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Prevalence and Trends of Staphylococcus aureus Bacteraemia in Hospitalized Patients in South Africa, 2010 to 2012: Laboratory-Based Surveillance Mapping of Antimicrobial Resistance and Molecular Epidemiology.

Perovic O, Iyaloo S, Kularatne R, Lowman W, Bosman N, Wadula J, Seetharam S, Duse A, Mbelle N, Bamford C, Dawood H, Mahabeer Y, Bhola P, Abrahams S, Singh-Moodley A - PLoS ONE (2015)

Bottom Line: Geographical distribution of MRSA was significantly higher in Gauteng compared to the other provinces (P<0.001).Children <5 years were significantly associated with MRSA with higher rates compared to all other age groups (P = 0.01).Majority of the isolates were classified as SCCmec type III (41%) and type IV (31%), which are typically associated with hospital and community- acquired infections, respectively.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Communicable Diseases at National Health Laboratory Service, Johannesburg, South Africa.

ABSTRACT

Introduction: We aimed to obtain an in-depth understanding on recent antimicrobial resistance trends and molecular epidemiology trends of S. aureus bacteraemia (SAB).

Methods: Thirteen academic centres in South Africa were included from June 2010 until July 2012. S. aureus susceptibility testing was performed on the MicroScan Walkaway. Real-time PCR using the LightCycler 480 II was done for mecA and nuc. SCCmec and spa-typing were finalized with conventional PCR. We selected one isolate per common spa type per province for multilocus sequence typing (MLST).

Results: S. aureus from 2709 patients were included, and 1231 (46%) were resistant to methicillin, with a significant decline over the three-year period (p-value = 0.003). Geographical distribution of MRSA was significantly higher in Gauteng compared to the other provinces (P<0.001). Children <5 years were significantly associated with MRSA with higher rates compared to all other age groups (P = 0.01). The most prevalent SCCmec type was SCCmec type III (531 [41%]) followed by type IV (402 [31%]). Spa-typing discovered 47 different spa-types. The five (87%) most common spa-types were t037, t1257, t045, t064 and t012. Based on MLST, the commonest was ST612 clonal complex (CC8) (n = 7) followed by ST5 (CC5) (n = 4), ST36 (CC30) (n = 4) and ST239 (CC8) (n = 3).

Conclusions: MRSA rate is high in South Africa. Majority of the isolates were classified as SCCmec type III (41%) and type IV (31%), which are typically associated with hospital and community- acquired infections, respectively. Overall, this study reveals the presence of a variety of hospital-acquired MRSA clones in South Africa dominance of few clones, spa 037 and 1257. Monitoring trends in resistance and molecular typing is recommended to detect changing epidemiological trends in AMR patterns of SAB.

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Distribution of 1003 SCCmec types over the period of three years per province.
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pone.0145429.g005: Distribution of 1003 SCCmec types over the period of three years per province.

Mentions: MRSA isolates (1236) were typed to identify the prevalent mec element types. Distribution of SCCmec types across provinces differed as the numbers of isolates received from each province varied. SCCmec types III and IV were predominantly isolated in Gauteng and the emergence of type V was noted in 2012. Type V was identified in KwaZulu Natal in 2011. SCCmec type VI was predominantly isolated in Western Cape in 2011. Type IV was found in all provinces. Overall the most prevalent SCCmec type for all three years was SCCmec type III (531 [41%]) followed by types IV (402 [31%]), II (64 [5%]), VI (4 [0.3%]) and V (2 [0.2%]) (Fig 5). SCCmec type I was not observed but unknown typing patterns were identified (185 [12%]). Three isolates produced no amplicons. The majority of isolates representing SCCmec types III and IV were from Gauteng [482 (37%) and 212 (16%), respectively] followed by the Western Cape [31 (2%) and 83 (6%), respectively] and KwaZulu-Natal [5 (0.4%] and 97 (8%) respectively] (Fig 6). Of the 185 unknown typing patterns observed, the majority (113, 61%) was from the Western Cape.


Prevalence and Trends of Staphylococcus aureus Bacteraemia in Hospitalized Patients in South Africa, 2010 to 2012: Laboratory-Based Surveillance Mapping of Antimicrobial Resistance and Molecular Epidemiology.

Perovic O, Iyaloo S, Kularatne R, Lowman W, Bosman N, Wadula J, Seetharam S, Duse A, Mbelle N, Bamford C, Dawood H, Mahabeer Y, Bhola P, Abrahams S, Singh-Moodley A - PLoS ONE (2015)

Distribution of 1003 SCCmec types over the period of three years per province.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697812&req=5

pone.0145429.g005: Distribution of 1003 SCCmec types over the period of three years per province.
Mentions: MRSA isolates (1236) were typed to identify the prevalent mec element types. Distribution of SCCmec types across provinces differed as the numbers of isolates received from each province varied. SCCmec types III and IV were predominantly isolated in Gauteng and the emergence of type V was noted in 2012. Type V was identified in KwaZulu Natal in 2011. SCCmec type VI was predominantly isolated in Western Cape in 2011. Type IV was found in all provinces. Overall the most prevalent SCCmec type for all three years was SCCmec type III (531 [41%]) followed by types IV (402 [31%]), II (64 [5%]), VI (4 [0.3%]) and V (2 [0.2%]) (Fig 5). SCCmec type I was not observed but unknown typing patterns were identified (185 [12%]). Three isolates produced no amplicons. The majority of isolates representing SCCmec types III and IV were from Gauteng [482 (37%) and 212 (16%), respectively] followed by the Western Cape [31 (2%) and 83 (6%), respectively] and KwaZulu-Natal [5 (0.4%] and 97 (8%) respectively] (Fig 6). Of the 185 unknown typing patterns observed, the majority (113, 61%) was from the Western Cape.

Bottom Line: Geographical distribution of MRSA was significantly higher in Gauteng compared to the other provinces (P<0.001).Children <5 years were significantly associated with MRSA with higher rates compared to all other age groups (P = 0.01).Majority of the isolates were classified as SCCmec type III (41%) and type IV (31%), which are typically associated with hospital and community- acquired infections, respectively.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Communicable Diseases at National Health Laboratory Service, Johannesburg, South Africa.

ABSTRACT

Introduction: We aimed to obtain an in-depth understanding on recent antimicrobial resistance trends and molecular epidemiology trends of S. aureus bacteraemia (SAB).

Methods: Thirteen academic centres in South Africa were included from June 2010 until July 2012. S. aureus susceptibility testing was performed on the MicroScan Walkaway. Real-time PCR using the LightCycler 480 II was done for mecA and nuc. SCCmec and spa-typing were finalized with conventional PCR. We selected one isolate per common spa type per province for multilocus sequence typing (MLST).

Results: S. aureus from 2709 patients were included, and 1231 (46%) were resistant to methicillin, with a significant decline over the three-year period (p-value = 0.003). Geographical distribution of MRSA was significantly higher in Gauteng compared to the other provinces (P<0.001). Children <5 years were significantly associated with MRSA with higher rates compared to all other age groups (P = 0.01). The most prevalent SCCmec type was SCCmec type III (531 [41%]) followed by type IV (402 [31%]). Spa-typing discovered 47 different spa-types. The five (87%) most common spa-types were t037, t1257, t045, t064 and t012. Based on MLST, the commonest was ST612 clonal complex (CC8) (n = 7) followed by ST5 (CC5) (n = 4), ST36 (CC30) (n = 4) and ST239 (CC8) (n = 3).

Conclusions: MRSA rate is high in South Africa. Majority of the isolates were classified as SCCmec type III (41%) and type IV (31%), which are typically associated with hospital and community- acquired infections, respectively. Overall, this study reveals the presence of a variety of hospital-acquired MRSA clones in South Africa dominance of few clones, spa 037 and 1257. Monitoring trends in resistance and molecular typing is recommended to detect changing epidemiological trends in AMR patterns of SAB.

Show MeSH
Related in: MedlinePlus