Determinants of carriage of resistant Staphylococcus aureus among S. aureus carriers in the Indonesian population inside and outside hospitals.
OBJECTIVE
To identify determinants of carriage of resistant Staphylococcus aureus in both hospitalized patients and individuals from the community in two urban centres in Indonesia.


METHODS
Staphylococcus aureus cultures and data on recent antibiotic use, demographic, socioeconomic, disease-related and healthcare-related variables were collected from 3995 community dwellers and hospitalized persons. Nasal S. aureus carriage was found in 362 persons (9.1%). Logistic regression analysis was performed to identify which variables were independently associated with carriage of resistant S. aureus.


RESULTS
The penicillins were the most frequently used antibiotics both in the community and in hospitalized patients. In the community, admission to a hospital was associated with carriage of S. aureus resistant to any of the tested antibiotics [odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.3-4.9] and any tetracycline resistance (OR 2.4, 95% CI 1.1-5.1). Having no symptoms was associated with less carriage of S. aureus with resistance to any of the tested antibiotics (OR 0.5, 95% CI 0.3-0.9) and any tetracycline resistance (OR 0.5, 95% CI 0.3-0.9). Crowding (OR 4.5, 95% CI 1.2-4.9) and low income (OR 8.9, 95% CI 1.8-43.9) were associated with multidrug resistance. In hospitalized patients, the use of penicillins was associated with resistance to any of the tested antibiotics (OR 3.9, 95% CI 1.4-11.6) and any tetracycline resistance (OR 3.7, 95% CI 1.1-12.0).


CONCLUSIONS
Antibiotic policies including proper diagnosis, treatment and drug delivery process should be made by healthcare providers in Indonesia to help limit the emergence of antibiotic resistance.
Lestari
Endang Sri
ES
Department of Clinical Microbiology, Medical Faculty, Diponegoro University, Semarang, Indonesia.
Duerink
D Offra
DO
Hadi
Usman
U
Severin
Juliëtte A
JA
Nagelkerke
Nico J D
NJ
Kuntaman
Kuntaman
K
Wahjono
Hendro
H
Gardjito
Widjoseno
W
Soejoenoes
Ariawan
A
Van Den Broek
Peterhans J
PJ
Keuter
Monique
M
Gyssens
Inge C
IC
Verbrugh
Henri A
HA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000175:diagnosis*; D024881:Drug Resistance, Bacterial; D006760:Hospitalization; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D016015:Logistic Models; D008826:Microbial Sensitivity Tests; D009296:Nasal Cavity / Q000382:microbiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification*; D013753:Tetracycline Resistance
D000900:Anti-Bacterial Agents