Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Clinical characteristics and antibiotic resistance profle with emphasis on macrolide-lincosamide-streptogramin B resistance
Journal Title: Sultan Qaboos University Medical Journal - Year 2016, Vol 16, Issue 2
Abstract
Objectives: Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen worldwide and its multidrug resistance is a major concern. Tis study aimed to determine the clinical characteristics and antibiotic susceptibility profle of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-streptogramin B (MLSB) phenotypes and vancomycin. Methods: Tis cross-sectional study was carried out between February 2014 and February 2015 across four tertiary care hospitals in Mangalore, South India. Healthcare-associated infections among 291 inpatients at these hospitals were identifed according to the Centers for Disease Control and Prevention guidelines. Clinical specimens were collected based on infection type. S. aureus and MRSA isolates were identifed and antibiotic susceptibility tests performed using the Kirby-Bauer disk diffusion method. Te minimum inhibitory concentration of vancomycin was determined using the Agar dilution method and inducible clindamycin resistance was detected with a double-disk diffusion test (D-test). Results: Out of 291 healthcare-associated S. aureus cases, 88 were MRSA (30.2%). Of these, 54.6% were skin and soft tissue infections. All of the isolates were susceptible to teicoplanin and linezolid. Four MRSA isolates exhibited intermediate resistance to vancomycin (4.6%). Of the MRSA strains, 10 (11.4%) were constitutive MLS B phenotypes, 31 (35.2%) were inducible MLSB phenotypes and 14 (15.9%) were macrolide-streptogramin B phenotypes. Conclusion: Healthcare-associated MRSA multidrug resistance was alarmingly high. In routine antibiotic susceptibility testing, a D-test should always be performed if an isolate is resistant to erythromycin but susceptible to clindamycin. Determination of the minimum inhibitory concentration of vancomycin is necessary when treating patients with MRSA infections.
Authors and Affiliations
Jyoti Kumari| Departments of Microbiology , Kasturba Medical College, Mangalore, India, Shalini M. Shenoy| Departments of Microbiology , Kasturba Medical College, Mangalore, India, Shrikala Baliga| Departments of Microbiology , Kasturba Medical College, Mangalore, India, Chakrapani M. | Departments of Medicine, Kasturba Medical College, Mangalore, India, Gopalkrishna K. Bhat| Departments of Microbiology , Kasturba Medical College, Mangalore, India
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