Abstract
Staphylococcus aureus has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of S. aureus are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of S. aureus infections in Kenya. Published data between 2000 and 2020 were evaluated. S. aureus isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance has consistently been high, last line and recent antibiotics such as vancomycin, linezolid, teicoplanin and daptomycin have retained their efficacy. Data on MRSA carriage in the community, among HCWs and inpatients is limited. Global clones (CC1, CC5, CC8, CC22, CC30, CC45 and CC239) alongside a few novel MRSA strains have been reported with staphylococcal protein A (spa) sequence based clustering yielding four major clusters (spa CC359, spa CC005, spa CC121 and spa CC021) in circulation. MRSA strain ST239/241 (t037) seems predominant in the country. Despite a clear paucity of data, the present analysis points to a high infection and AMR burden in S. aureus with global MRSA clones in circulation. Standardized national surveillance and reporting incorporating molecular tools for identification and characterization will help fill existing gaps in the understanding of the evolving epidemiology of MRSA infections.
Highlights
Staphylococcus aureus is one of the most frequently encountered pathogens in clinical settings as a cause of a wide range of infections of varying severity which include boils, cellulitis, food poisoning, sepsis, osteomyelitis, pneumonia and endocarditis [1]
To contribute towards filling the current gaps in the epidemiology of S. aureus infections in Kenya, we have reviewed 20-year published data with respect to S. aureus isolation frequencies, antimicrobial resistance profiles and molecular epidemiology
A majority of Kenyan studies reporting on the occurrence of S. aureus infections are from public and private health facilities in the capital city of Nairobi
Summary
Staphylococcus aureus is one of the most frequently encountered pathogens in clinical settings as a cause of a wide range of infections of varying severity which include boils, cellulitis, food poisoning, sepsis, osteomyelitis, pneumonia and endocarditis [1]. Methicillin resistant S. aureus (MRSA) strains are especially troublesome as they may be associated with increased morbidity, a heightened risk of mortality, longer hospital stays and higher healthcare costs [2]. The first WHO report on global AMR surveillance identified MRSA prevalence of at least 50% in five of the six WHO regions [2]. Some MRSA strains have emerged as sources of infections in apparently healthy individuals in the community, a clear departure from their traditional association with healthcare settings among high risk patient populations [3]. The ever growing resistance coupled with a declining pipeline of new antimicrobials and a lack of an effective anti-staphylococcal vaccine necessitate concerted efforts in AMR surveillance, drug and vaccine discovery [4]
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