PREVALENCE OF METHYLENE RESISTANT STAPHYLOCOCCUS AUREUS FROM PRACTICAL YEAR STUDENTS AND STAFF IN UMUDIKE.

ABSTRACT

The prevalence of Methicillin resistantStaphylococcus aureus isolated from the nostrils, vaginal and urine of practical year students of Michael Okpara University, Umudike Nigeria was investigated. Three eighty(80) specimens was collected from 40 male and 40 female students and cultured on appropriate bacteriological media. The bacterial isolates (S. aureus) were identified by standard biochemical tests. The MRSA was determined using Oxacillin antibiotic disk. Antibiotic susceptibility of the isolates was performed according to Clinical Laboratory Standard testing Institute (CLSI) guidelines.Of the 80 samples collected and screened, a total 47 (58.7%) of the isolates were found to be S. aureus based on morphology and biochemical tests. The result showed the prevalence rate of S. aureus in males to be 22.5% and Females (36.3%). The incidence rate from female to male individuals were 29 (36.3%) and 18 (22.5%) respectively. The prevalence rate/colonization of MRSA among healthy individuals in the community of the S. aureus isolated was 47 (58.7%). The antibiotic resistant pattern of the MRSA isolates was: Augmentin 45 (95.7%), > Gentamycin12 (25.5), Cotrimoxazole 26 (55.3),%) >Erythromycin 43 (82.9%),>Ofloxacin 3(6.3%),> Ampicillin 45 (95.7%), >Tetracycline 39 (82.9), > Ceftriaxone29 (57.5 %). The MRSA isolates showed resistance to oxacillin with an interpretative diameter of S>20; R< 15. The result showed that the number of positive MRSA in the samples as Nasal 4(8.51%), Urine 9 (19.1%) and HVS (8.51%)respectively.This study showed a highprevalence of MRSA carriage in female practical year students  indicating the spread of MRSA in the community.

TABLE OF CONTENTS

Cover page                                                                                                                 

Title page                                                                                                                    i

Certification                                                                                                                ii

Dedication                                                                                                                  iii

Acknowledgements                                                                                                    iv

Table of contents                                                                                                        v

List of tables                                                                                                               viii

Abstract                                                                                                                      ix

CHAPTER ONE

1.1       Introduction                                                                                                    1

1.2       Objective of the study                                                                                                3

CHAPTER 2

2.0       Literature review

2.1       staphylococci                                                                                                   4

2.2       Staphylococcus aureus                                                                                    4         

2.2.1    Pathogenesis of S. aureus                                                                               5

2.2.2    Virulence factors in S. aureus                                                                         6

2.2.3    Epidemiology                                                                                                  7

2.3       Methicillin – resistant Staphylococcusaureus (MRSA)                                  8

2.3.1    Origin of methicillin resistance                                                                       8

2.3.2    Classificationof MRSA                                                                                  9

2.3.4    Reservoir                                                                                                         12

2.3.5    Modes of Transmission                                                                                   12

2.3.6    MRSA colonization                                                                                        13

2.3.7    MRSA infection                                                                                             13

2.3.8    Common risk factors for acquiring MRSA                                                     15

2.3.9    Diagnosis of MRSA infection                                                                        16

2.3.10  Treatment of MRSA infection                                                                        17

2.4       Current infection control strategy                                                                   17

2.4.1    Prevention of selection of methicillin-resistant                                              

 isolates by antibiotic stewardship.                                                                 18

2.4.1.1 Elimination of the reservoirs by patient decolonization                                 19

2.4.2    Prevention of patient-to-patient transmission                                                 20

2.4.2.1 Hand hygiene                                                                                                  20

2.4.2.2    Environmental decontamination                                                                  21

2.5       Antibiotics                                                                                                       22

2.5.1    Sources of Antibiotics                                                                                    23

2.5.1.1 Beta-Lactam antibiotics                                                                                  23

2.5.1.3 Clavams                                                                                                          25

CHAPTER THREE

3.0       Materials and methods                                                                                    26

3.1       Study population                                                                                            26

3.2       Media preparation                                                                                           26

3.3       Isolation                                                                                                          26

3.4       Characterization of the isolates                                                                       27

3.4.1    Gram Staining                                                                                                 27

3.5       Biochemical tests                                                                                            27

3.5.1    Catalase Test                                                                                                   27

3.5.2    Coagulase Test                                                                                                27

3.6       Antimicrobial susceptibility testing                                                                27

3.7       Detection of MRSA                                                                                       28

CHAPTER FOUR

4.0       RESULTS

CHAPTER FIVE

5.0       Discussion, conclusion and recommendation                                                 35

5.1       Discussion                                                                                                       35       

5.2       Conclusion                                                                                                      37

5.3       Recommendation                                                                                            37

References                                                                                                      38

LIST OF TABLES

Tables                                                                                                                         Pages

2.1:                  Classification of Health care associated infections (HAI)                 11

4.1:                  Distribution of S. aureus isolates among the samples             31

4.2:                  Frequency of Occurrence of isolates among the study population     32

4.3:                  Antibiotic Susceptibility pattern of the isolates                                  33

4.4:                  Distribution of MRSA isolates according to isolation source            34

CHAPTER ONE

1.1       INTRODUCTION

Staphylococcus aureus belong to the family Micrococcaceae and is part of the genus Staphylococcus which contains more than thirty (30) species such as Staphylococcus epidermidis, Staphylococcus saprophyticus and Staphylococcus haemolyticus. Among the Staphylococcus species, Staphylococcus aureus is by far the most virulent and pathogenic for human and animals. Staphylococcus aureus is 1µm in size. The organism is a Gram-positive bacterium which appears in pairs or as grape-like clusters. It is characterized as coagulase and catalase positive, non motile, non spore forming and as facultative anaerobic. It grows in yellow colonies on nutrient rich media and is referred to as the as the yellow Staphylococci (Win Washington et al., 2006).

Staphylococcus aureus is a widely distributed bacterium found in the air, soil, water and dust because Staphylococcus aureus has the ability to adapt to different environments and it may colonize the human skin, nails, nares and mucus membrane and  thereby disseminate among recipient host population through physical contact and aerosols (Lowy, 1998). Colonization with Staphylococcus aureus is an important factor for subsequent Staphylococcus aureus infection (Von Eiff et al., 2004; Wertheim et al., 2001). Numerous investigators have reported nasal carriers in normal adults varying from 30% to 80% (Osuide et al., 1996).

Farm animals such as sheep, cattle, goats, pig and rabbits and even man are known to harbor potentially pathogenic Staphylococcus in their body without any apparent clinical signs of illness (Oyekunle and Adetosoye, 1998), but diseases results only when the defensive mechanism of the host animal is broken. As a pathogen of domestic animals, Staphylococcus aureus has been found associated with cases of abortion in cattle as well as documented cases of clinical and subclinical mastitis in dairy farms worldwide (Daniel et al., 1986) and pneumonic lesions in goat ( Ugochukwu,1984).

Staphylococcus aureus causes a wide range of infection in humans, from a variety of skin, wound and deep tissue infection to more life threatening conditions such as pneumonia, endocarditis, septic arthritis and septicemia. The bacterium is also one of the most common species in nosocomial infection, however little is known about the virulence factor behind all these conditions. In addition, Staphylococcus aureus may also cause food poisoning, scalded skin syndrome and toxic shock syndrome through production of different toxins (Winn Washington, 2006). Widespread interchange of Staphylococci between animals and human has been observed possibly due to closeness of animals to human population in their environment (Adekeye, 1981).

Antibiotics are used to control bacterial infection in farm animals. Staphylococcus aureus in general are sensitive to many antibiotics but strains from different patients and carriers differs in the pattern and degree of the sensitivity to different drugs and many strains are now resistant to some of the drugs (Osterlundet al., 2002; O’Neill et al., 2004 ). This has been attributed to multiple use of antibiotics in agriculture as prophylactic agents and as growth promoter has led to the emergence of resistant bacteria in the environment.  As is apparent the use or misuse of antimicrobial agents to control animal infection in farm animals has resulted in development of resistance among microorganisms (Winn Washington, 2006). Moreover, there remains the possibility that resistance may be transmitted from antibiotic resistance bacteria to the susceptible ones (Linton et al., 2000). In line with above, Staphylococcus aureus is one of the bacteria that has remained resistant to antibiotics.

At first, Penicillin was used to treat Staphylococcus aureus infection soon afterwards resistance emerged when strain acquired a genetic element coding for beta-lactamase production and today over 80% of all Staphylococcus aureus strain are resistant to penicillin. The next drug to be introduced for treating infections with Staphylococcus aureus was the semi synthetic, penicillinase resistant penicillin named Oxacillin or Methicillin, but shortly after its introduction, the first isolate with resistance was detected (Winn Washington, 2006). With the emergence of resistance to Penicillinase-resistant Penicillin, the glycopeptides agent Vancomycin became the treatment of choice for infection with methicillin resistant Staphylococcus aureus (MRSA) and in the year 1996, the first isolate with intermediate vancomycin resistance was detected (Brown and Thomas, 2002). Resistance to Methicillin is considered the most important for Staphylococcus aureus. Methicillin resistant Staphylococcus aureus has become endemic in hospitals as well as in health care setting globally (Chamber and Deleo, 2009).

1.2       OBJECTIVE OF THE STUDY

1.      To isolate, purify and characterize staphylococcus aureus from nasal swab of practical students of MOUAU

2.      To determine the antimicrobial susceptibility of the S. aureus isolates.

3.      To identify the methicillin – resistant S. aureus isolates

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