Nasal Methicillin-Resistant Staphylococcus aureus Carriage Among Foreign Workers Recruited to Taiwan From Southeastern Asian Countries

Abstract

Background In 2012, we identified the dissemination of methicillin-resistant Staphylococcus aureus (MRSA) sequence type (ST)45 strain in 14 nursing homes in Taiwan and foreign nurse workers, a significant risk factor for MRSA carriage. We conducted this study to understand MRSA carriage and molecular characteristics among foreign workers recruited from Southeastern Asian countries. Methods A cross-sectional study involving a total of 1935 foreign workers—929 (arrival group) and 1006 (staying group)—from Vietnam (n = 843), Indonesia (n = 780), the Philippines (n = 239), and Thailand (n = 70) were conveniently recruited during upon-arrival and regular health examination in a regional hospital. A nasal swab was obtained from each participant for detection of MRSA. Results Overall, MRSA carriage rate was 2.72%, with 2.26% for arrival group and 3.18% for staying group, and 4.74% for Vietnamese, 1.28% for Indonesians, 1.26% for Filipino, and none for Thai workers. Pulsotype AK/ST45 (57%) and pulsotype AX/ST188 (14%) were the top 2 dominant clones for the arrival group, whereas pulsotype D/ST59 (41%) (an endemic community clone in Taiwan) and pulsotype AK/ST45 (19%) were predominant for the staying group. A significant decrease of pulsotype AK/ST45 from 57% to 19% (P = .007) and increase of pulsotype D/ST59 from 4.8% to 41% (P = .004) were found between the arrival and the staying groups. Conclusions Approximately 3% of foreign workers recruited from Southeastern Asian countries to Taiwan were colonized with MRSA, including the ST45 strain. However, the MRSA isolates from workers staying in Taiwan were mostly a locally endemic clone and genetically different from those identified from workers on arrival.

Nasal Methicillin-Resistant Staphylococcus aureus Colonization in Patients with Type 1 Diabetes in Taiwan

“…Two distinct types were classified: a virulent Taiwan clone (pulsotype D/ST59/SCCmec VT/PVL positive) and a commensal Asia-Pacific clone (pulsotype C/ST59/SCCmec IV/PVL negative) [49][50][51], both of which were identified in our study. Furthermore, we found a high frequency of strains with pulsotype AK/ST45/SCCmec IV/PVL negative, which were first identified in 2006 in Taiwan and reportedly predominant in immigrant workers from southeast Asian countries [52,53]. In recent years, this strain has been increasing in Taiwanese children [51].…”

Detection, spread and phylogeny of meticillin-resistant Staphylococcus aureus sequence type 45 in Taiwan

“…From July 2016 to February 2017, ST45 accounted for 85 (49.4 %) of 172 MRSA isolates collected from residents and HCWs in four nursing homes in northern Taiwan during a longitudinal survey (bimonthly for 6 months with four surveys) for MRSA carriage (unpublished data). ST45 also accounted for 18 (34.0 %) of 53 MRSA isolates identified from 1935 foreign workers recruited to Taiwan in 2017 [ 26 ] ( Table 2 ).…”

“…Among the 133 MRSA ST45 isolates identified from TSAR surveys, 16 isolates were selected for WGS and included the first ST45 isolate identified in 2004 (strain Sau41) and three isolates in each later survey ( Tables 1 and S1, available with the online version of this article). Among the 257 ST45 isolates identified from the CGMH-based laboratory, 59 isolates were selected for WGS and included 1 isolate (strain DR4) from a Vietnamese attendee at an international conference held in Taiwan in 2010 [ 27 ], 22 clinical (infecting) isolates from 6 hospitals during 2010 and 2011 [ 11 ], 20 colonizing isolates from 14 nursing homes in a 2012 survey (15 isolates from foreign HCWs, 4 isolates from Taiwanese HCWs and 1 from a resident) [ 13 ], 5 colonizing isolates from two nursing homes in 2016 (2 isolates from Indonesian HCWs, and 1 each from a Filipino HCW, a Vietnamese HCW and a resident, respectively) and 11 colonizing isolates from foreign workers recruited from south-eastern countries in the 2017 survey (7 isolates from Vietnamese workers, 3 isolates from Indonesian workers and 1 from a Filipino worker) [ 26 ] ( Tables 2 and S1).…”

Nasal Carriage of Staphylococcus Aureus in Pharmacist and Pharmacy Personnel

“…HCWs who interact with hospital and community can cause cross contamination of hospital-acquired and community-acquired MRSA [7]. It is difficult to treat infections caused by MRSA [8]. MRSA carriers can cause major problems for critically ill patients in the hospital [9].…”