Methicillin-resistant Staphylococcus Aureus Nasal Colonization Research Articles

Investigating the relationship between muscle mass and nasal Methicillin-Resistant Staphylococcus aureus (MRSA) colonization: Analysis of the National Health and Nutrition Examination Survey (NHANES).

Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is associated with an increased risk of infection disease. Low muscle mass has been linked to higher levels of inflammatory markers and weakened immune response, which may impact the susceptibility to nasal MRSA colonization. The relationship between muscle function and immune response to pathogens may be bidirectional. This study investigates the association between muscle mass and nasal MRSA colonization in adults. The present cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. Appendicular skeletal muscle mass (ASM) adjusted by body mass index (BMI) (ASM/BMI) was used to evaluate muscle mass. Multivariate logistic regression, adjusted for demographic and infection factors, was used to analyze the association between muscle mass and nasal colonization by MRSA. A subgroup analysis based on age and gender was performed to assess the impact of muscle mass on nasal MRSA colonization. Nasal MRSA colonization was more prevalent in females, those with smaller household sizes, lower income, lower ASM/BMI, those who had stayed in healthcare facilities in the past 12 months, and individuals with diabetes and smoking habits. After adjusting for confounding factors, a dose-dependent association was found between decreasing quartiles of ASM/BMI and the risk of nasal MRSA colonization (p < 0.05). Additionally, per 1 unit increase in ASM/BMI was related to a 64% lower risk of nasal MRSA colonization. This study suggests a significant negative correlation between ASM/BMI and the risk of nasal MRSA colonization. However, more prospective studies are required to investigate the causal relationship between muscle mass and colonization.

Comparison of prevalence and risk factors for methicillin-resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt; in two tertiary institutions, southern Nigeria.

Methicillin-resistant Staphylococcus aureus (MRSA) is an incessant public health challenge with a rising trend in community infection among students. This study compared the prevalence and risk factors for MRSA nasal colonization among students in two tertiary institutions in Southern(east and west) Nigeria. One hundred nasal swab samples were collected from healthy university students and questionnaire aided in the retrieval of demographic and possible risk data. Staphylococcus aureus isolates were identified using morphological and biochemical approach. MRSA was detected phenotypically using both cefoxitin test and double disk synergy test. The antibiotic susceptibility test was done on the MRSA isolates against 9 antibiotics. A total of18% (18/100) and 6% (6/100) Staphylococcus aureus and MRSA isolates was detected respectively. Of which, 8% (4/50) and 4% (2/50) MRSA strains was found in south eastern and south western Nigeria respectively (p = 0.036). The mean age of the students was 21.4 years ±1.81. Overall, the age-group and gender with the highest MRSA colonization was 20-24 years and females respectively. Significant association was found between MRSA colonization and regular hospital visitation, touching of nose/face, and use of antibiotics without doctor's prescription (P &lt;0.05) in both institutions. A total of 100% of the isolates were resistant to clotrimazole. High prevalence (67%) of multi-drug resistance was observed. The prevalence of MRSA in both institutions had significant difference; with the risk factors: regular hospital visitation, touching of nose/face and indiscriminate use of antibiotics among the students.

Methicillin-resistant Staphylococcus aureus nasal carriage among patients on haemodialysis with newly inserted central venous catheters.

Although methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is common among end-stage kidney disease patients undergoing haemodialysis, few studies were focused on MRSA nasal carriers among haemodialysis patients with central venous catheters (CVCs). The aim of this study is to evaluate the risk factors, various clinical outcomes and effect of decolonization for MRSA nasal colonization among patients on haemodialysis via CVCs. This was a single-centre non-concurrent cohort study of 676 patients who had new haemodialysis CVCs inserted. They were all screened for MRSA colonization via nasal swabs and were categorized into two groups: MRSA carriers and MRSA noncarriers. Potential risk factors and clinical outcomes were analysed in both groups. All MRSA carriers were given decolonization therapy and the effect of decolonization on subsequent MRSA infection was also performed. Eighty-two patients (12.1%) were MRSA carriers. Multivariate analysis showed that MRSA carrier (OR 5.44; 95% CI 3.02-9.79), long-term care facility resident (OR 4.08; 95% CI 2.07-8.05), history of Staphylococcus aureus infection (OR 3.20; 95% CI 1.42-7.20) and CVC in situ > 21days (OR 2.12; 95% CI 1.15-3.93) were independent risk factors for MRSA infection. There was no significant difference in all-cause mortality between MRSA carriers and noncarriers. The MRSA infection rates were similar between MRSA carriers with successful decolonization and those who had failed/incomplete decolonization in our subgroup analysis. MRSA nasal colonization is an important cause of MRSA infection among haemodialysis patients with CVCs. However, decolonization therapy may not be effective in reducing MRSA infection.

Identification of Risk Factors for Nasal Colonization of Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Staphylococcus aureus in Health Workers at a Tertiary Hospital, Indonesia

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant S. aureus (VRSA) frequently cause nosocomial infections yearly. During the COVID-19 pandemic, the potential for excessive use of antibiotics is a global threat to the increasing incidence of multiresistant bacteria. AIM: This study aimed to determine MRSA and VRSA colonization and identify factors associated with the risk of MRSA and VRSA nasal colonization in health workers at Dr. Soemarno Sosroatmodjo General Hospital, Kuala Kapuas, as one of the type C hospitals in Indonesia. METHODS: This cross-sectional analytic study at Dr. Soemarno Sosroatmodjo General Hospital, a tertiary hospital in Indonesia. A 128 health workers’ subjects had undergone nasal swab screening for MRSA and VRSA colonization examinations. Then, they were asked to complete a questionnaire concerning the risk factors of MRSA and VRSA infections. RESULTS: Nasal swab results obtained as many as 30 (23.5%) MRSA positive subjects and 6 (4.7%) subjects with positive VRSA. The most common risk factors that led to MRSA colonization included a history of positive MRSA in the previous hospital (60%), a history of ear, nose, and throat infection (41.7%), and did not do hand rub/handwash (36.7%). In comparison, the most risk factors for VRSA colonization were having pigs farm at home (33.3%), a history of positive MRSA in the previous hospital (20%), and a history of hospitalization in the past 6–12 months (16.7%). The results of multivariate analysis showed the most powerful and statistically significant risk factors in influencing nasal MRSA colonization were a history of positive MRSA in the previous hospital (OR 13.69, 95% confidence intervals [CI]: 1.34–140.25, p = 0.028) and did not do hand rub/handwash (OR 2.95, 95% CI: 1.167–7.49, p = 0.023). Meanwhile, marital status (OR 0.160, 95% CI: 0.02–1.06), p = 0.058) and home care service (OR 6.10, 95% CI: 0.79–46.96, p = 0.082) were the strongest risk factors for nasal colonization of VRSA but not statistically significant. CONCLUSION: As many as, 23.5% and 4.7% of healthcare workers’ subjects were found with nasal colonization of MRSA and VRSA, respectively. Accordingly, strict policies are needed to minimize the transmission of these organisms from the hospital setting to the community.

Association between nasal colonization of Staphylococcus aureus and surgical site infections in spinal surgery patients: a systematic review and meta-analysis.

The study aimed at examining the relationship between nasal colonization of Staphylococcus aureus (SA) or methicillin-resistant Staphylococcus aureus (MRSA) and the risk of SSI after spinal surgeries MATERIALS AND METHODS: PubMed, CENTRAL, Scopus, Web of Science, and Embase databases up to 24th September 2022 for articles on nasal colonization of SA/MRSA and spine surgeries. Ten studies were included. Meta-analysis revealed that the incidence of SSI was not significantly different between SA-positive and SA-negative patients (RR: 0.75, 95% CI: 0.47, 1.18 I2=2% p=0.21). It was noted that when no decolonization was done, there was no statistically significant difference in the risk of SSI between MRSA positive and MRSA negative patients, but a tendency of higher SSI in MRSA carriers (RR: 2.40, 95% CI: 0.91, 6.32, I2=37% p=0.08). However, in the subgroup analysis with decolonization, the risk of SSI was significantly higher in the MRSA-positive group (RR: 2.99, 95% CI: 1.27, 7.03, I2=24% p=0.01). Specifically, the risk of MRSA-SSI was significantly higher in MRSA carriers with (RR: 6.05, 95% CI: 1.14, 31.99, I2=43% p=0.03) and without decolonization (RR: 7.54, 95% CI: 1.43, 39.85, I2=38% p=0.02). Evidence from observational studies indicates that only MRSA nasal colonization increases the risk of SSIs in spinal surgery patients. Nasal decolonization was unable to reduce the risk of overall or MRSA-specific SSIs in MRSA carriers. Evidence was biased due to the extremely small number of MRSA-positive patients in the studies and the lack of adjustment of confounding factors.

204. Genomic comparison of blood and colonizing nasal isolates in patients hospitalized with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of health-care associated infections, particularly bloodstream infections (BSI). Concomitant colonization of the anterior nares has been shown to have implications on persistence, recurrence, and transmission events. We performed genomic comparisons between paired nasal and blood MRSA isolates obtained from the same patient to elucidate the genetic differences that may contribute to within-host invasion and virulence. Methods Patients hospitalized with MRSA bloodstream infection were swabbed in the bilateral nares. Paired blood and nasal isolates underwent DNA extraction and spa typing. Nasal and blood isolates from the same patients with matching spa types were sequenced by Illumina and PacBio respectively. For genomic analysis, PathoSPOT and Snippy were used to compare genomes of nasal and blood isolate pairs to evaluate single nucleotide polymorphisms, insertions and deletions. Results Of 121 patients with MRSA BSI, 87 patients (72%) had concomitant colonization of the anterior nares with MRSA. Spa type of t002 predominated in both blood and nasal isolates. From the 76 pairs that underwent genomic analysis, several mutated genes were identified across all pairwise comparisons, 8 of which recurred in more than one patient pair. These included genes involved in conferring antibiotic resistance, increased mutability, immune evasion, and adaptive metabolism. Conclusion In patients with MRSA BSI and concomitant MRSA nasal colonization, mutations identified by genomic analysis in blood-nasal pairs are implicated in contributing to invasion and within-host adaptability. Disclosures All Authors: No reported disclosures.

PREVALENCE OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AND OTHER STAPHYLOCOCCAL NASAL CARRIAGES AMONG HEALTHCARE WORKERS, PHRAMONGKUTKLAO HOSPITAL

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a group of S. aureus strains containing the SCCmec gene causing beta-lactam antibiotic resistance. MRSA is common in healthcare settings and can cause serious problems.&#x0D; Objective: The study aimed to investigate the prevalence of MRSA nasal colonization among privates of the Medical Private Company, Phramongkutklao Hospital, including antibiotic susceptibility pattern of S. aureus isolates and risk factors of S. aureus nasal carriage.&#x0D; Methods: Nasal swabs were obtained from the anterior nares of 170 privates. Staphylococcal isolates were identified using a catalase test, tube coagulase test and matrix-assisted laser desorption/ ionization time of flight mass spectrometry (MALDI-TOF MS). MRSA detection was screened using cefoxitin disk diffusion and confirmed using the mecA gene detection and SCCmec typing. Antibiotic susceptibility patterns of S. aureus were examined using the disk diffusion method. A questionnaire was collected from the subjects to determine risk factors for S. aureus nasal carriage.&#x0D; Results: Of 170 subjects, 157 (92.35%) revealed staphylococcal positive, yielding 161 staphylococcal isolates. The prevalence of MRSA, methicillin-resistant Staphylococcus epidermidis (MRSE), and methicillin-susceptible Staphylococcus aureus (MSSA) nasal carriage was 0.59, 1.18 and 8.82%, respectively. The MRSA isolate carried mecA revealing SCCmec type II. The MSSA isolates indicated low resistance to tetracycline (13.3%), whereas the MRSA isolate resisted ciprofloxacin, clindamycin, erythromycin, gentamicin, oxacillin and tetracycline. Using multiple logistic regression analysis, a significant risk factor for S. aureus nasal carriage was utensil sharing (adjusted odds ratio=4.41; 95% CI=1.33-14.61).&#x0D; Conclusion: Healthcare-associated MRSA existed among privates of the Medical Private Company. An associated risk factor for acquiring S. aureus was utensil sharing which could be used to help improve prevention and control management among privates.

Does a Positive Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screen Predict the Risk for MRSA Skin and Soft Tissue Infection?

Skin and soft tissue infections (SSTIs) are often caused by gram-positive bacteria that colonize the skin. Given the overuse of antibiotics, SSTIs are increasingly caused by resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Guidance on the utility of MRSA nasal screening for MRSA SSTI is limited. To determine whether MRSA nasal screening predicts the risk of MRSA SSTIs. This was a single-center, retrospective cohort study of adult patients with an SSTI diagnosis that had MRSA nasal screening and wound cultures obtained within 48 hours of starting antibiotics. Sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios were calculated using VassarStats. Pretest and posttest probabilities were estimated with Microsoft Excel. A total of 884 patient encounters were reviewed between December 1, 2018, and October 31, 2021, and 300 patient encounters were included. The prevalence of MRSA SSTI was 18.3%. The MRSA nasal colonization had a sensitivity of 63.6%, specificity of 93.9%, positive predictive value of 70.0% (95% CI = 55.2%-81.7%), negative predictive value of 92.0% (95% CI = 87.7%-94.9%), positive likelihood ratio of 10.39 (95% CI = 6.12-17.65), negative likelihood ratio of 0.39 (95% CI = 0.27-0.55), positive posttest probability of 70.0%, and negative posttest probability of 8.0%. Given the high positive likelihood ratio, a positive MRSA nasal screen was associated with a large increase in the probability of MRSA SSTI at our institution, and a negative MRSA nasal screen was associated with a small but potentially significant decrease in the probability of MRSA SSTI.

Methicillin resistance Staphylococcus aureus nasal carriage and its associated factors among HIV patients attending art clinic at Dessie comprehensive specialized hospital, Dessie, North East Ethiopia.

Globally the incidence of nosocomial infections and colonization due to methicillin resistant Staphylococcus aureus (MRSA) has become greater concern. The objective of the study was to determine the prevalence and associated factors of nasal carriage of MRSA with its antimicrobial susceptibility patter among HIV patients attending ART clinic. cross-sectional study was conducted from January 01 to May 30, 2020 at Dessie comprehensive specialized hospital, north east Ethiopia. A total of 206 HIV patients were recruited by applying systematic random sampling technique. Nasal specimen was collected from both anterior nares, and inoculated directly on mannitol salt agar, MacConkey, 5% blood agar. Screening of MRSA and methicillin susceptible Staphylococcus aureus (MSSA) strain was done by using cefoxitin antibiotic disc following modified Kirby-Bauer disc diffusion technique. Bivariable and multivariable logistic regression analyses were performed to assess the associated factors with S. aureus and MRSA. study participants were in the age range between 12 and 72 years and their mean (±SD) age was 41.52 (±11.2). The rate of S. aureus and MRSA colonization was 127/206 (61.7%) and 58/206 (28.2%), respectively. Having job close contact with human [AOR = 4.41; 95% CI = 1.5-13.02; p = 0.007], picking the nose [AOR = 4.38; 95% CI = 1.34-14.29; p = 0.014] and ART failure [AOR = 7.41; 95% CI = 2.08-26.41; p = 0.002] had statistically significant association with MRSA colonization. MRSA showed resistance for tetracycline (53.4%), erythromycin (84.5%), and trimethoprim-sulfamethoxazole (86.2%). Multi-Drug Resistance (MDR) was detected among 96.5% of MRSA and 20.3% of MSSA isolates. the rate of S. aureus and MRSA nasal colonization was high and it has associated with different factors. Understanding and managing MRSA among HIV patients is mandatory and stakeholders should find out the way how to decolonize the bacteria from nasal area.

Methicillin-resistant Staphylococcus aureus nasal colonization in children with cerebral palsy.

A retrospective cohort of children admitted to the pediatric intensive care unit (PICU) with cerebral palsy was matched 1:3 by age and admission year to determine odds of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization. Adjusted odds of MRSA nasal colonization at PICU admission were 2.6-fold higher among children with cerebral palsy.

Nasal colonization of methicillin resistant staphylococcus aureus among slaughterhouse workers in Dar es salaam, Tanzania

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is a zoonotic pathogen that is associated with serious and sometimes fatal infections in humans. The pathogen has ability to acquire resistance to most antibiotics. Working in slaughterhouses increase the chance of workers to contract this pathogen. This study aimed to determine the prevalence of MRSA and its associated factors among slaughterhouse workers in Dar es Salaam, Tanzania. Methods: A cross-sectional study was conducted from June-July 2018 involving workers from 4 registered slaughterhouses. Social demographics and other information was collected using a semi-structured questionnaire. Swabs were collected and inoculated in Mannitol salt agar for S. aureus isolation. The isolates were tested for antimicrobial susceptibility using 10µg Oxacillin discs implanted on Muller Hinton Agar plates. Binary logistic regression was employed to determine the association between prevalence of MRSA and independent variables. Results: MRSA was isolated from 39,2% of the 258 enrolled slaughterhouse workers. MRSA colonization was more likely in persons who have been working for more than 21 years (p=0,014) and smokers (p=0,02). On-job training (adjOR=0,417; 95% CI: 0,202-0,858, p= 0,018) was protective against MRSA nasal colonization. Conclusion: Our study has demonstrated the occurrence of MRSA in slaughterhouse workers in Dar es salaam, Tanzania. It is more prevalent in persons who have been working for a long time in slaughterhouses. In addition, provision of on-job training is protective against MRSA nasal colonization. More studies are required to confirm whether the MRSA detected were livestock-associated.

1138. Utility of Methicillin-resistant Staphylococcus aureus Nares Screening in Hospitalized Children With Acute Infectious Disease Syndromes

BackgroundEmpirical antibiotic regimens frequently include treatment for methicillin-resistant Staphylococcus aureus (MRSA). Studies in adults with pneumonia support the use of a negative MRSA nares screening (MNS) to help de-escalate antibiotic therapy. Comparable pediatric data in the literature is scarce. We aimed to evaluate the use of MNS for antibiotic de-escalation in hospitalized children (< 18 years) at a tertiary children’s hospital. MethodsA retrospective chart review was conducted of pediatric inpatients (January 01, 2015 to December 31, 2020) with a presumed infectious diagnosis who had a PCR-based MNS test and a clinical culture (i.e. site of infection or blood) performed as part of their diagnostic work up. Those who were screened >5 days since admission or > 48 hours since start of MRSA-active antimicrobials, and those who had antibiotic treatment withdrawn after 48 hours because of negative cultures were excluded. ResultsA total of 101 children were included with a median age (range) of 2 years (0-17) and about half (n=57, 56.4%) were male. Top three diagnosis groups were skin and soft tissue infections (n=33, 32.7%), toxin-mediated syndromes (n=21, 20.8%), and osteoarticular infections (n=13, 12.9%). Pneumonia accounted for only six (5.9%) patients. The prevalence of nasal MRSA colonization was 6.9% (n=7). The sensitivity of the MNS test to predict a MRSA infection was 42.9% with a specificity of 95.7%. The positive predictive value (PPV) and negative predictive values (NPV) were 42.9% and 95.7%, respectively. In about half (55/95, 57.9%) of patients initiated on anti-MRSA therapy, these agents were discontinued during the admission. A quarter (n=14, 25.5%) were de-escalated based on the negative MNS test alone, and another third (n=21, 38.2%) after negative MNS test and negative culture results became available. ConclusionPediatric providers at this institution have started to use the MNS to help limit anti-MRSA therapy. We noted a high NPV which suggests that MNS may be useful for timely de-escalation of anti-MRSA therapy and thereby a useful antimicrobial stewardship tool for hospitalized children. Prospective studies to evaluate the utility of MNS for the various infectious syndromes are warranted.Disclosures All Authors: No reported disclosures

Methicillin-resistant Staphylococcus aureus nasal colonization in people living with HIV and healthypeople in Kathmandu, Nepal.

Aim:This study aimed to compare methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in people living with HIV (PLHIV) and healthy people from Kathmandu.Methods:MRSA isolated from 400 nasal swabs was screened using a cefoxitin disc and confirmed by the presence of the mecA gene.Results:MRSA nasal carriers among the PLHIV and control cohorts were 3.5% (7 out of 200) and 5.0% (10 out of 200), respectively. All the MRSA from PLHIV and most of MRSA from healthy controls were PVL positive. Longer duration of antiretroviral therapy significantly reduces the risk of MRSA nasal colonization in PLHIV.Conclusion:There is no significant difference in MRSA nasal colonization in PLHIV and healthy controls in this study region.

Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening in Hospitalized Children with Acute Infectious Disease Syndromes.

Studies in adults support the use of a negative methicillin-resistant Staphylococcus aureus (MRSA) nares screening (MNS) to help limit empiric anti-MRSA antibiotic therapy. We aimed to evaluate the use of MNS for anti-MRSA antibiotic de-escalation in hospitalized children (<18 years). Records of patients admitted between 1 January 2015 and 31 December 2020 with a presumed infectious diagnosis who were started on anti-MRSA antibiotics, had a PCR-based MNS, and a clinical culture performed were retrospectively reviewed. A total of 95 children were included with a median age (range) of 2 (0–17) years. The top three diagnosis groups were skin and soft tissue infections (n = 38, 40%), toxin-mediated syndromes (n = 17, 17.9%), and osteoarticular infections (n = 14, 14.7%). Nasal MRSA colonization and growth of MRSA in clinical cultures was found in seven patients (7.4%) each. The specificity and the negative predictive value (NPV) of the MNS to predict a clinical MRSA infection were both 95.5%. About half (n = 55, 57.9%) had anti-MRSA antibiotics discontinued in-house. A quarter (n = 14, 25.5%) were de-escalated based on the negative MNS test alone, and another third (n = 21, 38.2%) after negative MNS test and negative culture results became available. A high NPV suggests that MNS may be useful for limiting unnecessary anti-MRSA therapy and thereby a useful antimicrobial stewardship tool for hospitalized children. Prospective studies are needed to further characterize the utility of MNS for specific infectious diagnoses.

Methicillin-resistant Staphylococcus aureus colonization among healthcare workers in Oman.

Methicillin-Resistant Staphylococcus aureus (MRSA) is a S. aureus strain characterized by resistance to cloxacillin. Healthcare workers (HCWs), are recognized for their heightened risk for MRSA acquisition and possibly for MRSA nosocomial transmission. This cross-sectional study aimed to determine the prevalence and the associated risk factors of MRSA colonization among healthcare workers at Sultan Qaboos University Hospital (SQUH) in Oman. A total of 200 nasal swab samples were collected from the healthcare workers at SQUH during the period October 2nd 2018 to January 7th 2019. All nasal swab samples were examined microbiologically for the presence of MRSA using the standard method and the results were confirmed by detection of the mecA product (PBP2a). Data on associated risk factors for MRSA colonization was collected and analyzed. Forty-one of the 200 screened healthcare workers (20.5%) were found to have nasal carriage of Staphylococcus aureus of which 63.4% were Methicillin Sensitive and 36.6% were Methicillin-Resistant (MRSA). Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from fifteen of the 200 screened healthcare workers giving a prevalence rate of nasal colonization with MRSA of 7.5%. We found no statistical association between healthcare worker MRSA nasal colonization and age, gender, HCWs specialty, hand hygiene practices, skin condition, previous MRSA infection, and previous exposure to antibiotics. Identification of the prevalence and the associated risk factors of MRSA colonization in healthcare workers mandates continuous surveillance and the implementation of all possible preventive measures to reduce re-occurrences.

Epidemiology of Methicillin-Resistant Staphylococcus Aureus in Arab Countries of the Middle East and North African (MENA) Region.

Available data suggest a high burden of methicillin-resistant staphylococcus aureus (MRSA) in Arab countries of the Middle East and North Africa (MENA). To review the MRSA rates and molecular epidemiology in this region, we used PubMed search engine to identify relative articles published from January 2005 to December 2019. Great heterogeneity in reported rates was expectedly seen. Nasal MRSA colonization ranged from 2%–16% in Gulf Cooperation Council (GCC), 1–9% in the Levant, and 0.2%–9% in North African Arab states. Infective MRSA rates ranged from 9%–38% in GCC, 28%–67% in the Levant, and 28%–57% in North African states. Studies demonstrated a wide clonal diversity in the MENA. The most common molecular types belonged to 5 clonal complexes (CC) known to spread worldwide: CC5, CC8, CC22, CC30, and CC80. The most prevalent strains had genotypes related to the European community-acquired MRSA (CA-MRSA), Brazilian/Hungarian hospital-acquired MRSA (HA-MRSA), UK-EMRSA-15 HA-MRSA, and USA300 CA-MRSA. Finally, significant antimicrobial resistance was seen in the region with variation in patterns depending on location and clonal type. For a more accurate assessment of MRSA epidemiology and burden, the Arab countries need to implement national surveillance systems.

Nasal Methicillin-Resistant Staphylococcus aureus Colonization in Patients with Type 1 Diabetes in Taiwan.

Nasal methicillin-resistant Staphylococcus aureus (MRSA) colonies are an essential reservoir of infection, especially for patients with diabetes. However, data on MRSA colonization in patients with type 1 diabetes are limited. We investigated the epidemiology of MRSA colonization in patients with type 1 diabetes. This prospective cross-sectional study was conducted in a medical center (Chang Gung Memorial Hospital) in Taiwan from 1 July to 31 December 2020. Nasal sampling and MRSA detection were performed. The molecular characteristics of MRSA isolates were tested, and factors associated with MRSA colonization were analyzed. We included 245 patients with type 1 diabetes; nasal MRSA colonization was identified in 13 (5.3%) patients. All isolates belonged to community-associated MRSA genetic strains; the most frequent strain was clonal complex 45 (53.8%), followed by ST59 (30.8%) (a local community strain). MRSA colonization was positively associated with age ≤ 10 years, body mass index < 18 kg/m2, and diabetes duration < 10 years; moreover, it was negatively associated with serum low-density lipoprotein cholesterol ≥ 100 mg/dL. No independent factor was reported. The nasal MRSA colonization rate in type 1 diabetes is approximately 5% in Taiwan. Most of these colonizing strains are community strains, namely clonal complex 45 and ST59.

Evaluation of the Cepheid Xpert SA Nasal Complete for direct detection of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in nasal swabs from pediatric patients

Nasal carriers of Staphylococcus aureus (SA) are at increased risk for health-care associated infections with this organism. Timely detection of SA and Methicillin-resistant SA (MRSA) and subsequent decolonization are important components of infection control. While performance of nucleic acid amplification-based tests for detection of SA/MRSA in adults has been well-described, limited data are available in children. Our objective was to evaluate the performance of the Xpert SA in pediatric patients. Overall, for detection of SA, Xpert SA demonstrated a sensitivity and specificity of 95.1% and 93.5%, respectively and 87.8% sensitive and 98.1% specific for detection of MRSA. Performance in different age groups was similar but neonates had the lowest sensitivity and highest invalid rates. The Xpert SA is a rapid, reliable test to detect MSSA and MRSA nasal colonization in pediatric patients. Depending on the potential clinical impact, culture may be considered as a companion test to improve sensitivity.

Exposure to Environmental Chemical Mixtures is Associated with Nasal Colonization by Staphylococcus aureus: NHANES 2001-2004

Background: Understanding the health effects of exposure to chemical mixtures is critical given the broad range of concurrent exposures throughout the life-course. While investigations of environmental chemicals and components of the human microbiome are becoming more common, few have examined associations with chemical mixtures. This study assesses the association between exposure to mixtures of 66 different environmental chemicals and nasal colonization of Staphylococcus aureus (SA) and methicillin resistant SA (MRSA).Methods: Data came from the National Health and Nutrition Examination Survey (NHANES) 2001-2004. The analytical sample consists of 10,312 participants, subdivided into 8 different chemical mixture groups. Within each of 6 chemical classes (metals, phthalates, polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs), polyfluorochemicals (PFCs), and phenols), weighted quantile sum (WQS) regression was used to analyze the joint association of the component compounds and nasal SA colonization. WQS was also used to assess the joint association of 3 chemical mixtures (metals, metal and PAHs, and metal and triclosan) and nasal MRSA colonization. All regression models were adjusted for confounders.Results: The analytical sample was between ages 6-85, slightly more female, and predominantly non-smokers. Prevalence of SA carriage was 29.2%, and MRSA colonization prevalence was 1.2%. Within each chemical class, odds of SA colonization increased significantly with exposure to mixtures of metals (OR = 1.11, 95% CI = 1.02-1.20), phthalates (OR = 1.09, 95% CI = 1.04-1.14), and phenols (OR = 1.08, 95% CI = 1.01-1.15). Exposure to a mixture of metals combined with PAHs was also associated with increased odds of MRSA carriage (OR=1.38, 95% CI = 1.02-1.86).Conclusion: Results indicate an association between multiple environmental chemical mixtures and SA colonization, including MRSA. These findings support the need for further analysis of associations between chemical mixtures and SA colonization, as well as other components of the human microbiome.

Risk Factors Association for MRSA Nasal Colonization in Preoperative Patients in Azadi Teaching Hospital-Duhok, Kurdistan Region, Iraq

Background: Nasal colonization with Methicillin-resistant Staphylococcus aureus (MRSA) can predispose to subsequent infections in surgical and non-surgical patients, making the management challenging with increased rates of morbidity, mortality and cost burden.&#x0D; Objectives: The present study was carried out to evaluate the risk factors of MRSA nasal colonization in preoperative patients in Azadi Teaching Hospital in Duhok Province - Kurdistan Region-Iraq.&#x0D; Methods: Nasal swabs were obtained from 150 patients after completing a questionnaire. Conventional laboratory methods were carried out to identify Staphylococcus aureus (S. aureus) and antimicrobial susceptibility test was conducted for recognizing MRSA isolates.&#x0D; Results: A total of 41 (27.3%) of 150 patients were MRSA carriers. The mean age of participants MRSA carriers was 35.27±20.40 years old. The highest prevalence rate of nasal colonization with MRSA was in males (27.94%) than females (26.82%). In logistic regression analysis, no significant differences was detected between MRSA carriage and the associated risk factors including age [OR: 0.99 (95 % CI: 0.97- 1.01); P = 0.45], gender [OR: 1.05 (95 % CI: 0.51- 2.17); P = 0.87] and medical comorbidities [OR: 1.11 (95 % CI: 0.42- 2.92); P = 0.82].&#x0D; Conclusions: Age, gender and medical comorbidities were not associated common risk factors for nasal colonization of MRSA in preoperative patients. This study should be considered preliminary and studies with larger sample sizes and with using advance molecular tools are needed in the future.