Table 2.
Characteristics of the 43 eligible studies on screening for mupirocin resistance in Staphylococcus aureus from various sources in Africa
| Region | Country | Study Period | Setting | Sample | Method for testing resistance to mupirocin | Guideline (year of publication) | Published reports for detection of mupR S. aureus | Number of S. aureus isolates screened with mupirocin | Mupirocin resistant isolates | Reference | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Source | Type | Number (%) | Number MRSA (%) | Number LmupR/HmupR | Number mupA gene + LMupR/HmupR (Method) | |||||||||
| North Africa | Algeria | 2005–2007 | C & H | Human | Pus, venous catheter, tracheal aspirate, punction fluid, blood, urine | Disk diffusion VITEK-2 | CLSI (NA) | – | 19 | 0 (0) | 0 (0) | – | – | [47] |
| Egypt | 2005–2006 | C & H | Human | NA | Disk diffusion | NCCLS (2003) | – | 64 | 0 (0) | 0 (0) | – | – | [28] | |
| Egypt | 2008–2009 | C & H | Human | Skin and soft tissue, post-operative wound swab | Disk diffusion | CLSI (2007) | – | 386 | 1 (0.3) | NA | NA | – | [29] | |
| Egypt | 2007–2008 | C | Human | Pus, sputum, catheter, blood, urine, wound abscess | Broth dilution | CLSI (2005) | – | 21 | 0 (0) | 0 (0) | – | – | [58] | |
| Egypt | 2010 | H | Human | Sputum, blood, catheter, traumatic wound, urine | E-test | – | Kresken et al., (2004) | 86 | 30 (34.9) | 30 (34.9) | 25/5 | 2/3 (PCR) | [30] | |
| Egypt | 2012 | H | Human | Wound discharge, blood, body fluid aspirate, urine, faeces, sputum, nasal, throat, ear and genital swab | Disk diffusion Agar dilution | CLSI (2007) | – | 150 | 0 (0) | 0 (0) | – | – | [40] | |
| Egypt | 2012–2013 | H | Human | Nasal swab | Disk diffusion | CLSI (2011) | – | 39 | 3 (7.7) | 3 (3.7) | NA | – | [31] | |
| Egypt | 2013–2015 | H | Human | Pus & Wound swab | Agar dilution | CLSI (2011) | – | 73 | 13 (17.8) | 13 (17.8) | 5/8 | 0/6 (PCR) | [52] | |
| Libya | NA | H | Human | Skin swab | Disk diffusion | NA | – | 40 | 0 (0) | NA | – | – | [61] | |
| Libya | 2008–2009 | H | Human & Environment | NA | Disk diffusion | BSAC (2008) | – | 86 | 13 (15.1) | 13 (8.1) | NA | – | [56] | |
| Libya | 2009 | H | Human | Nasal swab | Disk diffusion Agar dilution | BSAC (2008) | – | 109 | 5 (4.6) | 5 (4.6) | 4/1 | – | [57] | |
| Morocco | 2008- | H | Human | Nasal swab | Disk diffusion | CA-SFM (2007) | – | 81 | 0 (0) | 0 (0) | – | – | [62] | |
| Tunisia | 2008–2009 | C | Human | Nasal swab | Disk diffusion | CLSI (2008) | – | 55 | 0 (0) | 0 (0) | – | – | [41] | |
| Tunisia | 2003–2005 | C | Human | Pus, blood, articular puncture, venous catheter | Phoenix Automated Microbiology System | CA-SFM (2006) | – | 64 | NA | NA | – | – | [59] | |
| Tunisia | 2013 | H | Human | Wound abscess | Disk diffusion | CA-SFM (2013) | – | 8 | NA | NA | – | – | [60] | |
| Tunisia | 2010 | C | Animal (Sheep) | Nasal swab | Disk diffusion | CLSI (2010) | – | 73 | 0 (0) | 0 (0) | – | – | [42] | |
| Tunisia | 2010 | C | Animal (Donkeys) | Nasal swab | Disk diffusion | CLSI (2010) | – | 50 | 0 (0) | 0 (0) | – | – | [43] | |
| West Africa | Ghana | 2011–2012 | H | Human | Nasal swab | Disk diffusion | EUCAST (2012) | – | 105 | 1 (0.9) | 0 (0) | 0/1 | – | [54] |
| Ghana | 2011–2012 | C | Human | Nasal swab | Disk diffusion | EUCAST (2012) | – | 124 | 0 (0) | 0 (0) | – | – | [67] | |
| Ghana | 2010–2013 | C & H | Human | NA | Broth microdilution | EUCAST (NA) | – | 30 | 4 (13.3) | 4 (13.3) | 4/0 | 0/0 (DNA microarray) | [55] | |
| Ghana | 2012–2013 | C | Human | Nasal & Wound swab | VITEK-2 | EUCAST (NA) | – | 91 | 0 (0) | 0 (0) | – | – | [68] | |
| Nigeria* | NA | NA | Human | NA | Disk diffusion | NA | – | 1 | 0 (0) | 0 (0) | – | – | [80] | |
| Nigeria* | 2002–2004 | H | Human | Wound, blood, ear, eye, urine | Disk diffusion | – | Udo et al., (1999) | 200 | 1 (0.5) | 0 (0) | 0/1 | 0/1 (PCR) | [53] | |
| Nigeria | 2006 | C | Human | Nasal swab | Disk diffusion | CLSI (2005) | – | 101 | 12 (11.9) | NA | NA | – | [44] | |
| Nigeria | 2007 | H | Human | NA | Disk diffusion | CLSI (NA) | – | 96 | 0 (0) | 0 (0) | – | – | [48] | |
| Nigeria* | NA | H | Human | Wound swab, blood, urine, endotracheal aspirate | Disk diffusion E-test | NCCLS (2003) | – | 1 | 1 | 0 (0) | 0/1 | 0/1 (PCR) | [45] | |
| Nigeria | 2009 | H | Human | Wound, sputum, semen, nasal swab | Broth microdilution | DIN 58940 (2004) | – | 68 | 0 (0) | 0 (0) | – | – | [63] | |
| Nigeria | 2010 | H | Human | NA | VITEK-2 | – | – | 51 | 0 (0) | 0 (0) | – | – | [64] | |
| Nigeria | 2009–2011 | H | Human | Aspirate, blood, ear, eye, vaginal discharge, sputum, wounds, urine, nasal swab | Disk diffusion | CLSI (NA) | – | 62 | 0 (0) | 0 (0) | – | – | [49] | |
| Nigeria | 2010–2011 | H | Human | NA | VITEK-2 | EUCAST (NA) | – | 290 | 0 (0) | 0 (0) | – | – | [65] | |
| Nigeria | 2008–2010 | C | Animal (Bats) | Faecal swab | Disk diffusion | – | Udo et al., (1999) | 107 | 0 (0) | 0 (0) | – | – | [66] | |
| Nigeria | 2006–2007 | C & H | Animal (Bovine) & (Ovine) | Nasal & skin swab | Disk diffusion | – | Udo et al., (1999) | 173 | 0 (0) | 0 (0) | – | – | [35] | |
| Nigeria | 2012 | C | Human Animal | Nasal swab Milk | Disk diffusion | CLSI (2006) | – | 10 Humans 77 Animals | 33 (37.9) | NA | 0/33 | – | [36] | |
| Central Africa | Gabon | 2009 | C & H | Human | Nasal, axillae, inguinal swab | VITEK-2 | – | – | 5 | 0 (0) | 0 (0) | – | – | [69] |
| São Tomé & Príncipe | 2010–2012 | H | Human | Nasal swab | Disk diffusion | BSAC (NA) | – | 55 | 0 (0) | 0 (0) | – | – | [70] | |
| East Africa | Ethiopia | NA | H & R | Cockroach | Cockroach Body surface/Gut | Disk diffusion | – | Jorgenson et al., (1999) | 17 | 17 (100) | NA | NA | – | [37] |
| Kenya | 2011 | H | Human | Nasal and axillary skin swab | VITEK-2 | CLSI (2012) | – | 86 | 0 (0) | 0 (0) | – | – | [71] | |
| Kenya | 2011–2013 | H | Human | Pus, blood, urine | VITEK-2 | CLSI (2010) | – | 731 | 0 (0) | 0 (0) | – | – | [72] | |
| Kenya | NA | C | Animal (Camel) | Raw camel milk | Disk diffusion Broth microdilution | CLSI (2008) | – | 47 | 0 (0) | 0 (0) | – | – | [38] | |
| South Africa | South Africa | 1996 | H | Human | Wound, urine, skin and blood | Disk diffusion | NCCLS (2000) | – | 236 | 5 (2.1) | NA | NA | – | [46] |
| South Africa** | 2001–2003 | H | Human | Wound, sputum, blood | Disk diffusion | – | Udo et al., (1999) | 227 | 16 (7.0) | 15 (6.6) | 14/2 | 0/2 (PCR) | [50] | |
| South Africa | 2005–2006 | H | Human | Blood, pus & skin wound, cerebrospinal fluid | Disk diffusion E-test | – | Udo et al., (2006) | 248 | 123 (49.6) | 123 (49.6) | 117/6 | – | [32] | |
| South Africa** | NA | H | Human | Wound swab, blood, urine, endotracheal aspirate | Disk diffusion E-test | NCCLS (2003) | – | 16 | 16 (100) | 14 (87.5) | 14/2 | 0/2 (PCR) | [45] | |
| South Africa | 2013 | H | Human | Tissue, blood, cerebrospinal fluid, wound swab | Disk diffusion VITEK-2 | CLSI (2012) | – | 997 | 277 (27.8) | NA | 43/234 | 0/5 (Real time PCR) | [33] | |
| South Africa | 2010–2012 | H | Human | Blood | Microscan (MIC Panel Type 33) | CLSI (2015) | – | 2709 | 236 (8.7) | 202 (7.5) | NA | – | [51] | |
| South Africa | 2009–2010 | H | Human & Environment | Nasal & hand swab, dialysate fluid, surface swab, air samples | VITEK-2 | – | – | 13 | 4 (30.8) | 4 (30.8) | 0/4 | – | [34] | |
KEY: mupR S. aureus: mupirocin resistant Staphylococcus aureus; LmupR low-level mupirocin resistance, HmupR high-level mupirocin resistance, mupA mupirocin resistance gene, MIC Minimum inhibitory concentration, BSAC British Society for Antimicrobial Chemotherapy, CA-SFM Comité de l’Antibiogramme de la Société Française de Microbiologie, CLSI Clinical and Laboratory Standards Institute, DIN 58940 Deutsches Institut für Normung DIN 58940, EUCAST European Committee on Antimicrobial Susceptibility Testing, NCCLS National Committee for Clinical Laboratory Standards, PCR Polymerase Chain Reaction; − Not determined, NA Not available, H Hospital, C Community, R Restaurant
*Separate reports that analyzed the same isolates but answered different questions (considered as one single study) in Nigeria; **: Separate reports that analyzed the same isolates but answered different questions (considered as one single study) in South Africa.
Reference [45] is recorded in Nigeria and South Africa, but the isolates were derived from studies in Nigeria [53] and South Africa [50], respectively
Other published reports applied for the detection of mupR S. aureus in Africa
1. Jorgenson JH, Turnidge JD, Washington JA. Dilution and disc diffusion method. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Manual of Clinical Microbiology, 7th edition. American Society for Microbiology, Washington DC, 1999. p. 1526–1543. Adapted from NCCLS: National Committee for Clinical Laboratory Standards 1997. Approved Standard M2-A6; National Committee for Clinical Laboratory Standards 1999. Approved Standard M100-S9.
2. Kresken M, Hafner D, Schmitz FJ, Wichelhaus TA. Prevalence of mupirocin resistance in clinical isolates of Staphylococcus aureus and Staphylococcus epidermidis. Results of the antimicrobial resistance surveillance study of the Paul-Ehrlich Society for Chemotherapy, 2001. Int J Antimicrob Agents, 2004, 23:577–81. The widely accepted breakpoints: ≤4 mg/l (susceptible), 8–256 mg/l (low-level resistance) and ≥ 512 mg/l (high-level resistance) was utilized in this study.
3. Udo EE, Farook VS, Mokadas EM, Jacob LE, Sanyal SC. Molecular fingerprinting of mupirocin-resistant methicillin-resistant Staphylococcus aureus from a burn unit. Int J Infect Dis, 1999,3:82–7. Growth within a 14-mm zone of inhibition with the 5 μg mupirocin disk detected low-level resistance, while growth to the edge of the 200 μg mupirocin disk indicated high-level resistance.
4. Udo EE, Al-Sweih N, Mokaddas E, Johny M, Dhar R, Gomaa HH, Al-Obaid I, Rotimi VO. Antibacterial resistance and their genetic location in MRSA isolated in Kuwait hospitals, 1994–2004. BMC Infect Dis, 2006;6:168. The widely accepted breakpoints:≤4 mg/l (susceptible), 8–256 mg/l (low-level resistance) and ≥ 512 mg/l (high-level resistance) was utilized in this study.