Methicillin-resistant Staphylococcus aureus colonization in a Colombian hospital intensive care unit: phenotypic and molecular characterization
Keywords:
Methicillin-resistant Staphylococcus aureus, intensive care, carrier state, mass screening, Colombia
Abstract
Introduction. Methicillin-resistant Staphylococcus aureus (MRSA) cause nosocomial and community infections. MRSA colonization in hospitals has been described as an important risk factor during hospitalization.Objective. The colonization characteristics of MRSA was described using the tools of molecular biology.
Materials and methods. Between February 2007 and February 2008, 705 patients entering a Colombian intensive care unit (ICU) were screened for MRSA by taking nasopharyngeal samples. For 683 of these patients, a weekly follow-up was provided after they left the ICU. The susceptibility of each S. aureus isolate was tested against 11 antibiotics using agar dilution methods. Sixty two percent (62.0%) of the MRSA isolates were characterized at genetic and molecular level with the detection of resistant genes, SCCmec typing using PCR and the genetic profile with pulsed field gel electrophoresis (PFGE).
Results. Of the 705 patients screened at entry to the ICU, 182 (25.8%) were colonized by S. aureus, and of these, 51 (7.2%) were MRSA. Of the 683 patients with follow-up, 62 (9.1%) were infected by MRSA contracted in the hospital ICU. The prevalence of the Chilean clone was 76.5% at entry and 88.9% for follow-up patients. Of the 113 patients colonized with MRSA, nosocomial infection was present in 18 patients (16.0%). Three community-acquired MRSA isolates related to the USA300-0114 pandemic clone were identified. These were also positive for Panton-Valentine leucidin cytotoxin genes of S.aureus.
Conclusions. This is the first report in Colombia of patients colonized with CA-MRSA-ST8-SCCmec IVc isolates, and it is a probable source of dissemination of this bacteria in Colombian hospitals.
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References
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24. Tenover F, Arbeit R, Goering R, Mickelsen P, Murray B, Persing D, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233-9.
25. Talbot T. Two studies feed the debate on active surveillance for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci carriage: to screen or not to screen? J Infect Dis. 2007;195:314-7.
26. Guzmán-Blanco M, Mejía C, Isturiz R, Álvarez C, Bavestrello L, Gotuzzo E, et al. Epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) in Latin America. Int J Antimicrob Agents. 2009:34;304-8.
27. Weber S, Huang S, Oriola S, Huskins W, Noskin GA, Harriman K, et al. Legislative mandates for use of activesurveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the Joint SHEA and APIC Task Force. Am J Infect Control. 2007;35:73-85.
28. Coello R, Jiménez J, García M, Arroyo P, Minguez D, Fernández C, et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis. 1994;13:74-81.
29. Gorwitz R, Kruszon-Moran D, McAllister S, McQuillan G, McDougal L, Fosheim GE, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis. 2008;197:1226-34.
30. Londoño J, Ortiz G, Gaviria A. Prevalencia de Staphylococcus aureus resistente a meticilina en personal de la unidad de terapia intensiva de la Clínica Universitaria Bolivariana de Medellín, 2004. Infectio. 2006;10:160-6.
31. Davis K, Stewart J, Crouch H, Flórez CE, Hospenthal DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis. 2004;39:776-82.
32. Samad A, Banerjee D, Carbarns N, Ghosh S. Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital. J Hosp Infect. 2002;51:43-6.
33. Niven D, Laupland K, Gregson D, Church D. The S. aureus Screening Initiative Group. Epidemiology of Staphylococcus aureus nasal colonization and influence on outcome in the critically ill. J Crit Care. 2009;24:583-9.
34. Garrouste-Orgeas M, Timsit J, Kallel H, Ben Ali A, Dumay M, Paoli B, et al. Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol. 2001;22:687-92.
35. Salgado C, Farr B, Calfee D. Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis. 2003;36:131-9.
36. Robicsek A, Beaumont J, Peterson L. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2009;48:910-3.
37. Gomes A, Sanches I, Aires De Sousa M, Castañeda E, de Lencastre H. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Colombian hospitals: dominance of a single unique multidrug-resistant clone. Microb Drug Resist. 2001;7:23-32.
38. Safdar N, Bradley E. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med. 2008;121:310-5.
39. Tseng C, Kyme P, Low J, Rocha M, Alsabeh R, Miller L, et al. Staphylococcus aureus Panton-Valentine leukocidin contributes to inflammation and muscle tissue injury. PLoS One. 2009;27:e6387.
40. Hongo I, Baba T, Oishi K, Morimoto Y, Ito T, Hiramatsu K. Phenol-soluble modulin alpha 3 enhances the human neutrophil lysis mediated by Panton-Valentine leukocidin. J Infect Dis. 2009;200:715-23.
2. Grundmann H, Aires-De-Sousa M, Boyce J, Tiemersma E. Emergence and resurgence of methicillin-resistant Staphylococcus aureus as a public health threat. Lancet. 2006;368:874-85.
3. Nicola Z, Francis J, Nuermberger E, Bishai W. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis. 2005;5:275-86.
4. Álvarez C, Cortés J, Arango A, Correa C, Leal A, Grupo para el Control de la Resistencia Bacteriana en Bogotá. Resistencia antimicrobiana en unidades de cuidado intensivo de Bogotá, Colombia, 2001-2003. Rev Salud Pública. 2006;8(Supl.1):86-101.
5. De Lencastre H, Oliveira D, Tomasz A. Antibiotic resistant Staphylococcus aureus: a paradigm of adaptive power. Curr Opin Microbiol. 2007;10:428.
6. Boyle-Vavra S, Daum R. Community-acquired methicillin-resistant Staphylococcus aureus: the role of Panton-Valentine leukocidin. Lab Invest. 2007;87:3-9.
7. Voyich J, Otto M, Mathema B, Braughton K, Whitney A, Welty D, et al. Is Panton-Valentine leukocidin the major virulence determinant in community-associated methicillin-resistant Staphylococcus aureus disease? J Infect Dis. 2006;194:1761.
8. Álvarez C, Barrientes O, Leal A, Contreras G, Barrero L, Rincón S, et al. Community-associated methicillin-resistant Staphylococcus aureus, Colombia. Emerg Infect Dis. 2006;12:2000-1.
9. Arias C, Rincón S, Chowdhury S, Martínez E, Coronel W, Reyes J, et al. MRSA USA300 clone and vancomycin-resistant Enterococcus faecalis: a United States.- Colombian connection? N Eng J Med. 2008;359:2177-9.
10. Álvarez C, Yomayusa N, Leal A, Moreno J, Ibáñez M, Méndez-Álvarez S, et al. Hospital-onset infections caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Colombia. Am J Infec Control. 2010;38:315-8.
11. Corbella X, Domínguez M, Pujol M, Ayats J, Sendra M, Pallares R, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis. 1997;16:351-7.
12. Wallin T, Gene H, Frazee B. Community- associated methicillin-resistant Staphylococcus aureus. Emerg Med Clin North Am. 2008;26:431-55.
13. Huang S, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis. 2003;36:281-5.
14. Miller L, Diep B. Colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis. 2008;46:752-60.
15. Fridkin S, Hageman J, Morrison M, Sanza LT, Como-Sabetti K, Jernigan JA, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. 2005;352:1436-44.
16. Ledell K, Muto C, Jarvis W, Farr B. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol. 2003;24:639-41.
17. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infection. Am J Infect Control. 1988;16:128-40.
18. Martineau F, Francois J, Picarda I, Paul H, Roya M, Michel G, et al. Trial. Multiplex PCR assays for the detection of clinically relevant antibiotic resistance genes in Staphylococci isolated from patients infected after cardiac surgery. J Antimicrob Chemother. 2000;46:527-34.
19. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: Fifteenth Informational Supplement. Vol. 25. M100-S14. Wayne, PA.: CLSI; 2008.
20. Ribeiro A, Dias C, Silva-Carvalho M, Berquó L, Ferreira F, Soares R, et al. First report of infection with community acquired methicillin-resistant Staphylococcus aureus in South America. J Clin Microbiol. 2005;43:1985-8.
21. Oliveira D, De Lencastre H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2002;46:2155-61.
22. Milheirico C, Oliveira D, De Lencastre H. Multiplex PCR strategy for subtyping the staphylococcal cassette chromosome mec type IV in methicillin-resistant Staphylococcus aureus: ‘SCCmec IV multiplex'. J Antimicrob Chemother. 2007;60:42-8.
23. Cruz C, Moreno J, Renzoni A, Hidalgo M, Reyes J, Schrenzel J, et al. Tracking methicillin-resistant Staphylococcus aureus clones in Colombian hospitals over 7 years (1996-2003): emergence of a new dominant clone. Int J Antimicrob Agents. 2005;26:457-62.
24. Tenover F, Arbeit R, Goering R, Mickelsen P, Murray B, Persing D, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233-9.
25. Talbot T. Two studies feed the debate on active surveillance for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci carriage: to screen or not to screen? J Infect Dis. 2007;195:314-7.
26. Guzmán-Blanco M, Mejía C, Isturiz R, Álvarez C, Bavestrello L, Gotuzzo E, et al. Epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) in Latin America. Int J Antimicrob Agents. 2009:34;304-8.
27. Weber S, Huang S, Oriola S, Huskins W, Noskin GA, Harriman K, et al. Legislative mandates for use of activesurveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the Joint SHEA and APIC Task Force. Am J Infect Control. 2007;35:73-85.
28. Coello R, Jiménez J, García M, Arroyo P, Minguez D, Fernández C, et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis. 1994;13:74-81.
29. Gorwitz R, Kruszon-Moran D, McAllister S, McQuillan G, McDougal L, Fosheim GE, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis. 2008;197:1226-34.
30. Londoño J, Ortiz G, Gaviria A. Prevalencia de Staphylococcus aureus resistente a meticilina en personal de la unidad de terapia intensiva de la Clínica Universitaria Bolivariana de Medellín, 2004. Infectio. 2006;10:160-6.
31. Davis K, Stewart J, Crouch H, Flórez CE, Hospenthal DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis. 2004;39:776-82.
32. Samad A, Banerjee D, Carbarns N, Ghosh S. Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital. J Hosp Infect. 2002;51:43-6.
33. Niven D, Laupland K, Gregson D, Church D. The S. aureus Screening Initiative Group. Epidemiology of Staphylococcus aureus nasal colonization and influence on outcome in the critically ill. J Crit Care. 2009;24:583-9.
34. Garrouste-Orgeas M, Timsit J, Kallel H, Ben Ali A, Dumay M, Paoli B, et al. Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol. 2001;22:687-92.
35. Salgado C, Farr B, Calfee D. Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis. 2003;36:131-9.
36. Robicsek A, Beaumont J, Peterson L. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2009;48:910-3.
37. Gomes A, Sanches I, Aires De Sousa M, Castañeda E, de Lencastre H. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Colombian hospitals: dominance of a single unique multidrug-resistant clone. Microb Drug Resist. 2001;7:23-32.
38. Safdar N, Bradley E. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med. 2008;121:310-5.
39. Tseng C, Kyme P, Low J, Rocha M, Alsabeh R, Miller L, et al. Staphylococcus aureus Panton-Valentine leukocidin contributes to inflammation and muscle tissue injury. PLoS One. 2009;27:e6387.
40. Hongo I, Baba T, Oishi K, Morimoto Y, Ito T, Hiramatsu K. Phenol-soluble modulin alpha 3 enhances the human neutrophil lysis mediated by Panton-Valentine leukocidin. J Infect Dis. 2009;200:715-23.
How to Cite
1.
Olarte NM, Valderrama IA, Reyes KR, Garzón MI, Escobar JA, Castro BE, et al. Methicillin-resistant Staphylococcus aureus colonization in a Colombian hospital intensive care unit: phenotypic and molecular characterization. biomedica [Internet]. 2010 Sep. 30 [cited 2024 May 18];30(3):353-61. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/269
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2010-09-30
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