Methicillin-Resistant Staphylococcus aureus in the Community in Luanda, Angola: Blurred Boundaries with the Hospital Setting

Abstract

Although the nosocomial prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Angola is over 60% and one of the highest in Africa, the extent of MRSA in the community is unknown. To fill this gap, we conducted a hospital-based study in which 158 children attending the emergency ward and ambulatory services of a pediatric hospital in Luanda, the capital of Angola, were screened for S. aureus nasal colonization. Overall, 70 (44.3%) individuals were colonized with S. aureus, of which 20 (28.6%) carried MRSA, resulting in a prevalence of 12.7% (20/158) of MRSA in the population screened. Molecular characterization by pulsed-field gel electrophoresis (PFGE), spa typing, multilocus sequence typing, and SCCmec typing distributed the isolates into two major MRSA clones and one dominant methicillin-susceptible S. aureus (MSSA) lineage, corresponding to the main clones circulating in hospitals in Luanda. The MRSA isolates mainly belonged to clones A (PFGE type A, spa type t105, ST5-IVa-65%) and B (PFGE B, t3869, ST88-IVa-30%), while MSSA isolates mainly belonged to clone L (PFGE type L, t861, ST508-42%). S. aureus isolates showed resistance to penicillin (96%), rifampin (87%), and trimethoprim-sulfamethoxazole (21%). In conclusion, the prevalence of MRSA among children in the community in Luanda is high and seems to originate from hospitals, warranting continuous monitoring and implementation of additional infection control measures.

Differences in gram-positive bacterial colonization and antimicrobial resistance among children in a high income inequality setting

“…MRSA colonization among all SES groups (8.1%) in Niterói was higher than frequencies observed in high-income populations (≤ 1%), such as in USA, Canada, northern Europe, and Hong Kong [28]. However, the difference in colonization prevalence between high and low SES groups observed in the present study (6% vs. 14%) reflects differences in prevalence among children from these high-income populations compared with 6–29% in populations from LMICs, such as Iran, Botswana, Angola, India [29–31, 33, 35], and public childcare centers in Brazil [22, 34].…”

“…Here, S. aureus colonization prevalence was 32% among high-income SES children. This frequency is similar to that found in healthy or outpatient children in high-income countries, such as USA (35–37%) [24, 25], Canada (24%) [26], Taiwan (29%) [27], China (28%) [28], as well as in some LMIC, such as India (35%) [29], Botswana (52%) [30], Iran (28%) [31], Gambia (25%) [32] and Angola (44%) [33]. However, the colonization frequency (40%) found among middle/low-income SES group and slum residents was higher than found in most of these countries, but similar to those found among public childcare centers in Brazil (47–48%) [22, 34].…”

Diversity of Staphylococcus aureus Isolates in European Wildlife

“…All three harbored blaZ and the cat gene (encoding chloramphenicol resistance). CC88 is a widespread human lineage from which MRSA strains evolved that are common in Australia [145] and Sub-Saharan Africa [119,146,147,148,149]. It has been described from laboratory mice [35], from retail food [143] and from pigs [150].…”

Aerobic bacteria associated with chronic suppurative otitis media in Angola

“…Studies on antimicrobial susceptibility of pathogens involved in CSOM from Angola are scarce, and generally do not regard the antibiotics commonly used to treat this particular infection. A high incidence of methicillin resistant S. aureus (MRSA) and carbapenemase-producing Enterobacteriaceae has, however, been reported [ 13 , 14 ]. In the current study, we present microbiological findings from middle ear discharge and the nasopharynx in patients with CSOM in Luanda and three other provinces in Angola with the aim to provide a background for recommendations on the treatment of the disease in the public health care system.…”