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Abstract：
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of mortality due to bacterial antimicrobial resistance. While S. aureus is common in skin and soft tissue infections (SSTI) in Africa, data on MRSA rates are scarce and reports vary widely across the continent (5%-80%). In this study, we describe the proportion of MRSA causing SSTI in Lambaréné, Gabon, over an 11-year period.
METHODS: We retrospectively analyzed data from 953 bacterial specimens collected from inpatients and outpatients with SSTI at the Albert Schweitzer Hospital, Lambaréné, Gabon, between 2009 and 2019. We determined temporal changes in the prevalence of MRSA and identified risk factors for SSTI with MRSA.
RESULTS: 68% of all specimens with bacterial growth yielded S. aureus (n = 499/731), of which 7% (36/497) with antimicrobial susceptibility testing were identified as MRSA. Age above 18 years, admission to the surgical ward, and deep-seated infections were significantly associated with MRSA as the causative agent. After an initial decline from 7% in 2009, there was a marked increase in the proportion of MRSA among all S. aureus from SSTI from 3 to 20% between 2012 and 2019. The resistance rate to erythromycin was significantly higher in MRSA than in methicillin-susceptible S. aureus (73% vs. 10%), and clindamycin resistance was detected exclusively in MRSA isolates (8%).
CONCLUSIONS: The increasing proportion of MRSA causing SSTI over the 11-year period contrasts with many European countries where MRSA is on decline. Continuous surveillance of MRSA lineages in the hospital and community along with antibiotic stewardship programs could address the increasing trend of MRSA.
METHODS: We retrospectively analyzed data from 953 bacterial specimens collected from inpatients and outpatients with SSTI at the Albert Schweitzer Hospital, Lambaréné, Gabon, between 2009 and 2019. We determined temporal changes in the prevalence of MRSA and identified risk factors for SSTI with MRSA.
RESULTS: 68% of all specimens with bacterial growth yielded S. aureus (n = 499/731), of which 7% (36/497) with antimicrobial susceptibility testing were identified as MRSA. Age above 18 years, admission to the surgical ward, and deep-seated infections were significantly associated with MRSA as the causative agent. After an initial decline from 7% in 2009, there was a marked increase in the proportion of MRSA among all S. aureus from SSTI from 3 to 20% between 2012 and 2019. The resistance rate to erythromycin was significantly higher in MRSA than in methicillin-susceptible S. aureus (73% vs. 10%), and clindamycin resistance was detected exclusively in MRSA isolates (8%).
CONCLUSIONS: The increasing proportion of MRSA causing SSTI over the 11-year period contrasts with many European countries where MRSA is on decline. Continuous surveillance of MRSA lineages in the hospital and community along with antibiotic stewardship programs could address the increasing trend of MRSA.
摘要：
背景：耐甲氧西林金黄色葡萄球菌（MRSA）是细菌抗菌素耐药性导致死亡的主要原因之一。虽然金黄色葡萄球菌在非洲的皮肤和软组织感染（SSTI）中很常见，关于MRSA比率的数据很少,整个大陆的报告差异很大(5%-80%).在这项研究中,我们描述了在Lambaréné引起SSTI的MRSA的比例，加蓬,在11年的时间里。
方法：我们回顾性分析了从AlbertSchweitzer医院SSTI住院和门诊患者收集的953个细菌样本的数据，Lambaréné,加蓬,2009年至2019年。我们确定了MRSA患病率的时间变化，并确定了SSTI伴MRSA的危险因素。
结果：所有细菌生长的标本中有68％产生金黄色葡萄球菌（n=499/731），其中7%(36/497)的抗菌药物敏感性试验被鉴定为MRSA.年龄在18岁以上，进入外科病房，深部感染与MRSA作为病原体显著相关.在从2009年的7％开始下降之后，在2012年至2019年期间，来自SSTI的所有金黄色葡萄球菌中MRSA的比例从3％显着增加到20％。MRSA对红霉素的耐药率显着高于甲氧西林敏感的金黄色葡萄球菌（73％vs.10%),而克林霉素耐药仅在MRSA分离株中检测到(8%)。
结论：在过去的11年中，引起SSTI的MRSA比例不断增加，这与许多MRSA下降的欧洲国家形成对比。在医院和社区中持续监测MRSA谱系以及抗生素管理计划可以解决MRSA增加的趋势。
方法：我们回顾性分析了从AlbertSchweitzer医院SSTI住院和门诊患者收集的953个细菌样本的数据，Lambaréné,加蓬,2009年至2019年。我们确定了MRSA患病率的时间变化，并确定了SSTI伴MRSA的危险因素。
结果：所有细菌生长的标本中有68％产生金黄色葡萄球菌（n=499/731），其中7%(36/497)的抗菌药物敏感性试验被鉴定为MRSA.年龄在18岁以上，进入外科病房，深部感染与MRSA作为病原体显著相关.在从2009年的7％开始下降之后，在2012年至2019年期间，来自SSTI的所有金黄色葡萄球菌中MRSA的比例从3％显着增加到20％。MRSA对红霉素的耐药率显着高于甲氧西林敏感的金黄色葡萄球菌（73％vs.10%),而克林霉素耐药仅在MRSA分离株中检测到(8%)。
结论：在过去的11年中，引起SSTI的MRSA比例不断增加，这与许多MRSA下降的欧洲国家形成对比。在医院和社区中持续监测MRSA谱系以及抗生素管理计划可以解决MRSA增加的趋势。
