Multidrug-resistantStaphylococcus aureusColonization in Healthy Adults Is more Common in Bhutanese Refugees in Nepal than Those Resettled in Ohio

Abstract

Although studies have shown that human migration is one of the risk factors for the spread of drug-resistant organisms such as methicillin-resistantStaphylococcus aureus(MRSA), surveillance studies examining MRSA among refugee populations in the US are lacking. This study aimed to assess the prevalence and molecular characteristics ofS. aureusamong Bhutanese refugees living in Nepal and resettled in Northeast Ohio (NEO). One hundred adult Bhutanese refugees from each geographic location were enrolled between August 2015 and January 2016. The participants were interviewed to collect demographic information and potential risk factors for carriage. Nasal and throat swabs were collected for bacterial isolation. AllS. aureusisolates were characterized byspatyping and tested for the presence of Panton-Valentine leukocidin (PVL) andmecA genes; selected isolates were tested by multilocus sequence typing (MLST). The overall prevalence ofS. aureuswas 66.0% and 44.0% in NEO and Nepal, respectively. In Nepal, 5.8% (3/52) of isolates were MRSA and 1.1% (1/88) in NEO. Twenty-one isolates in NEO (23.9%) were multidrug-resistantS. aureus(MDRSA), while 23 (44.2%) in Nepal were MDRSA. In NEO, 41spatypes were detected from 88S. aureusisolates. In Nepal, 32spatypes were detected from 52S. aureusisolates.spatypes t1818 and t345 were most common in NEO and Nepal, respectively. The overall prevalence of PVL-positive isolates amongS. aureusin Nepal and NEO was 25.0% and 10.2%. ST5 was the most common sequence type in both locations. Bhutanese refugees living in Nepal and resettled in NEO had high prevalence ofS. aureusand MDRSA.The findings suggest a potential need for CA-MRSA surveillance among the immigrant population in the U S and among people living in Nepal, and a potential need to devise appropriate public health measures to mitigate the risk imposed by community-associated strains ofS. aureusand MRSA.