Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi Hospital, Shiraz, Iran

SummaryObjectiveThe aim of this study was to determine the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers (HCWs) at Namazi Hospital, Shiraz, Iran.MethodsThis cross-sectional study was conducted from July to November 2006. Nasal swabs were taken from 600 randomly selected HCWs. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test, and mannitol salt agar fermentation. To analyze sensitivity patterns of MRSA strains more precisely, minimum inhibitory concentrations (MICs) of antibiotics were determined by the E-test method. All methicillin-resistant isolates were examined for the existence of the mecA gene by total DNA extraction and PCR.ResultsThe prevalence of nasal carriage of methicillin-sensitive S. aureus (MSSA) was 25.7% and of MRSA was 5.3%, with the highest nasal carriage of MRSA in surgical wards and the emergency department. There was no significant difference between the sexes (p=0.247), age (p=0.817), and years of healthcare service (p=0.15) with regard to the nasal carriage of MRSA and MSSA. In the univariate analysis, a statistically significant difference was only found for occupation (p=0.032) between the carriage of MSSA and MRSA. In the multivariate analysis, the occupation ‘nurse’ was independently associated with MRSA carriage (p=0.012, odds ratio 3.6, 95% confidence interval 1.3–9.7). The highest resistance rate for both gentamicin and clindamycin (69%) was noted among the MRSA strains. None of the MRSA strains were resistant to mupirocin, linezolid, fusidic acid, or vancomycin. The existence of the mecA gene in all 32 methicillin-resistant isolates was observed by PCR.ConclusionsThis study revealed the prevalence of nasal carriage of S. aureus strains among HCWs to be lower than that found in other studies from Iran. The antibiotic susceptibility patterns also differed, perhaps as a result of the excessive use of antibiotics at our hospital. Only the occupation of nurse was an independent risk factor for MRSA carriage

Antibiotic Susceptibility Patterns and Molecular Epidemiology of Metallo-β-Lactamase Producing Pseudomonas Aeruginosa Strains Isolated From Burn Patients.

BACKGROUND: Failure in the treatment of burn patients infected with Pseudomonas aeruginosa could happen as a result of the acquisition of antibiotic resistance, including carbapenems. OBJECTIVES: The aim of the present study was to investigate the phenotypic and genotypic characteristics of the Pseudomonas aeruginosa strains, isolated from burn patients. PATIENTS AND METHODS: During a 12 month period, in this cross-sectional study, two hundred seventy strains of Pseudomonas aeruginosa were isolated from the burn patients in Ghotbeddin Burn Hospital, Shiraz, Iran. Screening for the carbapenem resistance in the isolates was carried out by the E test method. Sensitivity patterns of metallo-β-lactamase (MβLs) producing strains of pseudomonas to eleven antibiotics were determined by the mentioned method. The epidemiological associations of these strains were determined by Pulsed-field gel electrophoresis (PFGE). RESULTS: Of the 270 strains, 60 (22.2%) were resistant to imipenem and meropenem, classified as MβLs producing. MβLs producing strains of pseudomonas were completely resistant to five tested antibiotics while their sensitivities to the three most effective antibiotics including ceftazidime, amikacin and ciprofloxacin were 23.4%, 6.7 % and 1.7%, respectively. In PFGE, 37 patterns from the genome of Pseudomonas aeruginosa were observed. Majority of the strains (43; 71.6%) exhibited more than 80% similarity, based on the drawn dendrogram. CONCLUSIONS: According to the results, none of the tested antibiotics is safe to prescribe. As PFGE revealed, a limited number of Pseudomonas aeruginosa types are predominant in the hospitals which infect the burn patients

Burn Patients Infected With Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa: Multidrug-Resistant Strains

Background: Metallo-beta-lactamase (MBL) producing Pseudomonas aeruginosa in the burn patients is a leading cause of morbidity and mortality and remains a serious health concern among the clinicians. Objectives: The aim of this study was to detect MBL-producing P. aeruginosa in burn patients and determine multidrug-resistant (MDR) strains, and respective resistance patterns. Patients and Methods: In this cross-sectional study, 270 strains of P. aeruginosa were isolated from the burn patients referred to Ghotbeddin Burn Hospital, Shiraz, Iran. Among them, 55 MBL-producing P. aeruginosa strains were isolated from 55 patients hospitalized in burn unit. Minimum inhibitory concentrations (MICs) and MBLs were determined by the E-test method. Results: Of the 55 burn cases, 29 (53%) were females and 26 (47%) males. Injured burn patients’ ages ranged from 16 to 87 years, with maximum number of cases in the age group of 16 to 36 years (n, 40; 72.7%). Overall, 32 cases were accidental (60%), and 22 were suicidal burns (40%). Of the 55 burn patients, 17 cases were expired (30%). All deaths were due to chemical exposures. In antibiotic susceptibility testing by E-test method, ceftazidime was the most effective one and 35 isolates (63.5%) were resistant to all the 11 tested antibiotics. Conclusions: Routine microbiological surveillance and careful in vitro testing of antibiotics prior to prescription and strict adherence to hospital antibiotic policy may help to prevent, treat, and control MDR and pandrug-resistant (PDR) P. aeruginosa strains in burn units

Distribution of staphylococcal cassette chromosome mec types among methicillin-resistant coagulase negative staphylococci in central Iran

Background and Objectives: Methicillin-resistant coagulase-negative staphylococci (MR-CoNS) are important nosocomial pathogens. They may serve as a reservoir of SCCmec, the genomic island encoding amongst other methicillin resistance. This study was designed to determine the distribution of different SCCmec types from MR-CoNS isolated from clinical specimens in a tertiary hospital in central Iran, having high frequency of nosocomial methicillin-resistant staphylococcal infections. Materials and Methods: We evaluated isolates from patients attending the Vali-Asr Hospital located in the center of Iran, from February to December 2012. Multiplex PCR was performed for SCCmec typing. For isolates in which SCCmec could not be typed directly, additional ccr and mec complex analyses were performed. Results: Totally, 70 MR-CoNS isolates, comprising of 47 S. epidermidis strains (67%), 10 S. saprophyticus (14.3%), 9 S. hemolyticus (13%) and 4 S. lugdunensis (5.7%) were identified. Thirty-nine were characterized as type IVa 19 (27%), type III 11 (16%), type II 7 (10%) and type V 2 (3%). Only 20 isolates (28.6%) carried the ccr complex, while the current methods could not characterize the 11 remaining isolates. Conclusion: A high level of SCCmec genetic diversity was found among MR-CoNS isolates. MR-CoNS may act as a reservoir of SCCmec IV for MRSA. This issue should be taken into consideration seriously

Characterization of Plasmid-Mediated AmpC and Carbapenemases among Iranain Nosocomial Isolates of Klebsiella pneumoniae Using Phenotyping and Genotyping Methods

Objectives: Plasmid-mediated AmpC β-lactamases (PMABLs) and carbapenemases are emerging groups of antimicrobial-resistance determinants. The aims of the study were to evaluate the occurrence of PMABLs and carbapenemases in clinical isolates of Klebsiella pneumoniae and compare the test performance of various phenotypic methods for detection of these enzymes in Iran. Methods: A total of 100 K. pneumoniae isolates were collected from clinical specimens obtained in Valiasr Hospital. AmpC production in all isolates was determined using the AmpC disk test, the cephamycin Hodge test, the AmpC Etest, and the boronic acid combined-disk test. In addition, carbapenemase production was determined using the modified Hodge test, the EDTA disk synergy test, and the boronic acid combined-disk test. The performances of various phenotypic methods were evaluated by the comparison of their results with polymerase chain reaction (PCR) method as the gold standard. Results: Of the 100 isolates, 19 (19%) were demonstrated to harbor the

Variability in gene cassette patterns of class 1 and 2 integrons associated with multi drug resistance patterns in Staphylococcus aureus clinical isolates in Tehran-Iran

Background: To investigate antibiotic resistance, the occurrence and distribution of class 1 and 2 integrons in multidrug- resistant Staphylococcus aureus isolates from hospitals in Tehran, Iran. The isolates were examined for susceptibility to antimicrobial agents. The mecA gene, class 1 and 2 integrons were detected by PCR. Integrase positive strains were further analysed for the presence of resistance gene cassettes using specific primers and were sequenced. Results: Among 139S.aureus isolates, 109 (78.4 ) and 112 (80.5 ) strains were considered as multidrug resistant and mecA positive, respectively. Class 1 integrons and internal variable regions were found in 72.6 (101/139) and 97 (98/101) and class 2 integrons and variable regions also in 35.2 (49/139) and 65.3 (32/49) of S.aureus clinical isolates, respectively. Twelve distinct cassette arrays were found, containing genes encoding resistance to β-lactams, aminoglycosides, streptothricin, trimethoprim, chloramphenicol,a putative glucose dehydrogenase precursor and a protein with unknown function. Gene cassette arrays aadB, aadA2 and dhfrA1-sat2-aadA1 were common in S.aureus isolates. We detected a completely new gene cassettes which contained aadB, oxa2, aacA4, orfD-aacA4-catB8, aadB-catB3, orfD-aacA4 and aadB-aadA1-cmlA6 of class 1 and dhfrA1-sat2-aadA1, dhfrA11, dhfrA1-sat2 of class 2 integrons. Conclusions: This is the first study to report carriage of class 1 and 2 integrons and associated gene cassettes among in S.aureus isolates from Iran. © 2015 Mostafa et al

Phylogenetic groups, virulence genes and quinolone resistance of integron-bearing Escherichia coli strains isolated from a wastewater treatment plant

We investigated phylogenetic affiliation, occurrence of virulence genes and quinolone resistance in 109 integron-containing strains of Escherichia coli isolated from a wastewater treatment plant. Selection for integron-bearing strains caused a shift toward phylogroup D, which was most numerous, followed by A, B1 and B2. Phylogroups D and B2, both of which are reported to include virulent extraintestinal pathotypes, made up 50.5% of all isolates and were present in every stage of wastewater treatment, including final effluent. Diarrheagenic pathotypes made up 21% of the strains. The average virulence factor genes score was low (1.40) and the range was from 0 to 5. Quinolone and fluoroquinolone resistance was observed in 56.0% and 50.4% of the strains, respectively; however, it was not associated with virulence factor score. Although the average virulence factor score was low, 17.4% of strains had three and more virulence genes. They were isolated mostly from raw sewage, but 30% of them were cultured from final effluent. Release of multiresistant integron-bearing E. coli strains with virulence traits into the environment may create potential threat and be of public health concern

Risk Factors of Nasal Carriage of Methicillin-Resistant Staphylococcus Aureus and its Antibiotic Susceptibility Pattern in Namazi Hospital Healthcare Workers in Shiraz, Iran

Abstract: Background & Aims: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. The aim of this study was to determine the risk factors of nasal carriage of MRSA and its antibiotic susceptibility pattern among healthcare workers at Namazi Hospital (Shiraz-Iran) Methods: In a cross-sectional study from July to November 2006, nasal swabs were taken from 600 stratified randomly selected health care workers. The isolates were identified as S. aureus based on morphology, gram stains, catalase test, coauglase test and DNase Agar. To differentiate Methicillinsusceptible S. aureus (MSSA) and Methicillin Resistant S. aureus (MRSA), agar screen plate was used. All methicillin-resistant isolates were examined for mecA genes existence by PCR performance. The sensitivity patterns of S.aureus isolates were determined by disc diffusion and E-test method. Results: Nasal screening identified 186 (31%) S. aureus carriers of whom, 154 ones (82.8%) were MSSA and 32 ones (17.2%) were MRSA._There was no significant association between related risk factors and gender, age, years of healthcare service and level of education. In the univariate analysis, a statistically significant difference was found only based on occupation (P=0.032) between carriers of MSSA and MRSA. In multivariate analysis(logistic regression), having nursing occupation (p=0.012, OR=3.6, 95%CI=1.3-9.7) was independently associated with MRSA carriage. All of the MRSA strains were sensitive to mupirocin. Conclusion: This study revealed that having nursing occupation is independently associated with MRSA carriage since all S.aureus isolates were susceptible to mupirocin, topical mupirocin could be used successfully to eradicate nasal staphylococcal colonization and carriers. Keywords: Staphylococcus aureus, Methicillin, Risk factors, Carrier, Microbial sensitivity, Health care provider