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Cited by 12Antimicrobial Resistance in StaphylococcusAntibiotic Use and ResistanceAntibiotic Resistance in Bacteria

Antibiotic resistance profiles and population structure of disease-associated Staphylococcus aureus infecting patients in Fort Portal Regional Referral Hospital, Western Uganda

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Ackers-Johnson, Gavin, Kibombo, Daniel, Kusiima, Brenda, Nsubuga, Moses L., Kigozi, Edgar, Kajumbula, Henry M., Kateete, David Patrick, Walwema, Richard +4 more·2021·Microbiology
DOI 10.1099/mic.0.001000PMC PMC8290103

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Abstract

Tackling antimicrobial resistance (AMR) is particularly challenging in low-resource settings such as Fort Portal Regional Referral Hospital (FPRRH) in Western Uganda. Specific knowledge of local AMR epidemiology is required to inform evidence-based improvement of antibiotic stewardship measures in the hospital. To address this, we combined existing antimicrobial susceptibility testing (AST) from FPRRH, with whole genome sequencing (WGS) of 41 Staphylococcus aureus isolates (2017–2019). AST revealed 73 % (30 of 41) of isolates were resistant to one or more antibiotics and 29 % (12 of 41) were multi-drug resistant (MDR). Resistance phenotypes were largely explained by the presence of antibiotic resistance genes in WGS data. Five isolates were methicillin-resistant S. aureus (MRSA) and MDR. Although all isolates were susceptible to clindamycin, a 24 % carriage of erm genes suggests potential for rapid development of resistance. We inferred a population structure for the S. aureus isolates by comparing their core genomes. Twenty isolates formed a tight cluster corresponding to multilocus sequence typing clonal complex (CC) 152, a CC found to be particularly prevalent in northern Africa. The frequency of genes associated with methicillin, chloramphenicol and ciprofloxacin resistance were significantly lower among CC152 strains than non-CC152 strains; thus, in keeping with previous work, we find that CC152 is almost exclusively methicillin-sensitive S. aureus (MSSA). Also, in agreement with other studies, we observed that the occurrence of Panton–Valentine leukocidin toxin-encoding genes was significantly higher among CC152 strains than non-CC152 strains. However, we also observed that the coagulase gene was over-represented in this CC, further defining the virulence strategy of this important pathogen. By generating detailed information about the epidemiology of circulating S. aureus and their antibiotic susceptibility, our study has provided, for the first time, data on which evidence-based infection and AMR interventions at FPRRH can be based.

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  • Community and healthcare-associated MRSA has been reported in most countries including Kenya, Uganda, Nigeria, South Africa, Ghana, Mozambique, Ethiopia, and Tanzania, with MRSA prevalence ranging from 1.25% to 53.4%.

    “Nevertheless, community and healthcare-associated MRSA has been reported in most countries, including Kenya, Uganda, Nigeria, South Africa, Ghana, Mozambique, Ethiopia, and Tanzania, where the MRSA prevalence ranges from 1.25% to 53.4%.[157][158][159][160][161][162][163][164]”

    From Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now? (2022) · cites this paper as [158]

    The Results & Discussion section (page not supplied) reports MRSA at Fort Portal Regional Referral Hospital in Uganda and cites a 2–50% prevalence range in Ugandan healthcare settings. It does not substantiate the stated 1.25–53.4% range or document community- and healthcare-associated MRSA across all the listed countries. (LLM, conf=0.87)

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Authors
Ackers-Johnson, G., Kibombo, D., Kusiima, B., Nsubuga, M. L., Kigozi, E., Kajumbula, H. M., Kateete, D. P., Walwema, R., Ackers, H. L., Goodhead, I. B., Birtles, R. J., & James, C. E.
Affiliations
  • University of Salford (GB)
  • Fort Portal Hospital (UG)
  • Makerere University (UG)
Corresponding author
James, Chloë E.
ORCID
Venue
Microbiology
Publisher
Microbiology Society
Published
2021-05-25
Volume
167
Issue
5
ISSN
  • 1350-0872 (ISSN-L)
  • 1465-2080
DOI
10.1099/mic.0.001000
PMC
PMC8290103
OpenAlex
W3164491593
Cited by
12
References
56
Citations by year
2026: 5 · 2025: 2 · 2024: 2 · 2022: 2 · 2021: 1
FWCI
0.40
Type
journal article
Language
en
Open access
Licence
Locations
  • Microbiology (publishedVersion, cc-by-nc)
  • bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • University of Salford Institutional Repository (University of Salford) (submittedVersion, cc-by)
Funders
THET Commonwealth Partnerships for Antimicrobial Stewardship (AMSB03)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Keywords
Staphylococcus aureus, antibiotic resistance, antimicrobial susceptibility, multidrug resistance, methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, population structure, core genome, Panton-Valentine leukocidin, coagulase, antibiotic resistance genes, clindamycin resistance, chloramphenicol resistance, ciprofloxacin resistance, nosocomial infections, antibiotic stewardship
MeSH terms
Anti-Bacterial Agents, Bacterial Proteins, Humans, Microbial Sensitivity Tests, Middle Aged, Referral and Consultation, Staphylococcal Infections, Staphylococcus aureus, Uganda, Genome, Bacterial, Drug Resistance, Bacterial, Virulence Factors

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