Preeja Puthiya Purayil, Kumar Sanath H, Shetty Veena
Department of Microbiology, KS Hegde Medical Academy, Nitte (Deemed to Be University), Mangalore 5750181, India.
QC Laboratory, Post Harvest Technology, ICAR-Central Institute of Fisheries Education, Mumbai 400061, India.
Antibiotics (Basel). 2021 Feb 18;10(2):197. doi: 10.3390/antibiotics10020197.
The community-associated methicillin-resistant (CA-MRSA) has become increasingly prevalent in both community and hospital settings. The aim of this study was to determine the prevalence, molecular characteristics and antibiotic resistance profiles of CA-MRSA from community- and hospital-associated infections in a tertiary care hospital in Mangalore, India. Of 520 isolates, 362 were from inpatients (IP) and 158 were from outpatients (OP). One-hundred and thirty-two MRSA isolates obtained from 94 inpatients and 38 outpatients with complete clinical details were further analyzed. Of these, 81 (61.4%) were CA-MRSA (IP-47.9%, OP-94.7%) and 51 (38.6%) were HA-MRSA (IP-52.1%, OP-5.3%). All (100%) MRSA isolates were gene positive. SCC typing identified SCC type IV (50.6%) and SCC type V (66.7%) in CA-MRSA, while SCC type I (41.2%), SCC type III (19.6%), SCC type IV (31.4%) and SCC type V (25.5%) were detected in HA-MRSA isolates. The Panton-Valentine Leukocidin (PVL) gene was found in 70.4% of CA-MRSA, 43.1% of HA-MRSA with SCC type IV and SCC type V, and in 7.8% of true HA-MRSA. The antibiotic resistance profiles were determined by the disc diffusion method. Resistance to cefoxitin was used to identify MRSA. A significant difference < 0.05) was observed between CA-MRSA and HA-MRSA with respect to resistance against cephalexin, cefotaxime, levofloxacin, linezolid and teicoplanin. CA-MRSA was predominantly resistant to ciprofloxacin (86.4%), erythromycin (66.7%), ofloxacin (49.4%), cefotaxime (44.4%), gentamicin (40.7%) and clindamycin (40.7%), while HA-MRSA showed resistance against ciprofloxacin (80.4%), erythromycin (80.1%), cefotaxime (70.6%),ofloxacin (58.8%), clindamycin (47.1%) and levofloxacin (41.2%).This study reports the prevalence of CA-MRSA in community and hospital settings and the possibility of multidrug-resistant CA-MRSA replacing HA-MRSA in hospitals. The observations from our study emphasize the need for urgent measures to manage this emerging crisis in healthcare settings.
社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）在社区和医院环境中都变得越来越普遍。本研究的目的是确定印度芒格洛尔一家三级护理医院中社区和医院相关感染的CA-MRSA的流行情况、分子特征和抗生素耐药谱。在520株分离株中，362株来自住院患者（IP），158株来自门诊患者（OP）。对从94名住院患者和38名门诊患者中获得的132株有完整临床细节的MRSA分离株进行了进一步分析。其中，81株（61.4%）为CA-MRSA（IP占47.9%，OP占94.7%），51株（38.6%）为医院获得性耐甲氧西林金黄色葡萄球菌（HA-MRSA）（IP占52.1%，OP占5.3%）。所有（100%）MRSA分离株均为mecA基因阳性。葡萄球菌盒式染色体（SCC）分型在CA-MRSA中鉴定出IV型SCC（50.6%）和V型SCC（66.7%），而在HA-MRSA分离株中检测到I型SCC（41.2%）、III型SCC（19.6%）、IV型SCC（31.4%）和V型SCC（25.5%）。在70.4%的CA-MRSA、43.1%的具有IV型和V型SCC的HA-MRSA以及7.8%的真正HA-MRSA中发现了杀白细胞素（PVL）基因。通过纸片扩散法测定抗生素耐药谱。使用对头孢西丁的耐药性来鉴定MRSA。在头孢氨苄、头孢噻肟、左氧氟沙星、利奈唑胺和替考拉宁的耐药性方面，CA-MRSA和HA-MRSA之间观察到显著差异（P<0.05）。CA-MRSA主要对环丙沙星（86.4%）、红霉素（66.7%）、氧氟沙星（49.4%）、头孢噻肟（44.4%）、庆大霉素（40.7%）和克林霉素（40.7%）耐药，而HA-MRSA对环丙沙星（80.4%）、红霉素（80.1%）、头孢噻肟（70.6%）、氧氟沙星（58.8%）、克林霉素（47.1%）和左氧氟沙星（41.2%）耐药。本研究报告了社区和医院环境中CA-MRSA的流行情况以及多重耐药CA-MRSA在医院中取代HA-MRSA的可能性。我们研究的观察结果强调了在医疗环境中采取紧急措施应对这一新兴危机的必要性。
