title: Molecular epidemiology and antimicrobial susceptibility of clinical Staphylococcus aureus from healthcare institutions in Ghana.
abstract: The objective of this study was to determine the antimicrobial susceptibility patterns and clonal diversity of clinical Staphylococcus aureus isolates from Ghana. A total of 308 S. aureus isolates from six healthcare institutions located across Northern, Central and Southern Ghana were characterized by antibiotyping, spa typing and PCR detection of Panton Valentine leukocin (PVL) genes. Methicillin-resistant S. aureus (MRSA) were confirmed by PCR detection of mecA gene and further characterized by SCCmec and multi-locus sequence typing (MLST). The prevalence of antimicrobial resistance was below 5% for all agents tested except for penicillin (97%), tetracycline (42%) and erythromycin (6%). Ninety-one spa types were found, with t355 (ST152, 19%), t084 (ST15, 12%) and t314 (ST121, 6%) being the most frequent types. Based on established associations between spa and MLST types, isolates were assigned to 16 clonal complexes (CCs): CC152 (n = 78), CC15 (n = 57), CC121 (n = 39), CC8 (n = 36), CC5 (n = 33), CC1 (n = 29), CC45 (n = 9), CC88 (n = 8), CC30 (n = 4), CC9 (n = 3), CC25 (n = 2), CC97 (n = 2) CC20 (n = 2), CC707 (n = 2), CC7 (n = 3) and CC522 (n = 1). Most isolates (60%) were PVL-positive, especially those belonging to ST152, ST121, ST5, ST15, ST1, ST8, and ST88. Nine (3%) isolates were MRSA belonging to seven distinct clones: ST88-IV (n = 2), ST250-I (n = 2), ST8-IV (n = 1), ST72-V (n = 1), ST789-IV (n = 1), ST2021-V (n = 1), and ST239-III (n = 1). The study confirmed a high frequency of PVL-positive S. aureus in Africa, low prevalence of antimicrobial resistance and high diversity of MRSA lineages in Ghana compared to developed countries and other African countries. The detection of known pandemic MRSA clones in the absence of routine MRSA identification in most Ghanaian clinical microbiology laboratories calls for capacity building to strengthen surveillance and prevent spread of these clones.
authors.affiliation: Department of Microbiology and Infection Control, Statens Serum Insitut, Copenhagen, Denmark ; Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark ; Bacteriology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana.
authors.forename: Beverly
authors.initials: B
authors.lastname: Egyir
authors.affiliation: Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
authors.forename: Luca
authors.initials: L
authors.lastname: Guardabassi
authors.affiliation: Department of Microbiology and Infection Control, Statens Serum Insitut, Copenhagen, Denmark.
authors.forename: Marit
authors.initials: M
authors.lastname: Sørum
authors.affiliation: Department of Large Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
authors.forename: Søren Saxmose
authors.initials: SS
authors.lastname: Nielsen
authors.affiliation: Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Augusta
authors.initials: A
authors.lastname: Kolekang
authors.affiliation: Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Enoch
authors.initials: E
authors.lastname: Frimpong
authors.affiliation: Bacteriology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana.
authors.forename: Kennedy Kwasi
authors.initials: KK
authors.lastname: Addo
authors.affiliation: Microbiology Department, University of Ghana Medical School, Accra, Ghana.
authors.forename: Mercy Jemima
authors.initials: MJ
authors.lastname: Newman
authors.affiliation: Department of Microbiology and Infection Control, Statens Serum Insitut, Copenhagen, Denmark.
authors.forename: Anders Rhod
authors.initials: AR
authors.lastname: Larsen
mesh_terms: D005869:Ghana; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D011446:Prospective Studies; D013207:Staphylococcal Skin Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics*