{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:09:07Z","timestamp":1792084147482,"version":"4.4.0"},"reference-count":70,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec039\">\n<jats:title>Background<\/jats:title>\n<jats:p>Cancer patients are predisposed to methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> and vancomycin-resistant <jats:italic>Enterococci<\/jats:italic> colonization. However, the prevalence of these pathogens among cancer cases in Northwestern Ethiopia remains underreported.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec040\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To determine the prevalence of colonization of methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> and vancomycin-resistant <jats:italic>Enterococci<\/jats:italic> and associated factors among cancer patients at the University of Gondar Comprehensive Specialized Hospital, Northwestern Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec041\">\n<jats:title>Method<\/jats:title>\n<jats:p>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\u2009cm 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\u00b0C for <jats:italic>Staphylococcus aureus<\/jats:italic> identification, which was confirmed by coagulase testing and Gram staining. <jats:italic>Enterococci<\/jats:italic> were cultured on Bile esculin agar at 43\u00b0C 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 <jats:italic>Staphylococcus aureus<\/jats:italic>, a cefoxitin disk was used. Inducible clindamycin resistance in <jats:italic>Staphylococcus aureus<\/jats:italic> 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 &lt;\u2009 0.05. Variables meeting this criterion underwent bivariable and multivariable logistic regression analyses, using p-value cutoffs of &lt;\u2009 0.2 for bivariable and &lt;\u2009 0.05 for multivariable analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec042\">\n<jats:title>Result<\/jats:title>\n<jats:p>The study involved 288 participants, with 51.0% being men and a mean age of 45.6 years. The prevalence of methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> was 11.1% (95% CI: 7.5\u201314.7%), while vancomycin-resistant <jats:italic>Enterococci<\/jats:italic> had a prevalence of 2.8% (95% CI: 0.9\u20134.7%). Inducible clindamycin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> comprised 13.5% of the isolates. The multidrug-resistant proportion of <jats:italic>Staphylococcus aureus<\/jats:italic> and <jats:italic>Enterococci<\/jats:italic> 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 <jats:italic>Staphylococcus aureus<\/jats:italic> colonization and low absolute neutrophil count (AOR =\u2009 13.050, 95% CI: 1.362-125.00, P =\u2009 0.026), and between vancomycin-resistant <jats:italic>Enterococci<\/jats:italic> colonization and having undergone an invasive procedure (AOR =\u2009 8.648, 95% CI: 1.870-39.992, P =\u2009 0.006).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec043\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The study reveals a significant prevalence of methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> and vancomycin-resistant <jats:italic>Enterococci<\/jats:italic> 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 <jats:italic>Staphylococcus aureus<\/jats:italic> is recommended as an important antibiotic stewardship measure, while early detection of vancomycin-resistant <jats:italic>Enterococci<\/jats:italic> colonization is crucial to reduce complications.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0318242","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T18:36:29Z","timestamp":1738953389000},"page":"e0318242","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Colonization of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci and its associated factors in cancer patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2078-7261","authenticated-orcid":true,"given":"Eden Getaneh","family":"Mekonnen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0363-3254","authenticated-orcid":true,"given":"Abebe","family":"Birhanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulugeta","family":"Yimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Segenet","family":"Bizuneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mucheye","family":"Gizachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baye","family":"Gelaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"key":"pone.0318242.ref001","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3322\/caac.20107","article-title":"Global 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Kaushik","year":"2024","journal-title":"Pathogens"},{"issue":"4","key":"pone.0318242.ref007","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.idc.2020.08.004","article-title":"Resistance in vancomycin-resistant Enterococci","volume":"34","author":"WR Miller","year":"2020","journal-title":"Infect Dis Clin North Am"},{"issue":"2","key":"pone.0318242.ref008","first-page":"264","article-title":"Virulence determinants and antimicrobial resistance patterns of vancomycin-resistant Enterococcus faecium isolated from different sources in Southwest Iran","volume":"47","author":"M Arshadi","year":"2018","journal-title":"Iran J Public Health"},{"issue":"6","key":"pone.0318242.ref009","doi-asserted-by":"crossref","first-page":"981","DOI":"10.3390\/antibiotics12060981","article-title":"Antibiotic susceptibility patterns and virulence-associated factors of vancomycin-resistant Enterococcal isolates from tertiary care hospitals","volume":"12","author":"A Doss Susai 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patients with acute Leukaemia and febrile neutropenia","volume":"99","author":"TA Kirkizlar","year":"2020","journal-title":"Leuk Res"},{"issue":"2","key":"pone.0318242.ref025","doi-asserted-by":"crossref","first-page":"11280","DOI":"10.1128\/microbiolspec.GPP3-0057-2018","article-title":"Antibiotic resistance and the MRSA problem","volume":"7","author":"M Vestergaard","year":"2019","journal-title":"Microbiol Spectr"},{"issue":"7","key":"pone.0318242.ref026","doi-asserted-by":"crossref","first-page":"814","DOI":"10.3390\/antibiotics10070814","article-title":"Clindamycin as an alternative option in optimizing periodontal therapy","volume":"10","author":"I Luchian","year":"2021","journal-title":"Antibiotics (Basel)"},{"issue":"6","key":"pone.0318242.ref027","doi-asserted-by":"crossref","first-page":"5777","DOI":"10.3390\/ijms24065777","article-title":"Antibiotics and bacterial resistance-a short story of an endless arms race","volume":"24","author":"A Baran","year":"2023","journal-title":"Int J Mol Sci"},{"key":"pone.0318242.ref028","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1111\/1751-7915.14268","article-title":"Novel antimicrobial strategies to treat multi-drug resistant Staphylococcus aureus infections","volume":"16","author":"EJA Douglas","year":"2023","journal-title":"Microb Biotechnol"},{"issue":"3","key":"pone.0318242.ref029","doi-asserted-by":"crossref","first-page":"e250723219043","DOI":"10.2174\/1871526523666230725103902","article-title":"An overview of the global alarming increase of multiple drug resistant: a major challenge in clinical diagnosis","volume":"24","author":"JA Alara","year":"2024","journal-title":"Infect Disord Drug Targets"},{"key":"pone.0318242.ref030","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.2147\/IDR.S183283","article-title":"Bacterial profile, antibiotic resistance pattern and associated factors among cancer patients at University of Gondar Hospital, Northwest Ethiopia","volume":"11","author":"A Fentie","year":"2018","journal-title":"Infect Drug Resist"},{"key":"pone.0318242.ref031","article-title":"Efficient techniques for identifying gram-positive clinical bacteria","author":"HI Sufa","year":"2023","journal-title":"Penerbit NEM"},{"key":"pone.0318242.ref032","first-page":"3220","article-title":"Coagulase test protocol.","author":"DS Katz","year":"2010"},{"issue":"1","key":"pone.0318242.ref033","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-017-2363-3","article-title":"Isolation of Enterococci, their antimicrobial susceptibility patterns and associated factors among patients attending at the University of Gondar Teaching Hospital","volume":"17","author":"A Yilema","year":"2017","journal-title":"BMC Infect Dis"},{"key":"pone.0318242.ref034","doi-asserted-by":"crossref","first-page":"6430026","DOI":"10.1155\/2024\/6430026","article-title":"High gastrointestinal colonization rate of vancomycin-resistant Enterococci among 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Med"},{"key":"pone.0318242.ref038","doi-asserted-by":"crossref","DOI":"10.7754\/Clin.Lab.2019.190729","article-title":"Determination of hematological reference intervals for healthy adults in Northeast Ethiopia","volume":"66","author":"T Gessese","year":"2020","journal-title":"Clinical Laboratory"},{"key":"pone.0318242.ref039","first-page":"65","article-title":"Reference values of hematological indices of infants, children, and adolescents in Port Harcourt, Nigeria","author":"F Buseri","year":"2010","journal-title":"Pathology Laboratory Med Int"},{"issue":"1","key":"pone.0318242.ref040","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s13369-017-2670-4","article-title":"Incidence of Methicillin-Resistant Staphylococcus aureus (MRSA) in microbial community of cancer patients and evaluation of their resistant pattern","volume":"43","author":"MMAA El-Gendy","year":"2017","journal-title":"Arab J Sci Eng"},{"issue":"4","key":"pone.0318242.ref041","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1177\/1049909112452335","article-title":"Prevalence of methicillin-resistant Staphylococcus aureus colonization and infection in hospitalized palliative care patients with cancer","volume":"30","author":"HM Ghanem","year":"2013","journal-title":"Am J Hosp Palliat Care Med"},{"key":"pone.0318242.ref042","doi-asserted-by":"crossref","first-page":"255","DOI":"10.31661\/gmj.v4i1.255","article-title":"The prevalence and the resistance profile of methicillin-resistant Staphylococcus aureus colonized in the nostrils of cancer patients in Namazi teaching hospital, Shiraz, Iran, 2011\u201312","volume":"4","author":"M Motamedifar","year":"2015","journal-title":"Galen Medical J"},{"key":"pone.0318242.ref043","first-page":"590891","article-title":"Different clinical utility of oropharyngeal bacterial screening prior to percutaneous endoscopic gastrostomy in oncological and neurological patients","author":"R Kroupa","year":"2014","journal-title":"Biomed Res Int"},{"key":"pone.0318242.ref044","article-title":"Nasal colonisation of MRSA in oral cancer patients in a tertiary care hospital of northern India","volume":"13","author":"D Kumar","year":"2019","journal-title":"J Clin Diagnostic Res"},{"issue":"2","key":"pone.0318242.ref045","doi-asserted-by":"crossref","first-page":"61","DOI":"10.18683\/germs.2017.1110","article-title":"Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer","volume":"7","author":"JR Spinardi","year":"2017","journal-title":"Germs"},{"issue":"1","key":"pone.0318242.ref046","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1200\/JOP.2014.001492","article-title":"Risk and Consequences of chemotherapy-induced febrile neutropenia in patients with metastatic solid tumors","volume":"11","author":"D Weycker","year":"2015","journal-title":"J Oncol 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