Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study

Abstract

Objective To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children. Methods Cross-sectional study of patients <14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018. Results A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9–35.1) and 1.44% (95% CI 0.9–2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥5 years (OR 1.10, 95% CI 1.07–1.12), male sex (OR 1.43, 95% CI 1.17–1.76), urban setting (OR 1.46, 95% CI 1.08–1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093–1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57–8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p<0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin. Conclusions The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.

Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions

“…The MRSA colonisation rates observed (2%) are similar to those reported in our previous community studies (1.4%) 9 , highlighting the fact that MRSA is not currently a relevant issue among children in Spain. A number of authors have also reported that, in children with CCCs, infections are mostly caused by Enterobacteriaceae and Pseudomonas , while S. aureus has a less relevant role 36 , 37 .…”

“…The prevalence of S. aureus colonisation in this series (16%) is below the 33% reported in community-dwelling children in Spain 9 , although our included patients were young, and the prevalence of colonization is usually increased in older children 7 , 9 . However, as we have analyzed children with CCCs, a higher rate of carriage status were expected to be found, at least for MRSA strains, compared to children from the community, as other authors have reported higher colonization rates of S. aureus and MRSA in chronically institutionalized children 7 .…”

“…Staphylococcus aureus colonizes 20–40% of healthy individuals 7 , 8 ; however, data on paediatric cases are scarce. A previous study (COSACO) by our group found a prevalence of 33% for S. aureus nasal colonisation in the community among Spanish children, with a low prevalence of MRSA 9 .…”

“…Nasal swabs to detect S. aureus and MRSA colonisation were collected during the first 48 h after hospital admission and analysed following the standardized protocol of the COSACO study 9 , 25 . Each sample was collected by inserting the swab tip into the two nostrils and rotating it for 5 s on each side, using ESwab™ flocked swabs with Liquid Amies Medium (Copan, Brescia, Italy) 9 . Methicillin resistance was detected by the disk diffusion method with cefoxitin (30 µg), as well as by susceptibility testing and disk diffusion to other antibiotics 25 .…”

New therapeutic applications of ozenoxacin in superficial skin infections

“…4 In Spain there are practically no available data on resistance to fusidic acid or mupirocin in outpatients, although recent data in children under 14 years of age which were nasal carriers showed a 2.2% of resistance to fusidic acid in S. aureus and 5.6% in MRSA16 and a 7% resistance to mupirocin in S. aureus and a 4% in MRSA. 17 The development of ozenoxacin followed the requirements for the development of new antibiotics for skin infections published in the FDA 2010 Guidance for Industry 18 . In this guidance, only impetigo is considered as a primary infection with enough entity to demonstrate the efficacy and Accepted paper safety of topical antibiotic treatment.…”