Multidrug-resistant Staphylococcus aureus Colonization in Healthy Adults Is more Common in Bhutanese Refugees in Nepal than Those Resettled in Ohio.

Jhalka Kadariya,Ram Lal Mahatara,Sandra Bempah,Tara C Smith,Dipendra Thapaliya,Nabin Dhakal,Sabana Bhatta

doi:10.1155/2019/5739247

Abstract

Although studies have shown that human migration is one of the risk factors for the spread of drug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), surveillance studies examining MRSA among refugee populations in the US are lacking. This study aimed to assess the prevalence and molecular characteristics of S. aureus among Bhutanese refugees living in Nepal and resettled in Northeast Ohio (NEO). One hundred adult Bhutanese refugees from each geographic location were enrolled between August 2015 and January 2016. The participants were interviewed to collect demographic information and potential risk factors for carriage. Nasal and throat swabs were collected for bacterial isolation. All S. aureus isolates were characterized by spa typing and tested for the presence of Panton-Valentine leukocidin (PVL) and mecA genes; selected isolates were tested by multilocus sequence typing (MLST). The overall prevalence of S. aureus was 66.0% and 44.0% in NEO and Nepal, respectively. In Nepal, 5.8% (3/52) of isolates were MRSA and 1.1% (1/88) in NEO. Twenty-one isolates in NEO (23.9%) were multidrug-resistant S. aureus (MDRSA), while 23 (44.2%) in Nepal were MDRSA. In NEO, 41 spa types were detected from 88 S. aureus isolates. In Nepal, 32 spa types were detected from 52 S. aureus isolates. spa types t1818 and t345 were most common in NEO and Nepal, respectively. The overall prevalence of PVL-positive isolates among S. aureus in Nepal and NEO was 25.0% and 10.2%. ST5 was the most common sequence type in both locations. Bhutanese refugees living in Nepal and resettled in NEO had high prevalence of S. aureus and MDRSA. The findings suggest a potential need for CA-MRSA surveillance among the immigrant population in the U S and among people living in Nepal, and a potential need to devise appropriate public health measures to mitigate the risk imposed by community-associated strains of S. aureus and MRSA.

Highlights

Staphylococcus aureus is a common opportunistic bacterium
A community-based cross-sectional study was conducted among Bhutanese refugees living in Nepal and Northeast Ohio (NEO) in between August 2015 and January 2016
All mecA-positive isolates were phenotypically resistant to oxacillin. In this cross-sectional study, we investigated the prevalence and molecular epidemiology of S. aureus among Bhutanese refugees living in Nepal (n=100) and in NEO (n=100)

Summary

Introduction

Staphylococcus aureus is a common opportunistic bacterium. This bacterium is an important pathogen due to combination of toxin-mediated virulence, invasiveness, and antibiotic resistance [1]. It may be part of the normal human microbiota, it can cause wide range of diseases from skin and soft-tissue infections (STIs) to severe invasive disease such as infective endocarditis, osteomyelitis, and toxic shock syndrome [2]. S. aureus can be recovered from many locations in and on the body, including the nose, throat, axillae, and groin, but the most important site for colonization is thought to be the anterior nares (nostrils) [4]. While colonization with S. aureus itself does not harm the host, colonization is a risk factor for developing subsequent symptomatic infections [6]

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