Antibiotic Resistance of Commensal Staphylococcus aureus and Coagulase-Negative Staphylococci in an International Cohort of Surgeons: A Prospective Point-Prevalence Study

Abstract

Nasal colonization with antibiotic resistant bacteria represents both a risk factor for the colonized individual and their immediate contacts. Despite the fact that healthcare workers such as orthopedic surgeons are at a critical interface between the healthcare environment and an at-risk patient population, the prevalence of antibiotic resistant bacteria within the surgical profession remains unclear. This study offers a snapshot of the rate of nasal colonization of orthopedic surgeons with multi-resistant staphylococci including methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS). We performed a prospective, observational study obtained at a single time point in late 2013. The participants were active orthopedic, spine and head & neck surgeons from 75 countries. The prevalence of nasal carriage of the different bacteria and the corresponding 95% confidence interval were calculated. From a cohort of 1,166 surgeons, we found an average S. aureus nasal colonization rate of 28.0% (CI 25.4;30.6) and MRSA rate of 2.0% (CI 1.3;2.9), although significant regional variations were observed. The highest rates of MRSA colonization were found in Asia (6.1%), Africa (5.1%) and Central America (4.8%). There was no MRSA carriage detected within our population of 79 surgeons working in North America, and a low (0.6%) MRSA rate in 657 surgeons working in Europe. High rates of MRCoNS nasal carriage were also observed (21.4% overall), with a similar geographic distribution. Recent use of systemic antibiotics was associated with higher rates of carriage of resistant staphylococci. In conclusion, orthopedic surgeons are colonized by S. aureus and MRSA at broadly equivalent rates to the general population. Crucially, geographic differences were observed, which may be partially accounted for by varying antimicrobial stewardship practices between the regions. The elevated rates of resistance within the coagulase-negative staphylococci are of concern, due to the increasing awareness of their importance in hospital acquired and device-associated infection.

Prevalence and characteristics ofStaphylococcus aureusand methicillin‐resistantStaphylococcus aureusnasal colonization among a community‐based diabetes population in Foshan, China

“…We found that S. aureus strains of both the diabetes population and non-diabetes population in the present study were highly resistant to erythromycin and penicillin, which was similar to several other studies 20,38,39 . This might be as a result of the extensive use of these antibiotics in medical institutions.…”

Colonização bacteriana e resistência antimicrobiana em trabalhadores de saúde: revisão integrativa

“…The studies were published in 2008, (22) 2009, (14,15) 2010, (25) 2011, (23) 2012, (21) 2013, (12,13,16) 2014, (14,15,18) 2016, (20) 2017, (24) all in English. (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) In terms of level of evidence, 13 articles were cross-sectional, observational studies (level of evidence 6), (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) whereas one was a cohort study (level of evidence 4).…”

“…(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) In terms of level of evidence, 13 articles were cross-sectional, observational studies (level of evidence 6), (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) whereas one was a cohort study (level of evidence 4). (25) The studies were conducted in the following locations: USA, (12) Iran, (23,13) Brazil, (14,16,17,19,22) Ethiopia, (15) Sri Lanka, (18) Switzerland, (20) Libya,…”

“…(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) The main data collection sectors in the articles were intensive care units, (17,22,25,27) emergency departments, (12,17,18) operating rooms, (17,22) and hemodialysis and nephrology units. (22) To detect colonizing microorganisms, the samples were collected through nasal swab specimen techniques, (12)(13)(14)(15)(20)(21)(22)(23)(24) as well as from saliva (17,19) and the hands. (18) Some studies collected samples from more than one anatomic site.…”

“…(16,22,25) In the analysis of the sample, it was detected that Staphylococcus aureus was colonizing in workers. (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) (19,25) Of the samples with colonization by Staphylococcus aureus, some researchers isolated strains of methicillin-resistant Staphylococcus aureus (MRSA) from strains that were susceptible to methicillin (MSSA). (12,13,15,17,18,21,24) These strains of MRSA were resistant to antibiotics such as ciprofloxacin, (12,17) clindamycin, (12,17,21) pristinamycin, (13) oxacillin, (13,17,21,24) penicillin G, (15) ampicillin, (15) amoxicillin, (15) tetracycline, (13) erythromycin, (17,21) mupirocin, (21) sulfamethoxazole (21) and cefoxetin.…”