Nasal colonization by potential bacterial pathogens in healthy kindergarten children of Nepal: a prevalence study

In low- and middle-income countries including Nepal, respiratory tract infection (RTI) is considered as one of the most prominent public health problems in children. Multiple carriage of respiratory pathogens is common in children, especially in preschoolers as they are easily transmitted through close contact and poor hygienic condition. Thus, this research is based on the study of prevalence, co-existence, associated factors and antibiogram of nasal isolates among healthy preschoolers.

The study was conducted in four randomly selected kindergarten schools (two government run and two private run) of Bhaktapur Municipality. Out of a total 140 students, 136 eligible participants of age group 2-5 years old were involved in the study. Nasal swab was collected for the isolation of five target isolates (Staphylococcus aureus, Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae and Haemophilus parainfluenzae) and their antibiotic resistance determination.

Of 136 participants involved, 128 (94.5%) were positive for carriage of at least one of the target bacteria. The most common isolate was M. catarrhalis 62.5% (80/128) followed by S. aureus 43.0% (55/128). There was a significant difference in bacterial carriage with respect to type of school (p value<0.05, OR=0.50, CI=0.20-0.90). Regarding bacterial co-existence, the most common co-existence was of S. aureus and M. catarrhalis & S. pneumoniae and M. catarrhalis 48.8%. Multiple logistic regression analysis showed that S. aureus was negatively associated with S. pneumoniae, M. catarrhalis and H. influenzae and S. pneumoniae was positively associated with M. catarrhalis and H. influenzae. Multidrug resistance was seen in 63 isolates (29.4%).

Nepalese kindergarten children are at a high risk of respiratory tract infection by multidrug resistant bacteria.