Colonization of HIV-Infected Children with Methicillin-Resistant Staphylococcus aureus

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) poses a public health threat owing to its extensive resistance to antibiotics, association with persistent outbreaks, and markedly increased healthcare costs. Moreover, HIV-infected individuals are at a greater risk for colonization with MRSA, and may act as reservoirs for subsequent transmission to other individuals. In Ghana, little is known about MRSA in relation to at-risk populations, such as HIV-infected children. The aim of this study was to investigate nasal carriage of S. aureus and MRSA among HIV-infected children in Accra, including the prevalence, risk factors and antibiotic resistance. Methodology: The study was cross-sectional, and involved 107 children with HIV infection and an equal number of sex- and age group- matched apparently healthy controls recruited from the Princess Marie Louis Children’s Hospital in Accra. Nasal swab specimens were collected from the study participants and cultured for bacteria. S. aureus isolates were confirmed by the coagulase test while MRSA was confirmed by PCR of the mecA gene. Antimicrobial susceptibility testing of S. aureus isolates was done by the Kirby Bauer method. A structured questionnaire was used to collect data on demographic, household and clinical features of the study participants. A logistic regression analysis was performed to identify determinants of S. aureus and MRSA carriage among participants of both study groups. Results: The carriage prevalence of S. aureus and MRSA were 44.9% (48) and 5.6% (6), respectively, among the HIV-infected individuals, and the corresponding values within the control group were 23.4% (25) and 0.9% (1). There was a significant association between HIV infection and S. aureus colonization (p < 0.001), but not MRSA colonization (p = 0.055). The main predictor of S. aureus colonization in both study groups was absence of colonization with coagulase negative staphylococcus (p < 0.001). Furthermore, the main predictor of MRSA colonization was regular hand washing with soap (p = 0.043); this was observed among HIV-infected individuals but not the control group. The proportion of S. aureus isolates that were multidrug resistant was 62.3% (33/53) in the HIV-infected group and 80% (20/25) in the control group (p = 0.192). Conclusions: HIV infection is a risk factor for nasal colonization of S. aureus among children in Accra but may not be for MRSA. Both the HIV-infected and uninfected children are reservoirs of multidrug resistant S. aureus. Demographic, household and clinical features appear to have little or no relationship with S. aureus and MRSA colonization in the study children.

Molecular epidemiology and mechanisms of antibiotic resistance inEnterococcusspp.,Staphylococcusspp., andStreptococcusspp. in Africa: a systematic review from a One Health perspective

“…Similar clinical studies detected drug‐resistant S. aureus ST15, ST152, ST5, ST45, ST707, ST121, ST72, ST6, and ST508. In an emergency ward environment, S. aureus ST15 and ST508, harboring blaZ ( n = 5) and dfrG ( n = 2), were detected …”

Nasopharyngeal Carriage and Antimicrobial Susceptibility Profile of Staphylococcus aureus among Children under Five Years in Accra

“…The human nasopharynx is colonized by a wide array of microorganisms, including Staphylococcus aureus , Moraxella catarrhalis , Haemophilus influenzae , and Streptococcus pneumoniae , of which S. aureus and S. pneumoniae seem the most clinically significant [ 2 , 3 , 4 , 5 , 6 , 7 , 12 , 13 , 14 ]. Attempts to control infections of the predominant nasopharyngeal colonizer, S. pneumoniae , via vaccination with PCVs have been met with concerns regarding potential disruption of the nasopharyngeal microbial homeostasis to favor S. aureus colonization [ 22 , 23 , 24 , 25 , 26 , 27 , 29 , 53 ].…”

“…S. aureus ATCC 25923 was taken as the positive control strain. Multidrug resistance (MDR) attribute determination was based on the resistance of an organism to three or more different classes of antimicrobials [ 13 ]. Isolates that were erythromycin-resistant and clindamycin-sensitive were confirmed for inducible resistance by use of the double disc-zone test (D-zone test).…”

“…Staphylococcus aureus , Moraxella catarrhalis , Haemophilus influenzae , and Streptococcus pneumoniae are examples of these organisms and have been reported to occasionally cause local and disseminated infections—such as pneumonia, bacteraemia, endocarditis, osteomyelitis, meningitis, and skin and soft tissue infections—as a sequel to colonization of these and other anatomical sites [ 2 , 3 ]. Of these commensals, S. aureus and S. pneumoniae (also called pneumococcus) are the most clinically significant, given their high capacity to cause invasive diseases [ 4 , 5 , 6 , 7 ] concurrent with their predisposition to developing multidrug resistance [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. However, of the two, S. pneumoniae is the predominant nasopharyngeal colonizer, and it frequently colonizes children below the age of five; this probably accounts for the high rates of its invasive infections in this population relative to adults [ 15 , 16 ].…”

Methicillin-Resistant Staphylococcus aureus in the Oral Cavity: Implications for Antibiotic Prophylaxis and Surveillance

“… 59 , 60 The rates at which penicillin resistance was reported in S. aureus has risen exponentially over the years to up to 100%. 61 - 64 The molecular basis of this penicillin resistance attribute is known to be the organism’s production of the heterogeneously expressed enzyme, the beta lactamase, which hydrolyzes the beta lactam ring of penicillin. 60 , 65 , 66 The emergence and spread of S. aureus strains with this attribute necessitated the inception of methicillin usage in 1959, with the purpose of treating infections of penicillin-resistant S. aureus .…”