IP International Journal of Medical Microbiology and Tropical Diseases 2022;8(3):255–259

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IP International Journal of Medical Microbiology and

Tropical Diseases
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Original Research Article

Study of antibiotic resistance pattern in Methicillin-resistant Staphylococcus
aureus: A six year analysis
Nayan Anjan1 , Vidya Rao S2 , Kanniyan Binub1 , Preethy Edavaloth1 ,
Ramakrishna Pai Jakribettu 3, *
1 MES Medical College, Perinthalmanna, Kerala, India
2 Father Muller Medical College Hospital, Mangalore, Karnataka, India
3 Dept. of Microbiology, Malabar Medical College Hospital & Research Centre, Kozhikode, Kerala, India

ARTICLE INFO ABSTRACT

Article history: Introduction: Methicillin resistant Staphylococcus aureus is the common pathogen worldwide. It requires
Received 18-07-2022 prolonged therapy to eradicate MRSA from a patient.
Accepted 25-07-2022 Aim: This study was undertaken to determine the changing trend of antimicrobial resistance in MRSA
Available online 06-09-2022 over six years in a tertiary care center.
Materials and Methods: This was a retrospective observational study done at the tertiary care teaching
hospital. The antibiotic sensitivity pattern of the MRSA isolated from various clinical samples from January
Keywords:
2013–December 2018 was studied. The data collected was entered in the Microsoft excel 2007, coded and
Methicillin resistant Staphylococcus
were analyzed by frequency and percentage.
aureus (MRSA) Results: During the study period from January 2013 to December 2018, 1006 (27.42%) patients had MRSA
antimicrobial resistance (AMR) out of 3668 patients diagnosed with Staphylococcus aureus infection. Almost equal gender distribution
Trend
was observed with males (52.78%), geriatric patients, i.e., ≥61 years constituted for around 32% infected
Skin & soft tissue infection (SSTI)
patients. The samples that were received during this period included pus (64.59%), blood (26.23%), urine
(5.53%) and sputum (3.65%). Other anti-MRSA drugs had changing resistance rate on year to year basis.
Conclusion: Continuous monitoring of antibiotic sensitivity and rationalizing the use of antibiotics remain
an important and effective strategy to minimize the emergence of multi-drug resistant MRSA strains.

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1. Introduction by direct contact or fomites. It is the leading cause

of bacteremia and infective endocarditis, 2 which has
Staphylococcus aureus is a major bacterial human
high mortality and morbidity. It can infect other sites
pathogen that causes a spectrum of diseases in humans.
also, which includes osteoarticular, skin and soft tissue,
Staphylococcus aureus is present in the environment and
pleuropulmonary, and device-related infections. With the
is also found in normal human flora, located on the skin
emergence of methicillin-resistant strains, S. aureus related
and mucous membranes (most often the nasal area) of
infections have increased significantly and high rates of
most healthy individuals. S. aureus does not normally
mortality and morbidity are occurring worldwide. 3
cause infection on healthy skin; however, if it is allowed
Methicillin-resistant Staphylococcus aureus (MRSA)
to enter the bloodstream or internal tissues, they cause a
were first reported in the early 1960’s and is now regarded
variety of serious infections. 1 Transmission is normally
as a major hospital acquired pathogen worldwide. The
* Corresponding author. term methicillin resistant is historically used to explain
E-mail address: [email protected] (R. P. Jakribettu). resistance to any of this class of anti-microbials. It is

https://doi.org/10.18231/j.ijmmtd.2022.050
2581-4753/© 2022 Innovative Publication, All rights reserved. 255
256 Anjan et al. / IP International Journal of Medical Microbiology and Tropical Diseases 2022;8(3):255–259

one of the most common causes of hospital-acquired the Microsoft excel 2007, coded and were analyzed by
infection all over the world. Prolonged duration of hospital frequency and percentage.
stay, intravenous drug abuse and irrational use or over-
prescription of antibiotics are important risk factors for 4. Results
MRSA acquisition. These factors along with the diversity in
mecA gene (responsible for resistant mechanisms of MRSA During the study period from January 2013 to December
isolates) pose a major challenge to prevent the spread of 2018, a total of 3668 patients were registered in the
disease in both community and hospitals. 4 hospital with Staphylococcus aureus infection. Of these,
Despite extensive infection control efforts, methicillin 1006 (27.42%) individuals were found to have MRSA
resistance among isolates of S. aureus has steadily increased infection. Among the patients infected with MRSA, 52.78%
around the world and in India. The major reservoirs of were male patients and 47.21% were female patients
Staphylococcus in hospitals are colonized/ infected in- showing a slightly higher incidence of the infection in
patients and colonized hospital workers. Transient hand males than females (Table 1). The geriatric patients, i.e.,
carriage of the organism by healthcare workers account ≥61 years constituted for around 32% infected patients
for the major factor for patient to patient transmission. and the least was noticed among individuals <18 years,
Constant monitoring of these strains is essential in order i.e., 9%. The samples that were received during this period
to control their spread in the hospital setting and spread to included pus (64.59%), blood (26.23%), urine (5.53%)
the community. It is very essential to know the prevalence and sputum (3.65%). The ward-wise distribution of the
of MRSA in any location, because of the public health positive samples showed considerable variation, the highest
importance and the threat posed by MRSA infection. 5 being OP (65.6%), then IP (26.93%) and finally from the
In North India study, out of 250 Staphylococcus aureus ICU (7.45%). Out of the 75 samples collected from ICU,
isolated, 115 (46%) were MRSA isolated. 6 Similar high rate 41(54.67%) were from MICU. Maximum isolation was
of prevalence is been noted in other parts of the country. 7 obtained during April-June (29.12%) and the least during
Even though the drugs for the treatment of these October-December (19.58%). Throughout the period of
multidrug resistant pathogens are available, they are costly study there was a steady rise in the MRSA from 8.77%
and toxic. So, to combat this drug resistant pathogen, close in 2013 to 45.44% in 2018 (Figure 1). Among the MRSA
monitoring of the resistance pattern of MRSA is essential. isolates, there was a steady rise in resistance to Clindamycin
Therefore, this study is undertaken to observe any change in and Erythromycin (Fig 2).
the sensitivity pattern of MRSA isolated from patients in a
tertiary care hospital over a period of six years.

2. Aims and Objectives

To analyse and study the change in sensitivity pattern
of methicillin-resistant S.aureus over a period of last six
years (2013-2018) from a tertiary care teaching hospital.
This study determines the prevalence and antimicrobial
susceptibility pattern of MRSA in the hospital.

3. Materials and Methods

3.1. Process of collection
Fig. 1: Showing the steady rise of MRSA infection during the
This was a retrospective study, carried out in the department study period.
of clinical Microbiology of the tertiary care teaching
hospital. The antibiotic sensitivity pattern of the MRSA
isolated from various clinical samples from January 2013-
4.1. Antibiotic resistance pattern
December 2018 was studied. The sensitivity pattern for
the following antibiotic was collected from the database: In this study, the prevalence and antibiotic susceptibility
Gentamicin (10µg), Ciprofloxacin (5µg), Erythromycin patterns of various MRSA isolates were obtained from
(15µg), Clindamycin (2µg), Cotrimoxazole (1.25/23.75µg), 2013 to 2018. Throughout the period of study there was
Tetracycline (30µg) Vancomycin (30µg), Linezolid (30µg), a steady rise in the MRSA from 8.77% in 2013 to
Teicoplanin (30µg) according to CLSI guidelines. 8 The 45.44% in 2018.Among the isolates of MRSA, there was a
standard ATCC strain of Escherichia coli 25922 and steady rise in resistance to Clindamycin and Erythromycin
Staphylococcus aureus 25923 were used for quality control as shown in the figure below. All other antibiotics i.e.,
of the antibiotic discs. The data collected was entered in Gentamicin, Ciprofloxacin, Cotrimoxazole and Tetracycline
 Anjan et al. / IP International Journal of Medical Microbiology and Tropical Diseases 2022;8(3):255–259 257

Fig. 2: Showing trend of resistance rate of various drugs tested against MRSA during the study period.

Table 1: Demographic details of the sample analysed during the study period 2013-18.
2013 2014 2015 2016 2017 2018 %
Male 20(44.44) 34(45.94) 91(54.81) 99(61.49) 106(51.45) 181(51.12) 52.78
Gender
Female 25(55.55) 40(54.05) 75(45.18) 62(38.50) 100(48.54) 173(48.87) 47.21
OP 10(22.22) 32(43.24) 103(62.04) 110(68.32) 142(69.41) 263(74.29) 65.6
Ward IP 27(60.00) 36(48.64) 55(33.13) 41(25.46) 43(20.87) 69(19.49) 26.93
ICU 7(15.55) 6(8.10) 8(4.81) 10(6.21) 21(10.19) 23(6.49) 7.45
Blood 7(15.55) 18(24.32) 35(21.08) 40(24.84) 51(24.75) 101(28.53) 25.05
Pus/Wound 36(80.00) 53(71.62) 110(66.26) 113(70.18) 155(75.24) 243(68.64) 70.57
Samples
swab
Urine 1(2.22) 0(0) 11(6.62) 6(3.72) 0(0) 6(1.69) 2.38
Sputum 1(2.22) 3(4.05) 10(6.02) 2(1.24) 0(0) 4(1.12) 1.98
<18 4(8.88) 9(12.16) 16(9.63) 11(6.83) 21(10.19) 34(9.60) 9.44
18-30 9(20.00) 12(16.21) 16(9.63) 11(6.83) 28(13.59) 35(9.88) 11.03
31-45 2(4.44) 9(12.16) 22(13.25) 29(18.01) 30(14.56) 58(16.38) 14.91
Age ( yrs)
46-60 21(46.66) 22(29.72) 50(30.12) 57(35.40) 73(35.43) 99(27.96) 32
61-75 6(13.33) 16(21.62) 51(30.72) 42(26.08) 40(19.41) 90(25.42) 24.35
>75 3(6.66) 6(8.10) 11(6.62) 11(6.83) 14(6.79) 38(10.73) 8.25
Jan-Mar 7(15.55) 15(20.27) 23(13.85) 57(35.40) 54(26.21) 122(34.46) 27.63
Apr-Jun 10(22.22) 27(36.48) 52(31.32) 57(35.40) 62(30.09) 85(24.01) 29.12
Months
July-Sept 8(17.77) 16(21.62) 47(28.31) 47(29.19) 49(23.78) 71(20.05) 23.66
Oct-Dec 20(44.44) 16(21.62) 44(26.50) 0(0) 41(19.90) 76(21.46) 19.58
258 Anjan et al. / IP International Journal of Medical Microbiology and Tropical Diseases 2022;8(3):255–259

showed decreasing trend in its resistance pattern (Figure 2). emergence of multi-drug resistant MRSA strains. However,
No MRSA strains were found resistant to Vancomycin, we found no strains resistant to Vancomycin, Linezolid and
Teicoplanin and Linezolid during the study. Teicoplanin, indicating need for prudent use of these drugs
for treatment of MRSA related infections.
5. Discussion
7. Conclusion
The six year long study shows an overall MRSA incidence
rate of 27.43% in the hospital. The findings are comparable In the present study, it was observed that there was a steady
with most of the reports where it ranged between 20% to rise in the MRSA from 8.77% in 2013 to 45.44% in 2018.
32.8%. 9,10 In the present study, MRSA was mostly isolated Among the patients infected with MRSA, slightly higher
from pus and wound swabs whereas a high prevalence of incidence was noted in males and in the geriatric age group.
MRSA (35% in ward and 43% in ICU) was observed from Most of the MRSA were isolated from pus and exudates
blood culture specimens in a study in Delhi. 11 In studies (70.57%) from skin and soft tissue infections. Majority
conducted in various hospitals in Nepal, MRSA were mostly of patients samples who were infected with MRSA were
isolated from pus specimen compared to other clinical from OP (65.6%) compared to IP and ICU admissions.
specimens. 12,13 In this study, MRSA isolation rates from The drug resistance pattern varied for different antibiotics,
ICU (7.45%) and wards (34.38%) were lower than that seen with an overall decreasing trend in the antibiotic resistance
among outpatients (65.6%) which is contrary to another pattern “between” 2013-18. However, there were rise and
study conducted in India which showed higher MRSA fall of resistance rate for individual antibiotics annually.
isolation from IPDs (69.82%) than from OPDs (30.18%). 14 But, Erythromycin and Clindamycin showed increasing
We found the occurrence of MRSA to be higher in resistance to MRSA.
the geriatric age group i.e., ≥61 years constituted for
around 32% infected patients and the least was noticed 8. Conflict of Interest
among individuals <18 years, i.e., only 9%.In a similar
study, patients between 0-10 age group showed the None.
maximum MRSA (31.5%), followed by age group 11-
20 (26.3%). 15 The study showed slightly higher incidence 9. Source of Funding
of MRSA infection in males than in females. A similar Mr. Nayan Anjan received ICMR STS 2019 fellowship for
study conducted in another Indian hospital had slightly the project.
higher incidence of female patients than males. 14 We have
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