Title: Prevalence and Antibiotic Susceptibility Pattern of Staphylococcus aureus isolated from Blood Culture in a Teritiary Care Centre

Authors: Dr Sindhu Cugati, Dr Chitralekha Saikumar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i4.178

Abstract

Introduction: Bloodstream infections (BSIs) are associated with significant patient morbidity and mortality. Staphylococcus aureus (S. aureus) is a leading cause of bacteremia. Methicillin resistant Staphylococcus aureus (MRSA) is problematic, as the therapeutic outcome of MRSA infections is much worse compared to methicillin sensitive Staphylococcus aureus (MSSA).

Aim: To determine the prevalence &antibiotic susceptibility pattern of Staphylococcus aureus strains isolated from blood culture.

Methodology: This study was carried out from July 2016 to December 2016 in which 982 blood culture bottles were processed by automated blood culture system. A total of 161 strains of S. aureus isolated, were identified by standard biochemical methods. Antibiotic susceptibility testing was performed by Kirby Bauer Disk Diffusion method. Methicillin resistance was detected using cefoxitin (30 µg) disc.

Results: In our study 52.9% of isolates from blood culture were S. aureus, out of which 57.1% were MRSA & 42.9% were MSSA. In MRSA strains, the resistant rates to Penicillin, Erythromycin, Clindamycin, Cotrimoxazole, Ciprofloxacin & Gentamycin were 100%, 60%, 45%, 40%, 35% & 40% respectively. In MSSA strains, the resistance rates to thesame antibiotics were 86%, 14%, 11%, 9%, 10% & 13 % respectively. All the S. aureus strains were sensitive to Linezolid & Teicoplanin.

Conclusion: Indiscriminate and irrational use of antibiotics have led to the emergence of superbugs like MRSA. Information regarding prevalence & antibiotic susceptibility patterns of MRSA strains guide the cliniciansto initiate empirical therapy and will help in formulation of antibiotic policy.

Keywords: Bacteremia; Blood Culture; MRSA; MSSA; S. aureus.

References

1.      Maj Puneet Bhatt, Gurpreet Singh Bhalla, Kundan Tandel, Prashant Jindamwar, CN Chaudhari, Naveen Grover Ajay Kumar Sahni. Antimicrobial Susceptibility Profile of Methicillin-resistant Staphylococcus aureus at a Tertiary Care Centre. Archives of Clinical Microbiology ISSN 1989-8436. 2015;6(3):6

2.      Madeleine Dulon, Frank Haamann, Claud-ia  Peters, Anja Schablon, Albert  Nienhaus. MRSA prevalence in european  healthcare settings: a review. BMC Infectious Diseases2011;11(1):138-150

3.      Steven Y. C. Tong, Joshua S. Davis, Emily Eichenberger, Thomas L. Holland, Vance G. Fowler. Staphylococcus aureus Infections: Epidemiology, Pathophys-iology, Clinical Manifestations, and Manag-ement. Clin Microbiol Rev 2015;28(3):603-661

4.      Kaisen Chen, Yanfang Huang, Qiuyue  Song, Chenhui Wu, Xiaowen Chen and Lingbing Zeng. Drug-resistance dynamics of Staphylococcus aureus between 2008 and 2014 at a tertiary teaching hospital, Jiangxi Province, China. BMC Infectious Diseases 2017;17:97

5.      R. Regha, Deepa Harichandran and B. Sulekha. Inducible Clindamycin Resistance among Clinical Isolates of Staphylococcus aureus in a Tertiary Care Centre, Kerala, India. Int.J.Curr. Microbiol.App.Sci 2016;5(4):929-934

6.      Sujata Baveja, Anuradha De, Shripad Taklikar, Alka Sonavane, Kanchan Wanjari. Multidrug Resistant Bacteria in A Tertiary Care Hospital. Journal of Evolution of Medical & Dental Sciences 2012;1(6):944-951

7.      Rabindran, Devendran V and Velmurugan D. Emerging Antibiotic Resistance of Blood Stream Infections among Children. J Infect Dis Ther 2015;3(6)

8.      Mogahid M. Elhassan, Hani A.Ozbak, Hassan A. Hemeg, Miskelyemen A. Elmekki and Leila M. Ahmed. Absence of the mecA Gene in Methicillin Resistant Staphylococcus aureus Isolated from Different Clinical Specimens in Shendi City, Sudan. Bio Med Research Interna-tional 2015;Article ID 895860:5 pages

9.      Minal B Trivedi, Mahendra Vegad, Sumeeta Soni. Prevalence of Methicillin-Resistant Staphylococcus aureus in various clinical samples in a tertiary-care hospital. Int J Med Sci Public Health2015 ;4(12):1735-1738

10.  Bilal Ahmad Mir, Dr. Srikanth. Prevalence and Antimicrobial Susceptibility of Methicillin Resistant Staphylococcus aureus and coagulase-negative staphylo-cocci in a tertiary care hospital. Asian J Pharm Clin Res 2013;6(3):231-234

11.  K Rajaduraipandi, KR Mani, K Panneerselvam, M Mani, M Bhaskar, P Manikandan. Prevalence and Antimicrobial Susceptibility Pattern of Methicillin Resistant Staphylococcus aureus: a multicentre study. Indian J Med Microbiol 2006 Jan;24(1):34-8

12.  Ankur Goyal, Manish Kumar Diwakar, Suneel Bhooshan, Sapna Goyal, Arti Agrawal. Prevalence and Antimicrobial Susceptibility Pattern of Methicillin-resistant Staphylococcus aureus [MRSA] isolates at a Tertiary Care Hospital in Agra, North India – A systemic annual review.  IOSR Journal of Dental and Medical Sciences 2013;11(6):80-84 

13.  Lyra. P R, Anuradha.K, Shilpa. A and  Venkatesha. D.  Linezolid resistance in isolates of Methicillin Resistant Staphylococci from blood cultures  Int J Pharm Bio Sci 2013 Oct;4(4):(B)1085-109

14.  Asad Ullah, Muhammad Qasim, Hazir Rahman, Jafar Khan, Mohammad Haroon, Niaz Muhammad et al. High frequency of methicillin-resistant Staphylococcus aureus in Peshawar Region of Pakistan. Springerplus 2016;5:600. doi:10.1186/s40064-016-2277-3

15.  Calik Zeki, Karamese Murat and Acar Osman. Prevalence and Antimicrobial Resistance of Staphylococcus aureus Isolated from Blood Culture in University Hospital, Turkey. Glob J Infect Dis Clin Res 1(1):010-013

16.  James A Karlowsky, Mark E Jones, Deborah  C Draghi, Clyde Thornsberry, Daniel F Sahm and Gregory A Volturo. Prevalence and antimicrobial suscepti-bilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002.Annals of Clinical Microbiology and Antimicrobials2004;3:7

17.  Mylotte JM, McDermott C, Spooner JA. Prospective study of 114 consecutive episodes of Staphylococcus aureus bacteremia. Rev Infect Dis 1987 Sep-Oct;9(5):891-907

18.  Shurland S, Zhan M, Bradham DD, Roghmann MC. Comparison of mortality risk associated with bacteremia due to Methicillin-resistant and Methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidem 2007 Mar;28(3):273-9

19.  Mesut Yilmaz, Nazif Elaldi, İlker İnanç Balkan, Ferhat Arslan, Ayşe Alga Batırel, Mustafa Zahir Bakıcı et al. Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study.Ann Clin Microbiol Antimicrob 2016;15:7

20.  T. P. Lodise, J. Graves, A. Evans, E. Graffunder, M. Helmecke, B. M. Lomaestro et al. Relationship between Vancomycin MIC and Failure among Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia Treated with Vancomycin. Antimicrob Agents Chemother 2008;52(9):3315–3320

21.  M. Shanthi, Uma Sekar. Antimicrobial susceptibility pattern of Methicillin Resistant Staphylococcus aureus at Sri Ramachandra Medical Centre. Sri Ramachandra Journal of Medicine, June 2009;2(2)

22.  J.G. Collee, Barrie P. Marmion, AG Fraser, A. Simmons. Mackie and McCartney Practical Medical Microbiology, 14th ed. Edinburgh: Churchill Livingstone;2007

23.  Clinical and Laboratory Standards Institute, 26th edition, M100S Performance standards for antimicrobial susceptibility testing.

24.  Rasmus V. Rasmussen, Vance G. Fowler Jr, Robert Skov, and Niels E. Bruun. Future challenges and treatment of Staphylococcus aureus bacteremia with emphasis on MRSA. Future Microbiol 2011;6(1):43–56

25.  Napolitano LM. Emerging issues in the diagnosis and management of infections caused by multi-drug-resistant, gram-positive cocci. Surg Infect (Larchmt). 2005;6 Suppl 2:S-5-22

26.  VanEperen AS, Segreti J. Empirical therapy in Methicillin-resistant Staphylococcus Aureus infections: An Up-To-Date approach. J Infect Chemother. 2016 Jun;22(6):351-9

27.  CennetRagbetli, MehmetParlak, Yasemin Bayram, Huseyin Guducuoglu, and Nesrin Ceylan. Evaluation of Antimicrobial Resistance in Staphylococcus aureus isolates by years. Interdisciplinary Perspe-ctives on Infectious Diseases Volume  2016 (2016), Article ID 9171395, 4 pages

28.  Vibhor Tak, Purva Mathur, Sanjeev Lalwani, and Mahesh Chandra Misra Staphylococcal Blood Stream Infections: Epidemiology, Resistance Pattern and Outcome at a Level 1 Indian Trauma Care Center. J Lab Physicians. 2013 Jan-Jun;5(1):46–50

29.  Sangeeta Joshi, Pallab Ray, Vikas Manchanda,Jyoti Bajaj,D.S. Chitnis, Vikas Gautam et al . Methicillin resistant Staphylococcus aureus(MRSA) in India: Prevalence & susceptibility patternIndian J Med Res. 2013 Feb;137(2):363–369.

Corresponding Author

Sindhu Cugati

Tutor, Department of Microbiology, Sree Balaji Medical College, Chennai

Mobile No: 8754582429, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.