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Staphylococcus aureus carriage in older populations in community residential care homes: Prevalence and molecular characterization of MRSA isolates
Colonización por Staphylococcus aureus en pacientes institucionalizados en residencias geriátricas: prevalencia y caracterización molecular de los aislados resistentes a meticilina
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"apellidos" => "Alcalá-Minagorre" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X18301976?idApp=UINPBA00004N" "url" => "/0213005X/0000003700000003/v1_201902260636/S0213005X18301976/v1_201902260636/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "<span class="elsevierStyleItalic">Staphylococcus aureus</span> carriage in older populations in community residential care homes: Prevalence and molecular characterization of MRSA isolates" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "172" "paginaFinal" => "175" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Fátima Galán-Sánchez, Maria Pérez-Eslava, Jesús Machuca, Teresa Trujillo-Soto, Jorge Arca-Suarez, Manuel Rodríguez-Iglesias" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Fátima" "apellidos" => "Galán-Sánchez" "email" => array:1 [ 0 => "fatima.galan@uca.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Maria" "apellidos" => "Pérez-Eslava" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Jesús" "apellidos" => "Machuca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Teresa" "apellidos" => "Trujillo-Soto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Jorge" "apellidos" => "Arca-Suarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Manuel" "apellidos" => "Rodríguez-Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "UGC Microbiología, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Salud Barrio Bajo, Arcos de la Frontera, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena y Virgen del Rocío, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colonización por <span class="elsevierStyleItalic">Staphylococcus aureus</span> en pacientes institucionalizados en residencias geriátricas: prevalencia y caracterización molecular de los aislados resistentes a meticilina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 845 "Ancho" => 3003 "Tamanyo" => 162444 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Dendrogram of <span class="elsevierStyleItalic">Sma</span>I-PFGE patterns illustrating genetic relationships between six <span class="elsevierStyleItalic">S. aureus</span> isolates: five from Center 1 and one from Center 3. The dendrogram was created with Fingerprinting 3.0 software (Bio-Rad, Madrid, Spain), using the Dice coefficient with position tolerance settings: 1% optimization and 0.85% position tolerance.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Staphylococcus aureus</span> is a highly versatile pathogen of great importance in human medicine. It is capable of causing a wide variety of diseases, ranging from food poisoning and skin infections to life-threatening conditions such as bacteremia, pneumonia, osteomyelitis and endocarditis. Besides its pathogenic advantages and ability to develop resistance mechanisms, <span class="elsevierStyleItalic">S. aureus</span> is able to colonize humans, primarily the nose.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> Colonization is an important factor in the pathogenesis and epidemiology of infections due to methicillin-susceptible <span class="elsevierStyleItalic">S. aureus</span> (MSSA) and methicillin-resistant <span class="elsevierStyleItalic">S. aureus</span> (MRSA). MRSA colonization is known to increase the risk of subsequent infection in hospital patients and nursing home residents.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The population dynamics of MRSA is undergoing significant change as a result of demographic variations due to the development of more sophisticated and complex healthcare systems (long-term residential care facilities, for example).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> The epidemiology of <span class="elsevierStyleItalic">S. aureus</span> depends on the characteristics of specific populations. In Spain, there are few studies of <span class="elsevierStyleItalic">S. aureus</span> colonization in the elderly population or describing the molecular characteristics of colonizing strains. We conducted a cross-sectional study in order to determine the prevalence and molecular epidemiology of MRSA colonization in an institutionalized population in community nursing homes in Cadiz, Spain.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients, materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A cross-sectional epidemiological study was conducted between September 2016 and May 2017, involving three nursing homes in Cadiz, Spain. A total of 359 eligible residents were asked to provide written informed consent. The distribution of patients was as follows: Center 1 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>160 residents), Center 2 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>120 residents) and Center 3 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>79 residents), with nurse/patient ratios of 0.05, 0.12 and 0.08, respectively. All patients were accommodated in double-rooms. The study was conducted in accordance with the Declaration of Helsinki<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> and approval was obtained from local ethics committees. If a resident was unable to provide informed consent because of documented cognitive difficulties, written informed consent was obtained from their durable power of attorney. Demographic data (age, sex, comorbidities (Charlson scale), functional status (Barthel scale), antibiotic therapy and hospitalization in the last three months) were obtained by chart review.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Samples were obtained on a single day (point prevalence screening) from the anterior nares and axillary areas, which were then streaked onto mannitol salt agar (MSA) and incubated at 35<span class="elsevierStyleHsp" style=""></span>°C for 48<span class="elsevierStyleHsp" style=""></span>h. Bright yellow colonies of <span class="elsevierStyleItalic">S. aureus</span> grown on mannitol agar were identified by MALDI-TOF MS (MALDI-TOF Biotyper 3.1; Microflex, Bruker). Antimicrobial susceptibility testing was performed using the commercialized microdilution PM 33 MicroScan panels (Beckman Coulter, Spain). A cefoxitin disk diffusion method was also used, following EUCAST recommendations (<a id="intr0005" class="elsevierStyleInterRef" href="http://www.eucast.org/">www.eucast.org</a>).</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">SCCmec</span> typing was carried out with multiplex PCR, using previously described primers and conditions.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleItalic">SCCmec</span> amplification products were analyzed by agarose gel electrophoresis, and amplicon size was determined by comparison with a 100<span class="elsevierStyleHsp" style=""></span>bp Lambda DNA ladder (Invitrogen, Carlsbad, CA, USA). Types were then assigned according to the size of the different fragments obtained. Further PCR typing was performed to detect SCC<span class="elsevierStyleItalic">mec</span> IV subtypes IVa, IVb, IVc, IVd, IVg and IVh.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Multilocus sequence typing, amplifying fragments of <span class="elsevierStyleItalic">arcC, aroE, glpF, gmk, pta, tpi</span>, and <span class="elsevierStyleItalic">yqiL</span> housekeeping loci, was performed on all MRSA strains. All amplicons were sequenced, and allelic profiles and ST types were assigned using the MLST database (<a id="intr0010" class="elsevierStyleInterRef" href="http://www.mlst.net/">http://www.mlst.net</a>).<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">PFGE analysis of <span class="elsevierStyleItalic">Sma</span>I-digested DNA was used to determine the degree of genetic relatedness between isolates.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> A dendrogram was constructed with Fingerprinting 3.0 software (Bio-Rad, Madrid, Spain) using the Dice coefficient and position tolerance settings: 1% optimization and 0.85% band position tolerance. Isolates were assigned to different pulsotypes if the similarity coefficient was <80%. Different subtypes were considered for similarity coefficients fluctuating in the 80–95% interval.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The presence of Panton–Valentine leukocidin (PVL) genes (<span class="elsevierStyleItalic">lukS-PV</span> and <span class="elsevierStyleItalic">lukF-PV</span>) was determined by PCR in all <span class="elsevierStyleItalic">S. aureus</span> strains, using the method described by Lina et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> A PVL-positive strain was used as a positive amplification control.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 293 residents were included; 20 patients refused to give their consent and 46 were unable to do so and their durable power of attorney agents could not be contacted. Median age in years was 83.9 (range: 50.7–99.6) and 61.1% were women. Thirty-eight per cent of residents had a Charlson comorbidity score ≥3 and 46.1% scored less than 40 points on the Barthel scale. Thirty-seven per cent of residents had received at least one course of antibiotics in the previous three months.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Overall, 51 (17.4%) of 293 residents were colonized with MSSA and eleven (3.8%) with MRSA. No cases of <span class="elsevierStyleItalic">S. aureus</span> infection were detected during the study. With respect to individual nursing homes, the percentages of MSSA and MRSA were as follows: Center 1: 16%, 6%; Center 2: 14%, 1%; Center 3: 24%, 3%. No significant differences in colonization rate by center were found.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Ten MSSA isolates (19.6%) showed resistance to amikacin, tobramycin and gentamicin, and three (5.8%) to tobramycin and amikacin. Forty-one isolates (80.3%) were resistant to levofloxacin. With respect to macrolides, the cMLS phenotype was detected in 23.6% of MSSA isolates, and the M phenotype in 21.5% (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">SCC<span class="elsevierStyleItalic">mec</span>IVc was detected in all MRSA isolates. ST8 was the main genotype and was detected in all isolates except one (ST125). MRSA antimicrobial susceptibility profiles showed that 2 isolates (18.2%) were resistant to amikacin, tobramycin and gentamicin, and 8 isolates (72.7%) to tobramycin and amikacin. Only one isolate (ST125-MRSA-IVc) was susceptible to all aminoglycosides. All isolates were resistant to levofloxacin. Moreover, ten ST8-MRSA-IVc isolates (90.1%) were resistant to erythromycin and clindamycin (cMLS phenotype) and the M phenotype was detected only in 1 (ST125-MRSA-IVc) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Six isolates, corresponding to ST8-MRSA-IVc (five from Center 1 and one from Center 3) were selected in order to determine the degree of genetic relatedness by PFGE and to assess inter- and intra-nursing home transmission of MRSA. All isolates belonged to the same clone, although two subtypes (91% similarity) were distinguished: A1 (with two pulsotypes, 97% similarity) and A2 (100% similarity) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">None of the 62 <span class="elsevierStyleItalic">S. aureus</span> isolates were positive for the Panton–Valentine leukocidin.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The aim of this study was to determine the prevalence of <span class="elsevierStyleItalic">S. aureus</span> carriage among residents of three community nursing homes with different characteristics in terms of size, number of residents and health personnel, and to characterize the MRSA isolates.</p><p id="par0080" class="elsevierStylePara elsevierViewall">MRSA colonization is known to increase the risk of subsequent infection in hospitalized patients and nursing home residents and can play an important role in the regional spread of MRSA.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In our study, 17.4% of residents were colonized with MSSA and 3.8% with MRSA. These percentages are lower than those reported in community nursing home settings in the USA (21.2% MSSA and 40.7% MRSA).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> In Belgium, Denis et al.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> conducted a cross-sectional study on the prevalence of MRSA carriage among residents in nursing homes and found that 19.9% of residents were MRSA carriers. In Hamburg, however, the number of cases of MRSA colonization among residents of geriatric nursing homes was rather low, 5.5%.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> Similar results have been found in other European countries, with a prevalence of 0% and 0.3% reported in Sweden<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> and the Netherlands,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> respectively. Results of a cross-sectional study among subjects living in long-term-care facilities in southern Spain during 2009–2010 showed that 79 (10.6%) and 67 (9%) were colonized by MRSA and MSSA, respectively.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> In our setting, this low prevalence could be explained by the implementation of effective hand-washing guidelines.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In our study, 80.3% of MSSA isolates exhibited quinolone resistance, which is a much higher rate than that described by Lozano et al. in strains isolated from healthy humans in Spain (3.8%).<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> There are two possible explanations for this situation. First, antibiotics are among the most commonly prescribed drugs in long-term care facilities, accounting for nearly 40% of all prescribed drugs and there is a 70% likelihood of residents receiving at least one course of antibiotics per year. A high percentage of antibiotic treatments are considered inappropriate, which contributes to increased antimicrobial resistance in the elderly population.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> Second, the pattern of antibiotic resistance seems to be correlated with the age of patients. In their recent study of 511 cases of MRSA infection, García et al. concluded that antibiotics that target DNA synthesis (namely fluoroquinolones) result in progressively higher numbers of resistant isolates in the older population.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">All the MRSA isolates in our study were resistant to levofloxacin and almost 91% were resistant to two or three aminoglycosides. These results are similar to those reported by Rodríguez-Baño et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> for healthcare-associated MRSA strains in Spain.</p><p id="par0100" class="elsevierStylePara elsevierViewall">SCC<span class="elsevierStyleItalic">mec</span>IVc was detected in all MRSA isolates in our study and ST8 was detected in all isolates except one (ST125). SCCmec type IV is not a good marker for community isolates in Spain, because it is the most frequent type in healthcare-associated and nosocomial isolates.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20,21</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In a recent study performed by Moreno-Flores et al., the major clonal type detected was ST8-MRSA-IVc (32.6%) in isolates with the oxacillin-resistant only phenotype (32.6%) and ST8 levofloxacin-resistant strains were not identified.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> Differences between this study and ours could be explained by the different populations included. Another interesting finding is that no PVL-positive (MRSA or MSSA) isolates were found in our study. The initial spread of a clone with genetic traits related to those of the USA300 clone (ST8-MRSA-IV-PVL+) has been reported in Spain and seems to be associated with community-acquired infections,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> although at least one case of healthcare-associated infection due to this clone has also been detected.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> Our study has also demonstrated intra-nursing home transmission of ST8-MRSA-IVc.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In the study performed by Vindel et al. in 145 Spanish hospitals, ST125-MRSA-IV was the most prevalent clone in Spain.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> In our study, however, only one isolate belonged to this sequence type. This lineage is associated with aminoglycoside resistance and, to a lesser extent, macrolide resistance and has been reported as causing bacteremia in a Spanish geriatric population.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> Moreno-Flores et al.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> found that strains belonging to this sequence type were levofloxacin-resistant. Although the only ST125-MRSA-IVc isolate in our study showed susceptibility to all aminoglycosides tested, it was resistant to macrolides and levofloxacin.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The limitations of our study are related to the small number of positive results, which makes difficult an adequate statistical analysis. However, our results could be extrapolated to centers with similar characteristics with effective hand-washing implementation. More studies should be conducted in the future to gain knowledge concerning the prevalence and the genetic lineages of <span class="elsevierStyleItalic">S. aureus</span> circulating among nursing homes of different characteristics.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In summary, there was a low rate of <span class="elsevierStyleItalic">S. aureus</span> carriage and a very low prevalence of MRSA detected in the elderly population in our area. ST8 was the predominant clone and only one strain belonged to ST125, although the latter sequence type is considered to be one of the predominant Spanish clones. We observed an evidence of MRSA transmission within nursing homes and a very high rate of quinolone resistance was also observed among MSSA and MRSA isolates, probably associated with the characteristics of the population included in the study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1155806" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1083172" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1155807" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1083171" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients, materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-16" "fechaAceptado" => "2018-05-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1083172" "palabras" => array:5 [ 0 => "Methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>" 1 => "Residential care homes" 2 => "SCC<span class="elsevierStyleItalic">mec</span>" 3 => "ST-8" 4 => "Quinolones" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1083171" "palabras" => array:5 [ 0 => "<span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina" 1 => "Residencias de ancianos" 2 => "SCC<span class="elsevierStyleItalic">mec</span>" 3 => "ST-8" 4 => "Quinolonas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The epidemiology of <span class="elsevierStyleItalic">S. aureus</span> depends on conditions in specific populations. Few studies of <span class="elsevierStyleItalic">S. aureus</span> colonization in the older population have been performed in Spain. The aim of this study was to determine the prevalence of methicillin-resistant <span class="elsevierStyleItalic">S. aureus</span> (<span class="elsevierStyleItalic">MRSA)</span> colonization and its molecular epidemiological characteristics in an institutionalized population in community residential care homes in Cadiz, Spain.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional epidemiological study was conducted in three residential care homes for older people. Axilla and nostril samples were tested. Identification of <span class="elsevierStyleItalic">S. aureus</span> and antimicrobial susceptibility testing were by MALDI-TOF and MicroScan panels. MRSA strains were subjected to <span class="elsevierStyleItalic">SCCmec</span> typing, multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). The presence of Panton–Valentine leukocidin (PVL) genes was determined by PCR in all <span class="elsevierStyleItalic">S. aureus</span> strains.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 293 residents were included. Fifty-one residents (17.4%) were colonized with methicillin-sensitive <span class="elsevierStyleItalic">S. aureus</span> (MSSA) and 11 (3.8%) with MRSA. Resistance to at least two aminoglycosides was observed in 25.4% of MSSA and 90.9% and of MRSA isolates, and resistance to levofloxacin in 80.3% of MSSA and 100% of MRSA isolates. SCC<span class="elsevierStyleItalic">mec</span>IV was detected in all isolates and all except one (ST-125) were ST-8. None of the <span class="elsevierStyleItalic">S. aureus</span> isolates were positive for PVL.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A low rate of <span class="elsevierStyleItalic">S. aureus</span> carriage was detected and the prevalence of MRSA was very low. ST8-MRSA-IVc was the dominant clone, and only one strain belonged to ST125-MRSA-IVc. We found MRSA transmission within the residential care homes and a very high rate of quinolone resistance in MSSA and MRSA.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La epidemiología de <span class="elsevierStyleItalic">S. aureus</span> depende de las condiciones particulares de cada población. En España se han realizado pocos estudios sobre la colonización por <span class="elsevierStyleItalic">S. aureus</span> en la población geriátrica. El objetivo de este estudio es determinar la prevalencia de colonización por <span class="elsevierStyleItalic">S. aureus</span> resistente a meticilina (SARM) y sus características epidemiológicas moleculares en población institucionalizada en residencias de ancianos en Cádiz, España.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio epidemiológico transversal en 3 residencias de ancianos. Se estudiaron muestras de las fosas nasales y axilas. La identificación y las pruebas de sensibilidad se realizaron utilizando MALDI-TOF y paneles MicroScan<span class="elsevierStyleSup">®</span>. En los aislados de SARM se determinó el tipo de SCC<span class="elsevierStyleItalic">mec</span> y se tiparon mediante Multilocus Sequence Typing (MLST) y Pulsed-field Gel Electrophoresis (PFGE). La presencia de genes de la leucocidina de Panton-Valentine (LPV) se determinó mediante PCR en todas las cepas de <span class="elsevierStyleItalic">S. aureus</span>.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 293 residentes. Cincuenta y un residentes (17,4%) estaban colonizados por <span class="elsevierStyleItalic">S. aureus</span> sensible a la meticilina (SASM) y 11 (3,8%) por SARM. Se observó resistencia frente al menos 2 aminoglucósidos en el 25,4 y 90,9% y resistencia a levofloxacino en el 80,3 y 100% de los aislamientos de SASM y SARM, respectivamente. Se detectó SCC<span class="elsevierStyleItalic">mec</span>IV en todos los aislados, y todos, excepto uno (ST-125) correspondían al ST-8. Ninguno de los aislados de <span class="elsevierStyleItalic">S. aureus</span> fue positivo para LPV.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se detectó una baja tasa de portadores de <span class="elsevierStyleItalic">S. aureus</span>, siendo el porcentaje de SARM muy bajo. ST8-MRSA-IVc fue el clon predominante, y solo una cepa pertenecía a ST125-MRSA-IVc. Se objetivó transmisión de SARM intracentro. Se observó una tasa muy alta de resistencia a quinolonas en SASM y SARM.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 845 "Ancho" => 3003 "Tamanyo" => 162444 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Dendrogram of <span class="elsevierStyleItalic">Sma</span>I-PFGE patterns illustrating genetic relationships between six <span class="elsevierStyleItalic">S. aureus</span> isolates: five from Center 1 and one from Center 3. The dendrogram was created with Fingerprinting 3.0 software (Bio-Rad, Madrid, Spain), using the Dice coefficient with position tolerance settings: 1% optimization and 0.85% position tolerance.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resistance profiles \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">(<span class="elsevierStyleItalic">n</span>1/<span class="elsevierStyleItalic">n</span>2, ST)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, ERY \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7/1, ST125 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, AMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, ERY, CLI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GEN, TOB, AMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TOB, AMI, ERY \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, GEN, TOB, AMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, TOB, AMI, ERY \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, GEN, TOB, AMI, ERY \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, GEN, TOB, ERY, CLI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, TOB, AMI, ERY, CLI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/8, ST8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LEV, GEN, TOB, AMI, ERY, CLI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/2, ST8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1973030.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Number of MSSA isolates (<span class="elsevierStyleItalic">n</span>1)/number of MRSA isolates (<span class="elsevierStyleItalic">n</span>2), ST.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">No resistance to GEN, TOB, AMI, LEV, ERY, CLI.</p> <p class="elsevierStyleNotepara" id="npar0015">GEN, gentamicin; TOB, tobramycin; AMI, amikacin; LEV, levofloxacin; ERY, erythromycin; CLI, clindamycin.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial resistance profiles of all isolates included in the study.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differences in epidemiological and molecular characteristics of nasal colonization with <span class="elsevierStyleItalic">Staphylococcus aureus</span> (MSSA-MRSA) in children from a university hospital and day care centers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.A. Rodriguez" 1 => "M.M. Correa" 2 => "S. Ospina" 3 => "S.L. Atehortua" 4 => "J.N. Jimenez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0101417" "Revista" => array:5 [ "tituloSerie" => "PLOS ONE" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "e101417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24987854" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0135" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identifying the risk factors for hospital-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> (MRSA) infection among patients colonized with MRSA on admission" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y. Fukuta" 1 => "C.A. Cunningham" 2 => "P.L. Harris" 3 => "M.M. Wagener" 4 => "R.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 9 | 4 | 13 |
| 2024 September | 13 | 2 | 15 |
| 2024 August | 14 | 1 | 15 |
| 2024 July | 11 | 5 | 16 |
| 2024 June | 14 | 2 | 16 |
| 2024 May | 15 | 6 | 21 |
| 2024 April | 22 | 9 | 31 |
| 2024 March | 17 | 4 | 21 |
| 2024 February | 38 | 3 | 41 |
| 2024 January | 30 | 3 | 33 |
| 2023 December | 22 | 5 | 27 |
| 2023 November | 31 | 9 | 40 |
| 2023 October | 54 | 7 | 61 |
| 2023 September | 30 | 4 | 34 |
| 2023 August | 28 | 4 | 32 |
| 2023 July | 22 | 1 | 23 |
| 2023 June | 36 | 3 | 39 |
| 2023 May | 65 | 4 | 69 |
| 2023 April | 64 | 2 | 66 |
| 2023 March | 37 | 10 | 47 |
| 2023 February | 29 | 5 | 34 |
| 2023 January | 11 | 6 | 17 |
| 2022 December | 19 | 12 | 31 |
| 2022 November | 41 | 11 | 52 |
| 2022 October | 27 | 13 | 40 |
| 2022 September | 21 | 24 | 45 |
| 2022 August | 25 | 20 | 45 |
| 2022 July | 20 | 13 | 33 |
| 2022 June | 18 | 15 | 33 |
| 2022 May | 29 | 20 | 49 |
| 2022 April | 36 | 14 | 50 |
| 2022 March | 31 | 32 | 63 |
| 2022 February | 35 | 12 | 47 |
| 2022 January | 38 | 17 | 55 |
| 2021 December | 26 | 24 | 50 |
| 2021 November | 53 | 17 | 70 |
| 2021 October | 34 | 12 | 46 |
| 2021 September | 18 | 8 | 26 |
| 2021 August | 33 | 11 | 44 |
| 2021 July | 29 | 8 | 37 |
| 2021 June | 24 | 8 | 32 |
| 2021 May | 19 | 8 | 27 |
| 2021 April | 63 | 23 | 86 |
| 2021 March | 16 | 6 | 22 |
| 2021 February | 26 | 13 | 39 |
| 2021 January | 21 | 10 | 31 |
| 2020 December | 13 | 8 | 21 |
| 2020 November | 21 | 3 | 24 |
| 2020 October | 28 | 7 | 35 |
| 2020 September | 30 | 10 | 40 |
| 2020 August | 23 | 10 | 33 |
| 2020 July | 21 | 6 | 27 |
| 2020 June | 20 | 9 | 29 |
| 2020 May | 15 | 8 | 23 |
| 2020 April | 19 | 6 | 25 |
| 2020 March | 22 | 10 | 32 |
| 2020 February | 31 | 8 | 39 |
| 2020 January | 30 | 5 | 35 |
| 2019 December | 34 | 11 | 45 |
| 2019 November | 21 | 9 | 30 |
| 2019 October | 23 | 10 | 33 |
| 2019 September | 31 | 11 | 42 |
| 2019 August | 3 | 0 | 3 |
| 2019 July | 0 | 2 | 2 |
| 2019 June | 6 | 0 | 6 |
| 2019 May | 0 | 2 | 2 |
| 2019 April | 10 | 6 | 16 |
| 2019 March | 123 | 66 | 189 |
| 2019 February | 80 | 34 | 114 |
| 2018 August | 0 | 1 | 1 |
| 2018 June | 0 | 1 | 1 |
Show all
