, Volume 46, Issue 3, pp 395–404 | Cite as

Management of superficial and deep-seated Staphylococcus aureus skin and soft tissue infections in sub-Saharan Africa: a post hoc analysis of the StaphNet cohort

  • Abraham Alabi
  • Theckla Kazimoto
  • Marthe Lebughe
  • Delfino Vubil
  • Patrick Phaku
  • Inacio Mandomando
  • Winfried V. Kern
  • Salim Abdulla
  • Alexander Mellmann
  • Lena Peitzmann
  • Markus Bischoff
  • Georg Peters
  • Mathias Herrmann
  • Martin P. Grobusch
  • Frieder SchaumburgEmail author
  • Siegbert Rieg
Original Paper



The incidence of Staphylococcus aureus skin and soft tissue infection (SSTI) is high in sub-Saharan Africa. This is fueled by a high prevalence of Panton-Valentine leukocidin (PVL), which can be associated with necrotizing disease. The aim was to describe the clinical presentation and the treatment of SSTI in the African setting and to identify challenges in the management.


Patients (n = 319) were recruited in DR Congo (n = 56, 17.6%), Gabon (n = 89, 27.9%), Mozambique (n = 79, 24.8%) and Tanzania (n = 95, 29.8%) during the prospective observational StaphNet cohort study (2010–2015). A physician recorded the clinical management in standardized questionnaires and stratified the entity of SSTI into superficial (sSSTI) or deep-seated (dSSTI). Selected virulence factors (PVL, β hemolysin) and multilocus sequence types (MLST) were extracted from whole genome sequencing data.


There were 220/319 (69%) sSSTI and 99/319 (31%) dSSTI. Compared to sSSTI, patients with dSSTI were more often hospitalized (13.2 vs. 23.5%, p = 0.03), HIV-positive (7.6 vs. 15.9%, p = 0.11), and required more often incision and drainage (I&D, 45.5 vs. 76.5%, p = 0.04). The proportion of an adequate antimicrobial therapy increased marginally from day 1 (empirical therapy) to day 3 (definite therapy), for sSSTI (70.7 to 72.4%) and dSSTI (55.4 to 58.9%). PVL was a risk factor for I&D (OR = 1.7, p = 0.02) and associated with MLST clonal complex CC121 (OR = 2.7, p < 0.001).


Appropriate antimicrobial agents and surgical services to perform I&D were available for the majority of patients. Results from susceptibility testing should be considered more efficiently in the selection of antimicrobial therapy.


Staphylococcus aureus Skin and soft tissue infection Sub-Saharan Africa Management Microbiology 



This study received grants from the Deutsche Forschungsgemeinschaft (HE 1850/11-1 to M.H., KE 700/3-1 to W.V.K., ME 3205/4-1 to A.M., and PE 296/6-1 to G.P.).

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre de Recherches Médicales de Lambaréné (CERMEL)Albert Schweitzer HospitalLambarénéGabon
  2. 2.Institut für TropenmedizinEberhard Karls UniversitätTübingenGermany
  3. 3.German Centre for Infection Research (DZIF)Partner Site TübingenTübingenGermany
  4. 4.Ifakara Health Institute (IHI)Dar es SalaamTanzania
  5. 5.Institut National de Recherche Bio-Médicale (INRB)Université de KinshasaKinshasaDemocratic Republic of the Congo
  6. 6.Manhiça Health Research CenterMaputoMozambique
  7. 7.Instituto Nacional de SaúdeMinistério da SaúdeMaputoMozambique
  8. 8.Division of Infectious Diseases, Department of Medicine II, Medical CenterUniversity of Freiburg Faculty of Medicine, University of FreiburgFreiburgGermany
  9. 9.Institute of HygieneUniversity Hospital MünsterMünsterGermany
  10. 10.Institute of Medical Microbiology and HygieneSaarland UniversityHomburgGermany
  11. 11.Institute of Medical MicrobiologyUniversity Hospital MünsterMünsterGermany
  12. 12.Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel MedicineUniversity of AmsterdamAmsterdamThe Netherlands

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