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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