title: Prevalence and correlates of MRSA and MSSA nasal carriage at a Ugandan regional referral hospital.
abstract: Despite increasing antimicrobial resistance globally, data are lacking on prevalence and factors associated with Staphylococcus aureus (SA) and MRSA carriage in resource-limited settings.
  
  
  
  To determine the prevalence of SA and MRSA nasal carriage and factors associated with carriage among Ugandan regional referral hospital patients.
  
  
  
  We enrolled a cross-section of 500 adults, sampling anterior nares for SA and MRSA carriage using Cepheid Xpert SA Nasal Complete.
  
  
  
  Mean age was 37 years; 321 (64%) were female and 166 (33%) were HIV infected. Overall, 316 (63%) reported risk factors for invasive SA infection; 368 (74%) reported current antibiotic use. SA was detected in 29% and MRSA in 2.8%. MRSA and MSSA carriers were less likely than SA non-carriers to be female (50% and 56% versus 68%, P  = 0.03) or to have recently used β-lactam antibiotics (43% and 65% versus 73%, P  = 0.01). MRSA carriers were more likely to have open wounds than MSSA carriers and SA non-carriers (71% versus 27% and 40%, P  = 0.001) and contact with pigs (21% versus 2% and 6%, P  = 0.008). MRSA carriage ranged from 0% of HIV clinic participants to 8% of inpatient surgical ward participants ( P  =   0.01). In multivariable logistic regression analysis, male sex was independently associated with SA carriage (OR 1.68, 95% CI 1.12-2.53, P  =   0.01) and recent β-lactam antibiotic use was associated with reduced odds of SA carriage (OR 0.61, 95% CI 0.38-0.97, P  =   0.04).
  
  
  
  MRSA nasal carriage prevalence was low and associated with pig contact, open wounds and surgical ward admission, but not with HIV infection.
authors.affiliation: Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Boston, MA 02114, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bebell
authors.affiliation: Epicentre Research Base, PO Box 1956, Mbarara, Uganda.|Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Arnold
authors.initials: A
authors.lastname: Ayebare
authors.affiliation: Epicentre Research Base, PO Box 1956, Mbarara, Uganda.|Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Boston, MA 02114, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
authors.affiliation: Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Joel
authors.initials: J
authors.lastname: Bazira
authors.affiliation: Center for Neural Engineering and Center for Infectious Disease Dynamics, Departments of Engineering Science and Mechanics, Neurosurgery and Physics, The Pennsylvania State University, University Park, PA, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Schiff
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Boston, MA 02114, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Stephen
authors.initials: S
authors.lastname: Ttendo
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Firth
mesh_terms: D000293:Adolescent; D000328:Adult; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology*; D009666:Nose / Q000382:microbiology; D015995:Prevalence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D014454:Uganda / Q000453:epidemiology