Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi Hospital, Shiraz, Iran

Objective: The aim of this study was to determine the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers (HCWs) at Namazi Hospital, Shiraz, Iran. Methods: This cross-sectional study was conducted from July to November 2006. Nasal swabs were taken from 600 randomly selected HCWs. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test, and mannitol salt agar fermentation. To analyze sensitivity patterns of MRSA strains more precisely, minimum inhibitory concentrations (MICs) of antibiotics were determined by the E-test method. All methicillin-resistant isolates were examined for the existence of the mecA gene by total DNA extraction and PCR. Results: The prevalence of nasal carriage of methicillin-sensitive S. aureus (MSSA) was 25.7% and of MRSA was 5.3%, with the highest nasal carriage of MRSA in surgical wards and the emergency department. There was no significant difference between the sexes (p = 0.247), age (p = 0.817), and years of healthcare service (p = 0.15) with regard to the nasal carriage of MRSA and MSSA. In the univariate analysis, a statistically significant difference was only found for occupation (p = 0.032) between the carriage of MSSA and MRSA. In the multivariate analysis, the occupation 'nurse' was independently associated with MRSA carriage (p = 0.012, odds ratio 3.6, 95% confidence interval 1.3-9.7). The highest resistance rate for both gentamicin and clindamycin (69%) was noted among the MRSA strains. None of the MRSA strains were resistant to mupirocin, linezolid, fusidic acid, or vancomycin. The existence of the mecA gene in all 32 methicillin-resistant isolates was observed by PCR. Conclusions: This study revealed the prevalence of nasal carriage of S. aureus strains among HCWs to be lower than that found in other studies from Iran. The antibiotic susceptibility patterns also differed, perhaps as a result of the excessive use of antibiotics at our hospital. Only the occupation of nurse was an independent risk factor for MRSA carriage. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.