Prevalence and antibiogram pattern of multidrug-resistant Staphylococcus aureus infections in individuals with sickle cell disease. A retrospective study, hematological and genetic analysis

Abstract

The prevalence of Staphylococcus aureus in the circulation (bacteremia) of individuals with sickle cell disease (SCD) may provide a substantial risk for illness and death. Strains of S. aureus exhibit a wide variety of virulence traits, including the ability to generate various toxins and develop treatment resistance. MRSA is characterized by its resistance to a range of beta-lactam antibiotics. This study’s objectives included assessing the frequency of S. aureus infection in SCA patients, analyzing laboratory markers of the CBC test, examining the antibiotic susceptibility pattern, and investigating the mecA gene and heteroresistance, which could potentially link to a higher occurrence of S. aureus infection in SCA patients. The retrospective study was done to gather clinical data on individuals with sickle cell anemia (SCA) who had bloodstream infections. From 2017 to 2021, blood samples and data were gathered by King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. The S. aureus strains were re-cultivation, Vitek system and PCR techniques were employed to ascertain the antibiotic resistance patterns. It was confirmed that 2406 patients with SCD had contracted an infection. A total of 138 (5.73 %) patients with SCD were diagnosed with bacteremia. “Of the 138 strains isolated, the MRSA strain revealed as the most prevailing, including 30 isolates (21.7 %), whereas non-MRSA strains constituted 17 isolates (12.3 %).” Males had a higher rate of infection compared to females. The results indicated that all the S. aureus isolates exhibited resistance to ampicillin, while the resistance to penicillin was 98 %. Furthermore, the results indicated that over 65 % of the isolates exhibited resistance to amoxicillin, amoxicillin, cefazolin, imipenem, and oxacillin. The mecA gene was identified in all S. aureus strains obtained from patients with SCD. The current study recognizes the PCR assay as a more dependable technique for assessing antibiotic resistances, in contrast to the Vitek method. A study found strong links between S. aureus infections in individuals with SCD and three different factors: hemoglobin (Hb) level, mean corpuscular volume (RDW), and white blood cell (WBC) count (p < 0.004, 0.005, and 0.02, respectively). The study revealed that 34 % of the S. aureus strains that were examined exhibited heteroresistance to the mecA gene as well as resistance to oxacillin. The results clearly demonstrated that Ampicillin, Penicillin, amoxicillin, cefazolin, imipenem, and oxacillin are unsuitable choices for the treatment of blood infections in individuals with SCD. “The findings of this study confirmed that all S. aureus isolates were sensitive to gentamicin, and more than 80 % of the isolates were sensitive to ciprofloxacin, moxifloxacin, levofloxacin, clindamycin, and vancomycin.” Further investigation is necessary to explore potential factors that increase the susceptibility of individuals with SCD to bacteremia caused by antibiotic-resistant strains of S. aureus.