Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Hospitalized Patients in Peru

Coralith García Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;
Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru;
Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru;

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Noemí Hinostroza Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Valeria Gordillo Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Maria L. Inchaustegui Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Lizeth Astocondor Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Omayra Chincha Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;
Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru;

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Saúl Alejos Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Marco Olivera Servicio de Infectología y Medicina Tropical, Hospital María Auxiliadora, Lima, Peru;

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Digna Bojórquez-Fernández Departamento de Patología ClÍnica y AnatomÍa Patológica, Hospital MarÍa Auxiliadora, Lima, Peru;

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Fátima Concha-Velasco Departamento de Medicina, Hospital Antonio Lorena, Cusco, Peru;
Escuela Profesional de Medicina Humana, Universidad Nacional San Antonio Abad del Cusco, Cusco, Peru;

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Nancy Vásquez Departamento de Apoyo al Diagnóstico, Hospital Antonio Lorena, Cusco, Peru;

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Alex Castaneda-Sabogal Departamento de Medicina, Hospital Base Víctor Lazarte Echegaray de EsSalud, La Libertad, Peru;
Facultad de Medicina Humana, Universidad Privada Antenor Orrego, Trujillo, Peru;

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Pedro Sullón Departamento de Especilaidades Médicas, Hospital Hipólito Unanue, Lima, Peru;

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Víctor Fernández Departamento de Medicina, Hospital Belén de Trujillo, La Libertad, Peru;

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Miguel Villegas-Chiroque Departamento de Áreas Clínicas, Hospital Regional Lambayeque, Lambayeque, Peru;

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Enrique López Departamento de Medicina Hospital Regional de Loreto Felipe Santiago Arriola Iglesias, Loreto, Peru;

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Miguel Hueda-Zavaleta Faculty of Health Sciences, Universidad Privada de Tacna, Tacna, Peru;
Departamento de Medicina, Hospital III Daniel Alcides Carrión–EsSalud Tacna, Tacna, Peru;

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Ana Vidaurre Departamento de Medicina, Hospital III EsSalud Chimbote, Ancash, Peru;

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César Bocángel Departamento de Medicina Hospital Goyeneche de Arequipa, Arequipa, Peru;

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Evelyn Barco Departamento de Patología Clínica, Hospital Regional II-2 José Alfredo Mendoza Olavarría, Tumbes, Peru;

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Eduardo Paricahua Departamento de Medicina, Hospital Santa Rosa de Puerto Maldonado, Madre de Dios, Peru;

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Marcus Zervos Infectious Disease Division, Henry Ford Health System, Detroit, Michigan;

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Jan Jacobs Institute of Tropical Medicine, Antwerp, Belgium;
Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium

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Fiorella Krapp Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;
Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru;
Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium

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ABSTRACT.

There is a knowledge gap in the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) causing bloodstream infections (BSIs) in Peru. Through a surveillance study in 13 hospitals of 10 Peruvian regions (2017–2019), we assessed the proportion of MRSA among S. aureus BSIs as well as the molecular typing of the isolates. A total of 166 S. aureus isolates were collected, and 36.1% of them were MRSA. Of note, MRSA isolates with phenotypic and genetic characteristics of the hospital-associated Chilean-Cordobes clone (multidrug-resistant SCCmec I, non–Panton-Valentine leukocidin [PVL] producers) were most commonly found (70%), five isolates with genetic characteristics of community-associated MRSA (CA-MRSA)—SCCmec IV, PVL-producer—(8.3%) were seen in three separate regions. These results demonstrate that hospital-associated MRSA is the most frequent MRSA found in patients with BSIs in Peru. They also show the emergence of S. aureus with genetic characteristics of CA-MRSA. Further studies are needed to evaluate the extension of CA-MRSA dissemination in Peru.

Author Notes

Financial support: This work was funded by the Belgian Directorate of Development Cooperation (DGD). F. K. holds a PhD scholarship from the Belgian DGD and was supported by the Fogarty International Center of the NIH under Award Number D43TW009343 and the University of California Global Health Institute.

Authors’ addresses: Coralith García, Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru and Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru, E-mail: coralith.garcia@upch.pe. Noemi Hinostroza, Lizeth Astocondor and Saul Alejos, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: noemi.hinostroza.s@gmail.com, astocondor.lizeth@gmail.com and savaf@hotmail.com. Valeria Gordillo and Maria L Inchaustegui, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: valeria.gordillo@upch.pe and maria.inchaustegui@upch.pe. Omayra Chincha, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru and Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru, E-mail: omychin@gmail.com. Marco Olivera Servicio de Infectología y Medicina Tropical, Hospital María Auxiliadora, Lima Peru, E-mail: marco_fmh@hotmail.com. Digna Bojórquez-Fernández, Departamento de Patología Clínica y Anatomía Patológica, Hospital María, LiAuxiliadorama Peru, E-mail: dina_849@hotmail.com. Fátima Concha-Velasco, Departamento de Medicina, Hospital Antonio Lorena, Cusco, Peru and Escuela Profesional de Medicina Humana, Universidad Nacional San Antonio de Abad del Cusco, Cusco, Peru, E-mail: fatima.concha.v@upch.pe. Nancy Vásquez, Departamento de Apoyo al Diagnóstico, Hospital Antonio Lorena, Cusco, Peru, E-mail: nancyvalu@hotmail.com. Alex Castaneda-Sabogal, Departamento de Medicina, Hospital Base Víctor Lazarte Echegaray de EsSalud, La Libertad, Peru, and Facultad de Medicina Humana, Universidad Privada Antenor Orrego, Trujillo, Peru, E-mail: alex.castaneda.s@upch.pe. Pedro Sullón, Departamento de Especialidades Médicas, Hospital Hipólito Unanue, Lima, Peru, E-mail: pedro_sullon1@yahoo.es. Víctor Fernández, Departamento de Medicina, Hospital Belén de Trujillo, La Libertad, Peru, E-mail: solhuanchac@hotmail.com. Miguel Villegas-Chiroque, Departamento de Áreas Clínicas, Hospital Regional Lambayeque, Lambayeque, Peru, E-mail: mivichi2003@hotmail.com. Enrique López, Departamento de Medicina, Hospital Regional de Loreto Felipe Santiago Arriola Iglesias, Loreto, Peru, E-mail: enriquelopez62879gmail.com. Miguel Hueda-Zavaleta, Faculty of Health Sciences, Universidad Privada de Tacna, Tacna, Peru, and Departamento de Medicina, Hospital III Daniel Alcides Carrión–EsSalud Tacna, Tacna, Peru, E-mail: miguelhueda90@gmail.com. Ana Vidaurre, Departamento de Medicina, Hospital III EsSalud Chimbote, Ancash, Peru, E-mail: ana.vidaurre@essalud.gob.pe. César Bocángel, Departamento de Medicina, Hospital Goyeneche de Arequipa, Arequipa, Peru, E-mail: cesdaboc@gmail.com. Evelyn Barco, Departamento de Patología Clínica, Hospital Regional II-2 José Alfredo Mendoza Olavarría, Tumbes, Peru, E-mail: evelynbarco@gmail.com. Eduardo Paricahua, Departamento de Medicina, Hospital Santa Rosa de Puerto Maldonado, Madre de Dios, Peru, E-mail: epaper4000@gmail.com. Marcus Zervos, Infectious Disease Division, Henry Ford Health System, Detroit, MI, E-mail: mzervos1@hfhs.org. Jan Jacobs, Institute of Tropical Medicine, Antwerp, Belgium, and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium, E-mail: jjacobs@itg.be. Fiorella Krapp, Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru, and Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium, E-mail: fiorella.krapp@upch.pe.

Address correspondence to Coralith García, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru. E-mail: coralith.garcia@upch.pe
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