Indian Journal of Medical Microbiology Home 

BRIEF COMMUNICATIONS
[Download PDF]
Year : 2005  |  Volume : 23  |  Issue : 3  |  Page : 186--188

Survey of Staphylococcus isolates among hospital personnel, environment and their antibiogram with special emphasis on methicillin resistance

KL Shobha, PS Rao, J Thomas 
 Department of Microbiology, Melaka Manipal Medical College, Manipal-576 104, Karnataka, India

Correspondence Address:
K L Shobha
Department of Microbiology, Melaka Manipal Medical College, Manipal-576 104, Karnataka
India

Abstract

The objective of this study was to find the prevalence of Staphylococcus spp. carriage among hospital personnel and hospital environment and their antibiogram with special emphasis on methicillin resistance. A total of 205 samples from hospital personnel and environment were collected from casualty, oncology and multidisciplinary cardiac unit ward of Kasturba Medical College Hospital, Manipal. Samples were collected using sterile cotton wool swabs and inoculated into brain heart infusion broth. Subcultures were done onto blood agar and MacConkey«SQ»s agar. Isolates were identified by standard methods up to species level. Antimicrobial susceptibility test was performed according to standardized disc diffusion Kirby-Bauer method. Each of the isolates was screened for methicillin resistance using oxacillin disc on Mueller Hinton agar plate followed by MIC for methicillin and cefoxitin susceptibility test by disc diffusion method. Sixty five out of 205 strains (31.7%) were Staphylococcus spp. and all of them were coagulase negative. Most of the strains belonged to S.epidermidis 49.23%(32/65) followed by S. saprophyticus 26.15%(17/65). Maximum isolates of S.epidermidis were from anterior nares 28.12%(9/32 strains of S.epidermidis ). Highest number of methicillin resistant coagulase negative strains (3/9, 33.33%) were isolated from stethoscope of multidisciplinary cardiac unit ward followed by carriers in the anterior nares (2/9, 22.22%). Methicillin resistant coagulase negative staphylococci are prevalent in anterior nares of hospital personnel and in the hospital environment thereby providing a definite source for hospital acquired infection. All isolates were sensitive to vancomycin, ciprofloxacin and amikacin.

How to cite this article:
Shobha K L, Rao P S, Thomas J. Survey of Staphylococcus isolates among hospital personnel, environment and their antibiogram with special emphasis on methicillin resistance.Indian J Med Microbiol 2005;23:186-188

How to cite this URL:
Shobha K L, Rao P S, Thomas J. Survey of Staphylococcus isolates among hospital personnel, environment and their antibiogram with special emphasis on methicillin resistance. Indian J Med Microbiol [serial online] 2005 [cited 2020 Apr 1 ];23:186-188
Available from: http://www.ijmm.org/text.asp?2005/23/3/186/16592

Full Text

Multidrug resistant Staphylococcus isolates in hospitals have been recognized as one of the major challenges in the hospital infection control.[1] Isolation of coagulase negative S taphylococcus and antibiotic sensitivity patterns are regarded with all seriousness in clinical practice and clinical epidemiology.[2] These strains are not only resistant to multiple antibiotics, but also act as a reservoir for drug resistance gene.[3] Higher percentage of methicillin resistant Staphylococcus among carriers can serve as a focus of nosocomial spread of multidrug resistant Staphylococcus in tertiary hospitals and cause problems to hospital infection control programs.[1]

In India, the study on the prevalence of Staphylococcus species among hospital personnel is much lacking.[4] Here we report the prevalence of Staphylococcus spp. isolated from hospital personnel and hospital wards and their antibiogram. We especially determined methicillin resistance among these isolates.

 Materials and Methods



A total of 205 samples were collected from casualty, oncology and multidisciplinary cardiac unit (MICU) wards of Kasturba Medical College Hospital, Manipal from December 2002 to February 2003. The specimens included swabs from floor, sink, tap, door handles of the wards and swabs from stethoscopes. Other samples included hospital staff 's fingernails, skin swab, scalp hair, nasal swabs and urine from catheteterized patients admitted to these wards.

Sterile cotton wool swabs, moistened with sterile normal saline were used to collect the specimen. Urine was collected by aspiration from the catheter using a sterile needle and syringe. Specimens were inoculated into brain heart infusion broth (BHI) immediately. Subcultures were done from BHI broth on to blood agar and MacConkey's plate. Staphylococcus species were identified up to species level as per the scheme described by Baird-Parker [5] The antimicrobial susceptibility test was performed according to standardized disc diffusion Kirby-Bauer method.[6] Each of the isolates was screened for methicillin resistance by disc diffusion method. Four of five colonies picked from overnight growth were inoculated into 4 to 5 mL of peptone water which was incubated at 35 °C until turbid to 0.5 McFarland standard. The methicillin susceptibility was tested using 1 µg Oxacillin discs (Hi-Media, Mumbai, India). The diameter of the clear zone around the disk was measured and the results were interpreted as susceptible or resistant.[1] Drug free plates were also inoculated for growth control. Methicillin Sensitivity was further confirmed by minimum inhibitory concentration at 0.2 mg/mL to 0.8 mg/mL and susceptibility to cefoxitin was tested by disc diffusion method. The zone size of 24 mm or less for cefoxitin was considered as resistant.[7]

 Results



Out of 205 samples screened 65 (31.7%) samples yielded Staphylococcus spp. and all of them were coagulase negative (CoNS). Resistance to oxacillin was 13.84% (9/65). Highest percentage of oxacillin resistant coagulase negative Staphylococcus strains (MR-CoNS) were isolated from the stethoscope 33.33% (3/9) followed by carriers in the anterior nares 22.22% (2/9) of hospital personnel [Table 1]. As shown in [Table 2], 32 out of 65 (49.23%) staphylococcal species belonged to S.epidermidis followed by S.saprophyticus 17/65 (26.15%).

Antibiotic sensitivity pattern of isolates showed 100% sensitivity to vancomycin, ciprofloxacin and amikacin. Resistance to ampicillin and amoxicillin-clavulinic acid was 70% each. Methicillin resistance was 14% [Table 3].

 Discussion



Of 205 samples collected from hospital wards and hospital personnel, 65 (31.7%) isolates were CoNS.This correlated well with the study conducted by Baumgalt et al[8] who reported 23% carrier rate of CoNS. Among the hospital staff, nasal carrier rate of CoNS was 45.94% (17/37 samples). This study is in concordance with the study conducted by Narayani et al [9] who reported nasal carrier rate of 62% CoNS. Our study showed a decreased incidence of CoNS in stethoscopes 33.71% (17/45) when compared to other studies, where 100% stethoscopes yielded CoNS. Smith et al reported 58% incidence of CoNS from stethoscope.[11]

Among the carrier isolates, S.epidermidis was the leading species followed by S. saprophyticus . Narayani et al [9] had found S.epidermidis as the commonest isolate followed by S. hominis . However, in our study S.hominis was the third commonest species. It is well known that S. saprophyticus is the leading agent among coagulase negative Staphylococcus strains associated with urinary tract infection. However, in our study there was no isolation from urine samples. CoNS had maximum resistance to ampicillin 69% (45/65), amoxicillin-clavulinic acid 69% (45/65) and TMP/SMX 65% (42/65). All strains were sensitive to vancomycin, amikacin and ciprofloxacin. Methicillin resistance was 14% (9/65), which was in concordance with the study conducted by Vijayalakshmi et al.[12] All these nine strains were confirmed to be methicillin resistant by MIC at 0.2 mg/mL to 0.8 mg/mL.Strains resistant to oxacillin were also resistant to cefoxitin. MR-CoNS carriage rate was highest in stethoscope 33.33% (3/9) when compared to other specimens. Marinella et al[10] reported more than 40% methicillin resistant Staphylococcus species from stethoscope which correlated with our study.

Methicillin resistant Staphylococcus spp. present in hospital personnels may act as carriers and can serve as a focus of nosocomial spread of multidrug resistant Staphylococci in tertiary level hospitals and cause problems to hospital infection control programmes.

References

1Majumder D, Sarma bordoloi JN, Phukan AC, Mahanta J. Antimicrobial susceptibility pattern among methicillin resistant staphylococcus isolates in Assam. Indian J Med Microbiol 2001; 19 :138-40.
2Jesudasan MV, Anandraj SW, Jagadeesan P. Incidence of methicillin resistant coagulase positive and coagulase negative staphylococcus in blood cultures. Indian J Med Res 1997; 105 :155-7.
3Jessen O, Rosendal K, Bulow P, Faber V, Erickson KR. Changing staphylococci and staphylococcal infection,a ten years study of bacteria and cases of bacteremia. N Engl J Med 1969; 281 :627-35.
4Joshi JR, Pawar S, Joshi PJ, Samuel A. Biological characters and antimicrobial sensitivity of staphylococcus epidermidis. Indian J Pathol Microbiol 1987; 30 :89-96.
5Baird-Parker AC. Methods for identifying Staphylococci and Micrococci: In skineer FA and Lovelock DW.(Editors): Identification Methods for Microbiologists. (Academic Press, London) 1979. p. 201-10.
6Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by standardized single disk method. Am J Clin Pathol 1966: 45 ;493-7.
7New CLIS/NCCLS Antimicrobial susceptibility testing (AST) Recommendations M100-S15.Available at http://www.phppo.cdc.gov/nltn/pdf/2005/4m100%20S15chectlist.pdf. Accessed March 5,2005
8Bavmgarlt S, Hall SE,Campos JM,Polin RA:Sepsis with CONS in critically ill newborn. AMJ dis child 1983; 137 :461-4.
9Narayani TV, Naseema K, Bhattacharya RN, Shyamkrishnan KG, Shanmugam J. Prevalence of Coagulase negative staphyloccus species Among Hospital personal and Surgical patients. Indian J Path Micro 1990; 33 :258-62.
10Marinello MA, Pierion C, Chenoweth C. The stethoscope, potential source of nosocomial infection? Arch Inter Med 1997; 157 :786-90.
11Smith MA, Mathewson JJ, Ulert IA, Scerpella EG, Ericsson CD. Contaminated stethoscopes revisited: Arch Inter Med 1996; 156 :82-4
12Vijayalakshmi N, Mohapatra LN, Bhujwala RA. Biological characters and antimicrobial sensitivity of S.epidermidis isolated from human source. Indian J Med Res 1980; 72 :16-22.