title: Prevalence of nasal colonisation by methicillin-sensitive and methicillin-resistant Staphylococcus aureus among healthcare workers and students in Madagascar.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) clones pose a significant threat to hospitalised patients because the bacteria can be transmitted by asymptomatic carriers within healthcare facilities. To date, nothing is known about the prevalence of S. aureus and MRSA among healthcare workers in Madagascar. The objective of our study was to examine the prevalence and clonal epidemiology of nasal S. aureus and MRSA among healthcare workers and non-medical University students in Antananarivo, Madagascar.
  
  
  
  This cross sectional study screened nasal swabs taken from students and healthcare workers for S. aureus. Multiplex PCR was performed to identify S. aureus-specific (nuc), MRSA-specific mecA and mecC genes, Panton-Valentine leukocidin (PVL) (lukF-PV), and toxic shock syndrome toxin-1 (TSST-1) specific genes in methicillin-sensitive S. aureus (MSSA) and MRSA isolates. Staphylococcus protein A gene (spa) typing was performed for all confirmed MRSA isolates. The frequency distribution of nasal S. aureus and MRSA of healthcare workers and non-medical students was compared using Pearson's χ(2) test.
  
  
  
  Of 1548 nasal swabs tested, 171 (11 %) were positive for S. aureus; 20 (1.3 %) of these isolates were identified as MRSA. S. aureus was detected in 91 of 863 healthcare workers (10.4 %) and in 80 (11.8 %) of 685 students; however, 14 (1.5 %) healthcare workers carried MRSA compared with six (0.9 %) students. Nasal carriage of S. aureus and MRSA was more prevalent in women than in men, and 21 (11.7 %) S. aureus isolates were PVL-positive and 36 (21 %) were TSST-1 positive. The mecC gene was not detected in any isolates. Five different spa types were identified, with spa type t186 being the predominant MRSA clone (16/20).
  
  
  
  The results of the present study reveal a low frequency of S. aureus and MRSA nasal carriage in both students and healthcare workers from Antananarivo, Madagascar. The predominant MRSA clone (t186) was previously described in hospitalised patients in Madagascar.
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany. hogan@bni-hamburg.de.
authors.forename: Benedikt
authors.identifier: 0000-0003-0853-4755
authors.initials: B
authors.lastname: Hogan
authors.affiliation: Department of Microbiology and Parasitology, University of Antananarivo, B.P. 175, Antananarivo, Madagascar.
authors.forename: Raphael
authors.initials: R
authors.lastname: Rakotozandrindrainy
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Emran
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Dekker
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hahn
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Jaeger
authors.affiliation: University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Poppert
authors.affiliation: Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.|Institute for Medical Microbiology, Virology and Hygiene, University Hospital of Rostock, Schillingallee 70, D-18057, Rostock, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Frickmann
authors.affiliation: Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Ralf Matthias
authors.initials: RM
authors.lastname: Hagen
authors.affiliation: Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Micheel
authors.affiliation: Institute for Medical Microbiology, Virology and Hygiene, University Hospital of Rostock, Schillingallee 70, D-18057, Rostock, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Crusius
authors.affiliation: Department of Microbiology and Parasitology, University of Antananarivo, B.P. 175, Antananarivo, Madagascar.
authors.forename: Jean Noel
authors.initials: JN
authors.lastname: Heriniaina
authors.affiliation: Department of Microbiology and Parasitology, University of Antananarivo, B.P. 175, Antananarivo, Madagascar.
authors.forename: Jean Philibert
authors.initials: JP
authors.lastname: Rakotondrainiarivelo
authors.affiliation: Department of Microbiology and Parasitology, University of Antananarivo, B.P. 175, Antananarivo, Madagascar.
authors.forename: Tsiriniaina
authors.initials: T
authors.lastname: Razafindrabe
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: May
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Norbert Georg
authors.initials: NG
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D001427:Bacterial Toxins / Q000235:genetics; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial / Q000302:isolation & purification / Q000378:metabolism; D004768:Enterotoxins / Q000235:genetics; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006282:Health Personnel; D006801:Humans; D007956:Leukocidins / Q000235:genetics; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics* / Q000302:isolation & purification; D060885:Multiplex Polymerase Chain Reaction; D009296:Nasal Cavity / Q000382:microbiology; D015995:Prevalence; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000235:genetics* / Q000302:isolation & purification; D013334:Students; D018089:Superantigens / Q000235:genetics
chemical_list: D001427:Bacterial Toxins; D004269:DNA, Bacterial; D004768:Enterotoxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal