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PubMed · 40980595

Molecular landscape of methicillin-resistant Staphylococcus aureus strains in clinical infections from hospitals in Lagos, Nigeria.

Adesola Olalekan·Sébastien Boutin·Christopher Mark Watson·Luiza Galarion·Solayide Adesida·Bamidele Iwalokun·Olayiwola Popoola·Seraphine Esemu·Richard Adegbola·Dennis Nurjadi
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Abstract

BACKGROUND AND OBJECTIVES: Multidrug-resistant Staphylococcus aureus (MRSA) accounts for a significant proportion of antimicrobial resistance (AMR)-associated infections worldwide. This study investigated the molecular profile of MRSA in Nigeria, providing valuable genomic data to fill existing knowledge gaps and highlighting its importance in the context of the global AMR crisis. METHODS: A total of 107 isolates were obtained from patient samples, including wound swabs/pus (65 isolates, 60.7%), blood cultures (16 isolates, 15%), urine/urinary catheter (8 isolates, 7.5%) and other sources. Species identification was performed using MALDI-TOF, and antimicrobial susceptibility testing was performed using the VITEK®2 system. Genomic DNA was extracted and subjected to whole-genome sequencing using short-read Illumina technology. In addition, a subset of isolates underwent long-read sequencing using Oxford Nanopore technology. RESULTS: Among the 107 isolates, 63 (59%) were identified as MRSA, with 58 (92%) carrying the mecA gene. The MRSA isolates exhibited high resistance to non-β-lactam antibiotics, particularly trimethoprim/sulfamethoxazole (95.3%), erythromycin (76.6%), gentamicin (71.4%) and quinolones (69.8%). The most prevalent MRSA belonged to the Bengal Bay clone [t657/ST772/Staphylococcal Cassette Chromosome mec (SCCmec) V(5C2)/Panton-Valentine leukocidin (PVL) + methicillin-susceptible Staphylococcus aureus (MRSA)], followed by t4690/ST152/SCCmec Vc(5C2&5)/PVL + MRSA and ST8 (t008, n = 1; t064, n = 4)/SCCmec Vc(5C2&5). Phylogenetic analysis suggests both community/associated transmission and possible importation of strains. CONCLUSIONS: This study highlights the significant burden of MRSA in Nigeria, with the high-risk Bengal Bay MRSA clone as the most common strain. The widespread resistance to non-β-lactam antibiotics underscores the urgent need for enhanced surveillance, infection control and antibiotic stewardship to mitigate its spread.

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Adesola Olalekan, Sébastien Boutin, Christopher Mark Watson, Luiza Galarion, Solayide Adesida, Bamidele Iwalokun, Olayiwola Popoola, Seraphine Esemu, Richard Adegbola, Dennis Nurjadi. 2025-09-19. Molecular landscape of methicillin-resistant Staphylococcus aureus strains in clinical infections from hospitals in Lagos, Nigeria.. https://doi.org/10.1093/jacamr%2Fdlaf161

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Effectiveness of high-dose versus standard-dose influenza vaccines against hospitalisation according to frailty risk: a prespecified analysis of the randomised trial DANFLU-2.

BACKGROUND: Frailty is a major risk factor for influenza-related complications and can influence vaccine effectiveness. We aimed to assess the relative vaccine effectiveness (rVE) of high-dose (HD-IIV) versus standard-dose inactivated influenza vaccine (SD-IIV) in older adults aged 65 years or older according to frailty risk. METHODS: This study was a prespecified analysis of DANFLU-2, an open-label, individually randomised trial, conducted in Denmark during three consecutive influenza seasons (2022-23, 2023-24, and 2024-25). Adults aged 65 years or older were randomised (1:1) to the HD-IIV or SD-IIV group. The primary endpoint was hospitalisation for influenza or pneumonia. Frailty was defined according to the validated Hospital Frailty Risk Score (HFRS) based on ICD-10 codes within 10 years before randomisation. Participants were stratified into three HFRS categories, namely low (<5 points), intermediate (5-15 points), and high (>15 points) frailty risk. The rVE of HD-IIV versus SD-IIV against the primary endpoint was assessed across prespecified HFRS categories and treating HFRS as a continuous variable. Pearson's chi-square test was used to compare safety events across frailty risk groups and randomisation groups. FINDINGS: Among 332&#x2009;438 randomised participants (mean age 73&#xb7;7 years [SD 5&#xb7;8]; 161&#x2009;538 [48&#xb7;6%] were female), 276&#x2009;173 (83&#xb7;1%) had low frailty risk, 52&#x2009;395 (15&#xb7;8%) had intermediate frailty risk, and 3861 (1&#xb7;2%) had high frailty risk. The primary endpoint of hospitalisation for influenza or pneumonia occurred in 1424 (0&#xb7;5%) of 276&#x2009;173 participants with low frailty risk, 761 (1&#xb7;5%) of 52&#x2009;395 with intermediate frailty risk, and 163 (4&#xb7;2%) of 3861 with high frailty risk (relative risk [RR] for intermediate vs low frailty risk 2&#xb7;8 [95% CI 2&#xb7;6-3&#xb7;1]; RR for high vs low frailty risk 8&#xb7;2 [7&#xb7;0-9&#xb7;6]). HFRS as a continuous variable significantly modified the effect of HD-IIV versus SD-IIV against the primary endpoint with higher rVE estimates with increasing HFRS (pinteraction=0&#xb7;020). The rVE was 0&#xb7;2% (95% CI -10&#xb7;8 to 10&#xb7;2) among those with low frailty risk, 13&#xb7;1% (-0&#xb7;4 to 24&#xb7;8) among those with intermediate frailty risk, and 19&#xb7;9% (-10&#xb7;3 to 42&#xb7;1) among those with high frailty risk. No significant interaction was observed when HFRS was assessed according to the prespecified categorical frailty groups (pinteraction=0&#xb7;17). The proportion of participants with at least one serious adverse event increased across frailty risk groups (13&#x2009;366 [4&#xb7;8%] of 275&#x2009;795 for low frailty risk, 5475 [10&#xb7;5%] of 52&#x2009;315 for intermediate frailty risk, and 777 [20&#xb7;2%] of 3850 for high frailty risk; p<0&#xb7;0001), with similar proportions of serious adverse events in the HD-IIV and SD-IIV groups for each frailty risk group. INTERPRETATION: Among adults aged 65 years or older in Denmark, frailty risk might modify the effects of HD-IIV versus SD-IIV against hospitalisation for influenza or pneumonia, with higher rVE estimates with increasing frailty risk. These findings might support considering high-dose influenza vaccines for frail older adults. However, effect modification was not evident when frailty was assessed using prespecified categorical subgroups, and subgroup-specific estimates were imprecise, with 95% CIs crossing the null. These results should be considered exploratory, warranting further investigation. FUNDING: The DANFLU-2 trial was funded by Sanofi.

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