ABSTRACT
ABSTRACT The spread of pandemic Staphylococcus aureus clones, mainly methicillin-resistant S. aureus (MRSA), must be kept under surveillance to assemble an accurate, local epidemiological analysis. In Ecuador, the prevalence of the USA300 Latin American variant clone (USA300-LV) is well known; however, there is little information about other circulating clones. The aim of this work was to identify the sequence types (ST) using a Multiple-Locus Variable number tandem repeat Analysis 14-locus genotyping approach. We analyzed 132 S. aureus strains that were recovered from 2005 to 2013 and isolated in several clinical settings in Quito, Ecuador. MRSA isolates composed 46.97% (62/132) of the study population. Within MRSA, 37 isolates were related to the USA300-LV clone (ST8-MRSA-IV, Panton-Valentine Leukocidin [PVL] +) and 10 were related to the Brazilian clone (ST239-MRSA-III, PVL−). Additionally, two isolates (ST5-MRSA-II, PVL−) were related to the New York/Japan clone. One isolate was related to the Pediatric clone (ST5-MRSA-IV, PVL−), one isolate (ST45-MRSA-II, PVL−) was related to the USA600 clone, and one (ST22-MRSA-IV, PVL−) was related to the epidemic UK-EMRSA-15 clone. Moreover, the most prevalent MSSA sequence types were ST8 (11 isolates), ST45 (8 isolates), ST30 (8 isolates), ST5 (7 isolates) and ST22 (6 isolates). Additionally, we found one isolate that was related to the livestock associated S. aureus clone ST398. We conclude that in addition to the high prevalence of clone LV-ST8-MRSA-IV, other epidemic clones are circulating in Quito, such as the Brazilian, Pediatric and New York/Japan clones. The USA600 and UK-EMRSA-15 clones, which were not previously described in Ecuador, were also found. Moreover, we found evidence of the presence of the livestock associated clone ST398 in a hospital environment.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Staphylococcal Infections/microbiology , Staphylococcus aureus/genetics , Bacterial Toxins/genetics , Exotoxins/genetics , Leukocidins/genetics , Anti-Bacterial Agents/pharmacology , Staphylococcus aureus/isolation & purification , Staphylococcus aureus/classification , DNA, Bacterial , Microbial Sensitivity Tests , Prevalence , Virulence Factors/genetics , Ecuador , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/classification , Methicillin-Resistant Staphylococcus aureus/genetics , Multilocus Sequence Typing , GenotypeABSTRACT
Una paciente de 83 años, con antecedentes de hipertensión arterial y diabetes mellitus bajo tratamiento, fue ingresó al hospital por un cuadro de sangrado digestivo, caracterizado por melenas y rectorragia, con compromiso hemodinámico. La endoscopia alta y colonoscopia no encontraron el origen del sangrado, por lo cual se empleó una cápsula endoscó- pica. El examen reveló a nivel de yeyuno medio y distal la presencia de sangrado activo proveniente de varios vasos pequeños y tortuosos, ligeramente elevados de diferentes tamaños, lesiones compatibles con múltiples angiodisplasias (foto 1 y 2). Además, a las dos horas del estudio, se visualizó imagen de una lesión ulcerada comprometiendo la luz yeyunal y cubierta con fbrina, sin sangrado activo, que como consecuencia generaba una estenosis luminal, por lo que la cápsula permaneció a este nivel por el lapso de 5 horas (foto 3). La paciente evolucionó con deterioro de su condición médica, fue ingresada a la Unidad de Terapia Intensiva y posteriormente falleció por una falla multiorgánica.
An 83-year-old patient with a history of hypertension arterial and diabetes mellitus under treatment, was admitted to hospital for a picture of digestive bleeding, characterized by mane and rectorragia, with hemodynamic commitment. The high endoscopy and colonoscopy did not find the origin of bleeding, whereby an endoscopic capsule was used pica. The examination revealed at the level of middle and distal jejunum the presence of active bleeding from several vessels small and tortuous, slightly elevated from different sizes, lesions compatible with multiple angiodysplasias (photo 1 and 2). In addition, two hours after the study, it was visualized image of an ulcerated lesion compromising jejunal light and covered with fbrine, without active bleeding, which as consequence generated a luminal stenosis, so the capsule remained at this level for 5 hours (photo 3). The patient evolved with deterioration of her medical condition, she was admitted to the Intensive Care Unit and He subsequently died of a multi-organ failure.