High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda

Abstract

BackgroundThere is limited data on Methicillin resistant Staphylococcus aureus (MRSA) in Uganda where, as in most low income countries, the routine use of chromogenic agar for MRSA detection is not affordable. We aimed to determine MRSA prevalence among patients, healthcare workers (HCW) and the environment in the burns units at Mulago hospital, and compare the performance of CHROMagar with oxacillin for detection of MRSA.ResultsOne hundred samples (from 25 patients; 36 HCW; and 39 from the environment, one sample per person/item) were cultured for the isolation of Staphylococcus aureus. Forty one S. aureus isolates were recovered from 13 patients, 13 HCW and 15 from the environment, all of which were oxacillin resistant and mecA/femA/nuc-positive. MRSA prevalence was 46% (41/89) among patients, HCW and the environment, and 100% (41/41) among the isolates. For CHROMagar, MRSA prevalence was 29% (26/89) among patients, HCW and the environment, and 63% (26/41) among the isolates. There was high prevalence of multidrug resistant isolates, which concomitantly possessed virulence and antimicrobial resistance determinants, notably biofilms, hemolysins, toxin and ica genes. One isolate positive for all determinants possessed the bhp homologue which encodes the biofilm associated protein (BAP), a rare finding in human isolates. SCCmec type I was the most common at 54% prevalence (22/41), followed by SCCmec type V (15%, 6/41) and SCCmec type IV (7%, 3/41). SCCmec types II and III were not detected and 10 isolates (24%) were non-typeable.ConclusionsHyper-virulent methicillin resistant Staphylococcus aureus is prevalent in the burns unit of Mulago hospital.

Molecular epidemiology of Panton-Valentine Leukocidin-positive community-acquired methicillin resistant Staphylococcus aureus isolates in pastoral communities of rural south western Uganda

“…While SCC mec type V strains have been isolated from hospital settings in Uganda, none were Spa type t318 [22]. However, Spa type t645, the second most frequent type in our collection (20.6%), also common in Western Europe and the Middle East (http://spaserver.ridom.de), was found to be the most frequent type isolated from SSI at Mulago National referral hospital [22], supporting the notion that there is a changing epidemiology reflected by community associated SCC mec genotypes being now more associated with hospital infections as observed elsewhere [23, 45]. However, it is noteworthy that some spa types of PVL+ S. aureus in the present study (t186, t729 and t355) have been previously identified in studies from Africa, and they all share the MLST type ST88 [46].…”

Molecular Characterization of Staphylococcus aureus from Patients with Surgical Site Infections at Mulago Hospital in Kampala, Uganda

“…The predominance of SCC mec type V was previously reported among isolates from the burns units at Mulago National Hospital [37] and in another study in Nigeria [34]. However, in these other studies SCC mec types I and III were also predominant.…”

Prevalence and Antimicrobial Susceptibility Patterns of Bacteria from Milkmen and Cows with Clinical Mastitis in and around Kampala, Uganda

“…This implies that the nasal carriage of Staphylococcus aureus in milkmen was 13% (4/31), lower than that reported in hospital settings in Uganda [22]. Additionally, similar species of CoNS to those detected in cows were identified; Staphylococcus scuiri (3), Staphylococcus saprophyticus (2), Staphylococcus xylosus (1) and Staphylococcus intermedius (1).…”