<i>Enterococci</i> species colony on Bile esculin agar

<div> Background Cancer patients are predisposed to methicillin-resistant <i>Staphylococcus aureus</i> and vancomycin-resistant <i>Enterococci</i> colonization. However, the prevalence of these pathogens among cancer cases in Northwestern Ethiopia remains underreported. Objective To determine the prevalence of colonization of methicillin-resistant <i>Staphylococcus aureus</i> and vancomycin-resistant <i>Enterococci</i> and associated factors among cancer patients at the University of Gondar Comprehensive Specialized Hospital, Northwestern Ethiopia. Method A cross-sectional study enrolled 288 confirmed cancer participants through stratified systematic random sampling, gathering socio-demographic and clinical data via pretested structured questionnaires from May 1 to July 30, 2023. Each participant provided two specimens: a nasal swab and a fecal sample. Nasal swabs were collected using sterile swabs, inserted at least 1 cm into each nostril, and rotated against the nasal membrane for 10 to 15 seconds, which were then placed in Amies transport medium. Fecal specimens were collected in leak-proof plastic containers, swabbed, and transferred to Cary Blair transport medium. Nasal swabs and fecal specimens were cultured on Mannitol salt agar at 37°C for <i>Staphylococcus aureus</i> identification, which was confirmed by coagulase testing and Gram staining. <i>Enterococci</i> were cultured on Bile esculin agar at 43°C and identified at the genus level by cultural characteristics, with confirmation through Gram reaction and catalase tests. Antibiotic susceptibility was evaluated using the Kirby-Bauer disk diffusion method, with minimum inhibitory concentrations for vancomycin determined via E-test strips. To detect methicillin-resistant <i>Staphylococcus aureus</i>, a cefoxitin disk was used. Inducible clindamycin resistance in <i>Staphylococcus aureus</i> was determined by the D test. Epi-info version 7 and SPSS version 27 were used for data entry and data analysis, respectively. The Pearson Chi-Square test was initially used to evaluate the association between factors and outcomes as the preliminary analysis, with a significance threshold of p < 0.05. Variables meeting this criterion underwent bivariable and multivariable logistic regression analyses, using p-value cutoffs of < 0.2 for bivariable and < 0.05 for multivariable analyses. Result The study involved 288 participants, with 51.0% being men and a mean age of 45.6 years. The prevalence of methicillin-resistant <i>Staphylococcus aureus</i> was 11.1% (95% CI: 7.5–14.7%), while vancomycin-resistant <i>Enterococci</i> had a prevalence of 2.8% (95% CI: 0.9–4.7%). Inducible clindamycin-resistant <i>Staphylococcus aureus</i> comprised 13.5% of the isolates. The multidrug-resistant proportion of <i>Staphylococcus aureus</i> and <i>Enterococci</i> were 56.2% and 55.2%, respectively. Both organisms exhibited the highest resistance to the antibiotic classes of penicillin and tetracycline. Significant associations were identified between methicillin-resistant <i>Staphylococcus aureus</i> colonization and low absolute neutrophil count (AOR = 13.050, 95% CI: 1.362-125.00, P = 0.026), and between vancomycin-resistant <i>Enterococci</i> colonization and having undergone an invasive procedure (AOR = 8.648, 95% CI: 1.870-39.992, P = 0.006). Conclusion The study reveals a significant prevalence of methicillin-resistant <i>Staphylococcus aureus</i> and vancomycin-resistant <i>Enterococci</i> colonization among cancer patients, raising public health concerns. High antibiotic resistance rates complicate treatment and may impact patient outcomes. Notably, the high inducible clindamycin resistance report, highlights the need for D-testing. Screening for methicillin-resistant <i>Staphylococcus aureus</i> is recommended as an important antibiotic stewardship measure, while early detection of vancomycin-resistant <i>Enterococci</i> colonization is crucial to reduce complications. </div>