Prevalence of methicillin resistant Staphylococcus aureus amongst the student

community of Michael Okpara University of Agriculture, Umudike, Nigeria

Keywords:
Staphylococcus aureus, methicillin, resistant, prevalence.
ABSTRACT:

Methicillin (oxacillin) resistant Staphylococcus aureus (MRSA) is a feared
strain of Staphylococcus aureus responsible for several difficult to treat infections in
humans. The prevalence of this organism was studied amongst the student
community of Michael Okpara University of Agriculture, Umudike. Of the 150 nasal
swab specimens (102 males and 48 females) investigated, all of which yielded positive
S. aureus colonies, 89(59.3%) were resistant, 47(31.3%) were susceptible and
14(9.3%) were intermediately sensitive to oxacillin. This result showed high
prevalence of MRSA among the population studied and requires urgent attention to
be given for the problem of hygiene, antibiotic abuse and under-dosage especially
among the youth.
014-019 | JRPH | 2012 | Vol 1 | No 1
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www.jhealth.info
Journal of Research in
Public Health
An International
Scientific Research Journal
Authors:
Edward KC, Chikezie FO,
Eze VC.


Institution:
Department of
Microbiology,
Michael Okpara University
of Agriculture, Umudike,
Nigeria.





Corresponding author:
Edward KC.















Email:
kechika@gmail.com.


Phone No:
+234-703 3420 330.


Web Address:
http://www.jhealth.info
documents/PH0008.pdf.


Dates:
Received: 17 May 2012 Accepted: 26 May 2012 Published: 14 Jun 2012
Article Citation:
Edward KC, Chikezie FO, Eze VC.
Prevalence of methicillin resistant Staphylococcus aureus amongst the student
community of Michael Okpara University of Agriculture, Umudike, Nigeria.
Journal of Research in Public Health (2012) 1: 014-019
Original Research
Journal of Research in Public Health
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An International Scientific Research Journal


INTRODUCTION
Staphylococcus aureus has been recognized as an
epidermiologically important pathogen. Its pathogenic
effect is characterized by its ability to haemolyze blood,
coagulate plasma and produce a variety of extracellular
enzymes and toxins. S. aureus is present in the nasal
passage, throat, hair and skin of healthy individuals
(Makoni, 2002).
Despite antibiotic therapy, Staphylococcus
infections occur and have severe consequences.
Methicillin was introduced in 1959 to treat infections but
in 1961, shortly after the introduction of methicillin,
Staphylococcus aureus isolates which had acquired
resistance to methicillin was reported. Methicillin
resistant Staphylococcus aureus (MRSA) is one of the
greatly feared strains of S. aureus. Its resistance to most
antibiotics makes its treatment to last longer and may
include second- and third-tier drugs that are generally
more expensive and have greater side effects. MRSA is
also known to be relatively quick to mutate. According
to Neihart et al., (1988), S. aureus strains carry a wide
variety of multidrug resistant genes on plasmid which
can be exchanged and spread among different species of
Staphylococci.
MRSA is a major cause of hospital acquired
infection causing several morbidity and mortality
worldwide (Grundman et al., 2006; Vindel et al., 2009).
Recently there has been a shift from it being a
nosocomial pathogen as it is now increasingly recovered
from nursing homes, prisons, school environments and
communities. This shift might be associated with its
mode of transmission which is primarily by direct/
indirect person to person contact and also by person to
surface contact (Fogg, 2002; Evans and Richard, 2009).
Outbreaks of community-associated (CA)MRSA
infections have been reported in correctional facilities,
among athletic teams, among military recruits, in
newborn nurseries, and among men who have sex with
men (Chambers, 2001, Ellis et al., 2004).
CA-MRSA infections now appear to be endemic
in many urban regions and cause most CAS. aureus
infections (Eady and Cove, 2003; Moran et al., 2005).
Denis et al., (2004) reported that since 1995, MRSA
isolates in Belgian hospitals were losing resistance to
older antimicrobial drugs such as gentamicin and
clindamycin. Some MRSA strains associated with CA
infection have been noted to cause Hospital Acquired
(HA) infections (Saiman et al., 2003). Another recent
report demonstrated that CA strains had emerged as a
substantial cause of HA bloodstream infections
(Seybold et al., 2006). The emergence of CA-MRSA is
of great concern to health officials but of greater concern
is the fact that strains frequently associated with
community outbreaks are now reported to be causing
Hospital acquired infections. (Denis et al., 2004). This in
turn renders treatment of Staphylococcal infections more
challenging, considering the fact that MRSA are
multidrug resistant.
The need to follow the trend of this infection in
my own community necessitated this work which is
aimed at determining the prevalence of MRSA amongst
the student community of Michael Okpara University of
Agriculture, Umudike, Nigeria.

MATERIALS AND METHODS
Sample collection
A total of 150 nasal swabs were aseptically
collected from students (102 males and 48 females) of
Michael Okpara University of Agriculture, Umudike
using sterile swab sticks (Everpon).
Isolation and Identification
The nasal swabs were aseptically inoculated into
Mannitol salt agar (MSA) using the streak method and
incubated aerobically at 37C for 18-24h. S. aureus was
identified using its colonial and morphological
characteristics, Gram reaction and biochemical tests
(catalase, coagulase) as described by Chigbu and
Ezeronye, 2003 ; Uaboi-Egbenni, 2003.
Edward et al., 2012
015 Journal of Research in Public Health (2012) 1: 014-019
Presumptive identification
Colonies that were Gram positive cocci in
clusters, catalase positive and coagulase positive were
identified as S. aureus.
Antimicrobial susceptibility testing
The Kirby-Bauer disc diffusion method as
described by Bauer et al., (1966) and modified by the
National Committee for Clinical Laboratory Standards
(NCCLS) were used. Oxacillin disc (Oxoid) was placed
on the surface of Mueller-Hinton agar that had been
streaked uniformly with a pure bacterial suspension.
After incubation for 18-24h, inhibition of growth was
seen as clear zones around the discs and depending on
the width of the zone in relation to the antibiotic was
interpreted as intermediate or sensitive. No inhibition of
growth was recorded as resistant.

RESULTS AND DISCUSSION
Staphylococcus aureus was isolated in all the 150
samples analyzed. (Tables 1 and 2) This is not surprising
as S. aureus is a normal flora of humans (Makoni, 2002)
inhabiting the skin, nasal passages and soft tissues
(Kaplan et al., 2005; Choi et al., 2006).
Of the 150 samples, 103(68.7%) i.e. (59.4%
resistant + 9.3% intermediate) were resistant to oxacillin
while 47(31.3%) were susceptible (Table 2). This is in
agreement with the works of Moran et al., (2006) who
isolated MRSA from 59% of patients in emergency
departments in USA although this disagrees with the
report of Ugbogu et al., (2010) who isolated MRSA from
83.5% of students of Abia State University, Uturu,
although the sample size might have affected the result
(less than 50). The fourteen isolates (9.3%) which were
intermediately sensitive to oxacillin might be in
intermediate phase of becoming resistant.
The high prevalence of oxacillin resistant
S. aureus might be due to the opportunistic nature
of S. aureus and the abuse of antibiotics. Also the
environment might present a unique risk of spreading
and contacting the disease. This is because many contact
the infection through contact with colonized or infected
patients, colonized or infected body sites of the personnel
themselves, or devices, items, or environmental surfaces
contaminated with body fluids containing MRSA.
Hence, the sample group being made up of students, the
overcrowded nature of their hostels increases their
chances of spreading the organism. Community acquired
MRSA (CA-MRSA) has been recorded to have occurred
in healthy individuals who come in contact with people
unaware that they may have the infection, According to
Evans and Richard, (2009) the chances of acquiring the
infection is higher when five or more carriers are put
together.
Of the 102 nasal swabs collected from male
students, 60(58.8%) of the male population showed
resistance to oxacillin, 31(30.4%) sensitivity, while
11(10.8%) gave intermediate sensitivity. The female
students samples gave 29(60.4%) resistance and
16(33.3%) sensitivity and 3(6.3%) intermediate
sensitivity to oxacillin. This result showed that higher
number of the isolates from male students is in the
intermediate stage as compared with the isolates from the
female students. The high resistance value obtained from
the female students might be attributed more to antibiotic
abuse and/ or misuse than contact problem.
Studies have shown that prevention is the most
effective solution in dealing with the MRSA infection.
Therefore, according to Evans and Richard (2009), one
of the simplest and easiest ways to curb patients from
contracting MRSA is to take steps to reduce the rate of
contact with the bacterium. By avoiding the five Cs
(Crowding, Frequent skin-to-skin Contact, Compromised
skin (cuts or abrasions), Contaminated items and
surfaces, Lack of Cleanliness), a guideline of American
Association of Orthopedic Surgeons (AAOS), MRSA
and other opportunistic infections can be prevented.


Edward et al., 2012
Journal of Research in Public Health (2012) 1: 014-019 016



Edward et al., 2012
017 Journal of Research in Public Health (2012) 1: 014-019
S/N SEX
Zone of
inhibition
S/N SEX
Zone of
inhibition
S/N SEX
Zone of
inhibition
1 F 17.5
S
26 M 7
R
51 F 10
R

2 M NIL
R
27 M NIL
R
52 F 10
R

3 F 7.5
R
28 M 10.5
I
53 F 12
I

4 F 17.5
S
29 M NIL
R
54 M NIL
R

5 M 14.5
S
30 M NIL
R
55 M NIL
R

6 M 10.5
I
31 F NIL
R
56 M 10
R

7 F 10
R
32 F 9
R
57 M NIL
R

8 F 10
R
33 M 14.5
S
58 M NIL
R

9 M 9
R
34 M 15.5
S
59 M NIL
R

10 M NIL
R
35 M 20
S
60 M NIL
R

11 M 14.5
S
36 F 11
I
61 M NIL
R

12 M 16.5
S
37 F 8.5
R
62 M NIL
R

13 M 15.5
S
38 M NIL
R
63 M 9
R

14 M 8
R
39 F 6
R
64 M 7.5
R

15 M 10
R
40 M NIL
R
65 M 14.5
S

16 M NIL
R
41 M NIL
R
66 M 14
S

17 M 9
R
42 M NIL
R
67 M 14
S

18 M 8.5
R
43 F 7
R
68 M 15
S

19 M 10
R
44 F 8
R
69 M 10.5
I

20 M NIL
R
45 M NIL
R
70 M 15.5
S

21 M 12.5
I
46 F 15.5
S
71 M 15
S

22 M 15
S
47 F 10
R
72 M NIL
R

23 M 15
S
48 F 11.5
I
73 F NIL
R

24 M 10.5
I
49 F 15
S
74 M NIL
R

25 M 9
R
50 F 10.5
I
75 F NIL
R

26 M 10.5
I
101 M 11
I
126 M NIL
R

27 M 9
R
102 M 11.5
I
127 M NIL
R

28 M 8.5
R
103 M NIL
R
128 F 15.5
S

29 M 15.5
S
104 M NIL
R
129 F 14.5
S

30 M 15.5
S
105 M 12
I
130 F NIL
R

31 M 14.5
S
106 M 17.5
S
131 F 14
S

32 F NIL
R
107 M 8
R
132 M 14.5
S

33 M NIL
R
108 M 10.5
I
133 M 15.5
S

34 F NIL
R
109 F 14
S
134 M NIL
R

35 M 7
R
110 M 14.5
S
135 M 15.5
S

36 M 9
R
111 F 15
S
136 F NIL
R

37 F NIL
R
112 M 15
S
137 M NIL
R

38 M NIL
R
113 F 15.5
S
138 F 15.5
S

39 M 15.5
S
114 M 11
I
139 M 15.5
S

40 M 15.5
S
115 F 14
S
140 F NIL
R

41 F NIL
R
116 F 13
S
141 F 14
S

42 M NIL
R
117 M NIL
R
142 M NIL
R

43 M 9
R
118 M NIL
R
143 F NIL
R

44 F NIL
R
119 M NIL
R
144 F NIL
R

45 M 14
S
120 F NIL
R
145 M NIL
R

46 M NIL
R
121 F 14.5
S
146 M NIL
R

47 F NIL
R
122 F 14
S
147 M NIL
R

48 M 14.5
S
123 F NIL
R
148 M NIL
R

49 M NIL
R
124 M 15
S
149 M NIL
R

50 F NIL
R
125 M 15
S
150 M NIL
R

KEY: M = MALE F = FEMALE R = RESISTANCE S = SENSITIVE
Table 1: Sex distribution, diameter zone of inhibition and antibiotic sensitivity/resistance pattern of oxacillin
CONCLUSION
The increase in prevalence of MRSA amongst
the youth should be of utmost concern to health
authorities. Overcrowding, body or surface contact,
sharing of private personal belongings like towel, cloths
etc. should be avoided while maintaining a good
hygiene. The rate at which unprescribed and incomplete
dosage of antibiotics are taken should also be reduced to
prevent the microorganisms becoming resistant to them.

REFERENCES
Bauer AW, Kirby WM, Sheris JC, Truck, M. 1966.
Antibiotic susceptibility testing by a standardized single
disc method. Am J Clin Pathol., 45(4)493-496.

Chambers HF. 2001. The changing epidemiology of
Staphylococcus aureus?Emerg Infect Dis. 7:178-82

Chigbu CO, Ezeronye OU. 2003. Antibiotic resistant
Staphylococcus aureus in Abia State of Nigeria. African
J Biotechnol., 2:374-37.

Choi CS, Yin C, Bakar AA, Sakewi Z, Naing NN,
Jamel F. 2006. Nasal carriage of Staphylococcus among
healthy adults. J Microbiol Immunol infect. 39:458-464.

Denis O, Deplano A, Nonhoff C, De Ryck R, De
Mendonca R, Roltiers S. 2004. National surveillance of
methicillin-resistant Staphylococcus aureus in Belgian
hospitals indicates rapid diversification of epidemic
clones. Antimicrob Agents Chemother. 48:3625-3629.

Eady EA, Cove JH. 2003. Staphylococcal resistance
revisited: community-acquired methicillin-resistant
Staphylococcus aureusan emerging problem for the
management of skin and soft tissue Curr Opin Infect Dis.
16:103-24.
Ellis MW, Hospenthal DR, Dooley DP, Gray PJ,
Murray CK. 2004. Nat ural hist ory of
c o mmu ni t y- a c qu i r e d me t hi c i l l i n- r e s i s t a nt
Staphylococcus aureus colonization and infection in
soldiers .Clin Inf Dis. 39:971-979.

Evans MD, Richard P. 2009. "The silent epidemic:
CA-MRSA and HA-MRSA. American Association of
Orthopedic Surgeons. Dec.

Fogg D. 2002. Clinical issues. Association of
perioperative registered nurses. 76(1):175-177.

Grundman H, Aires-de souza M, Tiemersma E. 2006.
Emergence and resurgence of methicillin resistant
Staphylococcus aureus as a public health threat. Lancet.
378:874-885.

Kaplan SL, Hulten KG, Gonzalez BE, Hammerman
WA, Lamberth L, Versalovic J, Mason Jr. EO. 2005.
Three-year surveillance of community-acquired
Staphylococcus aureus infections in children. Clin Infect
Dis. 40:1785-91.

Makoni T. 2002. MRSA: Risk assessment and
flexibility management. Nursing standard. 16(28):39-41.

Moran GJ, Krishnadasan A, Gornite R. J, Forshein
G.E, McDonald LK, Garrey RB, Talan DA. 2006.
MRSA infection among patients in the emergency. N
Engl J Med., 365:666-674.

Moran GJ, Amii RN, Abrahamian FM, Talan DA.
2005. Methicillin-resistant Staphylococcus aureus in
community-acquired skin infections .Emerg Infect Dis.
11:928-30.

Neihart RE, Freid, JS, Hodger GR. 1988. Coagulase
positive Staphylococcus. South Med J., 89:491-500.
Edward et al., 2012
Journal of Research in Public Health (2012) 1: 014-019 018
Table 2: The percentage oxacillin sensitivity/resistance pattern of the S. aureus isolates.
Sex Sensitive Resistant Intermediate Total
Male 31(20.7%, 30.4%) 60(40%, 58.8%,) 11(7.3%, 10.8%) 102(68%, 100%)
Female 16(10.7%, 33.3%) 29(19.3%, 60.4%) 3(2%, 6.3%) 48(28.7%, 100%)
Total 47(31.3%) 89(59.4%) 14(9.3%) 150(100%)


Saiman L, OKeefe M, Graham PLIII, Wu F,
Said-Salim B, Kreiswirth B, Schlievert PM,
Della-Latta P. 2003. Hospital transmission of
c o mmu ni t y- a c qu i r e d me t hi c i l l i n- r e s i s t a nt
Staphylococcus aureus among postpartum women. Clin
Infect Dis. 37:1313-1319.

Seybold U, Kourbatova EV, Johnson JG, Halvosa SJ,
Wang YF, King MD, Ray SM, Blumberg H. 2006.
E me r g e n c e o f c o mmu n i t y- a s s o c i a t e d
methicillin-resistant Staphylococcus aureus USA300
genotype as a major cause of health care-associated
blood stream infections. Clin Infect Dis. 42:647-656.

Uaboi- Egbenni PO. 2003. Incidence of
Staphylococcus aureus among healthy humans in Lagos
and its Environs. Nig J Microbiol., 17:162-172.

Ugbogu OC, Ahuama OC, Atusiaba S, Okorie JE.
2010. Methicillin-resistant Staphylococcus aureus
(MRSA) among students and susceptibility of MRSA to
Garcinia kola extracts. Nig J of Microbiol.,
24(1):2043-2047.

Vindel A, Cuevas O, Cernado E, Marcos C, Bautista
V, Castellares C, Princado P, Boquete T,
Perez-Vazquez M, Marin M, Bouza E. 2009. And the
Spanish group for the study of Staphylococcus.
Methicillin-resistant Staphylococcus aureus in Spain.
Molecular epidemiology and utility of different typing
methods. J Clin Microbiol., 47(16):1620-1627.
Edward et al., 2012
019 Journal of Research in Public Health (2012) 1: 014-019
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