Study of antibiotic resistance pattern in methicillin-resistant Staphylococcus aureus isolated from clinical samples of hospitals in Tabriz – Iran

Document Type : Original Article

Authors

1 Department of Microbiology, Kazeroon branch, Islamic Azad University, Kazeroon, Iran.

2 Department of Research and Development, Razi Vaccine and Serum Research Institute, Agricultural Research Education and Extension Organization (AREEO), Karaj, Iran

Abstract

Introduction:Methicillin-resistant Staphylococcus aureus (S. aureus) is commonly a cause of nosocomial infections. The increase in infection rates caused by this bacteriain developing countries has led to many problems. The aim of this study is to determine the antibiotic resistance pattern in methicillin-resistant S. aureus strains isolated from clinical specimens.
Methods: In this cross-sectional study, 256 isolates of S. aureus were collected from Tabriz hospitals and treatment centers. The isolates were identified by standard laboratory methods and cultured in a specific environment. Identification of Methicillin-Resistant Staphylococcus aureus (MRSA) strains was made through phenotypic method. In order to evaluate antibiotic susceptibility patterns of strains, a disk diffusion method based on CLSI protocol was also performed. Data was analyzed by Chi-square test and SPSS 16 software.
Results:Out of 256 examined samples, 197 (76.95%) of them were methicillin-resistant Staphylococcus aureus. The phenotypic evaluation of the antibiotic resistance pattern of methicillin-resistant S. aureus showed that the highest resistance was for 100% penicillin antibiotics, 94.22% co-amoxiclav and 81.22% gentamicin antibiotics and the lowest resistance was observed as chloramphenicol (16.75%). There was no significant relationship between age, sex, and MRSA infections (P> 0.05).
Conclusion: High resistance S. aureus to penicillin, co-amoxiclav, gentamicin and also the high frequency of isolation of MRSA of hospital studied   samples are remarkable. The present study demonstrates the need for continuous monitoring of antimicrobial susceptibility in S. aureus in order to determine the optimal drug regimens.

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    1. Nimmo GR, Coombs GW, Pearson JC, O'Brien FG, Christiansen KJ, Turnidge JD, et al. Methicillin-resistant Staphylococcus aureus in the Australian community: an evolving epidemic. Med J Aust 2006; 184(8):384-8.
    2. Ostojić M, Hukić M. Genotypic and phenotypic characteristics of Methicillin-resistant Staphylococcus aureus (MRSA) strains, isolated on three different geography locations. Bosn J of Basic Med Sci. 2015; 15(3):48–56. doi:10.17305/bjbms.2015.402
    3. Ghaznavi-Rad E, Shamsudin MN, Sekawi Z, Khoon LY, Aziz MN, Hamat RA, et al. Predominance and emergence of clones of hospital-acquired methicillin-resistant S.aureus in Malaysia. J Clin Microbiol. 2010; 48(3):867-72. doi: 10.1128/JCM.01112-09
    4. Loewen K, Schreiber Y, Kirlew M, Bocking N, Kelly L. Community-associated methicillin-resistant Staphylococcus aureus infection: Literature review and clinical update. Can Fam Physician. 2017; 63(7):512-520.
    5. Graves SF, Kobayashi SD, DeLeo FR. Community-associated methicillin-resistant S. aureus immune evasion and virulence. J Mol Med. 2010; 88(2):109-14.
    6. Gutiérrez D, Fernández L, Rodríguez A, García P. Are phage lytic proteins the secret weapon to kill Staphylococcus aureus. MBio. 2018; 9(1):1-17. doi: 10.1128/mBio.01923-17
    7. Wilson TJ, Blackledge MS, Vigueira PA. Resensitization of methicillin-resistant Staphylococcus aureus by amoxapine, an FDA-approved antidepressant. Heliyon. 2018; 4(1): e00501.  doi:10.1016/j.heliyon.2017.e00501
    8. Ghaznavi-Rad E, Shamsudin MN, Sekawi Z, Van Belkum A, Neela V. A simplified multiplex PCR assay for fast and easy discrimination of globally distributed staphylococcal cassette chromosome mec types in meticillin-resistant Staphylococcus aureus. J Med microbial. 2010; 59(10):1135-9. doi:10.1099/jmm.0.021956-0
    9. Rajaduraipandi K, Mani K, Panneerselvam K, Mani M, Bhaskar M, Manikandan P. Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus: A multicentre study. Indian J Med Microbiol. 2006; 24(1):34-8. doi: 10.4103/0255-0857.19892
    10. Dibah S, Arzanlou M, Jannati M, Shapouri R. Prevalence and antimicrobial resistance pattern of methicillin resistant Staphylococcus aureus (MRSA) strains isolated from clinical specimens in Ardabil, Iran.  Iran J Microbiol. 2014; 6:163-168. PMID: 25870749
    11. Morell EA, Balkin DM. Methicillin-resistant Staphylococcus aureus:  A Pervasive Pathogen Highlights the need for new Antimicrobial development. Yale J Biol Med. 2010; 83:223-233.  PMCID: PMC3002151
    12. Köck  R,  Becker  K,  Cookson  B,  Van  Gemert-Pijnen  JE,  Harbarth  S,  Kluytmans  J, et  al. Methicillin-resistant Staphylococcus  aureus  (MRSA):  burden  of  disease  and  control  challenges  in  Europe.  Euro Surveill. 2010; 15 (41):19688.
    13. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: Twenty-second Informational Supplement; Clinical and Laboratory Standards Institute: Wayne, PA, USA: 2012.
    14. Forbes BA, Sahm DF, Weissfeld AS. bailey&scotts Diagnostic microbiology. 12th ed. USA; Elsevier 2007; 172-213.
    15. Kohner P, Uhl J, Kolbert C, Persing D, Cockerill F. Comparison of susceptibility testing method with mecA gene analysis for determining Oxacillin (Methicillin) resistance in clinical isolate of S. aureus and coagulase negative Staphylococcus spp. J Clin Microbiol. 1999; 37(9):2952-61.
    16. Zamani A, Sadeghian S, Ghaderkhani J, Alikhani MY, Najafimosleh M, Taghi Goodarzi M, et al. Detection of methicillin-resistance (mec-A) gene inS. aureus strains by PCR and determination of antibiotic susceptibility. Annals Microbiol. 2007; 57(2):273-6.
    17.  Moradi N, Javadpour S, Karmostaji A. Reduced sensitivity of S. aureus to vancomycin. HMJ. 2011; 15(3):169-77.
    18. Javani E, Falahati H, Sifi M, Talebi M, Ebrahimpor GH, Porshafie M. MecA gene in a strain of S. aureus resistant to oxacillin high from Tehran hospitals. Iranian J Infect Dis and Tropic. 2009; 25:17-22.
    19. Haghgoo S, Moaddab S, Rafi A. Study of antibiotic resistance pattern of S. aureus strains isolated from blood cultures in Tabriz Shahid Madani Hospital. Jentashapir J Health Res. 2012; 3(2):383-90.
    20. Wang H-K, Huang C-Y, Huang Y-C. Clinical features and molecular characteristics of childhood community-associated methicillin-resistant Staphylococcus aureus infection in a medical center in northern Taiwan, 2012. BMC Infect Dis. 2017; 17:470. doi:10.1186/s12879-017-2560-0
    21. Moosavian M, Shahin M, Navidifar T, Torabipour M. Typing of staphylococcal cassette chromosome mec encoding methicillin resistance in Staphylococcus aureus isolates in Ahvaz, Iran. New Microbes New Infect. 2018; 28(21):90-94. doi:10.1016/j.nmni.2017.11.006
    22. Udo EE, Al-Sweih R, Dahr TS, Dimitrov EM, Mokaddas M, Johny IA, et al. survaillance of antibacterial resistance in S. aureus isolated in Kuwaiti hospitals. Med Prink Pract. 2008; 17:71-75. doi:10.1159/000109594
    23. Mdani TA, Al-Abdollah NA, Al-Sanousi A. Methicillin –Resistant S. aureus in two tertiary-care centers in Jaddah Saudi Arabia. Infect Control Hosp Epidemiol. 2001; 22 (4):211- 216. doi:10.1086/501891  
    24. Rezazadeh M, Yousefi Mashouf R, Sarmadyan H, Ghaznavi-Rad E. Antibiotic Profile of Methicillin-Resistant S. aureus With Multiple-Drug Resistances Isolated from Nosocomial Infections in Vali-Asr Hospital of Arak. J Arak Uni Med Sci. J 2013; 16 (2):29-37.
    25. Parhizgari N, Moosavian S, Sharifi A. Antibiotic resistant pattern of methicillin resistant and sensitive S. aureus isolated from patients durining 2009-2010, Ahvaz, Iran. Armaghane danesh J. 2013;18(9):757-67
    26. Askari P, Ghazvini K, Namaee M H, Aryan E, Safdari H, Yousefi M. Prevalence of Methicillin-resistant S. aureus and their antibiotic resistance patterns in patients hospitalized in Birjand-based Imam Reza Hospital. J Birjand Univ Med Sci. 2017;24(3):218-26
    27. Vaez H, Ghazi Saeidi K, Moradi A, Tabaraei A, Khodabakhshi B, Bazouri M, et al. Antibiotic resistance pattern of methicillin resistant S. aureus isolated from Health-educational centers of Gorgan, Iran, 2008-2009. Iran J Med Microbiol. 2010; 3(4):31-36.
    28. Akanbi OE, Njom HA, Fri J, Otigbu AC, Clarke AM. Antimicrobial Susceptibility of Staphylococcus aureus Isolated from Recreational Waters and Beach Sand in Eastern Cape Province of South Africa. Int J Environ Res Public Health. 2017; 14(9):1001.  doi:10.3390/ijerph14091001
    29. Ghassemian, R. Najafi N Shojaeifar A. Evaluation of Carriers Staph. aureus in nose thesis. Mazandaran Univ Med Sci J. 2004; 14(44): 79-86.
    30. Mohraz M, Jonaidi N, Rasoulinejad M, Broum M A, Aligholi M, Shahsavan Sh. Determination of prevalence of methicillin resistant staphylococcus infections through measurement of mics of S. Aureus isolates Imam hospital (November 2001 To January 2003). Tehran Univ Med J. 2003; 61 (3):182-192.