Prevalence of nasal carriage rate for methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility profiles in health care workers at Nanakaly Hospital, Erbil, Iraq

  • Nasik Shawkat Dogramachy Department of Microbiology, College of Medicine, Hawler Medical University, Erbil, Iraq.
Keywords: Methicillin-resistant Staphylococcus aureus, Healthcare workers, Antibiotic susceptibility profiles, Erbil

Abstract

Background and objective: Healthcare workers have been identified as the source of infection in many outbreaks of methicillin-resistant Staphylococcus aureus in the hospital environment. Therefore, we aimed to demonstrate the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureusand their antibiotic resistance patterns among healthcare workers.

Methods: A cross-sectional study was carried out on a total of 94 healthcare workers at Nanakaly hospital. Nasal swabs were collected and cultured on Mannitol Salt Agar. Staphylococcus aureus was identified by Gram's stain, catalase test, and coagulase test. Staphylococcus aureus isolates were confirmed as methicillin-resistant Staphylococcus aureus using cefoxitin (30 μg) disc diffusion test. Antibiotic susceptibility was performed according to the Kirby-Bauer disc diffusion method.

Results: A total of 23 (24.5%) healthcare workers were nasal carrier for Staphylococcus aureus, and the overall methicillin-resistant Staphylococcus aureus carriage rate was 8.5%. There was no statistically significant difference between the gender (P = 0.29), age (P = 0.29), and occupations (P = 0.721) and the nasal carriage of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus. All isolates of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus were sensitive for linezolid and mupirocin. The highest resistance rate for both erythromycin and clindamycin (75%) was noted among the methicillin-resistant Staphylococcus aureusstrains, while the highest resistance rate in methicillin-sensitive Staphylococcus aureus strains was penicillin (72.5%), erythromycin (20%) and ciprofloxacin (13.3%).

Conclusion: Healthcare workers were the potential colonizers of methicillin-resistant Staphylococcus aureus. So regular screening of the healthcare workers is one of the effective methods to reduce and control of methicillin-resistant Staphylococcus aureus in any health care facility and applying the appropriate preventive measures will prevent transmission of methicillin-resistant Staphylococcus aureusto other contact patients.

References

Tokajian S. New epidemiology of Staphylococcus aureus infections in the Middle East. Clin Microbiol Infect 2014; 20(7):624–8.

David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010; 23:616–87.

Mohajeri P, Izadi B, Rezaei M, Farahani A. Frequency distribution of hospital-acquired MRSA nasal carriage among hospitalized patients in West of Iran. Jundishapur J Microbiol 2013; 6(6):9076.

Appelbaum PC. MRSA—the tip of the iceberg. Clin Microbiol Infect 2006; 12(2):3–10.

Iyer A, Kumosani T, Azhar E, Barbour E, Harake S. High incidence rate of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers in Saudi Arabia. J Infect Dev Ctries 2014; 8(3):372–8.

Von EC, Becker K, Machka K, Stammer H, Peter G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001; 344:11–6.

Miles AA, Williams REO, Clayton CB. The carriage of Staphylococcus aureus in man and its relation to wound infection. J Pathol Bacteriol 1944; 56:513–24.

Williams REO. Skin and nose carriage of bacteriophage types of S. aureus. J Pathol Bacteriol 1946; 58:259–68.

Gillespie EH, Devenish EA, Cowan ST. Pathogenic staphylococci: their incidence in the nose and on the skin. Lancet 1939; 2:870–3.

Kluytmans J, Van Belkum A, Verbrugh H. Nasal carriage of Staphylococcusaureus: epidemiology, underlying mechanisms, and associated risks. Clin Micro Rev 1997; 10:505–20.

Yu VL, Goetz A, Wagener M. Staphylococcus aureus carriage and infection in patients on hemodialysis. N Engl J Med 1986; 315:91–6.

Durai R, Ng PC, Hoque H. Methicillin-resistant Staphylococcus aureus: an update. AORN J 2010; 91(5):599–606.

Matouskova I, Janout V. Current knowledge of methicillin resistant Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 152(2):191–202.

Herman RA, Kee VR, Moores KG, Ross MB. Etiology and treatment of community-associated methicillin-resistant Staphylococcus aureus. Am J Health Syst Pharm 2008; 65(3):219–25.

Heymann DL. Control of communicable diseases manual. 19thed. Washington, DC: American Public Health Association; 2008.

Archer GL. Staphylococcus aureus: a well-armed pathogen. Clin Infect Dis 1998; 26(5):1179–81.

Tacconelli E, De Angelis G, Cataldo MA, Pozzi E, Cauda R. Does antibiotic exposure increase the risk of methicillinresistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother 2008; 61(1):26–38.

Nelson KE, Williams CM. Infectious disease epidemiology: theory and practice. 2nd ed. Sudbury, MA: Jones and Bartlett Publishers; 2007.

Ahmed MO, Elramalli AK, Amri SG, Abuzweda AR, Abouzeed YM. Isolation and screening of methicillin-resistant Staphylococcus aureus from health care workers in Libyan hospitals. East Mediterr Health J 2012; 8(1):37–41.

Conceição T, Santos SI, De Lencastre H, Aires-DM. Staphylococcus aureus nasal carriage among patients and health care workers in Sao Tome and Prıncipe. Microb Drug Resist 2014; 20(1):57–66.

Albrich WC, Harbarth S. Health-care workers: soruce, vector, or victim of MRSA? Lancet Infect Dis 2008; 8:289–301.

Hawkins G, Stewart S, Blachtford O, Reilly J. Should healthcare workers screened routinely for methicillin-resistant Staphylococcus aureus? A review of the evidence. J Hospital Infect 2011;77:285–9.

Islam SI, Moore C. Prevalence of methicillin-resistant Staphylococcus aureus and associated risk factors on admission to a specialist care eye hospital. Ann Saudi Med 2002;22:153–7.

Alghaithy AA, Bilal NE, Gedebou M, Weily AH. Nasal carriageand antibiotic resistance of Staphylococcus aureusisolates from hospital and non-hospital personnel in Abha, Saudi Arabia. Trans R Soc Trop Med Hyg 2000; 94:504–7.

Dimitrov T, Udo EE, Grover S. Point surveillance of Staphylococcus aureus carriage among medical staff in Infectious Diseases Hospital, Kuwait. Med Princ Pract 2003; 12:139–44.

Biber A, Abuelaish I, Rahav G, Raz M, Cohen L, Valinsky L, et al. A typical hospital-acquired methicillin-resistant Staphylococcus aureus clone is widespread in the community in the Gaza strip. PLoS One 2012; 7:428–64.

Halablab MA, Hijazi SM, Fawzi MA, Araj GF. Staphylococcus aureus nasal carriage rate and associated risk factors in individuals in the community. Epidemio Infect 2010; 138:702–6.

Adwan K, Jarrar N, Abu-Hijleh A, Adwan G, Awaad E, Salameh Y. Molecular analysis and susceptibility patterns of methicillin- resistant Staphylococcus aureus strains causingcommunity- and health care-associated infections inthe northern region of Palestine. AmJ Infect Control 2013; 41:195–8.

Habeeb A, Hussein N, Assafi, M, Al-Dabbagh S. Methicillin resistant Staphylococcus aureus nasal colonization among secondary school students at Duhok City-Iraq". J Microbiol Infect Dis 2015; 4(02):59–63.

Hussein NR, Basharat Z, Muhammed AH, Al-Dabbagh SA. Comparative evaluation of MRSA nasal colonization epidemiology in the urban and rural secondary school community of Kurdistan, Iraq. PLoS ONE 2015; 10(5):e0124920.

Abed SY, AL-Marjani MF, Esa KR, Mansour RF. Prevalence of nasal carriage of methicillin-resistant Staphylococcus spp. in Baghdad. EJBPS 2016; 3(5):106–9.

Al-Dahbi AM, Al-Mathkhury HJ. Distribution of methicillin resistant Staphylococcus aureus in Iraqi patients and healthcare worker. Iraqi J Sci 2013; 54(2):293–300.

Warnke P, Harnack T, Ottl P, Kundt G, Podbielski A. Nasal screening for Staphylococcus aureus– Daily routine with improvement potentials. PLoS ONE 2014; 9(2):e89667.

Kloos WE, Bannerman TL. Staphylococcus and Micrococcus. In: Murray PR, Baron EJ, P faller MA, Tenover FC, Yolken RH, editors. Manual of clinical microbiology. 7th ed. Washington: ASM Press; 1991.

Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility Testing; Twenty-fourth informational supplement. Vol. 34 (1). CLSI document M100-S21. Wayne: Clinical and Laboratory Standards Institute; 2014.

Basak S, Mallick SK, Bose S. Community associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) an emerging pathogen: are we aware? J Clin Diagn Res 2010; 4:2111–5.

Wertheim HF, Vos MC, Ott A. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet 2004; 364:703–5.

Hernandez DR, Newton DW, Ledeboer NA, Buchan B, Young C, Clark AE, Connoly J, Wolk DM. Multicenter evaluation of MRSA Select II chromogenic agar for identification of methicillin-resistant Staphylococcus aureus from wound and nasal specimens. J Clin Microbiol 2016; 54:305–11.

Hussein NR, Assafi MS, ljaz T. Methicillin-resistant Staphylococcus aureus nasal colonisation amongst healthcare workers in Kurdistan Region, Iraq. Journal of Global Antimicrobial Resistance 2017; 9:78–81.

Mohammed SH, Hmood MN, Abd AA, Obaid SA, Fahad BA, Kadhem FH. Screening of nasal carriage for Staphylococcus aureus and their resistance to oxacillin and cefoxitin among medical students in Karbala University. J Contemp Med Sci 2015; 1(1):13–6.

Askarian M, Zeinalzadeh A, Japoni A, Alborzi A, Memish ZA. Prevalence of nasal carriage of Methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi Hospital, Shiraz, Iran. Int J Infect Dis 2009; 13 (5):241–7.

Rahbar M, Karamiyar M, Gra-Agaji R. Nasal carriage of methicillin-resistant Staphylococcus aureus among healthcare workers of an Iranian hospital. Infect Control Hosp Epidemiol 2003; 24(4):236–7.

Saderi H, Oulia P, Jalali Nadushan MR, Falah N, Barati Namin M. The rate of Staphylococcus aureus nasal carriage among personnel of a hospital in Tehran. Daneshvar Medicine 2004; 11(49):33–8.

Aqel AA, Alzoubi HM, Vickers A, Pichon B, Kearns AM. Molecular epidemiology of nasal isolates of methicillin-resistant Staphylococcus aureus from Jordan. J Infect Public Health 2015;8:90–7.

Dulon M, Peters C, Schablon A, Nienhaus A. MRSA carriage among healthcare workers in non-outbreak settings in Europa and the United States: A systemicreview. BMC Infect Dis 2014; 14:363.

Naz H, Cevik F C, Aykin N. Nasal Staphylococcus aureus Carriage Among Hospital Staff in Eskişehir Yunus Emre State Hospital. Ankem 2006;20(3):141–4.

Arttan OM, Gulgun M, Baykan Z, Tok D. Investigation of nasal carriage rates and antimicrobial susceptibility of Staphylococcus aureus in hospital staff. Turkish J Infection 2008; 22 (2):87–90.

Yagmur G, Inci M. Investigation of nasal carriage and antibiotic susceptibility of Staphylococcus aureus in healthcare staff. J Harran Univ Med Fak 2015; 12:1.

El Aila NA, Al Laham NA, Ayesh BM. Nasal carriage of methicillin resistant Staphylococcus aureus among health care workers at Al Shifa hospital in Gaza Strip. BMC Infect Dis 2017;17:28.

Blok H, Troelstra A, Kamp-Hopmans, T, Gigengack-Baars A, Vandenbroucke-Grauls C, Weersink A. Role of healthcare workers in outbreaks of methicillin-resistant Staphylococcus aureus: A 10-year evaluation from a Dutch university hospital. Infect Control Hosp Epidemiol 2003; 24(9):679–85.

Kuehnert MJ, Kruszon-Moran D, Hill HA, McQuillan G, McAllister SK, Fosheim G. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001–2002. J Infect Dis 2006; 93:172–9.

Bouchillon SK, Johnson BM, Hoban DJ, Johnson JL, Dowzicky MJ, Wu DH, Visalli MA, Bradford PA. Determining incidence of extended spectrum β-lactamase producing Enterobacteriaceae, vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus in 38 centres from 17 countries: the PEARLS study 2001–2002. Int J Antimicrob Agents 2004; 24:119–24.

Barber M, Rozwadowska-Dowzenko M. Infection by penicillin-resistant staphylococci. Lancet 1948; 1:641–4.

Zinn CS, Westh H, Rosdahl VT. An international multicenter study of antimicrobial resistance and typing of hospital Staphylococcus aureus isolates from 21 laboratories in 19 countries or states. Microb Drug Resist 2004; 10:160–8.

Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe and the Western Pacific Region for the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001; 32(2):5114–32.

Published
2018-12-31
How to Cite
Dogramachy, N. (2018). Prevalence of nasal carriage rate for methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility profiles in health care workers at Nanakaly Hospital, Erbil, Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 22(3), 411-419. https://doi.org/10.15218/zjms.2018.053
Section
Original Articles