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

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.