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Worku S, Abebe T, Seyoum B, Alemu A, Shimelash Y, Yimer M, Abdissa A, Beyene GT, Swedberg G, Mihret A. Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus among Patients Diagnosed with Surgical Site Infection at Four Hospitals in Ethiopia. Antibiotics (Basel) 2023; 12:1681. [PMID: 38136715 PMCID: PMC10741212 DOI: 10.3390/antibiotics12121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of severe surgical site infections (SSI). The molecular epidemiology of MRSA is poorly documented in Ethiopia. This study is designed to determine the prevalence of MRSA and associated factors among patients diagnosed with SSI. A multicenter study was conducted at four hospitals in Ethiopia. A wound culture was performed among 752 SSI patients. This study isolated S. aureus and identified MRSA using standard bacteriology, Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS), and cefoxitin disk diffusion test. The genes mecA, femA, vanA, and vanB were detected through PCR tests. S. aureus was identified in 21.6% of participants, with 24.5% of these being methicillin-resistant Staphylococci and 0.6% showing vancomycin resistance. Using MALDI-TOF MS for the 40 methicillin-resistant Staphylococci, we confirmed that 31 (77.5%) were S. aureus, 6 (15%) were Mammaliicoccus sciuri, and the other 3 (2.5%) were Staphylococcus warneri, Staphylococcus epidermidis, and Staphylococcus haemolyticus. The gene mecA was detected from 27.5% (11/40) of Staphylococci through PCR. Only 36.4% (4/11) were detected in S. aureus, and no vanA or vanB genes were identified. Out of 11 mecA-gene-positive Staphylococci, 8 (72.7%) were detected in Debre Tabor Comprehensive Specialized Hospital. Methicillin-resistant staphylococcal infections were associated with the following risk factors: age ≥ 61 years, prolonged duration of hospital stay, and history of previous antibiotic use, p-values < 0.05. Hospitals should strengthen infection prevention and control strategies and start antimicrobial stewardship programs.
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Affiliation(s)
- Seble Worku
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1165, Ethiopia; (T.A.); (A.M.)
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor P.O. Box 272, Ethiopia
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa 1165, Ethiopia; (B.S.); (A.A.); (M.Y.); (A.A.); (G.T.B.)
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1165, Ethiopia; (T.A.); (A.M.)
| | - Berhanu Seyoum
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa 1165, Ethiopia; (B.S.); (A.A.); (M.Y.); (A.A.); (G.T.B.)
| | - Ashenafi Alemu
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa 1165, Ethiopia; (B.S.); (A.A.); (M.Y.); (A.A.); (G.T.B.)
| | - Yidenek Shimelash
- Debre Tabor Comprehensive Specialized Hospital, Debre Tabor P.O. Box 272, Ethiopia;
| | - Marechign Yimer
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa 1165, Ethiopia; (B.S.); (A.A.); (M.Y.); (A.A.); (G.T.B.)
| | - Alemseged Abdissa
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa 1165, Ethiopia; (B.S.); (A.A.); (M.Y.); (A.A.); (G.T.B.)
| | - Getachew Tesfaye Beyene
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa 1165, Ethiopia; (B.S.); (A.A.); (M.Y.); (A.A.); (G.T.B.)
| | - Göte Swedberg
- Department of Medical Biochemistry and Microbiology, Uppsala University, 750 08 Uppsala, Sweden;
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1165, Ethiopia; (T.A.); (A.M.)
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa 1165, Ethiopia; (B.S.); (A.A.); (M.Y.); (A.A.); (G.T.B.)
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Abdeta A, Beyene D, Negeri AA. Antimicrobial Resistance Patterns of Staphylococcus aureus and Enterococcus Species at the Ethiopian Public Health Institute, Ethiopia: A Five-Year Retrospective Analysis. Infect Drug Resist 2023; 16:6155-6166. [PMID: 37724092 PMCID: PMC10505397 DOI: 10.2147/idr.s429687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Abstract
Purpose The study aimed to investigate the antimicrobial resistance patterns of Staphylococcus aureus and Enterococcus species isolated from clinical specimens over a period of five years, including resistance to methicillin and vancomycin. Patients and Methods Bacterial identification and antimicrobial susceptibility testing reports from 2017 to 2021 at the Ethiopian Public Health Institute were used for this retrospective study. The organisms were identified using either BD Phoenix M50, Vitek 2 compact, or conventional biochemical methods, whichever was available at the time of testing. The antimicrobial susceptibility profiles of the isolates were determined using either Kirby-Bauer disc diffusion, BD phoenix M50, or Vitek 2 compact. WHONET software was used to analyze the antimicrobial resistance patterns of both organisms. The p-values of ≤0.05 were considered statistically significant. Results During the study period, a total of 315 Staphylococcus aureus and 92 Enterococcus species were isolated. Out of 315 Staphylococcus aureus isolates, 27% and 5.1% were methicillin and vancomycin resistant, respectively. Staphylococcus aureus showed very high resistance to Penicillin G (86.7%). Out of 92 Enterococcus species recovered, 8.7% were vancomycin-resistant. Enterococcus species showed very high resistance to Penicillin G (71.4%) and tetracyclines (83.3%). Methicillin-resistant Staphylococcus aureus shows 100% resistance to penicillin followed by ciprofloxacin (50%), erythromycin (45.6%), and tetracycline (44.2%) and lower resistance to vancomycin (18.8%). All vancomycin-resistant isolates of both organisms were fully resistant (100%) to all antibiotics tested, except for linezolid and daptomycin, to which they were susceptible. Conclusion This study found a high prevalence of methicillin and vancomycin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus species between 2017 and 2021. However, there were no statistically significant changes in the prevalence of these organisms during the study period. This suggests that larger and more representative nationwide data is needed to show trends of these pathogens.
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Affiliation(s)
- Abera Abdeta
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Degefu Beyene
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abebe Aseffa Negeri
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Almuhayawi MS, Alruhaili MH, Gattan HS, Alharbi MT, Nagshabandi M, Al Jaouni S, Selim S, Alanazi A, Alruwaili Y, Faried OA, Elnosary ME. Staphylococcus aureus Induced Wound Infections Which Antimicrobial Resistance, Methicillin- and Vancomycin-Resistant: Assessment of Emergence and Cross Sectional Study. Infect Drug Resist 2023; 16:5335-5346. [PMID: 37605760 PMCID: PMC10440082 DOI: 10.2147/idr.s418681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
Background Wound infection is a prevalent concern in the medical field, being is a multi-step process involving several biological processes. Methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) infections often occur in areas of damaged skin, such as abrasions and open wounds. Methods This research aims to light the incidence of MRSA and VRSA in wound swabs, the antimicrobial susceptibility configuration of isolated S. aureus patterns in pus/wound samples collected from Saudi Arabian tertiary hospital. The cross section study, β- lactamase detection, VRSA genotyping, MAR index, D-test and VRSA genotyping are methods, which used for completed this research. Results Patients of several ages and genders delivered specimens from two hospitals in the Al jouf area, in the northern province of Saudi Arabia. S. aureus was found in 188 (34.7%) of the 542 wounds. The traumatized wounds provided 71 isolates (38.8%), surgical wound provided 49 isolates (26.8%) and abscess were represented 16 by isolates (8.7%). In the study, 123 (65.4%) out of 188 were MRSA, 60 (31.9%) were MSSA, and five (2.7%) were VRSA. Linezolid and rifampin were found to be the most effective antimicrobials with 100% in vitro antibacterial activity against S. aureus isolates. The Multiple antimicrobials resistance (MAR) index revealed 73 isolates (38.9%) with a MAR index greater than 0.2, and 115 (61.1%) less than 0.2. The D-test showed that of MLSb phenotypes among S. aureus, 22 (11.7%) strains were D-test positive (MLSbi phenotype), 53 (28.2%) strains were constitutive MLSc phenotypes, and 17 (9%) strains were shown to have MSb phenotypes. All VRSA isolates (n=5) were found to be positive for vanA, and no vanB positive isolates were detected in the study. Conclusion Regular monitoring and an antimicrobials stewardship program should be in place to provide critical information that can be utilized for empirical therapy and future prevention strategies.
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Affiliation(s)
- Mohammed S Almuhayawi
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Mohammed H Alruhaili
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King AbdulAziz University, Jeddah, Saudi Arabia
- Special Infectious Agents Unit, King Fahad Medical Research Center, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Hattan S Gattan
- Special Infectious Agents Unit, King Fahad Medical Research Center, King AbdulAziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohanned Talal Alharbi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, University of Jeddah, Jeddah, 23218, Saudi Arabia
| | - Mohammed Nagshabandi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, University of Jeddah, Jeddah, 23218, Saudi Arabia
| | - Soad Al Jaouni
- Department of Hematology/Oncology, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
- Yousef Abdulatif Jameel Scientific Chair of Prophetic Medicine Application, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Samy Selim
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Awadh Alanazi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Yasir Alruwaili
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Osama Ahmed Faried
- Medical Microbiology and Immunology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed E Elnosary
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
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Ibrahim RA, Berhe N, Mekuria Z, Seyoum ET, Balada-Llasat JM, Abebe T, Mariam SH, Tsige E, Fentaw Dinku S, Wang SH. Antimicrobial Resistance and Virulence Gene Profile of Clinical Staphylococcus aureus: A Multi-Center Study from Ethiopia. Infect Drug Resist 2023; 16:4835-4844. [PMID: 37520455 PMCID: PMC10386829 DOI: 10.2147/idr.s419577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
Background Staphylococcus aureus causes a wide range of infections from mild skin and soft tissue to severe life-threatening bacteremia. The pathogenicity of S. aureus infections is related to various bacterial surface components and extracellular proteins such as toxic-shock syndrome (TSS) toxin and Panton-Valentine leukocidin (PVL). In this study we determine the antimicrobial resistance of isolated strains and their virulence genes in Ethiopia. Methods A total of 190 archived S. aureus isolates from four Ethiopia Antimicrobial Resistance (AMR) Surveillance sites were analyzed. The identification of S. aureus was done by matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF Biotyper) and antimicrobial susceptibility test (AST) was done using VITEK® 2. Multiplex PCR was used to detect mecA, mecC, pvl and spa genes and super-antigens (sea, seb, sec, seh and sej staphylococcal enterotoxins). Results A total of 172 isolates were confirmed as S. aureus, 9 (5.23%) were methicillin-resistant S. aureus (MRSA) and 163 (94.76%) were methicillin-susceptible S. aureus (MSSA). AST showed that 152 (88.4%) isolates were resistant to penicillin; 90 (52.32%) resistant to trimethoprim-sulfamethoxazole; and 45 (26.16%) resistant to tetracycline. A total of 66 (38.37%) isolates harbored at least one staphylococcal enterotoxin gene and 31 (46.96%) isolates had more than one. The most frequent enterotoxin gene encountered was seb 28 (16.28%). The TSST-1 gene was detected in 23 (13.37%). Presence of staphylococcal enterotoxin gene showed significant association with antibiotic resistance to cefoxitin, benzylpenicillin, oxacillin, erythromycin, clindamycin, tetracycline and SXT. The pvl gene was detected in 102 (59.3%) of isolates. Isolates from patients below 15 years of age showed significantly high numbers of pvl gene (P = 0.02). Presence of sej (P = 0.011) and TSST-1 (P <0.001) genes were associated with the presence of pvl gene. Conclusion In this study, isolates were highly resistant to oral antibiotics and the pvl, seb, sea and TSST-1 genes were prevalent.
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Affiliation(s)
- Rajiha A Ibrahim
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Bacterial, Parasitic and Zoonotic Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, OH, USA
| | - Nega Berhe
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zelalem Mekuria
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, OH, USA
- Veterinary Preventive Medicine, Colleges of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Eyasu T Seyoum
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, OH, USA
| | - Joan-Miquel Balada-Llasat
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, OH, USA
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Tamrat Abebe
- Department of Microbiology, Immunology, and Parasitology, Schools of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon H Mariam
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Estifanos Tsige
- Bacterial, Parasitic and Zoonotic Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Surafel Fentaw Dinku
- Bacterial, Parasitic and Zoonotic Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Shu-Hua Wang
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, OH, USA
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Inhibition of Erythromycin and Erythromycin-Induced Resistance among Staphylococcus aureus Clinical Isolates. Antibiotics (Basel) 2023; 12:antibiotics12030503. [PMID: 36978370 PMCID: PMC10044026 DOI: 10.3390/antibiotics12030503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
The increasing incidence of erythromycin and erythromycin-induced resistance to clindamycin among Staphylococcus aureus (S. aureus) is a serious problem. Patients infected with inducible resistance phenotypes may fail to respond to clindamycin. This study aimed to identify the prevalence of erythromycin and erythromycin-induced resistance and assess for potential inhibitors. A total of 99 isolates were purified from various clinical sources. Phenotypic detection of macrolide-lincosamide-streptogramin B (MLSB)-resistance phenotypes was performed by D-test. MLSB-resistance genes were identified using PCR. Different compounds were tested for their effects on erythromycin and inducible clindamycin resistance by broth microdilution and checkerboard microdilution methods. The obtained data were evaluated using docking analysis. Ninety-one isolates were S. aureus. The prevalence of constitutive MLSB, inducible MLSB, and macrolide-streptogramin (MS) phenotypes was 39.6%, 14.3%, and 2.2%, respectively. Genes including ermC, ermA, ermB, msrA, msrB, lnuA, and mphC were found in 82.6%, 5.8%, 7.7%, 3.8%, 3.8%, 13.5%, and 3.8% of isolates, respectively. Erythromycin resistance was significantly reduced by doxorubicin, neomycin, and omeprazole. Quinine, ketoprofen, and fosfomycin combated and reversed erythromycin/clindamycin-induced resistance. This study highlighted the significance of managing antibiotic resistance and overcoming clindamycin treatment failure. Doxorubicin, neomycin, omeprazole, quinine, ketoprofen, and fosfomycin could be potential inhibitors of erythromycin and inducible clindamycin resistance.
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Prevalence of Constitutive and Inducible Clindamycin Resistance among Methicillin-Resistant Staphylococcus aureus Isolates in a Tertiary Care Hospital, Kashmir Valley. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2022. [DOI: 10.52547/jommid.10.3.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Woldeteklie AA, Kebede HB, Abdela AA, Woldeamanuel Y. Prevalence of Extended-Spectrum β-Lactamase and Carbapenemase Producers of Gram-Negative Bacteria, and Methicillin-Resistant Staphylococcus aureus in Isolates from Diabetic Foot Ulcer Patients in Ethiopia. Infect Drug Resist 2022; 15:4435-4441. [PMID: 35978723 PMCID: PMC9377397 DOI: 10.2147/idr.s371431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Infectious diabetic foot ulcers (IDFU) are a widespread health issue that affects people all over the world. IDFU, like other medical disorders, can have negative implications if drug resistance develops. Clinicians will be able to choose the optimal antibiotics to treat impacted patients based on the antibiotic susceptibility pattern of bacterial strains. In this project, we attempted to evaluate the levels of extended-spectrum beta-lactamase (ESBL), carbapenemase, and MRSA in patients with diabetic foot ulcers. Methods A sterile swab was used to collect a sample from the leg ulcer, while a sterile needle was used to collect the aspirated pus. Bacteria identification and antibiotic susceptibility tests are carried out based on conventional bacterial culture. The double-disc inactivation method and modified carbapenem (meropenem) were used to screen the production of ESBL and carbapenemase. Results Of the 76 isolates tested, 53.9% (41/76) were phenotypically ESBL producers. K. pneumoniae 75% (6/8), Acinetobacter species 75% (9/12), Serratia species 75% (3/4), Pseudomonas species 64.3% (14/9), E. coli 57.8% (11/19), Citrobacter species 50% (2/4) and Proteus mirabilis 25% (1/4) had the highest frequency of ESBL production. Of the 68 GNB isolates tested, 27.9% (19/68) were carbapenemase-producing organisms. K. pneumoniae 62.5% (5/8), Serratia 50% (3/6), Acinetobacter species 40% (4/10), Pseudomonas species 23.5% (4/17) and E. coli 15.8% (3/19) are the top five major carbapenemase producers. In this study, 32 isolates of Staphylococcus aureus were tested for methicillin resistance. Among them, 81.3% (26/32) were methicillin-resistant Staphylococcus aureus (MRSA), and 18.7% (6/32) of the remaining isolates were methicillin-sensitive Staphylococcus aureus (MSSA). Conclusion The result draws attention to the management of diabetic foot ulcer infections based on the results of microbiological analysis and drug susceptibility testing.
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Affiliation(s)
- Asegdew Atlaw Woldeteklie
- Department of Microbiology, Immunology, and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Medical Laboratory Science, Debre Berhan College of Health Sciences, Debre Berhan, Ethiopia
| | - Habtamu Biazin Kebede
- Department of Microbiology, Immunology, and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
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Inducible Clindamycin-Resistant Staphylococcus aureus Strains in Africa: A Systematic Review. Int J Microbiol 2022; 2022:1835603. [PMID: 35498395 PMCID: PMC9042618 DOI: 10.1155/2022/1835603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Excessive use of clindamycin enhances the acquisition of inducible clindamycin-resistant S. aureus strains, which is a significant health problem in Africa. The main objective of this review study was to determine the prevalence of inducible clindamycin resistance and related genes among S. aureus isolates in Africa. Methods A qualitative systematic review was conducted on inducible clindamycin resistance among S. aureus isolates in Africa using electronic databases such as Google Scholar and PubMed. Articles published in English before 2021 were selected, and relevant data were extracted, collected, and analyzed. Results In our search, 22 articles met the eligibility criteria for this review study. Of 3064 total S. aureus isolates, 605 had iMLSB phenotype. The overall prevalence of inducible clindamycin resistance in S. aureus isolates was 19.8% with a range of 2.9% to 44.0%. A high number of iMLSB phenotypes were observed in MRSA isolates (3.6–77.8%) than MSSA (0–58.8%). The overall prevalence of the iMLSB phenotype in MRSA strains was 26.8% (279/1041). The maximum peak prevalence of inducible clindamycin resistance among S. aureus isolates recorded in the continent was 44.0% in Egypt, followed by 35.8% in Libya and 33.3% in Uganda in 2017, 2007, and 2013, respectively. The highest prevalence of iMLSB phenotype in MRSA strains was reported in Egypt, 77.8%, followed by Nigeria, 75.0%, and Libya, 66.2%. Among the recovered drug-resistance genes, ermA, ermC, and msrA genes were commonly detected in Egypt with 67.9%, 70.0%, and 70.0% prevalence, respectively. Conclusion This review highlights a higher inducible resistance of S. aureus, including MRSA strains to clindamycin in the continent. Regular screening of these strains, wise use of clindamycin, and molecular detection and genotyping of resistant genes are urgent.
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Moutaouakkil K, Abdellaoui H, Arhoune B, Atarraf K, El Fakir S, Yahyaoui G, Mahmoud M, Afifi MA, Oumokhtar B. Paediatric osteoarticular infections caused by staphylococcus aureus producing panton-valentine leucocidin in morocco: Risk factors and clinical features. Afr J Paediatr Surg 2022; 19:78-82. [PMID: 35017376 PMCID: PMC8809469 DOI: 10.4103/ajps.ajps_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to estimate the prevalence of Staphylococcus aureus producing Panton-Valentine leucocidin (PVL) isolated from children diagnosed with osteoarticular infections (OAIs), and to examine risk factors and clinical features. METHODS This prospective study was conducted from January 2017 to December 2018. All hospitalised children diagnosed with S. aureus OAI are included. Blood cultures, articular fluids, synovial tissues and/or bone fragments were collected for bacteriological culture. Antimicrobial susceptibility tests were determined by disk diffusion method. Genes encoding methicillin resistance (mecA) and PVL virulence factors (luk-S-PV and luk-F-PV) were detected by multiplex polymerase chain reaction. The demographic, clinical, laboratory, radiographic and clinical features were reviewed prospectively from medical records. RESULTS A total of 37 children with S. aureus OAIs were included, 46% of them have PVL-positive infection and 70.6% were male. The mean age was 8.12 years (±4.57), and almost were from rural settings (76.5%). Children with Staphylococcus aureus producing Panton-Valentine leucocidin (SA-PVL) were significantly associated with type of infection (P = 0.005), location of infection (P = 0.037) and abnormal X-ray (P = 0.029). All strains SA-PVL+ are sensitive to methicillin, but one strain SA-PVL negative was methicillin-resistant S. aureus, confirmed by gene mecA positive. CONCLUSION The prevalence of S. aureus infections producing PVL toxin was high in OAIs amongst Moroccan children, mainly due to methicillin-susceptible S. aureus. Type and location of infections and abnormal X-ray were significantly associated with SA-PVL. Routine diagnostic testing of PVL-SA, continuous epidemiological surveillance and multidisciplinary management of OAI is essential to prevent serious complications.
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Affiliation(s)
- Kaoutar Moutaouakkil
- Microbiology and Molecular Biology Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Hicham Abdellaoui
- Pediatric Orthopedic Traumatology Department, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Btissam Arhoune
- Microbiology and Molecular Biology Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Karima Atarraf
- Pediatric Orthopedic Traumatology Department, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Samira El Fakir
- Laboratory of Epidemiology, Clinical Research and Community Health- Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Ghita Yahyaoui
- Central Laboratory of Medical Analysis, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mustapha Mahmoud
- Central Laboratory of Medical Analysis, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Moulay Abderrahmane Afifi
- Pediatric Orthopedic Traumatology Department, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Bouchra Oumokhtar
- Microbiology and Molecular Biology Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
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Detection of Inducible Resistance to Clindamycin among Methicillin Resistant and Sensitive strains of Staphylococcus aureus from India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.4.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The resistance to MLSB antibiotics, i.e. Macrolide-Lincosamide-Streptogramin B (MLSB), is an increasing problem among Methicillin-resistant Staphylococci. The resistance to macrolides can be by efflux mechanism or via inducible or constitutive resistance. Unfortunately, routine clindamycin susceptibility testing fails to detect the inducible resistance, which commonly results in treatment failure and necessitates incorporating a simple D-test to detect such resistance. A retrospective observational study was performed on S. aureus isolates from patients. The strains were subjected to antibiotic susceptibility testing followed by detection of mecA gene by a polymerase chain reaction and, the ‘D-test’ was performed to know the inducible resistance to clindamycin. A total of 235 isolates were identified as S. aureus. Antibiotic susceptibility test indicated 190 MRSA and 45 are sensitive to MLSB (MS). Inducible clindamycin resistance was found among 48 (20.4%) isolates and constitutive resistance in 104 (44.2%). MRSA strains had higher inducible and constitutive resistance than MSSA strains (22.1%, 51.6% and 13.3%, 13.3%, respectively). Clindamycin is a commonly used antibiotic in patients with MRSA infections to spare higher-end anti-MRSA antibiotics like linezolid and vancomycin. To detect inducible clindamycin to avoid treatment failures; the study showed the importance of incorporating the D-test in routine testing.
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Pradhan S, Regmi SM, Shrestha N. Inducible Clindamycin Resistant Staphylococcus aureus among Patients Attending Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:1111-1115. [PMID: 35199757 PMCID: PMC9124341 DOI: 10.31729/jnma.6882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/17/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Staphylococcus aureus, a superbug, resistant to multiple antibiotics led to growing interest in the usage of macrolide-lincosamide-streptogramin B antibiotics, which are now rapidly developing resistance. This study aims to find the prevalence of inducible clindamycin-resistant Staphylococcus aureus among obtained clinical samples from in-patient and out-patient departments of a tertiary care center. METHODS This is a descriptive cross-sectional study done in clinical samples from the in-patient and out-patient departments of a tertiary care center from September 2020-May 2021. Ethical clearance was taken from the Institutional Review Committee (Ref: 068/2077/2078). Staphylococcus aureus were isolated and antibiotic susceptibility tests were performed by disc diffusion method. Inducible clindamycin and methicillin resistance Staphylococcus aureus were detected using D-test and cefoxitin disc according to Clinical and Laboratory Standards Institute guidelines. Convenient sampling was done and the data was analyzed using Statistical Package for Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS Among a total of 141 Staphylococcus aureus isolated, the prevalence of inducible clindamycin resistant phenotype was 41 (29.1%) (21.6-36.59 at 95% Confidence Interval). Whereas, 30 (21.3%) were constitutive clindamycin resistant. The inducible 28 (47.5%) and 19 (32.2%) constitutive clindamycin resistance was higher among methicillin-resistant Staphylococcus aureus. CONCLUSIONS The frequency of inducible clindamycin resistance among methicillin resistant Staphylococcus aureus was high, which alarms the use of macrolide-lincosamide-streptogramin B antibiotics in Staphylococcus aureus infections. Hence, D-test should be performed to detect inducible clindamycin resistance in routine testing to prevent treatment failure.
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Affiliation(s)
- Shanti Pradhan
- Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal
| | - Sanjib Mani Regmi
- Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal
| | - Nabina Shrestha
- Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal
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Tefera S, Awoke T, Mekonnen D. Methicillin and Vancomycin Resistant Staphylococcus aureus and Associated Factors from Surgical Ward Inpatients at Debre Markos Referral Hospital, Northwest Ethiopia. Infect Drug Resist 2021; 14:3053-3062. [PMID: 34408449 PMCID: PMC8364347 DOI: 10.2147/idr.s324042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Staphylococcus aureus is a well-known superbug and leading causes of wound infections. The clinical epidemiology of methicillin resistant S. aureus (MRSA) and vancomycin resistant S. aureus (VRSA) is not well documented in Ethiopia. The aim of this study was to determine the proportion of MRSA, VRSA and associated factors from surgical inpatients in Debre Markos Referral Hospital (DMRH), Northwest Ethiopia. Methods A facility-based cross-sectional study was conducted from February to April 2020 at DMRH. A structured questionnaire was used to gather demographic and clinical data. Wound swab was collected from inpatients and then inoculated on blood agar and mannitol salt agar. The presence of MRSA and VRSA was determined using the cefoxitin (30 μg) antibiotic disk diffusion and vancomycin E-test methods, respectively. The data were analyzed using SPSS 20. Data were analyzed using bivariate and multivariate logistic regression analysis. A P-value <0.05 was considered statistically significant. Results A total of 242 wound cases were enrolled and the majority of them were males 172 (71.1%). Among the total enrolled cases, S. aureus was identified from 71 (29.3%) of the admitted patients. The proportion of MRSA was 32 (13.22%) and that of VRSA was 4.1%. The proportion of vancomycin intermediate S. aureus (VISA) was gauged at 4.5%. Hospital stay over 72 hrs, wound depth, current antibiotic use, and previous history of wound infection showed statistically significant association with MRSA. On the contrary, VRSA did not showed any significant association against the analyzed variables. Conclusion High proportions of S. aureus isolates became MRSA; resistant to all β-lactam antimicrobial agents excluding newer cephalosporin. In addition, the proportion of VRSA/VISA was also high. Multiple variables demonstrated significant associations with MRSA. Hence, intervention measures for MRSA risk groups must be in place. Furthermore, hospital infection control and an antibiotic stewardship program should be strengthened.
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Affiliation(s)
- Samrawit Tefera
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Department of Medical Laboratory, Debre Markos Referral Hospital, Debere Markos, Ethiopia
| | - Tewachew Awoke
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Mekonnen
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Department of Health Biotechnology, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
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Inducible clindamycin resistance among clinical Staphylococcus aureus strains in Iran: A contemporaneous systematic review and meta-analysis. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Enhanced Activity and Sustained Release of Protocatechuic Acid, a Natural Antibacterial Agent, from Hybrid Nanoformulations with Zinc Oxide Nanoparticles. Int J Mol Sci 2021; 22:ijms22105287. [PMID: 34069756 PMCID: PMC8156785 DOI: 10.3390/ijms22105287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/14/2022] Open
Abstract
Hybrid nanostructures can be developed with inorganic nanoparticles (NPs) such as zinc oxide (ZnO) and natural antibacterials. ZnO NPs can also exert antibacterial effects, and we used them here to examine their dual action in combination with a natural antibacterial agent, protocatechuic acid (PCA). To produce hybrid nanoformulations, we functionalized ZnO NPs with four types of silane organic molecules and successfully linked them to PCA. Physicochemical assessment confirmed PCA content up to ~18% in hybrid nanoformulations, with a PCA entrapment efficiency of ~72%, indicating successful connection. We then investigated the in vitro release kinetics and antibacterial effects of the hybrid against Staphylococcus aureus. PCA release from hybrid nanoformulations varied with silane surface modification. Within 98 h, only 8% of the total encapsulated PCA was released, suggesting sustained long-term release. We used nanoformulation solutions collected at days 3, 5, and 7 by disc diffusion or log reduction to evaluate their antibacterial effect against S. aureus. The hybrid nanoformulation showed efficient antibacterial and bactericidal effects that also depended on the surface modification and at a lower minimum inhibition concentration compared with the separate components. A hybrid nanoformulation of the PCA prodrug and ZnO NPs offers effective sustained-release inhibition of S. aureus growth.
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Goudarzi H, Goudarzi M, Sabzehali F, Fazeli M, Salimi Chirani A. Genetic analysis of methicillin‐susceptible
Staphylococcus aureus
clinical isolates: High prevalence of multidrug‐resistant ST239 with strong biofilm‐production ability. J Clin Lab Anal 2020; 34:e23494. [PMID: 32696587 PMCID: PMC7676197 DOI: 10.1002/jcla.23494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background The distributions of methicillin‐susceptible Staphylococcus aureus (MSSA) are divers geographically with different genetic backgrounds. Data related to molecular characteristics of MSSA compare to methicillin‐resistant Staphylococcus aureus (MRSA) is sparse. Methods In this cross‐sectional study, antimicrobial susceptibility testing, virulence genes analysis, biofilm formation, accessory gene regulator (agr) typing, and multilocus sequence typing (MLST) characterized on 75 MSSA isolates. Results Multidrug‐resistance MSSA was found to be 84%. Forty‐eight (64%) isolates were toxinogenic with 34 and 14 isolates carrying pvl and tst representing 45.3% and 18.7%. The most common SE genes were sed (20%), sec (16%), and sea (16%). Fifty‐five (73.3%) isolates were confirmed as biofilm producer with a markedly high prevalence of fnbA (93.3%), fnbB (86.7%), icaA (65.3%), icaD (53.3%), can (24%), ebp (10.7%), and bap (1.3%). A total of 3 agr types (I, 73.3%; III, 16%; II, 10.7%) and 4 clonal complexes (CCs) and sequence types (STs), namely CC8/ST293 (45.3%), CC/ST22 (28%), CC/ST30 (16%), and CC/ST5 (10.7%) were detected in this study. All the high and low‐level mupirocin resistance strains belonged to ST239 and ST22 strains, respectively. All the fusidic acid‐resistant isolates carried fusC and belonged to ST30. Conclusions These findings indicated that ST239 with strong biofilm production ability is the most common type in MSSA strains isolated from patients. It seems that the antimicrobial resistance profiles, toxin, and biofilm formation were closely associated with specific STs. Further studies are required to identify and control of these clonal lineages in our area.
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Affiliation(s)
- Hossein Goudarzi
- Department of Microbiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mehdi Goudarzi
- Department of Microbiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fattaneh Sabzehali
- Department of Microbiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Maryam Fazeli
- Department of Virology Pasteur Institute of Iran Tehran Iran
| | - Alireza Salimi Chirani
- Department of Microbiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
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Detection of Heavy Metal Tolerance among different MLSB Resistance Phenotypes of Methicillin-Resistant S. aureus (MRSA). JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) strains are widespread globally. Besides their virulence factors, the co-occurrence of antimicrobial and metal resistance has been reported. This study was designed to evaluate the antibiotic resistance and resistance phenotypes, investigate the occurrence of virulence factors, and detect heavy metal tolerance among MRSA strains. Antibiogram profiling was done as recommended by CLSI instructions. Resistance phenotypes were detected by D test, followed by characterization of enzymatic activities and biofilm formation assay. Antibacterial activity of different heavy metals was tested, and predictable synergistic assay was performed. Among MRSA strains collected, high resistance to ampicillin and amoxicillin/clavulanate (100%) and high susceptibility to clindamycin (70%) were obtained. Resistance phenotypes were detected as S, constitutive MLSB, inducible MLSB, and MS by percentages of 10%, 30%, 30% and 30% respectively. Virulence factors like lipolytic (50%) and hemolytic (70%) activity, and biofilm formation ability (100%) were detected. High resistance towards potassium and magnesium was observed. MTC of 500 ppm was detected for all isolates in case of cobalt and iron. In case of zinc and copper, MTC was detected as 500 ppm except for one isolate which was highly resistant, and 500 ppm for all isolates except for two isolates which were highly sensitive respectively. Magnesium in different concentrations (500 and 2000 ppm) showed synergistic activity with erythromycin and clindamycin. Results reveal high heavy metal tolerance among antibiotic resistant MRSA strains, in addition to the presence of virulence factors. Upcoming studies must be focused on the combination of sub-inhibitory concentration of different heavy metals with the available antibiotics.
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