Methicillin-resistant <i>Staphylococcus aureus</i> isolated from an intensive care unit in Minas Gerais, Brazil, over a six-year period

Nascimento, Thiago C.; Diniz, Cláudio G.; Silva, Vânia L.; Ferreira-Machado, Alessandra B.; Fajardo, Marina O.; de Oliveira, Tamara Lopes R.; Ferreira, Dennis de C.; Cavalcante, Fernanda S.; Santos, Kátia R. Netto dos

doi:10.1016/j.bjid.2017.10.004

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Brazilian Journal of Infectious Diseases

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Brief communications • Braz J Infect Dis 22 (1) • Jan-Feb 2018 • https://doi.org/10.1016/j.bjid.2017.10.004 copy

Methicillin-resistant Staphylococcus aureus isolated from an intensive care unit in Minas Gerais, Brazil, over a six-year period

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

To characterize methicillin-resistant Staphylococcus aureus isolates from an intensive care unit of a tertiary-care teaching hospital, between 2005 and 2010. A total of 45 isolates were recovered from patients admitted to the intensive care unit in the study period. Resistance rates higher than 80% were found for clindamycin (100%), erythromycin (100%), levofloxacin (100%), azithromycin (97.7%), rifampin (88.8%), and gentamycin (86.6%). The SCCmec typing revealed that the isolates harbored the types III (66.7%), II (17.8%), IV (4.4%), and I (2.2%). Four (8.9%) isolates carried non-typeable cassettes. Most (66.7%) of the isolates were related to the Brazilian endemic clone from CC8/SCCmec III, which was prevalent (89.3%) between 2005 and 2007, while the USA100/CC5/SCCmec II lineage emerged in 2007 and was more frequent in the last few years. The study showed high rates of antimicrobial resistance among methicillin-resistant S. aureus isolates and the replacement of Brazilian clone, a well-established hospital lineage, by the USA100 in the late 2000s, at the intensive care unit under study.

Keywords:
Clonal complex; MRSA; PFGE lineages; SCCmec

Antimicrobial agent	Minimal Inhibitory Concentration (µg/mL)			No (%) of resistant isolates
	MIC₅₀	MIC₉₀	Range	No (%) of resistant isolates
Azithromycin	>1024.0	>1024.0	0.5->1024.0	44 (97.7)
Chloramphenicol	32.0	64.0	4.0-128.0	29 (64.4)
Clindamycin	>1024.0	>1024.0	512.0->1024.0	45 (100)
Erythromycin	512.0	512.0	256.0-512.0	45 (100)
Gentamicin	128.0	1024.0	0.125->1024.0	39 (86.6)
Levofloxacin	4.0	16.0	2.0-32.0	45 (100)
Linezolid	2.0	2.0	1.0-2.0	0 (0)
Rifampin	2.0	256.0	0.0625->1024.0	40 (88.8)
Tetracycline	32.0	64.0	0.0625-128.0	31 (68.8)
Trimethoprim/sulfamethoxazole	32.0/608.0	128.0/2432.0	0.0625/2.3-1024.0/19,456.0	32 (71.1)
Vancomycin	1.0	2.0	0.5-2.0	0 (0)

Isolate number	Isolation date (mm/dd/yy)	Bed	Age (years)	Clinical source	Comorbidity	SCCmec type	Clonality^a a According to Cockfield et al.17 /CC	Antimicrobial resistance profile
1	01/11/05	04	77	Blood	Bladder cancer	III	BEC/8	A C E G L R S T
2	01/18/05	01	79	TS	Stomach cancer	III	BEC/8	A C E G L R S T
3	03/08/05	03	35	Urine	Respiratory failure	III	BEC/8	A H C E G L R S T
4	05/17/05	03	78	TS	Pneumonia	III	BEC/8	A H C E G L R S T
5	07/18/05	01	69	Blood	Bladder cancer	III	BEC/8	A H C E G L R S T
6	07/24/05	02	40	TS	Respiratory failure	III	BEC/8	A C E G L R S T
7	07/25/05	01	48	TS	Incarcerated hernia	III	BEC/8	A C E G L R S T
8	08/31/05	04	25	PL	Ascitis	NT	ND/ND	A C E G L R S T
9	09/08/05	03	69	Blood	Coronary artery disease	III	BEC/8	A H C E G L R S T
10	09/06/06	05	75	CT	Fahr disease	III	BEC/8	A C E G L R S T
11	09/23/06	02	66	TS	COPD	III	BEC/8	A C E G L R S T
12	10/09/06	02	60	TS	COPD	III	BEC/8	A H C E G L R S T
13	12/06/06	03	81	Blood	COPD	III	BEC/8	A C E G L R S T
14	12/09/06	04	23	TS	Acute intermittent porphyria	III	BEC/8	A H C E G L R S T
15	12/11/06	05	69	TS	Chronic kidney disease	III	BEC/8	A H C E G L R S T
16	12/18/06	03	53	CT	Rheumatoid arthritis	III	BEC/8	A H C E G L R S T
17	01/30/07	01	53	TS	Rheumatoid arthritis	III	BEC/8	A H C E G L R S T
18	02/04/07	01	56	TS	Neurogenic bladder	II	USA100/5	A H C E G L R
19	02/28/07	01	41	PL	Acute pancreatitis	III	BEC/8	A H C E G L R S T
20	03/25/07	02	76	TS	Cerebrovascular accident	III	BEC/8	A H C E G L R S T
21	04/02/07	04	54	Blood	Hodgkin lymphoma	II	USA100/5	A C E G L R
22	06/25/07	03	61	CT	Hemothorax	III	BEC/8	A H C E G L R S T
23	07/08/07	04	42	SS	Pancreatitis	III	BEC/8	A H C E G L R S T
24	09/10/07	06	35	TS	Aids	III	BEC/8	A H C E G L R S T
25	09/18/07	03	74	TS	Extrapontine myelinolysis	III	BEC/8	A H C E G L R S T
26	12/04/07	04	73	Blood	Bladder cancer	III	BEC/8	A H C E G L R S T
27	12/24/07	01	51	PL	Cirrhosis	III	BEC/8	A H C E G L R S T
28	12/31/07	01	73	Blood	Malnutrition	III	BEC/8	A C E G L R S T
29	01/14/08	02	23	CT	Diabetes mellitus	IV	USA800/5	C E G L T
30	01/30/08	03	65	TS	Chronic kidney disease	III	BEC/8	A H C E L R S T
31	02/03/08	02	84	TS	Respiratory failure	IV	USA400/1	A H C E G L
32	02/07/08	06	59	CT	Cirrhosis	III	BEC/8	A H C E G L R S T
33	03/16/08	03	81	CT	Acute kidney injury	NT	ND	A C E L S
34	08/16/08	06	61	Blood	Myocardial infarction	NT	ND	A C E G L R
35	10/13/08	01	65	SS	Appendicitis	I	USA500/5	A C E G L
36	07/18/09	03	42	TS	Renal transplantation	NT	ND	A H C E L R
37	08/03/09	05	19	TS	Pneumonia	II	USA100/5	A H C E L R
38	08/09/09	01	78	TS	Breast cancer	II	USA100/5	A H C E G L R
39	08/17/09	06	79	TS	COPD	II	USA100/5	A H C E G L R
40	12/14/09	01	83	TS	Cholangitis	III	BEC/8	A H C E G L R S T
41	02/06/10	02	44	TS	Acute kidney injury	II	USA100/5	A H C E G L R
42	02/21/10	04	98	TS	Aplastic anemia	III	BEC/8	A H C E G L R S
43	04/18/10	06	35	TS	Aids	III	BEC/8	A H C E G L R S T
44	08/25/10	06	59	Blood	Necrosis in amputation	II	USA100/5	A C E L
45	11/30/10	04	62	TS	Acute kidney injury	II	USA100/5	A C E L R

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[1] *Corresponding author. santoskrn@micro.ufrj.br