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Coagulase-negative staphylococci (CoNS) represent a diverse group of opportunistic pathogens associated with human and animal infections. The burden of infectious diseases attributed to antibiotic-resistant CoNS, particularly methicillin-resistant CoNS (MR-CoNS), is a global public health concern. However, there is limited data on the epidemiology of MR-CoNS in Africa. This systematic review provides insights on MR-CoNS from human and non-human sources in Africa, the methicillin-resistance gene determinants and the associated mobile genetic elements. The review retrieved articles from four electronic databases: PubMed, Scopus, Web of Science, and Google Scholar, using specific keywords. This study was carried out until 20 November 2024. Articles were screened and data was extracted and analyzed following the PRISMA guidelines. The meta-analysis used the binary random effects model with a 95% confidence interval. Overall, 65 articles from 16 African countries were included in the study. The pooled prevalence rates for CoNS and MR-CoNS in Africa were 27% and 36%, respectively. The review identified 36 species of CoNS from human and non-human sources. In addition, 20 (31%) studies each reported CoNS and MR-CoNS from human and animal infections. The most prevalent species of MR-CoNS included Staphylococcus epidermidis , Staphylococcus haemolyticus , and Mammaliicoccus sciuri . The African MR-CoNS harboured different staphylococcal chromosome cassette mec (SCC mec ) elements (types I, II, III, IV, V, VI, VIII, and a SCC mec - mecC (hybrid), and the most common SCC mec element was the SCC mec type IV. The findings highlight the paucity of data on the epidemiology of MR-CoNS in Africa. The identification of MR-CoNS from human and animal infections indicates the need for a detailed characterization using molecular methods. This strategy will provide data to healthcare practitioners and policymakers to develop effective measures to combat antimicrobial resistance in Africa.

Background MRSA represents a significant public health challenge, particularly in resource-constrained regions like Africa. A critical factor in its spread is the role of asymptomatic carriers, who not only facilitate transmission but also face a markedly higher risk of developing MRSA-related infections. Against this backdrop, the current meta-analysis provides a comprehensive evaluation of MRSA colonization rates, associated risk factors, and antibiotic resistance profiles across African populations. Methods A comprehensive literature search was conducted across African Journals Online, African Index Medicus, PubMed, Scopus, Google Scholar, and Web of Science from January 1, 2014, to January 1, 2025. Eligible studies reported on MRSA colonization rates, associated risk factors, or antibiotic resistance patterns within African populations. Results were presented as pooled prevalence or risk ratios (RR) with 95% confidence intervals, employing a random-effects model in R software (meta package). A p-value of < 0.05 was considered statistically significant. The study followed the PRISMA guidelines throughout. Results Sixty-nine studies with 23,484 participants from 16 African countries were included. Subgroup analyses identified Healthcare Workers and hospitalized patients as having the highest pooled prevalence at 13.6% and 12.9%, respectively. Conversely, lower prevalence rates were observed among healthy community residents and children, at 4.1% and 4.7%, respectively. Among HCWs, Egypt reported the highest MRSA colonization rate at 18.1%. Key risk factors for MRSA colonization include a history of hospitalization (RR: 2.2), prior antibiotic use (RR: 1.4), diabetes mellitus (RR: 4.4), HIV with CD4 < 200 cells/µL (RR: 2.8), invasive procedures (RR: 4.8), and being a nurse compared to a physician (RR: 1.8), all with p  < 0.05. Antibiotic resistance of MRSA was low for linezolid (2.7%) and vancomycin (5.9%), but higher for mupirocin (10.7%), clindamycin (23.6%), and Trimethoprim/sulfamethoxazole (38.9%). Conclusion MRSA colonization is a significant public health challenge in Africa, particularly among healthcare workers and hospitalized patients. Implementing targeted interventions for these high-risk groups can effectively reduce MRSA transmission and overall infection burden. Continuous monitoring is essential, especially given the resistance to mupirocin, a key antibiotic used for MRSA decolonization.

Background Streptococcus pneumoniae is a major cause of respiratory infections, particularly affecting children and the elderly. However, data on pneumococcal disease among Indian adults remain limited. This study investigated the epidemiology of S. pneumoniae from invasive and non-invasive sources in Indian adults using whole-genome sequencing (WGS). Methods A prospective study was undertaken in five hospitals of India between 2022 and 2023, including 254 S. pneumoniae isolates, 126 from invasive and 128 from non-invasive specimens. WGS was performed using the Illumina platform to determine serotypes, multi locus sequence types (STs), lineages, antimicrobial resistance (AMR), and virulence profiles. Antimicrobial susceptibility was assessed using the Vitek-2 system. Results A total of 37 serotypes, 53 Global Pneumococcal Sequence Clusters (GPSCs), and 128 STs (including 39 novel STs) were identified. Predominant serotypes included 19 F, 19 A, and 9 V, with GPSC1, GPSC10, and GPSC6 being the most common lineages. Vaccine coverage was estimated at 64% for PCV13 and 72% for PPSV23. Multidrug resistance (MDR) was observed in 70% of isolates, mainly among GPSC1, 10, and 6. Virulence genes were widely distributed, and pilus genes were more common in non-invasive isolates. Phylogenetic analysis showed GPSC1, 10, and 6 as dominant in both invasive and non-invasive sources. Conclusion The high prevalence of non-vaccine lineages, elevated MDR, and large number of novel STs reflect ongoing pneumococcal evolution in India, likely driven by recombination and capsular switching. These dynamics may reduce vaccine effectiveness. Continuous genomic surveillance is crucial to inform vaccine strategies and control pneumococcal disease in Indian adults.

Dermatophytosis is a common superficial fungal infection caused by dermatophytes that infect keratinized tissues, including the skin, scalp, and nails. Dermatophytes are categorized into three groups: anthropophilic, zoophilic, and geophilic. In this study, we aimed to explore the recent epidemiology of dermatophytosis across Kuwait from January 2021 to December 2024. Data were collected from the Reference Mycology Laboratory in Kuwait, and a statistical analysis was performed with GraphPad Prism 10. A total of 214 dermatophyte isolates from 211 patients were obtained during the study period. The predominant dermatophytes isolated were zoophilic species, accounting for 127 (59%) cases, followed by 57 cases involving anthropophilic species (26.5%), 8 cases involving geophilic dermatophytes (4%), and 22 cases involving unidentified species (10.5%). The most frequently isolated dermatophyte was Trichophyton spp., with 132 cases identified (61.5%), followed by 73 cases involving Microsporum spp. (34%) and 8 cases involving Nannizzia spp. (4%). Epidermophyton spp. were rarely isolated, with only one case being found (0.5%). Seven cases of Trichophyton indotineae (3.3%) were also detected among all the Trichophyton spp. The most frequently affected age group was children under 10 years of age. Dermatophytosis was slightly more prevalent in males than in females. The abundance of zoophilic dermatophytes was greater than that of anthropophilic species. Furthermore, the appearance of T. indotineae cases in Kuwait highlights the need for antifungal stewardship in dermatology clinics, active surveillance of refractory recurrent cases, and optimized mycology diagnostic services in dermatology clinics.

Background Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae is a critical priority pathogen for which there is a need for new antimicrobials and poses a great public health threat to many parts of the world including sub-Saharan Africa (SSA). This study aims to determine the prevalence of ESBL-producing K. pneumoniae in SSA using a one health perspective, and the predominant ESBL genes in the region. Methods Databases such as PubMed, Scopus, Web of Science, Africa Journal Online, and Google Scholar were searched for eligible articles based on pre-set eligibility criteria. After screening of titles, abstracts, and full texts, a meta-analysis using a random-effect model was conducted on the eligible studies to determine the overall and subgroup prevalence of ESBL-producing K. pneumoniae in SSA. Results This meta-analysis included 119 eligible studies from 25 SSA countries in all SSA subregions. The overall prevalence of ESBL-producing K. pneumoniae in SSA is estimated to be 8.6% [95% CI: 6.4–11]. South Africa (18.5%) and Central Africa (4.6%) subregions have the highest and lowest prevalence of ESBL-producing K. pneumoniae in the region, respectively. Additionally, South Africa (23.3%), Kenya (23%), and Nigeria (11.1%) are the top three countries with ESBL- K. pneumoniae . Animal samples were also seen to have the highest prevalence compared to clinical and environmental samples in this study. Lastly, bla CTX−M−15 was the most reported ESBL gene in SSA. Conclusion The widespread presence of resistant strains in certain regions poses a significant risk of inter-country transmission, highlighting the need for collaborative regional surveillance and control efforts.

Background The COVID-19 pandemic has significantly impacted healthcare systems, leading to increased antibiotic misuse and multidrug-resistant (MDR) infections. This study assessed microorganisms and antibiotic-resistance patterns in bloodstream infections at a tertiary teaching hospital in Shiraz, Iran. Methods This retrospective cohort study analyzed blood culture results from the Professor Alborzi Clinical Microbiology Research Center (2017–2023), comparing two periods: pre-pandemic (Period 1) (2017–2020) and pandemic/post-pandemic (Period 2) (2020–2023). Results Among 5,970 pathogenic strains, Gram-negative bacteria predominated (81.2% Period 1, 77.3% Period 2), maintaining a 1:5 ratio with Gram-positive bacteria. Stenotrophomonas maltophilia was the most common pathogen (23%) but declined significantly from 30 to 11% post-2020. In contrast, Escherichia coli (8–14%), Klebsiella spp. (6–13%), and Enterobacter spp. (6–13%) increased significantly. Staphylococcus aureus (7–12%) and Enterococcus spp. (6–8%) showed non-significant increases, while Pseudomonas spp. (10–6%) and streptococcus viridans (5–2%) declined without statistical significance. Acinetobacter spp. remained stable at 6%. Time-series analysis revealed pandemic-induced shifts: Enterobacter spp. reversed its pre-pandemic rise post-COVID (p < 0.001), while Stenotrophomonas maltophilia exhibited a declining trend in Period 1 and an increasing one in Period 2 (p = 0.016). No significant trend changes were observed for the remaining examined bacterial species. Among Gram-negative fermenters, carbapenems and amikacin remained the most effective antibiotics. While Acinetobacter spp. demonstrated elevated resistance to all tested antibiotics, including carbapenems, other Gram- negative non-fermenter bacteria displayed mixed resistance patterns, with increases, decreases, and stable resistance levels observed when comparing data from two periods. Methicillin-resistant S. aureus (MRSA) rates doubled (24% to 50%, p < 0.0001), with increased resistance to ciprofloxacin. High 54 rates of vancomycin-resistant Enterococci (VRE, 62%) were observed, with a 55 non-significant upward change (67%). Conclusions The study highlights shifts in pathogen epidemiology and antibiotic resistance during the pandemic, emphasizing the need for continuous surveillance and targeted antibiotic stewardship programs.

Background Streptococcus pneumoniae ( S. pneumoniae ) remains a major cause of community acquired pneumonia (CAP), particularly among older adults. In China, pneumococcal infections pose a substantial disease burden, with rising antibiotic resistance. Although vaccines have effectively reduced disease worldwide, data on adult serotype distribution and resistance in China are scarce. This study investigates serotype patterns and antimicrobial susceptibility of S. pneumoniae among Chinese adults. Methods We collected a total of 474 S. pneumoniae isolates from adult patients diagnosed with pneumococcal infections in 14 cities across five geographic regions of China between 2018 and 2019. Clinical specimens included sputum, blood, bronchoalveolar lavage fluid (BALF), cerebrospinal fluid (CSF), pharyngeal and nasal swabs, and middle ear fluid. Minimum inhibitory concentrations (MICs) of antimicrobial agents were determined using the agar dilution method. Pneumococcal serotyping was performed using the Pneumotest-Latex kit and type-specific antisera. Results Serotype 19F was the most prevalent across all age groups, specimen types, and regions. 20-valent pneumococcal conjugate vaccine (PCV20) is expected to provide the highest serotype coverage (69.4%) among all vaccines evaluated. Multidrug resistance was detected in over 94% of isolates, with high resistance to macrolides, tetracycline, and clindamycin. β-lactam resistance varied by syndrome and region. Non-invasive isolates showed slightly higher resistance than invasive ones. Serotypes covered by higher-valency vaccines were more likely to be antibiotic-resistant, although fluoroquinolone and vancomycin resistance remained low. Conclusions Our findings highlight a high burden of antimicrobial resistance and predominance of specific serotypes, particularly 19F, among adult S. pneumoniae isolates in China. The broad serotype coverage of PCV20 suggests its potential advantage in future adult immunization strategies. Continued surveillance of serotype distribution and resistance patterns is essential to inform vaccine policy and guide effective antibiotic use.

Background To investigate the epidemiological profile and antimicrobial resistance patterns of genital mycoplasma in Eastern China and provide evidence-based guidance for clinical management. Methods A retrospective analysis was conducted on clinical records, mycoplasma culture results, and antimicrobial susceptibility testing data from patients with suspected urogenital tract infections between 2018 and 2023. Results Among 47,619 suspected infected patients, 20,830 cases tested positive for genital mycoplasma infection, with an overall infection rate of 43.74%. The infection rate of pure Ureaplasma spp. was 37.00%, for pure Mycoplasma hominis (Mh) was 0.66%, and for the co-infections with Ureaplasma spp. and Mh was 6.08%. The infection rate in females (44.00%) was significantly higher than that in males (20.12%), with a statistically significant difference ( P  < 0.001). The observed changes in each age group showed statistically significant differences ( P  < 0.001). Seasonally, the infection rate of mycoplasma in spring was slightly higher than that in winter. Regarding drug resistance, genital mycoplasmas generally exhibited a higher resistance rate to fluoroquinolone drugs, while the resistance rates to tetracycline, doxycycline, pristinamycin, and josamycin were relatively low. The average resistance rates to ciprofloxacin and ofloxacin in patients with pure Ureaplasma spp. infections were relatively high, at 83.39% and 66.34%, respectively. And the resistance rates showed an increasing trend year by year ( P  < 0.001). Patients with pure Mh infections had the highest resistance rate to ofloxacin (80.32%), followed by ciprofloxacin (69.21%), with no significant differences in resistance rates across the years. Patients co-infected with Ureaplasma spp. and Mh had the highest average resistance rates to both ofloxacin and ciprofloxacin, exceeding 90.00%. Conclusion The infection rate of genital mycoplasma in Eastern China is relatively high, predominantly Ureaplasma spp., with significant resistance to fluoroquinolone drugs. It is necessary for the hospital to enhance monitoring for the genital mycoplasma infections and to conduct drug resistance analysis to guide rational medication use and infection control measures. Clinical trial number Not applicable.

Background Acinetobacter baumannii ( A. baumannii ) has emerged as a major public health threat in low- and middle-income countries (LMICs), particularly in Egypt, due to its remarkable ability to acquire and transfer resistance genes, as highlighted in the WHO bacterial Priority Pathogens List 2024 classification. This pilot study aimed to characterize 18 A. baumannii isolates from Egyptian healthcare settings, focusing on clonal lineages, antibiotic resistance determinants, horizontal gene transfer potential, and the presence of virulence factors and chromosomal mutations. Methods Antimicrobial susceptibility testing was performed to determine resistance profiles using minimum inhibitory concentrations. Whole-genome sequencing was used to identify β -lactamase, carbapenemase, and other antibiotic resistance genes (ARGs), as well as mobile genetic elements (MGEs). Clonal relationships among isolates were assessed via core genome multilocus sequence typing (cgMLST). Results Phenotypic analysis revealed that 72% of the isolates were extensively drug-resistant (XDR), exhibiting resistance to all tested antibiotics except colistin. Clonal diversity analysis identified 11 Oxford sequence types (STs), including two novel STs (ST3309 OXF and ST3321 OXF ), and six international clonal (IC) groups, with IC2 being the most prevalent. Additionally, eight Pasteur STs were detected, with ST570 PAS being the most frequent. The cgMLST analysis showed that two Egyptian ST570 PAS isolates clustered with a strain from Saudi Arabia, suggesting potential regional transmission. Genomic analysis revealed the widespread dissemination of ARGs via MGEs, particularly rep plasmids and insertion sequence elements, which contributed significantly to genomic diversity and antibiotic resistance. Conclusions This pilot study highlights the clonal diversity of A. baumannii in Egypt and underscores the critical role of MGEs in the spread of resistance genes. Targeted genomic surveillance and infection control are essential to curb the spread of high-risk resistant A. baumannii clones in Egyptian clinical settings.

Background Serratia marcescens is an opportunistic pathogen increasingly associated with healthcare-associated infections and rising antimicrobial resistance. The emergence of multidrug-resistant (MDR) and carbapenem-resistant S. marcescens (CRSM) presents significant therapeutic challenges. However, data on the clinical and microbiological analyses of these infections remain limited. Methods This retrospective study included 242 hospitalized patients with S. marcescens infections admitted to Nanjing Drum Tower Hospital, China, from January 2012 to December 2020. Clinical characteristics, antimicrobial susceptibility profiles, and resistance patterns were analyzed. Patients were categorized based on infection site (urinary tract infection [UTI] vs. bloodstream infection [BSI]) and resistance phenotype (MDR and CRSM). Antimicrobial susceptibility testing (AST) was performed according to CLSI 2024 guidelines. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors associated with BSI, UTI, and CRSM. Results MDR isolates exhibited significantly lower susceptibility to β-lactams, aminoglycosides, and fluoroquinolones compared to non-MDR isolates, although amikacin and sulfamethoxazole retained moderate activity. Isolates from blood samples showed higher susceptibility to most antibiotics than urinary isolates, particularly imipenem (23.5% vs. 3.2%). Multivariate analysis identified prior hospitalization as an independent risk factor for S. marcescens BSI (OR = 2.8, P  = 0.048), while kidney disease (OR = 4.2, P  < 0.001) was independently associated with UTIs. Pulmonary infection (OR = 3.2, P  = 0.020) and prior exposure to ≥ 3 antibiotic classes (OR = 3.7, P  = 0.031) were independent predictors of carbapenem-resistant infections. Patients with MDR bacteremia had a markedly higher 28-day mortality (50.0%) than non-MDR cases (12.0%). The 28-day mortality rate for CRSM infections was 28.6%. Conclusion This study reveals substantial differences in antimicrobial susceptibility between MDR and non-MDR S. marcescens isolates and highlights amikacin and sulfamethoxazole as potential treatment options against MDR strains. Didentified clinical risk factors—including prior hospitalization, kidney disease, and extensive antibiotic exposure—underscore the importance of early risk stratification and optimized antibiotic stewardship.