Table 3.
Prevalence of mupirocin-resistant S. aureus from various sources in Africa based on phenotypic and molecular methods
| Mupirocin resistance | Country | Source | Number positive/Total tested (%) | Phenotypic | Molecular | Guidelines or reports | Reference | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Agar Dilution | Broth microdilution | Disk diffusion | E-test | Microscan system | VITEK | PCR | Micro array | BSAC | CLSI | EUCAST | Other reports | |||||
| MupA-positive S. aureus | Egypt | Human | 5/86 (5.8) | – | – | – | √ | – | – | √ | – | – | – | – | √a | [30] |
| Egypt | Human | 6/73 (8.2) | √ | – | – | – | – | – | √ | – | – | √ | – | – | [52] | |
| Nigeria | Human | 1/200 (0.5) | – | – | √ | – | – | – | √ | – | – | – | – | √b | [53] | |
| South Africa | Human | 2/227 (0.9) | – | – | √ | – | – | – | √ | – | – | – | – | √b | [50] | |
| South Africa | Human | NA | – | – | √ | – | – | √ | √ | – | – | √ | – | – | [33] | |
| LmupR S. aureus | Egypt | Human | 25/86 (29.1) | – | – | – | √ | – | – | √ | – | – | – | – | √a | [30] |
| Egypt | Human | 5/73 (6.8) | √ | – | – | – | – | – | √ | – | – | √ | – | – | [52] | |
| Ghana | Human | 4/30 (13.3) | – | √ | – | – | – | – | – | √ | – | – | √ | – | [55] | |
| Libya | Human | 4/109 (3.7) | √ | – | √ | – | – | – | – | – | √ | – | – | – | [57] | |
| South Africa | Human | 14/227 (6.2) | – | – | √ | – | – | – | – | – | – | – | – | √b | [50] | |
| South Africa | Human | 117/248 (47.2) | – | – | √ | √ | – | – | – | – | – | – | – | √c | [32] | |
| South Africa | Human | 43/997 (4.3) | – | – | √ | – | – | √ | – | – | – | √ | – | – | [33] | |
| South Africa | Human & Environment | 4/13 (30.8) | – | – | – | – | – | √ | – | – | – | – | – | – | [34] | |
| HmupR S. aureus | Egypt | Human | 5/86 (5.8) | – | – | – | √ | – | – | √ | – | – | – | – | √a | [30] |
| Egypt | Human | 8/73 (11) | √ | – | – | – | – | – | √ | – | – | √ | – | – | [52] | |
| Ghana | Human | 1/105 (1.0) | – | – | √ | – | – | – | – | – | – | – | √ | – | [54] | |
| Libya | Human | 1/109 (0.9) | √ | – | √ | – | – | – | – | – | √ | – | – | – | [57] | |
| Nigeria | Human | 1/200 (0.5) | – | – | √ | – | – | – | √ | – | – | – | – | √b | [53] | |
| Nigeria | Human | 12/101 (11.9) | – | – | √ | – | – | – | – | – | – | √ | – | – | [44] | |
| Nigeria | Human & Animal | 33/87 (37.9) | – | – | √ | – | – | – | – | – | – | √ | – | – | [36] | |
| South Africa | Human | 2/227 (0.9) | – | – | √ | – | – | – | √ | – | – | – | – | √b | [50] | |
| South Africa | Human | 6/248 (2.4) | – | – | √ | √ | – | – | – | – | – | – | – | √c | [32] | |
| South Africa | Human | 234/997 (23.5) | – | – | √ | – | – | √ | – | – | – | √ | – | – | [33] | |
| mupR-MRSA | Egypt | Human | 30/86 (34.9) | – | – | – | √ | – | – | √ | – | – | – | – | √a | [30] |
| Egypt | Human | 3/39 (7.7) | – | – | √ | – | – | – | – | – | – | √ | – | – | [31] | |
| Egypt | Human | 13/73 (17.8) | √ | – | – | – | – | – | √ | – | – | √ | – | – | [52] | |
| Ghana | Human | 4/30 (13.3) | – | √ | – | – | – | – | – | √ | – | – | √ | – | [55] | |
| Libya | Human | 13/86 (15.1) | – | – | √ | – | – | – | – | – | √ | – | – | – | [56] | |
| Libya | Human | 5/109 (4.6) | √ | – | √ | – | – | – | – | – | √ | – | – | – | [57] | |
| Nigeria | Human & Animal | 33/87 (37.9) | – | – | √ | – | – | – | – | – | – | √ | – | – | [36] | |
| South Africa | Human | 15/227 (6.6) | – | – | √ | – | – | – | √ | – | – | – | – | √b | [50] | |
| South Africa | Human | 123/248 (49.6) | – | – | √ | √ | – | – | – | – | – | – | – | √c | [32] | |
| South Africa | Human | 202/2709 (7.5) | – | – | – | – | √ | – | – | – | – | √ | √ | – | [51] | |
| South Africa | Human & Environment | 4/13 (30.8) | – | – | – | – | – | √ | – | – | – | – | – | – | [34] | |
KEY: BSAC British Society for Antimicrobial Chemotherapy, CLSI Clinical and Laboratory Standards Institute, EUCAST European Committee on Antimicrobial Susceptibility Testing, NA Not Available, PCR Polymerase Chain Reaction, √: test was performed. -: test was not performed
aThe 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: 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. bGrowth 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 according to: 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. cThe 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: 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