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Background  Antimicrobial resistance of  Staphylococcus aureus  especially methicillin-resistant  S. aureus  (MRSA) continues to be a problem for clinicians worldwide. However, few data on the antibiotic susceptibility patterns of  S. aureus  isolates in South Africa have been reported and the prevalence of MRSA in the KwaZulu-Natal (KZN) province is unknown. In addition, information on the characterization of  S. aureus  in this province is unavailable. This study investigated the susceptibility pattern of 227  S. aureus  isolates from the KZN province, South Africa. In addition, characterization of methicillin-sensitive  S. aureus  (MSSA) and MRSA are reported in this survey.    Methods  The in-vitro activities of 20 antibiotics against 227 consecutive non-duplicate  S. aureus  isolates from clinical samples in KZN province, South Africa were determined by the disk-diffusion technique. Isolates resistant to oxacillin and mupirocin were confirmed by PCR detection of the  mecA  and  mup  genes respectively. PCR-RFLP of the coagulase gene was employed in the characterization of MSSA and MRSA.    Results  All the isolates were susceptible to vancomycin, teicoplanin and fusidic acid, and 26.9% of isolates studied were confirmed as MRSA. More than 80% of MRSA were resistant to at least four classes of antibiotics and isolates grouped in antibiotype 8 appears to be widespread in the province. The MSSA were also susceptible to streptomycin, neomycin and minocycline, while less than 1% was resistant to chloramphenicol, ciprofloxacin, rifampicin and mupirocin. The inducible MLS B  phenotype was detected in 10.8% of MSSA and 82% of MRSA respectively, and one MSSA and one MRSA exhibited high-level resistance to mupirocin. There was good correlation between antibiotyping and PCR-RFLP of the coagulase gene in the characterization of MRSA in antibiotypes 1, 5 and 12.    Conclusion  In view of the high resistance rates of MRSA to gentamicin, erythromycin, clindamycin, rifampicin and trimethoprim, treatment of MRSA infections in this province with these antibacterial agents would be unreliable. There is an emerging trend of mupirocin resistance among  S. aureus  isolates in the province. PCR-RFLP of the coagulase gene was able to distinguish MSSA from MRSA and offers an attractive option to be considered in the rapid epidemiological analysis of  S. aureus  in South Africa. Continuous surveillance on resistance patterns and characterization of  S. aureus  in understanding new and emerging trends in South Africa is of utmost importance.

Antimicrobial susceptibility patterns and characterization of clinical isolates of Staphylococcus aureus in KwaZulu-Natal province, South Africa