Antimicrobial Drug Sensitivity Pattern of Staphylococcus Aureus Isolated at Ringroad State Hospital, Ibadan.

doi:10.21203/rs.3.rs-5139434/v1

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Antimicrobial Drug Sensitivity Pattern of Staphylococcus Aureus Isolated at Ringroad State Hospital, Ibadan.

https://doi.org/10.21203/rs.3.rs-5139434/v1

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Staphylococcus aureus is a gram-positive, catalase-positive, coagulase-positive bacteria. They are known to be the causative agent of various infections, including pyogenic infections, impetigo, urinary tract infections, food poisoning, septicemia, meningitis, and osteomyelitis. Staphylococcus aureus, like every other bacterium, is resistant to antimicrobial drugs and continues to defend against medical control and empirical treatments for infections caused by this microorganism; thus, there is a need for antimicrobial sensitivity testing to determine the appropriate drugs for the treatment of staphylococcal infections. This study investigated the antimicrobial drug sensitivity pattern of Staphylococcus aureus isolated from clinical samples at Ring Road State Hospital, Ibadan. One hundred thirty-two (132) isolates were obtained from clinical samples and were confirmed as S. aureus. Thereafter, the antimicrobial sensitivity test was performed via the Kirby–Bauer disc diffusion method. The sensitivity of each of the isolates was as follows: 92.4% of the isolates were resistant to amoxicillin, 88.6% were resistant to Zinnacef, and 65.9% were resistant to Pefloxacin. In addition, 65.2% of the isolates were resistant to Rocephin, and 56.8% of the isolates were resistant to methicillin. Most of the isolates were sensitive to ciprofloxacin (65.2%), streptomycin (56.8%), and erythromycin (50.8%). Antimicrobial drugs such as amoxicillin, Zinnacef, pefloxacin, rocephin, and methicillin were shown to be less likely to be effective in the empirical treatment of staphylococcal infections. In the study region, however, ciprofloxacin, streptomycin, and erythromycin are recommended as first-line antibiotics for the empirical treatment of staphylococcal infections. Statistical analysis revealed that age and sex had no influence on the sensitivity pattern of the isolates to amoxicillin, ciprofloxacin, pefloxacin, rocephin, streptomycin, erythromycin, or methicillin, whereas sex influenced the sensitivity pattern of the isolates to gentamycin and Zinnacef. This study underscores the importance of surveillance of Staphylococcus aureus antibiotic sensitivity patterns to select appropriate therapies, the need to effectively monitor and improve antimicrobial policies, and funding for appropriate research and therapy for Staphylococcus aureus in the health sector.

General Microbiology

Bacteriology

Staphylococcus aureus

Antibiotic antimicrobial resistance

antimicrobial sensitivity testing. Kirby–Bauer disc diffusion method. Clinical samples

Ring Road State Hospital

Great damage to the health of animals, plants, and humans is endemic in populations with high ratios due to infectious diseases caused by vast numbers and types of bacteria. Some infectious diseases are as fatal as leading to death and are reported worldwide (Amissaha et al., 2017). One of the most dangerous pathogens of health concern is the well-known bacterium Staphylococcus aureus (Argudin et al., 2018), which has negative effects on the health of humans and other animals (Ayepola et al., 2018). Staphylococcus aureus is a human and animal pathogen. S. aureus colonizes approximately 30% of the human population, especially the skin, nose, and mucous membranes (Abubakar and Suleiman, 2018). When S. aureus enters an organism (human or animal) through the nasal cavity, skin punctures, or other routes, it can cause a wide range of infections, from minor skin infections and abscesses to life-threatening infections such as toxic shock syndrome (TSS), meningitis, pneumonia, septicemia, and endocarditis. (Brogan and Mossialos, 2016).

In humans, S. aureus is associated with folliculitis, furuncles, carbuncles, impetigo, wound infections, scalded skin syndrome, pneumonia, endocarditis, bone and joint infections, toxic shock syndrome, mastitis, food poisoning, and rarely urinary tract infection. While detailed epidemiological results reveal that the highest incidence of S. aureus infection has been observed at younger ages than at older ages, the bodies of infants, children, and young adults have the same pattern as elderly adults; through their body parts, especially the dermal layers and nasopharynx, S. aureus infection can cause infection, while detailed epidemiological results reveal that the highest incidence of S. aureus infection has been observed at younger ages (Ayepola et al, 2018). Additionally, in livestock, S. aureus is the key etiology of mastitis in cattle, buffalo, sheep, goats, and other ruminants; lethal systemic infections in rabbits; and bumble foot (ulcerative pododermatitis) in poultry.

Invasive S. aureus illness was a substantial cause of death before the advent of antimicrobials; however, the discovery of penicillin in the 1940s prevented many deaths caused by this bacterium. Early in the 1950s, strains resistant to penicillin and subsequently semisynthetic penicillin derivatives such as methicillin were identified. Methicillin-resistant S. aureus (MRSA) strains with intermediate and total vancomycin resistance have recently been found in hospitals, and certain MRSA strains are prevalent in a variety of community habitats. The pathogen has recently developed resistance to 15 antibiotics owing to a lack of control in the use of antimicrobial agents. (Bhattacharya et al., 2018).

According to Abdullahi and Iregbu (2018), MRSA can infect 53 million individuals worldwide. Furthermore, nasal carriage of S. aureus in humans has been reported across various settings in Nigeria (Ayepola et al., 2018), and infections associated with S. aureus have also been reported in various parts of the country (Ayepola et al., 2015; Abdullahi and Iregbu, 2018; Abubakar and Suleiman, 2018).

The ability of the clinical microbiology laboratory to perform antimicrobial susceptibility testing is critical for confirming sensitivity to empirical antimicrobial drugs or detecting resistance in particular bacterial isolates because resistance mechanisms have not been discovered, and empirical treatment continues to be successful against some bacterial infections. This is particularly relevant since staphylococcal species have been found in hospitals, where they pollute surfaces and transmit diseases to patients. Staphylococci have been isolated from indwelling medical equipment, laptops, bed rails, countertops, floors, door knobs, faucets, bed linens, tables, blood pressure cuffs/tourniquets, and healthcare personnel robes and gloves, for example. (Brogan and Mossialos, 2016). The focus of this research was to examine the antibiotic sensitivity of Staphylococcus aureus isolates from clinical samples.

Antimicrobials, on the other hand, target essential bacterial functions such as cell wall synthesis (beta-lactams and glycopeptides), protein synthesis (aminoglycosides, tetracyclines, macrolides, lincosamides, chloramphenicol, mupirocin, and fusidic acid), nucleic acid synthesis (quinolones), RNA synthesis (rifampin), and metabolic pathways such as (sulphonamides and trimethoprim) (Akanbi et al., 2017; Kolenda et al., 2017).

Antimicrobial resistance develops as a result of excessive usage, either through point mutations or the acquisition of foreign resistance genes, resulting in changes to the antimicrobial target, degradation of the antimicrobial agent, or a decrease in the internal antimicrobial concentration of the antimicrobial agent (Akanbi et al, 2017; Ayukekbong et al, 2017).

Because Staphylococcus aureus has the potential to evolve diverse mechanisms of resistance to most antimicrobial agents, empirical treatment for certain bacterial infections continues to be successful because resistance mechanisms have not yet been identified. Accurate determination of the resistance phenotype and the underlying mechanisms of resistance are crucial not only for therapy but also from a public health perspective. In addition to internal laboratory quality control procedures, several national and international external quality control assurance schemes for antimicrobial susceptibility testing have been established to assess the proficiency of testing in individual laboratories and to compare laboratories within a country or at an international level (Heyar et al., 2017; Khan et al., 2019a).

S. aureus is a multi-disease-causing pathogen that causes events ranging from minor infections to life-threatening sepsis in humans. Effective infection control practices and antibiotic policies should therefore be developed to prevent S. aureus infections. The selection of effective drugs for the treatment of staphylococcal infections requires in vitro determination of drug resistance patterns in S. aureus. The primary objective of this study was to investigate the antimicrobial drug sensitivity pattern of Staphylococcus aureus isolated from clinical samples at Ibadan's Ring Road State Hospital.

This study aimed to determine the antimicrobial drug sensitivity pattern of Staphylococcus aureus isolated from clinical samples at Ring Road State Hospital in Ibadan.

This study was carried out at the Medical Microbiology Laboratory of Ring Road State Hospital, Ibadan, located in Oluyole Local Government of Ibadan, Oyo State, Nigeria. Ring Road State Hospital is a tertiary health care system that is involved in teaching and research. The population for this study comprises all patients of the Ring Road State Hospital, Ibadan. However, the target population consisted of all the patients in the Medical Microbiology Laboratory of the Ring Road State Hospital, Ibadan, within the period of this research study.

Ethical approval

for the study was obtained from the Health Review Ethical Committee of Lead City University, Ibadan, and Oyo State Health Management Board Ethics Committee (with reference number LCU-REC/22/022 dated 11-05-2022).

The Cochran formula (n = Z² × P (1-P)/d²) was adopted to determine the sample size, which was 132. The provisionally identified S. aureus isolates were collected from the laboratory and confirmed via catalase and coagulase tests;

The Kirby–Bauer disc diffusion method was used to determine the susceptibility of all the isolates to pefloxacin, gentamycin, zinnacef, amoxicillin, rocephin, streptomycin, erythromycin, methicillin, and ciprofloxacin.

The biodata and sociodemographics obtained from the laboratory records at Ring Road State Hospital, Ibadan, where the S. aureus isolates were obtained, were analyzed via Statistical Package for the Social Sciences Version 23 (SPSS Inc., Chicago, IL) and MS Excel 2016. To answer the study questions, descriptive statistics such as charts, figures, and tables were employed, while chi-square and correlation statistical techniques were used to test the hypotheses via SPSS software.

Figure 4.1 shows a graphical bar chart indicating the specimen distribution of the S. aureus isolates in terms of frequency and percentage. However, the figure revealed that the total number of isolates was 132. A total of 41 (31.1%) of the clinical samples were urine, 30 (22.7%) were HVS, 23 (17.4%) were wound swabs, 13 (9.8%) were blood, 8 (6.1%) were ear swabs, 7 (5.3%) were semen, 6 (4.5%) were CSF, and 4 (3%) were eye swabs. Thus, urine represents the clinical sample with the highest number of isolates for this study.

Figure 4.2 shows a graphical bar chart indicating the age distribution of the S. aureus isolates in terms of frequencies and percentages. However, the figure revealed that the total number of isolates was 132. Thirty-one (23.5%) of the clinical isolates were from patients within the age range of 30–34 years, 25 (18.9%) of the clinical isolates were from patients within the age range of 20–24 years and 25–29 years, 24 (18.2%) of the clinical isolates were from patients within the age range of 30–34 years, 23 (17.4%) of the clinical isolates were from patients within the age range of 35–25 years, and 4 (3%) of the clinical isolates were from patients within the age range of 15–19 years.

Figure 4.3 shows a graphical bar chart indicating the sex distribution of S. aureus isolate frequencies and percentages. However, the figure revealed that the total number of isolates was 132. Eighty-seven (65.9%) of the clinical isolates were from females, whereas 45 (34.1%) of the clinical isolates were from males. It can be concluded that females have the highest number of clinical isolates.

Figure 4: Distribution of antimicrobial drug sensitivity patterns of S. aureus isolates from Ring Road State Hospital, Ibadan

Table 4.1 shows the sensitivity pattern of S. aureus to pefloxacin according to age. The table revealed that, of the total isolates, 87 (65.9%) were resistant to Pefloxacin, whereas 45 (34.1%) were sensitive to the drug. Furthermore, the age range of 30–34 years had the highest resistance (77.4%), while the age range of 15–19 years had the highest sensitivity (75.0%) to Pefloxacin. Additionally, χ2 _{(5, N = 132)} = 6.738, p > 0.05, since the p-value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the Pefloxacin sensitivity pattern of S. aureus and age.

Table 4.2 shows the sensitivity pattern of S. aureus to pefloxacin by sex. The table revealed that, of the total isolates, 87 (65.9%) were resistant to Pefloxacin, whereas 45 (34.1%) were sensitive to the drug. Furthermore, females had the highest resistance (70.1%), whereas males had the highest sensitivity (42.2%) to Pefloxacin. Additionally, χ2 _{(5, N = 132)} = 2.009, p > 0.05, since the p-value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the Pefloxacin sensitivity pattern of S. aureus and sex.

Table 4.1

Sensitivity pattern of *S. aureus* to pefloxacin by age.
AGE-RANGE		PEFLOXACIN		Total
AGE-RANGE		R (%)	S (%)	Total
	0–14	13(54.2%)	11(45.8%)	24
	15–19	1(25.0%)	3(75.0%)	4
	20–24	18(72.0%)	7(28.0%)	25
	25–29	16(64.0%)	9(36.0%)	25
	30–34	24(77.4%)	7(22.6%)	31
	≥ 35	15(65.2%)	8(34.8%)	23
Total		87(65.9%)	45(34.1%)	132

Table 4.2

Sensitivity pattern of *S. aureus* to pefloxacin by age
GENDER		PEFLOXACIN		Total
GENDER		R (%)	S (%)	Total
	F	61(70.1%)	26(29.9%)	87
	M	26(57.8%)	19(42.2%)	45
Total		87(65.9%)	45(34.1%)	132

Table 4.3 shows the sensitivity pattern of S. aureus to gentamycin with increasing age. The table revealed that among the total isolates, 132 (53.0%) were resistant to gentamycin, whereas 62 (47.0%) were sensitive to the drug. Furthermore, the age range of 25–29 years had the highest resistance (68.0%), while the age range of 0–14 years had the highest sensitivity (58.3%) to gentamycin. Additionally, χ2 _{(5, N = 132)} = 3.872, p > 0.05, since the p-value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the gentamycin sensitivity pattern of S. aureus and age.

Table 4.4 shows the sensitivity pattern of S. aureus to gentamycin according to sex. The table revealed that among the total isolates, 132 (53.0%) were resistant to gentamycin, whereas 62 (47.0%) were sensitive to the drug. Furthermore, females had the highest resistance (65.5%), whereas males had the highest sensitivity (71.1%) to gentamycin. Additionally, χ2 _{(5, N = 132)} = 15.975, p < 0.05, since the p-value is less than 0.05; thus, we accept the alternate hypothesis and conclude that there was a statistically significant difference between the gentamycin sensitivity pattern of S. aureus and sex.

Table 4.3

Sensitivity pattern of *S. aureus* to gentamycin according to age.
AGE-RANGE		GENTAMYCIN			Total
		R (%)		S (%)
	0–14	10 (41.7%)	14 (58.3%)		24
	15–19	2 (50.0%)	2 (50.0%)		4
	20–24	14 (56.0%)	11 (44.0%)		25
	25–29	17 (68.0%)	8 (32.0%)		25
	30–34	16 (51.6%)	15(48.4%)		31
	≥ 35	11 (47.8%)	12 (52.2%)		23
Total		70 (53.0%)	62 (47.0%)		132

Table 4.4

Sensitivity pattern of *Staphylococcus aureus* to gentamycin by sex.
GENDER		GENTAMYCIN		Total
GENDER		R (%)	S (%)	Total
	F	57 (65.5%)	30 (34.5%)	87
	M	13 (28.9%)	32 (71.1%)	45
Total		70 (53.0%)	62 (47.0%)	132

Table 4.5 shows the sensitivity pattern of S. aureus to Zinnacef by age. The table revealed that 132 of the total isolates were resistant to Zinnacef, 117 (88.6%) of which were resistant, whereas 15 (11.4%) were sensitive to the drug. Furthermore, the ages ranging from 20–24 years and 25–29 years presented the highest resistance (92.0% and 92.0%, respectively), whereas the ages ranging from 15–19 years presented the highest sensitivity (50.0%) to Zinnacef. Additionally, χ2 _{(5, N = 132)} = 6.756, p > 0.05, since the p-value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the gentamycin sensitivity pattern of S. aureus and age.

Table 4.6 shows the sensitivity pattern of S. aureus to Zinnacef by sex. The table revealed that 132 of the total isolates were resistant to Zinnacef, 117 (88.6%) of which were resistant, whereas 15 (11.4%) were sensitive to the drug. Furthermore, females had the highest resistance (89.7%), whereas males had the highest sensitivity (13.3%) to Zinnacef. Additionally, χ2 _{(5, N = 132)} = 3.872, p value = 0.000. Since the p-value is less than 0.05, we accept the alternate hypothesis and conclude that there was a statistically significant difference between the Zinnacef sensitivity pattern of Staphylococcus aureus and sex.

Table 4.5

Sensitivity pattern of *S. aureus* to Zinnacef by age
AGE-RANGE		ZINNACEF		Total
AGE-RANGE		R (%)	S (%)	Total
	0–14	21(87.5%)	3(12.5%)		24
	15–19	2(50.0%)	2(50.0%)		4
	20–24	23(92.0%)	2(8.0%)		25
	25–29	23(92.0%)	2(8.0%)		25
	30–34	27(87.1%)	4(12.9%)		31
	≥ 35	21(91.3%)	2(8.7%)		23
Total		117(88.6%)	15(11.4%)		132

Table 4.6

Sensitivity pattern of *S. aureus* to Zinnacef by sex.
GENDER		ZINNACEF		Total
		R (%)	S (%)
	F	78(89.7%)	9(10.3%)	87

	M	39(86.7%)	6(13.3%)	45
Total		117(88.6%)	15(11.4%)	132

Table 4.7 shows the sensitivity pattern of S. aureus to amoxicillin by age. The table revealed that of the total isolates, 132 (92.4%) were resistant to amoxicillin, whereas 10 (7.6%) were sensitive to the drug. Furthermore, individuals aged 20–24 years and 25–29 years presented the greatest resistance (96.0% and 96.0%, respectively), whereas those aged 15–19 years presented the highest sensitivity (25%) to amoxicillin. Additionally, χ2 _{(5, N = 132)} = 4.016, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the amoxicillin pattern of S. aureus and age.

Table 4.8 shows the sensitivity pattern of S. aureus to amoxicillin by sex. The table revealed that of the total isolates, 132 (92.4%) were resistant to amoxicillin, whereas 10 (7.6%) were sensitive to the drug. Furthermore, females had the highest resistance rate (93.1%), whereas males had the highest sensitivity (8.9%) to amoxicillin. Additionally, χ2 _{(5, N = 132)} = 0.168, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the amoxicillin sensitivity pattern of S. aureus and sex.

Table 4.7

Sensitivity pattern of *Staphylococcus aureus* to amoxicillin by age.
AGE-RANGE		AMOXICILLIN		Total
AGE-RANGE		R (%)	S (%)	Total
	0–14	21(87.5%)	3(12.5%)	24
	15–19	3(75.0%)	1(25.0%)	4
	20–24	24(96.0%)	(4.0%)	25
	25–29	24(96.0%)	1(4.0%)	25
	30–34	28(90.3%)	3(9.7%)	31
	≥ 35	22(95.7%)	1(4.3%)	23
Total		122(92.4%)	10(7.6%)	132

Table 4.8

Sensitivity pattern of *Staphylococcus aureus* to amoxicillin by sex
GENDER			AMOXICILLIN		Total
			R (%)	S (%)
	F	81(93.1%)		6(6.9%)	87
	M	41(91.1%)		4(8.9%)	45
Total		122(92.4%)		10(7.6%)	132

As shown in Table 4.9, the sensitivity pattern of S. aureus to Rocephin by age revealed that there were 132 total isolates, 86 (65.2%) of which were resistant to Rocephin, whereas 46 (34.8%) were sensitive to the drug. Furthermore, the age range of 15–19 years had the highest resistance (75.0%), whereas the age range of ≥ 35 years had the highest sensitivity (39.1%) to Rocephin. Additionally, χ2 _{(5, N = 132)} = 1.005, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the rocephin sensitivity pattern of S. aureus and age.

Table 4.10 shows the sensitivity pattern of S. aureus to Rocephin by sex. The table revealed that among the total isolates, 86 (65.2%) of the clinical isolates were resistant to rocephin, whereas 46 (34.8%) were sensitive to the drug. Furthermore, females had the highest resistance rate (65.5%), whereas males had the highest sensitivity (35.6%) to Rocephin. Additionally, χ2 _{(5, N = 132)} = 0.015, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the rocephin sensitivity pattern of S. aureus and sex.

Table 4.9

*Pattern of the sensitivity of S. aureus* to *Rocephin* by age.
AGE-RANGE		ROCEPHIN		Total
AGE-RANGE		R (%)	S (%)	Total
	0–14	17(70.8%)	7(29.2%)		24
	15–19	3(75.0%)	1(25.0%)		4
	20–24	16(64.0%)	9(36.0%)		25
	25–29	17(68.0%)	8(32.0%)		25
	30–34	19(61.3%)	12(38.7%)		31
	≥ 35	14(60.9%)	9(39.1%		23
Total		86(65.2%)	46(34.8%)		132

Table 4.10

Sensitivity pattern of S. aureus to Rocephin by sex.
GENDER		ROCEPHIN		Total
		R (%)	S (%)
	F	57(65.5%)	30(34.5%)	87
	M	29(64.4%)	16(35.6%)	45
Total		86	46(34.8%)	132

Table 4.11 shows the pattern of sensitivity of S. aureus to ciprofloxacin according to age. The table revealed that 132 of the total isolates were resistant to ciprofloxacin, 52 (39.4%) of which were resistant, whereas 80 (60.6%) were sensitive to the drug. Furthermore, the results indicated that those aged 15--19 years presented the greatest resistance (50.0%), whereas those aged 30--40 years presented the greatest sensitivity (69.6%) to ciprofloxacin. Additionally, χ2 (5, N = 132) = 2.389, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the ciprofloxacin sensitivity pattern of S. aureus and age.

Table 4.12 shows the sensitivity pattern of S. aureus to ciprofloxacin. The table revealed that 132 of the total isolates were resistant to ciprofloxacin, 52 (39.4%) of which were resistant, whereas 80 (60.6%) were sensitive to the drug. Furthermore, the results indicated that aged females had the highest resistance (42.5%), whereas males had the highest sensitivity (66.7%) to ciprofloxacin. Additionally, χ2 _{(5, N = 132)} = 1.050, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the ciprofloxacin sensitivity pattern of S. aureus and sex.

Table 4.11

Pattern of the sensitivity of *Staphylococcus aureus* to ciprofloxacin according to age.
AGE-RANGE		CIPROFLOXACIN		Total
AGE-RANGE		R (%)	S (%)	Total
	0–14	8(33.3%)	16(66.7%)	24
	15–19	2(50.0%)	2(50.0%)	4
	15–19
	20–24	10(40.0%)	15(60.0%)	25
	25–29	10(40.0%)	15(60.0%)	25
	30–34	15(48.4%)	16(51.6%)	31
	≥ 35	7(30.4%)	16(69.6%)	23
Total		52(39.4%)	80(60.6%)	132

Table 4.12

Sensitivities of *Staphylococcus aureus* to ciprofloxacin by sex.
GENDER		CIPROFLOXACIN				Total
		R (%)		S (%)
	F		37(42.5%)		50(57.5%)	87

	M		15(33.3%)		30(66.7%)	45
Total			52(39.4%)		80(60.6%)	132

Table 4.13 shows the sensitivity pattern of S. aureus to streptomycin with increasing age. The table revealed that of the total isolates, 57 (43.2%) were resistant to streptomycin, whereas 75 (56.8%) were sensitive to the drug. Furthermore, the age range of 15–19 years had the highest resistance (50.0%), whereas the age range of ≥ 35 years had the highest sensitivity (65.2%) to streptomycin. Additionally, χ2 _{(5, N = 132)} = 1.069, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the streptomycin sensitivity pattern of S. aureus and age.

Table 4.14 shows the sensitivity pattern of S. aureus to streptomycin by sex. The table revealed that of the total isolates, 57 (43.2%) were resistant to streptomycin, whereas 75 (56.8%) were sensitive to the drug. Furthermore, females had the highest resistance rate (50.6%), whereas males had the highest sensitivity (71.1%) to streptomycin. Additionally, χ2 _{(5, N = 132)} = 5.685, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the streptomycin sensitivity pattern of S. aureus and sex.

Table 4.13

Sensitivity pattern of *S. aureus* to streptomycin according to age.
AGE-RANGE		STREPTOMYCIN		Total
AGE-RANGE		R (%)	S (%)	Total
	0–14	11(45.8%)	13(54.2%)		24
	15–19	2(50.0%)	2(50.0%)		4
	20–24	12(48.0%)	13(52.0%)		25
	25–29	11(44.0%)	14(56.0%)		25
	30–34	13(41.9%)	18(58.1%)		31
	≥ 35	8(34.8%)	15(65.2%)		23
Total		57(43.2%)	75(56.8%)		132

Table 4.14

Sensitivity pattern of *S. aureus* to streptomycin by sex.
GENDER		STREPTOMYCIN		Total
		R (%)	S (%)
	F	44(50.6%)	43(49.4%)	87

	M	13(28.9%)	32(71.1%)	45
Total		57(43.2%)	75(56.8%)	132

Table 4.15 shows the sensitivity pattern of S. aureus to erythromycin according to age. The table revealed that among the total isolates, 63 (47.7%) were resistant to erythromycin, whereas 69 (52.3%) were sensitive to the drug. Furthermore, the results indicated that those aged 20–24 years presented the highest resistance (64.0%), whereas those aged 15–19 years presented the highest sensitivity (100.0%) to erythromycin. Additionally, χ2 _{(5, N = 132)} = 10.227, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the erythromycin sensitivity pattern of S. aureus and age.

Table 4.16 shows the sensitivity pattern of S. aureus to erythromycin by sex. The table revealed that among the total isolates, 63 (47.7%) were resistant to erythromycin, whereas 69 (52.3%) were sensitive to the drug. Furthermore, males had the highest resistance (53.3%), whereas females had the highest sensitivity (55.2%) to erythromycin. Additionally, χ2 _{(5, N = 132)} = 0.860, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the erythromycin sensitivity pattern of S. aureus and sex.

Table 4.15

Sensitivity pattern of *S. aureus* to erythromycin according to age.
AGE-RANGE		ERYTHROMYCIN		Total
AGE-RANGE		R (%)	S (%)	Total
	0–14	10(41.7%)	14(58.3%)	24
	15–19	0(0.0%)	4(100.0%)	4
	20–24	16(64.0%)	9(36.0%)	25
	25–29	13(52.0%)	12(48.0%)	25
	30–34	17(54.8%)	14(45.2%)	31
	≥ 35	7(30.4%)	16(69.6%)	23
Total		63(47.7%)	69(52.3%)	132

Table 4.16

Sensitivity pattern of *S. aureus* to erythromycin by sex
GENDER		ERYTHROMYCIN			Total
		R (%)		S (%)
	F	39(44.8%)	48(55.2%)		87

	M	24(53.3%)	21(46.7%)		45
Total		63(47.7%)	69(52.3%)		132

Table 4.17 shows the sensitivity pattern of S. aureus to methicillin by age. The table revealed that among the total isolates, 75 (56.8%) of the clinical isolates were resistant to methicillin, whereas 57 (43.2%) were sensitive to the drug. Furthermore, the age range ≥ 35 years had the highest resistance (65.2%), whereas the age range 15–19 years had the highest sensitivity (50.0%) to methicillin. Additionally, χ2 _{(5, N = 132)} = 1.069, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the methicillin sensitivity pattern of S. aureus and age.

Table 4.18 shows the sensitivity pattern of S. aureus to methicillin by sex. The table revealed that among the total isolates, 75 (56.8%) of the clinical isolates were resistant to methicillin, whereas 57 (43.2%) were sensitive to the drug. Furthermore, the results indicated that males had the highest resistance rate (71.1%), whereas females had the highest sensitivity (50.6%) to methicillin. Additionally, χ2 _{(5, N = 132)} = 5.685, p > 0.05, since the p value is greater than 0.05; thus, we accept the null hypothesis and conclude that there was no statistically significant difference between the methicillin sensitivity pattern of S. aureus and sex.

Table 4.17

Sensitivity pattern of *Staphylococcus aureus* to methicillin by age.
AGE-RANGE		METHICILLIN		Total
AGE-RANGE		R (%)	S (%)	Total
	0–14	13(54.2%)	11(45.8%)		24
	15–19	2(50.0%)	2(50.0%)		4
	20–24	13(52.0%)	12(48.0%)		25
	25–29	14(56.0%)	11(44.0%)		25
	30–34	18(58.1%)	13(41.9%)		31
	≥ 35	15(65.2%)	8(34.8%)		23
Total		75(56.8%)	57(43.2%)		132

Table 4.18

Sensitivity pattern of *Staphylococcus aureus* to methicillin by sex
GENDER		METHICILLIN			Total
		R (%)		S (%)
	F	43(49.4%)	44(50.6%)		87

	M	32(71.1%)	13(28.9%)		45
Total		75(56.8%)	57(43.2%)		132

Staphylococcus aureus is a very common cause of infection in hospitals and is most likely to infect newborn babies, surgical patients, old and malnourished persons and patients with diabetes and other chronic diseases (Tuo et al., 1995). In this study, the antimicrobial drug sensitivity patterns of S. aureus isolated from clinical samples at Ring Road State Hospital, Ibadan, were determined. The highest percentage of isolates of Staphylococcus aureus (23.5%) in this study was observed in the (30–34)-year-old age group, whereas the lowest percentage of the isolates (3%) was observed in the (15–19)-year-old age group; thus, this is not in accordance with the findings of Kano by Nwanko and Nasiru (2011), where the highest percentage of isolates of Staphylococcus aureus (47.3%) in this study was observed in the (0–10)-year-old age group. This may be a result of low immunity; hence, these individuals are vulnerable and easily affected.

Furthermore, the highest percentage of Staphylococcus aureus isolates were from women (65.9%) with suspected cases of UTI. This finding agrees with reports from a previous study reported by Akortha and Ibadin (2008), where 65.8% of cases with suspected UTI infection caused by Staphylococcus aureus were from women. A similar study by Abdul and Online (2001) reported that UTI was common among women in Ilorin and that Staphylococcus aureus was among the frequently isolated organisms. The similarity in these reports may be due to the sociodemographic characteristics of the study areas. The higher rate of staphylococcal infections in UTIs may be due to proximity between the genital tract and the urethra/anus, which could facilitate autotransmission, as suggested (Audu and Kudi, 2004).

Staphylococcus aureus was found to be a frequent cause of burns, UTIs, boils, impetigo, endocarditis, pneumonia, food poisoning, septicemia, and wound sepsis (Emmerson, 1994). In this study, urine had the highest percentage of Staphylococcus aureus isolates (31.1%), followed by HVS (22.7%), wound swabs (17.4%), blood (9.8%), ear swabs (6.1%), semen (5.3%), CSF (4.5%), and eye swabs (3%). This finding is generally consistent with the findings of Akerele and Ahonkhai (2000), who reported a recovery rate of 35.6% Staphylococcus aureus from urine in Benin city, Nigeria. The high incidence of S. aureus in UTIs may be a result of poor hygiene, the presence of indwelling bladder catheters, or surgery.

The highest sensitivity of S. aureus was observed with ciprofloxacin (65.15%), followed by streptomycin (56.81%) and erythromycin (50.75%), whereas the lowest sensitivity was observed with amoxicillin (7.6%). This indicated percentages of resistance of 34.85%, 43.19%, 49.25%, and 92.4% for ciprofloxacin, streptomycin, erythromycin, and amoxicillin, respectively. A similar study carried out by Heyar et al. (2017) in southeastern Nigeria revealed that Staphylococcus aureus was 85.6% resistant to amoxicillin, which concurs with the findings of this study. Thus, this may be due to the high level of indiscriminate or incorrect use of amoxicillin in Nigeria because of its easy accessibility as an OTC (over the counter) antibiotic. The high level of resistance observed may be associated with earlier exposure of these drugs to isolates, which may have enhanced the development of resistance. The high level of antibiotic abuse in this environment arising from self-medication may be associated with inadequate dosage and failure to comply with treatment.

Additionally, there were relatively high levels of resistance to Zinnacef (88.6%), Rocephin (65.15%), and methicillin (56.81%) in the S. aureus isolates. The level of resistance to methicillin (56.81%) observed in this study corroborated the 47.8% resistance rate reported by Olowe et al. (2007) in a study conducted in Osogbo, Nigeria. Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a serious public health problem of global concern. A screening of methicillin-resistant isolates in this study revealed a prevalence rate of 56.8%. This was, however, lower than that reported in studies conducted in other areas in Nigeria, such as Ilorin (34.7%) (Taiwo et al., 2005) and Jos (43.0%) (Ikeh et al., 2003). In contrast, the prevalence of MRSA was found to be low in France (6%), Ireland (5%) and the United Kingdom (2%) (Denton et al., 2008). However, a high prevalence of 83% MRSA was reported in Pakistan (Mehta et al., 1998). This confirms the high degree of regional variation in the findings from different countries and cities.

In the present study, the susceptibility of Staphylococcus aureus to ciprofloxacin was 65.15%. This finding is consistent with reports from Pakistan (74%) (Baqir et al., 2002). Staphylococcus aureus sensitivity to gentamicin in this study was 46.9%, which contradicts the findings of a study conducted in Kano by Nwanko and Nasiru (2011), where a 73.4% sensitivity rate was observed. The indiscriminate use of antibiotics without prescriptions in developing countries such as Nigeria, where there are no regulatory policies, has rendered the commonly used antibiotics completely ineffective in the treatment of Staphylococcus aureus infections (Odugbemi, 1998).

In conclusion, the use of antibiotics such as amoxicillin, Zinnacef, pefloxacin, rocephin, and methicillin in the treatment of staphylococcal infections is less likely to be preferred in the research region. However, ciprofloxacin, streptomycin, and erythromycin are recommended as first-line antibiotics in the management of Staphylococcus aureus infections in the study region.

The findings of this study suggest that age and sex do not affect the sensitivity to antibiotics. Moreover, in vitro susceptibility testing is needed for all isolated clinical samples to identify medications that are appropriate for treating this illness, and there is a need for continuous surveillance of the antibiotic sensitivity pattern of S. aureus to select appropriate therapies.

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The authors declare no competing interests.

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Antimicrobial Drug Sensitivity Pattern of Staphylococcus Aureus Isolated at Ringroad State Hospital, Ibadan.

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