Prospective Multicenter Study of Community-Associated Skin and Skin Structure Infections due to Methicillin-Resistant Staphylococcus aureus in Buenos Aires, Argentina

María José López Furst,Edith Carbone,Marta Mollerach,Silvina Fernández,Flavio Rotryng,Graciana I Morera,Martín E Stryjewski,Noella Gardella,Lautaro De Vedia,María Cristina Ganaha,Sergio Prieto,Nicolás Lista

doi:10.1371/journal.pone.0078303

Abstract

BackgroundCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is now the most common cause of skin and skin structure infections (SSSI) in several world regions. In Argentina prospective, multicenter clinical studies have only been conducted in pediatric populations.ObjectivePrimary: describe the prevalence, clinical and demographic characteristics of adult patients with community acquired SSSI due to MRSA; secondary: molecular evaluation of CA-MRSA strains. Patients with MRSA were compared to those without MRSA.Materials and MethodsProspective, observational, multicenter, epidemiologic study, with molecular analysis, conducted at 19 sites in Argentina (18 in Buenos Aires) between March 2010 and October 2011. Patients were included if they were ≥14 years, were diagnosed with SSSI, a culture was obtained, and there had no significant healthcare contact identified. A logistic regression model was used to identify factors associated with CA-MRSA. Pulse field types, SCCmec, and PVL status were also determined.ResultsA total of 311 patients were included. CA-MRSA was isolated in 70% (218/311) of patients. Clinical variables independently associated with CA-MRSA were: presence of purulent lesion (OR 3.29; 95%CI 1.67, 6.49) and age <50 years (OR 2.39; 95%CI 1.22, 4.70). The vast majority of CA-MRSA strains causing SSSI carried PVL genes (95%) and were SCCmec type IV. The sequence type CA-MRSA ST30 spa t019 was the predominant clone.ConclusionsCA-MRSA is now the most common cause of SSSI in our adult patients without healthcare contact. ST30, SCCmec IV, PVL+, spa t019 is the predominant clone in Buenos Aires, Argentina.

Highlights

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged in different world regions [1] including Latin America [2,3] as a major cause of acute bacterial skin and skin structure infections (SSSI)
CA-MRSA was isolated in 70% (218/311) of patients
Clinical variables independently associated with CA-MRSA were: presence of purulent lesion and age,50 years

Summary

Introduction

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged in different world regions [1] including Latin America [2,3] as a major cause of acute bacterial skin and skin structure infections (SSSI). In Argentina prospective, multicenter, studies with molecular evaluation of community MRSA in patients with SSSI have only been conducted in pediatric populations [5,6]. Based studies have suggested the same clonal predominance of CA-MRSA among Argentinean adults [10] Whether this clone of CA-MRSA is still dominant or has been replaced in adult patient with SSSI in our country needs to be determined. The current study was conducted to establish the prevalence, clinical and molecular characteristics of CA-MRSA in adolescents and adults with SSSI in Argentina. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is the most common cause of skin and skin structure infections (SSSI) in several world regions. In Argentina prospective, multicenter clinical studies have only been conducted in pediatric populations

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Conclusion