Antibiotic resistance profile of Staphylococcus aureus isolated fromhealth facilities in Conakry

doi:10.21203/rs.3.rs-8522464/v1

Introduction: Staphylococcus aureus is a major public health issue, particularly due to the emergence of methicillin-resistant strains (MRSA). Little data are available on the resistance profile of Guinea. This study aimed to determine the prevalence, phenotypic distribution, and factors associated with the resistance of S. aureus strains isolated in Conakry.

Methods: A descriptive cross-sectional study was conducted from January 2023 to December 2024 atfour microbiological diagnostic facilities in Conakry. A total of 238 clinical specimens positive for S. aureus were included. Isolations were identified by conventional and Vitek2 methods, and sensitivity profiles were established according to CASFM/EUCAST recommendations. Sociodemographic and microbiological data were analyzed with SPSS 26. Proportions were compared by chi-square or Fisher's exact test, with a significance threshold of p < 0.05.

Results: Among the 238 isolates, 68.1% were MRSA, 21.8% were penicillinase producers and 10.1% were wild-type strains. Resistance to penicillin G was almost universal (99%), and resistance to oxacillin (79%), tetracycline (72%) and ciprofloxacin (50%) was high. Glycopeptides (vancomycin 99% sensitivity), linezolid and tigecycline remained active. The incidenceof MRSA was significantly greater in the hospital setting (74.2%) than in the community setting (57.5%; p = 0.027). Penicillinase producers were evenly distributed, while wild strains were rare (12.6% in the community vs. 8.6% in hospitals).

Conclusion: The high prevalence of MRSA infection, particularly in hospital settings, combined with significant circulation in the community underlines the urgency of strengthening integrated hospital-community surveillance, improving infection control and promoting the rational use of antibiotics in Guinea.

Bacteriology

General Microbiology

Methicillin-resistant Staphylococcus aureus

Antibiotic resistance

MRSA

Guinea

Staphylococcus aureus infections are a major public health problem worldwide, both in community and hospital settings. This opportunistic bacterium is responsible for a wide spectrum of infections, ranging from superficial skin infections to severe sepsis and osteoarticular infections [1, 2]. The emergence of methicillin-resistant strains (MRSA) represents a major challenge due to their associated multidrug resistance and the therapeutic difficulties they cause [3].

According to World Health Organization (WHO) reports, the incidence of MRSA varies greatly from region to region, with high rates observed in Africa and Asia [4, 5]. A recent meta-analysis showed that the average incidence of MRSA in sub-Saharan Africa was above 40%, with wide variability across countries [6–9]. Regional studies have shown high MRSA incidence rates—36% in Benin [10], 32% in Burkina Faso [11], 66% in Mali [12], and up to 80% in a study of healthcare-associated infections in Conakry [13]. Methicillin resistance is of particular concern, as it severely limits treatment options, leaving room for the use of last-resort antibiotics such as vancomycin [14].

The emergence and spread of multidrug-resistant strains are driven by inappropriate antibiotic use, lack of systematic microbiological surveillance, and gaps in infection control in hospital settings [15, 16]. Despite the establishment of some surveillance programmes in several African countries (Burkina Faso, Nigeria, Senegal, Kenya, etc.), the available data are limited, heterogeneous and often not very representative [17]. In this context, it becomes imperative to regularly assess the resistance profiles of local S strains. aureus to adapt therapeutic protocols and prevention policies.

The present study aimed to determine the prevalence of Staphylococcus aureus strains isolated in Conakry as well as their resistance profile to other antibiotics.

1. Type and setting of study

1.1 Type and period of study

This was a cross-sectional descriptive study conducted over a period of two (2) years, from January 2023 to December 2024, on the analysis of clinical samples (urine, blood, puncture fluid and pus).

1.2 Study Setting:

The data for this study were collected from four major structures with a national scope and located mainly in Conakry. These establishments were selected because of their central role in microbiological diagnosis and their representativeness of the different health contexts: hospital, community, institutional and private.

National Institute of Public Health (INSP)

The National Reference Laboratory is responsible for the surveillance and diagnosis of epidemic diseases and has modern microbiology and biosafety infrastructures (at the P2 level).

Donka University Hospital Center (CHU)

Donka University Hospital, Guinea's main university hospital, is a reference center for the management of complex cases and a major player in the surveillance of nosocomial infections.

Biomar-24 Laboratory

Biomar-24, located in the commune of Dixinn, is the first private laboratory in Guinea with advanced technologies, particularly in chemiluminescence for biological diagnostics.

National Social Security Fund (CNSS)

Although the CNSS is mainly in charge of managing the social security scheme for Guinean workers, it also has active medicosocial services. The latter carries out health check-ups and biological samples for the health monitoring of members.

2. Study population and sampling

All the clinical samples (urine, blood, CSF, and puncture fluid) were sent for suspected bacterial infection.

2.1 Inclusion criteria

All specimens for which Staphylococcus aureus strains were isolated and whose records contained complete information necessary for the analysis (age, sex, type of specimen, antimicrobial susceptibility test result) were included.

2.2 Noninclusion criteria

The noninclusion criteria used in this study excluded the following:

Samples contaminated with commensal flora or polymicrobial bacteria cannot be interpreted in the clinical context.
The absence of isolation of Staphylococcus aureus.

Incomplete files that did not allow analysis (age, sex, type of sample, missing antibiogram).

2.3 Sampling and sample size

The sample was comprehensive, and the sample size was 538 clinical samples that met the inclusion criteria.

3. Study variables

These variables were grouped into two categories:

Sociodemographic variables (age, sex, hospital or community origin) were collected.
Microbiological variables (isolated species, resistance profile, phenotype).

4. Microbiological analysis techniques

4.1 Sample collection and transport:

Urine: medium stream after local washing; Delivery≤2 hrs (or 2-8°C ≤24 hrs)

Blood: The collection of aerobic and anaerobic blood culture vials under conditions of rigorous asepsis and incubation in an automated system

Pus/CSF/puncture fluids: Sampling was performed in sterile vials, and transport was performed immediately.

4.2 Isolation, identification and antibiotic susceptibility testing

Classical bacteriological methods were used, namely, direct examination; isolation on Chapman's agar medium; ClED; and blood or chocolate agar depending on the sample type. Identification was based on morphological and biochemical characteristics: smooth, rounded, yellow or nonyellow "S" type colonies; gram-positive cocci in clusters; optional aeranaerobic bacteria; presence of catalase; and confirmation of the Vitek2 compact PLC. Antibiotic susceptibility tests were performed on the Viteck 2compact automaton according to the recommendations of the French Society of Microbiology (CASFM/EUCAST) [18]. The reference strain S. aureus strain ATCC 6538 was used as an internal control.

5. Statistical analysis

The data were entered into Kobocollect software version 1.25.1 and then exported and processed in Microsoft 365.

The statistical analysis was performed using SPSS version 26 (SPSS, Inc., Chicago, IL, USA). Statistical tests (χ² or Fisher's exact test) were used to compare proportions, with a significance threshold set at p < 0.05.

Quantitative variables such as age are presented as medians.

Qualitative variables (sex, resistance phenotype, etc.) are presented as frequencies and are expressed as percentages.

A total of 238 patients were included in the study. The proportion of males (56.3%) was slightly greater than that of females (43.7%) (Table 1). The mean age of the patients was 27.9 ± 10.7 years, with a predominance of the 21–40 age group (32.3%), followed by the 1–20 years (29.8%), 41–60 years (23.9%), and 61 years of age (13.9%).

Table 1: Sociodemographic characteristics of the patients (n = 238)

Characteristics	Number (N=238)	Percentage
Sex
Feminine	104	43,70%
Masculine	134	56,30%
Age range
1- 20	71	29,83%
21-40	77	32,35%
41-60	57	23,95%
>61 years old	33	13,87%

Average age (SD ±) 27,9 ± 10,7

Sensitivity analysis of the 238 strains of S. aureus revealed near-universal resistance to penicillin G (99%) and high resistance to oxacillin (79%), reflecting a high proportion of MRSA (Table 2). Strong resistance was observed for tetracycline (72%), ciprofloxacin (50%), gentamicin (43%) and trimethoprim-sulfamethoxazole (43%). In contrast, vancomycin (1% resistance), linezolid (7%), tigecycline (7%) and teicoplanin (2%) remained largely active.

Table 2: Antibiotic resistance patterns of S. aureus strains

Antibiotics	Resistance fighters (%)
Antibiotics	N=238
Penicillin G	99%
Oxacilline	79%
Gentamicin	43%
Erythromycin	38%
Clindamycine	22%
Quinupristine-Dalfopristine	8%
Ciprofloxacin	50%
Moxifloxacin	42%
Levofloxacin	36%
Tetracycline	72%
Tigecycline	7%
Linezolide	7%
Nitrofurantoin	4%
Teicoplanin	2%
Vancomycine	1%
Trimethoprim-Sulfamethoxazole	43%

Figure 2 shows a high predominance of methicillin-resistant S. aureus isolates (68.1%), a significant number of resistant strains through penicillinase production (21.8%), and a low proportion of methicillin-susceptible isolates (10.1%).

Comparative analysis of data from the four laboratories participating in the study highlighted marked heterogeneity in the distribution of Staphylococcus aureus phenotypes, particularly with regard to methicillin resistance (MRSA).

The distribution of phenotypes revealed that penicillinase-producing strains were more common in pus (71.1%), followed by urine (15.4%) and blood (7.7%). MRSA was mostly isolated from pus (43.8%) and urine (36.4%), while the percentage of MRSA in CSF was zero (Table 3).

Table 3: Distribution of S. aureus phenotypes by sample type

Type of samples	Pénicillinases	Wild phenotypes	SARM
LCR	0.00%	12.50%	0.00%
Pus	71.15%	58.33%	43.83%
Blood	7.69%	20.83%	17.90%
Semen	5.77%	0.00%	1.85%
Urine	15.38%	8.33%	36.42%

MRSA predominated among the 238 isolates, with a significantly greater frequency in the hospital setting (74.2%) than in the community setting (57.5%) (p<0.01). Penicillinases exhibit a balanced distribution between the two environments, unlike those of wild strains, which remain in the minority.

Phenotypes	Origins of the levy		P value	Total
Phenotypes	Community	Hospital	P value	Total
Pénicillinases	26	26		52
Wild phenotypes	11	13	*p < 0.01*	24
SARM	50	112		162
Total	87	151		238

The proportion of MRSA increased significantly between 2023 and 2024 (p < 0.01). In 2023, 32.7% of the isolates were MRSA (n=53), whereas 67.3% were MRSA in 2024 (n=109) (Table 4). The majority of MRSA strains originated in pus (43.8%) and urine (36.4%).

Table 4: Distribution of MRSA by year and sample type

	SARM (N=162)	P value
Years		p < 0.01
2023	53 (32,72%)
2024	109 (67,28%)
Types of samples
Pus (n=122)	71 (43,83%)	p < 0.01
Urine ((n=69)	59 (36,42%)
Blood (n=38)	29 (17,90%)
Semen (n=06)	3 (1,85%)
CSF (n=03)	0 (0,00%)

Among all 162 MRSA strains, the following strains exhibited marked multidrug resistance: gentamicin (50%), erythromycin (46%), ciprofloxacin (50%), moxifloxacin (49%), tetracycline (67%), and trimethoprim-sulfamethoxazole (51%) (Table 5). In contrast, resistance to linezolid (6%), tigecycline (8%) and vancomycin (1%) remained low.

Table 5: MRSA resistance patterns to other antibiotic families (n = 162)

Antibiotics	Nonbre de SARM (N=162)	Resistance Percentage
Gentamicin	81	50%
Erythromycin	75	46%
Clindamycine	46	28%
Quinupristine-Dalfopristine	12	7%
Ciprofloxacin	81	50%
Moxifloxacin	80	49%
Levofloxacin	58	36%
Tetracycline	109	67%
Tigecycline	13	8%
Linezolide	9	6%
Nitrofurantoin	8	5%
Trimethoprim/sulfamethoxazole	83	51%

The high prevalence of resistant strains of Staphylococcus aureus observed in this study is a major warning signal in the context of the fight against antibiotic resistance. Among the 238 patients included, 68.1% of the isolates were MRSA, a proportion comparable to that reported in several countries in sub-Saharan Africa (Cameroon, Uganda, Nigeria), where the prevalence of MRSA ranged from 40% to more than 70% [19, 20]. This is in stark contrast to European or North American countries, where strict control programmes have maintained a prevalence of approximately 20–30% [21, 22].

The distribution of patients was predominantly male (56.3%), and the mean age was 27.9 years. These results are in agreement with the findings of other African studies in which staphylococcal infections were found to mainly affect young men and active adults [23, 24]. The 21–40 age group, the most represented (32.3%), was also the most affected group, which may be explained by increased exposure to trauma, community infections and repeated hospitalizations [17, 25, 26].

At the microbiological level, the almost universal ineffectiveness of penicillin G (99%) confirms its obsolescence in the presence of S. aureus, a phenomenon also described in Morocco and Mauritania [27, 28]. Oxacillin has an alarming resistance rate (79%), placing Guinea among the highly MRSA endemic areas, well above the global average (~ 29%) [17, 29–32].

The prevalence of resistance to fluoroquinolones (ciprofloxacin 50%, moxifloxacin 42%, levofloxacin 36%) and tetracycline (72%) far exceeds the available African data (~ 30–40% and ~ 40%, respectively) [33–35]. These results suggest massive and insufficiently regulated consumption of these molecules in Guinea. Conversely, last-resort antibiotics such as vancomycin (99% sensitivity), linezolid (93%) and tigecycline (93%) remain effective, consistent with global trends [36].

The distribution of the samples highlights the predominance of pus (43.8%) and urine (36.4%), illustrating both community and complicated urinary tract infections [37–39]. The absence of MRSA in CSF is consistent with the rarity of meningitis caused by S. aureus, although the prognosis is particularly severe [40].

The results of this study revealed a very high incidence of MRSA among the 238 isolates analyzed, with a significantly greater frequency in hospital settings (74.2%) than in community settings (57.5%; p = 0.027), suggesting increased selection pressure within healthcare settings. However, the high proportion of community-acquired MRSA observed in Guinea far exceeds the rates reported in other sub-Saharan African countries, where prevalences vary from 3.7% in Kenya to 96.8% in Ethiopia, depending on the setting and population studied [41, 42]. This out-of-hospital spread of MRSA probably reflects the frequent and often uncontrolled use of antibiotics in outpatient settings, associated with insufficient hygiene practices and porosity between care sectors.

In addition, the penicillinase-producing strains were relatively evenly distributed between the two media, indicating an ancient and well-established resistance mechanism. Wild strains constitute the minority (10%) of strains, reflecting widespread selective pressure linked to the massive use of β-lactams [43]. The significant association between the origin of the samples and the distribution of phenotypes (χ² = 7.206; p = 0.027) underlines the importance of an integrated "hospital-community" approach in the fight against resistance. Strengthening the proper use of antibiotics, hygiene and training of health personnel appears essential for curbing the spread of these multidrug-resistant strains [44].

Equally worrying is the evolution of time, with a rapid increase in the proportion of MRSA from 32.7% in 2023 to 67.3% in 2024. This trend is in line with international observations that highlight a resurgence of MRSA after a period of decline, notably exacerbated by the COVID-19 pandemic [45]. A study from Northern Cyprus confirmed this trend, with the incidence of MRSA increasing from 38% before the pandemic to 56% during the pandemic, while Taiwanese surveillance showed similar fluctuations, with 48.9% in 2022, 42.3% in 2023, and 48.5% in 2024 [46–49].

Finally, the analysis of resistance patterns revealed marked multidrug resistance: approximately half of the MRSA isolates were resistant to gentamicin and ciprofloxacin, 46% were resistant to erythromycin, and 67% were resistant to tetracycline. These findings are in line with international data highlighting the increasing difficulty in managing MRSA infections [50–52]. Although glycopeptides and antibiotics of last resort retain high activity, the slightest occurrence of resistance in this group requires strict vigilance and reasoned use, in accordance with international recommendations for the management of antibiotic therapy (AMS) [53].

This study highlights the worrying situation of antimicrobial resistance in Staphylococcus aureus in Guinea, which is marked by a high prevalence of methicillin-resistant strains (68.1%) and widespread resistance to first-line antibiotics, including beta-lactams, fluoroquinolones and macrolides. The rapid increase in the incidence of MRSA between 2023 and 2024 reflects a worrying diffusion dynamic in hospital and community settings.

Maintaining high susceptibility to last-resort antibiotics, such as vancomycin, linezolid and tigecycline, still offers effective treatment options. However, their use must be strictly regulated to avoid the emergence of subsequent resistance.

These results underscore the urgent need to establish a national antibiotic resistance surveillance system to strengthen the continuous training of health professionals on the rational use of antibiotics and to improve infection prevention and control measures in health facilities. In addition, additional studies, including molecular typing of strains, are needed to better understand the epidemiological dynamics of MRSA in Guinea and to guide public health strategies.

Consent to participate statement

All human participants included in this study provided informed consent. Personal data were collected and processed in a strictly confidential and anonymous manner.

Ethical approval statement

This study received approval from the Institutional Ethics Committee of the National Institute of Public Health (INSP), Conakry, Guinea (accreditation number: 010/Lab/INSP/2025).

Funding statement

This study did not receive any specific funding from public, commercial, or not-for-profit organizations.

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The authors declare no competing interests.

Antibiotic resistance profile of Staphylococcus aureus isolated fromhealth facilities in Conakry

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Abstract

Figures

Introduction

Materials and Method