Methicillin Resistant Staphylococcus Aureus Among Patients On The General Wards At Kawolo General Hospital, Uganda.

Abstract

Introduction: Over time there has been a global increase of antimicrobial resistances among Staphylococcus aureus (S. aureus) with MRSA persistently becoming rampant especially among hospitalized patients. This has limited the choices for management with increasing treatment costs. Aim: This study aimed at establishing the prevalence of Methicillin Resistant S. aureus among patients admitted in the general wards at Kawolo general hospital, Uganda. Methodology: A cross sectional laboratory based experimental study was done. Samples included nasal and wound swabs from patients on female, male, and the peadiatric wards to isolate S. aureus that colonised the nares or caused wound infections. Drug susceptibility was done by Kirby Bauer method from which Methicillin resistant S. aureus (MRSA) were identified. Also, Multi drug resistant (MDR) and possible Extra drug resistant (XDR) S. aureus were identified. Results: A total of 204 samples were collected from 87 (42.57%) females and 117 (57.43%) males. Samples that grew organisims were 182 (89.2%) while 22 (10.8%) showed no growth. Among those that grew, 102/182 (56.04%) were S. aureus while 80/182 (43.96%) were other organisims. Among the S. aureus isolates, 44/102 (43.14%) were MRSA while 58/102 (56.86%) were MSSA. Samples from the female, male, and the peadiatric wards showed that 8/26 (30.77%), 26/50 (52%), 10/26 (38.46%) participants had MRSA respectively. Susceptibility testing showed that S. aureus was more susceptible to vancomycin > Gentamycin > Clindamycin > Erythromycin > Penicillin G > Trimethoprim sulfamethoxazole. Against the MRSA isolates, only vancomycin showed excellent performance with 100% sensitivity followed by gentamycin with a sensitivity of 24/44 (54.55%) but MRSA was a big predictor of gentamycin resistance (OR: 11.25, P-Value < 0.0001). A total of 92 (90.2%) S. aureus isolates were resistant to at least one antibiotic used among which 46/92 (45.10%) isolates were MDR, while 14/92 (13.73%) isolates were possible XDR. Conclusion: There is a high prevalence of MRSA in Kawolo general hospital. Before treatment, antimicrobial susceptibility should be done or where facilities are unavailable, vancomycin should be the drug of choice in empirical treatment/management of infections with MRSA. Also Trimethoprim sulfamethoxazole and Penicillins should not be used in any presumed MRSA infection in all places with limited isolation facilities.