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

David Patrick Kateete,Hannington Baluku,Jeremiah Seni,Freddie Bwanga,Edgar Kigozi,Raymond Mayanja,Fred K Ashaba,Karin Källander,Christine F Najjuka,Moses L Joloba,Benon B Asiimwe,Elizeus Rutebemberwa,Brian Mujuni

doi:10.1186/s13756-019-0551-1

Abstract

BackgroundMethicillin 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).MethodsBetween 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. SCCmec and spa typing were performed for MRSA isolates.ResultsA 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 SCCmec elements were types IV (40.5%, 17/42) and I (38.1%, 16/42). The overall frequency of SCCmec types IV and V combined, hence CA-MRSA, was 50% (21/42). Likewise, the overall frequency of SCCmec 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).ConclusionThe 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.

Highlights

Methicillin resistant Staphylococcus aureus (MRSA) strains were once confined to hospitals in the last 20 years MRSA infections have emerged in the community in people with no prior exposure to hospitals
Susceptibility testing and MRSA identification This cross-sectional study was nested in a study that investigated pneumococcal carriage in children under 5 years age in the Iganga/Mayuge Health & Demographic Surveillance Site (IMHDSS) [13], located in Iganga and Mayuge districts in eastern Uganda 120 km from Kampala city, Uganda’s capital
All MRSA isolates were susceptible to rifampicin and anti-MRSA agents and generally to clindamycin but they were significantly resistant to non-β-lactam antimicrobial agents commonly used to treat staphylococcal infections (SXT, erythromycin, gentamicin, chloramphenicol)

Summary

Introduction

Methicillin resistant Staphylococcus aureus (MRSA) strains were once confined to hospitals 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). Surveillance studies on bacterial infections in Africa show that S. Methicillin resistant S. aureus (MRSA) strains, widespread globally, have complicated treatment and control of staphylococcal infections. Once confined to hospitals and/or health care environments, MRSA strains are frequent causes of infection in the community. Surveillance studies have revealed differences in MRSA strains causing infections in hospitalized

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