Staphylococcus aureus Nasal Colonization among Children with Sickle Cell Disease at the Children's Hospital, Accra: Prevalence, Risk Factors, and Antibiotic Resistance

Vera A Appiah; George A Pesewu; Fleischer C N Kotey; Alahaman Nana Boakye; Samuel Duodu; Edem M A Tette; Mame Y Nyarko; Eric S Donkor

doi:10.3390/pathogens9050329

Staphylococcus aureus Nasal Colonization among Children with Sickle Cell Disease at the Children's Hospital, Accra: Prevalence, Risk Factors, and Antibiotic Resistance

Pathogens. 2020 Apr 28;9(5):329. doi: 10.3390/pathogens9050329.

Authors

Vera A Appiah¹, George A Pesewu¹, Fleischer C N Kotey^{2

3}, Alahaman Nana Boakye^{1

2}, Samuel Duodu^{4

5}, Edem M A Tette⁶, Mame Y Nyarko⁷, Eric S Donkor³

Affiliations

¹ Department of Medical Laboratory Science, School of Biomedical and Allied Health Sciences, University of Ghana, Legon P. O. Box LG 54, Accra, Ghana.
² FleRhoLife Research Consult, Teshie P. O. Box TS 853, Accra, Ghana.
³ Department of Medical Microbiology, University of Ghana Medical School, Accra P. O. Box 4236, Ghana.
⁴ West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon P. O. Box LG 54, Accra, Ghana.
⁵ Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon P. O. Box LG 54, Accra, Ghana.
⁶ Department of Community Health, University of Ghana Medical School, Accra P. O. Box 4236, Ghana.
⁷ Princess Marie Louise Children's Hospital, Accra P. O. Box GP 122, Ghana.

Abstract

The aim of this study was to investigate S. aureus carriage among children with sickle cell disease (SCD), including the prevalence, risk factors, and antibiotic resistance. The study was cross-sectional, and involved 120 children with SCD recruited at the Princess Marie Louise Children's Hospital (PML) in Accra and 100 apparently healthy children from environs of the hospital. Nasal swab samples were collected from the study participants and cultured for bacteria. Confirmation of S. aureus and methicillin-resistant Staphylococcus aureus (MRSA) isolates were done using the tube coagulase test and mecA polymerase chain reaction, respectively. All the S. aureus isolates were tested against standard antimicrobial agents using the Kirby-Bauer method. A structured questionnaire was used to obtain the socio-demographic and clinical data of the study participants. Binary logistic regression was used to identify determinants of S. aureus and MRSA carriage among the study participants. The nasal carriage prevalence of S. aureus was 33.3% (n = 40) and 10% (n = 10) among the participants of the SCD and control groups, respectively. As regards MRSA nasal carriage prevalence, the respective values were 3.33% (n = 4) and 0.00% (n = 0). SCD was significantly associated with S. aureus colonization (p < 0.0001, OR = 4.045), but not MRSA colonization (p = 0.128). In the SCD group, the significant predictors of S. aureus carriage were increasing age (p = 0.003; OR = 1.275) and living in self-contained apartments (p = 0.033; OR = 3.632), whereas male gender (p = 0.018; OR = 0.344) and the practice of self-medication (p = 0.039; OR = 0.233) were protective of S. aureus carriage. In the control group, a history of hospitalization in the past year was a risk factor for the carriage of S. aureus (p = 0.048; OR = 14.333). Among the participants of the SCD and control groups, respectively, the resistance prevalence recorded by S. aureus against the various antibiotics investigated were penicillin (100% each), cotrimoxazole (27.5% vs. 20%), tetracycline (25% vs. 50%), rifampicin (82.5% vs. 50%), erythromycin (30% vs. 20%), clindamycin (32.5% vs. 50%), gentamicin (7.5% vs. 20%), cefoxitin (27.5% vs. 20%), linezolid (30% vs. 40%), and fusidic acid (95% vs. 80%). The proportion of S. aureus isolates that were multidrug resistant (MDR) was 92.5% (37/40) in the SCD group and 100% (10/10) in the control group.

Keywords: Accra; MRSA; S. aureus; antibiotics; colonization.