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Management of superficial and deep-seated Staphylococcus aureus skin and soft tissue infections in sub-Saharan Africa: a post hoc analysis of the StaphNet cohort

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Abstract

Purpose

The incidence of Staphylococcus aureus skin and soft tissue infection (SSTI) is high in sub-Saharan Africa. This is fueled by a high prevalence of Panton-Valentine leukocidin (PVL), which can be associated with necrotizing disease. The aim was to describe the clinical presentation and the treatment of SSTI in the African setting and to identify challenges in the management.

Methods

Patients (n = 319) were recruited in DR Congo (n = 56, 17.6%), Gabon (n = 89, 27.9%), Mozambique (n = 79, 24.8%) and Tanzania (n = 95, 29.8%) during the prospective observational StaphNet cohort study (2010–2015). A physician recorded the clinical management in standardized questionnaires and stratified the entity of SSTI into superficial (sSSTI) or deep-seated (dSSTI). Selected virulence factors (PVL, β hemolysin) and multilocus sequence types (MLST) were extracted from whole genome sequencing data.

Results

There were 220/319 (69%) sSSTI and 99/319 (31%) dSSTI. Compared to sSSTI, patients with dSSTI were more often hospitalized (13.2 vs. 23.5%, p = 0.03), HIV-positive (7.6 vs. 15.9%, p = 0.11), and required more often incision and drainage (I&D, 45.5 vs. 76.5%, p = 0.04). The proportion of an adequate antimicrobial therapy increased marginally from day 1 (empirical therapy) to day 3 (definite therapy), for sSSTI (70.7 to 72.4%) and dSSTI (55.4 to 58.9%). PVL was a risk factor for I&D (OR = 1.7, p = 0.02) and associated with MLST clonal complex CC121 (OR = 2.7, p < 0.001).

Conclusion

Appropriate antimicrobial agents and surgical services to perform I&D were available for the majority of patients. Results from susceptibility testing should be considered more efficiently in the selection of antimicrobial therapy.

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Acknowledgements

This study received grants from the Deutsche Forschungsgemeinschaft (HE 1850/11-1 to M.H., KE 700/3-1 to W.V.K., ME 3205/4-1 to A.M., and PE 296/6-1 to G.P.).

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Authors and Affiliations

  1. Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon

    Abraham Alabi & Martin P. Grobusch

  2. Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany

    Abraham Alabi & Martin P. Grobusch

  3. German Centre for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany

    Abraham Alabi & Martin P. Grobusch

  4. Ifakara Health Institute (IHI), Dar es Salaam, Tanzania

    Theckla Kazimoto & Salim Abdulla

  5. Institut National de Recherche Bio-Médicale (INRB), Université de Kinshasa, Kinshasa, Democratic Republic of the Congo

    Marthe Lebughe & Patrick Phaku

  6. Manhiça Health Research Center, Manhiça, Maputo, Mozambique

    Delfino Vubil & Inacio Mandomando

  7. Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique

    Inacio Mandomando

  8. Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany

    Winfried V. Kern & Siegbert Rieg

  9. Institute of Hygiene, University Hospital Münster, Münster, Germany

    Alexander Mellmann & Lena Peitzmann

  10. Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany

    Markus Bischoff

  11. Institute of Medical Microbiology, University Hospital Münster, Münster, Germany

    Georg Peters, Mathias Herrmann & Frieder Schaumburg

  12. Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands

    Martin P. Grobusch

Authors
  1. Abraham Alabi
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  2. Theckla Kazimoto
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  12. Georg Peters
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  14. Martin P. Grobusch
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  15. Frieder Schaumburg
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Corresponding author

Correspondence to Frieder Schaumburg.

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Alabi, A., Kazimoto, T., Lebughe, M. et al. Management of superficial and deep-seated Staphylococcus aureus skin and soft tissue infections in sub-Saharan Africa: a post hoc analysis of the StaphNet cohort. Infection 46, 395–404 (2018). https://doi.org/10.1007/s15010-018-1140-6

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  • DOI: https://doi.org/10.1007/s15010-018-1140-6

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