Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Saraswati Dental College
Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : DC20 - DC24 Full Version

Speciation and Antibiotic Susceptibility Pattern of Coagulase Negative Staphylococci in a Tertiary Care Hospital of Manipur, India


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55012.16132
Ningombam Homendro Singh, Rajkumar Manojkumar Singh, Urvashi Chongtham

1. Senior Medical Officer, Manipur Health Services, District Hospital, Tamenglongg, Manipur, India. 2. Associate Professor, Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences, Imphal East, Manipur, India. 3. Associate Professor, Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences, Imphal East, Manipur, India.

Correspondence Address :
Dr. Rajkumar Manojkumar Singh,
Associate Professor, Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences, Imphal (East)-795005, Manipur, India.
E-mail: rkmksingh@gmail.com

Abstract

Introduction: Coagulase Negative Staphylococci (CoNS) are common opportunistic pathogens. They are increasingly being recognised as nosocomial pathogens and are associated with multiple antimicrobial resistance mechanisms particularly methicillin resistance. Therefore, rapid and reliable identification upto the species level is necessary to predict the potential pathogenicity or antibiotic susceptibility of each clinical isolate.

Aim: The aim of the present study was isolation and speciation of CoNS from various clinical samples, and to determine their antibiotic susceptibility pattern.

Materials and Methods: This study was a hospital-based cross-sectional study carried out in the Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India, during the period from September 2017-August 2019. Total 135 CoNS isolates were identified using conventional microbiological procedures and speciation was done following the scheme of Kloos and Schleifer. Antibiotic susceptibility was determined by using the Kirby Bauer’s disk diffusion method. Detection of methicillin resistance among CoNS was performed using cefoxitin disk (30 μg) diffusion method. Data analysis was done using descriptive statistics.

Results: CoNS isolates were identified from different clinical specimens, which included 88 (65.2%) from urine, 37 (27.5%) from blood, 3 (2.2%) from pus, 2 (1.5%) from catheter tip, 2 (1.5%) from wound swab, 1 (0.7%) each from aural swab, sputum and ascitic fluid. Predominant isolates were Staphylococcus epidermidis (40.7%) followed by Staphylococcus haemolyticus (19.3%), Staphylococcus hominis (11.9%), Staphylococcus xylosus (7.4%), Staphylococcus saprophyticus (6.0%), Staphylococcus schleiferi (5.2%), Staphylococcus simulans (4.4%), Staphylococcus warneri (3.0%), Staphylococcus lugdunensis (0.7%), Staphylococcus capitis (0.7%) and Staphylococcus cohnii (0.7%). Most isolates were resistant to penicillin (84.5%) and erythromycin (59.3%), and least to tigecycline (2.2%). No resistance to vancomycin and linezolid was seen. Methicillin sensitive CoNS (MSCoNS) was detected in 79 (58.5%) isolates and methicillin resistant CoNS (MRCoNS) in 56 (41.5%) isolates.

Conclusion: This study demonstrated the occurrence of various species of CoNS in our healthcare set up with varying antimicrobial susceptibility pattern. Therefore, there is a need for accurate identification to species level by simple, inexpensive methodology and their antibiogram.

Keywords

Antibiogram, Identification, Nosocomial, Staphylococcus epidermidis

The CoNS are considered as the normal flora of human skin and mucous membranes. The definition of this group of bacteria is still based on diagnostic procedures that need to differentiate between Staphylococcus aureus and those staphylococci classified as being less or non pathogenic (1).

It is important to identify CoNS up to the species level, as the epidemiology, pathogenicity and drug resistance varies from species to species (2). The CoNS constitute all species of staphylococci other than Staphylococcus aureus, also form clusters but small colonies on solid media and comprise of approximately 40 species, of which, several species have been recognised as potential pathogens to humans (3). The most common human pathogens include S. epidermidis, S. haemolyticus, S. hominis, and S. saprophyticus. Other significant opportunistic but rarely isolated species are S. warneri, S. lugdunensis, S. capitis, S. simulans, S. cohnii, S. saccharolyticus, and S. xylosu (4).

In the past, CoNS were generally considered to be contaminants having little clinical significance. However, they are increasingly being recognised as nosocomial pathogens, probably due to their abilities to act as opportunistic pathogens or due to the ability to survive on synthetic medical devices and equipment like intravenous catheters, prosthetic heart valves, orthopaedic implants, and also on various surfaces in hospitals for weeks to months (5). S. epidermidis is able to colonize foreign bodies such as vascular catheters or indwelling prosthesis. S. saprophyticus is an important pathogen of Urinary Tract Infection (UTI) in younger, sexually active women (6).

Another concern is the rising occurrence of methicillin-resistant MRCoNS in hospitalised patients (7). Overall higher incidence of resistance to all antibiotics is observed with MRCoNS as compared to MSCoNS particularly to non-beta-lactam antimicrobials (8).

Though the occurrence of CoNS as important pathogens of nosocomial infections has been reported worldwide as well as from different parts of India (9),(10),(11),(12),(13),(14),(15),(16), no such study has been undertaken extensively in Manipur, India. Hence, the proposed study is an attempt to identify and speciate CoNS and their antibiogram from the various clinical samples.

Material and Methods

This study was a hospital-based cross-sectional study carried out in the bacteriology section of Microbiology Department, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India, during the period from September 2017 to August 2019. Informed written consent was obtained from participating individuals. In case of minors, informed consent was taken from the parents/legal guardians. Privacy and confidentiality was maintained in all the cases. Approval of ethical committee was obtained from the Institutional Ethical Committee (IEC) JNIMS vide no. Ac/06/IEC/JNIMS/2017(PGT) dated: Imphal, the 26th August, 2017.

Inclusion criteria: Patients of all age group and both sex with a history of UTI, prolonged urinary catheterisation, neonatal sepsis, intravenous access for delivery of medications and transfusions or nutrition, presence of intravascular catheters or implants and wound infections, attending outpatient and inpatient departments of Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics, Orthopaedics and intensive care unit were included in the study.

Exclusion criteria: Clinical samples yielding polymicrobial growth, patients with history of prior antimicrobials administration and who refused to participate were excluded.

Study Procedure

Specimen collection: Clinical samples such as urine, blood, pus, wound swab, aural swab, catheter tip, ascitic fluid or sputum were collected from various inpatient and outpatient departments.

Identification, speciation and antibiogram of the isolates: A total of 135 CoNS isolates were identified on the basis of conventional microbiological procedures (17). Speciation of CoNS was done following the scheme of Kloos and Schleifer which was based on slide and tube coagulase tests, ornithine decarboxylase, Voges-Proskauer (VP) test, urease test, novobiocin (5 μg) disk test, and sugar fermentations of mannose, mannitol, trehalose, lactose, and xylose (18).

Antibiotic susceptibility was determined by using the Kirby Bauer’s disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) recommendations (19) using the Mueller Hinton agar (Hi-Media, Mumbai, India) and commercially available 6 mm antimicrobial disks of penicillin (10 μg), erythromycin (15 μg), clindamycin (2 μg), nitrofurantoin (300 μg), cotrimoxazole (1.25/23.7 μg), ciprofloxacin (5 μg), amikacin (30 μg), linezolid (30 μg) and tigecycline (15 μg).

Antimicrobial susceptibility testing of vancomycin was performed using vancomycin Minimum Inhibitory Concentrations (MIC) E-test strip E-test -Vancomycin (E-VA) having concentration of 0.016 to 256 μg/mL (Bio Mérieux India Pvt., Ltd., New Delhi, India) following manufacturer guidelines.

Detection of methicillin resistance among CoNS was performed using cefoxitin disk (30 μg) diffusion method. Diameter of the circular zone of inhibition ≥25 mm was interpreted as sensitive and ≤24 mm as resistant for CoNS, except for S. lugdunensis for which zone diameter ≤21 mm was considered as resistant (19).

Quality control: Every batch of media prepared was checked for sterility for 24 hours. Potency of disk used will be checked with Staphylococcus aureus American Type Culture Collection (ATCC) 25923.

Statistical Analysis

Descriptive statistics like percentage and proportion were used to present the data. Analysis was done using Epi Info 7. Level of significant in methicillin sensitive and methicillin resistant CoNS isolates was determined using Chi-square test. A p<0.05 was considered significant.

Results

During the study period of two years, 135 CoNS isolates were identified from different clinical specimens, which included 88 (65.1%) from urine, 37 (27.4%) from blood as shown in (Table/Fig 1).

A total of 39 (28.88%) isolates were identified in age group of 20-29 years and least 3 (2.2%) isolates in 80 years and above. Majority of the isolates were recovered from female (74.8%) as compared to male (25.2%) (Table/Fig 2).

The predominant isolates were S. epidermidis (40.7%) followed by S. haemolyticus (19.3%) and S. hominis (11.9%) as shown in (Table/Fig 3), (Table/Fig 4).

Maximum number of samples was urine (65.2%) samples followed by blood (27.5%) and the distribution of individual species of CoNS varied in different samples is shown in (Table/Fig 4). Majority of S. epidermidis (19/55 or 34.55%) and S. haemolyticus (8/26 or 30.77%) were observed in age groups of 20-29 years as showed in (Table/Fig 5). The maximum number of isolates was resistant to penicillin 114 (84.5%), followed by erythromycin 80 (59.3%), ciprofloxacin 57 (42.2%), cotrimoxazole 48 (35.5%), clindamycin 36 (26.7%), nitrofuratoin 14 (10.4%), and amikacin 11 (8.2%) as displayed in (Table/Fig 6). All the 135 isolates remained between the MIC of 0.016 μg/mL and 2 μg/mL. 41 isolates had shown MIC of 0.064 μg/mL followed by 34 isolates of 0.032 μg/mL to vancomycin as shown in (Table/Fig 7). The MSCoNS was detected in 79 (58.5%) isolates and MRCoNS in 56(41.5%) isolates. All the isolates of MRCoNS were found to be resistant to penicillin (100%) and least to vancomycin and linezolid (Table/Fig 8).

Discussion

In the laboratory, identification of staphylococci is often limited to a screening test for S. aureus, while non S. aureus isolates are simply reported as CoNS. As the pathogenic significance of CoNS increases, it has become important to know regarding the epidemiology and pathogenic potential of individual species (20). Therefore, rapid and accurate identification of CoNS species has gained importance in the recent few years.

In present study, majority of the isolates were obtained from urine (65.2%) followed by blood (27.5%). Alex AM et al., and Sharma P et al., reported that predominant isolates were from urine (62% and 36%, respectively) and blood (12.7% and 27%, respectively) (12),(21). A study by Sheik AF and Mehdinejad M showed a similar isolation rate from urine (51.5%) and blood (25.4%) (22). The present study revealed that the predominant isolates were S. epidermidis (40.7%) followed by S. haemolyticus (19.3%), S. hominis (11.9%). These findings were correlated with the study done by Al Tayyar IA et al., in Jordan where S. epidermidis and S. haemolyticus were the most common species isolated from all specimens representing 54.7% and 23.4% of all CoNS species, respectively (10). Comparative findings of CoNS isolates obtained from different studies are shown in (Table/Fig 9) (9),(10),(11),(12),(13),(14),(15),(16). The difference in the distribution of CoNS species among the various studies conducted in different parts of the country might be due to difference in geographical location and patient population. S. epidermidis, S. haemolyticus, S. hominis and S. saprophyticus were predominantly isolated from urine (60%, 61.5%, 62.5% and 100%, respectively) and blood (31%, 35%, 31.3% and 0, respectively). Nicolle LE et al., John JF Jr et al., Kumari N et al., and Asangi SY et al., obtained similar findings (23),(24),(25),(26).

In this study, isolates were recovered more in female (74.8%) than male patients (25.2%). Age group of 20-29 years showed highest isolation of CoNS (28.9%) while no isolate was recovered from the age group of 70-79 years. Similar parameters were reported by Alex AM et al., (12). On the contrary, Asangi SY et al., and Baddour LM and David L found majority of the CoNS isolates in males and above the age group of 40 years (26),(27). However, Roopa C and Biradar S revealed maximum number of isolates in the age group of 61-70 years with no particular gender predominance (9).

Antibiotic susceptibility testing has shown variability and multidrug resistance with maximum resistance to penicillin (84.5%) and least to tigecycline (2.2%). No resistance to vancomycin and linezolid was seen. Usha MG et al., Asangi SY et al., Sharma V et al., Pedroso SHSP et al., and Gunti R et al., have shown maximum resistance to penicillin, erythromycin, ciprofloxacin and cotrimoxazole with over 80% which correlate with the present study (2),(26),(28),(29),(30). Alex AM et al., and Jayakumar R et al., noted in their studies that all the isolates were uniformly susceptible to vancomycin and linezolid (12),(13).

This study demonstrated that the MIC of vancomycin against the CoNS isolates ranged between 0.016 to 2 μg/mL. Paiva RM et al., and Center KJ et al., reported higher range of MIC of vancomycin (0.38 to 4 μg/mL and 0.25 to 4 μg/mL, respectively) (31),(32). The vancomycin MICs at which 50% and 90% (MIC50 and MIC90) of isolates were inhibited for the total population of CoNS in the present study were 0.064 and 0.5 μg/mL, respectively. Paiva RM et al., and Center KJ et al., revealed higher MIC50 (1.5 μg/mL, 1 μg/mL, respectively) and MIC90 (2 μg/mL in both) of vancomycin (31),(32).

Present study revealed a prevalence of MRCoNS in 58.5% isolates, similar to the finding of Singh S et al., (57.6%) (8). Prevalence of MRCoNS ranging from 48.2% to 66% has been previously reported (33). However, the proportion of resistance to methicillin was very high in a study conducted at China by Cui J et al., where it ranged from 83.3%-100% (34). Highest methicillin resistant was found in S. haemolyticus, supporting the findings of other centres where resistance rates as high as 90% have been reported by Barros EM et al., (88%) (35).

An overall high prevalence of resistance to all antibiotics was seen with MRCoNS showing higher resistance to non beta lactam antimicrobials as compared to MSCoNS, difference being statistically significant for amikacin, erythromycin, ciprofloxacin, nitrofurantoin and tigecycline. The non beta lactam agents, most active against MRCoNS were clindamycin, nitrofurantoin and tigecycline probably due infrequent use at our centre, resulting in low selection pressure. Amikacin still remained sensitive to MRCoNS isolates despite its rampant administration. However, all MRCoNS isolates were susceptible to vancomycin and linezolid.

The strength of this study was that speciation of CoNS species could be carried out using simple phenotypic characteristics such as scheme of Kloos and Shchleifer and most findings of this study were correlated with other previous studies which followed the same scheme of characterisation.

Limitation(s)

Advance molecular methods for molecular characterisation of CoNS at the subspecies level could not be accessed due to lack of infrastructure.

Conclusion

The clinical significance of CONS is increasing day by day. Therefore, accurate identification to species level using simple and inexpensive methodology is needed. S. haemolyticus, S. epidermidis and S. hominis were the common species isolated in this study. Most isolates were resistant to penicillin and erythromycin. However, no resistance to vancomycin and linezolid was observed.

References

1.
Becker K, Heilmann C, Peters G. Coagulase-negative staphylococci. Clin Microbiol Rev. 2014;27(4):870-926. [crossref] [PubMed]
2.
Usha MG, Shwetha DC, Vishwanath G. Speciation of coagulase-negative staphylococci isolates from clinically significant specimens and their antibiogram. Indian J Pathol Microbiol. 2013;56:258-60. [crossref] [PubMed]
3.
Sarathbabu R, Rajkumari N, Ramani TV. Characterisation of coagulase-negative staphylococci isolated from urine, pus, sputum and blood samples. Int J Pharma Sci Inv. 2013;2:37-46.
4.
Bouchami O, Anchour W, Hassen AB. Species distribution and antibiotic sensitivity pattern of coagulase-negative staphylococci other than Staphylococcus epidermidis isolated from various clinical specimens. Afr J Microbio Res. 2011;5(11):1298-305. [crossref]
5.
Kloos WE, Bannerman TL. Update on clinical significance of coagulase-negative staphylococci. Clin Microbiol Rev. 1994;7:117-40. [crossref] [PubMed]
6.
Baird D. Staphylococcus: Cluster forming Gram positive cocci In: Collee JG, Fraser AG, Marmion BP, Simmons A. editorS.Mackie & McCartney Practical Microbiology. 14th ed. India: Elsevier; 2015; Pp. 250-52.
7.
Latif M, Usman J, Gilani M, Munir T, Mushtaq M, Anjum R. Coagulase negative staphylococci- A fast emerging threat. J Pak Med Assoc. 2015;65(3):283-86.
8.
Singh S, Dhawan B, Kapil A, Kabra SK, Suri A, Sreenivas V, et al. Coagulase negative staphylococci causing blood stream infection at an Indian tertiary care hospital: Prevalence, antimicrobial resistance and molecular characterisation. Indian J Med Microbiol. 2016;34(4):500-05. [crossref] [PubMed]
9.
Roopa C, Biradar S. Incidence and speciation of coagulase negative staphylococcus isolates from clinically relevant specimens with their antibiotic susceptibility patterns. Int J Curr Microbiol App Sci. 2015;4(9):975-80.
10.
Al Tayyar IA, Al-Zoubi MS, Hussein E, Khudairat S, Sarosiekf K. Prevalence and antimicrobial susceptibility pattern of coagulase-negative staphylococci (CoNS) isolated from clinical specimens in Northern of Jordan. Iran J Microbiol. 2015;7(6):294-301.
11.
Kashid RA, Kausalya R. Speciation and antimicrobial susceptibility of coagulase negative staphylococci, isolated from the anterior nares of health care workers, in a tertiary care hospital in south India, with special reference to methicillin resistance. Int J of Contemp Med Res. 2016;3(8):2329-33.
12.
Alex AM, Mahesh C, Navaneeth BV. Speciation and antibiotic susceptibility testing of coagulase negative staphylococci at a tertiary care teaching hospital. Int J Curr Microbiol App Sci. 2017;6(5):713-21. [crossref]
13.
Jayakumar R, Arumugam V, Srinivasagam M. Speciation and antibiogram of Coagulase Negative Staphylococci (CoNS) in a tertiary care hospital. Indian J Microbiol Res. 2018;5(2):194-97. [crossref]
14.
Senthilselvan B, Subitha B. Speciation, Biofilm production and antibiotic resistance pattern of coagulase-negative staphylococci isolated from neonatal septicemia. J Med Sci Clin Res. 2019;7(1):680-85. [crossref]
15.
Kulkarni M, Patil S. The speciation and antimicrobial susceptibility pattern of coagulase negative staphylococci in a tertiary care hospital in Mumbai. IP Int J Med Microbiol Trop Dis. 2020;6(4):227-29. [crossref]
16.
Raina D, Chandola I, Negi N, Kataria V, Roy R. Prevalence of coagulase negative staphylococcus and their antibiotic sensitivity pattern from various clinical samples. J Pure Appl Microbiol. 2020;14(2):1255-62. [crossref]
17.
Winn WC, Allen SD, Janda WM, Koneman EW, Procop GW, Schreckenberger PC, et al. Charts. In Koneman's Color Atlas and Textbook of Diagnostic Microbiology, 6th ed. London: Lippincott William and Wilkins; 2006. Pp.1443-71.
18.
Kloos WE, Schleifer KH. Simplified scheme for routine identification of human Staphylococcus species. J Clin Microbiol. 1975;1:82-88. [crossref] [PubMed]
19.
The Clinical and Laboratory Standards Institute (CLSI) Performance standards for antimicrobial susceptibility testing: Twenty seven Informational Supplement. Wayne, Pa:CLSI;(2017). Pp. M100-S27.
20.
Weinstein MP, Mirrett S, Van Pelt L, McKinnon M, Zimmer BL, Kloos W, et al. Clinical importance of identifying coagulase-negative staphylococci isolated from blood cultures: Evaluation of microscan rapid and dried overnight gram-positive panels versus a conventional reference method. J Clin Microbiol. 1998;36(7):2089-92. [crossref] [PubMed]
21.
Sharma P, Lahiri KK, Kapila K. Conventional and molecular characterisation of coagulase-negative staphylococcus in hospital isolates. Indian J Pathol Microbiol. 2011;54(1):85-89. [crossref] [PubMed]
22.
Sheikh AF, Mehdinejad M. Identification and determination of coagulase-negative staphylococci species and antimicrobial susceptibility pattern of isolates from clinical specimens. African J Microbiol Res. 2012;6(8):1669-74. [crossref]
23.
Nicolle LE, Hoban SA, Harding GK. Characterisation of coagulase-negative staphylococci from urinary tract specimens. J Clin Microbiol.1983;17(2):267-71. [crossref] [PubMed]
24.
John JF Jr, Gramling PK, O'Dell NM. Species identification of coagulase-negative staphylococci from urinary tract isolates. J Clin Microbiol. 1978;8(4):435-37. [crossref] [PubMed]
25.
Kumari N, Rai A, Jaiswal CP, Xess A, Shahi SK. Coagulase negative staphylococci as causative agents of urinary tract infections-prevalence and resistance status in IGIMS, Patna. Indian J Pathol Microbiol. 2001;44(4):415-19.
26.
Asangi SY, Mariraj J, Sathyanarayan MS, Nagabhushan R. Speciation of clinically significant coagulase negative staphylococci and their antibiotic resistant patterns in a tertiary care hospital. Int J Biol Med Res. 2011;2(3):735-39.
27.
Baddour LM, David L. Comparison of microbiologic characteristics of pathogenic and saprophytic coagulase-negative staphylococci from patients on continuous ambulatory peritoneal dialysis. Diag Microbiol Infect Dis.1986;5(3):197-205. [crossref]
28.
Sharma V, Jindal N, Devi P. Prevalence of methicillin resistant coagulase-negative staphylococci in a tertiary care hospital. Iran J Microbiol. 2010;2(4):185-88.
29.
Pedroso SHSP, Sandes SHC, Filho RTF, Nunes AC, Serufo JC, Farias LM, et al. Coagulase-negative staphylococci isolated from human bloodstream infections showed multidrug resistance profile. Microbial Drug Resistance. 2018;24(5):635-47. [crossref] [PubMed]
30.
Gunti R, Arava D, Koppada R. Speciation of coagulase-negative staphylococci and their antibiogram. J Dent Med Sci. 2016;15(1):28-31.
31.
Paiva RM, Mombach Pinheiro Machado AB, Zavascki AP, Barth A. Vancomycin MIC for methicillin-resistant coagulase-negative Staphylococcus isolates: evaluation of the broth microdilution and E-test methods. J Clin Microbiol. 2010;48(12):4652-54. [crossref] [PubMed]
32.
Center KJ, Reboli AC, Hubler R, Rodgers GL, Long SS. Decreased vancomycin susceptibility of coagulase-negative staphylococci in a neonatal intensive care unit: Evidence of spread of Staphylococcus warneri. J Clin Microbiol. 2003;41:4660-65. [crossref] [PubMed]
33.
Pereira VC, Cunha Mde L. Coagulase negative staphylococci strains resistant to oxacillin isolated from neonatal blood cultures. Mem Inst Oswaldo Cruz. 2013;108:939-42. [crossref] [PubMed]
34.
Cui J, Liang Z, Mo Z, Zhang J. The species distribution, antimicrobial resistance and risk factors for poor outcome of coagulase-negative staphylococci bacteraemia in China. Antimicrob Resist Infect Control. 2019;8:65:01-10. [crossref] [PubMed]
35.
Barros EM, Ceotto H, Bastos MC, Dos Santos KR, Giambiagi-Demarval M. Staphylococcus haemolyticus as an important hospital pathogen and carrier of methicillin resistance genes. J Clin Microbiol. 2012;50:166-68. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55012.16132

Date of Submission: Jan 17, 2022
Date of Peer Review: Jan 28, 2022
Date of Acceptance: Feb 08, 2022
Date of Publishing: Mar 01, 2022

AUTHOR DECLARATATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 18, 2022
• Manual Googling: Jan 25, 2022
• iThenticate Software: Jan 29, 2022 (17%)

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