Background: The carrier state of methicillin-resistant Staphylococcus aureus is pointed as an infection predictor and a factor for environmental and person-to-person dissemination, including health service workers. These, when colonized are commonly associated to outbreaks. Objective: Analyze the prevalence of Staphylococcus aureus in saliva of workers at a university hospital. Methodology: Epidemiologic longitudinal study carried out in Curitiba, Paraná, Brazil, with 486 workers between April 2006 and June 2008. Three saliva samples were collected and a data collection instrument was applied. Staphylococcus aureus were isolated from the clinical specimen and characterized by phenotypes. The data from the instrument and the laboratory results were organized and processed with EPI-Info software and analyzed via descriptive statistics. Results: Among the healthcare workers studied, 60.9% were colonized by Staphylococcus aureus in saliva; of those, 67.9% were transitory carriers and 32.1% were persistent carriers; the prevalence of meticillin-resistant Staphylococcus aureus (MRSA) among the isolated cases was 15.7%. The average prevalence of MRSA was 12.7% and higher among nurses’ aides (21.4%) and cleaning aides (20.6%) and lower among nurses (4.5%) and doctors (5.9%). Conclusions: Healthcare workers presented high prevalence of Staphylococcus aureus in saliva, indicating the mouth as an important body site to investigate colonization by MRSA and a potential source to its dissemination.

Introdução: O estado de portador de Staphylococcus aureus resistente à meticilina é apontado como preditor de infecção e fator para a disseminação ambiental e de pessoa a pessoa, incluindo trabalhadores de serviço de saúde. Estes quando colonizados são freqüentemente associados a surtos. Objetivo: Analisar a prevalência de Staphylococcus aureus na saliva de trabalhadores de hospital universitário. Metodologia: Estudo epidemiológico longitudinal realizado em Curitiba, Paraná, Brasil, com 486 trabalhadores no período de abril de 2006 a junho de 2008 compreendeu a coleta de três amostras de saliva e aplicação de instrumento de coleta de dados. Staphylococcus aureus foram isolados dos espécimes clínicos e caracterizados fenotipicamente. Os dados foram organizados e processados no Programa EPI-Info e analisados por meio de estatística descritiva. Resultados:Entre os trabalhadores investigados, 60,9% estavam colonizados por Staphylococcus aureus na saliva, sendo 67.9% carreadores transitórios e 32.1% carreadores persistentes; a prevalência de Staphylococcus aureus resistente à meticilina (MRSA) entre os isolados foi de 15.7%. A prevalência média de MRSA foi de 12.7% sendo maior entre técnicos em enfermagem (21.4%) e auxiliares de limpeza (20.6%) e menor entre enfermeiros (4.5%) e médicos (5.9%). Conclusões: Os trabalhadores apresentaram alta prevalência de Staphylococcus aureus na saliva, indicando a boca como importante sítio corporal para a investigação da colonização por MRSA e potencial fonte para sua disseminação.

In this study we report the first isolation of VanA-type vancomycin-resistant Enterococcus faecalis strains from two different patients hospitalized in the same intensive care unit at the hospital of Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.

Three Enterococcus faecalis and one Enterococcus faecium strains were characterized by plasmid profile, pulsed-field gel electrophoresis (PFGE) and determination of antimicrobial minimal inhibitory concentrations. VanA elements were characterized by Long PCR, overlapping PCR and DNA sequencing. Enterococcal strains showed resistance to vancomycin and harbored the vanA gene, and three these were teicoplanin susceptible while one showed intermediate resistance to teicoplanin. Two E. faecalis strains showed indistinguishable PFGE profile while the third was unrelated. E. faecalis strains showed a deletion in the right terminal region of the Tn1546-like element. The E. faecium strain showed an insertion element in the vanXY intergenic region. Mutations in VanA elements were not found. Rearrangements in the VanA element could be responsible for incongruities in genotype and phenotype in these strains.

The isolation of vancomycin resistant enterococci (VRE) in Brazil has rapidly increased, following the world wide tendency. We report in the present study the first isolation of vancomycin resistant Enterococcus faecalis (VRE) in the Northeast of Brazil. The four VRE isolates were characterized for antimicrobial susceptibility, genotypic typing by macro restriction of chromosomal DNA followed by pulsed-field gel electrophoresis and for characterization of the Tn1546-like element and plasmid contents. The isolates showed resistance to multiple antibiotics and a single genotype profile, suggesting the dissemination of a single clone among the patients. Tn1546 associated to genetic elements as plasmids shows the importance of infection control measures to avoid the spreading of glycopetide resistance by conjugative transfer of VanA elements.

This study reports the results about antimicrobial resistance of Enterococcus spp. isolated from intestinal tract of patients from a university hospital in Brazil. The identification of strains at species level was performed by conventional biochemical tests, API 20 Strep (bioMérieux), and polymerase chain reaction assay. The specie distribution was E. faecium (34%), followed by E. faecalis (33%), E. gallinarum (23.7%), E. casseliflavus (5.2%), E. avium (1%), and E. hirae (1%). Intrinsic resistance to vancomycin characterized by presence of vanC genes was found in E. gallinarum and E. casseliflavus. The high prevalence of VanC phenotype enterococci is very important because these species have been reported as causing a wide variety of infections. Vancomycin-resistant E. faecium or E. faecalis were not found and no one isolate of these species was a beta-lactamase producer. Thirteen clinical isolates of enterococci (13.4%) showed multiresistance patterns, which were defined by resistance to three classes of antibiotics plus resistance to at least one aminoglycoside (gentamicin and/or streptomycin). The resistance to several antimicrobials shown by enterococcal strains obtained in this study is of concern because of the decrease in the therapeutic options for treatment of infections caused by enterococci.