title: Co-detection of Panton-Valentine leukocidin encoding genes and cotrimoxazole resistance in Staphylococcus aureus in Gabon: implications for HIV-patients' care.
abstract: Patients infected with the human immunodeficiency virus (HIV) are frequently exposed to antimicrobial agents. This might have an impact on the resistance profile, genetic background and virulence factors of colonizing Staphylococcus aureus. Sub-Saharan Africa is considered to be endemic for Panton-Valentine leukocidin (PVL) positive S. aureus which can be associated with skin and soft tissue infections (SSTI). We compared S. aureus from nasal and pharyngeal swabs from HIV patients (n = 141) and healthy controls (n = 206) in Gabon in 2013, and analyzed determinants of colonization with PVL positive isolates in a cross-sectional study. S. aureus isolates were screened for the presence of selected virulence factors (incl. PVL) and were subjected to antimicrobial susceptibility testing and genotyping. In HIV patients, S. aureus was more frequently detected (36.9 vs. 31.6%) and the isolates were more frequently PVL positive than in healthy controls (42.1 vs. 23.2%). The presence of PVL was associated with cotrimoxazole resistance (OR = 25.1, p < 0.001) and the use of cotrimoxazole was a risk factor for colonization with PVL positive isolates (OR = 2.5, p = 0.06). PVL positive isolates were associated with the multilocus sequence types ST15 (OR = 5.6, p < 0.001) and ST152 (OR = 62.1, p < 0.001). Participants colonized with PVL positive isolates reported more frequently SSTI in the past compared to carriers of PVL negative isolates (OR = 2.7, p = 0.01). In conclusion, the novelty of our study is that cotrimoxazole might increase the risk of SSTI in regions where cotrimoxazole resistance is high and associated with PVL. This finding needs to be confirmed in prospective studies.
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster Münster, Germany ; Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital Lambaréné, Gabon.
authors.forename: Christian
authors.initials: C
authors.lastname: Kraef
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital Lambaréné, Gabon ; Institut für Tropenmedizin, Eberhard Karls Universität, Deutsches Zentrum für Infektionsforschung Tübingen, Germany.
authors.forename: Abraham S
authors.initials: AS
authors.lastname: Alabi
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster Münster, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Peters
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster Münster, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Becker
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital Lambaréné, Gabon ; Institut für Tropenmedizin, Eberhard Karls Universität, Deutsches Zentrum für Infektionsforschung Tübingen, Germany.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.affiliation: Centre de Traitement Ambulatoire Lambaréné, Gabon.
authors.forename: Elie G
authors.initials: EG
authors.lastname: Rossatanga
authors.affiliation: Institute of Hygiene, University Hospital Münster Münster, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mellmann
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital Lambaréné, Gabon ; Institut für Tropenmedizin, Eberhard Karls Universität, Deutsches Zentrum für Infektionsforschung Tübingen, Germany ; Division of Internal Medicine, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.affiliation: Institut für Tropenmedizin, Eberhard Karls Universität, Deutsches Zentrum für Infektionsforschung Tübingen, Germany ; Institute of Public Health, University Hospital Heidelberg Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Zanger
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster Münster, Germany ; Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital Lambaréné, Gabon.
authors.forename: Frieder
authors.initials: F
authors.lastname: Schaumburg
keywords: Africa; HIV; Panton-Valentine leukocidin; Staphylococcus aureus; cotrimoxazole resistance