Methicillin-Resistant (MRSA): Prevalence, Antimicrobial Susceptibility Pattern, and Detection of A Gene among Cardiac Patients from a Tertiary Care Heart Center in Kathmandu, Nepal.

Background: Methicillin Resistant (MRSA) is a significant human pathogen associated with nosocomial infections. A in the is a marker of MRSA. The main objective of this study was to detect A and genes conferring resistance in among cardiac patients attending Sahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal between May and November 2019.

Methods: A total of 524 clinical samples (blood, urine, sputum) were collected and processed. Bacterial isolates were tested for antimicrobial susceptibility test (AST) and screening for MRSA was carried out by cefoxitin disc diffusion method. Minimum inhibitory concentration (MIC) of vancomycin for MRSA was established by agar dilution method and chromosomal DNA was extracted and used in polymerase chain reaction targeting the A A genes.

Results: Out of 524 specimens, 27.5% (144/524) showed bacterial growth. Among 144 culture positive isolates, (27.1%; 39/144) was the predominant bacteria. Among 39 isolates, all isolates were found resistant to penicillin followed by erythromycin (94.9%; 37/39), gentamicin (94.9%; 37/39) and cefoxitin (87.2%; 34/39). Out of 39 , 87.2% (34/39) were MRSA. Among 34 MRSA, 8.8% (3/34) were vancomycin intermediate (VISA). None of the MRSA was resistant to vancomycin. All of the 3 VISA isolates were obtained from inpatients. Of 39 , 82.1% (32/39) harbored gene. Similarly, the entire VISA isolates and 94.1% (32/34) of the MRSA isolates were tested positive for gene.

Conclusions: High prevalence of MRSA among the cardiac patients indicates the increasing burden of drug resistance among bacterial isolates. Since infection control is the crucial step in coping with the burgeoning antimicrobial resistance in the country, augmentation of diagnostic facilities with routine monitoring of drug resistance is recommended.