Evolución del consumo de antibióticos y de la susceptibilidad antimicrobiana en el Centro Hospitalario Pereira Rossell en la era de Staphylococcus aureus resistente a meticilina

Abstract

Antibiotic consumption and antimicrobial susceptibility evolution in the Centro Hospitalario Pereira Rossell in methicillin resistant Staphylococcus aureus era Introduction: In the past few years, an increase in methicillin resistant-not multiresistant Staphylococcus aureus was observed in Uruguay among children with community acquired infections. Recommendations for empiric antibiotic treatment required adjustments and new national guidelines were recommended in July 2004. Adherence to these guidelines was indirectly performed by monitoring antibiotic consumption and antimicrobial susceptibility patterns in Uruguay. Objective: To describe and compare antibiotic consumption and antimicrobial susceptibility of Staphylococcus aureus in a Pediatric Hospital of the Centro Hospitalario Pereira Rossell (PH-CHPR) between 2001 and 2006. Methods: Antibiotic consumption in hospitalized children was calculated using the Defined Daily Dose per 100 bed-days (DDD/100). Reference values were obtained from the World Health Organization Collaborating Center for Drug Statistics Methodology of. Consumption. Data were obtained using the WinPharma programme of the Pharmacy Department of CHPR. The fraction of annual occupancy of hospital beds was obtained from the Statistic Division of CHPR. Antibiotic consumption was evaluated netween 2001 and 2006 and expressed as DDD/100 and percent change. Antimicrobial susceptibility was evaluated using CHPR's Microbiology Laboratory data during the same time period. Results: After 2003 a significant increase in consumption of clindamycin, ceftriaxone, trimethoprim-sulphamethoxazole, cefuroxime, vancomycin and gentamycin was observed, except for cephradine. Consumption of clindamycin, ceftriaxone and trimethoprim-sulphamethoxazole showed the highest increase (6.15%; 1.44% and 1.17% respectively). Detection of Staphylococcus aureus increased significantly mostly from skin and soft tissue infections. Oxacillin susceptibility of S aureus strains obtained from different sites had a significant and persistent decrease after 2003 (from 81% during year 2001 to 40% in year 2006 (p < 0.05). Susceptibility to others antibiotics did not decrease. Between 2004 and 2006 the "D effect" decreased from 28% to 21%. Antimicrobial susceptibility patterns did not differ by site of infection. Conclusions: Methicillin resistant-not multiresistant Staphylococcus aureus has established itself as a regular community pathogen in Uruguayan children. Changes in antimicrobial consumption patterns reflect the impact of this pathogen in clinical practice and the overall adherence to new recommendations. This change was not associated with an increase in antibiotic resistance. Clindamycin is an alternative treatment although Clindamycin inducible resistance is a worry. Continuous monitoring of antibiotic consumption and local susceptibility patterns are required to promote rational use of antibiotics.

Etiología y evolución de las infecciones osteo-articulares 2009-2015: Hospital Pediátrico del Centro Hospitalario Pereira Rossell, Uruguay

“…Estudios microbiológicos señalan que la gravedad de S. aureus no es una característica exclusiva de las cepas resistentes a meticilina, si bien éstas parecen poseer más atributos de virulencia, como la producción de una proteína de unión al colágeno (CNA) y de una exotoxina la leucocidina de PantonValantine que destruye los neutrófilos del hospedero generando inmunocompromiso y aumentando el riesgo de coagulopatía intravascular. Conduce además a la producción de material purulento más aglutinado, difícil de drenar y erradicar, por lo que el abordaje quirúrgico generalmente es más complejo y frecuente [36][37][38][39] . Las dos muertes se registraron también en este grupo etiológico.…”

Presence of &lt;i&gt;Staphylococcus aureus&lt;/i&gt; in the Nasal Cavity of Children Attending a Public Daycare Center in Francisco Beltr&#227;o—Paran&#225;—Brazil

“…Other authors have reported higher incidence of S. aureus in the nasal cavity of healthy children [14,25]. The highest prevalence was found in males, being this predominance also common in other research with children [26] and adults [27,28].…”

Detection of Vancomycin Resistance among Methicillin-Resistant Staphylococcus aureus Strains Recovered from Children with Invasive Diseases in a Reference Pediatric Hospital

“…Because most reports suggest that the frequency of hVISA, although increasing, is low and related to the use of vancomycin, we proposed to analyze all MRSA strains isolated over an extended period in a reference pediatric hospital which serves children from all over the country and where the use of vancomycin has increased since 2002. In doing so, we may be able to increase the likelihood of recovering strains with DSG to glycopeptides [7,8].…”

“…Most hVISA strains described from Asia, South America and Europe are MRSA isolated from adults and belong to ST5, ST8 and ST239. There are no data about the prevalence and microbiological characteristics of hVISA in MRSA recovered from children in Uruguay [6][7][8]. The aim of this research was to detect decreased susceptibility to glycopeptides (DSG) in MRSA strains isolated from children with invasive diseases assisted at the local reference public hospital between 2009 and 2019.…”