ABSTRACT The spread of pandemic Staphylococcus aureus clones, mainly methicillin-resistant S. aureus (MRSA), must be kept under surveillance to assemble an accurate, local epidemiological analysis. In Ecuador, the prevalence of the USA300 Latin American variant clone (USA300-LV) is well known; however, there is little information about other circulating clones. The aim of this work was to identify the sequence types (ST) using a Multiple-Locus Variable number tandem repeat Analysis 14-locus genotyping approach. We analyzed 132 S. aureus strains that were recovered from 2005 to 2013 and isolated in several clinical settings in Quito, Ecuador. MRSA isolates composed 46.97% (62/132) of the study population. Within MRSA, 37 isolates were related to the USA300-LV clone (ST8-MRSA-IV, Panton-Valentine Leukocidin [PVL] +) and 10 were related to the Brazilian clone (ST239-MRSA-III, PVL−). Additionally, two isolates (ST5-MRSA-II, PVL−) were related to the New York/Japan clone. One isolate was related to the Pediatric clone (ST5-MRSA-IV, PVL−), one isolate (ST45-MRSA-II, PVL−) was related to the USA600 clone, and one (ST22-MRSA-IV, PVL−) was related to the epidemic UK-EMRSA-15 clone. Moreover, the most prevalent MSSA sequence types were ST8 (11 isolates), ST45 (8 isolates), ST30 (8 isolates), ST5 (7 isolates) and ST22 (6 isolates). Additionally, we found one isolate that was related to the livestock associated S. aureus clone ST398. We conclude that in addition to the high prevalence of clone LV-ST8-MRSA-IV, other epidemic clones are circulating in Quito, such as the Brazilian, Pediatric and New York/Japan clones. The USA600 and UK-EMRSA-15 clones, which were not previously described in Ecuador, were also found. Moreover, we found evidence of the presence of the livestock associated clone ST398 in a hospital environment.

OBJECTIVE: To establish a resistance (R) surveillance program monitoring antimicrobial susceptibility patterns in Latin America (LATAM; Argentina [ARG], Brazil [BRA], Chile, Colombia [CBA], Costa Rica, Ecuador [ECU], Guatemala [GUA], Mexico [MEX], Panama [PAN], Peru, and Venezuela [VEN]). METHODS: In 2011, 4979 organisms were collected from 11 nations (20 laboratories) for susceptibility testing in a central laboratory design. Antimicrobials were tested by CLSI methods and results interpreted by CLSI and EUCAST breakpoints. Most common Gram-positive (Staphylococcus aureus [SA, 921], other staphylococci [CoNS; 299], enterococci [218], Streptococcus pneumoniae [SPN; 182], β-haemolytic streptococci [115]) and Gram-negative (E. coli [EC; 644], Klebsiella spp. [KSP; 517], Enterobacters [272], Pseudomonas aeruginosa [PSA; 586], Acinetobacters [ACB; 494]) pathogens were analyzed against linezolid (LZD), vancomycin (VAN), tigecycline (TIG), colistin (COL), cefoperazone/sulbactam (C/S), and amikacin (AMK). RESULTS: MRSA rates varied from 29% (CBA, BRA) to 79% (Peru); but LZD (MIC90, 2 mg/L), TIG (MIC90, 0.12mg/L) and VAN (MIC90, 1mg/L) covered all strains. Enterococci showed a 14% VRE rate, highest in BRA and MEX; all inhibited by TIG and daptomycin, but not LZD (three non-susceptible with G2576T mutations or cfr). Penicillin-R among SPN and viridans streptococci was 51.6 and 41.1%, respectively. LZD overall R against Gram-positives was 0.3%. High ESBL rates were observed in EC (54-71%) and KSP (>50%) from GUA, MEX and Peru, and six nations, respectively. Carbapenem-R in KSP was 9%, highest rates associated with KPC in BRA, CBA, ECU, PAN and VEN; also a NDM-1 in KSP from CBA. AMK, TIG, C/S and carbapenems were the broadest-spectrum agents tested against Enterobacteriaceae. Only COL inhibited >90% of PSA; COL and TIG (<2 mg/L) covered >85% of ACB. CONCLUSIONS: LATAM nations demonstrated variable levels of antimicrobial R especially among Enterobacteriaceae (β-lactamase-mediated), PSA and ACB. MRSA (48%), VRE (14%) and multidrug-R SPN were also regional therapeutic challenges.

Os sistemas de vigilância que monitoram a disseminação e divergência das cepas de Staphylococcus aureus resistentes à meticilina MRSA são essenciais para que as medidas preventivas e terapêuticas direcionadas para a infecção por MRSA sejam utilizadas de maneira mais eficaz. A vigilância proporciona informações sobre a disseminação de MRSA, o surgimento de novas cepas em hospitais e comunidades, o perfil de resistência a antibióticos e virulência das cepas, e os fatores de risco associados à infecção. Esses dados ajudam os clínicos a oferecer tratamento empírico apropriado das infecções que circulam em sua região, com melhores resultados para os pacientes. Conquanto as informações sobre epidemiologia do MRSA na América Latina venham avolumando-se, ainda existem lacunas significativas nos dados disponíveis, especialmente em áreas locais em que são poucos os recursos disponíveis para a caracterização e descrição das cepas de MRSA. Neste artigo, descrevemos o que se sabe atualmente sobre a epidemiologia do MRSA associado ao hospital e à comunidade, e oferecemos recomendações para o futuro desenvolvimento de sistemas de vigilância, com vistas ao fornecimento de dados consistentes nos níveis regional, nacional e local.

Surveillance systems monitoring the spread and divergence of methicillin-resistant Staphylococcus aureus (MRSA) strains are critical if preventive and therapeutic measures targeting MRSA infection are to be employed optimally. Surveillance provides information on the spread of MRSA, on the emergence of new strains within hospitals and communities, on the antibiotic resistance profile and virulence of strains, and on the risk factors associated with infection. These data help clinicians to provide appropriate empiric treatment of infections circulating in their region, leading to improved patient outcomes. While information on MRSA epidemiology in Latin America is growing, significant gaps exist in the available data, especially in local areas where fewer resources are available for characterizing and reporting MRSA strains. Here, we describe current knowledge of healthcare- and community-associated MRSA epidemiology in the region, and provide recommendations for future development of surveillance systems with a view to providing robust data at regional, national and local levels

As estratégias para monitoração e controle da propagação das infecções por Staphylococcus aureus resistente à meticilina (MRSA) dependem de um diagnóstico acurado e oportuno de MRSA, tanto no hospital como na comunidade. Na América Latina existe diversidade significativa nos procedimentos diagnósticos e nos testes de sensibilidade, nos níveis regional, nacional e local. São vários os testes para MRSA disponibilizados na clínica, mas a aplicação desses testes difere entre países e dentro do mesmo país, e as medidas de controle de qualidade não são uniformemente aplicadas para a verificação dos diagnósticos. Para que os diagnósticos de infecções por MRSA na América Latina sejam otimizados, faz-se necessária uma abordagem mais consistente. Essa abordagem pode consistir de: adoção e adaptação apropriada das recomendações específicas para testes de MRSA, dependendo dos recursos locais; estabelecimento de um sistema coordenado para controle de qualidade; acesso regional às instituições centrais de referência; educação dos profissionais médicos e paramédicos para as melhores práticas; e desenvolvimento de sistemas objetivando avaliar a implementação de orientações e das melhores práticas.

Strategies to monitor and control the spread of methicillin-resistant Staphylococcus aureus (MRSA) infections are dependent on accurate and timely diagnosis of MRSA in both hospital and community settings. In Latin America, significant diversity in diagnostic and susceptibility testing procedures exists at the regional, national and local levels. Various tests for S. aureus and MRSA are available in clinical settings, but the application of these techniques differs between and within countries, and quality control measures are not uniformly applied to verify diagnoses. To optimize the diagnosis of MRSA infections across Latin America, a more consistent approach is required. This may include: adoption and appropriate adaption of specific guidelines for MRSA testing, depending on local resources; establishment of a coordinated system for quality control; regional access to central reference facilities; education of medical and healthcare professionals in best practices; and development of systems to evaluate the implementation of guidelines and best practices

The frequency of the Beijing genotype of Mycobacterium tuberculosis as a cause of tuberculosis (TB) in South America was determined by analyzing genotypes of strains isolated from patients that had been diagnosed with the disease between 1997 and 2003 in seven countries of the subcontinent. In total, 19 of the 1,202 (1.6%) TB cases carried Beijing isolates, including 11 of the 185 patients from Peru (5.9%), five of the 512 patients from Argentina (1.0%), two of the 252 Brazilian cases (0.8%), one of the 166 patients from Paraguay (0.6%) and none of the samples obtained from Chile (35), Colombia (36) and Ecuador (16). Except for two patients that were East Asian immigrants, all cases with Beijing strains were native South Americans. No association was found between carrying a strain with the Beijing genotype and having drug or multi-drug resistant disease. Our data show that presently transmission of M. tuberculosis strains of the Beijing genotype is not frequent in Latin America. In addition, the lack of association of drug resistant TB and infection with M. tuberculosis of the Beijing genotype observed presently demands efforts to define better the contribution of the virulence and lack of response to treatment to the growing spread of Beijing strains observed in other parts of the world.