Baraa A Amir¹, Ali A Rabaan^2-4 and Salwa S Sheikh⁵*

¹College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
²Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
³College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
⁴Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
⁵Pathology Services Division, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia

*Corresponding Author: Salwa S Sheikh, Pathology Services Division, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.

Received: November 30, 2021; Published: December 27, 2021

Abstract

Background: The purpose of this study was to investigate community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) nasal carriage rates among outpatients attending a hospital in the Eastern Province of Saudi Arabia. Additionally, this study involved a literature review for comparison of data between different parts of Saudi Arabia and of the Saudi average to the USA and other countries.

Methods: Duplicate nasal swabs from 3188 outpatients attending Johns Hopkins Aramco Healthcare Center in Dhahran in the Eastern Province of Saudi Arabia between January 2013 and December 2014 were tested using Xpert MRSA-SA Nasal Complete G3 kits (Cepheid). A literature review was also conducted using Pubmed, Google Scholar, and Cochrane Library regarding MRSA nasal carrier status.

Results: Nine hundred and thirty-one patients (29.2%) were nasal S. aureus carriers, of which 121 (3.8% overall; 13% of S. aureus carriers) were colonized by CA-MRSA. Our measured CA-MRSA levels were lower than those observed in smaller studies from north-central or central Saudi Arabia, but comparable to levels observed among pediatric outpatients from Riyadh.

Conclusion: Overall Saudi levels were higher than for countries including the United States and European countries. Targeted public health strategies to address CA-MRSA levels in Saudi Arabia are indicated.

Keywords: CA-MRSA; Saudi Arabia; Staphylococcus aureus; Xpert MRSA-SA Nasal Complete

References

1. “Methicillin-Resistant Staphylococcus Aureus (MRSA)”. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 6 June (2018).
2. Naimi TS., et al. “Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection”. Journal of the American Medical Association 290 (2003): 2976-2984.
3. Shore AC and Coleman DC. “Staphylococcal cassette chromosome mec: recent advances and new insights”. International Journal of Medical Microbiology 303 (2013): 350-359.
4. Hetem DJ., et al. “Molecular epidemiology of MRSA in 13 ICUs from eight European countries”. Journal of Antimicrobial Chemotherapy 1 (2016): 45-52.
5. Rabaan AA and Bazzi AM. “Variation in MRSA identification results from different generations of Xpert MRSA real-time PCR testing kits from nasal swabs”. Journal of Infection and Public Health 10 (2017): 799-802.
6. Abou Shady HM., et al. “Staphylococcus aureus nasal carriage among outpatients attending primary health care centers: a comparative study of two cities in Saudi Arabia and Egypt”. Brazilian Journal of Infectious Diseases 19 (2015): 68-76
7. Alhussaini MS. “Methicillin-resistant Staphylococcus aureus nasal carriage among patients admitted at Shaqra General Hospital in Saudi Arabia”. Pakistan Journal of Biological Sciences 19 (2016): 233-238.
8. Alaklobi F., et al. “The prevalence of community-associated methicillin-resistant Staphylococcus aureus among outpatient children in a tertiary hospital: a prospective observational study in Riyadh, Saudi Arabia”. International Journal of Pediatrics and Adolescent Medicine 2 (2015): 136-140.
9. El Amin NM and Faidah HS. “Methicillin-resistant Staphylococcus aureus in the western region of Saudi Arabia: prevalence and antibiotic susceptibility pattern”. Annals of Saudi Medicine 32 (2012): 513-516.
10. Asghar AH. “Molecular characterization of methicillin-resistant Staphylococcus aureus isolated from tertiary care hospitals”. Pakistan Journal of Medical Sciences 3 (2014): 698-702.
11. Al-Zahrani I., et al. “Impact of mass migrations on the clonal variation of clinical Staphylococcus aureus strains isolated from the Western region of Saudi Arabia”. Journal of Infection and Public Health (2018).
12. Sarkar A., et al. “Antimicrobial resistance and virulence markers in methicillin sensitive Staphylococcus aureus isolates associated with nasal colonization”. Microbial Pathogenesis 93 (2016): 8-12.
13. Zakai SA. “Prevalence of methicillin-resistant Staphylococcus aureus nasal colonization among medical students in Jeddah, Saudi Arabia”. Saudi Medical Journal 36 (2015): 807-812.
14. Eed EM., et al. “Molecular characterisation of Panton-Valentine leucocidin-producing methicillin-resistant Staphylococcus aureus clones isolated from the main hospitals in Taif, KSA”. Indian Journal of Medical Microbiology 34 (2016): 476-482.
15. Marzec NS and Bessesen MT. “Risk and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia among patients admitted with and without MRSA nares colonization”. American Journal of Infection Control 44 (2016): 405-408.
16. Schechter-Perkins E., et al. “Prevalence and predictors of nasal and extranasal staphylococcal colonization in patients presenting to the emergency department”. Annals of Emergency Medicine 57 (2011): 492-499.
17. Albrecht VS., et al. “Staphylococcus aureus colonization and strain type at various body sites among patients with a closed abscess and uninfected controls at U.S. emergency departments”. Journal of Clinical Microbiology 53 (2015): 3478-3484.
18. Bearman GML., et al. “Nasal carriage of inducible dormant and community-associated methicillin-resistant Staphylococcus aureus in an ambulatory population of predominantly university students”. International Journal of Infectious Diseases 14 (2010): e18-e24.
19. Nair N., et al. “Molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among patients admitted to adult intensive care units: the STAR*ICU trial”. Infection Control and Hospital Epidemiology 32 (2011): 1057-1063.
20. Pardos de la Gandara., et al. “Molecular Types of methicillin-resistant Staphylococcus aureus and methicillin-sensitive aureus strains causing skin and soft tissue infections and nasal colonization, identified in community health centers in New York City”. Journal of Clinical Microbiology 53 (2015): 2648-2658.
21. Bes TM., et al. “Prevalence of methicillin-resistant Staphylococcus aureus colonization in individuals from the community in the city of Sao Paulo, Brazil”. Revista do Instituto de Medicina Tropical de São Paulo 60 (2018): 1.
22. Cavalcante FS., et al. “Characteristics of methicillin-resistant Staphylococcus aureus in patients on admission to a teaching hospital in Rio de Janeiro, Brazil”. American Journal of Infection Control 45 (2017): 1190-1193.
23. Joachim A., et al. “Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Salaam, Tanzania”. BMC Research Notes 10 (2017): 417.
24. den Heijer CDJ., et al. “Prevalence and resistance of commensal Staphylococcus aureus, including meticillin-resistant S aureus, in nine European countries: a cross-sectional study”. The Lancet Infectious Diseases 13 (2013): 409-415.
25. Gamblin J., et al. “Nasal self-swabbing for estimating the prevalence of Staphylococcus aureus in the community”. Journal of Medical Microbiology 62 (2013): 437-440.
26. George K., et al. “Prevalence of MRSA nasal carriage in patients admitted to a tertiary care hospital in Southern India”. Journal of Clinical and Diagnostic Research 10 (2016): DC11-DC13.
27. Kale P and Dhawan B. “The changing face of community-acquired methicillin-resistant Staphylococcus aureus”. Indian Journal of Medical Microbiology 34 (2016): 275-285.
28. Sader HS., et al. “Frequency and antimicrobial susceptibility of bacterial isolates from patients hospitalised with community-acquired skin and skin structure infection in Europe, Asia, and Latin America”. Journal of Global Antimicrobial Resistance (2018).
29. Walrath JJ., et al. “The prevalence of MRSA nasal carriage in preoperative pediatric orthopaedic patients”. Advances in Orthopedics 2016 (2016): 5646529.
30. Almeida GCM., et al. “Prevalence and factors associated with wound colonization by Staphylococcus spp. and Staphylococcus aureus in hospitalized patients in inland northeastern Brazil: a cross-sectional study”. BMC Infectious Diseases 14 (2014): 328.
31. Dagunton N., et al. “MRSA outbreak at neonatal ICU in Saudi Arabia”. Antimicrobial Resistance and Infection Control 4 (2015): P225.
32. Popovich KJ., et al. “Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains?” Clinical Infectious Diseases 46 (2008): 787-794.
33. Panhotra BR., et al. “Prevalence of methicillin-resistant and methicillin-sensitive Staphylococcus aureus nasal colonization among patients at the time of admission to the hospital”. Annals of Saudi Medicine 25 (2005): 304-308.
34. Khanfar H., et al. “Methicillin-resistant Staphylococcus aureus transmission in a low-prevalence healthcare setting”. Journal of Infection and Public Health 5 (2012): 311-316.
35. Klein EY., et al. “Trends in methicillin-resistant Staphylococcus aureus hospitalizations in the United States, 2010-2014”. Clinical Infectious Diseases 65 (2017): 1921-1923.
36. Li M., et al. “Increased community-associated infections caused by Panton-Valentine leukocidin-negative MRSA, Shanghai, 2005-2014”. Emerging Infectious Diseases 22 (2016): 1988-1991.
37. David MZ., et al. “Staphylococcus aureus bacteremia at 5 US academic medical centers, 2008-2011: significant geographic variation in community-onset infections”. Clinical Infectious Diseases 59 (2014): 798-807.
38. Bouchiat C., et al. “MRSA infections among patients in the emergency department: a European multicentre study”. Journal of Antimicrobial Chemotherapy 72 (2017): 372-375.
39. Laub K., et al. “High prevalence of Staphylococcus aureus nasal carriage among children in Szolnok, Hungary”. Acta Microbiologica et Immunologica Hungarica 65 (2018): 59-72.
40. Scerri J., et al. “Prevalence and characteristics of community carriage of methicillin-resistant Staphylococcus aureus in Malta”. Journal of Epidemiology and Global Health 3 (2013): 165-173.
41. Chuang Y and Huang Y. “Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Asia”. The Lancet. Infectious Diseases 13 (2013): 698-708.
42. Dantes R., et al. “National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011”. Journal of the American Medical Association Internal Medicine 173 (2013): 1970-1978.
43. Hultén KG., et al. “Analysis of invasive community-acquired methicillin-susceptible Staphylococcus aureus Infections during a period of declining community acquired methicillin-resistant Staphylococcus aureus infections at a large children's hospital”. Pediatric Infectious Disease Journal 37 (2018): 235-241.
44. General Authority for Statistics, Saudi Arabia. Hajj statistics (2019).

Citation

Citation: Salwa S Sheikh., et al. “Comparative Analysis of Community Acquired Methicillin-resistant Staphylococcus aureus Nasal Carriage in Eastern Province of Saudi Arabia". Acta Scientific Microbiology 5.1 (2022): 80-88.

Copyright

Copyright: © 2022Salwa S Sheikh., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.