RESUMO
Staphylococcus aureus resistente a meticilina (SAMR) es uno de los principales agentes asociados a infecciones intrahospitalarias; sin embargo, en los últimos años ha surgido como un patógeno emergente de la comunidad, causando infecciones graves, principalmente en jóvenes. Se describen 33 casos de infecciones por SAMR de origen comunitario, diagnosticadas entre mayo de 2005 y junio de 2006 en el HIGA "Eva Perón". Se estudiaron retrospectivamente los aislamientos; se confirmó la resistencia a meticilina mediante la detección del gen mecA, se investigó la presencia de genes que codifican dos factores de virulencia (leucocidina de Panton-Valentine -LPV- y g-hemolisina) y el tipo de casete mec mediante PCR. Todos los pacientes se encontraban sanos previamente. Cuatro pacientes menores de 12 años presentaron bacteriemia, uno con neumonía grave y los 3 restantes con infección osteoarticular; todos los pacientes mayores de 12 años presentaron infecciones de piel y partes blandas sin compromiso sistémico. Se constató la presencia de casete mec tipo IV en todos los aislamientos; la resistencia a meticilina no se acompañó de resistencia a otros antimicrobianos; los aislamientos fueron portadores de genes que codifican para LPV y para g-hemolisina. Es importante considerar la presencia de estas cepas de origen comunitario a fin de elaborar estrategias para su correcto tratamiento.
Methicillin- resistant Staphylococcus aureus (MRSA) is one of the most prevalent pathogens associated with nosocomial infections. However, most recently, MRSA has arisen as an emerging community pathogen, causing serious infections, mainly among young patients. We herein describe 33 cases of infections caused by community-acquired MRSA (CMRSA), diagnosed between May 2005 and June 2006, at "Eva Perón" Hospital. The isolations were retrospectively studied. Methicillin resistance was confirmed by means of the detection of the mecA gene, and the genes for two virulence factors (Panton-Valentine Leucocidin -PVL- and g-haemolysin) as well as the cassette mec type were screened by PCR. All the patients were previously healthy. Four patients under 12, presented bacteremia, one had serious pneumonia, and the three remaining patients had osteoarticular infections; all the patients over 12, had skin and soft tissue infections without systemic damage. The C-MRSA strains harboured cassette mec type IV, and the PVL and g-haemolysin genes. They were methicillin-resistant, with no other associated resistances. It is important to consider the presence of these community- acquired strains in order to develop strategies for their correct treatment.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/microbiologia , Resistência a Meticilina , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Doença Aguda , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/microbiologia , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Proteínas de Bactérias/genética , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla/genética , Hospitais Especializados/estatística & dados numéricos , Resistência a Meticilina/genética , Pneumonia Estafilocócica/epidemiologia , Pneumonia Estafilocócica/microbiologia , Estudos Retrospectivos , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/microbiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificaçãoRESUMO
The aim of this study was to characterize methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered from different infectious sites of hospitalized patients at two university hospitals. Fourteen isolates were analyzed by repetitive sequence based PCR (Rep-PCR), randomly amplified polymorphic DNA assay (RAPD-PCR), and pulsed-field gel electrophoresis (PFGE). We found that a prevalent clone of MRSA, susceptible to rifampin, minocycline, and trimethoprim/sulfamethoxazole (RIF S, MIN S, TMS S) was present in both hospitals in replacement of the multiresistant MRSA South American clone, previously described in these hospitals. The staphylococcal chromosomal cassette (SCCmec) type I element was detected in this new clone.
El objetivo de este trabajo fue la caracterización de aislamientos de Staphylococcus aureus meticilina-resistentes (SAMR), provenientes de diferentes procesos infecciosos de pacientes internados en dos hospitales universitarios. Catorce aislamientos fueron analizados mediante la PCR de secuencias repetitivas (Rep-PCR), la amplificación al azar de ADN polimórfico (RAPD-PCR) y la electroforesis de campo pulsado (PFGE). Encontramos que un clon prevalente de SAMR, sensible a rifampicina, minociclina y trimetoprima-sulfametoxazol (RIF S, MIN S, TMS S) estaba presente en ambos hospitales, reemplazando al clon SAMR y multi-resistente previamente descrito en estos mismos hospitales. En este nuevo clon se detectó el cassette cromosómico estafilocócico SCCmec tipo I.