Methicillin-Resistant Staphylococcus aureus Nasal Colonization Among Health Care Workers of a Tertiary Hospital in Ecuador and Associated Risk Factors

Hospital Hygiene Paradox: MRSA and Enterobacteriaceae Colonization Among Cleaning Staff in a Tertiary Hospital in Saudi Arabia

Background and Objectives: Despite extensive research on the sources and transmission pathways of Hospital-Acquired Infections (HAIs), the role of cleaning staff as potential vectors has been under-explored. This study addresses the gap by examining the cleaning staff's role in nosocomial infection transmission, focusing on pathogenic bacteria and fungi colonization. Identifying potential pathogens harbored by cleaning staff that carry the risk of causing HAIs, especially methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae. Materials and Methods: This current cross-sectional study was conducted on 96 cleaning staff at King Fahad Hospital of the University and Family and Community Medicine-Centre, Eastern Province, Saudi Arabia. Sample collection targeted hands and nostrils using cotton swabs, followed by laboratory testing, including MALDI-TOF mass spectrometry for bacterial identification, and the cefoxitin disc diffusion test for the screening of MRSA. Results: In total, the occurrence of MRSA colonization was 9.4% while Enterobacteriaceae colonization was 15.6%. No significant correlation was found for MRSA among departments or between day and night shifts. Alternatively, individuals working in the ICU and the operating room showed higher chances of being colonized by Enterobacteriaceae, and a notable connection was identified between Enterobacteriaceae and day shifts. Ultimately, the frequency of handwashing reduced the chances of being colonized by MRSA and Enterobacteriaceae, underscoring the significance of good hygiene practices. Conclusions: The study highlights the potential role of cleaning staff in transmitting HAIs, indicating a need for further research and consideration of enhanced hygiene protocols in hospital settings.

Inducible clindamycin-resistant and biofilm formation in the Staphylococcus aureus isolated from healthcare worker's anterior nasal carriage

OBJECTIVE

The purpose of this study is a new update on the resistance profile, Macrolide-Lincosamide-Streptogramin B resistance mechanisms and biofilm formation in the Staphylococcus aureus isolated from health care workers (HCWs) nasal carriage at a children's teaching hospital in Babol (Northern Iran).

RESULTS

A total of 143 non-repetitive nasal swab samples were collected from volunteers, where 53.8% (n; 77/143) were HCWs, 33.6% (n; 48/143) medical students, and 12.6% (n; 18/143) resident students. The prevalence of nasal carriers of S. aureus was 22.4% (n; 32/143), among them, 40.6% (n; 13/32) were identified as methicillin-resistant Staphylococcus aureus (MRSA( carriers. Antimicrobial susceptibility testing showed that erythromycin (68.8%, n; 22/32) and ciprofloxacin (15.6%, n; 5/32) had the highest and lowest resistance rate, respectively. The frequency of resistance genes in the strains was as follows; ermC (n; 17/32, 53.1%), ermA (n; 11/32, 34.4%), ermB (n; 6/32, 18.7%), ereA (n; 3/32, 9.4%). Moreover, 50.0% (n; 16/32), 28.1% (n; 9/32) and 21.8% (n; 7/32) of isolates were strongly, weakly and moderately biofilm producer, respectively. Macrolides-lincosamides-streptogramins B (MLSB) antibiotic resistance among S. aureus isolates from HCWs nasal carriage have found significant prevalence rates throughout the globe. It is crucial to remember that the development of biofilms and MLS B antibiotic resistance are both dynamic processes.

Occurrence, multidrug resistance and potential risk factors for Staphylococcus aureus infection at worker-animal and working equipment interfaces: a systematic review and meta-analysis of the Ethiopian literature

Background

Staphylococcus aureus (S. aureus) infecting animals and humans via close contact, handling, or consuming contaminated products is a growing public health concern. In Ethiopia, it is important to examine the overall prevalence of S. aureus, patterns of multidrug resistance, and potential risks in human-animal interface settings. Thus, this review was conducted to estimate the pooled prevalence of S. aureus, its multidrug resistance, and potential risk factors for worker-animal-working equipment interactions.

Methods

This systematic review and meta-analysis were carried out by the PRISMA guidelines. The research articles were searched from PubMed, HINARI, Web of Sciences, and Google Scholar databases.

Results

This meta-analysis included 13 independent articles and 52 dependent studies. In total, 5,329 humans, 5,475 animals, and 5,119 samples of working equipment were analyzed. The pooled prevalence of S. aureus at the interfaces between humans, animals, and working equipment was 22%, there was a high level of heterogeneity (I2 = 94%: p < 0.01). The overall pooled prevalence of S. aureus in dairy farm sources was 23% (95% CI, 17-30%) compared to 18% in abattoirs. The pooled prevalence of S. aureus was estimated to be 25% for human sources, 23% for animal sources, and 19% for working equipment. The total multidrug resistance (MDR) rate was 27%. The present study illustrates that a predominant antimicrobials comprising ampicillin, penicillin, chloramphenicol, tetracycline, and ciprofloxacin, accounts for the development of resistance in S. aureus strains, with a prevalence of 72%. According to the qualitative assessment of potential risk factors, animal age, worker education, lactation stage, and hand washing by milkers influenced the circulation of S. aureus at animal-worker and working equipment interfaces.

Conclusion

The pooled prevalence of S. aureus at the interface of human,-and animal-working equipment was quantified at 22%. S. aureus was found in humans, animals, and equipment at nearly the same rate. The results of this study demonstrate that S. aureus is hazardous and circulates among animals, workers, and equipment: farmers, animal owners, employees, and the public need to be educated about S. aureus. Moreover, animals and work equipment should be included in the control and prevention of S. aureus infection.

Brief Report: Nasal colonization with Staphylococcus aureus and methicillin resistant Staphylococcus aureus among community-dwelling older adults with comorbidities seeking follow-up medical care in Central Sri Lanka

Older adults are more severely affected by infections caused by drug-resistant bacteria including Methicillin-Resistant Staphylococcus aureus (MRSA). We aimed to identify the MRSA colonization rates and associated factors among older adults aged more than 65-years-old. Among the 309 recruited, 152 (49.2 %) were males. Self-collected nasal swabs were used to isolate Staphylococcus aureus and MRSA with routine microbiological methods. Staphylococcus aureus was isolated from 36 (11.7 %) participants while 11 (3.6 %) were colonized with MRSA. We identified a significant association between the male sex and MRSA colonization (P=0.028, Chi-square test). However, this needs careful interpretation given the smaller number of outcome events. Other factors studied had no statistically significant association with MRSA colonization.

Construction of a postoperative infection outbreak investigation form: A tool for early detection and control measures

BACKGROUND

To develop an investigation form for postoperative infection outbreak (PIO), and to identify sources of the outbreak in the early stage.

METHODS

After an exhaustive literature review, we used the Delphi method to determine the indicators and relative risk scores of the assessment tools through 2 rounds of specialist consultation and overall consideration of the opinions and suggestions of 20 specialists.

RESULTS

A total of 203 studies of PIO were eligible for inclusion. The mean authority coefficient (Cr) was 0.87. Kendall's W coefficient of the specialist consultation was 0.704 after 2 rounds of consultation (P < .005), suggesting that the specialists had similar opinions. Based on 4 primary items and 19 secondary items of the source of PIO, and tripartite distribution characteristics of infected patients, we constructed the PIO investigation form.

CONCLUSIONS

The PIO investigation form can be used in the investigation of the early-stage cluster of cases, it's a prerequisite for taking effective control measures, avoiding PIO occurrence. However, the effect of the investigation form needs to be further evaluated.

Co-colonization of methicillin-resistant Staphylococcus aureus and Candida spp. in children with malignancies

This study aimed to evaluate the interaction between methicillin-resistant Staphylococcus aureus(MRSA) and Candida spp. in the oral cavity of children with malignancies under chemotherapy. We evaluated the expression level of Als3p and mecA in Candida spp. and MRSA strains in both single colonization and co-colonization condition. Oral and nasal samples were collected by dry sponge swabs in 10 ml of sterile phosphate-buffered saline. The MRSA and Candida spp. was confirmed using the PCR method and mecA and Als3p genes, respectively. The SYBR Green-based quantitative real-time PCR was used to evaluate the relative expression levels of mecA and Als3p genes in MRSA and Candida spp., respectively. The frequency of S. aureus in oral-only and nasal-only swab samples were 14.1% (n = 24/170). 58.3% (n = 14/24) and 29.2% (n = 7/24) of S. aureus isolated from oral and nasal samples were MRSA, respectively. Among Candida species, C. albicans (n = 28/170; 16.5%) had the highest frequency. The oral co-colonization of MRSA and Candida spp. was detected in 4.7% (n = 8/170) patients. The overall average of gene expression levels among all Candida spp. and MRSA isolates indicated that the mecA and Als3p genes expression increased six and two times in co-colonization conditions compared to single colonization conditions, respectively. Our findings revealed the importance of polymicrobial infection in clinical settings and stated that it is possible that Candida spp. facilitates the infection of S. aureus and can lead to systemic infection in co-colonized patients.

Nasal Carriage Rate of Staphylococcus aureus, Its Associated Factors, and Antimicrobial Susceptibility Pattern Among Health Care Workers in Public Hospitals, Harar, Eastern Ethiopia

Background

Staphylococcus aureus is the bacteria that colonizes the nasal nares of health-care workers and serves as a reservoir for the spread of pathogen for subsequent infections, mainly Methicillin-resistant Staphylococcus aureus. However, there is a limited study conducted regarding this topic in Harar, Eastern Ethiopia.

Objective

The main objective of this study was to determine the prevalence of nasal carriage of Staphylococcus aureus, associated factors and antimicrobial susceptibility patterns among health-care workers of public hospitals in Harar, Eastern Ethiopia from May 15 to July 30, 2021.

Methods

A hospital-based cross-sectional study was conducted on 295 health-care workers. A simple random sampling technique was used to select the participant. Nasal swabs were collected and cultured at 35°C for 24hrs. S. aureus was identified using the coagulase test and catalase test. Methicillin resistance S. aureus (MRSA) was screened using a cefoxitin disc on Muller Hinton agar using the Kirby-Bauer disc diffusion method. Data were entered into EPI-Info version-7 and transferred to SPSS-20 for analysis. Factors associated with nasal carriage of Staphylococcus aureus were determined by using chi-square analysis. A p-value of less than 0.05 was considered statistically significant.

Results

The prevalence of Staphylococcus aureus in this study was 15.6% (95% CI: 11.7%, 20.3%) and methicillin-resistant Staphylococcus aureus was 11.2% (95% CI: 7.8%, 15.4%), respectively. Age (P < 0.001), work experience (p < 0.001), working unit (p < 0.02), antibiotic use within 3 months (p < 0.001), hand washing habit (p < 0.01), hand rub use (p < 0.001), living with smokers (p < 0.001), living with pets (p < 0.001) and having chronic diseases (p < 0.001) were found significantly associated with Staphylococcus aureus nasal carriage.

Conclusion

The prevalence of Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus are high in our study. The study emphasizes the need for regular surveillance among hospital staff and the environment to prevent MRSA transmission among health-care personnel.

Characteristics of Virulent ST5-SCCmec II Methicillin-Resistant Staphylococcus aureus Prevalent in a Surgery Ward

Objective

To investigate the transmission pathway of a MRSA prevalence in a pancreatic surgery ward in a Chinese teaching hospital.

Methods

Molecular epidemiology investigations were carried out combined PFGE, MLST, SCCmec typing and whole-genome sequencing for 20 successive MRSA isolates (2 isolates from the ward environment). Resistance and virulence genes were detected using specific PCR. Bacterial identification and AST were performed using the Vitek 2 Compact System. Clinical data of enrolled cases were retrieved from electronic case records.

Results

From January 2020 to May 2020, successive isolated 20 MRSA strains were clarified to 2 PFGE patterns (A = 19, B = 1) in the ward. Both isolates from environment and patients belonged to sequence type ST5-SCCmec II-spa type t311. MRSA-related resistance genes mecA, blaZ, ermA, ant(4')-Ia and norA were found in each clone. All 20 isolates carried tst, hlg, hla, eta, eap, fnbA and seo virulence genes, other virulence genes such as sea, sec, seb, seg, sei, sem, sen, ebpS and fnbB were also found in partial stains. All patients had fever symptom, 27.8% were accompanied by diarrhea, 88.9% had undergone surgery or invasive procedures within 30 days. Finally, 94.4% of these patients recovered.

Conclusion

This study confirmed a prevalence of ST5-MRSA-II-t311 clone in a surgery ward, indicated MRSA is a risk factor for post-surgery nosocomial infection and hand hygiene and environmental surveillance should not be ignored.

P, Molina CA, Castillejo P. Beta-Lactam Antibiotic Resistance Genes in the Microbiome of the Public Transport System of Quito, Ecuador

Multidrug-resistant bacteria present resistance mechanisms against β-lactam antibiotics, such as Extended-Spectrum Beta-lactamases (ESBL) and Metallo-β-lactamases enzymes (MBLs) which are operon encoded in Gram-negative species. Likewise, Gram-positive bacteria have evolved other mechanisms through mec genes, which encode modified penicillin-binding proteins (PBP2). This study aimed to determine the presence and spread of β-lactam antibiotic resistance genes and the microbiome circulating in Quito's Public Transport (QTP). A total of 29 station turnstiles were swabbed to extract the surface environmental DNA. PCRs were performed to detect the presence of 13 antibiotic resistance genes and to identify and to amplify 16S rDNA for barcoding, followed by clone analysis, Sanger sequencing, and BLAST search. ESBL genes bla_TEM-1 and bla_CTX-M-1 and MBL genes bla_OXA-181 and mecA were detected along QPT stations, blaTEM being the most widely spread. Two subvariants were found for bla_TEM-1, bla_CTX-M-1, and bla_OXA-181. Almost half of the circulating bacteria found at QPT stations were common human microbiota species, including those classified by the WHO as pathogens of critical and high-priority surveillance. β-lactam antibiotic resistance genes are prevalent throughout QPT. This is the first report of bla_OXA-181 in environmental samples in Ecuador. Moreover, we detected a new putative variant of this gene. Some commensal coagulase-negative bacteria may have a role as mecA resistance reservoirs.

Four Novel Leaderless Bacteriocins, Bacin A1, A2, A3, and A4 Exhibit Potent Antimicrobial and Antibiofilm Activities against Methicillin-Resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a major bacterial pathogen that causes hospital- and community-acquired infections. Owing to its multidrug resistance, it is imperative to develop new antimicrobial agents to treat MRSA infections. In this study, using genome mining analysis and a culture-based screening method to detect bacteriocin activity, we screened a strain, Bacillus sp. TL12, which harbored a putative leaderless bacteriocin gene cluster (bac gene cluster) and exhibited potent anti-MRSA activity. The antimicrobial agents, products of the bac gene cluster, were purified and identified as four novel leaderless bacteriocins: bacin A1, A2, A3, and A4. Bacin A2 was evaluated as a representative antimicrobial agent and showed remarkable antimicrobial activity against S. aureus, MRSA, and the foodborne pathogens Listeria monocytogenes and Bacillus cereus. Mechanistic experiments revealed that bacin A2 damaged cell membranes and exhibited bactericidal activity against MRSA. Bacin A2 effectively inhibited the formation of S. aureus and MRSA biofilms (>0.5× MIC) and killed the cells in their established biofilms (>4× MIC). The hemolytic and NIH/3T3 cytotoxicity assay results for bacin A2 confirmed its biosafety. Thus, bacins have potential as alternative antimicrobial agents for treating MRSA infections. IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) is a major human pathogen that is difficult to treat because of its resistance to several widely used antibiotics. The present study aimed to identify novel anti-MRSA bacteriocins in a prominent producer of bacteriocins, Bacillus cereus group. Four novel leaderless bacteriocins, bacin A1, A2, A3, and A4, which show potent bactericidal effect against S. aureus and MRSA, were identified in Bacillus sp. TL12. Moreover, bacins inhibited biofilm formation and killed cells in the established biofilms of S. aureus and MRSA. These findings suggest that bacins are promising alternatives to treat MRSA infections.

Methicillin resistance Staphylococcus aureus nasal carriage and its associated factors among HIV patients attending art clinic at Dessie comprehensive specialized hospital, Dessie, North East Ethiopia

Globally the incidence of nosocomial infections and colonization due to methicillin resistant Staphylococcus aureus (MRSA) has become greater concern. The objective of the study was to determine the prevalence and associated factors of nasal carriage of MRSA with its antimicrobial susceptibility patter among HIV patients attending ART clinic. cross-sectional study was conducted from January 01 to May 30, 2020 at Dessie comprehensive specialized hospital, north east Ethiopia. A total of 206 HIV patients were recruited by applying systematic random sampling technique. Nasal specimen was collected from both anterior nares, and inoculated directly on mannitol salt agar, MacConkey, 5% blood agar. Screening of MRSA and methicillin susceptible Staphylococcus aureus (MSSA) strain was done by using cefoxitin antibiotic disc following modified Kirby-Bauer disc diffusion technique. Bivariable and multivariable logistic regression analyses were performed to assess the associated factors with S. aureus and MRSA. study participants were in the age range between 12 and 72 years and their mean (±SD) age was 41.52 (±11.2). The rate of S. aureus and MRSA colonization was 127/206 (61.7%) and 58/206 (28.2%), respectively. Having job close contact with human [AOR = 4.41; 95% CI = 1.5-13.02; p = 0.007], picking the nose [AOR = 4.38; 95% CI = 1.34-14.29; p = 0.014] and ART failure [AOR = 7.41; 95% CI = 2.08-26.41; p = 0.002] had statistically significant association with MRSA colonization. MRSA showed resistance for tetracycline (53.4%), erythromycin (84.5%), and trimethoprim-sulfamethoxazole (86.2%). Multi-Drug Resistance (MDR) was detected among 96.5% of MRSA and 20.3% of MSSA isolates. the rate of S. aureus and MRSA nasal colonization was high and it has associated with different factors. Understanding and managing MRSA among HIV patients is mandatory and stakeholders should find out the way how to decolonize the bacteria from nasal area.