Prevalence of nasal carriage and diversity of Staphylococcus aureus among inpatients and hospital staff at Korle Bu Teaching Hospital, Ghana
Introduction
Staphylococcus aureus is an important pathogen associated with human infections in hospitals and communities worldwide [1]. Asymptomatic nasal carriage ranges between 15% and 40% of a population and is an established risk factor for S. aureus infection as well as for transmission between patients and healthcare workers [2], [3].
Meticillin-resistant S. aureus (MRSA) infections are a major healthcare and socioeconomic problem in hospitals worldwide as they are more difficult and expensive to treat compared with infections caused by meticillin-susceptible S. aureus (MSSA) strains [4]. Efforts to diminish the spread of MRSA in hospitals are therefore pivotal and may include various infection control initiatives such as improved hand hygiene, rapid diagnostics, and eradication of MRSA in asymptomatic carriers especially prior to surgery [1], [5].
Data on carriage, antibiotic susceptibility patterns and the molecular epidemiology of S. aureus in the African continent are limited. S. aureus carriage prevalences of 17–46% have been found among patients and hospital personnel in Somalia and Sudan [6], [7]. A prevalence of 29% was reported by a recent study investigating S. aureus carriage in a remote indigenous population in Central Gabon [8]. Data available from different African countries indicate a prevalence of MRSA ranging from 4.8% to 20% in clinical isolates [9], [10], [11].
The objective of this large-scale surveillance study was to determine the prevalence of nasal carriage, antimicrobial susceptibility patterns and clonal diversity of S. aureus and MRSA among inpatients (IP) and hospital staff (HS) at the largest hospital in Ghana.
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Study design, site and population
A cross-sectional study was conducted between September 2011 and May 2012 at Korle Bu Teaching Hospital, Ghana, which has over 2000 beds and an average admission of 250 patients daily. The hospital serves a population of over 3 million and acts as a major referral health facility for an estimated population of 24 million people across Ghana.
Nasal screening of IP and HS was conducted at the Child Health Department (CHD) (bed size, 168; staff, 180) and Surgical Department (SD) (bed size, 242;
Nasal carriage
Demographic characteristics of the study population are shown in Table 1. Distributions of S. aureus carriers and non-carriers stratified by population characteristics are shown in Table 2. A total of 632 participants were recruited, including 452 IP (71.5%) and 180 HS (28.5%). S. aureus was isolated from 105/632 (16.6%) of the study population. The S. aureus carrier prevalence in the two groups was 63/452 (13.9%) in IP and 42/180 (23.3%) in HS. HS had a higher chance of being S. aureus
Discussion
This is the first baseline study that provides insight into the prevalence of nasal carriage, antimicrobial susceptibility and clonal structure of S. aureus and MRSA among IP and HS in Ghana. The study reveals a statistically significant lower S. aureus carrier prevalence among IP (13.9%) compared with HS (23.3%). The difference in S. aureus carrier prevalence among IP and HS could be due to the observation that ≥44% of the IP received antibiotic therapy at the time of sampling. In line with
Funding
This study was supported by the Antibiotic Drug Use, Monitoring and Evaluation of Resistance (ADMER) project funded by the Danish International Development Agency (DANIDA).
Ethical approval
Ethical approval was obtained from the University of Ghana Medical School Ethical and Protocol Review Board (Accra, Ghana) [reference no. MS-EI/M.9 – P.3.212010-11].
Competing interests
None declared.
Acknowledgments
Prof. Bamenla Goka and Dr Clegg Lamptey, heads of the Child Health Department and Surgical Department at Korle Bu Teaching Hospital (Ghana), are thanked for their support to the study. The authors are grateful to Stephen Osei-Wusu, Lone Ryste Kildevang Hansen and Julie Hindsberg Nielsen for their technical support.
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