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Original article
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
Fátima Galán-Sáncheza,
Corresponding author
fatima.galan@uca.es

Corresponding author.
, Maria Pérez-Eslavab, Jesús Machucac, Teresa Trujillo-Sotoa, Jorge Arca-Suareza, Manuel Rodríguez-Iglesiasa
a UGC Microbiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
b Centro de Salud Barrio Bajo, Arcos de la Frontera, Cádiz, Spain
c Unidad Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena y Virgen del Rocío, Sevilla, Spain
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    "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&#46; It is capable of causing a wide variety of diseases&#44; ranging from food poisoning and skin infections to life-threatening conditions such as bacteremia&#44; pneumonia&#44; osteomyelitis and endocarditis&#46; Besides its pathogenic advantages and ability to develop resistance mechanisms&#44; <span class="elsevierStyleItalic">S&#46; aureus</span> is able to colonize humans&#44; primarily the nose&#46;<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&#46; aureus</span> &#40;MSSA&#41; and methicillin-resistant <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;MRSA&#41;&#46; MRSA colonization is known to increase the risk of subsequent infection in hospital patients and nursing home residents&#46;<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 &#40;long-term residential care facilities&#44; for example&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> The epidemiology of <span class="elsevierStyleItalic">S&#46; aureus</span> depends on the characteristics of specific populations&#46; In Spain&#44; there are few studies of <span class="elsevierStyleItalic">S&#46; aureus</span> colonization in the elderly population or describing the molecular characteristics of colonizing strains&#46; 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&#44; Spain&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients&#44; materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A cross-sectional epidemiological study was conducted between September 2016 and May 2017&#44; involving three nursing homes in Cadiz&#44; Spain&#46; A total of 359 eligible residents were asked to provide written informed consent&#46; The distribution of patients was as follows&#58; Center 1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>160 residents&#41;&#44; Center 2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>120 residents&#41; and Center 3 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79 residents&#41;&#44; with nurse&#47;patient ratios of 0&#46;05&#44; 0&#46;12 and 0&#46;08&#44; respectively&#46; All patients were accommodated in double-rooms&#46; 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&#46; If a resident was unable to provide informed consent because of documented cognitive difficulties&#44; written informed consent was obtained from their durable power of attorney&#46; Demographic data &#40;age&#44; sex&#44; comorbidities &#40;Charlson scale&#41;&#44; functional status &#40;Barthel scale&#41;&#44; antibiotic therapy and hospitalization in the last three months&#41; were obtained by chart review&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Samples were obtained on a single day &#40;point prevalence screening&#41; from the anterior nares and axillary areas&#44; which were then streaked onto mannitol salt agar &#40;MSA&#41; and incubated at 35<span class="elsevierStyleHsp" style=""></span>&#176;C for 48<span class="elsevierStyleHsp" style=""></span>h&#46; Bright yellow colonies of <span class="elsevierStyleItalic">S&#46; aureus</span> grown on mannitol agar were identified by MALDI-TOF MS &#40;MALDI-TOF Biotyper 3&#46;1&#59; Microflex&#44; Bruker&#41;&#46; Antimicrobial susceptibility testing was performed using the commercialized microdilution PM 33 MicroScan panels &#40;Beckman Coulter&#44; Spain&#41;&#46; A cefoxitin disk diffusion method was also used&#44; following EUCAST recommendations &#40;<a id="intr0005" class="elsevierStyleInterRef" href="http://www.eucast.org/">www&#46;eucast&#46;org</a>&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">SCCmec</span> typing was carried out with multiplex PCR&#44; using previously described primers and conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleItalic">SCCmec</span> amplification products were analyzed by agarose gel electrophoresis&#44; and amplicon size was determined by comparison with a 100<span class="elsevierStyleHsp" style=""></span>bp Lambda DNA ladder &#40;Invitrogen&#44; Carlsbad&#44; CA&#44; USA&#41;&#46; Types were then assigned according to the size of the different fragments obtained&#46; Further PCR typing was performed to detect SCC<span class="elsevierStyleItalic">mec</span> IV subtypes IVa&#44; IVb&#44; IVc&#44; IVd&#44; IVg and IVh&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Multilocus sequence typing&#44; amplifying fragments of <span class="elsevierStyleItalic">arcC&#44; aroE&#44; glpF&#44; gmk&#44; pta&#44; tpi</span>&#44; and <span class="elsevierStyleItalic">yqiL</span> housekeeping loci&#44; was performed on all MRSA strains&#46; All amplicons were sequenced&#44; and allelic profiles and ST types were assigned using the MLST database &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://www.mlst.net/">http&#58;&#47;&#47;www&#46;mlst&#46;net</a>&#41;&#46;<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&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> A dendrogram was constructed with Fingerprinting 3&#46;0 software &#40;Bio-Rad&#44; Madrid&#44; Spain&#41; using the Dice coefficient and position tolerance settings&#58; 1&#37; optimization and 0&#46;85&#37; band position tolerance&#46; Isolates were assigned to different pulsotypes if the similarity coefficient was &#60;80&#37;&#46; Different subtypes were considered for similarity coefficients fluctuating in the 80&#8211;95&#37; interval&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The presence of Panton&#8211;Valentine leukocidin &#40;PVL&#41; genes &#40;<span class="elsevierStyleItalic">lukS-PV</span> and <span class="elsevierStyleItalic">lukF-PV</span>&#41; was determined by PCR in all <span class="elsevierStyleItalic">S&#46; aureus</span> strains&#44; using the method described by Lina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> A PVL-positive strain was used as a positive amplification control&#46;</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&#59; 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&#46; Median age in years was 83&#46;9 &#40;range&#58; 50&#46;7&#8211;99&#46;6&#41; and 61&#46;1&#37; were women&#46; Thirty-eight per cent of residents had a Charlson comorbidity score &#8805;3 and 46&#46;1&#37; scored less than 40 points on the Barthel scale&#46; Thirty-seven per cent of residents had received at least one course of antibiotics in the previous three months&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Overall&#44; 51 &#40;17&#46;4&#37;&#41; of 293 residents were colonized with MSSA and eleven &#40;3&#46;8&#37;&#41; with MRSA&#46; No cases of <span class="elsevierStyleItalic">S&#46; aureus</span> infection were detected during the study&#46; With respect to individual nursing homes&#44; the percentages of MSSA and MRSA were as follows&#58; Center 1&#58; 16&#37;&#44; 6&#37;&#59; Center 2&#58; 14&#37;&#44; 1&#37;&#59; Center 3&#58; 24&#37;&#44; 3&#37;&#46; No significant differences in colonization rate by center were found&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Ten MSSA isolates &#40;19&#46;6&#37;&#41; showed resistance to amikacin&#44; tobramycin and gentamicin&#44; and three &#40;5&#46;8&#37;&#41; to tobramycin and amikacin&#46; Forty-one isolates &#40;80&#46;3&#37;&#41; were resistant to levofloxacin&#46; With respect to macrolides&#44; the cMLS phenotype was detected in 23&#46;6&#37; of MSSA isolates&#44; and the M phenotype in 21&#46;5&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">SCC<span class="elsevierStyleItalic">mec</span>IVc was detected in all MRSA isolates&#46; ST8 was the main genotype and was detected in all isolates except one &#40;ST125&#41;&#46; MRSA antimicrobial susceptibility profiles showed that 2 isolates &#40;18&#46;2&#37;&#41; were resistant to amikacin&#44; tobramycin and gentamicin&#44; and 8 isolates &#40;72&#46;7&#37;&#41; to tobramycin and amikacin&#46; Only one isolate &#40;ST125-MRSA-IVc&#41; was susceptible to all aminoglycosides&#46; All isolates were resistant to levofloxacin&#46; Moreover&#44; ten ST8-MRSA-IVc isolates &#40;90&#46;1&#37;&#41; were resistant to erythromycin and clindamycin &#40;cMLS phenotype&#41; and the M phenotype was detected only in 1 &#40;ST125-MRSA-IVc&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Six isolates&#44; corresponding to ST8-MRSA-IVc &#40;five from Center 1 and one from Center 3&#41; were selected in order to determine the degree of genetic relatedness by PFGE and to assess inter- and intra-nursing home transmission of MRSA&#46; All isolates belonged to the same clone&#44; although two subtypes &#40;91&#37; similarity&#41; were distinguished&#58; A1 &#40;with two pulsotypes&#44; 97&#37; similarity&#41; and A2 &#40;100&#37; similarity&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">None of the 62 <span class="elsevierStyleItalic">S&#46; aureus</span> isolates were positive for the Panton&#8211;Valentine leukocidin&#46;</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&#46; aureus</span> carriage among residents of three community nursing homes with different characteristics in terms of size&#44; number of residents and health personnel&#44; and to characterize the MRSA isolates&#46;</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&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In our study&#44; 17&#46;4&#37; of residents were colonized with MSSA and 3&#46;8&#37; with MRSA&#46; These percentages are lower than those reported in community nursing home settings in the USA &#40;21&#46;2&#37; MSSA and 40&#46;7&#37; MRSA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> In Belgium&#44; Denis et al&#46;<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&#46;9&#37; of residents were MRSA carriers&#46; In Hamburg&#44; however&#44; the number of cases of MRSA colonization among residents of geriatric nursing homes was rather low&#44; 5&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> Similar results have been found in other European countries&#44; with a prevalence of 0&#37; and 0&#46;3&#37; reported in Sweden<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> and the Netherlands&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> respectively&#46; Results of a cross-sectional study among subjects living in long-term-care facilities in southern Spain during 2009&#8211;2010 showed that 79 &#40;10&#46;6&#37;&#41; and 67 &#40;9&#37;&#41; were colonized by MRSA and MSSA&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> In our setting&#44; this low prevalence could be explained by the implementation of effective hand-washing guidelines&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In our study&#44; 80&#46;3&#37; of MSSA isolates exhibited quinolone resistance&#44; which is a much higher rate than that described by Lozano et al&#46; in strains isolated from healthy humans in Spain &#40;3&#46;8&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> There are two possible explanations for this situation&#46; First&#44; antibiotics are among the most commonly prescribed drugs in long-term care facilities&#44; accounting for nearly 40&#37; of all prescribed drugs and there is a 70&#37; likelihood of residents receiving at least one course of antibiotics per year&#46; A high percentage of antibiotic treatments are considered inappropriate&#44; which contributes to increased antimicrobial resistance in the elderly population&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> Second&#44; the pattern of antibiotic resistance seems to be correlated with the age of patients&#46; In their recent study of 511 cases of MRSA infection&#44; Garc&#237;a et al&#46; concluded that antibiotics that target DNA synthesis &#40;namely fluoroquinolones&#41; result in progressively higher numbers of resistant isolates in the older population&#46;<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&#37; were resistant to two or three aminoglycosides&#46; These results are similar to those reported by Rodr&#237;guez-Ba&#241;o et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> for healthcare-associated MRSA strains in Spain&#46;</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 &#40;ST125&#41;&#46; SCCmec type IV is not a good marker for community isolates in Spain&#44; because it is the most frequent type in healthcare-associated and nosocomial isolates&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In a recent study performed by Moreno-Flores et al&#46;&#44; the major clonal type detected was ST8-MRSA-IVc &#40;32&#46;6&#37;&#41; in isolates with the oxacillin-resistant only phenotype &#40;32&#46;6&#37;&#41; and ST8 levofloxacin-resistant strains were not identified&#46;<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&#46; Another interesting finding is that no PVL-positive &#40;MRSA or MSSA&#41; isolates were found in our study&#46; The initial spread of a clone with genetic traits related to those of the USA300 clone &#40;ST8-MRSA-IV-PVL&#43;&#41; has been reported in Spain and seems to be associated with community-acquired infections&#44;<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&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> Our study has also demonstrated intra-nursing home transmission of ST8-MRSA-IVc&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In the study performed by Vindel et al&#46; in 145 Spanish hospitals&#44; ST125-MRSA-IV was the most prevalent clone in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> In our study&#44; however&#44; only one isolate belonged to this sequence type&#46; This lineage is associated with aminoglycoside resistance and&#44; to a lesser extent&#44; macrolide resistance and has been reported as causing bacteremia in a Spanish geriatric population&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> Moreno-Flores et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> found that strains belonging to this sequence type were levofloxacin-resistant&#46; Although the only ST125-MRSA-IVc isolate in our study showed susceptibility to all aminoglycosides tested&#44; it was resistant to macrolides and levofloxacin&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The limitations of our study are related to the small number of positive results&#44; which makes difficult an adequate statistical analysis&#46; However&#44; our results could be extrapolated to centers with similar characteristics with effective hand-washing implementation&#46; More studies should be conducted in the future to gain knowledge concerning the prevalence and the genetic lineages of <span class="elsevierStyleItalic">S&#46; aureus</span> circulating among nursing homes of different characteristics&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In summary&#44; there was a low rate of <span class="elsevierStyleItalic">S&#46; aureus</span> carriage and a very low prevalence of MRSA detected in the elderly population in our area&#46; ST8 was the predominant clone and only one strain belonged to ST125&#44; although the latter sequence type is considered to be one of the predominant Spanish clones&#46; 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&#44; probably associated with the characteristics of the population included in the study&#46;</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&#46;</p></span></span>"
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            1 => "Residential care homes"
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            3 => "ST-8"
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            0 => "<span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina"
            1 => "Residencias de ancianos"
            2 => "SCC<span class="elsevierStyleItalic">mec</span>"
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        "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&#46; aureus</span> depends on conditions in specific populations&#46; Few studies of <span class="elsevierStyleItalic">S&#46; aureus</span> colonization in the older population have been performed in Spain&#46; The aim of this study was to determine the prevalence of methicillin-resistant <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;<span class="elsevierStyleItalic">MRSA&#41;</span> colonization and its molecular epidemiological characteristics in an institutionalized population in community residential care homes in Cadiz&#44; Spain&#46;</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&#46; Axilla and nostril samples were tested&#46; Identification of <span class="elsevierStyleItalic">S&#46; aureus</span> and antimicrobial susceptibility testing were by MALDI-TOF and MicroScan panels&#46; MRSA strains were subjected to <span class="elsevierStyleItalic">SCCmec</span> typing&#44; multilocus sequence typing &#40;MLST&#41; and pulsed-field gel electrophoresis &#40;PFGE&#41;&#46; The presence of Panton&#8211;Valentine leukocidin &#40;PVL&#41; genes was determined by PCR in all <span class="elsevierStyleItalic">S&#46; aureus</span> strains&#46;</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&#46; Fifty-one residents &#40;17&#46;4&#37;&#41; were colonized with methicillin-sensitive <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;MSSA&#41; and 11 &#40;3&#46;8&#37;&#41; with MRSA&#46; Resistance to at least two aminoglycosides was observed in 25&#46;4&#37; of MSSA and 90&#46;9&#37; and of MRSA isolates&#44; and resistance to levofloxacin in 80&#46;3&#37; of MSSA and 100&#37; of MRSA isolates&#46; SCC<span class="elsevierStyleItalic">mec</span>IV was detected in all isolates and all except one &#40;ST-125&#41; were ST-8&#46; None of the <span class="elsevierStyleItalic">S&#46; aureus</span> isolates were positive for PVL&#46;</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&#46; aureus</span> carriage was detected and the prevalence of MRSA was very low&#46; ST8-MRSA-IVc was the dominant clone&#44; and only one strain belonged to ST125-MRSA-IVc&#46; We found MRSA transmission within the residential care homes and a very high rate of quinolone resistance in MSSA and MRSA&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La epidemiolog&#237;a de <span class="elsevierStyleItalic">S&#46; aureus</span> depende de las condiciones particulares de cada poblaci&#243;n&#46; En Espa&#241;a se han realizado pocos estudios sobre la colonizaci&#243;n por <span class="elsevierStyleItalic">S&#46; aureus</span> en la poblaci&#243;n geri&#225;trica&#46; El objetivo de este estudio es determinar la prevalencia de colonizaci&#243;n por <span class="elsevierStyleItalic">S&#46; aureus</span> resistente a meticilina &#40;SARM&#41; y sus caracter&#237;sticas epidemiol&#243;gicas moleculares en poblaci&#243;n institucionalizada en residencias de ancianos en C&#225;diz&#44; Espa&#241;a&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio epidemiol&#243;gico transversal en 3 residencias de ancianos&#46; Se estudiaron muestras de las fosas nasales y axilas&#46; La identificaci&#243;n y las pruebas de sensibilidad se realizaron utilizando MALDI-TOF y paneles MicroScan<span class="elsevierStyleSup">&#174;</span>&#46; En los aislados de SARM se determin&#243; el tipo de SCC<span class="elsevierStyleItalic">mec</span> y se tiparon mediante Multilocus Sequence Typing &#40;MLST&#41; y Pulsed-field Gel Electrophoresis &#40;PFGE&#41;&#46; La presencia de genes de la leucocidina de Panton-Valentine &#40;LPV&#41; se determin&#243; mediante PCR en todas las cepas de <span class="elsevierStyleItalic">S&#46; aureus</span>&#46;</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&#46; Cincuenta y un residentes &#40;17&#44;4&#37;&#41; estaban colonizados por <span class="elsevierStyleItalic">S&#46; aureus</span> sensible a la meticilina &#40;SASM&#41; y 11 &#40;3&#44;8&#37;&#41; por SARM&#46; Se observ&#243; resistencia frente al menos 2 aminogluc&#243;sidos en el 25&#44;4 y 90&#44;9&#37; y resistencia a levofloxacino en el 80&#44;3 y 100&#37; de los aislamientos de SASM y SARM&#44; respectivamente&#46; Se detect&#243; SCC<span class="elsevierStyleItalic">mec</span>IV en todos los aislados&#44; y todos&#44; excepto uno &#40;ST-125&#41; correspond&#237;an al ST-8&#46; Ninguno de los aislados de <span class="elsevierStyleItalic">S&#46; aureus</span> fue positivo para LPV&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se detect&#243; una baja tasa de portadores de <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; siendo el porcentaje de SARM muy bajo&#46; ST8-MRSA-IVc fue el clon predominante&#44; y solo una cepa pertenec&#237;a a ST125-MRSA-IVc&#46; Se objetiv&#243; transmisi&#243;n de SARM intracentro&#46; Se observ&#243; una tasa muy alta de resistencia a quinolonas en SASM y SARM&#46;</p></span>"
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                  \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&nbsp;\t\t\t\t\t\t\n
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                  \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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;0&nbsp;\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&#44; ERY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;1&#44; ST125&nbsp;\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&#44; AMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;0&nbsp;\t\t\t\t\t\t\n
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                  \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&#44; TOB&#44; AMI&nbsp;\t\t\t\t\t\t\n
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                  \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&#44; AMI&#44; ERY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;0&nbsp;\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&#44; GEN&#44; TOB&#44; AMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;0&nbsp;\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&#44; TOB&#44; AMI&#44; ERY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;0&nbsp;\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&#44; GEN&#44; TOB&#44; AMI&#44; ERY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;0&nbsp;\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&#44; GEN&#44; TOB&#44; ERY&#44; CLI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;8&#44; ST8&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Number of MSSA isolates &#40;<span class="elsevierStyleItalic">n</span>1&#41;&#47;number of MRSA isolates &#40;<span class="elsevierStyleItalic">n</span>2&#41;&#44; ST&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">No resistance to GEN&#44; TOB&#44; AMI&#44; LEV&#44; ERY&#44; CLI&#46;</p> <p class="elsevierStyleNotepara" id="npar0015">GEN&#44; gentamicin&#59; TOB&#44; tobramycin&#59; AMI&#44; amikacin&#59; LEV&#44; levofloxacin&#59; ERY&#44; erythromycin&#59; CLI&#44; clindamycin&#46;</p>"
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Article information
ISSN: 2529993X
Original language: English
DOI:10.1016/j.eimce.2018.05.012
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