NASAL CARRIAGE RATE OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) AMONG STUDENTS OF MICHAEL OKPARA UNIVERSITY OF AGRICULTURE, UMUDIKE

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) is the most commonly identified antimicrobial-resistant pathogen in hospitals in many parts of the world. This study was aimed at evaluating the Methicillin resistance of S. aureus isolates from the noses of students of Michael Okpara University of Agriculture, Umudike. Nasal swabs from both male and female students living on and off campus were inoculated on to Mannitol salt agar plates. A total of 49 S. aureus was recovered from a total of 100 students sampled. A greater percentage of the S. aureus was obtained from the female participants (66.1%). The result of the antibiotics susceptibility profile showed that the most effective antibiotic against the isolates was Ofloxacin with a 79.6% susceptibility rate followed by Gentamicin, recording 67.3% susceptibility. High level of resistance to Augmentin, Ceftazidime and Cloxacillin was also recorded among the S. aureus isolates. Out of the 49% S. aureus isolates recovered from the students, 19 (38.8%) were found to be MRSA while 30 (61.2%) were MSSA and 40 (81.6%) out of the S. aureus isolates were positive to beta lactamase production. The findings of this study therefore calls for judicious use of antibiotics and strategies that would help in the prevention community spread of MRSA such as environmental decontamination.

TABLE OF CONTENTS

Title page                                                                                                                                i

Declaration                                                                                                                             ii

Certification                                                                                                                           iii

Dedication                                                                                                                               iv

Acknowledgements                                                                                                                v

Table of contents                                                                                                                    vi

List of tables                                                                                                                             ix

Abstract                                                                                                                                   x

CHAPTER ONE

1.0       Introduction                                                                                                               1

1.1       Background of the study                                                                                            1

1.2       Aims and objectives                                                                                                  2

CHAPTER TWO

2.0       Literature review                                                                                                        3

2.1       Epidemiology                                                                                                             4

2.2       Pathogenesis                                                                                                               5

2.3       Nasal carriage of Staphylococcus aureus                                                                   6

2.4       Antibiotic resistance                                                                                                   7

2.4.1    Beta-lactam resistance                                                                                                9

2.4.1.1 Penicillin resistance                                                                                                    9         

2.4.1.2 Methicillin resistance                                                                                                 9

2.4.2    Quinolones resistance                                                                                                 10

2.4.3    Vancomycin resistance                                                                                               11

2.4.4    Resistance to other antibiotics                                                                                    12

2.5       Methicillin-resistant Staphylococcus aureus                                                              12

2.5.1    Health-care associated methicillin resistant Staphylococcus aureus                         13

2.5.2    Community-associated MRSA (CA-MRSA)                                                             14

2.6       Hospital and community infections                                                                           15

2.7       Betalactamase production                                                                                          16

CHAPTER THREE

3.0       Materials and Methods                                                                                               18

3.1       Study area                                                                                                                   18

3.2       Sample collection                                                                                                       18

3.3       Media preparation                                                                                                      18

3.4       Sample inoculation                                                                                                     18

3.5       Sub-culturing and purification of isolates                                                                  19

3.6       Gram staining                                                                                                             19

3.7       Biochemical tests                                                                                                        19

3.7.1    Catalase test                                                                                                                19

3.7.2    Coagulase test                                                                                                             19

3.7.3    DNAse test                                                                                                                 20

3.7.4    Acidimetric test                                                                                                          20

3.8       Antimicrobial susceptibility                                                                                       20

CHAPTER FOUR

4.0       Results                                                                                                                        22

4.1       Frequency of isolation of S. aureus from nasal swabs                                               22

4.2       Colonial and Biochemical characteristics of the isolates                                           22

4.3       Antibiotic Susceptibility Profile of the Isolates                                                         22

4.4       Prevalence of MRSA among study participants                                                        22

4.5       Beta lactamase profile of S. aureus isolate                                                                22

CHAPTER FIVE

5.0       Discussion, conclusion and recommendations                                                           28

5.1       Discussion                                                                                                                   28

5.2       Conclusion                                                                                                                  29

5.3       Recommendation                                                                                                       30

References                                                                                                                             31

LIST OF TABLES

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Staphylococcus aureus (S. aureus) is a microorganism that colonizes the skin and mucosal surfaces of healthy individuals but it is also one of the most common causes of community acquired and hospital infections (Al-Haj et al.,2018). Staphylococcus aureus is a dynamic and adaptable bacterium that has an incredible ability to attain antibiotic resistance easily, thereby making its treatment problematic (Baag et al.,2017, Hema et al., 2017).

According to Alzoubi et al., (2014), Methicillin-resistant  Staphylococcus  aureus (MRSA) was first recognized in the early 1960s soon after introduction of methicillin. Since then it has been confined to healthcare settings. However, since the 1990s, the number of MRSA infections in populations that lack exposure to healthcare settings has increased. This has led to the recognition of community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) strains. Methicillin-resistant Staphylococcus aureus (MRSA) is the most commonly identified antimicrobial-resistant pathogen in hospitals in many parts of the world (Dulon et al., 2014). MRSA is the basis of nosocomial infections in the world.  MRSA  has  a  great  significance  in  terms  of mortality  and  morbidity  with  an  important  economic consequence  (Al-Haj et al.,2018, David et al., 2014).  MRSA is transmitted to nares by contaminated hands and from surfaces where it can survive for months (Hema et al., 2017). Nasal carriage of S. aureus represents a major risk factor especially for nosocomial infection of methicillin resistant strains (MRSA) (Al-Haj et al., 2018). 

Staphylococcus  aureus is  a bacterial pathogen  that  colonizes  20-30%  of  the human  population,  it is often  asymptomatic and causes widespread infections ranging from mild local skin infections amd soft tissue, bone  and  joint,  implants,  pneumonia,  sepsis  and  a variety  of  toxicosis  conditions  such  as  toxic  shock syndrome which may be fatal (David et al., 2014,  Hema et al., 2017), since MRSA strain is resistant to all β-lactam antibiotics and the treatment options are limited significantly (Hema et al., 2017).

For the past 20 – 30 years, MRSA strains have been present in hospitals as Hospital Acquired MRSA (HA-MRSA); they have become a major cause of hospital- acquired infection. (Shinde et al., 2016).

Community Acquired MRSA (CA-MRSA) emerged worldwide in late 90s. Nasal carriage of MRSA is recognised as a risk factor for subsequent infection of endogenous origin. CA-MRSA infections can affect healthy young patients leading to serious community infections (Alzoubi et al., 2014). It has become an increasing problem among schools as well as in the general population over recent years. It is an epidemiologically important pathogen that is known for its nasal colonization (David et al., 2014; Shinde et al., 2016). MRSA carriage is an important influencing factor for the development of MRSA infection (Joachim et al., 2018).

1.2 Aims and objectives

This study is aimed at evaluating the prevalence of nasal carriage rate of methicillin-resistant Staphylococcus aureus (MRSA) among students of MOUAU.

The objectives of this study are:

•                To isolate Staphylococcus aureus

•                To determine the prevalence of methicillin resistant Staphylococcus aureus

•                To determine the antibiotic susceptibility of the S. aureus isolates

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