Methicillin-resistant Staphylococcus aureus in Intensive Care Unit Setting of India: A Review of Clinical Burden, Patterns of Prevalence, Preventive Measures, and Future Strategies

Mehta, Yatin; Hegde, Ashit; Pande, Rajesh; Kg, Zirpe; Gupta, Vineet; Ahdal, Jaishid; Qamra, Amit; Motlekar, Salman; Jain, Rishi

doi:10.5005/jp-journals-10071-23337

Cited by 31 publications

(10 citation statements)

References 37 publications

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“…10 Over the past few years, several studies have reported the prevalence of MRSA in different clinical settings within the Indian subcontinent, but the results are inconsistent with limited sample sizes. 8,[11][12][13] Furthermore, few studies from the country suggest an impact of age and gender on MRSA carriage. 14,15 It is imperative to understand the prevalence of risk factors, such as age and gender, on MRSA colonization at the country level to facilitate the implementation of appropriate infection control measures.…”

Section: Introductionmentioning

confidence: 99%

A Systemic Literature Review and Meta-Analysis Reporting the Prevalence and Impact of Methicillin-Resistant Staphylococcus aureus Infection in India

2020

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Aim and objective: This systematic review and meta-analysis was conducted to assess the prevalence, burden and epidemiology of methicillin-resistant S. aureus (MRSA). This systemic review was also aimed to highlight the challenges in the diagnosis and management of methicillin-resistant S. aureus (MRSA) in India (for all age groups). We also examined the published literature on the available treatment options and the role of prevention in the management of MRSA in India. By summarizing the currently available data, our objectives were to highlight the need for the prevention of MRSA infections and also emphasize the role of vaccination in the prevention of MRSA infections in India. Methodology: Electronic databases such as PubMed and databases of the National Institute of Science Communication and Information Resources and Indian Council of Medical Research Embase were searched for relevant literature published from 2005/01/01 to 2020/05/13 in English language, according to the predefined inclusion and exclusion criteria. A manual search was also conducted using the key term “MRSA ‘or’ Methicillin Resistant Staphylococcus aureus ‘and’ India.” An independent reviewer extracted data from the studies using a structured Microsoft Excel spreadsheet, and a meta-analysis of proportion for MRSA prevalence with a corresponding 95% confidence interval (CI) for all included individual studies were performed. Result: A total of 34 studies involving 16 237 patients were included in the final meta-analysis. The pooled proportion of patients with MRSA infection was 26.8% (95% CI: 23.2%-30.7%). The MRSA infection was more prevalent among male patients (60.4%; 95% CI: 53.9%-66.5%) as compared to female patients (39.6%; 95% CI: 33.5%-46.1%), while the prevalence of MRSA was higher among adults (18 years and above; 32%; 95% CI: 5%-80%) in comparison to pediatric patients (0-18 years; 68%; 95% CI: 20%-94.8%). The degree of heterogeneity was found to be significant. Conclusion: The prevalence of MRSA in India was relatively high at 27% with a higher proportion observed among men aged >18 years. The high prevalence of MRSA infections in India necessitates the implementation of surveillance and preventive measures to combat the spread of MRSA in both hospital and community settings.

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Section: Introductionmentioning

confidence: 99%

A Systemic Literature Review and Meta-Analysis Reporting the Prevalence and Impact of Methicillin-Resistant Staphylococcus aureus Infection in India

2020

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“…Our results show that in a broad population of adult ICU patients with confirmed infection treated with vancomycin, the early attainment of therapeutic drug levels within 48 h was associated with a reduced risk of 30-day mortality. Compared to methicillin-susceptible S. aureus (MSSA), MRSA is independently associated with an increased risk of hospital mortality; thus, early attainment of MRSA treatments therapeutic levels is crucial [ 2 , 4 , 6 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Infections may induce sepsis or septic shock, which is common in critically ill patients [ 1 ]. Gram-positive infections are a growing concern given the increase in their resistant patterns, including methicillin-resistant Staphylococcus aureus (MRSA) with a reported mortality rate up to 55% in critically ill patients [ 2 , 3 ]. Vancomycin is still commonly used for suspected or confirmed Gram-positive infections in critically ill patients, despite having newer antimicrobial therapies with MRSA coverage [ 3 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of early target attainment of vancomycin in critically ill patients with confirmed Gram-positive infection: A retrospective cohort study

et al. 2021

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Background Vancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges, which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. This study aims to evaluate the timing to achieve therapeutic trough level of vancomycin on 30-day mortality in critically ill patients. Method A retrospective cohort study was conducted for all adult critically ill patients with confirmed Gram-positive infection who received IV vancomycin between January 1, 2017, and December 31, 2020. We compared early (< 48 h) versus late (≥ 48 h) attainment of vancomycin therapeutic trough levels. The primary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were the development of resistant organisms, microorganisms eradication within 4–5 days of vancomycin initiation, acute kidney injury (AKI), and length of stay (LOS). Propensity score-matched (1:1 ratio) used based on patient’s age, serum creatinine, and albumin values at baseline. Results A total of 326 patients were included; 110 patients attained the therapeutic trough levels within 48 h of vancomycin initiation. Late achievement of the therapeutic trough levels was associated with higher 30-day mortality (HR: 2.54; 95% CI [1.24–5.22]; p = 0.01). Additionally, patients who achieved therapeutic trough levels of vancomycin late were more likely to develop AKI (OR = 2.59; 95% CI [1.01–6.65]; p = 0.04). Other outcomes were not statistically significant between the two groups. Conclusion Early achievement of vancomycin therapeutic levels in patients with confirmed Gram-positive infection was associated with possible survival benefits.

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“…In India, the prevalence of MRSA has been recorded to be around 30–70% with high mortality rates among patients developing MRSA bacteremia ( Antimicrobial Resistance, C, 2022 ). Originally, MRSA was common in the healthcare setting contributing to nosocomial/hospital-acquired (HA-MRSA) infections like those associated with surgical procedures, indwelling catheters, or prosthetic devices ( Mehta et al, 2020 ). However, over the last decade, there has been an upsurge of community-associated MRSA (CA-MRSA) infections also like bone, joint and skin infections ( Masimen et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of freeze-thaw and sonication cycle-based methods for extracting AMR-associated metabolites from Staphylococcus aureus

et al. 2023

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Emerging antimicrobial resistance (AMR) among Gram-positive pathogens, specifically in Staphylococcus aureus (S. aureus), is becoming a leading public health concern demanding effective therapeutics. Metabolite modulation can improve the efficacy of existing antibiotics and facilitate the development of effective therapeutics. However, it remained unexplored for drug-resistant S. aureus (gentamicin and methicillin-resistant), primarily due to the dearth of optimal metabolite extraction protocols including a protocol for AMR-associated metabolites. Therefore, in this investigation, we have compared the performance of the two most widely used methods, i.e., freeze-thaw cycle (FTC) and sonication cycle (SC), alone and in combination (FTC + SC), and identified the optimal method for this purpose. A total of 116, 119, and 99 metabolites were identified using the FTC, SC, and FTC + SC methods, respectively, leading to the identification of 163 metabolites cumulatively. Out of 163, 69 metabolites were found to be associated with AMR in published literature consisting of the highest number of metabolites identified by FTC (57) followed by SC (54) and FTC + SC (40). Thus, the performances of FTC and SC methods were comparable with no additional benefits of combining both. Moreover, each method showed biasness toward specific metabolite(s) or class of metabolites, suggesting that the choice of metabolite extraction method shall be decided based on the metabolites of interest in the investigation.

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Methicillin-resistant Staphylococcus aureus in Intensive Care Unit Setting of India: A Review of Clinical Burden, Patterns of Prevalence, Preventive Measures, and Future Strategies

Cited by 31 publications

References 37 publications

A Systemic Literature Review and Meta-Analysis Reporting the Prevalence and Impact of Methicillin-Resistant Staphylococcus aureus Infection in India

A Systemic Literature Review and Meta-Analysis Reporting the Prevalence and Impact of Methicillin-Resistant Staphylococcus aureus Infection in India

The impact of early target attainment of vancomycin in critically ill patients with confirmed Gram-positive infection: A retrospective cohort study

Comparison of freeze-thaw and sonication cycle-based methods for extracting AMR-associated metabolites from Staphylococcus aureus

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