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Infectious Disorders - Drug Targets

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ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

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Research Article

Phenotypic and Molecular Screening of Nasal S. aureus from Adult Hospitalized Patients for Methicillin- and Vancomycin-resistance

Author(s): Mohammad Al-Tamimi*, Nisreen Himsawi, Jumana Abu-Raideh, Ashraf I. Khasawneh, Deaa Abu jazar, Hussam Al-jawaldeh and Hasan Hawamdeh

Volume 21, Issue 1, 2021

Published on: 09 January, 2020

Page: [68 - 77] Pages: 10

DOI: 10.2174/1871526520666200109143158

Price: $65

Abstract

Introduction: Nasal carriers of Staphylococcus aureus are common and play an important role in the transmission of infections. The aim of this study is a phenotypic and molecular investigation of nasal methicillin- and vancomycin-resistant S. aureus in hospitalized patients.

Methods: 202 nasal swabs were collected from patients at Prince Hamzah Hospital, Jordan, through 2016-2017. Swabs were processed according to standard microbiological procedures to isolate Staphylococci. Antibiotic susceptibility testing was performed using disk diffusion, E-test, microdilution and Vitek 2. Methicillin resistance was confirmed by testing for the mecA gene, while vancomycin resistance was screened by testing for the vanA and vanB genes.

Results: The mean age of participants was 50.17±18.18 years and 59.4% were females. Nasal Staphylococci was isolated in 64/202 (31.7%), S. aureus was isolated from 33 samples (16.3%), MRSA was isolated from 13 samples (6.4%) and constitutive Macrolide-lincosamidestreptogramin B (MLSB) was isolated from 12 samples (5.9%). All MRSA isolates harbored the mecA gene. All isolates were sensitive to vancomycin using E-test and the microdilution test and were negative for the vanA and vanB genes. The highest resistance rate was observed for benzylpenicillin (>90%), while the lowest resistance rate was for tobramycin (<5%) among all isolates. Nasal Staphylococci, S. aureus and MRSA colonization significantly correlate with increased number of family members and previous hospitalization (P<0.05), while nasal S. aureus significantly correlates with a history of skin infection (P=0.003).

Conclusion: Nasal colonization by mecA-mediated MRSA is common among hospitalized patients, while vanA- and vanB-mediated vancomycin resistance was not detected in any nasal isolates.

Keywords: S. aureus, methicillin, vancomycin, mecA, vanA, vanB.

Graphical Abstract

[1]
Tang, Y.W.; Stratton, C.W. Staphylococcus aureus: An old pathogen with new weapons. Clin. Lab. Med., 2010, 30(1), 179-208.
[http://dx.doi.org/10.1016/j.cll.2010.01.005] [PMID: 20513547]
[2]
Savini, V.; Passeri, C.; Mancini, G.; Iuliani, O.; Marrollo, R.; Argentieri, A.V.; Fazii, P.; D’Antonio, D.; Carretto, E. Coagulase-positive staphylococci: my pet’s two faces. Res. Microbiol., 2013, 164(5), 371-374.
[http://dx.doi.org/10.1016/j.resmic.2013.02.004] [PMID: 23481095]
[3]
Ippolito, G.; Leone, S.; Lauria, F.N.; Nicastri, E.; Wenzel, R.P. Methicillin-resistant Staphylococcus aureus: the superbug. Int. J. Infect. Dis., 2010, 14(Suppl. 4), S7-S11.
[http://dx.doi.org/10.1016/j.ijid.2010.05.003] [PMID: 20851011]
[4]
Howden, B.P.; Peleg, A.Y.; Stinear, T.P. The evolution of vancomycin intermediate Staphylococcus aureus (VISA) and heterogenous-VISA. Infect. Genet. Evol., 2013, 6.
[PMID: 23567819]
[5]
Miele, A.; Bandera, M.; Goldstein, B.P. Use of primers selective for vancomycin resistance genes to determine van genotype in enterococci and to study gene organization in VanA isolates. Antimicrob. Agents Chemother., 1995, 39(8), 1772-1778.
[http://dx.doi.org/10.1128/AAC.39.8.1772] [PMID: 7486917]
[6]
Breves, A.; Miranda, C.C.; Flores, C.; Filippis, I.; Clementino, M.M. Methicillin- and vancomycin-resistant Staphylococcus aureus in health care workers and medical devices. J. Bras. Patol. Med. Lab., 2015, 51, 143-152.
[http://dx.doi.org/10.5935/1676-2444.20150025]
[7]
Chen, B.J.; Xie, X.Y.; Ni, L.J.; Dai, X.L.; Lu, Y.; Wu, X.Q.; Li, H.Y.; Yao, Y.D.; Huang, S.Y. Factors associated with Staphylococcus aureus nasal carriage and molecular characteristics among the general population at a Medical College Campus in Guangzhou, South China. Ann. Clin. Microbiol. Antimicrob., 2017, 16(1), 28.
[http://dx.doi.org/10.1186/s12941-017-0206-0] [PMID: 28399856]
[8]
Wertheim, H.F.; Melles, D.C.; Vos, M.C.; van Leeuwen, W.; van Belkum, A.; Verbrugh, H.A.; Nouwen, J.L. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect. Dis., 2005, 5(12), 751-762.
[http://dx.doi.org/10.1016/S1473-3099(05)70295-4] [PMID: 16310147]
[9]
Drago, L.; Cappelletti, L.; Lamartina, C.; Berjano, P.; Mattina, R.; De Vecchi, E. Colonization by methicillin resistant staphylococci of nares and skin in healthcare workers: a pilot study in spinal surgeries. Injury, 2015, 46(Suppl. 8), S77-S80.
[http://dx.doi.org/10.1016/S0020-1383(15)30059-0] [PMID: 26747923]
[10]
Moshtagheian, S.; Halaji, M.; Sedaghat, H.; Shahin, M.; Esfahani, B.N.; Havaei, S.R.; Havaei, S.A. Molecular characteristics of methicillin-resistant Staphylococcus aureus nasal carriage from hospitalized patients and medical staff in Isfahan, Iran. Ann. Ig., 2018, 30(3), 237-244.
[PMID: 29670993]
[11]
Al-Tamimi, M.; Himsawi, N.; Abu-Raideh, J.; Abu Jazar, D.; Al-Jawaldeh, H.; Al Haj Mahmoud, S.; Hijjawi, N.; Hawamdeh, H. Nasal colonization by methicillin-sensitive and methicillin-resistant Staphylococcus aureus among medical students. J. Infect. Dev. Ctries., 2018, 12(5), 326-335.
[http://dx.doi.org/10.3855/jidc.9908]
[12]
Singh, A.K.; Agarwal, L.; Kumar, A.; Sengupta, C.; Singh, R.P. Prevalence of nasal colonization of methicillin-resistant Staphylococcus aureus among schoolchildren of Barabanki district, Uttar Pradesh, India. J. Family Med. Prim. Care, 2018, 7(1), 162-166.
[http://dx.doi.org/10.4103/jfmpc.jfmpc_345_16] [PMID: 29915752]
[13]
Shehabi, A.A.; Abu-Yousef, R.; Badran, E.; Al-Bakri, A.G.; Abu-Qatouseh, L.F.; Becker, K. Major characteristics of Staphylococcus aureus colonizing Jordanian infants. Pediatr. Int., 2013, 55(3), 300-304.
[http://dx.doi.org/10.1111/ped.12060] [PMID: 23360395]
[14]
Varona-Barquín, A.; Iglesias-Losada, J.J.; Ezpeleta, G.; Eraso, E.; Quindós, G. Vancomycin heteroresistant community associated methicillin-resistant Staphylococcus aureus ST72-SCCmecIVa strain colonizing the nostrils of a five-year-old Spanish girl. Enferm. Infecc. Microbiol. Clin., 2017, 35(3), 148-152.
[http://dx.doi.org/10.1016/j.eimc.2016.07.015] [PMID: 27590877]
[15]
Carvalho, S.P.; Almeida, J.B.; Andrade, Y.M.F.S.; Silva, L.S.C.D.; Oliveira, A.C.; Nascimento, F.S.; Campos, G.B.; Oliveira, M.V.; Timenetsky, J.; Marques, L.M. Community-acquired methicillin-resistant Staphylococcus aureus carrying SCCmec type IV and V isolated from healthy children attending public daycares in northeastern Brazil. Braz. J. Infect. Dis., 2017, 21(4), 464-467.
[http://dx.doi.org/10.1016/j.bjid.2017.04.001] [PMID: 28482183]
[16]
Banerjee, T.; Anupurba, S. Colonization with vancomycin-intermediate Staphylococcus aureus strains containing the vanA resistance gene in a tertiary-care center in north India. J. Clin. Microbiol., 2012, 50(5), 1730-1732.
[http://dx.doi.org/10.1128/JCM.06208-11] [PMID: 22337975]
[17]
Warren, D.K.; Liao, R.S.; Merz, L.R.; Eveland, M.; Dunne, W.M. Jr Detection of methicillin-resistant Staphylococcus aureus directly from nasal swab specimens by a real-time PCR assay. J. Clin. Microbiol., 2004, 42(12), 5578-5581.
[http://dx.doi.org/10.1128/JCM.42.12.5578-5581.2004] [PMID: 15583284]
[18]
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, 2018. Available from: http://www.facm.ucl.ac.be/intranet/CLSI/CLSI-2018-M100-S28-unlocked.pdf
[19]
Jarajreh, D.; Aqel, A.; Alzoubi, H.; Al-Zereini, W. Prevalence of inducible clindamycin resistance in methicillin-resistant Staphylococcus aureus: the first study in Jordan. J. Infect. Dev. Ctries., 2017, 11(4), 350-354.
[http://dx.doi.org/10.3855/jidc.8316] [PMID: 28459227]
[20]
Krismer, B.; Weidenmaier, C.; Zipperer, A.; Peschel, A. The commensal lifestyle of Staphylococcus aureus and its interactions with the nasal microbiota. Nat. Rev. Microbiol., 2017, 15(11), 675-687.
[http://dx.doi.org/10.1038/nrmicro.2017.104] [PMID: 29021598]
[21]
Zipperer, A.; Konnerth, M.C.; Laux, C.; Berscheid, A.; Janek, D.; Weidenmaier, C.; Burian, M.; Schilling, N.A.; Slavetinsky, C.; Marschal, M.; Willmann, M.; Kalbacher, H.; Schittek, B.; Brötz-Oesterhelt, H.; Grond, S.; Peschel, A.; Krismer, B. Human commensals producing a novel antibiotic impair pathogen colonization. Nature, 2016, 535(7613), 511-516.
[http://dx.doi.org/10.1038/nature18634] [PMID: 27466123]
[22]
Otto, M. Coagulase-negative staphylococci as reservoirs of genes facilitating MRSA infection: Staphylococcal commensal species such as Staphylococcus epidermidis are being recognized as important sources of genes promoting MRSA colonization and virulence. BioEssays, 2013, 35(1), 4-11.
[http://dx.doi.org/10.1002/bies.201200112] [PMID: 23165978]
[23]
Bartoloni, A.; Riccobono, E.; Magnelli, D.; Villagran, A.L.; Di Maggio, T.; Mantella, A.; Sennati, S.; Revollo, C.; Strohmeyer, M.; Giani, T.; Pallecchi, L.; Rossolini, G.M. Methicillin-resistant Staphylococcus aureus in hospitalized patients from the Bolivian Chaco. Int. J. Infect. Dis., 2015, 30, 156-160.
[http://dx.doi.org/10.1016/j.ijid.2014.12.006] [PMID: 25486009]
[24]
Gesualdo, F; Onori, M; Bongiorno, D; Campanile, F; Carloni, E; Mancinelli, L Methicillin-resistant Staphylococcus aureus nasal colonization in a department of pediatrics: a cross-sectional study. 2014, 40, 3.
[http://dx.doi.org/10.1186/1824-7288-40-3]
[25]
Gesualdo, F.; Onori, M.; Bongiorno, D.; Campanile, F.; Carloni, E.; Mancinelli, L.; Russo, C.; Villani, A.; Valentini, D.; Raponi, M.; Tozzi, A.E.; Stefani, S. Methicillin-resistant Staphylococcus aureus nasal colonization in a department of pediatrics: a cross-sectional study. Ital. J. Pediatr., 2014, 40, 3.
[http://dx.doi.org/10.1016/j.micpath.2017.03.023] [PMID: 28342937]
[26]
Johnson, K.; Frei, R.; Heininger, U. Prospective, cross-sectional study on MSSA and MRSA colonisation in hospitalised children. Eur. J. Pediatr., 2015, 174(9), 1255-1262.
[http://dx.doi.org/10.1007/s00431-015-2606-5] [PMID: 26272252]
[27]
Ungureanu, A.; Zlatian, O.; Mitroi, G.; Drocaş, A.; Ţîrcă, T.; Călina, D.; Dehelean, C.; Docea, A.O.; Izotov, B.N.; Rakitskii, V.N.; Cioboată, R.; Spandidos, D.A.; Tsatsakis, A.M.; Găman, A. Staphylococcus aureus colonisation in patients from a primary regional hospital. Mol. Med. Rep., 2017, 16(6), 8771-8780.
[http://dx.doi.org/10.3892/mmr.2017.7746] [PMID: 29039613]
[28]
Aqel, A.A.; Alzoubi, H.M.; Vickers, A.; Pichon, B.; Kearns, A.M. Molecular epidemiology of nasal isolates of methicillin-resistant Staphylococcus aureus from Jordan. J. Infect. Public Health, 2015, 8(1), 90-97.
[http://dx.doi.org/10.1016/j.jiph.2014.05.007] [PMID: 25002017]
[29]
Al-Bakri, A.G.; Al-Hadithi, H.; Kasabri, V.; Othman, G.; Kriegeskorte, A.; Becker, K. The epidemiology and molecular characterization of methicillin-resistant staphylococci sampled from a healthy Jordanian population. Epidemiol. Infect., 2013, 141(11), 2384-2391.
[http://dx.doi.org/10.1017/S0950268813000010] [PMID: 23340022]
[30]
Al-Zu’bi, E.; Bdour, S.; Shehabi, A.A. Antibiotic resistance patterns of mecA-positive Staphylococcus aureus isolates from clinical specimens and nasal carriage. Microb. Drug Resist., 2004, 10(4), 321-324.
[http://dx.doi.org/10.1089/mdr.2004.10.321] [PMID: 15650377]
[31]
Na’was, T.; Fakhoury, J. Nasal carriage of methicillin-resistant Staphylococcus aureus by hospital staff in north Jordan. J. Hosp. Infect., 1991, 17(3), 223-229.
[http://dx.doi.org/10.1016/0195-6701(91)90234-Y] [PMID: 1675651]
[32]
Heckel, M.; Geißdörfer, W.; Herbst, F.A.; Stiel, S.; Ostgathe, C.; Bogdan, C. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at a palliative care unit: A prospective single service analysis. PLoS One, 2017, 12(12)e0188940
[http://dx.doi.org/10.1371/journal.pone.0188940] [PMID: 29228010]
[33]
Jarvis, W.R.; Jarvis, A.A.; Chinn, R.Y. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am. J. Infect. Control, 2012, 40(3), 194-200.
[http://dx.doi.org/10.1016/j.ajic.2012.02.001] [PMID: 22440670]
[34]
Friedmann, R.; Raveh, D.; Zartzer, E.; Rudensky, B.; Broide, E.; Attias, D.; Yinnon, A.M. Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. Infect. Control Hosp. Epidemiol., 2009, 30(6), 534-542.
[http://dx.doi.org/10.1086/597505] [PMID: 19419270]
[35]
Hidron, A.I.; Kourbatova, E.V.; Halvosa, J.S.; Terrell, B.J.; McDougal, L.K.; Tenover, F.C.; Blumberg, H.M.; King, M.D. Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin. Infect. Dis., 2005, 41(2), 159-166.
[http://dx.doi.org/10.1086/430910] [PMID: 15983910]
[36]
Santos, H.B.; Machado, D.P.; Camey, S.A.; Kuchenbecker, R.S.; Barth, A.L.; Wagner, M.B. Prevalence and acquisition of MRSA amongst patients admitted to a tertiary-care hospital in Brazil. BMC Infect. Dis., 2010, 10, 328.
[http://dx.doi.org/10.1186/1471-2334-10-328] [PMID: 21073755]
[37]
Mahesh, C.B.; Ramakant, B.K.; Jagadeesh, V.S. The prevalence of inducible and constitutive clindamycin resistance among the nasal isolates of staphylococci. J. Clin. Diagn. Res., 2013, 7(8), 1620-1622.
[http://dx.doi.org/10.7860/JCDR/2013/6378.3223] [PMID: 24086856]
[38]
Joachim, A.; Moyo, S.J.; Nkinda, L.; Majigo, M.; Mmbaga, E.; Mbembati, N.; Aboud, S.; Lyamuya, E.F. Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Salaam, Tanzania. BMC Res. Notes, 2017, 10(1), 417.
[http://dx.doi.org/10.1186/s13104-017-2668-8] [PMID: 28830510]

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