assaf Rokney
- National Staphylococcus aureus Reference Center, Central Laboratories, Israel Ministry of Health, Jerusalem, Israel
| | - Avi Onn
- The Faculty of Medicine in the Galilee, Bar-Ilan University, Galilee, Israel.,Pediatric Gastrointestinal Unit, Padeh Poriya Medical Center, Poriya, Tiberias Israel
| | - Daniel Glikman
- The Faculty of Medicine in the Galilee, Bar-Ilan University, Galilee, Israel.,Pediatric Infectious Diseases Service, Galilee Medical Center, Nahariya, Israel
| | - Avi Peretz
- The Faculty of Medicine in the Galilee, Bar-Ilan University, Galilee, Israel.,Clinical Microbiology Laboratory, Padeh Poriya Medical Center, Poriya, Hanna Senesh 818/2, Tiberias, Israel
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