Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study

Abstract

Objective

To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children.

Methods

Cross-sectional study of patients <14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018.

Results

A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9–35.1) and 1.44% (95% CI 0.9–2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥5 years (OR 1.10, 95% CI 1.07–1.12), male sex (OR 1.43, 95% CI 1.17–1.76), urban setting (OR 1.46, 95% CI 1.08–1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093–1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57–8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p<0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin.

Conclusions

The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.

Keywords:

• S. aureus
• MRSA
• child
• colonization

Acknowledgments

To Claire Marsden and Dr. Kinga Amália Sándor-Bajusz for the revision of the English language. To all the member of the COSACO STUDY GROUP, who have collaborated in the samples collection and processing and clinical data acquisition. (M.R. Albañil- Ballesteros, M. Alcaraz-Quiñonero, E. Alvarez-Bueno, J. Anillo-Lago, J.M. Azcona-Gutierrez, F. Baquero-Artigao, J. Blanco- Gonzalez, A. Bercedo-Sanz, J.V. Bernad-Usoz, M. Biosca- Pamies, A. Bonet-Garrosa, C. Borja-Perez, B. Botella-Serrano, M.A. Caballero-Morales, M. Carballal-Mariño, M.T. Calvo-Lorenzo, J.E. Callejas-Pozo, A. Caro-Gomez, I. Casares- Alonso, G. Castillo-Aguas, C. Cayuela, J.L. Díaz de Tuesta, J. Díez-Sebastian, B. Dominguez, M. Duelo-Marcos, Y. Escanciano, C. Esteban-Redondo, F.J. Fernandez- Lopez, M.I. Galán Navarro, A. Gallego-Iborra, F. García-García, A. García-Merino, R. García- Perez, M. Gasca-Santiyán, I. Gil-Alexandres, S. Giner-Almaraz, M. Giribet- Folch, M.C. Gonzalez-Velasco, R. Gomez Casares, A. Gomez-Cobiá, D. Gros- Esteban, B. Guillot-Roselló, J.A. Heras-Galindo, A.B. Hidalgo- Calero, A. Iofrio De Arece, R. Jimenez Ales, J Jové-Naval, M.N Larrosa-Escartín, A. Leal-Negredo, C. Lobelle, I. López- Hernandez, A. Lorente García-Mauriño, M. Lozano-Vergara, S. Marfil-Olink, L. Martinez, M. Martinez, R.M. Masvidal, N. Menendez-Gonzalez, J. Mengual-Gil, R. Minguez-Verdejo, I. Miranda, C. Mourelo, M.E. Muñoz-Hiraldo, B. Nogueira-Gonzalez, V. Ortiz-Revuelta, M.A. Ordoñez- Alonso, P. Oscola, M.L. Padilla-Esteban, I. Perez-García, J. Pita-Carretero, D. Quílez -Agreda, R.M. Ramirez- Gavira, MJ. Ramos, E. Rico-Mari, M. Rodriguez, S. Rodriguez- Moldes, E. Rodriguez-Salinas, E. Ruiz-Chercoles, C.A Salas-Venero, T. Sainz, F. Sanatorio, E. Sanchez-Almeida, N. Sanchez-Cordero, M.D. Sanchez-Díaz, M. Sanchez-Echenique, B. Sancho-Madrid, C. Seral, C.I. Servera- Ginard, S. Solaz-Barrios, E. Suarez-Vincente, M.L. Torres-Alvarez de, C. Torres-Lloret, I. Ubeda-Sansano, M.J. Vaquerizo- Pollino, M.D. Villar- Fernandez, O. Rubio-Remiro, B. Viñado, A. Viudes de Velasco, A. Yagüe).

Abbreviations

CA, community-acquired; CI, confidence interval; MRSA, methicillin-resistant S. aureus; MSSA, methicillin-susceptible S. aureus; OR, odds ratio; SSTIs, soft tissue infections.

Disclosure

The authors declare that they have no potential conflicts of interest.