Subject(s)
Acinetobacter Infections/epidemiology , Acinetobacter baumannii/isolation & purification , Cross Infection/epidemiology , Imipenem/pharmacology , Temperature , Weather , Acinetobacter baumannii/drug effects , Anti-Bacterial Agents/pharmacology , Brazil/epidemiology , Climate , Cross Infection/microbiology , Drug Resistance, Bacterial , Hospital Units , Humans , Microbial Sensitivity Tests , beta-Lactam Resistance , beta-Lactamases/biosynthesisABSTRACT
BACKGROUND: Methicillin-resistant Staphylococcus aureus poses a threat to elderly living in nursing homes. Studies focusing on the epidemiology of colonization may help in the design of infection control strategies. OBJECTIVE: To identify factors associated with MRSA colonization and the dissemination of clones among nursing home residents. METHODS: Nasal swabs were collected from 300 persons from nine nursing homes in the city of Bauru, Brazil. Resistance to methicillin was identified through amplification of the mecA gene. Strain typing (Pulsed-Field Gel Electrophoresis) and characterization of the Staphylococcal Chromosome Cassette (SCC) mec was performed. Univariate and multivariable models were used to identify predictors of overall S. aureus and MRSA carriage. RESULTS: Rates of S. aureus and MRSA colonization were 17.7 and 3.7%, respectively. Age and recent admission to a hospital were independently associated with colonization with S. aureus. MRSA colonization was associated with living in small (< 15 residents) and medium-sized (15-49 residents) facilities, as well as with recent hospitalization. Most MRSA strains carried SCCmec types II or IV, and there was evidence of clonal spread within and among different facilities. CONCLUSIONS: MRSA may be introduced in nursing homes form hospitals or arise from the community setting. Screening for asymptomatic colonization may identify persons with greater risk for infection, and is advised for residents discharged from acute care hospitals.
Subject(s)
Genes, Bacterial/genetics , Methicillin Resistance/genetics , Methicillin-Resistant Staphylococcus aureus/pathogenicity , Molecular Epidemiology , Nose Diseases/microbiology , Nursing Homes , Staphylococcal Infections/epidemiology , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Brazil/epidemiology , Cross-Sectional Studies , DNA, Bacterial/genetics , Hospitalization , Humans , Methicillin , Methicillin Resistance/drug effects , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/genetics , Microbial Sensitivity Tests , Multivariate Analysis , Penicillin-Binding Proteins/genetics , Prevalence , Risk Factors , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effectsABSTRACT
Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their impact over settings of different complexity are scarce. We performed a study aimed at identifying determinants of VRE emergence and spread in a public hospital consortium (comprising 2 hospitals, with 318 and 57 beds) in inner Brazil. Molecular typing and case-control studies (addressing predictors of acquisition or clonality) were performed. Among 122 authocthonous isolates, 106 were Enterococcus faecium (22 clones), and 16, Enterococcus faecalis (5 clones). Incidence was greater in the small-sized hospital, and a previous admission to this hospital was associated with greater risk of VRE colonization or infection during admission to the larger one. Overall risk factors included comorbidities, procedures, and antimicrobials (piperacillin-tazobactam, cefepime, and imipenem). Risk factors varied among different hospitals, species, and clones. Our findings demonstrate that VRE can spread within low-complexity facilities and from these to larger hospitals.
