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. 2015 Dec 31;10(12):e0145429.
doi: 10.1371/journal.pone.0145429. eCollection 2015.

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

Olga Perovic  1   2 , Samantha Iyaloo  1 , Ranmini Kularatne  2   3 , Warren Lowman  2   4 , Noma Bosman  2   4 , Jeannette Wadula  2   5 , Sharona Seetharam  2   5 , Adriano Duse  2   4 , Nontombi Mbelle  6 , Colleen Bamford  7   8 , Halima Dawood  9 , Yesholata Mahabeer  10   11 , Prathna Bhola  10   11 , Shareef Abrahams  12 , Ashika Singh-Moodley  1
Affiliations

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

Olga Perovic et al. PLoS One. .

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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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Age distribution of 2711 patients with SA bacteraemia from June 2010—July 2012.
Fig 2
Fig 2. Number of MRSA isolates from four provinces.
Fig 3
Fig 3. Antimicrobial susceptibility of 2709 SA isolates.
Fig 4
Fig 4. Association between the most common SCCmec types and clindamycin susceptibility (n = 988).
Fig 5
Fig 5. Distribution of 1003 SCCmec types over the period of three years per province.
Fig 6
Fig 6. Distribution of the most common 393 spa-types per province (total number = 569).
Fig 7
Fig 7. Relationship between the most common SCCmec and spa types.
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