Nasal Carriage Rate, Antimicrobial Susceptibility Pattern, and Associated Factors of Staphylococcus aureus with Special Emphasis on MRSA among Urban and Rural Elementary School Children in Gondar, Northwest Ethiopia: A Comparative Cross-Sectional Study

Abstract

Introduction Staphylococcus aureus is a Gram-positive, catalase-positive, and coagulase-positive bacterial species commonly found on the skin and in the nose of most healthy individuals. The anterior nares of nose are the most frequent carriage sites for S. aureus in both adults and children. Methicillin resistance among S. aureus isolates has steadily increased worldwide. Objective The main objective of this study was to determine nasal carriage rate, antimicrobial susceptibility pattern, and associated risk factors of Staphylococcus aureus with special emphasis on MRSA among urban and rural elementary school children in Gondar, Northwest Ethiopia. Method A community based comparative cross-sectional study was conducted on 622 urban and rural elementary school children in Gondar from January 1st to March 30th, 2018. Data was collected using a questionnaire and nasal swab samples were collected by sterile cotton tip swab moistened with sterile normal saline. Collected samples were inoculated on mannitol salt agar and incubated aerobically at 37°C for 24 hrs. S. aureus was confirmed by observing colony characteristics and biochemical tests. MRSA was detected using cefoxitin disc by Modified Kirby-Bauer disk diffusion technique. Finally data was entered, cleared, and checked using Epi-info version 7 and exported to SPSS version 20 for analysis. Odds ratio and logistic regression were used for statistical association. P-value ≤ 0.05 at 95% CI was considered for statistical association. Result Of the 622 school children, the overall prevalence of S. aureus was 143/622 (23%). Of them, 14/143 (9.79%) were MRSA. The carriage rate in urban schools was 83/622 (13.3%) whereas it was 60/622 (9.6%) in rural schools. The prevalence of MRSA among urban schools, 9.1%, was higher than their urban counterparts, 0.7%. Gentamycin, clindamycin, and ciprofloxacin were the most effective whereas penicillin and tetracycline were resistant. Children's fathers' educational status and number of children in class room were significantly associated with S. aureus but only living in urban of children significantly associated with MRSA. Conclusion This study showed high prevalence of S. aureus and MRSA, 143/622 (23%) and 14/143 (9.79%), respectively. So, decolonization of nasal carriers of MRSA and reducing the number of students per classroom should be addressed. Moreover, regular large scale survey should be conducted to assess the burden and intervene accordingly.

Methicillin Resistant Staphylococcus aureus nasal carriage and associated factors in a rural tertiary hospital in Eastern Uganda: A prospective cross-sectional study

“…Results from this study indicated that the nasal carriage rates for S. aureus among the participants was 22.9%, a rate signi cantly higher than that reported from studies from Thika Hospital, Kenya (8.9%), Nigeria (18.3%), and China (2.4%) ( (30). The difference in the various ndings would have been attributed to the sample size used giving the different studies a better power to detect the S. aureus nasal carriage.…”

Nasopharyngeal carriage, spa types and antibiotic susceptibility profiles of Staphylococcus aureus from healthy children less than 5 years in Eastern Uganda

“…However, it is important to note that the resistance profiles among countries would depend on the different practices of antibiotic use between the countries, antibiotic stewardship and enforcement of infection control practices. Overall, clindamycin, rifampicin, vancomycin and linezolid were the most effective antibiotics in this study, in contrast to findings from Ethiopia where gentamicin and ciprofloxacin were the most effective among isolates from primary school children [34].…”

“…0.8%-1.5%)[4,33] and developing countries (e.g. 2.3%, 14/622 for urban/rural school children in Gondar, Ethiopia[34]; 0.6%, 85/950 for adult inpatients in a Kenyan government hospital[35]). However, the study populations are diverse making direct comparisons difficult.Several factors could be responsible for the high MRSA carriage rate in Ugandan children e.g.…”

Nasal Carriage and Methicillin Resistance of Staphylococcus Aureus Among Schoolchildren in Sana’a City, Yemen

“…Our nding was also similar to those reported from other countries [18][19][20] . However, the nasal carriage rate of S. aureus in this study tends to be lower than that reported in Nigeria (56.3%), India (46.67%), United State of America (39.6%; age group 1-19 years old), Netherland (36%; age group 1-19 years, and Nepal (31%; age group less than 15 years old) [21][22][23][24][25] .…”