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      Detección de Staphylococcus aureus meticilino-resistentes aislados de pacientes con infecciones nosocomiales y adquiridas en la comunidad Translated title: Detection of methicillin-resistant Staphyloccus aureus isolated from patients with nosocomials and community-acquired infections

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          Abstract

          Con el propósito de determinar la presencia de cepas de S. aureus resistentes a la meticilina en pacientes con infecciones nosocomiales y adquiridas en la comunidad, se analizaron 37 muestras de lesiones de piel y mucosa de pacientes con infección nosocomial y 40 de pacientes con infecciones adquiridas en la comunidad. El aislamiento e identificación se realizó siguiendo la metodología convencional, la serotipificación mediante la inhibición de la coagulación y la susceptibilidad antimicrobiana mediante el método de difusión del disco; adicionalmente se determinó la resistencia inducible a clindamicina y la producción de β-lactamasas. S. aureus se aisló en un 14,9% de pacientes con infecciones nosocomiales y 17,1% en pacientes con infecciones adquiridas en la comunidad. En ambos grupos se aisló con mayor frecuencia el serotipo 8. Las cepas aisladas en ambos grupos mostraron altos porcentajes de resistencia a la penicilina. En las cepas aisladas de los pacientes con infección nosocomial se obtuvo una mayor resistencia a la oxacilina (45,5%). Todas las cepas resistentes a la penicilina fueron productoras de β-lactamasas. La presencia de SARM es un problema tanto hospitalario como comunitario, por lo que se recomienda su identificaciσn como parte del diagnσstico bacteriológico.

          Translated abstract

          With the purpose of determining presence of methicillin-resistant S. aureus strains in patients with nosocomial and community acquired infections, we analyzed 37 samples of skin and mucous tissue lesions from patients with nosocomial infections and 40 from patients with community acquired infections. Isolation and identification were done according to conventional methods, serological typing through coagulation inhibition, and antimicrobial susceptibility through the disk diffusion method; we additionally determined inducible clindamycin resistance and β-lactamase production. S. aureus was isolated from 14.9% patients with nosocomial infections and 17.1% patients with community acquired infections. Both groups showed greater frequency of serotype 8. The strains isolated in both groups showed high percentages of penicillin resistance. Strains isolated from patients with nosocomial infection showed greater resistance to oxacillin (45.5%). All penicillin-resistant strains were ß-lactamase producers. MRSA presence is a hospital as well as a community problem, therefore, its identification is recommended as part of the bacteriological diagnosis.

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          Most cited references32

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          Methicillin resistance in staphylococci: molecular and biochemical basis and clinical implications.

          H Chambers (1997)
          Methicillin resistance in staphylococci is determined by mec, composed of 50 kb or more of DNA found only in methicillin-resistant strains. mec contains mecA, the gene for penicillin-binding protein 2a (PBP 2a); mecI and mecR1, regulatory genes controlling mecA expression; and numerous other elements and resistance determinants. A distinctive feature of methicillin resistance is its heterogeneous expression. Borderline resistance, a low-level type of resistance to methicillin exhibited by strains lacking mecA, is associated with modifications in native PBPs, beta-lactamase hyperproduction, or possibly a methicillinase. The resistance phenotype is influenced by numerous factors, including mec and beta-lactamase (bla) regulatory elements, fem factors, and yet to be identified chromosomal loci. The heterogeneous nature of methicillin resistance confounds susceptibility testing. Methodologies based on the detection of mecA are the most accurate. Vancomycin is the drug of choice for treatment of infection caused by methicillin-resistant strains. PBP 2a confers cross-resistance to most currently available beta-lactam antibiotics. Investigational agents that bind PBP 2a at low concentrations appear promising but have not been tested in humans. Alternatives to vancomycin are few due to the multiple drug resistances typical of methicillin-resistant staphylococci.
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            Performance standards for antimicrobial susceptibility testing

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              The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus.

              G Ayliffe (1996)
              Methicillin-resistant Staphylococcus aureus was initially detected in Europe in the 1960s, soon after the introduction of methicillin. Naturally-resistant strains were isolated in some countries before the use of methicillin or related agents. These strains probably spread initially from one or more ancestral genetic clones in natural populations of S. aureus by horizontal transfer and recombination. These original strains, possibly emerging in many countries, then increased in numbers and diversity in hospitals as a result of selection by exposure to antibiotics and by cross-infection. After a decline in the 1970s, new epidemic strains that differed from the original MRSAs emerged in Australia, the United States, and the Irish Republic and have now reached global proportions. Most strains are highly resistant to antibiotics and some are only sensitive to vancomycin or teicoplanin. Intercountry and intercontinental spread has also occurred by transfer of infected or colonized patients or staff. However, the main mode of spread is person-to-person within a unit or hospital and subsequently to other hospitals in the same country. New epidemic strains have continued to emerge and decline for unknown reasons. On the basis of evidence from countries where MRSA is not a problem, it has been suggested that early detection, effective infection control measures, and rational antibiotic use will limit the transmission of these organisms; however, spread is still increasing in many countries.
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                Author and article information

                Journal
                rsvm
                Revista de la Sociedad Venezolana de Microbiología
                Rev. Soc. Ven. Microbiol.
                Organo Oficial de la Sociedad Venezolana de Microbiología. (Caracas, DF, Venezuela )
                1315-2556
                2007
                : 27
                : 1
                : 349-363
                Affiliations
                [01] orgnameUniversidad de Oriente orgdiv1Escuela de Ciencias orgdiv2Departamento de Bioanálisis
                Article
                S1315-25562007000100009 S1315-2556(07)02700109
                d9545741-b523-4dc9-b0fa-d1799a4e84d9

                http://creativecommons.org/licenses/by/4.0/

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 15
                Product

                SciELO Venezuela

                Categories
                Investigaciones Originales y Otras Modalidades de Publicación

                meticilina,S. aureus,resistance,methicillin,resistencia
                meticilina, S. aureus, resistance, methicillin, resistencia

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