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LETTER TO THE EDITOR |
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Year : 2015 | Volume
: 8
| Issue : 5 | Page : 692-694 |
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Community acquired pyodermas and methicillin-resistant Staphylococcus aureus
Yukti Sharma, Sanjay Jain
Department of Microbiology, Hindu Rao Hospital, New Delhi, India
Date of Web Publication | 10-Sep-2015 |
Correspondence Address: Yukti Sharma 272 SFS (DDA) Flats, Mukherjee Nagar, New Delhi - 110 009 India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.164968
How to cite this article: Sharma Y, Jain S. Community acquired pyodermas and methicillin-resistant Staphylococcus aureus. Med J DY Patil Univ 2015;8:692-4 |
Sir,
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged recently contributing to longer hospital stays, patient morbidity and mortality. Studies from Geneva and Europe show most CA-MRSA strains isolated to be associated with skin and soft tissue infections (SSTIs), affecting their family members also.[1] There are plenty of reports regarding hospital-acquired MRSA but there is scarcity of data, regarding CA-MRSA from North India, from pyoderma cases. This propelled us into taking up the present study. The objective of this prospective study is to primarily determine the contribution of CA-MRSA in these infections, to assess risk factors, and susceptibility profile.
The study, carried out in a government hospital in North Delhi (July-August 2012), included 58 cases of community-acquired pyodermas visiting the outpatient department of Dermatology. Samples were proceeded according to Clinical and Laboratory Standards Institute.[2] Antimicrobial susceptibility was assessed by disk-diffusion tests. Discs used were: Oxacillin (1 µg), ciprofloxacin (5 µg), gentamicin (10 µg), amikacin (30 µg), linezolid (30 µg), cefuroxime (30 µg) and vancomycin (30 µg) (Hi-Media, Mumbai, India). S. aureus ATCC 25923 was used as internal control in each run.
Surveillance reports and risk factors for CA-MRSA transmission were studied[3],[4] and questionnaire was made. This included age; sex; occupation; household member with similar complaints; presence of chronic recurrent diseases; hospitalizations within the previous year; use of anti-biotics within the previous year; history of SSTIs within the previous year.
Patients with chronic diseases, hospitalized in previous 1-year, used anti-biotics in past 1-year or history of SSTIs in the previous year were excluded. To determine the significance, Chi-square test was used. P < 0.05 was considered as significant.
Of the 58 patients enrolled 19 were males and 39 females. Age ranged from 7 months to 76 years (mean age 26 years). Incidence of MRSA was 17% (10/58) [Table 1] and [Table 2]. Culture negative samples constituted 21% (12/58) of the total whereas MRSA constituted 27% (10/37) of all S. aureus isolates. Peak incidence of pyoderma was observed between 11 and 20 years [Table 3]. At least 14 patients infected with S. aureus had a household member having similar infection (14/37 = 38%). significant relation was seen with methicillin-susceptible Staphylococcus aureus (MSSA) (P < 0.0113) [Table 4]. S. aureus was the predominant pathogen isolated from 37 patients (64%). | Table 1: Bacteriological profile of various organisms cultured (percentage)
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| Table 3: Percentage wise distribution of drug resistance of MRSA and MSSA
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Amidst increasing reports of CA-MRSA, the present prospective study tried to determine the same in pyoderma patients visiting this hospital. MSSA was the predominant CA-SSTI pathogen. S. aureus was yielded in 64% (37/58) patients. It is the predominant pathogen reported in other studies as well (81%).[5] In South India no. of S. aureus isolated were higher compared to the present study (81%: 202/250).[6] National Staphylococcal Phage Typing Centre, New Delhi, reported an increase in the occurrence of MRSA strains from 10% in 1992 to 45% in 1998.[7] In North India, prevalence of MRSA was 19% as against South India (31%).[7] MRSA constituted 17% of isolates similar to Patil et al.(16%) and from Delhi (10%).[5],[6] This may also indicate toward a plateau phase in the occurrence of MRSA in North India. Intense studies are needed to support this observation.
Peak incidence of pyoderma was observed in the first decade (11-20 years) [Table 2] also observed by Carlos et al. (42%) amongst pediatric age group.[8] Surveillance studies across US found a five-fold increase, from 6% to 36%, in the proportion of CA-MRSA isolates from children under fifteen.[8] Population based studies regarding MRSA is need of the hour, which are presently lacking in India.
About 38% of patients infected with S. aureus had a household member with similar infection further pointing toward the contagious nature of S. aureus.[9] The possibility of patients harboring S. aureus strains in their body and thereby acting as sources for further spread, cannot be ruled out.
Gentamicin resistance for MRSA was 60% [Table 2]. More than 95.0% of MSSA tested susceptible to cefuroxime and ceftriaxone which have also been studied elsewhere.[6] Ciprofloxacin resistance was almost similar in MSSA (74%) and MRSA (80%).
Present study does emphasize the occurrence of community-acquired Staphylococcus, its ability to infect the young and spread in the family, thereby the community and its active implication in pyodermas. A rigorous combination of appropriate anti-microbial therapy along with surgical drainage helps in limiting morbidity and mortality related SSTIs. Anti-microbial of choice should include oral drugs like aminopenicillins. With other reports from India highlighting the prevalence of CA-MRSA, a strict surveillance needs to be maintained to detect the emergence of these strains in the community.[5],[6]
References | | |
1. | Francois P, Harbarth S, Huyghe A, Renzi G, Bento M, Gervaix A, et al. Methicillin-resistant Staphylococcus aureus, Geneva, Switzerland, 1993-2005. Emerg Infect Dis 2008;14:304-7. |
2. | Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Approved standard. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. p. S17. |
3. | Wang JT, Liao CH, Fang CT, Chie WC, Lai MS, Lauderdale TL, et al. Prevalence of and risk factors for colonization by methicillin-resistant Staphylococcus aureus among adults in community settings in Taiwan. J Clin Microbiol 2009;47:2957-63. |
4. | |
5. | Patil R, Baveja S, Nataraj G, Khopkar U. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired primary pyoderma. Indian J Dermatol Venereol Leprol 2006;72:126-8. [ PUBMED] |
6. | Nagaraju U, Bhat G, Kuruvila M, Pai GS, Jayalakshmi, Babu RP. Methicillin-resistant Staphylococcus aureus in community-acquired pyoderma. Int J Dermatol 2004;43:412-4. |
7. | Mehndiratta PL, Vidhani S, Mathur MD. A study on Staphylococcus aureus strains submitted to a reference laboratory. Indian J Med Res 2001;114:90-4. |
8. | Carlos TG, Sura S, Mohamed T, Lin T, Meadows M, Cynthia D, et al. Current role of community-acquired methicillin-resistant Staphylococcus aureus among children with skin and soft tissue infections. Pediatr Rep 2012;4:e5. |
9. | Phakade RS, Nataraj G, Kuyare SS, Khopkar US, Mehta PR. Is methicillin-resistant Staphylococcus aureus involved in community acquired skin and soft tissue infections? Experience from a tertiary care centre in Mumbai. J Postgrad Med 2012;58:3-7. [ PUBMED] |
[Table 1], [Table 2], [Table 3], [Table 4]
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