<i><span style="font-family:Verdana;">Staphylococcus</span></i><span style="font-family:Verdana;"> <i>aureus</i></span><span style="font-fami...<i><span style="font-family:Verdana;">Staphylococcus</span></i><span style="font-family:Verdana;"> <i>aureus</i></span><span style="font-family:""><span style="font-family:Verdana;"> has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> infections in Kenya. Published data between 2000 and 2020 were evaluated. </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance has consistently been high, last line and recent antibiotics such as vancomycin, linezolid, teicoplanin and daptomycin have retained their efficacy. Data on MRSA carriage in the community, among HCWs and inpatients is limited. Global clones (CC1, CC5, CC8, CC22, CC30, CC45 and CC239) alongside a few novel MRSA strains have been reported with staphylococcal protein A (</span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;">) sequence based clustering yielding four major clusters (</span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC359, </span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC005, </span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC121 and </span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC021) in circulation. MRSA strain ST239/241 (t037) seems predominant in the country. Despite a clear paucity of data, the present analysis points to a high infection and AMR burden in </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> with global MRSA clones in circulation. Standardized national surveillance and reporting incorporating molecular tools for identification and characterization will help fill existing gaps in the understanding of the evolving epidemiology of MRSA infections.展开更多
Introduction: Bacterial skin and soft tissue infections (SSTIs) are a cause of frequent inpatient and outpatient care visits whose causative agents are associated with a high antimicrobial resistance burden. For insig...Introduction: Bacterial skin and soft tissue infections (SSTIs) are a cause of frequent inpatient and outpatient care visits whose causative agents are associated with a high antimicrobial resistance burden. For insights on antimicrobial susceptibilities in a rural setting, we examined specimens from suspected SSTIs from two public health facilities in Kenya. We additionally assessed antibiotic use, appropriateness of empiric therapy and risk factors for SSTI. Methodology: Between 2021 and 2023, 265 patients at Kisii and Nyamira County Referral hospitals were enrolled. Wound swabs/aspirates were collected and processed following standard microbiological procedures. Identification and antimicrobial susceptibility were performed using the VITEK 2 Compact platform. Demographic, clinical, and microbiological data were analyzed with R Statistical software. Results: S. aureus was isolated in 16.2% (43/265) of patients with a methicillin resistance (MRSA) proportion of 14% (6/43). While 13/15 drugs elicited susceptibilities ranging from 84% - 100%, penicillin (16%) and trimethoprim-sulfamethoxazole [TMP-SXT] (23%) yielded the lowest susceptibilities. Escherichia coli (n = 33), Klebsiella pneumoniae (n = 8), Pseudomonas aeruginosa (n = 8), and Citrobacter species (n = 4) were the most commonly isolated gram-negative species. Gram-negative strains showed high susceptibilities to most of the tested drugs (71% - 100%) with the exception of ampicillin (18%), TMP-SXT (33%), and first and second generation cephalosporins. Conclusions: The low MRSA prevalence and generally high antibiotic susceptibilities for S. aureus and gram-negative bacteria present opportunities for antibiotic stewardship in the study setting. Diminished susceptibilities against penicillin/ampicillin and TMP-SXT accord with prevailing local data and add a layer of evidence for their cautious empiric use.展开更多
Background: Coagulase negative Staphylococci (CoNS) are normal inhabitants of the skin and mucous membranes and thus have been dismissed for a long time as culture contaminants even if they have been isolated from ste...Background: Coagulase negative Staphylococci (CoNS) are normal inhabitants of the skin and mucous membranes and thus have been dismissed for a long time as culture contaminants even if they have been isolated from sterile specimens. The risk factors for CoNS infections include patients who are immunocompromised, implanted with foreign bodies or with indwelling devices. The aim of this study was to determine the antimicrobial susceptibility patterns and presence of mecA gene in methicillin resistant CoNS isolated in a teaching and referral hospital in Kenya. Methodology: This was a cross sectional retrospective study. Archived isolates were sub-cultured on 5% sheep blood agar. Speciation and antimicrobial susceptibility patterns were performed by Vitek2 technique. The presence of mecA gene was determined by (PCR). Results: A total of seven species were identified with Staphylococcus epidermidis having the highest percentage at 45.4% and Staphylococcus warneri with the lowest at 2.6%. High resistance to antibiotics that were tested was observed regardless of the source of the isolate. MecA gene was found in 90% of the isolates. Conclusion: Coagulase negative Staphylococci exhibited high levels of resistance generally. Most of the isolates carried the mecA gene. Despite some of the isolates being resistant to Cefoxitin, the mecA gene was not found. There is a possibility that methicillin resistance in these isolates is mediated using a different mechanism.展开更多
Panton valentine leukocidin (PVL) is a pore forming exotoxin that is expressed by some Staphylococcus aureus (S. aureus) strains and is thought to add to its virulence. The prevalence of PVL in carriage and disease ca...Panton valentine leukocidin (PVL) is a pore forming exotoxin that is expressed by some Staphylococcus aureus (S. aureus) strains and is thought to add to its virulence. The prevalence of PVL in carriage and disease causing strains varies considerably from region to region. This study compared the prevalence of the PVL gene in S. aureus isolates obtained from healthcare workers and from patients seen at the Aga Khan University Hospital Nairobi (AKUHN). S. aureus isolates obtained from healthcare workers and patients attended to at AKUHN between July 2010 and March 2011 were used for this study. Forty five S. aureus isolates from healthcare workers and 63 from clinical specimens obtained from 59 patients were analysed for the PVL gene. The prevalence of PVL in isolates from healthcare workers was 24.4% compared to 39.7% in the isolates causing infection (P = 0.098). PVL prevalence was 58.8% in S. aureus isolates obtained from skin and soft tissue infections (SSIs) compared to 25.0% in carriage isolates (P = 0.002, OR 4.29). Prevalence in isolates from invasive infections was 11.1%. Patients with PVL positive S. aureus were younger than those with PVL negative isolates (P = 0.082). The high prevalence of PVL is comparable with that reported in other African countries. The significance of the high prevalence of PVL in S.aureus isolates carried by health care workers at AKUHN is unclear at the moment. PVL prevalence is significantly higher in S. aureus isolates causing SSIs compared to carriage and invasive isolates.展开更多
文摘<i><span style="font-family:Verdana;">Staphylococcus</span></i><span style="font-family:Verdana;"> <i>aureus</i></span><span style="font-family:""><span style="font-family:Verdana;"> has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> infections in Kenya. Published data between 2000 and 2020 were evaluated. </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance has consistently been high, last line and recent antibiotics such as vancomycin, linezolid, teicoplanin and daptomycin have retained their efficacy. Data on MRSA carriage in the community, among HCWs and inpatients is limited. Global clones (CC1, CC5, CC8, CC22, CC30, CC45 and CC239) alongside a few novel MRSA strains have been reported with staphylococcal protein A (</span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;">) sequence based clustering yielding four major clusters (</span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC359, </span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC005, </span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC121 and </span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC021) in circulation. MRSA strain ST239/241 (t037) seems predominant in the country. Despite a clear paucity of data, the present analysis points to a high infection and AMR burden in </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> with global MRSA clones in circulation. Standardized national surveillance and reporting incorporating molecular tools for identification and characterization will help fill existing gaps in the understanding of the evolving epidemiology of MRSA infections.
文摘Introduction: Bacterial skin and soft tissue infections (SSTIs) are a cause of frequent inpatient and outpatient care visits whose causative agents are associated with a high antimicrobial resistance burden. For insights on antimicrobial susceptibilities in a rural setting, we examined specimens from suspected SSTIs from two public health facilities in Kenya. We additionally assessed antibiotic use, appropriateness of empiric therapy and risk factors for SSTI. Methodology: Between 2021 and 2023, 265 patients at Kisii and Nyamira County Referral hospitals were enrolled. Wound swabs/aspirates were collected and processed following standard microbiological procedures. Identification and antimicrobial susceptibility were performed using the VITEK 2 Compact platform. Demographic, clinical, and microbiological data were analyzed with R Statistical software. Results: S. aureus was isolated in 16.2% (43/265) of patients with a methicillin resistance (MRSA) proportion of 14% (6/43). While 13/15 drugs elicited susceptibilities ranging from 84% - 100%, penicillin (16%) and trimethoprim-sulfamethoxazole [TMP-SXT] (23%) yielded the lowest susceptibilities. Escherichia coli (n = 33), Klebsiella pneumoniae (n = 8), Pseudomonas aeruginosa (n = 8), and Citrobacter species (n = 4) were the most commonly isolated gram-negative species. Gram-negative strains showed high susceptibilities to most of the tested drugs (71% - 100%) with the exception of ampicillin (18%), TMP-SXT (33%), and first and second generation cephalosporins. Conclusions: The low MRSA prevalence and generally high antibiotic susceptibilities for S. aureus and gram-negative bacteria present opportunities for antibiotic stewardship in the study setting. Diminished susceptibilities against penicillin/ampicillin and TMP-SXT accord with prevailing local data and add a layer of evidence for their cautious empiric use.
文摘Background: Coagulase negative Staphylococci (CoNS) are normal inhabitants of the skin and mucous membranes and thus have been dismissed for a long time as culture contaminants even if they have been isolated from sterile specimens. The risk factors for CoNS infections include patients who are immunocompromised, implanted with foreign bodies or with indwelling devices. The aim of this study was to determine the antimicrobial susceptibility patterns and presence of mecA gene in methicillin resistant CoNS isolated in a teaching and referral hospital in Kenya. Methodology: This was a cross sectional retrospective study. Archived isolates were sub-cultured on 5% sheep blood agar. Speciation and antimicrobial susceptibility patterns were performed by Vitek2 technique. The presence of mecA gene was determined by (PCR). Results: A total of seven species were identified with Staphylococcus epidermidis having the highest percentage at 45.4% and Staphylococcus warneri with the lowest at 2.6%. High resistance to antibiotics that were tested was observed regardless of the source of the isolate. MecA gene was found in 90% of the isolates. Conclusion: Coagulase negative Staphylococci exhibited high levels of resistance generally. Most of the isolates carried the mecA gene. Despite some of the isolates being resistant to Cefoxitin, the mecA gene was not found. There is a possibility that methicillin resistance in these isolates is mediated using a different mechanism.
文摘Panton valentine leukocidin (PVL) is a pore forming exotoxin that is expressed by some Staphylococcus aureus (S. aureus) strains and is thought to add to its virulence. The prevalence of PVL in carriage and disease causing strains varies considerably from region to region. This study compared the prevalence of the PVL gene in S. aureus isolates obtained from healthcare workers and from patients seen at the Aga Khan University Hospital Nairobi (AKUHN). S. aureus isolates obtained from healthcare workers and patients attended to at AKUHN between July 2010 and March 2011 were used for this study. Forty five S. aureus isolates from healthcare workers and 63 from clinical specimens obtained from 59 patients were analysed for the PVL gene. The prevalence of PVL in isolates from healthcare workers was 24.4% compared to 39.7% in the isolates causing infection (P = 0.098). PVL prevalence was 58.8% in S. aureus isolates obtained from skin and soft tissue infections (SSIs) compared to 25.0% in carriage isolates (P = 0.002, OR 4.29). Prevalence in isolates from invasive infections was 11.1%. Patients with PVL positive S. aureus were younger than those with PVL negative isolates (P = 0.082). The high prevalence of PVL is comparable with that reported in other African countries. The significance of the high prevalence of PVL in S.aureus isolates carried by health care workers at AKUHN is unclear at the moment. PVL prevalence is significantly higher in S. aureus isolates causing SSIs compared to carriage and invasive isolates.
