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 ~  Materials and Me...
 ~  Results
 ~  Discussion
 ~  References

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Year : 2003  |  Volume : 21  |  Issue : 1  |  Page : 49-51
 

Prevalence of methicillin resistant staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh


Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh, India

Correspondence Address:
Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh, India

 ~ Abstract 

We report the prevalence of methicillin resistant Staphylococcus aureus (MRSA) infections and their antibiotic susceptibility pattern in our hospital located in eastern Uttar Pradesh. Out of total 549 strains of Staphylococcus aureus isolated from different clinical specimens 301 (54.85%) were found to be methicillin resistant. More than 80% of MRSA were found to be resistant to penicillin, cotrimoxazole, ciprofloxacin, gentamicin, erythromycin, tetracycline, 60.5% to amikacin and 47.5% to netilmicin. However, no strains were resistant to vancomycin. Many MRSA strains (32.0%) were multi-drug resistant. To reduce the prevalence of MRSA, the regular surveillance of hospital associated infection, monitoring of antibiotic sensitivity pattern and formulation of definite antibiotic policy may be helpful.

How to cite this article:
Anupurba S, Sen M R, Nath G, Sharma B M, Gulati A K, Mohapatra T M. Prevalence of methicillin resistant staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh. Indian J Med Microbiol 2003;21:49-51


How to cite this URL:
Anupurba S, Sen M R, Nath G, Sharma B M, Gulati A K, Mohapatra T M. Prevalence of methicillin resistant staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh. Indian J Med Microbiol [serial online] 2003 [cited 2019 Dec 16];21:49-51. Available from: http://www.ijmm.org/text.asp?2003/21/1/49/8318


Methicillin resistant Staphylococcus aureus   (MRSA) strains were initially described in 1961 and emerged in the last decade as one of the most important nosocomial pathogens.[1] Infected and colonized patients provide the primary reservoir and transmission is mainly through hospital staff.[2] The risk factors which contribute to MRSA are excessive antibiotic usage, prolonged hospitalization, intravascular catheterization and hospitalisation in intensive care unit.[3] With the increased incidence of MRSA, the effectiveness of penicillin and cephalosporins is questioned. In fact many stains of MRSA exhibit resistance to both -lactams and aminoglycosides.[4] Hence, a knowledge of prevalence of MRSA and their antimicrobial profile becomes necessary in the selection of appropriate empirical treatment of these infections. This work was carried out to determine the prevalence of MRSA infections and their in vitro susceptibility pattern to various antimicrobial agents in our hospital which is a tertiary referral hospital, located in the eastern Uttar Pradesh.

 ~ Materials and Methods Top

A total of 549 S. aureus  strains were isolated from various clinical specimens like pus, blood, sputum, CSF, high vaginal swab, urine etc. All the strains were identified by standard techniques. Each of these strains was screened for oxacillin resistance as per the method described earlier.[5]
Oxacillin discs (1mg) obtained from Hi-Media Laboratories Pvt. Ltd. were used. A zone of inhibition less than 10 mm. or any discernible growth within zone of inhibition was indicative of methicillin resistance. The antibiotic susceptibility pattern of all the MRSA strains were determined by modified Kirby Bauer disc diffusion method against the following antibiotics: penicillin (10 units), gentamicin (10mg), erythromycin (15mg), tetracycline (30mg), cotrimoxazole (25mg), amikacin (30mg), netilmicin (30mg), ciprofloxacin (5mg) and vancomycin (30mg). S. aureus  ATCC 25923 was used as a standard control strain.

 ~ Results Top

Out of total 549 strains 301 were found to be MRSA (54.85%). Maximum isolation of MRSA was from pus and wound swabs. The number and percentage of isolation of MRSA from different clinical specimens is given in the [Table - 1].
More than 80% of MRSA were found to be resistant to majority of antibiotics tested like cephalexin, ciprofloxacin, penicillin, co-trimoxazole, gentamicin, erythromycin and tetracycline and 60.5% to amikacin, and only 47.5% to netilmicin. However, we found no strains resistant to vancomycin [Figure:1]. Many of the MRSA strains were resistant to all the antibiotics (97/301, 32%) tested except vancomycin.

 ~ Discussion Top

Our study shows an alarmingly high incidence of MRSA infection in this hospital. The prevalence rate is found to be 54.8%, which is much higher than most of the reports where it ranged between 20% to 32.8%.[6],[7] The only report which has given somewhat similar result i.e. 51.6% is from LN Hospital, New Delhi.[8] Further, a study from Indore has shown a rise in MRSA prevalence from 12% in 1992 to 80.89% in 1999.[9]
Such a high prevalence of MRSA in our study may be due to several factors. This hospital caters to the patients from eastern U.P., Bihar and adjacent areas. The indiscriminate use of antibiotics, lack of awareness and unethical treatment before coming to the hospital might have been contributing factors.
The epidemiology of MRSA is gradually changing since its emergence was reported. Initially there were occasional reports but now it has become one of the established hospital acquired pathogen. Moreover, the association of multidrug resistance with MRSA has added to the problem. B-lactam antibiotics like penicillin and cephalexin were not found to be effective against MRSA. Penicillin and cephalexin resistance were 100% and 88.7% respectively. Resistance to quinolones (ciprofloxacin) was also found to be very high i.e. 84.1%. This correlates with an earlier finding where it has been shown that the resistance to ciprofloxacin is steadily increasing from 39% in 1992 to 68% in 1996.7 In 1997 also a high incidence of ciprofloxacin resistance (95.8%) was reported.[6]
Susceptibility to aminoglycoside was maximum in netilmicin (52.5%) and minimum in gentamicin (10.3%), 39.5% of strains were sensitive to amikacin. In this study netilmicin sensitivity is found to be higher than other aminoglycosides, however, it can not be recommended for empirical treatment of MRSA associated infections.
Vancomycin seems to be the only antimicrobial agent which showed 100% sensitivity and may be used as the drug of choice for treating multidrug resistant MRSA infections. However, regular monitoring of vancomycin sensitivity, and routine testing of other newer glycopeptides like teicoplanin should be carried out. Further, the regular surveillance of hospital associated infections including monitoring antibiotic sensitivity pattern of MRSA and formulation of definite antibiotic policy may be helpful for reducing the incidence of MRSA infection. 

 ~ References Top

1.Maple PAC, Hamilton- Miller JMT, Brumfitt W. World wide antibiotic resistance in methicillin resistant Staphylococcus aureus. Lancet 1989;1:537-540.  Back to cited text no. 1    
2.McDonald M. The epidemiology of methicillin resistant Staphylococcus aureus: Surgical relevance 20 years on. Aust N Z J Surg 1997;67:682-685.  Back to cited text no. 2    
3.Doebbeling BN. The epidemiology of methicillin resistant Staphylococcus aureus colonization and infection. J Chemotherapeutics 1995;7 (Suppl.3):99-103.  Back to cited text no. 3    
4.Thornsberry C. The development of antimicrobial resistance in staphylococci. J Antimicrob Chemotherap 1998;21 (Suppl.C):9-16.  Back to cited text no. 4    
5.NCCLS. Performance standards for antimicrobial disc susceptibility tests. 6th Ed. Approved Standard NCCLS Document M2- A6 (ISBNI - 56238 - 308- 6). NCCLS, 940 West Valley Road, Suit 1400, Wayne, Pennsylvania, 1997: 19087-1898.  Back to cited text no. 5    
6.Udaya Shankar C, Harish BN, Umesh Kumar PM, Navaneeth BV. Prevalence of methicillin resistant Staphylococcus aureus in JIPMER hospital. Indian J Med Microbiol 1997;15:137-138.  Back to cited text no. 6    
7.Mehta AP, Rodrigue C, Seth K, Jani S, Hakimiyar A, Fazalbhoy N. Conrol of methicillin resistant Staphylococcus aureus in a tertiary care centre: A five year study. Indian J Med Microbiol 1998;16:31-34.  Back to cited text no. 7    
8.Vidhani S, Mehndiratta PL, Mathur MD. Study of MRSA isolates from high risk patients. Indian J Med Microbiol 2001;19:87-90.  Back to cited text no. 8    
9.Verma S, Joshi S, Chitnis V, Hemwani N, Chitnis D. Growing problem of methicillin resistant staphylococci: Indian Scenario. Indian J Med Sciences 2000;54:535-540.   Back to cited text no. 9    
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2004 - Indian Journal of Medical Microbiology
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