Prevalence and Antibiotic Susceptibility of Community-Associated Methicillin-Resistant Staphylococcus aureus in a Rural Area of India: Is MRSA Replacing Methicillin-Susceptible Staphylococcus aureus in the Community?

Abstract

Staphylococcus aureus (SA) is the most common cause of skin and soft tissue infections (SSTIs) and nosocomial infections. In developed countries there is a major concern about the rise of community-associated methicillin-resistant SA (CA-MRSA), but data from developing countries are scarce. In this study we describe the prevalence and antibiotic susceptibility of CA-MRSA and healthcare-associated MRSA (HA-MRSA) in a district hospital from rural India. We identified 119 CA-SA infections and 82 HA-SA infections. The majority of infections were SSTI, and the proportion of MRSA in CA-SA and HA-SA infections was 64.7% and 70.7%, respectively. The proportion of CA-MRSA in children <5 years was 73.7%. We did not observe any linezolid or vancomycin resistance. CA-SA had high levels of resistance to ciprofloxacin and low levels of resistance to chloramphenicol, doxycycline, rifampicin, and clindamycin. CA-MRSA had higher proportion of resistance to ciprofloxacin, erythromycin, gentamicin, and cotrimoxazole than CA methicillin-susceptible SA (CA-MSSA). HA-MRSA had higher proportion of resistance to clindamycin and doxycycline than CA-MRSA. The results of this study indicate that MRSA is replacing MSSA in CA-SA infections. If these findings are confirmed by other studies, the spread of CA-MRSA can be a major public health problem in India.

Antibiograms, toxin profiling and molecular typing of Staphylococcus aureus isolates from two tertiary hospitals in Jordan

“…In USA, prevalence of MRSA approached 60% of the S. aureus isolates in 2003 [27]. In India, the proportion of CA-MRSA in children <5 years was 73.7% [28]. The high prevalence of MRSA in different parts of the world could be due to different protocols in using antibiotics in these parts of the world.…”

Could chloramphenicol be used against ESKAPE pathogens? A review ofin vitrodata in the literature from the 21st century

“…Indeed, Livermore et al recently reported that the susceptibility to chloramphenicol among 20 carbapenemase-producing Enterobacter strains was only 20% [7]. According to this observation, we could speculate that the Enterobacter phenotype is similar to that of K. pneumoniae, where resistance to [60] 2009 Pakistan 501 KB 90 [61] 2010 Pakistan 139 KB 93 [62] 2010 India 69 KB 60 [63] 2010 USA 21 MicroScan 91 [64] 2010 Pakistan 174 KB; E-test 7 [65] 2011 Greece 44 KB 70 [66] 2011 USA 170 -96 [67] 2011 Canada 51 Sensititre 98 [68] 2011 Iran 140 KB 100 [69] 2011 Libya 62 KB 61 [70] 2011 Nigeria 16 KB 0 [71] 2012 Turkey 34 -94 [72] 2012 Nigeria 46 KB 20 [73] 2012 Spain 204 KB 99 [74] 2012 India 135 KB 94 [75] 2012 Brazil 1998 (Y): 48 KB 4 [76] 2008 (Y): 56 70 2012 USA 270 -100 [77] 2012 China 163 CA -85 [78] 77 HA 87 † All the strains belonged to a single clone. ‡…”

Panton-Valentine leukocidin-positive Staphylococcus aureus osteomyelitis of the tibia in a 10-year-old child

“…In a case-control study, Golding et al [12] have identified insect bites as a potential risk factor for both CA-MRSA and CA-MSSA infections. Further, a recent study in rural India has identified MRSA as replacing MSSA in causing many community-acquired soft-tissue infections, being responsible for 64.7% of community-acquired S. aureus infections in the series described [13]. One can only speculate about the significance of the insect bites in the current case, and, of note, the dominant sequence types identified in India have been ST22 and ST772, which are different from the organism identified here, although 69% PVL positivity is identified among strains in India [14].…”