To the Editor-Even though methicillin-resistant Staphylococcus aureus (MRSA) colonization and infections have been extensively reported among users who inject illicit drugs, 1,2 studies addressing other illicit drug users (IDUs), 3 alcoholics and psychiatric patients are scarce. 4 Those latter groups are of special concern when admitted to acute-care or long-term care facilities. In these settings, MRSA colonization may be a predisposing factor for invasive infection and/or for spread of potentially hazardous clones. 5 With that in mind, we conducted a survey for asymptomatic colonization with overall Staphylococcus aureus and MRSA among patients from 2 psychiatric care hospitals in Botucatu, inner Brazil. Notably, the use of injection drugs is extremely rare in this country, while there is endemic prevalence of use of inhaled cocaine, crack cocaine and marijuana smoking, and abuse of alcoholic beverages. 6 The study was conducted a reference hospital for short-term admissions of IDUs and alcoholics (70 beds) and a psychiatric hospital with both short and long-term admissions (80 beds). Nasal and oropharyngeal swabs were collected from patients upon admission, except for those in long-term care, who had their swabs collected during their hospital stay, which often lasted years. Species identification and antimicrobial susceptibility tests followed current microbiology practices. MRSA was characterized by amplification of the mecA gene and typing of the staphylococcal chromosome cassette (SCCmec). Molecular strain typing was performed with smaI-or ApaI-based pulsed-field gel electrophoresis (PFGE). A questionnaire was applied to study subjects in the moment of the collection of swabs, and extensive review of their medical charts was performed. Briefly, we assessed information on demographics, sexual behavior, history of previous incarceration, patterns of use of alcohol and illicit drugs. We also recorded the following data for the year previous to inclusion in our study: admissions to acute-care hospitals, invasive procedures (including surgeries), use of antimicrobials, respiratory infection, and skin or

Background: People with diabetes mellitus, especially insulin-dependent diabetic patients, are a risk group for staphylococcal infections. Asymptomatic infection with Staphylococcus aureus is common and favors dissemination of the microorganism, rendering these individuals a source of infection. This study aimed to characterize the resistance profile, clonal profile and sequence type, as well as to analyze the prevalence and risk factors for nasal and oropharyngeal carriage of methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) isolated from insulin-dependent diabetic individuals in the city of Botucatu, SP, Brazil. Methods: Staphylococcus aureus was collected from the nasopharynx and oropharynx of 312 community-dwelling insulin-dependent diabetic individuals over a period of 3 years (October 2015 to December 2018). The isolates were characterized by susceptibility profiling, detection of the mecA gene, SCCmec typing, and molecular typing by PFGE and MLST. The risk factors associated with S. aureus and MRSA carriage were determined by logistic regression analysis. Results: The overall prevalence of colonization with S. aureus and MRSA was 30.4% and 4.8%, respectively. Fifteen of the 112 S. aureus isolates carried the mecA gene; SCCmec type IV was identified in 10 isolates, SCCmec type I in three, and SCCmec type II in two. Among the 15 resistant isolates (MRSA), four were susceptible to oxacillin/cefoxitin by the disc diffusion method and one MSSA isolate was resistant to sulfamethoxazole/trimethoprim. The analysis of risk factors revealed a protective effect of age and lung disease, while lower-extremity ulcers were a risk factor for S. aureus. For MRSA, only male gender was significantly associated as a risk factor in multivariate analysis. Clonal profile analysis demonstrated the formation of clusters among MRSA isolates from different patients, with the identification of ST5-IV, ST5-I, and ST8-IV. Isolates carrying ST398 were identified among MSSA and MRSA (ST398-IV). Conclusion: Our findings reinforce the importance of epidemiological studies of S. aureus carriage, especially in populations at high risk of infections such as diabetics. The data suggest widespread dissemination of MRSA in the population of insulin-dependent diabetic patients studied, as well as the emergence of important lineages among these individuals.

Background People with diabetes mellitus, especially insulin-dependent diabetic patients, are a risk group for staphylococcal infections. Asymptomatic infection with Staphylococcus aureus is common and favors dissemination of the microorganism, rendering these individuals a source of infection. This study aimed to characterize the resistance profile, clonal profile and sequence type, as well as to analyze the prevalence and risk factors for nasal and oropharyngeal carriage of methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) isolated from insulin-dependent diabetic individuals in the city of Botucatu, SP, Brazil. Methods Staphylococcus aureus was collected from the nasopharynx and oropharynx of 312 community-dwelling insulin-dependent diabetic individuals over a period of 3 years (October 2015 to December 2018). The isolates were characterized by susceptibility profiling, detection of the mecA gene, SCCmec typing, and molecular typing by PFGE and MLST. The risk factors associated with S. aureus and MRSA carriage were determined by logistic regression analysis. Results The overall prevalence of colonization with S. aureus and MRSA was 30.4% and 4.8%, respectively. Fifteen of the 112 S. aureus isolates carried the mecA gene; SCCmec type IV was identified in 10 isolates, SCCmec type I in three, and SCCmec type II in two. Among the 15 resistant isolates (MRSA), four were susceptible to oxacillin/cefoxitin by the disc diffusion method and one MSSA isolate was resistant to sulfamethoxazole/trimethoprim. The analysis of risk factors revealed a protective effect of age and lung disease, while lower-extremity ulcers were a risk factor for S. aureus. For MRSA, only male gender was significantly associated as a risk factor in multivariate analysis. Clonal profile analysis demonstrated the formation of clusters among MRSA isolates from different patients, with the identification of ST5-IV, ST5-I, and ST8-IV. Isolates carrying ST398 were identified among MSSA and MRSA (ST398-IV). Conclusion Our findings reinforce the importance of epidemiological studies of S. aureus carriage, especially in populations at high risk of infections such as diabetics. The data suggest widespread dissemination of MRSA in the population of insulin-dependent diabetic patients studied, as well as the emergence of important lineages among these individuals.

No abstract

No abstract