1215. Geographic Distribution of Staphylococcus aureus With Reduced Sensitivity and Resistance to Vancomycin in the Dominican Republic

Abstract

BackgroundResistant Staphylococcus aureus (SA) poses a major challenge to clinicians. The prevalence of methicillin-resistant SA (MRSA) has increased over the past decades, while vancomycin resistance remains rare. Only 14 cases of vancomycin-resistant SA (VRSA) have been described in the United States since 2002. VRSA and SA with reduced susceptibility to vancomycin (VISA) cause high morbidity and mortality. There is a paucity of data on VRSA in developing nations. We seek to define the prevalence and resistance profile of SA in the Dominican Republic (DR).MethodsThis is a retrospective review of resistance patterns of SA isolates from a clinical laboratory in the DR (Amadita Laboratories). Amadita provides services nationwide. Data collected from 2016 to 2017 included SA phenotypic sensitivity patterns and geographic location and income level. VISA and VRSA were defined as having minimum inhibitory (MIC) concentrations between 4 and 8 and MIC >16.ResultsOf 5,372 SA samples, 2,735 (51%) were MRSA, 21 were VISA and 39 were VRSA. VRSA samples were more commonly from Santo Domingo (SD) (Figure 1). Communities in SD with mixed and low incomes had greater burden of VRSA (Figure 2). Antimicrobial susceptibilities are shown in Table 1.Figure 1.VRSA samples in the DR by location.Figure 2.VRSA samples in Metropolitan SD based on income level of communities.Table 1: Antimicrobial Susceptibility for SA Isolates by Drug Resistance Category (%)CiprofloxacinClindamycinErythromycinGentamicinLevofloxacinLinezolidOxacillinQuinupristin-DalfopristinPenicillin GTrimethoprim Sulfamethoxazole (TMP-SMX)RifampinTetracyclinesTigecyclineVISA812333908010052100010010057100VRSA874351948794641006929771100ConclusionIn this nationwide sample, we found an alarming number of VISA and VRSA. Most cases were in metropolitan SD, with lower income communities carrying a higher case burden. Linezolid and TMP-SMX retain activity against VISA and VRSA in the DR. The rise of vancomycin resistance in developing countries and the disproportionate burden on communities of low income is concerning and requires further study. Infection control measures and antimicrobial stewardship interventions may help prevent further spread of resistant strains.Disclosures All authors: No reported disclosures.