Antibacterial Susceptibility Patterns of Staphylococcus species to Common Antimicrobial Agents and Impact on Patients in Bayelsa State, Nigeritate, Southern Nigeria
Article Sidebar
Main Article Content
Abstract
Antimicrobial resistance is a growing problem in Nigeria, increasing treatment costs and complicating care, particularly in Bayelsa State, where local data remain scarce. This study examined antibacterial susceptibility patterns of Staphylococcus species isolated from two tertiary hospitals and assessed the economic implications of common treatment options. We retrospectively reviewed 12,640 microbiology laboratory records over 36 months (2021–2023) and selected 2,070 bacterial isolates by systematic random sampling; 590 Staphylococcus isolates were tested for susceptibility using standard disk diffusion according to CLSI guidelines. A prospective economic evaluation from a societal perspective included direct and indirect costs. Cost-of-Illness and Cost-Effectiveness analyses were performed for ceftriaxone, cefpodoxime, and ciprofloxacin using prevailing hospital prices. Staphylococcus species accounted for 28.5% of isolates. Susceptibility rates (including intermediate) were highest for cefpodoxime (90.3%), followed by ceftriaxone (66.1%), gentamicin (60.6%), ciprofloxacin (51.1%), and cefuroxime (50.9%). High resistance was observed to co-trimoxazole (96%), tetracycline (75.8%), ceftazidime (72.9%), and co-amoxiclav (61%). Ceftriaxone had the highest cost per episode (NGN 21,311.79 or USD 66.60), while ciprofloxacin and cefpodoxime tablets were more cost-effective for susceptible isolates. National extrapolation for one million episodes estimated costs exceeding NGN 4.3 billion with ciprofloxacin and NGN 21.3 billion with ceftriaxone. Isolates showed good susceptibility to cefpodoxime and moderate susceptibility to other agents, but marked resistance to several commonly used drugs. Ciprofloxacin and cefpodoxime were more affordable options. Strengthening antibacterial stewardship, routine surveillance, and susceptibility-guided prescribing is essential to reduce the substantial economic burden of Staphylococcal infections in the region.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Adamu, A., Aliyu, M. H., & Muhammad, B. (2021). Susceptibility patterns of Staphylococcus aureus in northern Nigeria. African Journal of Clinical and Experimental Microbiology, 22(3), 145–152.
Ahmad-Mansour, N., Loubet, P., Pouget, C., Dunyach-Remy, C., Sotto, A., Lavigne, J.-P., & Molle, V. (2021). Staphylococcus aureus virulence factors: An overview. Microorganisms, 9(10), Article 2146. https://doi.org/10.3390/microorganisms9102146
Al-Iede, M., Ayyad, D.M., Etoom, R.A., Aldameiry, R.H. and Toubasi, A.A., 2024 The prevalence and risk factors of methicillin-resistant Staphylococcus aureus among pediatric populations: a systematic review and meta-analysis. Eur J Pediatr 183, 3679–3687 (2024). https://doi.org/10.1007/s00431-024-05672-7
Ayé, P., Waiswa, P., & Ssengooba, F. (2010). Cost of treatment as a barrier to access in low-income countries. Health Policy and Planning, 25(4), 290–298.
Baltekin, Ö., Boucharin, A., Tüll, P., & Elf, J. (2017). Antibiotic susceptibility testing in less than 30 min using direct single-cell imaging. Proceedings of the National Academy of Sciences, 114(34), 9170–9175. https://doi.org/10.1073/pnas.1708558114
Bhattacharjee, M., Manimekalai, K. and Bhowmick, S., 2025. Systematic review of clinical outcomes from the implementation of hospital-based antimicrobial stewardship programs in India. Journal of Postgraduate Medicine, 71(4), p.180. doi: 10.4103/jpgm.jpgm_410_25
Bierowiec, K., Korzeniowska-Kowal, A., & Wzorek, A. (2019). Staphylococcal carriage in healthy individuals. Microorganisms, 7(11), 456. DOI: 10.1155/2019/436052
Cerdeira, C.D. and Brigagão, M.R., 2023. Macrophage polarization in infectious diseases: PAMP, viru-lence factors, immune signaling and receptors. https://www.preprints.org/manuscript/202312.0514
Chalmers, J. D., & Wylam, M. E. (2020). Community-acquired pneumonia in adults. New England Journal of Medicine, 383(9), 849–861. https://doi.org/10.1055/a-0993-0874
Clinical and Laboratory Standards Institute. (2009). Performance standards for antimicrobial disk susceptibility tests (10th ed.). CLSI. https://doi.org/10.1128/jcm.01934-17
David, M. Z., & Daum, R. S. (2017). Treatment of Staphylococcus aureus infections. Clinical Microbiology Reviews, 30(2), 409–456. https://doi.org/10.1128/CMR.00134-16
Elliott, R. and Payne, K., 2005. Essentials of economic evaluation in healthcare. pharmaceutical press.
Gbotche, E., Dougnon, V., Chabi, Y., Vissoh, S., Agbankpe, J., Deguenon, E., ... & Agbangla, C. (2020). Molecular characterization of Enterobacteriaceae producing β-lactamase and methicillin-resistant staphylococci isolated from the hospital environment and catheters in two public hospitals in Benin, Republic of Benin. Bio-Research, 18(2), 1164-1176. https://dx.doi.org/10.4314/br.V18i2.5
Keyal, N., Rai, S., & Shrestha, B. (2020). Antibiotic susceptibility pattern of bacterial isolates from wound infection in a tertiary care hospital. Journal of Nepal Health Research Council, 18(3), 456–460. http://ijbar.ssjournals.com/index.php/journal/article/view/302/827
Kim, Y., Kim, Y., Lee, H.J., Lee, S., Park, S.Y., Oh, S.H., Jang, S., Lee, T., Ahn, J. and Shin, S., 2022. The primary process and key concepts of economic evaluation in healthcare. Journal of Preventive Medicine and Public Health, 55(5), p.415. doi: 10.3961/jpmph.22.195
Ibrahim RA, Wang S-H, Gebreyes WA, Mediavilla JR, Hundie GB, Mekuria Z. (2024) Antimicrobial resistance profile of Staphylococcus aureus isolated from patients, healthcare workers, and the environment in a tertiary hospital in Addis Ababa, Ethiopia. PLoS ONE 19(8): e0308615 https://doi.org/10.1371/journal.pone.0308615
Iskandar, K., Murugaiyan, J., Hammoudi Halat, D., Hage, S.E., Chibabhai, V., Adukkadukkam, S., Roques, C., Molinier, L., Salameh, P. and Van Dongen, M., 2022. Antibiotic discovery and resistance: the chase and the race. Antibiotics, 11(2), p.182. https://www.mdpi.com/2079-6382/11/2/182#
Mensa, J., Barberán, J., Ferrer, R., Borges, M., Rascado, P., Maseda, E., Oliver, A., Marco, F., Adalia, R., Aguilar, G. and Estella, Á., 2021. Recommendations for antibiotic selection for severe nosocomial infections. Revista Española de Quimioterapia, 34(5), p.511. doi: 10.37201/req/126.2021
Murray, P. R. (Ed.). (1999). Manual of clinical microbiology (7th ed.). American Society for Microbiology.
Parsons, J.B., Westgeest, A.C., Conlon, B.P., Harbarth, S., Howden, B.P., Kim, Y.S., King, H.A., Lambregts, M.M., Miller, L.G., Patel, R. and Wang, M., 2026. Methicillin-resistant Staphylococcus aureus. Nature Reviews Disease Primers, 12(1), p.53. https://doi.org/10.1038/s41572-026-00729-3
Planey, A.M., 2020. Hearing health care in the United States: A multi-scale spatial & political economic analysis of health care policy and access to audiology services (Doctoral dissertation, University of Illinois at Urbana-Champaign). https://hdl.handle.net/2142/108257
Suleiman, A. B., Olayinka, B. O., & Onifade, A. K. (2012). Pharmacoeconomic evaluation of antibiotics in Nigeria. Tropical Journal of Pharmaceutical Research, 11(4), 645–652. https://doi.org/10.4314/tjpr.v11i4.15
Suleiman, I. A., Aremu, T. O., & Aremu, O. K. (2022). Epidemiology of antimicrobial resistance and its clinical, economic and humanistic outcomes in developing countries. West African Journal of Pharmacy, 33(1), 1-11. https://doi.org/10.60787/wapcp-33-2-258
Suleiman, A. B., Olanipekun, M. G., & Meyer, J. A. (2013). Antimicrobial susceptibility of Staphylococcus aureus isolates in a tertiary hospital in Nigeria. African Journal of Clinical and Experimental Microbiology, 14(2), 78–85. doi.org
Swaney, M.H., Sandstrom, S. and Kalan, L.R., 2020. Cobamide sharing drives skin microbiome dynamics. bioRxiv, pp.2020-12. doi: https://doi.org/10.1101/2020.12.02.407395
Tong, S. Y. C., Davis, J. S., Eichenberger, E., Holland, T. L., & Fowler, V. G., Jr. (2015). Staphylococcus aureus infections: Epidemiology, pathophysiology, clinical maifestations, and management. Clinical Microbiology Reviews, 28(3), 603–661. https://doi.org/10.1128/CMR.00134-14
Torres, L., Tormo, D., & Lasa, I. (2021). Staphylococcus aureus virulence factors. Frontiers in Microbiology, 12, Article 678.
Trujillo Jara, K., Voormolen, D.C., Brouwer, & van Exel, J. (2026). The value of health and well-being from a societal perspective: A willingness to pay experiment in the Netherlands. Eur J Health Econ 27, 259–276 (2026). https://doi.org/10.1007/s10198-025-01814-2
Usman, J., Onabunmeh Daniel, E., Abubakar, I., Salisu, H., Umar Nasiha, Z., & Sani, H. (2026). Identification of the methicillin-resistant gene mecA in Staphylococcus aureus: Methicillin-resistant gene mecA in Staphylococcus. Journal of Biological Research and Biotechnology, 24(1), 454–458. https://doi.org/10.4314/br.v24i1.1
Vena, A., Muñoz, P., & Bouza, E. (2023). Methicillin-resistant Staphylococcus aureus infections: Current challenges and future perspectives. Clinical Microbiology and Infection, 29(4), 412–420.
Walker, J. C., Smits, M. M., & van der Meer, J. W. M. (2013). Immune development in early childhood. Pediatric Research, 74(3), 245–252.
Wikler, M.A., Cockerill, F.R. and Craig, W.A., 2008. Clinical and laboratory standards institute. Performance Standards for Antimicrobial Susceptibility Testing: Eighteenth Informational Supplement. Wayne: Clinical and Laboratory Standards Institute.
Ygberg, S., & Nilsson, A. (2012). The developing immune system in children. Acta Paediatrica, 101(3), 236–242