Methicillin resistant staphylococcus aureus infection in neonates- a major concern and a call for action

Main Article Content

Samaha saleh Mustapha https://orcid.org/0000-0002-1565-9735
Aishatu Musa Zaidu
Muhammad Shamsuddeen Yusuf
Shamsudin Aliyu
Isa Abdulkadir

Keywords

Neonatal sepsis, Methicillin-Resistant Staphylococcus aureus, Resistance

Abstract

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is both a human commensal and a pathogen that causes neonatal infection which is associated with significant morbidity and mortality. Its genetic flexibility and versatility have equipped it with the ability to develop resistance to numerous antibiotics. Outbreaks of infections in neonatal intensive care units as well as community infections have been reported mostly in developed countries. However, there is a paucity of data on neonatal MRSA infection in developing countries. The study aims to highlight cases of MRSA infection, describe the clinical presentation, and outline the antibiotic susceptibility pattern among term neonates in our facility.


Methodology: It was a prospective cross-sectional hospital-based study carried out from October 2018 to July 2019. A total of 248 term neonates with suspected sepsis were enrolled in the study and had their blood samples taken for investigations including blood culture. Bacterial identification and antibiotic susceptibility patterns were carried out using MicrobactTM24E (Oxiod UK) and Staph ID and modified Kirby-Bauer disk diffusion technique respectively.


Results: Out of the 248 subjects enrolled in the study, 34.2% had proven sepsis, with Staphylococcus species accounting for 56.4% of these cases. Among those with staphylococcal sepsis, 56.3% were found to have MRSA infection. Notably, the majority (94.4%) of cases originated from outside the hospital, presenting as neonatal sepsis with non-specific clinical features. Sensitivity testing revealed that ciprofloxacin and chloramphenicol were the most effective antibiotics against the identified pathogens.


Conclusion: The presence of MRSA infections in neonates poses a critical public health threat. This trend underscores the emergence of antimicrobial resistance, potentially compromising treatment efficacy and jeopardizing neonatal well-being. Urgent and decisive measures are necessary to curb this trajectory.

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References

1. Ogston A. On Abscesses. Rev Infect Dis. 1984;6:122–128.

2. Myles IA, Datta SK. Staphylococcus aureus: An introduction. Semin Immunopathol. 2012;34(2):181–4.

3. Barber M. Sensitisation of Penicillin-Resistant Staphylococci.Lancet. 1948 May 8;1(6506):730. doi: 10.1016/s0140-6736(48)90428-0.

4. Barber M, Rozwadowska-dowzenko M. Infection by Penicillin-Resistant Staphylococci.Lancet. 1948 Oct 23;2(6530):641-4. doi: 10.1016/s0140-6736(48)92166-7.

5. Jevons MP, Coe AW, Parker MT. Methicillin Resistance in Staphylococci. Lancet. 1963;281(7287):904–7.

6. Itou T, Katayama Y, Hiramatsu K. A new mobile genetic element, staphylococcal cassette chromosome mec, encodes methicillin resistance in Staphylococcus aureus. Nippon saikingaku zasshi Japanese J Bacteriol. 2000;55(3):483–98.

7. Dong Y, Glaser K, Speer CP. New Threats from an Old Foe: Methicillin-Resistant Staphylococcus aureus Infections in Neonates. Neonatology. 2018;114(2):127–34.

8. Weeks JL, Garcia-Prats JA, Baker CJ. Methicillin-Resistant Staphylococcus aureus Osteomyelitis in a Neonate. JAMA 1981 Apr 24;245(16):1662–4. https://doi.org/10.1001/jama.1981.03310410040025

9. Dong Q, Liu Y, Li W, Chen M, Li W, Wang X, et al. Phenotypic and molecular characteristics of community-associated staphylococcus aureus infection in neonates. Infect Drug Resist. 2020;13:4589–600.

10. Peacock SJ, Justice A, Griffiths D, De Silva GDI, Kantzanou MN, Crook D, et al. Determinants of Acquisition and Carriage of Staphylococcus aureus in Infancy. J Clin Microbiol. 2003;41(12):5718–25.

11. Zervou FN, Zacharioudakis IM, Ziakas PD, Mylonakis E. MRSA colonization and risk of infection in the neonatal and pediatric ICU: a meta-analysis. Pediatrics. 2014;133(4):e1015–23.

12. Roca A, Bojang A, Camara B, Oluwalana C, Lette K, West P, et al. Maternal colonization with Staphylococcus aureus and Group B streptococcus is associated with colonization in newborns. Clin Microbiol Infect 2017;23(12):974–9.https://doi.org/10.1016/j.cmi.2017.04.020

13. Schaumburg F, Alabi AS, Mombo-Ngoma G, Kaba H, Zoleko RM, Diop DA, et al. Transmission of Staphylococcus aureus between mothers and infants in an African setting. Clin Microbiol Infect. 2014;20(6):0–6.

14. Vergnano S, Menson E, Smith Z, Kennea N, Embleton N, Clarke P, et al. Characteristics of invasive staphylococcus aureus in United Kingdom neonatal units. Pediatr Infect Dis J. 2011;30(10):850–4.

15. Isaacs D, Fraser S, Hogg G, Li HY. Staphylococcus aureus infections in Australasian neonatal nurseries. Arch Dis Child Fetal Neonatal Ed. 2004;89(4):331–5.

16. Filleron Anne, Lotthé Anne, Emilie J, Eric J, Didelot; OPM-N, Parer S, et al. Atypical pneumonia linked to community-acquired Staph- ylococcus aureus cross-transmission in the nursery. Neonatology. 2013;104(2):156–60.

17. Lowy FD. antimicrobial resistance: the example of SA. J Biolaw Bus. 2003;3(3):53–9.

18. Testing S. Clinical and Laboratory Standards Institute. 2018. 296 p.

19. Idris AM, Kumurya AS. Detection Of Methicillin-Resistant Staphylococcus Aureus Among Bacterial Isolated From Children Aged 0-5 Years With Septicaemia In Kano , North Western , Nigeria. 2018;1(1):51-57.

20. Sa’adu LO, Obasa TO, Saka AO, Saka MJ, Nwabuisi C. Multi-drug resistance in early and late onset neonatal sepsis in a tertiary hospital in Nigeria. Ann African Med Res. 2020;2(2). https://doi.org/10.4081/aamr.2019.69.

21. Uwe NO, Ezenwa BN, Fajolu IB, Oshun P, Chukwuma ST, Ezeaka VC. Antimicrobial susceptibility and neonatal sepsis in a tertiary care facility in Nigeria: A changing trend? JAC-Antimicrobial Resist 2022;4(5):1–7.https://doi.org/10.1093/jacamr/dlac100

22. Onalo R, Ogala WN, Ogunrinde GO, Olayinka AT, Adama SA, Ega BA. Predisposing factors to neonatal septicaemia at ahmadu bello university teaching hospital, zaria Nigeria. Niger Postgrad Med J 2011;18:20–5.

23. Olorukooba A, Ifusemu W, Ibrahim M, Jibril M, Amadu L, Lawal B. Prevalence and factors associated with neonatal sepsis in a tertiary hospital, North West Nigeria. Niger Med J 2020;61(2):60-66. doi: 10.4103/nmj.NMJ_31_19.

24. Medugu N, Iregbu K. Trends In Profiles Of Bacteria Causing Neonatal Sepsis In Central Nigeria Hospital. African J Clin Exp Microbiol. 2017;1(January):49–52.

25. Nwankwo E, Shehu A, Farouk Z. Risk factors and bacterial profile of suspected neonatal septicaemia at a teaching hospital in Kano, Northwestern, Nigeria. Sierra Leone J Biomed Res. 2011;3(2):104–9.

26. Mokuolu AO, Jiya N, Adesiyun OO. Neonatal septicaemia in Ilorin: bacterial pathogens and antibiotic sensitivity pattern. Afr J Med Med Sci 2002 Jun;31(2):127—130.

27. Ako-Nai AK, Adejuyigbe EA, Ajayi FM, Onipede AO. The bacteriology of neonatal septicaemia in Ile-Ife, Nigeria. J Trop Pediatr. 1999;45(3):146–51.

28. Obadare TO, Adejuyigbe EA, Adeyemo AT, Amupitan AA, Ugowe OJ, Anyabolu CH, et al. Clinical and bacteriological profiles of neonatal sepsis in a tertiary hospital, south-western Nigeria. Germs. 2023;13(2):137–50.

29. Onanuga A, Oyi AR, Onaolapo JA. Prevalence and susceptibility pattern of methicillin- resistant Staphylococcus aureus isolates among healthy women in Zaria , Nigeria. 2005;4(November):1321–4.

30. Okiki PA, Eromosele ES, Sobajo OA. Occurrence of mecA and blaZ genes in methicillin-resistant Staphylococcus aureus associated with vaginitis among pregnant women in Ado-Ekiti , Nigeria. New Microbes New Infect 2020;38:100772. https://doi.org/10.1016/j.nmni.2020.100772

31. Dolapo O, Dhanireddy R, Talati AJ. Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000-2009. BMC Pediatr. 2014;14(1):2–7.

32. Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, Bienvenu J. Procalcitonin and C-reactive protein levels in neonatal infections. Acta Paediatr. 1997;86:209–12.

33. Shittu A, Oyedara O, Abegunrin F, Okon K, Raji A, Taiwo S, et al. Characterization of methicillin-susceptible and -resistant staphylococci in the clinical setting: A multicentre study in Nigeria. BMC Infect Dis. 2012;12.

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