Community-Acquired Methicillin-Resistant Staphylococcus aureus in Hospitals: Age-Specificity and Potential Zoonotic-Zooanthroponotic Transmission Dynamics

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) lineages are a devastating clinical and public health issue. Data on local lineage profiles are limited. We report on the frequency of community-acquired and hospital-acquired cases (CA-MRSA, HA-MRSA). We studied 147 isolates from King Khalid tertiary care hospitals (KKH), each from a case in a patient and including 33 patients at the Maternity and Children's Hospital (MCH). Of the 147 isolates, 87 males (59%) and 60 females (41%) were in KKH. The overwhelming majority (80%; n = 119/147) were CA-MRSA in KKH. Intriguingly, despite significant differences between males (70%) and females (53%), lineage-acquisition remained age-specific around 58-60 years in both genders. However, while CA-MRSA dominated early in life (0-20, 70% MCH), it increased with age in KKH adults; 21-50 (28%), >50 (59%) until the overall 80% (n = 144/180). Major specimens included skin-wounds, surgeries (70.3%), blood (13.5%), sputum (8.8%), very rarely urine (4.1%), and nasal (3.4%), albeit most patients showed severe enteritis and necrotizing pneumonia. Antibiograms showed high beta lactam resistances, including amoxicillin-clavulanate (83%), oxacillin (84%), cefoxitin FOX (100%), penicillin and ampicillin (~100%), as well as high resistance (82%) to carbapenem. Fortunately, high susceptibility was seen to non-beta lactams and, to a lesser extent, gentamicin, erythromycin, and fusidic acid; 33%, 34%, and 38%, respectively, in KKH. A similar pattern was seen in MCH except for a low resistance pattern to gentamicin CN, clindamycin CD, erythromycin E, and tobramycin TOB; 34%, 31%, 39%, and 41%, respectively, except for fusidic acid. These findings have significant clinical implications for MRSA patient management strategies. Clinical- and lineage-profiles imply host-selection and zoonotic-zooanthroponotic transmission dynamics. Future molecular typing, sequencing, and characterization of dominant clone(s) is imperative.

Keywords: CA-MRSA age-specificity; S. aureus epidemiology; S. aureus-antibiogram; geriatric-HA-MRSA.

Figure 1

Antimicrobial susceptibility patterns of S. aureus isolates recovered from King Khalid Hospital across 22 antimicrobials showing (arrow heads) antibiogram patterns for beta lactam and non-beta lactam antibiotics. S = susceptible; I = intermediate resistance; R = resistance.

Figure 2

Antimicrobial susceptibility patterns of S. aureus isolates recovered from the Maternity and Children’s Hospital across 22 antimicrobials showing (arrow heads) antibiogram patterns for beta lactam and non-beta lactam antibiotics. S = susceptible; I = intermediate resistance; R = resistance.

Figure 3

(a) Age- and gender-specific distributions of Stapylococcus aureus isolates recovered from clinical infections in King Khalid Hospital, Ha’il, Saudi Arabia. (b) Age- and gender-specific distributions of Stapylococcus aureus isolates recovered from clinical infections in Maternity and Children’s Hospital, Ha’il, Saudi Arabia.