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Yuan JM, Nugent C, Wilson A, Verlander NQ, Alexander E, Fleming P, Modi N, Oughham K, Ratnaraja N, Wan Y, Thorn L, Felgate H, Webber MA, Ogundipe E, Brown CS, Paranthaman K, Demirjian A. Clinical outcomes of Staphylococcus capitis isolation from neonates, England, 2015-2021: a retrospective case-control study. Arch Dis Child Fetal Neonatal Ed 2024; 109:128-134. [PMID: 37751992 DOI: 10.1136/archdischild-2023-325887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Staphylococcus capitis, a coagulase-negative staphylococci (CoNS) species, has been increasingly detected from UK sterile site samples and has caused neonatal unit outbreaks worldwide. We compared survival to discharge and 30-day mortality for the detection of S. capitis versus other CoNS species. METHODS In this retrospective case-control study, we included hospitalised infants with any CoNS species detected from a normally sterile body site up to 90 days of age. We linked English laboratory reports from the Second Generation Surveillance System database, mortality data from the Personal Demographics Service, and neonatal unit admissions from the National Neonatal Research Database. In primary analysis, multivariable logistic regression was used, with two co-primary outcomes: survival to discharge and death within 30 days of positive specimen date. Sensitivity analyses using multiply imputed datasets followed. RESULTS We identified 16 636 CoNS episodes relating to 13 745 infants. CoNS episodes were highest among infants born extremely preterm (22-27 weeks) and with extremely low birth weight (400-999 g). In primary analysis, there were no differences in survival to discharge (p=0.71) or 30-day mortality (p=0.77) between CoNS species. In sensitivity analyses, there were no differences in outcomes between infection with four of the most common CoNS species (Staphylococcus epidermidis, S. capitis, Staphylococcus haemolyticus and Staphylococcus warneri) but the remaining CoNS species were at higher risk of adverse outcomes when treated in aggregate. CONCLUSION Infants with S. capitis detected from sterile site samples did not experience significant differences in either survival to discharge or 30-day mortality compared with infants with detection of other common CoNS species.
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Affiliation(s)
- Jin-Min Yuan
- Field Service, UK Health Security Agency, London, UK
| | - Christopher Nugent
- UK Field Epidemiology Training Programme, UK Health Security Agency, Belfast, UK
| | | | - Neville Q Verlander
- Statistics Unit, Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK
| | | | - Paul Fleming
- Homerton Healthcare NHS Foundation Trust, London, UK
- Queen Mary University of London, London, UK
| | - Neena Modi
- Section of Neonatal Medicine, Imperial College London, London, UK
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Kayleigh Oughham
- Section of Neonatal Medicine, Imperial College London, London, UK
| | - Natasha Ratnaraja
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yu Wan
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Louise Thorn
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
| | | | | | - Enitan Ogundipe
- Chelsea and Westminster Healthcare NHS Trust, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Colin S Brown
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | | | - Alicia Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
- Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Romero LC, Silva LP, Teixeira NB, de Camargo KV, Del Masso Pereira MA, Corrente JE, Pereira VC, Ribeiro de Souza da Cunha MDL. Staphylococcus capitis Bloodstream Isolates: Investigation of Clonal Relationship, Resistance Profile, Virulence and Biofilm Formation. Antibiotics (Basel) 2024; 13:147. [PMID: 38391533 PMCID: PMC10885910 DOI: 10.3390/antibiotics13020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Staphylococcus capitis has been recognized as a relevant opportunistic pathogen, particularly its persistence in neonatal ICUs around the world. Therefore, the aim of this study was to describe the epidemiological profile of clinical isolates of S. capitis and to characterize the factors involved in the persistence and pathogenesis of these strains isolated from blood cultures collected in a hospital in the interior of the state of São Paulo, Brazil. A total of 141 S. capitis strains were submitted to detection of the mecA gene and SCCmec typing by multiplex PCR. Genes involved in biofilm production and genes encoding enterotoxins and hemolysins were detected by conventional PCR. Biofilm formation was evaluated by the polystyrene plate adherence test and phenotypic resistance was investigated by the disk diffusion method. Finally, pulsed-field gel electrophoresis (PFGE) was used to analyze the clonal relationship between isolates. The mecA gene was detected in 99 (70.2%) isolates, with this percentage reaching 100% in the neonatal ICU. SCCmec type III was the most prevalent type, detected in 31 (31.3%) isolates and co-occurrence of SCCmec was also observed. In vitro biofilm formation was detected in 46 (32.6%) isolates but was not correlated with the presence of the ica operon genes. Furthermore, biofilm production in ICU isolates was favored by hyperosmotic conditions, which are common in ICUs because of the frequent parenteral nutrition. Analysis of the clonal relationship between the isolates investigated in the present study confirms a homogeneous profile of S. capitis and the persistence of clones that are prevalent in the neonatal ICU and disseminated across the hospital. This study highlights the adaptation of isolates to specific hospital environments and their high clonality.
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Affiliation(s)
- Letícia Calixto Romero
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil
| | - Lucas Porangaba Silva
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil
| | - Nathalia Bibiana Teixeira
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil
| | - Karen Vilegas de Camargo
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil
| | | | - José Eduardo Corrente
- Department of Biostatistics, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-900, Brazil
| | - Valéria Cataneli Pereira
- Microbiology Laboratory, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 18618-970, Brazil
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Zhang F, Huang W, Zhao L. Regulatory Effects of Ganoderma lucidum, Grifola frondosa, and American ginseng Extract Formulation on Gut Microbiota and Fecal Metabolomics in Mice. Foods 2023; 12:3804. [PMID: 37893697 PMCID: PMC10606397 DOI: 10.3390/foods12203804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The bioactivities of Ganoderma lucidum, Grifola frondosa, and American ginseng have been extensively studied and documented. However, the effects of their complexes on the structural properties of intestinal microbiota and fecal metabolism remain unclear. Therefore, this paper aims to present a preliminary study to shed light on this aspect. In this study, an immunocompromised mouse model was induced using cyclophosphamide, and Ganoderma lucidum, Grifola frondosa, and American ginseng extract formulation (referred to as JGGA) were administered via gavage to investigate their modulatory effects on gut microbiota and fecal metabolism in mice. The effects of JGGA on immune enhancement were explored using serum test kits, hematoxylin-eosin staining, 16SrDNA high-throughput sequencing, and UHPLC-QE-MS metabolomics. The findings revealed potential mechanisms underlying the immune-enhancing effects of JGGA. Specifically, JGGA administration resulted in an improved body weight, thymic index, splenic index, carbon scavenging ability, hypersensitivity, and cellular inflammatory factor expression levels in mice. Further analysis demonstrated that JGGA reduced the abundance of Firmicutes, Proteobacteria, and Actinobacteria, while increasing the abundance of Bacteroidetes. Additionally, JGGA modulated the levels of 30 fecal metabolites. These results suggest that the immune enhancement observed with JGGA may be attributed to the targeted modulation of gut microbiota and fecal metabolism, thus promoting increased immunity in the body.
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Affiliation(s)
- Fengli Zhang
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (F.Z.); (W.H.)
- College of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou 350002, China
| | - Wenqi Huang
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (F.Z.); (W.H.)
- College of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou 350002, China
| | - Lina Zhao
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (F.Z.); (W.H.)
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Moore G, Barry A, Carter J, Ready J, Wan Y, Elsayed M, Haill C, Khashu M, Williams OM, Brown CS, Demirjian A, Ready D. Detection, survival, and persistence of Staphylococcus capitis NRCS-A in neonatal units in England. J Hosp Infect 2023; 140:8-14. [PMID: 37487793 DOI: 10.1016/j.jhin.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The multidrug-resistant Staphylococcus capitis clone, NRCS-A, is increasingly associated with late-onset sepsis in low birthweight newborns in neonatal intensive care units (NICUs) in England and globally. Understanding where this bacterium survives and persists within the NICU environment is key to developing and implementing effective control measures. AIM To investigate the potential for S. capitis to colonize surfaces within NICUs. METHODS Surface swabs were collected from four NICUs with and without known NRCS-A colonizations/infections present at the time of sampling. Samples were cultured and S. capitis isolates analysed via whole-genome sequencing. Survival of NRCS-A on plastic surfaces was assessed over time and compared to that of non-NRCS-A isolates. The bactericidal activity of commonly used chemical disinfectants against S. capitis was assessed. FINDINGS Of 173 surfaces sampled, 40 (21.1%) harboured S. capitis with 30 isolates (75%) being NRCS-A. Whereas S. capitis was recovered from surfaces across the NICU, the NRCS-A clone was rarely recovered from outside the immediate neonatal bedspace. Incubators and other bedside equipment were contaminated with NRCS-A regardless of clinical case detection. In the absence of cleaning, S. capitis was able to survive for three days with minimal losses in viability (<0.5 log10 reduction). Sodium troclosene and a QAC-based detergent/disinfectant reduced S. capitis to below detectable levels. CONCLUSION S. capitis NRCS-A can be readily recovered from the NICU environment, even in units with no recent reported clinical cases of S. capitis infection, highlighting a need for appropriate national guidance on cleaning within the neonatal care environment.
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Affiliation(s)
- G Moore
- UK Health Security Agency, UK.
| | - A Barry
- UK Health Security Agency, UK
| | | | - J Ready
- UK Health Security Agency, UK
| | - Y Wan
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - M Elsayed
- Royal United Hospital, Bath NHS Foundation Trust, Bath, UK; Southmead Hospital, North Bristol Trust, Bristol, UK
| | - C Haill
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Khashu
- University Hospitals Dorset, Poole, UK
| | - O M Williams
- UK Health Security Agency, UK; Bristol Royal Infirmary, Bristol NHS Foundation Trust, UK
| | - C S Brown
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - A Demirjian
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - D Ready
- UK Health Security Agency, UK; Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Wan Y, Ganner M, Mumin Z, Ready D, Moore G, Potterill I, Paranthaman K, Jauneikaite E, Patel B, Harley A, Getino M, Brown CS, Demirjian A, Pichon B. Whole-genome sequencing reveals widespread presence of Staphylococcus capitis NRCS-A clone in neonatal units across the United Kingdom. J Infect 2023; 87:210-219. [PMID: 37394013 DOI: 10.1016/j.jinf.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Increased incidence of neonatal Staphylococcus capitis bacteraemia in summer 2020, London, raised suspicion of widespread multidrug-resistant clone NRCS-A. We set out to investigate the molecular epidemiology of this clone in neonatal units (NNUs) across the UK. METHODS We conducted whole-genome sequencing (WGS) on presumptive S. capitis NRCS-A isolates collected from infants admitted to nationwide NNUs and from environmental sampling in two distinct NNUs in 2021. Previously published S. capitis genomes were added for comparison. Genetic clusters of NRCS-A isolates were defined based on core-genome single-nucleotide polymorphisms. RESULTS We analysed WGS data of 838 S. capitis isolates and identified 750 NRCS-A isolates. We discovered a possible UK-specific NRCS-A lineage consisting of 611 isolates collected between 2005 and 2021. We determined 28 genetic clusters of NRCS-A isolates, which covered all geographical regions in the UK, and isolates of 19 genetic clusters were found in ≥2 regions, suggesting inter-regional spread. Within the NRCS-A clone, strong genetic relatedness was identified between contemporary clinical and incubator-associated fomite isolates and between clinical isolates associated with inter-hospital infant transfer. CONCLUSIONS This WGS-based study confirms the dispersion of S. capitis NRCS-A clone amongst NNUs across the UK and urges research on improving clinical management of neonatal S. capitis infection.
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Affiliation(s)
- Yu Wan
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK.
| | - Mark Ganner
- Reference Services Division, National Infection Service, UK Health Security Agency, London, UK
| | - Zaynab Mumin
- Reference Services Division, National Infection Service, UK Health Security Agency, London, UK
| | - Derren Ready
- UK Health Security Agency, Field Service South West, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
| | - Ginny Moore
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - Isabelle Potterill
- Reference Services Division, National Infection Service, UK Health Security Agency, London, UK
| | | | - Elita Jauneikaite
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK; Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Bharat Patel
- Public Health Laboratory London, Science Group, UK Health Security Agency, London, UK
| | - Alessandra Harley
- Reference Services Division, National Infection Service, UK Health Security Agency, London, UK
| | - Maria Getino
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Colin S Brown
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Alicia Demirjian
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK; Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Bruno Pichon
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
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6
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Brescini L, Fioriti S, Coccitto SN, Cinthi M, Mingoia M, Cirioni O, Giacometti A, Giovanetti E, Morroni G, Brenciani A. Genomic Analysis of a Linezolid-Resistant Staphylococcus capitis Causing Bacteremia: Report from a University Hospital in Central Italy. Microb Drug Resist 2023; 29:388-391. [PMID: 37222764 DOI: 10.1089/mdr.2022.0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Although coagulase negative staphylococci are rarely associated with complicated diseases, in some cases they cause life-threatening infections. Here we described a clinical case of a bacteremia due to a methicillin- and linezolid-resistant Staphylococcus capitis in a patient previously treated with linezolid. Whole genome sequencing revealed the common mutation G2576T in all rDNA 23S alleles and several acquired resistance genes. Moreover, the isolate was epidemiologically distant from the NRCS-A clade, usually responsible for nosocomial infections in neonatal intensive care units. Our findings further confirm the ability of minor staphylococci to acquire antibiotic resistances and challenge the treatment of these infections.
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Affiliation(s)
- Lucia Brescini
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Simona Fioriti
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Sonia N Coccitto
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Marzia Cinthi
- Unit of Microbiology, Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Marina Mingoia
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Oscar Cirioni
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Eleonora Giovanetti
- Unit of Microbiology, Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Morroni
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Andrea Brenciani
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
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Zhou W, Niu D, Gao S, Zhong Q, Liu C, Liao X, Cao X, Zhang Z, Zhang Y, Shen H. Prevalence, biofilm formation, and mass spectrometric characterization of linezolid-resistant Staphylococcus capitis isolated from a tertiary hospital in China. J Glob Antimicrob Resist 2023; 33:155-163. [PMID: 36724854 DOI: 10.1016/j.jgar.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Linezolid-resistant Staphylococcus capitis (LRSC) has become a new challenge for clinical anti-infective therapy. The present study aimed to investigate the trends of LRSC prevalence in a tertiary hospital of China 2017-2020. The resistance mechanisms, virulence genes, biofilm formation, and mass spectrometric characteristics of LRSC isolates were also analysed. METHODS This study retrospectively analysed the antibiotic resistance trends of coagulase negative staphylococci (CoNS) isolated from clinical samples collected between 2017-2020. Antimicrobial resistance profiles were tested by micro-broth dilution and the E-test method. Antimicrobial resistance genes and virulence genes were detected by polymerase chain reaction, and dru-typing sequences were obtained by Sanger sequencing. Crystal violet staining in 96-well plates was used to detect biofilm formation ability. Mass spectrometric characterization of LRSC was analysed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) coupled with ClinProTools. RESULTS The linezolid resistance rate in 3575 CoNS clinical strains was 1.6%, wherein the great majority of was LRSC (91.1%, n = 51/56), with a resistant rate of 15.5% (n = 51/328) in all S. capitis isolates. In this study, 48 out of the 51 LRSC strains and 54 of 277 linezolid-susceptible S. capitis (LSSC) strains were enrolled. G2576T, C2104T, T2130A, C2163T, and T2319C mutations in the 23S rRNA V region and acquisition of cfr were the main linezolid resistant mechanisms in LRSC. The biofilm-forming ability of LRSC was more potent than LSSC, with a higher detection rate of bap (P < 0.05). Eleven mass spectrometric peaks of interest were identified by using MALDI-TOF MS and ClinProTools, which were differently distributed between LRSC and LSSC strains, with the area under the receiver operating characteristic curve of more than 0.8, especially for 5465.37 m/z. CONCLUSIONS Linezolid resistance was mediated by mutations in the 23S rRNA V region and presence of the cfr gene in LRSC strains. LRSC strains have stronger biofilm-forming ability than LSSC strains, which maybe associated with the adhesion-related gene of bap. Further, linezolid-resistant and linezolid-susceptible S. capitis could be rapidly identified with mass spectrometric characterization. To the best of our knowledge, this study is the first to document the biofilm formation ability of LRSC and the potential usefulness of MALDI-TOF MS for the discrimination of LRSC and LSSC.
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Affiliation(s)
- Wanqing Zhou
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Dongmei Niu
- Department of Laboratory Medicine, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Shuo Gao
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Qiao Zhong
- Department of Laboratory Medicine, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, China
| | - Chang Liu
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiwei Liao
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoli Cao
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Zhifeng Zhang
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yan Zhang
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Han Shen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
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8
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Heath V, Cloutman-Green E, Watkin S, Karlikowska M, Ready D, Hatcher J, Pearce-Smith N, Brown C, Demirjian A. Staphylococcus capitis: Review of Its Role in Infections and Outbreaks. Antibiotics (Basel) 2023; 12:antibiotics12040669. [PMID: 37107031 PMCID: PMC10135222 DOI: 10.3390/antibiotics12040669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
In June 2021, a national incident team was formed due to an increased detection of Staphylococcus capitis in samples from hospitalised infants. Staphylococcus capitis has been known to cause outbreaks in neonatal units across the globe, but the extent of the UK spread was unclear. A literature review was undertaken to support case identification, clinical management and environmental infection control. A literature search was undertaken on multiple databases from inception to 24 May 2021, using keywords such as “Staphylococcus capitis”, “NRCS-A”, “S. capitis”, “neonate”, “newborn” and “neonatal intensive care unit” (NICU). After screening, 223 articles of relevance were included. Results show incidences of S. capitis outbreaks have frequently been associated with the outbreak clone (NRCS-A) and environmental sources. The NRCS-A harbours a multidrug resistance profile that includes resistance to beta-lactam antibiotics and aminoglycosides, with several papers noting resistance or heteroresistance to vancomycin. The NRCS-A clone also harbours a novel SCCmec-SCCcad/ars/cop composite island and increased vancomycin resistance. The S. capitis NRCS-A clone has been detected for decades, but the reasons for the potentially increased frequency are unclear, as are the most effective interventions to manage outbreaks associated with this clone. This supports the need for improvements in environmental control and decontamination strategies to prevent transmission.
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9
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França A. The Role of Coagulase-Negative Staphylococci Biofilms on Late-Onset Sepsis: Current Challenges and Emerging Diagnostics and Therapies. Antibiotics (Basel) 2023; 12:antibiotics12030554. [PMID: 36978421 PMCID: PMC10044083 DOI: 10.3390/antibiotics12030554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Infections are one of the most significant complications of neonates, especially those born preterm, with sepsis as one of the principal causes of mortality. Coagulase-negative staphylococci (CoNS), a group of staphylococcal species that naturally inhabit healthy human skin and mucosa, are the most common cause of late-onset sepsis, especially in preterms. One of the risk factors for the development of CoNS infections is the presence of implanted biomedical devices, which are frequently used for medications and/or nutrient delivery, as they serve as a scaffold for biofilm formation. The major concerns related to CoNS infections have to do with the increasing resistance to multiple antibiotics observed among this bacterial group and biofilm cells’ increased tolerance to antibiotics. As such, the treatment of CoNS biofilm-associated infections with antibiotics is increasingly challenging and considering that antibiotics remain the primary form of treatment, this issue will likely persist in upcoming years. For that reason, the development of innovative and efficient therapeutic measures is of utmost importance. This narrative review assesses the current challenges and emerging diagnostic tools and therapies for the treatment of CoNS biofilm-associated infections, with a special focus on late-onset sepsis.
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Affiliation(s)
- Angela França
- Centre of Biological Engineering, LIBRO—Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
- LABBELS—Associate Laboratory in Biotechnology and Bioengineering and Microelectromechanical Systems, Braga and Guimarães, Portugal
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10
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Desmond A, O’Halloran F, Cotter L, Hill C, Field D. Bioengineered Nisin A Derivatives Display Enhanced Activity against Clinical Neonatal Pathogens. Antibiotics (Basel) 2022; 11:1516. [PMID: 36358171 PMCID: PMC9686653 DOI: 10.3390/antibiotics11111516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023] Open
Abstract
Neonatal infection is a significant cause of mortality and morbidity in infants. The global incidence of multi-drug resistance continues to rise among neonatal pathogens, indicating a need for alternative treatment strategies. Nisin is an antimicrobial peptide that exhibits broad-spectrum activity against a wide variety of clinical pathogens and can be used in combination with antibiotics to improve their effectiveness. This study examined the activity of nisin and bioengineered derivatives against multi-drug resistant Streptococcus agalactiae and Staphylococcus capitis isolates and investigated the potential synergy between nisin peptides and selected antibiotics. Whole genome sequence analysis of the strains revealed the presence of multi-drug resistant determinants, e.g., macrolide, tetracycline, β-lactam, aminoglycoside, while the S. agalactiae strains all possessed both nsr and nsrFP genes and the S. capitis strains were found to encode the nsr gene alone. Deferred antagonism assays demonstrated that nisin PV had improved antimicrobial activity against all strains tested (n = 10). The enhanced specific activity of this peptide was confirmed using minimum inhibitory concentrations (MIC) (0-4-fold lower MIC for nisin PV) and broth-based survival assays. Combinations of nisin peptides with antibiotics were assessed for enhanced antimicrobial activity using growth and time-kill assays and revealed a more effective nisin PV/ampicillin combination against one S. capitis strain while a nisin A/erythromycin combination displayed a synergistic effect against one S. agalactiae strain. The findings of this study suggest that nisin derivatives alone and in combination with antibiotics have potential as alternative antimicrobial strategies to target neonatal pathogens.
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Affiliation(s)
- Anna Desmond
- Department of Biological Sciences, Munster Technological University, T12 P928 Cork, Ireland
| | - Fiona O’Halloran
- Department of Biological Sciences, Munster Technological University, T12 P928 Cork, Ireland
| | - Lesley Cotter
- Department of Biological Sciences, Munster Technological University, T12 P928 Cork, Ireland
| | - Colin Hill
- School of Microbiology, University College Cork, T12 YN60 Cork, Ireland
- APC Microbiome Ireland, University College Cork, T12 YN60 Cork, Ireland
| | - Des Field
- School of Microbiology, University College Cork, T12 YN60 Cork, Ireland
- APC Microbiome Ireland, University College Cork, T12 YN60 Cork, Ireland
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11
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Genetic Characterization of Staphylococcus aureus, Staphylococcus argenteus, and Coagulase-Negative Staphylococci Colonizing Oral Cavity and Hand of Healthy Adults in Northern Japan. Pathogens 2022; 11:pathogens11080849. [PMID: 36014970 PMCID: PMC9413425 DOI: 10.3390/pathogens11080849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
The spread of methicillin resistance and virulence among staphylococci in the community poses a public health concern. In this study, we investigated the prevalence of Staphylococcus species colonizing the oral cavity and hand (skin) of healthy university students and their phenotypic and genetic characteristics in northern Japan. Among a total of 332 subjects, 6 and 110 methicillin-resistant and susceptible Staphylococcus aureus (MRSA and MSSA, respectively) isolates were recovered from 105 subjects. MRSA isolates were genotyped as CC5, CC8, CC45, and CC59 with SCCmec-IIa or IV, among which an isolate of ST6562 (single-locus variant of ST8) harbored SCCmec-IVa, PVL genes and ACME-I, which are the same traits as the USA300 clone. ST1223 S. argenteus was isolated from the oral cavity and hand of a single student. Coagulase-negative Staphylococcus (CoNS) was recovered from 154 subjects (172 isolates), and classified into 17 species, with S. capitis being the most common (38%), followed by S. warneri (24%) and S. epidermidis (15%), including nine mecA-positive isolates. S. capitis was differentiated into seven clusters/subclusters, and genetic factors associated with the NRCS-A clone (nsr, tarJ, ebh) were detected in 10–21% of isolates. The colonization of the USA300-like MRSA variant and S. capitis with the traits of the NRCS-A clone in healthy individuals was noteworthy.
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12
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Marr I, Swe K, Henderson A, Lacey JA, Carter GP, Ferguson JK. Cefazolin susceptibility of coagulase-negative staphylococci (CoNS) causing late-onset neonatal bacteraemia. J Antimicrob Chemother 2022; 77:338-344. [PMID: 34791307 DOI: 10.1093/jac/dkab402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/06/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND CoNS bacteraemia causes significant neonatal morbidity. Previous work has suggested that β-lactam antibiotics vary in their binding affinity to PBP2a (produced by the mecA gene) present in most CoNS. OBJECTIVES We evaluated cefazolin MICs for CoNS isolated in an Australian neonatal ICU (NICU) and correlated them with isolate genotype and phenotype. METHODS Significant blood isolates from 2009 to 2017 were speciated and underwent broth microdilution testing for cefazolin, cefoxitin, oxacillin and flucloxacillin. Correlation with mecA presence and PBP2a expression was evaluated. A selection of Staphylococcus capitis isolates underwent WGS. RESULTS The CoNS (n = 99) isolates were confirmed as S. capitis (n = 57), Staphylococcus epidermidis (n = 32), Staphylococcus haemolyticus (n = 2) and Staphylococcus warneri (n = 8). The MIC of cefazolin was ≤2 mg/L for 30% of isolates and 75% had an MIC of ≤8 mg/L (MIC90 = 16 mg/L). This contrasted with MIC90s of cefoxitin, oxacillin and flucloxacillin, which were all ≥32 mg/L. WGS found a number of S. capitis isolates closely related to the globally established NRCS-A clone. CONCLUSIONS CoNS displayed distinctly lower MIC values of cefazolin than of other agents tested. MIC variation may be related to binding affinity of PBP2a or regulation of expression of mecA by mecR1-mecI functional genes. Further, NRCS-A S. capitis strains were present in this Australian NICU before and after the unit underwent physical relocation, which raised questions about a common environmental source. It is considered justified to conduct a randomized clinical trial that assesses cefazolin versus vancomycin for management of late-onset neonatal sepsis.
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Affiliation(s)
- I Marr
- Infectious Disease Department, The Canberra Hospital, ACT, Australia
| | - K Swe
- Infectious Disease Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - A Henderson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - J A Lacey
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia
| | - G P Carter
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia
| | - J K Ferguson
- Infectious Disease Department, John Hunter Hospital, Newcastle, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
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13
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Viability-Resolved Metagenomics Reveals Antagonistic Colonization Dynamics of Staphylococcus epidermidis Strains on Preterm Infant Skin. mSphere 2021; 6:e0053821. [PMID: 34523979 PMCID: PMC8550141 DOI: 10.1128/msphere.00538-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Preterm infants are at increased risk of infections caused by coagulase-negative staphylococci (CoNS) that colonize skin. Technical barriers in sequencing low-microbial-biomass skin swabs from preterm infants hinder attempts to gain a strain-level understanding of CoNS colonization dynamics within their developing skin microbiome. Here, the microbiome of five skin sites and available stool was studied from four preterm infants hospitalized over their first 2 months of life. We used propidium monoazide treatment of samples to enrich for the viable microbiome and metagenomic shotgun sequencing to resolve species and strains. The microbiome of different skin sites overlapped with each other, was dominated by the CoNS species Staphylococcus epidermidis and Staphylococcus capitis, and was distinct from stool. Species diversity on skin increased over time despite antibiotic exposure. Evidence of antagonism between the most common S. epidermidis strains, ST2 and ST59, included negative relationships for species correlation networks and in situ replication rates and that ST2 colonized skin earlier but was often replaced by ST59 over time. Experiments done with reference isolates showed that ST2 produced more biofilm than ST59 on plastic surfaces, which was reduced in mixed culture. We also discovered that a rare S. epidermidis strain, ST5, grew rapidly in stool in association with Stenotrophomonas maltophilia from a suspected episode of infection. Viability treatment of samples and moderate throughput shotgun sequencing provides strain-level information about CoNS colonization dynamics of preterm infant skin that ultimately might be exploited to prevent infections. IMPORTANCE The skin is a habitat for microbes that commonly infect preterm infants, but the use of sequencing for fine-scale study of the microbial communities of skin that develop in these infants has been limited by technical barriers. We treated skin swabs of preterm infants with a photoreactive dye that eliminates DNA from nonviable microbes and then sequenced the remaining DNA. We found that two strains of the most common species, Staphylococcus epidermidis, showed an antagonistic relationship on skin by cooccurring with different species, replicating fastest in different samples, and dominating skin sites at different times. Representatives of these strains also differed in their ability to stick to plastic surfaces—an important pathogenicity trait of this species. Our study shows the feasibility of gaining detailed information about strain colonization dynamics from this difficult-to-sequence body site of preterm infants, which might be used to guide novel approaches to prevent infections.
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14
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Vancomycin heteroresistance in Staphylococcus haemolyticus: elusive phenotype. Future Sci OA 2021; 7:FSO710. [PMID: 34258023 PMCID: PMC8256318 DOI: 10.2144/fsoa-2020-0179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To determine the presence of vancomycin heteroresistance in Staphylococcus haemolyticus. Materials & methods A total of 48 rifampicin-resistant S. haemolyticus isolates from bloodstream infections were included. Vancomycin heteroresistance was determined using the population analysis profile-area under curve (PAP-AUC) method. All the isolates were screened for the presence of mecA gene, mutations in the rpoB gene, staphylococcal cassette chromosome mec and multilocus sequence types. Results Fifteen isolates were identified as heteroresistant vancomycin-intermediate S. haemolyticus using PAP-AUC method. Dual rpoB mutations (D471E and I527M) contributed for the rifampicin resistance. The sequence types of heteroresistant vancomycin-intermediate S. haemolyticus were highly diverse. Conclusion These findings illustrate the potential of S. haemolyticus to develop heteroresistance, which emphasizes the need for routine surveillance of S. haemolyticus isolated from intensive care units for infection control practices.
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15
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França A, Gaio V, Lopes N, Melo LDR. Virulence Factors in Coagulase-Negative Staphylococci. Pathogens 2021; 10:170. [PMID: 33557202 PMCID: PMC7913919 DOI: 10.3390/pathogens10020170] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022] Open
Abstract
Coagulase-negative staphylococci (CoNS) have emerged as major pathogens in healthcare-associated facilities, being S. epidermidis, S. haemolyticus and, more recently, S. lugdunensis, the most clinically relevant species. Despite being less virulent than the well-studied pathogen S. aureus, the number of CoNS strains sequenced is constantly increasing and, with that, the number of virulence factors identified in those strains. In this regard, biofilm formation is considered the most important. Besides virulence factors, the presence of several antibiotic-resistance genes identified in CoNS is worrisome and makes treatment very challenging. In this review, we analyzed the different aspects involved in CoNS virulence and their impact on health and food.
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Affiliation(s)
- Angela França
- Laboratory of Research in Biofilms Rosário Oliveira, Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; (V.G.); (N.L.)
| | | | | | - Luís D. R. Melo
- Laboratory of Research in Biofilms Rosário Oliveira, Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; (V.G.); (N.L.)
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16
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Asadollahi P, Farzan B, Rezaei F, Delfani S, Ashrafi B, Soroush S. First Report on the Characteristics of Methicillin-Resistant Staphylococcus Capitis Isolates and an NRCS-A-clone Related Isolate Obtained from Iranian Children. Infect Disord Drug Targets 2021; 21:459-463. [PMID: 32389116 DOI: 10.2174/1871526520666200511011309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Methicillin-resistant staphylococcus capitis (MRSC) NRCS-A clone (Multi- resistant and vancomycin-non susceptible) has been recently described as an emerging cause of nosocomial bacteremia, especially in neonatal intensive-care units (NICUs). OBJECTIVE The objective of this study was to evaluate the antibiotic and antiseptic resistance patterns, biofilm-producing ability and the prevalence of SCCmec and ACME types among MRSC isolates as well as to check the possible presence of NRCS-A clone at Tehran's Children's Medical Center, Iran. METHODS A total of 256 coagulase-negative Staphylococcal isolates were collected, of which 10 S. capitis isolates were obtained and tested for susceptibility against 13 antimicrobial and 3 antiseptic agents, as well as biofilm production. The presence of 15 distinct resistance genes, staphylococcal cassette chromosome mec (SCCmec), and arginine catabolic mobile elements (ACMEs) were tracked. RESULTS Seven out of 10 S. capitis isolates were MRSC (MIC90 van=8μg/mL) and resistant to trimethoprim/sulfamethoxazole, produced biofilm, (3 as strong biofilm producers) and carried ACME types I and II. Despite the identification of mec and ccr complexes in some isolates, all the SCCmec cassettes were untypeable (UT). CONCLUSION According to the studied features, only one isolate belonged to the NRSC-A clone. The results indicate that MRSC with high antibiotic resistance and unknown SCCmec might become a serious problem in the future for the treatment of patients, particularly children.
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Affiliation(s)
- Parisa Asadollahi
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Behrooz Farzan
- Department of Anesthesiology, School of Medicine, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Faranak Rezaei
- Department of Microbiology, School of Medicine, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Somayeh Delfani
- Department of Microbiology, School of Medicine, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Behnam Ashrafi
- Department of Microbiology, School of Medicine, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Setareh Soroush
- Department of Microbiology, School of Medicine, Lorestan University of Medical Sciences, Khoramabad, Iran
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17
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Tevell S, Baig S, Hellmark B, Martins Simoes P, Wirth T, Butin M, Nilsdotter-Augustinsson Å, Söderquist B, Stegger M. Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infections. Sci Rep 2020; 10:22389. [PMID: 33372186 PMCID: PMC7769963 DOI: 10.1038/s41598-020-79225-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022] Open
Abstract
Staphylococcus capitis is a coagulase-negative staphylococcus that has been described primarily as causing bloodstream infections in neonatal intensive care units (NICUs), but has also recently been described in prosthetic joint infections (PJIs). The multidrug-resistant S. capitis subsp. urealyticus clone NRCS-A, comprising three sublineages, is prevalent in NICUs across the world, but its impact on other patient groups such as those suffering from PJIs or among adults planned for arthroplasty is unknown. Genome sequencing and subsequent analysis were performed on a Swedish collection of PJI isolates (n = 21), nasal commensals from patients planned to undergo arthroplasty (n = 20), NICU blood isolates (n = 9), operating theatre air isolates (n = 4), and reference strains (n = 2), in conjunction with an international strain collection (n = 248). The NRCS-A Outbreak sublineage containing the composite type V SCCmec-SCCcad/ars/cop element was present in PJIs across three Swedish hospitals. However, it was not found among nasal carrier strains, where the less virulent S. capitis subsp. capitis was most prevalent. The presence of the NRCS-A Outbreak clone in adult patients with PJIs demonstrates that dissemination occurs beyond NICUs. As this clone has several properties which facilitate invasive infections in patients with medical implants or immunosuppression, such as biofilm forming ability and multidrug resistance including heterogeneous glycopeptide-intermediate susceptibility, further research is needed to understand the reservoirs and distribution of this hospital-associated pathogen.
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Affiliation(s)
- Staffan Tevell
- Department of Infectious Diseases, Karlstad Hospital and Centre for Clinical Research and Education, Värmland County Council, SE-65182, Karlstad, Sweden. .,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Sharmin Baig
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Bengt Hellmark
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patricia Martins Simoes
- Department of Bacteriology, Institute for Infectious Agents, National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France.,Centre International de Référence en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS, University of Lyon, Lyon, France
| | - Thierry Wirth
- Institut de Systématique, Evolution, Biodiversité (ISYEB), UMR-CNRS 7205, Muséum National d'Histoire Naturelle, CNRS, EPHE, Sorbonne Université, Paris, France.,École Pratique des Hautes Études, PSL Université, Paris, France
| | - Marine Butin
- Centre International de Référence en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS, University of Lyon, Lyon, France.,Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Åsa Nilsdotter-Augustinsson
- Division of Inflammation and Infection, Department of Infectious Diseases, Linköping University, Norrköping, Sweden.,Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marc Stegger
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
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18
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Ding L, Li P, Yang Y, Lin D, Xu X. The epidemiology and molecular characteristics of linezolid-resistant Staphylococcus capitis in Huashan Hospital, Shanghai. J Med Microbiol 2020; 69:1079-1088. [PMID: 32729813 DOI: 10.1099/jmm.0.001234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction. Linezolid-resistant (LZR) Staphylococcus capitis has recently emerged in our hospital, and its potential resistance mechanisms are still not clear.Aim. This study aimed to investigate the epidemiology, clinical and genetic characteristics, resistance mechanisms and biofilm formation capacity of LZR S. capitis isolated from patients at Huashan Hospital, Shanghai, PR China between 2012 and 2018.Methodology. Strains were subjected to antimicrobial susceptibility testing (AST) with antibiotics using the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The presence of cfr, optrA and poxtA, as well as mutations in the 23S ribosomal (r)RNA and ribosomal proteins, was investigated using PCR and sequencing techniques. The genetic relationship between isolates was analysed using pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS). Biofilm biomasses were detected by using crystal violet staining.Results. Twenty-one LZR S. capitis strains displayed MICs of 32-512 μg ml-1. All LZR strains showed G2576T and C2104T mutations in the 23S rRNA V region. Besides G2576T and C2104T, no base mutations were detected in the V region. The cfr was detected in 12 strains, while optrA and poxtA were not amplified in 21 S. capitis strains. PFGE showed that the LZR S. capitis strains belonged to a single clone. The phylogenetic tree showed that 20 LZR S. capitis strains were highly similar to LNZR-1, isolated from Harbin (located in the north of China) in 2013, which showed resistance to linezolid.Conclusions. In this research, cfr-negative strains displayed linezolid MICs of 32 μg ml-1. In comparison, cfr-positive strains exhibited linezolid MICs of 128-512 μg ml-1, indicating that high levels of linezolid resistance appear to be related to the presence of cfr. The outbreak of LZR S. capitis in our hospital needs to be monitored closely.
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Affiliation(s)
- Li Ding
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China.,Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Pei Li
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China.,Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yang Yang
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China.,Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Dongfang Lin
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China.,Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiaogang Xu
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China.,Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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19
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Decalonne M, Dos Santos S, Gimenes R, Goube F, Abadie G, Aberrane S, Ambrogi V, Baron R, Barthelemy P, Bauvin I, Belmonte O, Benabid E, Ammar RB, Yahia SBH, Berrouane Y, Berthelot P, Beuchee A, Bille E, Bolot P, Bordes-Couecou S, Bouissou A, Bourdon S, Bourgeois-Nicolaos N, Boyer S, Cattoen C, Cattoir V, Chaplain C, Chatelet C, Claudinon A, Chautemps N, Cormier H, Coroller-Bec C, Cotte B, De Chillaz C, Dauwalder O, Davy A, Delorme M, Demasure M, Desfrere L, Drancourt M, Dupin C, Faraut-Derouin V, Florentin A, Forget V, Fortineau N, Foucan T, Frange P, Gambarotto K, Gascoin G, Gibert L, Gilquin J, Glanard A, Grando J, Gravet A, Guinard J, Hery-Arnaud G, Huart C, Idri N, Jellimann JM, Join-Lambert O, Joron S, Jouvencel P, Kempf M, Ketterer-Martinon S, Khecharem M, Klosowski S, Labbe F, Lacazette A, Lapeyre F, Larche J, Larroude P, Le Pourhiennec A, Le Sache N, Ledru S, Lefebvre A, Legeay C, Lemann F, Lesteven C, Levast-Raffin M, Leyssene D, Ligi I, Lozniewski A, Lureau P, Mallaval FO, Malpote E, Marret S, Martres P, Menard G, Menvielle L, Mereghetti L, Merle V, Minery P, Morange V, Mourdie J, Muggeo A, Nakhleh J, Noulard MN, Olive C, Patural H, Penn P, Petitfrere M, Pozetto B, Riviere B, Robine A, Ceschin CR, Ruimy R, Siali A, Soive S, Slimani S, Trentesaux AS, Trivier D, Vandenbussche C, Villeneuve L, Werner E, Le Vu S, Van Der Mee-Marquet N. Staphylococcus capitis isolated from bloodstream infections: a nationwide 3-month survey in 38 neonatal intensive care units. Eur J Clin Microbiol Infect Dis 2020; 39:2185-2194. [PMID: 32519215 PMCID: PMC7561542 DOI: 10.1007/s10096-020-03925-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/03/2020] [Indexed: 11/24/2022]
Abstract
To increase the knowledge about S. capitis in the neonatal setting, we conducted a nationwide 3-month survey in 38 neonatal intensive care units (NICUs) covering 56.6% of French NICU beds. We demonstrated 14.2% of S. capitis BSI (S.capBSI) among nosocomial BSIs. S.capBSI incidence rate was 0.59 per 1000 patient-days. A total of 55.0% of the S.capBSIs were late onset catheter-related BSIs. The S. capitis strains infected preterm babies (median gestational age 26 weeks, median birth weight 855 g). They were resistant to methicillin and aminoglycosides and belonged to the NRCS-A clone. Evolution was favorable in all but one case, following vancomycin treatment.
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Affiliation(s)
- Marie Decalonne
- SPIADI, CPIAS CVDL, Hôpital Bretonneau, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Sandra Dos Santos
- Cellule d'Epidémiologie Régionale des Infections Nosocomiales, CPIAS CVDL, Service de Bactériologie-Virologie-Hygiène, Hôpital Trousseau, CHRU, 37044, Tours, France
| | - Rémi Gimenes
- SPIADI, CPIAS CVDL, Hôpital Bretonneau, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Florent Goube
- SPIADI, CPIAS CVDL, Hôpital Bretonneau, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Géraldine Abadie
- Service de réanimation néonatale, Centre Hospitalier Universitaire Félix Guyon, 97400, Saint Denis de la Réunion, France
| | - Saïd Aberrane
- Laboratoire de Microbiologie, Centre Hospitalier Inter-Communal, 94010, Créteil, France
| | - Vanina Ambrogi
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 31059, Toulouse, France
| | - Raoul Baron
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 29609, Brest, France
| | - Patrick Barthelemy
- Équipe opérationnelle d'hygiène, Hôpital de la Conception, APHM, 13005, Marseille, France
| | - Isabelle Bauvin
- Service de réanimation néonatale, Centre Hospitalier, 64000, Pau, France
| | - Olivier Belmonte
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Félix Guyon, 97400, Saint Denis de la Réunion, France
| | - Emilie Benabid
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 95300, Pontoise, France
| | - Rafik Ben Ammar
- Service de réanimation néonatale, Centre Hospitalier Universitaire Antoine-Béclère, APHP, 92140, Clamart, France
| | | | - Yasmina Berrouane
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 06200, Nice, France
| | - Philippe Berthelot
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 42055, Saint Etienne, France
| | - Alain Beuchee
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 35000, Rennes, France
| | - Emmanuelle Bille
- Laboratoire de Microbiologie clinique, Hôpital universitaire Necker-Enfants malades, APHP, 75015, Paris, France
| | - Pascal Bolot
- Service de réanimation néonatale, Centre Hospitalier Delafontaine, 93205, Saint Denis, France
| | | | - Antoine Bouissou
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Sandra Bourdon
- Équipe opérationnelle d'hygiène, Centre Hospitalier du Havre, 76290, Montivilliers, France
| | - Nadège Bourgeois-Nicolaos
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Antoine-Béclère, APHP, 92140, Clamart, France
| | - Sophie Boyer
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Charles Nicolle, 76000, Rouen, France
| | - Christian Cattoen
- Laboratoire de Microbiologie, Centre Hospitalier, 59300, Valenciennes, France
| | - Vincent Cattoir
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 35000, Rennes, France
| | - Chantal Chaplain
- Laboratoire de Microbiologie, Centre Hospitalier Delafontaine, 93205, Saint Denis, France
| | - Céline Chatelet
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 62300, Lens, France
| | - Aurore Claudinon
- Laboratoire de Microbiologie, Centre Hospitalier, 95107, Argenteuil, France
| | - Nathalie Chautemps
- Service de réanimation néonatale, Centre Hospitalier Métropole Savoie-Site de Chambéry, 73 011, Chambéry, France
| | - Hélène Cormier
- UPLIN, Centre Hospitalier Universitaire, 49933, Angers, France
| | | | | | - Carole De Chillaz
- Service de Néonatalogie et Réanimation néonatale, Hôpital universitaire Necker-Enfants malades, APHP, 75015, Paris, France
| | - Olivier Dauwalder
- Laboratoire de Microbiologie, Hôpitaux Civils de Lyon, 69677, Bron, France
| | - Aude Davy
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 22000, Saint Brieuc, France
| | - Martine Delorme
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 79021, Niort, France
| | - Maryvonne Demasure
- Équipe opérationnelle d'hygiène, Centre Hospitalier Régional, 45100, Orléans, France
| | - Luc Desfrere
- Service de réanimation néonatale, Centre Hospitalier Universitaire, Hôpital Louis-Mourier, APHP, 92700, Colombes, France
| | - Michel Drancourt
- Laboratoire de Microbiologie, Hôpital de la Conception, APHM, 13005, Marseille, France
| | - Clarisse Dupin
- Laboratoire de Microbiologie, Centre Hospitalier, 22000, Saint Brieuc, France
| | - Véronique Faraut-Derouin
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire Antoine-Béclère, APHP, 92140, Clamart, France
| | - Arnaud Florentin
- Service d'hygiène et d'analyses environnementales (SHAE), Hôpitaux de Brabois, 54035, Nancy, France
| | - Virginie Forget
- Équipe opérationnelle d'hygiène, Centre Hospitalier Métropole Savoie-Site de Chambéry, 73 011, Chambéry, France
| | - Nicolas Fortineau
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, Kremlin Bicêtre, APHP, 94275, Le Kremlin Bicêtre, France
| | - Tania Foucan
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 97159, Pointe-à-Pitre, France
| | - Pierre Frange
- Laboratoire de Microbiologie clinique, Hôpital universitaire Necker-Enfants malades, APHP, 75015, Paris, France.,Équipe opérationnelle d'hygiène, Hôpital universitaire Necker-Enfants malades, APHP, 75015, Paris, France
| | - Karine Gambarotto
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire Félix Guyon, 97400, Saint Denis de la Réunion, France
| | - Géraldine Gascoin
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 49933, Angers, France
| | - Laure Gibert
- Équipe opérationnelle d'hygiène, Centre Hospitalier du Havre, 76290, Montivilliers, France
| | - Jacques Gilquin
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 81100, Castres, France
| | - Audrey Glanard
- Équipe opérationnelle d'hygiène, Centre Hospitalier Delafontaine, 93205, Saint Denis, France
| | - Jacqueline Grando
- Équipe opérationnelle d'hygiène, Hôpitaux Civils de Lyon, 69677, Bron, France
| | - Alain Gravet
- Laboratoire de Microbiologie, Centre Hospitalier, 68100, Mulhouse, France
| | - Jérôme Guinard
- Laboratoire de Microbiologie, Centre Hospitalier Régional, 45100, Orléans, France
| | - Geneviève Hery-Arnaud
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 29609, Brest, France
| | - Claire Huart
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 59300, Valenciennes, France
| | - Nadia Idri
- Équipe opérationnelle d'hygiène, Hôpital Louis-Mourier, APHP, 92700, Colombes, France.,Laboratoire de Microbiologie, Hôpital Louis-Mourier, APHP, 92700, Colombes, France
| | - Jean-Marc Jellimann
- Service de réanimation néonatale, Centre Hospitalier Universitaire, Hôpitaux de Brabois, 54035, Nancy, France
| | - Olivier Join-Lambert
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 14000, Caen, France
| | - Sylvie Joron
- Service d'hygiène, Centre Hospitalier, 62100, Calais, France
| | - Philippe Jouvencel
- Service de réanimation néonatale, Centre Hospitalier, 64100, Bayonne, France
| | - Marie Kempf
- Laboratoire de Bactériologie-Hygiène Institut de Biologie en Santé, CRCINA Inserm U1232, Université d'Angers, Centre Hospitalier Universitaire, 49933, Angers, France
| | - Sophie Ketterer-Martinon
- Service de réanimation néonatale et réanimation pédiatrique, Centre Hospitalier Universitaire de Martinique, 97261, Fort de France, France
| | - Mouna Khecharem
- Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire, Kremlin Bicêtre, APHP, 94275, Le Kremlin Bicêtre, France
| | - Serge Klosowski
- Service de réanimation néonatale, Centre Hospitalier, 62300, Lens, France
| | - Franck Labbe
- Laboratoire de Microbiologie, Centre Hospitalier du Havre, 76290, Montivilliers, France
| | - Adeline Lacazette
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 97159, Pointe-à-Pitre, France
| | - Fabrice Lapeyre
- Service de réanimation néonatale, Centre Hospitalier, 59300, Valenciennes, France
| | | | - Peggy Larroude
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 64000, Pau, France
| | | | - Nolwenn Le Sache
- Service de réanimation néonatale, Centre Hospitalier Universitaire, Kremlin Bicêtre, APHP, 94275, Le Kremlin Bicêtre, France
| | - Sylvie Ledru
- Laboratoire de Microbiologie, Centre Hospitalier, 62300, Lens, France
| | - Annick Lefebvre
- Équipe opérationnelle d'hygiène, Université de Reims Champagne-Ardenne, 51100, Reims, France
| | - Clément Legeay
- UPLIN, Centre Hospitalier Universitaire, 49933, Angers, France
| | - Florence Lemann
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 95107, Argenteuil, France
| | - Claire Lesteven
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 14000, Caen, France
| | - Marion Levast-Raffin
- Laboratoire de Biologie Médicale, Centre Hospitalier Métropole Savoie-Site de Chambéry, 73 011, Chambéry, France
| | - David Leyssene
- Laboratoire de Microbiologie, Centre Hospitalier, 64100, Bayonne, France
| | - Isabelle Ligi
- Service de réanimation néonatale, Centre Hospitalier Universitaire, Hôpital de la Conception, APHM, 13005, Marseille, France
| | - Alain Lozniewski
- Laboratoire de Microbiologie, Hôpitaux de Brabois, 54035, Nancy, France
| | - Pierre Lureau
- Laboratoire de Microbiologie, Centre Hospitalier, 79021, Niort, France
| | - Franck-Olivier Mallaval
- Équipe opérationnelle d'hygiène, Centre Hospitalier Métropole Savoie-Site de Chambéry, 73 011, Chambéry, France
| | - Edith Malpote
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 97159, Pointe-à-Pitre, France
| | - Stéphane Marret
- Service de réanimation néonatale, Centre Hospitalier Universitaire Charles Nicolle, 76000, Rouen, France
| | - Pascale Martres
- Laboratoire de Microbiologie, Centre Hospitalier, 95300, Pontoise, France
| | - Guillaume Menard
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 35000, Rennes, France
| | - Laura Menvielle
- Service de réanimation néonatale et réanimation pédiatrique, Centre Hospitalier Universitaire, Hôpital Robert Debré, Inserm UMR-S 1250 P3Cell, Université de Reims Champagne-Ardenne, 51100, Reims, France
| | - Laurent Mereghetti
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Véronique Merle
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire Charles Nicolle, 76000, Rouen, France
| | - Pascale Minery
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 68100, Mulhouse, France
| | - Virginie Morange
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Julien Mourdie
- Service de réanimation néonatale, Centre Hospitalier du Havre, 76290, Montivilliers, France
| | - Anaelle Muggeo
- Laboratoire de Bactériologie, Université de Reims Champagne-Ardenne, 51100, Reims, France
| | - Jean Nakhleh
- Service de réanimation néonatale, Centre Hospitalier, 68100, Mulhouse, France
| | | | - Claude Olive
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire de Martinique, 97261, Fort de France, France
| | - Hugues Patural
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 42055, Saint Etienne, France
| | - Pascale Penn
- Laboratoire de Microbiologie, Centre Hospitalier, 72000, Le Mans, France
| | | | - Bruno Pozetto
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 42055, Saint Etienne, France
| | - Brigitte Riviere
- Laboratoire de Microbiologie, Centre Hospitalier, 81100, Castres, France
| | - Audrey Robine
- Service de réanimation néonatale, Centre Hospitalier, 72000, Le Mans, France
| | | | - Raymond Ruimy
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 06200, Nice, France
| | - Amine Siali
- Équipe opérationnelle d'hygiène, Centre Hospitalier Inter-Communal, 94010, Créteil, France
| | - Stéphanie Soive
- Service de réanimation néonatale, Centre Hospitalier, 22000, Saint Brieuc, France
| | - Souad Slimani
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire de Martinique, 97261, Fort de France, France
| | | | - Dominique Trivier
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 62300, Lens, France
| | | | | | - Evelyne Werner
- Service de réanimation néonatale, Centre Hospitalier Régional, 45100, Orléans, France
| | - Stéphane Le Vu
- Agence Santé Publique France, 94415, Saint Maurice, France
| | - Nathalie Van Der Mee-Marquet
- SPIADI, CPIAS CVDL, Hôpital Bretonneau, Centre Hospitalier Universitaire, 37044, Tours, France. .,Cellule d'Epidémiologie Régionale des Infections Nosocomiales, CPIAS CVDL, Service de Bactériologie-Virologie-Hygiène, Hôpital Trousseau, CHRU, 37044, Tours, France.
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20
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Qu Y, Li Y, Cameron DR, Easton CD, Zhu X, Zhu M, Salwiczek M, Muir BW, Thissen H, Daley A, Forsythe JS, Peleg AY, Lithgow T. Hyperosmotic Infusion and Oxidized Surfaces Are Essential for Biofilm Formation of Staphylococcus capitis From the Neonatal Intensive Care Unit. Front Microbiol 2020; 11:920. [PMID: 32477314 PMCID: PMC7237634 DOI: 10.3389/fmicb.2020.00920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/17/2020] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus capitis is an opportunistic pathogen often implicated in bloodstream infections in the neonatal intensive care unit (NICU). This is assisted by its ability to form biofilms on indwelling central venous catheters (CVC), which are highly resistant to antibiotics and the immune system. We sought to understand the fundamentals of biofilm formation by S. capitis in the NICU, using seventeen clinical isolates including the endemic NRCS-A clone and assessing nine commercial and two modified polystyrene surfaces. S. capitis clinical isolates from the NICU initiated biofilm formation only in response to hyperosmotic conditions, followed by a developmental progression driven by icaADBC expression to establish mature biofilms, with polysaccharide being their major extracellular polymer substance (EPS) matrix component. Physicochemical features of the biomaterial surface, and in particular the level of the element oxygen present on the surface, significantly influenced biofilm development of S. capitis. A lack of highly oxidized carbon species on the surface prevented the immobilization of S. capitis EPS and the formation of mature biofilms. This information provides guidance in regard to the preparation of hyperosmolar total parenteral nutrition and the engineering of CVC surfaces that can minimize the risk of catheter-related bloodstream infections caused by S. capitis in the NICU.
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Affiliation(s)
- Yue Qu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Yali Li
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia.,Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia
| | - David R Cameron
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Christopher D Easton
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Xuebo Zhu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minli Zhu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mario Salwiczek
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Benjamin W Muir
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Helmut Thissen
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Andrew Daley
- Department of Microbiology, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - John S Forsythe
- Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia
| | - Anton Y Peleg
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Trevor Lithgow
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
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21
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Niche specialization and spread of Staphylococcus capitis involved in neonatal sepsis. Nat Microbiol 2020; 5:735-745. [PMID: 32341568 DOI: 10.1038/s41564-020-0676-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
The multidrug-resistant Staphylococcus capitis NRCS-A clone is responsible for sepsis in preterm infants in neonatal intensive care units (NICUs) worldwide. Here, to retrace the spread of this clone and to identify drivers of its specific success, we investigated a representative collection of 250 S. capitis isolates from adults and newborns. Bayesian analyses confirmed the spread of the NRCS-A clone and enabled us to date its emergence in the late 1960s and its expansion during the 1980s, coinciding with the establishment of NICUs and the increasing use of vancomycin in these units, respectively. This dynamic was accompanied by the acquisition of mutations in antimicrobial resistance- and bacteriocin-encoding genes. Furthermore, combined statistical tools and a genome-wide association study convergently point to vancomycin resistance as a major driver of NRCS-A success. We also identified another S. capitis subclade (alpha clade) that emerged independently, showing parallel evolution towards NICU specialization and non-susceptibility to vancomycin, indicating convergent evolution in NICU-associated pathogens. These findings illustrate how the broad use of antibiotics can repeatedly lead initially commensal drug-susceptible bacteria to evolve into multidrug-resistant clones that are able to successfully spread worldwide and become pathogenic for highly vulnerable patients.
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Thorn LM, Ussher JE, Broadbent RS, Manning JM, Sharples KJ, Crump JA. Risk factors for Staphylococcus capitis pulsotype NRCS-A colonisation among premature neonates in the neonatal intensive care unit of a tertiary-care hospital: a retrospective case-control study. Infect Prev Pract 2020; 2:100057. [PMID: 34368703 PMCID: PMC8335916 DOI: 10.1016/j.infpip.2020.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/12/2020] [Indexed: 11/01/2022] Open
Abstract
Background A S. capitis strain called NRCS-A (S. capitis NRCS-A) has emerged as a cause of bloodstream infections and sepsis in neonatal intensive care units (NICUs) worldwide. Aim To identify risk factors for S. capitis NRCS-A colonisation among neonates, Dunedin Hospital NICU, Dunedin, New Zealand, from September 2013 through March 2015. Methods Weekly axillary swabs categorised eligible neonates as a case or a control. A case was defined as a week ending with a neonate's first positive swab for S. capitis NRCS-A and a control as a week in which a neonate remained negative. Weekly exposures were abstracted from hospital medical records. Analyses were performed using conditional logistic regression. Findings The median (range) gestational age at birth of participants was 32.7 (23.1-41.3) weeks. Participants contributed 26 weeks of case data and 177 weeks of control data. On adjusted analysis compared with matched controls, cases had higher odds of requiring invasive mechanical ventilation (OR 3.6, 95% CI: 1.1-11.6, p=0.035) and of a patent ductus arteriosus (PDA) (OR 3.0, 95% CI: 1.0-9.0, p=0.044). Cases had lower odds of being part of a multiple birth (OR 0.24, 95% CI 0.08-0.73, p=0.001), having an area of inflamed skin (OR 0.31, 95% CI: 0.13-0.75, p=0.009), and specifically an area of inflamed axillary skin (OR 0.08, 95% CI: 0.01-0.50, p=0.006). Conclusions We found that premature neonates with invasive mechanical ventilation and PDA had greater odds for S. capitis NRCS-A colonisation. Transmission may be mediated by increased staff contact, but prospective research is needed to confirm this.
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Affiliation(s)
- Louise M Thorn
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James E Ussher
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand.,Southern Community Laboratories, Dunedin, New Zealand
| | - Roland S Broadbent
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Juliet M Manning
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Katrina J Sharples
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand.,Centre for International Health, University of Otago, New Zealand
| | - John A Crump
- Centre for International Health, University of Otago, New Zealand
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23
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Butin M, Dumont Y, Monteix A, Raphard A, Roques C, Martins Simoes P, Picaud JC, Laurent F. Sources and reservoirs of Staphylococcus capitis NRCS-A inside a NICU. Antimicrob Resist Infect Control 2019; 8:157. [PMID: 31636900 PMCID: PMC6798403 DOI: 10.1186/s13756-019-0616-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/01/2019] [Indexed: 12/23/2022] Open
Abstract
Background The methicillin-resistant clone Staphylococcus capitis NRCS-A, involved in sepsis in neonatal intensive care units (NICUs) worldwide, is able to persist and spread in NICUs, suggesting the presence of reservoirs inside each setting. The purpose of the present study was to identify these reservoirs and to investigate the cycle of transmission of NRCS-A in one NICU. Methods In a single institution study, NRCS-A was sought in 106 consecutive vaginal samples of pregnant women to identify a potential source of NRCS-A importation into the NICU. Additionally NICU caregivers and environmental including incubators were tested to identify putative secondary reservoirs. Finally, the efficacy of disinfection procedure in the elimination of NRCS-A from incubators was evaluated. Results No S. capitis was isolated from vaginal samples of pregnant women. Three of the 21 tested caregivers (14%) carried S. capitis on their hands, but none remain positive after a five-day wash-out period outside NICU. Moreover, the clone NRCS-A persisted during six consecutive weeks in the NICU environment, but none of the sampled sites was constantly contaminated. Finally in our before/after disinfection study, all of 16 incubators were colonized before disinfection and 10 (62%) incubators remained colonized with NRCS-A after the disinfection procedure. Conclusions The partial ineffectiveness of incubators’ disinfection procedures is responsible for persistence of NRCS-A inside a NICU, and the passive hand contamination of caregivers could be involved in the inter-patient transmission of S. capitis.
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Affiliation(s)
- Marine Butin
- 1Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie, 69364 Lyon Cedex 07, France.,2Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69500 Bron, France
| | - Yann Dumont
- 3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France
| | - Alice Monteix
- 3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France
| | - Aurane Raphard
- 3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France
| | - Christine Roques
- Laboratoire de Génie Chimique UMR 5503, Université de Toulouse, CNRS, INPT, UPS, Faculté des Sciences Pharmaceutiques, 35 chemin des maraîchers, 31062 Toulouse cedex 4, France
| | - Patricia Martins Simoes
- 1Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie, 69364 Lyon Cedex 07, France.,3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France
| | - Jean-Charles Picaud
- 5Réanimation Néonatale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France.,6CarMeN, INSERM U1060, INRA U1397, Université de Lyon, 165 Chemin du Grand Revoyet, 69310 Pierre Bénite, France
| | - Frédéric Laurent
- 1Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie, 69364 Lyon Cedex 07, France.,3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France.,7Département de Microbiologie et Mycologie, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, Université de Lyon, 6 Avenue Rockefeller, 69008 Lyon, France
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24
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Genomic analysis of Staphylococcus capitis isolated from blood cultures in neonates at a neonatal intensive care unit in Sweden. Eur J Clin Microbiol Infect Dis 2019; 38:2069-2075. [PMID: 31396832 PMCID: PMC6800862 DOI: 10.1007/s10096-019-03647-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/15/2019] [Indexed: 12/04/2022]
Abstract
Emergence of a genetically distinct, multidrug-resistant Staphylococcus capitis clone (NRCS-A) present in neonatal intensive care units has recently been extensively reported. The aims of the present study were to investigate which clones of S. capitis isolated from blood in a Swedish neonatal intensive care unit (NICU) have been present since 1987 and to investigate whether the NRCS-A clone has disseminated in Sweden. All S. capitis isolates from blood cultures of neonates (≤ 28 days of age) between 1987 and 2017 (n = 46) were whole-genome sequenced, and core genome multilocus sequence typing (cgMLST) was performed. Single-nucleotide polymorphism (SNP)-based phylogenetic relationships between the S. capitis isolates and in silico predictions of presence of genetic traits specific to the NRCS-A clone were identified. Furthermore, antibiotic susceptibility testing, including screening for heterogeneous glycopeptide-intermediate resistance, was performed. Thirty-five isolates clustered closely to the isolates previously determined as belonging to the NRCS-A clone and had fewer than 81 core genome loci differences out of 1063. Twenty-one of these isolates were multidrug resistant. The NRCS-A clone was found in 2001. Six pairs of isolates had differences of fewer than two SNPs. Genetic traits associated with the NRCS-A clone such as nsr, ebh, tarJ, and CRISPR were found in all 35 isolates. The increasing incidence of S. capitis blood cultures of neonates is predominantly represented by the NRSC-A clone at our NICU in Sweden. Furthermore, there were indications of transmission between cases; adherence to basic hygiene procedures and surveillance measures are thus warranted.
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25
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Kosecka-Strojek M, Sabat AJ, Akkerboom V, Becker K, van Zanten E, Wisselink G, Miedzobrodzki J, Kooistra-Smid AMDM, Friedrich AW. Development and Validation of a Reference Data Set for Assigning Staphylococcus Species Based on Next-Generation Sequencing of the 16S-23S rRNA Region. Front Cell Infect Microbiol 2019; 9:278. [PMID: 31456949 PMCID: PMC6698797 DOI: 10.3389/fcimb.2019.00278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
Many members of the Staphylococcus genus are clinically relevant opportunistic pathogens that warrant accurate and rapid identification for targeted therapy. The aim of this study was to develop a careful assignment scheme for staphylococcal species based on next-generation sequencing (NGS) of the 16S-23S rRNA region. All reference staphylococcal strains were identified at the species level using Sanger sequencing of the 16S rRNA, sodA, tuf, and rpoB genes and NGS of the 16S-23S rRNA region. To broaden the database, an additional 100 staphylococcal strains, including 29 species, were identified by routine diagnostic methods, 16S rRNA Sanger sequencing and NGS of the 16S-23S rRNA region. The results enabled development of reference sequences encompassing the 16S-23S rRNA region for 50 species (including one newly proposed species) and 6 subspecies of the Staphylococcus genus. This study showed sodA and rpoB targets were the most discriminative but NGS of the 16S-23S rRNA region was more discriminative than tuf gene sequencing and much more discriminative than 16S rRNA gene sequencing. Almost all Staphylococcus species could be distinguished when the max score was 99.0% or higher and the sequence similarity between the best and second best species was equal to or >0.2% (min. 9 nucleotides). This study allowed development of reference sequences for 21 staphylococcal species and enrichment for 29 species for which sequences were publicly available. We confirmed the usefulness of NGS of the 16S-23S rRNA region by identifying the whole species content in 45 clinical samples and comparing the results to those obtained using routine diagnostic methods. Based on the developed reference database, all staphylococcal species can be reliably detected based on the 16S-23S rRNA sequences in samples composed of both single species and more complex polymicrobial communities. This study will be useful for introduction of a novel diagnostic tool, which undoubtedly is an improvement for reliable species identification in polymicrobial samples. The introduction of this new method is hindered by a lack of reference sequences for the 16S-23S rRNA region for many bacterial species. The results will allow identification of all Staphylococcus species, which are clinically relevant pathogens.
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Affiliation(s)
- Maja Kosecka-Strojek
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland.,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Artur J Sabat
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Viktoria Akkerboom
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Evert van Zanten
- Certe, Department of Medical Microbiology, Groningen, Netherlands
| | - Guido Wisselink
- Certe, Department of Medical Microbiology, Groningen, Netherlands
| | - Jacek Miedzobrodzki
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Anna M D Mirjam Kooistra-Smid
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Certe, Department of Medical Microbiology, Groningen, Netherlands
| | - Alexander W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Jamrozy D, Misra R, Xu Z, Ter-Stepanyan MM, Kocharyan KS, Cave R, Hambardzumyan AD, Mkrtchyan HV. Novel Methicillin-Resistant Staphylococcus aureus CC8 Clone Identified in a Hospital Setting in Armenia. Front Microbiol 2019; 10:1592. [PMID: 31354680 PMCID: PMC6635598 DOI: 10.3389/fmicb.2019.01592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/26/2019] [Indexed: 11/17/2022] Open
Abstract
Whole-genome sequencing (WGS) of methicillin-resistant Staphylococcus aureus (MRSA) has been sparse in low- and middle-income countries, therefore, its population structure is unknown for many regions. We conducted a pilot surveillance of MRSA in the maternity ward of a teaching hospital in Armenia, to characterize the genotypes of circulating MRSA clones. In total, 10 MRSA isolates from a hospital environment (n = 4) and patients (n = 6) were recovered between March and May 2015 and April and May 2016, respectively. WGS analysis showed that the isolates belonged to two clonal complexes (CCs): CC8 (n = 8) and CC30 (n = 2). MRSA CC30 isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVa, whereas MRSA CC8 revealed a type-VT-related SCCmec, which contained a CRISPR/Cas array and showed a high similarity to SCCmec found in coagulase-negative staphylococci. All but one MRSA CC8 isolates carried a plasmid identical to the pSK67 and four also carried a pathogenicity island similar to SaPI5. Phylogenetic analysis showed that the MRSA CC8 isolates formed a monophyletic cluster, which emerged around 1995 and was distinct from representatives of globally-distributed MRSA CC8 lineages. WGS characterization of MRSA in countries with no previous S. aureus genomic surveillance can therefore reveal an unrecognized diversity of MRSA lineages.
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Affiliation(s)
- Dorota Jamrozy
- Wellcome Sanger Institute, Saffron Walden, United Kingdom
| | - Raju Misra
- Core Research Laboratories, Molecular Biology, Natural History Museum, London, United Kingdom
| | - Zhen Xu
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Department of Toxicology and Sanitary Chemistry, Tianjin Medical University, Tianjin, China
| | | | - Karine S. Kocharyan
- Department of Epidemiology, Yerevan State Medical University, Yerevan, Armenia
| | - Rory Cave
- School of Health, Sport and Bioscience, University of East London, London, United Kingdom
| | | | - Hermine V. Mkrtchyan
- School of Health, Sport and Bioscience, University of East London, London, United Kingdom
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Butin M, Claris O, Laurent F. Clinical impact of vancomycin heteroresistance in staphylococcal strains involved in neonatal sepsis: Discussion of a case report. Arch Pediatr 2019; 26:236-237. [PMID: 30954366 DOI: 10.1016/j.arcped.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/04/2019] [Accepted: 03/07/2019] [Indexed: 11/25/2022]
Abstract
Heteroresistance to vancomycin (HRV) represents a decreased susceptibility to vancomycin and is frequently observed in multidrug-resistant coagulase-negative staphylococci. The clinical significance of such heteroresistance is controversial, but several failures of vancomycin therapy have been related to HRV, especially in the neonatal population. Here we report the case of a preterm neonate, born at 26 weeks of gestation, who developed sepsis due to a multidrug-resistant HRV Staphylococcuscapitis isolate. Bacteremia persisted despite adequate vancomycin serum concentration and catheter removal. The patient finally recovered after replacing vancomycin by linezolid. Through this case report, we would like to alert clinicians of the potential clinical impact of HRV and to discuss the lack of therapeutic alternatives in neonates.
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Affiliation(s)
- M Butin
- Service de néonatologie et réanimation néonatale, hospices civils de Lyon, hôpital femme-mère-enfant, 59, boulevard Pinel, 69677 Bron cedex, France; Équipe « Pathogénèse des infections à Staphylocoques », Inserm U1111, centre international de recherche en infectiologie, 46, allée d'Italie, 69364 Lyon cedex 07, France.
| | - O Claris
- Service de néonatologie et réanimation néonatale, hospices civils de Lyon, hôpital femme-mère-enfant, 59, boulevard Pinel, 69677 Bron cedex, France; EA 4129, université Claude-Bernard, boulevard du 11-novembre-1918, 69100 Villeurbanne, France
| | - F Laurent
- Équipe « Pathogénèse des infections à Staphylocoques », Inserm U1111, centre international de recherche en infectiologie, 46, allée d'Italie, 69364 Lyon cedex 07, France; Centre national de référence des staphylocoques, groupement hospitalier est, hospices civils de Lyon, Institut des agents infectieux, 59, boulevard Pinel, 69677 Bron cedex, France
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28
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Ory J, Cazaban M, Richaud-Morel B, Di Maio M, Dunyach-Remy C, Pantel A, Sotto A, Laurent F, Lavigne JP, Butin M. Successful implementation of infection control measure in a neonatal intensive care unit to combat the spread of pathogenic multidrug resistant Staphylococcus capitis. Antimicrob Resist Infect Control 2019; 8:57. [PMID: 30962919 PMCID: PMC6437968 DOI: 10.1186/s13756-019-0512-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Once present in a neonatal intensive care unit (NICU), multidrug resistant Staphylococcus capitis NRCS-A is able to settle and diffuse. Objective The objective of this study was to evaluate the impact of infection control (IC) interventions to reduce the spread of Staphylococcus capitis NRCS-A in a NICU. Methods Between December 2012 and December 2017, all patients presenting positive sampling (blood, skin or catheter) to S. capitis were included, and clinical data were recorded from electronic clinical charts. The IC team has continually implemented measures of control infections (hand hygiene, standard precautions, patient contact isolation and disinfection of the inanimate environment). From May 2015, a steam cleaner was implemented in the cleaning procedure instead of disinfectant to disinfect heating tables and incubators. Four periods were determined: Period 1 (P1) before steam cleaner acquisition; Period 2 (P2) after implementation steam cleaner; Period 3 (P3) when the steam cleaner had broken down, and Period 4 (P4) when the steam cleaner was functional again. The consumption of antibiotics and the epidemiology of infections inside the NICU were investigated during the study period. Results During the studied period, 37 infants were infected or colonized by S. capitis. The incidences of infection or colonization by S. capitis were P1 = 1.04‰, P2 = 0.55‰, P3 = 3.95 ‰ and P4 = 0‰ and were significantly different between P1-P3 and P2-P4 (p < 0.001). During the different periods, antibiotics consumption and bacterial epidemiology of the ward were stable. Conclusions The use of steam vapor system was associated with a significantly decreased incidence of S. capitis NRCS-A infection or colonization and could constitute an effective and safe procedure to control and eradicate its diffusion inside NICUs.
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Affiliation(s)
- Jérôme Ory
- 1Department of Infection Control, Equipe Opérationnelle d'Hygiène, Place du Professeur Robert Debré, University Hospital Nîmes, Nîmes, France
| | - Michel Cazaban
- 1Department of Infection Control, Equipe Opérationnelle d'Hygiène, Place du Professeur Robert Debré, University Hospital Nîmes, Nîmes, France
| | - Brigitte Richaud-Morel
- 1Department of Infection Control, Equipe Opérationnelle d'Hygiène, Place du Professeur Robert Debré, University Hospital Nîmes, Nîmes, France
| | - Massimo Di Maio
- 2Department of Neonatalogy, University Hospital Nîmes, Nîmes, France
| | - Catherine Dunyach-Remy
- 3Bacterial virulence and Infectious Diseases, INSERM, Department of Microbiology, Université de Montpellier, University Hospital Nîmes, Nîmes cedex 02, 30908 Nîmes, France
| | - Alix Pantel
- 3Bacterial virulence and Infectious Diseases, INSERM, Department of Microbiology, Université de Montpellier, University Hospital Nîmes, Nîmes cedex 02, 30908 Nîmes, France
| | - Albert Sotto
- 4Department of Infectious Diseases, Bacterial virulence and Infectious Diseases, INSERM, Université de Montpellier, University Hospital Nîmes, Nîmes, France
| | - Frédéric Laurent
- 5International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, Lyon, France.,Institute of Infectious Agents, Lyon, France.,National Reference Center for Staphylococci, Lyon, France.,8Department of Microbiology-Mycology, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, University of Lyon, Lyon, France
| | - Jean-Philippe Lavigne
- 3Bacterial virulence and Infectious Diseases, INSERM, Department of Microbiology, Université de Montpellier, University Hospital Nîmes, Nîmes cedex 02, 30908 Nîmes, France
| | - Marine Butin
- 5International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, Lyon, France.,Institute of Infectious Agents, Lyon, France.,National Reference Center for Staphylococci, Lyon, France.,8Department of Microbiology-Mycology, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, University of Lyon, Lyon, France
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Laurent F, Butin M. Staphylococcus capitis and NRCS-A clone: the story of an unrecognized pathogen in neonatal intensive care units. Clin Microbiol Infect 2019; 25:1081-1085. [PMID: 30928561 DOI: 10.1016/j.cmi.2019.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/07/2019] [Accepted: 03/09/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND In neonatal intensive care units (NICUs), nosocomial late-onset sepsis (LOS), mostly due to coagulase negative staphylococci, constitute a major cause of death or impairment. Staphylococcus capitis, usually considered as a poorly virulent species, has been reported as a cause of LOS. OBJECTIVES To review data regarding S. capitis neonatal LOS and the features of isolates involved. SOURCES PubMed was searched up to August 2018 to retrieve studies on the topic; the keywords used were 'S. capitis', 'neonate', 'neonatal ICU', 'bloodstream infection' and 'late onset sepsis'. CONTENT Published data highlight the worldwide endemicity of a single S. capitis clone, named NRCS-A, specifically involved in LOS. NRCS-A harbours a multidrug resistance profile (including resistance to the usual first-line antibiotics used in NICUs). It is also able to adapt under vancomycin selective pressure that could confer an advantage for its implantation and dissemination in NICUs where this selective pressure is high. Moreover, a severe morbidity has been observed in NRCS-A-related LOS. The NICU environment, and especially incubators, constitute reservoirs of NRCS-A from which it could diffuse inside the setting. Finally, the virulome and resistome of S. capitis NRCS-A contain many genes potentially implicated in its specific epidemiology and pathophysiology, including the gene nsr that may be involved in its fitness and implantation in neonatal gut flora. IMPLICATIONS S. capitis must be considered as a true pathogen in neonates. The decreased susceptibility to vancomycin may be involved in failure of vancomycin therapy. Further studies are needed to better manage its diffusion inside each NICU but also worldwide.
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Affiliation(s)
- F Laurent
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie 69364 Lyon Cedex 07, France; Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France; Département de Microbiologie et Mycologie, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, Université de Lyon, 6 Avenue Rockefeller, 69008 Lyon, France
| | - M Butin
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie 69364 Lyon Cedex 07, France; Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Bd Pinel 69500 Bron, France.
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Asanin J, Misic D, Aksentijevic K, Tambur Z, Rakonjac B, Kovacevic I, Spergser J, Loncaric I. Genetic Profiling and Comparison of Human and Animal Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates from Serbia. Antibiotics (Basel) 2019; 8:E26. [PMID: 30884836 PMCID: PMC6466565 DOI: 10.3390/antibiotics8010026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 01/20/2023] Open
Abstract
The aim of this study was to characterize a collection of methicillin-resistant Staphylococcus aureus (MRSA) isolates of human and animal origin from Serbia. In total, 36 MRSA isolates-30 obtained from humans and six from companion animals-were investigated by PCR for the presence of antibiotic and biocide resistance determinants and virulence genes (PVL-Panton⁻Valentine leukocidin, ETs-exfoliative toxins, TSST-toxic shock syndrome toxin, SEs-staphylococcal enterotoxins, and MSCRAMMs-microbial surface components recognizing adhesive matrix molecules and biofilm). Isolates were analyzed by staphylococcal cassette chromosome mec (SCCmec), spa, and dru typing, as well as by multiple locus variable number of tandem repeat analyses (MLVA), multilocus sequence typing (MLST), and subsequently, eBURST. The majority of human MRSA isolates were resistant to gentamicin, erythromycin, clindamycin, and ciprofloxacin. Different antibiotic resistance genes were detected: aac-aphD, ant(6')-Ia, erm(A), erm(B), erm(C), tet(K), tet(M), fexA, and catpC221. All isolates were susceptible to teicoplanin and linezolid. SCCmec type III was prevalent in human isolates, while SCCmec elements in animals were mostly nontypeable. t037 was the predominant spa type in human and t242 in animal MRSA isolates. The prevalent dru type was dt11c in human and dt10a in animal MRSA isolates. MRSA isolates exhibited 27 different MLVA types. ST239 was predominant in human, while ST5 was prevalent in canine MRSA isolates. PVL was found in two, while tsst-1 was detected in three human isolates. Human-associated clones belonging to ST5, ST45, and ST239 MRSA clones were discovered in companion animals, which suggests anthropozoonotic transmission.
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Affiliation(s)
- Jelena Asanin
- Innovation Center of Faculty of Technology and Metallurgy, University of Belgrade, 11000 Beograd, Serbia.
| | - Dusan Misic
- Faculty of Veterinary Medicine, University of Belgrade, 11000 Beograd, Serbia.
| | | | - Zoran Tambur
- Institute of Hygiene Military Medical Academy, Belgrade, Serbia and Faculty of Stomatology in Pancevo, 11000 Beograd, Serbia.
| | - Bojan Rakonjac
- Institute of Microbiology Military Medical Academy, 11000 Beograd, Serbia.
| | - Ivana Kovacevic
- Institute of Hygiene Military Medical Academy, 11000 Beograd, Serbia.
| | - Joachim Spergser
- Institute of Microbiology, University of Veterinary Medicine, 1210 Wien, Austria.
| | - Igor Loncaric
- Institute of Microbiology, University of Veterinary Medicine, 1210 Wien, Austria.
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Brüggemann H, Poehlein A, Brzuszkiewicz E, Scavenius C, Enghild JJ, Al-Zeer MA, Brinkmann V, Jensen A, Söderquist B. Staphylococcus saccharolyticus Isolated From Blood Cultures and Prosthetic Joint Infections Exhibits Excessive Genome Decay. Front Microbiol 2019; 10:478. [PMID: 30915059 PMCID: PMC6423177 DOI: 10.3389/fmicb.2019.00478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/25/2019] [Indexed: 12/27/2022] Open
Abstract
The slow-growing, anaerobic, coagulase-negative species Staphylococcus saccharolyticus is found on human skin and in clinical specimens but its pathogenic potential is unclear. Here, we investigated clinical isolates and sequenced the genomes of seven strains of S. saccharolyticus. Phylogenomic analyses showed that the closest relative of S. saccharolyticus is Staphylococcus capitis with an average nucleotide identity of 80%. Previously sequenced strains assigned to S. saccharolyticus are misclassified and belong to S. capitis. Based on single nucleotide polymorphisms of the core genome, the population of S. saccharolyticus can be divided into two clades that also differ in a few larger genomic islands as part of the flexible genome. An unexpected feature of S. saccharolyticus is extensive genome decay, with over 300 pseudogenes, indicating ongoing reductive evolution. Many genes of the core metabolism are not functional, rendering the species auxotrophic for several amino acids, which could explain its slow growth and need for fastidious growth conditions. Secreted proteins of S. saccharolyticus were determined; they include stress response proteins such as heat and oxidative stress-related factors, as well as immunodominant staphylococcal surface antigens and enzymes that can degrade host tissue components. The strains secrete lipases and a hyaluronic acid lyase. Hyaluronidase as well as urease activities were detected in biochemical assays, with clade-specific differences. Our study revealed that S. saccharolyticus has adapted its genome, possibly due to a recent change of habitat; moreover, the data imply that the species has tissue-invasive potential and might cause prosthetic joint infections.
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Affiliation(s)
| | - Anja Poehlein
- Department of Genomic and Applied Microbiology, Institute of Microbiology and Genetics, University of Göttingen, Göttingen, Germany
| | - Elzbieta Brzuszkiewicz
- Department of Genomic and Applied Microbiology, Institute of Microbiology and Genetics, University of Göttingen, Göttingen, Germany
| | - Carsten Scavenius
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Jan J Enghild
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Munir A Al-Zeer
- Department of Applied Biochemistry, Institute of Biotechnology, Technical University of Berlin, Berlin, Germany
| | - Volker Brinkmann
- Microscopy Core Facility, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Anders Jensen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Bo Söderquist
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Genomic Analysis of Multiresistant Staphylococcus capitis Associated with Neonatal Sepsis. Antimicrob Agents Chemother 2018; 62:AAC.00898-18. [PMID: 30150477 PMCID: PMC6201123 DOI: 10.1128/aac.00898-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/18/2018] [Indexed: 12/29/2022] Open
Abstract
Coagulase-negative staphylococci (CoNS), such as Staphylococcus capitis, are major causes of bloodstream infections in neonatal intensive care units (NICUs). Recently, a distinct clone of S. capitis (designated S. capitis NRCS-A) has emerged as an important pathogen in NICUs internationally. Coagulase-negative staphylococci (CoNS), such as Staphylococcus capitis, are major causes of bloodstream infections in neonatal intensive care units (NICUs). Recently, a distinct clone of S. capitis (designated S. capitis NRCS-A) has emerged as an important pathogen in NICUs internationally. Here, 122 S. capitis isolates from New Zealand (NZ) underwent whole-genome sequencing (WGS), and these data were supplemented with publicly available S. capitis sequence reads. Phylogenetic and comparative genomic analyses were performed, as were phenotypic assessments of antimicrobial resistance, biofilm formation, and plasmid segregational stability on representative isolates. A distinct lineage of S. capitis was identified in NZ associated with neonates and the NICU environment. Isolates from this lineage produced increased levels of biofilm, displayed higher levels of tolerance to chlorhexidine, and were multidrug resistant. Although similar to globally circulating NICU-associated S. capitis strains at a core-genome level, NZ NICU S. capitis isolates carried a novel stably maintained multidrug-resistant plasmid that was not present in non-NICU isolates. Neonatal blood culture isolates were indistinguishable from environmental S. capitis isolates found on fomites, such as stethoscopes and neonatal incubators, but were generally distinct from those isolates carried by NICU staff. This work implicates the NICU environment as a potential reservoir for neonatal sepsis caused by S. capitis and highlights the capacity of genomics-based tracking and surveillance to inform future hospital infection control practices aimed at containing the spread of this important neonatal pathogen.
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Cantey JB, Anderson KR, Kalagiri RR, Mallett LH. Morbidity and mortality of coagulase-negative staphylococcal sepsis in very-low-birth-weight infants. World J Pediatr 2018. [PMID: 29536341 DOI: 10.1007/s12519-018-0145-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in the neonatal intensive care unit (NICU) and usually require vancomycin treatment. Our objective was to determine whether CoNS are associated with neonatal morbidity and mortality. METHODS This was a retrospective cohort study of very-low-birth-weight (VLBW, ≤ 1500 g) infants from 1989 to 2015. Exclusion criteria were major congenital anomaly or death within 72 h. CoNS was considered a pathogen if recovered from ≥ 2 cultures, or 1 culture if treated for ≥ 5 days and signs of sepsis were present. Logistic regression was used to examine factors associated with morbidity and mortality. RESULTS Of 2242 VLBW infants, 285 (12.7%) had late-onset sepsis. CoNS (125, 44%), Staphylococcus aureus (52, 18%), and Escherichia coli (36, 13%) were the most commonly recovered organisms. In multivariate analysis, CoNS sepsis was not associated with mortality [OR 0.6 (95% CI 0.2-2.6)), but sepsis with other organisms was [OR 4.5 (95% CI 2.6-8.0)]. CoNS sepsis was associated with longer hospitalization but not risk for bronchopulmonary dysplasia, intraventricular hemorrhage, or retinopathy of prematurity. CONCLUSION CoNS sepsis was not associated with mortality or morbidities other than length of stay. These findings support vancomycin-reduction strategies in the NICU.
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Affiliation(s)
- Joseph B Cantey
- Department of Pediatrics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | | | - Ram R Kalagiri
- Texas A&M Health Science Center, Baylor/Scott & White Health, Temple, TX, USA
| | - Lea H Mallett
- Texas A&M Health Science Center, Baylor/Scott & White Health, Temple, TX, USA
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Butin M, Martins-Simões P, Rasigade JP, Picaud JC, Laurent F. Worldwide Endemicity of a Multidrug-Resistant Staphylococcus capitis Clone Involved in Neonatal Sepsis. Emerg Infect Dis 2018; 23:538-539. [PMID: 28221122 PMCID: PMC5382751 DOI: 10.3201/eid2303.160833] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A multidrug-resistant Staphylococcus capitis clone, NRCS-A, has been isolated from neonatal intensive care units in 17 countries throughout the world. S. capitis NRCS-A prevalence is high in some neonatal intensive care units in France. These data highlight the worldwide endemicity and epidemiologic relevance of this multidrug-resistant, coagulase-negative staphylococci clone.
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35
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Butin M, Dumont Y, Rasigade JP, Martins Simoes P, Hoden L, Picaud JC, Laurent F. Chromogenic detection procedure for the multidrug-resistant, neonatal sepsis-associated clone Staphylococcus capitis NRCS-A. Diagn Microbiol Infect Dis 2017; 90:81-82. [PMID: 29157953 DOI: 10.1016/j.diagmicrobio.2017.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/14/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
The multiresistant Staphylococcus capitis clone NRCS-A is a major pathogen in neonates worldwide. We show that NRCS-A grows as mauve colonies with a cream-color halo after a 5-day incubation on MRSA Brilliance 2 agar (Oxoid®). This innovative protocol will ease the screening of clinical and environmental niches of this clone.
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Affiliation(s)
- Marine Butin
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, University of Lyon, Lyon, France; Neonatal Intensive Care Unit, Eastern Hospital Group, Hospices Civils de Lyon, Lyon, France; Institute of Infectious Agents, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France.
| | - Yann Dumont
- Institute of Infectious Agents, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Jean-Philippe Rasigade
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, University of Lyon, Lyon, France; Institute of Infectious Agents, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Patricia Martins Simoes
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, University of Lyon, Lyon, France; Institute of Infectious Agents, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Louise Hoden
- Institute of Infectious Agents, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Jean-Charles Picaud
- Neonatal Intensive Care Unit, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, University of Lyon, Lyon, France; Institute of Infectious Agents, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France; Department of Microbiology-Mycology, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, University of Lyon, Lyon, France
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Ehlersson G, Hellmark B, Svartström O, Stenmark B, Söderquist B. Phenotypic characterisation of coagulase-negative staphylococci isolated from blood cultures in newborn infants, with a special focus on Staphylococcus capitis. Acta Paediatr 2017. [PMID: 28631328 DOI: 10.1111/apa.13950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIM This Swedish study determined which species of coagulase-negative staphylococci (CoNS) were found in neonatal blood cultures and whether they included Staphylococcus capitis clones with decreased susceptibility to vancomycin. METHODS CoNS isolates (n = 332) from neonatal blood cultures collected at Örebro University Hospital during 1987-2014 were identified to species level with matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). The antibiotic susceptibility pattern of S. capitis isolates was determined by the disc diffusion test and Etest, and the presence of heterogeneous glycopeptide-intermediate S. capitis (hGISC) was evaluated. RESULTS Staphylococcus epidermidis (67.4%), Staphylococcus haemolyticus (10.5%) and S. capitis (9.6%) were the most common CoNS species. Of the S. capitis isolates, 75% were methicillin-resistant and 44% were multidrug-resistant. No isolate showed decreased susceptibility to vancomycin, but at least 59% displayed the hGISC phenotype. Staphylococcus capitis isolates related to the strain CR01 displaying pulsotype NRCS-A were found. CONCLUSION Staphylococcus epidermidis, S. haemolyticus and S. capitis were the predominant species detected in neonatal blood cultures by MALDI-TOF MS. The number of episodes caused by S. capitis increased during the study period, but no isolates with decreased susceptibility to vancomycin were identified. However, S. capitis isolates related to the strain CR01 displaying pulsotype NRCS-A were found.
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Affiliation(s)
- Gustaf Ehlersson
- School of Medical Sciences; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Department of Laboratory Medicine; Clinical Microbiology; Örebro University Hospital; Örebro Sweden
| | - Bengt Hellmark
- School of Medical Sciences; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Department of Laboratory Medicine; Clinical Microbiology; Örebro University Hospital; Örebro Sweden
| | - Olov Svartström
- Department of Clinical Microbiology; Linköping University Hospital; Linköping Sweden
| | - Bianca Stenmark
- School of Medical Sciences; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Department of Laboratory Medicine; Clinical Microbiology; Örebro University Hospital; Örebro Sweden
| | - Bo Söderquist
- School of Medical Sciences; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Department of Laboratory Medicine; Clinical Microbiology; Örebro University Hospital; Örebro Sweden
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37
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Butin M, Martins-Simões P, Pichon B, Leyssene D, Bordes-Couecou S, Meugnier H, Rouard C, Lemaitre N, Schramm F, Kearns A, Spiliopoulou I, Hyyryläinen HL, Dumitrescu O, Vandenesch F, Dupieux C, Laurent F. Emergence and dissemination of a linezolid-resistant Staphylococcus capitis clone in Europe. J Antimicrob Chemother 2017; 72:1014-1020. [PMID: 27999045 DOI: 10.1093/jac/dkw516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/03/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives We investigated the epidemiological, clinical, microbiological and genetic characteristics of linezolid-resistant (LZR) Staphylococcus capitis isolates from French ICUs, and compared them with LZR S. capitis isolates from other European countries. Methods All LZR isolates were subjected to antimicrobial susceptibility testing (AST) and the presence of cfr and optrA genes as well as mutations in the 23S rRNA and ribosomal proteins were investigated using specific PCR with sequencing. The genetic relationship between isolates was investigated using PFGE and WGS. Epidemiological data concerning LZR S. capitis were collected retrospectively in French microbiology laboratories. Results Twenty-one LZR isolates were studied: 9 from France, 11 from Greece and 1 from Finland. All were resistant to methicillin and aminoglycosides. In addition, this unusual AST profile was identified in S. capitis isolates from seven French hospitals, and represented up to 12% of the S. capitis isolates in one centre. A G2576T mutation in 23S rRNA was identified in all isolates; cfr and optrA genes were absent. All isolates belonged to the same clone on the basis of their PFGE profiles, whatever their geographical origin. WGS found at most 212 SNPs between core genomes of the LZR isolates. Conclusions We identified and characterized an LZR S. capitis clone disseminated in three European countries, harbouring the same multiple resistance and a G2576T mutation in the 23S rRNA. The possible unrecognized wider distribution of this clone, belonging to a species classically regarded as a low-virulence skin colonizer, is of major concern not least because of the increasing use of oxazolidinones.
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Affiliation(s)
- M Butin
- International Center for Infectiology Research (CIRI), INSERM U1111-CNRS UMR5308-ENS Lyon-University Claude Bernard Lyon 1, France.,Department of Bacteriology, Hospices Civils de Lyon, Lyon, France
| | - P Martins-Simões
- International Center for Infectiology Research (CIRI), INSERM U1111-CNRS UMR5308-ENS Lyon-University Claude Bernard Lyon 1, France.,Department of Bacteriology, Hospices Civils de Lyon, Lyon, France.,National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - B Pichon
- National Infection Service, Public Health England, Colindale, London, UK
| | - D Leyssene
- Department of Bacteriology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - S Bordes-Couecou
- Department of Bacteriology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - H Meugnier
- International Center for Infectiology Research (CIRI), INSERM U1111-CNRS UMR5308-ENS Lyon-University Claude Bernard Lyon 1, France.,Department of Bacteriology, Hospices Civils de Lyon, Lyon, France.,National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - C Rouard
- Department of Bacteriology, Hôpital Antoine-Béclère, University Paris Sud, Clamart, France
| | - N Lemaitre
- Univ. Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, U1019-UMR 8204, Center for Infection and Immunity of Lille, Lille, F-59000, France
| | - F Schramm
- Department of Bacteriology, CHRU de Strasbourg, EA7290 Early Bacterial Virulence, FMTS, Université de Strasbourg, Strasbourg, France
| | - A Kearns
- National Infection Service, Public Health England, Colindale, London, UK
| | - I Spiliopoulou
- National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece
| | | | - O Dumitrescu
- International Center for Infectiology Research (CIRI), INSERM U1111-CNRS UMR5308-ENS Lyon-University Claude Bernard Lyon 1, France.,Department of Bacteriology, Hospices Civils de Lyon, Lyon, France.,National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - F Vandenesch
- International Center for Infectiology Research (CIRI), INSERM U1111-CNRS UMR5308-ENS Lyon-University Claude Bernard Lyon 1, France.,Department of Bacteriology, Hospices Civils de Lyon, Lyon, France.,National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - C Dupieux
- International Center for Infectiology Research (CIRI), INSERM U1111-CNRS UMR5308-ENS Lyon-University Claude Bernard Lyon 1, France.,Department of Bacteriology, Hospices Civils de Lyon, Lyon, France.,National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - F Laurent
- International Center for Infectiology Research (CIRI), INSERM U1111-CNRS UMR5308-ENS Lyon-University Claude Bernard Lyon 1, France.,Department of Bacteriology, Hospices Civils de Lyon, Lyon, France.,National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
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Butin M, Rasigade JP, Subtil F, Martins-Simões P, Pralong C, Freydière AM, Vandenesch F, Tigaud S, Picaud JC, Laurent F. Vancomycin treatment is a risk factor for vancomycin-nonsusceptible Staphylococcus capitis sepsis in preterm neonates. Clin Microbiol Infect 2017; 23:839-844. [PMID: 28373147 DOI: 10.1016/j.cmi.2017.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Multidrug-resistant, vancomycin-nonsusceptible Staphylococcus capitis is an emerging cause worldwide of late-onset sepsis (LOS) in preterm neonates. The pathophysiology and risk factors for S. capitis-related LOS are poorly understood, but we hypothesized that S. capitis LOS follows translocation from the gut microbiota rather than catheter invasion. The objective of this study was to investigate the risk factors of S. capitis LOS and gut colonization. METHODS We conducted a prospective single-centre cohort study of patients hospitalized in a tertiary-care unit (Lyon, France) from June 2011 to January 2012. S. capitis gut colonization was determined weekly from stool cultures. The determinants of gut colonization and LOS were established by multivariate Cox proportional hazards models. RESULTS Eighty-three (36.2%) of 229 patients had S. capitis-positive stool culture, and 28 (12.2%) developed S. capitis LOS during hospitalization. Independent risk factors for S. capitis LOS included prior administration of vancomycin independent of a previous LOS episode (hazard ratio 6.44, 95% confidence interval 2.15-19.3, p 0.001) and low birth weight (hazard ratio 0.72 per 100 g increase, 95% confidence interval 0.55-0.95, p 0.02). The prior administration of vancomycin was also an independent risk factor for S. capitis colonization (hazard ratio 3.45, 95% confidence interval 2.07-5.76, p <0.001), particularly in the first week of life and in noncolonized neonates. CONCLUSIONS Neonates treated with vancomycin are at a higher risk of LOS caused by vancomycin-nonsusceptible S. capitis. The use of vancomycin in neonates must urgently be optimized to limit the selection of vancomycin-nonsusceptible strains, for which alternative antibiotics are lacking.
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Affiliation(s)
- M Butin
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France.
| | - J-P Rasigade
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; Institute of Infectious Agents, France; National Reference Center for Staphylococci, France
| | - F Subtil
- Department of Biostatistics, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, France
| | - P Martins-Simões
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; National Reference Center for Staphylococci, France
| | - C Pralong
- Institute of Infectious Agents, France
| | | | - F Vandenesch
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; Institute of Infectious Agents, France; National Reference Center for Staphylococci, France
| | - S Tigaud
- Institute of Infectious Agents, France
| | - J-C Picaud
- Neonatal Intensive Care Unit, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - F Laurent
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; Institute of Infectious Agents, France; National Reference Center for Staphylococci, France; Department of Microbiology-Mycology, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, University of Lyon, France
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Gilfillan M, Bhandari V. Biomarkers for the diagnosis of neonatal sepsis and necrotizing enterocolitis: Clinical practice guidelines. Early Hum Dev 2017; 105:25-33. [PMID: 28131458 DOI: 10.1016/j.earlhumdev.2016.12.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sepsis and necrotizing enterocolitis are major contributors to morbidity and mortality in neonates, especially in those born preterm. While therapeutic interventions are available for both (for e.g. antibiotics), a major dilemma is early diagnosis so that these interventions can be done in a timely manner. As clinical evaluation alone is unreliable in identifying infants in the early stages of neonatal sepsis or necrotizing enterocolitis, there is a need to find specific biomarkers associated with these conditions to improve diagnostic capabilities. Optimal use of biomarkers in the identification and management of affected neonates requires an understanding of the properties of each marker within the timeline of the inflammatory response. We propose that early- and mid-phase markers such as neutrophil CD64 and procalcitonin should be combined with the late-phase biomarker C-reactive protein for maximal diagnostic benefit. Appropriately powered trials evaluating the serial measurements of these markers in decisions related to antibiotic stewardship in the neonatal population are indicated, in addition to more studies investigating other potentially useful biomarkers.
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Affiliation(s)
- Margaret Gilfillan
- Section of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Vineet Bhandari
- Section of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
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40
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Simões PM, Lemriss H, Dumont Y, Lemriss S, Rasigade JP, Assant-Trouillet S, Ibrahimi A, El Kabbaj S, Butin M, Laurent F. Single-Molecule Sequencing (PacBio) of the Staphylococcus capitis NRCS-A Clone Reveals the Basis of Multidrug Resistance and Adaptation to the Neonatal Intensive Care Unit Environment. Front Microbiol 2016; 7:1991. [PMID: 28018320 PMCID: PMC5157051 DOI: 10.3389/fmicb.2016.01991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/28/2016] [Indexed: 01/22/2023] Open
Abstract
The multi-resistant Staphylococcus capitis clone NRCS-A has recently been described as a major pathogen causing nosocomial, late-onset sepsis (LOS) in preterm neonates worldwide. NRCS-A representatives exhibit an atypical antibiotic resistance profile. Here, the complete closed genome (chromosomal and plasmid sequences) of NRCS-A prototype strain CR01 and the draft genomes of three other clinical NRCS-A strains from Australia, Belgium and the United Kingdom are annotated and compared to available non-NRCS-A S. capitis genomes. Our goal was to delineate the uniqueness of the NRCS-A clone with respect to antibiotic resistance, virulence factors and mobile genetic elements. We identified 6 antimicrobial resistance genes, all carried by mobile genetic elements. Previously described virulence genes present in the NRCS-A genomes are shared with the six non-NRCS-A S. capitis genomes. Overall, 63 genes are specific to the NRCS-A lineage, including 28 genes located in the methicillin-resistance cassette SCCmec. Among the 35 remaining genes, 25 are of unknown function, and 9 correspond to an additional type I restriction modification system (n = 3), a cytosine methylation operon (n = 2), and a cluster of genes related to the biosynthesis of teichoic acids (n = 4). Interestingly, a tenth gene corresponds to a resistance determinant for nisin (nsr gene), a bacteriocin secreted by potential NRCS-A strain niche competitors in the gut microbiota. The genomic characteristics presented here emphasize the contribution of mobile genetic elements to the emergence of multidrug resistance in the S. capitis NRCS-A clone. No NRCS-A-specific known virulence determinant was detected, which does not support a role for virulence as a driving force of NRCS-A emergence in NICUs worldwide. However, the presence of a nisin resistance determinant on the NRCS-A chromosome, but not in other S. capitis strains and most coagulase-negative representatives, might confer a competitive advantage to NRCS-A strains during the early steps of gut colonization in neonates. This suggests that the striking adaptation of NRCS-A to the NICU environment might be related to its specific antimicrobial resistance and also to a possible enhanced ability to challenge competing bacteria in its ecological niche.
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Affiliation(s)
- Patrícia Martins Simões
- Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de LyonLyon, France; International Centre for Research in Infectious Diseases, Institut National de la Santé et de la Recherche Médicale U1111, University of LyonLyon, France; National Reference Center for Staphylococci, Hospices Civils de LyonLyon, France
| | - Hajar Lemriss
- Biotechnology Laboratory (Medbiotech), Medical and Pharmacy School, University Mohammed V de Rabat Rabat, Morocco
| | - Yann Dumont
- Department of Clinical Microbiology, Eastern Hospital Group, Hospices Civils de Lyon Lyon, France
| | - Sanâa Lemriss
- Department of Biosecurity PCL3, Laboratory of Research and Medical Analysis of the Fraternal of Gendarmerie Royale Rabat, Morocco
| | - Jean-Philippe Rasigade
- International Centre for Research in Infectious Diseases, Institut National de la Santé et de la Recherche Médicale U1111, University of LyonLyon, France; National Reference Center for Staphylococci, Hospices Civils de LyonLyon, France
| | - Sophie Assant-Trouillet
- Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de LyonLyon, France; International Centre for Research in Infectious Diseases, Institut National de la Santé et de la Recherche Médicale U1111, University of LyonLyon, France
| | - Azeddine Ibrahimi
- Biotechnology Laboratory (Medbiotech), Medical and Pharmacy School, University Mohammed V de Rabat Rabat, Morocco
| | - Saâd El Kabbaj
- Department of Biosecurity PCL3, Laboratory of Research and Medical Analysis of the Fraternal of Gendarmerie Royale Rabat, Morocco
| | - Marine Butin
- Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de LyonLyon, France; Neonatal Intensive Care Unit, Eastern Hospital Group, Hospices Civils de LyonLyon, France
| | - Frédéric Laurent
- Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de LyonLyon, France; International Centre for Research in Infectious Diseases, Institut National de la Santé et de la Recherche Médicale U1111, University of LyonLyon, France; National Reference Center for Staphylococci, Hospices Civils de LyonLyon, France
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Colonization of patients, healthcare workers, and the environment with healthcare-associated Staphylococcus epidermidis genotypes in an intensive care unit: a prospective observational cohort study. BMC Infect Dis 2016; 16:743. [PMID: 27938344 PMCID: PMC5148920 DOI: 10.1186/s12879-016-2094-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 12/06/2016] [Indexed: 01/22/2023] Open
Abstract
Background During the last decades, healthcare-associated genotypes of methicillin-resistant Staphylococcus epidermidis (HA-MRSE) have been established as important opportunistic pathogens. However, data on potential reservoirs on HA-MRSE is limited. The aim of the present study was to investigate the dynamics and to which extent HA-MRSE genotypes colonize patients, healthcare workers (HCWs) and the environment in an intensive care unit (ICU). Methods Over 12 months in 2006–2007, swab samples were obtained from patients admitted directly from the community to the ICU and patients transferred from a referral hospital, as well as from HCWs, and the ICU environment. Patients were sampled every third day during hospitalization. Antibiotic susceptibility testing was performed according to EUCAST guidelines. Pulsed-field gel electrophoresis and multilocus sequence typing were used to determine the genetic relatedness of a subset of MRSE isolates. Results We identified 620 MRSE isolates from 570 cultures obtained from 37 HCWs, 14 patients, and 14 environmental surfaces in the ICU. HA-MRSE genotypes were identified at admission in only one of the nine patients admitted directly from the community, of which the majority subsequently were colonized by HA-MRSE genotypes within 3 days during hospitalization. Almost all (89%) of HCWs were nasal carriers of HA-MRSE genotypes. Similarly, a significant proportion of patients transferred from the referral hospital and fomites in the ICU were widely colonized with HA-MRSE genotypes. Conclusions Patients transferred from a referral hospital, HCWs, and the hospital environment serve as important reservoirs for HA-MRSE. These observations highlight the need for implementation of effective infection prevention and control measures aiming at reducing HA-MRSE transmission in the healthcare setting. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2094-x) contains supplementary material, which is available to authorized users.
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Chong J, Caya C, Lévesque S, Quach C. Heteroresistant Vancomycin Intermediate Coagulase Negative Staphylococcus in the NICU: A Systematic Review. PLoS One 2016; 11:e0164136. [PMID: 27716838 PMCID: PMC5055326 DOI: 10.1371/journal.pone.0164136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/20/2016] [Indexed: 12/29/2022] Open
Abstract
CONTEXT NICUs in the province of Québec have seen an increase in hVICoNS, detected in the clinical laboratory. OBJECTIVE To investigate the clinical relevance of hVICoNS on the course of infection, and to determine the prevalence of hVICoNS sepsis in the NICU. METHODS We searched MEDLINE, EMBASE, and PubMed from 1 January 1980 to 1 July 2016. Both observational and interventional studies were considered eligible if they provided data on hVICoNS in the NICU population. Two investigators independently reviewed studies for data extraction. Data extracted included: number of CoNS cultures, prevalence of hVICoNS, and clonality of strains. RESULTS Of the 613 studies identified, 19 studies were reviewed, and 5 studies included in the final review. No studies addressed the clinical significance of hVICoNS in the NICU. The prevalence of hVICoNS in the NICU varied greatly, ranging from 2.3% to 100%. LIMITATIONS Publication bias could not be assessed, and risk of bias in some of the included studies due to small sample size and poor methods reporting. The quality of all included studies was low according to GRADE criteria, and the inclusion criteria restricted to either English or French studies. CONCLUSIONS Our review suggests that heteroresistance to vancomycin is much more common than previously believed. Our search however did not identify any studies that explicitly assessed any clinical implications of hVICoNS infections, thereby highlighting the need for research to assess the true impact of hVICoNS infection and to determine its significance on patient mortality and morbidity in the NICU.
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Affiliation(s)
- Jasmine Chong
- Department of Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada
| | - Chelsea Caya
- Department of Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada
| | - Simon Lévesque
- Laboratoire de santé publique du Québec, Montreal, QC, Canada
| | - Caroline Quach
- Department of Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada
- Infectious Disease Division, Department of Pediatrics and Department of Medical Microbiology, The Montreal Children’s Hospital of the McGill University Health Centre, Montreal, QC, Canada
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Ben Said M, Hays S, Bonfils M, Jourdes E, Rasigade JP, Laurent F, Picaud JC. Late-onset sepsis due to Staphylococcus capitis 'neonatalis' in low-birthweight infants: a new entity? J Hosp Infect 2016; 94:95-8. [PMID: 27424947 DOI: 10.1016/j.jhin.2016.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
During hospitalization, sepsis occurs in one of every five very-low-birthweight infants. The emergence of Staphylococcus capitis (SC)-related sepsis in preterm infants was observed recently. This study aimed to evaluate the clinical severity of SC-related sepsis in preterm infants. Of the 105 infants who presented with sepsis related to coagulase-negative staphylococci, 74 were SC. Severe morbidity was more common in the SC group (55.4%) than in the non-SC coagulase-negative staphylococci group (32.0%) (P=0.03). Multi-variate analysis identified SC-related sepsis as an independent risk factor for severe morbidity.
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Affiliation(s)
- M Ben Said
- Neonatology, University Hospital Croix Rousse, Hospices Civils de Lyon, Lyon, France; Faculty of Medicine of Tunis, University of Tunis El-Manar, Tunis, Tunisia
| | - S Hays
- Neonatology, University Hospital Croix Rousse, Hospices Civils de Lyon, Lyon, France; Rhone-Alpes Human Nutrition Research Centre, Pierre Bénite, France
| | - M Bonfils
- Neonatology, University Hospital Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - E Jourdes
- Neonatology, University Hospital Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - J-P Rasigade
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, University of Lyon, Lyon, France; Department of Bacteriology - National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - F Laurent
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, University of Lyon, Lyon, France; Department of Bacteriology - National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - J-C Picaud
- Neonatology, University Hospital Croix Rousse, Hospices Civils de Lyon, Lyon, France; Rhone-Alpes Human Nutrition Research Centre, Pierre Bénite, France; Lyon-Sud Charles Merieux Medical School, Claude Bernard University Lyon 1, Pierre Bénite, France.
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Genome Sequences of Multiresistant Staphylococcus capitis Pulsotype NRCS-A and Methicillin-Susceptible S. capitis Pulsotype NRCS-C. GENOME ANNOUNCEMENTS 2016; 4:4/3/e00541-16. [PMID: 27284154 PMCID: PMC4901238 DOI: 10.1128/genomea.00541-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Here, we report the draft genome sequences of methicillin-susceptible Staphylococcus captis pulsotype NCRS-C (CR02 strain) and multiresistant Staphylococcus captis pulsotype NCRS-A (CR07 strain).
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Abstract
Antibiotics are invaluable in the management of neonatal infections. However, overuse or misuse of antibiotics in neonates has been associated with adverse outcomes, including increased risk for future infection, necrotizing enterocolitis, and mortality. Strategies to optimize the use of antibiotics in the neonatal intensive care unit include practicing effective infection prevention, improving the diagnostic evaluation and empiric therapy for suspected infections, timely adjustment of therapy as additional information becomes available, and treating proven infections with an effective, narrow-spectrum agent for the minimum effective duration. Antibiotic stewardship programs provide support for these strategies but require the participation and input of neonatologists as stakeholders to be most effective.
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Affiliation(s)
- Joseph B Cantey
- Division of Neonatal/Perinatal Medicine, Division of Infectious Diseases, Texas A&M Health Science Center College of Medicine, Baylor Scott & White Health, Temple, TX, USA.
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Cui B, Smooker PM, Rouch DA, Deighton MA. Selection of suitable reference genes for gene expression studies in Staphylococcus capitis during growth under erythromycin stress. Mol Genet Genomics 2016; 291:1795-811. [PMID: 27000656 DOI: 10.1007/s00438-016-1197-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 03/05/2016] [Indexed: 11/28/2022]
Abstract
Accurate and reproducible measurement of gene transcription requires appropriate reference genes, which are stably expressed under different experimental conditions to provide normalization. Staphylococcus capitis is a human pathogen that produces biofilm under stress, such as imposed by antimicrobial agents. In this study, a set of five commonly used staphylococcal reference genes (gyrB, sodA, recA, tuf and rpoB) were systematically evaluated in two clinical isolates of Staphylococcus capitis (S. capitis subspecies urealyticus and capitis, respectively) under erythromycin stress in mid-log and stationary phases. Two public software programs (geNorm and NormFinder) and two manual calculation methods, reference residue normalization (RRN) and relative quantitative (RQ), were applied. The potential reference genes selected by the four algorithms were further validated by comparing the expression of a well-studied biofilm gene (icaA) with phenotypic biofilm formation in S. capitis under four different experimental conditions. The four methods differed considerably in their ability to predict the most suitable reference gene or gene combination for comparing icaA expression under different conditions. Under the conditions used here, the RQ method provided better selection of reference genes than the other three algorithms; however, this finding needs to be confirmed with a larger number of isolates. This study reinforces the need to assess the stability of reference genes for analysis of target gene expression under different conditions and the use of more than one algorithm in such studies. Although this work was conducted using a specific human pathogen, it emphasizes the importance of selecting suitable reference genes for accurate normalization of gene expression more generally.
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Affiliation(s)
- Bintao Cui
- School of Applied Sciences, RMIT University, Plenty Road, Bundoora, VIC, 3083, Australia
| | - Peter M Smooker
- School of Applied Sciences, RMIT University, Plenty Road, Bundoora, VIC, 3083, Australia
| | - Duncan A Rouch
- School of Applied Sciences, RMIT University, Plenty Road, Bundoora, VIC, 3083, Australia
| | - Margaret A Deighton
- School of Applied Sciences, RMIT University, Plenty Road, Bundoora, VIC, 3083, Australia.
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