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Background Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality worldwide. For the establishment of national strategies to combat MRSA infection in each country, accurate and current statistics characterizing the epidemiology of MRSA are essential. The purpose of this study was to determine the prevalence of MRSA among Staphylococcus aureus clinical isolates in Egypt. In addition, we aimed to compare different diagnostic methods for MRSA and determine the pooled resistance rate of linezolid and vancomycin to MRSA. To address this knowledge gap, we conducted a systematic review with meta-analysis. Methods A comprehensive literature search from inception to October 2022 of the following databases was performed: MEDLINE [PubMed], Scopus, Google Scholar, and Web of Science. The review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement. Based on the random effects model, results were reported as proportions with a 95% confidence interval (CI). Analyses of the subgroups were conducted. A sensitivity analysis was conducted to test the robustness of the results. Results A total of sixty-four (64) studies were included in the present meta-analysis, with a total sample size of 7171 subjects. The overall prevalence of MRSA was 63% [95% CI: 55–70]. Fifteen (15) studies used both PCR and cefoxitin disc diffusion for MRSA detection, with a pooled prevalence rate of 67% [95% CI: 54–79] and 67% [95% CI: 55–80], respectively. While nine (9) studies used both PCR and Oxacillin disc diffusion for MRSA detection, the pooled prevalences were 60% [95% CI: 45–75] and 64% [95% CI: 43–84], respectively. Furthermore, MRSA appeared to be less resistant to linezolid than vancomycin, with a pooled resistance rate of 5% [95% CI: 2–8] to linezolid and 9% [95% CI: 6–12] to vancomycin, respectively. Conclusion Our review highlights Egypt's high MRSA prevalence. The cefoxitin disc diffusion test results were found to be consistent with PCR identification of the mecA gene. A prohibition on antibiotic self-medication and efforts to educate healthcare workers and patients about the proper use of antimicrobials may be required to prevent further increases.

Objective: To determine the diagnostic accuracy of CHROMagar MRSA for detecting MRSA from screening swab specimens keeping the Cefoxitin disk diffusion test as the reference method. Study Design: A cross-sectional validation study. Place and duration of study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Mar to Aug 2019. Methodology: A total of 243 screening swab specimens, e.g., axillary, nasal and web swabs, each of hospitalized patients and healthcare workers (HCW) submitted for MRSA screening were included in the study and were processed simultaneously on blood agar, MacConkey agar and CHROMagar MRSA. The agar plates were incubated at 35°C ± 2°C for 18-24 hours in ambient air. The cefoxitin disk diffusion test followed the isolation and identification of MRSA according to the latest Clinical and Laboratory Standards Institute (CLSI) guidelines. In CHROMagar MRSA screening, after incubation, plates were examined for the presence of mauve colonies (MRSA detected), and the results were obtained and validated against the reference method of Cefoxitin disk diffusion. Results: Overall, the diagnostic accuracy of CHROMagar MRSA for detecting MRSA was 97.53%. Diagnostic accuracy of CHROMagar MRSA was 95.1%, 97.5% and 100% in axillary, nasal and web specimens, respectively. The rate of MRSA detection was maximum in axillary swabs, i.e., 40.7%, followed by 29.6% and 9.8% in nasal and web swabs, respectively. Conclusion: CHROMagar MRSA is found to be accurate for the detection of MRSA. It is reliable, easy to perform, less timeconsuming, and cost-effective. It is an affordable alternative to the conventional...

Background: Globally, Staphylococcus aureus is considered the most common cause of nosocomial infections. In recent times, there is a steady rise in the number of methicillin resistant S. aureus (MRSA) isolates. Aim: This study was done to find out the prevalence, antimicrobial sensitivity pattern and evaluation of different methods (cefoxitin disc diffusion [DD] method, Chrom agar and polymerase chain reaction [PCR]) in the detection of MRSA. Materials and Methods: A total of 100 S. aureus isolates from pus samples were identified by standard biochemical techniques. Antimicrobial susceptibility testing was done by Kirby Bauer's DD method as per Clinical and Laboratory Standards Institute guidelines. D test was done to detect clindamycin resistance. Methicillin resistance was evaluated by cefoxitin DD method, Chrom agar (HiCrome MeReSa agar base and selective supplement) and reverse transcription-PCR. Result: Out of 100 S. aureus isolates, 34% were detected as MRSA by cefoxitin DD method. All these isolates were detected by Chrom agar within 24 h. Additional isolates were not detected even after 48 h of incubation. mecA gene was detected by PCR in all these 34 MRSA isolates. Conclusion: The early detection of MRSA is of prime importance in the prognosis of staphylococcal infections. An integrated awareness program, good hand wash technique, epidemiological studies and effective control measures are the goals for elimination of MRSA in hospitals.

Although conventional antibiotic susceptibility tests are most commonly performed for methicillin-resistant Staphylococcus aureus (MRSA), the results of these phenotypic tests are dependent on the standardization of the culture conditions. The aim of the study was to evaluate the conventional phenotypic screening tests in comparison to the mecA gene polymerase chain reaction (PCR). One hundred and two clinical isolates of MRSA identified by the oxacillin disk diffusion were subjected to PCR for the mecA gene and by the cefoxitin disk diffusion test and culture on oxacillin screen agar, mannitol salt agar, and methicillin-resistant Staphylococcus aureus Agar (MeReSA) selective medium, for MRSA. Although all 102 isolates were resistant in oxacillin and cefoxitin disk diffusion, 92 (90.1%) isolates were positive for the mecA gene. The sensitivities of the mannitol salt agar, MeReSA agar, and oxacillin screen agar were 89.13, 97.82, and 98.91%, respectively. The oxacillin screen agar may be recommended for confirming methicillin resistance in the disk diffusion test in resource-poor settings, where molecular methods are not available.

Accurate and rapid detection of methicillin-resistant Staphylococcus aureus is very important in a clinical laboratory setting to avoid treatment failure. Conventional methods were compared against the gold standard polymerase chain reaction (PCR) technique to determine the best combination of the routine procedures. Methicillin resistance was investigated in 416 clinical Staphylococcus aureus isolates by PCR, oxacillin agar screening (OAS), oxacillin disk diffusion (ODD) and cefoxitin disk diffusion (CDD) methods. Two hundred and ten (51%) out of 416 S. aureus strains were found to be mecA-positive by PCR. Sensitivity and specificity of the ODD, CDD and OAS methods were detected as follows: 100% and 89%, 99.50% and 100%, and 99.50% and 100%, respectively. Combining the ODD and CDD methods could be a good choice for detecting methicillin resistance in S. aureus strains where mecA PCR cannot be performed.

Background: Accurate and rapid detection of methicillin-resistant Staphylococcus aureus is very important in a clinical laboratory setting to avoid treatment failure. Conventional methods were compared against the gold standard polymerase chain reaction (PCR) technique to determine the best combination of the routine procedures.Methodology: Methicillin resistance was investigated in 416 clinical Staphylococcus aureus isolates by PCR, oxacillin agar screening (OAS), oxacillin disk diffusion (ODD) and cefoxitin disk diffusion (CDD) methods.Results: Two hundred and ten (51%) out of 416 S. aureus strains were found to be mecA-positive by PCR. Sensitivity and specificity of the ODD, CDD and OAS methods were detected as follows: 100% and 89%, 99.50% and 100%, and 99.50% and 100%, respectively.Conclusion: Combining the ODD and CDD methods could be a good choice for detecting methicillin resistance in S. aureus strains where mecA PCR cannot be performed.

The synergistic effects of antimicrobial nanostructures with antibiotics present a promising solution for overcoming resistance in methicillin-resistant Staphylococcus aureus (MRSA). Previous studies have introduced iron as a novel coating for silver nanoparticles (AgNPs) to enhance both economic efficiency and potency against S. aureus. However, there are currently no available data on the potential of these novel nanostructures to reverse MRSA resistance. To address this gap, a population study was conducted within the MRSA community, collecting a total of 48 S. aureus isolates from skin lesions. Among these, 21 isolates (43.75%) exhibited cefoxitin resistance as determined by agar disk diffusion assay. Subsequently, a PCR test confirmed the presence of the mecA gene in 20 isolates, verifying them as MRSA. These results highlight the cefoxitin disk diffusion susceptibility test as an accurate screening method for predicting mecA-mediated resistance in MRSA. Synergy tests were performed on cefoxitin, serving as a marker antibiotic, and iron-coated AgNPs (Fe@AgNPs) in a combination study using the checkerboard assay. The average minimal inhibitory concentration (MIC) and fractional inhibitory concentration (FIC) of cefoxitin were calculated as 11.55 mg/mL and 3.61 mg/mL, respectively. The findings indicated a synergistic effect (FIC index < 0.5) between Fe@AgNPs and cefoxitin against 90% of MRSA infections, while an additive effect (0.5 ≤ FIC index ≤ 1) could be expected in 10% of infections. These results suggest that Fe@AgNPs could serve as an economically viable candidate for co-administration with antibiotics to reverse resistance in MRSA infections within skin lesions. Such findings may pave the way for the development of future treatment strategies against MRSA infections.

Extended spectrum Beta-lactamases (ESBLs) and AmpC beta-lactamases (AmpC) are the common enzymes produced by gram negative bacilli, which are their main mechanisms of resistance to all generations of cephalosporins. Hence, this study aimed to determine the magnitude of ESBLs and AmpC producing gram negative bacilli (GNB) isolated from clinical specimens at International clinical Laboratories in Addis Ababa, Ethiopia. A cross sectional study was conducted from January to May 2018. From different clinical specimens, 338 GNB were isolated and characterized. Bacterial species identification, antimicrobial susceptibility testing and screening for ESBLs and AmpC production were performed using Phoenix automated system (BD phoenix100). ESBLs production was confirmed using a combination disc method. All Cefoxitin resistant and confirmed ESBLs producing GNB were confirmed for AmpC beta-lactamases production by AmpC confirmatory Neo-Sensitabs discs (ROSCO tablet). Data were analyzed using SPSS version 20 software. E. coli 66.0% (224/338) followed by K. pneumoniae 12.1% (41/338) were GNB most frequently isolated. The overall magnitude of ESBLs producing GNB was 38.8% (131/338) and the extent of AmpC beta-lactamase producing GNB was 2.4% (8/338). Majority of ESBLs and AmpC beta-lactamases producing GNB were isolated from urine specimens 47.5% (116/338). Ampicillin (75.4%), amoxicillin with clavulanic acid (64.0%) and sulfamethoxazole-trimethoprim (55.6%) were most the antibiotics to which resistance was most commonly found. The multidrug resistance (MDR) level of GNB was 74.0% (250/338). Of ESBLs and AmpC beta-lactamases producing GNB, 99.3% were MDR (p < 0.05). The high magnitude of ESBLs and AmpC beta-lactamases producing GNB calls the needs of strong intervention to minimize further occurrence and spread of such GNB. More importantly, the MDR level was high which suggests continuous monitoring & reviewing of antimicrobial policy in hospitals and the country at large.

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS) with unusual pathogenicity resembling that of S. aureus. Unlike other CoNS, S. lugdunensis remains susceptible to most antibiotics. The resistance to penicillin varies widely (range, 15–87% worldwide), whereas methicillin resistance is still rare. We aimed to evaluate treatment options for infections caused by S. lugdunensis and more specifically to investigate whether penicillin G could be a better treatment choice than oxacillin. Susceptibility testing was performed using the disc diffusion method for penicillin G, cefoxitin, trimethoprim/sulfamethoxazole, erythromycin, clindamycin, gentamicin, norfloxacin, fusidic acid, rifampicin, and fosfomycin. Isolates susceptible to penicillin G were further tested with a gradient test for penicillin G and oxacillin. Of the 540 clinical isolates tested, 74.6% were susceptible to penicillin G. Among these penicillin-susceptible isolates, the MIC50 and MIC90 values for penicillin G were threefold lower than that for oxacillin. A majority of the isolates were susceptible to all other antibiotics tested. Breakpoints for fosfomycin have not yet been defined, and so no conclusions could be drawn. Two isolates were resistant to cefoxitin and carried the mecA gene; whole-genome sequencing revealed that both harbored the SCCmec element type IVa(2B). S. lugdunensis isolated in Sweden were susceptible to most tested antibiotics. Penicillin G may be a more optimal treatment choice than oxacillin. Although carriage of the mecA gene is rare among S. lugdunensis, it does occur.