Advanced Biomedical Research

Nasal carriage screening of community-associated methicillin resistant Staphylococcus aureus in healthy children of a developing country

Document Type : Original Article

Authors

1 Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Epidemiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The rapid emergence and spread of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has raised considerable public health concern in both developed and developing countries. The current study aimed to address the extent of this phenomenon in healthy preschool children of a developing country.
Materials and Methods: We conducted a prospective study from April 2013 to March 2014 on 410 healthy 2-6 years old preschool children in Isfahan, Iran. Demographic medical data and nasal samples were collected from the participating children. Isolates were identified as S. aureus and MRSA based on microbiological and molecular tests, including the presence of eap and mecA genes.
Results: The overall prevalence of S. aureus and CA-MRSA nasal carriage was 28% (115/410) and 6.1% (25/410), respectively. The identity of isolates was confirmed by molecular assay. The factors that were independently associated with nasal carriage of S. aureus were: Children crowding in day-care nurseries and income level of families. A total of 20/90 (22.2%) of methicillin-susceptible S. aureus and all 25 CA-MRSA displayed multiple drug resistance to 3–8 antibiotics.
Conclusions: The current report reflects issues and concerns that the high rate of colonization by CA-MRSA in Iranian healthy children provides obliging evidence that MRSA have established a foothold in the community and are emerging as important health threatening pathogens. It is suggested that we need more effective infection control measures to prevent transmission of nasal CA-MRSA in healthy preschool children.

Keywords

1.
Tokajian S. New epidemiology of Staphylococcus aureus infections in the Middle East. Clin Microbiol Infect 2014;20:624-8.  Back to cited text no. 1
    
2.
Chen CJ, Huang YC. New epidemiology of Staphylococcus aureus infection in Asia. Clin Microbiol Infect 2014;20:605-23.  Back to cited text no. 2
    
3.
Sharma Y, Jain S, Singh H, Govil V. Staphylococcus aureus: Screening for nasal carriers in a community setting with special reference to MRSA. Scientifica (Cairo) 2014;2014:479048.  Back to cited text no. 3
    
4.
Coombs GW, Monecke S, Pearson JC, Tan HL, Chew YK, Wilson L, et al. Evolution and diversity of community-associated methicillin-resistant Staphylococcus aureus in a geographical region. BMC Microbiol 2011;11:215.  Back to cited text no. 4
    
5.
Cocchi P, Taccetti G, Montagnani C, Campana S, Galli L, Braggion C, et al. Evidence of transmission of a Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus clone: A family affair. Clin Microbiol Infect 2013;19:1158-62.  Back to cited text no. 5
    
6.
Shetty V, Trumbull K, Hegde A, Shenoy V, Prabhu R, Sumathi K, et al. Prevalence of community-acquired methicillin-resistant Staphylococcus aureus nasal colonization among children. J Clin Diagn Res 2014;8:DC12-5.  Back to cited text no. 6
    
7.
Lo WT, Lin WJ, Tseng MH, Lu JJ, Lee SY, Chu ML, et al. Nasal carriage of a single clone of community-acquired methicillin-resistant Staphylococcus aureus among kindergarten attendees in Northern Taiwan. BMC Infect Dis 2007;7:51.  Back to cited text no. 7
    
8.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. M100-S23. Vol. 32. Wayne, PA: Clinical and Laboratory Standards Institute; 2013.  Back to cited text no. 8
    
9.
Reischl U, Pulz M, Ehret W, Wolf H. PCR-based detection of mycobacteria in sputum samples using a simple and reliable DNA extraction protocol. Biotechniques 1994;17:844-5.  Back to cited text no. 9
    
10.
Hussain M, von Eiff C, Sinha B, Joost I, Herrmann M, Peters G, et al. eap gene as novel target for specific identification of Staphylococcus aureus. J Clin Microbiol 2008;46:470-6.  Back to cited text no. 10
    
11.
Jonas D, Speck M, Daschner FD, Grundmann H. Rapid PCR-based identification of methicillin-resistant Staphylococcus aureus from screening swabs. J Clin Microbiol 2002;40:1821-3.  Back to cited text no. 11
    
12.
Schito GC. The importance of the development of antibiotic resistance in Staphylococcus aureus. Clin Microbiol Infect 2006;12 Suppl 1:3-8.  Back to cited text no. 12
    
13.
Matouskova I, Janout V. Current knowledge of methicillin-resistant Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008;152:191-202.  Back to cited text no. 13
    
14.
Lowy FD. Antimicrobial resistance: The example of Staphylococcus aureus. J Clin Invest 2003;111:1265-73.  Back to cited text no. 14
    
15.
Jensen JU, Jensen ET, Larsen AR, Meyer M, Junker L, Rønne T, et al. Control of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a day-care institution. J Hosp Infect 2006;63:84-92.  Back to cited text no. 15
    
16.
Wilson J, Conly J, Wong T, Jayaraman G, Sargeant J, Papadopoulos A, et al. Strategies to control community-associated antimicrobial resistance among enteric bacteria and methicillin-resistant Staphylococcus aureus in Canada – Executive summary. Can J Infect Dis Med Microbiol 2010;21:133-7.  Back to cited text no. 16
    
17.
Oguzkaya-Artan M, Baykan Z, Artan C. Nasal carriage of Staphylococcus aureus in healthy preschool children. Jpn J Infect Dis 2008;61:70-2.  Back to cited text no. 17
    
18.
Schneider-Lindner V, Delaney JA, Dial S, Dascal A, Suissa S. Antimicrobial drugs and community-acquired methicillin-resistant Staphylococcus aureus, United Kingdom. Emerg Infect Dis 2007;13:994-1000.  Back to cited text no. 18
    
19.
Chen CJ, Hsu KH, Lin TY, Hwang KP, Chen PY, Huang YC. Factors associated with nasal colonization of methicillin-resistant Staphylococcus aureus among healthy children in Taiwan. J Clin Microbiol 2011;49:131-7.  Back to cited text no. 19
    
20.
Gesualdo F, Bongiorno D, Rizzo C, Bella A, Menichella D, Stefani S, et al. MRSA nasal colonization in children: Prevalence meta-analysis, review of risk factors and molecular genetics. Pediatr Infect Dis J 2013;32:479-85.  Back to cited text no. 20
    
21.
Bygott J, Enoch DA, Carson RP, Karas JA. Presumed community-acquired meticillin-resistant Staphylococcus aureus (MRSA) isolates reflect spillover of healthcare-associated MRSA. J Hosp Infect 2008;69:197-8.  Back to cited text no. 21
    
22.
Fomda BA, Thokar MA, Khan A, Bhat JA, Zahoor D, Bashir G, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus among healthy population of Kashmir, India. Indian J Med Microbiol 2014;32:39-43.  Back to cited text no. 22
[PUBMED]  Medknow Journal  
23.
Charlebois ED, Perdreau-Remington F, Kreiswirth B, Bangsberg DR, Ciccarone D, Diep BA, et al. Origins of community strains of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2004;39:47-54.  Back to cited text no. 23
    
24.
De Angelis G, Francois P, Lee A, Schrenzel J, Renzi G, Girard M, et al. Molecular and epidemiological evaluation of strain replacement in patients previously harboring gentamicin-resistant MRSA. J Clin Microbiol 2011;49:3880-4.  Back to cited text no. 24
    
25.
Calderwood MS. Editorial commentary: Duration of colonization with methicillin-resistant Staphylococcus aureus: A question with many answers. Clin Infect Dis 2015;60:1497-9.  Back to cited text no. 25
    
26.
Braga ED, Aguiar-Alves F, de Freitas Mde F, de e Silva MO, Correa TV, Snyder RE, et al. High prevalence of Staphylococcus aureus and methicillin-resistant S. aureus colonization among healthy children attending public daycare centers in informal settlements in a large urban center in Brazil. BMC Infect Dis 2014;14:538.  Back to cited text no. 26
    
27.
Sedighi I, Moez HJ, Alikhani MY. Nasal carriage of methicillin resistant Staphylococcus aureus and their antibiotic susceptibility patterns in children attending day-care centers. Acta Microbiol Immunol Hung 2011;58:227-34.  Back to cited text no. 27
    
28.
Rebollo-Pérez J, Ordoñez-Tapia C, Herazo-Herazo C, Reyes-Ramos N. Nasal carriage of Panton Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus in healthy preschool children. Rev Salud Publica (Bogota) 2011;13:824-32.  Back to cited text no. 28
    
29.
Lee J, Sung JY, Kim YM, Oh CE, Kim HB, Choi EH, et al. Molecular characterization of methicillin-resistant Staphylococcus aureus obtained from the anterior nares of healthy Korean children attending daycare centers. Int J Infect Dis 2011;15:e558-63.  Back to cited text no. 29
    
30.
Dey S, Rosales-Klintz S, Shouche S, Pathak JP, Pathak A. Prevalence and risk factors for nasal carriage of Staphylococcus aureus in children attending anganwaries (preschools) in Ujjain, India. BMC Res Notes 2013;6:265.  Back to cited text no. 30
    
31.
Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976-84.  Back to cited text no. 31
    
32.
Munckhof WJ, Nimmo GR, Carney J, Schooneveldt JM, Huygens F, Inman-Bamber J, et al. Methicillin-susceptible, non-multiresistant methicillin-resistant and multiresistant methicillin-resistant Staphylococcus aureus infections: A clinical, epidemiological and microbiological comparative study. Eur J Clin Microbiol Infect Dis 2008;27:355-64.  Back to cited text no. 32
    
33.
Biber A, Abuelaish I, Rahav G, Raz M, Cohen L, Valinsky L, et al. A typical hospital-acquired methicillin-resistant Staphylococcus aureus clone is widespread in the community in the Gaza Strip. PLoS One 2012;7:e42864.  Back to cited text no. 33
    
34.
Mathanraj S, Sujatha S, Sivasangeetha K, Parija SC. Screening for methicillin-resistant Staphylococcus aureus carriers among patients and health care workers of a tertiary care hospital in south India. Indian J Med Microbiol 2009;27:62-4.  Back to cited text no. 34
[PUBMED]  Medknow Journal  
35.
Munckhof WJ, Nimmo GR, Schooneveldt JM, Schlebusch S, Stephens AJ, Williams G, et al. Nasal carriage of Staphylococcus aureus, including community-associated methicillin-resistant strains, in Queensland adults. Clin Microbiol Infect 2009;15:149-55.  Back to cited text no. 35
    
36.
Herman RA, Kee VR, Moores KG, Ross MB. Etiology and treatment of community-associated methicillin-resistant Staphylococcus aureus. Am J Health Syst Pharm 2008;65:219-25.  Back to cited text no. 36
Advanced Biomedical Research
Volume 2016, August
August 2016
Pages 1-7