Transmission dynamics of methicillin-resistant Staphylococcus aureus in a medical intensive care unit in India

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a global pathogen and an important but seldom investigated cause of morbidity and mortality in lower and middle-income countries where it can place a major burden on limited resources. Quantifying nosocomial transmission in resource-poor settings is difficult because molecular typing methods are prohibitively expensive. Mechanistic statistical models can overcome this problem with minimal cost. We analyse the transmission dynamics of MRSA in a hospital in south India using one such approach and provide conservative estimates of the organism''s economic burden.

Methods and Findings

Fifty months of MRSA infection data were collected retrospectively from a Medical Intensive Care Unit (MICU) in a tertiary hospital in Vellore, south India. Data were analysed using a previously described structured hidden Markov model.Seventy-two patients developed MRSA infections and, of these, 49 (68%) died in the MICU. We estimated that 4.2% (95%CI 1.0, 19.0) of patients were MRSA-positive when admitted, that there were 0.39 MRSA infections per colonized patient month (0.06, 0.73), and that the ward-level reproduction number for MRSA was 0.42 (0.08, 2.04). Anti-MRSA antibiotic treatment costs alone averaged $124/patient, over three times the monthly income of more than 40% of the Indian population.

Conclusions

Our analysis of routine data provides the first estimate of the nosocomial transmission potential of MRSA in India. The high levels of transmission estimated underline the need for cost-effective interventions to reduce MRSA transmission in hospital settings in low and middle income countries.     

On humus formation

Summary A scheme on humus formation has been proposed. This is as follows: Lignin/carbohydrates, the chief sources of C for the microorganisms are first broken down by extracellular enzymes into smaller units. Soluble units are absorbed into the microbial cell where part of them are converted to phenols/quinones. These together with oxidising enzymes are discharged into the environment where they polymerise by a free radical mechanism. The formation of FA (fulvic acids) has also been explained and it has been concluded that the difference between FAs and HAs (humic acids) is merely in the degree of polymerisation and that FAs are not necessarily more aliphatic than HAs.     

Studies on decomposition of humus in clay-humus complexes

Summary Decomposition studies with humic acids (HAs) present in HA-clay complexes revealed that such decomposition decreases at higher clay concentrations. At high clay concentration, moreover, it has also been observed that smaller and more flexible humic molecules are less susceptible to the said decomposition as compared to larger and more rigid structures.     

Effects of deforestation and cultivation on soil CEC and contents of exchangeable bases: A case study in Simlipal National Park,India

Deforestation in the tropics seems to be a serious problem probably because of the reduction in soil CEC and the consequent losses of nutrients from the soils. Here, changes in these parameters as influenced by deforestation as well as vegetative cover were studied; statistical methods were applied to interpret the results. Cultivation causes a significant reduction in CEC, total content of the exchangeable bases and exchangeable Ca2+ and Mg2+ levels compared to the adjoining unmanaged forest land. Levels of exchangeable K⁺ and Na⁺, however, do not change significantly. Evergreen forest soils have the highest levels of CEC, total exchangeable bases, exchangeable Ca²⁺ and K⁺. Deciduous forest, grassland and cultivated soils have statistically similar contents of exchangeable Ca²⁺, Mg²⁺, K⁺ and Na⁺. Exchangeable Mg²⁺, however, is not affected by vegetative cover. Soil CEC shows fairly good correlation with the organic carbon content only in evergreen forest soils. In others, organic carbon apparently does not influence CEC significantly. All soils show excellent correlation between their CEC and total exchangeable bases. It is concluded that for regeneration of weathered tropical soils, an evergreen cover provides the most effective means; deciduous vegetation or grass cover do not seem promising.     

Changes in carbon,nitrogen and phosphorus levels due to deforestation and cultivation: A case study in Simlipal National Park,India

The study area, within the Simlipal National Park, India, provides a rare variety of soil sampling sites. These include virgin forests in the proximity of several cultivated areas (where no chemical fertilizers or any modern technology has been used and where periods of cultivation vary from 5 to a little over 100 yr); samples from evergreen forests, deciduous forests and natural grasslands could also be obtained. The availability of numerous such samples made it possible to use statistical methods to evaluate the changes. This study showed that deforestation and cultivation result in statistically significant (P_0.05) reduction in organic C, total N and C:N ratios but no significant changes in total and available P levels; C:P and N:P ratios are also reduced. Loss of organic C and N occurs rapidly in the first 15 yr of cultivation and reaches quasi-steady state values around 1–2% organic C and 0.1–0.2% total N; extent of reduction is not related to initial levels. Significant reduction in C:N, C:P ratios following cultivation suggest that mineralisation losses of C are higher than loss of N whereas loss of P is lowest. Lack of significant correlation between organic C and P levels in all types of soils, suggests that the bulk of the P is in the inorganic form. Highest levels of organic C and N were observed in evergreen forests followed by deciduous forests, grasslands and cultivated areas in that order; total and available P levels, however, showed no significant differences. Evergreen vegetative cover appears to provide the ideal environment for organic matter accumulation.