Asymptomatic nasal bacterial colonization in Kenyan children: A cross-sectional study

Introduction Bacterial nasal colonization of Staphylococcus aureus (S. aureus) is common in healthy individuals and children across the world. Data are limited for children across Africa, with some studies showing the presence of Gram-negative rods. The aim of this study is to determine the prevalence of nasal colonization with S. aureus or other bacterial organisms among healthy Kenyan children and ascertain antibiotic resistance and susceptibilities to guide future antibiotic protocols. Methodology A cross-sectional study was implemented using a screening questionnaire in healthy children less than 15 years old presenting to outpatient clinics from March to May of 2023. Basic demographics and indication for the clinic visit were obtained. Nares swabs were performed and analyzed for bacterial growth. Results There were 13/45 (29%) positive nares swab cultures, with the most common bacteria being Staphylococcus aureus. Bacterial species were all Gram-positive bacteria. Eight of the positive swabs showed evidence of bacterial resistance; the remainder were not tested. Out of the six nasal swab cultures that grew Staphylococcus aureus, four were methicillin- or oxacillin-resistant S. aureus (MRSA). The overall rate of antibiotic-resistant bacterial colonization was 18%. Conclusion Children without previous hospital exposure had a high percentage of antibiotic-resistant bacteria on culture of nasal swabs. Staphylococcus aureus accounted for 29% of positive cultures, and 67% of these were MRSA. While MRSA has not been previously identified in healthy Kenyan pediatric populations, awareness of this nasal colonization result has contributed to hospital antibiotic stewardship in the pediatric population. Recommendation Using context-specific bacterial colonization data can improve the use of appropriate antibiotics and, therefore, antibiotic stewardship. We encourage Kenyan pediatric providers to consider MRSA coverage for children early in treatment for bacterial infections.