PREVALENCE OF HOSPITAL ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS ISOLATED FROM THE NOSTRILS OF IN-PATIENTS IN GOVERNMENT OWNED HOSPITALS

ABSTRACT

The prevalence of Hospital-acquired Methicillin resistant Staphylococcus aureus(HA-MRSA) from in-patients of the Abia State Diagnostic and Specialist Center, Umuahia was investigated. Out of 80 samples cultured, 73 isolates of Staphylococcus aureus were identified. The antibiotic susceptibility test was done using the Agar disc diffusion method. Multiple disc containing 8 antibiotics; Cloxacillin, Ofloxacin, Erthromycin, Gentamicin, Ceftazidine, Cefurozime. Augmentin and Ceftriazone.  59 (81%) of the isolates were resistant to Methicillin which was represented by Cloxacillin. There was relatively high resistance of the S. aureus isolates to Ofloxacin 52 (71.23%), Ceftriazone 42 (57.53%), Cefurozime 37 (50.68%), Erythromycin 40 (54.79%) and Ceftazidine 35 (47.94%). They were also sensitive to Gentamicin 53 (72.60%) and Augmentin 42 (57.53%).From this study, it can be deduced that there is high prevalence of methicilin resistance 59(81%) among in-patients of government owned hospitals. Radical measures should be put in place to curb this infection which is causing restlessness in the health care sector. 

TABLE OF CONTENTS

Title page i

Certification ii

Dedication iii

Acknowledgement iv

Table of content v

List of table viii

Abstract ix

CHAPTER ONE

1.0 Introduction 1

1.1 Aims and objectives 4

CHAPTER TWO: LITERATURE REVIEW

2.1 The organism Staphylococcus aureus 5

2.2 General characteristics 6

2.3 Pathogenicity / toxicity 6

2.4 Mode of transmission 7

2.5 Mode of reproduction 8

2.6 Virulence factors 8

2.7 Role of Staphylococcus aureus in causing disease 12

2.8 Antibiotic resistance and sensitivity 13

2.9 Methicillin resistant Staphylococcus aureus (MRSA) 14

2.9.1 Mode of transmission 15

2.9.2  Risk factors 16

2.9.3 Prevention and control of MRSA 18

CHAPTER THREE: MATERIALS AND METHODS

3.1 Study area 21

3.2 Study design 21

3.3 Sample collection 21

3.4 Preparation of culture media 21

3.5 Sterilization of materials 22

3.6 Isolation and identification of Staphylococcus aureus   22

3.7 Gram staining 22

3.8 Biochemical tests 23

3.9 Preparation of turbidity standard Equivalent to Mc FARLAND 0.5 24

3.10 Antibiotic susceptibility test 24

3.11 Measurement of zone of inhibition   25

CHAPTER FOUR

4.0  Result 26

CHAPTER FIVE: DISCUSSION AND CONCLUSION

5.1 Discussion

LIST OF TABLES

Table Title Page

1:    Identification and characterization of S. aureus isolates 27

2:    Occurrence of S.aureus in nasal passages of in- patients at the

Abia State Specialist and Diagnostic center, Umuahia. 28

3:      Antimicrobial susceptibility profile of Staphylococcus aureus isolates

   (Pattern of  inhibition). 29

4:     Antimicrobial Susceptibility profile of S.aureus isolates from nasal

 passages of Patients examined. 30

5 Prevalence of Methicillin resistant Staphylococcus aureus (MRSA)  31

CHAPTER ONE

1.0 INTRODUCTION

Staphylococcus aureus is the most common opportunistic pathogen often carried asymptomatically on the human body. It is a commensalistic bacterium found in warm, moist areas of the body particularly the nose, axillae (armpit), skin, and perineum.(ray and ryan,2004) This gram positive organism are cocci and belongs to the Family Staphylococcaceae, Order; bacillales, Class; coccus ;Phylum: Firmicutes and Kingdom; Eubacteria.(Cogston, 1984).

Although Staphylococcus aureus is not always pathogenic, it is a common cause of skin infections (example boils and pimples), respiratory disease (example sinusitis) and food poisoning. Disease associated strains often promote infection by producing potent protein toxins, and expressing cell-surface proteins that bind and inactivates antibodies. The emergence of antibiotic resistant forms of pathogenic Staphylococcus aureus is a worldwide problem in clinical medicine (Kluytmans et al, 1997).

Staphylococcus aureus has been recognized as an important pathogen associated with patients and common infections (Miller et al, 2007). It is a gram positive bacterium with a thick cell wall able to adapt to the presence of antibiotics and develop resistance by infiltrating the antibiotic molecule and disrupting its structure. Strains of Staphylococcus aureus becomes resistant to the almighty penicillin which led to the introduction of methicillin as replacement in 1959. Subsequently, after its introduction, Staphylococcus aureus isolates acquired resistance to methicillin and is the principal cause of several infections that are difficult to treat in humans. (Mernon, 2006).

The emergence of resistance to species of Staphylococcus aureus gave rise to what is called Methicillin Resistant Staphylococcus aureus (MRSA). MRSA is a strain of Staphylococcus aureus that has developed through the process of natural selection, resistance to beta-lactam antibiotics, which include the Penicillins (Methicillin, dicloxacillin, oxacillin, cloxacillin etc) and some Cephalosporins. (Akoua,  2004). Strains unable to resist these antibiotics are classified as Methicillin-Sensitive Staphylococcus aureus (MSSA). The evolution of such resistance does not cause the organism to be more intrinsically virulent than strains of MSSA which have no antibiotic resistance, but resistance does make MRSA infections more difficult to treat with standard types of antibiotics and thus more dangerous. (Abudu,2001).

Methicillin Resistant Staphylococcus aureus is especially troublesome in hospitals, prisons and nursing homes where patients with open wounds caused by invasive devices and weakened immune systems are at greater risks of nosocomial infections than the general public. Within the hospital environment, patients and staff act as reservoir and source for the spread of infection to susceptible individuals. Methicillin resistant Staphylococcus aureus began as a hospital acquired infection but has developed limited endemic status and is now sometimes community acquired. Hence, the two major group causing MRSA infections are Hospital acquired MRSA (HA-MRSA) and Community acquired MRSA (CA-MRSA). (Francois et al, 2008).

There is evidence that HA-MRSA infection increases morbidity, mortality risks and costs. In most cases, a person who is already sick or who has a weakened immune system become infected with HA-MRSA. These infections can occur in wounds or skin, burns or other sites where tubes enter the body as well as in the eyes, bones, nostrils, heart or blood. It is also associated with exposure to intravenous catheters, surgical procedures like joint replacement and contact with devices found in a hospital setting (Ceylan et al, 2011).

The spectrum of diseases caused by CA-MRSA in the community is high. Skin and soft tissue infections are the most frequently reported clinical manifestations (Fridkin, 2005). These infections can occur among people who have scratches, cuts or wounds and who have close contact with one another, such as members of a sports team and people living in over crowded homes and hostels. It is also associated with poor hygiene (Jean Christophe et al, 2005).

HA-MRSA which is the basis of this study regularly occurs and shows little variations in its prevalence. Most in-patients and hospital staff are transient carriers but may become persistent carries especially when they have skin lesions. Hence, the identification and treatment of infected hospital staff and in-patient (Both symptomatic and asymptomatic) can reduce the prevalence of Hospital acquired methicillin resistant Staphylococcus aureus because the unidentified carrier can act as reservoir in endemic situations (Ben-David et al,2008).

1.1 Aims and objectives

i. To determine the prevalence of Hospital Acquired Methicillin Resistant Staphylococcus aureus (HA-MRSA) isolated from nostrils of in-patients in government owned hospital in Umuahia.

ii. To determine the antibiotic sensitivity pattern of Methicillin resistant Staphylococcus aureus.

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