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Nasopharyngeal carriage, spa types and antibiotic susceptibility profiles of Staphylococcus aureus from healthy children less than 5 years in Eastern Uganda.
BMC Infect Dis. 2019 Dec 02; 19(1):1023.BI

Abstract

BACKGROUND

Staphylococcus aureus carriage is a known risk factor for staphylococcal disease. However, the carriage rates vary by country, demographic group and profession. This study aimed to determine the S. aureus carriage rate in children in Eastern Uganda, and identify S. aureus lineages that cause infection in Uganda.

METHODS

Nasopharyngeal samples from 742 healthy children less than 5 years residing in the Iganga/Mayuge Health and Demographic Surveillance Site in Eastern Uganda were processed for isolation of S. aureus. Antibiotic susceptibility testing based on minimum inhibitory concentrations (MICs) was determined by the BD Phoenix™ system. Genotyping was performed by spa and SCCmec typing.

RESULTS

The processed samples yielded 144 S. aureus isolates (one per child) therefore, the S. aureus carriage rate in children was 19.4% (144/742). Thirty one percent (45/144) of the isolates were methicillin resistant (MRSA) yielding a carriage rate of 6.1% (45/742). All isolates were susceptible to rifampicin, vancomycin and linezolid. Moreover, all MRSA were susceptible to vancomycin, linezolid and clindamycin. Compared to methicillin susceptible S. aureus (MSSA) isolates (68.8%, 99/144), MRSA isolates were more resistant to non-beta-lactam antimicrobials -trimethoprim/sulfamethoxazole 73.3% (33/45) vs. 27.3% (27/99) [p < 0.0001]; erythromycin 75.6% (34/45) vs. 24.2% (24/99) [p < 0.0001]; chloramphenicol 60% (27/45) vs. 19.2% (19/99) [p < 0.0001]; gentamicin 55.6% (25/45) vs. 25.3% (25/99) [p = 0.0004]; and ciprofloxacin 35.6% (16/45) vs. 2% (2/99) [p < 0.0001]. Furthermore, 42 MRSA (93.3%) were multidrug resistant (MDR) and one exhibited high-level resistance to mupirocin. Overall, 61 MSSA (61.6%) were MDR, including three mupirocin and clindamycin resistant isolates. Seven spa types were detected among MRSA, of which t037 and t064 were predominant and associated with SCCmec types I and IV, respectively. Fourteen spa types were detected in MSSA which consisted mainly of t645 and t4353.

CONCLUSIONS

S. aureus carriage rate in healthy children in Eastern Uganda is high and comparable to rates for hospitalized patients in Kampala. The detection of mupirocin resistance is worrying as it could rapidly increase if mupirocin is administered in a low-income setting. S. aureus strains of spa types t064, t037 (MRSA) and t645, t4353 (MSSA) are prevalent and could be responsible for majority of staphylococcal infections in Uganda.

Authors+Show Affiliations

Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda. davidkateete@gmail.com. Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. davidkateete@gmail.com.Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda.Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda. Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Makerere University Walter Reed Project, Kampala, Uganda.Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda. Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda.Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda. Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda.Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda.Malaria Consortium, London, UK. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.Makerere University School of Public Health, Kampala, Uganda.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31791276

Citation

Kateete, David Patrick, et al. "Nasopharyngeal Carriage, Spa Types and Antibiotic Susceptibility Profiles of Staphylococcus Aureus From Healthy Children Less Than 5 Years in Eastern Uganda." BMC Infectious Diseases, vol. 19, no. 1, 2019, p. 1023.
Kateete DP, Asiimwe BB, Mayanja R, et al. Nasopharyngeal carriage, spa types and antibiotic susceptibility profiles of Staphylococcus aureus from healthy children less than 5 years in Eastern Uganda. BMC Infect Dis. 2019;19(1):1023.
Kateete, D. P., Asiimwe, B. B., Mayanja, R., Mujuni, B., Bwanga, F., Najjuka, C. F., Källander, K., & Rutebemberwa, E. (2019). Nasopharyngeal carriage, spa types and antibiotic susceptibility profiles of Staphylococcus aureus from healthy children less than 5 years in Eastern Uganda. BMC Infectious Diseases, 19(1), 1023. https://doi.org/10.1186/s12879-019-4652-5
Kateete DP, et al. Nasopharyngeal Carriage, Spa Types and Antibiotic Susceptibility Profiles of Staphylococcus Aureus From Healthy Children Less Than 5 Years in Eastern Uganda. BMC Infect Dis. 2019 Dec 2;19(1):1023. PubMed PMID: 31791276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nasopharyngeal carriage, spa types and antibiotic susceptibility profiles of Staphylococcus aureus from healthy children less than 5 years in Eastern Uganda. AU - Kateete,David Patrick, AU - Asiimwe,Benon B, AU - Mayanja,Raymond, AU - Mujuni,Brian, AU - Bwanga,Freddie, AU - Najjuka,Christine F, AU - Källander,Karin, AU - Rutebemberwa,Elizeus, Y1 - 2019/12/02/ PY - 2019/06/24/received PY - 2019/11/22/accepted PY - 2019/12/4/entrez PY - 2019/12/4/pubmed PY - 2020/1/30/medline KW - Carriage KW - Genotyping KW - Iganga/Mayuge districts KW - MSSA/MRSA KW - Multidrug resistant KW - Staphylococcus aureus KW - Urban/rural SP - 1023 EP - 1023 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 19 IS - 1 N2 - BACKGROUND: Staphylococcus aureus carriage is a known risk factor for staphylococcal disease. However, the carriage rates vary by country, demographic group and profession. This study aimed to determine the S. aureus carriage rate in children in Eastern Uganda, and identify S. aureus lineages that cause infection in Uganda. METHODS: Nasopharyngeal samples from 742 healthy children less than 5 years residing in the Iganga/Mayuge Health and Demographic Surveillance Site in Eastern Uganda were processed for isolation of S. aureus. Antibiotic susceptibility testing based on minimum inhibitory concentrations (MICs) was determined by the BD Phoenix™ system. Genotyping was performed by spa and SCCmec typing. RESULTS: The processed samples yielded 144 S. aureus isolates (one per child) therefore, the S. aureus carriage rate in children was 19.4% (144/742). Thirty one percent (45/144) of the isolates were methicillin resistant (MRSA) yielding a carriage rate of 6.1% (45/742). All isolates were susceptible to rifampicin, vancomycin and linezolid. Moreover, all MRSA were susceptible to vancomycin, linezolid and clindamycin. Compared to methicillin susceptible S. aureus (MSSA) isolates (68.8%, 99/144), MRSA isolates were more resistant to non-beta-lactam antimicrobials -trimethoprim/sulfamethoxazole 73.3% (33/45) vs. 27.3% (27/99) [p < 0.0001]; erythromycin 75.6% (34/45) vs. 24.2% (24/99) [p < 0.0001]; chloramphenicol 60% (27/45) vs. 19.2% (19/99) [p < 0.0001]; gentamicin 55.6% (25/45) vs. 25.3% (25/99) [p = 0.0004]; and ciprofloxacin 35.6% (16/45) vs. 2% (2/99) [p < 0.0001]. Furthermore, 42 MRSA (93.3%) were multidrug resistant (MDR) and one exhibited high-level resistance to mupirocin. Overall, 61 MSSA (61.6%) were MDR, including three mupirocin and clindamycin resistant isolates. Seven spa types were detected among MRSA, of which t037 and t064 were predominant and associated with SCCmec types I and IV, respectively. Fourteen spa types were detected in MSSA which consisted mainly of t645 and t4353. CONCLUSIONS: S. aureus carriage rate in healthy children in Eastern Uganda is high and comparable to rates for hospitalized patients in Kampala. The detection of mupirocin resistance is worrying as it could rapidly increase if mupirocin is administered in a low-income setting. S. aureus strains of spa types t064, t037 (MRSA) and t645, t4353 (MSSA) are prevalent and could be responsible for majority of staphylococcal infections in Uganda. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/31791276/Nasopharyngeal_carriage_spa_types_and_antibiotic_susceptibility_profiles_of_Staphylococcus_aureus_from_healthy_children_less_than_5_years_in_Eastern_Uganda_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4652-5 DB - PRIME DP - Unbound Medicine ER -