Colonização por Staphylococcus aureus em pessoas vivendo com HIV/AIDS acompanhadas em um serviço ambulatorial de referência em Botucatu (SP): prevalência, resistência à meticilina e epidemiologia molecular
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Data
2016-02-25
Autores
Lastoria, Leticia Chamma [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Staphylococcus aureus resistente à meticilina (Methicillin-resistant S. aureus, MRSA) é cada vez mais reconhecido como uma ameaça para pessoas vivendo com HIV/AIDS (PVHA). No entanto, a magnitude da colonização por MRSA varia entre diferentes países e regiões geográficas. Nós realizamos um estudo que teve por objetivo identificar a prevalência e os fatores de risco para colonização por S. aureus como um todo e MRSA em PVHA residindo em cidades de pequeno porte do interior do Estado de São Paulo. Isolados de MRSA foram caracterizados por Eletroforese em Gel de Campo Pulsado (Pulsed-Field Gel Electrophoresis, PFGE) e tiveram o Cassete Cromossômico Estafilocóccico (Staphylococcal Chromosome Cassete, SCC) mec tipado. Análise espacial foi realizada para identificar agregados geográficos e correlação com indicadores socioeconômicos. No primeiro momento, realizamos um estudo de prevalência pontual coletando swab nasal e de orofaringe de 368 PVHA atendidas em ambulatório de referência em Botucatu, SP. Sessenta e sete sujeitos residentes na cidade sede foram seguidos com coletas em dois outros momentos, e tiveram seus contactantes domiciliares também investigados para colonização. As taxas de prevalência de S. aureus e MRSA no primeiro levantamento foram 25,8% e 2,7%. A colonização por S. aureus foi negativamente associada com o uso de antibióticos beta-lactâmicos e drogas ilícitas. Por outro lado, fatores de risco para MRSA incluíam uso de crack e internação hospitalar recente. Inquéritos repetidos identificaram novos casos de colonização por MRSA, mas nenhum sujeito apresentou positividade em mais de uma ocasião. Quatro clusters foram identificados na PFGE, agrupando sujeitos em diferentes níveis – domicílio, cidade, região. Dos 19 isolados caracterizados, apenas um não carreava o SCCmec tipo IV. Análise espacial identificou hot spots par sujeitos colonizados com S. aureus, mas não conseguimos ligar esse padrão a indicadores sócio-econômicos. Em conclusão, nós idenficamos baixa – mas relevante – prevalência de MRSA em PVHA. Foram identificados tanto fatores de risco tradicionalmente associados a aquisição na comunidade quanto outros ligados a exposição a hospitais, de modo que as rotas predominantes de transmissão não puderam ser determinadas com base epidemiológica.
Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly recognized as a threat for people living with HIV/AIDS (PLWHA). However, the magnitude of asymptomatic MRSA colonization in that group varies among different countries and geographic regions. We conducted a study that aimed at identifying the prevalence and risk factors for both overall S. aureus and MRSA colonization among PLWHA attending in small cities from inner São Paulo State, Brazil. MRSA isolates were characterized using Pulsed-Field Gel Electrophoresis (PFGE), and submitted to typing of the Staphylococcal Chromosome Cassete (SCC)mec. Spatial analysis was performed to search for geographical clusters and correlation with socioeconomic indicators. In a first point prevalence survey, nasal and oropharyngeal swabs of 368 people were collected. Sixty-seven subjects from the main city (Botucatu) were surveyed for colonization in two other occasions, and had swabs collected from household members. The prevalence rates for S. aureus and MRSA in the first survey were 25.8% and 2.7%. The overall S. aureus colonization was negatively associated with the use of beta-lactams and of illicit drugs. On the other hand, MRSA colonized subjects were more likely to use crack and to have been admitted to a hospital during the past year. Repeated surveys found additional cases of MRSA colonization, but all subjects were positive in only one occasion. Four PFGE clusters were characterized, grouping subjects in household, city and region level. Of 19 total MRSA isolates, only one did not harbor SCCmec type IV. Spatial analysis detected hot spots of S. aureus colonized subjects from Botucatu, but that finding could not be linked to socio-economic indicators. In conclusion, we found small but relevant prevalence of MRSA among PLWHA. Community and healthcare-associated risk factors were identified, so that predominant routes of transmission could not be determined on epidemiological grounds.
Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly recognized as a threat for people living with HIV/AIDS (PLWHA). However, the magnitude of asymptomatic MRSA colonization in that group varies among different countries and geographic regions. We conducted a study that aimed at identifying the prevalence and risk factors for both overall S. aureus and MRSA colonization among PLWHA attending in small cities from inner São Paulo State, Brazil. MRSA isolates were characterized using Pulsed-Field Gel Electrophoresis (PFGE), and submitted to typing of the Staphylococcal Chromosome Cassete (SCC)mec. Spatial analysis was performed to search for geographical clusters and correlation with socioeconomic indicators. In a first point prevalence survey, nasal and oropharyngeal swabs of 368 people were collected. Sixty-seven subjects from the main city (Botucatu) were surveyed for colonization in two other occasions, and had swabs collected from household members. The prevalence rates for S. aureus and MRSA in the first survey were 25.8% and 2.7%. The overall S. aureus colonization was negatively associated with the use of beta-lactams and of illicit drugs. On the other hand, MRSA colonized subjects were more likely to use crack and to have been admitted to a hospital during the past year. Repeated surveys found additional cases of MRSA colonization, but all subjects were positive in only one occasion. Four PFGE clusters were characterized, grouping subjects in household, city and region level. Of 19 total MRSA isolates, only one did not harbor SCCmec type IV. Spatial analysis detected hot spots of S. aureus colonized subjects from Botucatu, but that finding could not be linked to socio-economic indicators. In conclusion, we found small but relevant prevalence of MRSA among PLWHA. Community and healthcare-associated risk factors were identified, so that predominant routes of transmission could not be determined on epidemiological grounds.
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Staphylococcus aureus, MRSA, HIV, AIDS, Colonização, Epidemiologia molecular, Epidemiologia espacial, Molecular epidemiology, Spatial Epidemiology