Identification of Methicillin-Resistant Staphylococcus aureus (MRSA) carriers in the nasal passages of healthcare workers at Universitas Udayana Hospital
Main Article Content
Keywords
MRSA, Healthcare-Associated Infections, Staphylococcus aureus, Healthcare Workers, Antibiotic Resistant
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen responsible for healthcare-associated infections (HAIs), with growing global concern due to its resistance to multiple antibiotics, including beta-lactams. Healthcare workers (HCWs), particularly those in critical care settings, are at risk of being asymptomatic carriers, facilitating MRSA transmission. This study aimed to determine the prevalence and distribution of MRSA carriers among healthcare workers (HCWs) at Universitas Udayana Hospital, Bali, Indonesia.
Methods: A descriptive cross-sectional study was conducted from October to November 2024. A total of 44 nasal swab samples were collected from nurses across various hospital wards. Samples were cultured on Mannitol Salt Agar and underwent Gram staining, catalase, and coagulase testing. MRSA identification was confirmed using the cefoxitin disk diffusion method, with inhibition zones of ≤21 mm indicating methicillin resistance, as per CLSI guidelines. Data were analyzed descriptively.
Results: MRSA colonization was identified in 4 out of 44 samples (9.1%), with cases distributed in the NICU (2 cases), ICU (1 case), and Surgical Ward (1 case). In addition, 12 samples (27.3%) were positive for methicillin-sensitive Staphylococcus aureus (MSSA), while 28 samples (63.6%) contained coagulase-negative staphylococci (CNS), predominantly in the outpatient and emergency departments.
Conclusion: The presence of MRSA among HCWs, especially in critical units like NICU and ICU, emphasizes the importance of enhanced infection control measures. Routine screening, strict adherence to hand hygiene, appropriate use of personal protective equipment, and implementation of decolonization protocols, such as mupirocin application and chlorhexidine bathing, should be optimized to reduce MRSA transmission risks within healthcare facilities.
References
2. Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev. 2018;31(4):e00020-18. doi:10.1128/CMR.00020-18.
3. Duong TB, Duong MC, Campbell JI, Nguyen HVM, Nguyen HH, Bui HTB, et al. MRSA carriage among healthcare workers in a Vietnamese intensive care unit: a prospective cohort study. Drug Target Insights. 2022;16:71-77. doi:10.33393/dti.2022.2504
4. Okwu MU, Olley M, Akpoka AO, Izevbuwa OE. Methicillin-resistant Staphylococcus aureus (MRSA) and anti-MRSA activities of extracts of some medicinal plants: A brief review. AIMS Microbiol. 2019;5(2):117-137. doi:10.3934/microbiol.2019.2.117
5. Dewi AK. Isolasi, identifikasi dan uji sensitivitas Staphylococcus aureus terhadap amoxicillin dari sampel susu kambing peranakan Ettawa (PE) penderita mastitis di wilayah Girimulyo, Kulonprogo, Yogyakarta. J Sain Veteriner. 2013;31(2):138–150. doi:10.22146/jsv.3780.
6. Missiakas DM, Schneewind O. Growth and laboratory maintenance of Staphylococcus aureus. Curr Protoc Microbiol. 2013;Chapter 9:Unit-9C.1. doi:10.1002/9780471729259.mc09c01s28.
7. Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition. J Clin Microbiol. 2021;59(12):e0021321. doi:10.1128/JCM.00213-21.
8. Fitria A, Widiasi DE, Airlangga HRMH. Systematic Literature Review: Prevalensi Methicillin-Resistant Staphylococcus aureus (MRSA) terhadap Infeksi Nosokomial di Asia. Jurnal Sains Veteriner. 2023;41(1):1–12. doi: 10.20473/jsv.Vol41.Iss1.2023.1-12.
9. Syahniar R, Farsida F, Setyani RL, Malayanti M, Siswanti RT, Asmawati WO, et al. Edukasi Pencegahan dan Tatalaksana MRSA pada Tenaga Kesehatan. Jurnal Abdimas Kedokteran dan Kesehatan (JARAS). 2024;2(1):42–47. doi:10.24853/jaras.2.1.42‑47
10. Vasudevan R, Shin JH, Chopyk J, Peacock WF, Torriani FJ, Maisel AS, et al. Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):21-30. doi:10.1016/j.mayocpiqo.2019.10.010
11. Rohmah SN, Asdie RH, Yasopa I, Daryadijaya D. Identification of Risk Factors for Nasal Colonization of Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Staphylococcus aureus in Health Workers at a Tertiary Hospital, Indonesia. Open Access Maced J Med Sci. 2023;11(B):205–211. doi: 10.3889/oamjms.2023.11441.
12. Wang L, Pang X, Zhao J, Jin H, Yang X, Fu S, et al. Isolation and characteristics of new phage JK004 and application to control Cronobacter sakazakii on material surfaces and powdered infant formula. LWT - Food Science and Technology. 2022;153:112571. doi:10.1016/j.lwt.2021.112571.
13. Galuszka JE, Thomsen K, Knudsen JD, Stenkjaer RL, Nielsen R, Nielsen KL, et al. Risk factors for methicillin-resistant Staphylococcus aureus colonization in a level-IV neonatal intensive care unit: a retrospective study. Antimicrob Steward Healthc Epidemiol. 2023;3(1):e194. doi:10.1017/ash.2023.482
14. Jia P, Zhu Y, Li X, Kudinha T, Yang Y, Zhang G, et al. High Prevalence of Extended-Spectrum Beta-Lactamases in Escherichia coli Strains Collected From Strictly Defined Community-Acquired Urinary Tract Infections in Adults in China: A Multicenter Prospective Clinical Microbiological and Molecular Study. Front Microbiol. 2021;12:663033. Published 2021 Jul 7. doi:10.3389/fmicb.2021.663033.
15. Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, et al. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primers. 2018;4:18033. doi:10.1038/nrdp.2018.33.
16. Khairalla AS, Wasfi R, Ashour HM. Carriage frequency, phenotypic, and genotypic characteristics of methicillin-resistant Staphylococcus aureus isolated from dental health-care personnel, patients, and environment. Sci Rep. 2017;7(1):7390. doi:10.1038/s41598-017-07713-8
17. Becker K, Heilmann C, Peters G. Coagulase-negative staphylococci. Clin Microbiol Rev. 2014;27(4):870-926. doi:10.1128/CMR.00109-13
18. Boyce JM. Hand and environmental hygiene: respective roles for MRSA, multi-resistant gram negatives, Clostridioides difficile, and Candida spp. Antimicrob Resist Infect Control. 2024;13(1):110. Published 2024 Sep 27. doi:10.1186/s13756-024-01461-x
19. Otter JA, French GL. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2011;79(1):1–22. doi:10.1016/j.jhin.2011.01.024.