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Incidence and Antibiotic Susceptibility Profile of Staphylococcus aureus on Door Handles in Ahmadu Bello University, Zaria

Onaolapo JA1*, Afolabi OE1 and Igwe JC2

1Department of Pharmaceutics and Pharmaceutical Microbiology, Ahmadu Bello University, Zaria

2Department of Medical Biotechnology, National Biotechnology Development Agency, Abuja

*Corresponding Author:
Onaolapo JA
Department of Pharmaceutics and
Pharmaceutical Microbiology
Ahmadu Bello University, Zaria, Nigeria
Tel: 2348037033157
E-mail: [email protected]

Received Date: October 01, 2015; Accepted Date: October 26, 2015; Published Date: November 02, 2015

Citation: Onaolapo JA, Afolabi OE, Igwe JC (2015) Incidence and Antibiotic Susceptibility Profile of Staphylococcus aureus on Door Handles in Ahmadu Bello University, Zaria. J Trop Dis 4:184. doi:10.4172/2329-891X.1000184

Copyright: © 2015 Onaolapo JA,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Pathogenic microorganisms implicated in most diseases are transferable through contact with infected persons or objects. In this study, door handles in the Faculty of Pharmaceutical Sciences and Amina female hostel in Ahmadu Bello University, Zaria, Nigeria were evaluated for the presence of Staphylococcus aureus and their antibiotics susceptibility profile was tested, using standard microbiological methods. The results showed that out of the 143 door handles sampled (Amina female hostel = 89, Pharmacy main block = 40, Pharmacy old block = 14), the incidence of Staphylococcus aureus was 50.7%(34) [with highest occurrence in Amina female hostel (35.8%), followed by Pharmacy main block (8.9%) and Pharmacy old block (6.0%)], E. coli was observed to be the second most common organism (9%) followed by Shigella dysentery 7.5%, while Salmonella typhi, Seretia spp. and Pseudomonas aeruginosa were both 6% respectively. The antibiotic susceptibility profile of the isolates showed that they were 100% susceptible to Ciprofloxacin, Erythromycin and Tetracycline, 97% susceptible to Mupirocin, and Cotrimoxazole, and 92% to Pefloxacin and Oxacillin. Their levels of resistance to these antibiotics were very low (3% resistance to Mupirocin and Cotrimoxazole, 8% to Pefloxacin and Oxacillin), while their resistances to Amoxicillin, Cefuroxin sodium and Cefotaxime were very high (100%). An evaluation of the pattern of resistance of the isolates showed that 76.5% of the isolates had MAR index of ≤0.4 while 70.6% of the isolates were multidrug resistant; exhibiting resistance to some commonly used Fluoroquinolone, Cephalosporine (CEP), and Betalactam/Betalactamase inhibitors (BET) groups of antibiotics (73.5%). The high incidence of Staphylococcus aureus in this study suggests poor hygiene among students, and the possibility of transferring pathogenic Staphylococcus aureus through door handles in a densely populated environ during disease outbreak is probable. To curb the spread of pathogenic and resistant Staph. aureus, this study suggests that door handles in A.B.U, Zaria should be replaced with silver coated surfaces with antimicrobial properties, and frequent use of disinfectant/hand sanitizer is recommended. Also proper periodic antibiotic surveillance should be encouraged to have referable documentaries in disease outbreak.

Keywords

Staphylococcus aureus; Door handles; Antibiotic susceptibility profile; Hygiene

Introduction

Environmental contamination with pathogenic microorganisms which are of clinical importance due to their contribution to morbidity and mortality is increasing daily. Such microorganisms especially skin associated ones like Staphylococcus aureus have been isolated from various sites or surfaces touched by hands both in hospitals and nonhospital environments e.g. bed sheets, bed crank, tables, buttons on the infusion pump, cotton gowns, sink handles, toilet flushes, toilet seats, cell bars, light switches, soap dishes, window handles, locker handles, radios, door handle, boxing gloves, basketballs, abdominal crunch machine, seated and upright leg presses in gymnasium and hand sanitizer dispenser [1-3]. The possibilities of isolating Staphylococcus aureus from these environments might be as a result of their extreme flexibility and capacity for rapid growth and reproduction [4]. This wide spread of Staphylococcus aureus contributes to its importance as a nosocomial and community-acquired pathogen, whose genetic plasticity could facilitate the evolution of many virulent and antibiotics resistant strains, which could present a major and constantly changing clinical problems [5]. Staphylococcus aureus has been implicated in diseases such as dermatitis, pneumonia, septicaemia, osteomyelitis and meningitis in both humans and swine, as well as bovine mastitis in cattle and bumblefoot disease in poultry [6]. Studies have demonstrated that, even with high compliance to hand hygiene measures, cross-transmission of Staphylococcus aureus could still occur, but how beneficial or harmful Staphylococcus aureus as environmental contaminate could depend greatly on human measure or observation [7,8]. As microbial resistance to antibiotic commonly prescribed is becoming a global challenge, this study evaluates the antibiotics susceptibility profile of Staphylococcus aureus isolated from door handles in the Faculty of Pharmaceutical Sciences and Amina female hostels in Ahmadu Bello University, Zaria, Nigeria in order to quantify the level of antibiotics resistance and to proffer better treatment or management options to infections associated with Staphylococcus aureus contacted from door handles in this area.

Methodology

Sample collection

A total of one hundred and forty three (143) samples from door handles were randomly collected using sterile swab sticks containing sterile normal saline. The samples were aseptically collected from Amina female hostel, Pharmacy main block and Pharmacy old block of Ahmadu Bello University Zaria, Samaru Campus (A.B.U).

Microbial identification, isolation and microscopy

Collected samples were suspended in sterile nutrient broth for 24hrs and then inoculated on the surface of sterile nutrient agar (NA), and incubated at 37°C for 18hrs. Gram staining and microscopy were also carried out to differentiate between Gram positive and Gram negative organisms using the method described by Chakraborty and Nishith, [9] while further morphological characterization of the colonies were carried out on Mannitol salt agar using the method described by Cheesbrough [10]. The presence of other microbial growth on MacConkey agar, Eosin methylene blue agar and Cetrimide agar were also observed.

Biochemical test

The following conventional biochemical tests; catalase, coagulase and oxidase tests described by Cheesbrough [10] were adopted to distinguish Staphylococcus aureus from other forms of Staphylococcus spp. While the Gram negatives organisms were identified by their colour on indole, methyl red, Vogue Prosker, citrate and urease described by Chakraborty and Nishith [9].

Antibiotic susceptibility test and multiple antibiotic resistance index (MARI) evaluation

The susceptibility profiles of the identified Staphylococcus aureus was tested against twelve (12) selected antibiotics (Tetracycline (TE), Cefuroxin sodium (CXM), Cefotaxime (CTX), Mupirocin (MUP), Ciprofloxacin (CIP), Ofloxacin (OFX), Perfloxacin (PEF), Oxacillin (OX), Cotrimoxazole (SXT), Erythromycin (E), Amoxicillin/ clavulanic acid (AMC), Amoxicillin (AML)) using disc diffusion method as described by Cheesbrough [10] and the corresponding results interpreted using CLSI [11]. The multiple antibiotic resistant (MAR) index was determined for each isolate. This is defined as the number of antibiotics to which the organism is resistant to, divided by the total number of antibiotics tested [12].

Results

Out of the 143 door handles sampled, the incidence of Staphylococcus aureus was 23.8% (34) with highest occurrence in Amina female hostel (16.8%), followed by Pharmacy main block (4.2%) and Pharmacy old block (2.8%) as shown in Table 1. Among the samples collected, culture identification, microscopy and biochemical tests also showed the presences of other microorganisms. The incidence of E. coli (9%) and Shigella dysentery (7.5%) were found to be the most common bacteria compared to other microorganisms isolated after Staphylococcus aureus. This is shown in Table 2.

S/N Sample Source No. Of Door Handles Sampled Number of Staph. aureus Percentage of Staph. aureus(%)
1 Amina female hostel 89 24 35.8
2 Pharmacy main block 40 6 8.9
3 Pharmacy old block 14 4 6.0
Total   143 34 50.7

Table 1: Distribution of Staph. aureus In Door Handles in Ahmadu Bello University, Zaria.

S/N ORGANISMS Number of Isolates (n = 67) Percentage (%)
1 Staphylococcus aureus 34 50.7
2 Eschericheria coli 6 9
3 Shigella  dysentery 5 7.5
4 Salmonella typhi 4 6
5 Pseudomonas aeruginosa 4 6
6 Serretia  spp. 4 6
7 Klebsiella  spp. 3 4.4
8 Citrobacter  spp. 2 3
9 Proteus mirabilis 2 3
10 Salmonella paratyphi A 2 3
11 Enterobacter  spp. 1 1.4
    67 100

Table 2: Percentage of Bacteria Isolated from the Door Handles Sampled.

Antibiotics susceptibility profile of Staphylococcus aureus from the sampled area

The isolates were highly susceptible to Erythromycin, Ciprofloxacin, and Tetracycline (100%), 97% susceptible to mupirocine and cotrimoxazole, 90% to Pefloxacine, and 85% to Oxacillin. But the isolates were observed to be 100% (34) resistant to Cefotaxime and Amoxicillin, 96.7% (33) resistant to Cefuroxin sodium, 76.6% and 70 % resistant to Ofloxacine and Amoxicillin clavulanic acid respectively (Figure 1).

tropical-diseases-community-Susceptibility

Figure 1: Antibiotics Susceptibility Profile of Staphylococcus aureus.

Discussion

The dissemination of clinically significant microorganism within our environment is fast growing through cross contamination of the surfaces due to poor hygiene. Reports have pinpointed doors handle, computer surfaces, phones etc as sources of microbial transfer and could also be a route of infections in diseases outbreak [13,14]. This study evaluates the incidence and antibiotics susceptibility profile of Staphylococcus aureus from door handles in the Faculty of Pharmaceutical Sciences and Amina female hostels in Ahmadu Bello University, Zaria. Out of the 143 door handles sampled, the incidence of Staphylococcus aureus was 50.7% (34) with highest occurrence in Amina female hostel (35.8%), followed by Pharmacy main block (8.9%) and Pharmacy old block (6.0%) (Table 1).The result showed that a total of eleven (11) different microorganisms were isolated. Staphylococcus aureus was observed to be present in all the samples evaluated (50.7) (Table 3) followed by E. coli (9%), Shigella dysentery (7.5%), Salmonella typhi, P. aeruginosa, and Seretia spp. (6%), Klebsiella spp. (4.4%), Citrobacter spp., Proteus mirabilis and Salmonella paratyhi A (3%) and Enterobacter spp. (1.4%) (Table 3). These findings concurred with the report of Ajayi and Ekozien [15] in Ekpoma, Kawo et al., [16] in Kano and Itah and Ben [17] in Akwa Ibom, Nigeria, who reported that Staphylococcus aureus and E. coli are the most predominate surface microbe from door handles, tables, hand of students and computers. These surfaces especially the door handle are indeed a breeding ground for microbes as reported by Barker and Jones [18], who noted that contamination of the environment via the surface-to-hand-to-mouth could be an avenue of contacting diseases and encourages disease wide spread. This calls for good hygienic practices as these microbes are signal of unhygienic environment [19]. The antibiotic susceptibility profile of the Staphylococcus aureus isolated from the sampled door handles showed that the isolates were highly resistant (100% (34)) to Cefotaxime and Amoxicillin, 96.7% (33) resistance to Cefuroxin sodium, 76.6% and 70% resistance to Ofloxacine and Amoxicillin clavulanic acid respectively (Figure 1). This result concurs with other studies that Staphylococcus aureus from surfaces have high percentages of antibiotic resistance even to methicillin (60.4%) [2]; Gentamicin, Amoxicillin-clavulanic acid and Cotrimoxazole [15]. This suggests that in situation of such infections from door handle, these antibiotics should not be hoped on as the last resort for treatment. However, promising for therapeutics are Erythromycin, Ciprofloxacin, and Tetracycline as the isolates from this study showed 100%, 97% susceptibility to Mupirocine and Cotrimoxazole respectively, 90% to Pefloxacine, and 85% to Oxacillin. This result is supported by the study of Ajayi and Ekozien, [15]. Also in the areas sampled the antibiotic susceptibility pattern of the isolated Staphylococcus aureus showed that 96.7% of the isolates were simultaneously resistant to Amoxicillin, Cefuroxin sodium (CXM) and Cefotaxime (CTX); while 73.5% were resistant to Fluoroquinolone, Cephalosporine (CEP), and Betalactam/Betalactamase inhibitors (BET) groups of antibiotics. The result also showed that 76.5% of the isolates had MAR index of ≤0.4 while 70.6% of the isolates were multidrug resistant (Table 4). The high resistance observed in this study concur with the observation of Daniel and Kenneth [20], in whose study 50% (6) of the total antibiotics tested (12) (Ampicillin, Penicillin, Cefuroxime and Cloxacillin, and Amikacin) were inactive against both Gram-positive and Gram-negative bacteria isolated. Pattern of isolates antibiotics resistance was classified according to Magiorakos et al., [21]. The high multiple antibiotic resistance observed in this study also concur with the observation of Oluduro et al., [22], who observed that the isolates from door handles had 89.1% MDR, with a total of 68 resistance patterns and resistance to three antibiotics simultaneously were the most frequent (31.9%). This finding showed that the isolates might have been pre-exposed to the antibiotics used in this study and emphasized the need for antibiotic surveillance in order to curtail the development of resistance.

S/no Isolates Gram Positive Mannitol Catalase Coagulase Oxidase Probable organism
1 A2a + Golden yellow + + _ Staph.  aureus
2 A2b + Golden yellow + + _ Staph.  aureus
3 B1a + Golden yellow + + _ Staph.  aureus
4 D1b + Golden yellow + + _ Staph.  aureus
5 D2b + Golden yellow + + _ Staph.  aureus
6 E2a + Golden yellow + + _ Staph.  aureus
7 F1a + Golden yellow + + _ Staph.  aureus
8 F1b + Golden yellow + + _ Staph.  aureus
9 F2a + Golden yellow + + _ Staph.  aureus
10 F2b + Golden yellow + + _ Staph.  aureus
11 G2a + Golden yellow + + _ Staph.  aureus
12 H1a + Golden yellow + + _ Staph.  aureus
13 H1b + Golden yellow + + _ Staph.  aureus
14 H1c + Golden yellow + + _ Staph.  aureus
15 H2a + Golden yellow + + _ Staph.  aureus
16 H2b + Golden yellow + + _ Staph.  aureus
17 H2c + Golden yellow + + _ Staph.  aureus
18 I1a + Golden yellow + + _ Staph.  aureus
19 I1b  + Golden yellow + + _ Staph.  aureus
20 I2 + Golden yellow + + _ Staph.  aureus
21 J2a + Golden yellow + + _ Staph.  aureus
22 K1a + Golden yellow + + _ Staph.  aureus
23 K2b + Golden yellow + + _ Staph.  aureus
24 L1a + Golden yellow + + _ Staph.  aureus
25 L1b + Golden yellow + + _ Staph.  aureus
26 M1a + Golden yellow + + _ Staph.  aureus
27 M1b + Golden yellow + + _ Staph.  aureus
28 N2a + Golden yellow + + _ Staph.  aureus
29 N2b + Golden yellow + + _ Staph.  aureus
30 D2c + Golden yellow + + _ Staph.  aureus
31 M2p + Golden yellow + + _ Staph.  aureus
32 N2c + Golden yellow + + _ Staph.  aureus
33 N2g + Golden yellow + + _ Staph.  aureus
34 D2h + Golden yellow + + _ Staph.  aureus

Table 3: Isolation and Characterization of Staphylococcus aureus from Door handles in A.B.U.

,tbody>
S/N ISOLATES Antibiotics Resistant Pattern MARI CART DR
1 F1a CTX, CXM, AML 0.3 CEP, BET XDR
2 D2b  CTX, CXM, AML, OFX 0.3 CEP, BET XDR
3 I1b  AMC,  CTX, CXM, AML, PEF, OFX 0.5 CEP, BET, FLU MDR
4 H1b AMC, CTX, CXM, AML, OFX 0.4 CEP, BET, FLU MDR
5 H2c AMC,  CTX, CXM, AML, OX, OFX 0.5 CEP, BET, FLU MDR
6 K2b CTX, CXM, AML, 0.3 CEP, BET XDR
7 I2 CTX, CXM, AML, OFX 0.3 CEP, BET, FLU MDR
8 L1a AMC,  CTX, CXM, AML, OFX 0.4 CEP, BET, FLU MDR
9 F1b AMC,  CTX, CXM, AML, OFX 0.4 BET, CEP, FLU XDR
10 E2a AMC,  CTX, CXM, AML, PEF, OFX 0.5 BET, CEP, FLU MDR
11 F2b AMC,  CTX, CXM, AML, OFX 0.4 BET, CEP, FLU MDR
12 D2c AMC,  CTX, CXM, PEF, AML, OFX 0.5 BET, CEP, FLU MDR
13 A2b AMC,  CTX, CXM, AML, 0.3 BET, CEP XDR
14 A2a AMC,  CTX, CXM,  AML 0.3 BET, CEP XDR
15 H1a CTX, OX, OFX, AML, 0.3 CEP, BET, FLU MDR
16 I1a CTX, CXM, AML, OFX 0.3 BET, CEP, FLU MDR
17 H1c CTX, CXM, OFX, AML, 0.3 CEP, BET, FLU MDR
18 G2a AMC,  CTX, CXM, AML, OFX 0.4 BET, CEP, FLU MDR
19 H2b CTX, CXM, AML, OFX 0.3 BET, CEP, FLU MDR
20 B1a AMC,  CTX, CXM, OFX, MUP, AML 0.5 BET, CEP, FLU, PS MDR
21 J2 CTX, CXM, AML, 0.3 CEP, BET XDR
22 F2a AMC,  CTX, CXM, OFX, AML, 0.4 BET, CEP, FLU MDR
23 D1b CTX, CXM, AML, OFX 0.3 CEP, BET FLU MDR
24 K1b AMC,  CTX, CXM, AML, OFX 0.4 BET, CEP, FLU MDR
25 L1b AMC,  CTX, CXM, AML 0.3 BET, CEP XDR
26 M1a AMC, CTX, CXM, AML, OX, OFX 0.5 BET, CEP, FLU MDR
27 M1b AMC, CTX, CXM, AML, OFX 0.4 BET, CEP, FLU MDR
28 N2a AMC, CTX, CXM, AML, OFX 0.4 BET, CEP, FLU MDR
29 N2b AMC,  CTX, CXM, AML, OFX 0.5 BET, CEP, FLU MDR
30 H2a AMC,  CTX, CXM, AML, 0.3 BET, CEP XDR
31 M2p AMC,  CTX, CXM, AML, 0.3 BET, CEP XDR
32 N2c AMC,  CTX, CXM, AML, SXT, OFX 0.5 BET, CEP, FLU, FPI MDR
33 N2g AMC,  CTX, CXM, AML, OFX 0.4 BET, CEP, FLU MDR
34 D2h AMC,  CTX, CXM, AML,  OFX 0.4 BET, CEP, FLU MDR

Table 4: Evaluation of the Antibiotic Resistance Pattern and Index (MARI) of Staph. aureus.

Conclusion and Recommendations

This study on Staphylococcus aureus from door handles in A.B.U Zaria have proved that door handles serve as reservoir and route of microbial dissemination in disease outbreak. It also suggests the use of ciprofloxacin, erythromycin, tetracycline, mupirocin and oxacilline as the best antibiotics during infection associated with door Staphylococcus aureus. It also encourages the need to promote proper hygienic practice and adherence to antibiotic treatment in order to prevent the spread of resistance bacteria. For immediate action, this study suggests the use of silver coated door handles with antimicrobial activity in other to reduce the microbial load from this source, and frequent use of disinfectant/ hand sanitizer is recommended. Also proper periodic antibiotic surveillance should be encouraged to have referable documentaries in disease outbreak.

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