Staphylococcus aureus Drug Resistance in Sinusitis Patients | InformativeBD

Sasikala Shanmugam, Ramganesh Selvarajan, and Sundararaj Thangiah, from the different institute of the India. wrote a research article about, Staphylococcus aureus Drug Resistance in Sinusitis Patients. entitled, Drug resistance of Staphylococcus aureus in sinusitis patients. This research paper published by the International Journal of Biosciences (IJB). an open access scholarly research journal on Biosciences. under the affiliation of the International Network For Natural Sciences | NNSpub. an open access multidisciplinary research journal publisher.

Abstract

In this study on Sinusitis patients, we obtained 45 strains of Staphylococcus aureus. Antibiotic pattern of Staphyloccus aureus showed that resistance to Quinolones was 21% and 33% towards ciprofloxacin andoflaxacin respectively. Resistance to cephalosporins was 50% to cefuroxime, 41% and 50% to cefaperazone and cefotaxime respectively. Least resistance was noticed against aminoglycosides viz. Amikacin 47% and Gentamicin 21%. Resistance to Ampicillin and amoxicillin was 60% and 64% respectively. Oxacillin resistance was seen in 26% of the strains. Of the 45 isolates, 6 were found to be resistant for oxacillin . All these six isolates were subjected to Polymerase Chain Reaction (PCR) and they possessed the mecA gene. Correlation existed between the presence of mecA gene and oxacillin resistance in Staphylococcus aureus and these strains can be considered as MRSA and the patients can be advised for vancomycin therapy. Oxacillin resistance determination by phenotypic methods takes 24 hours to infer whereas PCR for mecA gene took only 6 hours. So the PCR techniques for the detection of mecA gene can be considered as gold standard (Rapid, Quick and accurate diagnosis) method for the detection of MRSA in spite of the cost involved.

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Introduction

Sinusitis is defined as inflammation of one or more of the paranasal sinuses caused by bacterial or viral infection; air-filled cavities in facial bones lined with pseudo stratified ciliated columnar epithelium and mucous goblet cells (Nord et al., 1995). There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses. Maxillary sinuses are located behind the check bones and inflammation causes pain or pressure in the cheek (maxillary) area. They are present at birth and continue to develop as long as teeth erupt. Tooth roots in some cases, can penetrate the floor of these sinuses. Frontal sinuses are located on both sides of the forehead and inflammation causes pain or pressure in the frontal sinus cavity. These sinuses are late in developing and so infection here is uncommon in children (Orobello et al., 1991). Ethmoid sinuses are located between the eyes and inflammation causes pain or pressure pain between eyes. They resemble a honeycomb and are vulnerable to obstruction. Sphenoid sinuses are located behind the eye and inflammation causes pain or pressure behind the eyes, but often refers to the vertex of the head. They are usually present at the age of 3 and are fully developed at the age of 12 (Nord et al., 1995).

The symptoms are generally the same in both acute and chronic rhinosinusitis. The symptoms include-nasal symptoms (facial congestion, facial pain-pressure fullness and headache), Oropharyngeal symptoms (halistosis, dental pain, cough and ear pain, pressure fullness) and, systematic symptoms (fever and fatigue). The symptoms in single or combine occur. Acute and chronic sinusitis may be accompanied by thick purulent nasal discharge (usually green in colour, with or without blood) and localized headache (toothache) are present and it is these symptoms that can differentiate sinus related (or rhinogenic) headache from other headache phenomena such as tension headache and migraine headache (Salord et al., 1990).

It is important to diagnose nasal complaints accurately, because sinusitis requires antibiotics for rapid resolution. Untreated sinusitis can lead to serious and possibly life threatening complications. The clinical diagnosis of sinusitis is difficult because of the overlap in the symptoms of rhinitis and sinusitis.

Several studies in adults have shown a good correlation between cultures of the middle meatus and the sinus aspirates in patients with acute sinusitis, especially when purulence is seen in the middle meatus (Walder et al., 1981). In many geographic areas, amoxicillin is a reasonable first-line antibiotic. Although trimethoprim- sulfamethoxazole and erythromycin- sulfisoxazole have traditionally been used as first line antibiotic for patients with acute bacterial sinusitis, surveillance studies indicate the development of significant pneumococcal resistance from alteration of penicillin binding proteins. Erythromycin alone provides unsatisfactory coverage and is effective against β -lactamase producing organisms. When first line agents have failed or there is a high prevalence of β–lactamase resistance, amoxicillin or clavulanate or second or third-generation cephalosporins (e.g., cefuroxime, cefpodoxime, cefprozil) provide broader coverage. First-generation cephalosoprins (eg-cephalexin) and second generation cephalosporins (eg, cefaclor) provide improved coverage. Several quinolones (eg, ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin) have specific indications for the treatment of sinusitis, but these should be reserved for second or third time use or for more serious infections.

MRSA stands for methicillin resistant Staphylococcus aureus and also multi-resistant Staphylococcus aureus. S. aureus strains which are resistant to the normal antibiotics were successfully treated with Vancomycin (Mark et al., 2002). This is one of the antibiotics used to treat emerging multi-resistant organisms. It has evolved an ability to survive treatment with beta-lactamase resistant beta-lactam antibiotics, including methicillin, dicloxacillin, nafcillin, and oxacillin. MRSA is especially troublesome in hospital-associated (nosocomial) infections. The methicillin resistance gene (mecA) encodes a methicillin resistant penicillin-binding protein that is not present in susceptible strains and is believed to have been acquired from a distantly related species. mecA is carried on a mobile genetic element. Many MRSA isolates are multiply resistant and are susceptible only to glycopeptide antibiotics such as Vancomycin and other investigational drugs (Mark et al., 2002). MRSA isolates have decreased susceptibility to glycopeptides. DNA fragments of mecA gene derived from MRSA are used as a probe and this has been reported to be a means of identifying methicillin resistance. More recently, several attempts to detect the presence of the mecA gene by the Polymerase Chain Reaction (PCR) have also been reported (Araj et al., 1991)

The widespread emergence of methicillin resistant Staphylococcus aureus (MRSA), especially in various types of nosocomial infections, is a serious clinical problem worldwide. The incidence of methicillin resistance among nosocomial isolates of S. aureus is higher than 70% in some Asian countries such as Taiwan, China, and Korea. Recently, MRSA has also emerged in the community setting in some countries, including Asian countries (Duong,D et al.,). One of the cardinal features of the rapid emergence of MRSA in many parts of the world is the dissemination of specific clones; this has contributed to the accelerated increases in the incidence of MRSA. Therefore, it is important to investigate the genotypic characteristics and evolutionary pathway of MRSA clones as well as the genetic relatedness of the strains isolated in different geographic regions.

The aim of the present work is to evaluate the Antimocrobial activity of Staphylococcus aureus from sinusitis patients with respect to different antibiotics and to detect the Methicillin Resistant Staphylococcus aureus (MRSA) using genotypic method, rather using a phenotypic method. So the PCR techniques for the detection of mecA gene can be considered as gold standard (genotypic method). Accordingly, we disclose that mecA gene carrying Staphylococcus aureus were considered as MRSA and the patients who carry MRSA were advised to take Vancomycin therapy rather going with other antibiotics.

Reference

Araj, Talhouk RS, Simaan CJ, Maasad. 1991. Discrepancies between mecA gene PCR & Conventional tests used for detection of Methicillin resistant Staphylococcus aureus. International Journal of Antimicrobial Agent 11, 45-52.

Archer GL, Pennell E. 1990. Detection of methicilin resistance in Staphylococcus by using a DNA probe. Antimicrobial Agents and chemotherapy 34, 1720-4.

Bect WD, Berger B, Kayser FH. 1980. Additional DNA in methicillin resistant Staphylococcus aureus and molecular cloning of mec-specific DNA. Bacteriol. 165, 373 – 378

Bogle, Bob RB, Graciela S. 1999. Acquiring vancomycin resistant Staphylococcus aureus perspective on measures needed for control. Ann. Intern. Med. 124(3), 329-34.

Boyce JM. 1990. Increasing prevalence of Methicillin Resistant Staphylococcus aureus in the United states. Infect control Hosp, Epidemiol. 11, 639-42

Nord. CE. 1995. The role of anaerobic bacteria in recurrent episodes of sinusitis and tonsillitis ClisInfect. Dis.20, 1512-1524.

Chikramane SG, Mathews N, Stewart D. 1991. Tn 54 inserts in methicillin-resistant Staphylococcus aureus from Australia and England. J. Gen. Microbial. 137, 1303-1311.

Clewell DB. 1998. Conjucative transposons  p.130-139. In F.j.de Bnijn, J.R. Lupski and G.M. Weinstock (ed.), Bacterial Genomes, Chapman and Hall, New York, N.Y.

Lews S, Montgomery. 1983.Sphenoid Sinusitis. N. Eng. J. Med. 309, 1149-1154.

Doem GV, Bruggeman AB, Pierce G, Holley HP, Rauch A. 1997. Antibiotic resistance among clinical isolates of Haemophilus influenzae in the United states in 1994 and 1995 and detection of beta – lactamase positive strains resistant to amoxicillin-clavanulate; results of a national mulicenter surveillance study Antimicrob. Agents Chemother. 35, 1661-1665.

Dubin M, Childeramance S. 1991. Physical mapping of mecA gene region of on American methicillin resistance Staphylococcus aureus strains. Antimicrobial Agents Chemother. 35, 1661-1665.

Duong G, Thompson. 2004. Methicillin resistance Staphylococcus aureus Antimicrob. Agents Chemother. 37, 1552-57.

Finegold S.M. 1997. Anaerobic bacteria in human disease .Orland’s, FL Academic press Inc.

Gold SM, Tami TA. 1997. Role of middle meatus aspiration culture in the diagnosis of Chronic Sinusitis. Laryyngoscope 107, 1586-1589.

Gordts F, AbuNassar I, Clement PA, Pieard D, Kaufman KL. 1999. Bacteriology of the middle meatus in children. Int. J. Pediatr. Otorhinolaryngol 48, 163-7.

Gwaltney J.J. 1996. Acute community acquired sinusitis .Clinical infection of disease 23,1209-1212.

Hart SA, Phelps K, Mulligan M.E, 1995. Instability and discriminatory power of methicillin resistant Staphylococcus aureus typing by restriction endonucleases analysis of plasmid DNA compared with those of other molecular methods. J. Cl. Microbial. 33, 2022-6.

Hiramatsu K, Hanaki H, Yubuta, Oguri T, Tenover FC. 1997. Methicillin- Resistant Staphylococcus aureus clinical strains with reduced vancomycin susceptibility. J. Antimicrobial Chemother. 40, 135-6.

Incaudo W. 1998. Diagnosis and treatment of acute and subacute sinusitis in children and adults. Clin. Rev. Allergy Immunol. 16, 157-204.

Jacobs MR, Bajaksouzian Z, Pankuch A. 1999. Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral Antimicrob agents based on pharmacodynamic parameters, US surveillance study, Antimicrob. Agents Chemother. 460-465.

Kazuhisa M, Wakio M. 1991. Identification of Methicillin-Resistant Strains of Staphylococci by Polymerase Chain Reaction. p. 2240-2244

Lacey RW. 1972. Genetic control in Methicillin Resistant strains of Staphylococcus aureus. J. Med. Microbial. 5, 197-508.

Lee CA. 1996. Pathogenicity islands and the evolution of bacterial pathogens. Infect. Agents Dis. 5, 1-7.

Mark AR, Raynor R, Edward JF, Hajo G. 2002. The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). PNAS 99 (11), 7687-7692.

Nadel L, Kennedy. 1999. Endoscopically guided sinus cultures in normal subjects. J. Rhinol. 13, 37-90.

Orobello PR, Belcher. 1991. Microbiology of chronic Sinusitis in children. Arch. Otolaryngol. Surg. 117, 980-983.

Paterson, David L. 2001. Reduced susceptibility of Staphylococcus aureus to vancomycin – A review of current knowledge. Communicate Diseases intelligence 23.

Quintiliani R, Courvalin. 1995. Mechanism of resistance to antimicrobial agents. In P.R.Murray, E.J.Barom. M.A. Pfaller, F.C.Tenover, and R.H.Yolden (ed.,), Manual of clinical Microbiology. American society for Microbiology, Washington.

Rechia GD, Hall. 1995. Gene cassettes; a new class of mobile element. Microbiology 141, 3015-3027

Salord F, Gaussorgues, Marti-Flich J. 1990. Noscomial Maxillary sinusitis during mechanical ventilation- a prospective comparison of orotracheal versus the nosotracheal route for incubation. Intensive Care Med. 18, 390-393.

Sjostrom JE, Lofdahi S, Philipson. 1975. Transformation reveals a chromosomal locus of the genes for the methicillin resistance of Staphylococcus aureus. J. Bacteriol. 123, 905-913.

Spector SL, Bemstein IL, Berger LIJT, Kaliner MA, Schuller DE. 1998. Parameters for the diagnosis and management of sinusitis- complete guidelines and references. J. Allergy Clin. Immunol. 102, 117-44.

Tos M. 1983. Distribution of Mucous Producing elements in the respiratory tract. Differences between upper and lower ainway. Eur J. Respir Dis. Suppl. 128, 296-79.

Unals, Wernerk, Degirolami P, Barsantif, Ellopoyles G. 1994. Comparison of tests for the detection of methicillin –resistant Staphylococcus aureus in a clinical microbiology laboratory. Antimicrobial Agents Chemother. 38, 345-7.

Vogan, Bolger WE, Keyes. 2000. As endoscopically guided Sinonal Cultures: a direct comparison with maxillary sinus aspirates cultures. Otolaryngol Head Neck Surg. 12, 370-373.

Walder, Mill GJ, Brown AD, Ledema I, Salomon N, Bluestone CD. 1981. Acute maxillary sinusitis in children. N. Engi J. Med. 304, 749-54.

Yauck JS, Smith TL. 2006. Patient undergoing sinus surgery constructing a demographic Profile. 116, 135-91.

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