Methicillin-resistant Staphylococcus aureus screening in healthcare workers: should a new protocol be introduced?

Sahil Gurjar, Namami Mathur, Sulochana R. Jadhavar


Background: In recent times, emerging resistance to majority of antibiotic classes seen in Methicillin-resistant Staphylococcus aureus (MRSA) isolates is of concern in hospital-acquired infection. MRSA carriage by healthcare workers (HCWs) has been documented to be as high as 50% in some studies. Higher carrier rate increases the risk of developing active infection as well as transmission of infection to the patients. The study aims to establish a relationship between MRSA carrier rate and healthcare workers of a tertiary care hospital in Pune and understand the need for screening regimens, based on the outcome.

Methods: A cross-sectional study including health care workers from a tertiary care hospital working in different clinical departments was carried out. Data was collected by taking samples of nasal swabs of 115 HCWs and inoculated immediately on blood agar. Culture plates were incubated at 37°C for 24 hours and colonies were tested by routine diagnostic techniques. Antibiotic sensitivity was tested using cefoxitin discs on Mueller Hinton medium.

Results: Prevalence of Staphylococcus aureus carriage was reported in 19 out of 115 (16.52%) healthcare workers, of which 63.2% were MRSA and 36.8% were MSSA. Prevalence of MRSA among Orthopaedic surgeons and General surgeons showed a carrier rate of 25% and 18.2% respectively. Nurses had a prevalence rate of 0.39 %. Overall prevalence of MRSA carriage in healthcare workers was reported to be 10.4%

Conclusions: MRSA carriage among HCWs at the hospital is considerably high. The high prevalence of MRSA carriage emphasizes the need for stringent hospital infection control and regular screening regimen of HCWs.


Antibiotic resistance, Infectious disease transmission, Methicillin resistant Staphylococcus aureus, Nosocomial infections, Screening

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Enright MC, D. Robinson A, Randle G, Feil EJ, Grundmann H, Brian G. Spratt. The evolutionary history of methicillin -resistant Staphylococcus aureus. Boston, MA. 2002.

Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005;5:751-62.

Albrich WC, Harbarth S. Health-care workers: source, vector, or victim of MRSA? Lancet Infectious Diseases. 2008;8:289-301.

Angen O, Skade L. Controlling Transmission of MRSA to Humans During Short-Term Visits to Swine Farms Using Dust Masks. Front microbial. 2018.

National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992 through June 2002. Am J Infection Control. 2003;31:2003.

National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992-June 2001, issued August 2001. Am J Infection Control. 2001;29.

Hiramatsu K. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J. Antimicrobial. Chemotherapy. 1997;40:135-6.

Staphylococcus aureus resistant to vancomycin. United States, 2002. MMWR. 2002;51:565-7.

Foster TJ. Antibiotic resistance in Staphylococcus aureus. Current status and future prospects, FEMS. Microbiology Reviews. 2017;41(3):430-49.

Pantosti A, Sanchini A, Moraco M. Mechanisms of antibiotic resistance in Staphylococcus aureus. Future microbiology. 2009;2:3.

Datta R, Huang SS. Risk of Infection and Death due to Methicillin- Resistant Staphylococcus aureus in Long-Term Carriers. Clinical Infectious Diseases. 2008;47(2):176-81.

Yu VL. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. Efficacy of antibiotic prophylaxis. N Engl J Med. 1986;315:91-6.

Kluytmans, J, van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev. 1997;10:505-20.

Perl TM. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002;346:1871-7.

Fishbain JT, Lee JC, Nguyen HD. Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates. Infect Control Hosp Epidemiol. 2003;2.

Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis. 2003;36.

Papia G, Louie M, Tralla A, Johnson C, Collins V, Simor A. Screening high-risk patients for methicillin resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiolol. 1999;20.

Girou E, Azar J, Wolkenstein P, Cizeau F, Brun-Buisson, Roujeau JC. Comparison of systematic screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward, Infect Control Hosp Epidemiol. 2000;21.

Brown DFJ, Edwards DI, Hawkey PM, Morrison D, Ridgway GL et al. On behalf of the Joint Working Party of the British Society for Antimicrobial Chemotherapy, Hospital Infection Society and Infection Control Nurses Association, Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). Journal of Antimicrobial Chemotherapy. 2005;56(5):1000-101.

NCCLS. 2004. Performance standards for antimicrobial susceptibility testing, 14th informational supplement. NCCLS document M100-S14. National Committee for Clinical Laboratory Standards, Wayne, PA.

Voss A, Milatovic D, Wallrauch-Schwarz C, Rosdahl VT, Braveny I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis. 1994;13:50-5.

Clinical and Laboratory Standard Institute. Performance standards for antibacterial disc diffusion tests. Approved standards 9thedition.CLSI document M2-M9, Wayne Pa; CLSI. 2009.

Schaefler S, Jones D, Perry W. Emergence of gentamicin and methicillin-resistant Staphylococcus aureus in New York City hospitals. J Clin Microbiol. 1981;13:754-9.

Radhakrishna M, D'Souza M, Kotigadde S, Saralaya KV, Kotian MS. Prevalence of Methicillin Resistant Staphylococcus aureus Carriage amongst Health Care Workers of Critical Care Units in Kasturba Medical College Hospital, Mangalore, India. J Clin Diagn Res. 2013;7(12):2697-700.

Vinodhkumaradithyaa A, Uma A, Srinivasan M, Ananthalakshmi I, Nallasivam P, Thirumalaikolundusubramanian P. Nasal Carriage of Methicillin – Resistant Staphylococcus aureus among Surgical Unit Staff. Jpn J Infect Dis. 2009;62:228-29.

Mathanraj S, Sujatha S, Sivasangeetha K, Parija SC. Screening for methicillin-resistant Staphylococcus aureus carriers among patients and health care workers of a tertiary care hospital in Southern India. Indian J Med Microbiol. 2009; 27:62-4.

Goyal R, Das S, Mathur M. Colonisation of methicillin resisitant Staphylococcal aureus among health care workers in a tertiary care hospital of Delhi. Indian J of Med Sciences. 2002;56(7):321-24.

Malini J, HarleShruti A, Padmavathy M, Umapathy BL, Navaneeth BV, KeerthiMannan J, Girish MS. Methicillin resistant Staphylococcus aureus Carriage among the Health Care Workers in a Tertiary Care Hospital. J Clin Diagn Res. 2012;6(5):791-93.

Rongpharpi SR, Hazarika NK, Kalita H. The Prevalence of Nasal Carriage of Staphylococcus aureus Among Healthcare Workers at a Tertiary Care Hospital in Assam with Special Reference to MRSA. J Clin Diagn Res. 2013;7(2):257-60.

Ravindra JS, Sujeet MM, Habib J. Screening for Methicillin Resistant Staphylococcus aureus among healthcare workers in a tertiary care hospital. Int J Health Sci Res. 2013;3(5):14-8.

Goetghebeur M, Landry PA, Han D, Vicente C. Methicillin-resistant Staphylococcus aureus: A public health issue with economic consequences. Can J Infect Dis Med Microbiol. 2007;18(1):27-34.