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Vol. 15, No. 1, 2006
Issue release date: December 2005
Section title: Original Paper
Open Access Gateway
Med Princ Pract 2006;15:52–55
(DOI:10.1159/000089386)

Methicillin Resistance among Staphylococcus aureus Isolates from Saudi Hospitals

Asghar A.H.a · Momenah A.M.b
aDepartment of Environmental and Health Research, The Custodian of the Two Holy Mosques Institute of Hajj Research, and bDepartment of Medical Microbiology, Faculty of Medical Sciences and Medicine, University of Um Al-Qura, Makkah, Saudi Arabia
email Corresponding Author

Abstract

Objective: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains among clinical isolates collected from the 4 tertiary hospitals in Makkah, Saudi Arabia, and to test the antimicrobial susceptibility patterns of S. aureus isolates against 9 antimicrobial agents. Materials and Methods: A total of 512 S. aureus clinical isolates were collected during a period of 1 year starting in April 2003 in Al-Noor, King Abdul-Aziz, Hera and King Faisal Hospitals, Makkah, Saudi Arabia. The sensitivity patterns of these isolates were determined using the Kirby-Bauer disk diffusion method. Results: The prevalence of MRSA among S. aureus isolates was 38.9% (199/512). Among 199 MRSA isolates, 78.8% showed multidrug resistance to erythromycin, gentamicin and oxytetracycline. Conclusion: The rate of MRSA resistance in this study was much higher than what had been reported in other areas of Saudi Arabia emphasizing the need for local or country-based surveillance to characterize and monitor MRSA and to develop strategies that will improve MRSA treatment and control.

© 2006 S. Karger AG, Basel


  

Key Words

  • Methicillin-resistant Staphylococcus aureus
  • Antimicrobial resistance
  • Nosocomial infection

References

  1. Struelens M, Mertens R, Groupement P: National survey of methicillin-resistant Staphylococcus aureus in Belgian hospital: detection methods, prevalence, trends and infection control measures. Eur J Clin Microbiol Infect Dis1994;13:56–63.
  2. Thompson R, Cabezudo I, Wenzel R: Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309–317.
  3. Archibald L, Phillips L, Monnet D: Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit. Clin Infect Dis 1997;24:211–215.
  4. Abramson M, Sexton DJ: Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.
  5. Duckworth G, Lothian J, Williams J: Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital. J Hosp Infect 1988;11:1–5.
  6. Tomasz A, Drugeon H, de Lencastre H, Jabes D, McDougall L, Bille J: New mechanism for methicillin resistance in Staphylococcus aureus: clinical isolates that lack the PBP2a gene and contain normal penicillin-binding capacity. Antimicrob Agents Chemother 1989;33:1869–1874.
  7. Blandino G, Marchese A, Ardito F, Fadda G, Fontana R, Lo Cascio G, Marchetti F, Schito G, Nicoletti G: Antimicrobial susceptibility profiles of Pseudomonas aeruginosa and Staphylococcus aureus isolated in Italy from patients with hospital-acquired infections. Int J Antimicrob Agents 2004;24:515–518.
  8. National Committee for Clinical Laboratory Standards: Performance standards for antimicrobial tests. NCCLS document M2-A8. Wayne, National Committee for Clinical Standards, 2003.
  9. Bell J, Turnidge J, SENTRY APAC Participants: Antimicrobial resistance trends in community-acquired respiratory tract pathogens in the Western Pacific Region and South Africa: report from SENTRY antimicrobial surveillance program, 1998–1999, including an in vitro evaluation of BMS284756. Int J Antimicrob Agents 2002;19:125–132.
  10. Stewart T, Jolt R: Evolution of natural resistance to newer penicillin. BMJ 1963;i:1309–1311.
  11. Centers for Disease Control: Guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. Morb Mortal Wkly Rep 1997;46:624–628.
  12. Hashimoto H, Inoue M, Hayashi I: A survey of Staphylococcus aureus for typing and drug resistance in various areas of Japan during 1992 and 1993. Jpn J Antibiot 1994;47:618–626.
  13. Communicable Disease Report: Epidemic methicillin-resistant Staphylococcus aureus. CDR Wkly 1996;6:197–201.
  14. Brumfitt W, Hamilton-Miller J: Methicillin-resistant Staphylococcus aureus. N Engl J Med 1989;320:1188–1196.
  15. Stefani S, Varaldo P: Epidemiology of methicillin-resistant staphylococci in Europe. Clin Microbiol Infect 2003;9:1179–1186.
  16. Bilal N, Gedebou M: Staphylococcus aureus as a paradigm of a persistent problem of bacterial multiple antibiotic resistance in Abha, Saudi Arabia. East Mediterr Health J 2000;6:948–954.
  17. Bukharie H, Abdelhadi M: The epidemiology of methicillin-resistant Staphylococcus aureus at a Saudi university hospital. Microb Drug Resist 2001;7:413–416.
  18. Bukharie HA, Abdelhadi MS, Saeed IA, Rubaish AM, Larbi EB: Emergence of methicillin-resistant Staphylococcusaureus as a community pathogen. Diagn Microbiol Infect Dis 2001;40:1–4.
  19. Navascues A, Garcia Irure J, Guillen F: State of methicillin resistant Staphylococcus aureus in the hospital of Navarre (2000–2001). An Sist Sanit Navar 2004;27:21–25.
  20. Hanumanthappa AR, Chandrappa NR, Rajasekharappa MG: Prevalence of methicillin resistant Staphylococcus aureus in Karanataka. Indian J Pathol Microbiol 2003;46:129–132.
  21. Kaszanyitzky EJ, Janosi S, Egyed Z, Agost G, Semjen G: Antibiotic resistance of Staphylococcus from human food, and different animal species according to data of the Hungarian resistance monitoring system in 2001. Acta Vet Hung 2003;51:451–464.
  22. Zaman R, Dibb W: Methicillin resistant Staphylococcus aureus (MRSA) isolated in Saudi Arabia: epidemiology and antimicrobial resistance patterns. J Hosp Infect 1994;26:297–300.
  23. Herold B, Immergluck L, Maranan M: Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.
  24. Maguire GP, Arthur AD, Boustead PJ, Dwyer B, Currie BJ: Clinical experience and outcomes of community-acquired and nosocomial methicillin-resistant Staphylococcus aureus in a northern Australian hospital. J Hosp Infect 1998;38:273–281.
  25. Lindenmayer JM, Schoenfeld S, O’Grady RO, Carney JK: Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998;158:895–899.

  

Author Contacts

Dr. Aiman M. Momenah
PO Box 6630
Makkah (Saudi Arabia)
Tel. +966 503501449, Fax +966 25270000, ext. 7111
E-Mail aiman34@hotmail.com

  

Article Information

Received: December 12, 2004
Revised: June 8, 2005
Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 2, Number of References : 25

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 15, No. 1, Year 2006 (Cover Date: December 2005)

Journal Editor: Al-Zaid, N.S. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Objective: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains among clinical isolates collected from the 4 tertiary hospitals in Makkah, Saudi Arabia, and to test the antimicrobial susceptibility patterns of S. aureus isolates against 9 antimicrobial agents. Materials and Methods: A total of 512 S. aureus clinical isolates were collected during a period of 1 year starting in April 2003 in Al-Noor, King Abdul-Aziz, Hera and King Faisal Hospitals, Makkah, Saudi Arabia. The sensitivity patterns of these isolates were determined using the Kirby-Bauer disk diffusion method. Results: The prevalence of MRSA among S. aureus isolates was 38.9% (199/512). Among 199 MRSA isolates, 78.8% showed multidrug resistance to erythromycin, gentamicin and oxytetracycline. Conclusion: The rate of MRSA resistance in this study was much higher than what had been reported in other areas of Saudi Arabia emphasizing the need for local or country-based surveillance to characterize and monitor MRSA and to develop strategies that will improve MRSA treatment and control.

© 2006 S. Karger AG, Basel


  

Author Contacts

Dr. Aiman M. Momenah
PO Box 6630
Makkah (Saudi Arabia)
Tel. +966 503501449, Fax +966 25270000, ext. 7111
E-Mail aiman34@hotmail.com

  

Article Information

Received: December 12, 2004
Revised: June 8, 2005
Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 2, Number of References : 25

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 15, No. 1, Year 2006 (Cover Date: December 2005)

Journal Editor: Al-Zaid, N.S. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/MPP


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/12/2004
Accepted: 6/8/2005
Published online: 12/9/2005
Issue release date: December 2005

Number of Print Pages: 4
Number of Figures: 0
Number of Tables: 2

ISSN: 1011-7571 (Print)
eISSN: 1423-0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Struelens M, Mertens R, Groupement P: National survey of methicillin-resistant Staphylococcus aureus in Belgian hospital: detection methods, prevalence, trends and infection control measures. Eur J Clin Microbiol Infect Dis1994;13:56–63.
  2. Thompson R, Cabezudo I, Wenzel R: Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309–317.
  3. Archibald L, Phillips L, Monnet D: Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit. Clin Infect Dis 1997;24:211–215.
  4. Abramson M, Sexton DJ: Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.
  5. Duckworth G, Lothian J, Williams J: Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital. J Hosp Infect 1988;11:1–5.
  6. Tomasz A, Drugeon H, de Lencastre H, Jabes D, McDougall L, Bille J: New mechanism for methicillin resistance in Staphylococcus aureus: clinical isolates that lack the PBP2a gene and contain normal penicillin-binding capacity. Antimicrob Agents Chemother 1989;33:1869–1874.
  7. Blandino G, Marchese A, Ardito F, Fadda G, Fontana R, Lo Cascio G, Marchetti F, Schito G, Nicoletti G: Antimicrobial susceptibility profiles of Pseudomonas aeruginosa and Staphylococcus aureus isolated in Italy from patients with hospital-acquired infections. Int J Antimicrob Agents 2004;24:515–518.
  8. National Committee for Clinical Laboratory Standards: Performance standards for antimicrobial tests. NCCLS document M2-A8. Wayne, National Committee for Clinical Standards, 2003.
  9. Bell J, Turnidge J, SENTRY APAC Participants: Antimicrobial resistance trends in community-acquired respiratory tract pathogens in the Western Pacific Region and South Africa: report from SENTRY antimicrobial surveillance program, 1998–1999, including an in vitro evaluation of BMS284756. Int J Antimicrob Agents 2002;19:125–132.
  10. Stewart T, Jolt R: Evolution of natural resistance to newer penicillin. BMJ 1963;i:1309–1311.
  11. Centers for Disease Control: Guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. Morb Mortal Wkly Rep 1997;46:624–628.
  12. Hashimoto H, Inoue M, Hayashi I: A survey of Staphylococcus aureus for typing and drug resistance in various areas of Japan during 1992 and 1993. Jpn J Antibiot 1994;47:618–626.
  13. Communicable Disease Report: Epidemic methicillin-resistant Staphylococcus aureus. CDR Wkly 1996;6:197–201.
  14. Brumfitt W, Hamilton-Miller J: Methicillin-resistant Staphylococcus aureus. N Engl J Med 1989;320:1188–1196.
  15. Stefani S, Varaldo P: Epidemiology of methicillin-resistant staphylococci in Europe. Clin Microbiol Infect 2003;9:1179–1186.
  16. Bilal N, Gedebou M: Staphylococcus aureus as a paradigm of a persistent problem of bacterial multiple antibiotic resistance in Abha, Saudi Arabia. East Mediterr Health J 2000;6:948–954.
  17. Bukharie H, Abdelhadi M: The epidemiology of methicillin-resistant Staphylococcus aureus at a Saudi university hospital. Microb Drug Resist 2001;7:413–416.
  18. Bukharie HA, Abdelhadi MS, Saeed IA, Rubaish AM, Larbi EB: Emergence of methicillin-resistant Staphylococcusaureus as a community pathogen. Diagn Microbiol Infect Dis 2001;40:1–4.
  19. Navascues A, Garcia Irure J, Guillen F: State of methicillin resistant Staphylococcus aureus in the hospital of Navarre (2000–2001). An Sist Sanit Navar 2004;27:21–25.
  20. Hanumanthappa AR, Chandrappa NR, Rajasekharappa MG: Prevalence of methicillin resistant Staphylococcus aureus in Karanataka. Indian J Pathol Microbiol 2003;46:129–132.
  21. Kaszanyitzky EJ, Janosi S, Egyed Z, Agost G, Semjen G: Antibiotic resistance of Staphylococcus from human food, and different animal species according to data of the Hungarian resistance monitoring system in 2001. Acta Vet Hung 2003;51:451–464.
  22. Zaman R, Dibb W: Methicillin resistant Staphylococcus aureus (MRSA) isolated in Saudi Arabia: epidemiology and antimicrobial resistance patterns. J Hosp Infect 1994;26:297–300.
  23. Herold B, Immergluck L, Maranan M: Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.
  24. Maguire GP, Arthur AD, Boustead PJ, Dwyer B, Currie BJ: Clinical experience and outcomes of community-acquired and nosocomial methicillin-resistant Staphylococcus aureus in a northern Australian hospital. J Hosp Infect 1998;38:273–281.
  25. Lindenmayer JM, Schoenfeld S, O’Grady RO, Carney JK: Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998;158:895–899.