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Vol. 14. Issue 1.
Pages 71-76 (January - February 2010)
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Vol. 14. Issue 1.
Pages 71-76 (January - February 2010)
Original article
Open Access
Methicillin/Oxacillin-resistant Staphylococcus aureus as a hospital and public health threat in Brazil
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Karinne Spirandelli Carvalho1,*, Elsa Masae Mamizuka2, Paulo P. Gontijo Filho3
1 Universidade Federal de Uberlândia
2 Universidade de São Paulo
3 Universidade Federal de Uberlândia
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Abstract

Methicillin-resistant Staphylococcus aureus is an established nosocomial pathogen (HA-MRSA, hospital acquired MRSA), but has recently begun to appear in the community (CA-MRSA, community acquired MRSA). The cause of resistance to methicillin and all other β-lactam antibiotics is the mecA gene, which is situated on a mobile genetic element, the Staphylococcal Cassette Chromosome mec (SCCmec). Seven major variants of SCCmec, type I to VII are distinguished. HA-MRSA disseminated worldwide and causes the majority of S. aureus nosocomial infections with a limited number of clones disseminated including the Brazilian Epidemic Clone (BEC, ST239-MRSA-III). CA-MRSA isolates are susceptible to non-β-lactam antibiotics, usually isolated from healthy individuals which do not possess any unknown risk factors for MRSA infection and are associated with a larger clonal diversity compared with HA-MRSA. However, during recent years distinction between HA-MRSA and CA-MRSA is beginning to fade. Actually, knowledge about MRSA disseminating clones is required to implement any strategies to control the transmission of MRSA either within hospitals or in community. For this reason, rapid identification of strains is an important issue. The rate of HAMRSA can be reduced substantially through the implementation of interventions strategies, even in settings where MRSA is endemic as in most Brazilian hospitals. However, these policies could be quite complicated in the light of an increasing CA-MRSA prevalence in healthcare facilities, considering that distinction between HA-MRSA and CA-MRSA has started to disappear.

Keywords:
methicillin-resistant Staphylococcus aureus
community acquired methicillin-resistant Staphylococcus aureus
nosocomial infections and community infections
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References
[1.]
B.C. Millar, A. Loughrey, J.S. Elborn, J.E. Moore.
Proposed definitions of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA).
J Hosp Infect, 67 (2007), pp. 109-113
[2.]
M.P. Jevons.
“Celbenin” – resistant Staphylococci.
BMJ, 1 (1961), pp. 124-125
[3.]
M.T. Parker, J.H. Hewitt.
Methicillin resistance in Staphylococcus aureus.
Lancet, 1 (1970), pp. 800-804
[4.]
J.M. Boyce, R.L. White, E.Y. Apruill.
Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infections.
J Infect Dis, 148 (1983), pp. 763
[5.]
P.A. Trindade, J.A. McCulloch, G.A. Oliveira, E.M. Mamizuka.
Molecular Techniques for MRSA Typing: Current Issues and Perspectives.
Braz J Infect Dis, 7 (2003), pp. 32-43
[6.]
H. Sader, R.N. Jones, A.C. Gales, J.B. Silva, A.C. Pignatari, The SENTRY participants.
SENTRY Antimicrobial Surveillance Program Report: Latin America and Brazilian results for 1997 through 2001.
Braz J Infect Dis, 8 (2004), pp. 25-79
[7.]
Carvalho RH. Bactérias resistentes e multirresistentes a antibióticos nos pacientes internados em uma UTI de adultos de hospital universitário brasileiro. Uberlândia, 2007. 38p. Dissertação (Mestrado em Imunologia e Parasitologia Aplicadas) – Programa de Pós-Graduação em Imunologia e Parasitologia Aplicadas – Universidade Federal de Uberlândia, 2007.
[8.]
M.C. Enright, D.A. Robinson, G. Randle, E.J. Feil, H. Grundmann, B.G. Spratt.
The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA).
Proc Natl Acad Sci U S A, 99 (2002), pp. 7687-7692
[9.]
E.E. Udo, J.W. Pearman, W.B. Grubb.
Genetic analysis of community isolates of methicillin-resistant Staphylococcus aureus in Western Australia.
J Hosp Infect, 25 (1993), pp. 97-108
[10.]
B.C. Herold, L.C. Immergluck, M.C. Maranan, et al.
Communityacquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk.
JAMA, 279 (1998), pp. 593-598
[11.]
F. Vandenesch, E. Naimi, M.C. Enright, et al.
Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwild emergence.
Emerg Infect Dis, 9 (2003), pp. 978-984
[12.]
K. Okuma, K. Iwakawa, J.D. Turnidge, et al.
Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community.
J Clin Microbiol, 40 (2002), pp. 4289-4294
[13.]
P. Dufour, Y. Gillet, M. Bes, et al.
Community-acquired methicillin resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin.
Clin Infect Dis, 35 (2002), pp. 819-824
[14.]
H.F. Chambers.
The changing epidemiology of Staphylococcus aureus?.
Emerging Infectious Diseases, 7 (2001), pp. 178-182
[15.]
J. Etienne.
Panton-Valentine leukocidin: a marker of severity for Staphylococcus aureus infection?.
Clin Infect Dis, 41 (2005), pp. 591-593
[16.]
US Centers for Disease Control and Prevention.
Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus – Minnesota and North Dakota, 1997-1999.
MMWR Morb Mortal Wkly Rep, 48 (1999), pp. 707-710
[17.]
Y. Gillet, B. Issartel, P. Vanhems, et al.
Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients.
[18.]
US Centers for Disease Control and Prevention.
Methicillin-resistant Staphylococcus aureus infections among competitive sports participants – Colorado, Indiana, Pennsylvania, and Los Angeles Country, 2000-2003.
MMWR Morb Mortal Wkly Rep, 52 (2003), pp. 793-795
[19.]
B.A. Cunha.
A useful clinical approach to community-acquired methicillin-resistant Staphylococcus aureus CA-MRSA infections.
J Hosp Infect, 68 (2008), pp. 271-272
[20.]
D.P. Levine, R.D. Cushing, J. Jui, W.J. Brown.
Community-acquired methicillin-resistant Staphylococcus aureus endocarditis in the Detroit Medical Center.
Ann Intern Med, 97 (1982), pp. 330-338
[21.]
P.A. Trindade, R.L. Pacheco, S.F. Costa, et al.
Prevalence of SCCmec type IV in nosocomial bloodstream isolates of methicillin-resistant Staphylococcus aureus.
J Clin Microbiol, 43 (2005), pp. 3435-3437
[22.]
O.P. Miranda, M.C. Silva-Carvalho, A. Ribeiro, et al.
Emergence in Brazil of methicillin-resistant Staphylococcus aureus isolates carrying SCCmecIV that are related genetically to the USA800 clone.
Clin Microbiol Infect, 13 (2007), pp. 1165-1172
[23.]
A. Ribeiro, A.Z. Coronado, M.C. Silva-Carvalho, et al.
Detection and characterization of international community-acquired infections by methicillin-resistant Staphylococcus aureus clones in Rio de Janeiro and Porto Alegre cities causing both community-and hospital-associated diseases.
Diagn Microbiol Infect Dis, 59 (2007), pp. 339-345
[24.]
K.S. Carvalho, N.V. da Trindade, P.P. Gontijo Filho.
Aspectos microbiológicos e epidemiológicos de infecções por MRSA suspeitas de CA-MRSA adquiridas em um hospital universitário brasileiro.
Program and abstracts: III Congresso Mineiro de Infectologia Belo Horizonte,
[25.]
J. Kluitmans, A. Van Belkum, H. Verbrugh.
Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms and associated risks.
Clin Microbiol Rev, 10 (1997), pp. 505-520
[26.]
C. Reinert, J.A. McCulloch, S. Watanabe, T. Ito, K. Hiramatsu, E.M. Mamizuka.
Type IV SCCmec found in decade old Brazilian MRSA isolates.
Braz J Infect Dis, 12 (2008), pp. 213-216
[27.]
F.D. Lowy.
Staphylococcus aureus infections.
N. Engl. J. Med, 339 (1998), pp. 520-532
[28.]
F.D. Lowy.
Antimicrobial resistance: the example of Staphylococcus aureus.
J Clin Invest, 111 (2003), pp. 1265-1273
[29.]
S.K. Fridkin, H.A. Hill, N.V. Volkova, et al.
Intensive Care Antimicrobial Resistance Epidemiology Project Hospitals. Temporal changes in prevalence of antimicrobial resistance in 23 US hospitals.
Emerg Infect Dis, 8 (2002), pp. 697-701
[30.]
E.W. Tiemersma, S.L. Bronzwaer, O. Lyytikainen, et al.
European antimicrobial resistance surveillance system participants. Methicillin-resistant Staphylococcus aureus in Europe, 1999–2002.
Emerg Infect Dis, 10 (2004), pp. 1627-1634
[31.]
D.J. Diekema, M.A. Pfaller, F.J. Schmitz, et al.
Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999.
Clin Infect Dis, 32 (2001), pp. S114-S132
[32.]
R.H. Deurenberg, E.E. Stobberingh.
The evolution of Staphylococcus aureus.
Infection, Genetics and Evolution, 8 (2008), pp. 747-763
[33.]
S.E. Cosgrove, Y. Qi, K.S. Kaye, S. Harbarth, A.W. Karchmer, Y. Carmeli.
The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges.
Infect Control Hosp Epidemiol, 26 (2005), pp. 166-174
[34.]
M.R. Moreira, R.L. Cardoso, A.B. Almeida, P.P. Gontijo Filho.
Risk factors and evolution of Ventilator-associated pneumonia by Staphylococcus aureus sensitive or resistant to Oxacillin in patients at Intensive Care Unit of a Brazilian University Hospital.
Braz J Infect Dis, 12 (2008), pp. 499-503
[35.]
D.A. Robinson, M.C. Enright.
Evolution of Staphylococcus aureus by large chromosomal replacements.
J Bacteriol, 186 (2004), pp. 1060-1064
[36.]
B. Hartman, A. Tomasz.
Altered penicillin-binding proteins in methicillin-resistant strains of Staphylococcus aureus.
Antimicrob Agents Chemother, 19 (1981), pp. 726-735
[37.]
T. Ito, K. Okuma, X.X. Ma, H. Yuzawa, K. Hiramatsu.
Insights on antibiotic resistance of Staphylococcus aureus from its whole genome: genomic island SCC.
Drug Resist Updat, 6 (2003), pp. 41-52
[38.]
D.C. Oliveira, A. Tomasz, H. de Lencastre.
The evolution of pandemic clones of methicillin-resistant Staphylococcus aureus: identification of two ancestral genetic backgrounds and the associated mec elements.
Microb Drug Resist, 7 (2001), pp. 349-361
[39.]
T. Ito, X.X. Ma, F. Takeuchi, K. Okuma, H. Yuzawa, K. Hiramatsu.
Novel type V staphylococcal cassette chromosome mec driven by a novel cassette chromosome recombinase, ccrC.
Antimicrob Agents Chemother, 48 (2004), pp. 2637-2651
[40.]
C.L. Wielders, M.R. Vriens, S. Brisse, et al.
In-vivo transfer of mecA DNA to Staphylococcus aureus.
Lancet, 357 (2001), pp. 1674-1675
[41.]
T. Ito, Y. Katayama, K. Asada, et al.
Structural comparison of three types of staphylococcal cassette chromosome mec integrated in the chromosome in methicillin-resistant Staphylococcus aureus.
Antimicrob Agents Chemother, 45 (2001), pp. 1323-1336
[42.]
D.A. Robinson, M.C. Enright.
Evolutionary models of the emergence of methicillin-resistant Staphylococcus aureus.
Antimicrob Agents Chemother, 47 (2003), pp. 3926-3934
[43.]
M.C. Enright.
The evolution of a resistant pathogen – the case of MRSA.
Curr Opin Pharmacol, 3 (2003), pp. 474-479
[44.]
G.J. Moran, A. Krishnadasan, R.J. Gorwitz, G.E. Fosheim, L.K. McDougal, R.B. Carey, Emergency Id Net Study Group, et al.
Methicillin-resistant S. aureus infections among patients in the emergency department.
N Engl J Med, 355 (2006), pp. 666-674
[45.]
M.C. Enright, D.A. Robinson, G. Randle, E.J. Feil, H. Grundmann, B.G. Spratt.
The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA).
Proc Natl Acad Sci U. S. A, 99 (2002), pp. 7687-7692
[46.]
T. Takano, W. Higuchi, T. Otsuka, et al.
Novel characteristics of community-acquired methicillin-resistant Staphylococcus aureus belonging to multilocus sequence type 59 in Taiwan.
Antimicrob Agents Chemother, 52 (2008), pp. 837-845
[47.]
W.J. Wannet, E. Spalburg, M.E. Heck, et al.
Emergence of virulent methicillin-resistant Staphylococcus aureus strains carrying Panton-Valentine leukocidin genes in The Netherlands.
J Clin Microbiol, 43 (2005), pp. 3341-3345
[48.]
A. Tristan, M. Bes, H. Meugnier, et al.
Global distribution of Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus 2006.
Emerg Infect Dis, 13 (2007), pp. 594-600
[49.]
F. Vandenesch, T. Naimi, M.C. Enright, et al.
Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence.
Emerg Infect Dis, 9 (2003), pp. 978-984
[50.]
E. Girou, G. Pujade, P. Legrand, F. Cizeau, C. Brun-Buisson.
Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA.
Clin Infect Dis, 27 (1998), pp. 543-550
[51.]
J.C. Lucet, S. Chevret, I. Durand-Zaleski, C. Chastang, B. Regnier.
Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study.
Arch Intern Med, 163 (2003), pp. 181-188
[52.]
J.A. Jernigan, M.G. Titus, D.H. Groschel, S. Getchell-White, B.M. Farr.
Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus.
Am J Epidemiol, 143 (1996), pp. 496-504
[53.]
J.E. Coia, G.J. Duckworth, D.I. Edwards, et al.
Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection Society; Infection Control Nurses Association. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities.
J Hosp Infect, 63S (2006), pp. S1-S44
[54.]
British Society for Antimicrobial Chemotherapy, Hospital Infection Society, the Infection Control Nurses Association.
Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals.
J Hosp Infect, 39 (1998), pp. 253-290
[55.]
D. Pittet, S. Dharan, S. Touveneau, V. Sauvan, T.V. Perneger.
Bacterial contamination of the hands of hospital staff during routine patient care.
Arch Intern Med, 159 (1999), pp. 821-826
[56.]
J.M. Boyce, G. Potter-Bynoe, C. Chenevert, T. King.
Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications.
Infect Control Hosp Epidemiol, 18 (1997), pp. 622-627
[57.]
H. Grundmann, M. Aires-de-Sousa, J. Boyce, E. Tiemersma.
Emergence and resurgence of meticillin-resistant Staphylococcus aureus as a public-health threat.
[58.]
J.S. Garner.
Guideline for isolation precautions in hospitals. The hospital infection control practices advisory committee.
Infect Control Hosp Epidemiol, 17 (1996), pp. 53-80
[59.]
B.D. Cookson.
The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice.
J Antimicrob Chemother, 41 (1998), pp. 11-18
[60.]
K.R.N. Santos, L.M. Teixeira, G.P. Bravo Neto, L.S. Fonseca, P.P. Gontijo Filho.
Mupirocin- and Methicillin-Resistant Staphylococcus aureus Spreading in an Intermediate-Care Unit in a Brazilian Hospital.
Letter to the editor Infect Control and Hosp Epidemiol, 19 (1998), pp. 622-623
[61.]
Gorwitz RJ, Jernigan DB, Powers JH, Jernigan JA. and Participants in the CDC Convened Experts’ Meeting on Management of MRSA in the Community. Strategies for clinical management of MRSA in the community: Summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. 2006. Available at http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html.
[62.]
J.J. Ruhe, N. Smith, R.W. Bradsher, A. Menon.
Community onset methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: impact of antimicrobial therapy on outcome.
Clin Infect Dis, 44 (2007), pp. 777-784
[63.]
L.G. Miller, C. Quan, A. Shay, et al.
A prospective investigation of outcomes after hospital discharge for endemic, community-acquired methicillin-resistant and -susceptible Staphylococcus aureus skin infection.
Clin Infect Dis, 44 (2007), pp. 483-492
[64.]
D.A. Robinson, A.M. Kearns, A. Holmes.
Re-emergence of early pandemic Staphylococcus aureus as a community-acquired methicillin-resistant clone.
Lancet, 365 (2005), pp. 1256-1258
[65.]
B.A. Diep, S.R. Gill, R.F. Chang, et al.
Complete genome sequence of USA300, an epidemic clone of community-acquired methicillin-resistant Staphylococcus aureus.
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