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. 2023 Jul 24:14:1208131.
doi: 10.3389/fmicb.2023.1208131. eCollection 2023.

Antimicrobial resistance and clonality of Staphylococcus aureus causing bacteraemia in children admitted to the Manhiça District Hospital, Mozambique, over two decades

Marcelino Garrine  1   2 , Sofia Santos Costa  2 , Augusto Messa Jr  1 , Sérgio Massora  1 , Delfino Vubil  1 , Sozinho Ácacio  1   3 , Tacilta Nhampossa  1   3 , Quique Bassat  1   4   5   6   7 , Inacio Mandomando  1   3   4 , Isabel Couto  2
Affiliations

Antimicrobial resistance and clonality of Staphylococcus aureus causing bacteraemia in children admitted to the Manhiça District Hospital, Mozambique, over two decades

Marcelino Garrine et al. Front Microbiol. .

Abstract

Background: Staphylococcus aureus is one of the main causes of bacteraemia, associated with high mortality, mainly due to the occurrence of multidrug resistant (MDR) strains. Data on antibiotic susceptibility and genetic lineages of bacteraemic S. aureus are still scarce in Mozambique. The study aims to describe the antibiotic susceptibility and clonality of S. aureus isolated from blood cultures of children admitted to the Manhiça District Hospital over two decades (2001-2019).

Methods: A total of 336 S. aureus isolates detected in blood cultures of children aged <5 years were analyzed for antibiotic susceptibility by disk diffusion or minimal inhibitory concentration, and for the presence of resistance determinants by PCR. The clonality was evaluated by SmaI-PFGE, spa typing, and MLST. The SCCmec element was characterized by SCCmec typing.

Results: Most S. aureus (94%, 317/336) were resistant to at least one class of antibiotics, and one quarter (25%) showed a MDR phenotype. High rates of resistance were detected to penicillin (90%) and tetracycline (48%); followed by erythromycin/clindamycin (25%/23%), and co-trimoxazole (11%), while resistance to methicillin (MRSA strains) or gentamicin was less frequent (≤5%). The phenotypic resistance to distinct antibiotics correlated well with the corresponding resistance determinants (Cohen's κ test: 0.7-1.0). Molecular typing revealed highly diverse clones with predominance of CC5 (17%, 58/336) and CC8 (16%), followed by CC15 (11%) and CC1 (11%). The CC152, initially detected in 2001, re-emerged in 2010 and became predominant throughout the remaining surveillance period, while other CCs (CC1, CC5, CC8, CC15, CC25, CC80, and CC88) decreased over time. The 16 MRSA strains detected belonged to clones t064-ST612/CC8-SCCmecIVd (69%, 11/16), t008-ST8/CC8-SCCmecNT (25%, 4/16) and t5351-ST88/CC88-SCCmecIVa (6%, 1/16). Specific clonal lineages were associated with extended length of stay and high in-hospital mortality.

Conclusion: We document the circulation of diverse MDR S. aureus causing paediatric bacteraemia in Manhiça district, Mozambique, requiring a prompt recognition of S. aureus bacteraemia by drug resistant clones to allow more targeted clinical management of patients.

Keywords: MDR; MLST; MRSA; Mozambique; Staphylococcus aureus; bacteraemia; paediatric; spa typing.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Temporal distribution of antibiotic resistance rates among Staphylococcus aureus isolated in children with bacteraemia. Resistant strains correspond to those presenting not susceptibility phenotype (resistant or intermediate). PEN, penicillin; TCY, tetracycline; ERY/CLID, erythromycin/clindamycin; SXT, co-trimoxazole.
Figure 2
Figure 2
Temporal distribution of multiresistant S. aureus isolated in children with bacteraemia. (A) MDR, multidrug resistant S. aureus defined as those not susceptible to ≥3 unrelated classes of antibiotics; (B) MRSA, methicillin-resistant S. aureus. The number in each point (n) corresponds to the number of MDR/MRSA strains, while the number at the top (N) corresponds to the total number of S. aureus related to bacteraemia isolated in that year.
Figure 3
Figure 3
Overview of the clonal relatedness among S. aureus isolated in children with bacteraemia. The genetic relatedness was determined using PHYLOViZ Online software, including all the STs/CCs found in this current study plus the ones deposited in the PubMLST database until December 2022. Lines link all STs up to triple locus variants. The zoomed colored boxes highlight the clonal complexes (CCs) identified in this study, indicating all STs found by red dots. The underlined STs (e.g., ST8) indicate the ones including MRSA strains.
Figure 4
Figure 4
Trends of the most prevalent S. aureus clonal complexes isolated in children with bacteraemia.
Figure 5
Figure 5
Distribution of the most prevalent clonal complexes among MDR (red) and non-MDR (green) S. aureus isolated in children with bacteraemia. Differences in the distribution of CCs between MDR and non-MDR strains were calculated with χ2 or Fisher’s exact test as appropriate; **p < 0.01.
See this image and copyright information in PMC

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