Staphylococcus aureus in former Portuguese colonies from Africa and the Far East: missing data to help fill the world map

Abstract

The aim of the present study was to determine the prevalence and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage among patients and healthcare workers in Angola (ANG), São Tomé and Príncipe (STP), Cape Verde (CV) and East Timor (ET), and to characterize the antimicrobial susceptibility, virulence content and population structure of all S. aureus. Despite the importance of MRSA as a major human pathogen, data from these former Portuguese colonies in Africa and Asia are scarce. A total of 2065 nasal swabs recovered between 2010-14 were included in the study. Antimicrobial susceptibility testing and molecular characterization of S. aureus showed: (i) a very high MRSA prevalence in ANG (61.6%), moderate in STP (25.5%), low in CV (5.6%) and null in ET; (ii) a high prevalence of Panton-Valentine leukocidin in STP (36.8%), ET (29.2%) and CV (28.3%) contrasting with ANG (7.9%); (iii) ST5-SCCmecIVa, ST8-IV/V and ST5-VI were the major MRSA clones in ANG (65.2%), STP (44.8%) and CV (50%), respectively; (iv) a high resistance to trimethoprim-sulfamethoxazole in ANG (66.5%) and STP (50.9%), to rifampin in ANG (77.3%), and to tetracycline in STP (26.3%) and ET (20.8%); (v) three major methicillin-susceptible S. aureus clones (ST15, ST508, ST152) were present in all four countries. Age <18 years (OR 2.03, 95% CI 1.24-3.31), previous surgery (OR 2.45, 95% CI 1.24-4.83), no smoking (OR 4.04, 95% CI 1.05-15.50), and longer hospitalization (OR 2.53, 95% CI 1.49-4.28) were risk factors for MRSA carriage. This study provided the first comprehensive overview on MRSA in former Portuguese colonies in Africa and Asia, missing data in the world map.

Community-Associated Staphylococcus aureus from Sub-Saharan Africa and Germany: A Cross-Sectional Geographic Correlation Study

“…The overall smaller studies from Sub-Saharan Africa indicate that CC5, CC15, and CC30 are prevalent 14, 20 , that MSSA-CC8 has been primarily reported from North Africa (whereas MRSA-CC8 has been found in Central and South Africa), and that CC121 was more frequently reported from Sub-Saharan countries compared to Europe 2 . Methicillin-sensitive CC80 has been more frequently reported from North Africa, and may be related to the community-associated MRSA clone ST80 prevalent in Europe 25 .…”

“…In Sub-Saharan Africa, numerous studies exist describing various S . aureus strain collections with phenotypic and/or genotypic methods 9–20 , yet, they have been collected from retrospective strain collections, lack accompanying clinical data, are not controlled for hospital acquisition of the isolate/disease, and have not been performed strictly comparing the genotype (as clonal complex [CC] attribution and putative virulence gene content). In other words, cross-sectional molecular epidemiologic studies on both methicillin-sensitive and methicillin-resistant S .…”

Frequent occurrence of trimethoprim-sulfamethoxazole hetero-resistant Staphylococcus aureus isolates in different African countries

“…A-ST5-IVa, B-ST88-IVa, and C-ST8-IV/V clones [21], being either fully resistant to SXT (clone C-ST5-IVa), or hetero-resistant (clones A-ST88-IVa and B-ST8-IV/V) to SXT. However, factors contributing to the epidemic success of these clonal types over the SXT-resistant Brazilian clone (ST239-III) are still unclear.…”

“…A total of 122 (85 MRSA and 37 MSSA) out of 424 S. aureus isolates previously recovered from nasal swabs in three Portuguese-speaking African countries (Angola, São Tomé and Príncipe, and Cape Verde) between 2010 and 2014 and previously reported as SXT-resistant [21] were included in the present study (Table 1). Additionally, 18 SXT-resistant isolates, representatives of the MRSA Brazilian clone, from South America (Argentina, Brazil, Chile and Uruguay), Portugal and Taiwan [6,8,17] were also included ( Table 2).…”

“…Isolates were characterized by pulsed-field gel electrophoresis (PFGE), spa typing, multilocus sequence typing (MLST) and SCCmec typing, as previously described [21].…”