Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage among patients with diabetes at the Korle Bu Teaching Hospital.

Ramzy B Anafo,Yacoba Atiase,Fleischer C N Kotey,Nicholas T K D Dayie,Samuel Duodu,Mary-Magdalene Osei,Patience B Tetteh-Quarcoo,Eric S Donkor,Khalid J Alzahrani,Taeok Bae

doi:10.1371/journal.pone.0257004

Ramzy B Anafo, Yacoba Atiase + Show 8 more

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https://doi.org/10.1371/journal.pone.0257004

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Abstract

AimTo investigate the epidemiology of S. aureus and MRSA nasal carriage among people with diabetes at the Korle Bu Teaching Hospital in Accra, including the prevalence, predictors of carriage, and antibiotic resistance.MethodologyThis study was cross-sectional, involving 300 diabetes patients and 106 non-diabetic individuals. Swab specimens of the nares were obtained from the participants and bacteriologically-cultured. Identification and characterization of S. aureus and MRSA were based on standard bacteriological methods; antimicrobial susceptibility testing was by the Kirby-Bauer method.ResultsThe prevalence of staphylococcal carriage, the diabetes group relative to the non-diabetes group, were 31.0% and 10.4% (S. aureus), and 3.3% and 0.0% (MRSA). Presence of diabetes predisposed to S. aureus carriage, but not MRSA nor coagulase-negative staphylococci (CoNS) carriage (OR = 3.88; p < 0.0001). Colonization with CoNS was protective of S. aureus (OR = 0.039, p < 0.001) and MRSA (OR = 0.115, p = 0.043) colonization among the diabetics. The antimicrobial resistance patterns recorded among the S. aureus isolated from the diabetic individuals relative to the non-diabetics were as follows: penicillin (95% vs. 91%), tetracycline (37% vs. 27%), cotrimoxazole (30% vs. 36%), erythromycin (17% vs. 0%), norfloxacin (13% vs. 0%), clindamycin (12% vs. 0%), gentamicin (9% vs. 0%), fusidic acid (10% vs. 9%), linezolid (4% vs. 0%), and rifampicin (5% vs. 0%). The proportion of multidrug resistant S. aureus was 41% (n = 38) in the diabetes group and 0% in the non-diabetes group; this difference was statistically significant (p = 0.01).ConclusionsThe presence of diabetes predisposed the participants to S. aureus carriage by almost four folds, but not MRSA carriage. Colonization with CoNS was protective of S. aureus and MRSA carriage in the diabetes group. Finally, linezolid remains a good therapeutic agent for anti-MRSA therapy.

Highlights

Staphylococcus aureus (S. aureus) is concurrently a commensal and a human pathogen [1,2]
The presence of diabetes predisposed the participants to S. aureus carriage by almost four folds, but not methicillin-resistant S. aureus (MRSA) carriage
Colonization with coagulase-negative staphylococci (CoNS) was protective of S. aureus and MRSA carriage in the diabetes group

Summary

Introduction

Staphylococcus aureus (S. aureus) is concurrently a commensal and a human pathogen [1,2]. Non-carriers, who comprise about half of the general population, have been presumed to be resistant to S. aureus carriage [5,6,7,8]. Based on their susceptibility to methicillin, S. aureus strains have been identified as methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA). S. aureus has been classified into healthcare-associated, community-associated, and livestock-associated, based on the origin of infection; MRSA strains have been categorized as healthcare-associated MRSA (HA-MRSA) [12], community-associated MRSA (CA-MRSA) [13,14,15,16], and livestockassociated MRSA (LA-MRSA) [17,18]

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