Antimicrobial Resistance and Virulence Gene Profile of Clinical Staphylococcus aureus: A Multi-Center Study from Ethiopia

Rajiha A Ibrahim; Nega Berhe; Zelalem Mekuria; Eyasu T Seyoum; Joan-Miquel Balada-Llasat; Tamrat Abebe; Solomon H Mariam; Estifanos Tsige; Surafel Fentaw Dinku; Shu-Hua Wang

doi:10.2147/IDR.S419577

Antimicrobial Resistance and Virulence Gene Profile of Clinical Staphylococcus aureus: A Multi-Center Study from Ethiopia

Infect Drug Resist. 2023 Jul 25:16:4835-4844. doi: 10.2147/IDR.S419577. eCollection 2023.

Authors

Rajiha A Ibrahim^{1

2

3}, Nega Berhe¹, Zelalem Mekuria^{3

4}, Eyasu T Seyoum³, Joan-Miquel Balada-Llasat^{3

5}, Tamrat Abebe⁶, Solomon H Mariam¹, Estifanos Tsige², Surafel Fentaw Dinku², Shu-Hua Wang^{3

7}

Affiliations

¹ Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
² Bacterial, Parasitic and Zoonotic Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
³ Global One Health Initiative (GOHi), The Ohio State University, Columbus, OH, USA.
⁴ Veterinary Preventive Medicine, Colleges of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
⁵ Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH, USA.
⁶ Department of Microbiology, Immunology, and Parasitology, Schools of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁷ Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.

Abstract

Background: Staphylococcus aureus causes a wide range of infections from mild skin and soft tissue to severe life-threatening bacteremia. The pathogenicity of S. aureus infections is related to various bacterial surface components and extracellular proteins such as toxic-shock syndrome (TSS) toxin and Panton-Valentine leukocidin (PVL). In this study we determine the antimicrobial resistance of isolated strains and their virulence genes in Ethiopia.

Methods: A total of 190 archived S. aureus isolates from four Ethiopia Antimicrobial Resistance (AMR) Surveillance sites were analyzed. The identification of S. aureus was done by matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF Biotyper) and antimicrobial susceptibility test (AST) was done using VITEK^® 2. Multiplex PCR was used to detect mecA, mecC, pvl and spa genes and super-antigens (sea, seb, sec, seh and sej staphylococcal enterotoxins).

Results: A total of 172 isolates were confirmed as S. aureus, 9 (5.23%) were methicillin-resistant S. aureus (MRSA) and 163 (94.76%) were methicillin-susceptible S. aureus (MSSA). AST showed that 152 (88.4%) isolates were resistant to penicillin; 90 (52.32%) resistant to trimethoprim-sulfamethoxazole; and 45 (26.16%) resistant to tetracycline. A total of 66 (38.37%) isolates harbored at least one staphylococcal enterotoxin gene and 31 (46.96%) isolates had more than one. The most frequent enterotoxin gene encountered was seb 28 (16.28%). The TSST-1 gene was detected in 23 (13.37%). Presence of staphylococcal enterotoxin gene showed significant association with antibiotic resistance to cefoxitin, benzylpenicillin, oxacillin, erythromycin, clindamycin, tetracycline and SXT. The pvl gene was detected in 102 (59.3%) of isolates. Isolates from patients below 15 years of age showed significantly high numbers of pvl gene (P = 0.02). Presence of sej (P = 0.011) and TSST-1 (P <0.001) genes were associated with the presence of pvl gene.

Conclusion: In this study, isolates were highly resistant to oral antibiotics and the pvl, seb, sea and TSST-1 genes were prevalent.

Keywords: Ethiopia; MRSA; PVL; Panton-Valentine leucocidin; enterotoxin genes.

Grants and funding

D43 TW008650/TW/FIC NIH HHS/United States