Mupirocin-resistant Staphylococcus aureus in Africa: a systematic review and meta-analysis

Abstract

BackgroundMupirocin is widely used for nasal decolonization of Staphylococcus aureus to prevent subsequent staphylococcal infection in patients and healthcare personnel. However, the prolonged and unrestricted use has led to the emergence of mupirocin-resistant (mupR) S. aureus. The aim of this systematic review was to investigate the prevalence, phenotypic and molecular characteristics, and geographic spread of mupR S. aureus in Africa.MethodsWe examined five electronic databases (EBSCOhost, Google Scholar, ISI Web of Science, MEDLINE, and Scopus) for relevant English articles on screening for mupR S. aureus from various samples in Africa. In addition, we performed random effects meta-analysis of proportions to determine the pooled prevalence of mupR S. aureus in Africa. The search was conducted until 3 August 2016.ResultsWe identified 43 eligible studies of which 11 (26%) were obtained only through Google Scholar. Most of the eligible studies (28/43; 65%) were conducted in Nigeria (10/43; 23%), Egypt (7/43; 16%), South Africa (6/43; 14%) and Tunisia (5/43; 12%). Overall, screening for mupR S. aureus was described in only 12 of 54 (22%) African countries. The disk diffusion method was the widely used technique (67%; 29/43) for the detection of mupR S. aureus in Africa. The mupA-positive S. aureus isolates were identified in five studies conducted in Egypt (n = 2), South Africa (n = 2), and Nigeria (n = 1). Low-level resistance (LmupR) and high-level resistance (HmupR) were both reported in six human studies from South Africa (n = 3), Egypt (n = 2) and Libya (n = 1). Data on mupR-MRSA was available in 11 studies from five countries, including Egypt, Ghana, Libya, Nigeria and South Africa. The pooled prevalence (based on 11 human studies) of mupR S. aureus in Africa was 14% (95% CI =6.8 to 23.2%). The proportion of mupA-positive S. aureus in Africa ranged between 0.5 and 8%. Furthermore, the frequency of S. aureus isolates that exhibited LmupR, HmupR and mupR-MRSA in Africa were 4 and 47%, 0.5 and 38%, 5 and 50%, respectively.ConclusionsThe prevalence of mupR S. aureus in Africa (14%) is worrisome and there is a need for data on administration and use of mupirocin. The disk diffusion method which is widely utilized in Africa could be an important method for the screening and identification of mupR S. aureus. Moreover, we advocate for surveillance studies with appropriate guidelines for screening mupR S. aureus in Africa.

Nasopharyngeal carriage, spa types and antibiotic susceptibility profiles of Staphylococcus aureus from healthy children less than 5 years in Eastern Uganda

“…Mupirocin is also commonly used for nasal decolonization of MSSA and MRSA in patients and health care workers in the developed countries [5, 32,37]. We have reported a high rate (4%) of mupirocin resistance (high-level) and this is consistent with the reported rates for this drug in Africa (5%-50%) [40]. The detection of mupirocin resistance in Uganda is worrying as MRSA decolonization is generally not a common practice in this country.…”

Species and drug susceptibility profiles of staphylococci isolated from healthy children in Eastern Uganda

“…8%, 5/62) were phenotypically resistant to gentamicin (an aminoglycoside). However, gentamicinsusceptible isolates positive for AMEs genes have been reported before [37,38]. Overall, the carriage of AMR genes in absence of significant antibiotic selective pressure points to presence of AMR drivers in the community that should be investigated [32,36] with robust approaches like whole genome sequencing [42] to better understand the mechanisms underlying altered AMR susceptibility in our setting.…”

The prevalence and molecular mechanisms of mupirocin resistance in Staphylococcus aureus isolates from a Hospital in Cape Town, South Africa

“…S. aureus nasal carriage is a risk factor for subsequent infections, especially amongst surgical and dialysis patients [2,3], and carriage of methicillin-resistant S. aureus (MRSA) is a particular problem in these high risk patients due to the limited therapeutic drugs available to treat postoperative infections [4]. Consequently, infection prevention strategies such as nasal decolonization are employed to minimize the occurrence of staphylococcal infection and reduce the risk of transmission within healthcare settings [5,6]. In routine intensive care unit practice, universal decolonization has proven more effective in reducing nosocomial bloodstream infections caused by MRSA as well as any other pathogen, compared to a targeted approach [7].…”

“…This is of particular concern for infection prevention and control practices involved in the management of MRSA outbreaks and in the preadmission management of surgical patients to minimize post-operative MRSA infections [10]. A recent systematic review describing mupirocin resistance in Africa highlighted the scarcity of data and advocated for the need for surveillance studies to monitor the levels of mupirocin resistance both in the community and healthcare settings [6]. Screening for mupirocin resistance has only been carried out in 12 of the 54 African countries, with an estimated pooled prevalence of 14% resistance amongst MRSA isolates.…”

“…Screening for mupirocin resistance has only been carried out in 12 of the 54 African countries, with an estimated pooled prevalence of 14% resistance amongst MRSA isolates. Only six studies have been conducted in South Africa reporting prevalences of 7-50%, 4-47%, and 0.9-23%, for overall mupirocin resistance, low-level and high-level mupirocin resistance, respectively, in MRSA [6]. There is a paucity of data describing associations between mupirocin resistance and the genetic background of S. aureus in Africa.…”