Nasal Methicillin-resistant Staphylococcus aureus Carriage, Its Multi-Drug Resistance Pattern and Associated Factors among Primary School Children At Chiro Town; Eastern Ethiopia

Nasal Methicillin-resistant Staphylococcus aureus Carriage, Its Multi-Drug Resistance Pattern and Associated Factors among Primary School Children At Chiro Town; Eastern Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Nasal Methicillin-resistant Staphylococcus aureus Carriage, Its Multi-Drug Resistance Pattern and Associated Factors among Primary School Children At Chiro Town; Eastern Ethiopia Wondimagegn Wolde Eba, Ebisa Zerihun, Kaleab Terefe, Abel Desalegn Demeke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6226496/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Methicillin-resistant Staphylococcus aureus is a major cause of healthcare- associated and community-acquired infections. In Ethiopia especially in West hararghe Zone, there is limited data on Methicillin-resistant Staphylococcus aureus among school children in our study setting. Objective: The aim of this study is to determine the prevalence of Methicillin-resistant Staphylococcus aureus its antimicrobial resistance patterns and associated factors among elementary school children in Chiro town, Ethiopia, from March 15 to June 30, 2024. Methods: A community-based cross-sectional study was conducted. Nasal swabs were collected using sterile cotton swabs and transported in labeled Tryptose soya broth. Samples were inoculated onto Mannitol salt agar and blood agar, and then incubated at 37°C for 24 hours. Isolates were identified using standard microbiological methods. Antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. Cefoxitin-resistant strains were confirmed as MRSA. Data were entered into EPI-Info version 7 and analyzed using SPSS version 20. Logistic regression identified factors associated with MRSA colonization, with statistical significance set at p < 0.05. Results: A total of 793 primary school children participated, with a male majority (54%) and most aged 10-15 years (52%). The prevalence of nasal Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus colonization was 16.9% and 2.27%, respectively. S. aureus colonization was significantly associated with age >15 years, larger classroom size, and hospitalization history. MRSA colonization was significantly linked to recent antibiotic use and hospitalization. S. aureus showed high resistance to Penicillin (91.8%) and Tetracycline (83.5%), while Ciprofloxacin and Chloramphenicol were fully effective. All MRSA isolates were Cefoxitin-resistant, with high resistance to Penicillin and Tetracycline but susceptibility to Ciprofloxacin and Chloramphenicol. Conclusion and Recommendation: Nasal Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus colonization were prevalent among school children, with significant associations with age, classroom size, hospitalization, and antibiotic use. High antibiotic resistance was observed. Strengthening hospital infection control, reducing classroom overcrowding, and improving student-to-teacher ratios are essential. Reinforcing antibiotic stewardship programs will help curb resistance. Future studies should focus on molecular characterization of Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus , and explore environmental and animal reservoirs using a One Health approach to understand transmission dynamics. Biological sciences/Genetics Biological sciences/Immunology Earth and environmental sciences/Environmental sciences Health sciences/Medical research Methicillin-resistant Staphylococcus aureus Nasal carriage School children Figures Figure 1 Figure 2 Introduction Staphylococcus aureus ( S. aureus ) is a Gram-positive, catalase-positive, and coagulase-positive bacterium that is commonly found on the skin and in the nose of most healthy individuals (Banu, Sarbesa et al. 2023). It is also a frequent cause of clinically important infections ranging in severity from superficial skin and soft tissue abscesses to invasive diseases (Linz, Mattappallil et al. 2023). S. aureus is a commensal microorganism that can be found in healthy people. Its carriage in healthy children is a major asymptomatic reservoir for community-acquired MRSA (Zajmi, Shiranee et al. 2022). The hand carriage and nasal carriage of S. aureus are strongly correlated, suggesting that contaminated hands most commonly cause the colonization of nares (Wolde, Mitiku et al. 2023). Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for difficult-to-treat infections in humans. Methicillin is a β-lactam antibiotic that was invented to treat penicillin-resistant S. aureus (Nandhini, Kumar et al. 2022). Nasal carriage of MRSA has been proven to be a significant risk factor for community as well as nosocomial infections at all age groups (Abdullahi, Lozano et al. 2021). It exhibits increasing virulence and resistance to various antibiotics, complicating prevention and treatment of infections (Qin, Xiao et al. 2022). Methicillin resistance is mediated by penicillin-binding protein (PBP) 2a. PBP encoded by mecA gene that permits the organism to grow in the presence of methicillin and other β-lactam antibiotics (Fergestad, Stamsås et al. 2020, Fisher and Mobashery 2020 ). Approximately 20% of individuals are persistently nasal carriers of S. aureus and 30% are intermittently colonized. The nose appears to be the primary reservoir for replication and spread to other body areas (González-García, Hamdan-Partida et al. 2021). Prolonged hospitalization, antibiotics exposure, and the presence of other patients with MRSA colonization or infection in the hospital are the major risk factors for acquiring MRSA infections (Mao, Peng et al. 2019). The rapid emergence and spread of MRSA has raised considerable public health concern in both developed and developing countries. Within the past 20 years, MRSA has been an important cause of nosocomial infections worldwide (Gajdács 2019 ). In Europe S. aureus and MRSA remains a public health priority in the hospital and community settings (Jurke, Daniels-Haardt et al. 2021). A community based study in Serbia showed that the prevalence of S. aureus nasal carriage rate was 2.59% among studied school children (Dinić, Vuković et al. 2013). In Brazil, 6.2% colonized with MRSA (Neto, Guerrero et al. 2020). Studies also showed that prevalence of S. aureus nasal carriage was 2.4% in china (He, Lin et al. 2021) and 25% in India of the examined school children (Ghia, Waghela et al. 2020). In Africa, S. aureus is a major human pathogen that causes a wide range of clinical infections. A study in primary school children in Nigeria showed that the prevalence of S. aureus nasal carriage rate is 18.3% among them 10.8% were methicillin resistance S. aureus (Kouhsari, Hosseini et al. 2020). Also a study in Ghana showed 22.1% and 1.6% children colonized with S. aureus and methicillin resistance S. aureus respectively (Kotey, Awugah et al. 2022). Children are important reservoirs of MRSA and play a central role in disseminating MRSA in the community and hospital settings (Barcudi, Sosa et al. 2020). Increased colonization with Staphylococcus aureus may be an important factor in the emergence and spread of MRSA as a pathogen in healthy children (Chen, Kuo et al. 2019). MRSA is characterized by acquiring resistance to several groups of other drugs that result in longer hospital stays and increased cost of treatment (Vestergaard, Frees et al. 2019). A study in Ethiopia found that the prevalence of nasal carriage of S. aureus was 22.5% among elementary school children. The study also found that children who were nasal carriers of S. aureus were more likely to have a history of skin infections (Beyene, Mamo et al. 2019). This high prevalence of nasal carriage of S. aureus among children in Ethiopia is a concern, as it is a risk factor for developing MRSA infections. More research is needed to identify the risk factors for nasal carriage of S. aureus and to develop effective strategies for preventing and treating MRSA infections. Information concerning nasal carriage rate of S. aurues and MRSA with associated risk factors in elementary school children in Ethiopia is limited leading to a scarcity of accurate and reliable data. Therefore, this study aims to determine the prevalence of MRSA and its antimicrobial resistance pattern among elementary school children in Chiro town, Ethiopia. Materials and Methods Study area and period The study was conducted on five governmental Elementary Schools in Chiro town, which is the capital city of west hararghae, located 325 Km east of Addis Ababa, the capital city of Ethiopia. Children aged less than 19 years in 2021 in the district was 21, 030 (Zonal health office). The town has latitude and longitude 9o 05N 40o 52E with an elevation of 1826 meters above sea level. It has two Kebeles with a projected population of 69,793 (44) (CSA, 2018). The town has 19 elementary schools with 15,433 total students in 2022 (Zonal berue of education). The study was conducted from March 15 to June 30, 2024. Study design A Community-based cross sectional study was conducted Populations Source population All primary school children of Chiro town were the source population Study subjects Children from selected primary schools who were present during the study period Eligibility criteria Inclusion criteria All selected elementary school children who were agreed to give socio-demographic information and nasal swab sample were included. Exclusion criteria A student who was unable to give nasal swab specimen, currently on antibiotic therapy and had recent history of treatment at the time of data collection was excluded. Those who were above 15 years old during the data collection Sample size determination and sampling technique Sample size The sample size was determined using the single proportion formula. Considering, Zα/2 = Standard normal distribution corresponding to 95% confidence, d = desired level of precision/marginal error (5%), P = Proportion in the target population to have nasal carriage of MRSA 41% (Vestergaard, Frees et al. 2019). According to the formula the calculated sample size is 372. After adding 10% non-response rate and using a design effect of 2 which is allowed for multistage sampling, the final calculated sample size was 818 elementary school children. Sampling technique A multistage sampling technique was used to select schools by using simple random sampling technique (lottery method) and stratifying the school to grades and the number of study participants were then allocated proportionally to each grades based on the school sampling frame and the study subjects were selected by simple random sampling technique (lottery method). Data and sample collection procedures Data collection instruments Data was collected by face to face interviews using structured questionnaire, prepared in English, translated in to Amharic and Afan Oromo then translated back into English to check the accuracy of translation. The questionnaire based on postulated or known risk factors was developed and modified to explore the objectives of the study among schools that were not included the actual study area. The questionnaire contains two parts: on the first part socio- demographic variables like : relationship of the respondent to the child, sex of respondent, marital status, educational status of mother or caregivers, occupation of the respondent, sex of child, total number of under-five children, age of the child, family size, birth order and family income, while the second part contains, possible risk factors associated with the prevalence of MRSA which was developed from different kinds of literature (Okwu, Bamgbala et al. 2012, Kejela and Bacha 2013 , Tigabu, Tiruneh et al. 2018) Data collectors Data was collected by four trained nurses who have diploma and ample of experiences. Two Medical Microbiologists had supervised the activities of data collectors. The training was provided to both data collectors and supervisors by the principal investigator for five days (two day theoretical and three day practical) on the data collection tools and procedure before the actual data and sample collection had started. Nasal swab specimen collection Appropriate nasal swab specimens were collected by laboratory technologist and a sterile swab for each individual will be used to collect nasal swabs from both anterior nares. Sterility of cotton swabs, test tubes, culture plates and other important equipment‘s was done by autoclaving them at 121°C for 15 minutes. Contamination was avoided by using proper aseptic techniques; wearing clean lab coats and washing hands and then samples were collected by inserting the swab and gently rotating three to four times by using a sterile cotton swab pre-wetted with sterile saline in both anterior nares of the participants after obtaining oral and written informed consent. The nasal swabs were inoculated in a properly labeled sterile Tryptose soya broth (Oxoid Ltd. England) and transported by using ice boxes to keep the cold chain until it reaches to the Haramaya University, College of Health Sciences Microbiology laboratory. Laboratory identification procedures Each nasal sample was inoculated (in duplicates) onto Manitol salt agar (Oxoid Ltd. England) and blood agar (Oxoid Ltd. England) and the plates were incubated aerobically at 37 o C for 24h. The characteristic of isolates were identified using standard microbiological methods which includes colonial morphology (golden yellow colony and beta hemolysis), Gram‘s stain reaction (Gram positive cocci in clusters). Biochemical tests such as catalase (Catalase acts as a catalyst in the breakdown of hydrogen peroxide to oxygen and water then bubbles of oxygen was released if the bacteria is a catalase producers) and coagulase (Coagulase causes plasma to clot by converting fibrinogen to fibrin then clumping of fresh plasma was formed if the bacteria is coagulase producers). Isolates that were golden yellow colony on Manitol salt agar plate, beta hemolytic on blood agar pate, Gram-positive cocci in clusters, showing active bubbling on hydrogen peroxide reagent (catalase positive), clumping of fresh plasma (coagulase positive) and fermenting Manitol were considered as S. aureus . Antimicrobial susceptibility testing Suspension of confirmed isolates was prepared using nutrient broth and incubated at 37 o C for at least 30 minutes and the turbidity was adjusted to match that of 0.5 McFarland standards to obtain approximately the organism number of 1 × 10 6 colony forming units (CFU) per ml. Using sterile cotton applicator stick, the suspension was distributed on Muller Hinton agar (Oxoid Ltd. England). As per Clinical Laboratory Standards Institute (CLSI, 2022) guideline, Modified Kirby-Bauer disk diffusion technique was used for antibiotic susceptibility pattern of Staphylococcus aureus using different antibiotics such as Cefoxitin discs (30 µg), penicillin (10 µg), ampicillin (10 µg), erythromycin (15 µg), cotrimoxazol (25 µg), chloramphenicol (30 µg), gentamycin (10 µg), kanamycin (30 µg), amikacin (30 µg), ciprofloxacin (5 µg), tetracycline (30 µg), and clindamycin (2 µg) (Oxoid Ltd. UK). After applying antibiotics on Mueller Hinton agar the plates were incubated for 24 h at 37°C. The zones of inhibition was measured by a caliper/Ruler/. Finally the results were interpreted as Susceptible, Intermediate and Resistant using CLSI 2022 Performance Standards for antimicrobial susceptibility testing interpretation table. Test for MRSA S. aureus isolates were tested for methicillin susceptibility patterns by using modified Kirby- Bauer disc diffusion technique. Broth suspension of confirmed isolates were done using nutrient broth and inoculum was adjusted at 0.5% McFarland standard and each streaked uniformly with swab sticks on Mueller-Hinton agar plates. Cefoxitin (30µg) discs were placed in the plates which were then incubated at 37 0 C for 24h. A zone diameter of the isolates was measured in millimeters with a ruler or caliper. All isolates ≤ 24 mm of cefoxitin, were considered as MRSA (CLSI 2022). Variables Dependent variables Methicillin resistance Staphylococcus aureus Independent variables Age, Sex, Grade level, Place of residence, Mothers educational status, Fathers educational status, Family Income, Family Size, History of Chronic disease, History of Hospitalization, History of Surgery, History of Hospitals/Clinics visits, History contact with health care worker, Antibiotic use in the past three weeks, proper adherence of antibiotic therapy, history of respiratory infection, number of children in class room. Operational definition MRSA: - A type of staphylococcus aureus strains resistant to the antibiotic methicillin (48). Children: - A person 15 years or younger age Quality control Data Quality control The questionnaire was pre-tested before the actual study begins to make sure that whether the questionnaire is appropriate and understandable on school children other than the actual study area. The collected data was checked daily for consistency and accuracy. Investigators were also followed appropriate data collection process. The collected data was checked daily for consistency and accuracy. Data collectors were trained and Investigators were followed the appropriate data collection process. Besides, the study participants were orientated about the purpose and usefulness of the study and thereby creating a friendly atmosphere. Laboratory quality control To avoid false positives, gloves and surgical masks were put on to avoid contamination of the samples by the sample collector perhaps her/himself resistant carrier. All samples were cultured immediately after collection. With rejection criteria applied to those which was deemed unfit for processing, such as mislabeled or contaminated specimen. Five percent (5%) of the prepared culture media were randomly selected and incubated for 24h at 35 0 C-37 0 C to cheek the sterility of the prepared culture media and also known strains of staphylococcus aureus (ATCC 25923) was inoculated to the prepared culture media to cheek the performance of the prepared culture media as positive control for Gram stain, catalase, coagulase and antibiotic susceptibility test as well as Escherichia coli (ATCC 25922 ) was also used as negative control Data processing and analysis Data was entered using Epi-Data (version 3.1). Its completeness and clearance was checked and then transferred to SPSS (version 20) package for analysis. The characteristics of the study population were summarized using descriptive statistics, frequency and percentage. Internal comparison were made using binary logistic regression to determine the independent effect of the variables by calculating the strength of the association between nasal carriage rate of MRSA and associated risk factors using odds ratio and 95% confidence interval. Adjusted odds ratio was computed using multivariable logistic regression to control the effect of confounding variables. P-value less than 0.05 were considered statistically significant. Results Sociodemographic characteristics of the participants A total of 793 elementary school children were included in the study with 96.93% response rate; of these, The majority of participants were males (54%), age ranged from 6 to 22 years with a mean of 11.1 years (SD + 2.86 ) with majority were between 10–15 years (52%), in grades 5–8 (52.5%), Higher proportions (58%) of participants were from families earning below 5000, A slightly larger proportion (56%) of participants came from households with 2–5 members, Most students (75%) were in classrooms with 41–65 students, whereas Only 12% of participants reported a history of hospitalization, 19% of participants had used antibiotics in the past two weeks, The largest group (44%) had mothers with secondary-level education, while (38%) had fathers with secondary education, and 20% of fathers were illiterate (Table 1 ). Table 1 Sociodemographic characteristics of participants Variable Characteristics n(%) Sex Male 428(54) Female 365(46) Age 6–10 317(40) 10–15 412(52) > 15 64(8) Educational status Grade 1–4 377(47.5) Grade 5–8 416(52.5) Family monthly income > 5000 333(42) 5 349(44) Number of students in the class room 25–40 143(18) 41–65 595(75) > 66 55(7) History of Hospitalization Yes 95(12) No 698(88) History of Antibiotic usage in the past two weeks Yes 151(19) No 642(81) Mothers Educational status Illiterate 177(22) Primary 211(27) Secondary 349(44) College 56(7) Fathers Educational status Illiterate 158(20) Primary school 262(33) Secondary school 301(38) College graduate 71(9) Prevalence of Nasal S. aureus and MRSA Colonization The overall prevalence of S. aureus and MRSA in this study was 134/793; 16.9 (95% CI: 14.3, 19.5) and 18/793; 2.27% (95% CI: 1.23, 3.31) respectively. Factors Associated with S. aureus Colonization Female participants had slightly lower odds of S. aureus colonization compared to males (OR = 0.91, 95% CI: 0.63–1.31), but the association was not statistically significant (p = 0.618). Individuals aged > 15 years had significantly higher odds of S. aureus colonization (OR = 7.38, 95% CI: 2.87–18.99, p < 0.001) compared to children aged 6–10 years. The odds of colonization for those aged 10–15 years were not significant (OR = 1.20, 95% CI: 0.49–2.97, p = 0.683). Participants from households with more than five members had significantly lower odds of S. aureus colonization (OR = 0.50, 95% CI: 0.34–0.75, p = 0.001) compared to those with smaller household sizes. Participants in grades 5–8 had lower odds of S. aureus colonization compared to those in grades 1–4, but the difference was not statistically significant (OR = 0.76, 95% CI: 0.50–1.14, p = 0.180). Those with a monthly income of < 5000 had slightly higher odds of S. aureus colonization (OR = 1.22, 95% CI: 0.83–1.80, p = 0.307), though this association was not significant. A significantly higher odds of S. aureus colonization was observed among students in classrooms with > 66 students (OR = 5.39, 95% CI: 2.65–10.96, p < 0.001) compared to those in classrooms with 25–40 students. Participants with a history of hospitalization had significantly higher odds of S. aureus colonization (OR = 5.85, 95% CI: 3.73–9.17, p < 0.001). Individuals who had used antibiotics in the past two weeks had marginally higher odds of S. aureus colonization (OR = 1.57, 95% CI: 1.00–2.45), with borderline statistical significance (p = 0.051) (Table 2 ). Table 2 Factors associated with the nasal colonization of S. aureus and MRSA Variable Characteristics S.aureus status OR(95%CI) P-value MRSA status OR(95%CI) P-value +ve -ve +ve -ve Sex Male 65 363 1 0.181 7 58 1 0.811 Female 69 296 0.77 (0.53, 1.12) 11 58 0.86 (0.34, 2.18) Age 6–10 (ref) 7 310 1 0.0001 0 7 1 0.588 10–15 87 325 0.087 (0.041, 0.187) 13 74 0.38 (0.02, 7.01) > 15 40 24 0.015 (0.006, 0.035) 0.0001 5 35 0.43 (0.02, 8.65) 1.000 Family size category 2–5(ref) 91 353 1 0.002 15 76 1 0.178 > 5 43 306 1.82 (1.23, 2.70) 3 40 2.34 (0.69, 7.95) Educational status Grade 1–4 (ref) 73 304 1 0.180 9 64 1 0.661 Grade 5–8 61 355 0.76 (0.50–1.14) 9 52 0.80 (0.29–2.18) Family monthly income > 5000(ref) 51 282 1 0.337 10 41 1 0.121 66 29 26 2.74 (1.39, 5.41) 0.004 4 25 1.26 (0.32, 4.96) 0.741 History of Hospitalization Yes 44 51 5.81 (3.68, 9.18) 0.0001 9 35 2.3 (0.86, 6.13) 0.111 No (ref) 90 608 1 9 81 1 History of Antibiotic usage in the past two weeks Yes 34 117 1.58 (1.03, 2.45) 0.053 10 24 4.66 (1.70, 12.78) 0.003 No 100 542 1 8 92 1 Factors Associated with MRSA Colonization The odds of MRSA colonization were higher among females than males (OR = 1.26, 95% CI: 0.46–3.44), though the association was not statistically significant (p = 0.644). Participants aged > 15 years had higher odds of MRSA colonization (OR = 5.00, 95% CI: 0.50–49.95), but this association was not significant (p = 0.175). Individuals from larger households (> 5 members) had lower odds of MRSA colonization (OR = 0.30, 95% CI: 0.08–1.10, p = 0.068), though this association did not reach statistical significance. There was no significant difference in MRSA colonization between students in grades 1–4 and those in grades 5–8 (OR = 0.80, 95% CI: 0.29–2.18, p = 0.661). Participants from lower-income families had lower odds of MRSA colonization (OR = 0.54, 95% CI: 0.21–1.39), though this association was not statistically significant (p = 0.202). No significant association was found between classroom size and MRSA colonization. Those with a history of hospitalization had significantly higher odds of MRSA colonization (OR = 2.87, 95% CI: 1.14–7.26, p = 0.025). Participants who had used antibiotics in the past two weeks had significantly higher odds of MRSA colonization (OR = 4.79, 95% CI: 1.85–12.40, p = 0.001) (Table 2 ). Drug susceptibility patterns of S . aureus and MRSA S. aureus Susceptibility Patterns Penicillin showed the highest resistance (91.8%), followed by Tetracycline (83.5%). Erythromycin had a resistance rate of 26.9%, with an additional 22.4% showing intermediate. Clindamycin (3.7%), Gentamicin (5.2%), and TMP/SMX (5.9%) had low resistance rates Whereas Ciprofloxacin and Chloramphenicol were 100% sensitive (Fig. 1). MRSA Susceptibility Patterns All MRSA isolates (100%) were resistant to Cefoxitin, confirming methicillin resistance. Penicillin (100%), Tetracycline (94.4%), and Erythromycin (33%) had the highest resistance rates. TMP/SMX (83.3%), Gentamicin (83.4%), and Chloramphenicol (94.4%) remained effective Whereas, Ciprofloxacin (95%) and Chloramphenicol (94.4%) had the highest susceptibility rates (Fig. 2). Discussion The study reports an overall prevalence of S. aureus colonization among elementary school children was 16.9% (134 out of 793; 95% CI: 14.3–19.5). This finding was in line with a cross-sectional study in Guangzhou, China (14.5%)(Lin, Zhang et al. 2018). These findings highlight the importance of monitoring S. aureus colonization in school settings to implement appropriate infection control measures. Similarly, the present study also reported an overall prevalence of MRSA colonization at 2.27% (18 out of 793; 95% CI: 1.23–3.31). This result was consistent with findings from a meta-analysis that reported MRSA colonization rates among healthy children ranging from 0.2–7.3% (Al-Iede, Ayyad et al. 2024). But smaller than a research conducted in Debre Markos town which reported a nasal MRSA colonization rate of 29.5% (Reta, Wubie et al. 2017). The prevalence rates observed in this study underscore the importance of monitoring S. aureus and MRSA colonization among school-aged children. Early detection and preventive measures are crucial to mitigate potential outbreaks and ensure the health and safety of students. A large European study involving over 32,000 non-hospitalized patients found that males were more likely than females to be carriers of S. aureus , with an odds ratio (OR) of 1.38 (95% CI: 1.31–1.46). In contrast, our findings indicated that female participants had slightly lower odds of S. aureus colonization compared to males (OR = 0.91), but this association was not statistically significant (p = 0.618)(Humphreys, Fitzpatick et al. 2015). Aligning with our findings, other studies have found no significant association between gender and S. aureus colonization (Patel, Weinheimer et al. 2008); However, The reasons for this disparity are not fully understood. These inconsistencies suggest that factors beyond gender, such as hormonal influences, immune responses, and behavioral differences, may play roles in S. aureus colonization. The observed finding that individuals aged over 15 years have significantly higher odds of S. aureus colonization (OR = 7.38, p < 0.001). this finding was in contrast with the study from Germany which reported 50% nasopharyngeal colonization rates of S. aureus in subjects aged 5–10 years, indicating higher colonization in younger age groups (Deinhardt-Emmer, Sachse et al. 2018). The study’s finding was also in contrary with another study involving school-age children reported a mean age of 9.5 years among participants, with 4.6% identified as carriers of S. aureus (Woods, Beiter et al. 2011). However, this study did not find a significant association between age and colonization rates within the elementary school population. These discrepancies suggest that factors beyond age, such as regional differences, environmental exposures, and population-specific characteristics, may influence colonization rates. The finding that participants from households with more than five members had significantly lower odds of S. aureus colonization (OR = 0.50, p = 0.001) contrasts with several studies suggesting higher transmission rates in larger households. For instance, a study analyzing 321 households found that larger household size was significantly associated with S. aureus colonization; households with colonization had an average of 3.7 members, compared to 2.2 members in non-colonized households (p < 0.001) (Miller, Cook et al. 2009). Therefore, while larger household size is often linked to increase S. aureus transmission, this relationship is not uniform across all settings. Other contextual factors, such as hygiene practices and socioeconomic conditions, play crucial roles in determining colonization rates. Additionally, households with higher income levels may have better access to healthcare resources, potentially reducing colonization risks (Rodriguez, Hogan et al. 2013). The observation that participants in grades 5–8 had lower odds of S. aureus colonization compared to those in grades 1–4, though not statistically significant (OR = 0.76, p = 0.18), aligns with studies indicating no clear association between educational attainment and S. aureus colonization. For instance, a study examining the relationship between educational achievement and asymptomatic S. aureus colonization in a predominantly Hispanic border community found no significant association between education level and colonization rates (Barger, Lininger et al. 2020). The finding that participants with a monthly income of less than 5,000 had slightly higher odds of S. aureus colonization (OR = 1.22, 95% CI: 0.83–1.80, p = 0.307), though not statistically significant, aligns with some studies indicating a potential association between lower socioeconomic status (SES) and increased S. aureus colonization. For example, a study comparing children from different SES communities found that those from middle/low SES backgrounds had higher colonization frequencies of S. aureus compared to their higher SES counterparts. Additionally, research has shown that socioeconomic factors, such as lower family income, can influence the success of decolonization treatments among individuals diagnosed with MRSA. These findings suggest that socioeconomic factors may play a role in S. aureus colonization and treatment outcomes, although further research is needed to fully understand these associations (Chun, Madigan et al. 2020, Kristensen, Abrantes et al. 2023). The observation that students in classrooms with more than 66 students had significantly higher odds of S. aureus colonization (OR = 5.39, p < 0.001) aligns with existing research indicating that crowded environments can facilitate the transmission of S. aureus . A study examining S. aureus colonization and transmission in schools found that environmental contamination, particularly on frequently touched surfaces, plays a significant role in the spread of S. aureus among students (Lin, Zhang et al. 2018). Larger classroom sizes may lead to increased contact among students and shared surfaces, thereby elevating the risk of colonization. This underscores the importance of implementing infection control measures, such as regular cleaning and promoting hand hygiene, especially in overcrowded educational settings. The finding that participants with a history of hospitalization had significantly higher odds of S. aureus and MRSA colonization (OR = 5.85, p < 0.001) is consistent with existing research. Hospitalized individuals are at increased risk for S. aureus colonization and infection due to factors such as invasive procedures, the presence of medical devices, and exposure to antibiotic-resistant strains like MRSA . A study on the epidemiology of S. aureus indicates that patients undergoing hemodialysis, those with surgical wounds, and individuals with compromised immune systems are particularly susceptible to colonization and subsequent infection (Ondusko and Nolt 2018 ).This underscores the importance of stringent infection control measures and surveillance in healthcare settings to mitigate the risk of S. aureus and MRSA transmission among hospitalized patients. ​The observation that individuals who had used antibiotics in the past two weeks had marginally higher odds of S. aureus and MRSA colonization (OR = 1.57, p = 0.051) aligns with findings from in a Veterans Affairs Medical Center which found that recent antibiotic use was a significant predictor of MRSA colonization, with an adjusted odds ratio of 4.8 (95% CI, 1.9–12.2; p = 0.001) (Patel, Weinheimer et al. 2008). Similarly, a systematic review and meta-analysis identified recent antibiotic use as a significant risk factor for MRSA colonization in pediatric populations (Al-Iede, Ayyad et al. 2024). These findings suggest that recent antibiotic use may disrupt normal flora, potentially facilitating S. aureus colonization. However, some studies have reported contrasting results; for example, a study on acne patients found that oral antibiotic use was associated with a lower prevalence of S. aureus colonization (prevalence odds ratio = 0.16; 95% CI, 0.08–1.37). These discrepancies highlight the need for further research to clarify the relationship between recent antibiotic use and S. aureus colonization (Fanelli, Kupperman et al. 2011). Regarding the resistance patterns of S. aureus in this study, Penicillin showed the highest resistance (91.8%), followed by Tetracycline (83.5%). This finding was in line with results from Ghana (95%) (Eibach, Nagel et al. 2017) and Jimma (100%) (Kejela and Bacha 2013 ). Similarly, MRSA isolates showed 100% resistance to penicillin and cefoxitin. This result was similar to a study conducted in Nigeria (100%) (Okwu, Bamgbala et al. 2012) and Gondar (100%) (Tigabu, Tiruneh et al. 2018). The high resistance to penicillin can be largely attributed to the widespread production of penicillinase by S. aureus , an enzyme that inactivates penicillin by hydrolyzing its beta-lactam ring, rendering this antibiotic largely ineffective for treatment (Lowy 1998 ). Similarly, tetracycline resistance is frequently mediated by the acquisition of tet genes that encode efflux pumps and ribosomal protection proteins, mechanisms that have been extensively documented and are linked to the overuse of tetracycline in both clinical and agricultural settings (Chopra and Roberts 2001 ). These high resistance rates underscore the impact of inappropriate antibiotic use and the consequent horizontal transfer of resistance determinants within bacterial populations, emphasizing the urgent need for improved antibiotic stewardship and alternative therapeutic strategies. Like studies from Jordan (Alzoubi, Aqel et al. 2014) and Bahir Dar (Reta, Gedefaw et al. 2015) in the present study, majority of the isolates show low resistance rates for Clindamycin (3.7%), Gentamicin (5.2%), and TMP/SMX (5.9%). These low resistance rates may be attributable to judicious antibiotic use, effective antimicrobial stewardship practices, and limited selective pressure that minimizes the dissemination of resistance-conferring genes. Continued surveillance is essential to ensure that these antibiotics remain effective for the management of S. aureus infections. In studies from Australia (Afzal, Vijay et al. 2021) and Kenya (Gitau, Masika et al. 2018) even though chloramphenicol and Ciprofloxacin remains effective against many strains, resistance is still present. But, in our study all s. aureus isolates were 100% sensitive Ciprofloxacin and Chloramphenicol. Full Susceptibility observed in within our sample population, could be attributed to factors such as limited prior exposure to these antibiotics, effective antimicrobial stewardship practices, or regional variations in resistance patterns. Conclusion In this study, the overall prevalence of S. aureus was 16.9% (95% CI: 14.3, 19.5), while MRSA colonization was 2.27% (95% CI: 1.23, 3.31%). Several sociodemographic and environmental factors influenced S. aureus colonization, with significantly higher odds observed among older students (> 15 years), those from smaller households, students in overcrowded classrooms (> 66 students), and those with a history of hospitalization. Similarly, MRSA colonization was significantly associated with a history of hospitalization and recent antibiotic use. Antimicrobial susceptibility testing revealed alarmingly high resistance rates to Penicillin (91.8%) and Tetracycline (83.5%) among S. aureus isolates, whereas Ciprofloxacin and Chloramphenicol showed 100% sensitivity. All MRSA isolates exhibited resistance to Cefoxitin, confirming methicillin resistance, and demonstrated high resistance to Penicillin, Tetracycline, and Erythromycin. However, Ciprofloxacin and Chloramphenicol remained highly effective against MRSA . Recommendation Healthcare institutions should strengthen hospital-based infection control strategies, particularly for individuals with a history of hospitalization. Schools and education authorities should implement strategies to reduce classroom overcrowding, as larger class sizes were significantly associated with S. aureus colonization. Policy-level interventions are needed to improve the student-to-teacher ratio and overall learning environment. Antibiotic stewardship programs should be reinforced to promote the appropriate use of antibiotics and prevent the development of resistance. Furthermore, Future studies should focus on the molecular characterization of S. aureus and MRSA strains to understand resistance mechanisms and transmission dynamics. Investigating environmental and animal reservoirs using a One Health approach will provide a broader understanding of S. aureus circulation. Declarations Ethical considerations The study was conducted after obtaining Institutional Research Ethics Review Committee (IRERC) of Oda Bultum University. Permission was also sought from directors of participating primary schools prior to sample and data collection. The participants were informed about the objectives of the study and their Participation was on voluntarily basis and participants have the right to withdraw him/her at any point from the study. A verbal consent from study participants and assent for parents/guardians of children were obtained from all study participants involved in the study. All the laboratory examinations of nasal swab were done free from charge and confirmed positives were given appropriate information to prevent further infection. Collected specimens were used only for the study objectives and participants were participated only once. Information obtained at any course of the study was kept confidential. Confidentiality was maintained by numeric coding of specimens and questionnaires. Consent for publication Not applicable. Availability of data and materials The data sets generated during and/or analyzed during the current study are available from the corresponding authors upon reasonable request. Conflict of interest The author declares no conflict of interest. Funding statement This research was funded by the Oda Bultum University Authors’ contributions WWE designed the study, participated in data collection, analysis, interpretation, and write-up, drafted, and critically revised of the manuscript. EZ, KT and ADD participated in the review proposal, data analysis, interpretation, and write-up, and critically revised the manuscript. All authors read and approved the final manuscript. Acknowledgements We would like to thank and appreciate the Oda Bultum University for funding this study and our appreciation also goes to the chiro branch central statistics agency as well as the Zonal Bureau of Education for their corporation in providing all available demographic data. References Abdullahi, I. N., et al. (2021). 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"Multidrug-resistant Staphylococcus aureus nasal carriage among HIV-positive outpatients in Guangzhou, China: Prevalence, risk factors, phenotypic and molecular characteristics." Journal of Infection and Chemotherapy 27 (2): 218-225. Humphreys, H., et al. (2015). "Gender differences in rates of carriage and bloodstream infection caused by methicillin-resistant Staphylococcus aureus: are they real, do they matter and why?" Clinical infectious diseases 61 (11): 1708-1714. Jurke, A., et al. (2021). "Changing Epidemiology of Methicillin-Resistant Staphylococcus aureus in 42 Hospitals in the Dutch-German Border Region, 2012 to 2016." NEW INSTRUMENT : 175. Kejela, T. and K. Bacha (2013). "Prevalence and antibiotic susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) among primary school children and prisoners in Jimma Town, Southwest Ethiopia." Annals of clinical microbiology and antimicrobials 12 : 1-11. Kotey, F. C., et al. (2022). "High prevalence of methicillin-resistant Staphylococcus aureus carriage among infants at the Children’s Hospital, Accra, Ghana." The Journal of Infection in Developing Countries 16 (09): 1450-1457. Kouhsari, E., et al. (2020). "Molecular Characterizations, Virulence Determinants and Antimicrobial Resistance Profiles of Methicillin-Resistant Staphylococcus aureus (MRSA) in the North of Iran." Kristensen, M. A., et al. (2023). "The association between socioeconomic factors and the success of decolonization treatment among individuals diagnosed with methicillin-resistant Staphylococcus aureus: a cohort study from 2007 to 2020." Infection Control & Hospital Epidemiology 44 (10): 1620-1628. Lin, J., et al. (2018). "School environmental contamination of methicillin-sensitive Staphylococcus aureus as an independent risk factor for nasal colonization in schoolchildren: An observational, cross-sectional study." PloS one 13 (11): e0208183. Linz, M. S., et al. (2023). "Clinical impact of Staphylococcus aureus skin and soft tissue infections." Antibiotics 12 (3): 557. Lowy, F. D. (1998). "Staphylococcus aureus infections." New England journal of medicine 339 (8): 520-532. Mao, P., et al. (2019). "Risk factors and clinical outcomes of hospital-acquired MRSA infections in Chongqing, China." Infection and drug resistance : 3709-3717. Miller, M., et al. (2009). "Staphylococcus aureus in the community: colonization versus infection." PloS one 4 (8): e6708. Nandhini, P., et al. (2022). "Recent developments in methicillin-resistant Staphylococcus aureus (MRSA) treatment: a review." Antibiotics 11 (5): 606. Neto, E. D. A., et al. (2020). "Genotypic distribution of Staphylococcus aureus colonizing children and adolescents in daycare centers, an outpatient clinic, and hospitals in a major Brazilian urban setting." Diagnostic Microbiology and Infectious Disease 97 (3): 115058. Okwu, M., et al. (2012). "Prevalence of nasal carriage of community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) among healthy primary school children in Okada, Nigeria." Prevalence 2 (4): 2224-3186. Ondusko, D. S. and D. Nolt (2018). "Staphylococcus aureus." Pediatrics in review 39 (6): 287-298. Patel, M., et al. (2008). "Active surveillance to determine the impact of methicillin-resistant Staphylococcus aureus colonization on patients in intensive care units of a Veterans Affairs Medical Center." Infection Control & Hospital Epidemiology 29 (6): 503-509. Qin, S., et al. (2022). "Pseudomonas aeruginosa: pathogenesis, virulence factors, antibiotic resistance, interaction with host, technology advances and emerging therapeutics." Signal transduction and targeted therapy 7 (1): 199. Reta, A., et al. (2015). "Nasal carriage, risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus among school children in Ethiopia." J Med Microb Diagn 4 (1): 1-6. Reta, A., et al. (2017). "Nasal colonization and antimicrobial susceptibility pattern of Staphylococcus aureus among pre-school children in Ethiopia." BMC research notes 10 : 1-7. Rodriguez, M., et al. (2013). "Measurement and impact of Staphylococcus aureus colonization pressure in households." Journal of the Pediatric Infectious Diseases Society 2 (2): 147-154. Tigabu, A., et al. (2018). "Nasal Carriage Rate, Antimicrobial Susceptibility Pattern, and Associated Factors of Staphylococcus aureus with Special Emphasis on MRSA among Urban and Rural Elementary School Children in Gondar, Northwest Ethiopia: A Comparative Cross‐Sectional Study." Advances in preventive medicine 2018 (1): 9364757. Vestergaard, M., et al. (2019). "Antibiotic resistance and the MRSA problem." Microbiology spectrum 7 (2): 10.1128/microbiolspec. gpp1123-0057-2018. Wolde, W., et al. (2023). "Nasal carriage rate of staphylococcus aureus, its associated factors, and antimicrobial susceptibility pattern among health care workers in public hospitals, Harar, Eastern Ethiopia." Infection and drug resistance : 3477-3486. Woods, S. E., et al. (2011). "The prevalence of asymptomatic methicillin-resistant Staphylococcus aureus in school-age children." Eastern Journal of Medicine 16 (1): 18. Zajmi, A., et al. (2022). Multidrug-Resistant Staphylococcus aureus as Coloniser in Healthy Individuals. Staphylococcal Infections-Recent Advances and Perspectives , IntechOpen. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6226496","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":429184866,"identity":"472475b6-a7cc-41af-9676-0b7c7258377a","order_by":0,"name":"Wondimagegn Wolde Eba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYJACiQQgwceQwHDgA5DBxk6sFjaGBMaHM0AMZmK0MEC0MBvzgFiEtBgc7z1442HOYTk29uRj0ja/tsnzMTMwfviYg0fLmXPJFonbDhuz8TxLk87tu23YxszALDlzG24tZjdyzCQSt91ObJPIMZPO7bnNCNTCxsxLnJb8b9KWPbftSdGSw2zM8APIIKTF/swZY6Bf/oP8Yviwt+F2chszYzNev0i29xje/LktTY6fPfnBgR9/btvOb28++OEjHi2ogLENTDYQqx4E/pCieBSMglEwCkYKAAAN6FGNkOAmwgAAAABJRU5ErkJggg==","orcid":"","institution":"Oda Bultum University","correspondingAuthor":true,"prefix":"","firstName":"Wondimagegn","middleName":"Wolde","lastName":"Eba","suffix":""},{"id":429184867,"identity":"20a618e1-49c4-47b5-b289-c36406a596ce","order_by":1,"name":"Ebisa Zerihun","email":"","orcid":"","institution":"Oda Bultum University","correspondingAuthor":false,"prefix":"","firstName":"Ebisa","middleName":"","lastName":"Zerihun","suffix":""},{"id":429184868,"identity":"3a7c8692-2305-4272-9931-56d21f2e64cd","order_by":2,"name":"Kaleab Terefe","email":"","orcid":"","institution":"Oda Bultum University","correspondingAuthor":false,"prefix":"","firstName":"Kaleab","middleName":"","lastName":"Terefe","suffix":""},{"id":429184870,"identity":"06c2d21b-ccec-4838-9f5e-d9e23f7058e7","order_by":3,"name":"Abel Desalegn Demeke","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Abel","middleName":"Desalegn","lastName":"Demeke","suffix":""}],"badges":[],"createdAt":"2025-03-14 12:53:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6226496/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6226496/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78734353,"identity":"c3367721-4d54-47be-9d34-af50d5c28c3f","added_by":"auto","created_at":"2025-03-18 07:59:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51270,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"figure1.AntimicrobalSusceptablitypatternsofS.aureus.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6226496/v1/5925bad511e2e6fd4c2963d1.jpg"},{"id":78734355,"identity":"6c60fd41-4e35-4b33-a970-6ff975231bc9","added_by":"auto","created_at":"2025-03-18 07:59:31","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36973,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure2.MDRMRSA.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6226496/v1/a16e76136fe72223c43a2549.jpg"},{"id":82205370,"identity":"8d0bef70-f7b3-4457-ad55-cd6828f3c982","added_by":"auto","created_at":"2025-05-07 17:16:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1300921,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6226496/v1/d8155470-b524-4547-9a4a-c0dd338c2e90.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nasal Methicillin-resistant Staphylococcus aureus Carriage, Its Multi-Drug Resistance Pattern and Associated Factors among Primary School Children At Chiro Town; Eastern Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (\u003cem\u003eS. aureus\u003c/em\u003e) is a Gram-positive, catalase-positive, and coagulase-positive bacterium that is commonly found on the skin and in the nose of most healthy individuals (Banu, Sarbesa et al. 2023). It is also a frequent cause of clinically important infections ranging in severity from superficial skin and soft tissue abscesses to invasive diseases (Linz, Mattappallil et al. 2023).\u003c/p\u003e \u003cp\u003e \u003cem\u003eS. aureus\u003c/em\u003e is a commensal microorganism that can be found in healthy people. Its carriage in healthy children is a major asymptomatic reservoir for community-acquired MRSA (Zajmi, Shiranee et al. 2022). The hand carriage and nasal carriage of \u003cem\u003eS. aureus\u003c/em\u003e are strongly correlated, suggesting that contaminated hands most commonly cause the colonization of nares (Wolde, Mitiku et al. 2023).\u003c/p\u003e \u003cp\u003eMethicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for difficult-to-treat infections in humans. Methicillin is a β-lactam antibiotic that was invented to treat penicillin-resistant S. aureus (Nandhini, Kumar et al. 2022). Nasal carriage of MRSA has been proven to be a significant risk factor for community as well as nosocomial infections at all age groups (Abdullahi, Lozano et al. 2021). It exhibits increasing virulence and resistance to various antibiotics, complicating prevention and treatment of infections (Qin, Xiao et al. 2022). Methicillin resistance is mediated by penicillin-binding protein (PBP) 2a. PBP encoded by mecA gene that permits the organism to grow in the presence of methicillin and other β-lactam antibiotics (Fergestad, Stams\u0026aring;s et al. 2020, Fisher and Mobashery \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eApproximately 20% of individuals are persistently nasal carriers of S. aureus and 30% are intermittently colonized. The nose appears to be the primary reservoir for replication and spread to other body areas (Gonz\u0026aacute;lez-Garc\u0026iacute;a, Hamdan-Partida et al. 2021). Prolonged hospitalization, antibiotics exposure, and the presence of other patients with \u003cem\u003eMRSA\u003c/em\u003e colonization or infection in the hospital are the major risk factors for acquiring \u003cem\u003eMRSA\u003c/em\u003e infections (Mao, Peng et al. 2019).\u003c/p\u003e \u003cp\u003eThe rapid emergence and spread of \u003cem\u003eMRSA\u003c/em\u003e has raised considerable public health concern in both developed and developing countries. Within the past 20 years, \u003cem\u003eMRSA\u003c/em\u003e has been an important cause of nosocomial infections worldwide (Gajd\u0026aacute;cs \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In Europe \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eMRSA\u003c/em\u003e remains a public health priority in the hospital and community settings (Jurke, Daniels-Haardt et al. 2021). A community based study in Serbia showed that the prevalence of \u003cem\u003eS. aureus\u003c/em\u003e nasal carriage rate was 2.59% among studied school children (Dinić, Vuković et al. 2013). In Brazil, 6.2% colonized with \u003cem\u003eMRSA\u003c/em\u003e (Neto, Guerrero et al. 2020). Studies also showed that prevalence of S. aureus nasal carriage was 2.4% in china (He, Lin et al. 2021) and 25% in India of the examined school children (Ghia, Waghela et al. 2020).\u003c/p\u003e \u003cp\u003eIn Africa, S. aureus is a major human pathogen that causes a wide range of clinical infections. A study in primary school children in Nigeria showed that the prevalence of S. aureus nasal carriage rate is 18.3% among them 10.8% were methicillin resistance S. aureus (Kouhsari, Hosseini et al. 2020). Also a study in Ghana showed 22.1% and 1.6% children colonized with S. aureus and methicillin resistance S. aureus respectively (Kotey, Awugah et al. 2022). Children are important reservoirs of \u003cem\u003eMRSA\u003c/em\u003e and play a central role in disseminating \u003cem\u003eMRSA\u003c/em\u003e in the community and hospital settings (Barcudi, Sosa et al. 2020). Increased colonization with Staphylococcus aureus may be an important factor in the emergence and spread of \u003cem\u003eMRSA\u003c/em\u003e as a pathogen in healthy children (Chen, Kuo et al. 2019). \u003cem\u003eMRSA\u003c/em\u003e is characterized by acquiring resistance to several groups of other drugs that result in longer hospital stays and increased cost of treatment (Vestergaard, Frees et al. 2019). A study in Ethiopia found that the prevalence of nasal carriage of S. aureus was 22.5% among elementary school children. The study also found that children who were nasal carriers of \u003cem\u003eS. aureus\u003c/em\u003e were more likely to have a history of skin infections (Beyene, Mamo et al. 2019). This high prevalence of nasal carriage of S. aureus among children in Ethiopia is a concern, as it is a risk factor for developing \u003cem\u003eMRSA\u003c/em\u003e infections. More research is needed to identify the risk factors for nasal carriage of S. aureus and to develop effective strategies for preventing and treating \u003cem\u003eMRSA\u003c/em\u003e infections. Information concerning nasal carriage rate of \u003cem\u003eS. aurues\u003c/em\u003e and \u003cem\u003eMRSA\u003c/em\u003e with associated risk factors in elementary school children in Ethiopia is limited leading to a scarcity of accurate and reliable data. Therefore, this study aims to determine the prevalence of \u003cem\u003eMRSA\u003c/em\u003e and its antimicrobial resistance pattern among elementary school children in Chiro town, Ethiopia.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area and period\u003c/h2\u003e \u003cp\u003eThe study was conducted on five governmental Elementary Schools in Chiro town, which is the capital city of west hararghae, located 325 Km east of Addis Ababa, the capital city of Ethiopia. Children aged less than 19 years in 2021 in the district was 21, 030 (Zonal health office). The town has latitude and longitude 9o 05N 40o 52E with an elevation of 1826 meters above sea level. It has two Kebeles with a projected population of 69,793 (44) (CSA, 2018). The town has 19 elementary schools with 15,433 total students in 2022 (Zonal berue of education).\u003c/p\u003e \u003cp\u003eThe study was conducted from March 15 to June 30, 2024.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eA Community-based cross sectional study was conducted\u003c/p\u003e\n\u003ch3\u003ePopulations\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSource population\u003c/h2\u003e \u003cp\u003eAll primary school children of Chiro town were the source population\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy subjects\u003c/h3\u003e\n\u003cp\u003eChildren from selected primary schools who were present during the study period\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAll selected elementary school children who were agreed to give socio-demographic information and nasal swab sample were included.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eA student who was unable to give nasal swab specimen, currently on antibiotic therapy and had recent history of treatment at the time of data collection was excluded.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThose who were above 15 years old during the data collection\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination and sampling technique\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eThe sample size was determined using the single proportion formula. Considering, Zα/2\u0026thinsp;=\u0026thinsp;Standard normal distribution corresponding to 95% confidence, d\u0026thinsp;=\u0026thinsp;desired level of precision/marginal error (5%), P\u0026thinsp;=\u0026thinsp;Proportion in the target population to have nasal carriage of \u003cem\u003eMRSA\u003c/em\u003e 41% (Vestergaard, Frees et al. 2019). According to the formula the calculated sample size is 372. After adding 10% non-response rate and using a design effect of 2 which is allowed for multistage sampling, the final calculated sample size was \u003cb\u003e818\u003c/b\u003e elementary school children.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSampling technique\u003c/h2\u003e \u003cp\u003eA multistage sampling technique was used to select schools by using simple random sampling technique (lottery method) and stratifying the school to grades and the number of study participants were then allocated proportionally to each grades based on the school sampling frame and the study subjects were selected by simple random sampling technique (lottery method).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData and sample collection procedures\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eData collection instruments\u003c/h2\u003e \u003cp\u003eData was collected by face to face interviews using structured questionnaire, prepared in English, translated in to Amharic and Afan Oromo then translated back into English to check the accuracy of translation. The questionnaire based on postulated or known risk factors was developed and modified to explore the objectives of the study among schools that were not included the actual study area. The questionnaire contains two parts: on the first part socio- demographic variables like : relationship of the respondent to the child, sex of respondent, marital status, educational status of mother or caregivers, occupation of the respondent, sex of child, total number of under-five children, age of the child, family size, birth order and family income, while the second part contains, possible risk factors associated with the prevalence of \u003cem\u003eMRSA\u003c/em\u003e which was developed from different kinds of literature (Okwu, Bamgbala et al. 2012, Kejela and Bacha \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, Tigabu, Tiruneh et al. 2018)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eData collectors\u003c/h2\u003e \u003cp\u003eData was collected by four trained nurses who have diploma and ample of experiences. Two Medical Microbiologists had supervised the activities of data collectors. The training was provided to both data collectors and supervisors by the principal investigator for five days (two day theoretical and three day practical) on the data collection tools and procedure before the actual data and sample collection had started.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eNasal swab specimen collection\u003c/h2\u003e \u003cp\u003eAppropriate nasal swab specimens were collected by laboratory technologist and a sterile swab for each individual will be used to collect nasal swabs from both anterior nares. Sterility of cotton swabs, test tubes, culture plates and other important equipment\u0026lsquo;s was done by autoclaving them at 121\u0026deg;C for 15 minutes. Contamination was avoided by using proper aseptic techniques; wearing clean lab coats and washing hands and then samples were collected by inserting the swab and gently rotating three to four times by using a sterile cotton swab pre-wetted with sterile saline in both anterior nares of the participants after obtaining oral and written informed consent. The nasal swabs were inoculated in a properly labeled sterile Tryptose soya broth (Oxoid Ltd. England) and transported by using ice boxes to keep the cold chain until it reaches to the Haramaya University, College of Health Sciences Microbiology laboratory.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLaboratory identification procedures\u003c/h2\u003e \u003cp\u003eEach nasal sample was inoculated (in duplicates) onto Manitol salt agar (Oxoid Ltd. England) and blood agar (Oxoid Ltd. England) and the plates were incubated aerobically at 37\u003csup\u003eo\u003c/sup\u003eC for 24h. The characteristic of isolates were identified using standard microbiological methods which includes colonial morphology (golden yellow colony and beta hemolysis), Gram\u0026lsquo;s stain reaction (Gram positive cocci in clusters). Biochemical tests such as catalase (Catalase acts as a catalyst in the breakdown of hydrogen peroxide to oxygen and water then bubbles of oxygen was released if the bacteria is a catalase producers) and coagulase (Coagulase causes plasma to clot by converting fibrinogen to fibrin then clumping of fresh plasma was formed if the bacteria is coagulase producers). Isolates that were golden yellow colony on Manitol salt agar plate, beta hemolytic on blood agar pate, Gram-positive cocci in clusters, showing active bubbling on hydrogen peroxide reagent (catalase positive), clumping of fresh plasma (coagulase positive) and fermenting Manitol were considered as \u003cem\u003eS. aureus\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eAntimicrobial susceptibility testing\u003c/h2\u003e \u003cp\u003eSuspension of confirmed isolates was prepared using nutrient broth and incubated at 37\u003csup\u003eo\u003c/sup\u003eC for at least 30 minutes and the turbidity was adjusted to match that of 0.5 McFarland standards to obtain approximately the organism number of 1 \u0026times; 10\u003csup\u003e6\u003c/sup\u003e colony forming units (CFU) per ml. Using sterile cotton applicator stick, the suspension was distributed on Muller Hinton agar (Oxoid Ltd. England). As per Clinical Laboratory Standards Institute (CLSI, 2022) guideline, Modified Kirby-Bauer disk diffusion technique was used for antibiotic susceptibility pattern of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e using different antibiotics such as Cefoxitin discs (30 \u0026micro;g), penicillin (10 \u0026micro;g), ampicillin (10 \u0026micro;g), erythromycin (15 \u0026micro;g), cotrimoxazol (25 \u0026micro;g), chloramphenicol (30 \u0026micro;g), gentamycin (10 \u0026micro;g), kanamycin (30 \u0026micro;g), amikacin (30 \u0026micro;g), ciprofloxacin (5 \u0026micro;g), tetracycline (30 \u0026micro;g), and clindamycin (2 \u0026micro;g) (Oxoid Ltd. UK). After applying antibiotics on Mueller Hinton agar the plates were incubated for 24 h at 37\u0026deg;C. The zones of inhibition was measured by a caliper/Ruler/. Finally the results were interpreted as Susceptible, Intermediate and Resistant using \u003cem\u003eCLSI\u003c/em\u003e 2022 Performance Standards for antimicrobial susceptibility testing interpretation table.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTest for MRSA\u003c/h2\u003e \u003cp\u003e \u003cem\u003eS. aureus\u003c/em\u003e isolates were tested for methicillin susceptibility patterns by using modified Kirby- Bauer disc diffusion technique. Broth suspension of confirmed isolates were done using nutrient broth and inoculum was adjusted at 0.5% McFarland standard and each streaked uniformly with swab sticks on Mueller-Hinton agar plates. Cefoxitin (30\u0026micro;g) discs were placed in the plates which were then incubated at 37\u003csup\u003e0\u003c/sup\u003eC for 24h. A zone diameter of the isolates was measured in millimeters with a ruler or caliper. All isolates\u0026thinsp;\u0026le;\u0026thinsp;24 mm of cefoxitin, were considered as MRSA (CLSI 2022).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003eDependent variables\u003c/h2\u003e \u003cp\u003eMethicillin resistance \u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003eAge, Sex, Grade level, Place of residence, Mothers educational status, Fathers educational status, Family Income, Family Size, History of Chronic disease, History of Hospitalization, History of Surgery, History of Hospitals/Clinics visits, History contact with health care worker, Antibiotic use in the past three weeks, proper adherence of antibiotic therapy, history of respiratory infection, number of children in class room.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eOperational definition\u003c/h2\u003e \u003cp\u003eMRSA: - A type of \u003cem\u003estaphylococcus aureus\u003c/em\u003e strains resistant to the antibiotic methicillin (48).\u003c/p\u003e \u003cp\u003eChildren: - A person 15 years or younger age\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eQuality control\u003c/h2\u003e \u003cdiv id=\"Sec26\" class=\"Section4\"\u003e \u003ch2\u003eData Quality control\u003c/h2\u003e \u003cp\u003eThe questionnaire was pre-tested before the actual study begins to make sure that whether the questionnaire is appropriate and understandable on school children other than the actual study area. The collected data was checked daily for consistency and accuracy. Investigators were also followed appropriate data collection process. The collected data was checked daily for consistency and accuracy. Data collectors were trained and Investigators were followed the appropriate data collection process. Besides, the study participants were orientated about the purpose and usefulness of the study and thereby creating a friendly atmosphere.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eLaboratory quality control\u003c/h2\u003e \u003cp\u003eTo avoid false positives, gloves and surgical masks were put on to avoid contamination of the samples by the sample collector perhaps her/himself resistant carrier. All samples were cultured immediately after collection. With rejection criteria applied to those which was deemed unfit for processing, such as mislabeled or contaminated specimen. Five percent (5%) of the prepared culture media were randomly selected and incubated for 24h at 35\u003csup\u003e0\u003c/sup\u003eC-37\u003csup\u003e0\u003c/sup\u003eC to cheek the sterility of the prepared culture media and also known strains of \u003cem\u003estaphylococcus aureus\u003c/em\u003e (ATCC 25923) was inoculated to the prepared culture media to cheek the performance of the prepared culture media as positive control for Gram stain, catalase, coagulase and antibiotic susceptibility test as well as \u003cem\u003eEscherichia coli\u003c/em\u003e (ATCC 25922\u003cem\u003e)\u003c/em\u003e was also used as negative control\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eData was entered using Epi-Data (version 3.1). Its completeness and clearance was checked and then transferred to SPSS (version 20) package for analysis. The characteristics of the study population were summarized using descriptive statistics, frequency and percentage. Internal comparison were made using binary logistic regression to determine the independent effect of the variables by calculating the strength of the association between nasal carriage rate of MRSA and associated risk factors using odds ratio and 95% confidence interval. Adjusted odds ratio was computed using multivariable logistic regression to control the effect of confounding variables. P-value less than 0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics of the participants\u003c/h2\u003e \u003cp\u003eA total of 793 elementary school children were included in the study with 96.93% response rate; of these, The majority of participants were males (54%), age ranged from 6 to 22 years with a mean of 11.1 years (SD\u0026thinsp;+\u0026thinsp;2.86 ) with majority were between 10\u0026ndash;15 years (52%), in grades 5\u0026ndash;8 (52.5%), Higher proportions (58%) of participants were from families earning below 5000, A slightly larger proportion (56%) of participants came from households with 2\u0026ndash;5 members, Most students (75%) were in classrooms with 41\u0026ndash;65 students, whereas Only 12% of participants reported a history of hospitalization, 19% of participants had used antibiotics in the past two weeks, The largest group (44%) had mothers with secondary-level education, while (38%) had fathers with secondary education, and 20% of fathers were illiterate (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e428(54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e365(46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e317(40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e412(52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64(8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 1\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e377(47.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 5\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e416(52.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily monthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e333(42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e460(58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily size category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e444(56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e349(44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of students in the class room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143(18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e595(75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of Hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95(12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e698(88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of Antibiotic usage in the past two weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151(19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e642(81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMothers Educational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177(22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211(27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e349(44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56(7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eFathers Educational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158(20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262(33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e301(38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71(9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePrevalence of Nasal\u003c/b\u003e \u003cb\u003eS. aureus\u003c/b\u003e \u003cb\u003eand\u003c/b\u003e \u003cb\u003eMRSA\u003c/b\u003e \u003cb\u003eColonization\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe overall prevalence of \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eMRSA\u003c/em\u003e in this study was 134/793; 16.9 (95% CI: 14.3, 19.5) and 18/793; 2.27% (95% CI: 1.23, 3.31) respectively.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors Associated with\u003c/b\u003e \u003cb\u003eS. aureus\u003c/b\u003e \u003cb\u003eColonization\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFemale participants had slightly lower odds of \u003cem\u003eS. aureus\u003c/em\u003e colonization compared to males (OR\u0026thinsp;=\u0026thinsp;0.91, 95% CI: 0.63\u0026ndash;1.31), but the association was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.618). Individuals aged\u0026thinsp;\u0026gt;\u0026thinsp;15 years had significantly higher odds of S. aureus colonization (OR\u0026thinsp;=\u0026thinsp;7.38, 95% CI: 2.87\u0026ndash;18.99, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to children aged 6\u0026ndash;10 years. The odds of colonization for those aged 10\u0026ndash;15 years were not significant (OR\u0026thinsp;=\u0026thinsp;1.20, 95% CI: 0.49\u0026ndash;2.97, p\u0026thinsp;=\u0026thinsp;0.683). Participants from households with more than five members had significantly lower odds of S. aureus colonization (OR\u0026thinsp;=\u0026thinsp;0.50, 95% CI: 0.34\u0026ndash;0.75, p\u0026thinsp;=\u0026thinsp;0.001) compared to those with smaller household sizes. Participants in grades 5\u0026ndash;8 had lower odds of S. aureus colonization compared to those in grades 1\u0026ndash;4, but the difference was not statistically significant (OR\u0026thinsp;=\u0026thinsp;0.76, 95% CI: 0.50\u0026ndash;1.14, p\u0026thinsp;=\u0026thinsp;0.180). Those with a monthly income of \u0026lt;\u0026thinsp;5000 had slightly higher odds of S. aureus colonization (OR\u0026thinsp;=\u0026thinsp;1.22, 95% CI: 0.83\u0026ndash;1.80, p\u0026thinsp;=\u0026thinsp;0.307), though this association was not significant. A significantly higher odds of S. aureus colonization was observed among students in classrooms with \u0026gt;\u0026thinsp;66 students (OR\u0026thinsp;=\u0026thinsp;5.39, 95% CI: 2.65\u0026ndash;10.96, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to those in classrooms with 25\u0026ndash;40 students. Participants with a history of hospitalization had significantly higher odds of S. aureus colonization (OR\u0026thinsp;=\u0026thinsp;5.85, 95% CI: 3.73\u0026ndash;9.17, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Individuals who had used antibiotics in the past two weeks had marginally higher odds of S. aureus colonization (OR\u0026thinsp;=\u0026thinsp;1.57, 95% CI: 1.00\u0026ndash;2.45), with borderline statistical significance (p\u0026thinsp;=\u0026thinsp;0.051) (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with the nasal colonization of \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eMRSA\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003eS.aureus\u003c/em\u003e status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cem\u003eMRSA\u003c/em\u003e status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOR(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e+ve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-ve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+ve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-ve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77 (0.53, 1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.86 (0.34, 2.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.087 (0.041, 0.187)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.38 (0.02, 7.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015 (0.006, 0.035)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.43 (0.02, 8.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily size category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;5(ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.82 (1.23, 2.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.34 (0.69, 7.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 1\u0026ndash;4 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 5\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76 (0.50\u0026ndash;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.80 (0.29\u0026ndash;2.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily monthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5000(ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.82 (0.56, 1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.25 (0.84, 5.99)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of students in the class room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e520\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89 (0.52, 1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.78 (0.24, 2.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.74 (1.39, 5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.26 (0.32, 4.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of Hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.81 (3.68, 9.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.3 (0.86, 6.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of Antibiotic usage in the past two weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.58 (1.03, 2.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.66 (1.70, 12.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors Associated with\u003c/b\u003e \u003cb\u003eMRSA\u003c/b\u003e \u003cb\u003eColonization\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe odds of \u003cem\u003eMRSA\u003c/em\u003e colonization were higher among females than males (OR\u0026thinsp;=\u0026thinsp;1.26, 95% CI: 0.46\u0026ndash;3.44), though the association was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.644). Participants aged\u0026thinsp;\u0026gt;\u0026thinsp;15 years had higher odds of \u003cem\u003eMRSA\u003c/em\u003e colonization (OR\u0026thinsp;=\u0026thinsp;5.00, 95% CI: 0.50\u0026ndash;49.95), but this association was not significant (p\u0026thinsp;=\u0026thinsp;0.175). Individuals from larger households (\u0026gt;\u0026thinsp;5 members) had lower odds of MRSA colonization (OR\u0026thinsp;=\u0026thinsp;0.30, 95% CI: 0.08\u0026ndash;1.10, p\u0026thinsp;=\u0026thinsp;0.068), though this association did not reach statistical significance. There was no significant difference in MRSA colonization between students in grades 1\u0026ndash;4 and those in grades 5\u0026ndash;8 (OR\u0026thinsp;=\u0026thinsp;0.80, 95% CI: 0.29\u0026ndash;2.18, p\u0026thinsp;=\u0026thinsp;0.661). Participants from lower-income families had lower odds of MRSA colonization (OR\u0026thinsp;=\u0026thinsp;0.54, 95% CI: 0.21\u0026ndash;1.39), though this association was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.202). No significant association was found between classroom size and MRSA colonization. Those with a history of hospitalization had significantly higher odds of MRSA colonization (OR\u0026thinsp;=\u0026thinsp;2.87, 95% CI: 1.14\u0026ndash;7.26, p\u0026thinsp;=\u0026thinsp;0.025). Participants who had used antibiotics in the past two weeks had significantly higher odds of MRSA colonization (OR\u0026thinsp;=\u0026thinsp;4.79, 95% CI: 1.85\u0026ndash;12.40, p\u0026thinsp;=\u0026thinsp;0.001) (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eDrug susceptibility patterns of S\u003c/b\u003e. \u003cb\u003eaureus\u003c/b\u003e \u003cb\u003eand\u003c/b\u003e \u003cb\u003eMRSA\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eS. aureus\u003c/b\u003e \u003cb\u003eSusceptibility Patterns\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePenicillin showed the highest resistance (91.8%), followed by Tetracycline (83.5%). Erythromycin had a resistance rate of 26.9%, with an additional 22.4% showing intermediate. Clindamycin (3.7%), Gentamicin (5.2%), and TMP/SMX (5.9%) had low resistance rates Whereas Ciprofloxacin and Chloramphenicol were 100% sensitive (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003cb\u003eMRSA\u003c/b\u003e \u003cb\u003eSusceptibility Patterns\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAll MRSA isolates (100%) were resistant to Cefoxitin, confirming methicillin resistance. Penicillin (100%), Tetracycline (94.4%), and Erythromycin (33%) had the highest resistance rates. TMP/SMX (83.3%), Gentamicin (83.4%), and Chloramphenicol (94.4%) remained effective Whereas, Ciprofloxacin (95%) and Chloramphenicol (94.4%) had the highest susceptibility rates (Fig.\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study reports an overall prevalence of \u003cem\u003eS. aureus\u003c/em\u003e colonization among elementary school children was 16.9% (134 out of 793; 95% CI: 14.3\u0026ndash;19.5). This finding was in line with a cross-sectional study in Guangzhou, China (14.5%)(Lin, Zhang et al. 2018). These findings highlight the importance of monitoring \u003cem\u003eS. aureus\u003c/em\u003e colonization in school settings to implement appropriate infection control measures. Similarly, the present study also reported an overall prevalence of \u003cem\u003eMRSA\u003c/em\u003e colonization at 2.27% (18 out of 793; 95% CI: 1.23\u0026ndash;3.31). This result was consistent with findings from a meta-analysis that reported \u003cem\u003eMRSA\u003c/em\u003e colonization rates among healthy children ranging from 0.2\u0026ndash;7.3% (Al-Iede, Ayyad et al. 2024). But smaller than a research conducted in Debre Markos town which reported a nasal \u003cem\u003eMRSA\u003c/em\u003e colonization rate of 29.5% (Reta, Wubie et al. 2017). The prevalence rates observed in this study underscore the importance of monitoring \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eMRSA\u003c/em\u003e colonization among school-aged children. Early detection and preventive measures are crucial to mitigate potential outbreaks and ensure the health and safety of students.\u003c/p\u003e \u003cp\u003eA large European study involving over 32,000 non-hospitalized patients found that males were more likely than females to be carriers of \u003cem\u003eS. aureus\u003c/em\u003e, with an odds ratio (OR) of 1.38 (95% CI: 1.31\u0026ndash;1.46). In contrast, our findings indicated that female participants had slightly lower odds of \u003cem\u003eS. aureus\u003c/em\u003e colonization compared to males (OR\u0026thinsp;=\u0026thinsp;0.91), but this association was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.618)(Humphreys, Fitzpatick et al. 2015). Aligning with our findings, other studies have found no significant association between gender and \u003cem\u003eS. aureus\u003c/em\u003e colonization (Patel, Weinheimer et al. 2008); However, The reasons for this disparity are not fully understood. These inconsistencies suggest that factors beyond gender, such as hormonal influences, immune responses, and behavioral differences, may play roles in \u003cem\u003eS. aureus\u003c/em\u003e colonization.\u003c/p\u003e \u003cp\u003eThe observed finding that individuals aged over 15 years have significantly higher odds of \u003cem\u003eS. aureus\u003c/em\u003e colonization (OR\u0026thinsp;=\u0026thinsp;7.38, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). this finding was in contrast with the study from Germany which reported 50% nasopharyngeal colonization rates of \u003cem\u003eS. aureus\u003c/em\u003e in subjects aged 5\u0026ndash;10 years, indicating higher colonization in younger age groups (Deinhardt-Emmer, Sachse et al. 2018). The study\u0026rsquo;s finding was also in contrary with another study involving school-age children reported a mean age of 9.5 years among participants, with 4.6% identified as carriers of \u003cem\u003eS. aureus\u003c/em\u003e (Woods, Beiter et al. 2011). However, this study did not find a significant association between age and colonization rates within the elementary school population. These discrepancies suggest that factors beyond age, such as regional differences, environmental exposures, and population-specific characteristics, may influence colonization rates.\u003c/p\u003e \u003cp\u003eThe finding that participants from households with more than five members had significantly lower odds of \u003cem\u003eS. aureus\u003c/em\u003e colonization (OR\u0026thinsp;=\u0026thinsp;0.50, p\u0026thinsp;=\u0026thinsp;0.001) contrasts with several studies suggesting higher transmission rates in larger households. For instance, a study analyzing 321 households found that larger household size was significantly associated with \u003cem\u003eS. aureus\u003c/em\u003e colonization; households with colonization had an average of 3.7 members, compared to 2.2 members in non-colonized households (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Miller, Cook et al. 2009). Therefore, while larger household size is often linked to increase S. aureus transmission, this relationship is not uniform across all settings. Other contextual factors, such as hygiene practices and socioeconomic conditions, play crucial roles in determining colonization rates. Additionally, households with higher income levels may have better access to healthcare resources, potentially reducing colonization risks (Rodriguez, Hogan et al. 2013).\u003c/p\u003e \u003cp\u003eThe observation that participants in grades 5\u0026ndash;8 had lower odds of \u003cem\u003eS. aureus\u003c/em\u003e colonization compared to those in grades 1\u0026ndash;4, though not statistically significant (OR\u0026thinsp;=\u0026thinsp;0.76, p\u0026thinsp;=\u0026thinsp;0.18), aligns with studies indicating no clear association between educational attainment and S. aureus colonization. For instance, a study examining the relationship between educational achievement and asymptomatic S. aureus colonization in a predominantly Hispanic border community found no significant association between education level and colonization rates (Barger, Lininger et al. 2020). The finding that participants with a monthly income of less than 5,000 had slightly higher odds of \u003cem\u003eS. aureus\u003c/em\u003e colonization (OR\u0026thinsp;=\u0026thinsp;1.22, 95% CI: 0.83\u0026ndash;1.80, p\u0026thinsp;=\u0026thinsp;0.307), though not statistically significant, aligns with some studies indicating a potential association between lower socioeconomic status (SES) and increased \u003cem\u003eS. aureus\u003c/em\u003e colonization. For example, a study comparing children from different SES communities found that those from middle/low SES backgrounds had higher colonization frequencies of \u003cem\u003eS. aureus\u003c/em\u003e compared to their higher SES counterparts. Additionally, research has shown that socioeconomic factors, such as lower family income, can influence the success of decolonization treatments among individuals diagnosed with MRSA. These findings suggest that socioeconomic factors may play a role in \u003cem\u003eS. aureus\u003c/em\u003e colonization and treatment outcomes, although further research is needed to fully understand these associations (Chun, Madigan et al. 2020, Kristensen, Abrantes et al. 2023).\u003c/p\u003e \u003cp\u003eThe observation that students in classrooms with more than 66 students had significantly higher odds of \u003cem\u003eS. aureus\u003c/em\u003e colonization (OR\u0026thinsp;=\u0026thinsp;5.39, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) aligns with existing research indicating that crowded environments can facilitate the transmission of \u003cem\u003eS. aureus\u003c/em\u003e. A study examining \u003cem\u003eS. aureus\u003c/em\u003e colonization and transmission in schools found that environmental contamination, particularly on frequently touched surfaces, plays a significant role in the spread of \u003cem\u003eS. aureus\u003c/em\u003e among students (Lin, Zhang et al. 2018). Larger classroom sizes may lead to increased contact among students and shared surfaces, thereby elevating the risk of colonization. This underscores the importance of implementing infection control measures, such as regular cleaning and promoting hand hygiene, especially in overcrowded educational settings.\u003c/p\u003e \u003cp\u003eThe finding that participants with a history of hospitalization had significantly higher odds of \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eMRSA\u003c/em\u003e colonization (OR\u0026thinsp;=\u0026thinsp;5.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) is consistent with existing research. Hospitalized individuals are at increased risk for S. aureus colonization and infection due to factors such as invasive procedures, the presence of medical devices, and exposure to antibiotic-resistant strains like \u003cem\u003eMRSA\u003c/em\u003e. A study on the epidemiology of S. aureus indicates that patients undergoing hemodialysis, those with surgical wounds, and individuals with compromised immune systems are particularly susceptible to colonization and subsequent infection (Ondusko and Nolt \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).This underscores the importance of stringent infection control measures and surveillance in healthcare settings to mitigate the risk of S. aureus and \u003cem\u003eMRSA\u003c/em\u003e transmission among hospitalized patients.\u003c/p\u003e \u003cp\u003e​The observation that individuals who had used antibiotics in the past two weeks had marginally higher odds of \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eMRSA\u003c/em\u003e colonization (OR\u0026thinsp;=\u0026thinsp;1.57, p\u0026thinsp;=\u0026thinsp;0.051) aligns with findings from in a Veterans Affairs Medical Center which found that recent antibiotic use was a significant predictor of \u003cem\u003eMRSA\u003c/em\u003e colonization, with an adjusted odds ratio of 4.8 (95% CI, 1.9\u0026ndash;12.2; p\u0026thinsp;=\u0026thinsp;0.001) (Patel, Weinheimer et al. 2008). Similarly, a systematic review and meta-analysis identified recent antibiotic use as a significant risk factor for \u003cem\u003eMRSA\u003c/em\u003e colonization in pediatric populations (Al-Iede, Ayyad et al. 2024). These findings suggest that recent antibiotic use may disrupt normal flora, potentially facilitating \u003cem\u003eS. aureus\u003c/em\u003e colonization. However, some studies have reported contrasting results; for example, a study on acne patients found that oral antibiotic use was associated with a lower prevalence of \u003cem\u003eS. aureus\u003c/em\u003e colonization (prevalence odds ratio\u0026thinsp;=\u0026thinsp;0.16; 95% CI, 0.08\u0026ndash;1.37). These discrepancies highlight the need for further research to clarify the relationship between recent antibiotic use and \u003cem\u003eS. aureus\u003c/em\u003e colonization (Fanelli, Kupperman et al. 2011).\u003c/p\u003e \u003cp\u003eRegarding the resistance patterns of \u003cem\u003eS. aureus\u003c/em\u003e in this study, Penicillin showed the highest resistance (91.8%), followed by Tetracycline (83.5%). This finding was in line with results from Ghana (95%) (Eibach, Nagel et al. 2017) and Jimma (100%) (Kejela and Bacha \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Similarly, MRSA isolates showed 100% resistance to penicillin and cefoxitin. This result was similar to a study conducted in Nigeria (100%) (Okwu, Bamgbala et al. 2012) and Gondar (100%) (Tigabu, Tiruneh et al. 2018). The high resistance to penicillin can be largely attributed to the widespread production of penicillinase by \u003cem\u003eS. aureus\u003c/em\u003e, an enzyme that inactivates penicillin by hydrolyzing its beta-lactam ring, rendering this antibiotic largely ineffective for treatment (Lowy \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Similarly, tetracycline resistance is frequently mediated by the acquisition of tet genes that encode efflux pumps and ribosomal protection proteins, mechanisms that have been extensively documented and are linked to the overuse of tetracycline in both clinical and agricultural settings (Chopra and Roberts \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). These high resistance rates underscore the impact of inappropriate antibiotic use and the consequent horizontal transfer of resistance determinants within bacterial populations, emphasizing the urgent need for improved antibiotic stewardship and alternative therapeutic strategies.\u003c/p\u003e \u003cp\u003eLike studies from Jordan (Alzoubi, Aqel et al. 2014) and Bahir Dar (Reta, Gedefaw et al. 2015) in the present study, majority of the isolates show low resistance rates for Clindamycin (3.7%), Gentamicin (5.2%), and TMP/SMX (5.9%). These low resistance rates may be attributable to judicious antibiotic use, effective antimicrobial stewardship practices, and limited selective pressure that minimizes the dissemination of resistance-conferring genes. Continued surveillance is essential to ensure that these antibiotics remain effective for the management of \u003cem\u003eS. aureus\u003c/em\u003e infections.\u003c/p\u003e \u003cp\u003eIn studies from Australia (Afzal, Vijay et al. 2021) and Kenya (Gitau, Masika et al. 2018) even though chloramphenicol and Ciprofloxacin remains effective against many strains, resistance is still present. But, in our study all s. aureus isolates were 100% sensitive Ciprofloxacin and Chloramphenicol. Full Susceptibility observed in within our sample population, could be attributed to factors such as limited prior exposure to these antibiotics, effective antimicrobial stewardship practices, or regional variations in resistance patterns.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, the overall prevalence of \u003cem\u003eS. aureus\u003c/em\u003e was 16.9% (95% CI: 14.3, 19.5), while \u003cem\u003eMRSA\u003c/em\u003e colonization was 2.27% (95% CI: 1.23, 3.31%). Several sociodemographic and environmental factors influenced \u003cem\u003eS. aureus\u003c/em\u003e colonization, with significantly higher odds observed among older students (\u0026gt;\u0026thinsp;15 years), those from smaller households, students in overcrowded classrooms (\u0026gt;\u0026thinsp;66 students), and those with a history of hospitalization. Similarly, \u003cem\u003eMRSA\u003c/em\u003e colonization was significantly associated with a history of hospitalization and recent antibiotic use.\u003c/p\u003e \u003cp\u003eAntimicrobial susceptibility testing revealed alarmingly high resistance rates to Penicillin (91.8%) and Tetracycline (83.5%) among \u003cem\u003eS. aureus\u003c/em\u003e isolates, whereas Ciprofloxacin and Chloramphenicol showed 100% sensitivity. All MRSA isolates exhibited resistance to Cefoxitin, confirming methicillin resistance, and demonstrated high resistance to Penicillin, Tetracycline, and Erythromycin. However, Ciprofloxacin and Chloramphenicol remained highly effective against \u003cem\u003eMRSA\u003c/em\u003e.\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section2\"\u003e \u003ch2\u003eRecommendation\u003c/h2\u003e \u003cp\u003eHealthcare institutions should strengthen hospital-based infection control strategies, particularly for individuals with a history of hospitalization. Schools and education authorities should implement strategies to reduce classroom overcrowding, as larger class sizes were significantly associated with \u003cem\u003eS. aureus\u003c/em\u003e colonization. Policy-level interventions are needed to improve the student-to-teacher ratio and overall learning environment. Antibiotic stewardship programs should be reinforced to promote the appropriate use of antibiotics and prevent the development of resistance. Furthermore, Future studies should focus on the molecular characterization of \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eMRSA\u003c/em\u003e strains to understand resistance mechanisms and transmission dynamics. Investigating environmental and animal reservoirs using a One Health approach will provide a broader understanding of \u003cem\u003eS. aureus\u003c/em\u003e circulation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted after obtaining Institutional Research Ethics Review Committee (IRERC) of Oda Bultum University. Permission was also sought from directors of participating primary schools prior to sample and data collection. The participants were informed about the objectives of the study and their Participation was on voluntarily basis and participants have the right to withdraw him/her at any point from the study. A verbal consent from study participants and assent for parents/guardians of children were obtained from all study participants involved in the study. All the laboratory examinations of nasal swab were done free from charge and confirmed positives were given appropriate information to prevent further infection. Collected specimens were used only for the study objectives and participants were participated only once. Information obtained at any course of the study was kept confidential. Confidentiality was maintained by numeric coding of specimens and questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets generated during and/or analyzed during the current study are available from the corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the Oda Bultum University\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWWE designed the study, participated in data collection, analysis, interpretation, and write-up, drafted, and critically revised of the manuscript. EZ, KT and ADD participated in the review proposal, data analysis, interpretation, and write-up, and critically revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank and appreciate the Oda Bultum University for funding this study and our appreciation also goes to the chiro branch central statistics agency as well as the Zonal Bureau of Education for their corporation in providing all available demographic data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdullahi, I. N., et al. 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(2015). \u0026quot;Nasal carriage, risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus among school children in Ethiopia.\u0026quot; \u003cu\u003eJ Med Microb Diagn\u003c/u\u003e \u003cstrong\u003e4\u003c/strong\u003e(1): 1-6.\u003c/li\u003e\n\u003cli\u003eReta, A., et al. (2017). \u0026quot;Nasal colonization and antimicrobial susceptibility pattern of Staphylococcus aureus among pre-school children in Ethiopia.\u0026quot; \u003cu\u003eBMC research notes\u003c/u\u003e \u003cstrong\u003e10\u003c/strong\u003e: 1-7.\u003c/li\u003e\n\u003cli\u003eRodriguez, M., et al. (2013). \u0026quot;Measurement and impact of Staphylococcus aureus colonization pressure in households.\u0026quot; \u003cu\u003eJournal of the Pediatric Infectious Diseases Society\u003c/u\u003e \u003cstrong\u003e2\u003c/strong\u003e(2): 147-154.\u003c/li\u003e\n\u003cli\u003eTigabu, A., et al. 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(2023). \u0026quot;Nasal carriage rate of staphylococcus aureus, its associated factors, and antimicrobial susceptibility pattern among health care workers in public hospitals, Harar, Eastern Ethiopia.\u0026quot; \u003cu\u003eInfection and drug resistance\u003c/u\u003e: 3477-3486.\u003c/li\u003e\n\u003cli\u003eWoods, S. E., et al. (2011). \u0026quot;The prevalence of asymptomatic methicillin-resistant Staphylococcus aureus in school-age children.\u0026quot; \u003cu\u003eEastern Journal of Medicine\u003c/u\u003e \u003cstrong\u003e16\u003c/strong\u003e(1): 18.\u003c/li\u003e\n\u003cli\u003eZajmi, A., et al. (2022). Multidrug-Resistant Staphylococcus aureus as Coloniser in Healthy Individuals. \u003cu\u003eStaphylococcal Infections-Recent Advances and Perspectives\u003c/u\u003e, IntechOpen.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Methicillin-resistant Staphylococcus aureus, Nasal carriage, School children","lastPublishedDoi":"10.21203/rs.3.rs-6226496/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6226496/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Methicillin-resistant Staphylococcus aureus is a major cause of healthcare- associated and community-acquired infections. In Ethiopia especially in West hararghe Zone, there is limited data on Methicillin-resistant Staphylococcus aureus among school children in our study setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e The aim of this study is to determine the prevalence of Methicillin-resistant Staphylococcus aureus its antimicrobial resistance patterns and associated factors among elementary school children in Chiro town, Ethiopia, from March 15 to June 30, 2024.\u003c/p\u003e\n\u003cp\u003eMethods: A community-based cross-sectional study was conducted. Nasal swabs were collected using sterile cotton swabs and transported in labeled Tryptose soya broth. Samples were inoculated onto Mannitol salt agar and blood agar, and then incubated at 37°C for 24 hours. Isolates were identified using standard microbiological methods. Antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. Cefoxitin-resistant strains were confirmed as MRSA. Data were entered into EPI-Info version 7 and analyzed using SPSS version 20. Logistic regression identified factors associated with MRSA colonization, with statistical significance set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e \u0026nbsp;A total of 793 primary school children participated, with a male majority (54%) and most aged 10-15 years (52%). The prevalence of nasal \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and \u003cem\u003eMethicillin-resistant Staphylococcus aureus\u003c/em\u003e colonization was 16.9% and 2.27%, respectively. S. aureus colonization was significantly associated with age \u0026gt;15 years, larger classroom size, and hospitalization history. MRSA colonization was significantly linked to recent antibiotic use and hospitalization. S. aureus showed high resistance to Penicillin (91.8%) and Tetracycline (83.5%), while Ciprofloxacin and Chloramphenicol were fully effective. All MRSA isolates were Cefoxitin-resistant, with high resistance to Penicillin and Tetracycline but susceptibility to Ciprofloxacin and Chloramphenicol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendation:\u003c/strong\u003e Nasal \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and \u003cem\u003eMethicillin-resistant Staphylococcus aureus\u003c/em\u003ecolonization were prevalent among school children, with significant associations with age, classroom size, hospitalization, and antibiotic use. High antibiotic resistance was observed. Strengthening hospital infection control, reducing classroom overcrowding, and improving student-to-teacher ratios are essential. Reinforcing antibiotic stewardship programs will help curb resistance. Future studies should focus on molecular characterization of \u003cem\u003eStaphylococcus aureus \u003c/em\u003eand\u003cem\u003e Methicillin-resistant Staphylococcus aureus\u003c/em\u003e, and explore environmental and animal reservoirs using a One Health approach to understand transmission dynamics.\u003c/p\u003e","manuscriptTitle":"Nasal Methicillin-resistant Staphylococcus aureus Carriage, Its Multi-Drug Resistance Pattern and Associated Factors among Primary School Children At Chiro Town; Eastern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-18 07:59:26","doi":"10.21203/rs.3.rs-6226496/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"34c1f74c-1c41-4016-a105-4e3efaa87f2c","owner":[],"postedDate":"March 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45721639,"name":"Biological sciences/Genetics"},{"id":45721640,"name":"Biological sciences/Immunology"},{"id":45721641,"name":"Earth and environmental sciences/Environmental sciences"},{"id":45721642,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-05-07T17:08:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-18 07:59:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6226496","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6226496","identity":"rs-6226496","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}