scholarly journals Recurrent Challenges for Clinicians: Emergence of Methicillin-resistant Staphylococcus aureus, Vancomycin Resistance, and Current Treatment Options

2013 ◽  
Vol 5 (02) ◽  
pp. 071-078 ◽  
Author(s):  
Bansidhar Tarai ◽  
Poonam Das ◽  
Dilip Kumar
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Agents ◽  
Hospital Setting ◽  
Vancomycin Resistance ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Coagulase Negative Staphylococcus ◽  
Gram Positive ◽  
Methicillin Resistant ◽  
Resistant Strains

ABSTRACTGram-positive pathogens mainly, Staphylococcus aureus, Enterococcus and coagulase-negative Staphylococcus, are developing increasing resistance to glycopeptides that pose a problem in treating infections caused by these pathogens. Vancomycin is the treatment of choice in treating methicillin-resistant S. aureus (MRSA). Community-acquired MRSA is associated with infections in patients without recent history of hospital admission and without the classical risk factors for MRSA carriage (including healthcare personnel). MRSA poses new threats and challenges beyond the hospital with the emergence of community-acquired MRSA. Indiscriminate use of vancomycin leads to the emergence and spread of vancomycin resistance in multidrug resistant strains is of growing concern in the recent years. Minimum Inhibitory concentration (MIC) remains an important determinant in choosing the right antibiotics. Infections caused by MRSA strains with vancomycin MIC > 4 μg/mL leads to the vancomycin treatment failure. The Clinical Laboratory Standards Institute had also lowered the cut-off susceptibility and resistance breakpoints for vancomycin. Despite the availability of newer antimicrobial agents (Linezolid, Daptomycin, Tigecycline) for drug-resistant Gram-positive pathogens, clinicians and patients still need options for treatment of MRSA infection. There is a need to reduce the global burden of infections caused by Gram-positive pathogens and its resistant strains (mainly MRSA). Continuous efforts should be made to prevent the spread and the emergence of glycopeptide resistance by early detection of the resistant strains and using the proper infection control measures in the hospital setting.

scholarly journals Colonization, Virulence Factors, and Antimicrobial Susceptibility Patterns of Staphylococcus Aureus Isolated from the Anterior Nares of Medical and Paramedical Students

2021 ◽  
pp. 57-67
Author(s):  
Venkataramana Kandi
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Hospital Environment ◽  
Blood Agar ◽  
Healthcare Personnel ◽  
Diffusion Method ◽  
Coagulase Negative Staphylococcus ◽  
Moderate Growth ◽  
Nasal Swabs

Background: Hospital environment and healthcare personnel form an integral part of healthcare system. Patients visit the hospital for various reasons. Some patients require hospitalization and others require medical and surgical interventions. Microbes present in the hospital environment and those colonized in the anterior nares, and on the skin of healthcare personnel could pose an increased threat of hospital acquired infections. Staphylococcus aureus (S. aureus) is one among many microbial species with potential to cause mild to severe infections that could be present colonized in the healthcare personnel. This study is aimed to evaluate the colonization of S. aureus in the anterior nares of medical and paramedical students. Methods: Nasal swabs were collected from a total of 100 medical, and paramedical students. The swabs were cultured on blood agar, and the staphylococcal isolates were identified to the species level by using standard and conventional microbiological techniques. The colonies were counted on isolation (<10 colonies-scanty growth; <25 colonies-moderate growth; <50 colonies-moderate to heavy growth; and > 50 colonies; heavy growth). The virulence determinants including hemolysis, pigment production was assessed. The antimicrobial susceptibility testing was performed using Kirby-Bauer disk diffusion method. Results: Microbes had grown in 97% of the nasal swabs. Most frequent bacterial isolates were Coagulase negative Staphylococcus (CONS), and diphtheroid bacteria (bacterial resembling Corynebacterium diphtheriae. S. aureus was isolated in 13% of the study participants. Conclusion: The isolation rates of S. aureus were noted to be 13%. Increased resistance was noted against vancomycin, and commonly used antimicrobial agents. Most isolates demonstrated hemolysis on blood agar.

Trends of Antimicrobial Resistance of Sepsis Pathogens at a University Hospital in New Delhi, India

Drug Research ◽  
2020 ◽  
Vol 70 (10) ◽  
pp. 463-471
Author(s):  
Md Shamshir Alam ◽  
Prem Kapur ◽  
ParuKutty Pillai ◽  
Krishna Kolappa Pillai
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Salmonella Typhi ◽  
University Hospital ◽  
Coagulase Negative Staphylococcus ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Acinetobacter Species ◽  
Gram Negative

AbstractKnowledge of the aetiological agents and its susceptibility to antimicrobial agents enables the clinician to initiate appropriate empirical antimicrobial therapy and guides diagnostic procedures. The aims of the study were to identify prevalence of bacterial pathogens causing sepsis and observe their antimicrobial resistance trends in hospitalized patients. A prospective cohort study was conducted on patients of sepsis admitted at a university hospital over a period of six months. Pathogens were identified by morphological, biochemical and serological tests as per the American Society for Microbiology. Antibacterial sensitivity of bacterial strains isolated from clinically diagnosed sepsis was carried out by Kirby-Bauer disk diffusion method and interpreted according Clinical and Laboratory Standards Institute guidelines. The data were analyzed by using Statistical Package for Social Sciences, version 16.0 (SPSS 16.0, Chicago, IL, USA). Coagulase negative Staphylococcus (63.5%) and Staphylococcus aureus (23.1%) were the most frequently isolated Gram positive bacteria. Acinetobacter species (31%) and Salmonella typhi (24.1%) were the most frequently isolated Gram negative bacteria. Coagulase negative Staphylococcus showed significant resistance to ciprofloxacin and tetracycline. Acinetobacter species showed significant resistance to ampicillin, amoxicillin and amoxiclav. Salmonella typhi showed significant resistance to ampicillin, amoxicillin, cefotaxime, netilmicin and, tetracycline. Escherichia coli showed significant resistance to ampicillin and netilmicin. All the stains of Staphylococcus aureus were resistant to amoxicillin. Coagulase negative Staphylococcus and Acinetobacter species were predominant Gram positive and Gram negative bacteria, respectively, causing sepsis. Increasing rates of bacterial resistance to commonly use antimicrobial agents were observed.

Dalbavancin for the Treatment of Complicated Gram-Positive Skin and Soft Tissue Infections

2020 ◽  
Vol 19 (3) ◽  
pp. 236-241 ◽  
Author(s):  
Vasilios Petrakis ◽  
Periklis Panagopoulos ◽  
Nikolaos Papanas
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Antimicrobial Agents ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Antimicrobial Treatment ◽  
Soft Tissue Infections ◽  
Gram Positive ◽  
Positive Skin ◽  
Methicillin Resistant ◽  
Complicated Skin

New antimicrobial agents have been developed to treat infections caused by methicillin-resistant Staphylococcus aureus and other multidrug-resistant pathogens. Dalbavancin is a novel semisynthetic lipoglycopeptide antibiotic, particularly active against methicillin-resistant Staphylococcus aureus. Due to its unique pharmacological characteristics and longer half-life, it can be administered once-weekly or every 15 days and in outpatient setting. Currently, it is indicated for complicated skin and soft tissue infections, but accumulating evidence points to its off-label efficacy in osteomyelitis and endocarditis. Further experience is still needed to increase our knowledge on the role of dalbavancin in a wider range of Gram-positive infections requiring prolonged antimicrobial treatment.

Methicillin-Resistant Staphylococcus Aureus: Interstate Spread of Nosocomial Infections with Emergence of Gentamicin-Methicillin Resistant Strains

1980 ◽  
Vol 1 (2) ◽  
pp. 81-89 ◽  
Author(s):  
George Saroglou ◽  
Margaret Cromer ◽  
Alan L. Bisno
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Agents ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Phage Type ◽  
Bacterial Strains ◽  
Methicillin Resistant ◽  
Selective Pressures ◽  
Potential Pathogen ◽  
Resistant Strains ◽  
Clinically Significant

AbstractA methicillin-resistant strain of Staphylococcus aureus (MRSA, phage type 84/85) was introduced into City of Memphis Hospital by a burn patient who had recently been treated for MRSA bacteremia in another institution 500 miles distant. Despite prompt recognition of the problem and institution of isolation procedures, six other patients developed secondary colonization during the ensuing six months, and five of these experienced clinically significant infections with MRSA. Three of the patients originally infected with MRSA, as well as two additional patients, subsequently developed colonization with staphylococcal strains of phage type 84/85 that were resistant to both methicillin and gentamicin (MRGRSA). Spread of the staphylococcal strains was most likely accomplished primarily via passive transfer from person to person. The hydrotherapy unit, which became contaminated with both MRSA and MRGRSA, may have played a secondary role. As illustrated by this outbreak, patients carrying potentially dangerous bacterial strains should be identified and informed of the problems posed by such carriage. It may be imprudent to admit such patients to hospitals that are free of the potential pathogen.The outbreak described here exemplifies a number of potential problems associated with control of nosocomial staphylococcal infections: (a) interhospital spread of methicillin-resistant strains; (b) secondary patient-to-patient intrahospital spread; and (c) emergence of even more resistant strains, possibly associated with selective pressures exerted by widespread use of broad-spectrum antimicrobial agents.

scholarly journals Nasal Carriage of Methicillin-Resistant Staphylococcus aureus among Health Care Workers in Tertiary and Regional Hospitals in Dar es Salam, Tanzania

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Agricola Joachim ◽  
Sabrina J. Moyo ◽  
Lillian Nkinda ◽  
Mtebe Majigo ◽  
Sima Rugarabamu ◽  
...  
Keyword(s):  
Health Care ◽  
Staphylococcus Aureus ◽  
Health Care Workers ◽  
Antimicrobial Agents ◽  
Nasal Carriage ◽  
Control Measures ◽  
Mannitol Salt Agar ◽  
Methicillin Resistant ◽  
Care Workers ◽  
Regional Hospitals

Methicillin-resistant Staphylococcus aureus (MRSA) among health care workers (HCWs) increases the risk of spreading the organism in hospital settings. A cross-sectional study was conducted between June and October 2016 among HCWs in tertiary and regional hospitals in Dar es Salaam, Tanzania, to determine the MRSA nasal carriage rate. Nasal swabs were collected from HCWs and cultured on mannitol salt agar. S. aureus was identified based on colonial morphology, Gram staining, catalase, coagulase, and DNase test results. MRSA was detected using the cefoxitin disk. Among 379 HCWs enrolled, 157/379 (41.4%) were colonized with S. aureus, of whom 59 (37.6%) were MRSA carriers giving an overall prevalence of 59/379 (15.6%). MRSA carriage was high among HCWs in Temeke (56.9%) and Amana (37.5%) regional hospitals. A high proportion of MRSA carriage was detected among nurses (35, 45.5%). MRSA isolates showed high resistance toward kanamycin (83.7%), gentamicin (83.1%), ciprofloxacin (71.2%), and trimethoprim-sulphamethoxazole (46.8%) compared to methicillin-sensitive S. aureus isolates (p≤0.001). In conclusion, we found a high nasal carriage of MRSA and resistance to commonly prescribed antimicrobial agents among HCWs. Implementation of infection control measures including contact precautions, urgent reporting of MRSA laboratory results, and routine MRSA screening of HCWs is highly needed to reduce MRSA spreading.

Changes in Causative Organisms and Their Antimicrobial Susceptibilities in Capd Peritonitis: A Single Center's Experience over one Decade

2004 ◽  
Vol 24 (5) ◽  
pp. 424-432 ◽  
Author(s):  
Dong Ki Kim ◽  
Tae-Hyun Yoo ◽  
Dong-Ryeol Ryu ◽  
Zhong-Gao Xu ◽  
Hyun Jin Kim ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Statistical Significance ◽  
Treatment Protocol ◽  
Major Complication ◽  
Catheter Removal ◽  
Coagulase Negative Staphylococcus ◽  
Removal Rates ◽  
Gram Positive ◽  
Gram Negative ◽  
Methicillin Resistant

Background In recent years, the rate of peritonitis during continuous ambulatory peritoneal dialysis (CAPD) has been significantly reduced. However, peritonitis remains a major complication of CAPD, accounting for considerable mortality and hospitalization among CAPD patients. Objective To generate a “center tailored” treatment protocol for CAPD peritonitis by examining the changes of causative organisms and their susceptibilities to antimicrobial agents over the past 10 years. Method Retrospective review of the medical records of 1015 CAPD patients (1108 episodes of peritonitis) who were followed up from 1992 through 2001. Results The overall incidence of peritonitis was 0.40 episodes/patient-year. The annual rate of peritonitis and the incidence of peritonitis caused by a single gram-positive organism were significantly higher in 1992 and 1993 compared with those in the rest of the years ( p < 0.05). The incidence of peritonitis due to coagulase-negative staphylococcus (CoNS) decreased significantly over time, whereas there was no significant change in the incidence of Staphylococcus aureus (SA)-induced peritonitis. Among CoNS, resistance to methicillin increased from 18.4% in 1992 – 1993 to 41.7% in 2000 – 2001 ( p < 0.05). In contrast, the incidence of methicillin-resistant SA was not different according to the calendar year. Catheter removal rates were significantly higher in peritonitis due to a single gram-negative organism (16.6%) compared with gram-positive peritonitis (4.8%, p < 0.005). The mortality associated with peritonitis was also higher in gram-negative (3.7%) compared with gram-positive peritonitis (1.4%), but there was no statistical significance. Among single gram-positive organism-induced peritonitis, catheter removal rates were significantly higher in SA (9.3%) than those in CoNS (2.9%, p < 0.01) and other gram-positive organisms (2.9%, p < 0.05). In peritonitis caused by CoNS, the methicillin-resistant group showed significantly higher removal rates than the methicillin-susceptible group (8.2% vs 1.0%, p < 0.01). Conclusion The incidence of peritonitis for 2001 decreased to less than half that for 1992, due mainly to a significant decrease in CoNS-induced peritonitis, whereas the proportions of peritonitis due to a single gram-negative organism and methicillin-resistant CoNS increased. These findings suggest that it is necessary to prepare new center-based guidelines for the initial empirical treatment of CAPD peritonitis.

Sensitivity of Staphylococcus Aureus, Isolated from Skin Infections in 1994, to 19 Antimicrobial Agents

1995 ◽  
Vol 23 (5) ◽  
pp. 328-334 ◽  
Author(s):  
S Nishijima ◽  
M Nakagawa ◽  
T Sugiyama ◽  
H Akamatsu ◽  
T Horio ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Fusidic Acid ◽  
Antimicrobial Agents ◽  
Skin Infections ◽  
In Vitro Susceptibility ◽  
Methicillin Resistant ◽  
Cefpodoxime Proxetil ◽  
Agar Dilution ◽  
Resistant Strains

The most common pathogen causing skin infections is Staphylococcus aureus and the incidence of multiply resistant strains of S. aureus has been increasing. The in vitro susceptibility of 130 isolates of S. aureus to 19 antimicrobial agents: ampicillin (ABPC), methicillin, cefaclor, cefpodoxime proxetil, gentamicin, erythromycin, clindamycin, minocycline, vancomycin, fusidic acid, norfloxacin, ofloxacin, enoxacin, ciprofloxacin, lomefloxacin, tosufloxacin, sparfloxacin, nadifloxacin and grepafloxacin, was evaluated by agar dilution tests. The S. aureus isolates were isolated from 130 patients with skin infections in 1994. The proportion of methicillin-resistant S. aureus isolates among the strains isolated was 19.2%. The concentration needed to inhibit 50% of the isolates was 3.13 mg/ml or less for all of the drugs, but the concentration needed to inhibit 90% of isolates was over 12.5 μg/ml, except in the cases of minocycline, vancomycin, fusidic acid, tosufloxacin and nadifloxacin. Tosufloxacin and nadifloxacin had the lowest minimum inhibitory concentrations. None of the S. aureus strains was resistant to nadifloxacin.

Prevalence of vanA Gene among Methicillin Resistant S. aureus Strains Isolated from Burn Wound Infections in Menoufia University Hospitals

2020 ◽  
Vol 29 (3) ◽  
pp. 97-104
Author(s):  
Amira H. Elkhyat ◽  
Amal F. Makled ◽  
Ahmed M. Albeltagy ◽  
Tarek F. Keshk ◽  
Amal M. Dawoud
Keyword(s):  
Staphylococcus Aureus ◽  
Vancomycin Resistance ◽  
Control Measures ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Dilution Method ◽  
University Hospitals ◽  
Burn Wound ◽  
Methicillin Resistant ◽  
Vana Gene

Background: Staphylococcus aureus is a leading cause of burn wound infection. Vancomycin resistance among methicillin-resistant Staphylococcus aureus (MRSA) is becoming a worldwide growing threat. Objectives: to detect the prevalence of MRSA in burn patients and its antibiotic susceptibility patterns. In addition, the resistance patterns of MRSA to vancomycin and the prevalence of vanA gene among MRSA isolates were investigated. Methodology: A total 250 clinical samples were obtained from patients admitted to Burn Unit in Menoufia University Hospitals. Identification and antimicrobial susceptibility testing of S. aureus isolates were performed. Cefoxitin disk diffusion method was used to identify MRSA strains. Vancomycin resistance was determined by agar dilution method. Detection of mecA and vanA genes by multiplex PCR was done. Results: Staphylococcus aureus represented 43.3% of all isolates. By cefoxitin disc diffusion method, 94% (79/84) of isolated S. aureus were MRSA that showed a high resistance to most antimicrobials used with rates ranged from 40.5 % to 100%. Phenotypically among MRSA isolates, vancomycin sensitive S. aureus (VSSA), vancomycin-intermediate S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA) were 59.5%, 15.2%, 25.3% respectively. Among MRSA isolates, 17 (21.5%) isolates had vanA gene by PCR (16 isolates were VRSA and one isolate was VSSA).Conclusion: This study is considered as an alarm demonstrating that implementation of proper infection control measures is mandatory to control spread of such resistant strains in our hospital.

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