Epidemiological and biological characteristics of methicillin-resistant staphylococcal infections in a Mexican hospital.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has spread worldwide since 1960. However, there is little information concerning methicillin-resistant coagulase-negative staphylococci (MRCNS) infections. METHODS: In order to study the clinical and epidemiological characteristics of methicillin-resistant staphylococci (MRS) infections and to determine the relationship between MRS and both synergistic hemolysis (SH) and slime production (SP), a laboratory-based survey and non-matched case-control study were carried out at a tertiary-care center in Mexico City. In regard to patients, from May 1991 to October 1992, 46 cases of MRS infection and 86 patients (controls) infected by methicillin-susceptible staphylococci (MSS) were included. Clinical and epidemiologic variables were analyzed. The isolates were identified and tested for antimicrobial susceptibility by standard methods. An MIC of oxacillin > or = 8 micrograms/mL was defined as an MRS. RESULTS: During the study, 94 nosocomial staphylococcal infections were diagnosed: S. aureus, 35 and CNS, 59; 43 (45.7%) by MRS (rate of MRS infections was 1.12 per 100 in-patients); 2 MRSA; 41 MRCNS, and only 19 were symptomatic. Three infections were community-acquired, including one MRSA and two MRCNS. After multivariate analysis, the significant risk factors were previous antimicrobial therapy (p = 0.013) and catheter-related (p = 0.009) and urinary-tract source (p = 0.0001). Forty-nine percent of MRS showed SH while only 15% of MSS (p < 0.001) showed SH, especially in 10/10 MR-S. hemolyticus. Additionally, 48% of MRCNS showed SP, as did 18% of MSCNS (p = 0.019), particularly in 15/20 MR-S. epidermidis. Of all MRS isolates, 38% showed a homogeneous phenotype, a trait associated with multi-drug resistance (p < 0.01) and SH (p < 0.001). CONCLUSIONS: CNS predominated as the cause of MRS infections in our setting. The homogenous phenotype was associated with SH and multi-drug resistance.

Strongyloidiasis detected by the agar plate culture method among patients infected by HIV.

To evaluate the rate of strongyloidiasis among HIV/AIDS patients, stools and duodenal juice were examined using the agar plate culture method. From January to June 1993, a total of 60 HIV/AIDS patients were required for duodenal aspirate and three serial samples of freshly passed stools. Stools and duodenal aspirate were dispensed on an agar plate culture; after incubation at 28 degrees C during 48 h, screening of plates was made at 10 x. The presence of furrows and worms of short buccal chamber and prominent genital primordium were positive for Strongyloides stercoralis. Most patients were men (91.7%); their mean age, of 33.9 years (SD +/- 10.6); their median CD4(+) T-cells count, of 105/microL (range of 12 to 646). S. stercoralis was detected in three patients (5%). In duodenal juice, the three patients showed the parasite, but in feces, only two (3.3%). In these two individuals, the worms were found in feces by agar culture and Faust's concentration method. The rate of S. stercoralis in feces of HIV/AIDS individuals (3.3%) by agar culture method was similar to that formerly reported from the general Mexican population (2.9%) using standard concentration procedures. Hence, in this immunocompromised population of a low prevalence city, there was no advantage to using an agar plate culture for strongyloidiasis.