CO-EXISTENCE OF CIPROFLOXACIN RESISTANCE IN METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS FROM CLINICAL SAMPLES
Background: Ciprofloxacin is a broad-spectrum, fluorinated quinolone antibiotic. It has been successfully prescribed against a variety of bacteria. Though its use was limited to a last resort therapy against complicated infections, however widespread usage has led to the emergence of ciprofloxacin resistance. The current study was planned to evaluate the existence of ciprofloxacin resistance in methicillin resistant and sensitive Staphylococcus aureus from clinical samples. Methods: The clinical S. aureus isolates from wound, blood, urine and nose, were obtained from various labs of Hyderabad over nine months. The methicillin resistant strains were identified by Kirbey baur disc diffusion test using oxacillin (1 Âµg) discs. The response of Methicillin Resistant S. aureus and Methicillin Sensitive S. aureus strains against 2nd generation flouroquinolone, i.e., ciprofloxacin was demonstrated. Results: A total of 150 S. aureus isolates from various clinical specimens were included in this study. About 14.6 % (n=22) showed resistance against ciprofloxacin while 30% (n=48) were identified as MRSA. About 25% of the Methicillin Resistant S. aureus (MRSA) isolates displayed the co-resistance against ciprofloxacin. Among various specimens the maximum co-resistance was seen in case of blood isolates (37.5%) followed by urine isolates (33.3%). Comparatively, ciprofloxacin resistance was found to be lower in Methicillin Sensitive S. aureus (MSSA) strains (9.1%). Odds Ratio [OR] was calculated to be 0.30 [95% CI=0.12â€“0.77]. Statistically significant differences (pË‚0.05) for ciprofloxacin resistance were seen between MRSA and MSSA. Conclusion: The results suggest a statistically significant increase of ciprofloxacin resistance in Methicillin Resistant S. aureus as compared to Methicillin Sensitive S. aureus in clinical samples.
Pak J Pysiol 2018;14(2)24â€“7
2. Lowy FD. Antimicrobial resistance: the example of Staphylococcus aureus. J Clin Invest 2003;111:1265â€“73.
3. Ashiq B, Tareen AK. Methicillin resistant Staphylococcus aureus in a teaching hospital of Karachi--a laboratory study. J Pak Med Assoc 1989;39:6â€“9.
4. Bukhari SZ, Ahmed S, Zia N. Antimicrobial susceptibility pattern of Staphylococcus aureus on clinical isolates and efficacy of laboratory tests to diagnose MRSA: a multi-centre study. J Ayub Med Coll Abbottabad 2011;23(1):139â€“42.
5. Ullah A, Qasim M, Rahman H, Khan J, Haroon M, Muhammad N, et. al. High frequency of methicillinâ€‘resistant Staphylococcus aureus in Peshawar Region of Pakistan. Springerplus 2016;5:600.
6. Vola ME, Moriyama AS, Lisboa R, Vola MM, Hirai FE, Bispo PJ, et al. Prevalence and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus in ocular infections. Arq Bras Oftalmol 2013;76(6):350â€“3.
7. Forstall GJ, Knapp CC and Washington JA. Activity of new quinolones against ciprofloxacin- resistant staphylococci. Antimicrob Agents Chemother 1991;35:1679â€“81.
8. Chang VS, Dhaliwal DK, Raju L, Kowalski RP. Antibiotic resistance in the treatment of staphylococcus aureus keratitis: a 20-Year Review. Cornea 2015;34(6):698â€“703.
9. Zechiedrich EL, Khodursky AB, Cozzarelli NR. Topoisomerase IV, not gyrase, decatenates products of site-specific recombination in Escherichia coli. Genes Dev 1997;11:2580â€“92.
10. David CH. Mechanisms of action and resistance of older and newer fluoroquinolones Clin Infect Dis 2000;31(Suppl 2):S24â€“8.
11. Patoli BB, Patoli AA, Kumar D. Trends in antibiotic resistance of Staphylococcus aureus from asymptomatic nasal carriers. J Postgrad Med Ins 2017; 31(4): 343â€“7.
12. Bernard SM, Saira I, Kidon S, Ohgew K, Carl EC, Saeed K. Molecular Characterization of Fluoroquinolone Resistance of Methicillin Resistant Clinical Staphylococcus aureus Isolates from Rawalpindi, Pakistan. Med Res Arch 2015; 2:2.
13. Raviglione MC, Boyle JF, Mariuz P, Pablos-Mendez A, Cortes H, Merlo A. Ciprofloxacin-Resistant Methicillin-Resistant Staphylococcus aureus in an Acute-Care Hospital. Antimicrob Agents Chemother 1990;34(11):2050â€“4.
14. Weber SG, Gold HS, Hooper DC, Karchmer AW, Carmeli Y. Fluoroquinolones and the Risk for Methicillin-resistant Staphylococcus aureus in Hospitalized Patients. Emerg Infect Dis 2003;9(11):1415â€“22.
15. Ibrar M, Hissain A, Zeb S, Hasan F, Maqbool F, Israr M. Diversity of Staphylococcus aureus in Clinical Isolates, Their Prevalence and Antimicrobial Resistance in District Peshawar, Pakistan World Appl Sci J 2014;32(11):2213â€“7.
16. Khatoon N, Hussain Bukhari SM, Riaz JR, Sheikh AS, Iqbal A, Naeem S, et al. Prevalence of methicillin resistant staphylococcus aureus (MRSA) infection laboratory study at Mayo Hospital Lahore. Biomedica 2002;18:49â€“52.
17. Ali SQ, Zehra A, Naqvi BS, Shah S, Bushra R. Resistance pattern of ciprofloxacin against different pathogens. Oman Med J 2010;25;249â€“8.
18. Abdullah FE, Memon AA, Bandukda MY, Jamil M. Increasing ciprofloxacin resistance of isolates from infected urines of a cross-section of patients in Karachi BMC Res Notes 2012;5:696.
19. Hizbullah, Ali F, Bahadar S, Shahid Z, Rahimullah, Khalil-ur-Rahman, et al. Antibiotic susceptibility patterns of methicillin resistant staphylococcus aureus at National Institute of Health Sciences, Islamabad, Pakistan World J Zool 2015;10(4):318â€“22.
20. Taj Y, Abdullah FE, Kazmi SU. Current pattern of antibiotic resistance in staphylococcus aureus clinical isolates and the emergence of vancomycin resistance. J Coll Physicians Surg Pak 2010;20(11):728â€“32.
21. Faizan M, Ullah I, Ullah K, Khan I, Jan SU, Ali F, et al. Prevalence and Antibiogram of Hospital Acquired Methicllin Resistant Stapylococcusaureus (HA-MRSA) from a Tertiary Care Hospital in Peshawar, Pakistan. J Bio Mol Sci 2014;2(2):28â€“37.
22. Brohi NA, Noor AA. Frequency of the Occurence of Methicilin Resistant Staphylococcus aureus Infections in Hyderabad, Pakistan. Pak J Anal Environ Chem 2017;18(1):84â€“90.
23. Crowcroft NS, Ronveaux O, Monnet DL, Mertens R. Methicillin resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals. Infect Control Hosp Epidemiol 1999;20(1):31â€“6.
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