title: Methicillin-resistant Staphylococcus aureus nasal carriage among primary school-aged children from Jordan: prevalence, antibiotic resistance and molecular characteristics.
abstract: OBJECTIVE
  Colonization with methicillin-resistant Staphylococcus aureus (MRSA) increases the risk for subsequent infections with an increased mortality and morbidity. Children were suggested to be a major asymptomatic reservoir for community-associated (CA) MRSA with an ability to quickly spread the MRSA within community. Therefore, the availability of epidemiological and antibiotic susceptibility data of CA-MRSA will be useful for the infection control and management policies. This study aimed to assess the nasal carriage, molecular characteristics and antibiotic susceptibility of MRSA in primary school-aged children from Jordan.
  
  
  METHODS
  A total of 210 nasal swabs were collected from children aged 6-11 years. Isolated MRSA and its SCCmec typing, Spa type and PVL (Panton-Valentine Leukociden) toxin were identified following culture, biochemical and PCR. Antibiogram was determined by the disc diffusion method.
  
  
  RESULTS
  The prevalence of CA-MRSA was 7.1%. Allergic rhinitis and recent antibiotic exposure were the only significant risk factors for MRSA nasal carriage among children. Resistance to erythromycin, trimethoprim-sulfamethoxazole and tetracycline was 33.4, 20 and 13.4%, respectively. All isolates were susceptible to the remaining non-β-lactam antibiotics used in this study, in particular linezolid and mupirocin. All MRSA isolates were SCCmec type IV and PVL toxin negative and the majority were Spa type t223.
  
  
  CONCLUSIONS
  This is the first study to assess the MRSA prevalence among children aged 6-11 years in Jordan. The prevalence in community children is within the range compared with other studies in other countries. The antibiogram, SCCmec and Spa types of the isolated MRSA are much similar to what was found previously in Jordan. However, all isolates were PVL toxin negative. The study recommends increasing the public awareness of MRSA and the proper antibiotics dispensing. Future studies to follow-up on the changing epidemiology of the CA-MRSA in Jordan are also recommended.
authors.affiliation: Departments of aMicrobiology and Immunology bBiochemistry and Molecular Biology cPediatrics, Faculty of Medicine, Mu'tah University, Al-Karak, Jordan.
authors.forename: Hamed M
authors.initials: HM
authors.lastname: Alzoubi
authors.forename: Amin A
authors.initials: AA
authors.lastname: Aqel
authors.forename: Sameeh A
authors.initials: SA
authors.lastname: Al-Sarayreh
authors.forename: Enas
authors.initials: E
authors.lastname: Al-Zayadneh
mesh_terms: D001426:Bacterial Proteins / Q000302:isolation & purification; D001427:Bacterial Toxins / Q000302:isolation & purification; D002648:Child; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005098:Exotoxins / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D007956:Leukocidins / Q000302:isolation & purification; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification*; D009297:Nasal Mucosa / Q000382:microbiology; D046915:Penicillin-Binding Proteins / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D015995:Prevalence; D065631:Rhinitis, Allergic; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D046915:Penicillin-Binding Proteins; C487789:mecA protein, Staphylococcus aureus