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Methicillin-resistant Staphylococcus aureus in Rio de Janeiro hospitals: Dissemination of the USA400/ST1 and USA800/ST5 SCCmec type IV and USA100/ST5 SCCmec type II lineages in a public institution and polyclonal presence in a private one

https://doi.org/10.1016/j.ajic.2012.08.008Get rights and content

Background

Methicillin-resistant Staphylococcus aureus (MRSA) infections have changed since certain non-multiresistant MRSA lineages have emerged in hospitals. In this study, 99 MRSA isolates, 77 from a public and 22 from a private hospital, were characterized.

Methods

Isolates were tested for antimicrobial susceptibility, whereas staphylococcal chromosomal cassette mec (SCCmec) typing and Panton-Valentine leukocidin genes were assessed by polymerase chain reaction. Pulsed-field gel electrophoresis and multilocus sequence typing analyses were carried out to determine the MRSA lineages.

Results

High rates of resistance were found to erythromycin (96%), ciprofloxacin (93%), and clindamycin (90%). The SCCmec types found were as follows: type II (14.2%), III (62.6%), and IV (23.2%). Approximately 85% of type III isolates was related to the Brazilian epidemic clone in both hospitals. For type IV isolates, 94.4% were related to both USA400/ sequence type (ST) 1 and USA800/ST5 lineages in the public hospital, whereas the USA400/ST1, USA800/ST5, USA1100/ST30, and EMRSA (Epidemic MRSA)-15/ST22 lineages were detected in the private hospital. Among the SCCmec II isolates, approximately 85% were related to the USA100/ST5 lineage. Three MRSA isolates were positive to Panton-Valentine leukocidin genes.

Conclusion

The study showed that there was an emergence of USA400/ST1, USA800/ST5 SCCmec IV, and USA100/ST5 SCCmec II MRSA lineages in both hospitals. There was a dissemination of them in the public hospital and a polyclonal presence of the MRSA isolates in the private hospital. The spread of these lineages can be facilitated by the characteristics of the health institution.

Section snippets

Settings

This study was conducted at 2 tertiary care hospitals in Rio de Janeiro, Brazil: the Marcilio Dias public hospital and the Copa D’Or private hospital. The public hospital is a military institution located in a suburb where the population is predominately low income. It has 532 beds, and 35 of them are in an intensive care unit (ICU). The private hospital is an institution with 188 beds: 47 of them are in an ICU, and it is located in a wealthy area of the city. There are also public hospitals in

Antimicrobial susceptibility and SCCmec typing

All MRSA isolates were susceptible to linezolid and teicoplanin and resistant to penicillin and cefoxitin by the disk diffusion test. The highest resistance rates were found for erythromycin (96%), ciprofloxacin (93%), and clindamycin (90%). The lowest resistance rate was found for mupirocin (25.2%). Except for mupirocin (P = .006) and chloramphenicol (P = .003), no statistically significant difference was found in relation to bacterial antimicrobial resistance between the 2 hospitals evaluated

Discussion

Some studies have evaluated the epidemiology of MRSA in Brazil and found that a great number of lineages once known to be restricted to other continents are emerging in Brazilian hospitals.9, 11, 27 However, in Brazil there are differences between the public and the private hospitals in terms of the economic profile of the patients and the number of patients per ward.14 In this study, for the first time, the molecular and phenotypic characteristics associated with MRSA isolates were evaluated

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    R.M.F.C. and F.S.C. contributed equally to this work.

    Supported by Brazilian grants from Fundação Carlos Chagas Filho de amparo à pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento Pessoal de Nível Superior (CAPES), Fundação Universitária José Bonifácio (FUJB), and Programa de Núcleos de Excelência (PRONEX).

    Conflicts of interest: None to report.

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