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Azzam A, Khaled H, Mosa M, Refaey N, AlSaifi M, Elsisi S, Elagezy FK, Mohsen M. Epidemiology of clinically isolated methicillin-resistant Staphylococcus aureus (MRSA) and its susceptibility to linezolid and vancomycin in Egypt: a systematic review with meta-analysis. BMC Infect Dis 2023; 23:263. [PMID: 37101125 PMCID: PMC10134521 DOI: 10.1186/s12879-023-08202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality worldwide. For the establishment of national strategies to combat MRSA infection in each country, accurate and current statistics characterizing the epidemiology of MRSA are essential. The purpose of this study was to determine the prevalence of MRSA among Staphylococcus aureus clinical isolates in Egypt. In addition, we aimed to compare different diagnostic methods for MRSA and determine the pooled resistance rate of linezolid and vancomycin to MRSA. To address this knowledge gap, we conducted a systematic review with meta-analysis. METHODS A comprehensive literature search from inception to October 2022 of the following databases was performed: MEDLINE [PubMed], Scopus, Google Scholar, and Web of Science. The review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement. Based on the random effects model, results were reported as proportions with a 95% confidence interval (CI). Analyses of the subgroups were conducted. A sensitivity analysis was conducted to test the robustness of the results. RESULTS A total of sixty-four (64) studies were included in the present meta-analysis, with a total sample size of 7171 subjects. The overall prevalence of MRSA was 63% [95% CI: 55-70]. Fifteen (15) studies used both PCR and cefoxitin disc diffusion for MRSA detection, with a pooled prevalence rate of 67% [95% CI: 54-79] and 67% [95% CI: 55-80], respectively. While nine (9) studies used both PCR and Oxacillin disc diffusion for MRSA detection, the pooled prevalences were 60% [95% CI: 45-75] and 64% [95% CI: 43-84], respectively. Furthermore, MRSA appeared to be less resistant to linezolid than vancomycin, with a pooled resistance rate of 5% [95% CI: 2-8] to linezolid and 9% [95% CI: 6-12] to vancomycin, respectively. CONCLUSION Our review highlights Egypt's high MRSA prevalence. The cefoxitin disc diffusion test results were found to be consistent with PCR identification of the mecA gene. A prohibition on antibiotic self-medication and efforts to educate healthcare workers and patients about the proper use of antimicrobials may be required to prevent further increases.
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Affiliation(s)
- Ahmed Azzam
- Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt.
| | - Heba Khaled
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Maha Mosa
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Neveen Refaey
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Mohammed AlSaifi
- Department of Orthopedic and Trauma, Faculty of Medicine, 21 September University for Medicine and Applied Sciences, Sana, Yemen
| | - Sarah Elsisi
- Department of Clinical Pharmacy Surgery, Alexandria Main University Hospital, Alexandria, Egypt
| | - Fatma Khaled Elagezy
- Department of Biotechnology, Faculty of Fisheries and Aquaculture Sciences, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | - May Mohsen
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Truppa C, Abo-Shehada MN. Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: a systematic review. BMC Infect Dis 2020; 20:936. [PMID: 33297983 PMCID: PMC7724697 DOI: 10.1186/s12879-020-05503-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In spite of the evident general negative effects of armed conflict on countries' health systems and populations' health outcomes, little is known about similar impacts of conflicts on the spread of antimicrobial resistances (AMR). This review was to address this evidence gap and describe: 1. Patterns of AMR in the Middle East (ME) and resistance profiles of pathogens included in the Global AMR Surveillance System (GLASS) supported by the World Health Organization; 2. Differences in proportions of AMR isolates between conflict and non-conflict countries. METHODS A systematic literature review was conducted following PRISMA guidelines and searching five electronic databases. Subject heading and free text were searched for "antimicrobial resistances" and "Middle East", to identify observational studies on AMR published from January 2011 to June 2018. Data were extracted from included articles on a predefined set of variables. Percentages of AMR were analysed as median and interquartile ranges. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 132 articles met the inclusion criteria. Included studies showed heterogeneity in study design, laboratory methods and standards for interpretation of results, and an overall high risk of bias. Main findings were the following: 1. High proportions of carbapenem resistance in Acinetobacter spp. (median 74.2%), and both carbapenem resistance (median 8.1 and 15.4% for E. coli and K. pneumoniae respectively) and ESBL-production (median 32.3 and 27.9% for E. coli and K. pneumoniae respectively) amongst Enterobacteriaceae. S. aureus isolates showed a median methicillin resistance percentage of 45.1%, while vancomycin resistance was almost absent. A median of 50% of the strains of S. pneumoniae showed non-susceptibility to penicillin. 2. Similar trends were observed in conflict and non-conflict affected countries. CONCLUSIONS There is a lack of standardization in the methodological approach to AMR research in the Middle East. The proportion of antibiotic resistances among specific GLASS pathogens is high, particularly among Acinetobacter spp.
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Affiliation(s)
- Claudia Truppa
- International Committee of the Red Cross, Geneva, Switzerland
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Mahmoud N. Abo-Shehada
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
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Shittu AO, Kaba M, Abdulgader SM, Ajao YO, Abiola MO, Olatimehin AO. Mupirocin-resistant Staphylococcus aureus in Africa: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2018; 7:101. [PMID: 30147868 PMCID: PMC6094907 DOI: 10.1186/s13756-018-0382-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mupirocin is widely used for nasal decolonization of Staphylococcus aureus to prevent subsequent staphylococcal infection in patients and healthcare personnel. However, the prolonged and unrestricted use has led to the emergence of mupirocin-resistant (mupR) S. aureus. The aim of this systematic review was to investigate the prevalence, phenotypic and molecular characteristics, and geographic spread of mupR S. aureus in Africa. Methods We examined five electronic databases (EBSCOhost, Google Scholar, ISI Web of Science, MEDLINE, and Scopus) for relevant English articles on screening for mupR S. aureus from various samples in Africa. In addition, we performed random effects meta-analysis of proportions to determine the pooled prevalence of mupR S. aureus in Africa. The search was conducted until 3 August 2016. Results We identified 43 eligible studies of which 11 (26%) were obtained only through Google Scholar. Most of the eligible studies (28/43; 65%) were conducted in Nigeria (10/43; 23%), Egypt (7/43; 16%), South Africa (6/43; 14%) and Tunisia (5/43; 12%). Overall, screening for mupR S. aureus was described in only 12 of 54 (22%) African countries. The disk diffusion method was the widely used technique (67%; 29/43) for the detection of mupR S. aureus in Africa. The mupA-positive S. aureus isolates were identified in five studies conducted in Egypt (n = 2), South Africa (n = 2), and Nigeria (n = 1). Low-level resistance (LmupR) and high-level resistance (HmupR) were both reported in six human studies from South Africa (n = 3), Egypt (n = 2) and Libya (n = 1). Data on mupR-MRSA was available in 11 studies from five countries, including Egypt, Ghana, Libya, Nigeria and South Africa. The pooled prevalence (based on 11 human studies) of mupR S. aureus in Africa was 14% (95% CI =6.8 to 23.2%). The proportion of mupA-positive S. aureus in Africa ranged between 0.5 and 8%. Furthermore, the frequency of S. aureus isolates that exhibited LmupR, HmupR and mupR-MRSA in Africa were 4 and 47%, 0.5 and 38%, 5 and 50%, respectively. Conclusions The prevalence of mupR S. aureus in Africa (14%) is worrisome and there is a need for data on administration and use of mupirocin. The disk diffusion method which is widely utilized in Africa could be an important method for the screening and identification of mupR S. aureus. Moreover, we advocate for surveillance studies with appropriate guidelines for screening mupR S. aureus in Africa.
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Affiliation(s)
- Adebayo O. Shittu
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shima M. Abdulgader
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Yewande O. Ajao
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Mujibat O. Abiola
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Ayodele O. Olatimehin
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
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Rathore K, Joseph B, Sharma DK, Gaurav A, Sharma SK, Milind M, Patel P, Prakash C, Singh L. Evaluation of multiplex polymerase chain reaction as an alternative to conventional antibiotic sensitivity test. Vet World 2018; 11:474-479. [PMID: 29805213 PMCID: PMC5960787 DOI: 10.14202/vetworld.2018.474-479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/12/2018] [Indexed: 11/16/2022] Open
Abstract
Aim This study was designed to evaluate the potential of the use of multiplex polymerase chain reaction (PCR) as an alternative to conventional antibiotic sensitivity test. Materials and Methods Isolates of Staphylococcus aureus (total = 36) from clinical cases presented to Teaching Veterinary Clinical Complex of College of Veterinary and Animal Sciences (CVAS), Navania, Udaipur, were characterized by morphological, cultural, and biochemical methods. Then, the isolates were further subjected to molecular characterization by PCR targeting S. aureus-specific sequence (107 bp). Phenotypic antibiotic sensitivity pattern was analyzed by Kirby-Bauer disc diffusion method against 11 commonly used antibiotics in veterinary medicine in and around Udaipur region. The genotypic antibiotic sensitivity pattern was studied against methicillin, aminoglycosides, and tetracycline targeting the gene mecA, aacA-aphD, and tetK by multiplex PCR. Results There was 100% correlation between the phenotype and genotype of aminoglycoside resistance, more than 90% correlation for methicillin resistance, and 58.3% in the case tetracycline resistance. Conclusion As there is a good correlation between phenotype and genotype of antibiotic resistance, multiplex PCR can be used as an alternative to the conventional antibiotic susceptibility testing, as it can give a rapid and true prediction of antibiotic sensitivity pattern.
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Affiliation(s)
- K Rathore
- Department of Veterinary Microbiology, College of Veterinary and Animal Science, Navania, Udaipur, 313601, Rajasthan, India
| | - B Joseph
- Department of Veterinary Microbiology, College of Veterinary and Animal Science, Navania, Udaipur, 313601, Rajasthan, India
| | - D K Sharma
- Department of Veterinary Microbiology, College of Veterinary and Animal Science, Navania, Udaipur, 313601, Rajasthan, India
| | - A Gaurav
- Department of Veterinary Public Health, College of Veterinary and Animal Science, Navania, Udaipur, 313601, Rajasthan, India
| | - S K Sharma
- Department of Veterinary Medicine, College of Veterinary and Animal Science, Navania, Udaipur, 313601, Rajasthan, India
| | - M Milind
- Department of Veterinary Microbiology, College of Veterinary and Animal Science, Navania, Udaipur, 313601, Rajasthan, India
| | - P Patel
- Department of Veterinary Microbiology, College of Veterinary and Animal Science, Navania, Udaipur, 313601, Rajasthan, India
| | - C Prakash
- Animal Health Division, CSWRI, Avikanagar, Malpura, Tonk, 304501 Rajasthan, India
| | - L Singh
- Department of Livestock Products Technology, College of Veterinary and Animal Science, Navania, Udaipur, 313601, Rajasthan, India
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Zhou Y, Zhang H, Bao H, Wang X, Wang R. The lytic activity of recombinant phage lysin LysKΔamidase against staphylococcal strains associated with bovine and human infections in the Jiangsu province of China. Res Vet Sci 2017; 111:113-119. [PMID: 28235706 DOI: 10.1016/j.rvsc.2017.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/15/2017] [Indexed: 12/28/2022]
Abstract
We investigated the lytic activity of the bacteriophage endolysin (lysin) LysKΔamidase against live methicillin-resistant and-susceptible staphylococcal strains clinically isolated from bovine milk and humans from different origins of China. Antibiotic resistance patterns, multilocus sequence typing and SCCmec type of 137 staphylococcal strains isolated from bovine milk associated with bovine mastitis and human diseases were studied. A lytic enzyme, LysKΔamidase, was constructed by fusing the N-terminal 220 amino acids with the C-terminal 105 amino acids of staphylococcal phage lysin LysK. Herein, the antimicrobial activity of LysKΔamidase against 66 methicillin-resistant staphylococcal strains and 71 methicillin-susceptible staphylococcal strains isolated from bovine milk and from humans in China were studied. Our results show that the lysin displayed a broad lytic spectrum; in vitro treatment killed all 137 of the milk and clinical isolates of staphylococci strains tested, including MRSA, methicillin-susceptible S. aureus (MSSA), MR-Staphylococcus hominis ssp. homins, MR-Staphylococcus epidermidis and MR-Staphylococcus haemolyticus as evidenced by scanning electron microscopy, transmission electron microscopy, turbidity reduction assay and disruption of biofilms. The present results suggest that LysKΔamidase has the potential to be an alternative therapeutic agent against pathogenic methicillin-resistant and-susceptible staphylococcal strains isolated from China.
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Affiliation(s)
- Yan Zhou
- Institute of Food Safety, Key Lab of Agro-Food Safety and Quality Ministry of Agriculture, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Hui Zhang
- Institute of Food Safety, Key Lab of Agro-Food Safety and Quality Ministry of Agriculture, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Hongduo Bao
- Institute of Food Safety, Key Lab of Agro-Food Safety and Quality Ministry of Agriculture, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Xiaomeng Wang
- School of Chemistry &Life Science, Nanjing University Jinling College, China
| | - Ran Wang
- Institute of Food Safety, Key Lab of Agro-Food Safety and Quality Ministry of Agriculture, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China.
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Proulx MK, Palace SG, Gandra S, Torres B, Weir S, Stiles T, Ellison RT, Goguen JD. Reversion From Methicillin Susceptibility to Methicillin Resistance in Staphylococcus aureus During Treatment of Bacteremia. J Infect Dis 2015; 213:1041-8. [PMID: 26503983 DOI: 10.1093/infdis/jiv512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/14/2015] [Indexed: 11/12/2022] Open
Abstract
Approximately 3% of Staphylococcus aureus strains that, according to results of conventional phenotypic methods, are highly susceptible to methicillin-like antibiotics also have polymerase chain reaction (PCR) results positive for mecA. The genetic nature of these mecA-positive methicillin-susceptible S. aureus (MSSA) strains has not been investigated. We report the first clearly defined case of reversion from methicillin susceptibility to methicillin resistance among mecA-positive MSSA within a patient during antibiotic therapy. We describe the mechanism of reversion for this strain and for a second clinical isolate that reverts at a similar frequency. The rates of reversion are of the same order of magnitude as spontaneous resistance to drugs like rifampicin. When mecA is detected by PCR in the clinical laboratory, current guidelines recommend that these strains be reported as resistant. Because combination therapy using both a β-lactam and a second antibiotic suppressing the small revertant population may be superior to alternatives such as vancomycin, the benefits of distinguishing between mecA-positive MSSA and MRSA in clinical reports should be evaluated.
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Affiliation(s)
| | | | | | - Brenda Torres
- Clinical Microbiology Laboratory, University of Massachusetts Medical School, Worcester
| | - Susan Weir
- Section of Infectious Diseases, Department of Medicine, Boston University
| | - Tracy Stiles
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Richard T Ellison
- Department of Microbiology and Physiological Systems Division of Infectious Disease
| | - Jon D Goguen
- Department of Microbiology and Physiological Systems
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