International Journal of Microbiology and Mycology | IJMM |

pISSN: 2309-4796
http://www.innspub.net
Vol. 7, No. 2, p. 1-7, 2018

Open Access RESEARCH PAPER

Screening for nasal carriage of methicillin resistant

Staphylococcus aureus among healthcare workers at a Rural
Teaching Hospital in Medchal District, Telangana

Jaya Banerjee1, K. Madhavi*1, S. Kiranmai1, R. K. Sureka2

1
Department of Microbiology, MediCiti Institute of Medical Sciences, Ghanpur Village,
Medchal Dist, Telangana state, India
2
Head of the Department, MediCiti Institute of Medical Sciences, Ghanpur Village,
Medchal Dist, Telangana state, India
Keywords: Staphylococcus aureus, MRSA, Healthcare worker, Nasal carrier

Publication date: March 30, 2018

Abstract
Staphylococcus aureus is a frequent cause of community and hospital acquired infections. One of the
important sources of Staphylococcus for nosocomial infection is nasal carriage among hospital
personnel. Emergence of drug resistance strains especially Methicillin resistant Staphylococcus aureus
is a serious problem in hospital environment. This study aimed to determine the nasal carriage rate of
Staphylococcus aureus with special reference to MRSA among healthcare workers at rural teaching
hospital in Medchal, Telangana. We screened 100 healthcare workers of various clinical departments of
MediCiti Institute of Medical Sciences. Nasal swabs taken from them were inoculated onto Blood Agar &
Mannitol Salt Agar within 1 hour and incubated aerobically at 37°C for 24–48 hours. β-haemolytic
colonies & Mannitol fermenting colonies which showed gram positive cocci in clusters in gram staining
and produced Catalase & Coagulase were identified as S. aureus. Antibiotic susceptibility test was
performed by Kirby-Bauer disc diffusion method. Methicillin resistance was detected using Cefoxitin
disc diffusion method. Out of 100 healthcare workers, 26 were nasal carriers of S. aureus and among
them 12 were carriers of MRSA. Overall nasal carriage rate of MRSA was 12%. Highest MRSA nasal
carriage was detected among housekeeping personnel. The high rate of nasal MRSA carriage among
healthcare workers found in this study necessitates improved infection control measures to be
employed to prevent MRSA transmission in our hospital setting through periodic surveillance.
* Corresponding Author: K. Madhavi  [email protected]

1 Banerjee et al.
Introduction Hence the screening of nasal carriage in HCWs is
Staphylococcus aureus (S. aureus) is one of the an important component in the control of MRSA
commonest bacterial pathogen causing in any healthcare facility.
community and hospital acquired infections. It is
a silent killer pathogen and it has remarkable The present study therefore, was aimed to
propensity for development of antibiotic determine the carriage rate of MRSA among the
resistance. The community and hospital acquired Healthcare Workers at a rural teaching hospital in
S. aureus infections has been rising, with Medchal district, Telangana.

increasing emergence of drug resistance strains,

Materials and methods
which are called as Methicillin Resistant S. aureus
Study design
(MRSA) and it has become a serious problem in
The present study was a cross sectional study
hospital environment.
conducted at MediCiti Institute of Medical

MRSA is currently the most commonly identified Sciences, Medchal, Telangana, India during the

antibiotic resistant pathogen in the world. period of October - November 2017.

Treatment of infection caused by S. aureus has

Sample size
become most difficult since the occurrence of
We screened 100 Healthcare Workers of various
MRSA strains are resistant to all β-lactam
clinical departments of MediCiti Institute of
antibiotics thereby significantly limiting the
Medical Sciences, Medchal.
treatment options. Infections caused by MRSA
strains are associated with worse outcomes, in Inclusion criteria
addition to longer hospital stay, prolonged Healthcare Workers such as Nursing staff, Ward
antibiotic administration, higher treatment cost boys, Sweepers, O.T staffs and other supporting
and increased mortality than methicillin- staffs related to the patient care, were included in
susceptible Staphylococcus aureus strains. the study.

One of the important sources of Staphylococcus Exclusion criteria

for nosocomial infection is nasal carriage among All the Doctors were excluded from the study.
hospital personnel. Similarly, healthcare
Sample collection
providers are also exposed to patients with
Single nasal swabs from both anterior nares of
MRSA infection and are colonized in the course
consenting HCWs were collected by using sterile
of their work. The ecological niches of S. aureus
cotton swabs which were moistened with normal
strains are the anterior nares and most of
saline. The swab was introduced 2-3 cm in the
invasive S. aureus infections are assumed to
nasal cavity and rotated 3-4 times both clockwise
arise from nasal carriages. Several studies have
and anticlockwise. Then the swabs were
reported that the rate of nasal carriage of S.
transported immediately to the microbiology
aureus among healthcare workers (HCW) ranges
laboratory for bacteriological analysis.
from 16.8%-56.1%.
Culture and identification
The role of MRSA carriers in the transmission of
Swabs were inoculated onto blood agar (BA) &
this pathogen is critical and healthcare workers
mannitol salt agar (MSA) within 1 hour of
who are at interface between the hospital and the
collection and incubated aerobically at 37°C for
community may serve as the agents of cross
24-48 hours. β-haemolytic colonies on blood agar
contamination of Hospital acquired and
and Mannitol fermenting colonies on MSA (yellow
Community acquired MRSA.
or golden yellow coloured) were subjected to

2 Banerjee et al.
smear microscopy, catalase test and tube Antibiotic sensitivity testing and interpretation of
coagulase test. Gram positive cocci in clusters on results were done according to CLSI guidelines.
gram staining and produced Catalase &
Coagulase were identified as S. aureus. Results
A total of 100 healthcare workers were screened
Antimicrobial susceptibility testing: The isolated from various clinical departments for MRSA,
strains of S. aureus were screened for methicillin among them 68% were females and 32% were
susceptibility by modified Kirby-Bauer disc males. Out of 100 screened healthcare workers,
diffusion method by using cefoxitin (30μg) discs 26 (26%) were positive for nasal carriage of S.
on Mueller-Hinton agar (MHA) by using an aureus and among them, 12 were carriers of
inoculum density which was equivalent to MRSA. The overall nasal carriage rate of MRSA
McFarland’s 0.5 standard (1.5×108 CFU/ml). was 12% which is depicted in Fig.1. The
Isolates which showed inhibition zone sizes of prevalence of MRSA nasal carriage was higher
diameter ≤21mm for cefoxitin discs, were among male HCWs (6.2%) than female HCWs
considered as MRSA strains. Antibiotic (1.4%) which is shown in table.1.
susceptibility testing for all isolates of S. aureus
was also done against other antibiotics like The distribution of S. aureus and MRSA carriage

ampicillin (10µg), ciprofloxacin (5μg), in relation to profession/designation has been

erythromycin (15μg), clindamycin (2µg), presented in table.2. S. aureus carriage rate

vancomycin (30µg) and linezolid (30μg), by the (60%) and MRSA carriage rate (40%) were found

modified Kirby-Bauer method. Inducible among housekeeping personnel. Based on the

clindamycin resistance was detected by D-zone area of work, the highest rate of MRSA carriers

test. In this study, S. aureus ATCC 25923 was were among HCWs in paediatric (42.8%) and

used for the control. surgery (14.2%) departments (Table.3).

Table 1. Gender wise distribution of S. aureus and MRSA carriage rate among HCWs.

Total no. of HCWS

Healthcare workers Positive for S.aureus Positive for MRSA
screened (n=100)
Males 32 (32%) 14 (43.7%) 2 (6.2%)
Females 68 (68%) 12 (17.6%) 10 (1.4%)

Table 2. Profession/designation related distribution of S. aureus and MRSA carriage status among
HCWs.
Healthcare workers No. of samples (n=100) S.aureus (%) MRSA (%)
Nursing staff 50 6 (12%) 6 (12%)
Attender 22 10 (45.4%) 2 (9%)
Housekeeping
10 6 (60%) 4 (40%)
personnel
O.T staff 8 2 (25%) 0 (0%)
Other supporting
10 2 (20%) 0 (0%)
staffs

Table 3. Distribution of S.aureus & MRSA among healthcare workers of different ward.
Total No. of samples Positive for Positive for
Departments (n=100) S. aureus (%) MRSA (%)
Obs & Gynec 34 8(23.5%) 2(5.88%)
Pediatrics 14 6 (42.8%) 6 (42.8%)
Medical 20 6 (30%) 2 (10%)
Surgical 14 4 (28.5%) 2 (14.2%)
Others 18 2 (11%) 0 (0%)

3 Banerjee et al.
 Fig. 3. Among all identified S. aureus isolates,
MRSA isolates were detected by resistance to
cefoxitin. All isolates were sensitive to
vancomycin and linezolid followed by
clindamycin (69.2%) and erythromycin (53.8%)
whereas resistance to ampicillin and
ciprofloxacin were 53.8%. of the total
erythromycin resistant isolates, inducible
clindamycin resistance (iMLS B) was seen in 50%
Fig. 1. Nasal carriage rate among 100 healthcare (6/12) isolates. Also all MRSA isolates were
workers. sensitive to vancomycin, and linezolid followed
by clindamycin (66.66%). Among MRSA isolates
The antibiotic susceptibility patterns of S. aureus iMLSB phenotype was observed in 33.3% of
and MRSA isolates have been shown in Fig. 2 and erythromycin resistant isolates.

Fig. 2. Antibiotic susceptibility pattern of S. aureus isolates.

Fig. 3. Antibiotic susceptibility patterns of MRSA isolates.

4 Banerjee et al.
Discussion carriage rate of S. aureus among male HCWs-
The present study detected a nasal carriage rate 54.28% than female HCWs- 45.71% (Rongpharpi
of S. aureus to be 26% among HCWs which is SR et al., 2013). Another study from Pondicherry
comparable to the other studies conducted in observed majority of the carriers were males-
Assam -22.22% and Gujrat - 22% (Rongpharpi 12.4% (Mathanraj S et al., 2009).
SR et al.,2013; Rutvi V et al.,2016).
The present study detected highest MRSA carriage
MRSA nasal carriage rate in the present study rate among the housekeeping personnel (40%).
was detected as 12% which is almost similar to This finding signifies the need to create awareness
other Indian studies carried out in Assam-11.43% among housekeeping staffs by educating them, to
and Bangalore-10% whereas lower than the other eradicate MRSA carriage among HCWs. The
studies conducted in West Bengal-18.39% and advantage of eradicating the MRSA carriage by the
Kashmir-19.1% (Rongpharpi SR et al., 2013; hospital staff and in the institution with effective
Malini J. et al., 2012; Himadri Mondal et al., hospital control policies, is the prevention of its
2016; Peer Maroof et al., 2016). transmission to the family members of the patients
and others in the community.
On the other hand MRSA carriage recorded is
higher in this study as compared to the other In this study, HCWs from paediatrics ward and
Indian studies reported from Mangalore-2.5%, surgical ward accounted for 42.8% and 14.3% of
Pondicherry- 1.8%, Madurai- 2% and Delhi- the MRSA carriers respectively. All MRSA isolates
6.6% (Radhakrishna M et al., 2013; S Mathanraj were 100% sensitive to Vancomycin and
et al., 2009; Vinodhkumaradithyaa A et al., Linezolid. The absence of vancomycin resistance
2009; Goyal R, Das S and Mathur M, 2002). of MRSA, which is compelled by its low toxicity
MRSA carriage rate among HCWs is higher in this and easy availability, signifies that it can be used
study indicating the possibility of hospital in eradication of MRSA carrier state of healthcare
acquired MRSA colonization among healthcare workers as well as for the treatment of MRSA
workers. However outside India, MRSA nasal outbreaks infection cases.
carriage rate of 7.5% from Nepal, 12.7% from
Ethiopia and a very high MRSA nasal carriage The susceptibility testing of MRSA to other

rate of 38.9% was reported from Nigeria (Khatri antibiotics revealed high resistance (66.6%) to

S et al., 2017; Shibabaw et al., 2013, ampicillin, ciprofloxacin and erythromycin.

Radhakrishna M et al., 2013). However all Clindamycin resistance was low- 33.3%; however

variations in the prevalence of MRSA between iMLSB phenotype was seen in 33.3% of

institutions and geographic areas may be erythromycin resistant MRSA isolates. Hence

explained by microbiological methods (from clindamycin can be considered for empirical

sample collection technique to culture media), therapy, but testing for detection of inducible

local infection control standards and local clindamycin resistance should be routinely

prevalence of MRSA. performed.

In the present study, carriage rate of S. aureus Conclusion

and MRSA was higher among male HCWs (43.7% It is necessary to detect the MRSA carriers

and 6.2% respectively) than female HCWs among health care workers (HCWs) in hospitals

(17.6% and 1.4% respectively). Similar type of as they act as a potential source of infection to

findings were reported from the study conducted their patients, causing nosocomial infections and

in Assam where they reported higher nasal thereby causing extended stays in the hospital.

5 Banerjee et al.
The high rate of nasal MRSA carriage (12%) Himadri Mondal, Indrajit Gupta, Poulami
among healthcare workers found in this study Nandi, Purbasha Ghosh, Saswati
necessitates improved infection control measures Chattopadhyay, Mitra GD. 2016. Nasal
to prevent MRSA transmission. Appropriate screening of healthcare workers for nasal carriage
measures should include laboratory based of methicillin resistance Staphylococcus aureus,
periodic surveillance, regular screening of HCWs, vancomycin resistance Staphylococcus aureus
giving an early warning in the presence of and prevalence of nasal colonization with
antimicrobial resistant pathogens, treatment of Staphylococcus aureus in Burdwan medical
MRSA-positive HCWs (carriers), isolation of college and hospital. International Journal of
colonized and infected patients and the use of Contemporary Medical Research 3, 3342-3346.
barrier precautions.
Khatri S, Pant ND, Bhandari et al, R. 2017.
The most important factor is to educate the Nasal Carriage Rate of Methicillin Resistant
healthcare professionals regarding the potential Staphylococcus aureus among Health Care
consequences of the nosocomial infections, to Workers at a Tertiary Care Hospital in
provide them periodic training about the Kathmandu, Nepal. Journal of Nepal Health
maintenance of hygiene and basic infection Research Council 15, 26-30
control measures and the effects of the use or
rather, the misuse of antibiotics. Malini J, Shruti AH, Padmavathy M,
Umapathy BL, Navaneeth BV, Keerthi
Ethical clearance Mannan J, Girish M. 2012. Methicillin-resistant
This study has been approved by institutional Staphylococcus aureus carriage amongst Health
ethics committee. Care Workers. Journal of Clinical and Diagnostic
Research 6, 791-793.
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