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A small proportion of community-associated methicillin-resistant Staphylococcus aureus bacteraemia, compared to healthcare-associated cases, in two South African provinces

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Abstract

We compared the proportion of cases of community-associated and healthcare-associated methicillin-resistant Staphylococcus aureus (CA-MRSA and HA-MRSA, respectively) bacteraemia among patients at five hospitals in the Gauteng and Western Cape provinces in South Africa and described the molecular characteristics and antimicrobial susceptibility trends. This was a cross-sectional study using data collected by enhanced surveillance for S. aureus bacteraemia. A total of 2511 cases of S. aureus bacteraemia were identified from January 2013 to January 2016. Among 1914 cases of S. aureus, 557 (29.1%) cases were identified as MRSA infection. Forty-four cases (44/1914 [2.3%] of all S. aureus cases) were considered CA-MRSA infection and 513/1914 (26.8% of all cases) had HA-MRSA infection; the majority were neonates. CA-MRSA constituted 7.9% (44/557) of all cases of MRSA infection. Staphylococcus aureus isolates demonstrated significantly reduced susceptibility to the following classes of antimicrobial agents: macrolides, tetracyclines, aminoglycosides and cotrimoxazole, in 2015 compared to 2013 (p < 0.05). Of the 557 MRSA isolates, 484 (87%) were typed for SCCmec elements and spa types: the most common SCCmec type was type III (n = 236, 48.76%), followed by type IV (n = 144, 29.76%). The most common spa types were t037 (n = 229, 47.31%) and t1257 (n = 90, 18.60%). Of 28 isolates selected for multilocus sequence typing (MLST), the most common sequence types (STs) were ST239 and ST612 of clonal complex 8 (CC8) (n = 8 each) and a novel ST (ST4121) was obtained for one isolate. This study demonstrates that S. aureus bacteraemia is common in South African academic centres and characterised by HA-MRSA SCCmec types III and IV. A small proportion of CA-MRSA cases were caused by a few different sequence types.

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Authors and Affiliations

  1. Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa

    O. Perovic, A. Singh-Moodley, N. P. Govender & E. Van Schalkwyk

  2. Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the University at the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa

    O. Perovic, A. Singh-Moodley, N. P. Govender, R. Kularatne & V. Chibabhai

  3. Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa

    N. P. Govender & P. Naicker

  4. Centre for Human Immunodeficiency Virus and Sexually Transmitted Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa

    R. Kularatne

  5. National Health Laboratory Service, Stellenbosch, Stellenbosch University, Stellenbosch, South Africa

    A. Whitelaw & C. Samuel

  6. Department of Medical Microbiology, University of Pretoria and National Health Laboratory Service, Pretoria, South Africa

    N. Mbelle

  7. Department of Medical Microbiology, University of Limpopo and National Health Laboratory Service, Polokwane, South Africa

    R. Lekalakala

  8. Division of Public Health Surveillance and Response, National Institute for Communicable Disease, Johannesburg, South Africa

    V. Quan

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  1. O. Perovic
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  2. A. Singh-Moodley
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  8. N. Mbelle
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  9. R. Lekalakala
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  11. C. Samuel
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  12. E. Van Schalkwyk
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Correspondence to O. Perovic.

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Conflict of interest

There is no conflict of interest from authors on this manuscript, as no external funding was received for the surveillance of Staphylococcus aureus bacteraemia.

Ethics approval

This study was approved by the University of the Witwatersrand Human Research Ethics Committee (Medical); clearance certificate number: M160667.

Informed consent

An informed consent form (ICF) was given to each patient enrolled in the study with description of the procedure, confidentiality and declaration with signatures of the participant, surveillance officer and witnesses.

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Perovic, O., Singh-Moodley, A., Govender, N.P. et al. A small proportion of community-associated methicillin-resistant Staphylococcus aureus bacteraemia, compared to healthcare-associated cases, in two South African provinces. Eur J Clin Microbiol Infect Dis 36, 2519–2532 (2017). https://doi.org/10.1007/s10096-017-3096-3

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  • DOI: https://doi.org/10.1007/s10096-017-3096-3

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