Epidemiology of Staphylococcus aureus and Vancomycin-resistant Enterococcus in patients with lower-extremity wounds in Central and South America

TYLER PRENTISS ; LAURA VALENZUELA ; BOCCO J.L; RAFAEL MENDO-LOPEZ ; MARY BETH PERRI ; SOLA CLAUDIA; ANA C. BARDOSSY ; PEDRO AYAU AGUILAR; DANIELA FURIASSE; MARCUS ZERVOS

Detroit

Simposio; Annual Symposium Henry Ford Global Health; 2017

Henry Ford Global Health

Background: Antimicrobial resistance is a significant problem in developing countries and is among the most important infectious disease threats. These regions usually have limited resources leading to difficulties to controlling the transmission of multidrug-resistant organisms. This study aims to describe the epidemiology of Staphylococcus aureus (SA) and vancomycin-resistant Enterococcus (VRE) colonizing patients with chronic wounds in Peru, Guatemala and Argentina. Methods: A prospective observational study was performed from November 2015-May 2017 at hospitals in Peru, Guatemala and Argentina. Patients with chronic lower extremity wounds for more than 28 days were enrolled. Demographic and medical history were collected. Wound, nasal and perineal swabs were collected and cultured for methicillin-resistant SA (MRSA), methicillin-susceptible SA (MSSA) and VRE following standard microbiological procedures. Identification of isolates and susceptibilities were done by the clinical microbiology laboratory at each site. Results: 104 patients were enrolled in the study. 68 (65.4%) were male, with a mean age of 60 years (range 18-86 years). 13 (12.5%) had positive cultures for MRSA, 7 (6.7%) had VRE, and 31 (29.8%) had MSSA. Two patients were co-colonized with MSSA and VRE. When comparing patients colonized with MRSA vs not colonized among 3 countries, we observed 69% were from Guatemala, 23% from Peru and 8% from Argentina (p=0.014). Surgery exposure in the past 3 months was observed in 23% of patients in the MRSA group vs 4% in the not colonized, (p=0.03); peripheral intravenous (IV) catheter use in the past 3 months were 38% in the MRSA group vs 11% in the not colonized, (p=0.02). There were not significant differences when comparing comorbidities, exposition to antibiotics, and wound care received. Conclusion: This study shows that there are differences in MRSA prevalence across South and Central America. VRE identification was rare. Surgery in the last 3 months and prior use of a peripheral intravenous catheter were risk factors for MRSA colonization.