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The History of Methicillin-Resistant Staphylococcus aureus in Brazil. ACTA ACUST UNITED AC 2020; 2020:1721936. [PMID: 33082892 PMCID: PMC7563066 DOI: 10.1155/2020/1721936] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/21/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022]
Abstract
Since the emergence of MRSA in the 1960s, a gradual increase in infections by resistant bacteria has been observed. Clinical manifestations may vary from brand to critical condition due to host risk factors, as well as pathogen virulence and resistance. The high adaptability and pathogenic profile of MRSA clones contributed to its spread in hospital and community settings. In Brazil, the first MRSA isolates were reported in the late 1980s, and since then different genetic profiles, such as the Brazilian epidemic clone (BEC) and other clones considered a pandemic, became endemic in the Brazilian population. Additionally, Brazil's MRSA clones were shown to be able to transfer genes involved in multidrug resistance and enhanced pathogenic properties. These events contributed to the rise of highly resistant and pathogenic MRSA. In this review, we present the main events which compose the history of MRSA in Brazil, including numbers and locations of isolation, as well as types of staphylococcal cassette chromosome mec (SCCmec) found in the Brazilian territory.
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Duarte FC, Tavares ER, Danelli T, Ribeiro MAG, Yamauchi LM, Yamada-Ogatta SF, Perugini MRE. Disseminated Clonal Complex 5 (CC5) methicillin-resistant Staphylococcus aureus SCCmec type II in a tertiary hospital of Southern Brazil. Rev Inst Med Trop Sao Paulo 2018; 60:e32. [PMID: 30043936 PMCID: PMC6056895 DOI: 10.1590/s1678-9946201860032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/07/2018] [Indexed: 12/03/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of human infections worldwide, with major dominant lineage circulating in particular geographical regions. The Brazilian Epidemic Clone (BEC, SCCmec III, ST 239) has been predominant in most Brazilian hospitals. Here, we report the prevalence of MRSA SCCmec type II exhibiting different STs, most of them belonging to CC5 in a tertiary hospital in Southern Brazil.
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Affiliation(s)
- Felipe Crepaldi Duarte
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Patologia, Análises Clínicas e Toxicológicas, Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Londrina, Paraná, Brazil
| | - Eliandro Reis Tavares
- Universidade Estadual de Londrina, Centro de Ciências Biológicas, Departamento de Microbiologia, Programa de Pós-Graduação em Microbiologia, Londrina, Paraná, Brazil.,Universidade Estadual de Londrina, Centro de Ciências Biológicas, Departamento de Microbiologia, Laboratório de Biologia Molecular de Microrganismos, Londrina, Paraná, Brazil
| | - Tiago Danelli
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Patologia, Análises Clínicas e Toxicológicas, Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Londrina, Paraná, Brazil
| | - Maria Alice Galvão Ribeiro
- Universidade Estadual de Londrina, Centro de Ciências Biológicas, Departamento de Microbiologia, Programa de Pós-Graduação em Microbiologia, Londrina, Paraná, Brazil
| | - Lucy Megumi Yamauchi
- Universidade Estadual de Londrina, Centro de Ciências Biológicas, Departamento de Microbiologia, Programa de Pós-Graduação em Microbiologia, Londrina, Paraná, Brazil.,Universidade Estadual de Londrina, Centro de Ciências Biológicas, Departamento de Microbiologia, Laboratório de Biologia Molecular de Microrganismos, Londrina, Paraná, Brazil
| | - Sueli Fumie Yamada-Ogatta
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Patologia, Análises Clínicas e Toxicológicas, Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Londrina, Paraná, Brazil.,Universidade Estadual de Londrina, Centro de Ciências Biológicas, Departamento de Microbiologia, Programa de Pós-Graduação em Microbiologia, Londrina, Paraná, Brazil.,Universidade Estadual de Londrina, Centro de Ciências Biológicas, Departamento de Microbiologia, Laboratório de Biologia Molecular de Microrganismos, Londrina, Paraná, Brazil
| | - Marcia Regina Eches Perugini
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Patologia, Análises Clínicas e Toxicológicas, Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Londrina, Paraná, Brazil.,Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Patologia, Análises Clínicas e Toxicológicas, Laboratório de Microbiologia Clínica, Londrina, Paraná, Brazil
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Furtado I, Xavier PCN, Tavares LVM, Alves F, Martins SF, Martins ADS, Palhares DB. Enterococcus faecium and Enterococcus faecalis in blood of newborns with suspected nosocomial infection. Rev Inst Med Trop Sao Paulo 2014; 56:77-80. [PMID: 24553613 PMCID: PMC4085837 DOI: 10.1590/s0036-46652014000100012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 06/06/2013] [Indexed: 11/22/2022] Open
Abstract
Enterococci are Gram-positive cocci saprophyte of the human gastrointestinal tract, diners who act as opportunistic pathogens. They can cause infections in patients hospitalized for a long time or who have received multiple antibiotic therapy. Enterococcus faecalis and Enterococcus faecium are the most common species in human infections. To evaluate the possibility of rapid detection of these species and their occurrence in the blood of newborns with suspected nosocomial infection, blood samples were collected from 50 newborns with late infections, admitted to the Neonatal Care Unit of the University Hospital Federal de Mato Grosso do Sul (UFMS-HU), from September 2010 to January 2011. The samples were subjected to conventional PCR and real time PCR (qPCR) to search for Enterococcus faecium and Enterococcus faecalis, respectively. The PCR results were compared with respective blood cultures from 40 patients. No blood cultures were positive for Enterococci, however, eight blood samples were identified as genomic DNA of Enterococcus faecium by qPCR and 22 blood samples were detected as genomic DNA of Enterococcus faecalis by conventional PCR. These findings are important because of the clinical severity of the evaluated patients who were found positive by conventional PCR and not through routine microbiological methods.
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Affiliation(s)
- Isabela Furtado
- Program Graduate Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Brazil, Program Graduate Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Paula Cristhina Niz Xavier
- Program Graduate Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Brazil, Program Graduate Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Luciana Venhofen Martinelli Tavares
- Department of Physical Therapy, Dom Bosco Catholic University and the Federal University of Mato Grosso do Sul, Campo Grande, Brazil, Department of Physical Therapy, Dom Bosco Catholic University and the Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Fabiana Alves
- Department of Physiology and Biofísica-ICB/UFMG, Belo Horizonte, Brazil, Department of Physiology and Biofísica-ICB/UFMG, Belo Horizonte, Brazil
| | - Sarah Fonseca Martins
- Department of Physiology and Biofísica-ICB/UFMG, Belo Horizonte, Brazil, Department of Physiology and Biofísica-ICB/UFMG, Belo Horizonte, Brazil
| | - Almir de Sousa Martins
- Department of Physiology and Biofísica-ICB/UFMG, Belo Horizonte, Brazil, Department of Physiology and Biofísica-ICB/UFMG, Belo Horizonte, Brazil
| | - Durval Batista Palhares
- Department of Pediatrics, University Hospital, Federal University of Mato Grosso do Sul, Campo Grande, Brazil, Department of Pediatrics, University Hospital, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Antimicrobial resistance and molecular typing of Staphylococcus aureus bloodstream isolates from hospitals in Peru. J Infect 2012; 65:406-11. [DOI: 10.1016/j.jinf.2012.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/03/2012] [Accepted: 06/07/2012] [Indexed: 11/20/2022]
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Lee BY, McGlone SM, Wong KF, Yilmaz SL, Avery TR, Song Y, Christie R, Eubank S, Brown ST, Epstein JM, Parker JI, Burke DS, Platt R, Huang SS. Modeling the spread of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks throughout the hospitals in Orange County, California. Infect Control Hosp Epidemiol 2011; 32:562-72. [PMID: 21558768 DOI: 10.1086/660014] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Since hospitals in a region often share patients, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in one hospital could affect other hospitals. METHODS Using extensive data collected from Orange County (OC), California, we developed a detailed agent-based model to represent patient movement among all OC hospitals. Experiments simulated MRSA outbreaks in various wards, institutions, and regions. Sensitivity analysis varied lengths of stay, intraward transmission coefficients (β), MRSA loss rate, probability of patient transfer or readmission, and time to readmission. RESULTS Each simulated outbreak eventually affected all of the hospitals in the network, with effects depending on the outbreak size and location. Increasing MRSA prevalence at a single hospital (from 5% to 15%) resulted in a 2.9% average increase in relative prevalence at all other hospitals (ranging from no effect to 46.4%). Single-hospital intensive care unit outbreaks (modeled increase from 5% to 15%) caused a 1.4% average relative increase in all other OC hospitals (ranging from no effect to 12.7%). CONCLUSION MRSA outbreaks may rarely be confined to a single hospital but instead may affect all of the hospitals in a region. This suggests that prevention and control strategies and policies should account for the interconnectedness of health care facilities.
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Affiliation(s)
- Bruce Y Lee
- University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Molecular epidemiology and risk factors for nasal carriage of staphylococcus aureus and methicillin-resistant S. aureus in infants attending day care centers in Brazil. J Clin Microbiol 2009; 47:3991-7. [PMID: 19828745 DOI: 10.1128/jcm.01322-09] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Investigations regarding Staphylococcus aureus carriage among Brazilian children are scarce. We evaluated the determinants of S. aureus and methicillin-resistant S. aureus (MRSA) nasal carriage in infants attending day care centers (DCCs) and the molecular features of the MRSA strains. A total of 1,192 children aged 2 months to 5 years attending 62 DCCs were screened for S. aureus and MRSA nasal carriage. MRSA isolates were characterized by pulsed-field gel electrophoresis, multilocus sequence typing, spa typing, staphylococcal cassette chromosome (SCC) mec typing and the presence of the Panton-Valentine leukocidin gene. Logistic regression was performed to determine risk factors associated with S. aureus and MRSA colonization. S. aureus and MRSA carriage were detected in 371 (31.1%) and 14 (1.2%) children, respectively. Variables found to be independently associated with an increased risk for S. aureus carriage included being older than 24 months (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3 to 2.6) and previous DCC attendance (OR, 1.5; 95% CI, 1.0 to 2.2). Having a mother with a high level of education was a protective factor for nasal colonization (OR, 0.4; 95% CI, 0.2 to 0.8). Moreover, we observed that more children carrying MRSA had younger siblings than children not colonized by MRSA. Among the 14 MRSA strains, three SCCmec types (IIIA, IV, and V) were detected, together with a multidrug-resistant dominant MRSA lineage sharing 82.7% genetic similarity with the Brazilian clone (ST239-MRSA-IIIA; ST indicates the sequence type determined by multilocus sequence typing). Although SCCmec type V was recovered from one healthy child who had been exposed to known risk factors for hospital-associated MRSA, its genetic background was compatible with community-related MRSA. Our data suggest that DCC attendees could be contributing to MRSA cross-transmission between health care and community settings.
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Lamaro-Cardoso J, Castanheira M, de Oliveira RM, e Silva SA, Pignatari ACC, Mendes RE, Pimenta FC, Andrade ALSS. Carriage of methicillin-resistant Staphylococcus aureus in children in Brazil. Diagn Microbiol Infect Dis 2007; 57:467-70. [PMID: 17240106 DOI: 10.1016/j.diagmicrobio.2006.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 09/19/2006] [Accepted: 10/08/2006] [Indexed: 11/26/2022]
Abstract
The extent of methicillin-resistant Staphylococcus aureus (MRSA) carriage in Brazilian infants is largely unknown. We evaluated the presence of MRSA nasopharyngeal (NP) carriage in 686 children younger than 5 years with respiratory tract infection (609) and meningitis (77). S. aureus was isolated in 93 (13.5%) NP specimens of which 7 (1.02%) were identified as MRSA (oxacillin MIC, >256 microg/mL) harboring SCCmec type III. The dendrogram derived from the pulsed-field gel electrophoresis gel images showed that the MRSA strains diverged from the Brazilian endemic hospital-acquired clones from 10.4% to 21.7%. Although the MRSA strains were recovered from children within the first 6 h of their admission to hospital, the presence of SCCmec type III along with the multidrug-resistant profile of the isolates raises the hypotheses that these MRSA strains may have hospital origin and are now spreading into the pediatric community as colonizing pathogens.
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Affiliation(s)
- Juliana Lamaro-Cardoso
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia-Goiás 74605-050, Brazil
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Andrade-Baiocchi S, Tognim MCB, Baiocchi OCG, Sader HS. Endocarditis due to glycopeptide-intermediate Staphylococcus aureus: case report and strain characterization. Diagn Microbiol Infect Dis 2003; 45:149-52. [PMID: 12614988 DOI: 10.1016/s0732-8893(02)00511-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of infective endocarditis due to vancomycin-intermediate Staphylococcus aureus (VISA) that did not respond to high doses of vancomycin. Initial vancomycin MIC of the last isolate recovered from blood was 8 micro g/mL, but could be induced up to 32 micro g/mL by consecutive growing with vancomycin. Clinical response was only accomplished when linezolid was included in therapy.
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Affiliation(s)
- Soraya Andrade-Baiocchi
- Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Sola C, Gribaudo G, Vindel A, Patrito L, Bocco JL. Identification of a novel methicillin-resistant Staphylococcus aureus epidemic clone in Córdoba, Argentina, involved in nosocomial infections. J Clin Microbiol 2002; 40:1427-35. [PMID: 11923368 PMCID: PMC140375 DOI: 10.1128/jcm.40.4.1427-1435.2002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are increasingly a main health concern worldwide for hospitalized patients. In addition, the prevalence of community-acquired infection has risen continuously during the last few years. Some MRSA clones spread easier than others within the hospital environment and therefore are frequently implicated in outbreaks. Thus, the spread of a unique epidemic multiresistant clone, the so-called South American clone, is the main cause of nosocomial infections produced by this bacterium in Brazil and in some regions of Argentina, Chile, and Uruguay. In the present work we describe the identification of a novel clone of MRSA that is involved in nosocomial infections and that shows a prevalence as high as that for the South American clone. A total of 53 consecutive single-patient MRSA isolates were recovered during a 3-month period (May to July 1999) from six different hospitals (955 beds) in Córdoba. The isolates were initially typed according the antibiotic resistance and phage susceptibility patterns, followed by genotyping using pulsed-field gel electrophoresis (PFGE). PFGE analysis of the 53 MRSA isolates revealed six major types (A to F) and 25 subtypes. The B-type DNA pattern was indistinguishable from that of the South American epidemic clone observed in 34% of the isolates. A novel highly prevalent clone, showing the A-type DNA pattern and representing 38% of the isolates, was also identified. Moreover, the most frequent subtype of the A clonal family triggered an outbreak in a hospital 2 months later, further confirming its epidemic feature.
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Affiliation(s)
- Claudia Sola
- Departamento de Bioquímica Clinica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Ciudad Universitaria, 5000 Córdoba, Argentina
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Talon D, Woronoff-Lemsi MC, Limat S, Bertrand X, Chatillon M, Gil H, Dupond JL. The impact of resistance to methicillin in Staphylococcus aureus bacteremia on mortality. Eur J Intern Med 2002; 13:31-36. [PMID: 11836080 DOI: 10.1016/s0953-6205(01)00189-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: It is unclear whether methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) differ in virulence. We therefore carried out a prospective study of cases of S. aureus bacteremia over a period of 2 years at our university hospital. We report herein the results of a comparative analysis of the clinical characteristics and mortality rates associated with cases of bacteremia caused by MRSA and MSSA. Methods: Over a 2-year period, we reviewed the medical records of hospitalized patients with blood cultures positive for S. aureus. Demographic characteristics, underlying diseases, diagnosis, clinical features, severity, laboratory findings, antimicrobial treatment, and resistance to methicillin were analyzed as possible risk factors for death attributed to bacteremia. Results: The rate of mortality attributed to bacteremia was 27.3% (27 patients): 13 (43.3%) deaths were recorded for patients infected with MRSA and 14 (20.3%) for patients infected with MSSA (P=0.0339, OR=3.00 (1.08--8.46)). Two variables were significantly associated with death within 14 days of the onset of bacteremia in univariate and multivariate analyses after adjusting for antimicrobial treatment: malignant hematologic disease (protective factor; OR=0.184 (0.038--0.882)) and resistance to methicillin (risk factor; OR=2.97 (1.12--7.88)). Conclusion: This study shows that S. aureus bacteremia has a high mortality rate, especially if the strain involved is methicillin-resistant, regardless of patient age and the efficacy of antimicrobial treatment.
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Affiliation(s)
- D Talon
- Service d'Hygie'ne Hospitalie're, CHU Jean Minjoz, Bd Fleming, 25030, Besancon, France
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Aires De Sousa M, Miragaia M, Sanches IS, Avila S, Adamson I, Casagrande ST, Brandileone MC, Palacio R, Dell'Acqua L, Hortal M, Camou T, Rossi A, Velazquez-Meza ME, Echaniz-Aviles G, Solorzano-Santos F, Heitmann I, de Lencastre H. Three-year assessment of methicillin-resistant Staphylococcus aureus clones in Latin America from 1996 to 1998. J Clin Microbiol 2001; 39:2197-205. [PMID: 11376057 PMCID: PMC88111 DOI: 10.1128/jcm.39.6.2197-2205.2001] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Four hundred ninety-nine methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered from 1996 to 1998 from 22 hospitals in five countries of Latin America-Argentina, Brazil, Chile, Uruguay and Mexico-were examined for antimicrobial susceptibility and clonal type in order to define the endemic clones in those hospitals. The hybridization of ClaI restriction digests with the mecA- and Tn554-specific DNA probes combined with pulsed-field gel electrophoresis of chromosomal SmaI digests (ClaI-mecA::ClaI-Tn554::PFGE clonal types) documented not only the predominance and persistence of the Brazilian clone (XI::B::B) in Brazil (97%) and Argentina (86%) but also its massive dissemination to Uruguay (100%). Moreover, a close relative of the Brazilian clone (XI::kappa::B) was highly represented in Chile (53%) together with a novel clone (47%) (II::E'::F) resistant to pencillin, oxacillin, ciprofloxacin, chloramphenicol, clindamycin, erythromycin, and gentamicin. A unique clonal type (I::NH::M) was detected in Mexico among pediatric isolates and was resistant to penicillin, oxacillin, and gentamicin only. This study clearly documented the very large capacity for geographic expansion and the persistence of the Brazilian clone, contributing not only to the increasing uniformity of the MRSA in South America but worldwide as well.
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Affiliation(s)
- M Aires De Sousa
- Molecular Genetics Laboratory, Instituto de Tecnologia Química e Biológica da Universidade Nova de Lisboa (ITQB/UNL), Oeiras, Portugal
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