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      Methicillin- and Inducible Clindamycin-Resistant Staphylococcus aureus among Patients with Wound Infection Attending Arba Minch Hospital, South Ethiopia

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          Abstract

          Background

          Wound infection is one of the most common hospital-acquired infections. Different bacteria cause infection, of which Staphylococcus aureus is one of the known bacteria in causing infection with increased drug-resistant isolates.

          Objective

          To assess the prevalence and antimicrobial susceptibility pattern of methicillin and inducible clindamycin-resistant Staphylococcus aureus among patients with wound infections attending Arba Minch Hospital.

          Methods

          A facility-based cross-sectional study was conducted from April to June 2017. A pretested questionnaire was used to collect demographic data and clinical characteristics. Wound swabs were cultured and identified by standard techniques. Antibiotic susceptibility tests were performed by the Kirby–Bauer disc diffusion method. Methicillin resistance was detected using the cefoxitin (30  μg) antibiotic disc while inducible clindamycin resistance was detected by the D-zone test. The data were analyzed using Statistical Package for Social Science, version 20. p value <0.05 was considered statistically significant.

          Results

          A total of 161 patients were enrolled and a majority of them were female (90, 50.9%). Among the collected samples, 79 (49.7%) were positive for S. aureus; of this, methicillin resistance accounted for 65 (82.3%). Out of 22 (27.8%) erythromycin-resistant isolates, 19 (24.1%) showed inducible clindamycin resistance. Methicillin-resistant S. aureus showed higher resistance against tetracycline (72.3%) followed by cotrimoxazole (43.1%) and 100% sensitivity to vancomycin. The overall prevalence of inducible clindamycin resistance among methicillin-resistant isolates was 16 (24.6%).

          Conclusion

          The increasing prevalence of methicillin-resistant S. aureus and the coresistance against other therapeutic options like clindamycin is becoming an obstacle in the treatment of infections which need attention from concerned bodies.

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          Most cited references35

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          Epidemiology and burden of multidrug-resistant bacterial infection in a developing country

          Little is known about the excess mortality caused by multidrug-resistant (MDR) bacterial infection in low- and middle-income countries (LMICs). We retrospectively obtained microbiology laboratory and hospital databases of nine public hospitals in northeast Thailand from 2004 to 2010, and linked these with the national death registry to obtain the 30-day mortality outcome. The 30-day mortality in those with MDR community-acquired bacteraemia, healthcare-associated bacteraemia, and hospital-acquired bacteraemia were 35% (549/1555), 49% (247/500), and 53% (640/1198), respectively. We estimate that 19,122 of 45,209 (43%) deaths in patients with hospital-acquired infection due to MDR bacteria in Thailand in 2010 represented excess mortality caused by MDR. We demonstrate that national statistics on the epidemiology and burden of MDR in LMICs could be improved by integrating information from readily available databases. The prevalence and mortality attributable to MDR in Thailand are high. This is likely to reflect the situation in other LMICs. DOI: http://dx.doi.org/10.7554/eLife.18082.001
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            Epidemiology and microbiology of surgical wound infections.

            This study included 676 surgery patients with signs and symptoms indicative of wound infections, who presented over the course of 6 years. Bacterial pathogens were isolated from 614 individuals. A single etiologic agent was identified in 271 patients, multiple agents were found in 343, and no agent was identified in 62. A high preponderance of aerobic bacteria was observed. Among the common pathogens were Staphylococcus aureus (191 patients, 28.2%), Pseudomonas aeruginosa (170 patients, 25.2%), Escherichia coli (53 patients, 7.8%), Staphylococcus epidermidis (48 patients, 7.1%), and Enterococcus faecalis (38 patients, 5.6%).
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              Antibiotic resistance genes & susceptibility patterns in staphylococci

              Background & objectives: This study was carried out to evaluate the association between the antibiotic susceptibility patterns and the antibiotic resistance genes in staphylococcal isolates obtained from various clinical samples of patients attending a teaching hospital in Hatay, Turkey. Methods: A total of 298 staphylococci clinical isolates were subjected to antimicrobial susceptibility testing. The genes implicated in resistance to oxacillin (mecA), gentamicin (aac(6’)/aph(2”), aph(3’-IIIa, ant(4’)-Ia), erythromycin (ermA, ermB, ermC, and msrA), tetracyclin (tetK, tetM), and penicillin (blaZ) were amplified using multiplex PCR method. Results: Methicillin resistance rate among 139 Staphlococcus aureus isolates was 16.5 and 25.9 per cent of S. aureus carried mecA gene. Of the 159 CoNS isolates, methicillin resistance rate was 18.9 and 29.6 per cent carried mecA gene. Ninety four isolates identified as gentamicin resistant phenotypically, contained at least one of the gentamicin resistance genes [aac(6’)/aph(2”), aph(3’)-IIIa, ant(4’)-Ia], 17 gentamicin-susceptible isolates were found as positive in terms of one or more resistance genes [aac(6’)/aph(2”), aph(3’)-IIIa, ant(4’)-Ia] by multiplex PCR. A total of 165 isolates were resistant to erythromycin, and contained at least one of the erythromycin resistance genes (ermA, ermB, ermC and msrA). Phenotypically, 106 staphylococcal isolates were resistant to tetracycline, 121 isolates carried either tetK or tetM or both resistance genes. The majority of staphylococci tested possessed the blaZ gene (89.9%). Interpretation & conclusions: The present results showed that the phenotypic antibiotic susceptibility patterns were not similar to those obtained by genotyping done by multiplex PCR. Rapid and reliable methods for antibiotic susceptibility are important to determine the appropriate therapy decisions. Multiplex PCR can be used for confirmation of the results obtained by conventional phenotypic methods, when needed.
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                Author and article information

                Contributors
                Journal
                Int J Microbiol
                Int J Microbiol
                IJMICRO
                International Journal of Microbiology
                Hindawi
                1687-918X
                1687-9198
                2019
                1 April 2019
                : 2019
                : 2965490
                Affiliations
                1Department of Medical Laboratory Sciences, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
                2Department of Medical Laboratory Sciences, Arba Minch University, Arba Minch, Ethiopia
                3Black Lion Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
                4Kebridehar Primary Hospital, Ethio-Somale, Ethiopia
                5Arba Minch Hospital, Arba Minch, Ethiopia
                Author notes

                Academic Editor: Barbara H. Iglewski

                Author information
                http://orcid.org/0000-0001-8698-399X
                Article
                10.1155/2019/2965490
                6466912
                b5d02ced-707c-4cc0-a4bb-f431efa889e7
                Copyright © 2019 Mohammedaman Mama et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 December 2018
                : 11 March 2019
                Categories
                Research Article

                Microbiology & Virology
                Microbiology & Virology

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