Carriage of methicillin‐resistant Staphylococcus aureus in a Queensland Indigenous community

Abstract

Objective: To determine the prevalence of community‐acquired methicillin‐resistant Staphylococcus aureus (CA‐MRSA) carriage and infection among children living in an Indigenous community in Queensland. Design, setting and participants: Swabs for culture of S. aureus were collected from the nose, throat and skin wounds of primary school children. Main outcome measures: MRSA carriage, antibiotic sensitivity, genotype, and presence of the virulence factor Panton–Valentine leukocidin (PVL); and epidemiological risk factors for MRSA carriage. Results: 92 (59%) of 157 eligible children were included in the study. Twenty‐seven (29%) carried S. aureus; 14 of these (15% of total) carried MRSA. MRSA was isolated from 29% of wound swabs, 8% of nose swabs, and 1% of throat swabs. Fourteen of 15 MRSA isolates were sensitive to all non‐β‐lactam antibiotics tested. Eight children (9%) carried CA‐MRSA clonal types: six carried the Queensland clone (ST93), and two carried the South West Pacific clone (ST30). All these isolates carried the virulence factor PVL. The remaining six children carried a hospital‐associated MRSA strain (ST5), negative for PVL. Conclusions: We have identified a high prevalence of CA‐MRSA carriage in school children from a Queensland Indigenous community. In this setting, antibiotics with activity against CA‐MRSA should be considered for empiric therapy of suspected staphylococcal infection. Larger community‐based studies are needed to improve our understanding of the epidemiology of CA‐MRSA, and to assist in the development of therapeutic guidelines for this important infection.

Whole genome sequencing to investigate a putative outbreak of the virulent community-associated methicillin-resistant Staphylococcus aureus ST93 clone in a remote Indigenous community

“…The observed pattern of ST93 as a common cause of skin infections but an infrequent nasal colonizer is consistent with other colonization surveys in the NT and Queensland (Vlack et al , 2006; Brennan et al , 2013). In an impetigo treatment trial undertaken in children from NT Indigenous communities, nasal colonization with S. aureus was less common among those with S. aureus -related impetigo (13 %) compared to those without S. aureus impetigo (24 %) (Bowen et al , 2014), suggesting that there may not be a significant overlap of skin and nasal populations of S. aureus .…”

Molecular epidemiology of Panton-Valentine Leukocidin-positive community-acquired methicillin resistant Staphylococcus aureus isolates in pastoral communities of rural south western Uganda

“…The authors hypothesized that the result could be due to limited use of antibiotics in that population. Studies in North America and Australia, however, have shown that native and indigenous populations have been associated with a high risk of colonization and infection with CA-MRSA which may be related to many of these groups being disadvantaged, due to their association with low socio-economic status, crowded living conditions and frequent use of antibiotics [36, 37]. There have been reports of absolute resistance to penicillin and high percentage resistance to other antibiotics in milk from similar settings in central Uganda, hence risk of spread to humans through the food chain [27].…”

Population dynamics of methicillin-susceptible and -resistant Staphylococcus aureus in remote communities

“…No Singleton 93 MRSA was found during the period of the surveys. PVL-positive ST93-MRSA-IVa (2B), also known as the Queensland clone, however, is an important Australian CA-MRSA that was originally found in a Caucasian population in Queensland in 2000 and has been reported in Indigenous people from Queensland 5,37 and the Northern Territory. 38 It is interesting that in an environment of high β-lactam use a methicillin-resistant variant of ST93-MSSA was not found in WA during these surveys.…”

“…In Australia the first CA-MRSA, colloquially known as ‘WA MRSA’, was reported in 1993 in infected Indigenous people from remote communities in the sparsely populated Kimberley region of Western Australia (WA). 2 This was followed by reports of CA-MRSA from Indigenous people in the Northern Territory, 4 Queensland 5 and Central Australia. 6 …”