Has COVID-19 Shifted Staphylococcus Aureus Resistance? Five Years Of Surveillance Across Kwazulu-Natal Hospitals

Abstract

Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA), remains a significant cause of morbidity and mortality in intensive care units (ICUs) worldwide. The COVID-19 pandemic introduced unprecedented changes to hospital infection control, antimicrobial usage, and all patient profiles factors that may influence resistance trends.

Objectives:This study aimed to evaluate temporal shifts in all wards-associated Staphylococcus aureus isolates over a five-year period (2018–2022) across six tertiary hospitals in KwaZulu-Natal, South Africa, with a specific focus on comparing pre- and post-COVID-19 patterns.

Methods:We conducted a retrospective, multicentre analysis of microbiological records from all admissions in six public hospitals. S. aureus isolates were stratified by year, resistance phenotype (e.g., MRSA vs. MSSA), and demographic variables. The timeline was divided into pre-COVID-19 (2018–2019) and post-COVID-19 (2020–2022) periods. Trends were analysed using descriptive statistics and regression modelling.

Results:A total of 11,664 S. aureus isolates were identified. The proportion of MRSA fluctuated across the years, with a slight increase on MRSA prevalence following the onset of COVID-19. Differences in antimicrobial susceptibility profiles and all-wards patient demographics were also observed between the two periods. A higher infection rate was observed among male patients in both study periods. Antimicrobial susceptibility testing showed high sensitivity to linezolid, teicoplanin, fusidic acid, and vancomycin, with notable resistance to cefoxitin and penicillin-ampicillin.

Conclusion:These findings suggest that COVID-19 have not influenced the epidemiology of Staphylococcus aureus as the slight increase is not statistically prevalence in all-wards settings, with fluctuating measurable changes in resistance trends post-pandemic. Ongoing surveillance and adaptive infection control policies are essential to mitigate future AMR risks in critical care environments.