Nasal colonization in children with community acquired methicillin-resistant Staphylococcus aureus

Authors
Fazlollah Davoodabadi 1
Sina Mobasherizadeh 2
Kamyar Mostafavizadeh 2
Hasan Shojaei 1
Seyed Asghar Havaei 3
Ali Mehrabi Koushki 4
Zahra Moghadasizadeh 1
Mohsen Meidani 1
Kiana Shirani 5
1 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Nosocomial Infection 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
5 Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infections. The changing epidemiology of MRSA became evident in the 1990s when CA-MRSA cases were first reported. Nasal carriage of CA-MRSA is associated with an increased risk for development of infections in various populations.
Materials and Methods: Anterior nares culture for the presence of methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA was taken from 345 children attending kindergartens, who didn't have any known risk factor for MRSA colonization. Also, children demographic variables were recorded. Identification of SA and community-acquired methicillin-resistant Staphylococcus aureus ( CA-MRSA) with standard microbiological test was performed. Finally, the susceptibility of isolated to various antibiotics determined. The data were analyzed with Whonet 5.6 software.




Results: Of 345 children, 20 children (5.8%) were colonized with CA-MRSA, 86 children (24.9%) with MSSA and 239 cases (69.3%) didn't have SA colonization. The highest rate of MSSA and MRSA colonization was obtained at the age of 6 years. The frequency distribution of SA (MSSA and MRSA) colonization prevalence didn't have any significant differences based on age, gender and the admission time (P > 0.05); but it was significantly different in the urban areas (P < 0.001). The lowest resistance rate of CA-MRSA isolates, with a frequency of 10%, was detected with gentamicin, rifampin, and trimethoprim-sulfamethoxazole.
Conclusions: In summary, CA-MRSA colonization was observed in child care centers remarkably. Therefore, by facing various infections due to SA especially in areas of low socio-economic status, it must be considered. Based on antibiogram test, empirical treatment with rifampin, gentamicin and ciprofloxacin is recommended during CA-MRSA infections.

Keywords

1.
Cohen J, Powderly WG, Opal SM. Infectious Diseases. 3rd ed. London: Mosby Elsevier Science; 2010.  Back to cited text no. 1
    
2.
Davis JP, Fox BC. Hospital and Clinics Community Associated Methicillin Resistant Staphylococcus aureus (CA MRSA) Guidelines for Clinical Management and Control of Transmission PPH 42160, University of Wsconsin, October, 2005.  Back to cited text no. 2
    
3.
Salmenlinna S, Lyytikäinen O, Vuopio-Varkila J. Community-acquired methicillin-resistant Staphylococcus aureus, Finland. Emerg Infect Dis 2002;8:602-7.  Back to cited text no. 3
    
4.
Fridkin SK, Hageman JC, Morrison M, Sanza LT, Como-Sabetti K, Jernigan JA, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436-44.  Back to cited text no. 4
    
5.
Gerald L. Mandell, John E. Bennett, Raphael Dolin. Principles and Practice of Infectious Diseases. 7th ed. London: Churchill Livingstone; 2010.  Back to cited text no. 5
    
6.
Rolo J, Miragaia M, Turlej-Rogacka A, Empel J, Bouchami O, et al. High genetic diversity among community-associated staphylococcus aureus in Europe: Results from a multicenter study. PLoS One 2012;7:e34768.  Back to cited text no. 6
    
7.
Anderson DJ, Sexton DJ, Baron EL. Epidemiology of methicillin-resistant Staphylococcus aureus infection in adults-UptoDate version 19.3, 2011  Back to cited text no. 7
    
8.
Faria NA, Oliveira DC, Westh H, Monnet DL, Larsen AR, Skov R, et al. Epidemiology of emerging methicillin-resistant Staphylococcus aureus (MRSA) in Denmark: A nationwide study in a country with low prevalence of MRSA infection. J Clin Microbiol 2005;43:1836-42.  Back to cited text no. 8
    
9.
Erdenizmenli M, Yapar N, Senger SS, Ozdemir S, Yuce A. Investigation of colonization with methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population in Turkey. Jpn J Infect Dis 2004;57:172-5.  Back to cited text no. 9
    
10.
Samileh N, Siadati A, Mohammad F, Shahnaz R, Tabatabaei A. Methicillin resistant Staphylococcus aureus in children. Iran J Pediatr Soc 2007;1:24-30.  Back to cited text no. 10
    
11.
Sedighi I, Yousefi MR, Pak N, Seif MA. D-test method for detection of inducible clindamycin resistance in Staphylococcus aureus. Iran J Pediatr 2009;19:293-7.  Back to cited text no. 11
    
12.
Pathak A, Marothi Y, Iyer RV, Singh B, Sharma M, Eriksson B et al. Nasal carriage and antimicrobial susceptibility of Staphylococcus aureus in healthy preschool children in Ujjain, India. BMC Pediatr. 2010; 29:100.  Back to cited text no. 12
    
13.
Etok CA, Ochang EA, Inyang V, Onwuezobe IA, Asuquo EE. Antibiogram of nasal methicillin resistant Staphylococcus aureus (MRSA) from antenatal clinic attendees in a tertiary hospital, South-South Nigeria. IJAPA 2012;2:79-82.  Back to cited text no. 13
    
14.
Tiwari HK, Das AK, Sapkota D, Sivrajan K, Pahwa VK. Methicillin resistant Staphylococcus aureus: Prevalence and antibiogram in a tertiary care hospital in western Nepal. J Infect Dev Ctries 2009;3:681-4.  Back to cited text no. 14
    
15.
Kaplan SL. Clinical Implications of Community-acquired Methicillin-Resistant Staphylococcus aureus. Program and Abstracts of the Pediatrics Academic Societies Annual Meeting; May 14-17, 2005. Washington, DC: Course # 5102.  Back to cited text no. 15
    
16.
Sobhy N, Aly F, Abd El Kader O, Ghazal A, Elbaradei A. Community-acquired methicillin-resistant Staphylococcus aureus from skin and soft tissue infections (in a sample of Egyptian population): Analysis of mec gene and staphylococcal cassette chromosome. Braz J Infect Dis 2012;16:426-31.  Back to cited text no. 16
Advanced Biomedical Research
Volume 2016, May
May 2016
Pages 1-5