Epidemiological and biological characteristics of methicillin-resistant staphylococcal infections in a Mexican hospital.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) has spread worldwide since 1960. However, there is little information concerning methicillin-resistant coagulase-negative staphylococci (MRCNS) infections.


METHODS
In order to study the clinical and epidemiological characteristics of methicillin-resistant staphylococci (MRS) infections and to determine the relationship between MRS and both synergistic hemolysis (SH) and slime production (SP), a laboratory-based survey and non-matched case-control study were carried out at a tertiary-care center in Mexico City. In regard to patients, from May 1991 to October 1992, 46 cases of MRS infection and 86 patients (controls) infected by methicillin-susceptible staphylococci (MSS) were included. Clinical and epidemiologic variables were analyzed. The isolates were identified and tested for antimicrobial susceptibility by standard methods. An MIC of oxacillin > or = 8 micrograms/mL was defined as an MRS.


RESULTS
During the study, 94 nosocomial staphylococcal infections were diagnosed: S. aureus, 35 and CNS, 59; 43 (45.7%) by MRS (rate of MRS infections was 1.12 per 100 in-patients); 2 MRSA; 41 MRCNS, and only 19 were symptomatic. Three infections were community-acquired, including one MRSA and two MRCNS. After multivariate analysis, the significant risk factors were previous antimicrobial therapy (p = 0.013) and catheter-related (p = 0.009) and urinary-tract source (p = 0.0001). Forty-nine percent of MRS showed SH while only 15% of MSS (p < 0.001) showed SH, especially in 10/10 MR-S. hemolyticus. Additionally, 48% of MRCNS showed SP, as did 18% of MSCNS (p = 0.019), particularly in 15/20 MR-S. epidermidis. Of all MRS isolates, 38% showed a homogeneous phenotype, a trait associated with multi-drug resistance (p < 0.01) and SH (p < 0.001).


CONCLUSIONS
CNS predominated as the cause of MRS infections in our setting. The homogenous phenotype was associated with SH and multi-drug resistance.
Urdez-Hernández
E
E
Departamento de Enfermedades Infecciosas, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F., Mexico.
Sifuentes-Osornio
J
J
Calva
J J
JJ
Villalobos-Zapata
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016022:Case-Control Studies; D003428:Cross Infection; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008800:Mexico / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013210:Staphylococcus / Q000187:drug effects / Q000302:isolation & purification
D000900:Anti-Bacterial Agents