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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 2019 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. Results: Among 90 MRSA isolates, most were from pus (51) followed by Urine (23), Blood (9), followed by Miscellaneous samples (7). Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 16.0 software. 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Methicillin resistance in Staphylococcus aureus is associated with multidrug resistance, an aggressive course, increased mortality and morbidity in both community and health care facilities. Monitoring of newly emerging and prevalent Methicillin Resistant Staphylococcus aureus (MRSA) strains for their resistance patterns to conventional as well as novel drugs, are essential for infection control. Aims: To study the changing trends in resistance patterns of MRSA at our hospital. Settings and Design: This cross sectional study was carried out in a 750 bed tertiary care hospital in south India. Material and Methods: One hundred and two clinical isolates of MRSA which were obtained in 2004-2011 were identified by using oxacillin, cefoxitin disc diffusion test and oxacillin screening agar test. Antibiotic susceptibility test was done for commonly used non beta lactam anti-Staphylococcal drugs, as well as for anti-MRSA drugs like vancomycin, linezolid, mupirocin and rifampicin. Minimum inhibitory concentration (MIC) of vancomycin was determined by using Vancomycin HiComb strip (Himedia, Mumbai, India). Statistical Analysis which was done: Chi-square test and proportions were used to compare the two groups. Results: MRSA isolates showed high resistance to cotrimoxazole (82.3%), ciprofloxacin (76.4%), gentamicin (64.7%) and tetracycline (49%) as compared to other drugs. High prevalence of ciprofloxacin resistance was detected, particularly among outpatients. Multi resistant MRSA with a ≥ 3 non-beta lactam agent resistance was 79%. All MRSA isolates were sensitive to vancomycin, linezolid, mupirocin and rifampicin. MRSA had displayed increase in resistance to most antibiotics except tetracycline in recent years. Conclusions: Taking into consideration the prevalence of multidrug resistance in MRSA, resistance patterns should be evaluated periodically and antibiotic therapy should be guided by susceptibility testing. [ABSTRACT FROM AUTHOR]

Purpose: Staphylococcus aureus has developed resistance against most of the therapeutic agents. The most notable example of this phenomenon was the emergence of Methicillin resistant Staphylococcus aureus (MRSA). We are reporting the prevalence and the antibiotic susceptibility pattern of the MRSA isolates from a tertiary care hospital. Methods: A total of 450 Staphylococcus aureus isolates from clinical samples were taken up for the study and they were screened for MRSA by using standard microbiological methods. An antibiotic assay was done for the confirmed MRSA isolates. The differentiation of the isolates into community acquired MRSA (CAMRSA) and hospital acquired MRSA (HAMRSA) was done according to the prescribed criteria. The double disc diffusion test was performed for both the groups, to identify the inducible clindamycin resistance. The HAMRSA and the CAMRSA isolates were subjected to a molecular analysis by PCR, to detect the presence of the Mec A gene and the PVL gene respectively. Results: Out of the 450 Staphylococcus aureus isolates, 121 were Methicillin Resistant Staphylococcus aureus (MRSA, 27%) and 329 were Methicillin Sensitive Staphylococcus aureus (MSSA, 73%). 91 MRSA isolates were grouped into HAMRSA and 30 were grouped into CAMRSA, with a prevalence of 20% and 7% respectively. All the MRSA strains were resistant to Penicillin (100%), Cefoxitin (100%) and Oxacillin (100%). 53.7% of the HAMRSA isolates showed inducible clindamycin resistance against that of 44.4% among the CAMRSA isolates. All the isolates were susceptible to Vancomycin and Linezolid. 64% of the HAMRSA isolates showed the presence of the Mec A gene and 48% of the CAMRSA isolates showed the presence of the PVL genes. Conclusion: The prevalence of the HAMRSA was higher than that of the CAMRSA and they showed a higher drug resistance. [ABSTRACT FROM AUTHOR]

Background and Objectives: The treatment of Staphylococcus aureus infections is becoming increasingly more complicated due to the emergence of various types of antibiotic resistance. The present study was undertaken to know the prevalence of methicillin resistant Staphylococcus aureus (MRSA), vancomycin intermediate and vancomycin resistant Staphylococcus aureus (VISA and VRSA respectively) and multidrug resistant MRSA and to evaluate the phenotypic detection methods. Materials and Methods: A total of 250 non-duplicate isolates of Staphylococcus aureus which were isolated from various clinical samples were tested for methicillin resistance by using the oxacillin disc diffusion test (1μg), the cefoxitin disc diffusion test (30 μg) and the oxacillin agar screen method (Muller Hinton agar (MHA) with 4% NaCl+6 μg/ml oxacillin). Vancomycin screen agar (MHA containing 5 μg/ml vancomycin) was used for screening the VISA/VRSA isolates. The MIC of vancomycin was determined by using the agar dilution method and the E-test. The antibiogram of the isolates to other antibiotics was studied by the Kirby-Bauer disc diffusion method. Results: 80 (32%) isolates were found to be methicillin resistant by the cefoxitin disc diffusion method, 78 (31.2%) were found to be methicillin resistant by the oxacillin agar screen test and 77 (30.8%) were found to be methicillin resistant by the oxacillin disc diffusion method. No VISA and VRSA isolate was detected by using the vancomycin screen agar test, agar dilution and the E-test. The vancomycin screen agar showed 100% specificity and 100% negative predictive value. Sixty seven (83.8%) of the 80 MRSA isolates and 26.8 % of the total 250 Staphylococcus aureus isolates tested were found to be multidrug resistant MRSA. Conclusions: Where the facilities are limited, the cefoxitin disc diffusion test and the vancomycin screen agar test can be used for screening the MRSA and the VRSA isolates respectively. With the revised CLSI guidelines, the screening method for VISA with an MIC of 4μg/ml needs to be evaluated with further more studies. [ABSTRACT FROM AUTHOR]

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infection outbreaks and prevalence among various populations have been well reported in the literature, particularly with respect to the developed and the developing countries. The hospital personnel tend to have higher colonization of MRSA than the general population. The personnel with MRSA colonization are the sources of dissemination of the organisms, both in the hospital and the community. Aim: The present study was conducted to assess the carriage rate of MRSA among health care workers (HCWs). Design: A hospital based prospective study. Place and Duration: Department of Microbiology, ESIC-MC-PGIMSR, Rajajinagar, Bangalore, from October 2010 to April 2011. Materials and Methods: A total of 150 HCWs who were involved in the management of critically ill patients [in the intensive care unit (adult), all surgical specialties, post-operative surgical wards, major OT and minor OT] were screened for MRSA by collecting their nasal swabs, throat swabs and swabs from the webs of their fingers. Staphylococcus aureus was identified by the standard methods. Antibiotic susceptibility was performed according to the Kirby-Bauer disc diffusion method. MRSA was identified by using a cefoxitin 30 mcg disc and it was interpreted according to the Clinical Laboratory Standards Institute guidelines. All the carriers which were identified were decolonized with Mupirocin (Supirocin ointment 2% Glen mark), local application twice a day for ten days, and subsequently, they were checked for the decolonized state. Statistical analysis: The findings were statistically analyzed by using the Chi-square test. Results: Of the 150 HCWs who were screened, 15 (10%) had MRSA either in the nose or on the hand. The nasal carriage of MRSA was higher (8%) than the hand carriage (2%) and none had throat carriage as compared to the Methicillin sensitive Staphylococcus aureus carriage rate in the nose and on the hand 3.4% and 0.6% respectively, which was statistically significant (p< 0.05). Doctors, nurses and nursing orderlies were the predominant carriers (4%, 2%, and 2%, respectively). The antibiogram of the MRSA isolates revealed the highest resistance to penicillin and amoxyclav (93% each). The sensitivity to erythromycin, gentamicin, amikacin, ciprofloxacin and cotrimoxazole was variable (53%-73%). All the MRSA isolates were sensitive to vancomycin. Thirteen (86.6 %) carriers were successfully decolonized with the local application of Mupirocin. However, two of the carriers did not take part in the further studies. Conclusion: The MRSA carriage rate among the HCWs in our hospital was high, particularly among the doctors and nurses. Screening and decolonization may be effective in decreasing the MRSA carriage rate among the HCWs. Standard infection control precautions should be employed in the professional practice to minimize either the carriage or the transmission rate. [ABSTRACT FROM AUTHOR]

Introduction: Mupirocin is widely used topical antibiotic for the treatment of skin and soft tissue infections caused by Staphylococcus and Streptococcus. In addition nasal formulations are approved for the use in nasal eradication of methicillin-resistant Staphylococcus aureus in patients and health care workers. Wide usage of mupirocin has resulted in resistance leading to treatment failure. Aim: To screen for the mupirocin resistance among the Staphylococcus isolates using disc diffusion and minimum inhibitory concentration method. Materials and Methods: A cross-sectional study was done at Microbiology Department of Sri Ramachandra University with 100 strains of Staphylococcus spp isolated from skin and soft tissue infections. Methicillin susceptibility was done by disc diffusion method using oxacillin (1 μgm) and cefoxitin (30 μgm) discs. Isolates were screened for mupirocin resistance by disc diffusion method using 5 μgm discs. High level and low level resistance determined by MIC using agar dilution method. Results: In 100 Staphylococcus spp 56 were Staphylococcus aureus and 44 were CoNS. Among the 56 Staphylococcus aureus 49 (87.5%) were mupirocin susceptible and 7 (12.5%) resistant by 5μg disc diffusion method. However by MIC method 11 (19.6%) were high and low level mupirocin resistant. Out of 44 CoNS 22 (50%) and 18 (41%) were susceptible by disc diffusion and MIC method respectively. Of the 26 resistant CoNS low level and high level mupirocin resistant was observed in 7 (15.9%) and 19 (43.1%) respectively. Conclusion: Screening for mupirocin resistance by disc diffusion method is important before attempting decolonisation. Mupirocin resistance is more with CoNS. Disc diffusion method may miss low level Mupirocin resistance [ABSTRACT FROM AUTHOR]