Investigation of nasal Staphylococcus aureus carriage by real-time PCR in patients receiving hemodialysis treatment

Abstract

Objectives: Staphylococcus aureus, coagulase-negative staphylococci (CoNS), and methicillin-resistant S. aureus (MRSA), which are significant nosocomial pathogens, have become a growing global problem because their carriage and diseases have become resistant to many antibiotics. This study aimed to investigate and determine the rate of MRSA carriage among patients receiving hemodialysis treatment using molecular methods.

Methods: In the 254 hemodialysis patients, the nasal carriage rates, susceptibility and resistance to S. aureus, CoNS and MRSA were examined using culture and real-time PCR methods. Nasal samples from hemodialysis patients were examined using real-time PCR. Microscopic examination was performed using the Gram staining method, and S. aureus was identified using catalase and coagulase. The strains were then tested for antibiotic susceptibility. Staphylococci was isolated from 231 of the 254 patients.

Results: S. aureus carriage was detected in 50 patients, MRSA in 16, methicillin-susceptible S. aureus (MSSA) in 33, CoNS in 66, methicillin-resistant CoNS (MR-CoNS) in 38, and methicillin-susceptible CoNS (MS-CoNS) in 28. S. aureus and MRSA strains exhibited 100% susceptibility to nitrofurantoin, and vancomycin. MSSA strains showed the highest susceptibility to chloramphenicol, clindamycin (84.8%), and co-trimoxazole (36.4%). CoNS showed 100% susceptibility to vancomycin, and 16.7% susceptibility to ampicillin. Vancomycin was found to be the most effective antibiotic against S. aureus, CoNS, and MRSA pathogens identified in patients undergoing hemodialysis, whereas penicillin resistance was found.

Conclusions: It can be concluded that one of the most effective ways to prevent the formation of antibiotic resistant strains is the hygiene of the hospital and hospital staff. Real-time PCR is very important for analyzing with high sensitivity.

Keywords

• Staphylococcus aureus
• nasal carriage
• antibiotic resistant
• infection
• real-time PCR

References

1. 1. Abroo S, Jazani NH, Sharifi Y. Methicillin-resistant Staphylococcus aureus nasal carriage between healthy students of medical and nonmedical universities. Am J Infect Control 2017;45:709-12.
2. 2. Ansari S, Jha RK, Mishra, SK, Tiwari BR, Asaad AM. Recent advances in Staphylococcus aureus infection: focus on vaccine development. Infect Drug Resist 2019;12:1243.
3. 3. Siddiqui AH, Koirala J. Methicillin resistant Staphylococcus aureus. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2020.
4. 4. Kollef MH, Micek ST. Methicillin-resistant Staphylococcus aureus: a new community-acquired pathogen. Curr Opin Infect Dis 2006;19:161-8.
5. 5. von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344:11-6.
6. 6. Cimolai N. MRSA and the environment: implications for comprehensive control measures. Eur J Clin Microbiol Infect Dis 2008;27:481-93.
7. 7. Atalik K, Selale DS, Dinc HO, Aydinli A, Babaoglu UT, Kaya AD, et al. [Investigation of Staphylococcus aureus nasal carriage in nursing students]. Value Health Sci 2022;12:104-7. [Article in Turkish]
8. 8. Bagheri A, Kumar S. Methicillin-resistant Staphylococcus aureus (MRSA) carriage certainly poses a risk in pregnant women. Cukurova Med J 2015;40:28-35.

9. 9. Aribas E, Ozcan M, Altindis M. [The antibiotics resistance rates of Staphylococci isolated from various clinical specimens]. Turkish J Infect 2001;15:73-7. [Article in Turkish]
10. 10. Leclercq R. [Staphylococci resistant to antibiotic therapy]. Ann Fr Anesth Reanim 2002;21:375-83. [Article in French]
11. 11. Ayliffe G. The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1997;24:74-9.
12. 12. Altındiş M. Hemşireler için mikrobiyoloji. Nobel Tıp Kitabevi, 2010.
13. 13. Winn W, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, et al. Staphylococci and related Gram-positive cocci. Color Atlas and Textbook of Diagnostic Microbiology. Philadelphia, Lippincott Williams and Wilkins, 2006.
14. 14. Kirecci E, Ozer A, Aral M, Miraloglu M. A research of nasal methicillin resistant/sensitive Staphylococcus aureus and pharyngeal beta-haemolytic Streptococcus carriage in midwifery students in Kahramanmaras, Eastern Mediterranean Region Turkey. Ethiop J Health Dev 2010;24:57-60.
15. 15. Aydin N, Gultekin B, Eyigor M, Gurel M. [The antibiotic resıstance of Staphylococci isolated of clinical specimens]. ADÜ Týp Fakültesi Dergisi 2001;2:21-6. [Article in Turkish]
16. 16. Oguzkaya-Artan M, Baykan Z, Artan C. Nasal carriage of Staphylococcus aureus in healthy preschool children. Jpn J Infect Dis 2008;61:70-2.
17. 17. Kilic A, Li H, Stratton CW, Tang YW. Antimicrobial susceptibility patterns and staphylococcal cassette chromosome mec types of, as well as Panton-valentine leukocidin occurrence among, methicillin-resistant Staphylococcus aureus isolates from children and adults in middle Tennessee. J Clin Microbiol 2006;44:4436-40.
18. 18. Fang H, Hedin G. Rapid screening and identification of methicillin-resistant Staphylococcus aureus from clinical samples by selective-broth and real-time PCR assay. J Clin Microbiol 2003;41:2894-9.
19. 19. Grisold AJ, Kessler HH. Use of hybridization probes in a real-time PCR assay on the LightCycler® for the detection of methicillin-resistant Staphylococcus aureus. Methods Mol Biol 2006;345:79-89.
20. 20. Dulger D, Ekici S, Albuz O, Pakdemirli A. Investigation of nasal Staphylococcus aureus carriage in hospital employees and rapid detection of PVL and mecA genes by RT-PCR. Etlik Vet Microbiol Derg 2020;31:47-51.
21. 21. Kirecci E, Ali O, Mustafa G, Tanis H, Sucakli MH. [Nasal MRSA carriages in nursing home residents]. Kocatepe Med J 2013;14:77-82. [Article in Turkish]
22. 22. Yuksel E, Safak K, Gunay E. [Evaluation of catheter-related bloodstream infections in hemodialysis patients]. Dicle Med J 2020;47:665-70. [Article in Turkish]
23. 23. Savas L, Duran N, Onlen Y, Savas N, Erayman M. Prospective analysis of antibiotic susceptibility patterns of MRSA in a Turkish University Hospital. Turk J Med Sci 2005;35:323-7.
24. 24. Tetik T, Eryilmaz M, Ahmet A. [Investigation of the relation between slime production and antibiotic resistance of Staphylococci isolated from various clinical specimens]. J Fac Pharm Ankara 2010;39:187-94. [Article in Turkish]
25. 25. Yasar KK, Bilir YA, Pehlivanoglu F, Sengoz G. [The relations between slime factor positivity, methicillin and antibiotic resistance in Staphylococci]. Ankem Derg 2011;25:89-93. [Article in Turkish]
26. 26. Al-Tamimi M, Himsawi N, Abu-Raideh J, Al-jawaldeh H, Mahmoud SAH, Hijjawi N, et al. Nasal colonization by methicillin-sensitive and methicillin-resistant Staphylococcus aureus among medical students. J Infect Dev Ctries 2018;12:326-35.
27. 27. Chen BJ, Xie XY, Ni LJ, Dai XL, Lu Y, Wu XQ, et al. Factors associated with Staphylococcus aureus nasal carriage and molecular characteristics among the general population at a Medical College Campus in Guangzhou, South China. Ann Clin Microbiol Antimicrob 2017;16:28.
28. 28. Budri PE, Shore AC, Coleman DC, Kinnevey PM, Humpreys H, Fitzgerald-Hughes D. Observational cross-sectional study of nasal staphylococcal species of medical students of diverse geographical origin, prior to healthcare exposure: prevalence of SCCmec, fusC, fusB and the arginine catabolite mobile element (ACME) in the absence of selective antibiotic pressure. BMJ Open 2018;8:e020391.
29. 29. Sezgin FM, Sarihan S, Turkoglu HN, Yagmur M, Bucak G, Buyuktatar NS, et al. Nasal carriage of Staphylococcus aureus by medical students: assessment of antibiotic susceptibility and risk factors. Cumhur Med J 2020;42:259-70.
30. 30. Domenico P, Baldassarri L, Schoch PE, Kaehler K, Sasatsu M, Cunha BA. Activities of bismuth thiols against staphylococci and staphylococcal biofilms. Antimicrobl Agents Chemother 2001;45:1417-21.