https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/498 Sun, 22 Oct 2023 11:32:44 +0000 Abstract Introduction and Objectives: Transmission of methicillin-resistant Staphylococcus aureus (MRSA) from healthcare workers is one of the most frequent causes of nosocomial infections globally. There is a significant burden of nosocomial MRSA infections in low and low-middle income countries (LMICs), including Nepal. The present study investigated the rate of nasal carriage of MRSA among the healthcare workers in a tertiary care hospital, in Kathmandu, Nepal with emphasis on inducible macrolide-lincosamide-streptogramin B (iMLSB) resistance. Material and method: The study was conducted at Star Hospital, Lalitpur, Nepal, from September 2022 to November 2022. Healthcare workers (HCWs) working at the different departments of the hospital were enrolled. Nasal swabs from both anterior nares of HCWs were collected aseptically and cultured on Mannitol Salt agar. S. aureus was identified by Gram stain and standard biochemical tests. Antibiotic susceptibility of S. aureus was performed by disc diffusion method. MRSA isolates were detected phenotypically by disc diffusion method using cefoxitin disc (30 µg), and inducible clindamycin resistance was detected phenotypically by the D-zone test. Results: Total 105 HCWs were enrolled in the study. Out of 105 HCWs, 14 (13.3%) were positive for S. aureus among which 6 (5.7%) were MRSA carriers. The nasal carriage of MRSA was highest among doctors (16.7%) and the HCWs of the post-operative department (14.3%). All the isolated MRSA were susceptible to chloramphenicol and vancomycin. Inducible MLSB resistance was detected in 33.3% MRSA while the rate was 21.4% in all isolated S. aureus. Conclusion: The study demonstrated that HCWs could be the potential source of nosocomial infection by methicillin and inducible clindamycin resistant S. aureus. Thus, preventive measures should be initiated to mitigate the risk of its spread and the test for detection of inducible clindamycin resistance should be incorporated into the routine antibiotic susceptibility testing in hospital settings. IMC J Med Sci. 2024; 18(1):005. DOI: https://doi.org/10.55010/imcjms.18.005   *Correspondence: Gaurab Pandey, Non-Communicable Disease Laboratory, National Public Health Laboratory, Teku, Kathmandu, 44600, Nepal; E-mail: pandeygaurab67@gmail.com   Introduction Staphylococcus aureus is a Gram-positive coccus, arranged in clusters and is ubiquitously present as normal flora in humans and animals [1]. S. aureus is a highly infectious human pathogen that, despite being a normal component of the floral biota, has the potential to cause a wide variety of infections ranging from minor cutaneous symptoms to fatal sepsis [2]. Its adaptive versatility to alternating host and environmental conditions has rendered it a clinically important bacterium. Macrolide-lincosamide-streptogramin B (MLSB) antibiotics are commonly used for the management of infection by MRSA [5]. The category of antibiotics known as MLSB includes the macrolides (such as erythromycin, azithromycin, and spiramycin), lincosamides (such as clindamycin, and lincomycin), and streptogramin B (such as quinupristin). Clindamycin is a popular choice for various staphylococcal infections, notably skin and soft tissue infections, and it is an alternative for people who are allergic to penicillin. This has caused clinicians to become more interested in MLSB antibiotics to treat S. aureus infections rather than penicillin derivatives [6,7]. However, with time and overuse, S. aureus has also acquired resistance against MLSB antibiotics. Resistance to MLSB antibiotics is mediated by methylation of rRNA, active efflux and enzymatic inactivation [8]. The expression of the bacterial resistance to MLSB antibiotics may either be constitutive or inducible. Therefore, clinical failures may result if resistance to MLSB antibitics is not sufficiently investigated in the laboratory [6,8]. Hospital-acquired infections (HAIs) are a major problem in the world today and healthcare workers are an important reservoir of infectious agents. Undoubtedly, HAIs are an important interface between healthcare centers and the community [15,16]. HAIs due to MRSA is associated with significant morbidity, mortality and cost burden [15]. HCWs are more frequently viewed as vectors, rather than being the main source of MRSA transmission [17]. The commonest mode of MRSA transmission has been through the hands of HCWs contaminated with colonizer MRSA. Several case reports have documented symptomatic clinical MRSA infections among carrier HCWs [18]. This study examined the nasal carriage of MRSA in a tertiary care hospital in Kathmandu, Nepal, and studied their antibiotic susceptibility pattern with emphasis on inducible macrolide-lincosamide-streptogramin B (iMLSB) resistance. The findings of this project are aimed at bringing forth the importance of antimicrobial procedures and infection control strategies by and within healthcare workers. Materials and Methods 3.     Jevons MP. “Celbenin”-resistant Staphylococci. Br Med J. 1961;1(5219):124-125. 5.     Adaleti R, Nakipoglu Y, Ceran N, Tasdemir C, Kaya F, Tasdemir S. Prevalence of phenotypic resistance of Staphylococcus aureus isolates to macrolide, lincosamide, streptogramin B, ketolid and linezolid antibiotics in Turkey. Braz J Infect Dis. 2010; 14(1): 11-14. doi:10.1590/s1413-86702010000100003. 7.     Sathish JV, Janakiram K, Vijaya D. Inducible clindamycin resistance in Staphylococcus aureus: Reason for treatment failure. J Int Med Dentistry; 2015; 2(2): 97-103.doi: 10.18320/JIMD/201502.0297. 9.     Samia NI, Robicsek A, Heesterbeek H, Peterson LR. Methicillin-resistant Staphylococcus aureus nosocomial infection has a distinct epidemiological position and acts as a marker for overall hospital-acquired infection trends. Sci Rep. 2022; 12(1): 17007. doi:10.1038/s41598-022-21300-6. 11. Rongpharpi SR, Hazarika NK, Kalita H. The prevalence of nasal carriage of Staphylococcus aureus among healthcare workers at a tertiary care hospital in Assam with special reference to MRSA. J Clin Diagn Res. 2013; 7(2): p.257. doi:10.7860/JCDR/2013/4320.2741. 13.  Khanal LK, Jha BK. Prevalence of methicillin resistant Staphylococcus aureus (MRSA) among skin infection cases at a hospital in Chitwan, Nepal. Nepal Med Coll J. 2010; 12(4): 224-228. 15.  Kandel SN, Adhikari N, Dhungel B, Shrestha UT, Angbuhang KB, Karki G, et al. Characteristics of Staphylococcus aureus isolated from clinical specimens in a tertiary care hospital, Kathmandu, Nepal. Microbiol Insights. 2020; 13:1178636120972695. doi:10.1177/1178636120972695. 17.  Albrich WC, Harbarth S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis. 2008; 8(5): 289-301. doi:10.1016/S1473-3099(08)70097-5. 23.  Giri N, Maharjan S, Thapa TB, Pokhrel S, Joshi G, Shrestha O, et al. Nasal Carriage of Methicillin-Resistant Staphylococcus aureus among Healthcare Workers in a Tertiary Care Hospital, Kathmandu, Nepal. Int J Microbiol. 2021;2021:8825746. doi:10.1155/2021/8825746. 25.  Neupane R, Bhatt N, Poudyal A, Sharma A. Methicillin-resistant Staphylococcus aureus nasal carriers among laboratory technical staff of tertiary hospital in Eastern Nepal. Kathmandu Univ Med J (KUMJ). 2020; 18(69): p. 3-8. 2026 Ibrahim Medical College. All rights reserved.