Staphylococcus aureus bacteraemia in Gauteng academic hospitals, South Africa

Smidt, Melony C Fortuin-de; Singh-Moodley, Ashika; Badat, Rubeina; Quan, Vanessa; Kularatne, Ranmini; Nana, Trusha; Lekalakala, Ruth; Govender, Nelesh P.; Perovic, Olga

doi:10.1016/j.ijid.2014.10.011

Cited by 40 publications

(44 citation statements)

References 36 publications

(36 reference statements)

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“…HIV-infected persons were more likely to have CA-MRSA than HA-MRSA. This association might be explained by overall increase in this group of incidence of S. aureus bacteraemia (1,20). In addition, fever at diagnosis was associated with HA-MRSA.…”

Section: Discussionmentioning

confidence: 88%

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

Perovic

Singh-Moodley

Govender

et al. 2017

Eur J Clin Microbiol Infect Dis

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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.

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Section: Discussionmentioning

confidence: 88%

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

Perovic

Singh-Moodley

Govender

et al. 2017

Eur J Clin Microbiol Infect Dis

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“…For effective analysis of bacteremia, the collection of blood cultures should precede empirical treatment and modified based on antibiotic susceptibility and resistance pattern [8]. Bacteremia caused by methicillin-resistant S. aureus results in greater mortality with an increased tendency of resistance to various antimicrobial agents when compared to Methicillin-sensitive S. aureus (MSSA) bacteremia [35].…”

Section: Antimicrobial Resistancementioning

confidence: 99%

Staphylococcus aureus and Coagulase-Negative Staphylococci in Bacteraemia: The Epidemiology, Predisposing Factors, Pathogenicity and Antimicrobial Resistance

Grace¹,

Olayinka²,

Onaolapo³

et al. 2019

Clin Microbiol

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Staphylococcus species are the predominant Gram-positive organisms obtained from blood culture samples. Its incidence in bloodstream infection among children and adults varies among. Staphylococcus aureus is regarded as pathogenic with high morbidity and mortality while coagulase-negative staphylococci (CoNS) are often regarded as a contaminant and not a true cause of bacteremia despite its rising occurrence. Predisposing factors of staphylococcal bacteremia include malnutrition, malaria, HIV/AIDS and nosocomial infections. Methicillin-resistance in Staphylococcus aureus and CoNS in bacteremia is associated with an increase in multidrug-resistant virulent strains when compared to methicillin-sensitive S. aureus or CoNS. The impact of coagulase-negative staphylococci in bacteremia is on the increase with marked clinical complications. However, this review summarizes the prevalence and epidemiology of S. aureus and CoNS in bacteremia based on research outcomes in Africa, Asia, Europe, and North America.

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“…[27] Whilst no previous studies conducted on S aureus prevalence in a TJA population in South Africa, an epidemiological study found that nosocomial incidence of MSSA and MRSA varied from 1.9 to 3.7 cases per 1000 admissions and 0.03 to 0.08 cases per 1000 admissions, respectively. [28] In the USA, several studies of patients for TJA report the incidence of S aureus colonization to range between 17.5%-25.1% for MSSA and 1.8%-5% for MRSA respectively. [29][30][31] concurrent skin infections and antibiotic treatment misuse.…”

Section: Discussionmentioning

confidence: 99%

“…[36][37] Amongst nosocomial S aureus infections in South Africa, the overall prevalence of HIV was found to be 32%, which subdivided into 42% and 27% for MRSA and MSSA cases respectively (p=0.106). [28] In a review of 404 HIV-infected outpatients from two separate centers in Botswana, the nasal colonization of S aureus and MRSA was 36.9% and 3.2% respectively. [37] In HIV-infected patients, those living with children and in high population-density areas were at significantly increased risk for S aureus colonization.…”

Section: Discussionmentioning

confidence: 99%

Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

Pietrzak

Maharaj

Mokete

2020

Preprint

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Background: Periprosthetic joint infections (PJIs) are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty (TJA). Staphylococcus aureus (S aureus) colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in S aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of S aureus colonization in patients awaiting TJA in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for S aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher’s exact tests, and chi square analyses. Results: The overall prevalence of Methicillin Sensitive S aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant S aureus. Nasal swabs returned a yield of 81.6% (n=31), with groin swabs and axillary swabs at 39.5% (n=15) and 28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the S aureus -colonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60- and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of S aureus colonization in patients undergoing elective TJA in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.

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Staphylococcus aureus bacteraemia in Gauteng academic hospitals, South Africa

Abstract: HIV infection was an independent risk factor for MRSA infection. The selection of appropriate empirical antimicrobial treatment is essential in patients with MRSA infections because of non-susceptibility to many other antimicrobial classes.

Cited by 40 publications

References 36 publications

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

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

Staphylococcus aureus and Coagulase-Negative Staphylococci in Bacteraemia: The Epidemiology, Predisposing Factors, Pathogenicity and Antimicrobial Resistance

Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

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