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Chávez-Vivas, M. ., Martínez, A. del C. ., & Esparza-Mantilla, M. . (2017). Caracterización de Staphylococcus aureus obtenido del ambiente hospitalario y del personal de salud en un hospital de la ciudad de Cali. Biosalud, 16(2), 22–33. https://doi.org/10.17151/biosa.2017.16.2.3
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La colonización nasal de Staphylococcus aureus en el personal de salud y la contaminación de superficies hospitalarias puede preceder a la infección nosocomial. El objetivo de este estudio fue caracterizar los aislamientos de S. aureus que se encuentran en el ambiente hospitalario y en el personal de salud de un hospital de Cali. Material y Métodos: Se empleó un total de 164 muestras (86 del personal de salud y 78 de las salas del hospital). Se realizó antibiograma y se amplificó por PCR los genes mecA y agr. El S. aureus resistente a meticilina asociado al hospital (SARM-AH) o el SARM asociado a la comunidad (SARM-AC) se estableció mediante el análisis de estos genes. Resultados: El S. aureus registró un 21,3% de prevalencia, se detectó en el personal de salud (9,1%) y en el ambiente hospitalario (12,2%). El S. aureus en la unidad de cuidados intensivos fue significativo, con un riesgo mayor de tres (6,1%; OR=3,143, min=1,086, max=9,099; P=0,031). Se identificaron tres perfiles de resistencia (I, II y III), el ambiente hospitalario presentó mayor riesgo de presentar aislamientos con perfil I (20%; OR= 3,500; IC 95% min= 0,050; max = 16,430; p= 0,147). Sin embargo, los aislamientos con el perfil III con multirresistencia a los antibióticos, fueron los más prevalentes en el personal de salud (25,7%) y el ambiente hospitalario (20%).Los aislamientos SARM se encontraron colonizando al 11,4% del personal de salud y en el 17,1% de las superficies del ambiente hospitalario. Todos los aislamientos SARM fueron SCCmec tipo II, compatible con un origen hospitalario. Según el análisis del locus agr, se identificaron tres grupos agr, el 51,4% de los aislamientos pertenecen al grupo agr 1, el 22,8% al agr 2 y el 25,7% al agr 3. Conclusión: Se evidenció la presencia de SARM en el personal y en diferentes salas del hospital. Esta condición podría ser un factor de riesgo para desarrollar infecciones adquiridas en el hospital.
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1. Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015; 28(3):604-660. doi:10.1128/CMR.00134-14.
2. Coates R, Moran J, Horsburgh MJ. Staphylococci: colonizers and pathogens of human skin. Future Microbiol. 2014. 9:75–91. http://dx.doi.org/10.2217/fmb.13.145.
3. Boucher H, Miller LG, Razonable RR. Serious infections caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2010; 51Suppl 2:S183-97.
4. Chambers HF, DeLeo FR. Waves of Resistance: Staphylococcus aureus in the Antibiotic Era. Nature rev Microb. 2009; 7(9):629-641. doi: 10.1038/nrmicro2200
5. Baron EJ, Tenover FC. Methicillin-resistant Staphylococcus aureus diagnostics: state of the art. Expert Opin Med Diagn.2012;6(6):585-92.
6. Al Laham N. Detection and antibiotic resistance pattern of Staphylococcus aureus and MRSA isolated from healthcare workers nares at Gaza Hospitals, Palestine. IAJAA. 2016; doi: 10.3823/3779.
7. Arteaga LC, Espinosa Y, Chávez M. Prevalencia de Staphylococcus aureus que coloniza el personal de salud de un hospital de la ciudad de Cali. Rev Cienc Salud. 2016;14(1): 9-19.
8. Collazos LF Estupiñan G Chavez M. Characterization of Staphylococcus aureus Isolates That Colonize Medical Students in a Hospital of the City of Cali, Colombia. Int J Microbiol. 2015. Disponible en: http://dx.doi.org/10.1155/2015/358489
9. Gurieva TV, Bootsma MC, Bonten MJ. Decolonization of patients and health care workers to control nosocomial spread of methicillin-resistant Staphylococcus aureus: a simulation study. BMC Infect Dis. 2012; n12:302.
10. Hawkins G, Stewart S, Blatchford O, Reilly J. Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence. J Hosp Infect. 2011; 14:285–289.
11. Rashid Z, Farzana K, Sattar A, Murtaza G. Prevalence of nasal Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in hospital personnel and associated risk factors. Acta Pol Pharm- Drug Res. 2012; 69 (5):985-991.
12. Shakya B, Shrestha S, Mitra T. Nasal carriage rate of methicillin resistant Staphylococcus aureus among at National Medical College Teaching Hospital, Birgunj, Nepal. Nepal Med Coll J. 2010; 12(1):26-9.
13. Souza Damasceno Q, de Oliveira AC. Superfícies do ambiente hospitalar como possíveis reservatórios de bactérias resistentes: uma revisão. Rev Esc Enferm USP 2010; 44(4): 1118-1123. Disponible en: http://www.redalyc.org/articulo.oa?id=361033306038.
14. Coughenour C, Stevens V, Stetzenbach LD. An evaluation of methicillin-resistant Staphylococcus aureus survival on five environmental surfaces. Microb Drug Resist 2011; 17:457-61
15. Desai R, Pannaraj PS, Agopian J, Sugar CA, Liu GY, Miller LG. Survival and transmission of community-associated methicillin-resistant Staphylococcus aureus from fomites. Am J Infect Control. 2011; 39(3):219-25.
16. Faires MC, Pearl DL, Berke O. Reid-Smith RJ, Weese JS. The identification and epidemiology of meticillin-resistant Staphylococcus aureus and Clostridium difficile in patient rooms and the ward environment. BMC Infect Dis. 2013;13:342-44
17. Hayden MK, Blom DW, Lyle EA, Moore CG, Weistein RA. Risk of hand or glove contamination after contact with vancomycin-resistant enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol. 2008;29(2):149-54
18. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J ClinPathol. 1966; 45(4): 493–496.
19. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing:Twenty-third Informational Supplement; M100-S23. CLSI, Wayne, PA, USA, 2013.
20. Cheng HR, Jiang N. Extremely rapid extraction of DNA from bacteria and yeasts. Biotech Lett 2006; 28:55-57.
21. Becker K, Denis O, Roisin S, Mellmann A, Idelevich EA, Knaack D, et al. Detection of mecA- and mecC-positive methicillin-resistant Staphylococcus aureus (MRSA) isolates by the new Xpert MRSA Gen 3 PCR assay. J Clin Microbiol.2016; 54(1):180-4
22. Turlej A, Hryniewicz W, Empe J. Staphylococcal Cassette Chromosome mec (SCCmec) Classification and Typing Methods: an Overview. Pol J Microbiol. 2011; 60 (2,): 95–103
23. Azimian A, Najar-pirayeh S, Mirab-Samiee S, Naderi M. Ocurrence of Methicillin Resistant Staphylococcus aureus (MRSA) among clinical samples in Tehran - Iran and its correlation with polymorphism of specific accessory gene regulator (agr) groups. Braz. J. Microbiol. 2012; 43(2):779-85.
24. Sakoulas G, Eliopoulos GM, Moellering RC Jr, Wennersten C, Venkataraman L, Novick RP. Accessory gene regulator (agr) locus in geographically diverse Staphylococcus aureus isolates with reduced susceptibility to vancomycin. Antimicrob Agents Chemother 2002; 46:1492-502.
25. Chávez M, Erazo NC, Reina DA, Esparza M. Métodos de tipificación y epidemiología molecular de Staphylococcus aureus con resistencia a la meticilina. Rev Biosalud 2015; 14(2): 81-90. doi: 10.17151/biosa.2015.14.2.8
26. Ridenour GA, Wong ES, Call MA, Climo MW: Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit: Implications for intervention. Infect Control Hosp Epidemiol. 2006; 27: 271–278.
27. Datta R, Huang SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis. 2008; 47:176–181.
28. Patel M, Weinheimer JD, Waites KB, Baddley JW: Active surveillance to determine the impact of methicillinresistant Staphylococcus aureus colonization on patients in intensive care units of a Veterans Affairs Medical Center. Infect Control Hosp Epidemiol. 2008; 29:503–509.
29. Klevens RM, Edwards JR, Tenover FC, McDonald LC, Horan T, et al. National Nosocomial Infections Surveillance System. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US Hospitals, 1992–2003. Clin Infect Dis. 2006; 42:389–391.
30. Ellingson K, Muder RR, Jain R, Kleinbaum D, Feng PJ, Cunningham C, et al. Sustained reduction in the clinical incidence of methicillin-resistant Staphylococcus aureus colonization or infection associated with a multifaceted infection control intervention. Infect Control Hosp Epidemiol. 2011 Jan; 32(1):1–8.
31. Morgan DJ, Rogawski E, Thom KA, Johnson JK, Perencevich EN, Shardell M, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med. 2012; 40(4):1045–1051
32. Rebmann T, Aureden K. Preventing methicillin-resistant Staphylococcus aureus transmission in hospitals: An Executive Summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide. AmJ Infect Control. 2011;2011 Epub ahead of print.
33. Otth L, Wilson M, Bustamante N, Fernández H, Otth C. Susceptibilidad antimicrobiana y patrones de resistencia de Staphylococcus aureus aislados de pacientes y portadores en la ciudad de Valdivia, Chile. Rev Chil Infect 2008; 25 (3): 175-178.
34. Olarte NM, Valderrama IA, Reyes KR, Garzón MI, Escobar JA, Castro BE, et al. Colonización por Staphylococcus aureus resistente a la meticilina en una unidad de cuidados intensivos de adultos de un hospital colombiano: caracterización fenotípica y molecular con detección de un clon de circulación en la comunidad. Biomédica 2010;30:353-6.
35. Budimir A. Detection and typing methods of methicillin-resistant Staphylococcus aureus strains. Med Sci. 2012; 37:73–88.
36. Acevedo C, Guillén F, Fariña B, Aquino M. PCR múltiple para la detección simultánea de los genes mecA y pvl en Staphylococcus spp. Investig. Cienc. Salud. 2012; 10(1): 5-13
37. Rivero-Pérez B, Alcoba-Flórez J, Méndez-Álvarez S. Diversidad de clones de Staphylococcus aureus resistentes a meticilina y emergencia de nuevos clones encontrados en comunidades de Tenerife, punto caliente de turismo en España. Trauma Fund MAPFRE. 2011; 23(3):191-198
38. Girgis SA, Gomaa HE, Saad NE, Salem MM. A Comparative Study for Detection of Methicillin Resistance Staphylococci by Polymerase Chain Reaction and Phenotypic Methods Life Sci J 2013; 10(4) http://www.lifesciencesite.com
39. Huang SS, Hinrichsen VL, Datta R, Spurchise L, Miroshnik I, Nelson K, et al. Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection. PLoS One. 2011; 6:e24340.doi: 10.1371/journal.pone.0024340.
40. Castillo JS, Leal AL, Cortes JA, Alvarez CA, Sanchez R, Buitrago G, et al. Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia. Rev Panam Salud Publica. 2012; 32(5):343–50.
41. Alvarez CA, Barrientes OJ, Leal AL, Contreras GA, Barrero L, Rincón S, et al. Community associated methicillinresistant Staphylococcus aureus, Colombia. Emerg Infect Dis J. 2006; 12 12):2000-1. http://dx.doi.org/10.7705/biomedica.v34i3.1692
42. Álvarez CA, Yomayusa N, Leal AL, Moreno J, Méndez-Álvarez S, Ibáñez M, et al. Nosocomial infections caused by community-associated methicillin-resistant Staphylococcus aureus in Colombia. Am J Infect Control. 2010; 38:315-8.
43. Barrero LI, Castillo JS, Leal AL, Sánchez R, Cortés JA, Álvarez CA et al. Impacto económico de la resistencia a la meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá. Biomédica. 2014; 34(3): 345-353. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S012041572014000300005&lng
44. Arias C, Rincón S, Chowdhury S, Martínez E, Coronel W, Reyes J, et al. MRSA USA300 clone and vancomycinresistant Enterococcus faecalis: a United States–Colombian connection? N Eng J ed. 2008; 359:2177-9.45. Reyes J, Rincón S, Díaz L, Panesso D, Contreras GA, Zurita J, et al. Dissemination of methicillin-resistant Staphylococcus aureus USA300 sequence type 8 lineage in Latin America. Clin Infect Dis. 2009; 49:1861-7
46. Diep BA, Gill SR, Chang RF, Phan TH, Chen JH, Davidson MG, et al. Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus. Lancet. 2006; 367 (9512):731-739.
47. Escobar-Pérez JA, Castro BE, Márquez-Ortiz RA, Gaines S, Chavarro B, Moreno J, et al. Aislamientos de Staphylococcus aureus sensibles a meticilina relacionados genéticamente con el clon USA300, ¿origen de los aislamientos SARM de genotipo comunitario en Colombia? Biomédica 2014; 34(Supl.1):124-36. doi: http://dx.doi.org/10.7705/biomedica.v34i0.1661
48. Shopsin B, Mathema B, Alcabes P, Said-Salim B, Lina G, Matsuka A, Martinez J, et al. Prevalence of agr Specificity Groups among Staphylococcus aureus Strains Colonizing Children and Their Guardians. J Clin Microb. 2003;41(1):456–459.
49. Manago K, Nishi J, Wakimoto N, Miyanohara H, Sarantuya J, Tokuda K, et al. Biofilm formation by and accessory gene regulator typing of Methicillin-Resistant Staphylococcus aureus strains recovered from patients with nosocomial infections. Infect Control Hosp Epidemiol. 2006; 27(2):188-190.
2. Coates R, Moran J, Horsburgh MJ. Staphylococci: colonizers and pathogens of human skin. Future Microbiol. 2014. 9:75–91. http://dx.doi.org/10.2217/fmb.13.145.
3. Boucher H, Miller LG, Razonable RR. Serious infections caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2010; 51Suppl 2:S183-97.
4. Chambers HF, DeLeo FR. Waves of Resistance: Staphylococcus aureus in the Antibiotic Era. Nature rev Microb. 2009; 7(9):629-641. doi: 10.1038/nrmicro2200
5. Baron EJ, Tenover FC. Methicillin-resistant Staphylococcus aureus diagnostics: state of the art. Expert Opin Med Diagn.2012;6(6):585-92.
6. Al Laham N. Detection and antibiotic resistance pattern of Staphylococcus aureus and MRSA isolated from healthcare workers nares at Gaza Hospitals, Palestine. IAJAA. 2016; doi: 10.3823/3779.
7. Arteaga LC, Espinosa Y, Chávez M. Prevalencia de Staphylococcus aureus que coloniza el personal de salud de un hospital de la ciudad de Cali. Rev Cienc Salud. 2016;14(1): 9-19.
8. Collazos LF Estupiñan G Chavez M. Characterization of Staphylococcus aureus Isolates That Colonize Medical Students in a Hospital of the City of Cali, Colombia. Int J Microbiol. 2015. Disponible en: http://dx.doi.org/10.1155/2015/358489
9. Gurieva TV, Bootsma MC, Bonten MJ. Decolonization of patients and health care workers to control nosocomial spread of methicillin-resistant Staphylococcus aureus: a simulation study. BMC Infect Dis. 2012; n12:302.
10. Hawkins G, Stewart S, Blatchford O, Reilly J. Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence. J Hosp Infect. 2011; 14:285–289.
11. Rashid Z, Farzana K, Sattar A, Murtaza G. Prevalence of nasal Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in hospital personnel and associated risk factors. Acta Pol Pharm- Drug Res. 2012; 69 (5):985-991.
12. Shakya B, Shrestha S, Mitra T. Nasal carriage rate of methicillin resistant Staphylococcus aureus among at National Medical College Teaching Hospital, Birgunj, Nepal. Nepal Med Coll J. 2010; 12(1):26-9.
13. Souza Damasceno Q, de Oliveira AC. Superfícies do ambiente hospitalar como possíveis reservatórios de bactérias resistentes: uma revisão. Rev Esc Enferm USP 2010; 44(4): 1118-1123. Disponible en: http://www.redalyc.org/articulo.oa?id=361033306038.
14. Coughenour C, Stevens V, Stetzenbach LD. An evaluation of methicillin-resistant Staphylococcus aureus survival on five environmental surfaces. Microb Drug Resist 2011; 17:457-61
15. Desai R, Pannaraj PS, Agopian J, Sugar CA, Liu GY, Miller LG. Survival and transmission of community-associated methicillin-resistant Staphylococcus aureus from fomites. Am J Infect Control. 2011; 39(3):219-25.
16. Faires MC, Pearl DL, Berke O. Reid-Smith RJ, Weese JS. The identification and epidemiology of meticillin-resistant Staphylococcus aureus and Clostridium difficile in patient rooms and the ward environment. BMC Infect Dis. 2013;13:342-44
17. Hayden MK, Blom DW, Lyle EA, Moore CG, Weistein RA. Risk of hand or glove contamination after contact with vancomycin-resistant enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol. 2008;29(2):149-54
18. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J ClinPathol. 1966; 45(4): 493–496.
19. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing:Twenty-third Informational Supplement; M100-S23. CLSI, Wayne, PA, USA, 2013.
20. Cheng HR, Jiang N. Extremely rapid extraction of DNA from bacteria and yeasts. Biotech Lett 2006; 28:55-57.
21. Becker K, Denis O, Roisin S, Mellmann A, Idelevich EA, Knaack D, et al. Detection of mecA- and mecC-positive methicillin-resistant Staphylococcus aureus (MRSA) isolates by the new Xpert MRSA Gen 3 PCR assay. J Clin Microbiol.2016; 54(1):180-4
22. Turlej A, Hryniewicz W, Empe J. Staphylococcal Cassette Chromosome mec (SCCmec) Classification and Typing Methods: an Overview. Pol J Microbiol. 2011; 60 (2,): 95–103
23. Azimian A, Najar-pirayeh S, Mirab-Samiee S, Naderi M. Ocurrence of Methicillin Resistant Staphylococcus aureus (MRSA) among clinical samples in Tehran - Iran and its correlation with polymorphism of specific accessory gene regulator (agr) groups. Braz. J. Microbiol. 2012; 43(2):779-85.
24. Sakoulas G, Eliopoulos GM, Moellering RC Jr, Wennersten C, Venkataraman L, Novick RP. Accessory gene regulator (agr) locus in geographically diverse Staphylococcus aureus isolates with reduced susceptibility to vancomycin. Antimicrob Agents Chemother 2002; 46:1492-502.
25. Chávez M, Erazo NC, Reina DA, Esparza M. Métodos de tipificación y epidemiología molecular de Staphylococcus aureus con resistencia a la meticilina. Rev Biosalud 2015; 14(2): 81-90. doi: 10.17151/biosa.2015.14.2.8
26. Ridenour GA, Wong ES, Call MA, Climo MW: Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit: Implications for intervention. Infect Control Hosp Epidemiol. 2006; 27: 271–278.
27. Datta R, Huang SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis. 2008; 47:176–181.
28. Patel M, Weinheimer JD, Waites KB, Baddley JW: Active surveillance to determine the impact of methicillinresistant Staphylococcus aureus colonization on patients in intensive care units of a Veterans Affairs Medical Center. Infect Control Hosp Epidemiol. 2008; 29:503–509.
29. Klevens RM, Edwards JR, Tenover FC, McDonald LC, Horan T, et al. National Nosocomial Infections Surveillance System. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US Hospitals, 1992–2003. Clin Infect Dis. 2006; 42:389–391.
30. Ellingson K, Muder RR, Jain R, Kleinbaum D, Feng PJ, Cunningham C, et al. Sustained reduction in the clinical incidence of methicillin-resistant Staphylococcus aureus colonization or infection associated with a multifaceted infection control intervention. Infect Control Hosp Epidemiol. 2011 Jan; 32(1):1–8.
31. Morgan DJ, Rogawski E, Thom KA, Johnson JK, Perencevich EN, Shardell M, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med. 2012; 40(4):1045–1051
32. Rebmann T, Aureden K. Preventing methicillin-resistant Staphylococcus aureus transmission in hospitals: An Executive Summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide. AmJ Infect Control. 2011;2011 Epub ahead of print.
33. Otth L, Wilson M, Bustamante N, Fernández H, Otth C. Susceptibilidad antimicrobiana y patrones de resistencia de Staphylococcus aureus aislados de pacientes y portadores en la ciudad de Valdivia, Chile. Rev Chil Infect 2008; 25 (3): 175-178.
34. Olarte NM, Valderrama IA, Reyes KR, Garzón MI, Escobar JA, Castro BE, et al. Colonización por Staphylococcus aureus resistente a la meticilina en una unidad de cuidados intensivos de adultos de un hospital colombiano: caracterización fenotípica y molecular con detección de un clon de circulación en la comunidad. Biomédica 2010;30:353-6.
35. Budimir A. Detection and typing methods of methicillin-resistant Staphylococcus aureus strains. Med Sci. 2012; 37:73–88.
36. Acevedo C, Guillén F, Fariña B, Aquino M. PCR múltiple para la detección simultánea de los genes mecA y pvl en Staphylococcus spp. Investig. Cienc. Salud. 2012; 10(1): 5-13
37. Rivero-Pérez B, Alcoba-Flórez J, Méndez-Álvarez S. Diversidad de clones de Staphylococcus aureus resistentes a meticilina y emergencia de nuevos clones encontrados en comunidades de Tenerife, punto caliente de turismo en España. Trauma Fund MAPFRE. 2011; 23(3):191-198
38. Girgis SA, Gomaa HE, Saad NE, Salem MM. A Comparative Study for Detection of Methicillin Resistance Staphylococci by Polymerase Chain Reaction and Phenotypic Methods Life Sci J 2013; 10(4) http://www.lifesciencesite.com
39. Huang SS, Hinrichsen VL, Datta R, Spurchise L, Miroshnik I, Nelson K, et al. Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection. PLoS One. 2011; 6:e24340.doi: 10.1371/journal.pone.0024340.
40. Castillo JS, Leal AL, Cortes JA, Alvarez CA, Sanchez R, Buitrago G, et al. Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia. Rev Panam Salud Publica. 2012; 32(5):343–50.
41. Alvarez CA, Barrientes OJ, Leal AL, Contreras GA, Barrero L, Rincón S, et al. Community associated methicillinresistant Staphylococcus aureus, Colombia. Emerg Infect Dis J. 2006; 12 12):2000-1. http://dx.doi.org/10.7705/biomedica.v34i3.1692
42. Álvarez CA, Yomayusa N, Leal AL, Moreno J, Méndez-Álvarez S, Ibáñez M, et al. Nosocomial infections caused by community-associated methicillin-resistant Staphylococcus aureus in Colombia. Am J Infect Control. 2010; 38:315-8.
43. Barrero LI, Castillo JS, Leal AL, Sánchez R, Cortés JA, Álvarez CA et al. Impacto económico de la resistencia a la meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá. Biomédica. 2014; 34(3): 345-353. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S012041572014000300005&lng
44. Arias C, Rincón S, Chowdhury S, Martínez E, Coronel W, Reyes J, et al. MRSA USA300 clone and vancomycinresistant Enterococcus faecalis: a United States–Colombian connection? N Eng J ed. 2008; 359:2177-9.45. Reyes J, Rincón S, Díaz L, Panesso D, Contreras GA, Zurita J, et al. Dissemination of methicillin-resistant Staphylococcus aureus USA300 sequence type 8 lineage in Latin America. Clin Infect Dis. 2009; 49:1861-7
46. Diep BA, Gill SR, Chang RF, Phan TH, Chen JH, Davidson MG, et al. Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus. Lancet. 2006; 367 (9512):731-739.
47. Escobar-Pérez JA, Castro BE, Márquez-Ortiz RA, Gaines S, Chavarro B, Moreno J, et al. Aislamientos de Staphylococcus aureus sensibles a meticilina relacionados genéticamente con el clon USA300, ¿origen de los aislamientos SARM de genotipo comunitario en Colombia? Biomédica 2014; 34(Supl.1):124-36. doi: http://dx.doi.org/10.7705/biomedica.v34i0.1661
48. Shopsin B, Mathema B, Alcabes P, Said-Salim B, Lina G, Matsuka A, Martinez J, et al. Prevalence of agr Specificity Groups among Staphylococcus aureus Strains Colonizing Children and Their Guardians. J Clin Microb. 2003;41(1):456–459.
49. Manago K, Nishi J, Wakimoto N, Miyanohara H, Sarantuya J, Tokuda K, et al. Biofilm formation by and accessory gene regulator typing of Methicillin-Resistant Staphylococcus aureus strains recovered from patients with nosocomial infections. Infect Control Hosp Epidemiol. 2006; 27(2):188-190.
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