Methicillin-resistant Staphylococcus aureus nasal carriage in neonates and children attending a pediatric outpatient clinics in Brazil

Vieira, María Aparecida; Minamisava, Ruth; Pessoa-Júnior, Vicente; Lamaro‐Cardoso, Juliana; Ternes, Yves Mauro Fernandes; André, Maria Cláudia Porfirio; Sgambatti, Sabrina; Kipnis, André; Andrade, Ana Lúcia

doi:10.1016/j.bjid.2013.04.012

Cited by 19 publications

(17 citation statements)

References 29 publications

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“…Moreover, CoNS have been the major reservoirs of resistant genes and their ability to transfer them to S. aureus may influence therapy for patients as vulnerable as neonates. Unlike Ternes et al, who reported SCCmec types I, II, and III as prevalent among nasal CoNS isolates [24], we detect the type V among the CoNS isolates, demonstrating a striking difference for the SCCmec carriage between regions of the same country. Furthermore, 91.7% of our methicillinresistant isolates were non-typeable, reinforcing that CoNS isolates present high variability in their SCCmec structure conformation.…”

Section: Discussioncontrasting

confidence: 97%

“…Among 98 neonates colonized 77.6% had at least one methicillin-resistant Staphylococcus species. Despite the low prevalence of MRSA isolates in our study (2%), similar to that observed by other authors [11,24], the majority of the S. aureus isolates (55.6%) harbored pvl genes. Such a high frequency was previously reported by us, however in a study with pediatric outpatients [25].…”

Section: Discussionsupporting

confidence: 91%

“…Fifty-six percent of the neonates evaluated were colonized by Staphylococcus species. An overall prevalence of 50.9% and 10.3% were detected for CoNS species and S. aureus, respectively, consistent with other studies developed in Brazilian NICUs [23,24]. We did not identify any relation between clinical data and number or species of Staphylococcus isolated.…”

Section: Discussionsupporting

confidence: 90%

“…We identified staphylococcal clones that persisted in the NICU of this study. Worldwide reports for S. aureus isolates show the presence of persistent clones, such as the Brazilian endemic clone (BEC)/ST239 in Brazilian hospitals [18,24], and USA300/ST8 in USA [21]. Unlike another Brazilian NICU report that found BEC as the prevalent clone among nasal isolates [24], the Pediatric clone was the most frequent lineage in our study.…”

Section: Discussioncontrasting

confidence: 77%

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High rate of neonates colonized by methicillin-resistant Staphylococcus species in an Intensive Care Unit

Salgueiro

Seixas

Guimarães

et al. 2019

J Infect Dev Ctries

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Introduction: Staphylococcal colonization is a risk factor for healthcare-associated infections, which are frequent in Neonatal Intensive Care Units (NICU). This study analyzed microbiology, epidemiology and clinical aspects of Staphylococcus spp. colonizing neonates. Methodology: Nasal or periumbilical swabs were evaluated from 175 newborns admitted to a NICU of a Rio de Janeiro hospital from March to September 2009. Clinical data were obtained from the medical records. SCCmec typing and the mecA and Panton-Valentine Leukocidin (PVL) genes were detected by PCR. Clonal diversity was evaluated by pulsed-field gel electrophoresis. Results: Staphylococcus spp. isolates were detected in 98 (56%) neonates, 66.3% of them had birth weight ≤ 2500 g, 62.2% were preterm (˂ 37 weeks) and the mean length of hospitalization was 14.9 days. Among the 133 isolates identified, 48.1% were S. epidermidis, 23.3% S. haemolyticus and 13.5% S. aureus. Methicillin-resistant Staphylococcus isolate was detected in 77.6% of neonates. The methicillin-resistant S. aureus isolates carried the SCCmec type IV, while 94.6% of S. epidermidis and 85.7% of S. haemolyticus presented non-typeable cassettes. Among the S. aureus, 55.6% had PVL genes and the USA800 genotype was prevalent. Two genotypes of S. epidermidis and one of S. haemolyticus clustered 42.2% and 25.8% of the isolates, respectively. S haemolyticus colonization was associated with the use of parenteral nutrition and mechanical ventilation. Conclusion: High rate of neonates colonized by methicillin-resistant Staphylococcus species and the permanence of clones circulating in the NICU highlight the importance for continuous and preventive surveillance in this high-risk population.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 77%

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High rate of neonates colonized by methicillin-resistant Staphylococcus species in an Intensive Care Unit

Salgueiro

Seixas

Guimarães

et al. 2019

J Infect Dev Ctries

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“…According to the authors, replacement of clonal groups over time might be explained by microevolution of the pathogen or by competition to adapt to the hospital environment. Furthermore, the report of the presence of the pediatric clone in central Brazil suggests that this clone is settling in Brazilian hospitals and spreading in the community, increasing the likelihood of expanding its reservoir [31]. …”

Section: Discussionmentioning

confidence: 99%

Characterization of the clonal profile of MRSA isolated in neonatal and pediatric intensive care units of a University Hospital

Pereira

Riboli

Cunha

2014

Ann Clin Microbiol Antimicrob

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BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) are important pathogens in neonatal and pediatric intensive care units, which can cause severe infections in hospitalized children. Detection of the mecA gene and classification of the staphylococcal cassette chromosome mec (SCCmec) permit the characterization of MRSA strains isolated from infections caused by these microorganisms. In contrast, pulsed-field gel electrophoresis (PFGE) is used to type MRSA clones. This method is commonly used to analyze the epidemiology of bacteria causing nosocomial infections. The objective of this study was to detect and characterize MRSA isolated from clinical specimens of children hospitalized in the neonatal and pediatric intensive care units of the University Hospital of the Botucatu Medical School.MethodsA total of 119 S. aureus strains were isolated from clinical specimens and the mecA gene was detected by PCR. SCCmec was detected by multiplex PCR and the clonal profile was analyzed by PFGE.ResultsThe mecA gene was detected in 17.6% (21/119) of the isolates; 42.9% (9/21) of MRSA were characterized as SCCmec type III and 57.1% (12/21) as type IV. Analysis of the clonal profile of these strains revealed three distinct clones, with SCCmec type III being related to the Brazilian endemic clone and type IV to clones JCSC4469 and USA800.ConclusionsReplacement of clonal groups occurred in the neonatal and pediatric units over the period studied, a fact highlighting the importance of improving hygiene practices and control measures of nosocomial infections in these units.

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Neonatal Colonization With Antibiotic-Resistant Pathogens in Low- and Middle-Income Countries

Beaumont,

Kermorvant-Duchemin,

Breurec

et al. 2024

JAMA Netw Open

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ImportanceIn low- and middle-income countries (LMICs), neonatal bacterial infections are mainly caused by Enterobacterales species and Staphylococcus aureus, which are also the leading causes of mortality directly attributable to antimicrobial resistance. As bacterial colonization often precedes infection, better knowledge of colonization is crucial to prevent antibiotic-resistant neonatal sepsis.ObjectiveTo synthesize current evidence on the prevalence of and factors associated with colonization with third-generation cephalosporin–resistant Enterobacterales (3GCRE), carbapenem-resistant Enterobacterales (CRE), and methicillin-resistant S aureus (MRSA) during the first 3 months of life in LMICs.Data SourcesPubMed, Scopus, Web of Science, and the World Health Organization Global Index Medicus were searched for articles published from January 1, 2000, through July 29, 2024.Study SelectionIncluded studies were conducted in LMICs and reported prevalence rates or factors associated with colonization with 3GCRE, CRE, or MRSA in neonates and infants up to 3 months of age. Outbreak reports were excluded.Data Extraction and SynthesisData extraction and risk-of-bias assessment using a Joanna Briggs Institute tool were performed by 2 independent reviewers. Pooled prevalence for each pathogen was computed using a random-effects model. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.Main Outcomes and MeasuresPrevalence of and factors associated with 3GCRE, CRE, and MRSA colonization.ResultsOf the 3147 articles identified in the search, 67 studies (51 for 3GCRE and CRE and 16 for MRSA) including 17 152 individuals were eligible. The pooled prevalence of 3GCRE colonization was 30.2% (95% CI, 21.4%-40.7%; τ2 = 1.48; I2 = 95.1%), varying from 18.2% (95% CI, 10.8%-29.1%) in nonhospitalized individuals to 48.2% (95% CI, 36.4%-60.2%) in hospitalized individuals. The prevalence of CRE colonization was 2.6% (95% CI, 0.7%-8.8%; τ2 = 7.79; I2 = 95.6%), while it was 2.7% (95% CI, 1.0%-6.7%; τ2 = 2.58; I2 = 93.5%) for MRSA. Increased risk of colonization with 3GCRE was associated with hospital birth (odds ratio [OR], 1.87; 95% CI, 1.33-2.64), neonatal antibiotic use (OR, 2.96; 95% CI, 1.43-6.11), and prolonged rupture of membranes (OR, 3.86; 95% CI, 2.19-6.84).Conclusions and RelevanceIn this systematic review and meta-analysis of antibiotic-resistant pathogen carriage in individuals aged 0 to 3 months, the pooled prevalence was substantial despite a limited exposure period. Although high heterogeneity between studies limited extrapolation of results, the findings highlight the need for further investigation to identify transmission routes and to design targeted and effective preventive measures.

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Methicillin-resistant Staphylococcus aureus nasal carriage in neonates and children attending a pediatric outpatient clinics in Brazil

Abstract: Despite the high antibiotic pressure in our area, and the cross transmission of the healthcare-associated methicillin-resistant S. aureus clones between neonatal intensive care units and outpatients, the prevalence of methicillin-resistant S. aureus carriage is still low in our setting.

Cited by 19 publications

References 29 publications

High rate of neonates colonized by methicillin-resistant Staphylococcus species in an Intensive Care Unit

High rate of neonates colonized by methicillin-resistant Staphylococcus species in an Intensive Care Unit

Characterization of the clonal profile of MRSA isolated in neonatal and pediatric intensive care units of a University Hospital

Neonatal Colonization With Antibiotic-Resistant Pathogens in Low- and Middle-Income Countries

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