title: Prevalence and Trends of Staphylococcus aureus Bacteraemia in Hospitalized Patients in South Africa, 2010 to 2012: Laboratory-Based Surveillance Mapping of Antimicrobial Resistance and Molecular Epidemiology.
abstract: BACKGROUND
  We aimed to obtain an in-depth understanding on recent antimicrobial resistance trends and molecular epidemiology trends of S. aureus bacteraemia (SAB).
  
  
  METHODS
  Thirteen academic centres in South Africa were included from June 2010 until July 2012. S. aureus susceptibility testing was performed on the MicroScan Walkaway. Real-time PCR using the LightCycler 480 II was done for mecA and nuc. SCCmec and spa-typing were finalized with conventional PCR. We selected one isolate per common spa type per province for multilocus sequence typing (MLST).
  
  
  RESULTS
  S. aureus from 2709 patients were included, and 1231 (46%) were resistant to methicillin, with a significant decline over the three-year period (p-value = 0.003). Geographical distribution of MRSA was significantly higher in Gauteng compared to the other provinces (P<0.001). Children <5 years were significantly associated with MRSA with higher rates compared to all other age groups (P = 0.01). The most prevalent SCCmec type was SCCmec type III (531 [41%]) followed by type IV (402 [31%]). Spa-typing discovered 47 different spa-types. The five (87%) most common spa-types were t037, t1257, t045, t064 and t012. Based on MLST, the commonest was ST612 clonal complex (CC8) (n = 7) followed by ST5 (CC5) (n = 4), ST36 (CC30) (n = 4) and ST239 (CC8) (n = 3).
  
  
  CONCLUSIONS
  MRSA rate is high in South Africa. Majority of the isolates were classified as SCCmec type III (41%) and type IV (31%), which are typically associated with hospital and community- acquired infections, respectively. Overall, this study reveals the presence of a variety of hospital-acquired MRSA clones in South Africa dominance of few clones, spa 037 and 1257. Monitoring trends in resistance and molecular typing is recommended to detect changing epidemiological trends in AMR patterns of SAB.
authors.affiliation: National Institute for Communicable Diseases at National Health Laboratory Service, Johannesburg, South Africa.|Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Olga
authors.initials: O
authors.lastname: Perovic
authors.affiliation: National Institute for Communicable Diseases at National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Samantha
authors.initials: S
authors.lastname: Iyaloo
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.|National Health Laboratory Service, Helen Joseph Hospital, Johannesburg, South Africa.
authors.forename: Ranmini
authors.initials: R
authors.lastname: Kularatne
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.|National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital Laboratory Complex, Johannesburg, South Africa.
authors.forename: Warren
authors.initials: W
authors.lastname: Lowman
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.|National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital Laboratory Complex, Johannesburg, South Africa.
authors.forename: Noma
authors.initials: N
authors.lastname: Bosman
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.|National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Wadula
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.|National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
authors.forename: Sharona
authors.initials: S
authors.lastname: Seetharam
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.|National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital Laboratory Complex, Johannesburg, South Africa.
authors.forename: Adriano
authors.initials: A
authors.lastname: Duse
authors.affiliation: Department of Medical Microbiology at University of Pretoria, Pretoria, South Africa.
authors.forename: Nontombi
authors.initials: N
authors.lastname: Mbelle
authors.affiliation: National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.|University of Cape Town, Cape Town, South Africa.
authors.forename: Colleen
authors.initials: C
authors.lastname: Bamford
authors.affiliation: Department of Medicine, Greys Hospital and Caprisa, Pietermaritzburg, South Africa, University of KwaZulu Natal, Durban, South Africa.
authors.forename: Halima
authors.initials: H
authors.lastname: Dawood
authors.affiliation: National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.|School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Yesholata
authors.initials: Y
authors.lastname: Mahabeer
authors.affiliation: National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.|School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Prathna
authors.initials: P
authors.lastname: Bhola
authors.affiliation: National Health Laboratory Service, Stellenbosch, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Shareef
authors.initials: S
authors.lastname: Abrahams
authors.affiliation: National Institute for Communicable Diseases at National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Ashika
authors.initials: A
authors.lastname: Singh-Moodley
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020128:Inhibitory Concentration 50; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult