Sandra Valderrama-Beltrán1, Sandra Gualtero2, Carlos Álvarez-Moreno3, Fabian Gil4, Alvaro J Ruiz4, José Yesid Rodríguez5, Johanna Osorio6, Ivan Tenorio7, Carlos Gómez Quintero8, Sebastián Mackenzie2, María Alejandra Caro2, Alberto Zhong2, Gerson Arias9, Indira Berrio10, Ernesto Martinez11, Gloria Cortés12, Alejandro De la Hoz2, Cesar A Arias13. 1. Division of Infectious Diseases, Department of Internal Medicine, Hospital Universitario San Ignacio, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia. Electronic address: slvalderrama@husi.org.co. 2. Division of Infectious Diseases, Department of Internal Medicine, Hospital Universitario San Ignacio, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia. 3. Department of Internal Medicine, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia; Clínica Universitaria Colombia, Bogotá, Colombia. 4. Department of Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia. 5. Division of Infectious Diseases, Hospital Rosario Pumarejo Lopez, Valledupar, Colombia; Division of Infectious Diseases, Clínica Médicos LTDA, Clinica Laura Daniela, Valledupar, Colombia. 6. Division of Infectious Diseases, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia. 7. Division of Infectious Diseases, Clínica Universitaria San Juan de Dios, Cartagena, Colombia. 8. Division of Infectious Diseases, Clínica de la Mujer, Bogota, Colombia. 9. Division of Infectious Diseases, Hospital Santa Clara, Bogotá, Colombia. 10. Division of Infectious Diseases, Clínica El Rosario, Hospital General de Medellin "Luz Castro de Gutiérrez" ESE, Medellín, Colombia. 11. Division of Infectious Diseases, Hospital Universitario del Valle, Cali, Colombia. 12. Division of Clinical Laboratory, Hospital Universitario San Ignacio, Bogotá, Colombia. 13. Division of Infectious Diseases, Department of Internal Medicine, Department of Microbiology and Molecular Genetics, UTHealth McGovern Medical School, Houston, TX, USA; Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia; Center for Infectious Diseases, UTHealth, School of Public Health, Houston, TX, USA.
Abstract
OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) represent a major clinical problem in Colombia. The aim of this study was to evaluate the risk factors associated with MRSA SSTI in Colombia. METHODS: A multicenter cohort study with nested case-control design was performed. Patients with an SSTI with at least 48h of inpatient care were included. Patients with an MRSA SSTI were considered the case group and patients with either a non-MRSA SSTI or with an Methicillin-susceptible S. aureus (MSSA) SSTI were the control groups. A multivariate logistic regression approach was used to evaluate risk factors associated with MRSA SSTI with two different statistical models. RESULTS: A total 1134 patients were included. Cultures were positive for 498 patients, of which 52% (n=259) were Staphylococcus aureus. MRSA was confirmed in 68.3% of the S. aureus cultures. In the first model, independent risk factors for MRSA SSTI were identified as the presence of abscess (P<0.0001), cellulitis (P=0.0007), age 18-44 years (P=0.001), and previous outpatient treatment in the previous index visit (P=0.003); surgical site infection was a protective factor (P=0.008). In the second model, the main risk factor found was previous outpatient treatment in the previous index visit (P=0.013). CONCLUSIONS: Community-acquired SSTIs in Colombia are commonly caused by MRSA. Therefore, clinicians should consider MRSA when designing the initial empirical treatment for purulent SSTI in Colombia, although there seems to be low awareness of this fact.
OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) represent a major clinical problem in Colombia. The aim of this study was to evaluate the risk factors associated with MRSA SSTI in Colombia. METHODS: A multicenter cohort study with nested case-control design was performed. Patients with an SSTI with at least 48h of inpatient care were included. Patients with an MRSA SSTI were considered the case group and patients with either a non-MRSA SSTI or with an Methicillin-susceptible S. aureus (MSSA) SSTI were the control groups. A multivariate logistic regression approach was used to evaluate risk factors associated with MRSA SSTI with two different statistical models. RESULTS: A total 1134 patients were included. Cultures were positive for 498 patients, of which 52% (n=259) were Staphylococcus aureus. MRSA was confirmed in 68.3% of the S. aureus cultures. In the first model, independent risk factors for MRSA SSTI were identified as the presence of abscess (P<0.0001), cellulitis (P=0.0007), age 18-44 years (P=0.001), and previous outpatient treatment in the previous index visit (P=0.003); surgical site infection was a protective factor (P=0.008). In the second model, the main risk factor found was previous outpatient treatment in the previous index visit (P=0.013). CONCLUSIONS: Community-acquired SSTIs in Colombia are commonly caused by MRSA. Therefore, clinicians should consider MRSA when designing the initial empirical treatment for purulent SSTI in Colombia, although there seems to be low awareness of this fact.
Authors: Teresa Del Rosal; Ana Méndez-Echevarría; Cesar Garcia-Vera; Luis Escosa-Garcia; Martin Agud; Fernando Chaves; Federico Román; José Gutierrez-Fernandez; Enrique Ruiz de Gopegui; Guillermo Ruiz-Carrascoso; Maria Del Carmen Ruiz-Gallego; Albert Bernet; Sara Maria Quevedo; Ana Maria Fernández-Verdugo; Jesús Díez-Sebastian; Cristina Calvo Journal: Infect Drug Resist Date: 2020-12-23 Impact factor: 4.003