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

Users Online :

AbstractMaterial and MethodsResultsDiscussionAcknowledgementReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
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."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
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 : 2007 | Month : December | Volume : 1 | Issue : 6 | Page : 494 - 499 Full Version

Nasal screening and survey of pre-clinical medical students from Malaysia for nasal carriage of coagulase positive MRSA and rate of nasal colonization with Staphylococcus species


Published: December 1, 2007 | DOI: https://doi.org/10.7860/JCDR/2007/.150
SANTHOSH DV, SHOBHA K L, BAIRY I, RAO G, ANAND K M, D’SOUZA J

Melaka Manipal Medical College (Manipal Campus), International Centre for Health Sciences Manipal, Karnataka, India.

Correspondence Address :
Daphne Vincent Santhosh, Department of Microbiology, Melaka Manipal Medical College (Manipal Campus), International Centre for Health Sciences, Manipal - 576 104, Karnataka, India. Telephone nos: Office: +91-0820-2922634, Personal: +91-9886901222, Fax no: +91-820-257190. Email address: daphnevincent@yahoo.com

Abstract

Background: MRSA has long been implicated in the spread of nosocomial and community acquired infections which pose a threat for the emergence of carriers among the community and hospitals. This study was aimed at screening for methicillin resistant Staphylococcus aureus (MRSA) in students hailing from Malaysia, and characterizing the rate of carrier state along with nasal colonization with Staphylococcus species, among the different ethnicities of pre-clinical medical students before their entry into the clinical phase of their study.
Methods: 157 students were involved in the study. Samples were collected from the anterior nares of student volunteers. Biochemical tests were done to isolate Staphylococcus aureus. Species confirmation for Staphylococcus aurues was done using the tube coagualse test and the DNase test. Coagualse positive Staphylococci were subjected to oxacillin agar screen method to screen for MRSA.
Results: Out of 157 specimens, Staphylococcus species were isolated from 156 (99.3%) specimens, and one specimen showed no isolation of Staphylococcus species; 37 (23.7%) were Coagulase positive Staphylococcus aureus (CoPS), and 119 (76.2%) were Coagualse negative Staphylococcus species (CoNS). Of the total of 37 isolates of Coagualse positive Staphylococcus aureus, none were found to be resistant to methicillin (0%). All the 37 (100%) strains of CoPS isolated were methicillin susceptible Staphylococcus aureus (MSSA). The nasal carriage of CoPS among ethnic student communities were observed to be 22 (34.3%) in the Chinese; followed by Indians 12 (16.0%), and Malay 3 (17.6%).
Conclusions: The study revealed that out of the total specimens collected from student volunteers, none were carriers for MRSA. The highest percentage of nasal carriage for CoPS among the three main ethnicities of Malaysia was observed to be among the Chinese. All CoPS obtained were MSSA, while the highest rate of nasal colonisation with CoNS was observed in the Indian community. Screening should be made an essential protocol in order to assess and curb the in-flux of carrier transmitted drug resistant strains of Staphylococci from the community to the hospital setting.

Keywords

MRSA, MSSA, CoPS, CoNS, Oxacillin agar screen, Nasal carriage,Antimicrobial drug resistance, methicillin susceptibility, Nasal carriage, Nasal colonisation Pre-clinical survey

Introduction
Staphylococcus aureus is one of the most common pathogen that has been known to cause a wide range of infections. Staph aureus colonization in the anterior nares is quite common, as its primary habitat is the moist squamous epithelium of the nares. Healthy individuals could become carriers of the organism and have a small risk of contracting an invasive infection due to Staph aureus.

The incidence of community-acquired and hospital-acquired Staph aureus infections has been on the rise, with the emergence of drug resistant strains called methicillin- resistant Staph aureus (MRSA). Prevalence of MRSA had been previously confined or limited to hospital settings, but as of late, incidences of MRSA infections in the community have also been reported in epidemiological surveys and studies. Bacterial, genetic and microbiological adaptive changes and properties gave rise to the emergence of antibiotic resistance of the organism. The drug of choice for Staphylococcal infections was penicillin, but indiscriminate use and genetic manipulations on the part of the organism slowly led to penicillin resistance.

Penicillin resistance was rampant during the antibiotic era, and in order to replace penicillin, methicillin was used. A year after the discovery of methicillin in 1959, Staphylococci started to show resistance even to methicillin, which led to the emergence of the ‘super bug’ MRSA (Methicillin resistant Staphylococcus aureus). Two years later, Staphylococcus aureus showed resistance to other beta-lactam antibiotics like oxacilllin, nafcillin, and the cephalosporins, that invariably contributed to a multiple drug resistance (MDR) pattern in this organism, (1) due to genetic mutations brought about by the mecA gene in the Staphylococcal chromosomal cassette. MRSA was first reported in 1961.(2) There were only sporadic outbreaks of MRSA, and this became a major problem only during the late 1970s and in the early 1980s. Many outbreaks were reported after that from different parts of the world (5). Geographically, MRSA is distributed world wide.(11)

MRSA has been implicated in both community-acquired and hospital-acquired infections. They express heterogenous resistance to methicillin through the penicillin-binding protein 2a (PBP2a). This has been found to be the case in community acquired strains, as opposed to the hospital-acquired strains that show homogenous resistance patterns, though both contain the same gene (3), (4). Some strains are called the epidemic strains, and can spread within or between hospitals, and can also spread between countries.(11) There is a greater risk now being posed, that these methicillin resistant strains could lead to heterogenous glycopeptide resistance which was first reported from Japan in 1997,(6) of intermediate resistance pattern to vancomycin of Staphylococcus aureus (VISA). It was thought that the resistant strains of Staphylococcus aureus had their origin in the hospital, but case studies throughout the world provided facts that were surprising to the scientific community in that, sporadic cases of MRSA isolations were being reported from the community reservoirs.

Since many clinical infections arise from spread from healthy carriers; it is important to assess and survey the population coming from other countries into India, as these become reservoirs of the organism. Clinical isolates from invasive infections can only focus on the severity of the disease, but does not give an estimate or prevalence of carriers among the healthy population. This formed the basis for our study and its importance of screening for healthy carriers of MRSA, and also to study the rate of colonisation of CoPs an

Material and Methods

Study Design and sampling:
This study was approved by the institutional Kasturba hospital ethical clearance committee (KHEC) of Kasturba Medical College, Manipal, India, for the collection of samples from the student community which included 65 males and 92 females. This was a cohort study analyzing the carrier rate of MRSA in 157 students from Malaysia, whose ages were between 18-22 years. The 157 students were voluntary participants in this study, and samples were taken after written consent was obtained from the population under study.

Specimen Collection:
For the isolation of MRSA, samples were collected from the anterior nares of student volunteers using sterile cotton swabs soaked in sterile saline, and samples were directly inoculated onto sheep blood agar (FI-Chemechtron, Pvt. Ltd., Bangalore, India).

Processing of specimens:
Inoculated sheep blood agar plates were kept for 24 hours of incubation at 37oC. Golden yellow to white, opaque, rounded, convex colonies were isolated for further analysis. These colonies were subjected to biochemical tests. Strains that were catalase positive and those that fermented mannitol, were identified as Staphylococcus species. Slide and tube coagulase tests were done for the confirmation of CoPS, followed by DNase test using DNase test agar with toludine blue. Control strains for the assays included, MRSA strains ATCC 33592 and ATCC 43300, and MSSA strain ATCC 29213.

Slide coagulase and tube coagulase test(7) : These tests were done in order to confirm coagulase positive Staphylococci.

DNase test(22): Further confirmation of CoPS was done by detecting DNase activity by the use of DNase test agar w/ Toluidine Blue (M1041, HiMedia Laboratories Pvt. Ltd., Mumbai, India). The medium was prepared according to the manufacturer’s instructions. Pinkish clearing around the colonies on the DNase test medium confirmed DNase activity.

Susceptibility screening:
Phenotypic detection of MRSA:
Oxacillin agar screen(8) :
Mueller-Hinton agar (MHA) No. 2 (M1084, HIMEDIA) with 4% NaCl (Universal Laboratories Pvt. Ltd., Mumbai, India) was used with 6µg/ml of Cloxacillin (500mg; Biochem Pharmaceutical Industries Pvt. Ltd., Mumbai, India ) incorporated in MHA. CoPS were standardized to 0.5xMcFarland. The standardized suspensions were spot inoculated onto MHA.

Statistical Analyses:
Chi-Square test was applied to test the association between organism type and ethnicities. A significant association was observed between the organism type and the three different ethnicities of Malay, Chinese, and Indian Malaysian student population screened.

Results

Of the 157 samples screened, 156 isolates were Staphylococcus species. With the help of biochemical characterization; 37 were identified as CoPS, and 119 were CoNS (Table/Fig 1). MRSA from the oxacillin agar screen obtained were none. One specimen did not show any growth of Staphylococci. 156 specimens showed nasal colonization with Staphylococcus species. Staphylococci were isolated from 17 (10.8%) specimens taken from Malay Malaysians, 64 (40.7%) from Chinese Malaysians, and 75 (47.7%) from Indian Malaysians. Of the 17 specimens from Malay Malaysians, 3 (17.6%) were CoPS; from a total of 65 Chinese specimens, 22 (33.8%) were CoPS, and from 75 Indian Malaysians, 11 (14.6%) were CoPS (Table/Fig 2).

Although MRSA were not isolated, the highest rate of nasal carriage for CoPS according to this study was seen among the Chinese, followed by the Malay (even given their small sample size of 17), and the Indians in that order, while the highest rate of CoNS nasal colonisation was seen among the Indian students (84.9%) followed by the Malay (82.3%), and the Chinese (64.6%). 92 nasal swabs were collected from females, and 65 were collected from male students. Out of 91 females (one sample from a Chinese Malaysian female yielded only Gram negative bacteria), 17 were carriers of CoPS (18.6%), while 74 were carriers of CONS (80.4%). Out of 65 specimens obtained from the males; 20 were COPS (30.7%), while 45 were CoNS (69.2%). From this study, from a sample size of 157, males showed a greater rate of nasal carriage of CoPS than the females.

Discussion

The ratio of carriage of CoPS in the males and females in our study showed that the rate of carriage of CoPS was higher in males than in the females, although the sample size collected was much larger in females than in the males. There are no significant data available to correlate this finding. Two major ethnic communities in this study comprised of the Indians (75 in number) and Chinese (65 in number), apart from the Malays who were a minimum (17 in number). Taking the mean of the samples of these two ethnicities (Indian and Chinese Malaysians) into consideration; the ratio-proportion of nasal carriage of CoPS in Chinese to the Indians was 2:1. It is very interesting to see that the Chinese seem to have a greater rate of nasal carriage of CoPS. If we take the hypothesis of inflammatory markers into question, the most probable explanation to this could mean that the healthy Chinese population could well be having immunological tolerance towards the nasal colonization of CoPS, or could be harbouring genotype-dependent glucocorticoid insensitivity.(20), (21). The explanations are purely hypothetical, and warrant for further study at the molecular and genetic level for analysis of S.aureus predilection in certain ethnicities.

It would be further interesting to study the same student volunteers after they are exposed to the hospital setting in their clinical exposure, during the second phase of their medical term; in order to get a comparative data to analyze the rate of carriage of Staphylococci and isolation of MRSA during their pre and post exposure to clinical hospital settings. Screening for resistant strains of Staphylococci in healthy students should be adopted as a protocol in medical colleges, in order to curb the spread of drug resistant Staphylococci from the community to the hospital. This will also help in monitoring the student population who might pose a risk to patients and hospital personnel; and the community at large.

Acknowledgement

We thank the Dean of Melaka Manipal Medical College for his encouragement and facilities provided to carry out the project. We also thank the student volunteers from Malaysia.
Financial support was obtained from Manipal University, in the form of departmental funds to carry out the project.
Assistance in statistical analysis was given by Dr.Srimathi Mayya from the Department of Biostatistics and Research, Manipal University, Manipal, India.

References

1.
Chambers HF. The changing epidemiology of Staphylococcus aureus? Emerging Infectious Diseases. 2001; 2: 178-182.
2.
Jevons MP. ‘Calbenin’-resistant Staphylococci. British Medical Journal. 1961; 1: 124-125.
3.
Chambers HF. Methicillin resistance in staphylococci: molecular and biochemical basis and clinical implications. Clinical Microbiology Reviews. 1997; 10: 781-791.
4.
Quintiliani R. Jr, Courvalin P. Mechanisms of resistance to antimicrobial agents. Manual of Clinical Microbiology, 6th edn (Murray PR, Barron EJ, Pfaller MA, Tenover FC. & Yolken RH, Eds) 1995; 1308-1326. American Society for Microbiology, Washington, DC.
5.
Grubb WB. Genetics of MRSA. Reviews in Medical Microbiology. 1998; 9: 153-162.
6.
Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T and Tenover FC. Methicillin resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J. Antimicrob. Chemotherapy. 1997; 40: 135-136.
7.
Health Protection Agency (2005). Coagulase test. National Standard Method BSOP TP 10 Issue 3.
8.
National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility testing for bacteria that grow aerobically. 5th ed. Approved standard M7–A5. National Committee for Clinical Laboratory Standards, Wayne, PA.USA. 2000.
9.
Trish MP, Joseph JC, Richard PW et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. New. Eng. J. Medicine. 2002; 346: 1871-1877.
10.
van den Akker EL, Nouwen JL, Melles DC.et al. Staphylococcus nasal carriage is associated with glucocorticoid receptor gene polymorphisms. J.Infect.Dis. 2006; 194: 814-818.
11.
Lee JH. Methicillin (Oxacilllin) resistant Staphylococcus aureus strains isolated from major food animals and their transmission to humans. Appl.Environ. Microbiology. 2003; 69: 10886-10891.
12.
Duquette RA, Nuttal TJ. Methicillin resistant Staphylococcus aureus in dogs and cats: an emerging problem? J.Small.Anim.Pract. 2004:12:591-597.
Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3]

JCDR is now Monthly and more widely Indexed .