title: Antibiotic resistance and clonal diversity of invasive Staphylococcus aureus in the rural Ashanti Region, Ghana.
abstract: Staphylococcus aureus is among the most common pathogens isolated from blood cultures in Ghana; yet the epidemiology of blood infections in rural settings is poorly described. This study aims to investigate antimicrobial susceptibility and clonal diversity of S. aureus causing bloodstream infections in two hospitals in the Ashanti Region, Ghana.
  
  
  
  Blood cultures were performed for all febrile patients (≥37.5 °C) on hospital admission. Antibiotic susceptibility testing for S. aureus isolates was carried out by the VITEK 2 system. Multiplex polymerase chain reaction (PCR) was used to detect S. aureus-specific nuc gene, Panton-Valentine leukocidin (PVL), and methicillin-resistant S. aureus (MRSA)-specific mecA and mecC genes. The population structure of S. aureus was assessed by spa typing.
  
  
  
  In total, 9,834 blood samples were cultured, out of which 0.6% (n = 56) were positive for S. aureus. Multidrug resistance (MDR) was detected in 35.7% (n = 20) of the S. aureus strains, of which one was a MRSA. The highest rate of antibiotic resistance was seen for commonly available antibiotics, including penicillin (n = 55; 98.2%), tetracycline (n = 32; 57.1%) and trimethoprim/sulfamethoxazole (n = 26; 46.4%). Of all S. aureus strains, 75.0% (n = 42) carried the PVL-encoding genes. We found 25 different spa types with t355 (n = 11; 19.6%), t314 (n = 8; 14.3%), t084 (n = 8; 14.3%) and t311 (n = 5; 8.9%) being predominant.
  
  
  
  The study exhibited an alarmingly large level of antibiotic resistance to locally available antibiotics. The frequency of genetically diverse and PVL-positive methicillin-sensitive S. aureus (MSSA) was high and could represent a reservoir for the emergence of virulent PVL-positive MRSA clones.
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany. dekker@bnitm.de.|German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Hamburg, Germany. dekker@bnitm.de.
authors.forename: Denise
authors.identifier: 0000-0001-5432-3217
authors.initials: D
authors.lastname: Dekker
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Martinistr.52, D-20246, Hamburg, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Wolters
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.|German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Hamburg, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Mertens
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.
authors.forename: Kennedy Gyau
authors.initials: KG
authors.lastname: Boahen
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.|German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Krumkamp
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eibach
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.
authors.forename: Norbert G
authors.initials: NG
authors.lastname: Schwarz
authors.affiliation: Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Adu-Sarkodie
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Martinistr.52, D-20246, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Rohde
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Martinistr.52, D-20246, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Christner
authors.affiliation: International Vaccine Institute (IVI), Seoul, Republic of Korea.
authors.forename: Florian
authors.initials: F
authors.lastname: Marks
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.
authors.forename: Nimako
authors.initials: N
authors.lastname: Sarpong
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.|German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Hamburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: May
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects / Q000235:genetics; D005098:Exotoxins / Q000235:genetics; D005260:Female; D014644:Genetic Variation; D005869:Ghana; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D008826:Microbial Sensitivity Tests; D060885:Multiplex Polymerase Chain Reaction; D046915:Penicillin-Binding Proteins / Q000235:genetics; D012424:Rural Population; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D046915:Penicillin-Binding Proteins; C487789:mecA protein, Staphylococcus aureus
keywords: Antibiotic resistance; Panton-Valentine leukocidin; Rural ghana; S. aureus; Spa typing