Document Type : Original Article

Authors

1 Department of Microbiology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran

2 Expert in Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

10.55705/cmbr.2024.442150.1221

Abstract

Methicillin-resistant S. aureus (MRSA) strains circulating among populations and crossing borders constitute a major problem for health control and require a fast and simple genotypic approach. The objective of this study was to determine the prevalence, molecular types and drug resistance pattern of S. aureus isolated from Hospitalized Patients in teaching Hospitals of Ahvaz. this cross-sectional study was from April to September 2023, MRSA strains were identified by phenotypic and molecular methods. The antibiotics studied were), Cefoxitin (15 μg) Gentamicin (10 μg), Ciprofloxacin (5 μg), Erythromycin (15 μg), Clindamycin (2 μg), linzolide(10μg), azithromycin(5 μg). The tests were performed according to the guidelines of clinical and Laboratory Standards Institute (CLSI). It also detected the mecA gene of Methicillin-resistant S. aureus strains (MRSA). 470 Staphylococcus aureus samples from patients hospitalized in different departments of Ahvaz Hospitals included 283 blood culture samples, 75 wound samples, 72 body fluid samples and 40 catheter samples, and 321 (68.3%) MRSA isolates were reported. All these 321 MRSA isolates were tested with ampicillin, ciprofloxacin, clindamycin, linezolid, gentamicin, erythromycin, and azithromycin antibiotics. Also, the results of molecular identification of the mec A gene in 321 strains of S. aureus showed that 312 strains carry the mec A gene. The high prevalence of S. aureus samples can be caused by long-term hospitalization of patients in the ward and excessive use of antibiotics to treat the infection and increased resistance in isolates. As a result, more monitoring of the hospital's infection control department, as well as the expansion of the correct use of antibiotics, seems necessary and important.

Graphical Abstract

Antibiotic resistance pattern of Methicillin-resistant Staphylococcus aureus isolated from hospitalized patients

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Dr. Hassan Momtaz
Islamic Azad University

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  1. Silva ECBFd, Antas MdGC, B Neto AM, Rabelo MA, Melo FLd, Maciel MAV (2008) Prevalence and risk factors for Staphylococcus aureus in health care workers at a university hospital of Recife-PE. Brazilian Journal of Infectious Diseases 12: 504-508. doi: https://doi.org/10.1590/S1413-86702008000600012
  2. Vinodhkumaradithyaa A, Uma A, Srinivasan M, Ananthalakshmi I, Nallasivam P, Thirumalaikolundusubramanian P (2009) Nasal carriage of methicillin-resistant Staphylococcus aureus among surgical unit staff. Japanese journal of infectious diseases 62 (3): 228-229. doi: https://doi.org/10.7883/yoken.JJID.2009.228
  3. Peacock SJ, Paterson GK (2015) Mechanisms of methicillin resistance in Staphylococcus aureus. Annual review of biochemistry 84: 577-601. doi: https://doi.org/10.1146/annurev-biochem-060614-034516
  4. Goudarzi M, Abiri P, Nasirian S, Afshari SG (2018) SCCmec and spa typing of Staphylococcus aureus strains isolated from patients with urinary tract infection: emergence of spa types t426 and t021 in Iran. Jundishapur Journal of Microbiology 11 (5): e62169. doi: http://dx.doi.org/10.5812/jjm.62169
  5. Hay CY, Sherris DA (2020) Staphylococcus lentus sinusitis: a new sinonasal pathogen. Ear, Nose & Throat Journal 99 (6): NP62-NP63. doi: https://doi.org/10.1177/0145561319848990
  6. Van De Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, Ferech M, System EARS (2008) Antimicrobial drug use and resistance in Europe. Emerging infectious diseases 14 (11): 1722-1730. doi: https://doi.org/10.3201%2Feid1411.070467
  7. Tufan ZK, Irmak H, Bulut C, Cesur S, Kınıklı S, Demiröz AP (2012) The effectiveness of hand hygiene products on MRSA colonization of health care workers by using CHROMagar MRSA. Mikrobiyoloji bulteni 46 (2): 236-246. doi: https://pubmed.ncbi.nlm.nih.gov/22639312/
  8. Gleeson A, Larkin P, Walsh C, O’Sullivan N (2016) Methicillin-resistant Staphylococcus aureus: Prevalence, incidence, risk factors, and effects on survival of patients in a specialist palliative care unit: A prospective observational study. Palliative medicine 30 (4): 374-381. doi: https://doi.org/10.1177/0269216315595158
  9. Robicsek A, Beaumont JL, Paule SM, Hacek DM, Thomson Jr RB, Kaul KL, King P, Peterson LR (2008) Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Annals of internal medicine 148 (6): 409-418. doi: https://doi.org/10.7326/0003-4819-148-6-200803180-00003
  10. Merlino J, Watson J, Rose B, Beard-Pegler M, Gottlieb T, Bradbury R, Harbour C (2002) Detection and expression of methicillin/oxacillin resistance in multidrug-resistant and non-multidrug-resistant Staphylococcus aureus in Central Sydney, Australia. Journal of Antimicrobial chemotherapy 49 (5): 793-801. doi: https://doi.org/10.1093/jac/dkf021
  11. Long KS, Poehlsgaard J, Kehrenberg C, Schwarz S, Vester B (2006) The Cfr rRNA methyltransferase confers resistance to phenicols, lincosamides, oxazolidinones, pleuromutilins, and streptogramin A antibiotics. Antimicrobial agents and chemotherapy 50 (7): 2500-2505. doi: https://doi.org/10.1128/aac.00131-06
  12. LaMarre JM, Howden BP, Mankin AS (2011) Inactivation of the indigenous methyltransferase RlmN in Staphylococcus aureus increases linezolid resistance. Antimicrobial agents and chemotherapy 55 (6): 2989-2991. doi: https://doi.org/10.1128/aac.00183-11
  13. Stefani S, Bongiorno D, Mongelli G, Campanile F (2010) Linezolid resistance in staphylococci. Pharmaceuticals 3 (7): 1988-2006. doi: https://doi.org/10.3390/ph3071988
  14. Grabe M, Bjerklund-Johansen T, Botto H, Çek M, Naber K, Tenke P, Wagenlehner F (2015) Guidelines on urological infections. European association of urology 182: 237-257. doi:
  15. Goetghebeur M, Landry P-A, Han D, Vicente C (2007) Methicillin-resistant Staphylococcus aureus: a public health issue with economic consequences. Canadian Journal of Infectious Diseases and Medical Microbiology 18: 27-34. doi: https://doi.org/10.1155/2007/253947
  16. Liu E, Chen Y, Xu J, Gu S, An N, Xin J, Wang W, Liu Z, An Q, Yi J, Yin W (2022) Platelets Inhibit Methicillin-Resistant Staphylococcus aureus by Inducing Hydroxyl Radical-Mediated Apoptosis-Like Cell Death. Microbiol Spectr 10 (4): e0244121. doi: https://doi.org/10.1128/spectrum.02441-21
  17. Faria NA, Carrico JA, Oliveira DC, Ramirez M, de Lencastre H (2008) Analysis of typing methods for epidemiological surveillance of both methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains. Journal of clinical microbiology 46 (1): 136-144. doi: https://doi.org/10.1128/jcm.01684-07
  18. Youssef CR, Kadry AA, Shaker GH, El-Ganiny AM (2021) The alarming association between antibiotic resistance and reduced susceptibility to biocides in nosocomial MRSA isolates from two regional hospitals in Egypt. Archives of microbiology 203: 3295-3303. doi: https://doi.org/10.1007/s00203-021-02314-6
  19. Mitra SS, Pachpute SR (2023) Surveillance of bacterial carriage in the nose and hands of healthcare workers and patients attending maternity and children's hospital. J Family Med Prim Care 12 (12): 3262-3265. doi: https://doi.org/10.4103/jfmpc.jfmpc_741_23
  20. Taha AE, Alduraywish AS, Alanazi AA, Alruwaili AH, Alruwaili AL, Alrais MM, Alyousef AA, Alrais AA, Alanazi MA, Alhudaib SN, Alazmi BM (2023) High Bacterial Contamination Load of Self-Service Facilities in Sakaka City, Aljouf, Saudi Arabia, with Reduced Sensitivity to Some Antimicrobials. Microorganisms 11 (12). doi: https://doi.org/10.3390/microorganisms11122937
  21. Li X, Cai Y, Xia Q, Liao Y, Qin R (2023) Antibacterial sensitizers from natural plants: A powerful weapon against methicillin-resistant Staphylococcus aureus. Front Pharmacol 14: 1118793. doi: https://doi.org/10.3389/fphar.2023.1118793
  22. Ramirez-Lozada T, Loranca-Garcia MC, Fuentes-Venado CE, Rodriguez-Cerdeira C, Ocharan-Hernandez E, Soriano-Ursua MA, Farfan-Garcia ED, Chavez-Gutierrez E, Ramirez-Magana X, Robledo-Cayetano M, Loza-Mejia MA, Santa-Olalla IAG, Torres-Paez OU, Pinto-Almazan R, Martinez-Herrera E (2022) Does the Fetus Limit Antibiotic Treatment in Pregnant Patients with COVID-19? Antibiotics (Basel, Switzerland) 11 (2). doi: https://doi.org/10.3390/antibiotics11020252
  23. Lv F, Wang W, Luo Y, Wang H, Zhi T, Li X, Guo Z, Zhao Z (2022) Genome-Based Analysis of a Multidrug-Resistant Hypervirulent Klebsiella pneumoniae. Microbial drug resistance (Larchmont, NY) 28 (8): 853-860. doi: https://doi.org/10.1089/mdr.2021.0307
  24. Shetty VP, Akshay SD, Rai P, Deekshit VK (2023) Integrons as the potential targets for combating multidrug resistance in Enterobacteriaceae using CRISPR- Cas9 technique. J Appl Microbiol 134 (7). doi: https://doi.org/10.1093/jambio/lxad137
  25. Yan X, Su X, Ren Z, Fan X, Li Y, Yue C, Yang M, Deng H, Deng Y, Xu Z, Zhang D, Li L, Hou R, Liu S, Deng J (2021) High Prevalence of Antimicrobial Resistance and Integron Gene Cassettes in Multi-Drug-Resistant Klebsiella pneumoniae Isolates From Captive Giant Pandas (Ailuropoda melanoleuca). Front Microbiol 12: 801292. doi: https://doi.org/10.3389/fmicb.2021.801292
  26. Prakash R, Garg A, Arya R, Kumawat RK (2023) Chronicity of high and low level mupirocin resistance in Staphylococcus aureus from 30 Indian hospitals. Sci Rep 13 (1): 10171. doi: https://doi.org/10.1038/s41598-023-37399-0
  27. Shohayeb M, El-Banna T, Elsawy LE, El-Bouseary MM (2023) Panton-Valentine Leukocidin (PVL) genes may not be a reliable marker for community-acquired MRSA in the Dakahlia Governorate, Egypt. BMC Microbiol 23 (1): 315. doi: https://doi.org/10.1186/s12866-023-03065-8
  28. Elsayed MM, Elkenany RM, El-Khateeb AY, Nabil NM, Tawakol MM, Hassan HM (2024) Isolation and encapsulation of bacteriophage with chitosan nanoparticles for biocontrol of multidrug-resistant methicillin-resistant Staphylococcus aureus isolated from broiler poultry farms. Sci Rep 14 (1): 4702. doi: https://doi.org/10.1038/s41598-024-55114-5
  29. Sadeghi Moghaddam T, Namaei MH, Afshar D, Yousefi M (2022) High frequency of SCCmec type IV and multidrug-resistant SCCmec type I among hospital acquired methicillin-resistant Staphylococcus aureus isolates in Birjand Imam Reza Hospital, Iran. Iran J Microbiol 14 (1): 67-75. doi: https://doi.org/10.18502/ijm.v14i1.8803
  30. Sami Awayid H, Qassim Mohammad S (2022) Prevalence and Antibiotic Resistance Pattern of Methicillin-Resistant Staphylococcus aureus Isolated from Iraqi Hospitals. Arch Razi Inst 77 (3): 1147-1156. doi: https://doi.org/10.22092/ari.2022.357391.2031
  31. Omidi M, Firoozeh F, Saffari M, Sedaghat H (2021) Detection of Methicillin-resistant Staphylococcus aureus according to mecA and femA Genes Among Hospitalized Patients in Kashan and Isfahan Hospitals. Alborz University Medical Journal 10 (1): 33-42. doi: http://dx.doi.org/10.29252/aums.10.1.33
  32. Ahmadi Z, Tajbakhsh E, Momtaz H (2014) Detection of the antibiotic resistance pattern in Staphylococcus aureus isolated from clinical samples obtained from patients hospitalised in Imam Reza hospital, Kermanshah. Journal of Microbial World 6 (4): 299-311. doi:
  33. Jafari-Sales A, Jafari B (2019) Evaluation of the Prevalence of mec A Gene in staphylococcus aureus strains isolated from clinical specimens of hospitals and treatment centers. Pajouhan Scientific Journal 17 (3): 41-47. doi: http://dx.doi.org/10.52547/psj.17.3.41
  34. Rajabiani A, Kamrani F, Boroumand MA, Saffar H (2014) mec-A-mediated Resistance in Staphylococcus aureus in a Referral Hospital, Tehran, Iran. Jundishapur Journal of Microbiology 7 (4): e9181. doi: https://doi.org/10.5812%2Fjjm.9181
  35. Suleiman SA, Onaolapo JA, Olayinka BO (2020) Molecular detection of chloramphenicol-florfenicol resistance (cfr) genes among linezolid resistant MRSA isolates in Sokoto State, Nigeria. Journal of Health & Biological Sciences 8 (1): 1-6. doi: https://doi.org/10.12662/2317-3076jhbs.v8i1.2979.p1-6.2020
  36. Mendes RE, Deshpande LM, Castanheira M, DiPersio J, Saubolle MA, Jones RN (2008) First report of cfr-mediated resistance to linezolid in human staphylococcal clinical isolates recovered in the United States. Antimicrobial agents and chemotherapy 52 (6): 2244-2246. doi: https://doi.org/10.1128/aac.00231-08
  37. Hentschke M, Saager B, Horstkotte M, Scherpe S, Wolters M, Kabisch H, Grosse R, Heisig P, Aepfelbacher M, Rohde H (2008) Emergence of linezolid resistance in a methicillin resistant Staphylococcus aureus strain. Infection 36 (1): 85. doi: https://doi.org/10.1007/s15010-007-7220-7
  38. Wilson P, Andrews J, Charlesworth R, Walesby R, Singer M, Farrell D, Robbins M (2003) Linezolid resistance in clinical isolates of Staphylococcus aureus. Journal of Antimicrobial Chemotherapy 51 (1): 186-188. doi: https://doi.org/10.1093/jac/dkg104
  39. Gales AC, Sader HS, Andrade SS, Lutz L, Machado A, Barth AL (2006) Emergence of linezolid-resistant Staphylococcus aureus during treatment of pulmonary infection in a patient with cystic fibrosis. International Journal of Antimicrobial Agents 27 (4): 300-302. doi: https://doi.org/10.1016/j.ijantimicag.2005.11.008