Temporal trends of skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus in Gabon.
Humans
Methicillin-Resistant Staphylococcus aureus
/ isolation & purification
Gabon
/ epidemiology
Soft Tissue Infections
/ microbiology
Retrospective Studies
Male
Female
Adult
Adolescent
Middle Aged
Anti-Bacterial Agents
/ pharmacology
Young Adult
Microbial Sensitivity Tests
Prevalence
Child
Risk Factors
Staphylococcal Skin Infections
/ epidemiology
Staphylococcal Infections
/ epidemiology
Child, Preschool
Aged
Infant
Cross sectional studies
Low and middle income countries
Methicillin-resistant Staphylococcus aureus
Soft tissue infections
Sub-Saharan Africa
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
25 Jun 2024
25 Jun 2024
Historique:
received:
13
02
2024
accepted:
18
06
2024
medline:
26
6
2024
pubmed:
26
6
2024
entrez:
25
6
2024
Statut:
epublish
Résumé
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of mortality due to bacterial antimicrobial resistance. While S. aureus is common in skin and soft tissue infections (SSTI) in Africa, data on MRSA rates are scarce and reports vary widely across the continent (5%-80%). In this study, we describe the proportion of MRSA causing SSTI in Lambaréné, Gabon, over an 11-year period. We retrospectively analyzed data from 953 bacterial specimens collected from inpatients and outpatients with SSTI at the Albert Schweitzer Hospital, Lambaréné, Gabon, between 2009 and 2019. We determined temporal changes in the prevalence of MRSA and identified risk factors for SSTI with MRSA. 68% of all specimens with bacterial growth yielded S. aureus (n = 499/731), of which 7% (36/497) with antimicrobial susceptibility testing were identified as MRSA. Age above 18 years, admission to the surgical ward, and deep-seated infections were significantly associated with MRSA as the causative agent. After an initial decline from 7% in 2009, there was a marked increase in the proportion of MRSA among all S. aureus from SSTI from 3 to 20% between 2012 and 2019. The resistance rate to erythromycin was significantly higher in MRSA than in methicillin-susceptible S. aureus (73% vs. 10%), and clindamycin resistance was detected exclusively in MRSA isolates (8%). The increasing proportion of MRSA causing SSTI over the 11-year period contrasts with many European countries where MRSA is on decline. Continuous surveillance of MRSA lineages in the hospital and community along with antibiotic stewardship programs could address the increasing trend of MRSA.
Sections du résumé
BACKGROUND
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of mortality due to bacterial antimicrobial resistance. While S. aureus is common in skin and soft tissue infections (SSTI) in Africa, data on MRSA rates are scarce and reports vary widely across the continent (5%-80%). In this study, we describe the proportion of MRSA causing SSTI in Lambaréné, Gabon, over an 11-year period.
METHODS
METHODS
We retrospectively analyzed data from 953 bacterial specimens collected from inpatients and outpatients with SSTI at the Albert Schweitzer Hospital, Lambaréné, Gabon, between 2009 and 2019. We determined temporal changes in the prevalence of MRSA and identified risk factors for SSTI with MRSA.
RESULTS
RESULTS
68% of all specimens with bacterial growth yielded S. aureus (n = 499/731), of which 7% (36/497) with antimicrobial susceptibility testing were identified as MRSA. Age above 18 years, admission to the surgical ward, and deep-seated infections were significantly associated with MRSA as the causative agent. After an initial decline from 7% in 2009, there was a marked increase in the proportion of MRSA among all S. aureus from SSTI from 3 to 20% between 2012 and 2019. The resistance rate to erythromycin was significantly higher in MRSA than in methicillin-susceptible S. aureus (73% vs. 10%), and clindamycin resistance was detected exclusively in MRSA isolates (8%).
CONCLUSION
CONCLUSIONS
The increasing proportion of MRSA causing SSTI over the 11-year period contrasts with many European countries where MRSA is on decline. Continuous surveillance of MRSA lineages in the hospital and community along with antibiotic stewardship programs could address the increasing trend of MRSA.
Identifiants
pubmed: 38918863
doi: 10.1186/s13756-024-01426-0
pii: 10.1186/s13756-024-01426-0
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
68Subventions
Organisme : Deutsche Forschungsgemeinschaft
ID : 404893180
Organisme : Deutsche Forschungsgemeinschaft
ID : 404893180
Informations de copyright
© 2024. The Author(s).
Références
Becker K, Schaumburg F, Fegeler C, Friedrich AW, Kock R. Prevalence of Multiresistant Microorganisms PMMS. Staphylococcus aureus from the German general population is highly diverse. Int J Med Microbiol. 2017;307(1):21–7. https://doi.org/10.1016/j.ijmm.2016.11.007 .
doi: 10.1016/j.ijmm.2016.11.007
pubmed: 28017539
Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015;28(3):603–61. https://doi.org/10.1128/CMR.00134-14 .
doi: 10.1128/CMR.00134-14
pubmed: 26016486
pmcid: 4451395
Lowy FD. Staphylococcus aureus infections. N Engl J Med. 1998;339(8):520–32. https://doi.org/10.1056/NEJM199808203390806 .
doi: 10.1056/NEJM199808203390806
pubmed: 9709046
Collaborators GBDAR. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;400(10369):2221–48; https://doi.org/10.1016/S0140-6736(22)02185-7 .
Antimicrobial RC. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–55. https://doi.org/10.1016/S0140-6736(21)02724-0 .
doi: 10.1016/S0140-6736(21)02724-0
Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, et al. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primers. 2018;4:18033. https://doi.org/10.1038/nrdp.2018.33 .
doi: 10.1038/nrdp.2018.33
pubmed: 29849094
Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev. 2018;31(4); https://doi.org/10.1128/CMR.00020-18 .
Falagas ME, Karageorgopoulos DE, Leptidis J, Korbila IP. MRSA in Africa: filling the global map of antimicrobial resistance. PLoS ONE. 2013;8(7):e68024. https://doi.org/10.1371/journal.pone.0068024 .
doi: 10.1371/journal.pone.0068024
pubmed: 23922652
pmcid: 3726677
Karimkhani C, Dellavalle RP, Coffeng LE, Flohr C, Hay RJ, Langan SM, et al. Global Skin Disease Morbidity and Mortality: An Update From the Global Burden of Disease Study 2013. JAMA Dermatol. 2017;153(5):406–12. https://doi.org/10.1001/jamadermatol.2016.5538 .
doi: 10.1001/jamadermatol.2016.5538
pubmed: 28249066
pmcid: 5817488
Engelman D, Hofer A, Davis JS, Carapetis JR, Baird RW, Giffard PM, et al. Invasive Staphylococcus aureus Infections in Children in Tropical Northern Australia. J Pediatric Infect Dis Soc. 2014;3(4):304–11. https://doi.org/10.1093/jpids/piu013 .
doi: 10.1093/jpids/piu013
pubmed: 26625450
Stryjewski ME, Chambers HF. Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2008;46(Suppl 5):S368–77. https://doi.org/10.1086/533593 .
doi: 10.1086/533593
pubmed: 18462092
Ruffing U, Alabi A, Kazimoto T, Vubil DC, Akulenko R, Abdulla S, et al. Community-Associated Staphylococcus aureus from Sub-Saharan Africa and Germany: A Cross-Sectional Geographic Correlation Study. Sci Rep. 2017;7(1):154. https://doi.org/10.1038/s41598-017-00214-8 .
doi: 10.1038/s41598-017-00214-8
pubmed: 28273954
pmcid: 5428059
Urban E, Stone GG. Impact of EUCAST ceftaroline breakpoint change on the susceptibility of methicillin-resistant Staphylococcus aureus isolates collected from patients with complicated skin and soft-tissue infections. Clin Microbiol Infect. 2019;25(11):1429 e1-e4. https://doi.org/10.1016/j.cmi.2019.03.023 .
doi: 10.1016/j.cmi.2019.03.023
pubmed: 30980925
Schaumburg F, Ngoa UA, Kosters K, Kock R, Adegnika AA, Kremsner PG, et al. Virulence factors and genotypes of Staphylococcus aureus from infection and carriage in Gabon. Clin Microbiol Infect. 2011;17(10):1507–13. https://doi.org/10.1111/j.1469-0691.2011.03534.x .
doi: 10.1111/j.1469-0691.2011.03534.x
pubmed: 21595798
Dikoumba A-C, Onanga R, Mbehang Nguema PP, Mangouka L, Iroungou B, Kassa F, et al. Phenotipic Prevalence of Antibiotic Resistance in Gabon. Open Journal of Medical Microbiology. 2021;11:100–18. https://doi.org/10.4236/ojmm.2021.112009 .
doi: 10.4236/ojmm.2021.112009
Alabi A, Kazimoto T, Lebughe M, Vubil D, Phaku P, Mandomando I, et al. Management of superficial and deep-seated Staphylococcus aureus skin and soft tissue infections in sub-Saharan Africa: a post hoc analysis of the StaphNet cohort. Infection. 2018;46(3):395–404. https://doi.org/10.1007/s15010-018-1140-6 .
doi: 10.1007/s15010-018-1140-6
pubmed: 29667040
CLSI. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard—Eleventh Edition. CLSI document M02-A11. Wayne, PA: Clinical and Laboratory Standards Institute; 2012.
Maina EK, Kiiyukia C, Wamae CN, Waiyaki PG, Kariuki S. Characterization of methicillin-resistant Staphylococcus aureus from skin and soft tissue infections in patients in Nairobi. Kenya Int J Infect Dis. 2013;17(2):e115–9. https://doi.org/10.1016/j.ijid.2012.09.006 .
doi: 10.1016/j.ijid.2012.09.006
pubmed: 23092752
Bouvet C, Gjoni S, Zenelaj B, Lipsky BA, Hakko E, Uckay I. Staphylococcus aureus soft tissue infection may increase the risk of subsequent staphylococcal soft tissue infections. Int J Infect Dis. 2017;60:44–8. https://doi.org/10.1016/j.ijid.2017.05.002 .
doi: 10.1016/j.ijid.2017.05.002
pubmed: 28487239
Alabi AS, Frielinghaus L, Kaba H, Kosters K, Huson MA, Kahl BC, et al. Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon. Central Africa BMC Infect Dis. 2013;13:455. https://doi.org/10.1186/1471-2334-13-455 .
doi: 10.1186/1471-2334-13-455
pubmed: 24083375
Ateba Ngoa U, Schaumburg F, Adegnika AA, Kosters K, Moller T, Gaus E, et al. Epidemiology and population structure of Staphylococcus aureus in various population groups from a rural and semi urban area in Gabon. Central Africa Acta Trop. 2012;124(1):42–7. https://doi.org/10.1016/j.actatropica.2012.06.005 .
doi: 10.1016/j.actatropica.2012.06.005
pubmed: 22750045
Lawal OU, Ayobami O, Abouelfetouh A, Mourabit N, Kaba M, Egyir B, et al. A 6-Year Update on the Diversity of Methicillin-Resistant Staphylococcus aureus Clones in Africa: A Systematic Review. Front Microbiol. 2022;13:860436. https://doi.org/10.3389/fmicb.2022.860436 .
doi: 10.3389/fmicb.2022.860436
pubmed: 35591993
pmcid: 9113548
Adegbite BR, Edoa JR, Schaumburg F, Alabi AS, Adegnika AA, Grobusch MP. Knowledge and perception on antimicrobial resistance and antibiotics prescribing attitude among physicians and nurses in Lambarene region, Gabon: a call for setting-up an antimicrobial stewardship program. Antimicrob Resist Infect Control. 2022;11(1):44. https://doi.org/10.1186/s13756-022-01079-x .
doi: 10.1186/s13756-022-01079-x
pubmed: 35241171
pmcid: 8892789
Rts SCTP. Efficacy and safety of the RTS, S/AS01 malaria vaccine during 18 months after vaccination: a phase 3 randomized, controlled trial in children and young infants at 11 African sites. PLoS Med. 2014;11(7):e1001685. https://doi.org/10.1371/journal.pmed.1001685 .
doi: 10.1371/journal.pmed.1001685
Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137(10):791–7. https://doi.org/10.7326/0003-4819-137-10-200211190-00007 .
doi: 10.7326/0003-4819-137-10-200211190-00007
pubmed: 12435215