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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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Wolska-Gębarzewska M, Międzobrodzki J, Kosecka-Strojek M. Current types of staphylococcal cassette chromosome mec (SCC mec) in clinically relevant coagulase-negative staphylococcal (CoNS) species. Crit Rev Microbiol 2023:1-17. [PMID: 37882662 DOI: 10.1080/1040841x.2023.2274841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
Coagulase-negative staphylococci (CoNS) colonize human skin and mucosal membranes, which is why they are considered harmless commensal bacteria. Two species, Staphylococcus epidermidis and Staphylococcus haemolyticus belong to the group of CoNS species and are most frequently isolated from nosocomial infections, including device-associated healthcare-associated infections (DA-HAIs) and local or systemic body-related infections (FBRIs). Methicillin resistance, initially described in Staphylococcus aureus, has also been reported in CoNS species. It is mediated by the mecA gene within the staphylococcal cassette chromosome (SCCmec). SCCmec typing, primarily using PCR-based methods, has been employed as a molecular epidemiological tool. However, the introduction of whole genome sequencing (WGS) and next-generation sequencing (NGS) has enabled the identification and verification of new SCCmec types. This review describes the current distribution of SCCmec types, subtypes, and variants among CoNS species, including S. epidermidis, S. haemolyticus, and S. capitis. The literature review focuses on recent research articles from the past decade that discuss new combinations of SCCmec in coagulase-negative Staphylococcus. The high genetic diversity and gaps in CoNS SCCmec annotation rules underscore the need for an efficient typing system. Typing SCCmec cassettes in CoNS strains is crucial to continuously updating databases and developing a unified classification system.
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Affiliation(s)
- Mariola Wolska-Gębarzewska
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
- Doctoral School of Exact and Natural Sciences, Jagiellonian University, Krakow, Poland
| | - Jacek Międzobrodzki
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Maja Kosecka-Strojek
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
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Felgate H, Sethi D, Faust K, Kiy C, Härtel C, Rupp J, Clifford R, Dean R, Tremlett C, Wain J, Langridge G, Clarke P, Page AJ, Webber MA. Characterisation of neonatal Staphylococcus capitis NRCS-A isolates compared with non NRCS-A Staphylococcus capitis from neonates and adults. Microb Genom 2023; 9:001106. [PMID: 37791541 PMCID: PMC10634448 DOI: 10.1099/mgen.0.001106] [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: 01/10/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Staphylococcus capitis is a frequent cause of late-onset sepsis in neonates admitted to Neonatal Intensive Care Units (NICU). One clone of S. capitis, NRCS-A has been isolated from NICUs globally although the reasons for the global success of this clone are not well understood.We analysed a collection of S. capitis colonising babies admitted to two NICUs, one in the UK and one in Germany as well as corresponding pathological clinical isolates. Genome analysis identified a population structure of three groups; non-NRCS-A isolates, NRCS-A isolates, and a group of 'proto NRCS-A' - isolates closely related to NRCS-A but not associated with neonatal infection. All bloodstream isolates belonged to the NRCS-A group and were indistinguishable from strains carried on the skin or in the gut. NRCS-A isolates showed increased tolerance to chlorhexidine and antibiotics relative to the other S. capitis as well as enhanced ability to grow at higher pH values. Analysis of the pangenome of 138 isolates identified characteristic nsr and tarJ genes in both the NRCS-A and proto groups. A CRISPR-cas system was only seen in NRCS-A isolates which also showed enrichment of genes for metal acquisition and transport.We found evidence for transmission of S. capitis NRCS-A within NICU, with related isolates shared between babies and multiple acquisitions by some babies. Our data show NRCS-A strains commonly colonise uninfected babies in NICU representing a potential reservoir for potential infection. This work provides more evidence that adaptation to survive in the gut and on skin facilitates spread of NRCS-A, and that metal acquisition and tolerance may be important to the biology of NRCS-A. Understanding how NRCS-A survives in NICUs can help develop infection control procedures against this clone.
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Affiliation(s)
- Heather Felgate
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Dheeraj Sethi
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | - Kirsten Faust
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Cemsid Kiy
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Rebecca Clifford
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Rachael Dean
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | | | - John Wain
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Gemma Langridge
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Paul Clarke
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | - Andrew J. Page
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
| | - Mark A. Webber
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
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Jaloustre M, Cohen R, Biran V, Decobert F, Layese R, Audureau E, Le Saché N, Chevallier M, Boukhris MR, Bolot P, Caeymaex L, Tauzin M. Determinants of morbidity and mortality related to health care-associated primary bloodstream infections in neonatal intensive care units: a prospective cohort study from the SEPREVEN trial. Front Pediatr 2023; 11:1170863. [PMID: 37325351 PMCID: PMC10264575 DOI: 10.3389/fped.2023.1170863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Background Health care-associated primary bloodstream infections (BSIs), defined as not secondary to an infection at another body site, including central line-associated BSI, are a leading cause of morbidity and mortality in patients in neonatal intensive care units (NICUs). Our objective was to identify factors associated with severe morbidity and mortality after these infections in neonates in NICUs. Methods This ancillary study of the SEPREVEN trial included neonates hospitalized ≥2 days in one of 12 French NICUs and with ≥ 1 BSI during the 20-month study period. BSIs (all primary and health care-associated) were diagnosed in infants with symptoms suggestive of infection and classified prospectively as possible (one coagulase-negative staphylococci (CoNS)-growing blood culture) or proven (two same CoNS, or ≥1 recognized pathogen-growing blood culture). BSI consequences were collected prospectively as moderate morbidity (antibiotic treatment alone) or severe morbidity/mortality (life-saving procedure, permanent damage, prolonged hospitalization, and/or death). Results Of 557 BSIs identified in 494 patients, CoNS accounted for 378/557 (67.8%) and recognized bacterial or fungal pathogens for 179/557 (32.1%). Severe morbidity/mortality was reported in 148/557 (26.6%) BSIs. Independent factors associated with severe morbidity/mortality were corrected gestational age <28 weeks (CGA) at infection (P < .01), fetal growth restriction (FGR) (P = .04), and proven pathogen-related BSI vs. CoNS-related BSI (P < .01). There were no differences in severe morbidity and mortality between proven and possible CoNS BSIs. In possible BSI, S. epidermidis was associated with a lower risk of severe morbidity than other CoNS (P < .01), notably S. capitis and S. haemolyticus. Conclusions In BSIs in the NICU, severe morbidity/mortality was associated with low CGA at infection, FGR, and proven pathogen-related BSIs. When only one blood culture was positive, severe morbidity/mortality were less frequent if it grew with S. epidermidis compared to other CoNS. Further studies to help distinguish real CoNS BSIs from contaminations are needed. Study registration ClinicalTrials.gov (NCT02598609).
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Affiliation(s)
- Morgane Jaloustre
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Robert Cohen
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Medicine, University Paris Est Creteil, Creteil, France
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, APHP, CHU Robert Debré, Paris, France
| | - Fabrice Decobert
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Richard Layese
- Assistance Publique-Hôpitaux de Paris AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, France
- University Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France
| | - Etienne Audureau
- Assistance Publique-Hôpitaux de Paris AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, France
- University Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France
| | - Nolwenn Le Saché
- Pediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Marie Chevallier
- Neonatal Intensive Care Unit, CHU Grenoble Alpes, Grenoble, France
| | | | - Pascal Bolot
- Neonatal Intensive Care Unit, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Laurence Caeymaex
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Medicine, University Paris Est Creteil, Creteil, France
| | - Manon Tauzin
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
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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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6
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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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Gan MY, Lee WL, Yap BJ, Seethor STT, Greenberg RG, Pek JH, Tan B, Hornik CPV, Lee JH, Chong SL. Contemporary Trends in Global Mortality of Sepsis Among Young Infants Less Than 90 Days: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:890767. [PMID: 35722477 PMCID: PMC9204066 DOI: 10.3389/fped.2022.890767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Current knowledge on the global burden of infant sepsis is limited to population-level data. We aimed to summarize global case fatality rates (CFRs) of young infants with sepsis, stratified by gross national income (GNI) status and patient-level risk factors. Methods We performed a systematic review and meta-analysis on CFRs among young infants < 90 days with sepsis. We searched PubMed, Cochrane Central, Embase, and Web of Science for studies published between January 2010 and September 2019. We obtained pooled CFRs estimates using the random effects model. We performed a univariate analysis at patient-level and a meta-regression to study the associations of gestational age, birth weight, onset of sepsis, GNI, age group and culture-proven sepsis with CFRs. Results The search yielded 6314 publications, of which 240 studies (N = 437,796 patients) from 77 countries were included. Of 240 studies, 99 were conducted in high-income countries, 44 in upper-middle-income countries, 82 in lower-middle-income countries, 6 in low-income countries and 9 in multiple income-level countries. Overall pooled CFR was 18% (95% CI, 17-19%). The CFR was highest for low-income countries [25% (95% CI, 7-43%)], followed by lower-middle [25% (95% CI, 7-43%)], upper-middle [21% (95% CI, 18-24%)] and lowest for high-income countries [12% (95% CI, 11-13%)]. Factors associated with high CFRs included prematurity, low birth weight, age less than 28 days, early onset sepsis, hospital acquired infections and sepsis in middle- and low-income countries. Study setting in middle-income countries was an independent predictor of high CFRs. We found a widening disparity in CFRs between countries of different GNI over time. Conclusion Young infant sepsis remains a major global health challenge. The widening disparity in young infant sepsis CFRs between GNI groups underscore the need to channel greater resources especially to the lower income regions. Systematic Review Registration [www.crd.york.ac.uk/prospero], identifier [CRD42020164321].
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Affiliation(s)
- Ming Ying Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Li Lee
- Duke-NUS Medical School, Singapore, Singapore
| | - Bei Jun Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rachel G Greenberg
- Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jen Heng Pek
- Emergency Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Bobby Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Christoph Paul Vincent Hornik
- Division of Critical Care Medicine, Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shu-Ling Chong
- Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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Ba-Alwi NA, Aremu JO, Ntim M, Takam R, Msuya MA, Nassor H, Ji H. Bacteriological Profile and Predictors of Death Among Neonates With Blood Culture-Proven Sepsis in a National Hospital in Tanzania-A Retrospective Cohort Study. Front Pediatr 2022; 10:797208. [PMID: 35450105 PMCID: PMC9017808 DOI: 10.3389/fped.2022.797208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/07/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Neonatal sepsis is still a major cause of death and morbidity in newborns all over the world. Despite substantial developments in diagnosis, treatments, and prevention strategies, sepsis remains a common problem in clinical practice, particularly in low-resource countries. METHODS A retrospective cohort study of 238 neonates with positive blood culture-proven sepsis (in Muhimbili National Hospital) was conducted from January 2019 to December 2020. The outcomes of hospitalization were survival and death. RESULTS In total, 45.4% mortality resulted from 238 neonates who had sepsis exclusively based on blood culture positivity. A significant association was found between very low birth weight (VLBW), hyperglycemia, mechanical ventilation, and high neonatal mortality. Among the different clinical presentations of neonatal sepsis, lethargy, vomiting, and respiratory distress were found to be frequently associated with neonatal mortality. Furthermore, sepsis with Gram-negative bacteria and early-onset sepsis were also associated with high neonatal mortality. Of the 108 neonatal deaths, the largest proportion (40%) was observed with Staphylococcus aureus, and the remaining 38% was caused by Klebsiella, 14% by Escherichia coli, 5% by Pseudomonas, 4% by Acinetobacter, and 2% by Streptococcus. No neonatal deaths from Serratia infection were observed. The overall resistance of isolated organisms to the recommended first-line antibiotics was 84% for ampicillin and 71.3% for gentamicin. The resistance pattern for the recommended second-line antibiotics was 76.2% for ceftriaxone, 35.9% for vancomycin, and 17.5% for amikacin. CONCLUSION VLBW, early-onset sepsis, clinical and laboratory parameters like lethargy, vomiting, and hyperglycemia, sepsis with Gram-negative bacteria, and being on mechanical ventilation are strong predictors of death in neonatal sepsis. In addition, this study discovered extraordinarily high resistance to conventional antibiotics. These findings give light on the crucial aspects to consider in preventing this disease and poor outcomes.
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Affiliation(s)
- Nour Abdallah Ba-Alwi
- Department of Pediatrics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Michael Ntim
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Hamid Nassor
- Temeke Regional Referral Hospital, Dar es Salaam, Tanzania
| | - Hong Ji
- Department of Pediatrics, First Affiliated Hospital of Dalian Medical University, Dalian, China
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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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10
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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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11
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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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12
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Becker K, Both A, Weißelberg S, Heilmann C, Rohde H. Emergence of coagulase-negative staphylococci. Expert Rev Anti Infect Ther 2020; 18:349-366. [DOI: 10.1080/14787210.2020.1730813] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Karsten Becker
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Anna Both
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samira Weißelberg
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Heilmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
- Interdisciplinary Center for Clinical Research (IZKF), University of Münster, Münster, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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13
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Smith F, Lee K, Binnie-McLeod E, Higgins M, Irvine E, Henderson A, Orr A, Clark F, Spence J. Identifying the World Health Organization's fifth moment for hand hygiene: Infection prevention in the operating room. J Infect Prev 2019; 21:28-34. [PMID: 32030101 DOI: 10.1177/1757177419879996] [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: 12/17/2018] [Accepted: 08/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background The World Health Organization have designed the fifth of their '5 moments' for hand hygiene to account for microbial transfer from patients to equipment in a narrow area around that patient, known as the patient zone. The study was prompted by emerging local confusion about application of the patient zone in the operating room (OR). Aim/Objectives In two phases, we aimed to create a '5 moments' style poster displaying an OR patient zone: phase 1, quantify equipment, in direct contact with the patient and, touched by non-scrubbed staff immediately after touching the patient; and phase 2, categorise equipment identified in phase 1 into patient zone and healthcare zone. An objective is to produce a '5 moments' poster for the OR. Methods The first phase used non-participant direct overt observation. In phase 2, phase 1 data were collaboratively assigned to patient zone or healthcare zone. Photography and graphic design were used to produce the OR '5 moments' poster. Results In 11 full-length surgeries, 20 pieces of equipment were in direct contact with the patient and 57 pieces of equipment were touched. In phase 2, a '5 moments' poster showing an OR patient zone was designed. Discussion Content of the patient zone was identified and displayed in a novel resource. Having shared understanding of the patient zone has potential to sustain hand hygiene compliance and equipment cleaning in the OR. Conclusion Limitations in methods were balanced by collaboration with frontline staff. The study has been used as a teaching tool in the OR and similar settings.
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Affiliation(s)
- Fiona Smith
- NHS Grampian Infection Prevention and Control Nurse, Aberdeen, UK
| | - Karen Lee
- University of Dundee Senior Lecturer Infection Prevention and Control, Dundee, Tayside, UK
| | | | - Mark Higgins
- NHS Grampian Operating Room Department, Aberdeen, UK
| | | | | | - Ann Orr
- NHS Grampian Operating Room Department, Aberdeen, UK
| | - Fiona Clark
- NHS Grampian Operating Room Department, Aberdeen, UK
| | - Joanne Spence
- NHS Grampian Operating Room Department, Aberdeen, UK
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14
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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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15
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Allegaert K, Flint R, Smits A. Pharmacokinetic modelling and Bayesian estimation-assisted decision tools to optimize vancomycin dosage in neonates: only one piece of the puzzle. Expert Opin Drug Metab Toxicol 2019; 15:735-749. [PMID: 31402708 DOI: 10.1080/17425255.2019.1655540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Vancomycin is commonly administered to neonates, while observational data on therapeutic drug monitoring (TDM, trough levels) suggest that vancomycin exposure and dosage remain substandard. Area covered: Data on vancomycin pharmacokinetics (PK) and its covariates are abundant. Consequently, modeling is an obvious tool to improve targeted exposure, with a shift from TDM trough levels to area under the curve (AUC24h) targets, as in adults. Continuous administration appeared as a practice to facilitate AUC24h target attainment, while Bayesian model-supported targeting emerged as a novel tool. However, the AUC24h/MIC (minimal inhibitory concentration) target itself should consider neonate-specific aspects (bloodstream infections, coagulase-negative staphylococci, protein binding, underexplored causes of variability, like assays, preparation and administration inaccuracies, or missing covariates). Expert opinion: To improve targeted exposure in neonates, initial vancomycin prescription should be based on 'a priori model-based individual dosing' using validated dosing regimens, followed by further tailoring by dosing optimization applying Bayesian estimation-assisted TDM. Future research should focus on the feasibility to integrate these tools (individualized dosing, Bayesian models) in clinical practice, and to perform PK/PD studies in the relevant animal models and human neonatal setting (coagulase-negative staphylococci, bloodstream infections).
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Affiliation(s)
- Karel Allegaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam , Rotterdam , the Netherlands.,Department of Development and Regeneration, KU Leuven , Leuven , Belgium
| | - Robert Flint
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam , Rotterdam , the Netherlands.,Department of Pharmacy, Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven , Leuven , Belgium.,Neonatal Intensive Care Unit, University Hospitals Leuven , Leuven , Belgium
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16
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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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17
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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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18
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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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19
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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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