“Nasal Colonization With Methicillin-Resistant Staphylococcus Aureus (MRSA) Among Sickle Cell Disease Children”

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) poses a public health threat as it is extensively resistant to antimicrobials, is associated with persistent outbreaks in hospital and community settings, and is associated with markedly increased healthcare costs. Moreover, sickle cell disease patients frequently visit hospitals and often consume antibiotics, hence could potentially harbor MRSA, and consequently serve as reservoirs for dissemination of the pathogen. Globally, little is known about MRSA carriage among sickle cell disease patients. General aim: The aim of this study was to investigate nasal carriage of S. aureus and MRSA among children with and without sickle cell disease in Accra, including the prevalence, risk factors and antibiogram. Methodology: “This study was cross-sectional, and involved 120 children with sickle cell disease and 100 apparently healthy children without the disease recruited at the Princess Marie Louis Children’s Hospital (PML) in Accra. ‘Nasal swab specimens were collected from the study participants and cultured. S. aureus isolates were confirmed by the tube coagulase test, while MRSA was confirmed via PCR targeting the mecA gene. S. aureus susceptibility to standard antimicrobial agents was tested by the Kirby Bauer method. A pretested structured questionnaire was also used to obtain data on demographic, household, and clinical features of the study participants. A binary logistic regression was used to identify determinants of S. aureus and MRSA carriage among the study participants. Results: The nasal carriage prevalence of S. aureus were 33.3% (n = 40) and 10% (n = 10) respectively among the sickle cell disease children and the participants of the control group. With regard to MRSA nasal carriage prevalence, the respective values were 9.2% (n = 11) and 5% (n = 5). Sickle cell disease was significantly associated with S. aureus colonization (χ2 = 16.91, p < .0001, OR = 4.045), but not MRSA colonization (χ2 = 1.4, p = .237). The significant predictors of S. aureus colonization among the sickle cell disease patients were increasing age (p = 0.003; OR = 1.275), male gender (p = 0.018; OR = 0.344), living in self-contained apartments (p = 0.033; OR = 3.632), and practice of self-medication (p = 0.039; OR = 0.233). In the control group, history of hospitalization in the past year was a risk factor for carriage of both S. aureus (p = 0.048; OR = 14.333) and MRSA (p = 0.044; OR = 21.176). The proportion of S. aureus

isolates that were multidrug resistant (MDR) was 92.5% (37/40) in the sickle cell group and 100% (10/10) in the control group. Conclusions: Among children in Accra, sickle cell disease predisposed to carriage of S. aureus, but not MRSA; the odds ratio of S. aureus carriage in relation to the presence of sickle cell disease was 4.045. In addition, increasing age, male gender, living in self-contained apartments, and practice of self-medication, were risk factors for carriage of S. aureus among the sickle cell disease children. History of hospitalization in the past year, was a risk factor for MRSA and S. aureus carriage. Finally, both the sickle cell disease children and participants of the control group harbored multidrug resistant S. aureus, and this may be due to extensive antimicrobial use in the country.