CA-MRSA and HA-MRSA coexist in community and hospital settings in Uganda

Abstract

Background Methicillin resistant Staphylococcus aureus (MRSA) strains were once confined to hospitals however, in the last 20 years MRSA infections have emerged in the community in people with no prior exposure to hospitals. Strains causing such infections were novel and referred to as community-associated MRSA (CA-MRSA). The aim of this study was to determine the MRSA carriage rate in children in eastern Uganda, and to investigate coexistence between CA-MRSA and hospital-associated (HA-MRSA). Methods Between February and October 2011, nasopharyngeal samples (one per child) from 742 healthy children under 5 years in rural eastern Uganda were processed for isolation of MRSA, which was identified based on inhibition zone diameter of ≤19 mm on 30 μg cefoxitin disk. SCC mec and spa typing were performed for MRSA isolates. Results A total of 140 S. aureus isolates (18.9%, 140/742) were recovered from the children of which 5.7% (42/742) were MRSA. Almost all (95.2%, 40/42) MRSA isolates were multidrug resistant (MDR). The most prevalent SCC mec elements were types IV (40.5%, 17/42) and I (38.1%, 16/42). The overall frequency of SCC mec types IV and V combined, hence CA-MRSA, was 50% (21/42). Likewise, the overall frequency of SCC mec types I, II and III combined, hence HA-MRSA, was 50% (21/42). Spa types t002, t037, t064, t4353 and t12939 were detected and the most frequent were t064 (19%, 8/42) and t037 (12%, 5/42). Conclusion The MRSA carriage rate in children in eastern Uganda is high (5.7%) and comparable to estimates for Mulago Hospital in Kampala city. Importantly, HA-MRSA (mainly of spa type t037) and CA-MRSA (mainly of spa type t064) coexist in children in the community in eastern Uganda, and due to high proportion of MDR detected, outpatient treatment of MRSA infection in eastern Uganda might be difficult. Electronic supplementary material The online version of this article (10.1186/s13756-019-0551-1) contains supplementary material, which is available to authorized users.

Minimum Inhibitory Concentrations of Vancomycin and Daptomycin Against Methicillin-resistant Staphylococcus Aureus Isolated from Various Clinical Specimens: A Study from South India

“…Emergence and spread of MRSA, both the CA-MRSA and the HA-MRSA, have been increasingly responsible for treatment failures as noted by a previous research report [15]. Vancomycin is the drug of choice to treat invasive MRSA infections [16].…”

Molecular Epidemiology of Staphylococcus aureus Lineages in Wild Animals in Europe: A Review

“…Community-acquired MRSA (CA-MRSA) emerged in the late 1990s as major causes of skin and soft tissue infections in healthy people with no previous hospitalizations or recent histories of invasive procedures. CA-MRSA are newer and more virulent strains frequently associated with PVL which are associated with increased virulence [60]. CA-MRSA are distinct from HA-MRSA from an epidemiological, genotypic and phenotypic point of view.…”

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

“…This cross-sectional study was nested in previous studies/projects that investigated the pneumococcal nasopharyngeal colonization and integrated community case management of malaria and pneumonia in children less than 5 years of age at the Iganga/Mayuge Health and Demographic Surveillance Site (IMHDSS) in rural Eastern Uganda [20,21]. The study population was described before [20][21][22]; briefly, 764 healthy children less 5 years at the IMHDSS were enrolled and sampled. Following consent, a study nurse collected two nasopharyngeal samples (swabs) from each child.…”

“…To validate automated species'-level identification by the Phoenix ID/AST Expert System, we randomly selected 24 isolates representing presumptively identified isolates of S. aureus, S. epidermidis and S. haemolyticus, and molecularly re-identified them by polymerase chain reaction (PCR) as described previously [26]. To determine the SCCmec types among the methicillin resistant staphylococci (MRS), SCCmec typing was done and interpreted as described previously [17,22,27]. For quality control, S. aureus ATCC™ 29213 and Enterococcus faecalis ATCC™ 29212 were included in the Phoenix ID/AST panels and molecular assays.…”