Prevalence and antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus among janitors of Mekelle University, North Ethiopia

Methicillin-resistant Staphylococcus aureus nasal carriage among janitors working in hospital and non-hospital areas: a comparative cross-sectional study

BACKGROUND

Nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of both healthcare-associated and community-acquired MRSA infections in various populations. Screening of MRSA nasal colonization is important in the prevention and control of infection and may provide useful information to guide antimicrobial therapy. This study aimed to determine nasal carriage of MRSA, its antimicrobial susceptibility pattern, and associated factors among janitors working in hospital & non-hospital areas at the University of Gondar, Northwest Ethiopia.

METHODS

A comparative cross-sectional study was carried out in a total of 436 study participants (221 hospital and 215 non-hospital janitors) from January to May 2019. The study participants were sampled using a simple random sampling technique. Data on socio-demographic characteristics and associated factors were collected through face to face interviews using a structured questionnaire. Nasal swabs were collected and inoculated into Mannitol salt agar. MRSA was detected using cefoxitin (30 µg) disc and an antibiotic susceptibility test was done using the disc diffusion method. Data were entered and analyzed using SPSS version 20 statistical package. P value ≤ 0.05 was considered as statistically significant.

RESULTS

The overall prevalence of S. aureus was 101/436 [23.2%, (95% CI: 19.3-27.8)], of which, 29.4% (65/221) were isolated from hospital and 16.7% (36/215) non-hospital janitors. The prevalence of MRSA was 4.8% (21/436) [95% CI: 3.0-6.9]; of these, 8.1% (18/221) of the isolates were from the hospital and 1.4% (3/215) non-hospital janitors, while methicillin-sensitive S. aureus (MSSA) in hospital & non-hospital janitors were 49 (22.2%) and 31 (14.4%), respectively. Among the MRSA isolates, 52.4% (11/21) were multi-drug resistant. Of these, 42.9% (9/18) were isolated from hospital and 66.7% (2/3) non-hospital janitors. Hence, nasal carriage of MRSA was significantly associated with hospitalization within the preceding year (AOR = 3.15, CI = 1.13-8.71).

CONCLUSION

The present study revealed that high MSSA and MRSA were isolated from the hospital as compared to non-hospital janitors and high rates of antibiotics resistance were recorded in the hospital janitors. Consequently, hospitalizations were significantly associated with MRSA. Accordingly, regular screening of carriers in apparently healthy janitors is required for the prevention of nosocomial infections.

Methicillin-resistant Staphylococcus aureus colonization in HIV patients of Arba Minch province, Ethiopia: Carriage rates, antibiotic resistance, and biofilm formation

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant opportunistic pathogen among human immunodeficiency virus (HIV) patients of Ethiopia. This study aimed at delineating the prevalence, antimicrobial resistance, and biofilm-forming potentials of nasally colonized MRSA among HIV patients in the Arba Minch province of Ethiopia. A cross-sectional study was performed in HIV patients who visit anti-retroviral therapy clinic of the Arba Minch Hospital between February and April 2017. Nasal samples were collected and inspected for Staphylococcus following standard procedures. MRSA was identified using cefoxitin disk and antibiotics sensitivity test was performed as per Kirby-Baur disk diffusion method. The formation of biofilm was inspected using both qualitative and quantitative methods. A total of 307 HIV patients were examined. The overall prevalence of S. aureus was found to be 39.7%. The prevalence of MRSA was 20.8%. The rate of nasal colonization of MRSA was relatively higher among females. In bivariate analysis, MRSA colonization was statistically significant in patients with CD₄ count ≤350 (p value = 0.002) and co-trimoxazole prophylaxis (p value = 0.003). Concomitant resistance to erythromycin, tetracycline, and co-trimoxazole were 48.4%, 45.3%, and 39.0%, respectively. Invariably, all MRSA isolates were 100% sensitive to vancomycin. Of the 64 MRSA isolates, 18.7% were considered as multidrug-resistant. The rate of biofilm formation was 34.3%. The results revealed a high prevalence rate in the nasal colonization of MRSA in HIV patients.

Nasal colonization of methicillin resistant Staphylococcus aureus in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Methicillin-resistant Staphylococcus aureus (MRSA) is one of a medically important Gram-positive bacteria, which can be harboured majorly in the nasal cavity. Risk of consequent infection in a person colonized with S. aureus as well as MRSA upsurges with time and remains insistently increased. Hence, the objective of this meta-analysis was to determine the prevalence of S. aureus and MRSA nasal colonization in Ethiopia at large.

METHODS

PubMed, Google Scholar, Embase, Hinari, Sci Hub, Scopus, and the Directory of Open Access Journals were searched and a total of 10 studies have been selected for meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the literature search strategy, selection of publications, data extraction, and the reporting of results for the review. All statistical analyses were performed using STATA version 11 software via random effects model. The pooled prevalence was presented in forest plots and figure with 95% CI.

RESULTS

A total of ten studies with 2495 nasal swab samples were included in this meta-analysis, and the overall pooled estimated prevalence of S. aureus and MRSA nasal colonization in Ethiopia were 30.90% [95% CI 21.81-39.99%], 10.94% [95% CI 8.13-13.75%] respectively. Subgroup analysis was also noted in different regions of Ethiopia, henceforth Oromia region ranked first 21.28% [95% CI 8.22-34.35%], followed by Amhara region 6.78% [95% CI 3.02-10.54%], whereas relatively low magnitude of MRSA colonization was demonstrated from Tigray region 4.82% [95% CI 2.18-7.45%].

CONCLUSION

The analysis showed that the overall prevalence of S. aureus and MRSA nasal colonization in Ethiopia were comparable with the global prevalence. But a huge variation between the regions, so the Ministry of Health of Ethiopia should design appropriate decolonization program that can address the specific regional groups as well as the national population.