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Staphylococcus Aureus Infection Associated with Childbirth

Study of Staphylococcus Aureus Infection Associated with Childbirth in Mulago Hospital Uganda

Professor Stephen Bentley is leading this research in collaboration with Professor Ashley Moffett and our research partners at Mulago Hospital, part of Makerere University in Uganda. The study which spans the research areas of pathogen evolution and maternal and child health.

Puerperal sepsis is a major cause of maternal morbidity and mortality especially in Sub-saharan Africa (Ronsmans and Graham 2006). Pathogens that cause puerperal sepsis are acquired from community contacts, normal flora or health facilities. Of the nosocomial pathogens, S. aureus is the most common Gram positive bacteria isolated (Maharaj 2007). Management of Staphylococcal infections has become complicated with emergence of MRSA strains. The burden of community or nosocomial acquisition of MRSA varies widely (Appelbaum 2006) with about half of Staphylococcal isolates in Mulago hospital resistant to methicillin (Seni, Najjuka et al. 2013).

Different clones of Staphylococcus aureus carry unique sets of virulence factors that facilitate their ability to cause disease and persist in the host and hospital environment (Chen, Unger et al. 2013; Cheng, Yuan et al. 2013; Andersen, Kahl et al. 2014).

It is noteworthy that S. aureus can switch its tropism between hosts, indeed such events have been documented between human and animal infections (Shepheard, Fleming et al. 2013; Viana, Comos et al. 2015). Bacterial isolates that succeed to switch hosts have different susceptibilities to antibiotics and ability to acquire resistance to antimicrobial agents (Sung and Lindsay 2007). It is likely some of the Staphylococcal isolates found among humans could have been acquired from livestock since in our settings close association with livestock especially chicken is common. 

Therefore, it is essential that detailed analysis of MRSA, both community-carriage and health facility-acquired forms, is performed to inform infection control. This molecular characterization precisely defines the associated virulence factors compared to the phenotypic analyses. The aim of this study is to define community carriage and hospital acquisition of MRSA in Mulago hospital using molecular biology techniques. We will focus on pregnant women and the obstetrics wards/theater environment to identify sources of bacterial infection.

 Objectives

  1. To determine community MRSA carriage and nosocomial acquisition among pregnant women scheduled for elective caesarean section.
  2. To determine MRSA carriage among attendants and health care workers to postnatal women.
  3. To determine MRSA presence in the obstetric ward, examination rooms, NICU and gynaecology theatres at Mulago Hospital.
  4. To determine the clonal relationship of MRSA isolated from the environment to that isolated from patients.
  5. To investigate transmission of S. aureus from the mother to her newborn.

The Cambridge Centre for Global Health Research is funded by the Wellcome Trust. In close collaboration with The Wellcome Trust Sanger Institute, it supports researchers working in public health and tropical medicine to develop their careers, and foster interchange between institutions in the UK and those based in low- and middle-income countries.