Aspectos epidemiológicos, fisiológicos e moleculares da resistência à oxacilina em Staphylococcus aureus e avaliação da sua susceptibilidade a novas moléculas sintéticas

Abstract

Staphylococcus aureus is a major cause of health care associated infections worldwide. The aim of this work was to evaluate epidemiological, physiological and molecular characteristics of aureus oxacillin resistant S. aureus (ORSA) isolated from infections in a tertiary university hospital and evaluated their susceptibility to new synthetic molecules. A total of 103 samples of ORSA for clinical and epidemiological data related to patients susceptibility profile to antimicrobial drugs, assessment of biofilm production and hemolytic capacity and confirmation of genetic identity, detection of the mecA gene and characterization of SCCmec were evaluated, PCR. For 45 samples from CTI, also the profile of DNA analysis by PFGE and characterization of the CC, PCR were performed. For 21 samples susceptibility to alkylated aromatic amines was evaluated. Considering the clinical samples, most samples contained in males (71%) from tracheal secretion (26.2%) and blood (23.3%) followed by surgical site and swab tip of the catheter (15.5%), exudates (14.6 %) and urine (4.9%), associated with infection of the respiratory system (34%) and bacteremia (20.4%) in the intensive care unit (43.7%). Overall, a high frequency of resistance was observed against clindamycin and erythromycin (100%), azithromycin (99%), levofloxacin (93.2%), gentamicin (84.5%), trimethoprim-sulfamethoxazole (75.7%), tetracycline (77.6%), chloramphenicol (59.3%) and rifampicin (50.5%). The amino alcohols also showed antibacterial activity against most isolates of ORSA. SCCmec type III (66.7%), II (17.8%), IV (4.4%) and I (2.2%) were found. The majority (66.7%) isolates were related to the brazilian epidemic clone (CEB)/CC8/SCCmec III, which prevailed between 2005 and 2008, while the USA100/CC5/SCCmec lineage II emerged in 2007 and was more frequent in 2009 and 2010 in the ICU. The strains carrying the SCCmec type IV (USA400/CC1 and USA800/CC5 lineages) and I (USA500/CC5) were also detected. Our data are highly relevant to surveillance systems enabled map on a larger scale the dynamic movement of ORSA and raise discussions on containment strategies and rational use of empirical chemotherapy.