title: Emergence of methicillin resistance and Panton-Valentine leukocidin positivity in hospital- and community-acquired Staphylococcus aureus infections in Beira, Mozambique.
abstract: OBJECTIVE
  The objective of this study was to investigate the antibiotic resistance patterns, including methicillin resistance, inducible macrolide-lincosamide-streptogramin B (MLSB ) resistance and Panton-Valentine leukocidin (PVL) toxin gene carriage among hospital-acquired Staphylococcus aureus (HA-SA) and community-acquired S. aureus (CA-SA), in Beira, Mozambique.
  
  
  METHODS
  In 2010-2011, two prospective surveillance studies were conducted on post-operative and burn wound infections at the Central Hospital of Beira and on skin and soft tissue abscesses at the São Lucas Health Centre. We cultured pus samples, identified suspected S. aureus isolates and performed antimicrobial susceptibility testing, including detection of MLSB resistance. Real-time polymerase chain reaction was used to detect mecA, Martineau and PVL genes.
  
  
  RESULTS
  The prevalence of hospital-acquired methicillin-resistant S. aureus (HA-MRSA) infection among 53 inpatients was 15.1%; the prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA) infection among 100 outpatients was 1.0%. Inducible MLSB resistance was present in 41.7% and 10.7% of HA-SA and CA-SA isolates, respectively. PVL toxin gene was detected in 81.1% of methicillin-susceptible S. aureus (MSSA) compared with 11.1% of methicillin-resistant S. aureus.
  
  
  CONCLUSIONS
  Our study shows, for the first time in Mozambique, the emergence of HA-MRSA. The prevalence of CA-MRSA was low, whereas the rate of PVL toxin gene carriage in MSSA was high. The high rate of inducible MLSB resistance indicates the importance of performing routine D-tests. Overall, our results show the need of strengthening laboratory facilities to provide microbiological data for both directed therapy and surveillance.
authors.affiliation: Universidade Católica de Moçambique, Beira, Mozambique; Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Birgitta T
authors.initials: BT
authors.lastname: van der Meeren
authors.forename: Peter S
authors.initials: PS
authors.lastname: Millard
authors.forename: Marco
authors.initials: M
authors.lastname: Scacchetti
authors.forename: Mirjam H
authors.initials: MH
authors.lastname: Hermans
authors.forename: Mirrian
authors.initials: M
authors.lastname: Hilbink
authors.forename: Timótio B
authors.initials: TB
authors.lastname: Concelho
authors.forename: Josefo J
authors.initials: JJ
authors.lastname: Ferro
authors.forename: Peter C
authors.initials: PC
authors.lastname: Wever
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001427:Bacterial Toxins / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005098:Exotoxins / Q000235:genetics*; D005260:Female; D005798:Genes, Bacterial; D006801:Humans; D007956:Leukocidins / Q000235:genetics*; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000378:metabolism; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin
keywords: Mozambique; Panton-Valentine leukocidin; Staphylococcus aureus; antimicrobial resistance pattern; inducible clindamycin resistance; methicillin resistance