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Frontiers in Biology

ISSN 1674-7984

ISSN 1674-7992(Online)

CN 11-5892/Q

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Front. Biol.    2017, Vol. 12 Issue (3) : 226-234    https://doi.org/10.1007/s11515-017-1448-0
RESEARCH ARTICLE
Intervention points for community- acquired methicillin– resistant Staphylococcus aureus colonization and load in healthy population of lesser Himalayan Belt, South Asia, India
Anup Kainthola(), Ajay Bhatt
Hemwati Nandan Bahuguna Garhwal University, Department of Botany & Microbiology, Srinagar Uttarakhand India Srinagar Uttarakhand 246174, India
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Abstract

OBJECTIVES: To trace the critical practicing, clinical and epidemiological risk factors in bacterial load and points of intervention in spread of community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) in healthy community.

STUDY DESIGN: 2872 individuals with no prominent clinical features were enrolled and administered a pre-tested questionnaire prepared on the basis of outcome of a prior pilot study in same region. Swab samples from skin, throat and nasal nares were tested for MRSA and molecular identification was done to track the strains moving from hospital to community.

METHODS: Swab samples from skin, throat and nasal nares were tested for MRSA culture followed by molecular characterization of isolates and antimicrobial resistance pattern. Bacterial load was estimated to better understand the burden in different categories. Statistical analysis was done using SPSS 16.0 version.

RESULTS: History of prior infection (OR 3.9, 95% CI 1.363 – 5.793), habit of self remedy (OR 3.2, 95% CI 0.991 – 1.473) and incomplete treatment (OR 0.26, 95% CI 0.08 – 0.80) (P<0.05 for each) were the predominant factors that contributed to spread of CA-MRSA. Increased drug resistance in CA-MRSA was observed for 4 different clones: SCCmec+ IVa/PVL+, SCCmec+ IVa/PVL− and SCCmec+ IVc/PVL+, SCCmec+ IVc/PVL−. Bacterial load was found significantly high in below poverty line dwellers and drug abusers (P<0.05).

CONCLUSION: We identified habit of self remedy, drug abusing and incomplete treatment as practicing risk factors where interventions can be made to manage the dissemination of CA-MRSA in rural population.
Keywords community-acquired MRSA      risk factors      bacterial load      himalayan region      pantone-valentine leuckocidin     
Corresponding Author(s): Anup Kainthola   
Online First Date: 06 April 2017    Issue Date: 19 June 2017
 Cite this article:   
Anup Kainthola,Ajay Bhatt. Intervention points for community- acquired methicillin– resistant Staphylococcus aureus colonization and load in healthy population of lesser Himalayan Belt, South Asia, India[J]. Front. Biol., 2017, 12(3): 226-234.
 URL:  
https://academic.hep.com.cn/fib/EN/10.1007/s11515-017-1448-0
https://academic.hep.com.cn/fib/EN/Y2017/V12/I3/226
Factors Subjects
n= 2872 MRSA carrier MSSA carrier OR
(95% CI)		 P Non carriers
Age group(years)
1 to 10 281 42 53 Reference 186
11 to 20 448 158 209 0.954 (0.606 – 1.503) 0.839 81
21 to 30 1187 324 276 1.956 (1.259 – 3.039) 0.103 587
31 to 40 554 78 134 0.357 (0.221 – 0.574) <0.001 342
40 above 402 20 140 0.188 (0.101 – 0.350) <0.001 242
Total 622 812
Gender
Male 1514 354 479 Reference 681
Female 1358 268 333 2.590 (2.025 – 3.314) <0.001 757
Family size
1 to 3 1327 202 393 Reference 732
4 to 7 1027 152 209 0.888 (0.687 – 1.147) 0.364 666
7 to 10 518 268 210 2.495 (1.947 – 3.197) 0.051 40
Profession
Student 1132 254 301 Reference 577
Daily wager 201 125 44 0.705 (0.535 – 0.931) 0.013 32
Farmer 714 77 82 2.074 (1.381 – 3.113) <0.000 555
Shopkeepers 307 180 97 2.601 (1.908 – 3.547) <0.001 30
Others 518 165 238 2.016 (1.491 – 2.725) 0.811 115
Economic status
APL 1861 411 567 Reference 883
BPL 1011 211 245 1.223 (0.977 – 1.531) 0.079 555
No. of toilets 1.64±1.2 1.7±1.3 1.5±1.1 0.676 (0.088 – 1.423) 0.879
Practicing factors
Hand washing frequency 4.9±3.1 4.6±3.1 5.4±3.8 0.57 (0.071 – 2.021) 0.032
Self remedy 943 112 131 2.435 (1.813 – 3.269) 0.001 700
Drug abuse 402 74 129 1.403 (1.032 – 1.907) 0.301 199
Incomplete treatment 354 69 186 2.163 (1.605 – 2.914) <0.000 99
Clinical factors
History of infection 222 114 8 9.8 (4.44-21.87) <0.001 100
Frequent visits to healthcare center 814 414 280 0.697 (0.574 – 0.845) 0.014 120
On receipt of antibiotics 2 months prior to study 464 74 131 0.541 (0.391 – 0.748) <0.001 259
Tab.1  Independent factors associated with overall occurrence of CA-MRSA by bivariate regression analysis
Factors OR (95% confidence interval) P
Farmers in field 0.21 (0.091 – 0.142) 0.002
Shopkeepers near THCC a 1.6 (0.381 – 2.241) 0.012
Self remedy 3.2 (0.991 – 1.473) 0.003
Incomplete treatment 0.26 (0.08 – 0.80) 0.022
History of infection 3.9 (1.363 – 5.793) 0.001
Have taken antibiotics in the prior 2 months 1.1 (0.065 – 0.699) 0.81
Tab.2  Risk factors for methicillin-resistant Staphylococcus aureus nasal carriage: Multivariate logistic regression analysis
SCC mec type No. of isolates Virulence factor ( pvl)
+ –
IVa 414 384 30
I 41 –
II 121 –
IVc 208 181 27
III 28 –
Tab.3  Distribution of MRSA strains
Fig.1  Patterns of antimicrobial susceptibility for 622 community acquired Methicillin-resistantStaphylococcus aureus isolates. MET, methicillin; OXA, oxacillin; E, erythromycin; AMP, ampicillin; TET, tetracycline; OF, ofloxacin.
Fig.2  Resistivity (%) pattern of 622 recovered CA-MRSA isolates. OXA, oxacillin; TET, tetracycline; CIP, ciprofloxacin; VAN, vancomycin; AK, amikacin; AMP, ampicillin; CD, clindamycin; E, erythromycin; K, kanamycin; MET, methicillin; OF, ofloxacin; C, chloramphenicol.
Factors Occurrence of MRSA Load
F P F P
Age 6.501 0.000 40.688 <0.000
Economic status 6.521 0.003 40.932 <0.000
Prior incomplete treatment 2.078 0.150 0.329 0.566
Have taken antibiotics 4.399 0.036 2.125 0.096
Drug abuse 2.272 0.079 20.938 0.001
Profession 9.351 0.004 1.808 0.165
History of prior infection 6.491 0.002 0.322 0.725
Gender 3.028 0.029 11.329 <0.001
Frequent visits to healthcare center 3.555 0.029 2.613 0.074
Tab.4  ANOVA: Impact of independent factors on occurrence and load of MRSA
Fig.3  Prevalence of CA-MRSA in the study site (41.35 km2).
Fig.4  Multiplex PCR of samples run to type the SCCmec gene.
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