title: Isolation and antimicrobial susceptibility pattern of Staphylococcus aureus in patients with surgical site infection at Debre Markos Referral Hospital, Amhara Region, Ethiopia.
abstract: BACKGROUND
  Staphylococcus aureus, especially Methicillin Resistant Staphylococcus Aureus (MRSA) is a major health problem recognized as the most important nosocomial pathogen, often causing postoperative wound infections. Antibiotic resistance by MRSA has grown to be common, and resistance to almost all antibiotics has been found among these strains. The aim of this study was to determine the prevalence, antimicrobial susceptibility patterns and associated risk factors of S. aureus in patients with surgical site infections in an Ethiopian hospital.
  
  
  METHODS
  A cross-sectional study was conducted from December 1, 2011 to March 30, 2012 among patients with surgical site infections at Debre Markos Referral Hospital, Debre Markos, Ethiopia. All wound swabs obtained from patients with surgical site infections during the study period were cultured on mannitol salt agar media which is selective for S. aureus. Isolated strains of S. aureus were tested for antibiotic susceptibility patterns using standard disc diffusion technique, and interpretation of resistance was done based on Clinical and Laboratory Standard Institute criteria. Univariate and multivariable analyses were used to assess the risk factors.
  
  
  RESULTS
  Of the 184 surgical patients who had developed surgical site infection, S. aureus was isolated from 73 (39.7%) cases. Out of the 73 isolates of S. aureus, 36 (49.7%) were MRSA. Among the study participants, prevalence of MRSA was found to be 19.6%. The clinical isolates showed >80% level of resistance to ampicillin, amoxicillin, penicillin G, erythromycin, gentamicin and cotrimoxazole whereas <50% level of resistance was observed against clindamycin, oxacillin, tetracycline and vancomycin. MRSA strains showed resistance ranging from 5.6% (vancomycin) to 100% (cotrimoxazole). Of the following risk factors: sex, age, pus consistency, duration of operation, type of surgery, ward and hospital stay, laparotomy type of surgery was identified as a risk factor for infection by S. aureus.
  
  
  CONCLUSIONS
  The prevalence of S. aureus and/or MRSA infection in surgical and gynaecology & obstetrics wards of Debre Markos Referral Hospital was found to be high. The majority of isolates were highly resistant to major antimicrobial agents.
authors.affiliation: Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia ; School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
authors.forename: Amlsha
authors.initials: A
authors.lastname: Kahsay
authors.affiliation: School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia ; Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Adane
authors.initials: A
authors.lastname: Mihret
authors.affiliation: School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia ; Department of Biochemistry, WHO Immunology Research and Training Center, University of Lausanne, Lausanne, Switzerland.
authors.forename: Tamrat
authors.initials: T
authors.lastname: Abebe
authors.affiliation: Debre Markos Referral Hospital, Debre Markos, Ethiopia.
authors.forename: Tebkew
authors.initials: T
authors.lastname: Andualem
keywords: Antibiotic susceptibility; MRSA; Prevalence; S. aureus; Surgical site infection