Increased incidence of methicillin resistant Staphylococcus aureus and methicillin resistant Staphylococcus epidermidis in the skin and nasal carriage among healthcare workers and inanimate hospital surfaces after the COVID-19 pandemic
-
Esraa H. Al-Nsour
,
Hadeel T. AL-Hadithi
,
Rania Mhammad Al-Groom
,
Saqr Abushattal
,
Abdallah Y Naser
,
Ahmad H. Al Nsour
,
Rawand A. Sallam
,
Lara M. Kollab
,
Laila Alswalha
,
Mohd Sajjad Ahmad Khan
Abstract
Background and Objectives: Healthcare workers in hospitals are exposed to infectious diseases that occur in the hospital making them a source of infection for the patients. It is interfaced as cross-contamination agents for MRSA and MR-CoNS, and preventive measures need to be adapted accordingly. The study aimed to assess Methicillin-Resistant Staphylococcus (MRS) on the skin and nasal cavities of healthcare workers (HCWs) and identifying isolates to the species level.
Materials and Methods: Swab samples were cultured on mannitol salt agar (MSA) to obtain MRS and determine their ability to produce coagulase. Their susceptibility to antibiotics were determined by agar screening and disk diffusion methods and further identification was done at the species level.
Results: The highest percentage of methicillin resistant coagulase positive Staphylococci (MRCoPS) was reported among skins of male HCWs, (71.4%) were identified as MRSA. The highest levels of methicillin resistant coagulase negative Staphylococci (MRCoNS) were mainly detected in both nasal cavities, (75%) were identified as MRSE. MRSA was reported from doctors (p-value 0.033), whereas the highest incidence of MRSE was obtained from the nurses (p-value 0.048).
Conclusion: This study highlighted that incidence of MRSA was mainly detected in doctors and MRCoNS in both nasal cavities. The highest percentage of MRCoNS was recovered from the patients’ room followed by the reception table. Moreover, vancomycin is suggested to be highly effective in managing and controlling S. aureus, MRSA- and MRSE related infections.
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7. Rossi CC, Pereira MF, Giambiagi-deMarval M. Underrated Staphylococcus species and their role in antimicrobial resistance spreading. Genet Mol Biol 2020; 43(1 suppl 2): e20190065.
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12. Ackah JK, Neal L, Marshall NR, Panahi P, Lloyd C, Rogers LJ. Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and republic of Ireland. J Infect Prev 2021; 22: 83-90.
13. Barbier F, Ruppé E, Hernandez D, Lebeaux D, Francois P, Felix B, et al. Methicillin‐Resistant Coagulase‐Negative Staphylococci in the community: high Homology of SCCmec IVa between Staphylococcus epidermidis and Major clones of methicillin‐resistant Staphylococcus aureus. J Infect Dis 2010; 202: 270-281.
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21. Hasan AA, Hassawi DS, Al-Daghistani HI, Hawari AD. Molecular and biochemical identification of coagulase positive Staphylococcus species isolated from human and animal sources in Jordan. Int J Med Med Sci 2014; 47: 1491-1507.
22. Kateete DP, Kimani CN, Katabazi FA, Okeng A, Okee MS, Nanteza A, et al. Identification of Staphylococcus aureus: DNase and Mannitol salt agar improve the Efficiency of the tube coagulase Test. Ann Clin Microbiol Antimicrob 2010; 9: 23.
23. Pourmand MR, Hassanzadeh S, Mashhadi R, Askari E. Comparison of four diagnostic methods for detection of methicillin resistant Staphylococcus aureus. Iran J Microbiol 2014; 6: 341-344.
24. Xu Z, Shah HN, Misra R, Chen J, Zhang W, Liu Y, et al. The Prevalence, Antibiotic resistance and mecA characterization of coagulase negative Staphylococci recovered from Non-Healthcare settings in London, UK. Antimicrob Resist Infect Control 2018; 7: 73.
25. Kumar P, Shukla I, Varshney S. Nasal screening of healthcare workers for nasal carriage of coagulase positive MRSA and prevalence of nasal colonization with Staphylococcus aureus. Biol Med 2011; 3: 182-186.
26. Effendi MH, Hisyam MAM, Hastutiek P, Tyasningsih W. Detection of coagulase gene in Staphylococcus aureus from several dairy farms in east Java, indonesia, by polymerase Chain reaction. Vet World 2019; 12: 68-71.
27. Javid F, Taku A, Bhat MA, Badroo GA, Mudasir M, Sofi TA. Molecular Typing of Staphylococcus Aureus based on coagulase Gene. Vet World 2018; 11: 423-430.
28. Behshood P, Tajbakhsh E, Momtaz H. Ecognition of (Sesc) for easy identification of Staphylococcus epidermidis and molecular and phenotypic study of Β-Lactam resistance in Staphylococcus epidermidis isolates in Isfahan. Rep Biochem Mol Biol 2020; 9: 309-314.
29. Giri N, Maharjan S, Thapa TB, Pokhrel S, Joshi G, Shrestha O, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus among healthcare workers in a tertiary care hospital, kathmandu, Nepal. Int J Microbiol 2021; 2021: 8825746.
30. Desta K, Aklillu E, Gebrehiwot Y, Enquselassie F, Cantillon D, Al-Hassan L, et al. High levels of methicillin-resistant Staphylococcus aureus carriage among healthcare workers at a teaching hospital in Addis Ababa Ethiopia: first evidence using mecA detection. Infect Drug Resist 2022; 15: 3135-3147.
31. Haque N, Bari MS, Haque N, Khan RA, Haque S, Kabir MR, et al. Methicillin resistant Staphylococcus epidermidis. Mymensingh Med J 2011; 20: 326-331.
32. Efa F, Alemu Y, Beyene G, Gudina EK, Kebede W. Methicillin-resistant Staphylococcus aureus carriage among medical students of Jimma university, southwest ethiopia. Heliyon 2019; 5(1): e01191.
33. Salman MK, Ashraf MS, Iftikhar S, Baig MAR. Frequency of nasal carriage of Staphylococcus aureus among health care workers at a tertiary care hospital. Pak J Med Sci 2018; 34: 1181-1184.
34. Zhanel GG, Adam HJ, Baxter MR, Fuller J, Nichol KA, Denisuik AJ, et al. 42936 Pathogens from Canadian hospitals: 10 years of results (2007–16) from the CANWARD Surveillance study. J Antimicrob Chemother 2019; 74(Suppl 4): iv5-iv21.
35. Mun Y, Kim MK, Oh JY. Ten-Year analysis of microbiological profile and antibiotic sensitivity for bacterial keratitis in Korea. PLoS One 2019; 14(3): e0213103.
36. 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.
37. Chauhan S, Surender, Rappai TJ. Mupirocin resistance in Staphylococcus aureus isolated from nasal swabs of ICU and OT Staff- A study from A tertiary care hospital. J Pure Appl Microbiol 2021; 15: 2059-2064.
38. Al-Dmour O, Al-Groom R, Alsheikh A, Mahmoud S, Amawi K, Yousef I, et al. Genetic identification of Methicillin-resistant Staphylococcus aureus nasal carriage and Its antibiogram among kidney dialysis patients at a tertiary care hospital in AL-Karak, Jordan. Int J Microbiol 2023; 2023: 9217014.
2. Tajeddin E, Rashidan M, Razaghi M, Javadi SS, Sherafat SJ, Alebouyeh M, et al. The Role of the intensive care unit environment and Health-Care workers in the transmission of bacteria associated with hospital acquired infections. Infect Public Health 2016; 9: 13-23.
3. Price JR, Cole K, Bexley A, Kostiou V, Eyre DW, Golubchik T, et al. Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit: a longitudinal cohort study based on whole-genome sequencing. Lancet Infect Dis 2017; 17: 207-214.
4. Geberemariyam BS, Donka GM, Wordofa B. Assessment of knowledge and practices of healthcare workers towards infection prevention and associated factors in healthcare facilities of west arsi district, southeast ethiopia: A facility-based cross-sectional study. Arch Public Health 2018; 76: 69.
5. Livermore DM. Antibiotic resistance in Staphylococci. Int J Antimicrob Agents 2000; 16 Suppl 1: S3-10.
6. Bomar L, Brugger SD, Lemon KP. Bacterial microbiota of the nasal passages across the span of human life. Curr Opin Microbiol 2018; 41: 8-14.
7. Rossi CC, Pereira MF, Giambiagi-deMarval M. Underrated Staphylococcus species and their role in antimicrobial resistance spreading. Genet Mol Biol 2020; 43(1 suppl 2): e20190065.
8. Budri PE (2019). Evidence for a role for Coagulase-Negative Staphylococci and their biofilms in the historic and future evolution of Staphylococcus aureus including MRSA. https://doi.org/10.25419/RCSI.10802789.V1
9. Albrich WC, Harbarth S. Health-Care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008; 8: 289-301.
10. Sassmannshausen R, Deurenberg RH, Köck R, Hendrix R, Jurke A, Rossen JW, et al. MRSA prevalence and associated risk factors among health-care workers in non-outbreak situations in the Dutch-German EUREGIO. Front Microbiol 2016; 7: 1273.
11. Seng R, Kitti T, Thummeepak R, Kongthai P, Leungtongkam U, Wannalerdsakun S, et al. Biofilm formation of methicillin-resistant coagulase negative Staphylococci (MR-CoNS) isolated from community and hospital environments. PLoS One 2017; 12(8): e0184172.
12. Ackah JK, Neal L, Marshall NR, Panahi P, Lloyd C, Rogers LJ. Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and republic of Ireland. J Infect Prev 2021; 22: 83-90.
13. Barbier F, Ruppé E, Hernandez D, Lebeaux D, Francois P, Felix B, et al. Methicillin‐Resistant Coagulase‐Negative Staphylococci in the community: high Homology of SCCmec IVa between Staphylococcus epidermidis and Major clones of methicillin‐resistant Staphylococcus aureus. J Infect Dis 2010; 202: 270-281.
14. Al-Tamimi M, Abu-Raideh J, Himsawi N, Khasawneh A, Hawamdeh H. Methicillin and vancomycin resistance in Coagulase-Negative Staphylococci isolated from the nostrils of hospitalized patients. J Infect Dev Ctries 2020; 14: 28-35.
15. Möllers M, von Wahlde MK, Schuler F, Mellmann A, Böing C, Schwierzeck V, et al. Outbreak of MRSA in a Gynecology/Obstetrics department during the COVID-19 pandemic: A cautionary tale. Microorganisms 2022; 10: 689.
16. Polly M, de Almeida BL, Lennon RP, Cortês MF, Costa SF, Guimarães T. Impact of the COVID-19 pandemic on the incidence of multidrug-resistant bacterial infections in an acute care hospital in Brazil. Am J Infect Control 2022; 50: 32-38.
17. Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB Jr, et al. A Guide to utilization of the Microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the infectious diseases society of America (IDSA) and the American society for Microbiology (ASM)a. Clin Infect Dis 2013; 57(4): e22-e121.
18. Clinical and Laboratory Standards Institute, M100 30th edition – Performance standards for antimicrobial susceptibilityt. 2020.
19. Giske CG, Turnidge J, Cantón R, Kahlmeter G; EUCAST Steering Committee. Update from the European committee on antimicrobial susceptibility testing (EUCAST). J Clin Microbiol 2022; 60(3): e0027621.
20. Aryal S (2022). Catalase Test- Principle, uses, procedure, result. interpretation with precautions. Available from: https://microbiologyinfo.com/catalase-test-principle-uses-procedure-result-interpretation-with-precautions/
21. Hasan AA, Hassawi DS, Al-Daghistani HI, Hawari AD. Molecular and biochemical identification of coagulase positive Staphylococcus species isolated from human and animal sources in Jordan. Int J Med Med Sci 2014; 47: 1491-1507.
22. Kateete DP, Kimani CN, Katabazi FA, Okeng A, Okee MS, Nanteza A, et al. Identification of Staphylococcus aureus: DNase and Mannitol salt agar improve the Efficiency of the tube coagulase Test. Ann Clin Microbiol Antimicrob 2010; 9: 23.
23. Pourmand MR, Hassanzadeh S, Mashhadi R, Askari E. Comparison of four diagnostic methods for detection of methicillin resistant Staphylococcus aureus. Iran J Microbiol 2014; 6: 341-344.
24. Xu Z, Shah HN, Misra R, Chen J, Zhang W, Liu Y, et al. The Prevalence, Antibiotic resistance and mecA characterization of coagulase negative Staphylococci recovered from Non-Healthcare settings in London, UK. Antimicrob Resist Infect Control 2018; 7: 73.
25. Kumar P, Shukla I, Varshney S. Nasal screening of healthcare workers for nasal carriage of coagulase positive MRSA and prevalence of nasal colonization with Staphylococcus aureus. Biol Med 2011; 3: 182-186.
26. Effendi MH, Hisyam MAM, Hastutiek P, Tyasningsih W. Detection of coagulase gene in Staphylococcus aureus from several dairy farms in east Java, indonesia, by polymerase Chain reaction. Vet World 2019; 12: 68-71.
27. Javid F, Taku A, Bhat MA, Badroo GA, Mudasir M, Sofi TA. Molecular Typing of Staphylococcus Aureus based on coagulase Gene. Vet World 2018; 11: 423-430.
28. Behshood P, Tajbakhsh E, Momtaz H. Ecognition of (Sesc) for easy identification of Staphylococcus epidermidis and molecular and phenotypic study of Β-Lactam resistance in Staphylococcus epidermidis isolates in Isfahan. Rep Biochem Mol Biol 2020; 9: 309-314.
29. Giri N, Maharjan S, Thapa TB, Pokhrel S, Joshi G, Shrestha O, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus among healthcare workers in a tertiary care hospital, kathmandu, Nepal. Int J Microbiol 2021; 2021: 8825746.
30. Desta K, Aklillu E, Gebrehiwot Y, Enquselassie F, Cantillon D, Al-Hassan L, et al. High levels of methicillin-resistant Staphylococcus aureus carriage among healthcare workers at a teaching hospital in Addis Ababa Ethiopia: first evidence using mecA detection. Infect Drug Resist 2022; 15: 3135-3147.
31. Haque N, Bari MS, Haque N, Khan RA, Haque S, Kabir MR, et al. Methicillin resistant Staphylococcus epidermidis. Mymensingh Med J 2011; 20: 326-331.
32. Efa F, Alemu Y, Beyene G, Gudina EK, Kebede W. Methicillin-resistant Staphylococcus aureus carriage among medical students of Jimma university, southwest ethiopia. Heliyon 2019; 5(1): e01191.
33. Salman MK, Ashraf MS, Iftikhar S, Baig MAR. Frequency of nasal carriage of Staphylococcus aureus among health care workers at a tertiary care hospital. Pak J Med Sci 2018; 34: 1181-1184.
34. Zhanel GG, Adam HJ, Baxter MR, Fuller J, Nichol KA, Denisuik AJ, et al. 42936 Pathogens from Canadian hospitals: 10 years of results (2007–16) from the CANWARD Surveillance study. J Antimicrob Chemother 2019; 74(Suppl 4): iv5-iv21.
35. Mun Y, Kim MK, Oh JY. Ten-Year analysis of microbiological profile and antibiotic sensitivity for bacterial keratitis in Korea. PLoS One 2019; 14(3): e0213103.
36. 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.
37. Chauhan S, Surender, Rappai TJ. Mupirocin resistance in Staphylococcus aureus isolated from nasal swabs of ICU and OT Staff- A study from A tertiary care hospital. J Pure Appl Microbiol 2021; 15: 2059-2064.
38. Al-Dmour O, Al-Groom R, Alsheikh A, Mahmoud S, Amawi K, Yousef I, et al. Genetic identification of Methicillin-resistant Staphylococcus aureus nasal carriage and Its antibiogram among kidney dialysis patients at a tertiary care hospital in AL-Karak, Jordan. Int J Microbiol 2023; 2023: 9217014.
| Files | ||
| Issue | Vol 16 No 5 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v16i5.16791 | |
| Keywords | ||
| Healthcare workers; Methicillin resistant staphylococci; Methicillin-resistant Staphylococcus aureus; Methicillin-resistant coagulase-negative Staphylococci; Staphylococcus aureus; COVID 19 | ||
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How to Cite
1.
Al-Nsour E, AL-Hadithi H, Al-Groom R, Abushattal S, Naser A, Al Nsour A, Sallam R, Kollab L, Alswalha L, Ahmad Khan MS. Increased incidence of methicillin resistant Staphylococcus aureus and methicillin resistant Staphylococcus epidermidis in the skin and nasal carriage among healthcare workers and inanimate hospital surfaces after the COVID-19 pandemic. Iran J Microbiol. 2024;16(5):584-597.
