Vol.:(0123456789) 1 3 Infection https://doi.org/10.1007/s15010-018-1140-6 ORIGINAL PAPER Management of super fcial and deep‑seated Staphylococcus aureus skin and soft tissue infections in sub‑Saharan Africa: a post hoc analysis of the StaphNet cohort Abraham Alabi 1,2,3  · Theckla Kazimoto 4  · Marthe Lebughe 5  · Delfno Vubil 6  · Patrick Phaku 5  · Inacio Mandomando 6,7  · Winfried V. Kern 8  · Salim Abdulla 4  · Alexander Mellmann 9  · Lena Peitzmann 9  · Markus Bischof 10  · Georg Peters 11  · Mathias Herrmann 11  · Martin P. Grobusch 1,2,3,12  · Frieder Schaumburg 11  · Siegbert Rieg 8 Received: 24 January 2018 / Accepted: 12 April 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Purpose The incidence of Staphylococcus aureus skin and soft tissue infection (SSTI) is high in sub-Saharan Africa. This is fueled by a high prevalence of Panton-Valentine leukocidin (PVL), which can be associated with necrotizing disease. The aim was to describe the clinical presentation and the treatment of SSTI in the African setting and to identify challenges in the management. Methods Patients (n = 319) were recruited in DR Congo (n = 56, 17.6%), Gabon (n = 89, 27.9%), Mozambique (n = 79, 24.8%) and Tanzania (n = 95, 29.8%) during the prospective observational StaphNet cohort study (2010–2015). A physician recorded the clinical management in standardized questionnaires and stratifed the entity of SSTI into superfcial (sSSTI) or deep-seated (dSSTI). Selected virulence factors (PVL, β hemolysin) and multilocus sequence types (MLST) were extracted from whole genome sequencing data. Results There were 220/319 (69%) sSSTI and 99/319 (31%) dSSTI. Compared to sSSTI, patients with dSSTI were more often hospitalized (13.2 vs. 23.5%, p = 0.03), HIV-positive (7.6 vs. 15.9%, p = 0.11), and required more often incision and drainage (I&D, 45.5 vs. 76.5%, p = 0.04). The proportion of an adequate antimicrobial therapy increased marginally from day 1 (empirical therapy) to day 3 (defnite therapy), for sSSTI (70.7 to 72.4%) and dSSTI (55.4 to 58.9%). PVL was a risk factor for I&D (OR = 1.7, p = 0.02) and associated with MLST clonal complex CC121 (OR = 2.7, p < 0.001). Conclusion Appropriate antimicrobial agents and surgical services to perform I&D were available for the majority of patients. Results from susceptibility testing should be considered more efciently in the selection of antimicrobial therapy. Keywords Staphylococcus aureus · Skin and soft tissue infection · Sub-Saharan Africa · Management · Microbiology * Frieder Schaumburg frieder.schaumburg@ukmuenster.de 1 Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon 2 Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany 3 German Centre for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany 4 Ifakara Health Institute (IHI), Dar es Salaam, Tanzania 5 Institut National de Recherche Bio-Médicale (INRB), Université de Kinshasa, Kinshasa, Democratic Republic of the Congo 6 Manhiça Health Research Center, Manhiça, Maputo, Mozambique 7 Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique 8 Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany 9 Institute of Hygiene, University Hospital Münster, Münster, Germany 10 Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany 11 Institute of Medical Microbiology, University Hospital Münster, Münster, Germany 12 Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands