A small proportion of community-associated methicillin-resistant Staphylococcus aureus bacteraemia, compared to healthcare-associated cases, in two South African provinces

Abstract

We compared the proportion of cases of community-associated and healthcare-associated methicillin-resistant Staphylococcus aureus (CA-MRSA and HA-MRSA, respectively) bacteraemia among patients at five hospitals in the Gauteng and Western Cape provinces in South Africa and described the molecular characteristics and antimicrobial susceptibility trends. This was a cross-sectional study using data collected by enhanced surveillance for S. aureus bacteraemia. A total of 2511 cases of S. aureus bacteraemia were identified from January 2013 to January 2016. Among 1914 cases of S. aureus, 557 (29.1%) cases were identified as MRSA infection. Forty-four cases (44/1914 [2.3%] of all S. aureus cases) were considered CA-MRSA infection and 513/1914 (26.8% of all cases) had HA-MRSA infection; the majority were neonates. CA-MRSA constituted 7.9% (44/557) of all cases of MRSA infection. Staphylococcus aureus isolates demonstrated significantly reduced susceptibility to the following classes of antimicrobial agents: macrolides, tetracyclines, aminoglycosides and cotrimoxazole, in 2015 compared to 2013 (p < 0.05). Of the 557 MRSA isolates, 484 (87%) were typed for SCCmec elements and spa types: the most common SCCmec type was type III (n = 236, 48.76%), followed by type IV (n = 144, 29.76%). The most common spa types were t037 (n = 229, 47.31%) and t1257 (n = 90, 18.60%). Of 28 isolates selected for multilocus sequence typing (MLST), the most common sequence types (STs) were ST239 and ST612 of clonal complex 8 (CC8) (n = 8 each) and a novel ST (ST4121) was obtained for one isolate. This study demonstrates that S. aureus bacteraemia is common in South African academic centres and characterised by HA-MRSA SCCmec types III and IV. A small proportion of CA-MRSA cases were caused by a few different sequence types.

Molecular epidemiology and mechanisms of antibiotic resistance in Enterococcus spp., Staphylococcus spp., and Streptococcus spp. in Africa: a systematic review from a One Health perspective

“…The study showed that S. aureus bacteremia is common and accounts for high mortality in South Africa. The study by Perovic et al . came to a similar conclusion showing that 202 patients died from S. aureus bacteremia infections, with HIV patients being more likely to acquire HA‐MRSA.…”

“…Three studies reported the prevalence of 29.1%, 45.44%, and 100% MRSA recovered from humans; the MRSA expressed resistance to macrolides, TET, aminoglycosides, cotrimoxazole, and RIF. MRSA ST612, ST239, ST36, and ST5 were the dominant strains, similar to other findings in Australia and Europe .…”

Molecular Epidemiology and Mechanisms of Antibiotic Resistance in Gram-positive Bacteria in Africa: A Systematic Review and Meta-Analysis from a One Health Perspective

“…Three studies reported a prevalence of 29.1% 135 , 45.44% 60 and 100% 136 MRSA recovered from humans, expressing resistance to macrolides, tetracycline, aminoglycoside, cotrimoxazole and rifampicin. MRSA ST612, ST239, ST36 and ST5 were the dominant strains similar to other findings in Australia and Europe 137 .…”

“…The study showed that S. aureus bacteremia is common and account for high mortality in South Africa. For instance, in a study by Perovic et al, 135 202 patients died from S. aureus bacteremia infections, with HIV patients being more likely to acquire HA-MRSA. The isolates were however susceptible to glycopeptides, fluoroquinolones, linezoid, tigecycline, fosfomycin and fusidic acid, confirming their clinical usefulness in treating MRSA infections.…”

Genome Mining and Comparative Pathogenomic Analysis of An Endemic Methicillin-Resistant Staphylococcus Aureus (MRSA) Clone, ST612-CC8-t1257-SCCmec_IVd(2B), Isolated in South Africa

“…This parent clone has undergone clonal expansion into two main types, ST612-MRSA-IV-A and ST612-MRSA-IV-B, and it has been postulated that its global spread has occurred via travel to these popular tourist countries [14,26]. In South Africa, the clonal subtype ST612-CC8-t1257-SCCmec_IVd(2B) is dominant and has spread to different provinces across the country [16,[27][28][29][30]. This multi-drug-resistant (MDR) local dominant clone was recently found in poultry and occupational farm workers with a diverse resistome to antibiotics commonly used in human and veterinary medicine with the concern of its spread across the poultry food-chain in the country [31].…”