ArticlePDF Available

Nasal Carriage Rates of Staphylococcus aureus and CA-Methicillin Resistant Staphylococcus aureus among University Students

Authors:
Mahde Assafi at University of Duhok
Mahde Assafi
Reem Qasim Mohammed at University of Zakho
Reem Qasim Mohammed
Nawfal Hussein at University of Zakho
Nawfal Hussein
Download full-text PDF
Read full-text
Download citation

Abstract and Figures

The treatment of methicillin resistant Staphylococcus aureus (MRSA) infection is challenging because of their high resistance to different antibiotics. The objectives of this study were to determine the prevalence of S.aureus and MRSA nasal carriers among healthy students in Zakho University and to study their resistance pattern to vancomycin. During December 2013 to July 2014, a total of 405 nasal swabs were collected from healthy students and screened for S. aureus. The microorganisms were identified based on morphology and biochemical tests. Then, antibiotic susceptibility to methicillin and vancomycin was determined. The nasal carriage rate of S.aureus and MRSA among participated students were 17.5% (71/405) and 4.2% (17/405), respectively. The highest nasal carriage rate of S.aureus was found in third year students (24.7%, p =0.04). The nasal carriage rate of S.aureus was more common in males than females (20.6% and 14.8%, respectively, p = 0.14). However, the nasal carriage rate of MRSA was more common in females than males (5% and 3% respectively, p = 0.45). All isolates were sensitive to vancomycin.S.aureus and MRSA nasal carriage rates observed amongst university students were comparable to other studies. The transmission of S.aureus and MRSA colonization, infection, and treatment should be explained to the students in order to prevent the spread and control their infections.
Figures - uploaded by Mahde Assafi
Author content
All figure content in this area was uploaded by Mahde Assafi
Content may be subject to copyright.
Content uploaded by Mahde Assafi
Author content
All content in this area was uploaded by Mahde Assafi on Aug 15, 2015
Content may be subject to copyright.
Journal of Microbiology Research 2015, 5(4): 123-127
DOI: 10.5923/j.microbiology.20150504.01
Nasal Carriage Rates of Staphylococcus aureus
and CA-Methicillin Resistant Staphylococcus aureus
among University Students
Mahde S. Assafi1,*, Reem Qasim Mohammed1, Nawfal R. Hussein2
1Department of Biology, Faculty of Sciences, University of Zakho, Zakho, Kurdistan region, Iraq
2Department of Internal Medicine, School of Medicine Faculty of Medical Sciences, University of Duhok, Duhok, Kurdistan region, Iraq
Abstract The treatment of methicillin resistant Staphylococcus aureus (MRSA) infection is challenging because of their
high resistance to different antibiotics. The objectives of this study were to determine the prevalence of S. aureus and MRSA
nasal carriers among healthy students in Zakho University and to study their resistance pattern to vancomycin. During
December 2013 to July 2014, a total of 405 nasal swabs were collected from healthy students and screened for S. aureus. The
microorganisms were identified based on morphology and biochemical tests. Then, antibiotic susceptibility to methicillin and
vancomycin was determined. The nasal carriage rate of S. aureus and MRSA among participated students were 17.5%
(71/405) and 4.2% (17/405), respectively. The highest nasal carriage rate of S. aureus was found in third year students (24.7%,
p =0.04). The nasal carriage rate of S. aureus was more common in males than females (20.6% and 14.8%, respectively,
p = 0.14). However, the nasal carriage rate of MRSA was more common in females than males (5% and 3% respectively,
p = 0.45). All isolates were sensitive to vancomycin. S. aureus and MRSA nasal carriage rates observed amongst university
students were comparable to other studies. The transmission of S. aureus and MRSA colonization, infection, and treatment
should be explained to the students in order to prevent the spread and control their infections.
Keywords Nasal carriage, S. aureus, MRSA, Iraq
1. Introduction
Staphylococcus aureus is one of the most successful and
adaptable human pathogens and responsible for difficult
infections [1]. Overuse and misuse of antibiotics have led to
increased levels of antibiotics-resistance. Methicillin was
invented for the treatmentof pencillin-resistnat S. aureus [1].
However, methicillin-resistant S. aureus (MRSA) emerged
and at the beginning such strains were a challenge in
hospitals and health care units. Then, MRSA turned into the
public-health problem affecting healthy individuals and has
become the most frequent cause of skin and soft-tissue
infections in the community [2-4]. As a result and to
discriminate between community and healthcare facility
strains, community-associated MRSA (CA-MRSA) and
health care-associated MRSA (HA-MRSA) have been used.
Several studies have examined the prevalence of MRSA
nasal carriage among health workers, outpatient settings,
injection drug users and medical students [5-8]. Also,
researchers have investigated the CA-MRSA carriage rates
* Corresponding author:
mahdy.assafi@yahoo.co.uk (Mahde S. Assafi)
Published online at http://journal.sapub.org/microbiology
Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved
in a general population [9, 10]. The aims of this paper were
to study the prevalence of S. aureus and MRSA in the
anterior nares of healthy students and to study their
susceptibility to vancomycin at Zakho university, Kurdistan
region, Iraq.
2. Materials and Methods
Setting and sample collection
A cross-sectional study was conducted in University of
Zakho, Zakho city, Kurdistan region-Iraq. The study was
conducted with the approval of ethics committee in the
University of Zakho. A total of 432 students aged 19 to 25
years were participated in this study from December 2013 to
July 2014. Nasal swabs (moistened with sterile distilled
water) were taken from anterior nares of the participants. The
swab was inserted about 2 cm into the naris and directly
transported for specimen processing.
Laboratory analysis of S. aureus and MRSA isolates
Nasal swabs were screened for S. aureus and MRSA.
Samples were directly cultured on Mannitol Salt Agar
(Oxoid) and incubated at 35ºC for 24 hours. Positive
colonies on mannitol salt agar were identified as S. aureus
strains based on morphology, Gram stain and biochemical
124 Mahde S. Assafi et al.: Nasal Carriage Rates of Staphylococcus aureus and CA-Methicillin
Resistant Staphylococcus aureus among University Students
tests including catalase and coagulase.
The bacterial suspension was adjusted to the concentration
of 0.5 McFarland and then 10μl inoculum was spread on the
agar plate (final concentration = 106 CFU/ml). Antimicrobial
susceptibility testing to oxacillin was carried out according
to Clinical Laboratory Standards Institute (CLSI)
recommendations using Kirby-Bauer disk diffusion and agar
dilution assay methods using Muller-Hinton agar (Oxoid
Limited, Hampshire, England). BHI agar plates
supplemented with 6 μg/ml vancomycin were used for
testing of strains for vancomycin resistance [11].
Data analysis
Statistical analysis of data was performed by using the
chi-squared test with significance set at a p value of <0.05
using Minitab 15 software (Minitab Ltd., Coventry, UK).
3. Results
Because hospitalization and admission to healthcare
facilities increase the risk of MRSA colonization, we
excluded every student with history of hospitalization,
surgery, dialysis or residence in a long-term care facility
within one year of the MRSA culture date, the presence of an
indwelling catheter or a percutaneous device at the time of
culture and history of previous isolation of MRSA. A total of
432 participants volunteered in this study, 27 students
(6.25%) were excluded because of the above mentioned
factors. The included students (405) were examined for
presence of S. aureus and MRSA. The male and female
participants were 47% (189/405) and 53% (216/405)
respectively. A total of 71 S. aureus and 17 MRSA were
isolated from 405 participants, giving an overall positivity
rate of 17.5% and 4.2%, respectively (Table 1). With regard
to the year of study, prevalence of S. aureus rate was higher
in the 3rd stage students 24.7% (24/97) than students in other
stages (p=0.045) (Table 1).
Table 1. Distribution of S. aureus and MRSA nasal carriage among
students
Year of
study Participants S. aureus
positive (%)
MRSA
positive (%)
1st 104 16 (15.4) 5 (4.8)
2nd 101 13 (12.8) 3 (3)
3rd 97 24 (24.7)* 5 (5.2)
4th 103 18 (17.5) 4 (3.9)
Total 405 71 (17.5) 17 (4.2)
* p value = 0.045
Among the 189 males screened, 39 (20.6%) and 6 (3%)
were positive for S. aureus and MRSA respectively,
compared to 32 (14.8%) and 11 (5%) of the 216 females.
However, there were no significant differences of the
prevalence of S. aureus and MRSA among students as regard
to their gender (p > 0.05) (Table 2). Fortunately, all isolates
were sensitive to vancomycin antibiotics.
Table 2. Distribution of S. aureus and MRSA nasal carriage the different
genders
Year of
study
Participants S. aureus
MRSA
M*
F*
M (%)
F (%)
M (%)
F (%)
1st 48
56
7 (14.6)
9 (16)
2 (4.2)
3 (5.3)
2nd 39
62
6 (15.4)
7 (11.3)
1 (2.6)
2 (3.2)
3rd 51
46
15 (29.4)
9 (19.6)
2 (4)
3 (6.5)
4th 51
52
11 (21.6)
7 (13.5)
1 (2)
3 (5.8)
Total 189
216
39 (20.6)
32 (14.8)
6 (3)
11 (5)
*M refers to males and F refers to females.
4. Discussion
S. aureus is a normal commensal in the nose of about
25-30% of healthy people [12]. Different factors contribute
to the transmission of this microorganism such as crowded
living conditions, and poor hygiene [13, 14]. The presence of
S. aureus on the skin appears to play a key role in the
pathogenesis of infection with S. aureus [15, 16].
Eradication of S. aureus from the nose reduced the incidence
of invasive infection [16, 17]. In this study, the prevalence of
S. aureus nasal carriage among students was 17.5%. This
result is comparable with other studies from Iraq, Iran and
Turkey [9, 18-20] and is lower than those reported in Nigeria,
Ethiopia and India [21-25]. S. aureus nasal carriage rate was
significantly higher among third year students. Outbreaks
have been reported among different groups such as athletes,
military recruits, prisons detainees, livestock handlers, pet
owners, intravenous drug users, students [14, 26, 27]. There
are different factors contributing to spread of S. aureus and
MRSA including crowded living conditions, poor hygiene
habits, close skin-to-skin contact, sharing of personal items,
frequent antibiotic exposure, hospitalization and intravenous
drug abuse [28]. It was found that the carriage rate of S.
aureus was higher on participants who had been hospitalized
within the past 1 year than those who had not [7]. One factor
that could assist to distribute S. aureus among third year
students is that the colonization of these bacteria among
household members is shown to be higher than rates reported
among the general population [4]. Member of this group of
students may live in shared houses or accommodate internal
departments of the university. More study is needed to
explore this result.
MRSA was identified as a nosocomial pathogen which is
one of the causative agents of healthcare associated
infections worldwide. MRSA has traditionally considered as
Journal of Microbiology Research 2015, 5(4): 123-127 125
associated with healthcare settings. However, new strains
have emerged in the community and an increasing numbers
were observed in people who have not been hospitalized or
had a medical procedure [29, 30]. Different studies showed
variable rate (0.8 - 36%) of MRSA nasal colonization
[7, 31-34]. In our region, the nasal carriage rate of MRSA
was 4.2%. Combination of factors could contribute to the
nasal carriage of S. aureus and MRSA among population
including host, geographical, environmental and bacterial
factors.
Epidemiological evidence supports that the mechanism
for transmission S. aureus and MRSA usually via direct
contact with patients and other close contacts [35]. In our
study, male students had a highest prevalence of S. aureus
nasal carriage. This is in agreement with other studies that
found that S. aureus nasal carriage rate is higher in males
than females [7, 36, 37]. In agreement with other study, it
was found that the prevalence of MRSA was more common
in females than males [38, 39]. A similar result was abstained
by Braga et al. [28] who showed that the prevalence of S.
aureus are more common in males and MRSA are more
prevalence in females. It is observed that females harbour a
greater diversity of bacteria on their hands than males, but it
is not obvious whether this is due to physiological factors or
differences in hygiene and cosmetic usage [40]. Furthermore,
the microbial differences between male and female could be
due to the physiological and anatomical differences between
genders cutaneous environments such as sweat, sebum and
hormone production [41].
Vancomycin is considered one of the last options of
treatment for S. aureus infections that are resistant to other
antibiotics. Analysis of different studies revealed the
emergence of Vancomycin-Resistant Staphylococcus aureus
(VRSA) from different parts of the neighboring countries
[42-45]. Fortunately, no vancomycin-resistant S. aureus
(VRSA) isolates was found in this study.
In conclusion, the nasal carriage rate of S. aureus and
MRSA observed in this study was relatively low and
comparable to other studies in surrounding area. No
vancomycin-resistant S. aureus was observed in our study.
The implications of S. aureus and MRSA colonization,
infection, and treatment should be explained to the students
in order to prevent the spread and control their infections.
REFERENCES
[1] Gerard JT, Berdell RF, and Christine LC. Microbiology: An
Introduction with MasteringMicrobiology. 10th ed San
Francisco: Pearson Benjamin Cummings 2010.
[2] Yan M, Pamp SJ, Fukuyama J, Hwang PH, Cho DY, Holmes
S, and Relman DA. Nasal microenvironments and
interspecific interactions influence nasal microbiota
complexity and S. aureus carriage. Cell Host Microbe 2013;
14:631-40. doi:10.1016/j.chom.2013.11.005.
[3] Zetola N, Francis JS, Nuermberger EL, and Bishai WR.
Community-acquired meticillin-resistant Staphylococcus
aureus: an emerging threat. Lancet Infect Dis 2005; 5:275-86.
doi:10.1016/S1473-3099(05)70112-2.
[4] Zafar U, Johnson LB, Hanna M, Riederer K, Sharma M,
Fakih MG, Thirumoorthi MC, Farjo R, and Khatib R.
Prevalence of nasal colonization among patients with
community-associated methicillin-resistant Staphylococcus
aureus infection and their household contacts. Infect Control
Hosp Epidemiol 2007; 28:966-9. doi:10.1086/518965.
[5] Lari AR, Pourmand MR, Ohadian MS, Abdossamadi Z,
Namvar AE, and Asghari B. Prevalence of PVL-Containing
MRSA Isolates Among Hospital Staff Nasal Carriers. Lab
Medicine 2011; 42:283-286. doi:10.1309/lman7hr6vjea3nmr.
[6] Amorim ML, Vasconcelos C, Oliveira DC, Azevedo A,
Calado E, Faria NA, Pereira M, Castro AP, Moreira A, Aires
E, et al. Epidemiology of methicillin-resistant Staphylococcus
aureus (MRSA) nasal colonization among patients and
healthcare workers in a Portuguese hospital: a
pre-intervention study toward the control of MRSA. Microb
Drug Resist 2009; 15:19 - 26.
[7] Chen CS, Chen CY, and Huang YC. Nasal carriage rate and
molecular epidemiology of methicillin-resistant
Staphylococcus aureus among medical students at a
Taiwanese university. International Journal of Infectious
Diseases 2012; 16:799-803. doi:10.1016/j.ijid.2012.07.004.
[8] Kaminski A, Kammler J, Wick M, Muhr G, and Kutscha LF.
Transmission of methicillin-resistant Staphylococcus aureus
among hospital staff in a German trauma centre: a problem
without a current solution? J Bone Joint Surg Br 2007; 89:642
- 645.
[9] Habeeb A, Hussein NR, Assafi MS, and Al-Dabbagh SA.
Methicillin resistant Staphylococcus aureus nasal
colonization among secondary school students at Duhok
City-Iraq. J Microbiol Infect Dis 2014; 4:59-63.
doi:10.5799/ahinjs.02.2014.02.0128.
[10] Lindenmayer JM, Schoenfeld S, O'Grady R, and Carney JK.
Methicillin-resistant Staphylococcus aureus in a high school
wrestling team and the surrounding community. Arch Intern
Med 1998; 158:895-9. doi:10.1001/archinte.158.8.895.
[11] CLSI. Clinical and Laboratory Standards Institute. Methods
for Broth Dilution Susceptibility Testing of Bacteria Isolated
from Aquatic Animals, Approved Guideline. Document
M49-A CLSI, Wayne, Pennsylvania 19087-1898, USA.
2006b;.
[12] CDC. Centers for Disease Control and Prevention. Workplace
Safety & Health Topics. MRSA and the Workplace. Last
updated September 19, 2014, Accessed 11 April 2015., 2014;.
[13] Shibabaw A, Abebe T, and Mihret A. Nasal carriage rate of
methicillin resistant Staphylococcus aureus among Dessie
Referral Hospital Health Care Workers; Dessie, Northeast
Ethiopia. Antimicrob Resist Infect Control 2013; 2:25.
doi:10.1186/2047-2994-2-25.
[14] David MZ and Daum RS. Community-associated
methicillin-resistant Staphylococcus aureus: epidemiology
and clinical consequences of an emerging epidemic. Clin
Microbiol Rev 2010; 23:616-87. doi:10.1128/CMR.00081-09
126 Mahde S. Assafi et al.: Nasal Carriage Rates of Staphylococcus aureus and CA-Methicillin
Resistant Staphylococcus aureus among University Students
[15] Casewell MW and Hill RL. Elimination of nasal carriage of
Staphylococcus aureus with mupirocin ('pseudomonic acid') a
controlled trial. J Antimicrob Chemother 1986; 17:365-72.
doi:10.1093/jac/17.3.365.
[16] Wertheim HFL, Melles DC, Vos MC, van Leeuwen W, van
Belkum A, Verbrugh HA, and Nouwen JL. The role of nasal
carriage in Staphylococcus aureus infections. The Lancet
Infectious Diseases 2005; 5:751-762.doi:10.1016/s1473-309
9(05)70295-4.
[17] von Eiff C, Becker K, Machka K, Stammer H, and Peters G.
Nasal Carriage as a Source of Staphylococcus aureus
Bacteremia. New England Journal of Medicine 2001;
344:11-16. doi:10.1056/NEJM200101043440102.
[18] Shehabi AA, Abu-Yousef R, Badran E, Al-Bakri AG,
Abu-Qatouseh LF, and Becker K. Major characteristics of
Staphylococcus aureus colonizing Jordanian infants. Pediatr
Int 2013; 55:300-4. doi:10.1111/ped.12060.
[19] Oguzkaya-Artan M, Baykan Z, and Artan C. Nasal carriage of
Staphylococcus aureus in healthy preschool children. Jpn J
Infect Dis 2008; 61:70-2.
[20] Hussein NR, Basharat Z, Muhammed AH, and Al-Dabbagh
SA. Comparative evaluation of MRSA nasal colonization
epidemiology in the urban and rural secondary school
community of kurdistan, iraq. PLoS One 2015; 10:e0124920.
doi:10.1371/journal.pone.0124920.
[21] Onanuga A and Temedie TC. Nasal carriage of multi-drug
resistant Staphylococcus aureus in healthy inhabitants of
Amassoma in Niger delta region of Nigeria. Afr Health Sci
2011; 11:176-81.
[22] Erami M, Soltani B, Taghavi Ardakani A, Moravveji A, Haji
Rezaei M, Soltani S, and Moniri R. Nasal Carriage and
Resistance Pattern of Multidrug Resistant Staphylococcus
aureus Among Healthy Children in Kashan, Iran. Iran Red
Crescent Med J 2014; 16:e21346. doi:10.5812/ircmj.21346.
[23] Motamedifar M, Hassanzadeh P, and Ghafari N. Relative
frequency of Staphylococcal carriage and antibiotic
sensitivity of isolated Staphylococci in hemodialysis patients
in Shiraz, Iran. Med Princ Pract 2010; 19:379-83.
doi:10.1159/000316377.
[24] Chatterjee SS, Ray P, Aggarwal A, Das A, and Sharma M. A
community-based study on nasal carriage of Staphylococcus
aureus. Indian J Med Res 2009; 130:742-8.
[25] Shibabaw A, Abebe T, and Mihret A. Nasal carriage rate of
methicillin resistant Staphylococcus aureus among Dessie
Referral Hospital Health Care Workers; Dessie, Northeast
Ethiopia. Antimicrobial Resistance and Infection Control
2013; 2:doi:10.1186/2047-2994-2-25.
[26] Lowy FD, Aiello AE, Bhat M, Johnson-Lawrence VD, Lee
MH, Burrell E, Wright LN, Vasquez G, and Larson EL.
Staphylococcus aureus colonization and infection in New
York State prisons. J Infect Dis 2007; 196:911-8.
doi:10.1086/520933.
[27] Zinderman CE, Conner B, Malakooti MA, LaMar JE,
Armstrong A, and Bohnker BK. Community-acquired
methicillin-resistant Staphylococcus aureus among military
recruits. Emerg Infect Dis 2004; 10:941-4.
doi:10.3201/eid1005.030604.
[28] Braga ED, Aguiar-Alves F, de Freitas Mde F, de e Silva MO,
Correa TV, Snyder RE, de Araujo VA, Marlow MA, Riley
LW, Setubal S, 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. doi:10.1186/1471-2334-14-5381471-2334-14
-538 [pii].
[29] Naimi TS, LeDell KH, Como-Sabetti K, and et al.
Comparison of community- and health care–associated
methicillin-resistant Staphylococcus aureus infection. JAMA
2003; 290:2976-2984. doi:10.1001/jama.290.22.2976.
[30] David MZ, Cadilla A, Boyle-Vavra S, and Daum RS.
Replacement of HA-MRSA by CA-MRSA infections at an
academic medical center in the midwestern United States,
2004-5 to 2008. PLoS One 2014; 9:92760.
doi:10.1371/journal.pone.0092760.
[31] Fatholahzadeh B, Emaneini M, Gilbert G, Udo E, Aligholi M,
Modarressi MH, Nouri K, Sedaghat H, and Feizabadi MM.
Staphylococcal cassette chromosome mec (SCCmec) analysis
and antimicrobial susceptibility patterns of
methicillin-resistant Staphylococcus aureus (MRSA) isolates
in Tehran, Iran. Microb Drug Resist 2008; 14:217-20.
doi:10.1089/mdr.2008.0822.
[32] Kuehnert MJ, Kruszon-Moran D, Hill HA, McQuillan G,
McAllister SK, Fosheim G, McDougal LK, Chaitram J,
Jensen B, Fridkin SK, et al. Prevalence of Staphylococcus
aureus nasal colonization in the United States, 2001-2002. J
Infect Dis 2006; 193:172-9. doi:10.1086/499632.
[33] Akhtar N. Staphylococcal nasal carriage of health care
workers. J Coll Physicians Surg Pak 2010; 20:439-43.
doi:07.2010/JCPSP.439443.
[34] Fritz SA, Garbutt J, Elward A, Shannon W, and Storch GA.
Prevalence of and risk factors for community-acquired
methicillin-resistant and methicillin-sensitive Staphylococcus
aureus colonization in children seen in a practice-based
research network. Pediatrics 2008; 121:1090-8.
doi:10.1542/peds.2007-2104.
[35] Skov R, Christiansen K, Dancer SJ, Daum RS, Dryden M,
Huang YC, and Lowy FD. Update on the prevention and
control of community-acquired meticillin-resistant
Staphylococcus aureus (CA-MRSA). Int J Antimicrob Agents
2012; 39:193-200. doi:10.1016/j.ijantimicag.2011.09.029.
[36] Olsen K, Sangvik M, Simonsen GS, Sollid JU, Sundsfjord A,
Thune I, and Furberg AS. Prevalence and population structure
of Staphylococcus aureus nasal carriage in healthcare
workers in a general population. The Tromso Staph and Skin
Study. Epidemiol Infect 2013; 141: 143-52.
doi:10.1017/S0950268812000465.
[37] Sangvik M, Olsen RS, Olsen K, Simonsen GS, Furberg AS,
and Sollid JU. Age- and gender-associated Staphylococcus
aureus spa types found among nasal carriers in a general
population: the Tromso Staph and Skin Study. J Clin
Microbiol 2011; 49:4213-8. doi:10.1128/JCM.05290-11.
[38] Shakya B, Shrestha S, and Mitra T. Nasal carriage rate of
methicillin resistant Staphylococcus aureus among at
National Medical College Teaching Hospital, Birgunj, Nepal.
Nepal Med Coll J 2010; 12:26-9.
Journal of Microbiology Research 2015, 5(4): 123-127 127
[39] Mainous AG, 3rd, Hueston WJ, Everett CJ, and Diaz VA.
Nasal carriage of Staphylococcus aureus and
methicillin-resistant S. aureus in the United States,
2001-2002. Ann Fam Med 2006; 4:132-7.
doi:10.1370/afm.526.
[40] Fierer N, Hamady M, Lauber CL, and Knight R. The
influence of sex, handedness, and washing on the diversity of
hand surface bacteria. Proc Natl Acad Sci U S A 2008;
105:17994-9. doi:10.1073/pnas.0807920105.
[41] Giacomoni PU, Mammone T, and Teri M. Gender-linked
differences in human skin. J Dermatol Sci 2009; 55:144-9.
doi:10.1016/j.jdermsci.2009.06.001.
[42] Zarifian AR, Askari E, Pourmand MR, and Nasab MN.
High-Level Vancomycin-Resistant Staphylococcus aureus
(VRSA) in Iran: A Systematic Review. Journal of Medical
Bacteriology 2012; 1:53-61.
[43] Tiwari HK and Sen MR. Emergence of vancomycin resistant
Staphylococcus aureus (VRSA) from a tertiary care hospital
from northern part of India. BMC Infect Dis 2006; 6:156.
doi:10.1186/1471-2334-6-156.
[44] Cesur S, Irmak H, Simsek H, Coplu N, Kilic H, Arslan U,
Bayramoglu G, Baysan BO, Gulay Z, Hosoglu S, et al.
Evaluation of antibiotic susceptibilities and VISA-VRSA
rates among MRSA strains isolated from hospitalized patients
in intensive care units of hospitals in seven provinces of
Turkey. Mikrobiyol Bul 2012; 46:352-8.
[45] Alzolibani AA, Al Robaee AA, Al Shobaili HA, Bilal JA, Issa
Ahmad M, and Bin Saif G. Documentation of
vancomycin-resistant Staphylococcus aureus (VRSA) among
children with atopic dermatitis in the Qassim region, Saudi
Arabia. Acta Dermatovenerol Alp Pannonica Adriat 2012;
21:51-3. doi:10.2478/v10162-012-0015-2.
... Antibiotic-resistant bacteria are an increasing problem worldwide, contributing to longer hospital stays, higher medical costs, and higher rates of morbidity and mortality among patients (24). MRSA strains spread quickly in vulnerable hospitalized (exposed) and healthy non-exposed individuals, profoundly changing the current therapeutic options for the prevention and treatment of staphylococcal infections (22,25). ...
... This is corroborated by a study conducted in Ethiopia (12%) (17), the Democratic Republic of Congo (16.6%) (29), and Nepal (15%) (30). But lower than a report in Ethiopia (22.1%) (22), Tanzania (21%) (21), Nigeria (51.9%) (31), India (29.7%) (6), Taiwan (24.7%) (32), Iran (19.6%) (33), Iraq (17.5%) (25), Thailand (29.7%) (34), Malaysia (31%) (35). In this study, the total prevalence of MRSA was 5.9% (95% CI: 3.09-8.7). ...
... The incidence of MRSA nasal carriage was greater in female students than in male students in our study, but the difference was not statistically significant (p = 0.758). This is following an earlier study among clinical samples of S. aureus in Ethiopia (17) and other findings conducted by healthy students in Iraq (25) and Afghanistan (2), which shows that gender was not found to be a risk factor for MRSA infection. Additionally, nasal carriage of MRSA was studied in two age groups: 18-22 years and 23-27 years. ...
Nasal carriage rate, associated factors, and antimicrobial susceptibility patterns of methicillin resistance Staphylococcus aureus among pre-clinical undergraduate students at the College of Health and Medical Sciences, Haramaya University, Ethiopia
Article
Full-text available
  • May 2024
Background Staphylococcus aureus nasal carriage has been linked to higher rates of infection and morbidity. People with Methicillin-resistant Staphylococcus aureus can be a potential source of infection for others. University students living together in crowded conditions increase their risk of acquiring infections. The prevalence of S. aureus, particularly Methicillin-resistant Staphylococcus aureus nasal carriage, in Ethiopian university students is sparse. Objective This study aimed to determine the nasal carriage rate, associated factors, and antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus among pre-clinical students at the College of Health and Medical Sciences, Haramaya University, Ethiopia, from 1 July to 30 August 2022. Methods An institutional-based cross-sectional study was conducted among 270 randomly selected pre-clinical Health and Medical Sciences students. Data on associated factors were collected using pre-tested, structured questionnaires. A nasal swab was taken from each participant and sent to the microbiology laboratory via Amies transport media in a cold chain. There, it was cultivated using conventional techniques. The isolated colonies were found to be S. aureus, and its antimicrobial susceptibility was performed using the Kirby–Bauer disk diffusion method on Muller–Hinton agar. Methicillin-resistant Staphylococcus aureus expressing using cefoxitin based on CLSI breakpoint. Data were entered into Epi-Data version 4.4.2.1 and exported to the Statistical Package for Social Sciences (SPSS) software version 25 for analysis. Pearson’s chi-square test was performed to predict the associations between variables. A p-value less than 0.05 was regarded as statistically significant. Result Methicillin-resistant Staphylococcus aureus nasal carriage was 5.9% (95% CI: 3.09–8.7) of cases of S. aureus nasal colonization, which was found to be 12.96% (95% CI: 8.85–16.96). Methicillin-resistant Staphylococcus aureus nasal colonization was significantly associated with the history of cigarette smoking (p = 0.000), intake of khat (p = 0.042), nose-picking habit (p = 0.003), history of sharing personal goods (p = 0.021), and history of hospitalizations (p = 0.00). All of the Methicillin-resistant Staphylococcus aureus isolates were resistant to ampicillin and cefoxitin. Conclusion Based on the findings, a considerable proportion of healthy students harbored Methicillin-resistant Staphylococcus aureus strains associated with behavioral factors. Furthermore, these isolates showed high resistance to cefoxitin and ampicillin. Hence, it is crucial to regularly test pre-clinical students to prevent endogenous infections and the spread of Methicillin-resistant Staphylococcus aureus.
View
... These data can be alarming due to apparently healthy medical students could also pose a risk for the frequent and direct transmission and contact with patients. Multiple causes could play role of the nasal carriage of MRSA in certain community setting notably host status, geographical area, environmental and bacterial virulence factors (Assafi et al., 2015;Rampal et al., 2020). ...
... In a Hungarian study by Laub et al., (2011) on university non-medical students, MRSA colonization was very less as (0.7%). Assafi et al., (2015) in Iraq stated that (4.2 %) MRSA colonization was among healthy collegiate nonmedical students. Mentioned results is back to clear indication that medical students who are rottenly in contact with hospitals can acquire the MRSA pathogen during their hospital works hours inversely, students who are not exposed to clinical works are less contact with the pathogens and are at low risk of nasal colonization. ...
... fourth year students 3/27(11.1%). Dissimilar to Assafi et al., (2015) in Iraq reported highest nasal carriage 24.7% was in third year students. Also in study at Belgrade University, no MRSA carriers were detected in medical students of first and second year study, only 0.3 % in third and fourth year students (Cirkovic et al., 2013). ...
Nasal Carriage of Methicillin-resistant Staphylococcus Aureus) Mrsa) among Medical And Non-medical Students of Sheikhan-polytechnique College And Technical Institute, Iraq
Article
Full-text available
  • Nov 2022
Background and Aims In population, Staphylococcus aureus is present in the nasal vestibule of 35%-50% and one tenth of these are methicillin resistant S aureus (MRSA). This study aimed to investigates the prevalence of MRSA nasal carriage among students of Sheikhan-Polytechnique College (Public health and Medical laboratory technology Department) and Technical Institute (TI). Methods: During December 2018 to February 2019 data collection has been achieved. About 150 students are screened, 66 were males and 84 females with age ranged (18-24 years). A cross-sectional study was conducted and 150 nasal swabs were taken from students groups of several grades in various departments (Public Health, Medical laboratory technology and IT department). The samples were examined through standard microbiological methods. Antibiotic susceptibility tests for all isolates were checked for methicillin resistance using disk diffusion agar. Molecular characterization using PCR test targeting mecA gene was studied. Results: The overall prevalence of MRSA was 27(18%), (12 males and 15 females). High prevalence found among public health students 12/27(44.4%) followed by information technology 9/27(33.3%) and less 6/27(22.2) cases in laboratory technology students. Students of first grade followed by second grade of various departments recorded high rates than third and fourth grade (12, 9, 3 and 3, respectively). Moreover, MRSA was higher among those students that live within their family 19/27(70.3%) than those that live in hostels 8/27(29.6%) and negative in those that live with family relatives. Out of 28 MRSA isolate 14(51.8%) were positive for mecA gene and public health students accounted more carriage 8/14 (57.1%). Conclusions: This study highlighted that students of several grades of medical study are more carriers and should admit enough information concerning control measures to limit contaminate with this pathogen
View
... [17] In another study in Nepal ,prevalence of MRSA nasal carriage was 4.6 % among HCWs [3]. Other studies in Nepal have demonstrated 20.37 -43.8 % nasal carriage rate of S.aurues among HCWs [18][19][20][21] and agreed with study in Iraq in which the prevalence of MRSA was 4.2% [22]. In contrast ,some studies didn't agree with the present study , in Jordan ,rate of nasal MRSA was 10.1% among HCWs [23], 73% among healthcare workers from Saudi Arabia [24]. in Northern China (16.5%), of which 0.3% were MRSA and in adults in community settings in Taiwan (22.1%) [25,26]. ...
... Distribution of Nasal carriage S.aureus and MRSA among HCWsAccording to the age(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) and (51-60) age group were demonstrated the higher rate of S.aureusTable8 : Prevalence of Nasal carriage S.aureus and MRSA isolates according to their ageTable9 : Prevalence of Nasal carriage S.aureus and MRSA isolates according to their sexIn the present study, also 50 clinical samples were collected by which 25 samples were from burn patients and 25 samples from surgery wound patients : the higher rate of S.aureus and MRSA isolates ...
Bacteriological and Molecular Detection of Staphylococcus Aureus and its Resistance to Methicillin among Specimens from Kirkuk Community
Article
Full-text available
  • Jan 2021
Background: The nasal cavity is the main colonization site of Staphylococcus aureus (S. aureus) in human body. Nasal carriage may be a strong risk factor for some serious infection. Methods: One thousand anterior nasal swabs were collected,700 from healthy adult individuals in Kirkuk university which include 100 swabs from science staff , 300 from science students , 150 swabs from medical and 150 swabs from nursing students and 300 from health care workers with other 50 clinical samples from burn and surgery wound patients in Azadi teaching hospital in Kirkuk city\Iraq the samples were collected by cotton swabs and diagnosed by standard tests in addition to molecular diagnosis and mecA gene detection for the isolates. Results : 159 (22.7)% of isolates from community students and 91 (30.3)% from HCWs were recorded as S.aureus and 3(1.9%) with 4(4.4%) were identified as CA-MRSA and HA-MRSA respectively depending on the standard tests of S.aureus identification, According to the age (18-28) and (51-60) age group were demonstrated the higher rate of S.aureus and MRSA carriage 181 (72.4) and 3 (1.2) respectively. According to sex the male 131 (52.4) and 3 (1.2) were recorded the higher range of S.aureus and MRSA carriage respectively. Also 50 clinical samples were collected by which 25 samples were from burn patients and 25 samples from surgery wound patients : the higher rate of S.aureus and MRSA isolates were from burn patients 13 (54.2)% and 11 (45.8)% respectively.all S.aureus and MRSA isolates were demonstrated high resistant towards beta-lactam antibiotics except oxacillin because in present study 10mg of oxacillin was used, while the isolates were recorded low resistant towards non beta-lactam antibiotics and all of them were sensitive towards ciprofloxacin and vancomycin. All the isolates (n = 20) molecularly diagnosed as S.aureus, also all of them expressed specific sequence gene of mecA gene that confirmed all the isolates were MRSA Conclusions: The continuous monitoring of nasal S.aureus is needed to control MRSA-related infections
View
... In the current study CA-MRSA and HA-MRSA were detected in 25.32% and 12.87 % of isolates. Variable rates of MRSA were reported in this Province, with a very low rate (4.2%) among university students (Assafi et al., 2015). While a higher rate (50.4%) of MRSA was reported among healthcare workers in Duhok (Hussein et al., 2019). ...
... The degree of influence of some factors in increasing the rate of MRSA carriage was studied such as gender, in which males significantly showed a higher rate of CA-MRSA 38.46% than females. This might be due to several reasons, including levels of vitamin D, elevated smoking habits, sharing shaving tools, sports clothing, and poor practice of hands hygiene (Assafi et al., 2015) As regards to age, older ages (above 40 -50 years) had the highest CA-MRSA rate (64.29%). Since infections in older patients are commonly considered as a serious medical issue, moreover it is known that the humoral and cellular immune responses are declined as consequences of aging especially in old individuals, making them more susceptible to infections as compared to younger once. ...
Comparison of Healthcare - Associated Methcillin Resistant Staphylococcus Aureus (ha-mrsa) And Community- Associated Methcillin Resistant Staphylocccus Aureus (ca-mrsa) Using Some Phenotypic And Molecular Assays in Hospitals of Duhok Province, Iraq
Article
Full-text available
  • Sep 2023
Infection of healthcare workers with methicillin resistant Staphylococcus aureus (HA-MRSA) occurs by direct contact with infected wounds, through hand contamination from asymptomatic people or medical devices. While Community-associated MRSA (CA-MRSA) infections arise in healthy non-hospitalized people or in those having medical procedure within the past year. The study was conducted from April 2021 to March 2022 to determine the rates of S. aureus and MRSA isolates, their antibiotic resistance and virulence factors among 712 specimens (308 out-patients and 404 healthcare workers) of Azadi and Bedari hospitals/ Duhok province. Staphylococcus aureus isolated at rates of 28.57% and 16.83%, among out-patients and healthcare workers, respectively. Male outpatients’, and patients with ages of >40-50 years showed higher isolate rate than healthcare worker (46.15% vs 35.38% and 85.71% vs 46.42 %) respectively. CA-MRSA showed higher resistance to beta lactam antibiotics, while HA-MRSA showed higher multidrug resistance. Males of both MRSA types (CA-MRSA and HA-MRSA) carried higher isolate rates than females (38.46% and 15.87%) respectively. The higher rates of CA-MRSA and HC-MRSA isolates were 64.29% and 22.54% at ages of >40-50 and >20-30 years, respectively. PCR analysis detected nuc and mecA genes in 100% of both MRSA types, also, the genes arcA lukS/F-pvl and lukE-lukD were detected at high rates (30.3%, 42.42% and 33.33%), respectively
View
... In the current study, only 14.99% of students accepted to participate and 86.7 % of students refused to perform the nasal culture. Although researchers working on this study tried to explain the future benefits of screening and nasal culture and the negative impact of carriage, there was a low turnout of students to participate in the study which could be considered one limitation for the current study and we can also consider it as a tool to measure students' understanding of the importance of screening for their safety and the safety of those around them [19]. However, Staphylococcus species isolated from 12 (8.28%) ...
Genomic characterization of virulence toxins of multidrug resistant Staphylococcus species isolated from the nasal passages of students of medicine
Article
Full-text available
  • Jan 2022
Nasal carriage of Staphylococcus aureus/Methicillin-resistant Staphylococcus aureus (S. aureus/MRSA) poses a major risk for the transmission and infection of this pathogen especially in hospital setting. The new emerging of multidrug resistant coagulase negative staphylococci is another problem of concern. The main objective of this study was to investigate the colonization of S. aureus/MRSA along with multidrug resistant Staphylococcus species among healthy individuals students of Faculty of Medicine/ University of Kufa and to determine their susceptibility patterns to common antibiotics and virulence genes. A total of 145 medicine students have been volunteered and nasal swabs were collected from all apparently healthy students. Samples were cultured on selective media for proper identification of S. aureus. The rate of nasal colonization with multidrug resistant Staphylococcus strains was 8.28%. higher rate was recorded by females comparing to males 75% and 25% respectively with a male to female ratio = 1:3. MRSA recorded the highest rate 6 (4.14%) followed by S. heamolyticus 5 (3.44%) and the least S.warnni 1 (0.68%). All Staphylococcus isolates were resist to Penicillin 12 (100 %). Oxacillin 12 (93.33%) Ceftizoxime 10 (83.33%) Ciprofloxacin 2 (16.66%) Cefoxitin 12 (100%) Amoxicillin 12 (100%) Clarithromycin 2(16.66%) Amoxicillin-clavulanic acid 2(16.66%). Monoplex PCR results and Genotypic characterization for the genes responsible for antibiotic resistance (MecA) and the Panton-Valentine Leukocidin revealed that all the isolated strains 12 (100%) have those genes including the non-aureus staphylococci. Results revealed that our students were carriers not for MRSA but also of multidrug resistant coagulase negative Staphylococci, these results emphasized the necessity of an annual structured survey of such cases among healthcare providers including undergraduate students to control spreading of resistant strains.
View
... Although P. aeruginosa produces numerous virulence factors, for instance, pili, flagella, proteases, elastase, lipases, iron chelators, and a variety of various toxins, including pyocyanin and exotoxin A [7], The type III secretion system (T3SS) toxins (exoS, exoT, exoU, exoY) were identified as the major virulence determents that transport via T3SS system from pathogen cytosol directly into the cytoplasm of the eukaryotic host cell [8]. S. aureus is considered one of the most clinically important zoonotic pathogens, it can cause skin and soft tissue infections, and bloodstream infections [9]. ...
Prevalence and antibiogram of Pseudomonas aeruginosa and Staphylococcus aureus clinical isolates from burns and wounds in Duhok City, Iraq
Article
Full-text available
  • Jan 2024
Introduction: this study aimed to isolate P. aeruginosa and S. aureus, investigate the antimicrobial resistance of collected isolates, and investigate the distribution of exoU and mecA genes in P. aeruginosa and S. aureus isolates. Methodology: Out of 150 samples, 32 isolates were identified as P. aeruginosa, 48 isolates were identified as S. aureus. All isolates were checked for AST. Then, a PCR was applied to detect exoU and mecA genes in P. aeruginosa and S. aureus. Results: 12.0% and 29.3% of the samples showed co-isolates and single isolates of studied pathogens, respectively. Regarding burn samples, S. aureus was the most prevalent pathogen (38.0%, 38/100) among males (41.8%, 23/55), followed by P. aeruginosa (27.0%, 27/100) among females (28.9%, 13/45). The highest burn infection rates of S. aureus (50.0%) and P. aeruginosa (32.7%) were recorded among age groups (≥ 50) and (18-49), respectively. Comparatively, wound samples were less infected with these pathogens. P. aeruginosa isolates usually exhibited high resistance to gentamicin, tobramycin, and netilmicin, whereas, imipenem showed low resistance at 46.87%. S. aureus isolates were susceptible to trimethoprim-sulphamethoxazole and rifampin. 56.25% of P. aeruginosa isolates were exoU positive and 37.5% of S. aureus isolates were mecA positive. Results of the cefoxitin inhibition zone with mecA gene amplification, 33.3% isolates were MRSA, 4.2% isolates were nmrMRSA, and 62.5% isolates were MSSA. Most of the resistant isolates of P. aeruginosa carried the exoU gene, 80% resistant isolates to imipenem were exoU positive. Conclusions: S. aureus was more predominant than P. aeruginosa in burns and wounds infections.
View
... MDR bacteria can be found in the animal, human, and environmental niches, and these pathogens are all linked in this triad [17][18][19]. Currently, lack of new antimicrobials on the horizon to replace ineffective drugs added urgency to the need to protect the efficacy of existing drugs [20,21]. ...
View
... MDR bacteria can be found in the animal, human, and environmental niches, and these pathogens are all linked in this triad [17][18][19]. Currently, lack of new antimicrobials on the horizon to replace ineffective drugs added urgency to the need to protect the efficacy of existing drugs [20,21]. ...
Asymptomatic nasopharyngeal bacterial carriage, multi-drug resistance pattern and associated factors among primary school children at Debre Berhan town, North Shewa, Ethiopia
Article
Full-text available
  • Jan 2023
Background Nasopharyngeal carriage of bacteria is the main source for transmission of pathogens across individuals and horizontal spread of organisms in the community. It is an important risk factor for the acquisition of community-acquired respiratory tract infection. It is the major public health problem among children. The asymptomatic carriage of nasopharyngeal bacteria is different globally, particularly in Africa, carriage is higher in children and decreases with increasing age, 63.2% in children less than 5 years, 42.6% in children 5–15 years, and 28.0% in adults older than 15 years. Objective The aims of this study was to determine asymptomatic nasopharyngeal bacterial carriage, multi-drug resistance pattern and associated factors among primary school children at Debre Berhan town, North Shewa, Ethiopia. Methods Institutional based cross-sectional study was conducted at Debre Berhan town primary schools from February 1 to April 30, 2021. Primarily, the schools were stratified into two strata, public and private primary schools. From a total of sixteen government and fourteen private primary schools, five government and five private schools were selected by using a simple random sampling technique. Socio-demographic variables and potential risk factors were assessed using a structured questionnaire. A total of 384 nasopharyngeal swab samples were collected using sterile swabs aseptically; and inoculated on Blood agar, Chocolate agar, MacConkey agar, and Mannitol salt agar. The colony was characterized to isolate bacteria, and bacterial identification was performed by Gram reaction, hemolysis patterns, colonial characteristics and pigmentation, catalase test, coagulase test, mannitol fermentation test, oxidase test, fermentation of carbohydrates, H 2 S production, motility, formation of indole, triple sugar iron agar (TSI), citrate utilization, lysine decarboxylase or methyl red vogues proskur utilization, urea hydrolysis and satellitism tests. Antimicrobial sensitivity tests were performed by using modified Kirby-Bauer disk diffusion method. Data were entered into statistical package Epi data 4.0.0.6 and transferred to and analyzed using SPSS software version-23. P value of < 0.05 with Odds ratio (OR) and 95% confidence interval (CIs) was considered as statistically significant. Results The overall prevalence of nasopharyngeal carriage of bacterial isolate was 35.7% (95% CI 30.7–40.7%). The predominant isolates were Staphylococcus aureus 54.5% followed by coagulase-negative Staphylococcus 35.8%, and Streptococcus pyogens 4.5%. Most bacterial isolates were susceptible to chloramphenicol, ciprofloxacin, gentamycin, nitrofurantoin, azithromycin, ciprofloxacin; and the overall multidrug resistance pattern of isolated bacteria was 62.03% out of 137 bacterial isolates. Numbers of rooms ≤ 2 per house [AOR = 5.88, 95%CI 1.26–27.57], having history of hospitalization [AOR = 4.08, 95%CI 1.45–11.53], passive smoking [AOR = 4.87, 95%CI 1.49–15.97], family size of > 5 members [AOR = 2.17, 95%CI 1.24–3.81], and number of students in the classroom [AOR = 2.35,95%CI 1.37–4.02] were statistically significant associated risk factors for nasopharyngeal bacteria carriage . Conclusion Asymptomatic nasopharyngeal bacteria carriage in children is alarming for community-acquired infection. The overall multidrug resistance was very high. The risk of the carriage was increased with having a history of passive smoking, being in large family size and number of students per class. Longitudinal follow-up studies would be helpful for better understanding the infection risk in bacterial pathogen carriers.
View
... In the current study, only 14.99% of students accepted to participate and 86.7 % of students refused to perform the nasal culture. Although researchers working on this study tried to explain the future benefits of screening and nasal culture and the negative impact of carriage, there was a low turnout of students to participate in the study which could be considered one limitation for the current study and we can also consider it as a tool to measure students' understanding of the importance of screening for their safety and the safety of those around them [19]. However, Staphylococcus species isolated from 12 (8.28%) ...
Genomic characterization of virulence toxins of multidrug resistant Staphylococcus species isolated from the nasal passages of students of medicine
Conference Paper
  • Dec 2022
Nasal carriage of Staphylococcus aureus/Methicillin-resistant Staphylococcus aureus (S. aureus/MRSA) poses a major risk for the transmission and infection of this pathogen especially in hospital setting. The new emerging of multidrug resistant coagulase negative staphylococci is another problem of concern. The main objective of this study was to investigate the colonization of S. aureus/MRSA along with multidrug resistant Staphylococcus species among healthy individuals students of Faculty of Medicine/ University of Kufa and to determine their susceptibility patterns to common antibiotics and virulence genes. A total of 145 medicine students have been volunteered and nasal swabs were collected from all apparently healthy students. Samples were cultured on selective media for proper identification of S. aureus. The rate of nasal colonization with multidrug resistant Staphylococcus strains was 8.28%. higher rate was recorded by females comparing to males 75% and 25% respectively with a male to female ratio=1:3. MRSA recorded the highest rate 6 (4.14%) followed by S. heamolyticus 5 (3.44%) and the least S.warnni 1 (0.68%). All Staphylococcus isolates were resist to Penicillin 12 (100 %). Oxacillin 12 (93.33%) Ceftizoxime 10 (83.33%) Ciprofloxacin 2 (16.66%) Cefoxitin 12 (100%) Amoxicillin 12 (100%) Clarithromycin 2(16.66%) Amoxicillin-clavulanic acid 2(16.66%). Monoplex PCR results and Genotypic characterization for the genes responsible for antibiotic resistance (MecA ) and the Panton-Valentine Leukocidin revealed that all the isolated strains 12 (100%) have those genes including the non-aureus staphylococci. Results revealed that our students were carriers not for MRSA but also of multidrug resistant coagulase negative Staphylococci, these results emphasized the necessity of an annual structured survey of such cases among healthcare providers including undergraduate students to control spreading of resistant strains.
View
... In the present study, 26.61% of S. aureus isolates were resistant to oxacillin, this resistant rate was comparatively lower when compared to other studies done in Iraq (41.1%) (Rasheed and Hussein, 2020b), and was higher than the report conducted in Syria (9.4% ) (Tabana et al., 2015) and Iraq (2.04%) (Habeeb et al., 2014a), 4.2% (Assafi et al., 2015) and 21.95% . This highly resistance rate of S. aureus in the current study to oxacillin is alarming and required special action to control this problem. ...
Staphylococcus aureus Among Athletes In Zakho City, Kurdistan Region, Iraq: Nasal Carriage Rate, Risk Factors, and Antibiotic Sensitivity Profile
Article
Full-text available
  • Jul 2022
Background and aims: Staphylococcus aureus is a leading cause of infectious diseases and responsible for outbreaks among athletes’ team. The aims of this study were to determine the prevalence rate of S. aureus among athletes, and evaluate the antibiotic resistance and risk factors associated with S. aureus isolates. Materials and methods: We performed a cross-sectional study to determine the S. aureus nasal carriage rate among athletes practicing different sports. Swabs were collected from the anterior nares of 510 athletes aged between 14-55 years. Conventional bacteriological tests were used for the identification of the S. aureus isolates. The antibiotic sensitivity test was performed according to the Clinical and Laboratory Standards Institute (CLSI). Results:Out of recruited samples, S. aureus carriage rate among athletes was 156 (30.2%). The highest infection rate was reported among boxing athletes 8/24(33.33%) and gym 80/245 (32.65%). S. aureus colonization was significantly higher among the athletes who had low body mass index (p=0.001), longer duration of training/day (p=0.001) and higher number of training session /week (p=0.012). S. aureus carriage was significantly higher among male athletes 119 (77.27%) than female athletes 35 (22.73%) (p=0.002). The oxacillin resistance rate was estimated at 26.61%. S. aureus isolates were highly susceptible to rifampicin, gentamycin and fusidic acid. Conclusion: Nasal carriage of S. aureus is relatively high and this bacterial was predominant among male athletes and a relevant resistance to antibiotics used for treatment of S. aureus infection. It is recommended that the prevention control practices be implemented to reduce nasal colonization, and risk factors associated with S. aureus among athletes. Further studies on S. aureus carriage should include throat sampling among athletes
View
A community-based study on nasal carriage of Staphylococcus aureus
Article
Full-text available
  • Dec 2009
  • INDIAN J MED RES
Background & objectives: Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is a major global problem. Colonization rates of MRSA in the community have been reported to range from 0 to 9.2 per cent. The present study was conducted to detect S. aureus nasal colonization and prevalence of MRSA in children (5 to 15 yr) in an Indian community setting of rural, urban and semiurban slums, as also evaluation of an in-house PCR to detect MRSA. Methods: Nasal swabs from children were cultured and S. aureus isolates were processed for antibiotic susceptibility. mecA gene was studied by polymerase chain reaction (PCR) on S. aureus isolates and directly from enrichment broth aliquots inoculated with nasal swabs, at sequential time intervals. Results: The overall prevalence of S. aureus nasal colonization was 52.3 per cent and that of MRSA 3.89 per cent. CA-MRSA nasal carriage was 3.16 per cent in children without prior exposure to health care settings. PCR detection directly on nasal swabs and enrichment broth had a poor sensitivity of 60.42 per cent. Interpretation & conclusions: There was a high rate of S. aureus nasal colonization in the 5-15 yr age group and an alarming rate (3.89%) of community acquired methicillin resistant S. aureus nasal colonization in the community. PCR as a method of direct detection of MRSA from nasal samples needs further fine tuning.
View
Comparative Evaluation of MRSA Nasal Colonization Epidemiology in the Urban and Rural Secondary School Community of Kurdistan, Iraq
Article
Full-text available
Background:To study the nasal carriage rate of Staphylococcus aureus (S. aureus) (including methicillin-resistant strains) in secondary school community of the urban and rural districts of the Kurdistan region of Iraq, a cross-sectional population based survey was carried out in the city Duhok and rural areas of Amedya, Akre and Zakho. Methods:Nasal swabs were obtained from nostrils of 509 students aged 14-23 years. Resistance to methicillin was assessed by Kirby-Bauer disk diffusion and agar dilution assay. Vancomycin sensitivity was also tested on Muller-Hinton agar. Results:It was found that the frequency of overall S. aureus nasal carriage (SANC) was 17.75% (90/509, CI95, 14.58–21.42%). In urban areas, the carriage rate was 20.59% (49/239, CI95, 15.64–26.29%), whereas it was 15.24% (41/270, CI95, 11.17–20.10%) in rural districts. The frequency of methicillin-resistant S. aureus (MRSA) among the isolated strains was found to be 2.04% (1/49) and 21.95% (9/41) in urban and rural areas respectively. It was found that in urban residents, the odd ratio (OR) of acquiring SANC was 1.44 (CI95, 0.91-2.27%) and risk ratio (RR) was at least 1.35 (CI95, 0.92-1.96%) while OR decreased to 0.12 (CI95, 0.01-0.96%) for MRSA carriage. Hence, the S. aureus carriage rate was higher in urban districts compared to rural areas while more MRSA were found in rural areas compared to urban districts. All studied strains were sensitive to vancomycin. Conclusion:This study provided baseline information for S. aureus nasal colonization in the region. Also, it showed that living in rural areas increased the odds of MRSA colonization. More attention should be paid to control MRSA colonization in rural communities.
View
Nasal Carriage and Resistance Pattern of Multidrug Resistant Staphylococcus aureus Among Healthy Children in Kashan, Iran
Article
Full-text available
  • Sep 2014
Nasal carriage of Staphylococcus aureus is a substantial source of human infections. Detection and treatment of nasal carriage in children with methicillin-resistant and multidrug resistant S. aureus (MRSA and MDRSA, respectively) may be an important modality in prevention of infections. This study determined the prevalence, antibiotic resistance patterns and risk factors for nasal carriage of MDRSA among healthy children. This cross-sectional study was carried out on 350 one-month to 14-year-old healthy children in Kashan city, Iran. From all health-care centers, four were chosen by simple random sampling. Nasal samples were cultured in blood agar medium for S. aureus and antibiotic susceptibility profile was determined by disc diffusion and E-test. Risk factors for nasal carriage of MDRSA were also determined. A total of 92 (26.3%) S. aureus isolates were obtained, of which 33 (35.9%) were MRSA and 27 (29.3%) were MDRSA. Of MRSA strains, 19 (70.4%) were MDRSA. S. aureus isolates showed 52.2% resistance to cephalothin, 33.7% to co-trimoxazole, 26.1% to clindamycin, 26.1% to ciprofloxacin, 4.3% to vancomycin, and 35.9% to oxacillin. The risk factors for nasal carriage of MDRSA were antibiotic usage during the last three months (P = 0.006), family size of more than four members (P = 0.044), and parental smoking (P = 0.045). MDRSA was not uncommon among healthy children in Kashan and prevention of its spread in the population is judicious.
View
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
Article
Full-text available
  • Oct 2014
  • BMC INFECT DIS
Background In the past decade methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly prevalent in community settings. Attending a daycare center (DCC) is a known risk factor for colonization with MRSA. Brazil operates free, public DCCs for low-income families, some of which are located in census tracts defined by the Brazilian Census Bureau as informal settlements (aglomerados subnormais, AGSN). Physical and demographic characteristics of AGSNs suggest that S. aureus colonization prevalence would be higher, but little is known about the prevalence of MRSA in these settings. Methods We conducted a cross-sectional study to assess risk factors for S. aureus and MRSA colonization among children attending DCCs located in AGSN vs non-AGSN. Nasal swabs were collected from children aged three months to six years in 23 public DCCs in Niterói, Brazil between August 2011 and October 2012. Results Of 500 children enrolled in the study, 240 (48%) were colonized with S. aureus and 31 (6.2%) were colonized with MRSA. Children attending DCCs in AGSNs were 2.32 times more likely to be colonized with S. aureus (95% CI: 1.32, 4.08), and 3.27 times more likely to be colonized with MRSA than children attending non-AGSN DCCs (95% CI: 1.52, 7.01), adjusted for confounding variables. Conclusion S. aureus and MRSA colonization prevalence among children attending DCCs in informal settlement census tracts was higher than previously reported in healthy pre-school children in Latin America. Our data suggest that transmission may occur more frequently in DCCs rather than at home, highlighting the importance of DCCs in AGSNs as potential MRSA reservoirs. This finding underscores the importance of local epidemiologic surveillance in vulnerable AGSN communities.
View
Methicillin resistant Staphylococcus aureus nasal colonization among secondary school students at Duhok City-Iraq
Article
Full-text available
  • Jul 2014
Objective:Methicillin-resistant Staphylococcus aureus (MRSA) widely distributed in hospitals around the world. There is strong relationship between disease development and S. aureus nasal carriage. The aim of this study was to evaluate the prevalence and epidemiology of nasal colonization with S. aureus and MRSA in the community of Duhok city, Iraq. Methods: 489 students aged 16 to18 years were included. Nasal swab samples were collected followed by antimicrobial susceptibility test. MRSA isolates were selected and investigated for the mecA gene. Also the prevalence of PantonValentine Leukocidin (PVL) gene was also studied. Results: A total of 90 (18.4%) out of 489 (18.4%) of the students were found to be colonized by S. aureus . Only 10 (2.04%) of the students were found to be MRSA carrier. All MRSA isolates were sensitive to Vancomycin. PLV gene was detected in one MRSA strain. Conclusion: This is the first study investigating S. aureus colonization in students in the Duhok city. Nasal carriage of S. aureus and MRSA is comparable with reports from elsewhere. Fortunately, all trains included in our study were sensitive to vancomycin. Further research is needed to examine the SCCmec elements and the evolution of MRSA over the time. J Microbiol Infect Dis 2014;4(2): 59-63
View
Replacement of HA-MRSA by CA-MRSA infections at an academic medical center in the midwestern United States, 2004-5 to 2008
Article
Full-text available
We noted anecdotally that infections designated as health care-associated (HA-) MRSA by epidemiologic criteria seemed to be decreasing in incidence at the University of Chicago Medical Center (UCMC) after 2004. We compared MRSA patients seen at any site of clinical care at UCMC and the isolates that caused their infections in 2004-5 (n = 545) with those in 2008 (n = 135). The percent of patients with MRSA infections cultured > 2 days after hospital admission decreased from 19.5% in 2004-5 to 7.4% in 2008 (p = 0.001). The percent in 2004-5 compared with 2008 who had a hospitalization (49.1% to 26.7%, p = 0.001) or surgery (43.0% to 14.1%, p<0.001) in the previous year decreased. In 2008 a greater percent of patients was seen in the emergency department (23.1% vs. 39.3%) and a smaller percent both in intensive care units (15.6% vs. 6.7%) and in other inpatient units (40.7% vs. 32.6%) (p<0.001). The percent of patients with CA-MRSA infections by the CDC epidemiologic criteria increased from 36.5% in 2004-5 to 62.2% in 2008 (p<0.001). The percent of MRSA isolates sharing genetic characteristics of USA100 decreased from 27.9% (152/545) to 12.6% (17/135), while the percent with CA-MRSA (USA300) characteristics increased from 53.2% (290/545) to 66.7% (90/135). The percent of infections that were invasive did not change significantly. Our data suggest that HA-MRSA infections, both by epidemiologic and microbiologic criteria, relative to CA-MRSA, decreased between 2004-5 and 2008 at UCMC.
View
Nasal carriage rate of methicillin resistant Staphylococcus aureus among Dessie Referral Hospital Health Care Workers; Dessie, Northeast Ethiopia
Article
Full-text available
  • Oct 2013
Staphylococcus aureus is a common cause of community and hospital acquired infections. One of the important sources of staphylococci for nosocomial infection is nasal carriage among hospital personnel. Emergence of drug resistant strains especially methicillin resistant Staphylococcus aureus is a serious problem in hospital environments. The aim of this study was to determine the nasal carriage rate of methicillin resistant Staphylococcus aureus among Dessie Referral Hospital healthcare-workers in Ethiopia METHODS: A cross sectional study was conducted on a total of 118 healthcare workers. Nasal swabs were collected and cultured on Mannitol Salt Agar. Slide coagulase test was performed. An oxacillin susceptibility test was carried out on Muller Hinton agar using modified Kirby-Bauer disc diffusion method. Of the 118 healthcare workers, 34 (28.8%) carried S. aureus of which 15 were methicillin resistant. Therefore, 12.7% of all HCWs were identified as MRSA carriers. The rate of methicillin resistance among all S. aureus isolates was 44.1% (15/34). MRSA carriage was particularly high among nurses (21.2%). The highest rate of MRSA carriers (57.1%) were workers of surgical wards. The high rate of nasal MRSA carriage among healthcare workers found in this study indicates the need for adjusted infection control measures to prevent MRSA transmission in our healthcare setting.
View
High-Level Vancomycin-Resistant Staphylococcus aureus (VRSA) in Iran: A Systematic Review
Article
Full-text available
  • Jan 2012
Background: Staphylococcus aureus is a major human pathogen worldwide. Vancomycin has been used for decades to treat multidrug resistant S. aureus. Ten years has passed since the first report of vancomycin resistant S. aureus (VRSA). The objective of this systematic review was to determine the total number of VRSA isolates that have been reported from Iran. Methods: Search terms reflected "Iran", "vancomycin" and "S. aureus" were searched in the ISI web of knowledge, PubMed, SciVerse, and Google scholar. Also two Persian scientific databases and 13 recent national congresses were investigated. Articles / abstracts working on S. aureus in Iran, evaluating vancomycin MIC and / or PCR of vanA/B were included in this systematic review. Results: Out of the 3484 records found in mentioned resources, 13 related studies were included in the final analysis. The result showed that at least 24 VRSA isolates which have been reported from Iran up to September 2012. Conclusion: It seems that many Iranian researchers did not follow a specific guideline for reporting and confirming VRSA. Establishing an Iranian reference center where studies on VRSA can be registered, evaluated and confirmed is strongly recommended.
View
Prevalence of PVL-Containing MRSA Isolates Among Hospital Staff Nasal Carriers
Article
  • Apr 2011
Background Staphylococcus aureus (S. aureus) carrying Panton-Valentine leukocidin (PVL) has become a serious global problem. Panton-Valentine leukocidin-positive Staphylococcus aureus can result in several infections, especially cutaneous ones. This study was conducted to determine the frequency of PVL-positive genes in methicillin-resistant Staphylococcus aureus (MRSA) among hospital staff nasal carriers. Methods Collectively, 270 nasal swabs were taken from the personnel of 5 university hospitals in Tehran, Iran. Then polymerase chain reaction (PCR) was used to detect the PVL gene. Results Among the samples taken, 72 (27%) S. aureus isolates were approved. Among the total isolates, there were 23 MRSA (32%) and 14 (19%) PVL gene-containing cases. Conclusion This study determined that a prevalence of strains exists among hospital staff members who are continuously in direct contact with patients. This may propose the significance of detecting the carriers and decolonizing them to reduce transmission of S. aureus in the hospital.
View
Nasal Microenvironments and Interspecific Interactions Influence Nasal Microbiota Complexity and S. aureus Carriage
Article
  • Dec 2013
The indigenous microbiota of the nasal cavity plays important roles in human health and disease. Patterns of spatial variation in microbiota composition may help explain Staphylococcus aureus colonization and reveal interspecies and species-host interactions. To assess the biogeography of the nasal microbiota, we sampled healthy subjects, representing both S. aureus carriers and noncarriers at three nasal sites (anterior naris, middle meatus, and sphenoethmoidal recess). Phylogenetic compositional and sparse linear discriminant analyses revealed communities that differed according to site epithelium type and S. aureus culture-based carriage status. Corynebacterium accolens and C. pseudodiphtheriticum were identified as the most important microbial community determinants of S. aureus carriage, and competitive interactions were only evident at sites with ciliated pseudostratified columnar epithelium. In vitro cocultivation experiments provided supporting evidence of interactions among these species. These results highlight spatial variation in nasal microbial communities and differences in community composition between S. aureus carriers and noncarriers.
View