Frequency of Methicillin Resistant Staphylococcus Aureus carriers in Intensive Care  Unit Staff of Tertiary Care Hospitals

Authors

  • Muhammad Hammad Department of Medicine, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Asad Mahmood Department of Medicine, Combined Military Hospital Sialkot/National University of Medical Sciences (NUMS) Pakistan
  • Amna Aziz Department of Hematology, Armed Forces Institute of Pathology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Muhammad Yasir Department of Medicine, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Hafiz Asad Saeed Department of Medicine, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i3.9712

Keywords:

Decolonization, Intensive care unit staff, MRSA carrier.

Abstract

 

Objective: To investigate and compare the frequency of MRSA carriers among medical and surgical Intensive Care Unit staff in Tertiary Care Hospitals.

Study Design: Cross-sectional comparative study.

Place and Duration of Study: Department of Medicine, Two Tertiary Care Hospitals, Rawalpindi Pakistan, from Mar to May 2022.

Methodology: A total of 134 ICU staff in different working shifts, including consultants, residents, nurses, paramedics, ward attendants, and sanitary workers, were subjected to nasal swabs, which were sent for culture and sensitivity. The nasal swab culture was found to be positive and negative for MRSA.

Results: Out of 70 individuals from the surgical ICU, 12(17.14%) tested positive for MRSA, while 8(11.4%) out of 64 individuals from the medical ICU tested positive for MRSA (p=0.568). The overall MRSA carriage among ICU staff was found to be 14.9%. Out of these 20(14.9%) individuals, 3 were doctors, 4 nurses, 10 paramedical staff, 1 ward attendant, and 2 sanitary workers. Only 7(35%) had confirmed contact with MRSA patients within the last 2 months, and 15(11.2%) had received prior decolonization. A total of 44(32.8%) out of 134 individuals had contact with a MRSA-carrier patient in the last 2 months. 27(20.1%) individuals had received prior decolonization for MRSA carriage, with a mean duration of 5.37±4.404 months.

Conclusion MRSA is an important superbug in our ICUs. With the use of prophylactic and gunshot therapies in intensive care units, these bacteria tend to acquire resistance to the anti-microbial agents, rendering our most expensive and last line of defence ineffective.

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References

Andrade MM, Luiz WB, Souza RDO, Amorim JH. The History of Methicillin-Resistant Staphylococcus aureus in Brazil. Can J Infect Dis Med Microbiol 2020; 1721936.

https://doi.org/10.1155/2020/1721936

Benner EJ, Kayser FH. Growing clinical significance of methcillin-resistant Staphylococcus aureus. Lancet 1968; 2(7571): 741-744.

https://doi.org/10.1016/s0140-6736(68)90947-1

Lim WW, Wu P, Bond HS, Wong JY, Ni K, Seto WH, et al. De-terminants of methicillin-resistant Staphylococcus aureus (MRSA) prevalence in the Asia-Pacific region: A systematic review and meta-analysis. J Glob Antimicrob Resist 2019; 16: 17-27.

https://doi.org/10.1016/j.jgar.2018.08.014

European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report 2019. Stockholm: European Centre for Disease Prevention and Control; 2020.

Magill SS, O'Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, et al; Emerging Infections Program Hospital Prevalence Survey Team. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med 2018; 379(18): 1732-1744.

https://doi.org/10.1056/NEJMoa1801550

Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev 2018; 31(4): e00020-18.

https://doi.org/10.1128/CMR.00020-18

Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997; 10(3): 505-520.

https://doi.org/10.1128/CMR.10.3.505

Eriksen NH, Espersen F, Rosdahl VT, Jensen K. Carriage of Staphylococcus aureus among 104 healthy persons during a 19-month period. Epidemiol Infect 1995; 115(1): 51-60.

https://doi.org/10.1017/s0950268800058118

Sim BL, McBryde E, Street AC, Marshall C. Multiple site surveillance cultures as a predictor of methicillin-resistant Staphylococcus aureus infections. Infect Control Hosp Epidemiol 2013; 34(8): 818-24.

https://doi.org/10.1086/671273

Cobos-Trigueros N, Solé M, Castro P, Torres JL, Hernández C, Rinaudo M, et al. Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure. Crit Care 2015; 19(1): 218.

https://doi.org/10.1186/s13054-015-0916-7

Bonten MJ, Weinstein RA. Bird's-eye view of nosocomial infections in medical ICU: blue bugs, fungi, and device-days. Crit Care Med 1999; 27(5): 853-854.

https://doi.org/10.1097/00003246-199905000-00001

Huskins WC, Huckabee CM, O'Grady NP, Murray P, Kopetskie H, Zimmer L, et al; STAR*ICU Trial Investigators. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011; 364(15): 1407-1418.

https://doi.org/10.1056/NEJMoa1000373

Derde L, Cooper B, Goossens H, Malhotra-Kumar S, Willems R, Gniadkowski M et al; MOSAR WP3 Study Team. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 2014; 14(1): 31-39.

https://doi.org/10.1016/S1473-3099(13)70295-0 Erratum in: Lancet Infect Dis 2014; 14(1): 11.

Kohler P, Bregenzer-Witteck A, Rettenmund G, Otterbech S, Schlegel M. MRSA decolonization: success rate, risk factors for failure and optimal duration of follow-up. Infection 2013;

(1): 33-40. https://doi.org/10.1007/s15010-012-0290-1

Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, Harbarth S. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primers 2018; 4: 18033.

https://doi.org/10.1038/nrdp.2018.33

Rhodes A, Evans L, Alhazzani W, Levy M, Antonelli M, Ferrer R et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 43(3): 304-377.

https://doi.org/10.1007/s00134-017-4683-6

Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect 2020; 26(12): 1622-1629.

https://doi.org/10.1016/j.cmi.2020.07.016

Pineda R, Kanatani M, Deville J. 102. Effects of an Antimicrobial Stewardship-guided MRSA Nasal Screening Review on Vancomycin Utilization for Respiratory Infections: A Quasi-Experimental Study. Open Forum Infect Dis 2020; 7(Suppl 1): S65.

https://doi.org/10.1093/ofid/ofaa439.147

Turner SC, Seligson ND, Parag B, Shea KM, Hobbs ALV. Evaluation of the timing of MRSA PCR nasal screening: How long can a negative assay be used to rule out MRSA-positive respiratory cultures? Am J Health Syst Pharm 2021; 78(Supplement_2): S57-S61.

https://doi.org/10.1093/ajhp/zxab109

Dulon M, Peters C, Schablon A, Nienhaus A. MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review. BMC Infect Dis 2014; 14: 363. https://doi.org/10.1186/1471-2334-14-363

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Published

28-06-2024

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Original Articles

How to Cite

1.
Hammad M, Mahmood A, Aziz A, Yasir M, Saeed HA. Frequency of Methicillin Resistant Staphylococcus Aureus carriers in Intensive Care  Unit Staff of Tertiary Care Hospitals. Pak Armed Forces Med J [Internet]. 2024 Jun. 28 [cited 2024 Dec. 25];74(3):785-9. Available from: https://pafmj.org/PAFMJ/article/view/9712