title: Prevalence of Community-Acquired Methicillin-Resistant Staphylococcus aureus Nasal Colonization Among Children.
abstract: BACKGROUND
  Invasive infections from community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasingly being encountered in healthy children. Nasal colonization of MRSA is associated with increased risk for acquiring invasive disease. The objective of this study was to determine prevalence and risk factors for CA-MRSA nasal colonization among a healthy paediatric population and to determine antibiotic susceptibilities of S. aureus isolates.
  
  
  METHODS
  Using a cross-sectional study design, children aged 1mnth-17y attending well-child clinic at an academic hospital and a local public school in Mangalore, India were screened for S. aureus colonization via nasal swabs. A questionnaire was administered and data on risk factors for nasal colonization was collected. Samples were obtained from the anterior nares and cultured quantitatively. S. aureus isolates were confirmed by growth on selective media and coagulase testing. Disk diffusion antibiotic susceptibility tests were performed according to Clinical and Laboratory Standard Institute guidelines.
  
  
  RESULTS
  Of the 500 children included in the study, S. aureus was isolated from the anterior nares in 126 (25%) children; four (3%) isolates were classified as CA-MRSA. Factors associated with S. aureus nasal colonization were children <6 y old (p=0.030) and members of joint families (p=0.044). Resistance to many classes of antibiotics were noted among S. aureus isolates including trimethoprim-sulfamethoxazole (39%), ciprofloxacin (16%), erythromycin (19%) and clindamycin (5%). Inducible clindamycin resistance (positive D test) was detected in 11 of the erythromycin-resistant strains not already classified as resistant to clindamycin. No resistance to vancomycin was observed.
  
  
  CONCLUSIONS
  Children in India have a high rate of nasal colonization of S. aureus. Nasal colonization of community-associated methicillin-resistant S. aureus exists but is still low among healthy children. The high rate of resistance to many classes of antibiotics among S. aureus strains is of great concern warranting continued surveillance and antimicrobial stewardship.
authors: Associate Professor, Department of Microbiology, K.S. Hegde Medical Academy, Nitte University , Karnataka, India .
authors: Veena
authors: V
authors: Shetty
authors: Medical Student, Wake Forest School of Medicine , Winston-Salem, NC .
authors: Katherine
authors: K
authors: Trumbull
authors: Head of Department, Department of Pedodontics, K.S. Hegde Medical Academy, Nitte University , Karnataka, India .
authors: Amitha
authors: A
authors: Hegde
authors: Head of Department, Department of Pediatrics, K.S. Hegde Medical Academy , Nitte University, Karnataka, India .
authors: Vijaya
authors: V
authors: Shenoy
authors: Associate Professor, Department of Pediatrics, K.S. Hegde Medical Academy, Nitte University , Karnataka, India .
authors: Raghavendra
authors: R
authors: Prabhu
authors: Lecturer, Department of Statistics, K.S. Hegde Medical Academy, Nitte University , Karnataka, India .
authors: Sumathi
authors: S
authors: K
authors: Director Clinical Microbiology, Department of Pathology, Wake Forest School of Medicine , Winston-Salem, NC .
authors: Elizabeth
authors: E
authors: Palavecino
authors: Professor, Department of Pediatrics, Wake Forest School of Medicine , Winston-Salem, NC .
authors: Avinash K
authors: AK
authors: Shetty
keywords: Children; Disk diffusion test; Karnataka; Nasal carriage; Staphylococcus aureus
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