No abstract available.
Methicillin-Resistant Staphylococcus aureus*

Introduction: The emergence of methicillin-resistant Staphylococcus aureus (MRSA) is a challenge in the management of skin and soft tissue infections (SSTIs). Objective: To describe the epidemiology of MRSA SSTIs among admitted patients at the University of Santo Tomas Hospital (USTH). Methods : This was a retrospective study of inpatients with MRSA SSTIs from 2011-2015. MRSA infections were classii ed as community-associated (CA-MRSA) and healthcare-associated (HA-MRSA). Demographic characteristics, clinical proi le, comorbidities, complications, risk factors, antibiotic susceptibility and resistance, treatment used, and clinical outcome were determined. Results: Out of the 331 inpatients with Staphylococcus aureus SSTIs, 211 had MRSA with a prevalence of 63.7%, 80.1% of MRSA were CAMRSA while 19.9% were HA-MRSA. The mean age was 41.58 years with male predominance. The majority presented with abscess (62.9%), on the legs (21.8%). The abscess was signii cantly associated with CA-MRSA while infected wounds, previous hospitalization, and surgery were correlated with HA-MRSA. Growing resistance to ciprol oxacin, tetracycline, macrolides, co-trimoxazole, and clindamycin was noted. A low percentage of resistance to vancomycin and linezolid was observed. Almost all cases improved with appropriate antibiotic therapy and 3.3% mortality Conclusion More than half of the patients with Staphylococcus aureus SSTIs had MRSA. and were mostly CA-MRSA and males. Abscess on the leg was the common presentation and signii cantly associated with CA-MRSA. Infected wounds, previous hospitalization, and surgery were associated with HA-MRSA. There was high resistance of MRSA to ciprol oxacin and tetracycline while low resistance to vancomycin and linezolid. Almost all improved with appropriate treatment.
Methicillin-Resistant Staphylococcus aureus

Abstract: CA-MRSA infection is a global concern. It is important to determine the local prevalence of CA-MRSA skin and soft-tissue infection as this information will provide a more accurate and rational basis for empiric treatment, improve management and outcomes in patients, and reduce the economic burden associated with failed treatment. This study was conducted to determine the clinical profile and prevalence of CA-MRSA skin and soft tissue infections among pediatric patients admitted at the Philippine General Hospital. Methods: A prospective, observational study was performed involving all pediatric patients admitted at U-PGH for skin and soft tissue infections from September to December 2012. Demographic profile, clinical characteristics of patients, results of laboratory examinations, the outcome of treatment were described and summarized. Risk factors for acquisition of MRSA were also determined. Period-prevalence was computed. Results: There were 25 children admitted for SSTIs, 16 have positive cultures and 62.5% of these had CA-MRSA. The majority were male children younger than 5 years old without identifiable risk factors. infections presented as solitary masses and cellulitis usually at the head and neck area. isolates were taken from aspirates during incision and drainage. Invasive infections were seen 3 patients. The length of hospital stay, type of antibiotics used and surgery performed was variable. All patients were discharge well and there were no mortalities. The period prevalence of CA-MRSA among children with SSTI was 0.36. Conclusion CA-MRSA as a cause of SSTIs in Filipino children is an emerging concern, especially in very young patients even without risk factors. management of SSTI’s should include incision and drainage of abcesses and prompt submission of aspirates for culture and antibiotic sensitivity testing. The period prevalence of pediatric patients with SSTI is high among hospitalized patients. Empiric antibiotics with MRSA coverage such as clindamycin and vancomycin should be considered clinical situations wherein MRSA is deemed likely.
Methicillin-Resistant Staphylococcus aureus

Background and Objective: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of hospital and community-acquired infections, showing antimicrobial resistance (AMR), which is an increasing public health concern. One of the commonly-used methods to evaluate resistance include the Kirby-Bauer disk diffusion method. However, this test is found to be time-consuming, lacking in terms of mechanization and automation, alongside its non-applicability to certain antibiotics such as vancomycin. Thus, the Clinical Laboratory Standards Institute (CLSI) recommends using the broth microdilution method in the evaluation of antibacterial activities against S. aureus. A rapid laboratory identification of MRSA is important in the treatment of patients. Therefore, this study aims to optimize and evaluate the effectiveness of a rapid microplate assay using resazurin dye as a colorimetric indicator in determining antibacterial activity against clinical isolates of MRSA and methicillin-susceptible S. aureus (MSSA). Methods: Clinical isolates of MRSA and MSSA were obtained from the Philippine General Hospital (PGH) Microbiology Section, and American Type Culture Collection (ATCC) controls of both strains (ATCC 25923 and ATCC 43300) were acquired. These were then subjected to identification and confirmation procedures. A standardization of bacterial inoculum was performed by comparing its 24-hr growth in Mueller Hinton Broth to 0.5 McFarland Standard. The resazurin microplate assay (REMA) was set-up using two-fold serial dilution of control antibiotics such as oxacillin, vancomycin, and cefoxitin. Each plate was inoculated with standardized bacterial growth of controls and clinical isolates. To determine the time needed for the reduction of the resazurin dye, a qualitative assessment was conducted by comparing the reaction time between a 6.75 mg/mL dye with a 0.01 mg/mL dye. The plates were also subjected to different incubation times and dye concentrations, and the optical densities of the plates were compared using a microplate reader. Results: Results showed that there were no significant differences between the optical densities of the wells of those incubated for 5 hours and for 24 hours (p >0.05). Furthermore, there was a significant reduction in the reaction time of the dye (from 18 hours to 1 hour) when the dye concentration was reduced from 6.75 mg/mL to 0.01 mg/mL. The optimized REMA showed a significant difference between the minimum inhibitory concentrations (MICs) of the different antibiotics against the control and isolate strains of MRSA and MSSA, showing a W of -2.98 (p <0.05) using the Wilcoxon Rank-Sum non-parametric test. Furthermore, the REMA has shown better illustration of anti-MRSA and anti-MSSA activities as compared to the Kirby Bauer disk diffusion method. Conclusion Based on the results presented, the researchers determined the optimal condition for the resazurin microtiter assay, which was 0.01 g/mL concentration of resazurin dye, at a 5-hour incubation period. This study has shown that an optimized REMA is an efficient and fast method to determine the antimicrobial activities of oxacillin, cefoxitin, and vancomycin against MRSA and MSSA.
Methicillin Resistant Staphylococcus aureus

Background/Objective: An outbreak of nosocomial infections through nasal carriage of organisms by health care workers may also occur. The health care workers (who are in close contact with the patients are possible sources of hospital-acquired infections. Staphylococci are a leading cause of bacteremia, surgical wound infections and nosocomial infection in many areas around the globe. The objective of this study was to determine the nasal carriage rate of Staphylococcus aureus among health care workers in a pediatric intensive care unit. Methods: Twenty six healthcare workers in a pediatric intensive care unit of a tertiary hospital were included. Cultures from the anterior nares were obtained using a sterile cotton tip swab, which was moistened with sterile normal saline solution. Samples were then analyzed using standard microbiological methods. The susceptibilities of the isolates to antibiotics were then determined by the Kirby Bauer disk diffusion method. Nasal carriage rate of Staphylococcus aureus was determined. Results: The mean age of the subjects was 35 years (range 22-56) old. There were 20 nurses (76.9%), 4 (15.4%) nurse assistants, and 2(7.7%) utility workers; 3 (11. 5%) were males and 23 (88.5%) were females. Two subjects (7.7%) grew Staphylococcus aureus. Both reported 100% sensitivity to all tested antibiotics except for Penicillin G which showed 100% resistance. Twenty four of the subjects (92.3%) grew Staphylococcus epidermidis, 5 (20.83%) were methicillin resistant. All showed 100% sensitivity to Gatifloxacin, Levofloxacin, Oxacillin, and Vancomycin. There was high resistance (62.5%) to Penicillin G. Conclusion The nasal carriage rate (7.7%) of Staphylococcus aureus in this study is lower compared to earlier reports. The results of this study showed higher nasal carriage of Staphylococcus epidermidis (92.3%).
Staphylococcus ; Staphylococcus aureus ; Methicillin-Resistant Staphylococcus aureus

No Abstract Available.
Methicillin Resistance* ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus* ; Staphylococcus aureus* ; Staphylococcus*

No Abstract Available.
Methicillin Resistance* ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus* ; Staphylococcus aureus* ; Staphylococcus*

Background: Osteomyelitis is a debilitating disease if not properly treated. Epidemiologic and microbiologic data will be of great importance in the direction of treatment. Objective: To determine the epidemiologic and clinical profile of pediatric patients with chronic osteomyelitis admitted at Philippine General Hospital from 2006 to 2010. Methodology: This is a retrospective study involving a review of medical records of pediatric patients with chronic osteomyelitis admitted at the Philippine General Hospital during the 5 year study period. Frequencies and percentages were computed for nominal data. Comparison of the different variables was done using Chisquare and Fisher Exact test. Results: Eighty of the 134 cases of pediatric patients with chronic osteomyelitis were reviewed. Twenty-three percent of all operations involved the femur (N=18) and tibia (N=18). On radiograph, the presence of sequestrum was the most common finding noted in 53% of the cases. The predominant organism isolated in bone cultures was MSSA (40%) followed by MRSA (20%). On tissue cultures MRSA was the most common isolate in 34%, followed by MSSA(31%). Majority of the patients were given Oxacillin as empiric therapy (55%).No significant difference was observed with respect to the areas of bone involvement, signs and symptoms, radiologic findings and laboratory parameters between MSSA and MRSA osteomyelitis (p>0.05). Conclusion There were 239 per 100,000 cases of chronic osteomyelitis. The most common bones involved were the femur and tibia with sequestrum as the most common radiologic finding. In the previous studies, MRSA was not reported but was noted in the present study. Most of the patients in our study were treated with both antibiotics and surgery to optimize management. Ninety-eight percent of the cases had significant clinical improvement upon discharge. Based on this study, laboratory parameters, clinical manifestations and area involved cannot be utilized in differentiating MRSA from MSSA osteomyelitis. Further studies are needed to support our findings and isolation of the organism is still required for definitive identification to distinguish between MRSA from MSSA osteomyelitis.
Staphylococcus aureus ; Methicillin-Resistant Staphylococcus aureus

Objective: This study aims to determine the staphylococcal nasal carriage rates of children who are between one-to-five years old and residing in Botanical Gardens, Barangay Pio Del Pilar, Makati City. The following shall also be investigated: antibiotic resistance patterns of isolates, factors associated with S. aureus nasal carriage, and other pathologic organisms colonizing the anterior nares in this population. Methods: Nasal swabs were taken from each subject and cultured after informed consent was obtained. Statistical analysis was performed to determine factors with significant association with nasal colonization. Results: Ten (12.9%) out of 77 subjects were positive for S. aureus nasal colonization, one of which was oxacillin-resistant. Only the gross monthly income showed significant association with nasal carriage (p=0.03, OR = 0.59, 95% CI). Four subjects (5.1%) were carriers of S. pneumoniae. Conclusions The study shows a relatively low rate of Methicillin Sensitive S. aureus (MSSA) and Methicillin Resistant S. aureus (MRSA) nasal carriage. The MRSA isolate was sensitive to all other anti-staphylococcal drugs tested, similar to other studies on Community Acquired-MRSA (CA-MRSA). Local surveillance studies are essential in the control of CA-MRSA and in guiding local antibiotic policies for staphylococcal infections. Further studies on a bigger population are needed to determine rates, resistance patterns and risk factors associated with nasal colonization.
Staphylococcus aureus ; Methicillin-Resistant Staphylococcus aureus

Background/Objective: There is a deep concern about the rapid rise in resistance of bacteria to antimicrobial agents. Methicillin-resistant Staphylococcus aureus (MRSA) which pose challenges to the medical community. This study aimed to determine the prevalence and sensitivity pattern of Methicillin-Resistant Staphylococcus Aureus (MRSA) in a tertiary hospital in Cebu City from January 1, 2007 to December 31, 2010. Methods: Charts of patients with MRSA growths were reviewed upon their admission. The sensitivity pattern, demographic profile and risk factors were noted. Results: Out of the 637 isolates of Staphylococcus aureus, MRSA had a prevalence rate of 38.6% (n=246), while Methicillin Sensitive Staphylococcus aureus (MSSA) had 61.4% (n=391). The prevalence rate of health-care associated MRSA was 2% (n=5). The majority of the specimens sent for culture were wound/abscess (70% of pediatric and 76% of adult patients isolates). All MRSA growths were resistant to penicillin G, ampicillin, oxacillin, cefuroxime and amikacin. Local MRSA strains were still susceptible to ciprofloxacin (82.3%), clindamycin (90.6%), erythromycin (91.5%), and sulfamethoxazole-trimethoprim (85.9%). There was no resistance to linezolid and vancomycin. Vancomycin-resistant Staphylococcus aureus was not isolated. The mortality rate on both pediatric and adult population was 2.1% and 4.8%, respectively. Conclusion The prevalence of MRSA is increasing. Clindamycin, erythromycin, sulfamethoxazole- trimethoprim and vancomycin are excellent treatment options treat MRSA.
Methicillin-Resistant Staphylococcus aureus ; Staphylococcus aureus ; Vancomycin