Retrospective Study on the Prevelance of Antimicrobial susceptibility pattern of staphylococcus species among patients attending Tertiary Care Hospital

 

Hrithik Shyam¹, Bhuvaneshwari. G²*, D. Aruna², P. Neelusree³

¹CRRI - MBBS Student, Saveetha Medical College, Thandalam

²Assistant Professor, Department of Microbiology, Saveetha Medical College, Thandalam,

³Professor and Head of the Department, Department of Microbiology, Saveetha Medical College, Thandalam.

 

ABSTRACT:

Staphylococcus is a group of bacteria that comprises of more than 30 species of medical importance. Among which Staphylococcus aureus causes most infections. 60% of Healthcare associated infections were caused by Staphylococcus aureus. They cause many different types of infections like Skin infections, which are the most common types. They also cause Bacteremia, an infection of the bloodstream, which can lead to sepsis. Bone infections, Endocarditis, Food poisoning and Pneumonia were also commonly caused by this bacterium. In past one-decade Staphylococcus species is gaining resistance to the antibiotics which is commonly used and also to the higher level antibiotics. This study mainly emphasis upon the prevalence of these species in a tertiary care hospital in order to frame the antimicrobial stewardship policy. The samples were received from the different departments and antimicrobial susceptibility pattern was interpreted. All the clinical specimens yielding Staphylococcus species were included in this study. 63% of Staphylococcus species were isolated from Exudate specimen following by Urine, Respiratory and Blood. The prevalence of MRCONS and MRSA is higher among inpatients with varying susceptibility pattern. This requires periodical surveillance and stringent infection control practices. This retrospective study was conducted to evaluate the value of the antimicrobial stewardship team (AST) combined with infectious diseases consultation on management and outcomes of Staphylococcus infections in a tertiary-care center.

 

 

 

INTRODUCTION: 

Staphylococcus is a genus of bacteria which causes wide range of infectious diseases in humans. It is been classified into Staphylococcus aureus and Coagulase Negative Staphylococci [CONS]^1,2,3. These Staphylococci colonize the skin and mucus membrane of human body and represents to be a predominant part of human normal flora⁴. Staphylococcus species especially CONS infects the immunocompromised patients and causes severe infections.⁵.

 

In order to treat the infections wide range of antibiotics were used and continuous and irrational   use of antibiotics lead to antimicrobial resistance in these species. Most common area of antimicrobial resistance⁶ is seen in the hospital where the exposure of a antibiotics is more for the bacteria leading to resistance. Methicillin resistant Staphylococcus aureus was first described in 1961 reported after one year after the introduction of methicillin.⁷

 

MRSA is a now endemic in India incidence of MRSA varies around the regions of India counter therapeutic options for MRSA are limited to few expensive drugs like vancomycin, linezoliod, tecoplanin, daptomycin, streptogramins. Even coagulase negative streptococci also casues nosocomial infections and exhibits resistance to antibiotics⁸. During last decades the infection with staph aureus has increased and also the mortality so the antibiotic resistance of the staphylococcus species is an emerging problem⁸.The gene complex encoding for methicillin resistance is the mec gene complex¹⁹.

 

The objective of our study was to find out the prevalence of these staphylococcal species in order to frame the antimicrobial stewardship policy.

 

AIM AND OBJECTIVES:

To investigate the prevalence of MRSA and MSSA in a tertiary care hospital in order to frame the antimicrobial stewardship policy.

 

MATERIALS AND METHODS:

The retrospective study was conducted at Saveetha Medical College Hospital, Thandalam, Chennai, India. Duration of the research was from April 2021 to November 2021. All the specimens yielding the Staphylococcus species were included in this study. Microbial cultures from various clinical samples were processed as per the standard protocol. This study was approved by the institutional review board (IRB)[SMC/IEC/2021/07/338].

 

The samples like exudates, urine, blood and body fluids that were received in Clinical Microbiology Laboratory were inoculated onto a Blood agar, Chocolate agar, Macconkey agar and were incubated in the presence of oxygen for 37^*C for two days.

 

Bacterial identification and antibiotic susceptibility testing:

After the initial colony isolation from the culture plates these colonies were then again subjected for species identification by automated system (VITEK) and conventional biochemical identification^[10]. After identification of the species antimicrobial susceptibility test was performed by Kirby Bauer disk diffusion method ^11,12,13. The statistical analysis was performed and the final conclusion was interpreted.

 

RESULT:

Isolates collected from various clinical specimens and the graphical analysis is depicted below. Figures 1-6 explains the antimicrobial susceptibility of Staphylococcus species from clinical specimens with number of isolates on the Y axis and antibiotics to which the susceptibility was tested on X axis. Total no. of Staphylococcus aureus isolated were 207 and Coagulase negative Staphylococcus species were 116. The Staphylococcus aureus strains collected from the outpatient and Inpatient department were 56 and 151 respectively. Coagulase negative staphylococcus strains collected from the outpatient and Inpatient department were 48 and 68 respectively. 83%, 76% and 52% of strains were collected from the specimens received from Medicine, Surgery and OBG Inpatient departments respectively.

 

 

Figure 1: Overall antimicrobial susceptibility testing of Staphylococcus species

 

Figure 2: Antimicrobial susceptibility testing of Staphylococcus species from Blood specimen

 

 

Figure 3: Antimicrobial susceptibility testing of Staphylococcus aureus from Blood specimen

 

 

Figure 4: Antimicrobial susceptibility testing of Staphylococcus species from Urine specimen

 

 

Figure 5: Antimicrobial susceptibility testing of Staphylococcus aureus from Urine specimen

 

 

Figure 6: Antimicrobial susceptibility testing of Staphylococcus species from Exudate specimen

 

On analysis in Medicine department the prevalence of MR CONS was higher than MRSA & MSSA, the same trend was followed in the ICU because of continuous exposure of high level antibiotics in the ICU.

 

On taking the surgery department in concern prevalence of MRSA and MR CONS was high the MRSA prevalence was high in the exudates op samples. Same pattern of prevalence is seen in the department of OBG. In the study antibiotic resistance pattern was maximum for Staphylococcus aureus and had a high (128 strains) resistance for cefoxitin (CX) followed by Erythromycin (105 strains). Blood samples of the inpatient department showed maximum resistance to Gentamicin (60%) and followed by Cefuroxime (40%) for MRSA and for CONS high resistance was observed to Erythromycin. CONS Strains from samples of urine collected from the inpatient department 69% exhibited resistance to Penicillin, Erythromycin and Cefoxitin. MRSA Species exhibited high resistance to penicillin. The strains taken from exudates inpatient department exhibited resistance to erythromycin (91 strains 80% of isolates) and to cefoxitin (93 strains). Samples taken from respiratory inpatient department MRSA was resistance towards cefoxitin (60% of isolates) and erythromycin (50% of isolates) even cefaclor (CF) exhibited resistance to 40% of isolates. The samples from the outpatient department also exhibited the same pattern of resistance to erythromycin and cefoxitin due to indiscriminate use. Only one strain was identified as Vancomycin Resistant Staphylococcus aureus (VRSA)¹⁴. All strains were sensitive to Linezolid.

 

DISCUSSION:

Staphylococcus is the part of the human commensals in the skin and also the causes various infections.^[14] MRSA and MRCONS has disseminated throughout India as well as the globe¹⁴. In India, the importance of MRSA has been recognized relatively late. The prevalence of MRSA varies in different parts of India and is not uniform. In another study conducted in Tamil nadu, out 906 strains of S.aureus isolated from clinical samples 31.1% were found to be methicillin resistance. An overall high prevalence of resistance to all antibiotics was seen with MRCONS showing higher resistance to non beta lactam antibiotics compared to MSCONS.¹⁵

 

In our study maximum number for MRSA and MRCONS strains were found in the Internal Medicine and General Surgery department as the antibiotic use in the department is high. In the department of internal medicine the resistant strains were found higher in the outpatient population when compared to inpatients. These strains were more resistant to wide range of antibiotics. Previous studies stated that infections caused by MRSA were more common among patients treated with antibiotics.¹⁶ MRCONS are one of the most common cause of human  infection than the MSCONS and the resistant pattern were observed more with MRCONS.^17,18

 

Most common reason of multidrug resistance MRSA is indiscriminate use of antibiotics without drug sensitivity testing which may be due to poor laboratory facilities, medical practioner negligence and poor socioeconomic status of the patient. There are differences between the antibiogram of MRSA and MSSA and thus the routine testing of methicillin resistance should be done.^19,20 Prolonged stay in hospitals also plays a vital role in antimicrobial resistance. In our study isolates from other departments like otorhinolarygology and urology the strains of MRSA, MSSA and CONS were reported.²⁰

 

Patient factors also have a role in antimicrobial resistance which is by usage of antibiotics over the counter and not finishing the proper dosage indicated by the practioner.

 

CONCLUSION:

After exposure to multiple antibiotics, surgical prophylaxis, indiscriminate use of antibiotics patients become colonized by multidrug resistance CONS species, this lead to the use of glycopeptides in high risk patients and thereby low level susceptibility in hospital strains.

 

The present study showed a high prevalence of MRSA, MDR CONS and MSSA strains which are resistant against widely used antimicrobial agents. The regular testing of these resistant species would help in framing a antibiotic stewardship policy for effective treatment of patients against these infections. Future research works are needed and it should get a standard protocol for the rapid detection of MRSA and MRCONS techniques for supporting the clinicians and Antimicrobial Stewardship team in controlling the spread of Staphylococcus species. Regular screening would also help in finding out the changing trends in the antimicrobial susceptibility patterns. Judicial and sustainable use of antibiotics should be done in order to prevent the antimicrobial resistance which is a rising problem. Involvement of Antibacterial Susceptibility Testing or Infectious Disease control was associated with reduced mortality of Staphylococcus aureus infected patients.

 

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Accepted on 13.09.2023           © RJPT All right reserved

Research J. Pharm. and Tech 2023; 16(11):5354-5357.