ReviewEpidemiology of meticillin-resistant Staphylococcus aureus (MRSA) in Latin America
Introduction
Staphylococcus aureus is a major global pathogen that can cause severe infections both in healthy and immunocompromised people. Oxacillin and meticillin were first used in the clinic in the early 1960s, but after only a few years strains of S. aureus appeared that were resistant to these agents, collectively termed meticillin-resistant S. aureus (MRSA). These strains, carrying the mecA gene that confers resistance to meticillin and oxacillin, first spread within the hospital environment and, in more recent times, have also been found circulating in the community [1]. MRSA has been widely disseminated between countries and across continents; >50% of S. aureus isolates now show resistance to meticillin in areas of the USA and some European countries [2], [3], [4]. The rise in cases of MRSA infection is a significant concern for public health since they are associated with increased morbidity and mortality and use of healthcare resources compared with infections caused by non-resistant strains [5], [6].
Knowledge of the local epidemiology of MRSA underpins effective prevention and treatment strategies, including the rational use of antibiotics. In this article, we review the current state of surveillance in the Latin American region where MRSA is highly prevalent but resources are limited. We also discuss the epidemiology and clinical implications both of nosocomial and community-acquired MRSA infections. By summarising currently available data from Latin America, we aim to highlight the pervasiveness of MRSA in the region and raise awareness of the need for important changes in clinical and microbiological practice to combat the escalating challenge presented by this organism.
Section snippets
Surveillance programmes and methodology
Until the year 2000, epidemiological surveillance in Latin America was conducted in only a few countries, including Venezuela and Argentina. Since then, with the support of the Pan American Health Organization (PAHO) and the United States Agency for International Development (USAID), a network for surveillance of bacterial resistance has been organised, which includes the majority of Latin American countries: the Monitoring/Surveillance Network for Resistance to Antibiotics. Criteria for
Conclusions
MRSA is an increasing problem in Latin America, both in the healthcare environment and in the community. In nosocomial S. aureus infections the frequency of meticillin resistance has surpassed 50% in over one-half of the Latin American countries for which data were identified (Fig. 1). Community-acquired MRSA has been reported in Latin America and even though large outbreaks such as the one that occurred in Uruguay, causing 12 deaths, have not been reported elsewhere, this example highlights
References (36)
- et al.
Community-acquired methicillin-resistant Staphylococcus aureus infections
Int J Antimicrob Agents
(2006) - et al.
Community-acquired meticillin-resistant Staphylococcus aureus: an emerging threat
Lancet Infect Dis
(2005) The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus
Clin Infect Dis
(1997)- et al.
Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992–2003
Clin Infect Dis
(2006) - et al.
Methicillin-resistant S. aureus infections among patients in the emergency department
N Engl J Med
(2006) - EARSS Annual Report 2006. http://www.rivm.nl/earss/Images/EARSS%202006%20Def_tcm61-44176.pdf [accessed 8 July...
Epidemiology and economic impact of meticillin-resistant Staphylococcus aureus: review and analysis of the literature
Pharmacoeconomics
(2007)- et al.
Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis
Clin Infect Dis
(2003) ‘Celbenin’-resistant staphylococci
Br Med J
(1961)- et al.
Methicillin-resistant Staphylococcal aureus evolution in Australia over 35 years
Microb Drug Resist
(2000)
Understanding the success of methicillin-resistant Staphylococcus aureus strains causing epidemic disease in the community
J Infect Dis
Identification of novel cytolytic peptides as key virulence determinants for community-associated MRSA
Nat Med
Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database
J Clin Microbiol
Community-associated methicillin-resistant Staphylococcus aureus
Canada. Emerg Infect Dis
Results survey number 7
Revista Panamericana de Infectología
Study of multi-drug resistant microorganisms isolated from blood cultures of hospitalized newborns in Rio de Janeiro city, Brazil
Braz J Microbiol
The prevalence of nosocomial infection in Intensive Care Units in the State of Rio Grande do Sul
Rev Bras Ter Intensiva
Cited by (76)
A multidisciplinary approach to analyze the antimicrobial resistance in natural ecosystems
2024, Environmental ResearchMethicillin resistant Staphylococcus aureus carriage among guinea pigs raised as livestock in Ecuador
2020, One HealthCitation Excerpt :It is usually from 20 to 30%, but can be higher than 50% for children in developing countries like Ecuador (article under preparation). Prevalence of MRSA among SA in humans is also highly variable- from 6 to 80% in Latin America [5], with one report from Ecuador showing a prevalence of almost 50% of MRSA among SA clinical isolates [6]. There are two studies showing nosocomial acquired MRSA in Ecuador, reporting a nasal carriage rate of 2.5% among intensive care unit workers and 45.9% for medical school students respectively [7,8].
Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey
2018, The Lancet Global HealthCitation Excerpt :A remarkably high frequency of vancomycin use was noted in North American and Latin American hospitals (appendix). This high vancomycin use can be explained by the high prevalence of meticillin-resistant Staphylococcus aureus (MRSA) infection reported in Latin American hospitals,23 which is in line with the high proportion of patients who received targeted treatment against MRSA infections in our survey (table 5). Carbapenems (mainly meropenem) were widely prescribed in Latin America and Asia, probably because of the high frequency of infections caused by extended-spectrum β-lactamase-producing Gram-negative bacteria (table 4), which has been reported in previous surveillance studies.24–26
Early switch/early discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections in Brazil
2019, Brazilian Journal of Infectious DiseasesCitation Excerpt :Methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections (cSSTIs), which include all skin and soft tissue infections beyond the superficial and uncomplicated ranging from cellulitis to necrosis, pose an enormous clinical and economic burden within the Brazilian healthcare system.1–3 The prevalence of MRSA infection is increasing in Latin America reaching 40–50% in most of Latin American countries.4,5 In Brazil, 45–64% of S. aureus cultures have been reported to be methicillin-resistant.4,5
Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes
2022, Infection Control and Hospital Epidemiology
- 1
The Latin American Working Group on Gram-Positive Resistance.