High prevalence of methicillin-resistant Staphylococcus aureus carriage among infants at the Children's Hospital, Accra, Ghana.

INTRODUCTION: Infants are at risk of Staphylococcus aureus (S. aureus) colonization and infection. The aim of this study was to investigate S. aureus and methicillin-resistant S. aureus (MRSA) colonization among infants, including the prevalence, predictors of colonization, and antibiogram. METHODOLOGY: The study was cross-sectional, and involved infants aged less than one year recruited at the Princess Marie Louise Children's Hospital in Accra, Ghana. Sociodemographic and clinical data of the participants were gathered with a structured questionnaire. Nasal swabs were also obtained from them and bacteriologically cultured. S. aureus was confirmed with the coagulase test, and MRSA was confirmed by polymerase chain reaction (PCR) of the mecA gene. Antimicrobial susceptibility testing of S. aureus was done using the Kirby-Bauer method. RESULTS: The carriage prevalence of S. aureus and MRSA were 34.9% (45/129) and 17.10% (22/129), respectively. Colonization with coagulase-negative Staphylococci (CoNS) was protective of both S. aureus (OR = 0.008; p < 0.001) and MRSA (OR = 0.052; p = 0.005) carriage. Maintenance of good hand hygiene prevented S. aureus carriage (OR = 0.16; p < 0.001). S. aureus resistance to antibiotics decreased across penicillin (96%), trimethoprim-sulfamethoxazole (61%), tetracycline (61%), erythromycin (39%), gentamicin (39%), fusidic acid (26%), rifampicin (17%), clindamycin (7%), and linezolid (0%); 68.8% S. aureus were multidrug resistant. CONCLUSIONS: S. aureus and MRSA prevalence were high among the infants. Colonization with CoNS and good hand hygiene maintenance were predictive of MRSA and methicillin-sensitive S. aureus (MSSA) colonization, respectively.

Occurrence of influenza and bacterial infections in cancer patients receiving radiotherapy in Ghana.

BACKGROUND: Influenza co-infection with bacteria is a leading cause of influenza-related deaths and severe respiratory infections, especially among high-risk groups like cancer patients undergoing treatment. However, acute respiratory infection (ARI)-like symptoms developed by upper-torso cancer (UTC) patients receiving radiotherapy are considered as side-effects of the radiation. Hence influenza and bacterial pathogens implicated in ARI are not investigated. METHODS: This prospective cohort study examined 85 in-patients with upper-torso cancers undergoing radiotherapy at the National Radiotherapy, Oncology and Nuclear Medicine Centre (NRONMC) of Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana. Eligible patients who consented were recruited into the study from September 2018 to April 2019. Influenza viruses A and B in addition to the following bacteria species Streptococcus pneumonia, Haemophilus influenzae, Neisseria meningitidis and Staphylococcus aureus were detected from oropharyngeal and nasopharyngeal swab specimens collected at three different time points. Presence of respiratory pathogens were investigated by influenza virus isolation in cell culture, bacterial culture, polymerase chain reaction (PCR) and next generation sequencing (NGS) assays. RESULTS: Of the 85 eligible participants enrolled into the study, 87% were females. Participants were 17 to 77 years old, with a median age of 49 years. Most of the participants (88%) enrolled had at least one pathogen present. The most prevalent pathogen was N. meningitidis (63.4%), followed by H. influenzae (48.8%), Influenza viruses A and B (32.9%), S. pneumoniae (32.9%) and S. aureus (12.2%). Approximately, 65% of these participants developed ARI-like symptoms. Participants with previous episodes of ARI, did not live alone, HNC and total radiation less than 50 Gy were significantly associated with ARI. All treatment forms were also significantly associated with ARI. CONCLUSION: Data generated from the study suggests that ARI-like symptoms observed among UTC patients receiving radiotherapy in Ghana, could be due to influenza and bacterial single and co-infections in addition to risk factors and not solely the side-effects of radiation as perceived. These findings will be prime importance for diagnosis, prevention, treatment and control for cancer patients who present with such episodes during treatment.

Whole Genome Sequencing and Antimicrobial Resistance of Staphylococcus aureus from Surgical Site Infections in Ghana.

Staphylococcus aureus (S. aureus) is a common cause of surgical site infections (SSIs) globally. Data on the occurrence of methicillin-susceptible S. aureus (MSSA) as well as methicillin-resistant S. aureus (MRSA) among patients with surgical site infections (SSIs) in sub-Saharan African are scarce. We characterized S. aureus from SSIs in Ghana using molecular methods and antimicrobial susceptibility testing (AST). Wound swabs or aspirate samples were collected from subjects with SSIs. S. aureus was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS); AST was performed by Kirby-Bauer disk diffusion, and results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Detection of spa, mecA, and pvl genes was performed by polymerase chain reaction (PCR). Whole-genome sequencing (WGS) was done using the Illumina MiSeq platform. Samples were collected from 112 subjects, with 13 S. aureus isolates recovered. Of these, 92% were sensitive to co-trimoxazole, 77% to clindamycin, and 54% to erythromycin. Multi-drug resistance was detected in 5 (38%) isolates. The four mecA gene-positive MRSA isolates detected belonged to ST152 (n = 3) and ST5 (n = 1). In total, 62% of the isolates were positive for the Panton-Valentine leukocidin (pvl) toxin gene. This study reports, for the first time, a pvl-positive ST152-t355 MRSA clone from SSIs in Ghana. The occurrence of multi-drug-resistant S. aureus epidemic clones suggests that continuous surveillance is required to monitor the spread and resistance trends of S. aureus in hospital settings in the country.