Staphylococcus aureus nasal carriage and patterns of antibiotic resistance in bacterial isolates from patients and staff in a dialysis center of southeast Iran
-
Mahnaz Tashakori
,
Fateme Mohseni-Moghadam
,
Nazanin Ziasheikholeslami
,
Parvin Jafarpour
,
Maryam Behsoun
,
Maryam Hadavi
,
Mohammadhossein Gomreei
Abstract
Background and Objective: Staphylococcus aureus is an important infection in hemodialysis patients. We studied the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and its antibiotic resistance pattern in patients receiving hemodialysis as well as in dialysis unit staff.
Materials and Methods: From June to September 2012, we evaluated 74 cases including 61 patients on hemodialysis and 13 dialysis unit staff. Nasal swabs were taken from all cases and were cultured on a blood medium agar. We identified S. aureus based on conventional laboratory methods. For antimicrobial resistance patterns, we used disk diffusion method. Oxacillin MIC, oxacillin and cefoxcitin disk diffusion methods were used for detection of MRSA. Disk approximation test (D-test) was applied for the frequency of erythromycin induced clindamycin resistance.
Results: S. aureus carrier state was determined in 12 of the 61 patients on hemodialysis (19.67%) and 5 of the 13 dialysis unit staffs (38.46%). In hemodialyzed patients, MRSA and MSSA carrier of S. aureus were 6.56% and 13.11%, respectively. All nasal carriage states in studied staffs were MSSA. All isolated S. aureus were found to be sensitive to vancomycin, teicoplanin, and rifampin. However, reduced sensitivity of MRSA isolates to other antibiotics was noted. Resistance frequencies to tested antibiotic was as follows: cefteriaxone and penicillin (100%), tetracycline and doxycilin (75%), gentamicin, cloxacillin, and cefazolin (50%), ciprofloxacin, trimethoprim-sulfamethoxazol, erythromycin, and clindamycin (25%). The resistance rate of isolated MSSA against tested antibiotics was lower than isolated MRSA. Inducible clindamycin resistance was shown in 25% of identified MRSA strains.
Conclusion: S. aureus nasal carrier state was lower than former reports from other parts of Iran. The antibiotic resistance patterns also differed, perhaps due to different pattern of administering antibiotics at our hospital. Screening of these patients should be noted as a health priority and microbial sensitivity tests should be considered in order to optimize treatment options.
Tacconelli E, Cameli Y, Aizer A, Ferreria G, Foreman MG, D Agata EM. Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: ameta-analysis. Clinic Infect Dis 2003; 37:1629-1638.
Berman SJ. Infections in patients with end-stage renal disease. An overview. Infect Dis Clin North Am 2001;15: 709-20, vii
von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001; 344:11-16.
Garrouste-Orgeas M, Timsit JF, Kallel H, Ben Ali A, Dumay MF, Paoli B, Misset B et al. Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptides use. Infect Control Hosp Epidemiol 2001; 22: 687-692.
Safdar N, Bradley EA. The risk of infection after nasal colonization with Staphylococcus aureus.The Am J of Med 2008; 121: 310-315.
Kluytmans JA, Mouton JW, Ijzerman EP, Vandenbroucke-Grauls CM, Maat AW, Wagenvoort JH, et al. Nasal carriage of Staphylococcous aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995; 171: 216-219.
Lu PL, Tsai JC, Chiu YW, Chang FY, Chen YW, Hsiao CF, et al. Methicillin-resistant Staphylococcus aureus carriage, infection and transmission in dialysis patients, healthcare workers and their family members. Nephrol Dial Transplant 2008; 23: 1659-1665.
Sheikholeslami NZ, Tashakori M, Bahsoun M. The effectiveness of the mupirocin ointment of nasal carriers of Staphylococcus aureus in Medical staff in Ali EbneAbtaleb Hospital, Rafsanjan (Southeast of Iran). Trend Med Res 2011; 6: 191-194.
Dupeyron CB, Campillo JP, Richardet, CJ Soussy CJ.Long-term efficacy of mupirocin in the prevention of infections with meticillin-resistant Staphylococcus aureus in a gastroenterology unit. J Hosp Infect 2006;63: 385-392.
Ghazvini K, Hekmat R. Nasal and skin colonization of Staphylococcus aureus in hemodialysis patients in northeast of Iran. Iran J Kidney Dis 2007; 1: 21-24.
Ghasemian R, Najafi N, Makhlough A, Khademloo M.Frequency of nasal carriage of Staphylococcus aureus and its antimicrobial resistance pattern in patients on hemodialysis. Iran J Kidney Dis 2010; 4: 218-222.
Aminzadeh Z, Mastari Farahani A, Gchkar L. Prevalence of Staphylococcus aureus carriage in patients on hemodialysis and the pattern of antibacterial resistance. Iran J Clin Infect Dis 2006; 1: 5-10.
Hekmat F, Mamani M, Hajia M, Sharifi M A. Prevalence of Staphylococcus aureus carriage in patients on hemodialysis and their correlation to infections. Bth international congress on infections diseases. Nov.2008. Tehran, Iran.
Forbes BE, Sahm DF, Weissfeld AS, Trevino EA.Bailey &Scotts Diagnostic Microbiology 11thed. The C.V. Mosby Company, Toronto, 2002.
Clinical and Laboratory Standards Institue/CLSI (2005) Preformance standards for antimicrobial susceptibility for antimicrobial susceptibility testing; Fifteen Informational Supplement. CLSI/NCCLS documents M100-S15 .USA.
Skov R, Smyh R, Clausen M, Larsen AR, Moller- Frimo dtN. Evaluation of a cefoxcitin disk on IKso- Sensitest agar for detection of methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 2003;52: 204-207.
Velasco D, Tomas MMT, Cartelle M. Evalution of different methods for detecting methicillin (oxacillin) resistance in Staphylococcus aureus. J Antimicrob Chemother 2005; 55: 379-382.
Clinical and Laboratory Standards Institue/NCCLS Performance standards for antimicrobial disc diffusion tests; Approved standards. 9th ed. CLSI Document M2-M9. Wayne Pa: Clinicaland Laboratory standards Institue; 2006.
Sedighi I, JaefariMoez H, Alikhani M S. Nasal carriage of methicilin resistant Staphylococcus aureus and their antibiotic susceptibility patterns in children attending day-care centers. Acta Microbiologica et Immunologica Hungaria 2011; 58: 227-234.
Sexena AK, Panhotra BR, Chopra R. Advancing age and the risk of nasal carriage of Staphylococcus aureus among patients on long-term hospital-based hemodialysis. Ann Saudi Med 2004; 24: 337-342.
Duran N, Ocak S, Eskiocak AF. Staphylococcus aureus nasal carriage among the diabetic and non-diabetic haemodialysis patients. Int J Clin Pract 2006; 15:162-171.
Sewell CM, Clarridge J, Lacke C, Weinman EJ, Young EJ. Staphylococcal nasal carriage and subsequent infection in peritoneal dialysis patients. JAMA 1982 24;248: 1493-1495.
Sadar N, Bradley EA.The risk of infection after nasal colonization with Staphylococcus aureus. The Am J Med 2008; 121: 310-315.
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: 241-247.
Kim HB, Jang HC, Nam HJ, Lee YS, Kim BS, Park WB et al. Invitro activities of 28 antimicrobial agents against Staphylococcus aureus isolates from tertiary- care hospitals in Korea: a nationwide survey. Antimicrob Agents Chemother 2004; 48: 1124-1127.
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: 160-168.
| Files | ||
| Issue | Vol 6 No 2 (2014) | |
| Section | Articles | |
| Keywords | ||
| Hemodialyzed patients Iran MRSA Nasal carriers Staphylococcus aureus | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
