Phenotypic Characterization and Risk Factors of Nosocomial Staphylococcus aureus from Health Care Centers


Multidrug resistant Staphylococcus aureus (MDRS) is a serious threat to hospitalized patients globally and now represents a challenge for public health, as community-acquired infections appear to be on the increase in both adults and children. S. aureus colonization has been shown to be a risk factor for community-acquired and nosocomial infections. A total of 130 subjects from the community and 100 subjects from health care-related facilities were evaluated for the prevalence of Staphylococcus aureus colonization and to identify risk factors associated with methicillin-resistant S. aureus (MRSA) and vancomycin resistant S. aureus (VRSA) colonization. Among the community subjects, 35.38% had MRSA and 1.53% VRSA colonization. Subjects from health care-related facilities had a lower MRSA colonization rate (17%) than community subjects and the colonization VRSA has not been found. Age was a risk factor for S. aureus colonization, with subjects under age 20 years or between 60 and 80 years showing higher rates of colonization. In conclusion, a high prevalence of MRSA colonization was observed among people with relationship to the hospital setting. The high level of multiple-drug resistance among community MRSA strains in association with the previously reported excessive use of antibiotics highlights the importance of the problem of antibiotic selective pressure. Our results indicate that the spread of both MRSA and VRSA and the transmission of hospital isolates contribute to the high MRSA/VRSA burden in the community.

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C. G. Unakal and B. B. Kaliwal, "Phenotypic Characterization and Risk Factors of Nosocomial Staphylococcus aureus from Health Care Centers," Advances in Microbiology, Vol. 2 No. 2, 2012, pp. 122-128. doi: 10.4236/aim.2012.22017.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] D. E. Townsend, N. Ashdown, S. Bolton, J. Bradley, G. Duckworth, E. C. Moorhouse, et al., “The International Spread of Methicillin-Resistant Staphylococcus aureus,” Journal of Hospital Infection, Vol. 9, No. 1, 1987, pp. 60-71. doi:10.1016/0195-6701(87)90097-1
[2] A. Voss, D. Milatovic, C. Wallrauch-Schwarz, V. T. Rosdahl and I. Braveny, “Methicillin-Resistant Staphylococcus aureus in Europe,” European Journal of Clinical Microbiology & Infectious Diseases, Vol. 13, No. 1, 1994, pp. 50-55. doi:10.1007/BF02026127
[3] R. P. Wenzel, R. L. Thompson and S. M. Landry, “Hospital Acquired Infections in Intensive Care Unit Patients: An Overview with Emphasis on Epidemics,” American Journal of Infection Control, Vol. 4, No. 5, 1983, pp. 371-375.
[4] J. D. Edgeworth, D. F. Treacher and S. J. Eykyn, “A 25-Year Study of Nosocomial Bacteremia in Adult Intensive Care Unit,” Critical Care Medicine, Vol. 27, No. 8, 1999, pp. 1421-1428. doi:10.1097/00003246-199908000-00002
[5] J. L. Vincent, D. J. Bihari, P. M. Suter, et al., “The Prevalence of Nosocomial Infection in Intensive Care Units in Europe: Results of the European Prevalence of Infection in Intensive Care (EPIC) Study,” The Journal of the American Medical Association, Vol. 274, No. 8, 1995, pp. 639-644. doi:10.1001/jama.1995.03530080055041
[6] R. P. Wenzel and M. B. Edmond, “The Impact of Hospital-Acquired Bloodstream Infections,” Emerging Infectious Disease, Vol. 7, No. 2, 2001, pp. 174-177. doi:10.3201/eid0702.010203
[7] J. E. Peacock Jr., F. J. Marsik and R. P. Wenzel, “Methicillin-Resistant Staphylococcus aureus: Introduction and Spread within a Hospital,” Annals of Internal Medicine, Vol. 93, No. 4, 1980, pp. 526-532.
[8] J. M. Hughes, “Setting Priorities: Nationwide Nosocomial Infection Prevention and Control Programs in the USA,” European Journal of Clinical Microbiology & Infectious, Vol. 6, No. 3, 1987, pp. 348-351. doi:10.1007/BF02017638
[9] S. Al-Obeid, E. Collatz and L. Gutman, “Mechanism of Resistance to Vancomycin in Enterococcus faecium D366 and Enterococcus fecalis A256,” Antimicrobial Agents and Chemotherapy, Vol. 34, No. 2, 1990, pp. 252-256.
[10] S. Salmenlinna, O. Lyytikainen and J. Vuopio-Varkila, “Community Acquired methicillin resistant Staphylococcus aureus, Finland,” Emerging Infectious Diseases, Vol. 18, No. 1, 2002, pp. 602-607.
[11] World Health Organization, “Recommendations for the Control of Methicillin Resistant Staphylococcus aureus (MRSA),” WHO, Geneva, 1996.
[12] E. Dickinson, “Mortality from Methicillin-Resistant Staphylococcus aureus in England and Wales: Analysis of Death Certificates,” British Medical Journal, Vol. 325, No. 7377, 2002, pp. 1390-1391. doi:10.1136/bmj.325.7377.1390
[13] L. Collier, A. Balows and M. Sussman, “Bacterial Infections. Topley and Wilson’s Microbiology and Microbial Infections,” 9th Edition, Arnold Publication, London, 1998, pp. 231-256.
[14] B. N. Doebbeling, “The Epidemiology of Methicillin Resistant Staphylococcus aureus Colonization and Infection,” Journal of Chemotherapeutics, Vol. 7, Suppl. 3, 1995, pp. 99-103.
[15] A. L. Panlilio, D. H. Culver, R. P. Gaynes, S. Banerjee, T. S. Henderson, J. S. Tolson, et al., “Methicillin-Resistant Staphylococcus aureus in US Hospitals, 1975-1991,” Infection Control and Hospital Epidemiology, Vol. 13, No. 10, 1992, pp. 582-586. doi:10.1086/646432
[16] S. Verma, S. Joshi, V. Chitnis, N. Hemwani, D. Chitnis, “Growing Problem of Methicillin Resistant Staphylococci—Indian Scenario,” Indian Journal of Medical Sciences, Vol. 54, No. 12, 2000, pp. 535-540.
[17] A. P. Mehta, C. Rodrigues, K. Sheth, S. Jani, A. Hakimiyar and N. Fazalbhoy, “Control of Methicillin Resistant Staphylococcus aureus in a Tertiary Care Centre: A Five Year Study,” Indian Journal of Medical Microbiology, Vol. 16, No. 1, 1998, pp. 31-34.
[18] K. Hiramatsu, H. Hanaki and T. Ino, “Methicillin-Resistant Staphylococcus aureus Clinical Strain with Reduced Vancomycin Susceptibility,” Journal of Antimicrobial Chemotherapy, Vol. 40, No. 1, 1997, 135-136. doi:10.1093/jac/40.1.135
[19] J. E. Geraci, “Some Laboratory and Clinical Experiences with a New Antibiotic, Vancomycin,” In: Antibiotic Annual 1955-1956, Medical Encyclopedia, New York, 1956, pp. 90-106.
[20] R. C. Moellering, “The Specter of Glycopeptide Resistance: Current Trends and Future Considerations,” American Journal of Medicine, Vol. 104, Suppl. 5A, 1998, pp. 3S-6S. doi:10.1016/S0002-9343(98)00148-X
[21] C. U. Tuazon and H. Miller, “Clinical and Microbiologic Aspects of Serious Infections Caused by Staphylococcus epidermidis,” Scandinavian Journal of Infectious Diseases, Vol. 15, No. 4, 1983, pp. 347-360.
[22] C. G. Unakal and B. B. Kaliwal, “Vancomycin-Resistant Staphylococcus aureus Containing van A Gene Isolated from Clinical Samples of Community Health Care Centers of North Karnataka, India,” Proceedings of International Society BioTechnology Conference (ISBT-2008), Gangtok, 28-30 December 2008, pp. 464-468.
[23] National Committee for Clinical Laboratory Standards, “Methods for Dilution a Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically: Approved Standard 2000, M7-A5,” 5th Edition, NCCLS, Wayne, 2000.
[24] J. Valles, C. Leon and F. Alvarez-Lerma, “Nosocomial Bacteremia in Critically Ill Patients: A Multi-Center Study Evaluating Epidemiology and Prognosis,” Clinical Infectious Diseases, Vol. 24, No. 3, 1997, 24: pp. 387-395. doi:10.1093/clinids/24.3.387
[25] D. R. Schaberg, D. H. Culver and R. P. Gaynes, “Major Trends in the Microbial Etiology of Nosocomial Infection,” American Journal of Medicine, Vol. 91, Suppl. 3B, 1991, pp. 72-75. doi:10.1016/0002-9343(91)90346-Y
[26] W. Sligl, G. Taylor and P. G. Brindley, “Five Years of Nosocomial Gram-Negative Bacteremia in a General Intensive Care Unit: Epidemiology, Antimicrobial Susceptibility Patterns, and Outcomes,” International Journal of Infectious Diseases, Vol. 10, No. 4, 2006, pp. 320-325. doi:10.1016/j.ijid.2005.07.003
[27] V. Suljagic, M. Cobeljic, S. Jancovic, V. Mirovic, L. Markovic-Denic, P. Romic and D. Mikic, “Nosocomial Bloodstream Infections in ICU and Non-ICU Patients,” American Journal of Infection Control, Vol. 33, No. 6, 2005, pp. 333-340. doi:10.1016/j.ajic.2005.03.010
[28] T. N. Jang, B. I. Kuo, S. H. Shen, C. P. Fung, S. H. Lee, T. L. Yang and C. S. Huang, “Nosocomial Gram-Negative Bacteremia in Critically Ill Patients: Epidemiologic Characteristics and Prognostic Factors in 147 Episodes,” Journal of the Formosan Medical Association, No. 7, 1999, 98: pp. 465-473.
[29] A. Colpan, E. Akinci, A. Erbay, N. Balaban and H. Bodur, “Evaluation of Risk Factors for Mortality in Intensive Care Units: A Prospective Study from a Referral Hospital in Turkey,” American Journal of Infection Control, Vol. 33, No. 1, 2005, pp. 42-47. doi:10.1016/j.ajic.2004.09.005
[30] K. B. Laupland, D. A. Zygun, C. J. Doig, S. M. Bagshaw, L. W. Svenson and G. H. Fick, “One-Year Mortality of Bloodstream Infection-Associated Sepsis and Septic Shock among patients Presenting to a Regional Critical Care System,” Intensive Care Medicine, Vol. 31, No. 2, 2005, pp. 213-219. doi:10.1007/s00134-004-2544-6
[31] M. Arvanitidou, E. Katikaridou, J. Douboyas and A. Tsakris, “Prognostic Factors for Nosocomial Bacteraemia Outcome: A Prospective Study in a Greek Teaching Hospital,” Journal of Hospital Infection, Vol. 61, No. 3, 2005, pp. 219-324. doi:10.1016/j.jhin.2005.03.006
[32] Y. C. Lin, T. L. Chen, H. L. Ju, H. S. Chen, F. D. Wang, K. W. Yu and C. Y. Liu, “Clinical Characteristics and Risk Factors for Attributable Mortality in Enterobacter cloacae Bacteremia,” Journal of Microbiology, Immunology and Infection, Vol. 39, No. 1, 2006, pp. 67-72.
[33] A. Alborzi, B. A. Pourabbas, H. Salehi, B. H. Pourabbas, B. Oboodi and M. R. Panjehshahin, “Prevalence and Pattern of Antibiotic Sensitivity of Methicillin Sensitive and Resistant Staphylococcus aureus in Shiraz-Iran,” Iranian Journal of Medical Sciences, Vol. 25, 2000, pp. 1-8.
[34] S. Vidhani, P. L. Mehndiratta and M. D. Mathur, “Study of Methicillin Resistant S. aureus (MRSA) Ilolates from High Risk Patients,” Indian Journal of Medical Microbiology, Vol. 19, 2001, pp. 13-16.
[35] J. P. Arbuthnott, D. C. Coleman and J. S. DeAsavedo, “Staphylococcal Toxins in Human Disease,” Journal of Applied Bacteriology, Vol. 69, Suppl. 19, 1990, pp. 101S-107S. doi:10.1111/j.1365-2672.1990.tb01802.x
[36] R. L. Thompson, I. Cabezuclo and R. P. Werizel, “Epidemiology of Nosocomial Infections Caused by Methicillin-Resistant Staphylococcus Aureus Infections Caused by Methicillin-Resistant Staphylococcus Aureus,” Annals of Internal Medicine, Vol. 97, No. 3, 1982, pp. 309-317.
[37] J. R. Myers and C. C. Linnemann, “Bacteremia Due to Methicillin Resistant Staphylococcus aureus,” Journal of Infectious Diseases, Vol. 145, No. 4, 1982, pp. 532-536. doi:10.1093/infdis/145.4.532
[38] S. Nishijima, S. Namura, K. Mitsuya, et al., “The Incidence of Isolation of MRSA Strains from Skin Infections during 1989-1991,” Journal of Dermatology, Vol. 20, No. 4, 1993, pp. 193-197.
[39] S. K. Mathur, S. Singhal, K. N. Prasad, et al., “Prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) in a Tertiary Care Hospital,” Indian Journal of Medical Microbiology, Vol. 12, 1994, pp. 96-101.
[40] K. G. Bhat and M. G. Bhat, “Prevalence of Nosocomial Infections Due to Methicillin Resistant Staphylococcus aureus in Mangalore, India,” Biomedicine, Vol. 17, No. 1, 1997, pp. 17-20.

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