Prevalence and Characterization of Methicillin-Resistant Staphylococcus aureus from Community- and Hospital-Associated Infections: A Tertiary Care Center Study

Abstract

The community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become increasingly prevalent in both community and hospital settings. The aim of this study was to determine the prevalence, molecular characteristics and antibiotic resistance profiles of CA-MRSA from community- and hospital-associated infections in a tertiary care hospital in Mangalore, India. Of 520 S. aureus isolates, 362 were from inpatients (IP) and 158 were from outpatients (OP). One-hundred and thirty-two MRSA isolates obtained from 94 inpatients and 38 outpatients with complete clinical details were further analyzed. Of these, 81 (61.4%) were CA-MRSA (IP-47.9%, OP-94.7%) and 51 (38.6%) were HA-MRSA (IP-52.1%, OP-5.3%). All (100%) MRSA isolates were mecA gene positive. SCCmec typing identified SCCmec type IV (50.6%) and SCCmec type V (66.7%) in CA-MRSA, while SCCmec type I (41.2%), SCCmec type III (19.6%), SCCmec type IV (31.4%) and SCCmec type V (25.5%) were detected in HA-MRSA isolates. The Panton–Valentine Leukocidin (PVL) gene was found in 70.4% of CA-MRSA, 43.1% of HA-MRSA with SCCmec type IV and SCCmec type V, and in 7.8% of true HA-MRSA. The antibiotic resistance profiles were determined by the disc diffusion method. Resistance to cefoxitin was used to identify MRSA. A significant difference (p < 0.05) was observed between CA-MRSA and HA-MRSA with respect to resistance against cephalexin, cefotaxime, levofloxacin, linezolid and teicoplanin. CA-MRSA was predominantly resistant to ciprofloxacin (86.4%), erythromycin (66.7%), ofloxacin (49.4%), cefotaxime (44.4%), gentamicin (40.7%) and clindamycin (40.7%), while HA-MRSA showed resistance against ciprofloxacin (80.4%), erythromycin (80.1%), cefotaxime (70.6%),ofloxacin (58.8%), clindamycin (47.1%) and levofloxacin (41.2%).This study reports the prevalence of CA-MRSA in community and hospital settings and the possibility of multidrug-resistant CA-MRSA replacing HA-MRSA in hospitals. The observations from our study emphasize the need for urgent measures to manage this emerging crisis in healthcare settings.

Nasal Carriage of Community Acquired and Inducible Dormant Methicillin Resistant Staphylococcus aureus among Healthcare Workers of Mansoura University Children's Hospital

“…Like our findings, CA-MRSA isolates containing the SCCmec type IV demonstrated stronger antibiotic resistance than HA-MRSA according to Preeja et al, 26 and CA-MRSA isolates were shown to be resistant to three or more antibiotic classes. MDR CA-MRSA has been reported worldwide as mentioned by Earls et al, 29 and Lee et al 30 .…”

“…Higher prevalence reported by Buenaventura-Alcazaren et al 6 who observed that the prevalence of positive PVL-SCCmec IV community acquired MRSA isolates from HCWs was 33%. However, lower prevalence documented by Preeja et al, 26 who found that 12.3% of MRSA isolates were PVL-SCCmec IV community acquired MRSA.…”

Genomic Investigation of Methicillin-Resistant Staphylococcus aureus ST113 Strains Isolated from Tertiary Care Hospitals in Pakistan

“…The in-silico SCCmec typing revealed that strains P10 and R46 ST113 harbor SCCmec type IV, and therefore possibly CA-MRSA as SCCmec types IV and V are predominantly associated with CA-MRSA [12][13][14]. CA-MRSA are generally susceptible to non-β-lactam antibiotics and possesses the virulence-associated gene Panton-Valentine Leucocidin (PVL), whereas HA-MRSA are associated with nosocomial infections and are generally resistant to non-β-lactam antibiotics and do not possess the PVL gene [25]. The strain P10 contains a plasmid pI5S5 (HE579068.1), an unnamed plasmid "unnamed1" (CP030577.1), and three complete phages of length 42 kbp, 48.4 kbp, and 74.2 kbp.…”

Prevalence of MRSA and Antimicrobial Susceptibility Staphylococcus aureus in Clinical Samples in National Capital Region, India

“…As showed in the table-5, MRSA presented with highly resistant (Erythromycin-69.0) to lowest resistant (Linozolid-7.8). Another research also found that 44.4 percent of MRSA isolates were resistant to cefotaxime, 40.7% to gentamicin, 86.4% to ciprofloxacin, 40.7 percent to clindamycin, 66.7% to erythromycin, and 49.4% to ofloxacin [32].…”