High prevalence of methicillin resistant staphylococci strains isolated from surgical site infections in Kinshasa

Abstract

IntroductionSurgical site infections (SSIs) after surgery are usually caused by Staphylococcus aureus and coagulase-negative staphylococci (CNS). In low income countries, methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase-negative staphylococci (MR-CNS) surgical site infections are particularly associated with high treatment cost and remain a source of mortality and morbidity. This study aimed to determine the prevalence and the sensitivity to antibiotics of MRSA and MR-CNS isolated from SSIs.MethodsWound swabs were collected from 130 hospitalized surgical patients in two major hospitals of Kinshasa. S. aureus and CNS strains were identified by standard microbiological methods and latex agglutination test (Pastorex Staph-Plus). The antibiotic susceptibility of all staphylococcal strains was carried out using disk-diffusion method.ResultsEighty nine staphylococcal strains were isolated. Out of 74 S. aureus and 15 CNS isolated, 47 (63.5%) and 9 (60%) were identified as MRSA and MR-CNS respectively. Among the MRSA strains, 47 strains (100%) were sensitive to imipenem, 39 strains (89%) to amoxycillin-clavulanic acid and 38 strains (81%) to vancomycin. All MR-CNS were sensitive to imipenem, amoxycillin-clavulanic acid and vancomycin. The isolated MRSA and MR-CNS strains showed multidrug resistance. They were both resistant to ampicillin, cotrimoxazole, erythromycin, clindamycin, ciprofloxacin, cefotaxime and ceftazidime.ConclusionThe results of the present study showed a high prevalence of MRSA and MR-CNS. Imipenem, amoxycillin-clavulanic acid and vancomycin were the most active antibiotics. This study suggests that antibiotic surveillance policy should become national priority as MRSA and MR-CNS were found to be multidrug resistant.

Prevalence and resistance pattern of methicillin-resistant coagulase negative Staphylococci among orthopaedic patients in a tertiary institution in North western Nigeria

“…However the prevalence observed in this study was consistent with the reports from other parts of the world: 67.5% prevalence of MRCoNS was reported from blood cultures of septicaemia patients in Turkey (Ko Ksai et al, 2009) and 45% prevalence from surgical wounds (Rahman et al, 2013), 52% from a tertiary care hospital in Iran (Sharma et al, 2010). Iyamba et al, 2014 reported 60% prevalence of MRCoNS from surgical site infections from Kinshasa. The high prevalence of MRCoNS should be of great concern to health institutions and the community at large due to its antibiotics multi-resistance challenge and the financial burden on the in-patients especially here in Nigeria, a developing country.…”

“…In a report by Diekema et al, 2001, resistance to penicillin among the coagulase-negative staphylococci (CoNS) approaches 90 to 95 percent, resistance to methicillin and semisynthetic penicillins has been observed in more than 80 percent of CoNS isolates; these isolates are often resistant to multiple classes of antibiotics in addition to beta-lactams, therefore limiting traditional treatment options, like those with semi-synthetic penicillins. Iyamba et al, 2014 reported high resistant of MRCoNS isolates to ampicillin (beta lactam), erythromycin (macrolide), clindamycin (lincosamine) and ciprofloxacin.…”

Review of Clinically and Epidemiologically Relevant Coagulase-Negative Staphylococci in Africa

“…82 Conversely, CoNS accounted for a high incidence of surgical site infections, following surgical procedures, when surgical site infections were characterized (Table 1). 6 Surgical site infections are infections affecting either the incision or deep tissue at the site of operation, and occurs up to 30 days postsurgery or up to 1 year in cases of those with implants. 6 Although improvements have been made in the prevention of postsurgical infections, surgical site infections remain problematic in surgical practice and account for increased cost of health care and prolonged hospitalization.…”

“…6 Surgical site infections are infections affecting either the incision or deep tissue at the site of operation, and occurs up to 30 days postsurgery or up to 1 year in cases of those with implants. 6 Although improvements have been made in the prevention of postsurgical infections, surgical site infections remain problematic in surgical practice and account for increased cost of health care and prolonged hospitalization. 83 Studies show that most of the causes of surgical site infections are normal residents of the skin, such as CoNS and S. aureus.…”

“…1 Even though CoNS are usually considered innocuous, they are frequently associated with nosocomial infections, leading to greater interest in them as relevant pathogens rather than mere contaminants. 1,2 Bacterial eye infections, 3 prosthetic joint infections, 4 urinary tract infections (UTIs) especially among immunocompromised patients, 5 surgical site infections, 6 infective endocarditis 7 and cattle mastitis 8 are some conditions that have been associated with CoNS. 9 Because CoNS usually form part of the microbiota of the skin and mucous membranes, proper differentiation between clinically significant and contaminant bacteria is important in bacterial etiology of suspected infections.…”