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Indian Pediatr 2016;53: 923-924 |
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Antibiotic Sensitivity and Clinico- epidemiological Profile of
Staphylococcal Infections
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Manas Kumar Mahapatra, *Devdeep Mukherjee,
#Sumon Poddar and Ritabrata
Kundu
From *Departments of Pediatric Medicine and #Microbiology,
Institute of Child Health, Kolkata.
Email: [email protected]
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This hospital-based study describes
the antibiotic sensitivity of 66 S. aureus isolates from the
admitted children (age 0-18 y) in a tertiary hospital of Kolkata, India.
Methicillin-resistant S. aureus constituted 16.7% (n=11)
of the isolates. Clindamycin-resistance was observed in 60% and 82% of
methicillin-sensitive and methicillin-resistant strains, respectively.
Keywords: Antibiotic resistance,
Epidemiology, S.aureus.
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There is a significant difference in prevalence
and antibiotics sensitivity of Staphylococcus aureus infections
across the world [1]. Reports available regarding the epidemiology of
S. aureus in India are scarce, especially in the pediatric
population [2,3]. This observational study was conducted from August
2014 to September 2015 at Institute of Child Health, Kolkata, India.
Hospitalized children (age 0-18 y) with culture-positive S. aureus
infection were included in the study. Cases from out-patient department
were excluded. Ethical clearance was obtained from the institutional
ethics committee.
Blood, pus, cerebro-spinal fluid (CSF) or other body
fluids (pleural, pericardial and joint fluids) were collected from
patients having suspected infection, and sent for culture and
sensitivity. After informed written consent, data were collected for
age, sex, clinical features and antibiotic sensitivity pattern.
Infections were defined as community acquired (CA), hospital acquired
(HA) and Healthcare-associated Community-onset (HACO) [4]. Isolates were
identified and antibiotic sensitivity was tested as per Clinical and
Laboratory Standards Institute guidelines [5].
A total of 1017 specimens collected from admitted
patients during study period showed culture positivity. Of these, 13% (n=125)
were positive for Staphylococcus species; 52.8% (n=66)
were S. aureus and 47.2% (n=59) were CONS. Of the total
CONS, 33 isolates were positive within 24 hours, of which 48.5% (n=16)
were in neonates. Clinico-epidemiological data of included children is
presented in Table I.
TABLE 1 Profile of Staphylococcus Aureus Infection in Our Study
Study variables |
All cases |
MRSA |
MSSA
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(n=66) No. |
(n=11) No. |
(n=55) No. |
Community acquired |
50
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8
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42 |
Healthcare associated
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community onset |
12
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2
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10 |
Hospital acquired |
4
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1 |
3 |
Age category |
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< 1 year |
29
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5
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24
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1 year - < 5 year
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23
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5
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18
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> 5 year
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14
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1
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13
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Diagnosis |
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Skin and soft tissue infection |
38
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6
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32
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Septicemia |
7
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1
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6
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Pneumonia |
7
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1
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6
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Meningitis |
3
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1
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2
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Bone and joint space |
6
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1
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5
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Disseminated |
7
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1
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6
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Specimen |
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BACTEC |
28
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5
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23
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CSF |
2
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1
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1
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Pus |
42
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7
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35
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Others (pleural fluid, joint) |
1
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0 |
1
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Multiple sites |
7
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1
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6
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In 2013, Indian Network for Surveillance of
Antimicrobial Resistance (INSAR) reported proportion of methicillin-resistant
S. aureus (MRSA) between 22%-68% in Indian hospitals [6].
Contrary to the rising trends of MRSA, it was documented in only 16.7%
patients in our study, most of which was CA-MRSA (n=8). Community
acquired infections (75.8%, n=50) out-numbered hospital acquired
infections in our study, similar to that reported by Eshwara, et al.
[3].
All Staphylococcus isolates in our study were
sensitive to Vancomycin, Linezolid and Teicoplanin. Methicillin-sensitive
S. aureus (MSSA) were also sensitive to Amikacin, Gentamycin and
Levofloxacin. Clindamycin resistance (inducible + constitutional) among
MSSA, MRSA, CA-MRSA was 60%, 81.8% and 87.5%, respectively. Shenoy,
et al. [7] showed about 22.9% CA-MRSA clindamycin resistant
in India, which was considerably less than our study. We also saw
increased resistance of MSSA, MRSA and CA-MRSA towards Co-trimoxazole,
Erythromycin, Ciprofloxacin and Ofloxacin similar to findings by Eshwara,
et al. [3].
Our study had limitations of a small sample size. We
also could not test for SCC mecA gene and PVL toxins. Rational
antibiotic policy to prevent the rise in resistant staphylococci is the
need of the hour.
Acknowledgements: Joydeep Das (Assistant
professor), Prabal Niyogi (Deputy Director), Dolly Kalita (Post graduate
trainee) and Surupa Basu (Assistant Professor, Department of
Biochemistry) who were involved at various stages with valuable inputs,
data collection and statistical analysis.
Contributions: MKM, DM, SP: in data
collection and conceptualizing the study; RK: supervised the study; MKM,
DM: manuscript writing. All the authors approved the manuscript.
Funding: None; Competing
interest: None stated.
References
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