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Objective: To provide an inclusive blend of extant meta-analyses on the burden of Staphylococcus (S.) aureus and its resistant strains across diverse study populations, settings, and temporal contexts. Methods: The study has adopted PRISMA 2020-based guides and registered its protocol on Open Science Framework with an extensive literature search. Study quality was assessed by QUOROM and AMSTAR techniques. Data analysis included parsing of study-level statistical power, assessment of primary study overlap, pooling of meta-analysis results, subgroup and temporal analysis. Results: Totally 41 studies (64 meta-analyses) were selected by the inclusion criteria. The summary meta-analysis revealed global prevalence rates for S. aureus [24.8%, 95%C1 0.248(0.204-0.293), I2 = 93%], methicillin resistant S. aureus (MRSA) [5.8%, 95%CI 0.058(0.044-0.073), I2 = 92%], vancomycin intermediate S. aureus [1.7%, 95%C1 0.017(0.013–0.021), I2 = 36.4%], heterogeneous vancomycin intermediate S. aureus [5.2%, 95%CI 0.052(0.038–0.056), I2 = 36.4%], community-associated methicillin-resistant S. aureus [19.9%, 95%C1 0.199(-0.170–0.568), I2 = 96.67%), livestock-associated-MRSA [13.6%, 95%CI 0.136(-0.028–0.243), I2 = 97.7%], and mupirocin resistant S. aureus [7.6%, 95%CI 0.076(0.062–0.090), 12 = 0%]. Temporal analysis revealed that the burden community-associated methicillin-resistant S. aureus notably increased from 1.3% in 2003 to 39.0% in 2014. Coagulase-negative staphylococci rose from 23.2% in 2021 to 29.8% in 2022. Vancomycin resistant S. aureus peaked at 9.0% in 2018, declining to 2.6% in 2020. Livestock-associated-MRSA significantly increased to 19.0% in 2020. MRSA fluctuated, peaking at 52.7% in 2012 and 31.0% in 2022. Conclusions: The study reveals a considerable global prevalence of S. aureus at 24.8%. Regional differences were apparent, with Africa facing a high burden of MRSA at 40.8% of S. aureus and temporal trends exposed a dynamic state.

Background: Today, Methicillin-Resistant Staphylococcus Aureus (MRSA) has become one of the public health concerns due to its resistance to antimicrobial drugs, and this problem makes treating patients with infections caused by this bacterium difficult. Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) strains are pervasive in both community and hospital settings, primarily attributable to Staphylococcus aureus' capacity to colonize areas like the nose or skin. In this study, with the aim of comparing phenotypic (disc diffusion method) and genotypic (PCR) methods, to detect methicillin-resistant Staphylococcus aureus isolated from patients of hospitals under supervision of Tehran university of medical sciences, and also detection of nor A, that is the one of the most important genes in efflux pump cluster genes. Methods: The present research was a cross- sectional study that was conducted from February 2022 to September 2023. In this research, 43 isolated strains of Staphylococcus aureus from wound discharge and blood samples, were collected from different departments of Tehran hospitals and had submitted to the research laboratory of the school of allied medical sciences in Tehran university of medical sciences. After identifying the strains, the resistance of the isolates to 14 types of antibiotics was checked by disk diffusion method. Results: Staphylococcus aureus diagnostic tests including gram staining on colonies, catalase, coagulase, DNase tests were performed and it was found that all strains were Staphylococcus aureus. In the next step, all samples were resistant to Cloxacillin by disc diffusion method, and the presence of mec A gene in them was confirmed by PCR method, thus the presence of MRSA strains was confirmed from the genotypic point of view. Of the 43 Staphylococcus aureus strains, 26 samples were identified as having the nor A gene by PCR and electrophoresis. Conclusion: The results of the present research have shown that the prevalence of Staphylococcus aureus bacteria in hospital samples is significant and resistance to methicillin and ciprofloxacin has increased in the strains of this bacteria.

Background: Most nosocomial infections are caused by bacteria that proliferate within quorum sensing mediated biofilms. The disruption of quorum sensing signals in biofilm-forming bacteria is the potential substitution strategy. Purpose: The current study focuses on the evaluation of isolated juglone derivatives from Reynoutria japonica as anti-biofilm agents and enzyme inhibitors against Methicillin Resistant Staphylococcus aureus (MRSA). Methods: The antibacterial and anti-biofilm activity of the juglone derivatives were investigated against laboratory strains MRSA using well and disc diffusion method. In addition, we evaluated the anti-biofilm inhibition potential of the juglone derivatives using a crystal violet-based assay in 96-well micro-titer plate. The suppression of S. aureus β-hemolytic, coagulase and proteolytic activity was evaluated using standard assay protocols. High Performance Liquid Chromatography (HPLC) was performed to analyze the acyl homoserine lactones (AHLs) signals degradation by juglone derivatives. Furthermore, all three ligand molecules were docked into the binding site of the S. aureus coagulase protein. Results: All the three juglone derivatives showed potent antimicrobial activity against clinical strains of MRSA. Among these compounds, 2-ethoxy-6-acetyl-7-methyljuglone displayed potent inhibitory activity with zones of inhibition of 15 ± 0.03 and 17 ± 0.03 against MRSA respectively. In the spectrophotometric assay, we confirmed that juglone derivatives inhibit biofilm formation. All the compounds markedly inhibited the coagulase, β-hemolytic and proteolytic activity of MRSA. The application of compounds as a treatment resulted in a notable decrease in biofilm density and thickness, as demonstrated by HPLC. The untreated MRSA exhibited quorum sensing signals of N-Butanoyl-l-homoserine lactone (C4-HSL) with retention time 3.6 min and of N-hexanoyl-l-Homoserine lactone (C6-HSL) at 5.8 minutes’ vs the treated with MRSA where no peaks were observed. The docking studies and Molecular dynamics (MD) simulation results revealed that all molecules are actively binding in the target site that correlates well with the in-vitro inhibitory properties of compounds against S. aureus. Conclusion: our results demonstrated the potential of juglone derivatives from R. japonica as a promising anti-biofilm agent and as quorum quencher for future therapy to combat multi-drug resistant infections in particular MRSA.

Aims: Methicillin-Resistant Staphylococcus aureus cause many nosocomial, and community-acquired infections, burdening healthcare systems globally. The aim of the current study was to identify the potent inhibitors of MRSA strains as first step towards drug discovery against MRSA related infections. Methods and Results: Clioquinol derivatives 1–10 were evaluated against MRSA strains, using microplate alamar blue assay (MABA). Among them compounds 1–3, and 6–8 were found to be active with MIC values within the range of 61.08–213.58 µM. Compounds 1, and 7 were found highly potent with MIC values of 64.04 and 61.08 µM, respectively. Both these compounds also showed non-covalent interactions with active site key residues of topoisomerase IV enzyme in molecular docking studies. Mechanisms of action of the most active compounds 1, and 7 were further studied through AFM, and fluorescence microscopy. It was observed that compounds 1, and 7 caused a massive destruction in shape, and greatly reduced the size and number of viable cells. Flow cytometry analysis showed a significant rise in DiBAC4(3) fluorescence, and a non-significant rise in PI fluorescence indicating increased bacterial membrane depolarization of treated cells. Most importantly the clioquinol derivatives 1, and 7 did not cause any hemolytic effect. Moreover, all the compounds were found to be non-cytotoxic to BJ (Human fibroblast) normal cell line. Conclusion: Our findings suggest that clioquinol derivatives 1, and 7 possess highly potent antibacterial activity against three MDR, and one sensitive strains of S. aureus. Significance and impact of the study: Clioquinol derivatives 1, and 7 could be further studied as potential antibacterial agents.

Background: Staphylococcus aureus is one of the most common causes of nosocomial and community-acquired infections in all parts of the world. Prevalence of methicillin resistance in staphylococci has increased and become a serious concern worldwide. Clindamycin resistance is on the rise among clinically important staphylococcal isolates. Objectives: Identification and antimicrobial susceptibility testing of Staphylococcus aureus isolates from different clinical samples by using Standard Microbiological procedures as per CLSI guidelines. Detection of Methicillin resistant Staphylococcus aureus was carried out by using Cefoxitin screening test. Inducible clindamycin resistance among clinical isolates of Staphylococcus aureus was tested by using D-test and Vitek -2 compact automated system. Methods: Total 107 Staphylococcus aureus isolates from different clinical specimens were processed in the microbiology department at B.K.L. Walawalkar rural medical college. All samples were tested for Cefoxitin screening test and detection of Inducible clindamycin resistance was carried out by using D test and Vitek 2 panel automated system. Results: Out of 107 samples of Staphylococcus aureus isolates, cefoxitin screening test result showed 19(17.75%) positive result (MRSA). Percentages of inducible clindamycin resistance were higher amongst MRSA as compared to MSSA. The study revealed 32 (29.90 %) isolates are inducible clindamycin resistance detection result were positive (are Macrolides/ Lincosamides/ Streptogramins MLSB phenotype inducible) by Vitek 2 automated system. Conclusion: Detection of inducible clindamycin resistance should be included in the routine antimicrobial susceptibility testing, as it will help in guiding the empirical therapy.

To better understand host–phage interactions and the genetic bases of phage resistance in a model system relevant to potential phage therapy, we isolated several spontaneous mutants of the USA300 S. aureus clinical isolate NRS384 that were resistant to phage K. Six of these had a single missense mutation in the host rpoC gene, which encodes the RNA polymerase β’ subunit. To examine the hypothesis that mutations in the host RNA polymerase affect the transcription of phage genes, we performed RNA-seq analysis on total RNA samples collected from NRS384 wild-type (WT) and rpoCG17D mutant cultures infected with phage K, at different timepoints after infection. Infection of the WT host led to a steady increase of phage transcription relative to the host. Our analysis allowed us to define 53 transcriptional units and to categorize genes based on their temporal expression patterns. Predicted promoter sequences defined by conserved −35, −10, and, in some cases, extended −10 elements, were found upstream of early and middle genes. However, in many cases, sequences upstream of late genes did not contain clear, complete, canonical promoter sequences, suggesting that factors in addition to host RNA polymerase are required for their expression. Infection of the rpoCG17D mutant host led to a transcriptional pattern that was similar to that of the WT at early timepoints. However, beginning at 20 min after infection, transcription of late genes (such as phage structural genes and host lysis genes) was severely reduced. Our data indicate that the rpoCG17D mutation prevents the expression of phage late genes, resulting in a failed infection cycle for phage K. In addition to illuminating the global transcriptional landscape of phage K throughout the infection cycle, this study will inform our investigations into the basis of phage K’s control of its transcriptional program as well as mechanisms of phage resistance.

Background and Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial and community acquired infections. Nanoparticles are considered as proper tools to overcome the therapeutic problem of antimicrobial-resistant infections because of the drug concentration increment at the desired location and protection from enzymatic degradation. The goal of this study was to evaluate the effect of the antibacterial and antibiofilm activities of zingerone and niosome containing zingerone against pre-formed biofilm of MRSA isolates. Materials and Methods: 62 MRSA isolates cultured from patients with diabetic ulcers were investigated. Niosomes were synthesized and characterized by X- ray diffraction, zeta potential and scanning electron microscopy (SEM). The size of niosomal particles measured by SEM and zetasizer. Results: The surface charge of prepared niosomes was about -37 mV. The effect of the zingerone and noisome containing zingerone was evaluated against biofilms of MRSA isolates. Also, the antibiofilm activity of prepared niosomes on gene expression of MRSA biofilms was evaluated using Real Time PCR. Our results demonstrated that the niosome containing zingerone had a diameter of 196.1 nm and a -37.3-mV zeta potential. Zingerone removed one and three-day old biofilms of MRSA at the concentration of 1000 µg/ml, while the zingerone-laoded niosomes removed 1, 3- and 5-days old biofilms at the concentration of 250 µg/ml, 250 µg/ml, and 500 µg/ml. Conclusion: The results indicated that niosome containing zingerone eliminated MRSA and its biofilms faster compared with free zingerone and it suggested that zingerone-encapsulated niosomes could be considered as a promising treatment against MRSA and its biofilms.

Background & Aims: Staphylococcus aureus is a common bug responsible for infections ranging from minor skin infections to fatal sepsis. Common colonizing sites include anterior nares, hand surfaces. Inadequate use of antibiotics has led to development of resistance giving rise to bugs like MRSA. Nursing staff particularly has a greater duration of patient contact and is thus more likely to become MRSA carrier- hence chosen as study population. This study aimed to study the prevalence and antimicrobial sensitivity profile of MRSA isolated from nasal carriers among nursing staff. Material & Methods: A short-term cross-sectional study done in which nursing staff members were screened for nasal carriage of MRSA by collecting swabs from anterior nares. S.aureus isolates were screened for Methicillin susceptibility using cefoxitin disc. MRSA thus obtained were studied for antibiotic sensitivity profile by using Vitek-2 compact. Results: Study showed the nasal carriage of MRSA as 13.3%. Maximum carriage was in staff members with >5 years of work experience in hospital. All isolates showed 100% resistance to Ampicillin, Erythromycin, Amoxiclav. Sensitivity reported was 12.5% to Ciprofloxacin; 37.5% to Clindamycin and Amikacin; 87.5% to Cotrimoxazole. All isolates were 100% sensitive to Linezolid, Vancomycin, Teicoplanin and Rifampin. Conclusion: This study showed a significant carriage of MRSA in the nursing staff. Considering that nurses are more involved in-patient care activity, regular screening should be done. Also, the importance of handwashing should be emphasized. Strict implementation of hospital infection control norms is necessary.

With the overuse and misuse of antibiotics, multi-drug resistant organisms have become a prominent issue in healthcare, increasing morbidity and mortality in affected patients. One such organism of concern is methicillin-resistant Staphylococcus aureus (MRSA) which is a leading cause of a variety of clinical infections. Therefore, in the interest of finding alternate substances to antibiotics, there has been increased interest in the antibacterial properties of lavender essential oil (LEO). This systematic review aims to collate information regarding the antibacterial properties of LEO against S. aureus and MRSA. A systematic search was conducted across four databases between the years 2002 and 2022, and through this, 23 studies were included in this paper. These studies used a variety of methods to ascertain the antibacterial effectiveness of LEO alone or in combination with other substances. Overall, there were mixed results regarding the antibacterial effectiveness of LEO against S. aureus and MRSA, with some studies reporting significant effectiveness, while other studies reporting a minimal to negligible effect. However, findings suggest that LEO works synergistically with other antibacterial substances, and it would be beneficial for additional research to be conducted in this area.

IntroductionMethicillin resistant Staphylococcus aureus (MRSA) is a major contributor to the global burden of antimicrobial resistance (AMR). As MRSA continues to evolve, the need for continued surveillance to evaluate trends remains crucial. This study was carried out to assess MRSA trends in the United Arab Emirates (UAE) based on analysis of data from the national AMR surveillance program.MethodsWe carried out a 12-year (2010–2021) retrospective analysis of MRSA demographic and microbiological data collected as part of the UAE national AMR surveillance program. Participating centers from across the country routinely submit AMR surveillance data collected by trained personnel to the National AMR Surveillance Committee, where data is analyzed using a unified WHONET platform. Data on non-duplicate isolates associated with clinical infections were obtained and included in the analysis.ResultsA total of 29,414 non-duplicate MRSA isolates associated with clinical infections were reported between 2010 and 2021 (2010: n = 259; 2021: n = 4,996). MRSA represented 26.4% of all S. aureus (n = 111,623) isolates identified during the study period. In 2010, among the S. aureus isolates with reported oxacillin testing, 21.9% (n/N = 259/1,181) were identified as MRSA and this showed an increase to 33.5% (n/N = 4,996/14,925) in 2021. Although there was variation in the distribution of MRSA across the seven emirates of the country, most had an upward trend. Patient demographics reflected a male preponderance, with most being adults and from the outpatient setting. Isolates were mostly from skin and soft tissue infection specimens (72.5%; n/N = 21,335/29,414). Among the inpatients (N = 8,282), a total of 3,313 MRSA isolates were from specimens obtained ≤ 48 h after admission indicative of community acquired infection. Increasing resistance trends were observed for most antibiotics including ciprofloxacin, levofloxacin, moxifloxacin, erythromycin, gentamicin, trimethoprim-sulfamethoxazole, and quinupristin/dalfopristin. Low levels of resistance (0.0–0.8%) were sustained for linezolid except for 2015, 2016, and 2017 with 2.5, 2.6, and 2.9%, respectively. No confirmed vancomycin resistance was reported.ConclusionThe increasing trend of MRSA isolates associated with clinical infections in the hospital and community settings is a concern. Continued monitoring including incorporation of genomic surveillance and infection control measures are recommended to stem the dissemination.

Background & Aims: Chronic Suppurative Otitis Media (CSOM) is defined as chronic inflammation of middle ear and mastoid cavity that may present with recurrent ear discharges. Its importance lies in its refractoriness to treatment and chronicity, leading to complications. CSOM is almost always associated with mixed bacterial flora. Knowledge of the local microbial flora as well as continuous, periodic evaluation of microbiological pattern, and antibiogram of isolates are necessary to decrease the potential risk of complications by early institutions of appropriate treatment. Materials & Methods: In this prospective cross-sectional study, a total of 134 consecutive swab samples of the patients diagnosed with CSOM, referred to a tertiary care hospital in Kashmir Valley, India were included. The bacterial colonies were identified in line with standard procedures. Antimicrobial sensitivity testing (AST) was carried out according to the Clinical Laboratory Standards Institute (CLSI) guidelines by modified Kirby-Bauer disc diffusion method on Mueller Hinton agar (MHA) medium. The data was analysed using SPSS version 24 and the prevalence of the organisms was determined and expressed in percentages. Results: Out of total 134 ear swabs processed, microbial growth was seen in 111 (83%). The most common organism isolated was Methicillin Resistant Staphylococcus aureus (MRSA) in 43 (39%) of the patients, followed by Pseudomonas in 37 (27.6%). 9 (8%) of the cases had fungal etiology. Linezolid (LZ) showed 100% sensitivity in Gram-positive Cocci whereas, Tigecycline (TIG) showed 100% sensitivity in Gram-negative Bacilli. All MRSA were 100 % sensitive to tetracycline, linezolid, amikacin. All the isolates of Pseudomonas were 100 % sensitive to Tigecycline, Ofloxacin, Colistin, Imipenem, Aztreonam, Cefepime. Conclusion: Isolation of various aerobic, anaerobic, and fungal isolates shows that different conditions of CSOM could be differentiated on microbiological grounds. Thus, for better management of CSOM, microbial classification of infection as well as drug sensitivity test of organisms recovered are essential for making appropriate decision of antimicrobials that will effectively eradicate the pathogen.

Background:Azadirachta indica has been used against a few disease in traditional medicine and have long history of use, and their use is worldwide in both developing and devolved countries, also have multiple health benefits. This study aimed to evaluate the antibacterial activity of Neem leaves extract against standard bacterial strain and only one drug resistant strain of important human pathogenic bacteria by using in vitro methods. Methods: This study aimed to evaluate the antimicrobial effects of Azadirachta indica (Neem) leaves extracts against selected pathogens. The present study was carried out to screen and evaluate antimicrobial activity of leaves of Azadirhta indica (Neem)methanol and petroleum ether extracts. Azadirchta indica extracts were tested against standard strains of S. aureus ATCC 6538, E. coli ATCC 25922, P. aeroginosa ATCC 9027, K. pneumonia ATCC 700603, and S. typhimurium ATCC 14028. The effeminacy of the extracts was studied and determined by applying different concentration of extracts on the selected bacterial strains and synthetic antimicrobial discs were used as positive control by using disc diffusion method. Results: With the statistical test analysis the comparison done showed that, no significant different between the two extracts used, and Staphylococcus aureus and Methicillin resistant staphylococcus aureus were the only bacteria susceptibly affected by this Neem extracts used. Conclusions: The result obtained indicate the leaves extracts of Neem plant have enormous antimicrobial effect, and may be exploited for the treatment of various infectious diseases

Introduction: Urinary tract infections (UTIs) represent widespread human microbial disorders involving any part of the urinary tract. Urinary tract infections (UTIs) are prevalent all over the world and are known to affect approximately 150 million people each year worldwide. Objectives: The aim of this study was to assess the demographic and bacterial profile of patients presenting with symptoms of urinary tract infections. Methods: A retrospective study on urine bacteriology over a period of one year between June 2021 to July 2022 was done in the Department of Microbiology, University College of Medical sciences and associated GTB Hospital, Delhi. The data collected was analyzed using Statistical Package for Social Sciences (SPSS) software, Chicago,version 20.0. Result: In this study, a total of 21359 samples were received for urine culture and sensitivity testing. 2265 samples were positive with an overall positivity rate of 10.60% with majority of the positive samples from females. The majority of positive samples (1559; 68.83%) were from age group between 21-60 years of age, females again being predominant gender (914; 58.62%). In outpatient department, inpatient department and in ICU services, Gram negative bacilli were the predominant microorganisms isolated. In case of Staphylococcus aureus, majority ,i.e., 66 (61.68%) out of total 107 of isolates were resistant to methicillin. Conclusion: Our findings support the fact that females in the age group 21-60 are more prone to develop UTIs as compared to males. There is a shift in methicillin resistance of Staphyloccus aureus from hospital acquired to community acquired cases.

Faiqa Arshad,1 Sidrah Saleem,1 Romeeza Tahir,2 Shah Jahan,2 Kokab Jabeen,3 Aneela Khawaja,4 Zille Huma,1 Muhammad Roman,1 Faheem Shahzad2 1Department of Microbiology, University of Health Sciences, Lahore, Punjab, Pakistan; 2Department of Immunology, University of Health Sciences, Lahore, Punjab, Pakistan; 3Department of Pathology, Ammer ud Din Medical College, PGMI, Lahore, Punjab, Pakistan; 4Department of Pathology, Rahbar Medical & Dental College, Lahore, Punjab, PakistanCorrespondence: Faiqa Arshad, Department of Microbiology, University of Health Sciences, Khayaban-e-Jamia, Block D Muslim Town, Lahore, Punjab, 54600, Pakistan, Email drfaiqaimran@gmail.comBackground: The association of treatment failure and mortality with vancomycin minimum inhibitory concentration creep (MIC) is a matter of serious concern in patients with severe methicillin resistant Staphylococcus aureus (MRSA) infections. The purpose of the study was to identify and characterize staphylococcal cassette chromosome mec (SCCmec) and clonal types of MRSA strains, exhibiting the vancomycin MIC creep phenomenon.Methods: A total of 3305 S. aureus strains were isolated from various clinical samples of Lahore General Hospital, Lahore, Pakistan. MRSA strains were identified by cefoxitin resistant (≤ 21mm) followed by mecA and mecC gene genotyping. Vancomycin MIC creep was determined by E-test. Isolates having MIC values > 1.5 μg/mL were further subjected for SCCmec typing (I–V and XI) and multiple-locus variable number tandem repeat analysis (MLVA) by amplification of spa, sspA, clfA, clfB, and sdrCDE genes. A dendrogram was created based on the similarity index using bioneumerics software.Results: About 13.3% (440/3305) isolates were MRSA with 99.3% (437/440) and 0.7% (3/440) carried mecA and mecC genes, respectively. In 120 MRSA isolates, the MIC of vancomycin was > 1.5μg/mL. In MRSA isolates with high vancomycin MIC (> 1.5μg/mL), the most common SCCmec type was SCCmec III (38.3%), followed by SCCmec IVa (15.8%), SCCmec IIIa (13.3%,), SCCmec IVc (7.5%), SCCmec IVe (5.8%), SCCmec IVd (5.8%), SCCmec IVb (4.2%), SCCmec II (2.5%), SCCmec V (1.7%), SCCmec I (1.7%) and SCCmec XI (1.7%). MLVA revealed 60 genotypic groups of MRSA isolates having a 92% similarity index.Conclusion: SCCmec III was the most common type in genetically related MRSA isolates showing vancomycin MIC creep. The presence of SCCmec XI may further add burden to infection control measures.Keywords: methicillin resistant Staphylococcus aureus, staphylococcal chromosomal cassette, multilocus variable number tandem repeat analysis

Abstract Staphylococcus aureus is a common mastitis pathogen in dairy cows, and methicillin-resistant S. aureus (MRSA) has been found in dairy farms all over the world. The study carried out on bovines from three governorates in Egypt, with the goal of determining the prevalence of MRSA in positive milk samples of subclinical mastitis, performing an antibiotic susceptibility test against MRSA isolates and determining the risk factors associated with MRSA. A total of 350 quarter milk samples (n = 200 mixed breed cow; n = 150 water buffalo) were collected and examined for subclinical mastitis using the California mastitis test (CMT) before being exposed to standard microbiological procedures for S. aureus isolation. The disc diffusion method was used to phenotypically analyse the positive S. aureus isolates for MRSA, which was verified by a PCR assay targeting the mecA gene. According to the findings of the study, 41.4% (145/350) milk samples were positive based on CMT, while 35.7% (125/350) of positive samples identified as MRSA based on PCR assay. However, the obtained results revealed non-significant disparity between cattle and buffalo and all predicted risk factors were strongly associated with prevalence of subclinical mastitis. The in-vitro antibiotic susceptibility test revealed that cefoxitin was completely resistant, whereas linezolid, ciprofloxacin, and trimethoprim + sulphamethoxazole were sensitive against the MRSA isolates. The relevance of S. aureus to public health, as well as the development of resistance to antibiotics like methicillin, needs ongoing testing of antimicrobial medications against MRSA isolates.

Introduction: The most important pathogen isolated from Skin and Soft Tissue Infections (SSTIs) is a gram positive organism, Staphylococcus aureus (S. aureus). Wide range of emerging Methicillin Resistant Staphylococcus aureus (MRSA) infections is leading to global threat causing Community Acquired-MRSA (CA-MRSA) or Hospital Acquired MRSA (HA-MRSA). Minimum Inhibitory Concentration (MIC) is done to ensure that antibiotics are chosen efficiently in the clinical settings by Vitek 2, Epsilometertest (E-test) and Broth Microdilution (BMD) method. Aim: To determine the clinical spectrum of MRSA and comparison of vancomycin MICs obtained by E-test, Vitek 2C and BMD method. Materials and Methods: This was a cross-sectional study conducted at Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, during the period of November 1st 2019 to December 31st, 2020 from Inpatient Department (IPD) and Outpatient Department (OPD). Among 464 SSTIs, 132 were S. aureus, out of which 38 isolates were MRSA. Identification and sensitivity of the isolates such as pus, wound swabs and tissues were identified through Vitek 2 compact system. Statistical analysis of the demographic and clinical characteristics was represented as frequency and percentages. Results: Among the total 464 SSTIs, S. aureus were 132 of which MRSA were 38 (29%) and Methicillin sensitive Staphylococcus aureus (MSSA) were 94 (71%) with male predominance of 29 (76.3%) with MRSA. Most of the patients were in the age group of 21-30 years (26%). Amongst the total 38 patients analysed, 25 were from IPD and 13 were from OPD. Around 23/38 were wound swabs (60%) 12/38 of pus (31.5%) and 3/38 (8%) were tissues. The predominant risk factor observed was Surgical Site Infections (SSI) in 19 cases (50%) followed by prior antibiotic therapy in 17 (44.7%) cases. The median duration of hospitalisation was 31.5 days. Vancomycin susceptibility by all three methods with an MIC range of 0.5-2 μg/m by all three methods, except for one isolate where the MIC was >32 ug/mL by Vitek 2C and 8 ug/mL by E-test, which was sensitive by BMD with an MIC of 0.25 µg/mL. Conclusion: Implementing infection control practices and controlling the risk factors will help in management of MRSA infections. Drug resistance to glycopeptides can be avoided by regular screening of vancomycin creeps by different susceptibility methods in order to avoid treatment failures.

Latar Belakang: Chlorhexidine gluconate merupakan antiseptik yang sering digunakan untuk mencegah penyebaran infeksi karena luasnya cakupan antiseptik tersebut dalam membunuh bakteri. Antiseptik ini juga sering digunakan untuk mencegah penyebaran infeksi beberapa bakteri MDRO, salah satunya bakteri MRSA. Akan tetapi, seringnya penggunaan antiseptik tersebut dikhawatirkan dapat meningkatkan resistensi bakteri MRSA terhadap chlorhexidine gluconate. Objektif: Studi ini bertujuan untuk mengetahui efektivitas antiseptik dengan kandungan chlorhexidine gluconate terhadap bakteri strain MRSA. Metode: Kajian literatur naratif ini menggunakan artikel hasil pencarian Google Scholar dan PubMed dengan kata kunci “Methicillin Resistant Staphylococcus aureus”, “MRSA”, “Anti-Infective Agents, Local”, dan “Chlorhexidine gluconate” yang diterbitkan dalam 10 tahun terakhir (2010-2020), dan menggunakan Bahasa Inggris. Artikel yang tidak bisa didapatkan secara lengkap dan literature review dieksklusi. Artikel kemudian dinilai menggunakan critical appraisal checklist untuk dikaji. Hasil: Hasil pencarian menampilkan 355 artikel, dimana 345 artikel dieliminasi berdasarkan kriteria inklusi dan eksklusi, sehingga didapatkan 8 artikel. Delapan artikel yang ditinjau terdiri dari empat studi terkontrol acak, dua studi laboratorium, satu uji hewan, dan satu studi observasional. Kesimpulan: Penelitian ini mendapatkan 8 literatur untuk dikaji. Lima literatur melaporkan bahwa chlorhexidine gluconate menurunkan prevalensi infeksi bakteri MRSA, walaupun dua literatur menyatakan bahwa penurunan tersebut tidak signifikan. Tiga literatur lain melaporkan adanya penurunan sensitivitas bakteri MRSA terhadap chlorhexidine gluconate, terutama pada isolat yang diidentifikasi memiliki gen qacA/B atau gen smr. Background: Chlorhexidine gluconate is an antiseptic that can prevent infection because of its broad-spectrum antimicrobial activity. It can prevent MDRO infection, including MRSA. However, frequent use of chlorhexidine gluconate may result in the emergence of MRSA with reduced susceptibility or even resistance against it. Objective: This study aims to determine the effectiveness of an antiseptic containing chlorhexidine gluconate against MRSA. Methods: A literature search of PubMed and Google Scholar was performed with keywords such as “Methicillin Resistant Staphylococcus aureus”, “MRSA”, “Anti-Infective Agents, Local”, and “Chlorhexidine gluconate”. Articles published from the last 10 years in English were included. Articles that were not available in full text as well as literature reviews were excluded. These articles were appraised using critical appraisal checklist for review. Results: We identified 355 articles, of which 345 were eliminated based on the inclusion and exclusion criteria, leaving 8 articles. These eight articles consisted of four randomized controlled studies, two laboratory studies, one animal study, and one observational study. Conclusion: Five studies reported that chlorhexidine gluconate reduces rate of MRSA infection, although two studies stated that the rates are not significant. Three studies reported reduced susceptibility against chlorhexidine gluconate in MRSA isolates with qacA/B or smr genes.

Background: Nasal colonization of Staphylococcus aureus is very common among health care workers, as part of a comprehensive Methicillin Resistant Staphylococcus aureus (MRSA) decolonization strategy, Mupirocin (Pseudomonic acid) is a topical antibiotic largely used to eradicate staphylococcal nasal carriage. Increased mupirocin use predisposes to mupirocin resistance, which is significantly associated with persistent MRSAcarriage. This resistance is both low level as well as high level among the isolated strains. Aim and Objectives: To estimate the nasal carriage of MRSA in Healthcare Workers (HCWs) and to detect level of Mupirocin resistance in isolated MRSA strains. Material and Methods: A total 670 nasal swabs of HCWs (doctors, nursing staff and housekeeping staff) from various high risk areas were tested. High level and low level Mupirocin resistance among the isolated MRSA strains was detected by Kirby Bauer disc diffusion method. Minimum Inhibitory Concentration (MIC) of Mupirocin resistance was determined by E test. Results: Among 670 nasal swabs, 280 (41.79 %) showed growth of Staphylococcus aureus and 353 (52.68%) were Coagulase Negative Staphylococci (CONS). Of 280 Staphylococcus aureus strains, 61 (21.78%) strains were methicillin-resistant (MRSA). Mupirocin resistance both low level and high level was observed in 1 (1.63%) MRSAcarrier only. Conclusion: The present study showed a high incidence of nasal carriage of MRSA among health care workers. Therefore we suggest MRSA screening of HCWs as a routine practice and insist on Mupirocin resistance detection so that in case if resistance detected alternative treatment can be given.

Introduction: Osteomyelitis is an inflammatory process that affects bone due to the contiguous infection, direct inoculation, or haematogenous spread of microorganisms. It is an infectious disease that is difficult to diagnose and treatment is complex because of its heterogeneity, pathophysiology, clinical presentation and management. Aim: To determine microbiological profile osteomyelitis and antibiotic resistance pattern of bacterial isolates with special reference to Multidrug Resistance (MDR) strains. Materials and Methods: A cross-sectional study was conducted in the Department of Microbiology and Department of Orthopedics Rama Medical College Hospital and Research Centre Kanpur, Uttar Pradesh, India. A total of 100 samples from osteomyelitis cases were aerobically cultured and isolates from culture positives were identified by standard procedures. Antimicrobial Susceptibility Testing (AST) was done following Clinical and Laboratory Standards Institute (CLSI) guidelines. Staphylococcal isolates were screened for methicillin resistance and Gram negative bacilli were screened for MDR production. Results: Out of 100 samples, 76% were culture positive and 24% were culture negative. Males were more affected than females. Staphylococcal spp. (47.3%) was predominant, E. coli (14.4%) and Klebsiella spp. (11.8%), Pseudomonas spp. (9.2%), Proteus spp. (5.2%), Coagulase-Negative Staphylococci (CoNS) (3.9%). Among the MDR strains, Methicillin Resistant Staphylococcus aureus (MRSA) was 44.4%. All the MDR Staphylococcal isolates were 100% sensitive for linezolid. Among the MDR Gram negative bacilli were Extended Spectrum Beta Lactamases (ESBL) (50%), AmpC (17.6%) and Metallo Beta Lactamase (MBL) (14.7%) and they were 100% sensitive for polymixin B and colistin. Conclusion: The microbiological profile of osteomyelitis in the present study showed high prevalence of MRSA44% as the commonest agent, sensitive only to linezolid. E. coli ESBL (50%) and MBL-14.7% were sensitive only to colistin and polymixin B, therefore proper infection control practices and antibiotic policy has to be followed to reduce the incidence of MDR strains.

Previous research on methicillin susceptible Staphylococcus aureus (MSSA) belonging to livestock-associated (LA-) sequence type (ST) 398, isolated from pigs and their local surroundings, indicated that differences between these MSSA and their methicillin resistant predecessors (MRSA) are often limited to the absence of the staphylococcal cassette chromosome mec (SCCmec) and few single nucleotide polymorphisms. So far, our understanding on how LA-MRSA endure the environmental conditions associated with pig-farming as well as the putative impact of this particular environment on the mobilisation of SCCmec elements is limited. Thus, we performed in-depth genomic and transcriptomic analyses using the LA-MRSA ST398 strain IMT38951 and its methicillin susceptible descendant. We identified a mosaic-structured SCCmec region including a putative replicative SCCmecVc which is absent from the MSSA chromosome through homologous recombination. Based on our data, such events occur between short repetitive sequences identified within and adjacent to two distinct alleles of the large cassette recombinase genes C (ccrC). We further evaluated the global transcriptomic response of MRSA ST398 to particular pig-farm associated conditions, i.e., contact with host proteins (porcine serum) and a high ammonia concentration. Differential expression of global regulators involved in stress response control were identified, i.e., ammonia-induced alternative sigma factor B-depending activation of genes for the alkaline shock protein 23, the heat shock response and the accessory gene regulator (agr)-controlled transcription of virulence factors. Exposure to serum transiently induced the transcription of distinct virulence factor encoding genes. Transcription of genes reported for mediating the loss of methicillin resistance, especially ccrC, was not significantly different compared to the unchallenged controls. We concluded that, from an evolutionary perspective, bacteria may save energy by incidentally dismissing a fully replicative SCCmec element in contrast to the induction of ccr genes on a population scale. Since the genomic SCCmec integration site is a hot-spot of recombination, occasional losses of elements of 16 kb size may restore capacities for the uptake of foreign genetic material. Subsequent spread of resistance, on the other hand, might depend on the autonomous replication machinery of the deleted SCCmec elements that probably enhance chances for reintegration of SCCmec into susceptible genomes by mere multiplication.

Introduction: A rising incidence of Multidrug Resistance Organisms (MDRO) have become a major challenge to human health infections due to MDRO results in higher mortality rates, longer durations of hospital stays, and higher healthcare costs. MDRO contribute to over 50% of Healthcare Associated Infections (HAIs). Aim: To monitor the trends of Antimicrobial Resistance (AMR) among bacterial pathogens over a period of three years by using Cumulative Antibiogram (CA). Materials and Methods: A retrospective study was done to measure the trends of AMR among gram positive and gram negative organisms over a period of three years. CA capturing the susceptibility data was prepared for Enterobacteriacae, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp. and Enterococcus spp. once in every three year (2017, 2018 and 2019) in the month of January. Results: A total of 1032 isolates, of 10 medically important bacteria were analysed. Total of 21.49%, 30.38% and 54.55% isolates were Extended Spectrum β Lactamase (ESBL) producer in 2017, 2018 and 2019, respectively. There was a rising carbapenem resistance in 2019 (15.5% in E.coli, 26% in Klebsiella pneumonaie an 21% in P. aeruginosa). Among isolates of S. aureus identified in 2019, 56% were Methicillin Resistant Staphylococcus aureus (MRSA). Conclusion: CA helps in monitoring resistance trends among clinical isolates which helps in preparation of antibiotic policy. There is rising incidence of ESBL and carbapenem resistance among gram negative bacilli.

Occurrence of Staphylococcus aureus in children with osteomyelitis. This study was conducted at K. M. M. C. & Hospital, Mathura (UP). A total of 60 patients with osteomyelitis contributed to this study from October 2017 to October 2019. Patients with known immunodeficiency syndromes were excluded. Specimen collections were meticulously performed to avoid contamination which was accomplished by needle aspiration or surgical sampling. Staphylococcus aureus was recovered in more than half of the cases of osteomyelitis in both infants and children. Amikacin, Clindamycin and Cefazolin were effective in such cases. The distal end of the femur and upper-end tibia were the most common sites of infection where boys were more infected than girls. The haematogenous route was the main cause of the transmission of osteomyelitis in children. Principally Staphylococcus aureus causes the majority of cases of osteomyelitis in children followed by H. influenza, Group B Streptococcus, P. aeruginosa, E. coli and Serratia marcescens.

ABSTRACT In a study of antibiotic resistance in Staphylococcus aureus, specific cell wall mutants were previously generated for the peptidoglycan biosynthesis gene murF, by the insertion of an integrative plasmid. A collection of 30 independent mutants was obtained, and all harbored a variable number of copies of the inserted plasmid, arranged in tandem in the chromosome. Of the 30 mutants, only 3, F9, F20 and F26, with a lower number of plasmid copies, showed an altered peptidoglycan structure, lower resistance to β-lactams and a different loss-of-function mutation in rho gene, that encodes a transcription termination factor. The rho mutations were found to correlate with the level of oxacillin resistance, since genetic complementation with rho gene reestablished the resistance and cell wall parental profile in F9, F20 and F26 strains. Furthermore, complementation with rho resulted in the amplification of the number of plasmid tandem repeats, suggesting that Rho enabled events of recombination that favored a rearrangement in the chromosome in the region of the impaired murF gene. Although the full mechanism of reversion of the cell wall damage was not fully elucidated, we showed that Rho is involved in the recombination process that mediates the tandem amplification of exogeneous DNA fragments inserted into the chromosome. IMPORTANCE The cell wall of bacteria, namely, peptidoglycan, is the target of several antibiotic classes such as β-lactams. Staphylococcus aureus is well known for its capacity to adapt to antibiotic stress and develop resistance strategies, namely, to β-lactams. In this context, the construction of cell wall mutants provides useful models to study the development of such resistance mechanisms. Here, we characterized a collection of independent mutants, impaired in the same peptidoglycan biosynthetic step, obtained through the insertion of a plasmid in the coding region of murF gene. S. aureus demonstrated the capacity to overcome the cell wall damage by amplifying the copy number of the inserted plasmid, through an undescribed mechanism that involves the Rho transcription termination factor.

Introduction: Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolone with potent activity against Methicillin Resistant Staphylococcus aureus (MRSA) and Quinolone Resistant Staphylococcus aureus (QRSA). Both intravenous levonadifloxacin and its oral formulation have recently been approved in India for the treatment of acute bacterial skin related infections. Aim: To assess the activity of levonadifloxacin against gram positive clinical isolates collected from Intensive Care Units (ICUs) using the disk-diffusion method. Materials and Methods: The present descriptive study where non duplicate isolates of Staphylococcus aureus (S. aureus) and other gram positive isolates from various clinical samples from all Intensive Care Units (ICUs) were collected from June to December 2020 and subjected to levonadifloxacin susceptibility testing (disk diffusion method) as per the Clinical and Laboratory Standards Institute (CLSI) guidelines, 2020. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) software, version 25.0. Results: A total of 142 gram positive clinical isolates collected from all ICUs of the hospital were analysed. These isolates included coagulase negative S. aureus 109 (76.8%), S. aureus 21 (14.8%) and Enterococcus faecalis 12 (8.4%). All the gram positive isolates of the study were susceptible to levonadifloxacin as per the prespecified interpretive criteria identified based on population pharmacokinetic model and Monte Carlo simulation enabled probability of pharmacodynamic target attainment analysis. Conclusion: Results of this in vitro study shows good activity of levonadifloxacin against gram positive isolates including difficult to-treat methicillin resistant staphylococcal isolates collected from ICU patients.

ObjectiveTo investigate the prevalence, antimicrobial susceptibility, and enterotoxin gene of Staphylococcus aureus (S. aureus) isolates in ready-to-eat (RTE) foods in Guangzhou from 2008 to 2019.MethodsRTE food samples were randomly collected from retail outlets and supermarkets in 11 districts of Guangzhou and the isolation and identification of S. aureus were performed. All isolated S. aureus were tested for antimicrobial susceptibility, enterotoxin genes and multilocus sequence typing (MLST). Methicillin resistant S. aureus (MRSA) isolates were further characterized by staphylococcal cassette chromosome mec (SCCmec) typing.ResultsA total of 157 S. aureus isolates(11.22%) were detected from 1 399 RTE food samples in Guangzhou from 2009 to 2018. The prevalence of S. aureus in cooked pork samples was significantly higher than those in non-meat samples (17.95% vs 9.43%, P

Background: Hospital acquired infection (HAI) or Nosocomial Infection (NI) is a well-known entity among patients. The onco-hemological patients are immune-compromised and are at high risk of acquiring these infections. Routine screening of these patients for the presence of micro-organisms, their identification and sensitivity at the time of admission, and during stay, can help us in identifying infections and guiding therapy. Aims and Objective: This study was undertaken to find out the role of routine screening of admitted patients in oncology ward with empirical therapy during neutropenic episodes. Nosocomial Infection Screening (NIS) test was performed for these patients. This test was done to detect Methicillin Resistant Staphylococcus Aureus (MRSA) and Extended Spectrum Beta Lactamases (ESBL) producing Gram Negatives. The NIS results obtained were correlated with organisms isolated from blood cultures. Material and Methods: This retrospective study was done from period of May, 2013 to February,2017 in patients of oncology ward. Only those patients whose NIS test and blood culture was sent to the lab were included in the study. Result: A Total number of 52 NIS tests and blood cultures were included in the study. Among 28 positive NIS samples, 19 samples correlated with blood cultures. Among 24 negative NIS sample 17 correlated with blood cultures. The p value was 0.017, PPV 73%, NPV 64%. SPSS software was used to calculated values. Conclusion: This study showed that NIS test can be used as a tool for predictive marker for septic episodes in these patients.There is a higher probability of developing septic episodes with positive NISsamples.At the same time negative NIS result does not rule out infection.

Objective: To compare the in-vitro efficacy by determining Minimum Inhibitory Concentration of Vancomycin using the reference Agar Dilution to the E-Strip in Methicillin Resistant Staphylococcus aureus isolates. Study Design: Validation study. Place and Duration of Study: The department of Microbiology Army Medical College/National University of Medical Sciences in collaboration with Pak Emirates Military Hospital Rawalpindi, from Dec 2016 to Dec 2017. Methodology: Non-duplicate 84 isolates of Methicillin resistant Staphylococcus aureus from various clinical specimens were included in the study. All these isolates were screened for susceptibility to glycopeptide by E-strips method (Bio mérieux) as well as Agar Dilution method, using vancomycin concentrations of 0.25, 0.50, 1.00, 2.00, 4.00 and 8.00µgm/ml respectively in two fold serial dilutions. Results: There was an overall agreement on 83 samples by both the methods i.e. 83 were Vancomycin Sensitive Staphylococcus aureus by both methods while one isolate with intermediate resistance to Vancomycin was only detected by Agar Dilution. The sensitivity of the E–strips compared to Agar Dilution was found to be 100%. The positive predictive value was 98.8% with a diagnostic accuracy of 98.8%. Specificity and negative predictive value could not be ascertained for E-strips because of the limitation of the method to detect the Vancomycin Intermediate Staphylococcus aureus isolates. Conclusion: E-strip can be a convenient alternative to the gold standard Agar Dilution but its inability to identify VISA challenges its reliability in determining the Vancomycin resistance in MRSA isolates.

Abstract Objective This study was designed to discover the dissemination of virulence genes in Methicillin-resistant Staphylococcus aureus from clinical, community and environmental settings. Results This study includes 1165 isolates collected from hospital, community and environmental settings. Among them sixty three were confirmed as MRSA with varied SCCmec types viz; type I, type II, type III, type IV, type V, type VI, type VII, type VIII and type XII. The virulence gene such as sea (n = 54), seb (n = 21), eta (n = 27), etb (n = 2), cna (n = 24), ica (n = 2) and tst (n = 30) was also revealed from this study. The study underscores coexistence of resistance cassette and virulence genes among clinical and environment isolates which is first of its kind from this part of the world.

Background and Objectives: Resistance to methicillin in methicillin resistant strains of Staphylococcus aureus (MRSA) is due to the presence of mec-A gene ,which encodes a low affinity penicillin binding protein (PBP)-2a or PBP2. Accurate and rapid identification of MRSA in clinical specimens is essential for timely decision on effective treatment. The aim of the study was to compare three different methods for detection of MRSA namely cefoxitin disc diffusion, CHROM agar MRSA and VITEK-2 susceptibility with PCR which is the gold standard reference method and to find the antibiotic susceptibility pattern of these isolates by VITEK-2. Materials and Methods: A Total of 100 non-duplicate S. aureus isolates were collected from different clinical samples among both outpatient and inpatients. Detection of MRSA among these isolates was done by cefoxitin disc diffusion, VITEK-2, CHROM agar MRSA and PCR. Results: The sensitivity and specificity of cefoxitin disc diffusion and Vitek was found to be 97.2% and 100%, while that of CHROM agar was found to be 100% and 78.6%. The overall prevalence of MRSA in our study by PCR was 72%. Conclusion: Based on the findings in our study, isolates which show cefoxitin zone diameter < 22 mm can be reported as MRSA. However, those isolates which have a zone diameter between 22-24 mm, should ideally be confirmed by PCR.

INTRODUCTION: Surgical site infections are associated with devastating consequences in vascular surgery patients but the data on Methicillin Resistant Staphylococcus aureus (MRSA) infection among those remains scant and conflicting. Most vascular surgery antibiotic prophylaxis assume that all patients submitted to surgery are tested prior to the intervention or that all patients with risk factors for MRSA are presumed to be colonized. However, the costs associated with testing all patients are not negligible, and most of the vascular surgery patients have risk factors for MRSA colonization. The purpose of this study was to evaluate the burden of MRSA clinical infection and its outcome and to adjust clinical practice accordingly. METHODS: A retrospective analysis of clinical data from all patients with MRSA isolations that were submitted to vascular surgery in the year 2019 was conducted. The primary endpoint was in-hospital mortality. Secondary endpoints were timing of infection (pre-existent infection or post-surgical infection), need for ICU and length of hospital stay. RESULTS: Out of 1681 patients admitted for surgery in the year 2019 in the vascular surgery ward, only 21 had clinical infection with positive MRSA isolates. All the patients had risk factors for MRSA colonization. Seventeen were admitted for PAD (Rutherford grade 5 or 6). Eight patients had post-operatory infections, whilst the remaining presented with MRSA infection prior to the intervention. Post-operatory infections ranged from superficial incisional in three patients, deep incisional in one patient, and organ/space/prosthesis infection in four patients (of the last group, two had prosthesis infection). There were five deaths, of which two were unrelated to the infection. Of the three deaths probably infection-related, all were post-operatory surgical site infections, and all were organ/space/prosthesis infections (one with prosthesis infection). There was no patient admitted to the ICU that survived. The mean hospital stay was increased by 26 days (31 days, 95% CI, 19-43). CONCLUSION: Infection by MRSA was less frequent than expected in our population, which may mean that colonization might be smaller than expected. Pre-operative infection was almost always related to chronic wounds and did not increase the risk of post-operative wound infection or death, contrary to post-operative infection, which seems to significantly increase mortality.

Methicillin-Resistant Staphylococcus aureus (MRSA) infections have created a critical need for the development of natural antibacterials from a biological source. This research aimed to investigate the antibacterial activity of the seed extract of three-member Artocarpus (Artocarpus heterophyllus, A. champeden, and A. camansi) against MRSA which are the most prevalent causes of infections in patients. Crude seed extracts of three-member Artocarpus were evaluated for their antibacterial activity against MRSA. The antibacterial activity against MRSA of the three extracts was assayed in vitro by the agar well diffusion assay and agar microdilution method and minimum bactericidal concentration. The antibacterial activity, calculated as a zone of inhibition and MIC, MBC values. The Crude seed extracts of three-member Artocarpus showed antibacterial activity against the MRSA in the agar well diffusion assay (1.5-9 mm inhibition diameter). The MIC value of extract showed at 15.62 mg/mL and the MBC value of seed extract of A. heterophyllus at 62.5 mg/mL, A. champeden at 31.25 mg/mL, A. camansi at 250 mg/mL. All seed extracts have the potential to be developed as antibacterial agents, particularly against MRSA strain. Studies on the antibacterial activity against MRSA can provide new information about the benefits seed of members of Artocarpus as a source of natural antibacterial.

Methicillin resistant Staphylococcus aureus (MRSA) is the main pathogen of hospital- and community-associated infections. Methicillin resistance is due to mecA gene located in a mobile complex element, staphylococcal cassette chromosome mec (SCCmec). The structure of the staphylococcal cassettes is diverse. At present eleven types of the cassettes are described. Types I-IV SCCmec are always associated with epidemiologically significant genetic lines of Staphylococcus. Thus, the pandemic hospital-associated MRSA (HA MRSA) belonging to CC5 and CC8 are of the types I-III SCCmec. The prevalence of virulent community-associated MRSA (CA MRSA) in many regions of the world is first of all connected with the characteristics of the type IV SCCmec structure and the presence of a recently described arginine catabolic mobile element (ACME) increasing the colonization activity of Staphylococcus. The review presents the up-to-date data on the origin, genetic structure and classification of SCCmec. Global genetic lines of MRSA are described and the problem of CA MRSA is discussed.

Background and Objectives: MRSA became a widely recognized cause of mortality worldwide with necessity of its epidemiological pattern study. Typing of MRSA isolates was performed molecularly based on SCCmec type and relation to resistance pattern was investigated. Materials and Methods: Out of 200 clinical specimens, S. aureus was detected phenotypically and confirmed as MRSA by PCR in 124 isolates obtained from associated laboratories of different hospitals of Zagazig, during 2018-2019. Antimicrobial resistance pattern was detected and MRSA SCCmec was typed by two methods. Results: S. aureus rate was high in wounds, sputum, blood, and urine isolates. Antimicrobial resistance rates against cefotaxime, tetracycline, gentamicin, ciprofloxacin, erythromycin, azithromycin, clindamycin, chloramphenicol, sulfamethoxazole-trimethoprim, linezolid and vancomycin were 82.3%, 65.3%, 56.4%, 45.1%, 37.1%, 32.3%, 32.3%, 25%, 7.3%, 2.4% and 0%, respectively. Multiplex-PCR(M-PCR ) was able to detect SCCmec element among 57% of isolates classified as SCCmec II (n=40), III (n=21), IVa (n=3), IVd (n=2), V(n=1), and four isolates contain both SCCmec ІІ and SCCmec ІV. Traditional typing by PCR for mec and ccr gene complexes was almost concordant with M-PCR. Furthermore, it was able to identify SCCmec types VI, IX, and XIV among 1, 3 and 18 isolates, respectively. No Statistical correlation was established between type of cassette and rate of antimicrobial resistance. Phylogenetic analysis reveals that all ccr types were related to each other and no significant variation in the same ccr type of different SCCmec cassettes. Conclusion: Most MRSA isolates were MDR reflecting antimicrobials misuse. Detection of various SCCmec types among MRSA isolates indictae the complexity of MRSA epidemiology and increase chance for gene sharing creating new types.The presented investigation was important in understanding MRSA epidemiology and diversity in Egypt providing advice for improving therapeutic protocols.

Introduction: Infections caused by Methicillin Resistant Staphylococcus aureus (MRSA) are associated with increased morbidity, longer antimicrobial therapy, etc. First option for treating invasive MRSA infections is glycopeptide vancomycin. Daptomycin, a lipopeptide rapidly bactericidal invitro against MRSA, is an acceptable alternative. Aim: To identify MRSA isolates from clinical specimens and assess their vancomycin and daptomycin susceptibility pattern. Materials and Methods: The cross-sectional study was conducted over a period of six months (January to June 2019) on 90 clinical samples in a rural teaching hospital in Pune, Maharashtra, India, including all samples except sputum received in the Microbiology laboratory. MRSA isolates were tested for vancomycin and daptomycin susceptibility by Epsilometer (E) test Minimum Inhibitory Concentration (MIC) method. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 16.0 software. Results: Among 90 MRSA isolates, most were from pus 51 (56.7%) followed by urine 23 (25.5%), blood 9 (10%), followed by miscellaneous samples 7 (7.7%). All MRSA isolates in this study were susceptible to daptomycin with MIC in the range of 0.25-1 µg/ mL with maximum isolates (39) with MIC of 0.38 µg/mL. Vancomycin MIC creep phenomenon was observed in 68 isolates. All these isolates also showed reduced susceptibility to daptomycin. Conclusion: MRSA in hospital set up mandates strict infection control practices in place. Daptomycin can be a good therapeutic alternative to treat infections caused by MRSA keeping in mind its therapeutic limitations and prior vancomycin usage in the same patient. Empirical therapy should always be based on antibiogram pattern. Adherence to hospital antibiotic policy and constant surveillance of antimicrobial resistance is the need of the hour.

Research has shown the implication of Penicillin-Binding Protein 2A (PBP2A) as a critical factor in Methicillin-Resistant Staphylococcus aureus (MRSA) as it confers resistance to β‐lactam antibiotics on S. aureus, resulting in an increase in morbidity and mortality rate globally. The introduction of immuno-informatics methods has transformed vaccine development since antigen proteins can be used to elicit antibody responses as well as cell-mediated immunity.The present study aimed to design and propose a multi-epitope-based vaccine candidate against S. aureus by targeting PBP2A. Using an in-silico approach, 6 cytotoxic T-lymphocyte (CTL) epitopes, 3 helper T-lymphocyte (HTL) epitopes, and 8 B-cell epitopes were predicted from all target protein sequences.The multi-epitope vaccine construct was generated by mapping the entire shortlisted epitopes with appropriate adjuvant and linkers. The total amino acid residues are 350, with a molecular weight of 37,357.88 Da, while the Protrusion Index (PI) of the construct is 8.49. The docked complex of our vaccine (ligand) and TLR4 (receptor) predicted an excellent binding affinity between the two molecules with a plausible scoring function. The final multi-epitope vaccine candidate is considered potently antigenic, non-allergenic, and non-toxic. Antibodies that were generated against the designed vaccines showed higher levels of IgM, IgM + IgG, and IgG1 + IgG2 in secondary and tertiary immune responses. The multi-epitope vaccine construct was successfully cloned into the pET-28a (+) plasmid vector of Escherichia coli (strain-K12) for expression capacity. Our results demonstrate the potential of an in silico designed multi-epitope vaccine and suggest the need to further investigate efficacy in humans in vivo.

Available data suggests a high burden of methicillin-resistant staphylococcus aureus (MRSA) in Arab countries of the Middle East and North Africa (MENA). To review the MRSA prevalence and molecular epidemiology in this region, we used PubMed search engine to identify relative articles published from January 2005 to December 2019. Great heterogeneity in reported rates was expectedly seen. Nasal MRSA colonization ranged from 0-32% in healthy volunteers but 4-73% in healthcare workers. Infective MRSA rates ranged between 6%-66% in Saudi Arabia, 12%-29% in United Arab of Emirates, 13%-21% in Qatar, 14%-37% in Oman, 20%-72% in Lebanon, 56% in Gaza, 32%-68% in Jordan, 34%-88% in Iraq and Iraqi Kurdistan, 47%-77% in Egypt, 19-86% in Algeria, and 18-40% in Tunisia. In the GCC, [PVL-] ST239-III, [PVL+] ST80-IV, [PVL+] ST30-IV, [PVL-] ST22-IV and its [PVL+] and [tst1+] variants, [PVL-] CC6-IV, [PVL-] CC5-IV, and [PVL-] ST5-II had a significant presence. In the Levant region, [PVL+] ST80-IV, [PVL+] ST30-IV, [PVL-] ST239-III, [PVL-] ST22-IV were prevalent in Lebanon, Jordan, and Gaza; [PVL-] ST22-IVa-t223 (“Gaza strain”) was prevalent in Gaza and Jordan; USA300, and USA800 were prevalent in Iraq. In North Africa, [PVL+] ST80-IV and [PVL-] ST239-III was commonly reported in Egypt, Algeria, and Tunisia. Finally, significant antimicrobial resistance was seen in the region with variation in patterns depending on location and clonal type. For a more accurate assessment of MRSA epidemiology and burden, the Arab countries need to implement national surveillance systems.

Introduction: Surgical site infection (SSI) is one of the most common hospitals acquired infection. The present study describes resistogram of bacterial pathogens in SSIs in the hospitals in and around Sangli, Maharashtra, India. Materials and Methods: The resistogram pattern was studied by modified Kirby-Bauer disc diffusion method. Results: A total of 1491 pus samples from patients clinically diagnosed of SSIs were processed and 911 isolates were obtained. The most common Gram-positive isolates were Staphylococcus aureus(53.92%), coagulase-negative Staphylococci (31.17%), Enterococcus (10.58%), and Streptococcus pyogens (4.31%); while Gram-negative isolates were Escherichia coli (33.16%), Klebsiella spp. (28.92%), Citrobacter species (4.98%), Pseudomonas aeruginosa (12.96%), Acinetobacter species (1.99%), Proteus mirabilis (10.97%), and Proteus vulgaris (6.98%). The frequency of methicillin-resistant S. aureus (MRSA) was 28% whereas the frequency of methicillin sensitive S. aureus was 72%. The MRSA showed multidrug resistance pattern. Conclusion: Twenty-eight percent are MRSA which showed multidrug resistance pattern. While most of the Gram-positive isolates were resistance toward the amoxicillin/clavulanate, gentamicin, and ceftriaxone. Most of the Gram-negative isolates were resistant to ampicillin, ciprofloxacin and ceftriaxone.

Introduction: Antibiotic-carrying nanoparticles have cytotoxic effects on drug-resistant bacteria. The aim of the present study was to evaluate the effect of chitosan nanoparticles carrying amoxicillin and clavulanic acid on the viability of staphylococcus aureus strains. Materials & Methods: In this study, chitosan nanoparticles were prepared by ionic gelation method and were loaded by amoxicillin and clavulanic acid leading to the production of nanoparticles with dimension less than 100 nm. To evaluate the effect of different nanoparticle concentration on the bacteria, chitosan and amoxicillin concentrations of 0.25-8 and 1-128 µg/ml were prepared, respectively, using the microdilution method. Subsequently, 100 nm of different chitosan nanoparticle concentration with antibiotic was transferred to each well and 1 μl of bacterial suspension was added to the wells. Turbidity in the wells was observed without armed eye and the light absorbance was read in the wavelength range of 630 nm by enzyme-linked immunosorbent assay. Findings: The results showed that minimum inhibitory concentrations of chitosan nanoparticles carrying amoxicillin and clavulanic were 0.9 and 3.6 µg/ml in susceptible and resistant specimens, respectively. Moreover, their minimum destructive concentrations were obtained at 1.8 and 7.2 µg/ml, respectively. Discussion & Conclusions: According to the results, the obtained combination showed more antibacterial effectiveness, compared to chitosan and amoxicillin alone. This reveals the synergistic effect of amoxicillin with clavulanic acid and chitosan.

Introduction: Staphylococcus aureus is one of the critical pathogens resulted in hospital land community-acquired infections. Aminoglycosides are potent bactericidal agents that are often used in staphylococcal infection treatment in combination with a beta-lactam or glycopeptide antibiotics. The aim of this study was to determine the frequency of encoding gene ofaac (6΄)-Ie/aph (2˝).This gene is one of the important aminoglycoside modifying enzymes in combination with mecA which results in methicillin resistance. In doing so, disk diffusion and polymerase chain reaction (PCR) methods were utilized in clinical isolates of methicillin resistant staphylococcus aureus (MRSA). Materials & Methods: In the current study, 174 clinical isolates of MRSA were obtained from different clinical specimens, including blood, sputum, trachea, brunch, pleura, urine, wound, and catheter. Antibiotic resistance of erythromycin, clindamycin, ciprofloxacin, gentamicin, cefazolin, rifampicin, doxycycline, cotrimoxazole and vancomycin was determined using Kirby-Bauer disk diffusion test method according to the CLSI guidelines. The presence of MRSA was confirmed using oxacillin and cefoxitin anti biotic disc diffusion. Subsequently, DNA of MRSA isolates was investigated to detect mecA and aminoglycoside resistance aac (6΄)-Ie/aph (2˝) genes using PCR. Findings: The results obtained from biogram anti-microbial susceptibility test system indicated that all of the isolates were resistant to oxacillin and cefoxitin. All of the isolates were sensitive to vancomycin and majority of them were resistant to erythromycin (84.8%). According to PCR test results, 100 and 78.3% of the isolates were positive for the mecA and aac(6′)/aph(2˝)-Ia genes, respectively. Discussion & Conclusions: According to the results, the aminoglycoside resistance geneswere highly prevalent in MRSA isolates.

Introduction: Staphylococcus aureus is one of the critical pathogens resulted in hospital land community-acquired infections. Aminoglycosides are potent bactericidal agents that are often used in staphylococcal infection treatment in combination with a beta-lactam or glycopeptide antibiotics. The aim of this study was to determine the frequency of encoding gene ofaac (6΄)-Ie/aph (2˝).This gene is one of the important aminoglycoside modifying enzymes in combination with mecA which results in methicillin resistance. In doing so, disk diffusion and polymerase chain reaction (PCR) methods were utilized in clinical isolates of methicillin resistant staphylococcus aureus (MRSA). Materials & Methods: In the current study, 174 clinical isolates of MRSA were obtained from different clinical specimens, including blood, sputum, trachea, brunch, pleura, urine, wound, and catheter. Antibiotic resistance of erythromycin, clindamycin, ciprofloxacin, gentamicin, cefazolin, rifampicin, doxycycline, cotrimoxazole and vancomycin was determined using Kirby-Bauer disk diffusion test method according to the CLSI guidelines. The presence of MRSA was confirmed using oxacillin and cefoxitin anti biotic disc diffusion. Subsequently, DNA of MRSA isolates was investigated to detect mecA and aminoglycoside resistance aac (6΄)-Ie/aph (2˝) genes using PCR. Findings: The results obtained from biogram anti-microbial susceptibility test system indicated that all of the isolates were resistant to oxacillin and cefoxitin. All of the isolates were sensitive to vancomycin and majority of them were resistant to erythromycin (84.8%). According to PCR test results, 100 and 78.3% of the isolates were positive for the mecA and aac(6′)/aph(2˝)-Ia genes, respectively. Discussion & Conclusions: According to the results, the aminoglycoside resistance geneswere highly prevalent in MRSA isolates.

Abstract Background This study analyzes colonization of the neonates in a NICU and incidence of these colonized infants developing infections due to the colonizers. Methods Over a 12 month period, samples (surface swabs and rectal swabs) were obtained from all the infants admitted to NICU. The samples were cultured and examined for the presence of colonizers and especially for multi-drug resistant organisms. Results From the total 533 patients, 473 (89%) neonates acquired colonizers and 60 (11%) did not. Of the 473 (89%) colonized infants, 57 (12%) developed infections of whom 33 (58%) were infected from the same organism as the colonizer and 24 (42%) neonates developed an infection that was different from the colonizer. 416 (88%) infants did not develop any infection inspite of being colonized. Conclusions The total numbers of babies contracting infection were more in the colonized group than the non-colonized. Other factors like gestational age and preterm may have played a role in development of infection in addition to colonization in these babies. Screening for the presence of MDRO colonization may be of limited use in predicting infections in the colonized individual. However, knowledge of their presence results in implementation of strict infection control practices. This along with judicious uses of antimicrobials effectively reduces infections from colonized bacteria and more importantly prevent their spread.

Abstract Background This is the first review of literature and synthesis of data on community onset methicillin resistant Staphylococcus aureus (CO-MRSA) infections in Australia. Incidence of CO-MRSA varies considerably in Australia, depending on geographic and demographic factors. Methods Data for the rates of MRSA infections were collected from articles identified using PubMed, Scopus, the grey literature and data from State and Federal Government Surveillance Systems. We synthesized data and developed a framework for how data was selected, collated, linked, organized and interpreted. Results The results of our literature search demonstrates considerable gaps in the reporting of CO-MRSA in Australia. Consequently, total incidences were under reported; however the available data suggests the incidence varied between 44 (Tasmania) and 388 (southern Northern Territory) cases per 100,000 person years. Hospitalised cases of CO-MRSA varied between 3.8 (regional Victoria) and 329 (southern Northern Territory). Taking the median percentage of infections by site for all regions available, skin and soft tissue infections (SSTIs) consisted of 56% of hospitalized CO-MRSA, compared with bacteremias, which represented 14%. No region had a complete data set of CO-MRSA infections treated in out-patient settings and so incidences were underestimates. Nevertheless, estimates of the incidence of CO-MRSA treated outside hospitals varied between 11.3 (Melbourne) and 285 (Northern Territory) per 100,000 person-years. These infections were chiefly SSTIs, although urinary tract infections were also noted. Incidences of CO-MRSA blood-stream infections and outpatient skin and soft tissue infections have been increasing with time, except in Tasmania. CO-MRSA is observed to affect people living in remote areas and areas of socioeconomic disadvantage disproportionately. Conclusions We generated the first estimates of the incidence of CO-MRSA infections in Australia and identified stark regional differences in the nature and frequency of infections. Critically, we demonstrate that there has been a lack of consistency in reporting CO-MRSA and a general dearth of data. The only government in Australia that requires reporting of CO-MRSA is the Tasmanian, where the infection was least prevalent. Some regions of Australia have very high incidences of CO-MRSA. To improve surveillance and inform effective interventions, we recommend a standardized national reporting system in Australia that reports infections at a range of infection sites, has broad geographic coverage and consistent use of terminology. We have identified limitations in the available data that hinder understanding the prevalence of CO-MRSA.

Abstract Background Community- associated methicillin resistant Staphylococcus aureus (CA-MRSA) cause serious infections and rates continue to rise worldwide. Use of geocoded electronic health record (EHR) data to prevent spread of disease is limited in health service research. We demonstrate how geocoded EHR and spatial analyses can be used to identify risks for CA-MRSA in children, which are tied to place-based determinants and would not be uncovered using traditional EHR data analyses. Methods An epidemiology study was conducted on children from January 1, 2002 through December 31, 2010 who were treated for Staphylococcus aureus infections. A generalized estimated equations (GEE) model was developed and crude and adjusted odds ratios were based on S. aureus risks. We measured the risk of S. aureus as standardized incidence ratios (SIR) calculated within aggregated US 2010 Census tracts called spatially adaptive filters, and then created maps that differentiate the geographic patterns of antibiotic resistant and non-resistant forms of S. aureus. Results CA-MRSA rates increased at higher rates compared to non-resistant forms, p = 0.01. Children with no or public health insurance had higher odds of CA-MRSA infection. Black children were almost 1.5 times as likely as white children to have CA-MRSA infections (aOR 95% CI 1.44,1.75, p

Despite increased pre and postoperative care including screening procedures, improvement in the operating room environment, and controlled prophylactic antibiotic therapy, the health burden of Surgical Site Infections (SSIs) in India is far more escalated than that in developed countries. SSIs ranging from superficial skin infection to life threatening septicemia affect one third of the patient population undergoing surgery, thereby contributing to morbidity and mortality. One of the most dominant bacterial species that causes SSIs is Staphylococcus aureus, wherein Methicillin Resistant S.aureus (MRSA) alone contributes to a significant increase in both the cost and the length of hospitalisation along with an increased mortality rate among patients with SSIs. The rising resistance pattern among pathogens coupled with the concerns over the tolerance and safety of currently available agents against MRSA limits treatment options available for patients with SSIs. Levonadifloxacin and its oral prodrug alalevonadifloxacin are novel benzoquinolizine anti‑MRSA agents which have recently been approved in India to tackle gram positive ‘super-bugs’. Herein, the aim of this review article was to collate the possible factors contributing toward SSIs, its implications on health and economy, antibiotic resistance, possible preventive measures, and the need for new antimicrobial agents.

Methicillin-resistant staphylococcus aureus (MRSA) sequence type 28 (ST 28) and spa type t021 is a CC30, prototype of ST-30, Community Associated-MRSA (CA-MRSA) (lukS-lukF +). It is a multi-drug resistant strain harbouring staphylococcal endotoxins, haemolysins, ureolysin, serine protease, and antimicrobial resistance genes. In this study, we report the draft genome sequence of this MRSA isolated from the most commonly used food fish, ribbon fish (Trichiurus lepturus). The total number of assembled paired-end high-quality reads was 7,731,542 with a total length of 2.8Mb of 2797 predicted genes. The unique ST28/ t021 CA- MRSA in fish is the first report from India, and in addition to antibiotic resistance is known to co-harbour virulence genes, haemolysins, aureolysins and endotoxins. Comprehensive comparative genomic analysis of CA-MRSA strain7 can help further understand their diversity, genetic structure, diversity and a high degree of virulence to aid in fisheries management.

In this study, we aimed to investigate the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudintermedius (MRSP) clinical and colonizing isolates of dogs and cats to profile contributing factors associated with their isolation. Nasal and rectal samples were collected from dogs and cats between 2015 and 2017 to identify colonizing isolates. Clinical isolates collected between 2003 and 2016 were retrieved from a Queensland university veterinary diagnostic laboratory. All isolates were identified using standard microbiological and molecular methods and were characterized by whole genome sequencing. Phylogenetic relationships and differences in epidemiological factors were investigated. Seventy-two MRSP isolates out of 1,460 colonizing samples and nine MRSP clinical isolates were identified. No MRSA was isolated. ST496 and ST749 were the most commonly isolated sequence types with different SCCmec types. ST496 clones spread both along the coast and more inland where ST749 was more centered in Brisbane. The resistance and virulence factors differed significantly between the two sequence types. ST496 colonizing and clinical isolates were similarly multidrug resistant. The virulence genes of ST749 colonizing and clinical isolates were similar as both contained the gene nanB for sialidase. There were no differences in the individual and clinical factors between predominant sequence types. High levels of antimicrobial resistance occurred in the majority of isolates, which is of potential concern to human and veterinary health. The phylogenetic clustering of isolates from this study and others previously identified in countries, particularly New Zealand, with which Australia has high volume of pet movements could suggest the importation of clones, which needs further investigation.

Introduction: Methicillin-Resistant Staphylococcus aureus (MRSA) infection is a major global healthcare problem, the prevalence of which varies from 25-50% in India. It is known to cause Skin and Soft tissue Infections (SSI), endovascular infections, endocarditis, pneumonia, septic arthritis, osteomyelitis, and sepsis. Vancomycin is the drug of choice for treating severe MRSA infections. Ceftaroline, a fifth-generation cephalosporin has been approved by the United States Food and Drug Administration (US FDA) for treating acute bacterial SSI caused by susceptible micro-organisms including MRSA, Community acquired respiratory tract infection, MRSA bacteremia and endocarditis. Aim: To assess the susceptibility of clinical isolates of S. aureus to ceftaroline, in a Tertiary Care Hospital. Materials and Methods: This prospective study was conducted in the Department of Microbiology of a Tertiary Care Hospital over a period of two months from June 2019 to July 2019. S.aureus isolates from various clinical samples were screened for methicillin resistance by disc diffusion method using cefoxitin disc and ceftaroline susceptibility of these isolates was assessed by E-strip method. The isolates were classified as ceftaroline susceptible, Susceptibility Dose Dependent (SDD) and ceftaroline resistant respectively as per CLSI guidelines. A descriptive analysis of the data was done and the results were presented as frequencies and percentages. Results: All the S.aureus isolates were found to be susceptible to ceftaroline. Methicillin Sensitive Staphylococcus aureus (MSSA) isolates had lower Minimum Inhibitory Concentration (MIC) when compared to MRSA. The highest MIC among MRSA was 0.5 μg/mL. Conclusion: Ceftaroline can be considered as an effective alternative for treatment of infections caused by MRSA.

Toxins produced by bacteria can result into various systemic manifestations through the release of cytokines which leads to changes at the molecular level. This index case of an 18 years old adult immuno-competent male patient, presented with high grade ongoing fever for 3 days, had wound on left arm in deltoid region. there were diffuse maculo-papular rash predominantly in both palms feet and trunk, erythematous and blanchable on examination. Patient was treated with inj. Piperacillin- Tazobactam and Linezolid, i.v. fluids and nor-adrenaline infusion. Patient was diagnosed with concurrent Staphylococcal Scalded Skin Syndrome (SSSS) and Toxic Shock Syndrome (TSS). The two syndromes are caused by different toxins produced by different strains of Staphylococcus aureus. The source of infection was a pus discharging sinus on left arm. The findings were proven on skin biopsy and met the case definition criteria of TSS. He is currently asymptomatic after the treatment being given against Methicillin-resistant Staphylococcus aureus (MRSA) isolated from the pus. It is therefore possible for a single strain of bacteria being capable of producing different toxins, resulting in two different clinical syndromes having a concurrent presentation.

Introduction: Postoperative infections in orthopaedic implants is a major concerning factor. It can lead to the failure of implants and in severe cases can even lead to amputation and mortality. Total joint replacements and fracture fixations do help by reducing the agony of many patients but postoperative infections are a detrimental complication. It is an economic disaster for hospitals that treat large number of these patients therefore identification of risk factors, common pathogens involved, early initiation and prompt use of empirical therapy is necessary to prevent implant failures and also collection of deep tissue samples improves the diagnostic reliability and microbiological yield of implant related infections. Hence, appropriate collection of specimens is a key factor for early diagnosis and differentiating colonisers from true pathogens. Aim: To evaluate the rate of implant related infections, sensitivity of Gram’s stain and its accuracy in tissue samples over wound swabs and also to determine the trends in the antibiogram. Materials and Methods: A retrospective analysis was performed from the samples (tissues and wound swabs) received to the Department of Microbiology from October 1st 2017-October 30th 2018 (a period of one year) in patients with orthopaedic implants. Identification and susceptibility patterns of the bacterial pathogens were identified by the automated Vitek 2 compact system (biomeriux). The data was analysed in terms of frequency and percentage. Results: A total of 141 cases were analysed out of which 45.3% (64/141) were tissue samples and 54.6% (77/141) were wound swabs. Culture positivity observed in tissues was 43.7% (28/64), in wound swabs 50.6% (39/77) and mixed infections were observed in 7.14% (2/28) of tissues and 5.12% (2/39) of wound swabs. Colonisers were observed in 14.2% (11/77) of wound swabs. Specificity of Gram’s stain in comparison with tissue cultures was found to be 83.3% and sensitivity was 50%. Methicillin Sensitive Staphylococcus aureus (MSSA) 17.8% (05/28) and Escherichia coli 21.4% (6/28) were the major pathogens isolated from tissue cultures. Methicillin Resistant Staphylococcus aureus (MRSA) was isolated from 33.3% (13/39) of wound swabs followed by Escherichia coli (28.2%) (11/39). In the present study 25% (7/28) of tissue isolates showed Multidrug Resistance (MDR) and 3.5% (1/28) were Extended Spectrum Beta Lactamase (ESBL) producers. Among wound swabs 23% (9/39) isolates were MDR and 10.2% (4/39) were ESBL producers. Conclusion: In the present study it was observed that tissue samples were found to be better specimens in comparison with wound swabs for the diagnosis of implant infections. Hence, appropriate collection of sample helps in accurate isolation of pathogens in implant infections.

Aparajita Chatterjee,1 Shipra Rai,1 Vasudeva Guddattu,2 Chiranjay Mukhopadhyay,3 Kavitha Saravu1,4 1Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India; 2Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India; 3Department of Microbiology, Kasturba Medical College Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India; 4Manipal McGill Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India Purpose: To determine morbidity and mortality of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) infections in a tertiary health care facility.Methods: A cohort study among hospitalized adult patients with culture proven MRSA or MSSA monoinfection were recruited in a tertiary referral center in South India from November 2011 to December 2012.Results: Of total 551 subjects, 284 (52%) had MRSA and 267 (48%) MSSA infection. A total of 184 (65%) subjects had health care-associated MRSA (HA-MRSA) and 100 (35%) community-associated MRSA (CA-MRSA). Chronic kidney disease and recent antibiotic use had significant association with MRSA. MRSA patients had significant respiratory infection (OR 2.24 [1.04, 5.16]) and bacteremia (OR 2.24 [10.40, 5.16]), relative to MSSA. MSSA group had better survival function compared to MRSA group (P=0.028). Median duration of ICU stays were 5 days (IQR 4, 8) and 2 days (IQR 2, 2) in MRSA and MSSA, respectively. Complications such as acute kidney injury, sepsis, multiorgan dysfunction, need for supportive measures were more in the MRSA group.Conclusion: MRSA imposes a huge burden in Indian scenario and HA-MRSA remains the main culprit. Patients with history of chronic kidney disease and recent use of antibiotics were found to be at a higher risk. Patients with MRSA infections tend to have poorer outcomes in terms of longer hospital stay, greater complications, and mortality. Keywords: methicillin-resistant Staphylococcus aureus, Staphylococcus aureus, risk factors, outcome, mortality, India, prognosis, impact, morbidity