MRSA carriage in a tertiary governmental hospital in Thailand: emphasis on prevalence and molecular epidemiology.

We investigated prevalence and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) in a case-control study performed in a 900-bed tertiary governmental healthcare facility in Bangkok, Thailand. Multivariate unconditional logistic regression was used to identify risk profiles for MRSA carriage. Phage typing, pulsed-field gel electrophoresis (PFGE), polymorphisms of the coa and spa genes, hypervariable region (HVR) of SCCmec, multi-locus sequence typing (MLST), and identification of ST30/ST8 mosaic chromosome by heteroduplex-polymerase chain reaction (heteroduplex-PCR) were used to demonstrate a clonal relationship. Fifty-seven of 619 in-patients (9.2%) were positive for MRSA. Risk factors were being male, long admission, low modified McCabe score, history of MRSA infection, and use of broad spectrum cephalosporin. Molecular typing results indicated close relatedness among MRSA isolates. Successful epidemic subtypes were recovered from many different wards. However, all subtypes with different multi-locus sequence types were single locus variants (SLVs) of ST239. Heteroduplex-PCR gave two positive bands from ST8/ST30 mosaic chromosomal structures in all SLVs indicating all isolates were of the ST239 origin. The burden of MRSA nosocomial infections is high in the governmental tertiary hospital. The sole ST239 and its SLVs identified in this hospital is striking and calls for better policy for infection control and prevention.

Serotyping, PCR, phage-typing and antibiotic sensitivity testing of Salmonella serovars isolated from urban drinking water supply systems of Nepal.

AIMS: To study the occurrence and diversity of Salmonella serovars in urban water supply systems of Nepal. METHODS AND RESULTS: Occurrence of Salmonella was detected in 42 out of 300 water samples by enrichment culture technique in selenite F broth followed by plating on Salmonella Shigella agar. A total of 54 isolates identified to genus level by standard tests were subsequently confirmed by serotyping, phage typing and PCR detection of virulence genes (inv A and spv C). The predominant serotype was Salmonella Typhimurium, followed by Salm. Typhi, Salm. Paratyphi A and Salmonella Enteritidis. Most of the Salm. Typhi isolates were E1 phage type followed by UVS4, A and UVS1. All isolates of Salm. Paratyphi A and Salm. Enteritidis were an untypable (UT) phage type. The majority of isolates were multi-drug resistant as revealed by Kirby-Bauer disc diffusion technique. Ceftriaxone resistant isolates of Salm. Enteritidis indicated the presence of one of the ESBL genes, blaSHV, whereas the genes blaTEM and blaCTX were absent. CONCLUSIONS: The microbiological quality of the urban water supply is poor and indicates possibility of fatal outbreaks of enteric fever and related infections in Nepal. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study will be useful in water borne disease control and prevention strategy formulation in Nepal and in the global context.

Epidemiological analysis of methicillin resistant Staphylococcus aureus in Thailand.

The geographical distribution of 65 clinical isolates of methicillin resistant Staphylococcus aureus (MRSA) recovered from 7 hospitals in Thailand was investigated. The presence of mecA gene in MRSA was determined by specific PCR with the use of primers 5'-GTAGTTGTCGGGTTTGGT-3' and 5'-GGTATCATCTTGTACCCA-3'. Chromosomal DNA restriction analysis with SmaI was resolved by pulsed-field gel electrophoresis (PFGE) compared with antibiotype analysis and phage type analysis. All 65 strains carried mecA gene. They all were resistant to penicillin, tetracycline, erythromycin, amoxicillin/clavulanic acid and variably resistant to gentamicin, ofloxacin, trimethoprim-sulfamethoxazole, chloramphenicol, fosfomycin and clindamycin; and all isolates were susceptible to vancomycin. A total of 19 PFGE patterns designated as type A, A1, A2, A3, A4, B, B1, C, D, E, E1, E2, F, F1, F2, G, H, I and J was identified. Type A4 and E were commonly found in every studied areas. Phage typing showed even greater variability that 52 (80%) isolates belonged to 25 different phage types; 13 (20%) isolates were non-typable. The clarity and polymorphism of the PFGE patterns enable us to discriminate between isolates which could not be differentiated by antibiogram or phage type analysis. The findings demonstrate the existence of a common epidemic MRSA clone in Thailand.

Environmental surveillance of Legionella species in Thailand.

Legionellae was found in 57 per cent of 94 cooling towers and 21.8 per cent of 78 other environmental sources. These figures reveal that the existence of legionellae in cooling towers is more prevalent than that found in other environmental sources. Legionella pneumophila serogroup 1 was the most prevalent organism among the legionellae found in cooling towers and other environmental sources. The recovery of legionellae in each province was seasonally independent and was found throughout the year. This is the first report of an environmental survey representing the existence of legionellae in every region of Thailand.