Clonal relation of nasal MRSA carrier status among hospital personnel, hospitalized patients and community

Year 2013, , 49 - 55, 01.06.2013

Mehmet Çabalak Ahmet Kalkan Nuran Akmirza İnci Ahmet Çalışkan Kutbeddin Demirdağ

https://doi.org/10.5799/ahinjs.02.2013.02.0080

Cited By: 1

Abstract

Objective: Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) among the healthcare workers (HCWs), hospitalized patients, and healthy individuals was investigated by pulsed field gel electrophoresis (PFGE) for defining of clonally distribution of them. Methods: Totally 403 healthcare personnel, 744 patients, and 204 healthy individuals from the population were enrolled. Microbiological procedures were performed in the Bacteriological Laboratory at the Clinical Microbiology and Infectious Diseases Department of Firat University, and PFGE procedures were performed in the Microbiology Department of Inonu University. Results: Staphylococcus aureus was isolated in 296 (21.9%) of 1351 nasal swabs, and 69 out of 296 (23.3%) were defined as MRSA. Nasal S.aureus carrier state was identical between the patients and HCWs carrier state (p=0.14). It was significantly lower in healthy subjects than the other groups (p=0.02). Seventeen (25.8%) of 66 MRSA strains were defined to be in the cluster. These strains were in 7 different clusters. Among the typed strains, 21 had close relationship, 2 had possible relationship, and 26 had no relation. PFGE pattern was defined in 33 (50%) out of 66 strains and it was inconclusive in 3 strains. Conclusion: MRSA strains can be transferred commonly in the same hospital, among the hospitals located in the same region and the population. The results might be the indicators of increasing frequencies in population based MRSA infections. Multi-center studies are required to define clonally distribution of MRSA and the explanation of epidemiology may be helpful for preventing and controlling of MRSA related infections.

Keywords

MRSA, nasal carrier, PFGE

Clonal relation of nasal MRSA carrier status among hospital personnel, hospitalized patients and community

Abstract

Amaç: Sağlık çalışanları, hospitalize hastalar ve sağlıklı gönüllülerde nazal metisilin-dirençli Staphylococcus aureus (MRSA) kolonizasyonu ve klonal dağılımı pulsed field gel electrophoresis (PFGE) ile araştırıldı.Yöntemler: Çalışmaya 403 hastane çalışanı, 744 hasta ve 204 sağlıklı toplum bireyi alındı. Mikrobiyolojik işlemler Fırat Üniversitesi Klinik Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı Bakteriyoloji Laboratuarı’nda, PFGE işlemi ise İnönü Üniversitesi Mikrobiyoloji Anabilim Dalı’nda çalışıldı.Bulgular: Toplam 1351 nazal sürüntü kültüründen 296 Staphylococcus aureus suşu izole edildi ve bunların 69 (% 23,3)’u MRSA idi. Nazal S. aureus taşıyıcılığı sağlık çalışanları ve hastalar arasında benzer idi (p=0,14). Sağlıklı gönüllü gurupta ise diğer guruplara göre anlamlı derecede az olarak bulundu (p=0,02). PFGE yöntemiyle 66 MRSA suşunun 17 (% 25,8)’sinin küme içinde olduğu saptandı. Bu suşlar 7 küme içinde yer almaktaydı. Tiplendirilen suşların 21 tanesi yakın ilişkili, ikisi ise muhtemel ilişkili olarak saptandı. Yirmi altı suş klonal olarak ilişkisiz bulundu. Toplam 66 suş içinde 33 (% 50) PFGE paterni belirlendi.Sonuç: Çalışmamız sonucunda MRSA suşlarının aynı hastane içinde daha fazla olmakla birlikte bölgedeki hastaneler arasında ve hastane-toplum arasında taşınabileceğini gördük. Çalışmadan elde edilen sonuçlar toplumda artan MRSA enfeksiyon sıklığı için bir indikatör olabilir. MRSA’nın klonal dağılımının saptanması ve epidemiyolojisinin belirlenmesi için çok merkezli çalışmalara ihtiyaç olduğunu ve MRSA epidemiyolojisinin aydınlatılmasının MRSA’ya bağlı enfeksiyonların önlenmesi ve kontrolünde yardımcı olacağını düşünüyoruz

Keywords

MRSA, nazal taşıyıcılık, PFGE

References

• Boyce JM. Methicillin resistant Staphylococcus aureus in hos- pitals and long-term care facilities: Microbiology, epidemiol- ogy and preventive measures. Infect Control Hosp Epidemiol 1992;13:725-737.
• Boyce JM, White RL, Causey WA, Lockwood WR. Burn units as a source of methicillin-resistant Staphylococcus aureus infections. JAMA 1983; 249:2803-2807.
• Murchan S, Kaufmann ME, Deplano A, et al. Harmonization of pulsed-field gel electrophoresis protocols for epidemiologi- cal typing of strains of methicillin-resistant Staphylococcus aureus: a single approach developed by consensus in 10 Eu- ropean laboratories and its application for tracing the spread of related strains. J Clin Microbiol 2003; 41:1574-1585.
• Salgado CD, Farr BM, Calfee DP. Community-acquired meth- icillin-resistant Staphylococcus aureus: a metaanalysis of prevalence and risk factors. Clin Infect Dis 2003;36:131-9.
• Bilgehan H. Gram olumlu koklar. Klinik Mikrobiyolojik Tanı. Ba- rış Yayınları, Fakülteler Kitabevi, İzmir 2004; 184-204 (Tur- kish).
• CLSI, Antimikrobik disk duyarlılık testleri için uygulama stan- dartları; onaylanmış standart-dokuzuncu baskı. M2-A9 cilt 26, sayı 1, Ocak 2006.
• Durmaz R, Otlu B, Çalışkan A, Gürsoy N. Staphylococcus au- reus suşlarının moleküler tiplendirilmesinde kullanılabilecek kısa süreli “pulsed field’’ jel elektroforez protokolü. IV uygula- malı moleküler mikrobiyoloji kursu kitabı, Eylül 2007;201-207 (Turkish).
• Tenover FC, Arbeit RD, GoerinG RV, the Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Infect Control Host Epidemiol 1997;18:426-439.
• Sheppard MJ. Control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 1997; 37:73-75.
• Reagen DR, Doebbeling BN, Pfaller MA, Sheetz CT, Houston AK, Hollis RJ, Wenzel RP. Elimination of coincident Staphy- lococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium oinment. Ann Intern Med 1991;114:101-106.
• Cespedes C, Miller M, Quagliarello B. Differences between Staphylococcus aureus isolates from medical and nonmedi- cal hospital personnel. J Clin Microbiol 2002;40:2594-2597.
• Coello R, Jiménez J, García M, et al. Prospective study of infection, colonization and carriage of methicillin- resistant Staphylococcus aureus in an outbreak affecting 990 pa- tients. Eur J Clin Microbiol Infect Dis January 1994;13:74-81.
• Yorgancıgil B, Demirci M. Süleyman Demirel Üniversitesi Tıp Fakültesi hastane personelinde Staphylococcus aureus burun taşıyıcılığı. Enfeksiyon Dergisi; 1999;13:195-198 (Tur- kish).
• Reboli AC, John JF Jr, Platt CG, Cantey JR. Methicillin-re- sistant Staphylococcus aureus outbreak at a Veterans’ Af- fairs Medical Center: importance of carriage of the organ- ism by hospital personnel. Infect Control Hosp Epidemiol 1990;11:291-296.
• Alghaithy AA, Bilal NE, Gedebou M, Weily AH. Nasal carriage and antibiotic resistance of Staphylococcus aureus isolates from hospital and non-hospital personnel in Abha, Saudi Ara- bia. Trans R Soc Trop Med Hyg 2000; 94:504-507.
• Gupta N, Prakash SK, Malik VK, Mehndiratta PL, Mathur MD. Community acquired methicillin-resistant Staphylococcus aureus: a new threat for hospital outbreaks? Indian J Pathol Microbiol 1999;42:421-426.
• Scudeller L, Leoncini O, Boni S, et al. MRSA carriage: the relationship between community and healthcare setting. A study in an Italian hospital. J Hosp Infect 2000;46:222-229.
• Hsu CC. Serial survey of methicillin-resistant Staphylococcus aureus nasal carriage among resident in a nursing home. Infect Control Hosp Epidemiol 1991;12:416-421.
• Rashid Z, Farzana K, Sattar A, Murtaza G. Prevalence of na- sal Staphylococcus aureus and methicillin-resistant Staphy- lococcus aureus in hospital personnel and associated risk factors. Acta Pol Pharm 2012;69:985-991.
• Durmaz B, Tekerekoğlu M, Otlu B, Taştekin N. Turgut Özal Tıp Merkezi personelinde burunda S. aureus ve metisilin di- rençli S. aureus taşıyıcılık oranları. Turgut Özal Tıp Merkezi Dergisi 1999; 6:1150-1153 (Turkish).
• Kilic A, Mert G, Senses Z, et al. Molecular characterization of methicillin-resistant Staphylococcus aureus nasal isolates from Turkey. Antonie van Leeuwenhoek 2008; 94:615-619.
• Çaylan R, Aydın K, Köksal İ, Kostakoğlu U. Hastanemizde nozokomiyal stafilokoklarda metisilin direncinin saptan- ması ve personelde MRSA taşıyıcılığı. Mikrobiyol Bülteni 1999;33:163-169.
• Kutlay EL. Hastane personelinde ve normal populasyonda S. aureus taşıyıcılığı. Gazi Üniversitesi Mikrobiyoloji A.B.D Uzmanlık tezi, 1993; 1-80 (Turkish).
• Rafee Y, Abdel-Haq N, Asmar B, et al. Increased prevalence of methicillin-resistant Staphylococcus aureus nasal coloni- zation in household contacts of children with community ac- quired disease. BMC Infect Dis 2012;12:45-48.
• Blanc DS, Petignat C, Moreillon P, Wenger A, Bille J, Fran- cioli P. Quantitative antibiogram as a typing method for the prospective epidemiological surveillance and control of MRSA: Comparison with molecular typing. Infect Cont Host Epidemiol 1996;17:654-659.
• Singh A, Goering RV, Simjee S, Foley SL, Zervos MJ. Appli- cation of molecular techniques to the study of hospital infec- tion. Clin Microbiol Rev 2006;19:512-530.
• Layton MC, Hierholzer WJ Jr, Patterson JE. The evolving epidemiology of methicillin-resistant Staphylococus au- reus at a university hospital. Infect Control Host Epidemiol 1995;16:12-17.
• Roberts RB, de Lancastre A, Eisner W et al. Molecular epi- demiology of methicillin-resistant Staphylococcus aureus in 12 New York hospitals. MRSA Collaborative Study Group. J Infect Dis 1998;178:167-171.
• Aygen B, Yoruk A, Yildiz O, et al. Bloodstream infections caused by Staphylococus aureus in a university hospital in Turkey: clinical and molecular epidemiology of methicil- lin-resistant Staphylococcus aureus. Clin Microbiol Infect 2004;4:309-314.
• Tosun I, Udo EE, Noronha B, Caylan R, Aydin F, Yetiskul S, Koksal I. Emergence of rifampicin resistance in methicillin- resistant Staphylococcus aureus isolated at a Turkish univer- sity hospital. Microb Drug Resist 2005;11:48-52.