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Background The antibacterial activities of aqueous leaf extracts of  Moringa oleifera, Vernonia amygdalina, Azadirachta indica  and  Acalypha wilkesiana  against multidrug resistance (MDR)  Staphylococcus aureus  associated with skin and soft tissue infections were investigated. Methods Staphylococcus aureus  ( n  = 183) from the skin and soft tissue infections with evidence of purulent pus, effusions from aspirates, wounds, and otorrhea were biotyped, and evaluated for biofilm production. The phenotypic antibiotic resistance and MDR strains susceptibility to plant leaves extract were determined using disc diffusion and micro-broth dilution assays respectively. The correlation of plant extract bioactive components with inhibitory activities was determined. Results High occurrence rate of  S. aureus  were recorded among infant and adult age groups and 13.2% mild biofilm producers from the wound ( p  &lt; 0.05). Of 60.2% MDR strains with overall significant MARI of more than 0.85 ( p  &lt; 0.05), high resistant rates to linozidine (92.7%; 95% CI:7.27–10.52), ofloxacin (94.2%; 95% CI:6.09–8.15), chloramphenicol (91.2%; 95% CI:6.11–8.32), gentamicin (97.3%; 95% CI:6.20–8.22), ciprofloxacin (92.7%; 95% CI: 5.28–7.99) and vancomycin (86.6%; 95% CI:6.81–9.59) were observed.  Vernonia amygdalina  and  Azadirachta indica  showed significant antimicrobial activity at 100 mg/ml and 75 mg/ml, with low susceptibility of less than 10% to 25 mg/ml, 50 mg/ml, and 75 mg/ml  Moringa oleifera.  Alkaloids, saponin and terpenoids were significant in  Moringa oleifera, Acalypha wilkesiana, Azadirachta indica  and  Vernonia amygdalina  leaves extracts ( p  &lt; 0.05). High inhibitory concentrations at IC50; 3.23, 3.75 and 4.80 mg/ml ( p  = 0.02, CI: − 0.08 – 11.52) and IC90; 12.9, 7.5, and 9.6 mg/ml ( p  = 0.028, CI: 2.72–23.38) were shown by  Acalypha wilkesiana, Vernonia amygdalina and Moringa oleifera  respectively. Comparative outcome of the plant extracts showed  Acalypha wilkesiana ,  Vernonia amygdalina  and  Moringa oleifera  to exhibit significant inhibition activities ( p  &lt; 0.05) compared to other extracts. Significant median inhibitory concentration (15.3 mg/ml) of  Azadirachta indica  were observed ( p  &lt; 0.01) and strong associations of phytochemical compounds of  Azadirachta indica  (eta = 0.527, p  = 0.017),  Vernonia amygdalina  (eta = 0.123, p  = 0.032) and  Acalypha wilkesiana  (eta = 0.492, p  = 0.012) with their respective inhibitory values. Conclusion Observed high occurrence rate of skin and soft tissue infections caused by biofilm-producing MDR  S. aureus  requires alternative novel herbal formulations with rich bioactive compounds from  Moringa oleifera, Acalypha wilkesiana, Azadirachta indica  and  Vernonia amygdalina  as skin therapeutic agents.

bmc complementary medicine and therapies

Antibacterial activities of plant leaf extracts against multi-antibiotic resistant Staphylococcus aureus associated with skin and soft tissue infections