Differences in gram-positive bacterial colonization and antimicrobial resistance among children in a high income inequality setting

Felipe Piedade Gonçalves Neves,Mariel Asbury Marlow,Maria De Fátima Nogueira De Freitas,Fábio Aguiar-Alves,Gabriel Rezende-Pereira,Lee Woodland Riley,Rosana Rocha Barros,Marcos Gabriel Pinheiro,Claudete Aparecida Araújo Cardoso,Allyne Fandino Martinez Dos Santos

doi:10.1186/s12879-019-4104-2

Felipe Piedade Gonçalves Neves, Mariel Asbury Marlow + Show 8 more

Open Access

https://doi.org/10.1186/s12879-019-4104-2

Copy DOI

Abstract

BackgroundStaphylococcus aureus and beta-hemolytic streptococci (BHS) diseases disproportionately affect populations in middle/low-income countries. To assess if this disparity is reflected in colonization by these organisms, we compared their colonization frequency among children from different socioeconomic status (SES) communities in a city with high income inequality.MethodsBetween May–August 2014, we collected nasal and throat swabs to investigate S. aureus and BHS colonization among children who attended private and public pediatric clinics. Patients were classified as high SES, middle/low SES, and slum residents. We investigated the antimicrobial resistance profile, the SCCmec types and the presence of PVL genes among methicillin-resistant S. aureus (MRSA). We also examined the antimicrobial resistance profile and serogroups of BHS.ResultsOf 598 children, 221 (37%) were colonized with S. aureus, of which 49 (22%) were MRSA. MRSA colonization was higher in middle/low SES (n = 18; 14%) compared with high SES (n = 17; 6%) and slum (n = 14; 8%) residents (p = 0.01). All MRSA strains were susceptible to clindamycin, nitrofurantoin, and rifampin. The highest non-susceptibility frequency (42.9%) was observed to erythromycin. SCCmec type V was only found in isolates from high SES children; types I and II were found only in middle/low SES children. Ten (20%) MRSA isolates carried PVL genes. Twenty-four (4%) children were BHS carriers. All BHS (n = 8) found in high SES children and six (67%) isolates from slum patients belonged to group A. All group B streptococci were from middle/low SES children, corresponding to five (71%) of the seven BHS isolated in this group. BHS isolates were susceptible to all drugs tested.ConclusionsChildren from different SES communities had distinct bacterial colonization profiles, including MRSA carriage. Public health officials/researchers should consider SES when assessing disease transmission and control measures.

Highlights

Staphylococcus aureus and beta-hemolytic streptococci (BHS) diseases disproportionately affect populations in middle/low-income countries
All methicillin-resistant S. aureus (MRSA) strains were susceptible to clindamycin, nitrofurantoin, and rifampin
Patient demographic characteristics were consistent with patient socioeconomic status (SES) group, with high SES, middle/low SES, and slum groups, being significantly different across all demographic characteristics investigated except gender (Table 1)

Summary

Introduction

Staphylococcus aureus and beta-hemolytic streptococci (BHS) diseases disproportionately affect populations in middle/low-income countries. Staphylococcus aureus and beta-hemolytic streptococci (BHS), including Streptococcus pyogenes (group A streptococci, GAS) and Streptococcus agalactiae (group B streptococci, GBS), are Gram-positive bacteria that cause a range of infections, from mild cutaneous and upper-respiratory infections to invasive bloodstream and respiratory infections [1,2,3]. They permeate our environment, and can be found in food, hospitals, schools, childcare centers, and households [4]. Despite the low mortality rate (1–2%) for hospitalized children with methicillin-resistant

Methods

Results

Discussion

Conclusion