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Journal of Medical Microbiology logo Journal of Medical Microbiology

Volume 73, Issue 9

Clinical presentation and microbiological characteristics of community-acquired bacteraemia at a tertiary hospital in Costa Rica No Access

Abstract

is a leading agent in community-acquired bacteraemia (CAB) and has been linked to elevated mortality rates and methicillin resistance in Costa Rica.

To update and enhance previous data obtained in this country, we analysed the clinical manifestations of 54  CAB cases in a tertiary hospital and delineated the sequence types (STs), virulome, and resistome of the implicated isolates.

Clinical information was retrieved from patient files. Antibiotic susceptibility profiles were obtained with disc diffusion and automated phenotypic tests. Genomic data were exploited to type the isolates and for detection of resistance and virulence genes.

Primary infections predominantly manifested as bone and joint infections, followed by skin and soft tissue infections. Alarmingly, 70% of patients continued to exhibit positive haemocultures beyond 48 h of treatment modification, with nearly a quarter requiring mechanical ventilation or developing septic shock. The 30-day mortality rate reached an alarming 40%. More than 60% of the patients were found to have received suboptimal or inappropriate antibiotic treatment, and there was an alarming tendency towards the overuse of third-generation cephalosporins as empirical treatment. Laboratory tests indicated elevated creatinine levels, leukocytosis, and bandaemia within the first 24 h of hospitalization. However, most showed improvement after 48 h. The isolates were categorized into 13 STs, with a predominance of representatives from the clonal complexes CC72 (ST72), CC8 (ST8), CC5 (ST5, ST6), and CC1 (ST188). Twenty-four isolates tested positive for , with ST72 strains accounting for 20. In addition, we detected genes conferring acquired resistance to aminoglycosides, MLS antibiotics, trimethoprim/sulfamethoxazole, and mutations for fluoroquinolone resistance in the isolate collection. Genes associated with biofilm formation, capsule synthesis, and exotoxin production were prevalent, in contrast to the infrequent detection of enterotoxins or exfoliative toxin genes.

Our findings broaden our understanding of infections in a largely understudied region and can enhance patient management and treatment strategies.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): bacteraemia , clinical presentation , community infections , resistome , Staphylococcus aureus , typing , virulome and whole-genome sequencing
Funding
This study was supported by the:
  • ASOFAHO
    • Principal Award Recipient: NotApplicable
© 2024 The Authors
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2024-09-05
2025-12-15

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References

  1. Supplementary Table 1. Clinical data obtained for patients with S. aureus bacteremia of community origin in Costa Rica [View Article]
  2. Supplementary Table 3. Genes encoding resistance and virulence factors detected among S. aureus isolates implicated in community-associated bacteremia in Costa Rica [View Article]
  3. Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler Jr VG Jr. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603–661 [View Article] [PubMed]
     [Google Scholar]
  4. PubMLST - Public databases for molecular typing and microbial genome diversity. n.d https://pubmlst.org/ accessed 7 April 2024
  5. Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S et al. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primers 2018; 4:18033 [View Article] [PubMed]
     [Google Scholar]
  6. Rasmussen G, Monecke S, Ehricht R, Söderquist B. Prevalence of clonal complexes and virulence genes among commensal and invasive Staphylococcus aureus isolates in Sweden. PLoS One 2013; 8:e77477 [View Article] [PubMed]
     [Google Scholar]
  7. DeLeo FR, Otto M. An antidote for Staphylococcus aureus pneumonia?. J Exp Med 2008; 205:271–274 [View Article] [PubMed]
     [Google Scholar]
  8. Cameron DR, Howden BP, Peleg AY. The interface between antibiotic resistance and virulence in Staphylococcus aureus and its impact upon clinical outcomes. Clin Infect Dis 2011; 53:576–582 [View Article] [PubMed]
     [Google Scholar]
  9. Phetsouvanh R, Phongmany S, Soukaloun D, Rasachak B, Soukhaseum V et al. Causes of community-acquired bacteremia and patterns of antimicrobial resistance in Vientiane, Laos. Am J Trop Med Hyg 2006; 75:978–985 [View Article] [PubMed]
     [Google Scholar]
  10. Dat VQ, Vu HN, Nguyen The H, Nguyen HT, Hoang LB et al. Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome. BMC Infect Dis 2017; 17:493 [View Article] [PubMed]
     [Google Scholar]
  11. van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL et al. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin Microbiol Rev 2012; 25:362–386 [View Article] [PubMed]
     [Google Scholar]
  12. Méndez E, Ramírez M. Characterization of bacteremia by Staphylococcus aureus in hospitalized patients of the San Juan de Dios Hospital between January 2015 to December 2017. Revista De Medicina Legal De Costa Rica 2019; 36:21–31
     [Google Scholar]
  13. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 137:791–797 [View Article] [PubMed]
     [Google Scholar]
  14. CLSI M100 Performance Standards for Antimicrobial Susceptibility Testing, 34th edn Clinical and Laboratory Standards Institute; 2024
     [Google Scholar]
  15. Arias CA, Reyes J, Carvajal LP, Rincon S, Diaz L et al. A prospective cohort multicenter study of molecular epidemiology and phylogenomics of Staphylococcus aureus bacteremia in nine Latin American countries. Antimicrob Agents Chemother 2017; 61:e00816-17 [View Article] [PubMed]
     [Google Scholar]
  16. Di Gregorio S, Vielma J, Haim MS, Rago L, Campos J et al. Genomic epidemiology of Staphylococcus aureus isolated from bloodstream infections in South America during 2019 supports regional surveillance. Microb Genom 2023; 9:mgen001020 [View Article] [PubMed]
     [Google Scholar]
  17. Batool N, Shamim A, Chaurasia AK, Kim KK. Genome-wide analysis of Staphylococcus aureus sequence type 72 isolates provides insights into resistance against antimicrobial agents and virulence potential. Front Microbiol 2021; 11:613800 [View Article]
     [Google Scholar]
  18. Khokhlova O, Tomita Y, Hung WC, Takano T, Iwao Y et al. Elderly infection in the community due to ST5/SCCmecII methicillin-resistant Staphylococcus aureus (the New York/Japan clone) in Japan: Panton-Valentine leukocidin-negative necrotizing pneumonia. J Microbiol Immunol Infect 2015; 48:335–339 [View Article] [PubMed]
     [Google Scholar]
  19. Zhou Y, He YY, Wang FW, He P, Hou SP et al. Molecular characterization of Staphylococcus aureus ST6 and ST7 isolates from food-borne illness outbreaks. Chin J Prev Med 2022; 56:178–184 [View Article] [PubMed]
     [Google Scholar]
  20. Joo E-J, Chung DR, Ha YE, Park SY, Kim HA et al. Clinical predictors of community-genotype ST72-methicillin-resistant Staphylococcus aureus-SCCmec type IV in patients with community-onset S. aureus infection. J Antimicrob Chemother 2012; 67:1755–1759 [View Article] [PubMed]
     [Google Scholar]
  21. Azmi K, Qrei W, Abdeen Z. Screening of genes encoding adhesion factors and biofilm production in methicillin resistant strains of Staphylococcus aureus isolated from Palestinian patients. BMC Genom 2019; 20:578 [View Article] [PubMed]
     [Google Scholar]
  22. Drożdż K, Ochońska D, Ścibik Ł, Gołda-Cępa M, Biegun K et al. The frequency of occurrence of resistance and genes involved in the process of adhesion and accumulation of biofilm in Staphylococcus aureus strains isolated from tracheostomy tubes. Microorganisms 2022; 10:1210 [View Article] [PubMed]
     [Google Scholar]
  23. Foster TJ. The MSCRAMM family of cell-wall-anchored surface proteins of gram-positive cocci. Trends Microbiol 2019; 27:927–941 [View Article] [PubMed]
     [Google Scholar]
  24. Atshan SS, Nor Shamsudin M, Sekawi Z, Lung LTT, Hamat RA et al. Prevalence of adhesion and regulation of biofilm-related genes in different clones of Staphylococcus aureus. J Biomed Biotech 2012; 2012:1–10 [View Article]
     [Google Scholar]
/content/journal/jmm/10.1099/jmm.0.001883
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Clinical presentation and microbiological characteristics of community-acquired Staphylococcus aureus bacteraemia at a tertiary hospital in Costa Rica
J. Med. Microbiol. 73, 001883 (2024); https://doi.org/10.1099/jmm.0.001883
/content/journal/jmm/10.1099/jmm.0.001883
/content/journal/jmm/10.1099/jmm.0.001883
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