Prevalence of nasal carriage of MRSA in diabetic patients attending the outpatient department

Background: Up to 30% of the human population is asymptomatically colonized with nasal Staphylococcus aureus. Study was done to determine the prevalence and risk factors for MRSA colonization as nasal carrier in a population of outpatients with diabetes.Methods: The study enrolled patients with diabetes from whom nasal swabs were obtained and were analyzed for presence of MRSA.Results: Out of the 402 patients evaluated, 254 (63.18%) were colonized with S. aureus and 164 (64.56%) of them were MRSA.Conclusions: Diabetes have more propensity for MRSA colonization than non-diabetic patients. A better understanding of the epidemiology and risk factors for nasal MRSA colonization in the persons with diabetes may have significant implications for the treatment and prevention of MRSA infections.

High level of MRSA colonization in health care worker: alarm to implement health care policy.

The aim of the study was to investigate probable carrier rate of the healthcare workers and screened for carriers of MRSA as they could pose a potential risk factor for nosocomial transmission when the same carrier are exposed to the hospital setting during their clinical postings. A total of 100 nasal swabs were collected from the nursing staff and doctors. Sterile cotton swabs moistened with glucose broth were used for sample collection. Swabs were cultured on to nutrient agar, blood agar, and mannitol salt agar, incubated at 35 °C for 48 hrs. Staphylococcus aureus was identified by standard methods according to CLSI guidelines. Methicillin resistance was detected by using cefoxitin disc 30pgm on Mueller Hinton agar with 4% NaCL Of the 100 samples screened 30(30%) strains of Staphylococcus aureus were isolated, out of which 16 (53.33%) were Methicillin resistant Staphylococcus aureus (MRSA) and 14 (46.66%) were methicillin sensitive Staphylococcus aureus (MSSA). The overall carriage rate of methicillin resistant Staphylococcus aureus in our study was 16% with the highest rate being seen among the nursing staff (19.35%) and clinical staff carriage rate was lesser (10.52%) as compared to the nursing staff. Chest department samples showed higher carriage rate (33.33%) followed by pediatrics department (28.57%). The present study revealed that HCWs who have contact with patients are at risk of acquisition and colonization with antimicrobial resistant bacteria especially MRSA. Transient hand colonization is the primary mean of cross transmission. Simply education of HCWs on hygienic measures especially proper hand wash is the key to overcome MRSA infection in ICUs.

Carriage frequency, phenotypic and genotypic characteristics of Staphylococcus aureus isolated from dialysis and kidney tranplant patients at a hosptial in northern Paraná

The objective of the present study was to determine the frequency of Staphylococcus aureus nasal carriage among dialysis and kidney transplant patients, to identify the antimicrobial resistance profile of these strains and to verify their genetic profiles with the RW3A primer. The study included 159 individuals, comprising 111 dialysis and 48 kidney transplant patients. Of the 48 transplant patients, 75% were positive for S. aureus, whereas 49% of the 111 dialysis patients were carriers. Two samples yielded conflicting results for oxacillin sensitivity between the disk diffusion and minimum inhibitory concentration (MIC) assays: both were sensitive by the disk diffusion assay and resistant by MIC (4 μg/ml). In the antibiogram by disk diffusion, ten samples were resistant to cefoxitin, among which eight were also resistant to oxacillin. The resistance of the ten samples to cefoxitin by the disk diffusion assay was confirmed by MIC. Of the ten oxacillin-resistant samples, eight harbored the mecA gene. All samples were sensitive to vancomycin, and most were resistant to penicillin and demonstrated high rates of resistance to the other antimicrobials tested. The samples from dialysis patients exhibited a more homogenous genetic profile. Among the samples with a high percent similarity, no correlation with sensitivity or resistance to oxacillin was observed. According to the results of this study, the implementation of prevention and control measures, such as increased restrictions on prescriptions for antimicrobial drugs and nasal decontamination prior to high-risk procedures, is recommended.

Portadores nasales de Staphylococcus aureus en personal que labora en un Hospital de Santander / Nasal carriers of Staphylococcus aureus in the personnel that works in a Hospital of Santander

Introducción: Las infecciones intrahospitalarias constituyen un problema de salud pública mundial, la diseminación de bacterias patógenas a partir del personal de salud, ha sido el enfoque de numerosas investigaciones que buscan mejorar la calidad de vida de los pacientes. Objetivo: Determinar la frecuencia de portadores de Staphylococcus aureus en fosas nasales del personal que labora en las unidades de cuidados intensivos, infectología pediátrica y lactario en un Hospital en Santander. Metodología: Se estudiaron muestras provenientes de fosas nasales de 87 trabajadores del Hospital. Las cepas aisladas se identificaron mediante las pruebas bioquímicas y posteriormente, se determinó el perfil de susceptibilidad ante diferentes antibióticos, se realizó test D a las cepas de S. aureus. Resultados: La frecuencia de portadores de bacterias patógenas fue 41,4%; el patógeno aislado con mayor frecuencia fue S. aureus (72%), donde el porcentaje de S. aureus meticilino-resistentes (SARM) fue de 11,6%, Enterobacter aerogenes (6%), Proteus mirabilis (2,3%), Haemophylus influenzae (1,1%), Citrobacter koseri (1,1%) y Providencia rettgeri (1,1%). Conclusión: S. aureus es el agente aislado con mayor frecuencia de las fosas nasales del personal de salud y la presencia de SARM es preocupante por su resistencia a los antibióticos, lo que dificulta su tratamiento. Este hecho evidencia la necesidad de actuar con un carácter preventivo, en el cual el control de portadores es crítico y debe asociarse con medidas de bioseguridad que establezcan barreras más eficientes, para reducir la diseminación del microorganismo y la ocurrencia de infecciones intrahospitalarias. Salud UIS 2011; 43 (2): 111-117.

Introduction: Nosocomial infections are a public health problem worldwide, its spread start from health personnel carrier of pathogenic bacteria, it has been the focus of a large number of research to improve the quality of life of the patients. Objective: To determine the frequency of nasal carriers of Staphylococcus aureus in the personnel that works in intensive care units (adults ICU and pediatric ICU), pediatric infectology and lactary in a Hospital in Santander. Methodology: Nasal samples from 87 workers from of the Hospital were studied. Isolated strains were identified by the corresponding biochemical tests and subsequently determined their susceptibility profiles to different antibiotics and test D for S. aureus. Results: The frequency of nasal carriers of pathogenic bacteria was 41.4%; it was found that S. aureus was the most isolated pathogenic microorganism, with a frequency of (72%). The percentage of meticilin resistant S. aureus (MRSA) was 11.6% , Enterobacter aerogenes (6%), Proteus mirabilis (2.3%); Haemophylus influenzae (1.1%); Citrobacter koseri (1.1%) and Providencia rettgeri (1.1%). Conclusion: S. aureus is the most frequently isolated agent in health personnel's nasal nostrils and the presence of MRSA is worrying, additionally, it presents characteristic of resistance to antibiotics, making harder its treatment. This fact evidences the necessity to act with a preventive character, in which the control of carriers is critical and it should be associated with biosecurity measures to establish effective barriers to reduce the dissemination of the microorganism and occurrence of nosocomial infections. Salud UIS 2011; 43 (2): 111-117.

Comparison of BBL chromagar MRSA to conventional media for the detection of methicillin resistant staphylococcus aureus in surveillance nasal swabs

Objectives This study aims to detect MRSA nasal carriers among medical staff and patients in Dermatology ward Hospital Kuala Lumpur by using two methods, the conventional blood sheep agar (BSA) and the novel BBL CHROMagar MRSA (C-MRSA). It also aims to compare the BSA medium with the C-MRSA medium in terms of specificity, sensitivity and time to detection to MRSA. Method A single centre, prospective study where 100 nasal swab samples were taken from medical staff and inpatients, then plated on to both BSA and C-MRSA. After 24 hours incubation, the plates were examined for presence of bacterial colonies, then incubated for another 24 hours if no colonies were present. All colonies on C-MRSA and BSA were subjected to coagulase and susceptibility testing for confirmation of MRSA. MRSA strains produce mauve colonies on CMRSA from hydrolysis of the chromogenic substance, thus C-MRSA uses colour as a diagnostic tool. Results Mauve colonies were present on nine C-MRSA plates in the first 24 hours which were all confirmed to be MRSA. Another nine CMRSA plates isolated bluish colonies which were not MRSA. There were colonies on 96 BSA plates, nine of which were MRSA. C-MRSA medium has 100% sensitivity and specificity in detecting MRSA. Both culture media had similar detection rates of MRSA from nasal swabs, however C-MRSA allows for earlier detection of MRSA within 24 hours compared to BSA which takes 48 hours. 2.2% of ward staff and 15.7% of inpatients were found to be MRSA carriers. Conclusion CHROMagar MRSA allows for more rapid identification of MRSA carriers within 24 hours compared to the conventional BSA which takes 48 hours. This allows earlier action to be taken to reduce the spread of MRSA infection.

Preoperative Nasal Carriage of Methicillin-Resistant Staphylococcus aureus and the Risks of Nosocomial Infection in Cardiac Surgery Patients / 병원감염관리

BACKGROUND: This study was conducted to investigate whether the preoperative nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) was a risk factor for surgical site infections and nosocomial infections in open heart surgery patients. METHODS: From June 10, 2002 to October 30, 2002, data were collected by prospective surveillance carried out by infection control nurses. Nasal swabs were taken from patients (N= 106) on the day before surgery. The swabs were incubated in staphylococcal broth for 24 hours, and then it was incubated on mannitol salt agar for 24 hours. Muller-Hinton agar supplemented with oxacillin (6 microgram/mL) was used to identify MRSA. RESULTS: Among the study patients (N=106), four(4/106, 3.8%) were identified as MRSA carriers and nine (9/103 , 8.7%) developed nosocomial infections, including three patients (3/103 , 2.9%) who had postoperative mediastinitis Preoperative nasal carriage of MRSA was not associated with nosocomial infections nor surgical site infections (P>0.05). However, the length of hospital stay prior to nasal swab or surgery was found to be associated with MRSA carriage (OR=1.108, 95%CI: 1.026-1.197) or nosocomial infections (OR=1.087, 95%CI: 1.017-1.161). Additionally, the patients with nosocomial infections were more likely than those without to stay in the hospital for a longer period after surgery (P<0.00l). CONCLUSION: Preoperative nasal carriage of MRSA by the patient was not identified as a risk factor for surgical site infection and nosocomial infections in open heart surgery.

Health Care Workers' Nasal Carriage and Outbreak Control of Epidemic Methicillin-resistant Staphylococcus aureus / 감염

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is the major pathogen of nosocomial infections. There are many reports that MRSA nasal cariers play a major role in the transmission of MRSA. We studied to assess the nasal carriage rates, therapeutic effects of nasal carriers and control of MRSA outbreak in a tertiary, acute and educational hospital. METHODS: From 1990 to 1997, eight MRSA epidemics were detected and investigated for outbreak control. We surveyed the MRSA colonization of anterior nares and hands of health care workers (HCW). MRSA was identified by staphylococcal broth, mannitol-salt- agar, Muller-Hinton-oxacillin agar. To identify the permanent carriers in the HCWs, the nasal swab was done weekly for 3 weeks. Two percent povidone iodine ointment or 2% mupirocin ointment was applied topically to treat the permanent MRSA nasal carriers. RESULTS: Of eight MRSA outbreaks, five epidemics occurred in the intensive care unit, all of them occurred in surgical departments and five of them occurred in winter seasons. For eight MRSA outbreaks, 351 HCWs were surveyed. The rates of transient carriers was 10.8% (38/351) and the rates of that were 9.0% (10/111) in medical doctors (MD), 12.5% (24/192) in registered nurses (RN) and 11.4% (4/35) in aid nurses (P=0.470). The rate of permanent carrier in doctors was 1.8%, and that in RNs was 3.7% (P=0.490). After topical therapy with 2% povidone iodine ointment or 2% mupirocin ointment for permanent carriers, MRSA was not identified for 2 months follow up. CONCLUSION: In MRSA epidemics, the rate of the transient carrier rate of MRSA in HCWs was 10.8% and the rate of the permanent carrier was 2.6%. The difference of carrier rates in HCWs was not significant statistically. The therapy for the permanent nasal carriers in HCWs with two percent povidone iodine ointment or 2% mupirocin ointment was very effective. And MRSA outbreaks were ended and controlled for 6months follow up.