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Abstract
The hospital environment acts as a reservoir in the transmission of pathogens, such as MRSA, which may cause hospital-acquired infections. This study aimed to ascertain the prevalence, genetic relatedness, antibiotic resistance, and virulence profile of MRSA on some frequently touched hospital sites in South Africa. A total of 777 swabs were randomly collected from 11 frequently touched sites in the hospital environment of three wards of four public hospitals in the KwaZulu-Natal province of South Africa. Isolation of S. aureus and confirmation were done using genotypic and phenotypic methods. Antibiotic susceptibility testing was performed using the Kirby–Bauer disk-diffusion method. MRSA isolates were determined by the presence of the mecA gene. Virulence and resistance genes were detected using a standard monoplex PCR assay. ERIC-PCR was conducted to evaluate the genetic relatedness. An overall prevalence of 12.7% for S. aureus isolates was obtained. Out of these, 89.9% (89/99) were confirmed to be MRSA. The sites with the highest prevalence were the occupied beds (16.2% (16/99)), unoccupied beds (16.2% (16/99)), patient files (14.1% (14/99)), ward phones (13.1% (13/99)), and nurses' tables (14.1% (14/99)). The virulence genes with the highest observed frequency were hld (87 (87.9%)) and LukS/F-PV (53 (53.5%)). The resistance genes with the highest frequency were the tetM and tetK genes detected in 60 (60.6%) and 57 (57.6%) isolates, respectively. The ERIC-PCR results obtained indicated a high level of genetic diversity; however, intraclonal (within a hospital) and interclonal (between hospitals) clusters of MRSA were observed. The study showed that MRSA can contaminate various surfaces, and this persistence allows for the dissemination of bacteria within the hospital environment. This highlights the need for improved infection prevention and control (IPC) strategies in public hospitals in the country to curb their potential transmission risks.
Highlights
A hospital-acquired infection (HAI) or nosocomial infection develops during hospitalisation or within 48 hours after the patient has been discharged
S. aureus is one of eight significant pathogens listed by the Global Antimicrobial Resistance Surveillance System (GLASS) alongside Shigella spp., Salmonella spp., Streptococcus pneumoniae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Acinetobacter spp., and Escherichia coli [6]
Four provincial public hospitals are classified under the South African National Health Act of 2003 [17] according to their different levels of healthcare viz. central, tertiary, regional, and district
Summary
A hospital-acquired infection (HAI) or nosocomial infection develops during hospitalisation or within 48 hours after the patient has been discharged. Staphylococcus aureus (S. aureus) is considered one of the most important [2] pathogens responsible for HAIs. HAIs are a financial burden in developed and developing countries causing significant strain on the economy due to the high cost of treatments and increased mortality and morbidity rates that are associated with these types of infections [3,4,5]. S. aureus is one of eight significant pathogens listed by the Global Antimicrobial Resistance Surveillance System (GLASS) alongside Shigella spp., Salmonella spp., Streptococcus pneumoniae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Acinetobacter spp., and Escherichia coli [6]
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