A Review of Prevalence, Antimicrobial Susceptibility Patterns and Molecular Characteristics of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in the Caribbean

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen causing infections resulting in severe morbidity and mortality worldwide. To date, the true nature and extent of MRSA infections in the Caribbean are not well understood. This is a review of the limited studies in the Caribbean describing the prevalence, epidemiology, and molecular characteristics of MRSA in hospitalized and non-hospitalized patients. Relevant articles were searched and extracted from PubMed and Mendeley and a narrative review of the findings was constructed. An aggregate of 24 articles, from 1999 to 2020, was found from 10 of 27 countries. Majority of the studies were from Trinidad and Tobago (29%) and Jamaica (21%) while 50% were from Barbados, Dominican Republic, Martinique, Haiti, Cuba, St. Kits & Nevis, Guadeloupe, and Guyana. Approximately 75% of investigations were conducted on hospitalized patients versus 20% on outpatients. The data revealed geographical differences in the prevalence of MRSA within the Caribbean; 20% - 100% of Staphylococcus aureus clinical isolates from hospitalized patients and outpatients were resistant to methicillin, macrolides, and fluoroquinolones, but susceptible to several non-beta lactam antibiotics, due to the widespread occurrence of CA-MRSA clone ST8 SCCmec IV, PVL positive. There was moderate prevalence of ST72 SCCmec V (14% - 25%) in both hospital and community settings in a few of the countries while ST30 SCCmec IV, PVL positive, was moderately prevalent (27%) only in Dominican Republic. Also, there was moderate prevalence of HA-MRSA ST5 SCCmec II (18%) in community settings in the Dominican Republic and Martinique, but high prevalence of HA-MRSA ST239 SCCmec III (60%) in hospitalized patients in Cuba and Trinidad & Tobago. The epidemiologic profile of MRSA in both hospital and community settings is changing in the Caribbean. Epidemiological studies on outpatient settings and the implementation of stringent hospital infection control measures are needed in the region.