Prevalence of and risk factors associated with the presence of <i>Staphylococcus aureus</i> in the chronic wounds of patients treated in primary health care settings in Brazil

Pereira-Franchi, Eliane Patricia Lino; Barreira, Maria Rachel Nogueira; Costa, Natália de Sousa Lima Moreira da; Fortaleza, Carlos Magno Castelo Branco; Cunha, Maria de Lourdes Ribeiro de Souza da

doi:10.1590/0037-8682-0205-2017

Acessibilidade / Reportar erro

Brasil

Revista da Sociedade Brasileira de Medicina Tropical

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Short Communications • Rev. Soc. Bras. Med. Trop. 50 (06) • Nov-Dec 2017 • https://doi.org/10.1590/0037-8682-0205-2017 copy

Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Wounds can be colonized by methicillin-resistant Staphylococcus aureus (MRSA).

METHODS:

We evaluated the prevalence of S. aureus and MRSA in the wounds of patients treated at Basic Health Units in Brazil and identified risk factors associated with their presence.

RESULTS:

The prevalence rates of S. aureus and MRSA were 51.5% and 8.7%, respectively. There was a correlation between the presence of S. aureus in wounds and nostrils (p<0.01). A positive association was detected between S. aureus infection and previous benzylpenicillin use (p=0.02). No associations were observed for MRSA.

CONCLUSIONS:

Multidrug-resistant pathogens are present in primary healthcare settings in Brazil.

Keywords:
S. aureus; Wounds; Primary healthcare

Risk factor	Univariate analysis				Multivariate analysis
	S. aureus (n=88)	other (n=83)	crude OR (95% CI)	p	adjusted OR (95% CI)	p
Socioeconomic and demographic factors:
males	32 (52.46)	29 (47.54)	1.06 (0.57-1.99)	0.85
median age, years	63 (55.0-73.5)	72 (63-81)	0.96 (0.94-0.99)	<0.01	0.94 (0.90-0.98)	<0.01
rural	4 (4.55)	4 (4.2)	0.94 (0.23-3.89)	1
home-ownership	70 (79.55)	64 (77.11)	0.86 (0.41-1.79)	0.69
water treatment	86 (97.73)	77 (92.77)	0.29 (0.05-1.52)	0.15
sewage treatment	82 (93.18)	76 (91.57)	0.79 (0.25-2.46)	0.69
paved road	79 (89.77)	73 (87.95)	1.2 (0.46-3.12)	0.7
Family income*
≤ 2 wages	54 (61.36)	54 (65.06)	Reference	-
3-4 wages	29 (32.95)	25 (30.12)	1.16 (0.6-2.23)	0.66
≥ 4 wages	5 (5.68)	4 (4.82)	1.25 (0.32-4.91)	0.74
Alcoholism**	4 (4.55)	3 (3.61)	1.26 (0.27-5.84)	0.76
Tobacco smoking	17 (19.32)	7 (8.54)	2.56 (1-6.55)	0.04
regular sports practice	1 (1.15)	3 (3.61)	0.31 (0.03-3.12)	0.35
retired/homemaker	69 (84.15)	74 (93.67)	2.78 (0.94-8.22)	0.05
presence of pets	45 (51.14)	38 (45.78)	1.24 (0.68-2.26)	0.48
household size	3 (2-4.5)	2 (2.5-4)	1.05 (0.89-1.24)	0.2
Schooling
Illiterate	16 (18.39)	30 (36.14)	reference	-
< elementary	52 (59.77)	43 (51.81)	2.26 (1.09-4.69)	0.02
≥ elementary	19 (21.84)	10 (12.05)	2.56 (1.34-9-46)	0.01
Health and lesion history
diabetes	28 (32.18)	27 (32.93)	0.96 (0.5-1.84	0.91
arterial hypertension	55 (62.5)	52 (62.65)	0.99 (0.53-1.85)	0.98
dyslipidemia	21 (23.86)	15 (18)	1.42 (0.67-2.98)	0.35
obesity	6 (6.82)	3 (3.61)	1.95 (0.47-8.07)	0.49
cardiovascular disease	9 (10.23)	11 (13.41)	0.73 (0.29-1.88)	0.51
mental health disorder	5 (5.68)	7 (8.43)	0.65 (0.19-2.15)	0.48
thyroid disease	2 (2.27)	4 (4.82)	0.45 (0.08-2.58)	0.36
Year of collection
2010	34 (38.64)	48 (57.83)	Reference	-
2011	10 (11.36)	6 (7.23)	2.35 (0.78-7)	0.12
2012	25 (28.41)	22 (26.51)	1.6 (0.7-3.3)	0.19
2013	19 (21.59)	7 (8.43)	3.8 (1.4-10.1)	<0.01
Signs of infection	10 (11.36)	22 (26.51)	0.35 (0.15-0.80)	0.01
recurring lesion	34 (38.64)	25 (30.12)	1.46 (0.77-2.46)	0.24
venous ulcer	57 (64.77)	44 (53)	0.61 (0.33-1.33)	0.11
median age of the wound***	14 (3-108)	5 (2-132)	0.99 (0.99-1)	0.19
Previous antibiotic therapy:
amoxicillin	13 (14.77)	22 (16.51)	0.48 (0.22-1.03)	0.05	0.16 (0.04-0.60)	<0.01
azithromycin	2 (2.27)	1 (1.2)	1.9 (0.16-21.43)	1
Bactrim	6 (6.82)	5 (6.02)	1.14 (0.33-3.89)	0.83
Benzylpenicillin	25 (28.41)	15 (18.29)	1.77 (0.85-3.66)	0.12	3.81 (1.23-11.82)	0.02
cephalexin	49 (55.68)	49 (59.04)	0.87 (0.47-1.59)	0.65
clindamycin	11 (12.5)	17 (20.48)	0.55 (0.25-1.26)	0.15
ciprofloxacin	12 (13.64)	16 (19.28)	0.66 (0.29-1.49)	0.31	0.28 (0.08-0.98)	0.04
erythromycin	4 (4.55)	2 (2.41)	1.92 (0.34-0.81)	0.68
gentamicin	1 (1.2)	1 (1.14)	0.94 (0.05-5.31)	1
levofloxacin	1 (1.15)	5 (6.02)	0.18 (0.02-1.58)	0.11

Patient	MRSA	Type	Resistance	Origin	BHU**
1	1	II	oxa, cfo, lvx, cli, ery, pen	wound*	A
2	2	II	oxa, cfo, lvx, cli, ery, pen	wound*	B
3	3	II	oxa,cfo, lvx, cli, ery, pen	wound*	C
4	4	II	oxa, cfo, lvx, cli, ery, pen	wound	D
	5	II	oxa, cfo, lvx, cli, ery, pen	nasal
5	6	II	oxa, cfo, lvx, gen, cli, ery, pen	wound*	E
6	7	IV	oxa, cfo, lvx, cli, ery, pen	wound*	B
7	8	IV	oxa, cfo, pen	wound	D
	9	IV	oxa, cfo, pen	nasal
8	10	IV	oxa, cfo, pen	wound	F
9	11	IV	oxa, cfo, pen	wound	G
10	12	IV	oxa, cfo, pen	wound	H
11	13	IV	oxa, cfo, gen, ery, pen	wound*	C
12	14	IV	oxa, cfo, ery, pen	wound*	I
13	15	IV	oxa, cfo, ery, pen	wound	G
14	16	IV	oxa, cfo, ery, pen	nasal	C
15	17	IV	oxa, cfo, ery, pen	wound	C
	18	IV	oxa, cfo, ery, pen	nasal

Sociedade Brasileira de Medicina Tropical - SBMT Sociedade Brasileira de Medicina Tropical - SBMT, Núcleo de Medicina Tropical UnB, Sala 43C 70904-970, E-mails: rsbmt@uftm.edu.br | artes.rsbmt@gmail.com | sbmt@sbmt.org.br , WhatsApp: SBMT (61) 9.9192-6496, WhatsApp: RSBMT (34) 9.9996-5807 - Brasília - DF - Brazil
E-mail: rsbmt@uftm.edu.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Dra. Eliane Patricia Lino Pereira Franchi. e-mail:fliane24@yahoo.com.br