Elevada proporción de Staphylococcus aureus meticilino resistentes aislados en pacientes atendidos en un servicio ambulatorio dermatológico de referencia nacional: cohorte 2010 a 2019 / High proportion of isolated resistant methicillin-resistant Staphylococcus aureus in patients treated in a national refe rence dermatological outpatient service: cohort 2010 to 2019

RESUMEN

Resumen Objetivo: Estimar la resistencia del Staphylococcus aureus frente a diferentes antibióticos usados para el manejo ambulatorio de piodermias. Métodos: Se realizaron análisis descriptivos y de tendencias mediante modelos de regresión segmentada. Resultados: La mayor resistencia se presentó a la oxacilina, con mediana de 54,3% (RIQ 43 - 58,8), seguido de eritromicina con el 20%, (RIQ 15,4 - 26,5), clindami cina con el 14% (RIQ 7,9 - 20), gentamicina con el 7,5% (RIQ 0 -10), trimetoprima/sulfametoxazol (SXT) con el 5,5% (RIQ 4 - 11), y ciprofloxacina con 2,1% (RIQ 2 - 8.4). La tendencia de la resistencia del S. aureus a la oxacilina fue creciente con un cambio anual porcentual no significativo de (0,07) (IC 95% -3,7; 3,9). Para eritromicina, clindamicina, ciprofloxacina, trimetoprima/sulfametoxazol, y gentamicina hubo decrecimiento. Conclusiones: La resistencia del S. aureus a oxacilina fue ligeramente creciente para el periodo 2010 al 2019 y francamente creciente en los últimos 3 años, superando en promedio a lo reportado a nivel país y Latinoamérica. Los antibióticos con menor resistencia fueron ciprofloxacina, SXT, clindamicina para uso sistémico, y ácido fusídico, mupirocina para manejo tópico y descolonización. Es pertinente articular la vigilancia del S. aureus en la atención ambulatoria a la red de vigilancia nacional.

ABSTRACT

Abstract Objective: To estimate the resistance trend of Staphylococcus aureus (S. aureus) against different antibiotics in a reference dermatology outpatient center in Colombia. Methods: Descriptive and trend analyzes were performed using segmented regression models for the period 2010 to 2019. Results: The greatest resistance was presented to oxacillin, with a median of 54.3% (RIQ 43 - 58.8), followed by erythromycin with 20%, (RIQ 15.4 - 26.5), then clindamycin with 14% (RIQ 7.9 - 20), gentamicin with 7.5% (RIQ 0 -10), trimethoprim / sulfamethoxazole (SXT) with 5.5% (RIQ 4 - 11), and ciprofloxacin with 2.1% (RIQ 2 - 8.4). The trend of S. aureus resistance to oxacillin from 2010 to 2019 was increasing with a non-significant Annual Percent Change (APC) of (0.07) (95% CI -3.7, 3.9). APC for erythromycin (-1.2) (95% CI -11.3; 10), clindamycin (-1.7) (95% CI 11; -12.9), ciprofloxacin (-25.4) (95% CI -44.6; 0.5) and trimethoprim / sul famethoxazole (-20.7) (95% CI -43.5; 11.2), were decreasing not significant. For gentamicin the trend was decreasing and significant (-44.2) (95% CI -19.9; -61.1). Conclusions: The resistance of S. aureus to oxacillin exhibited a slightly increasing trend for the period 2010 to 2019 and increasing in the last 3 years, exceeding on average that reported at the country level and the world average. Antibiotics for outpatient management of skin and soft tissue pyoderma with less resistance were ciprofloxacin, SXT, clindamycin for systemic use, and fusidic acid, mupirocin for topical management and decolonization. It is important to articulate surveillance of S. aureus in outpatient care to the national surveillance network.