Estudo da epidemiologia molecular dos Staphylococcus aureus resistentes a oxacilina em pacientes portadores de sindrome de imonodeficiencia adquirida

AUTOR(ES)
DATA DE PUBLICAÇÃO

1998

RESUMO

The Staphylococcus aureus is an important nosocomial pathogen. Methicillin-Resistant Staphylococcus aureus (MRSA) strains has been caused outbreaks and endemics at hospitals, main1y in university and terciary care hospitals. Many control measures are used by health care units to reduce MRSA spread. There is some difficult to eradicate MRSA in hospitals where it has been endemic. Epidemiological surveillance of nosocomial pathogens is frequently aided by the application of DNA typing methods in order to determine the effectiveness of control measures. Since 1990, MRSA has become endemic in some wards at Hospital das Clínicas of the UNICAMP. Among them there is the Infectious Diseases (ID) ward. In 1993 a day care unit was created to care for AIDS patients. This group of patients needs frequent hospitalization at ID ward and their role in the MRSA epidemiology has been unclear. The objective was to study the incidence of nasal colonization by MRSA in AIDS patients in the AIDS day care unit and ID ward. It was performed a chromosomal DNA analysis of MRSA colonization and infection strains in both units, using Pulsed-Field Gel Electrophoresis (PFGE). This study was carried out in two phases: first the AIDS patients were followed from the AIDS day care unit and ID ward from December 1993 to December 1995. Swabs of anterior nares cultures (SN) were weekly obtained from these patients. 178 AIDS patients were followed and 62 (34, 83%) had at least one positive culture for MRSA. The average follow up in AIDS day care unit was 141,3 days (range: 1 - 720) and in the ID ward was 8,68 days (range: 1 - 270). It was obtained 1239 SN (mean: 7 SN per patient): 1085 SN negative, 116 positive for MRSA and 38 positive for methicillin-sensitive S. aureus. It was found 18 patients with a single positive culture without follow-up. There were 27 transient colonization episodes and 27 persistent colonization episodes. There was difference among the group of patients in wich were collected more than three SN in LD and MI units comparing with the two other groups that were collected 1 or from 2 to 3 SN per patient. Sixty MRSA strains from 33 AIDS patients and non-AIDS patients cared for in the day care unit and ID ward were typed by PFGE. It was found 7 difIerent profiles (A, AI, A2, B, C, D e E). The profile "A" was found in 52 (86,66%) isolates typed. There was no statistical difference ong AIDS and non-AIDS patients with respect to this profile. Some of the strains typed have been collected from the saroe patient in different days. In 11 cases, these sequential isolates show the same profile. In 3 cases, the sequential isolates changed their profile. In conclusion, this study detected high MRSA incidence in AIDS patients. The predominance of the profile "A" at the AIDS day care and ID units strongly suggest cross-colonization and these patients shouldbe considered potential MRSA carrier

ASSUNTO(S)

infecção hospitalar aids (doença)

ACESSO AO ARTIGO

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