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Singapore Med J 2009; 50 (2) : 208
Antibiotic susceptibility pattern of
Staphylococcus species isolated from
telephone receivers
Smith S I, Opere B, Goodluck H T, Akindolire O T, Folaranmi A, Odekeye O M,
Omonigbehin E A

prevent the spread of infectious diseases through
Introduction: Microorganisms are transferred the use of public telephones.
to everyday objects from the environment and

infected individuals. Pathogenic microbes are Keywords: antibiotic resistance, antimicrobial
transmissible from the air, skin, hands and other susceptibility pattern, Staphylococcus aureus
interpersonal contacts and cause diseases most telephone receivers
of the time. This study centres on the microbial
Singapore Med J 2009; 50(2): 208-211
assessment of telephone receivers, their ability
to transfer bacterial infections and the isolation INTRODUCTION
of these microorganisms from receivers, with
Microorganisms are ubiquitous, and a mixture of
an emphasis on Staphylococcus aureus and its microbes are often transferred to everyday objects from
antibiotic susceptibility pattern.
the environment and infected individuals. Pathogenic microbes are transmissible via air, skin, food, water and Methods:1,591 isolates were obtained from other interpersonal contacts, and in most cases, they
roadside telephone booths in 16 different cause diseases and infections. Transmission of these
Molecular Biology and locations in the Lagos metropolis. They were all
infectious agents typically involves their escape from the Biotechnology Division, characterised using the Cowan and Steel’s manual,
Nigerian Institute of
host and entry into a new host.(1,2) These organisms can Medical Research,
after which the antimicrobial susceptibility also be transmitted through the sharing of instruments
PMB 2013,

pattern of the most frequently-occurring isolate and materials, such as bedding and telephones. The

was determined.
telephone system, for example, is an instrument or system used in sending sounds and messages across a distance Results: Of all the locations, Oshodi was found through a cable. It is a device used for the conversion of
to have the largest number of microorganisms, sound into an electrical impulse that is converted back
with Akoka having the least. The organisms were
into sound at the receiving end, and has to a large extent Providencia, Klebsiella, Citrobacter, Enterobacter, promoted the transmission of pathogenic microbes. Due
Proteus, Escherichia, Staphylococcus, Bacillus, to the importance of communication, people now use
Streptococcus, Micrococcus and yeast . telephones everywhere and in all areas of life, such as in
Department of Botany, Staphylococcus spp. was the most frequently
Lagos State University,
their homes, offices, schools, churches, mosques, hotels Lasu Ojo,
occurring, making up 20.2 percent of the total and hospitals, and it is used by both the healthy and the

number of isolated organisms, followed by Bacillus sick.(3) During usage, bacterial agents can be transferred
(18 percent), while Enterobacter and Citrobacter from an infected individual or an asymptomatic carrier
were the least common. 44 percent of the total of a microorganism to the surface of telephones through
Staphylococcus screened for an antimicrobial either direct contact with parts of the body, such as the
susceptibility pattern showed high resistance to mouth, ear and skin, or by indirect contact with aerosols,
most of the antibiotics used.
saliva droplets and infectious particles, to other users of Conclusion: This result could be related to the
Organisms from the normal flora can be transmitted Correspondence to:
emergence of Staphylococcus-resistant strains, onto phone receivers via sneezing or coughing. The
Dr Stella Ifeanyi Smith especially in a highly-populated area where there proliferation of bacteria in the mouth is due to the
Tel: (234) 80 3705 8989
Fax: (234) 1 342 6171 are health and hygiene problems and where presence of food particles in the mouth, which can be
drugs are abused. Precautions should be taken to passed onto the telephone receiver when talking as
Singapore Med J 2009; 50 (2) : 209
Table I. Distribution of organisms isolated from Table II. Antimicrobial susceptibility patterns of
telephone receivers.

Staphylococcus aureus strains isolated.
rents that are affordable for everyone even though they lack good infrastructure and are poorly kept; whereas droplet aerosol.(4) Direct contamination of the telephone areas with better sanitation and good infrastructure are receiver by microorganisms from the hand, throat and sparsely populated because of the high rent. Regardless skin of users also occurs.(5) The microorganisms are of the area, however, all have telephone booths that continuously disseminated from the mouth and the are accessible to the public. The aim of this study was nasal cavity when someone sneezes, coughs, laughs, to isolate bacterial agents that can be transmitted by talks and breathes into the surrounding air and this can telephone receivers and to screen Staphylococci (being in turn be transmitted to susceptible healthy individuals the most commonly-isolated microorganism) for their by way of the respiratory tract. The microorganisms are antimicrobial susceptibility patterns.
well adapted to transmission by way of nasopharyngeal secretions and saliva droplets and are highly resistant to drying and desiccation, thus their easy movement from 500 swabs were collected from roadside telephone one host to another.(6) Telephone boxes located in hostels, booths in 16 different locations in the Lagos metropolis. lobbies, corporate offices and public centres are possible The locations were selected randomly from all the transmitters of these pathogenic microbes. Some of the local government areas in the state. All the swabs were known normal flora sometimes cause diseases when the collected with aseptically-moistened swab sticks using tissue defences of the host are lowered, e.g., Staphylococci normal saline solution and transported to the laboratory can be carried frequently from the nose and moistened in coolers containing ice packs. The swabs were then areas of the skin, where they do not cause diseases, but streaked onto blood agar and MacConkey agar plates and when they land on other parts of the body, they may cause incubated at 37°C for 18–24 hours. Microscopy and Gram diseases or infections especially in immunosuppressed staining were carried out on the isolated organisms for presumptive identification, after which the isolates were The direct dissemination of bacteria from people is characterised according to Cowan and Steel’s manual.(7) of particular importance in the assessment of telephones Antimicrobial susceptibility tests were carried out using for the presence of microorganisms. Bacteria can be the disc diffusion method of Clinical and Laboratory liberated from human beings through three principal Standards Institute.(8) The most frequently-occurring means, viz. activities involving the respiratory tract, such organism was inoculated and streaked aseptically on as sneezing, coughing, talking, laughing; movements that Muller-Hinton agar plates, after which the antibiotic discs shed bacteria-bearing particles from the body, skin wound were placed on them and incubated at 37°C for 18–24 or discharge from body lesions; and re-dissemination of hours. The plates were observed after 24 hours for culture organism-bearing particles from dust in phone booths, streets and sidewalks. In Lagos, however, one of the major means of communication is by telephone, and the government has placed several telephone booths in Out of 500 swabs collected from different public telephone strategic areas of the state. Every local government has at centres in the Lagos metropolis, 1,591 organisms were least two booths, depending on how large and populated isolated. Samples collected from Oshodi were found the area is. Most densely populated areas have cheaper to have the highest number of isolates, while samples Singapore Med J 2009; 50 (2) : 210
collected from Akoka had the least number of isolates. Of all the isolates, Staphylococcus spp. was most frequently The isolation of S. aureus was closely followed by isolated (20.2%) from all 16 locations, followed by Bacillus subtilis, which is known to be free-living in the Bacillus, (18.0%), and the least occurring organism was soil, atmosphere and water.(11) The presence of the Bacillus Enterobacter spp. (1.3%). (Table I). Table II shows the spp. on the telephone may be a result of the unhygienic antibiotic susceptibility patterns of 27 Staphylococcus handling of the telephone receiver. Streptococcus aureus (S. aureus) isolated and identified by tube catalase pneumoniae found in the oral and nasal passages was test, out of which 12 (44%) were resistant to oxacillin.
also isolated. Infections that are caused by it include pneumonia, meningitis, endocarditis, otitis, bronchitis, DISCUSSION
bacteraemia and sinusitis.(12) Other organisms isolated It was noticed from this study that the frequency of include Micrococcus spp. which causes micrococcal isolation of the bacterial agents vary with location and infections associated with that of Staphylococcus spp. species. Oshodi was found to have the highest number of e.g. abscess. Some yeast or yeast-like organisms are microorganisms, with Akoka having the lowest number parasites for people, e.g. Candida albicans, which of isolates. This can be explained by the fact that Oshodi generally produces an ulcerative condition of the mouth is a densely-populated area with a high level of activity.
and throat, and may later be localised in some internal It is also a market place with debris, waste materials, organs and produce infections. However, a previous perishable food items and diseased individuals all over report by O’Connor et al showed the lack of occurrence its environs, and hence Oshodi is highly polluted, with of methicillin-resistant S. aureus (MRSA) on municipal a high presence of airborne microorganisms that could settle on the telephone. On the other hand, Akoka, The susceptibility patterns shown in this study which is sparsely populated, has less activities within its suggest that it is absolutely necessary to obtain sensitivity environment and therefore a lower level of pollution.
reports before the initiation of antibiotic therapy in The occurrence of Staphylococcus spp. was also the suspected MRSA patients. It should also be noted that highest among all the isolated organisms, with S. aureus antibiotic sensitivity testing is only a guide and that making up 8.4% (27) of the total. This high occurrence conditions in vivo may be different from those obtained may be due to its resistance to drying which favours its in vitro. The ultimate decision to utilise a particular transmission and its presence as part of the normal flora of antibiotic depends on such factors as toxicity, costs and the nose, mouth and skin. Its transmission from one host serum attainable levels. This study agrees with other to another susceptible host is known to be responsible studies that MRSA, besides having established itself as for epidemic pyogenic infections in hospitals as well a major hospital pathogen, is now beginning to prevail as epidemic diseases. However, this study agrees with in a wider community.(14) The emergence of MRSA in earlier work conducted by other researchers who reported the community is a major public health threat because that S. aureus makes up about 20% of the microbial these strains are resistant to B-lactam antibiotics, which load in the air. They also reported that the organism is are used empirically to treat a variety of infections, constantly disseminated from the nasal cavity during including pneumonia.(15,16) The result of this study is talking, breathing and even exercising.(9) 44% of the worrying because most resistant strains were isolated total number of strains screened for antimicrobial from areas with isolated risk factors, such as health and susceptibility patterns showed strong resistance to most hygiene problems, sharing of contaminated items, having of the antibiotics used. This may be associated with the active diseases and crowded living conditions. Most of practice of self-medication and the indiscriminate use of the transmission therefore appears to be from people with antibiotics, which has led to S. aureus becoming resistant to relatively safe antibiotics. It is noteworthy that this In conclusion, it can be established that the number organism is present in all the samples. It is known to be a of microorganisms that are constantly present on public normal component of humans’ indigenous microflora and telephone receivers depends on the frequency of usage is carried asymptomatically in/on a number of body sites. and location of each particular telephone. The telephone Its transmission from these sites causes both endemic and could be a very good source of infectious diseases. epidemic diseases.(10) Thus, staphylococcal infection can Further studies should be carried out to determine the rate be transmitted by the holding of telephones contaminated of infection through the use of public telephones.
Singapore Med J 2009; 50 (2) : 211
9. Gandara A, Mota LC, Flores C, et al. Isolation of Staphylococcus 1. Mercola J. Germs easily transferred from everyday objects to aureus and antibiotic-resistant Staphylococcus aureus from hands. Los Angeles: Annual Meeting of the American Society for residential indoor bioaerosols. Environ Health Perspect 2006; 2. Centers for Disease Control and Prevention (CDC). Outbreaks 10. Cruickshank R, Duguid JP, Marmion BP, Swain RHA. Medical of community-associated methicillin-resistant Staphylococcus Microbiology. A guide to the laboratory diagnosis and control of aureus skin infections--Los Angeles County, California, 2002- infection. Edinburgh: Churchill Livingstone, 1973: 345.
2003. MMWR Morb Mortal Wkly Rep 2003; 52:88.
11. Huys G, D’Haene K, Van Eldere J, von Holy A, Swings J. 3. Lajunen HR, Keski-Rahkonen A, Pulkkinen L, et al. Are Molecular diversity and characterization of tetracycline-resistant computer and cell phone use associated with body mass index and Staphylococcus aureus isolates from a poultry processing plant. overweight? A population study among twin adolescents. BMC Appl Environ Microbiol 2005; 71:574-9.
12. Salle AJ. Fundamental Principles of Bacteriology. New Delhi: 4. Brooks GF, Butel JS, Morse SA. Jawetz, Melnick, & Adelberg’s Tata McGraw-Hill Publishing Company, 1985: 649-59.
Medical Microbiology. 21st ed. Stamford, CT: Appleton and 13. O’Connor A, Loughrey A, Miller BC, et al. Lack of occurrence of methicillin-resistant Staphylococcus aureus on municipal public 5. Cozanitis DA, Grant J, Mäkelä P. Bacterial contamination of telephones. Am J Infect Control 2007; 35:285-6.
telephones in an intensive care unit. Anaesthesist 1978; 27: 14. Okuma K, Iwakawa K, Turnidge JD, et al. Dissemination of 6. Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998; new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002; 40: 4289-94. 7. Barrow GI, Feltham RKA, eds. Cowan and Steel’s Manual for the 15. Okesola AO, Oni AA, Bakare RA. Nosocomial infections: Identification of Medical Bacteria: 3rd ed. Cambridge: Cambridge methicillin resistant Staphylococcus auerus in wound infection in Ibadan, Nigeria. Afr J Med Sci 1999; 28:55-7.
8. Clinical and Laboratory Standards Institute. Performance standards 16. Gillet Y, Issartel B, Vanhems P, et al. Association between for antimicrobial susceptibility testing. Fifteenth informational Staphylococcus aureus strains carrying gene for Panton-Valentine supplement. CLSI document no. Ml00-515. Wayne, PA: CLSI, leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2002; 359:753-9.


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