Methicillin- and Inducible Clindamycin-ResistantStaphylococcus aureusamong Patients with Wound Infection Attending Arba Minch Hospital, South Ethiopia

Background. Wound infection is one of the most common hospital-acquired infections. Different bacteria cause infection, of whichStaphylococcus aureusis one of the known bacteria in causing infection with increased drug-resistant isolates.Objective. To assess the prevalence and antimicrobial susceptibility pattern of methicillin and inducible clindamycin-resistantStaphylococcus aureusamong patients with wound infections attending Arba Minch Hospital.Methods. A facility-based cross-sectional study was conducted from April to June 2017. A pretested questionnaire was used to collect demographic data and clinical characteristics. Wound swabs were cultured and identified by standard techniques. Antibiotic susceptibility tests were performed by the Kirby–Bauer disc diffusion method. Methicillin resistance was detected using the cefoxitin (30 μg) antibiotic disc while inducible clindamycin resistance was detected by the D-zone test. The data were analyzed using Statistical Package for Social Science, version 20.pvalue <0.05 was considered statistically significant.Results. A total of 161 patients were enrolled and a majority of them were female (90, 50.9%). Among the collected samples, 79 (49.7%) were positive forS. aureus; of this, methicillin resistance accounted for 65 (82.3%). Out of 22 (27.8%) erythromycin-resistant isolates, 19 (24.1%) showed inducible clindamycin resistance. Methicillin-resistantS. aureusshowed higher resistance against tetracycline (72.3%) followed by cotrimoxazole (43.1%) and 100% sensitivity to vancomycin. The overall prevalence of inducible clindamycin resistance among methicillin-resistant isolates was 16 (24.6%).Conclusion. The increasing prevalence of methicillin-resistantS. aureusand the coresistance against other therapeutic options like clindamycin is becoming an obstacle in the treatment of infections which need attention from concerned bodies.

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Antibiogram of Staphylococcus aureus in a Tertiary Care Hospital: Changing Trends

International Journal of Current Microbiology and Applied Sciences ◽

10.20546/ijcmas.2021.1010.040 ◽

2021 ◽

Vol 10 (10) ◽

pp. 319-325

Author(s):

Priyanka Pradhan Sneha Mohan ◽

Tarana Sarwat Dalip Kakru

Keyword(s):

Staphylococcus Aureus ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Diffusion Method ◽

Care Hospital ◽

Cross Sectional ◽

Inducible Clindamycin Resistance ◽

Healthcare Facilities ◽

Antimicrobial Susceptibility Pattern

Methicillin resistant Staphylococcus aureus (MRSA) is major cause of nosocomial and community infections. Its prevalence varies with country and with hospitals within a country. Therefore, it is important for continuous surveillance in hospitals and other healthcare facilities in order to limit the spread of infections caused by MRSA. To determine the antibiogram of Staphylococcus aureus in a tertiary care hospital and to determine the change in trends in the antimicrobial susceptibility pattern of Staphylococcus aureus. To determine the prevalence of MRSA in a tertiary care hospital. This cross- sectional study was conducted at the Department of Microbiology, SMSR, Sharda University and Hospital. A total of 100 strains identified by morphological and biochemical characteristics were tested for antibiotic susceptibility using Kirby-Bauer disc diffusion method and the Prevalence of Inducible Clindamycin Resistance among the isolates. 100 out of 13,639 isolates clinical comprising samples were obtained Pus (78.6%), Blood (7%), Swab (4.1%), Sputum (4.1%), Urine (4.1%), Semen (2%). Maximum MRSA were obtained from pus samples (81%). However, out of total 7 isolates of Staphylococcus aureus obtained from blood 4 were MRSA and 3 were MSSA. The prevalence of MRSA that is (40%) infections was a high in our setup and is comparable to studies done earlier. This trend is particularly alarming for Staphylococcus aureus because of the severity and diversity of disease caused by this uniquely versatile pathogen.

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Bacterial Etiology of Wound Exudates in Tertiary Care Cancer Patients and Antibiogram of the Isolates

Infectious Diseases Research and Treatment ◽

10.1177/1178633720952077 ◽

2020 ◽

Vol 13 ◽

pp. 117863372095207

Author(s):

Kiran Duwadi ◽

Sujan Khadka ◽

Sanjib Adhikari ◽

Sanjeep Sapkota ◽

Pabitra Shrestha

Keyword(s):

Staphylococcus Aureus ◽

Pathogenic Bacteria ◽

Methicillin Resistance ◽

Tertiary Care ◽

Antibiotic Sensitivity ◽

Cross Sectional Study ◽

Diffusion Method ◽

Disc Diffusion ◽

Biochemical Tests ◽

Cross Sectional

Introduction: Patients with malignancies frequently develop infections as a result of surgical procedures and fungating wounds leading to pus formation. This cross-sectional study was conducted to explore the bacteriological spectra of infections of various cancer sites and their antibiotic sensitivity patterns among the patients visiting minor operation theatre (OT) of B.P. Koirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal. Methods: Over a period of 3 months from September to November 2018, a total of 183 wound exudates and pus samples were collected and analyzed by standard microbiological procedures. Isolates were identified based on the colony characters, Gram staining and an array of biochemical tests. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion technique according to criteria set by CLSI, 2016. Methicillin resistance in Staphylococcus aureus was tested with the help of cefoxitin using disc diffusion method. Results: Out of the 183 samples, 149 (81.4%) were culture positive. Among 13 different isolates identified, S. aureus (43.0%) was predominant followed by E. coli (14.0%). Higher incidence of bacteria was seen among the males (52.3%), in the age group 51 to 60 years (26.8%) and among the patients undergoing surgical intervention to deal with cancer (34.2%). The prevalence of wound infection was significantly affected by gender, age, and treatment regimen ( P < .01). Out of the total 68 S. aureus isolates, 38 (44.1%) were deemed as Methicillin-resistant Staphylococcus aureus (MRSA). Among the 158 isolates, 85 (53.8%) were multi-drug resistant (MDR). Cefepime was the most effective antibiotic for Gram positive isolates whereas both imipenem and meropenem were found to be equally more effective for Gram negative isolates. Conclusion: This study suggests that patients with malignancies harbor pathogenic bacteria; therefore, prudent use of antibiotics is essential to prevent the emergence of MDR pathogens.

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A cross sectional study to assess nasal carriage of methicillin resistant Staphylococcus aureus in healthcare professionals in a tertiary care hospital

Journal of the Pakistan Medical Association ◽

10.47391/jpma.062 ◽

2020 ◽

pp. 1-12

Author(s):

Fibhaa Syed ◽

Nasim Akhtar ◽

Mohammad Ali Arif ◽

Adil Ramzan ◽

Rauf Niazi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Healthcare Workers ◽

Methicillin Resistant Staphylococcus Aureus ◽

Tertiary Care ◽

Nasal Carriage ◽

Cross Sectional Study ◽

Diffusion Method ◽

Cross Sectional ◽

Methicillin Resistant ◽

Nasal Swabs

Abstract Objective: To determine the nasal carriage of staphylococcus aureus and methicillin-resistant staphylococcus aureus among healthcare workers in a tertiary care setting. Methods: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from April to July 2018, and comprised healthcare workers at the institution. Nasal swabs were collected and cultured on Mannitol salt agar. Mannitol fermenting colonies which were gram-positive cocci, catalase-positive and coagulase-positive were identified as staphylococcus aureus. Antibiotic susceptibility test was performed by modified Kirby-Bauer disc diffusion method. Methicillin resistance was detected using cefoxitin disc diffusion method. Data was analysed using SPSS 23. Results: Of the 210 nasal swabs, 52(24.76%) had a staphylococcus aureus growth, and, of them, 15(7.1%) were methicillin-resistant. No association could be established with either any single category of healthcare worker or an inter-department variation (p>0.05). Likewise, there was no association with age, gender, duration of service, smoking, co-morbidities, use of antibiotics in the preceding six months, treating a patient with methicillin-resistant staphylococcus aureus in the preceding six months and hospitalisation in the preceding year (p>0.05). Conclusion: The frequency of nasal carriage of methicillin resistant staphylococcus aureus amongst healthcare workers was regardless of the nature of their professional engagement. Key Words: Methicillin resistant staphylococcus aureus, Nasal carriage, Continuous...

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Methicillin-Resistant Staphylococcus aureus Nasal Carriage among Janitors Working in Hospital and Non-Hospital Areas: A Comparative Cross-Sectional Study

10.21203/rs.3.rs-36534/v1 ◽

2020 ◽

Author(s):

Seid Abie ◽

Moges Tiruneh ◽

Wondwossen Abebe

Keyword(s):

Staphylococcus Aureus ◽

Associated Factors ◽

Nasal Carriage ◽

Cross Sectional Study ◽

Diffusion Method ◽

Nasal Colonization ◽

Sectional Study ◽

Cross Sectional ◽

Methicillin Resistant ◽

Study Participants

Abstract Background: Nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of both healthcare-associated and community-acquired MRSA infections in various populations. Screening of MRSA nasal colonization is important in the prevention and control of infection and may provide useful information to guide antimicrobial therapy. This study aimed to determine nasal carriage of MRSA, its antimicrobial susceptibility pattern, and associated factors among janitors working in hospital & non-hospital areas at the University of Gondar, Northwest Ethiopia.Methods: A comparative cross-sectional study was carried out in a total of 436 study participants (221 hospital and 215 non-hospital janitors) from January to May 2019. The study participants were sampled using a simple random sampling technique. Data on socio-demographic characteristics and associated factors were collected through face to face interviews using a structured questionnaire. Nasal swabs were collected and inoculated into Mannitol salt agar. MRSA was detected using cefoxitin (30µg) disc and an antibiotic susceptibility test was done using the disc diffusion method. Data were entered and analyzed using SPSS version 20 statistical package. P-value ≤ 0.05 was considered as statistically significant.Results: The overall prevalence of S. aureus was 101/436 (23.2%, [95% CI: 19.3-27.8], of which, 29.4% (65/221) were isolated from hospital and 16.7% (36/215) non-hospital janitors. The prevalence of MRSA was 4.8% (21/436) [95% CI: 3.0-6.9]; of these, 8.1% (18/221) of the isolates were from the hospital and 1.4% (3/215) non-hospital janitors, while MSSA in hospital & non-hospital janitors were 49 (22.2%) and 31 (14.4%), respectively. Among the MRSA isolates, 52.4% (11/21) were multi-drug resistant. Of these, 42.9% (9/18) were isolated from hospital and 66.7% (2/3) non-hospital janitors. Hence, nasal carriage of MRSA was significantly associated with hospitalization within the preceding year (AOR = 3.15, CI = 1.13-8.71).Conclusion: The present study revealed that high MSSA and MRSA were isolated from the hospital as compared to non-hospital janitors and high rates of antibiotics resistance were recorded in the hospital janitors. Consequently, hospitalizations were significantly associated with MRSA. Accordingly, regular screening of carriers in apparently healthy janitors is required for the prevention of nosocomial infections.

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Methicillin-resistant Staphylococcus aureus nasal carriage among janitors working in hospital and non-hospital areas: a comparative cross-sectional study

10.21203/rs.3.rs-36534/v2 ◽

2020 ◽

Author(s):

Seid Abie ◽

Moges Tiruneh ◽

Wondwossen Abebe

Keyword(s):

Staphylococcus Aureus ◽

Associated Factors ◽

Nasal Carriage ◽

Cross Sectional Study ◽

Diffusion Method ◽

Nasal Colonization ◽

Sectional Study ◽

Cross Sectional ◽

Methicillin Resistant ◽

Study Participants

Abstract Background: Nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of both healthcare-associated and community-acquired MRSA infections in various populations. Screening of MRSA nasal colonization is important in the prevention and control of infection and may provide useful information to guide antimicrobial therapy. This study aimed to determine nasal carriage of MRSA, its antimicrobial susceptibility pattern, and associated factors among janitors working in hospital & non-hospital areas at the University of Gondar, Northwest Ethiopia.Methods: A comparative cross-sectional study was carried out in a total of 436 study participants (221 hospital and 215 non-hospital janitors) from January to May 2019. The study participants were sampled using a simple random sampling technique. Data on socio-demographic characteristics and associated factors were collected through face to face interviews using a structured questionnaire. Nasal swabs were collected and inoculated into Mannitol salt agar. MRSA was detected using cefoxitin (30µg) disc and an antibiotic susceptibility test was done using the disc diffusion method. Data were entered and analyzed using SPSS version 20 statistical package. P-value ≤ 0.05 was considered as statistically significant.Results: The overall prevalence of S. aureus was 101/436 (23.2%, [95% CI: 19.3-27.8], of which, 29.4% (65/221) were isolated from hospital and 16.7% (36/215) non-hospital janitors. The prevalence of MRSA was 4.8% (21/436) [95% CI: 3.0-6.9]; of these, 8.1% (18/221) of the isolates were from the hospital and 1.4% (3/215) non-hospital janitors, while methicillin-sensitive S. aureus (MSSA) in hospital & non-hospital janitors were 49 (22.2%) and 31 (14.4%), respectively. Among the MRSA isolates, 52.4% (11/21) were multi-drug resistant. Of these, 42.9% (9/18) were isolated from hospital and 66.7% (2/3) non-hospital janitors. Hence, nasal carriage of MRSA was significantly associated with hospitalization within the preceding year (AOR = 3.15, CI = 1.13-8.71).Conclusion: The present study revealed that high MSSA and MRSA were isolated from the hospital as compared to non-hospital janitors and high rates of antibiotics resistance were recorded in the hospital janitors. Consequently, hospitalizations were significantly associated with MRSA. Accordingly, regular screening of carriers in apparently healthy janitors is required for the prevention of nosocomial infections.

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PREVALENCE OF INDUCIBLE CLINDAMYCIN RESISTANCE IN CLINICAL ISOLATES OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS MEDIATED THROUGH GENE ERMC EXPRESSION

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i9.25928 ◽

2018 ◽

Vol 11 (9) ◽

pp. 106

Author(s):

Nimisha Tandon ◽

Madhuri Kulkarni ◽

Sowmya Gs ◽

Fauzia Tabassum ◽

Sayeed Akhtar Md

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Good Alternative ◽

Clinical Isolates ◽

University Teaching ◽

Diffusion Method ◽

Disc Diffusion ◽

Cross Sectional ◽

Methicillin Resistant ◽

Inducible Clindamycin Resistance

Objective: The objective of this study is to determine the phenotypic and genotypic expression of inducible clindamycin resistance due to the expression of ermA, ermB, and ermC genes in clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) by double disc diffusion and uniplex PCR.Method: This cross-sectional study was conducted in microbiology department of an university teaching hospital. A total of 604 non-duplicate clinical isolates of S. aureus evaluated for MRSA and were subjected to uniplex PCR for ermA, ermB, and ermC genes, respectively.Result: The analysis of 604 isolates showed that 220 (36.42%) were of MRSA. Out of which, 69 (11.42%) were demonstrated as inducible clindamycin resistance by double-disc diffusion method, and among inducible resistant isolates, 25 isolates of ermC (84%) were positive and 4 (16%) were negative, whereas, ermA and ermB genes could not be demonstrated by the genotypic method.Conclusion: We observed that clindamycin may serve as a good alternative and advocated in severe MRSA infection based on susceptibility pattern. We observed D test as a mandatory method to detect inducible clindamycin Staphylococcus. Importantly, ermC gene is a major determinant of resistance to macrolides among MRSA.

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Methicillin-resistant Staphylococcus aureus on surfaces of an Intensive Care Unit

Acta Paulista de Enfermagem ◽

10.1590/s0103-21002011000400002 ◽

2011 ◽

Vol 24 (4) ◽

pp. 453-458 ◽

Cited By ~ 5

Author(s):

Adriano Menis Ferreira ◽

Denise de Andrade ◽

Marcelo Alessandro Rigotti ◽

Margarete Teresa Gottardo de Almeida

Keyword(s):

Intensive Care Unit ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Descriptive Analysis ◽

Infusion Pump ◽

Cross Sectional Study ◽

Cross Sectional ◽

Methicillin Resistant

OBJECTIVE: To evaluate the presence of methicillin-resistant Staphylococcus aureus (MRSA) in areas close to patients in a General Intensive Care Unit. METHODS: This is a cross-sectional study, in which microbiological samples were collected from five surfaces (left / right bed siderails, bed crank, table, buttons on the infusion pump, and cotton gowns) from each of ten patient rooms, totaling 63 samples. To collect samples, the Petri FilmTM Staph Express Count System 3M TM was used to screen for methicillin resistance, with the Mueller-Hinton agar supplemented with 4% sodium chloride and 6 µg / ml of oxacillin. Descriptive analysis was conducted to determine the frequency (n) and percentage (%) of contamination of environmental surfaces. RESULTS: Of 48 samples positive for Staphylococcus aureus, 29 (60.4%) were resistant to methicillin. The incidence on the siderails and bed cranks, table, buttons on the infusion pumps and aprons were, respectively, 55.5%, 57.1%, 57.1%, 60.0% and 75.0%. CONCLUSION: The results suggest that the surfaces around the patient constitute a major threat, as they represent secondary reservoirs of MRSA.

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Panton Valentine Gene in both Community-acquired and Healthcare-acquired Methicillin Resistant Staphylococcus aureus Isolates from Ain Shams University Hospitals

QJM ◽

10.1093/qjmed/hcaa053 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R A Mohamed ◽

L F Fathi ◽

N N Salaheldeen

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Meca Gene ◽

Cross Sectional Study ◽

P Value ◽

University Hospitals ◽

Cross Sectional ◽

Mannitol Salt Agar ◽

Methicillin Resistant

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen that is associated with both hospital and community infections. Panton Valentine leukocidin (PVL) is an important virulence factor of S. aureus that is considered by many authors a marker of community acquired MRSA (CA-MRSA). Aim of the Work This study aimed to determine the prevalence of PVL genes among healthcare acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and CA-MRSA isolates, and to test the hypothesis that PVL is a reliable marker of CA-MRSA isolates. Material and Methods This comparative cross-sectional study was done on fifteen community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) and fifteen hospital acquired methicillin resistant Staphylococcus aureus (HA-MRSA), obtained from patients attending outpatient clinics, presenting with community-acquired pyogenic infections and patients with healthcare acquired pyogenic infections in Intensive Care Units (ICUs), during the period from May 2017 till February 2018. Clinical specimens included pus and different body fluids. Staphylococcus aureus was isolated and identified using conventional microbiological methods3. Isolates were then tested for methicillin resistance by culture on mannitol salt agar (MSA) with cefoxitin4. The presence of mecA and pvl genes in all MRSA isolates was subsequently detected by PCR5,6. Results Among 15 HA-MRSA isolates, mecA gene was positive in 40% (6/15) of isolates, while pvl gene was positive in 53.3% (8/15) of isolates. Among 15 CA-MRSA isolates, mecA gene was positive in 46.7% (7/15) of isolates, while pvl gene was positive in 26.7% (4/15) of isolates. Conclusion We conclude that pvl gene is not a sole genetic marker for diagnosis CA-MRSA, as there was no significant correlation between mecA that encodes for methicillin resistance and pvl genes among fifteen CA-MRSA isolates (P value =1).

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Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus nasal carriage in the West of Iran: a population-based cross-sectional study

BMC Infectious Diseases ◽

10.1186/s12879-019-4567-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Elham Ahmadi ◽

Mohammad Khojasteh ◽

Seyed Mohammad Mortazavi ◽

Fatemeh Khan-Mohammadi ◽

Ali Kazemnia ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistance ◽

Pcr Amplification ◽

Nasal Carriage ◽

Health Concern ◽

Diffusion Method ◽

The West ◽

Cross Sectional ◽

Disk Diffusion Test ◽

Methicillin Resistant

Abstract Background Several reports designate the recent increase in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) nasal carriage. Because of the scanty information regarding the nasal carriage sate of MRSA in the west of Iran, the purpose of the present study was to determine the frequency of CA-MRSA in Sanandaj city. Methods Swabs collected from anterior nares of 600 volunteers were analyzed for the presence of S. aureus. The isolates were further investigated for methicillin resistance by using the cefoxitin disk diffusion test, followed by PCR-amplification of the mecA gene. SCCmec types and the presence of the Panton-Valentine Leukocidin (pvl) encoding genes were determined through PCR. Finally, the antimicrobial susceptibility of the isolates was determined by the agar diffusion method. Results Nasal screening identified 181 S. aureus, of which 55 isolates were MRSA. SCCmec types IV and V were detected in MRSA at frequencies of 80 and 20%, respectively. The overall frequency of pvl genes among the MRSA isolates was 14.54%. MRSA isolates were highly susceptible (98.18%) to mupirocin, gentamicin, and fusidic acid. Conclusions The high prevalence of CA-MRSA carriage in the population could pose a serious public health concern for the region. Additionally, advent of drug-resistant pvl-positive strains demands continuous surveillance on the colonization state of CA-MRSA in order to prevent dissemination of the bacterium in the community.

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D-Test as a tool to detect the frequency of clindamycin resistance in community acquired and hospital acquired methicillin resistant Staphylococcus aureus infections (MRSA).

The Professional Medical Journal ◽

10.29309/tpmj/2019.27.01.181 ◽

2020 ◽

Vol 27 (01) ◽

pp. 1-4

Author(s):

Sadaf Razzak ◽

Hina Faisal ◽

Amir Bux Detho ◽

Muhammad Asif Durrani ◽

Fakhuruddin ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Skin Lesions ◽

Cross Sectional Study ◽

Cross Sectional ◽

Methicillin Resistant ◽

Inducible Clindamycin Resistance ◽

Resistant Strains ◽

Medical Wards ◽

Hospital Acquired

Objectives: D-Test as a tool to detect the frequency of clindamycin resistance in community acquired and hospital acquired methicillin resistant Staphylococcus aureus infections. Study Design: A cross-sectional study. Setting: Microbiology department of BMSI, JPMC, Karachi. Period: January 2015 till December 2015. Material & Methods: Pus samples from deep wounds, skin lesions, abscesses, postoperative wounds from surgical, medical wards and OPDs were collected. MRSA testing and susceptibility testing for antibiotics was done according to CLSI2014. The frequency of inducible clindamycin resistance was detected by D-Test of the CA-MRSA and HA-MRSA. Result: In a total of 402 S. aurous isolates, 253 (62.93%) were methicillin-sensitive and 149 (37.06%) were methicillin-resistant. Out of 149 MRSA, 106 (71.14%) were HA-MRSA and 43(28.85%) were CA-MRSA. Among the HA-MRSA, 63(59.8%) were resistant to clindamycin while with D-Test, it increased to 78(73.58%). Out of 43 CA-MRSA, 9 (21.6%) were clindamycin resistant, while with D-Test, the resistance to clindamycin increased to 13 (30.23%). Conclusion: Inducible clindamycin-resistant strains may lead to clindamycin treatment failure in patients with S. aureus infection. Therefore, D-test should be done in priority to detect inducible clindamycin resistance in S. aurous.

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