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Map of Ghana indicating the region and communities from which the 19 BU patients colonized with S. aureus originated.
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Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. Previous studies have shown that wounds of BU patients are colonized with M. ulcerans and several other microorganisms, including Staphylococcus aureus, which may interfere with wound healing. The present study was therefore aimed at investigating the diversity and to...
Citations
... Groschel et al. discuss how recombinant heterologous BCG expression of the ESX-1 secretion system in the BCG vaccine increases cytosolic immune signaling by inducing the cGAS/STING/TBK1/IRF-3/type I interferon axis, as well as enhancing AIM2 and NLRP3 inflammasome activity, resulting in increased CD8+ effector T cells and CD4+ Th1 immune response against ESX-1 specific antigens, thereby increasing protection against M. marinum infection, while also maintaining low virulence [121]. This is an exciting development in further enhancing BCG vaccine efficacy. ...
The genus mycobacterium includes several species that are known to cause infections in humans. The microorganisms are classified into tuberculous and non-tuberculous based on their morphological characteristics, defined by the dynamic relationship between the host defenses and the infectious agent. Non-tuberculous mycobacteria (NTM) include all the species of mycobacterium other than the ones that cause tuberculosis (TB). The group of NTM contains almost 200 different species and they are found in soil, water, animals—both domestic and wild—milk and food products, and from plumbed water resources such as sewers and showerhead sprays. A systematic review of Medline between 1946 and 2014 showed an 81% decline in TB incidence rates with a simultaneous 94% increase in infections caused by NTM. Prevalence of infections due to NTM has increased relative to infections caused by TB owing to the stringent prevention and control programs in Western countries such as the USA and Canada. While the spread of typical mycobacterial infections such as TB and leprosy involves human contact, NTM seem to spread easily from the environment without the risk of acquiring from a human contact except in the case of M. abscessus in patients with cystic fibrosis, where human transmission as well as transmission through fomites and aerosols has been recorded. NTM are opportunistic in their infectious processes, making immunocompromised individuals such as those with other systemic infections such as HIV, immunodeficiencies, pulmonary disease, or usage of medications such as long-term corticosteroids/TNF-α inhibitors more susceptible. This review provides insight on pathogenesis, treatment, and BCG vaccine efficacy against M. leprae and some important NTM infections.
... Toutefois, ce qui a relancé la question de l'antibiothérapie chez l'homme, étaient les telle que l'ulcère de Buruli était considéré comme une maladie émergente [133,150]. Le traitement est fait actuellement de huit semaines d'antibiothérapie, de soins des plaies, de chirurgie et de prévention des incapacités par la rééducation fonctionnelle [151,152]. Les techniques standards au laboratoire pour confirmer l'ulcère de Buruli sont l'amplification 37 génique (PCR), la culture, l'histopathologie, la recherche des bacilles acido-alcoolorésistants (BAAR) au microscope [153]. En 1997, l'OMS a mis en place l'Initiative Mondiale de lutte contre l'UB (IMUB 44 ...
Buruli ulcer or Mycobacterium ulcerans infection is an emerging tropical disease neglected by World Health Organization (WHO) criteria. It has become the third mycobacteriosis in the world after tuberculosis and leprosy. To date, preventive measures are insufficient due to a lack of knowledge of the modes of transmission of the bacteria. The implementation of preventive measures is a key element in controlling this infectious disease. The development of suitable preventive measures requires the implementation of a global approach integrating a better knowledge of human behavior. The present work, which consisted of the analysis of data collected in the framework of epidemiological, environmental and microbiological studies, from Buruli ulcer patients treated at the Leprosy and Buruli Ulcer Screening and Treatment Center (CDTLUB) of Pobè in Benin, aimed to: 1) Determine the behavioral risk factors for Mycobacterium ulcerans infection, 2) Evaluate the rate of environmental contamination by Mycobacterium ulcerans, 3) To analyze the interactions between the environment, patient lifestyle and the ecology of Mycobacterium ulcerans. The present study, carried out using an approach involving several disciplines (medicine, epidemiology, microbiology, spatial analysis and health geography), consists of two parts.The first part corresponds to the case-control epidemiological study. The analyzes in this part used data from 217 patients treated by the CDTLUB de Pobè from 2005 to 2020 and 434 controls. The conditional logistic regression model was used to identify environmental and anthropogenic factors associated with varying Buruli ulcer incidence.The second part corresponds to environmental and microbiological studies. The analyzes focused on environmental samples (aquatic plants, aquatic vertebrates and invertebrates, and organic matter) collected from 90 major unprotected water source sites frequented by patients. The test of positivity to Mycobacterium ulcerans by the QPCR (Quantitative Polymerase Chain Reaction) technique was performed on the extracted and purified DNA from the samples. The human behaviors most at risk identified are accessing and using unprotected water points located in lowlands (OR = 10.8; 95% CI = 1, 09 to 107.59) for the various daily activities. On the other hand, access and use of drilling water (OR = 0.2; 95% CI = 0.08-0.44) and the knowledge of the population about Buruli ulcer before they contract the disease (OR = 0.2; 95% CI = 0.07-0.39) are protective factors for the disease. Our results show that access to and use of clean water from a drilling confers protection against Buruli ulcer. Combining the results of the different analyses, we concluded that the risk factor most associated with the development of Buruli ulcer is the frequency of contact with natural and unprotected water sources, especially when these water points are located in lowland areas that are regularly flooded or irrigated. The results and methods of this study finally allowed us to propose a primary prevention model adapted to endemic areas and could be used for further investigations on Buruli ulcer and other neglected tropical diseases. All these results highlight the need to develop an integrated approach to control Buruli ulcer within a unique framework "One Health Initiative - One World One Medicine One Health" responding to WHO priorities. It makes the care of patients and the prevention of neglected tropical diseases more efficient in exposed populations.
... Toutefois, ce qui a relancé la question de l'antibiothérapie chez l'homme, étaient les telle que l'ulcère de Buruli était considéré comme une maladie émergente [133,150]. Le traitement est fait actuellement de huit semaines d'antibiothérapie, de soins des plaies, de chirurgie et de prévention des incapacités par la rééducation fonctionnelle [151,152]. Les techniques standards au laboratoire pour confirmer l'ulcère de Buruli sont l'amplification génique (PCR), la culture, l'histopathologie, la recherche des bacilles acido-alcoolorésistants (BAAR) au microscope [153]. En 1997, l'OMS a mis en place l'Initiative Mondiale de lutte contre l'UB (IMUB [3,77]. ...
L’ulcère de Buruli ou infection à Mycobacterium ulcerans est une maladie émergente tropicale négligée selon les critères de l’Organisation Mondiale de Santé (OMS). Elle est devenue la troisième mycobactériose humaine dans le monde après la tuberculose et la lèpre. Jusqu’à ce jour, les mesures préventives sont insuffisantes en raison d’une méconnaissance des modes de transmission de la bactérie. La mise en place de mesures préventives est un élément clé pour contrôler cette maladie infectieuse. Le développement de mesures préventives adaptées requière la mise en œuvre d’une approche globale intégrant une meilleure connaissance des comportements humains. Le présent travail, qui a consisté en l’analyse des données provenant des patients d’ulcère de Buruli traités au Centre de Dépistage et de Traitement de Lèpre et de l’Ulcère de Buruli (CDTLUB) de Pobè au Bénin, collectées dans le cadre d’études épidémiologique, environnementale et microbiologique, avait pour objectifs de : 1) Déterminer les facteurs comportementaux à risque pour l’infection à Mycobacterium ulcerans, 2) Apprécier la contamination environnementale par Mycobacterium ulcerans, 3) Analyser les interactions entre l’environnement, le mode de vie des patients et l’écologie de Mycobacterium ulcerans. La présente étude, réalisée avec une approche impliquant plusieurs disciplines (médecine, épidémiologie, microbiologie, analyse spatiale et géographie de la santé), comprend deux parties. La première partie correspond à l’étude épidémiologique cas - témoins. Les analyses de cette partie ont exploité les données de 217 patients traités par le CDTLUB de Pobè de 2005 à 2020 et 434 témoins. Le modèle de régression logistique conditionnelle a été utilisé pour identifier les facteurs environnementaux et anthropiques associés à la variation de l’incidence de l’ulcère de Buruli. La seconde partie correspond aux études environnementale et microbiologique. Les analyses ont porté sur les échantillons environnementaux (plantes aquatiques, vertébrés et invertébrés aquatiques et des matières organiques) collectés sur 90 principaux sites de sources d’eau non protégés fréquentés par les patients. Le test de positivité à Mycobacterium ulcerans par la technique QPCR « Quantitative Polymerase Chain Reaction» a été réalisé sur les ADN extraits et purifiés issus des échantillons.Les comportements humains les plus à risque identifiés sont l’accès et l’utilisation des points d'eau non protégés situés dans les bas-fonds (OR = 10,8 ; IC à 95 % = 1,09 à 107,59) pour les différentes activités quotidiennes. En revanche, l’accès et l’utilisation de l'eau de forage (OR = 0,2 ; 95 % IC = 0,08-0,44) et la connaissance de la population sur l’ulcère de Buruli avant qu'elle ne contracte la maladie (OR = 0,2 ; IC à 95% = 0,07-0,39) sont des facteurs protecteurs de la maladie.Nos résultats révèlent que l’accès et l’utilisation d’eau propre provenant du forage confèrent une protection contre l’ulcère de Buruli. En combinant les résultats des différentes analyses, nous avons ainsi conclu que le facteur de risque le plus associé à l’apparition de l’ulcère de Buruli est la fréquence des contacts avec des sources d’eau naturelles et non protégées, surtout lorsque ces points d’eau sont situés dans les zones de bas-fonds régulièrement inondées ou irriguées. Les résultats et méthodes de cette étude nous ont permis enfin de proposer un modèle de prévention primaire adapté aux zones endémiques et pourront servir à des investigations plus poussées sur l’ulcère de Buruli et d’autres maladies tropicales négligées. Tous ces résultats soulignent la nécessité de développer une approche intégrée pour lutter contre l’ulcère de Buruli dans un cadre unique « One Health Initiative - One World One Medicine One Health » répondant aux priorités de l’OMS. Elle permet de rendre la prise en charge des patients et la prévention des maladies tropicales négligées plus efficientes dans les populations exposées.
... Significant suppression of hla promoter activity occurred between 3.5-6.5H, [9][10][11][12].5H, and 14-24H for the S. aureus + 100 ng mycolactone treatment (Supplemental Fig. S1). At 4 h, the mean percent difference in luminescence between the vehicle control and mycolactone treatment was − 57% (p = 0.004, Fig. 4). ...
Buruli ulcer is a neglected tropical disease caused by the environmental pathogen, Mycobacterium ulcerans whose major virulence factor is mycolactone, a lipid cytotoxic molecule. Buruli ulcer has high morbidity, particularly in rural West Africa where the disease is endemic. Data have shown that infected lesions of Buruli ulcer patients can be colonized by quorum sensing bacteria such as Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa , but without typical pathology associated with those pathogens’ colonization. M. ulcerans pathogenesis may not only be an individual act but may also be dependent on synergistic or antagonistic mechanisms within a polymicrobial network. Furthermore, co-colonization by these pathogens may promote delayed wound healing, especially after the initiation of antibiotic therapy. Hence, it is important to understand the interaction of M. ulcerans with other bacteria encountered during skin infection. We added mycolactone to S. aureus and incubated for 3, 6 and 24 h. At each timepoint, S. aureus growth and hemolytic activity was measured, and RNA was isolated to measure virulence gene expression through qPCR and RNASeq analyses. Results showed that mycolactone reduced S. aureus hemolytic activity, suppressed hla promoter activity, and attenuated virulence genes, but did not affect S. aureus growth . RNASeq data showed mycolactone greatly impacted S. aureus metabolism. These data are relevant and significant as mycolactone and S. aureus sensing and response at the transcriptional, translational and regulation levels will provide insight into biological mechanisms of interspecific interactions that may play a role in regulation of responses such as effects between M. ulcerans , mycolactone, and S. aureus virulence that will be useful for treatment and prevention.
... Um aspecto importante que tem sido considerado mais recentemente é a ocorrência de diferentes genótipos presentes no mesmo ambiente ou no mesmo indivíduo. Um estudo recente, realizado em Gana, mostrou que em pacientes com um determinado tipo de úlcera, um total de 26% apresentava o mesmo genótipo de S. aureus na narina anterior e nas lesões e 16% estavam colonizados por isolados pertencentes a dois genótipos diferentes 26 . Outro fator relevante é que esta bactéria vem se tornando cada vez mais resistente a antibióticos, no Brasil e no mundo 27 . ...
Objetivo – As infecções relacionadas à assistência à saúde são um problema mundial. A contaminação de pacientes através de mãos e
objetos constitui-se na principal causa de infecção. O objetivo deste foi avaliar a contaminação bacteriana de terminais de computadores
utilizados em diferentes setores do Hospital de Clínicas de Passo Fundo-RS (HCPF), analisando o possível papel dos mesmos como fômites de infecção hospitalar. Métodos – Ao todo foram coletadas amostras de 221 terminais de computadores situados em setores críticos, semicríticos e não críticos. A coleta foi realizada com swab umedecido em solução salina, por fricção, sendo o material semeado em placas de Petri contendo ágar sangue e ágar MacConkey. As placas foram incubadas a 35-37ºC por 24 horas e as colônias presentes nos meios de cultura foram identificadas por técnicas convencionais. Resultados – Em 87,5% das amostras houve crescimento de micro-organismos, sendo identificados 11 tipos de bactérias. Cocos Gram-positivos foram os mais frequentes, com predominância de Staphylococcus coagulase-negativos (44,3%). As bactérias Gram-negativas foram responsáveis por apenas 4,2% dos casos. Não houve diferença significativa entre os três setores, embora Staphylococcus aureus tenha ocorrido com maior frequência nos setores críticos. Conclusão – Elevados níveis de contaminação foram observados nos terminais de computadores dos três setores, reforçando a importância da higienização desses equipamentos para evitar a transmissão cruzada de micro-organismos para os pacientes.
Descritores: Bactéria; Computador; Contaminação; Hospital
... One may hypothesize that the cutaneous microbiota, which is part of the individual, partially controls the expression of the M. ulcerans infection 17 . Indeed, bacteria and fungi present on skin contaminated with M. ulcerans could interact with the pathogen, as previously shown with the antagonism between Staphylococcus lugdunensis and Staphylococcus aureus in the nasal mucosa 18,19 . ...
Mycobacterium ulcerans secrete a series of non-ribosomal-encoded toxins known as mycolactones that are responsible for causing a disabling ulceration of the skin and subcutaneous tissues named Buruli ulcer. The disease is the sole non-contagion among the three most common mycobacterial diseases in humans. Direct contact with contaminated wetlands is a risk factor for Buruli ulcer, responsible for M. ulcerans skin carriage before transcutaneous inoculation with this opportunistic pathogen. In this study, we analysed the bacterial and fungal skin microbiota in individuals exposed to M. ulcerans in Burkina Faso. We showed that M. ulcerans-specific DNA sequences were detected on the unbreached skin of 6/52 (11.5%) asymptomatic farmers living in Sindou versus 0/52 (0%) of those living in the non-endemic region of Tenkodogo. Then, we cultured the skin microbiota of asymptomatic M. ulcerans carriers and negative control individuals, all living in the region of Sindou. A total of 84 different bacterial and fungal species were isolated, 21 from M. ulcerans-negative skin samples, 31 from M. ulcerans-positive samples and 32 from both. More specifically, Actinobacteria, Aspergillus niger and Aspergillus flavus were significantly associated with M. ulcerans skin carriage. We further observed that in vitro, mycolactones induced spore germination of A. flavus, attracting the fungal network. These unprecedented observations suggest that interactions with fungi may modulate the outcome of M. ulcerans skin carriage, opening new venues to the understanding of Buruli ulcer pathology, prophylaxis and treatment of this still neglected tropical infection.
... This information is also important in the holistic treatment and management of the disease. Although risk factors for bacteria colonization on BU lesions have not been extensively investigated, delayed treatment and insufficient wound assessment might contribute to the colonization and may prolong wound healing [27]. This study thus aimed at identifying secondary contaminating microorganism that may colonize BU wounds. ...
... Majority of the Staphylococci identified in this study were mannitol fermenters which are considered pathogenic. S. aureus, abundantly found in BU lesions of this study has been found to be the predominant bacteria isolated from several BU wounds [14,27,28]. S. aureus have been found to harbor a diverse repertoire of virulence factors such as α-hemolysin, and other mobile genetic elements (MGEs) including genomic island prophages and pathogenicity islands [34]. ...
... The type of secondary microbial infection on a BU patient may not necessarily depend on factors such as geographical area, personal hygiene, type of treatment, among others. In recent studies majority of the secondary bacterial infection in BU patients were like those found in this study [10,27,28]. Sequence analysis revealed that majority of the bacteria identified on the BU lesions are Gram positive and negative rods compared to the cocci. ...
Background
Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans and is the second most common mycobacterial disease after tuberculosis in Ghana and Côte d’Ivoire. M. ulcerans produces mycolactone, an immunosuppressant macrolide toxin, responsible for the characteristic painless nature of the infection. Secondary infection of ulcers before, during and after treatment has been associated with delayed wound healing and resistance to streptomycin and rifampicin. However, not much is known of the bacteria causing these infections as well as antimicrobial drugs for treating the secondary microorganism. This study sought to identify secondary microbial infections in BU lesions and to determine their levels of antibiotic resistance due to the prolonged antibiotic therapy required for Buruli ulcer.
Results
Swabs from fifty-one suspected BU cases were sampled in the Amansie Central District from St. Peters Hospital (Jacobu) and through an active case surveillance. Forty of the samples were M. ulcerans (BU) positive. Secondary bacteria were identified in all sampled lesions ( N = 51). The predominant bacteria identified in both BU and Non-BU groups were Staphylococci spp and Bacilli spp. The most diverse secondary bacteria were detected among BU patients who were not yet on antibiotic treatment. Fungal species identified were Candida spp, Penicillium spp and Trichodema spp. Selected secondary bacteria isolates were all susceptible to clarithromycin and amikacin among both BU and Non-BU patients. Majority, however, had high resistance to streptomycin.
Conclusions
Microorganisms other than M. ulcerans colonize and proliferate on BU lesions. Secondary microorganisms of BU wounds were mainly Staphylococcus spp, Bacillus spp and Pseudomonas spp. These secondary microorganisms were less predominant in BU patients under treatment compared to those without treatment. The delay in healing that are experienced by some BU patients could be as a result of these bacteria and fungi colonizing and proliferating in BU lesions. Clarithromycin and amikacin are likely suitable drugs for clearance of secondary infection of Buruli ulcer.
... Buruli ulcer lesions have necrotic sloughs at some point in time, during the course of the disease; secondary colonization by a large array of commensal bacterial populations including Staphylococcus aureus and Pseudomonas Article highlights • Buruli ulcer is a Neglected Tropical Disease caused by Mycobacterium ulcerans • epidemiology is volatile; the micro-organism has an as yet poorly defined environmental reservoir; transmission is poorly understood, though direct inoculation in the subcutaneous tissues is likely • disease features, including necrosis of subcutis and skin, immune down-regulation and lack of pain are all mediated by the secreted toxin, the polyketide mycolactone • drug treatment appears highly effective, as evidenced by a recently reported clinical trial; resection surgery has become redundant and unnecessary • oral drug treatment with 8-weeks rifampicin and clarithromycin appears safe and highly effective • healing is slow, as a result of a slow wash-out of mycolactone that impairs spontaneous tissue repair • research in wound care and early case finding in rural African settings are needed aeruginosa is common [74][75][76]. It is currently unclear whether these organisms are colonizing 'innocent bystanders,' or whether these organisms cause additional harm. ...
Introduction: Pharmacological treatment of Buruli ulcer (Mycobacterium ulcerans infection; BU) is highly effective, as shown in two randomized trials in Africa.
Areas covered: We review BU drug treatment – in vitro, in vivo and clinical trials (PubMed: ‘(Buruli OR (Mycobacterium AND ulcerans)) AND (treatment OR therapy).’ We also highlight the pathogenesis of M. ulcerans infection that is dominated by mycolactone, a secreted exotoxin, that causes skin and soft tissue necrosis, and impaired immune response and tissue repair. Healing is slow, due to the delayed wash-out of mycolactone. An array of repurposed tuberculosis and leprosy drugs appears effective in vitro and in animal models. In clinical trials and observational studies, only rifamycins (notably, rifampicin), macrolides (notably, clarithromycin), aminoglycosides (notably, streptomycin) and fluoroquinolones (notably, moxifloxacin, and ciprofloxacin) have been tested.
Expert opinion: A combination of rifampicin and clarithromycin is highly effective but lesions still take a long time to heal. Novel drugs like telacebec have the potential to reduce treatment duration but this drug may remain unaffordable in low-resourced settings. Research should address ulcer treatment in general; essays to measure mycolactone over time hold promise to use as a readout for studies to compare drug treatment schedules for larger lesions of Buruli ulcer.
... , moderate and severe). Other studies investigating a variety of skin diseases, such as scabies, psoriasis, atopic dermatitis, eczema herpeticum, kerion, and leishmaniosis, have also shown a high prevalence of this microorganism(Amissah et al. 2015;Serra et al. 2015; Sonesson et al. 2017). In this context, it is important to discuss the composition of normal microbiota, which depends on the colonized area of the human host. ...
Chromoblastomycosis (CBM) is a chronic subcutaneous infection caused by melanotic fungi, affecting mainly rural workers in tropical and subtropical regions. Secondary bacterial infections (SBIs) in CBM lesions bring complications to the disease, but little is known about the agents involved. Fungal and bacterial identification and epidemiological profile of 50 patients with CBM were analyzed in this study. Bacteria were tested for susceptibility to antibacterial drugs. Fonseacea pedrosoi and Rhinocladiella aquaspersa were the fungal agents isolated. 88% of the patients presented SBI. Gram-positive bacteria coinfected mainly upper limbs, and Gram-negative bacteria were more isolated from lower limbs. Streptococcus pyogenes and mixed bacterial microbiota were associated with severe lesions. Staphylococcus aureus was associated with mixed infections and consequently with the severity of the infection. Resistance to β-lactams and methicillin was detected. Our results emphasize the necessity of bacterial culture and susceptibility testing as part of routine monitoring CBM cases.
... S. aureus resistance to mupirocin was investigated in Nigeria [35,36,44,48,49,53,[63][64][65][66] and Ghana [54,55,67,68]. Only two studies from Ghana reported on mupR S. aureus [54,55]. ...
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.
