Background
Nosocomial infection is a worldwide problem causing high number of deaths. The major causative agent of infection is methicillin resistant Staphylococs aureus (MRSA). Surgical site infections in orthopedic surgery (SSIS) are mainly (48%) caused by Staph. aureus, out of which 68% are MRSA and causes a number of deaths annually.
Hypothesis
As medicinal plants like (Opuntia delinii, Acacia nilotica and Alo vera) have the anti bacterial activity, So these plants may be effective against methicillin resistant Staphylococs aureus (MRSA) And antibiotic like (Moxifloxacillin, Cefipime and Imipenem/Cilastatin and Ampicillin+Cloxacillin) selected in this study have antibacterial activity against gram positive bacteria so may these have effectiveness against methicillin resistant Staphylococs aureus (MRSA).
Material and method
In this study MRSA isolated from the post operative wounds of one hundred hospitalized patients from three hospitals (Mayo Hospital, Services Institute of Medical Sciences and Jinnah Hospital) of Lahore. The isolates obtained from the wound identified as MRSA by cultural and biochemical characteristics. Methicillin resistant Staphylococs aureus strains are resistant to many antibiotics even vancomycin. In the present study the efficacy of three medicinal plants (Opuntia delinii, Acacia nilotica and Alo vera) studied against MRSA using extracts of the plants. The extracts also further used to determine MICs against methicillin resistant Staphylococs aureus isolated strains. MICs of four antibiotics and their combinations commonly used for treatment of post operative wounds like Moxifloxacin, Cefipime, Imipenem/Cilastatin and Ampicillin+Cloxacillin determined using Linezolid and Vancomycin as standards by micro dilution method in vitro.
Statistical Design
The data collected analyzed using SPSS version13.0X soft ware.
Outcome
The prevalence of MRSA found in different hospitals as under 72.5% in case of Mayo, 63.33% in case of Services Hospital and 66.66% in case of Jinnah hospital Lahore. The highest percentage found in Mayo hospital and lowest was observed in case of services hospital.
MIC results found in this study indicate that Acacia nilotica and Alo vera contain antibacterial agents which showed the good results against MRSA while Opuntia dileinii showed not promising results against MRSA and high MICs found put a question mark on its efficacy. Average MICs found in case of acacia leaves and bark are as 84 (µg)/ml and 62.5 (µg)/ml respectively. Average MIC observed in case of Aloe vera is 32.25 (µg)/ml. The highest MIC value calculated in case of Opuntia dillenii is 1228 (µg)/ml.
Antibiotics like Moxifloxacin and Imipenem/Cilastatin showed the good results and the average MICs value found 2.681 And 2.85 respectively closely resembles to the MICs of stander drugs e.i vancomycin and linezolid caluculated as 1.61 and 2.43. Cefipime showed the less activity against MRSA with the average MIC 57.81.The synergistic effects of Ampicillin+Cloxacillin was not so good as compared to the stander drugs and combination of ampicillin and cloxacillin exhibit the average MIC as 11.87.
The lowest MIC in of plants extracts observed in case of Aloe vera and highest found in case of Opuntia dillenii.