Presence of methicillin-resistant staphylococcus aureus amongst patients admitted to the intensive care units of six Kwazulu-Natal hospitals, 2018 to 2022

Abstract

BACKGROUND The rate of nosocomial infection is detrimental to the health system, exacerbating themanagement costs, mortality, and morbidity globally. Staphylococcus aureus accounts for community and nosocomial infections associated with humans, including bacteraemia, pneumonia and bloodstream infection. Methicillin-resistant Staphylococcus aureus is major contributor to infections linked to healthcare, especially in the intensive care unit. It is also a major public health concern around the world due to its resistance to routinely used antibiotics and associated with severe infections. There is no study that has recently determine the presence of MRSA strain from patients admitted to ICU ward of six Kwazulu- Natal hospitals, which are the King Edward VIII Hospital, Inkosi Albert Luthuli Central Hospital, Addington Hospital, Mahatma Gandhi Memorial hospital, Prince Mshiyeni Memorial Hospital and Northdale Hospital during the pandemic period. AIM The aim of the study was to determine the prevalence and antimicrobial profile of MRSA identified at King Edward VIII, Inkosi Albert Luthuli Central Hospital, Addington, Mahatma Gandhi Memorial, Prince Mshiyeni Memorial Hospital, and Northdale hospitalised patients older than 18 years of age, for a period of five years. METHOD This retrospective study was conducted from six KZN hospitals from 2018 to 2022, utilising data obtained from National Health Laboratory Services (NHLS). The initial plan was to concentrate more on ICU patients above 18 years of age. Data received from the CDW for MRSA isolates were detected from 2018 to 2022 for patients in the ICU of the six hospitals. However, due to the very limited ICU data received, since one of six hospitals (Mahatma Gandhi) does not have an ICU ward and the ICU admits fewer patients compared to other hospital wards, we chose to concentrate on the total MRSA prevalence across all wards because low sample numbers may make statistical analysis unreliable. Data comprised infection rate, test data, and demographic information. MRSA and Staphylococcus aureus cases were compared using descriptive analysis and cross-tabulation. Data was analysed using IBM SPSS version 27. RESULTS Amongst 11663 Staphylococcus aureus isolated from Six KZN hospitals, 2357 isolated tests were resistant to methicillin. The most prevalent age groups affected by MRSA infection were individuals between the ages of 18 and 29 as well as those aged between 30 and 40 years. More males than females were infected with MRSA in both pre and post-COVID- 19. MRSA was commonly isolated in pus specimens, followed by automated blood culture. Inkosi Albert Luthuli Central hospital is presented with a high number of MRSA compared to other hospitals in pre-COVID-19. In post-COVID-19 high rate of MRSA infection was observed in Northdale hospital. Antimicrobial susceptibility revealed that MRSA is highly sensitive to linezolid, teicoplanin, fusidic acid and vancomycin. High resistance patterns were seen in cefoxitin and penicillin-ampicillin. CONCLUSION The results of the study found that there was a 20,2% MRSA prevalence rate over the fivey ear period across all six hospitals, which is alarming. This clearly calls for drastic measures to curb the spread of this resistant isolate by employing improved infection control strategies and antimicrobial stewardship in healthcare settings. The slight increase in MRSA incidence from pre-COVID-19 (19,46%) to post-COVID-19 (20,84%) implies that COVID-19 had little impact on MRSA transmission. Strategies for control and prevention, such as decolonisation, should be prioritised. Drugs that are found to be of choice for the treatment of MRSA are linezolid, teicoplanin and vancomycin. Continuous monitoring and surveillance should be implemented to ensure drug resistant organisms are identified sooner.