Review
Epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) in Latin America

https://doi.org/10.1016/j.ijantimicag.2009.06.005Get rights and content

Abstract

Meticillin-resistant Staphylococcus aureus (MRSA) has become a serious threat to public health worldwide. Ongoing surveillance is essential to support infection control committees and clinicians in the prevention and treatment of infection. However, in Latin America, resources for monitoring the changing epidemiology of MRSA remain limited. In this article, we review the current situation of MRSA in Latin America in order to highlight the need for a more harmonised effort to improve its management. Literature in the PubMed and SciELO databases as well as the website of the Pan American Health Organization were searched for articles and information about the epidemiology of MRSA in Latin America. MRSA is already the leading cause of nosocomial infection in the Latin American region, and the number of reports of community-acquired MRSA infections is also rising. However, the extent of the problem is not fully understood, especially since data tend to come from large hospitals whereas much of the population is served by small community healthcare centres that do not have extensive facilities for performing microbiological surveillance. In conclusion, wider-reaching and co-ordinated programmes to provide regular MRSA surveillance reports are required across the Latin American region.

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

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