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Background  With the global efforts of reducing pneumococcal disease through widespread introduction of pneumococcal vaccines, concerns have emerged on the potential increase of morbidity and mortality from  S. aureus  disease. Little is known however, of the carriage rates of  S. aureus  or of its’ relationship with carriage of  S. pneumoniae  in rural Africa, and West Africa in particular where very high rates of carriage of  S. pneumoniae  have been reported. This study aims to evaluate the prevalence, antibiotic susceptibility patterns and genotypes of  S. aureus  isolated from the nasopharynx of healthy individuals in rural Gambia before the introduction of routine use of pneumococcal conjugate vaccines in the country.    Results  Overall prevalence of  S. aureus  nasopharyngeal carriage was 25.2 %. All  S. aureus  isolates tested were susceptible to methicillin. Resistant was observed for sulphamethoxazole-trimethoprim (15 %) and tetracycline (34.3 %). We found 59 different sequence types (ST), 35 of which were novel. The most prevalent sequence types were ST 15 (28 %) and ST 5 (4 %). Eighty two percent (494/600) of study individuals were  S. pneumoniae  carriers with  S. pneumoniae  carriage rates decreasing with increasing age groups.  S. aureus  carriage among pneumococcal carriers was slightly lower than among non-pneumococcal carriers (24.3 versus 29.3 %;  p  = 0.324). There were no associations of carriage between these two bacteria across the 4 age groups. However, analysis of pooled data children < 2 years and children 2 to < 5 years of age showed a statistically significant inverse association (24.1 and 50.0 % for  S. aureus  carriage among  S. pneumoniae  carriers and non-carriers respectively;  p  = 0.015).    Conclusions  We report that nasopharyngeal carriage of  S. aureus  in rural Gambia is high in all age groups, with approximately 1 out of 4 individuals being carriers in the pre-pneumococcal vaccination era. There are indications that nasopharyngeal carriage of  S.aureus  could be inversely related to carriage of  S. pneumoniae  amongst younger children in The Gambian and that  S. aureus  clones in The Gambia show significant genetic diversity suggesting worldwide dissemination. Findings from this study provide a useful background for impact studies evaluating the introduction of pneumococcal vaccines or other interventions targeting the control of  S. aureus  infections and disease.

bmc microbiology

High genetic diversity of Staphylococcus aureus strains colonising the nasopharynx of Gambian villagers before widespread use of pneumococcal conjugate vaccines