Emergence of methicillin resistance and Panton-Valentine leukocidin positivity in hospital- and community-acquired Staphylococcus aureus infections in Beira, Mozambique.
OBJECTIVES
The objective of this study was to investigate the antibiotic resistance patterns, including methicillin resistance, inducible macrolide-lincosamide-streptogramin B (MLSB ) resistance and Panton-Valentine leukocidin (PVL) toxin gene carriage among hospital-acquired Staphylococcus aureus (HA-SA) and community-acquired S. aureus (CA-SA), in Beira, Mozambique.


METHODS
In 2010-2011, two prospective surveillance studies were conducted on post-operative and burn wound infections at the Central Hospital of Beira and on skin and soft tissue abscesses at the São Lucas Health Centre. We cultured pus samples, identified suspected S. aureus isolates and performed antimicrobial susceptibility testing, including detection of MLSB resistance. Real-time polymerase chain reaction was used to detect mecA, Martineau and PVL genes.


RESULTS
The prevalence of hospital-acquired methicillin-resistant S. aureus (HA-MRSA) infection among 53 inpatients was 15.1%; the prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA) infection among 100 outpatients was 1.0%. Inducible MLSB resistance was present in 41.7% and 10.7% of HA-SA and CA-SA isolates, respectively. PVL toxin gene was detected in 81.1% of methicillin-susceptible S. aureus (MSSA) compared with 11.1% of methicillin-resistant S. aureus.


CONCLUSIONS
Our study shows, for the first time in Mozambique, the emergence of HA-MRSA. The prevalence of CA-MRSA was low, whereas the rate of PVL toxin gene carriage in MSSA was high. The high rate of inducible MLSB resistance indicates the importance of performing routine D-tests. Overall, our results show the need of strengthening laboratory facilities to provide microbiological data for both directed therapy and surveillance.
['van der Meeren|Birgitta T|BT|', 'Millard|Peter S|PS|', 'Scacchetti|Marco|M|', 'Hermans|Mirjam H|MH|', 'Hilbink|Mirrian|M|', 'Concelho|Timótio B|TB|', 'Ferro|Josefo J|JJ|', 'Wever|Peter C|PC|']
D000293:Adolescent D000328:Adult D000368:Aged D001427:Bacterial Toxins D002648:Child D002675:Child, Preschool D017714:Community-Acquired Infections D003428:Cross Infection D024901:Drug Resistance, Multiple, Bacterial D005098:Exotoxins D005260:Female D005798:Genes, Bacterial D006801:Humans D007956:Leukocidins D008297:Male D016106:Methicillin Resistance D055624:Methicillin-Resistant Staphylococcus aureus D008875:Middle Aged D009073:Mozambique D015995:Prevalence D060888:Real-Time Polymerase Chain Reaction D013203:Staphylococcal Infections D055815:Young Adult
methicillin resistance Panton-Valentine leukocidin Staphylococcus aureus Mozambique antimicrobial resistance pattern inducible clindamycin resistance