MRSA dynamic circulation between the community and the hospital setting: New insights from a cohort study. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Barcudi, Danilo; Sosa, Ezequiel J.; Lamberghini, Ricardo; Garnero, Analía; Tosoroni, Dario; Decca, Laura; Gonzalez, Liliana; Kuyuk, María A.; Lopez, Teresa; Herrero, Ivana; Cortes, Paulo; Figueroa, Myrian; Egea, Ana L.; Gagetti, Paula; Fernandez Do Porto, Darío A.; Corso, Alejandra; Turjanski, Adrián G.; Bocco, José L.; Sola, Claudia
• Is Part Of: Journal of infection. Volume 80:Issue 1(2020)
• Page Start: 24
• Page End: 37
• Publication Date: 2020-01
• Subjects: MRSA -- MRSA carriage -- CA-MRSA -- Hospital-acquired infections -- ST5-IV -- ST30-IV -- Argentina; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2019.10.001
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: MRSA carriage at admission was of 4.2%, children: 6.1% and adult: 2.5%, Argentina. Higher CA-MRSAG carriage in children than in adult. All acquisitions were CA-MRSAG, acquisition rate was 2.3/1000 patient-days at-risk. 3.2% of patients admitted for ≥3 days were discharged carrying MRSA, most CA-MRSAG . Most imported and acquired MRSA belonged to CA-MRSA ST30-IV and ST5-IV clones. Summary: Dissemination of methicillin-resistant- Staphylococcus aureus/ (MRSA) is a worldwide concern both in hospitals [healthcare-associated-(HA)-MRSA] and communities [community-associated-(CA)-MRSA]. Knowledge on when and where MRSA colonization is acquired and what clones are involved is necessary, to focus efforts for prevention of hospital-acquired MRSA-infections. Methods: A prospective/longitudinal cohort study was performed in eight Argentina hospitals (Cordoba/ October-December/2014). Surveillance cultures for MRSA (nose-throat-inguinal) were obtained on admission and at discharge. MRSA strains were genetically typed as CA-MRSAG and HA-MRSAG genotypes. Results: Overall, 1419 patients were screened and 534 stayed at hospital for ≥3 days. S. aureus admission prevalence was 30.9% and 4.2% for MRSA. Overall MRSA acquisition rate was 2.3/1000 patient-days-at-risk with a MRSA acquisition prevalence of 1.96% (95%CI: 1.0%-3.4%); 3.2% of patients were discharged back to community with MRSA. CA-MRSAG accounted for 84.6% of imported, 100.0% of hospital-acquired and 94% of discharged MRSA strains. Most imported and acquired MRSA strains belonged to two major epidemic CA-MRSA clones spread in Argentina: PFGEtypeI-ST5-IVa- t 311-PVL + and PFGEtypeN/ST30-IVc- t 019-PVL + . Conclusions: CA-MRSA clones, particularly ST5-IV-PVL + and ST30-IV-PVL +, with main reservoir in the community, not only enter but also are truly acquired within hospital, causing healthcare-associated-hospital-onset infections, having a transmission capacity greater or similar than HA-MRSAG . This information is essential to develop appropriate MRSA infection prevention-control programs, considering hospital and community.