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Comparative prevalence of MRSA in two Nepalese tertiary care hospitals

Open Journal of Clinical Diagnostics 2013年第2期3卷 67-73页

作者： bidya shrestha Department of Microbiology Tri-Chandra Campus Tribhuvan University Kathmandu Nepal

This comparative study has been focused on the prevalence of MRSA types and their antibiotic resistance in two tertiary care hospitals of Nepal. During November 2007 to June 2009, clinical samples from patients with nosocomial infection from two Nepali hospitals, Kathmandu Based Hospital (KBH) and Lalitpur Based Hospital (LBH) were cultured and antibiotic susceptibility tests done following standard methodology in Microbiology laboratory, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Occurrence of MRSA (52.9% of 304 Staphylococcus aureus isolates) in KBH and that of MSSA (62% of 100 S. aureus isolates) in LBH were significant. No association of age was observed with MRSA or MSSA. Among MSSA from both hospitals, the highest resistance was found against penicillin. KBH urinary isolates were resistant to norfloxacin (51.4%), while isolates from other sites were resistant to ciprofloxacin (30.6%), erythromycin (12%), gentamicin (10.3%). LBH isolates were resistant to co-trimoxazole (22.6%), erythromycin (17.2%), ciprofloxacin (13.8%), gentamicin (12.9%). Among MRSA, most of the isolates from both hospitals were resistant to a wide array of antibiotics. A majority of the MSSA and MRSA isolates were susceptible to rifampicin and chloramphenicol. Most of KBH MRSA were homogeneous MRSA, 80.5% (significant), of which, 99.2% were multiresistant oxacillin resistant S. aureus (MORSA). And among the heterogeneous MRSA isolates from KBH, 71% were MORSA. On the other hand, among LBH MRSA isolates, 52.6% were homogeneous MRSA, cent percent of which were MORSA while 47.4% were heterogeneous MRSA of which 44.5% were MORSA. Since almost all of the homogeneous MRSA and most of the heterogeneous MRSA from both hospitals were MORSA, there is a possibility that a hospital acquired S. aureus could be MORSA. Hence, every infected patient should be considered as a potential source of MORSA.

关键词： MRSA Nepal Hospital Antibiotic Resistance

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Comparative Study of Three β Lactamase Test Methods in <i>Staphylococcus</i>aureus Isolated from Two Nepalese Hospitals

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Open Journal of Clinical Diagnostics 2014年第1期4卷 47-52页

作者： shrestha bidya Rana Shamser Suman Department of Medicine Nepal Police Hospital Kathmandu Nepal Department of Microbiology Tri-Chandra Campus Tribhuvan University Kathmandu Nepal

Background: β lactamase is a plasmid-encoded enzyme that hydrolyzes β lactam ring of β lactam antibiotics rendering them ineffective. These enzymes, produced by Staphylococcus aureus along with many other organisms, have hindered the use of many useful and once life-saving β lactam antibiotics from clinical practice. Methods: This study was aimed to compare three test methods-chromogenic, acidimetric and iodometric-for the detection of β lactamase enzyme produced by 404 nosocomial induced S. aureus isolated from two Nepali hospitals, Kathmandu based hospital (KBH) and Lalitpur based Hospital (LBH). The study was carried out following standard methodology during November 2007 to June 2009 in the Department of Microbiology, Institute of Medicine, Kathmandu, Nepal. Sensitivity, specificity, efficiency, positive predictive value, and negative predictive values of the tests were calculated taking penicillin resistance and sensitivity as the standard. Results: Chromogenic method was found to be the most sensitive (98.93%) and efficient (98.51%) test and had a high positive predictive value (99.46%). Sensitivity (98.4%) and efficiency (98.27%) of iodometric method was found to be comparable to chromogenic test;its specificity (96.55 %) and positive predictive value (99.73%) were the highest among the 3 tests. Acidimetric test was the least sensitive (97.33%) and efficient (96.78%). Of note, the sensitivity and specificity of these test methods have been compromised due to the negativity of few penicillin resistant isolates and positivity of some penicillin sensitive isolates, respectively. Conclusion: Chromogenic method was found comparatively to be the best test method for the detection of β lactamase production. However, in contrast to the other two test methods whose reagents can be locally and economically prepared, chromogenic test’s use has been impeded by its cost and unavailability in the local Nepali market.

关键词： β Lactam β Lactamase Nosocomial S. aureus MSSA MRSA Nepal

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