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Methicillin-Resistant Staphylococcus aureus (MRSA): Prevalence and Antimicrobial Sensitivity Pattern among Outdoor and Indoor Patients Dhaka City Hospital Bangladesh

Md. Ashiqur Rahman, Kohinoor Akter Raton, Md. Asif Hossain*

Department of Microbiology, BIRDEM General Hospital, Dhaka, Bangladesh

Abstract: Methicillin-Resistant S. aureus (MRSA) is one of the significant pathogens with associated public-health concern in the world. The present study has been focused on the prevalence of MRSA and their antibiotic resistance of indoor and outdoor patients different age & gender in clinical history, Dr. Sirajul Islam medical college and hospital Dhaka, Bangladesh. We were performed during the period of January 2019 to July 2019. A total 964 samples which is outdoor 354 (36.72%) indoor 610 (63.27%). We were observation 5 days (BACTEC-9050 Machine) then inoculated selective onto Blood agar media and the culture plates were incubated at 37°C for 24 h. The S. aureus colonies showing golden yellow colour on Blood agar were primarily identified as S. aureus, which were then subjected for catalase and coagulase tests. The Methicillin-Resistant S. aureus (MRSA) could be detected outdoor and indoor patients only 42 (4.35%) into, males 18 and female 24 in total sample, on the other hand S. aureus. (MSSA) 50 (5.18%), Pseudomonas spp. 14 (1.45%), Klebsiella spp. 13 (1.34%), Salmonella spp. 27 (2.80%), E. coli 21 (2.17%), no MRSA, MSSA and other organisms are found 797 (82.67%). Total identified MRSA Staphylococci aureus. 42 (4%) in all blood samples, and other 922 (96%). Standard antimicrobial disks representing multiple sixteen drug were, Sensitive-381 (56.69%), Resistance-284 (42.26%), as well as Intermediate-7 (1.04%) against antibiotics, Oxacillin, Vancomycin, Erythromycin, Co-trimoxazole, Ciprofloxacin, Gentamicin, Linezolid, Amoxicillin, Amoxyclave, Azithromycin, Imipenem, Meropenem, Netilmicin, Gatifloxacin, Cloxacillin, Sparfloxacin. In this study, we describe the current burden of MRSA infections in healthcare and community of Bangladesh. And settings across other country the main threats caused by recent changes in the epidemiology of MRSA. This data has important implication for quality of patients care antibiotic selection and infection control practices.

Keywords: Methicillin-Resistance, Staphylococcus aureus, hospital indoor outdoor patients blood, antimicrobial sensitivity

Received January 01, 2021; Revised January 15, 2021; Accepted January 24, 2021

Citation: Md. Ashiqur Rahman, Kohinoor Akter Raton, Md. Asif Hossain, Methicillin-Resistant Staphylococcus aureus (MRSA): Prevalence and Antimicrobial Sensitivity Pattern among Outdoor and Indoor Patients Dhaka City Hospital Bangladesh. American Journal of Microbiological Research, 9 (1). 9-13. January 2021. doi:10.12691/ajmr-9-1-2

1. Introduction

1.1. Background

In today’s world antimicrobial resistance (AMR) is a vital public-health concern. It is true that Methicillin-Resistant S. aureus (MRSA) is one of the significant pathogens in worldwide as well as is associated with high morbidity and mortality amount with rapid development of resistance [1,2,3]. Science 1960s, S. aureus initially described, on the other hand, S. aureus, is principally amalgamated with skin, skin glands and mucous membrane of warm-blooded animals so an adaptable microbe as well as a frequent invader of animals, and humans [4]. The organism is favour nosocomial bacteria implicate with several infections, including pneumonia, septic arthritis, osteomyelitis, endocarditis, toxic-shock syndrome and food poisoning [5,6,7,8]. Many scientists are of the opinion that, (healthcare associated Methicillin-Resistant S. aureus, HA-MRSA), the burden of MRSA colonisation and infection has recently enlarged to further ecological slot [9]. After that 1990s, an increasing prevalence of MRSA infections emerges in the community (Community Associated Methicillin-Resistant S. aureus, CA -MRSA), has been described from many countries globally [10,11]. Research show that, Bangladesh is a high prevalence of MRSA infection, where the proportion is greater than three quarter has been observed in Asian several countries, including Japan, India, Pakistan, Thailand and Vietnam [12,13]. Those countries as well experience a high incidence of MRSA infection [14,15]. In the present study, we estimated the prevalence of S. aureus and MRSA in blood sample indoor as well as outdoor medical patient whereas anti- microbial resistance typing was used to determine the relatedness among the MRSA isolates.

2. Method and Materials

2.1. Sample Collection

A total of 964 blood samples were cultured for the isolation of S. aureus from patients in hospitals, (outdoor and indoor) Dr Sirajul Islam medical college and hospital Ltd. S. aureus was identified and antibiotic susceptibility tests were performed in the Department of Microbiology. The tests were performed during the period of January 2019 to July 2019. Records including clinical history, type of infection, gender, age, consumption of antibiotics, were obtained from patients whose sample S. aureus (MRSA) had been isolated from blood agar media [16] ( Figure 1).

Figure 1. Work flow of the study.

2.2. Isolation and Identification of S. aureus

Isolation and enumeration of S. aureus was carried out as previously described. Enumeration was performed only in blood sample. At first, we were collected blood sample from collection department, then we were preserving blood sample 5 days (BACTEC 9050) while as is observed machine called positive signal, we were sub culture selective on Blood agar media. Then microorganism’s primary identified by aerobically incubated for 24 hours at 37°C golden yellow colony. Secondary recognized by characterization on blood agar were subjected to gram staining, catalase test, and coagulase test [17].

2.3. Antimicrobial Sensitivity Testing

Antimicrobial susceptibility of S. aureus against 16 antimicrobials was determined by the agar-dilution method in Mueller-Hinton agar. According to the Clinical and Laboratory Standard Institute (CLSI) guidelines and the results were appraised after incubation at 37°C for 24 hours [18]. The final plate combination (mg/mL) were used (Oxoid, UK) antibiotics, Oxacillin, Vancomycin, Erythromycin, Co-trimoxazole, Ciprofloxacin, Gentamicin, Linezolid, Amoxicillin, Amoxyclave, Azithromycin, Imipenem, Meropenem, Netilmicin, Gatifloxacin, Cloxacillin, Sparfloxacin.

3. Results & Discussion

3.1. Isolation of Methicillin Resistant S. aureus

Methicillin-Resistant S. aureus MRSA (green yellowish colony) was isolated from 42 (4.35%) out of the 964 blood samples analysed. The isolation frequencies outdoor and indoor patient Dr Sirajul Islam medical college and hospital Ltd. Sample type is shown in (Table 1). January was the first month we were collected 86 blood sample in which present 3 (0.31%) patients MRSA, and February 79 sample were present 1 (0.10%) patients MRSA in indoor patients. In contrast, the number of MRSA is present indoor & outdoor patients is 5 (0.51%) and 1 (0.10%) in March out of 112 sample. Between April and May, the number of MRSA blood sample was same indoor patients 4 (0.41%), 4 (0.41%) as well as outdoor patience in April was 1 (0.10%) and May is 0 (0.00%) from 103 and 117 blood sample. The number of MRSA abruptly increased from indoor patients 10 (1.03%) & 11 (1.14%) outdoor patients 2 (0.20%), 0 (0.00%) between June and July.

Table 1. Prevalence of Methicillin-Resistant S. aureus isolates and classified by period of collection, indoor & outdoor patients. Dr Sirajul Islam medical college and hospital Ltd

3.2. Antibiotic susceptibility of MRSA isolates

According to antibiogram outline, the 42 (4.35%) MRSA isolates from 964 (100%) indoor and outdoor patients blood sample. The fact of the matter is Cefoxitin disk dispersion test we were used to screen all S. aureus isolates. Isolates with a zone of growth inhibition ≥ 22 mm are defined as Methicillin-Sensitive S. aureus (MSSA), and those with a zone diameter < 21 mm as Methicillin Resistant S. aureus (MRSA) [19]. Where resistant and sensitive against Oxacillin S=4 (0.59%), R=38 (5.65%), Ciprofloxacin S=33 (4.91%) R=8 (1.19%) I=1 (0.14%), Gentamicin S=22 (3.27%) R=20 (2.97%), Amoxicillin R=30 (4.46%) S=12 (1.78%), Cloxacillin S=5 (0.74%) R=37 (5.50%), Sparfloxacin S=24 (3.57%) R=18 (2.67%), Vancomycin S=40 (5.95%) R=2 (0.29%), Erythromycin R=10 (1.48%) S=30 (4.46%) I=2 (0.29%), Co-trimoxazole R=17 (2.52%) S=25 (3.72%), Linezolid S=36 (5.35%) R=6 (0.89%), Amoxyclave R=14 (2.08%) S=28 (4.16%), Azithromycin I=3 (0.44%) S=22 (3.27%) R=17 (2.52%), Imipenem R=9 (1.33%) S=33 (4.91%), Meropenem S=21 (3.12%) R=21 (3.12%), Netilmicin I=1 (0.29%) R=4 (0.59%) S=37 (5.50%), Gatifloxacin S=34 (5.05%) R=8 (1.19%). (R=Resistance, S=Sensitive, I=Intermediate)

Table 2. Sensitivity patterns of Methicillin Resistances S. aureus isolated from blood samples.

3.3 Prevalence of Methicillin-Resistant S. aureus of different age and gender

The study shows that, a total of 964 patients’ (outdoor and indoor) blood samples were raised of which 18 were males and 24 were female. The age range of the study members was from <10 year to >80 years. In a more recent time of the study participants Methicillin-Resistant Staphylococcus aureus (MRSA) most were between the age groups of 31–60. After that, lowest concentration participant’s Methicillin -Resistant Staphylococcus aureus was between the age group of 10-30 and 71-90 (Figure 2).

3.4. Total Bacterial Count of Indoor and Outdoor Patients.

In this study presents total Staphylococcus aureus 92 (9.53%) among the Methicillin-Resistant Staphylococcus aureus (MRSA) 42 (4.35%), as well as Staphylococci aureus. 50 (5.18%), (Figure 3) nevertheless, we were found different type of microorganisms were produce Salmonella spp. 27 (2.80%), E. coli, 21 (2.17%), Klebsiella spp. 13 (1.34%), as well as Pseudomonas spp. 14 (1.45%), and we were not identified (no growth) 797 (82.67%). (Table 3). Remarkably, we can identified total MRSA Staphylococci aureus. 42 (4%) in all blood samples, and other 922 (96%) (Figure 3).

Figure 2. The MRSA percentages of Age and Gender

Figure 3. Total MRSA count in all blood samples.

Table 3. Total bacterial count of indoor and outdoor patients

4. Conclusions

Methicillin-Resistant Staphylococcus aureus has been a cause of human disease comprehensively recorded history. Methicillin Resistant Staphylococcus aureus (MRSA) infections constitute a vital and still developing public health challenge for globally [20]. This current circumstance applies to MRSA. In this study, we presented data on the frequency of MRSA in Dr. Sirajul Islam Medical Collage & Hospitals Ltd in Dhaka, the capital city of Bangladesh. As a matter of fact, we were identifying most of the affected (MRSA) indoor patients while low affected outdoor patients (Table 1). The common perception is, the greater portion invaded (MRSA) female 24 patients on the other hand, and few portions invaded male 18 patients (Figure 2). The antibiotic period was perhaps extremely prospective to eliminate S. aureus (MRSA) as a leading cause of human infections. However, S. aureus has remarkable efficiency to develop resistance to antibiotics, which have been the impulse for waves of antibiotic resistance over the past 50 years [21] (Table 2). We were found Methicillin-Resistant Staphylococcus aureus (MRSA) 42 (4.35%) and other organisms E. coli 21 (2.17%), Salmonella spp. 27 (2.80%), Klebsiella spp. 13 (1.34%), Pseudomonas spp. 14 (1.45%), Staphylococcus aureus (MSSA) 50 (5.18%), No MRSA, MSSA and other organisms are found, 797 (82.67%) (Table 3). Finally in this study, we were indentified 42 (4%) (MRSA) Methicillin-Resistant Staphylococcus aureus in all blood sample (Figure 3). The public health department may have information on other prevalence within the same community or new information on resistance or treatment patterns. These efforts should begin with an agreement upon definitions for outdoor and indoor patients and continue with the improvement of record-based guidance and the implementation of preventive measures to result in better prevention and control of MRSA in our country.

Acknowledgments

We are extremely grateful to the Department of Microbiology, Dr. Sirajul Islam Medical College & Hospital Ltd.

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