Duarte Felipe Crepaldi, Danelli Tiago, Tavares Eliandro Reis, Morguette Ana Elisa Belotto, Kerbauy Gilselena, Grion Cintia Magalhães Carvalho, Yamauchi Lucy Megumi, Perugini Marcia Regina Eches, Yamada-Ogatta Sueli Fumie
Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Departamento de Patologia, Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Brazil.
Bolsista do Programa Nacional de Pós-Doutorado do Programa de Pós-graduação em Microbiologia, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil; Laboratório de Biologia Molecular de Microrganismos, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil.
J Infect Chemother. 2019 Apr;25(4):293-297. doi: 10.1016/j.jiac.2018.09.010. Epub 2018 Oct 25.
mecA-positive oxacillin phenotypically susceptible Staphylococcus aureus (OS-MRSA) is increasingly reported worldwide. This bacterium poses a therapeutic threat, as it can be misidentified as an oxacillin-susceptible organism by phenotypic methods that are routinely used in the majority of clinical microbiology laboratories. Herein, we report the first case of fatal sepsis in a 43-year-old female patient caused by an OS-MRSA SCCmec type IVa/ST1/CC1 in a tertiary hospital in southern Brazil, which highlights the difficulties involved in diagnosing this bacterium. Blood cultures and phenotypic susceptibility tests on admission yielded a penicillin-resistant S. aureus. Although vancomycin therapy was initiated, this antibacterial was replaced by oxacillin, based on the susceptibility result. However, the clinical conditions of the patient deteriorated rapidly evolving to fatal septic shock. Clinical microbiology laboratories should consider the use of additional tests to accurately distinguish between various antimicrobial phenotypes of S. aureus.
mecA基因阳性但对苯唑西林表型敏感的金黄色葡萄球菌（OS-MRSA）在全球范围内的报道日益增多。这种细菌构成了治疗威胁，因为在大多数临床微生物实验室常规使用的表型方法可能会将其误鉴定为对苯唑西林敏感的菌株。在此，我们报告了巴西南部一家三级医院中一名43岁女性患者因一株IVa型/ST1/CC1型的OS-MRSA导致致命性败血症的首例病例，这凸显了诊断这种细菌所涉及的困难。入院时的血培养和表型药敏试验结果显示为一株对青霉素耐药的金黄色葡萄球菌。尽管开始了万古霉素治疗，但根据药敏结果，该抗菌药物被苯唑西林替代。然而，患者的临床状况迅速恶化，发展为致命性感染性休克。临床微生物实验室应考虑使用额外的检测方法，以准确区分金黄色葡萄球菌的各种抗菌表型。
