Donkor Eric S, Kotey Fleischer C N, Dayie Nicholas T K D, Duodu Samuel, Tetteh-Quarcoo Patience B, Osei Mary-Magdalene, Tette Edem M A
Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
Pathogens. 2019 Mar 17;8(1):35. doi: 10.3390/pathogens8010035.
Methicillin-resistant (MRSA) poses a public health threat owing to its extensive resistance to antibiotics, association with persistent outbreaks, and markedly increased healthcare costs. Moreover, HIV-infected individuals are at a greater risk for colonization with MRSA, and may act as reservoirs for subsequent transmission to other individuals. In Ghana, little is known about MRSA in relation to at-risk populations, such as HIV-infected children. The aim of this study was to investigate nasal carriage of and MRSA among HIV-infected children in Accra, including the prevalence, risk factors and antibiotic resistance.
The study was cross-sectional, and involved 107 children with HIV infection and an equal number of sex- and age group- matched apparently healthy controls recruited from the Princess Marie Louis Children's Hospital in Accra. Nasal swab specimens were collected from the study participants and cultured for bacteria. isolates were confirmed by the coagulase test while MRSA was confirmed by PCR of the A gene. Antimicrobial susceptibility testing of isolates was done by the Kirby Bauer method. A structured questionnaire was used to collect data on demographic, household and clinical features of the study participants. A logistic regression analysis was performed to identify determinants of and MRSA carriage among participants of both study groups.
The carriage prevalence of and MRSA were 44.9% (48) and 5.6% (6), respectively, among the HIV-infected individuals, and the corresponding values within the control group were 23.4% (25) and 0.9% (1). There was a significant association between HIV infection and colonization ( 0.001), but not MRSA colonization ( = 0.055). The main predictor of colonization in both study groups was absence of colonization with coagulase negative staphylococcus ( < 0.001). Furthermore, the main predictor of MRSA colonization was regular hand washing with soap ( = 0.043); this was observed among HIV-infected individuals but not the control group. The proportion of isolates that were multidrug resistant was 62.3% (33/53) in the HIV-infected group and 80% (20/25) in the control group ( = 0.192).
HIV infection is a risk factor for nasal colonization of among children in Accra but may not be for MRSA. Both the HIV-infected and uninfected children are reservoirs of multidrug resistant . Demographic, household and clinical features appear to have little or no relationship with and MRSA colonization in the study children.
耐甲氧西林金黄色葡萄球菌（MRSA）因其对多种抗生素具有广泛耐药性、与持续性暴发相关以及显著增加医疗成本，对公共卫生构成威胁。此外，感染人类免疫缺陷病毒（HIV）的个体感染MRSA的风险更高，且可能成为后续传播给其他个体的传染源。在加纳，对于像感染HIV的儿童这样的高危人群中的MRSA情况知之甚少。本研究的目的是调查阿克拉感染HIV儿童的鼻腔金黄色葡萄球菌携带情况，包括其患病率、危险因素及抗生素耐药性。
本研究为横断面研究，纳入了107名感染HIV的儿童以及从阿克拉玛丽·路易丝公主儿童医院招募的数量相等、性别和年龄组匹配的明显健康对照。从研究参与者中采集鼻拭子标本并进行细菌培养。通过凝固酶试验确认金黄色葡萄球菌分离株，通过A基因的聚合酶链反应（PCR）确认MRSA。采用 Kirby Bauer法对金黄色葡萄球菌分离株进行药敏试验。使用结构化问卷收集研究参与者的人口统计学、家庭和临床特征数据。进行逻辑回归分析以确定两个研究组参与者中金黄色葡萄球菌和MRSA携带的决定因素。
在感染HIV的个体中，金黄色葡萄球菌和MRSA的携带率分别为44.9%（48例）和5.6%（6例），对照组中的相应数值分别为23.4%（25例）和0.9%（1例）。HIV感染与金黄色葡萄球菌定植之间存在显著关联（P<0.001），但与MRSA定植无显著关联（P = 0.055）。两个研究组中金黄色葡萄球菌定植的主要预测因素是无凝固酶阴性葡萄球菌定植（P<0.001）。此外，MRSA定植的主要预测因素是经常用肥皂洗手（P = 0.043）；这在感染HIV的个体中观察到，但在对照组中未观察到。感染HIV组中多重耐药的金黄色葡萄球菌分离株比例为62.3%（33/53），对照组为80%（20/25）（P = 0.192）。
HIV感染是阿克拉儿童鼻腔金黄色葡萄球菌定植的一个危险因素，但可能不是MRSA定植的危险因素。感染HIV和未感染HIV的儿童都是多重耐药金黄色葡萄球菌的传染源。人口统计学、家庭和临床特征似乎与研究儿童中的金黄色葡萄球菌和MRSA定植几乎没有关系。
