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Hospital-associated methicillin-resistant Staphylococcus aureus: A cross-sectional analysis of risk factors in South African tertiary public hospitals
Open accessAbstract
INTRODUCTION: Hospital-associated methicillin-resistant S. aureus (HA-MRSA) remains a significant cause of morbidity and mortality worldwide. We conducted a study to determine risk factors for HA-MRSA in order to inform control strategies in South Africa. METHODS: We used surveillance data collected from five tertiary hospitals in Gauteng and Western Cape provinces during 2014 for analysis. A case of HA-MRSA was defined as isolation of MRSA from a blood culture 48 hours after admission and/or if the patient was hospitalised in the six months prior to the current culture. Multivariable logistic regression modelling was used to determine risk factors for HA-MRSA. RESULTS: Of the 9971 patients with positive blood cultures, 7.7% (772) had S. aureus bacteraemia (SAB). The overall prevalence of MRSA among those with SAB was 30.9% (231/747; 95% confidence interval [CI] 27.6%- 34.3%). HA-MRSA infections accounted for 28.3% of patients with SAB (207/731; 95% CI 25.1%- 31.7%). Burns (adjusted odds ratio [aOR] 12.7; 95% CI 4.7-34.4), age ≤1 month (aOR 8.7; 95% CI 3.0-24.6), residency at a long-term care facility (aOR 5.2; 95% CI, 1.5-17.4), antibiotic use within two months of the current SAB episode (aOR 5.1; 95% CI 2.8-9.1), hospital stay of 13 days or more (aOR 2.8; 95% CI 1.3-5.6) and mechanical ventilation (aOR 2.2; 95% CI 1.07-4.6), were independent risk factors for HA-MRSA infection. CONCLUSION: The prevalence of MRSA remains high in South African tertiary public hospitals. Several identified risk factors of HA-MRSA infections should be considered when instituting infection and prevention strategies in public-sector hospitals, including intensifying the implementation of antimicrobial stewardship programmes. There is an urgent need to strengthen infection prevention and control in burn wards, neonatal wards, and intensive care units which house mechanically ventilated patients.
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“The most common risk factors associated with MRSA infection are HIV infection, prior antibiotic use, ICU admission, prior or prolonged hospitalization, indwelling catheters, invasive procedures, open wounds and burns, residency at long-term care facilities, mechanical ventilation, renal failure, and MRSA colonization history.165,166”
From Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now? (2022) · cites this paper as [165]
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Multistate point-prevalence survey of health care-associated infections
Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., Lynfield, R., Maloney, M., McAllister-Hollod, L., Nadle, J., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1306801 · Cited by 3,931
Cosgrove, S. E., Sakoulas, G., Perencevich, E. N., Schwaber, M. J., Karchmer, A. W., & Carmeli, Y. (2003) · Clinical Infectious Diseases · doi:10.1086/345476 · Cited by 1,981
Stefani, S., Chung, D. R., Lindsay, J. A., Friedrich, A. W., Kearns, A. M., Westh, H., & MacKenzie, F. M. (2012) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2011.09.030 · Cited by 590
Health Care–Associated Invasive MRSA Infections, 2005-2008
Kallen, A. J. (2010) · JAMA · doi:10.1001/jama.2010.1115 · Cited by 439
Graffunder, E. M. (2002) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkf009 · Cited by 411
Risk of death from methicillin‐resistant Staphylococcus aureus bacteraemia: a meta‐analysis
Whitby, M., McLaws, M., & Berry, G. (2001) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2001.tb143562.x · Cited by 296
Kaasch, A. J., Barlow, G. D., Edgeworth, J. D., Fowler, V. G., Hellmich, M., Hopkins, S., Kern, W. V., Llewelyn, M., Rieg, S., Rodríguez‐Baño, J., et al. (2013) · Journal of Infection · doi:10.1016/j.jinf.2013.10.015 · Cited by 278
MRSA in Africa: Filling the Global Map of Antimicrobial Resistance
Falagas, M. E., Karageorgopoulos, D. E., Leptidis, J., & Korbila, I. P. (2013) · PLoS ONE · doi:10.1371/journal.pone.0068024 · Cited by 248
Antimicrobial stewardship across 47 South African hospitals: an implementation study
Brink, A. J., Messina, A. P., Feldman, C. H., Richards, G. A., Becker, P., Goff, D. A., Bauer, K. A. A., Nathwani, D., & van den Bergh, D. (2016) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(16)30012-3 · Cited by 217
Bahemia, I. A., Muganza, A., Moore, R., Sahid, F., & Menezes, C. N. (2015) · Burns · doi:10.1016/j.burns.2015.05.007 · Cited by 123
Research works printed but not linked: 1
- M Mendelson, 2015, The South African antimicrobial resistance strategy framework, Monitoring, surveillance and National Plans, 54
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Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now?
Kariuki, S., Kering, K., Wairimu, C., Onsare, R., & Mbae, C. (2022) · Infection and Drug Resistance · doi:10.2147/idr.s342753 · Cited by 245
Metadata
- Authors
- Shuping, L. L., Kuonza, L., Musekiwa, A., Iyaloo, S., & Perovic, O.
- Affiliations
- National Health Laboratory Service (ZA)
- Corresponding author
- Perovic, Olga
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-11-16
- Volume
- 12
- Issue
- 11
- Pages
- e0188216
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5690649
- OpenAlex
- W2768406667
- Cited by
- 30
- References
- 40
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 6 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 1 · 2018: 3
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UpSpace Institutional Repository (University of Pretoria) (submittedVersion, cc-by)
- Funders
- U.S. Department of Health and Human Services
- National Health Laboratory Service
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Keywords
- risk factors, Staphylococcus aureus bacteremia, bloodstream infection, burns, neonates, long-term care facilities, mechanical ventilation, length of hospital stay, antibiotic use, antimicrobial stewardship, infection control, MRSA prevalence, intensive care unit, burn ward
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Cross Infection, Cross-Sectional Studies, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Risk Factors, South Africa, Staphylococcal Infections, Prevalence, Methicillin-Resistant Staphylococcus aureus, Young Adult
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- Shuping, L. L., Kuonza, L., Musekiwa, A., Iyaloo, S., & Perovic, O. (2017). Hospital-associated methicillin-resistant Staphylococcus aureus: A cross-sectional analysis of risk factors in South African tertiary public hospitals. PLOS ONE. https://doi.org/10.1371/journal.pone.0188216
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