Community-genotype methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Latin America: a systematic review

Leme, Ricardo José de Almeida; Bispo, Paulo José Martins; Salles, Mauro José Costa

doi:10.1016/j.bjid.2021.101539

Cited by 15 publications

(12 citation statements)

References 52 publications

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“…The prevalence of CA-MRSA ST8 SCC mec V, PVL+ among hospitalized patients ranged between 20% and 100% in Trinidad & Tobago, Dominican Republic, Martinique, Jamaica, St Kitts & Nevis, Barbados, and Cuba. This result is consistent with reports of continued expansion of CA-MRSA among hospitalized patients in the United States [51], Europe [52], Asia [53] [54], Africa [48] and Latin America [55], indicating the invasion of these strains into hospitals and they may replace the classical HA-MRSA strains due to their unique characteristics and faster growth patterns [11].…”

Section: Discussionsupporting

confidence: 91%

A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in the Caribbean

Owolabi¹,

Olatunde²

2022

AiM

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Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen causing infections resulting in severe morbidity and mortality worldwide. To date, the true nature and extent of MRSA infections in the Caribbean are not well understood. This is a review of the limited studies in the Caribbean describing the prevalence, epidemiology, and molecular characteristics of MRSA in hospitalized and non-hospitalized patients. Relevant articles were searched and extracted from PubMed and Mendeley and a narrative review of the findings was constructed. An aggregate of 24 articles, from 1999 to 2020, was found from 10 of 27 countries. Majority of the studies were from Trinidad and Tobago (29%) and Jamaica (21%) while 50% were from Barbados, Dominican Republic, Martinique, Haiti, Cuba, St. Kits & Nevis, Guadeloupe, and Guyana. Approximately 75% of investigations were conducted on hospitalized patients versus 20% on outpatients. The data revealed geographical differences in the prevalence of MRSA within the Caribbean; 20% -100% of Staphylococcus aureus clinical isolates from hospitalized patients and outpatients were resistant to methicillin, macrolides, and fluoroquinolones, but susceptible to several non-beta lactam antibiotics, due to the widespread occurrence of CA-MRSA clone ST8 SCCmec IV, PVL positive. There was moderate prevalence of ST72 SCCmec V (14% -25%) in both hospital and community settings in a few of the countries while ST30 SCCmec IV, PVL positive, was moderately prevalent (27%) only in Dominican Republic. Also, there was moderate prevalence of HA-MRSA ST5 SCCmec II (18%) in community settings in the Dominican Republic and Martinique, but high prevalence of HA-MRSA ST239 SCCmec III (60%) in hospitalized patients in Cuba and Trinidad & Tobago. The epidemiologic profile of MRSA in both hospital and How to cite this paper: Owolabi, J.B. and Olatunde, S.K. (2022) A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant Staphylococcus aureus (MRSA) in the Caribbean. Advances in Microbiology, 12, 459-480.

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Section: Discussionsupporting

confidence: 91%

A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in the Caribbean

Owolabi¹,

Olatunde²

2022

AiM

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“…In 2018, a Latin American observational study reported an occurrence of only 8.6% of CA-MRSA infections, with a low prevalence in Brazil [ 7 ]. A systematic review with data from Brazil, Argentina, Uruguay, Guyana, French Guiana, and Mexico showed CA-MRSA infection ranging from 0 to 87.9%, where Argentina presented the highest prevalence, followed by Mexico (51.1%) [ 21 ]. In this same systematic review, the CA-MRSA prevalence in Brazil ranged from 4.5 to 8.6%, reaching 25% in a study of skin infections in patients with dermatological conditions [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and risk factors for mortality among methicillin-resistant Staphylococcus aureus bacteremic patients in Southern Brazil

Riche

Cassol²,

Falci³

et al. 2023

PLoS ONE

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This study aimed to evaluate the epidemiology and 30-day mortality of adult patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. We retrospectively reviewed the demographic and clinical data of adult patients with S. aureus bloodstream infections (BSI), admitted to a tertiary public teaching medical center in Porto Alegre, Southern Brazil, from January 2014 to December 2019. A total of 928 patients with S. aureus BSI were identified in the study period (68.5 per 100,000 patient-years), and the proportion of MRSA isolates was 22% (19–27%). Thus, 199 patients were included in the analyses. The median age was 62 (IQR: 51–74) years, Charlson Comorbidity Index (CCI) median was 5 (IQR: 3–6), the Pitt bacteremia score (PBS) median was 1 (IQR: 1–4), and the most common site of infection was skin and soft tissue (26%). Most infections were hospital-acquired (54%), empirical anti-MRSA treatment was initiated in 34% of the cases, and in 44% vancomycin minimum inhibitory concentration was 1.5mg/L or above. Sixty-two (31.2%) patients died up to 30 days after the bacteremia episode. Patients with more comorbid conditions (higher CCI; aOR 1.222, p = 0.006) and a more severe presentation (higher PBS; aOR 1.726, p<0.001) were independently associated with mortality. Empiric antimicrobial therapy with an anti-MRSA regimen was associated with reduced mortality (aOR 0.319, p = 0.016). Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI in a population with a high incidence of S. aureus bacteremia. Empiric treatment with an anti-MRSA drug was a protective factor. No significant variation in the incidence of S. aureus BSI was recorded throughout the period.

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“…The prospective cohort study published by Muñoz-Gallego et al [33] shows a high frequency of MRSA, with 80% CC5 in PJI associated with treatment failure. In fact, MRSA isolates of hospital origin belonging to CC5 and CC8 are closed related, and spreads globally including within Latin American countries [17,34,35]. Likewise, in the CoNS group, only one strain of S. epidermidis (403) and S. lugdunensis did not harbor mecA gene.…”

Section: Discussionmentioning

confidence: 99%

“…Analysis of SCCmec types in S. aureus isolates identified types I, II, and V. SCCmec I and II are large genetic elements capable of conferring resistance to many antibiotics and are found in hospital-sourced MRSA isolates limiting antibiotic therapy options. On the other hand, SCCmec V are minor genetic elements, harboring few resistant genes and are generally associated with MRSA isolates of community origin [35,38]. Interestingly, the three MRSA isolates were recovered from sonication fluid of osteosynthesis from patients with treatment failure associated with FRI (260 and 371) and spinal infection (215) in which ciprofloxacin had been employed empirically, while cefazolin was used to patients with S. epidermidis (216) and S. lugdunensis infection, and vancomycin to the others.…”

Section: Discussionmentioning

confidence: 99%

Comparative Phenotypic and Genomic Features of Staphylococci from Sonication Fluid of Orthopedic Implant-Associated Infections with Poor Outcome

et al. 2022

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Staphylococcus spp. remain the leading biofilm-forming agents causing orthopedic implant-associated infections (OIAI). This is a descriptive study of phenotypic and genomic features identified in clinical isolates of S. aureus and coagulase-negative Staphylococcus (CoNS) recovered from OIAIs patients that progressed to treatment failure. Ten isolates were identified by matrix-time-of-flight laser-assisted desorption mass spectrometry (MALDI-TOF-MS) and tested for antibiotic susceptibility and biofilm formation. Genotypic characteristics, including, MLST (Multi Locus Sequence Typing), SCCmec typing, virulence and resistance genes were assessed by whole-genome sequencing (WGS). All S. aureus harbored mecA, blaZ, and multiple resistance genes for aminoglycosides and quinolones. All MRSA were strong biofilm producers harboring the complete icaADBC and icaR operon. Seven CoNS isolates comprising five species (S. epidermidis, S. haemolyticus, S. sciuri, S. capitis and S. lugdunensis) were analyzed, with mecA gene detected in five isolates. S. haemolitycus (isolate 95), and S. lugdunensis were unable to form biofilm and did not harbor the complete icaADBCR operon. High variability of adhesion genes was detected, with atl, ebp, icaADBC operon, and IS256 being the most common. In conclusion, MRSA and CoNS isolates carrying genes for biofilm production, and resistance to β-lactam and aminoglycosides are associated with treatment failure in OIAIs.

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Community-genotype methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Latin America: a systematic review

Cited by 15 publications

References 52 publications

A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in the Caribbean

A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in the Caribbean

Epidemiology and risk factors for mortality among methicillin-resistant Staphylococcus aureus bacteremic patients in Southern Brazil

Comparative Phenotypic and Genomic Features of Staphylococci from Sonication Fluid of Orthopedic Implant-Associated Infections with Poor Outcome

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Community-genotype methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Latin America: a systematic review

Cited by 15 publications

References 52 publications

A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt; (MRSA) in the Caribbean

A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt; (MRSA) in the Caribbean

Epidemiology and risk factors for mortality among methicillin-resistant Staphylococcus aureus bacteremic patients in Southern Brazil

Comparative Phenotypic and Genomic Features of Staphylococci from Sonication Fluid of Orthopedic Implant-Associated Infections with Poor Outcome

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A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in the Caribbean

A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in the Caribbean