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Tanzania administrative zones. Modified map adopted from Suleiman 2018 (Suleiman 2018). Tanzania regions are classified into 9 zones: 1. Eastern Zone ( Morogoro, Pwani and Dar es Salaam) 2. Northern Zone (Arusha, Kilimanjaro and Tanga); 3. Lake Zone (Kagera, Mwanza, and Mara); 4. Western Zone (Kigoma,Tabora and Shinyanga); 5. Central Zone (Dodoma, Manyara and Singida); 6. South West Highlands (Katavi, Mbeya and Rukwa); 7. Southern Highlands Zone (Iringa, Njombe and Ruvuma); 8. Southern Zone (Lindi and Mtwara) and 9. Zanzibar Zone
Source publication
Background
Data on the prevalence, genotypes and antibiotic resistance patterns of colonizing and infection-associated Staphylococcus aureus ( S. aureus ) strains both in humans and animals in Tanzania are scarce. Given the wide range of infections caused by S. aureus and the rise of methicillin-resistant S. aureus (MRSA) globally, this review aims...
Context in source publication
Context 1
... most of the data obtained for review are based in relatively well to do regions (Tanzania National Bureau of Statis- tics 2018). No published data between 2010 and 2020 on the epidemiology of S. aureus were available for the southern and western parts of the country, which are home to some of the most impoverished regions in Tanzania (refer to Fig. 3). It is well known that poverty struck areas also face other challenges as poor healthcare facilities and access, lack of basic needs such as food, proper housing and sanitation, which in turn leaves the population ridden by different infectious diseases ( Alvarez-Uria et al. 2016). Furthermore, since the income gained by the poor is ...
Citations
... Thus further exacerbate di culty to treat MRSA strain consequently making it one of the successful pathogen causing infections accompanied with high morbidity, mortality rate, prolonged hospital stays, and treatment failure(6, 10) (11,12. Such dire consequences prompted the World Health Organization to prioritize MRSA at the top of the high-priority list of bacteria in 2017, compelling the scienti c community to seek novel antibacterial agents (11,13). Nevertheless, the signi cance of S. aureus extends beyond MRSA, as methicillin-susceptible S. aureus (MSSA) strains remain medically relevant, capable of causing serious clinical infections though the absence of mecA gene renders this strain susceptible to wide variety of βlactams and less virulent (14). ...
Background
The emergency of multidrug-resistant S. aureus (MRSA) strains, driven by acquisition of resistance gene in mecA imposes a substantial challenge in the treatment and control of their related infections. Despite the fact that Quinolones have historically been effective against both MRSA and methicillin-susceptible S. aureus (MSSA) strains, the escalating rising of quinolones resistance among S. aureus isolates particularly in MRSA, has severely curtailed their potency and further narrow down the therapeutic options. This study aimed at determining the burden of MRSA among isolates, their resistance profile, genotypic characterization and determining the molecular relatedness through construction of phylogenetic tree.
Material and Methods
Archieved clinical S. aureus isolates from a descriptive cross-sectional study involving six regional referral hospitals in Dodoma, Songea, Kigoma, Kitete, and Morogoro in mainland and Mnazi Mmoja in Zanzibar were analyzed. Bacterial identification was performed using both classical microbiology and whole genome sequencing on Illumina Nextseq 550 Sequencer. Species identification was done using KmerFinder 3.2, Multilocus Sequence Types using MLST 2.0, SCCmec type using SCCmecFinder 1.2, resistance genes using ResFinder 4.1, and phylogenetic relatedness using CSI Phylogeny 1.4.
Results
Out of the 140 isolates analyzed, 69 (49.3%) were identified as MRSA, with 57 (82.6%) exhibiting quinolone resistance. Conversely, 71 isolates were identified as MSSA, and none of them exhibited resistance to quinolone. Spa-typing revealed 6 spa types, with t355, t1476, and t498 being most common. Moreover, all (69) MRSA were found to carry SCCmec type IV. The isolates exhibited 14 different sequence types (ST). Notably, ST152 was prevalent 50(70%) among MSSA while ST8 was the predominant 58(84%) sequence type among MRSA. The antimicrobial resistance profile revealed at least three horizontally acquired resistance genes, with blaZ, dfrG, tet(K), and aac (6’)-aph (2’’) genes being highly prevalent.
Conclusion
There is a high genetic diversity among the S. aureus isolates existing in Tanzania regional hospitals, with a concerning burden of quinolone resistance in MRSA isolates. The diversity in resistance genes among MRSA lineages emphasizes the necessity for development of sustainable antimicrobial stewardship and surveillance to support evidence-based guidelines for the management and control of MRSA infections in both community and hospital settings.
... The inability to perform D-tests routinely in the laboratory causes inadequate treatment of infections by Staphylococcus, which can cause treatment failures, leading to the development of a constitutive resistance (Khashei et al., 2018). Globally, there is a significant variation in the rates of inducible clindamycin resistance in different regions (Adhikari et al., 2017;Mzee et al., 2021). ...
... In Tanzania, very few reports have been published regarding the prevalence of inducible clindamycin-resistant S. aureus in clinical specimens (Mzee et al., 2021). This study was conducted at Muhimbili National Hospital (MNH), the largest referral hospital in Tanzania, to determine the prevalence of inducible clindamycin resistance in clinical isolates of Staphylococcus spp. ...
... The prevalence of MRSA varies worldwide and is higher in lower and middle-income countries (LMIC) (Klein et al., 2019;Gandra et al., 2020;Sulis et al., 2022). In our study, the proportion of MRSA was 75%, higher than the findings in the same hospital (Nkuwi et al., 2018) and other hospitals in Tanzania (Mzee et al., 2021). Furthermore, our study found that CoNS were highly resistant to methicillin, reaching 66.7%. ...
Methicillin and clindamycin resistance (constitutive and inducible) pose a common clinical challenge in treating Staphylococcal infections. This cross-sectional study, conducted at Muhimbili National Hospital (MNH) in Tanzania from April to June 2023, to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and clindamycin-resistant Staphylococcus (S.) species by using a cefoxitin disk (30 μg) and the D-test method as per CLSI 2022 guidelines. Of the 361 clinical samples, 125 (34.6%) were culture-positive. Among Staphylococcus spp., S. aureus was 6% (12/125), while 33.6% (42/125) were coagulase-negative staphylococci (CoNS). Among the isolated S. aureus, 75% were resistant to methicillin, while 66.7% of the CoNS were resistant to methicillin. Further, 92% (11/12) of the S. aureus isolates were resistant to erythromycin, and 50% (6/12) were resistant to clindamycin. Among the CoNS, 83% (35/42) were resistant to erythromycin, and 52% (22/42) were resistant to clindamycin. The proportion of inducible macrolides lincosamide streptogramin B resistance (iMLSB), constitutive macrolides lincosamide streptogramin B resistance (cMLSB), and macrolides lincosamide streptgramin B methicillin susceptible (MS) phenotypes among S. aureus isolates was 16.7%, 41.7%, and 33.3%, respectively, and among CoNS was 19%, 35.7%, and 28.6%, respectively. The overall prevalence of iMLSB and cMLSB phenotypes was 18.5% (10/54) and 37% (20/54), respectively. Comparatively, MRSA had more resistance to ciprofloxacin than methicillin-susceptible S. aureus (MSSA) (88.9% vs. 33.3% p = 0.027), while methicillin-resistant coagulase-negative staphylococci (MR-CoNS) had significantly higher resistance to gentamicin (35.7% vs. 7.1% p= 0.005), and trimethoprim-sulfamethoxazole (78.6% vs. 50% p=0.007) than methicillin-susceptible coagulase-negative staphylococci (MS-CoNS). The high prevalence of methicillin and inducible clindamycin resistance in this study points out a potential rise in treatment failures, prolonged hospitalization, and limited treatment options. Thus, emphasizes the importance of antibiotic stewardship and laboratory-guided antibiotic decisions. To address the growing challenge of antibiotic resistance in Tanzania, it is advisable to implement stringent public health measures, including monitoring antibiotic usage, conducting educational initiatives, and raising awareness among patients and healthcare professionals.
... Formation of Staphylococci biofilm, particularly in wound infection and skin abscess, usually increases severity and chances of bloodstream infection, thereby aiding the SSTIs morbidity mostly among the In-patients [4]. Persistent antibiotic resistance to β-lactams [7], fluoroquinolones [8], and cephalosporins [9], provide a high magnitude of skin morbidity and infection burden. Due to the poor efficacy of antibiotics against resistant S. aureus in SSTIs, selected plant extracts such as Moringa oleifera, Vernonia amygdalina, Azadirachta indica and Acalypha wilkesiana showed high antimicrobial activities as alternative skin therapy used mainly by numerous infected individuals as local concoction with undocumented successes. ...
Abstract Background The antibacterial activities of aqueous leaf extracts of Moringa oleifera, Vernonia amygdalina, Azadirachta indica and Acalypha wilkesiana against multidrug resistance (MDR) Staphylococcus aureus associated with skin and soft tissue infections were investigated. Methods Staphylococcus aureus (n = 183) from the skin and soft tissue infections with evidence of purulent pus, effusions from aspirates, wounds, and otorrhea were biotyped, and evaluated for biofilm production. The phenotypic antibiotic resistance and MDR strains susceptibility to plant leaves extract were determined using disc diffusion and micro-broth dilution assays respectively. The correlation of plant extract bioactive components with inhibitory activities was determined. Results High occurrence rate of S. aureus were recorded among infant and adult age groups and 13.2% mild biofilm producers from the wound (p
Background
Staphylococcus aureus is one of the main causes of bacteraemia, associated with high mortality, mainly due to the occurrence of multidrug resistant (MDR) strains. Data on antibiotic susceptibility and genetic lineages of bacteraemic S. aureus are still scarce in Mozambique. The study aims to describe the antibiotic susceptibility and clonality of S. aureus isolated from blood cultures of children admitted to the Manhiça District Hospital over two decades (2001–2019).
Methods
A total of 336 S. aureus isolates detected in blood cultures of children aged <5 years were analyzed for antibiotic susceptibility by disk diffusion or minimal inhibitory concentration, and for the presence of resistance determinants by PCR. The clonality was evaluated by S ma I-PFGE, spa typing, and MLST. The SCC mec element was characterized by SCC mec typing.
Results
Most S. aureus (94%, 317/336) were resistant to at least one class of antibiotics, and one quarter (25%) showed a MDR phenotype. High rates of resistance were detected to penicillin (90%) and tetracycline (48%); followed by erythromycin/clindamycin (25%/23%), and co-trimoxazole (11%), while resistance to methicillin (MRSA strains) or gentamicin was less frequent (≤5%). The phenotypic resistance to distinct antibiotics correlated well with the corresponding resistance determinants (Cohen’s κ test: 0.7–1.0). Molecular typing revealed highly diverse clones with predominance of CC5 (17%, 58/336) and CC8 (16%), followed by CC15 (11%) and CC1 (11%). The CC152, initially detected in 2001, re-emerged in 2010 and became predominant throughout the remaining surveillance period, while other CCs (CC1, CC5, CC8, CC15, CC25, CC80, and CC88) decreased over time. The 16 MRSA strains detected belonged to clones t064-ST612/CC8-SCC mec IVd (69%, 11/16), t008-ST8/CC8-SCC mec NT (25%, 4/16) and t5351-ST88/CC88-SCC mec IVa (6%, 1/16). Specific clonal lineages were associated with extended length of stay and high in-hospital mortality.
Conclusion
We document the circulation of diverse MDR S. aureus causing paediatric bacteraemia in Manhiça district, Mozambique, requiring a prompt recognition of S. aureus bacteraemia by drug resistant clones to allow more targeted clinical management of patients.
373.
A
Abstract
200 samples were collected , 100 swabs from the nose and 100 swabs from the hands, of dental workers (96 dentists and 4 assistants ) of both sexes ,61 males and 39 females , their ages ranged from 17 to 50 years in the teaching hospital of the Collage of Dentistry, University of Mosul from the period 17th Dec. 2020 to 9th Feb.2021.
The isolates were diagnosed based on culture traits, microscopic examination, biochemical tests, and the use of the Vitek – 2compact device to confirm the the type of isolate 66 isolates ( 36.85%) ;32( 37.2%) of the hands and 34 ( 36.5%) of the nose were capable of fermenting mannitol sugar, and all Staphylococcus aureus isolates were positive for catalase test at 100%, while 17( 53.125%) of the isolates from the hands and 25 (73.52%) of the nasal isolates were positive for the coagulase test. Using the Vitek 2-compact 36 fermented isolates were diagnosed which were distribute as follows 20 ( 55.55%) isolates of S.aureus bacteria; 14 isolates (63.63%) from the nose and 6 isolates (42.85%) from hands, 5 ( 13.88%) isolates of S.lugdunensis;4 isolates (18.18%) from the nose and one isolate (7.14%) from the hands, 4 ( 11.11%) isolates of S. saprophyticus bacteria; two isolate (9.09%) from the nose and two isolate (14.28%) from the hands, 2 (5.55%) isolates of S.hominis (14.28%%) from hands only and 3 ( 8.33%) isolates of S.warneri; two isolates from the nose (9.09%) and one isolate ( 7.14%) from the hands, and finally one ( 2.77%) isolate from each of S.sciuri and Leuconostoc mesenteroides bacteria and from hands with percentage (7.14%).
The sensitivity of the different Staphylococcus isolates to oxacillin was determined using minimum inhibitory concentration (MIC) and using the Vitek device because the antibiotic oxacillin is similar to methicillin
B
in the device, and it was found that the isolates differed in their resistance to this antibiotic, were the highest resistance (100%) was for S.lugdunensis and S.sciuri while for S.aureus its resistance was 80% then S.warneri S.hominis, S. saprophyticus 66.67%, 50%, 25% respectively. On the other hand, the sensitivity of different isolates to antibiotics was determined according to Kirby – Bauer method. And by using seven types of antibiotics Penicillin G, Methicillin,Oxacillin, Ciprofloxacin, Rifampicin, Vancomycin, Erythromycin where all Staphylococcus isolates showed resistance to Oxacillin and Methicillin at percentage 100% except for isolates S. saprophyticus, the resistance was 50% for oxacillin.
Six isolates of S.aureus were selected to study their ability to form biofilms by microtiter plate method supported by molecular study and using PCR technique, the results showed that the six isolates of Staphylococcus aureus have the ability to form biofilms because they have genes icaA and size 188 bp and icaD and size198 bp with percentage of ( 83.3 and 100%) respectively, and it was found that (83.3%) of these isolates contained the icaA and icaD genes except for one isolate that possessed the icaD gene only at rate of ( 16.6%) therefore formed a biofilm to a lesser degree than the rest of the isolates, the results showed that (50%) isolates of S.aureus bacteria were resistant to methicillin due to their possession mecA gene and size 125 bp that encodes resistance to this antibiotic,When investigating genes that are resistant to antibiotics and antiseptics, it was found that all six isolates did not contain the gene qacA\ B and size 1125 bp while they possessed the smr gene and size 286 bp with a percentage of (16.6%) and Conjugation test was carried out using two isolates of S.aureus with different genetic markers, which it is the characteristics of resistance to antibiotics, heavy metals and formation of biofilms, the donor isolate was resistant to antibiotics Vancomycin, sensitive to antibiotics Rifampcin and resistant to heavy metals, mercury chloride, cadmium chloride, nickel chloride and
C
copper chloride and composed of biofilm, As for the received isolate it was resistant to antibiotics Vancomycin sensitive to antibiotics Rifampcin, sensitive to mercury chloride resistant to cadmium chloride, nickel chloride and copper chloride and not forming biofilms,therefore antibiotics Vancomycin and Rifampcin and heavy metal mercury chloride were selected to test isolates resulting from conjugation this bacterial isolate showed resistance to mercury chloride and showed its ability to form biofilms using micro titer plates method. The coupling frequency was 21×10-4.Upon molecular investigation of the genes responsible for the formation of biofilms which are icaA and icaD, the results were that the donor and recipient isolate possess both genes icaA and icaD together, As for the isolate resulting from conjugation, it possesses only one icaA gene.And when the gene expression was measured using qRT-PCR technique for the two genes icaA and icaD responsible for the formation of adhesive proteins in the biological membranes in the studied donor, recipient and resulting from conjugation, The isolation resulting from conjugation showed the highest value in gene expression for these two genes as it reached 2.143547 and 2.297397 respectively, from donor isolate as it is genetic expression reached (1and1) for both genes as for the receiving isolate, it is gene expression was reported 1.414214 and 0.933033 respectively. Propolis was selected for the preparation of the alcoholic extract and the study of the antibacterial activity of the S.aureus isolates, as all the isolates used were sensitive to it at a concentration of 1\10 compared to Vancomycin used as a negative comparison as the effect ratio was 0.32288.As for the other concentration used in this study which are 1\1 and 1\100, the bacterial isolates were resistance to it, as their resistance 0.86475 and 0.80613 respectively compared with the significant value used.
