DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162275

Clinico-microbiological study of community acquired and health care associated methicillin-resistant Staphylococcus aureus from skin and soft tissue infections

Swapna Helen John, Sarada Devi Karunakaran Lelitha, Remadevi Surendran

Abstract


Background: Methicillin-resistant Staphylococcus aureus (MRSA) has long been a problematic pathogen, confined largely to hospitals and health care environments. But in the past decade, resistant strains have begun to appear among healthy community members without the traditional health care associated risk factors. In the present study, we sought to determine the prevalence of community acquired MRSA (CA-MRSA) and health care associated MRSA (HA-MRSA) among patients with skin and soft tissue infections (SSTIs ) and to study the differences between these with respect to clinical features, risk factors and antibiotic sensitivity patterns.

Methods: 100 consecutive Staphyococcus aureus isolates from each from community acquired and health care associated SSTIs (a total of 200 isolates) were studied. Standard identification protocols were employed and antibiotic susceptibility testing was interpreted according to CLSI guidelines.

Results: The prevalence of HA- MRSA was 54% while that of CA- MRSA was 52%. Majority of the HA-MRSA infections occurred in patients with extremes of age. In contrast, majority of CA-MRSA patients were young children. History of hospitalization in the past one year and a history of surgery in the past three months were the significant risk factors for acquiring HA-MRSA. CA-MRSA found no significant association with the known risk factors. Though the antibiotic resistance to Cotrimoxazole, Erythromycin and Clindamycin were lower among CA-MRSA isolates when compared with HA-MRSA isolates (55.8% versus 85.2%; 76.9% versus 92.6 %; 19.3% versus 29.7%), the rates of resistance of CA-MRSA isolates to non β-lactam antibiotics were higher than expected.

Conclusions: CA-MRSA strains are equally prevalent as HA-MRSA strains and can no longer be lightly regarded in the current scenario. Moreover the susceptibility of CA-MRSA strains to non β lactam antibiotics seem to be decreasing and can no longer be used as defining criteria to differentiate them from HA- MRSA strains.

 


Keywords


Acquired MRSA, Community, Skin infections

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References


David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: Epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev. 2010;23(3):616-87.

Dulon M, Haamann F, Peters C, Schablon A, Nienhaus A. MRSA prevalence in European healthcare settings: a review. BMC Infect Dis. 2011;11:138.

Khadri H, Alzohairy M. Prevalence and antibiotic susceptibility pattern of methicillin-resistant and coagulase-negative staphylococci in a tertiary care hospital in India. Int J Med Med Sci. 2010;2(4):116-20.

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;21:49-51

D’Souza N, Rodrigues C, Mehta A. Molecular characterization of methicillin resistant Staphylococcus aureus with emergence of epidemic clones of Sequence Type (ST) 22 and ST 772 in Mumbai, India. J Clin Microbiol. 2010;48(5):1806-11.

Huang H, Flynn NM, King JH, Monchaud C, Morita M, Cohen SH. Comparisons of community-associated methicillin-resistant Staphylococcus aureus (MRSA) and Hospital-Associated MSRA Infections in Sacramento, California. J Clin Microbiol. 2006;44(7):2423-7.

Patel M, Waites KB, Moser SA, Cloud GA, Hoesley CJ. Prevalence of inducible clindamycin resistance among community- and hospital-associated Staphylococcus aureus Isolates. J Clin Microbiol. 2006;44(7):2481-4.

Shen HN, Chin-Li Lu. Skin and soft tissue infections in hospitalized and critically ill patients: a nationwide population-based study. BMC Infect Dis. 2010;10:151.

Kamath S, Mallaya S, Shenoy S. Nosocomial infections in neonatal intensive care units: profile, risk factor assessment and antibiogram. Indian J Pediatr. 2010;77(1):37-9.

Larsen AR, Stegger M, Böcher S, Sørum M, Monnet DL, Skov RL. Emergence and characterization of community-associated methicillin-resistant Staphyloccocus aureus infections in Denmark, 1999 to 2006. J Clin Microbiol. 2009;47:73-8.

McCullough AC, Seifried M, Zhao X, Haase J, Kabat WJ, Yogev R et al. Higher incidence of perineal community acquired MRSA infections among toddlers. BMC Pediatr. 2011;11:96.

Teran CG, Sura S, Thant Lin TM, Medows M, Cynthia D, Wong SH. Current role of community acquired Methicillin Resistant Staphylococcus aureus among children with skin and soft tissue infections. Pediatr Rep. 2012;4:e5.

Tavares DA, Sá‐Leão R, Miragaia M, De Lencastre H. Large screening of CA‐MRSA among Staphylococcus aureus colonizing healthy young children living in two areas (urban and rural) of Portugal. BMC Infect Dis. 2010;10:110.

Zervos MJ, Freeman K, Vo L, Haque N, Pokharna H, Raut M, et al. Epidemiology and outcomes of complicated skin and soft tissue infections in hospitalized patients. J Clin Microbiol. 2012;50(2):238-45.

Forcade NA, Parchman ML, Jorgensen JH, Du LC, Nyren NR, Treviño LB. Prevalence, severity, and treatment of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections in 10 medical clinics in texas: a south texas ambulatory research network (STARNet) Study. J Am Board Fam Med. 2011;24(5):543-50.

Stryjewski ME, Chambers HF. Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2008;46(suppl 5):S368-77.

Khawcharoenporn T, Tice AD, Grandinetti A, Chow D. risk factors for community-associated methicillin-resistant staphylococcus aureus cellulitis and the value of recognition. Hawaii Med J. 2010;69(10):232-6.

Chaudhary U, Behera SA. Comparitive study of community–and health care associated Methicillin Resistant staphylococcus aureus infections. Int J Pharm Bio Sci. 2012;3(3):(B)717-22.

Patel M, Waites KB, Moser SA, Cloud GA, Hoesley CJ. Prevalence of inducible clindamycin resistance among community and hospital-associated Staphylococcus aureus Isolates. J Clin Microbiol. 2006;44(7):2481-4.

Valsesia G, Rossi M, Bertschy S, Pfyffer GE. Emergence of SCCmec type IV and SCCmec type V methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leukocidin genes in a large academic teaching hospital in central Switzerland: external invaders or persisting circulators? J Clin Microbiol. 2010;48(3):720-7.

Walraven CJ, Lingenfelter E, Rollo J, Madsen T, Alexander DP. Diagnostic and therapeutic evaluation of community-acquired Methicillin Resistant Staphylococcus aureus (MRSA) skin and soft tissue infections in the emergency department. J Emerg Med. 2012;42(4):392-9.

Chua K, Laurent F, Coombs G, Grayson ML, Howden BP. Antimicrobial resistance: Not community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). A clinician's guide to community MRSA-its evolving antimicrobial resistance and implications for therapy. Clin Infect Dis. 2011;52(1):99-114.

Baddour MM, Abuelkheir MM, Fatani AJ. Trends in antibiotic susceptibility patterns and epidemiology of MRSA isolates from several hospitals in Riyadh, Saudi Arabia. Ann Clin Microbiol Antimicrob. 2006;5:30.

Rice LB. Antimicrobial Resistance in Gram-Positive Bacteria. Am J Med. 2006;119(6 Suppl 1):S11-9.

Mandelia C, Shenoy S. Community Associated- MRSA in skin and soft tissue infections. J Clin Diagn Res. 2010;(4):2673-26.