\u3cem\u3eStaphylococcus aureus\u3c/em\u3e Skin and Soft Tissue Infections at a Tertiary Hospital in Botswana

Objectives. To study the epidemiology of Staphylococcus aureus skin and soft-tissue infections (SSTIs) in hospitalised children and adults in Gaborone, Botswana, and to describe the changes in antimicrobial susceptibilities of S. aureus isolates over time. Methods. A retrospective cohort study evaluated SSTI isolates from January 2000 to December 2007 at Princess Marina Hospital (PMH), a large tertiary referral centre in Gaborone. Eligible subjects were those hospitalised at PMH during the study period who had a skin or soft-tissue culture yielding a bacterial or fungal pathogen. The primary outcome measure was a skin or soft-tissue culture yielding S. aureus. Secondary outcomes were the organism’s antimicrobial susceptibilities. Results. S. aureus was detected in 857 (35.8%) of single-organism SSTI cultures, and 194 (22.6%) of these isolates were methicillin resistant (MRSA). The proportion of MRSA isolates increased over time (linear test of trend: p=0.03 from 2000 to 2003), and MRSA isolates were more likely than methicillin-susceptible isolates to be resistant to commonly used antimicrobials recommended by the national SSTI treatment guideline. Conclusions. We report a high and increasing proportion of MRSA SSTIs in Gaborone. This high rate of MRSA resistance to currently recommended empiric antibiotics for SSTIs dictates the need for revising national guidelines and ongoing prospective surveillance of SSTIs in this setting

Staphylococcus aureus skin and soft tissue infections at a tertiary hospital in Botswana

Objectives. To study the epidemiology of Staphylococcus aureus skin and soft-tissue infections (SSTIs) in hospitalised children and adults in Gaborone, Botswana, and to describe the changes in antimicrobial susceptibilities of S. aureus isolates over time. Methods. A retrospective cohort study evaluated SSTI isolates from January 2000 to December 2007 at Princess Marina Hospital (PMH), a large tertiary referral centre in Gaborone. Eligible subjects were those hospitalised at PMH during the study period who had a skin or soft-tissue culture yielding a bacterial or fungal pathogen. The primary outcome measure was a skin or soft-tissue culture yielding S. aureus. Secondary outcomes were the organism’s antimicrobial susceptibilities. Results. S. aureus was detected in 857 (35.8%) of single-organism SSTI cultures, and 194 (22.6%) of these isolates were methicillin resistant (MRSA). The proportion of MRSA isolates increased over time (linear test of trend: p=0.03 from 2000 to 2003), and MRSA isolates were more likely than methicillin-susceptible isolates to be resistant to commonly used antimicrobials recommended by the national SSTI treatment guideline. Conclusions. We report a high and increasing proportion of MRSA SSTIs in Gaborone. This high rate of MRSA resistance to currently recommended empiric antibiotics for SSTIs dictates the need for revising national guidelines and ongoing prospective surveillance of SSTIs in this setting

Association of WBC and RBC with the presence of bacteria or parasites.

<p>Abbreviations: WBC, white blood cells; RBC, red blood cells; WBC or RBC were counted as present if laboratory records indicated scanty, few, moderate, or many cells upon microscopic evaluation.</p

Demographic Characteristics of Included Stool Specimens^*.

<p>*values listed as number (percent of specimens in gender or age group).</p><p>**data on sex missing for 25 samples positive for bacteria, 19 samples positive for parasites, 1 sample positive for both bacteria and parasites, and 315 samples with no pathogen identified.</p

Comparison of antibiotic resistance among <i>Salmonella</i> spp., <i>Shigella</i> spp., and all bacterial isolates.

<p># Number (and %) of organisms resistant.</p><p>*p-values calculated using two-tailed Fisher Exact Test.</p><p>†This section includes all bacterial isolates (<i>Salmonella spp.</i>and <i>Shigella spp.</i>as well as the few isolates of <i>Campylobacter spp.</i> and <i>E.coli</i>). This summary section may be a useful guide to empiric therapy of dysentery in Southern Botswana.</p

Proportion of pathogens by age group^*.

<p>Abbreviations: mo, month(s); yr, year(s); spp, species.</p><p>*values listed as number (percent of specimens in age group).</p><p>**not all columns sum to 100% due to co-infection with multiple pathogens among some specimens.</p

Comparison of pathogen proportions between selected study periods.

<p># Number (and %) of specimens in selected study period.</p><p>*p-values calculated using two-tailed Fisher Exact Test.</p><p>**not all columns sum to 100% due to co-infection with multiple pathogens among some specimens.</p