Abstract
Methicillin Resistant Staphylococcus aureus (MRSA) were noticed in 1961 and they developed into a Health-care associated organism throughout the world. Recently the appearance of endemic Community- acquired MRSA has been reported. Infections due to community acquired MRSA are recent world wide phenomenon. This study was undertaken to compare CA-MRSA and HA-MRSA isolates on the basis of their genotyping results, clinical presentations and antibiotic susceptibilitiy pattern.
Method
Study design: Descriptive study.
Study Setting: Central Microbiology laboratory, Govt. Medical College, Thiruvananthapuram.
Sample size: 161 isolates of Methicillin Resistant Staphylococcus aureus.
Study period: 1 year.
Results: The proportion of HA-MRSA is 94(58%) and CA-MRSA 67(42%) among 161 MRSA isolates. A male preponderance is observed in both types of MRSA. The commonest clinical presentation of HA-MRSA is cellulitis ie,32(34.04%) ,followed by post operative wound infection ie,27 (28.72%). The commonest clinical presentation of CA-MRSA is abscess ie,27(40%), followed by post traumatic wound infection ie,14 (21% ) . Extremes of age, history of recent hospitalization in past I year, history of surgery in the past and Type 2 Diabetes Mellitus are the risk factors observed in case of HA-MRSA. CA-MRSA isolates show lower resistance rate towards Trimethoprim –Sulfamethoxazole 15(22.3%) than 27,(28.72%) of HA-MRSA. Resistance rates of Gentamicin were high in both CA- MRSA and HA-MRSA, ie 92.5% and 93.6% respectively. CA-MRSA showed more resistance to Amikacin 28(41.79%) and HA-MRSA 0(21.27%).CA-MRSA showed resistance to Ciprofloxacin for 65 strains (97%) and HA- MRSA to 62 strains (65.9%). Both types of MRSA showed a low and similar resistance rate of Tetracycline ie, 10.44% CA and 9.57% HA-MRSA respectively. Lower rate of Clindamycin resistance was shown by both CA-MRSA and HA-MRSA ie, 1 (1.49%) and 6 (6.38%) respectively. All 94 isolates of HA-MRSA and 67 isolates of CA-MRSA were uniformly sensitive to Vancomycin , Linezold and Rifampicin.
Keywords: CA-MRSA,HA-MRSA.
References
1. Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN,Beach M. SENTRY Participants Group: Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis 2001, 32 (Suppl 2):114-132.
2. Rohani, M. Antibiotic resistance patterns of bacteria isolated in Malaysian hospitals. Int. Med. J.1999; 6: 47- 51
3. Zinn C S, Westh H, Rosdahl VT, the SARISA Study Group: An International multicenter study of antimicrobial resistance and typing of hospital Staphylococcus aureus isolates from 21 laboratories in 19 countries or states. Microb Drug Resist. 2004; 10:160- 168.
4. Maple PAC, Hamilton- Miller JMT, Brumfitt W. Worldwide antibiotic resistance in Methicillin resistant Staphylococcus aureus. Lancet 1989;1:537-40.
5. Habeeb Khadri and Mohammed Alzohairy. Prevalence and antibiotic susceptibility pattern of methicillin-resistant abd coagulase-negative staphylococci in a tertiary care hospital in India. International Journal of Medicine and Medical Sciences April 2010;Vol.2(4), pp.116-120
6. Anupurba S, Sen MR, Nath G, Sharma BM, Gulati AK, Mohapatra TM. Prevalence of Methicillin Resistant Staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh. Indian J Med Microbiol 2003; 49-51
7. Centres for Disease Control and Prevention http://www.cdc.gov/ncidod/dhpq/ar_mrsa_ca_clinicians.htm1#4
8. Nicolas.A.Forcade, Michael L. Parchman, et al. Prevalence, Severity, and Treatment of Community - Acquired Methicillin-Resistant Staphy-lococus Aureus (CA-MRSA) Skin and Soft Tissue Infections in 10 Medical Clinics in Texas: A South Texas Ambulatory Research Netrok (STRARNet) Study. J and Board Fam Med September -October 2011; Vol.24 no.5 543-550.
9. Manal M Baddour, Manal M Abuelkheir and Amal J Fatani. Trends in antibiotic susceptibility patterns and epidemiology of MRSA isolates from several hospitals in Riyadh, Saudi Arabia. Annals of Clinical Microbiology and Antimicrobials 2006; 5:30.
10. L K Khanal and B K Jha.Prevalence of Methicillin resistant Staphylococcus aureus (MRSA) among skin infection cases at a hospital in Chitwan, Nepal. Nepal Med Coll J.2010; 12(4): 224-228.
11. Hsin Huang, Neil M. Flynn et al. Comparisons of Community Associated Methicillin Resistant Staphylococcus aureus (MRSA) and Hospital Associated Methicillin Resistant Staphylococcus aureus (MRSA)d July 2006; Vol.7:2423-2427.
12. Marcus J. Zervos, Katherine Freeman, Lien Vo. Epidemiology and Outcomes of Complicated Skin and Soft Tissue Infections in Hospitalized patients. Journal of Clinical Microbiology 2012; p. 238 – 245
13. Dr.Uma Chaudhary, Dr.Swati Behera, Dr.Aparna. Comparative study of community and health care associated Methacillin Resistant staphylococcus aureus infections. Int J Pharm Bio Sci 2012 July; 3(3)O (g) 717-722A
14. Mel-Hatra Arakama, Myrna Mendoza, Patrick Fernadez. Emergence of Methicillin – resistant Staphycolococcus aureus among Patients in a Teritary Renal Medical Centre. Philippine Journal of Microbiology and Infectious Disease. January – June 2010 ; Vol.39, Issue 1
15. Saikia .L, Nath.R, Choudary.B, Sarkar.M, Prevalence and antimicrobial susceptibility pattern of Methicillin resistant Staphylococcus aureus in Assam Indian J Crit Care Med 2009;13:156-8
16. Louis B.Rice. Antimicrobial resistance in Gram positive bacteria.The American journal of Medicine 2006;Vol 119(6A)
17. Gorwitz RJ, Jernigan DB, Powers JH, Jernigan JA, and Participants in the CDC Convened Experts’ Meeting on Management of MRSA in the Community . Strategies for Clinical management of MRSA in the community: Summary of an experts meeting convened by the Centres for Disease Control and Prevention. 2006.
18. http://www.cdc.gov/ncidod/hip/ARESIST/mrsa.htmWalraven CJ, Lingenfelter E, Rolloi J et al. diagnostic and therapeutic evaluation of community acquired Methicillin Resistant Staphylococuss aureus (MRSA) skin and soft tissue infections in the emergency department. J Hosp Infect 2007; 67: 109-113.
19. Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK, Chaudhary R. Inducible Clindamycin resistance in clinical isolates of Staphylococcus aureus. Indian J Med Res 2006 ; 123: 571-3
20. K.M.Mohanasoudaram & M.K. Lalitha. Comparison of phenotypic versus genotypic methods in the detection of methicillin resistance in Staphylococcus aureus.Indian J Med Res,January 2008;127:78-84
21. Abeer Ghazal,Ola Kader,Samia Ebid,Nancy Mostafa and Shima El Sayed.Detection of Community Acquired Methicillin resistance Staphylococcus aureus among Staphylococcus aureus isolates. Journal of American Science,2011;7
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.61
