Susceptibility to Vancomycin of Biofilm Producing Staphylococci Isolated from Tertiary Care Hospital of Nepal

Authors

  • Sarita Manandhar TriChandra Multiple College, Tribhuvan University
  • Ratna Tuladhar
  • Raju Shrestha
  • Sunil Lekhak
  • Mahesh Chaudhary
  • Krishna Prajapati

DOI:

https://doi.org/10.17533/udea.vitae.v29n2a348937

Keywords:

staphylococci, methicillin resistant staphylococci, biofilm, ica genes, vancomycin resistant staphylococci

Abstract

BACKGROUND: Methicillin resistance and biofilm-producing Staphylococci are emerging as multidrug-resistant strains narrowing the efficacy of antimicrobial therapy. Although vancomycin is used as the drug of choice to treat such isolates, different studies worldwide have documented the emergence of strains that are intermediately susceptible or resistant to this antibiotic.

OBJECTIVE: The study aimed to determine the minimum inhibitory concentration of vancomycin to methicillin-resistant and biofilm-producing staphylococci isolated from different clinical specimens.

METHODS: 375 staphylococci isolated from different clinical specimens over one year were included in the study. Biofilm formation was determined by the Tissue culture plate method (TCP), and ica genes were identified by Polymerase Chain Reaction (PCR). Antibiotic susceptibility and methicillin resistance were done following Clinical and Laboratory Standards Institute (CLSI) guidelines. The minimum inhibitory concentration (MIC) of vancomycin in all isolates was determined by the agar dilution method.

RESULTS: Among 375 Staphylococci studied, 43% and 57% represented S. aureus and Coagulase-Negative Staphylococci (CNS), respectively. The rate of Methicillin-Resistant S. aureus (MRSA) and Methicillin-Resistant Coagulase Negative Staphylococci (MRCNS) were 81.4% and 66.8% respectively and determined by the disc diffusion method. The most potential antibiotics were tetracycline and chloramphenicol showing sensitivity to more than 90% isolates. The Minimum Inhibitory Concentration (MIC) value of oxacillin for staphylococci ranged from 0.125-32 μg/ml. Oxacillin agar diffusion method showed 51.6% and 79.9% isolates as MRSA and MRCNS, respectively, revealing a very high percentage of S. aureus and CNS isolates as methicillin-resistant. All isolates had susceptible vancomycin MICs that ranged from 0.125-2 μg/ml. Two S. aureus isolated from Central Venous Catheter (CVC) and catheter specimens were detected with intermediate susceptibility to vancomycin. Similarly, three CNS isolated from blood, CVC, and wound/pus (w/p) were intermediately susceptible to vancomycin. Strong biofilm formation was observed in 22.1% of clinical isolates, and the ica gene was detected among 22.9% of isolates. Only one S. aureus detected as a biofilm producer by the TCP method was found to have intermediate susceptibility to vancomycin.

CONCLUSIONS: The increment in vancomycin MIC among methicillin-resistant and biofilm-producing staphylococci is alarming. Strict control measures to prevent methicillin-resistant isolates spread and routine surveillance for vancomycin-resistant isolates must be incorporated in hospitals to prevent antimicrobial treatment failure.

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References

Papa R, Artini M, Cellini A, Tilotta M, Galano E, Pucci P, et al. A new anti-infective strategy to reduce the spreading of antibiotic resistance by the action on adhesion-mediated virulence factors in Staphylococcus aureus. Microbial Pathogenesis. 2013;63:44–53. DOI: https://doi.org/10.1016/j.micpath.2013.05.003

Deurenberg RH, Vink C, Kalenic S, Friedrich AW, Bruggeman CA, Stobberingh EF. The molecular evolution of methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection. 2007;13:222-35. DOI: https://doi.org/10.1111/j.1469-0691.2006.01573.x

Becker K, Heilmann C, Peters G. Coagulase-negative staphylococci. Clinical Microbiology Reviews. 2014;27:870-926. DOI: https://doi.org/10.1128/CMR.00109-13

Berger-Bachi B, Rohrer S. Factors influencing methicillin resistance in staphylococci. Archives of Microbiology. 2002;178:165-171. DOI: https://doi.org/10.1007/s00203-002-0436-0

LaPlante KL, Rybak MJ, Amjad M, Kaatz GW. Antimicrobial susceptibility and staphylococcal chromosomal cassette mec type in community and hospital-associated methicillin-resistant Staphylococcus aureus. Pharmacotherapy. 2007;27:3-10. DOI: https://doi.org/10.1592/phco.27.1.3

Kshetry AO, Pant ND, Bhandari R, Khatri S, Shrestha KL, Upadhaya SK. Minimum inhibitory concentration of vancomycin to methicillin resistant Staphylococcus aureus isolated from different clinical samples at a tertiary care hospital in Nepal. Antimicrobial Resistance and Infection Control. 2016;5:27. DOI: https://doi.org/10.1186/s13756-016-0126-3

Sakoulas G, Moellering Jr RC, Eliopoulos GM. Adaptation of methicillin-resistant Staphylococcus aureus in the face of vancomycin therapy. Clinical Infectious Diseases. 2006;42 (Suppl 1):S40-50. DOI: https://doi.org/10.1086/491713

Gonzalez BE, Rueda AM, Shelburne III SA, Musher DM, Hamill RJ, Hulten KG. Community-associated strains of methicillin-resistant Staphylococcus aureus as the cause of healthcare-associated infection. Infection Control and Hospital Epidemiology. 2006;27:1051–1056. DOI: https://doi.org/10.1086/507923

Chen SY, Liao CH, Wang JL, Chianh WC, Lai MS, Chie WC. Method-specific performance of vancomycin MIC susceptibility tests in predicting mortality of patients with methicillin-resistant Staphylococcus aureus bacteraemia. Journal of Antimicrobial Chemotherapy. 2014;69:211–218. DOI: https://doi.org/10.1093/jac/dkt340

Amatya R, Devkota P, Gautam A. Reduced susceptibility to vancomycin in methicillin resistant Staphylococcus aureus: a time for action. Nepal Medical College Journal. 2014;16:42–44. PMID: 25799810

Holt JG, Krieg NR, Sneath PHA, Staley JT, Williams ST. Gram positive cocci. In: Hensyl WR (ed). Bergey’s manual of determinative microbiology, 9th ed., Williams and Wilkins, Baltimore; 1994: 527-558.

Cunha MDLRS, Sinzato YK, Silveira LV. Comparison of methods for the identification of coagulase-negative staphylococci. Memorias do Instituto Oswaldo Cruz. 2004;99:855–860. DOI: https://doi.org/10.1590/s0074-02762004000800012

Clinical Laboratory Standards Institute (CLSI). CLSI supplement M100. Performance Standards for Antimicrobial Susceptibility Testing. 28th ed.. Wayne, PA: CLSI; 2018.

Clinical Laboratory Standards Institute (CLSI). CLSI standard M0. Methods for Dilution Antimicrobial susceptibility test for Bacteria that Grow Aerobically. 11th ed.. Wayne, PA: CLSI; 2018.

Christensen GD, Simpson WA, Younger JJ, Baddour LM, Barrett FF, Melton DM, et al. Adherence of coagulase-negative staphylococci to plastic tissue culture plates: A quantitative model for the adherence of staphylococci to medical devices. Journal of Clinical Microbiology.1985;22:996–1006. DOI: https://doi.org/10.1128/jcm.22.6.996-1006.1985

Manandhar S, Singh A, Varma A, Pandey A, Shrivastava N. Biofilm Producing Clinical Staphylococcus aureus Isolates Augmented Prevalence of Antibiotic Resistant Cases in Tertiary Care Hospitals of Nepal. Frontiers in Microbiology. 2018;9:2749. DOI: https://doi.org/10.3389/fmicb.2018.02749

Sanjana R, Shah R, Chaudhary N, Singh Y. Prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) in CMS-teaching hospi tal: a preliminary report. Journal of College of Medical Sciences Nepal. 2010;l6:1–6. DOI: https://doi.org/10.3126/jcmsn.v6i1.3595

Pandey S, Raza MS, Bhatta CP. Prevalence and antibiotic sensitivity pattern of Methicillin-Resistant Staphylococcus aureus in Kathmandu Medical College Teaching Hospital. Journal of Institute of Medicine. 2012;34:13–17. DOI: https://doi.org/10.3126/jiom.v34i1.9117

Mukhiya RK, Shrestha A, Rai SK, Panta K, Rai G, Prajapati A. Prevalence of Methicillin-Resistant Staphylococcus aureus in Hospitals of Kathmandu Valley. Nepal Journal of Science and Technology. 2012;12:185-190. DOI: https://doi.org/10.3126/njst.v13i2.7734

Ansari S, Nepal HP, Gautam R, Rayamajhi N, Shrestha S, Upadhyay G, et al. Threat of drug resistant Staphylococcus aureus to health in Nepal. BMC Infectious diseases. 2014;14:157. DOI: https://doi.org/10.1186/1471-2334-14-157

Bhatta DR, Cavaco LM, Nath G, Gaur A, Gokhale S, Bhatta DR. Threat of multidrug resistant Staphylococcus aureus in Western Nepal. Asian Pacific Journal of Tropical Diseases. 2015;5:617–621. DOI: https://doi.org/10.1186/s12879-016-1531-1

Pant ND, Sharma M. Carriage of methicillin resistant Staphylococcus aureus and awareness of infection control among health care workers working in intensive care unit of a hospital in Nepal. Brazilian Journal of Infectious Disease. 2016;20:218–219. DOI: https://doi.org/10.1016/j.bjid.2015.11.009

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug resistant, extensively drug-resistant and pandrug resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection.2012;18:268–281. DOI: https://doi.org/10.1111/j.1469-0691.2011.03570.x

Ba X, Harrison EM, Edwards GF, Holden MTG, Larsen AR, Petersen A, et al. Novel mutations in penicillin-binding protein genes in clinical Staphylococcus aureus isolates that are methicillin resistant on susceptibility testing, but lack the mec gene. Journal of Antimicrobial Chemotherapy. 2014;69:594–597. DOI: https://doi.org/10.1093/jac/dkt418

Maalej SM, Rhimi FM, Fines M, Mnif B, Leclercq R, Hammami A. Analysis of borderline oxacillin resistant Staphylococcus aureus (BORSA) strains isolated in Tunisia. Journal of Clinical Microbiology. 2012;50:3345-3348. DOI: https://doi.org/10.1128/jcm.01354-12

Nunes APF, Schuenck RP, Bastos CCR, Magnanini MMR, Long JB, Iorio NLP, et al. Heterogeneous resistance to vancomycin and teicoplanin among Staphylococcus spp. isolated from bacteremia. Brazilian Journal of Infectious Disease. 2007;11:345–350.

Pahadi PC, Shrestha UT, Adhikari N, Shah PK, Amatya R. Growing resistance to vancomycin among methicillin resistant Staphylococcus aureus isolates from different clinical samples. Journal of Nepal Medical Association. 2014;52:977–981.

Adhikari R, Pant ND, Neupane S, Neupane M, Bhattari R, Chaudhary R, et al. Detection of Methicillin Resistant Staphylococcus aureus and Determination of Minimum Inhibitory Concentration of Vancomycin for Staphylococcus aureus isolated from Pus/Wound Swab Samples of the Patients Attending a Tertiary Care Hospital in Kathmandu, Nepal. Canadian Journal of Infectious Diseases and Medical Microbiology. 2017;Article ID 2191532:6 pages. DOI: https://doi.org/10.1155/2017/2191532

Mashaly GE, El Mahdy RH. Vancomycin heteroresistance in coagulase negative Staphylococcus blood stream infections from patients of intensive care units in Mansoura University Hospitals, Egypt. Annals of Clinical Microbiology and Antimicrobials. 2017;16:63. DOI: https://doi.org/10.1186/s12941-017-0238-5

Ahlstrand E, Svensson K, Persson L, Tidefelt U, Soderquist B. Glycopeptide resistance in coagulase-negative staphylococci isolated in blood cultures from patients with hematological malignancies during three decades. European Journal of Clinical Microbiology and Infectious Diseases. 2011;30:1349–1354. DOI: https://doi.org/10.1007/s10096-011-1228-8

Mirani ZA, Aziz M, Khan MN, Lal I, Hassan N ul, Khan SI. Biofilm formation and dispersal of Staphylococcus aureus under the influence of oxacillin. Microbial Pathogenesis. 2013;61-62:66–72. DOI: https://doi.org/10.1016/j.micpath.2013.05.002

Al Tayyar IA, Al-Zoubi MS, Hussein E, Khudairat S, Sarosiekf K. Prevalence and antimicrobial susceptibility pattern of coagulase-negative staphylococci (CoNS) isolated from clinical specimens in northern of Jordan. Iranian Journal of Microbiology. 2015;7:294–301.

May L, Klein EY, Rothman RE, Laxminarayan R. Trends in antibiotic resistance in coagulase-negative staphylococci in the United States, 1999 to 2012. Antimicrobial Agents and Chemotherapy. 2014;58:1404–1409. DOI: https://doi.org/10.1128/AAC.01908-13

Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clinical Microbiology Reviews. 2002;15:167–193. DOI: https://doi.org/10.1128/CMR.15.2.167-193.2002

Abassi MS, Bouchami O, Touati A, Achour W, Hassen AB. Clonality and occurrence of genes encoding antibiotic resistance and biofilm in methicillin-resistant Staphylococcus epidermidis strains isolated from catheters and bacteremia in neutropenic patients. Current Microbiology. 2008;57:442-448. DOI: https://doi.org/10.1007/s00284-008-9227-4

Koksal F, Yasar H, Samasti M. Antibiotic resistance patterns of coagulase-negative staphylococcus strains isolated from blood cultures of septicemic patients in Turkey. Microbiological Research. 2009;164:404-410. DOI: https://doi.org/10.1016/j.micres.2007.03.004

Klingenberg C, Aarag E, Ronnestad A, Sollid JE, Abrahamsen TG, Kjeldsen G, et al. Coagulase-negative staphylococcal sepsis in neonates: association between antibiotic resistance, biofilm formation and the host inflammatory response. Pediatric Infectious Disease Journal. 2005;24:817-822. DOI: https://doi.org/10.1097/01.inf.0000176735.20008.cd

Savage VJ, Chopra I, O’Neill AJ. Staphylococcus aureus biofilms promote horizontal transfer of antibiotic resistance. Antimicrobial Agents and Chemotherapy. 2013;57:1968–1970. DOI: https://doi.org/10.1128/aac.02008-12

Loomba PS, Taneja J, Mishra B. Methicillin and vancomycin resistant Staphylococcus aureus in hospitalized patients. Journal of Global Infectious Disease. 2010;2:275-283. https://www.jgid.org/text.asp?2010/2/3/275/68535

Raad I, Hanna H, Jiang Y, Dvorak T, Reitzel R, Chaiban G. Comparative activities of daptomycin, linezolid and tigecycline against catheter-related methicillin resistant Staphylococcus bacteremic isolates embedded in biofilm. Antimicrobial Agents and Chemotherapy. 2007;51:1656-1660. DOI: https://doi.org/10.1128/AAC.00350-06.

Palazzo ICV, Araujo MLC, Darini ALC. First report of vancomycin-resistant staphylococci isolated from healthy carriers in Brazil. Journal of Clinical Microbiology. 2005;43:179-185. DOI: https://doi.org/10.1128/JCM.43.1.179-185.2005

Shrestha LB, Bhattarai NR, Khanal B. Antibiotic resistance and biofilm formation among coagulase-negative staphylococci isolated from clinical samples at a tertiary care hospital of eastern Nepal. Antimicrobial resistance and infection control. 2017;6:89. DOI: https://doi.org/10.1186/s13756-017-0251-7

Archer NK, Mazaitis MJ, Costerton JW, Leid JG, Powers ME, Shirtliff ME. Staphylococcus aureus biofilms. Virulence. 2011;2:445–459. DOI: https://doi.org/10.4161/viru.2.5.17724

Arciola CR, Campoccia D, Speziale P, Montanaro L, Costerton JW. Biofilm formation in Staphylococcus implant infections. A review of molecular mechanisms and implications for biofilm-resistant materials. Biomaterials. 2012;33:5967–5982. DOI: https://doi.org/10.1016/j.biomaterials.2012.05.031

Oxacillin MIC values among Staphylococcal isolates

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Published

27-05-2022

How to Cite

Manandhar, S., Tuladhar, R., Shrestha, R., Lekhak, S., Chaudhary, M., & Prajapati, K. (2022). Susceptibility to Vancomycin of Biofilm Producing Staphylococci Isolated from Tertiary Care Hospital of Nepal. Vitae, 29(2). https://doi.org/10.17533/udea.vitae.v29n2a348937

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Section

Pharmacology and Toxicology

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