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. 2017 Mar 28;17(1):75.
doi: 10.1186/s12866-017-0982-x.

Short-term increase in prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus following mass drug administration with azithromycin for trachoma control

Ebrima Bojang  1 , James Jafali  1 , Vincent Perreten  2 , John Hart  3 , Emma M Harding-Esch  3 , Ansumana Sillah  4 , David C W Mabey  3 , Martin J Holland  3 , Robin L Bailey  3 , Anna Roca  1   5 , Sarah E Burr  6   7
Affiliations

Short-term increase in prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus following mass drug administration with azithromycin for trachoma control

Ebrima Bojang et al. BMC Microbiol. .

Abstract

Background: Mass drug administration (MDA) with azithromycin is a corner-stone of trachoma control however it may drive the emergence of antimicrobial resistance. In a cluster-randomized trial (Clinical trial gov NCT00792922), we compared the reduction in the prevalence of active trachoma in communities that received three annual rounds of MDA to that in communities that received a single treatment round. We used the framework of this trial to carry out an opportunistic study to investigate if the increased rounds of treatment resulted in increased prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus. Three cross-sectional surveys were conducted in two villages receiving three annual rounds of MDA (3 × treatment arm). Surveys were conducted immediately before the third round of MDA (CSS-1) and at one (CSS-2) and six (CSS-3) months after MDA. The final survey also included six villages that had received only one round of MDA 30 months previously (1 × treatment arm).

Results: In the 3 × treatment arm, a short-term increase in prevalence of S. aureus carriage was seen following MDA from 24.6% at CSS-1 to 38.6% at CSS-2 (p < 0.001). Prevalence fell to 8.8% at CSS-3 (p < 0.001). A transient increase was also seen in prevalence of carriage of azithromycin resistant (AzmR) strains from 8.9% at CSS-1 to 34.1% (p < 0.001) in CSS-2 and down to 7.3% (p = 0.417) in CSS-3. A similar trend was observed for prevalence of carriage of macrolide-inducible-clindamycin resistant (iMLSB) strains. In CSS-3, prevalence of carriage of resistant strains was higher in the 3 × treatment arm than in the 1 × treatment (AzmR 7.3% vs. 1.6%, p = 0.010; iMLSB 5.8% vs. 0.8%, p < 0.001). Macrolide resistance was attributed to the presence of msr and erm genes.

Conclusions: Three annual rounds of MDA with azithromycin were associated with a short-term increase in both the prevalence of nasopharyngeal carriage of S. aureus and prevalence of carriage of AzmR and iMLSB S. aureus.

Trial registration: This study was ancillary to the Partnership for the Rapid Elimination of Trachoma, ClinicalTrials.gov NCT00792922 , registration date November 17, 2008.

Keywords: Azithromycin; Macrolide resistance; Mass drug administration; Staphylococcus aureus carriage; The Gambia; Trachoma; West Africa; iMLSB.

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Figures

Fig. 1
Fig. 1
Time-line of treatment and sample collection. MDA with azithromycin is depicted by black arrows; NPS sample collection is depicted by red arrows
Fig. 2
Fig. 2
Study profile
See this image and copyright information in PMC

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References

    1. World Health Organization . Report of the first meeting of the WHO alliance for the Global Elimination of Trachoma, WHO/PBL/GET/97.1. 1997.
    1. World Health Organization . Report of the third meeting of the WHO Alliance for the Global Elimination of Trachoma, WHO/PBD/GET/99.3. 1998.
    1. Porco TC, Gebre T, Ayele B, House J, Keenan J, Zhou Z, et al. Effect of mass distribution of azithromycin for trachoma control on overall mortality in Ethiopian children: a randomized trial. JAMA. 2009;302:962–8. doi: 10.1001/jama.2009.1266. - DOI - PubMed
    1. Keenan JD, Ayele B, Gebre T, Zerihun M, Zhou Z, House JI, et al. Childhood mortality in a cohort treated with mass azithromycin for trachoma. Clin Infect Dis. 2011;52:883–8. doi: 10.1093/cid/cir069. - DOI - PMC - PubMed
    1. Matheson AI, Manhart LE, Pavlincan PB, Means AR, Akullian A, Levine GA, et al. Prioritizing countries for interventions to reduce child mortality: tools for maximizing the impact of mass drug administration of azithromycin. PLoS One. 2014;9:e96658. doi: 10.1371/journal.pone.0096658. - DOI - PMC - PubMed

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