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van Duijkeren E, Brouwer MSM, Wullings B, Rapallini M, Wit B, Cuperus T, Hengeveld PD, Witteveen S, Hendrickx APA, Dierikx CM, Veldman KT. Methicillin-resistant Staphylococcus aureus GG0398 on livestock farms and meat in the Netherlands. J Glob Antimicrob Resist 2025; 43:79-85. [PMID: 40258490 DOI: 10.1016/j.jgar.2025.04.007] [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: 12/19/2024] [Revised: 04/07/2025] [Accepted: 04/14/2025] [Indexed: 04/23/2025] Open
Abstract
OBJECTIVES The objective of this collaborative surveillance project was to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among livestock farms, persons working/living on these farms, and on meat. METHODS Samples from Dutch broiler, pig, veal calf, dairy cattle, and sheep farms, persons living/working on these farms and retail meat collected between 2018 and 2023 were cultured using (pre-) enrichment and selective plates. Next-generation sequencing of a subset of MRSA was performed to detect mecA/mecC, Panton-Valentine leucocidin (PVL) and to assign genogroups (GGs). RESULTS On 113 of 149 (75.8%) pig farms, MRSA was present. The prevalence was lower among veal calf (44/173; 25.4%), and dairy (11/181; 6.1%), sheep (7/156; 4.5%), and broiler farms (0/195; 0%). Among 375 persons working/living on the farms, we identified 17 (4.5%) nasal MRSA carriers and all were farmers. All but two isolates from the farms belonged to GG0398 (= CC398). In total, 4529 Dutch retail meat samples were analysed and 412 (9.1%) were MRSA-positive. Poultry meat was most often contaminated. Most meat isolates (97/148; 65.5%) belonged to GG0398. All but one isolate carried mecA, and all were PVL-negative. CONCLUSIONS Despite the reduction of antimicrobial use by > 70% in veterinary medicine since 2009, most pig farms are still MRSA positive. Farmers have a higher risk of being a nasal MRSA carrier than persons in the general population. Meat is regularly contaminated with MRSA, but this is considered a limited risk for consumers. Almost all the MRSA belonged to GG0398 confirming the continuous predominance of this type of MRSA in livestock and on meat.
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Affiliation(s)
- Engeline van Duijkeren
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
| | - Mike S M Brouwer
- Wageningen Bioveterinary Research (WBVR), Bacteriology, Host Pathogen Interaction & Diagnostics, Lelystad, The Netherlands
| | - Bart Wullings
- Wageningen Food Safety Research (WFSR), Team Bacteriology, Molecular Biology & AMR, Wageningen, The Netherlands
| | - Michel Rapallini
- Wageningen Food Safety Research (WFSR), Team Bacteriology, Molecular Biology & AMR, Wageningen, The Netherlands
| | - Ben Wit
- Netherlands Food and Consumer Product Safety Authority (NVWA), Food Safety, Utrecht, The Netherlands
| | - Tryntsje Cuperus
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Paul D Hengeveld
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Sandra Witteveen
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Antoni P A Hendrickx
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Cindy M Dierikx
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Kees T Veldman
- Wageningen Bioveterinary Research (WBVR), Bacteriology, Host Pathogen Interaction & Diagnostics, Lelystad, The Netherlands
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Locke TE, Keeley AJ, Laundy N, Keil C, Hamilton J, Pandor A, I de Silva T, Darton TC. Prevalence and risk factors for Staphylococcus aureus colonisation among healthy individuals in low- and middle-income countries: A systematic review and meta-analysis. J Infect 2025; 90:106462. [PMID: 40054669 DOI: 10.1016/j.jinf.2025.106462] [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: 01/07/2025] [Accepted: 02/28/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Staphylococcus aureus is capable of asymptomatic colonisation, which can progress to opportunistic and potentially life-threatening infection. The data on S. aureus colonisation in low- and middle-income countries (LMIC) are limited. This systematic review and meta-analysis estimates the prevalence of S. aureus colonisation in asymptomatic individuals in LMIC, with secondary objectives of assessing antimicrobial resistance, colonisation risk factors, and the molecular epidemiology of colonising strains. METHODS Articles published up to July 2023 were identified by searching four electronic databases. Studies that presented S. aureus colonisation prevalence in healthy individuals from a community setting in LMIC were included. Data extraction was performed independently by two reviewers with disagreement resolved through consensus. Studies were critically appraised using the Joanna Briggs Institute Prevalence tool. Random effects meta-analysis was conducted where appropriate. This study was registered in advance with PROSPERO (CRD42019147780). FINDINGS A total of 16 610 citations were identified of which 138 studies (59 732 participants) met the eligibility criteria. The majority of studies had a low risk of bias. The pooled prevalence of S. aureus colonisation at nose and/or throat sites was 26·4% (95% CI 23·8 - 29·1%). The prevalence of methicillin-resistance in colonising S. aureus strains was 15·0% (95% CI: 11·8 to 18·6%), with a higher prevalence observed in Africa compared to Asia and South America (22·5% vs. 13·1% vs. 5·4% respectively). Panton-Valentine leukocidin genes were present in 26·4% (95% CI: 17·1% to 32·8%) of 2531 isolates. INTERPRETATION While the prevalence of asymptomatic S. aureus colonisation in LMIC mirrors that found in high-income countries, there was a higher prevalence of antimicrobial resistance and other virulence factors. Variability in study methods and sparsity of data from many LMIC, underscore the need for a global approach to S. aureus surveillance. This will be critical for informing effective infection prevention strategies.
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Affiliation(s)
- Thomas E Locke
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, UK; The Florey Institute of Infection, The University of Sheffield, UK.
| | - Alexander J Keeley
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, UK; The Florey Institute of Infection, The University of Sheffield, UK; Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas Laundy
- The Royal Hobart Hospital and University of Tasmania, Tasmania, Australia
| | - Christopher Keil
- Department of Medical Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jean Hamilton
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, UK
| | - Abdullah Pandor
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, UK
| | - Thushan I de Silva
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, UK; The Florey Institute of Infection, The University of Sheffield, UK; Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Thomas C Darton
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, UK; The Florey Institute of Infection, The University of Sheffield, UK
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Wise AD, TenBarge EG, Mendonça JDC, Mennen EC, McDaniel SR, Reber CP, Holder BE, Bunch ML, Belevska E, Marshall MG, Vaccaro NM, Blakely CR, Wellawa DH, Ferris J, Sheldon JR, Bieber JD, Johnson JG, Burcham LR, Monteith AJ. Mitochondria sense bacterial lactate and drive release of neutrophil extracellular traps. Cell Host Microbe 2025; 33:341-357.e9. [PMID: 40020664 PMCID: PMC11955204 DOI: 10.1016/j.chom.2025.02.003] [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: 06/11/2024] [Revised: 11/06/2024] [Accepted: 02/05/2025] [Indexed: 03/03/2025]
Abstract
Neutrophils induce oxidative stress, creating a harsh phagosomal environment. However, Staphylococcus aureus can survive these conditions, requiring neutrophils to deploy mechanisms that sense bacterial persistence. We find that staphylococcal lactate is a metabolic danger signal that triggers neutrophil extracellular trap release (NETosis). Neutrophils coordinate mitochondria in proximity to S. aureus-containing phagosomes, allowing transfer of staphylococcal lactate to mitochondria where it is rapidly converted into pyruvate and causes mitochondrial reactive oxygen species, a precursor to NETosis. Similar results were observed in response to phylogenetically distinct bacteria, implicating lactate accumulation as a broad signal triggering NETosis. Furthermore, patients with systemic lupus erythematosus (SLE) are more susceptible to bacterial infections. We find that SLE neutrophils cannot sense bacterial lactate impairing their capacity to undergo NETosis upon S. aureus infection but initiate aberrant NETosis triggered by apoptotic debris. Thus, neutrophils adapt mitochondria as sensory organelles that detect bacterial metabolic activity and dictate downstream antibacterial processes.
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Affiliation(s)
- Ashley D Wise
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | - Eden G TenBarge
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | | | - Ellie C Mennen
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | - Sarah R McDaniel
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | - Callista P Reber
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | - Bailey E Holder
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | - Madison L Bunch
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA; Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
| | - Eva Belevska
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | | | - Nicole M Vaccaro
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | | | - Dinesh H Wellawa
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada; Vaccine and Infectious Disease Organization, Saskatoon, SK, Canada
| | - Jennifer Ferris
- Division of Rheumatology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Jessica R Sheldon
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada; Vaccine and Infectious Disease Organization, Saskatoon, SK, Canada
| | - Jeffry D Bieber
- Division of Rheumatology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Jeremiah G Johnson
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA; Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
| | - Lindsey R Burcham
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA
| | - Andrew J Monteith
- Department of Microbiology, University of Tennessee, Knoxville, TN, USA; Department of Biochemistry & Cellular and Molecular Biology, University of Tennessee, Knoxville, TN, USA.
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Hartlage W, Imlay H, Spivak ES. The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e214. [PMID: 39758879 PMCID: PMC11696604 DOI: 10.1017/ash.2024.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 01/07/2025]
Abstract
A β-lactam plus a macrolide or a respiratory fluoroquinolone alone is recommended as standard empiric antibacterial therapy for non-severe adults hospitalized with community-acquired pneumonia (CAP) per Infectious Diseases Society of America guidelines. However, the evidence in support of adding empiric atypical antibacterial therapy, and specifically the addition of a macrolide, is conflicting and should be balanced with additional factors: the necessity of covering atypical organisms, benefits of macrolide-associated immunomodulation, harms associated with antibiotic use, and selection for antibiotic-resistant organisms. In this review, we examine the role of atypical coverage in standard treatment regimens for patients admitted with non-severe CAP and specifically focus on the addition of macrolides to β-lactams. We conclude that a subset of patients should not be given atypical coverage as part of their regimen.
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Affiliation(s)
- Whitney Hartlage
- Division of Infectious Diseases, Veteran’s Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Hannah Imlay
- Division of Infectious Diseases, Veteran’s Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Emily S. Spivak
- Division of Infectious Diseases, Veteran’s Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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5
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Weiss A, Kramer A, Taube R, Mattner F, Premke K. Prevalence of methicillin sensitive and resistant Staphylococcus aureus carriage among German emergency medical providers. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc35. [PMID: 38993380 PMCID: PMC11238403 DOI: 10.3205/dgkh000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Background Health care workers (HCW) in Emergency Medical Services (EMS) frequently come into contact with carriers of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) strains and may acquire and transmit them to patients. However, there is little data on MSSA and MRSA colonization of medical personnel in the emergency services. Additionally, few studies have analyzed the association between personal hygiene of staff and colonization. Therefore, we examined the prevalence of MSSA and MRSA in EMS staff of two German regions and evaluated their personal hygiene behavior. Method Throat and nasal swabs from 300 EMS workers were analyzed. Both direct and pre-enriched cultures of the swabs were cultivated on culture media to identify MSSA and MRSA. Results were analyzed together with questionnaires about sociodemographic data and a self-assessment of hygiene behavior. Statistical analysis was done using the R statistical software. Results Of the total 300 swabs, 55% were from paramedics, 39% were from emergency medical technicians (EMT) and 5% were from emergency physicians. With 1%, the MRSA prevalence was comparable to that of the German population, while the MSSA rate - 43.7% - was higher than expected. Colonization with MSSA was significantly associated with poor hand hygiene and male sex, and was inversely correlated to time on the job in EMS. Conclusion The sample size of 300 and a MRSA prevalence of 1% made a meaningful analysis of potential influencing factors on the prevalence of MRSA infeasible. The comparatively high prevalence of MSSA and the association with decreasing frequency of hand antisepsis suggests an influence of personal hygiene on MSSA colonization. HCW in EMS should be encouraged to make use of their personal protective equipment and practice frequent hand hygiene. The implementation of diagnostic tools such as the Hand Hygiene Self-Assessment Framework of the WHO could be utilized to reveal problems in organizations, followed by an individual program to promote hand hygiene.
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Affiliation(s)
- Aaron Weiss
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robert Taube
- Technical Microbiology, Faculty of Nature and Engineering, City University of Applied Sciences, Bremen, Germany
| | - Frauke Mattner
- Institute for Hygiene, Cologne Merheim Medical Centre, University Hospital Witten/Herdecke, Germany
| | - Katrin Premke
- Department of Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
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Piewngam P, Otto M. Staphylococcus aureus colonisation and strategies for decolonisation. THE LANCET. MICROBE 2024; 5:e606-e618. [PMID: 38518792 PMCID: PMC11162333 DOI: 10.1016/s2666-5247(24)00040-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/24/2024]
Abstract
Staphylococcus aureus is a leading cause of death by infectious diseases worldwide. Treatment of S aureus infections is difficult due to widespread antibiotic resistance, necessitating alternative approaches and measures for prevention of infection. Because S aureus infections commonly arise from asymptomatic colonisation, decolonisation is considered a key approach for their prevention. Current decolonisation procedures include antibiotic-based and antiseptic-based eradication of S aureus from the nose and skin. However, despite the widespread implementation and partial success of such measures, S aureus infection rates remain worrisome, and resistance to decolonisation agents is on the rise. In this Review we outline the epidemiology and mechanisms of S aureus colonisation, describe how colonisation underlies infection, and discuss current and novel approaches for S aureus decolonisation, with a focus on the latest findings on probiotic strategies and the intestinal S aureus colonisation site.
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Affiliation(s)
- Pipat Piewngam
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA.
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7
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Maucotel AL, Kolenda C, Laurent F, Tristan A. Staphylococcus aureus: No ticket for the Paris 2024 Olympic Games! Infect Dis Now 2024; 54:104882. [PMID: 38849255 DOI: 10.1016/j.idnow.2024.104882] [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: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 06/09/2024]
Abstract
Athletes are vulnerable to Staphylococcus aureus infections due to skin-to-skin contact and skin abrasions during training and competitions involving sharied sport equipment or toiletries, which promote the spread of the bacteria between athletes and within sport teams. This results not only in higher prevalence of S.aureus carriage among athletes compared to the general population, but also in outbreaks of infections, particularly skin infections, within sports teams. To limit the spread of S. aureus among athletes, a decolonization protocol can be applied when clustered cases of S. aureus infections occur, especially if Panton-Valentine leukocidin-producing strains are implicated. Finally, to avoid exposing athletes to S.aureus transmission/colonization, it is recommended to establish strict and clearly formulated individual and collective hygiene rules and to regularly disinfect shared sports equipment.
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Affiliation(s)
- Anne-Lise Maucotel
- Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France; Laboratoire de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France.
| | - Camille Kolenda
- Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France; Laboratoire de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France.
| | - Frédéric Laurent
- Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France; Laboratoire de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France.
| | - Anne Tristan
- Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France; Laboratoire de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France.
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8
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Napolitano M, Potestio L, Nocerino M, Patruno C. Considerations for managing elderly patients with atopic dermatitis. Expert Rev Clin Immunol 2024; 20:501-511. [PMID: 38193289 DOI: 10.1080/1744666x.2024.2301967] [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: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Atopic dermatitis (AD) diagnosis in elderly is challenging, due to its clinical polymorphism and the lack of diagnostic biomarkers. Moreover, the chronicity of the disease and the complex pathogenetic mechanism, make elderly AD management challenging. AREAS COVERED A narrative review of the current literature was performed using the PubMed, Medline, Embase, and Cochrane Skin databases, by researching the following terms: 'atopic dermatitis,' 'clinical phenotypes,' 'eczema,' 'elderly patients,' 'elderly type atopic dermatitis,' 'eczema clinical presentation.' The aim was to report the current knowledge on pathogenesis, clinical presentation, and treatment options of elderly AD. EXPERT OPINION Elderly type AD has recently been identified as a separate entity, with an increasing prevalence. With aging, both immunosenescence and barrier alterations can cause or modify AD presentation. Moreover, a chronic proinflammatory state (so-called 'inflammaging') is often present in elderly subjects. Older patients with AD may present with peculiar immunophenotypic profile, making AD diagnosis challenging. Similarly, the chronicity of the disease and the complex pathogenetic mechanism, make AD management a challenge. Indeed, systemic therapies for AD are often contraindicated or not tolerated and the management of elderly type AD is often burdened with numerous difficulties, leading to undertreated disease. Even if dupilumab and tralokinumab represent a valuable therapeutic weapon, more data on safety of JAK inhibitors are required.
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Affiliation(s)
- Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mariateresa Nocerino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Clowry J, Dempsey DJ, Claxton TJ, Towell AM, Turley MB, Sutton M, Geoghegan JA, Kezic S, Jakasa I, White A, Irvine AD, McLoughlin RM. Distinct T cell signatures are associated with Staphylococcus aureus skin infection in pediatric atopic dermatitis. JCI Insight 2024; 9:e178789. [PMID: 38716729 PMCID: PMC11141913 DOI: 10.1172/jci.insight.178789] [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: 12/26/2023] [Accepted: 04/03/2024] [Indexed: 06/02/2024] Open
Abstract
Atopic dermatitis (AD) is an inflammatory skin condition with a childhood prevalence of up to 25%. Microbial dysbiosis is characteristic of AD, with Staphylococcus aureus the most frequent pathogen associated with disease flares and increasingly implicated in disease pathogenesis. Therapeutics to mitigate the effects of S. aureus have had limited efficacy and S. aureus-associated temporal disease flares are synonymous with AD. An alternative approach is an anti-S. aureus vaccine, tailored to AD. Experimental vaccines have highlighted the importance of T cells in conferring protective anti-S. aureus responses; however, correlates of T cell immunity against S. aureus in AD have not been identified. We identify a systemic and cutaneous immunological signature associated with S. aureus skin infection (ADS.aureus) in a pediatric AD cohort, using a combined Bayesian multinomial analysis. ADS.aureus was most highly associated with elevated cutaneous chemokines IP10 and TARC, which preferentially direct Th1 and Th2 cells to skin. Systemic CD4+ and CD8+ T cells, except for Th2 cells, were suppressed in ADS.aureus, particularly circulating Th1, memory IL-10+ T cells, and skin-homing memory Th17 cells. Systemic γδ T cell expansion in ADS.aureus was also observed. This study suggests that augmentation of protective T cell subsets is a potential therapeutic strategy in the management of S. aureus in AD.
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Affiliation(s)
- Julianne Clowry
- Department of Dermatology, National Children’s Research Centre, Children’s Health Ireland at Crumlin, Dublin, Ireland
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Daniel J. Dempsey
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Tracey J. Claxton
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Aisling M. Towell
- Department of Microbiology, Moyne Institute of Preventive Medicine, School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
| | - Mary B. Turley
- Department of Microbiology, Moyne Institute of Preventive Medicine, School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Martin Sutton
- Department of Microbiology, Moyne Institute of Preventive Medicine, School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
| | - Joan A. Geoghegan
- Department of Microbiology, Moyne Institute of Preventive Medicine, School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sanja Kezic
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ivone Jakasa
- Laboratory for Analytical Chemistry, Department of Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Arthur White
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Alan D. Irvine
- Department of Dermatology, National Children’s Research Centre, Children’s Health Ireland at Crumlin, Dublin, Ireland
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rachel M. McLoughlin
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Darrieutort-Laffite C, Coiffier G, Aïm F, Banal F, Bart G, Chazerain P, Couderc M, Coquerelle P, Ducourau Barbary E, Flipo RM, Faudemer M, Godot S, Hoffmann C, Lecointe T, Lormeau C, Mulleman D, Piot JM, Senneville E, Seror R, Voquer C, Vrignaud A, Guggenbuhl P, Salliot C. 2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis. Joint Bone Spine 2024; 91:105664. [PMID: 37995861 DOI: 10.1016/j.jbspin.2023.105664] [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: 08/19/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
Septic bursitis (SB) is a common condition accounting for one third of all cases of inflammatory bursitis. It is often related to professional activities. Management is heterogeneous and either ambulatory or hospital-based, with no recommendations available. This article presents recommendations for managing patients with septic bursitis gathered by 18 rheumatologists from the French Society for Rheumatology work group on bone and joint infections, 1 infectious diseases specialist, 2 orthopedic surgeons, 1 general practitioner and 1 emergency physician. This group used a literature review and expert opinions to establish 3 general principles and 11 recommendations for managing olecranon and prepatellar SB. The French Health authority (Haute Autorité de santé [HAS]) methodology was used for these recommendations. Designed for rheumatologists, general practitioners, emergency physicians and orthopedic surgeons, they focus on the use of biological tests and imaging in both outpatient and inpatient management. Antibiotic treatment options (drugs and duration) are proposed for both treatment modalities. Finally, surgical indications, non-drug treatments and prevention are covered by specific recommendations.
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Affiliation(s)
- Christelle Darrieutort-Laffite
- Rheumatology Department, CHU de Nantes, Nantes, France; Nantes Université, Oniris, CHU de Nantes, Inserm, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000 Nantes, France
| | | | - Florence Aïm
- Orthopedic Unit and Osteoarticular Reference Center, GH Diaconesses Croix Saint-Simon, Paris, France
| | - Fréderic Banal
- Department of Rheumatology, Centre Hospitalier Universitaire Amiens Picardie, 80054 Amiens, France
| | - Géraldine Bart
- Internal Medicine and Rheumatology department, Percy Army Training Hospital, Clamart, France
| | - Pascal Chazerain
- Rheumatology Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 75020 Paris, France
| | - Marion Couderc
- Rheumatology Department, CHU Gabriel-Montpied, Clermont-Ferrand, France; Inserm/Imost, UMR 1240, Clermont-Ferrand, France
| | | | | | - René-Marc Flipo
- Department of Rheumatology, CHU de Lille, Université de Lille, 59000 Lille, France
| | - Maël Faudemer
- Rheumatology Department, CHU Saint-Antoine, 75012 Paris, France
| | - Sophie Godot
- Internal Medicine and Rheumatology department, Percy Army Training Hospital, Clamart, France
| | - Céline Hoffmann
- Emergency Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 75020 Paris, France
| | - Thibaut Lecointe
- Orthopedic surgery Department, CHU d'Orléans, Orléans University, 45067 Orléans, France
| | | | - Denis Mulleman
- EA6295 Nano Medicines & Nano Probes Research Group, University of Tours, Department of Rheumatology, CHRU de Tours, Tours, France
| | - Jean-Maxime Piot
- Rheumatology Department, Centre Hospitalier du Mans, Le Mans, France
| | - Eric Senneville
- Department of Infectious Diseases, Tourcoing Hospital, Tourcoing, France
| | - Raphaèle Seror
- Rheumatology Department, AP-HP, Hôpitaux Universitaires Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Centre of Immunology of Viral Infections and Autoimmune Diseases (IMVA), Inserm U1184, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | | | - Pascal Guggenbuhl
- Rheumatology Department, Hôpital Sud, CHU de Rennes, 35000 Rennes, France; Rennes University, Inserm, CHU de Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR 1317, 35000 Rennes, France
| | - Carine Salliot
- Rheumatology Department, CHU d'Orléans, Orléans University, 45067 Orléans, France.
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11
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Cuny C, Layer-Nicolaou F, Werner G, Witte W. A look at staphylococci from the one health perspective. Int J Med Microbiol 2024; 314:151604. [PMID: 38367509 DOI: 10.1016/j.ijmm.2024.151604] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/19/2024] Open
Abstract
Staphylococcus aureus and other staphylococcal species are resident and transient multihost colonizers as well as conditional pathogens. Especially S. aureus represents an excellent model bacterium for the "One Health" concept because of its dynamics at the human-animal interface and versatility with respect to host adaptation. The development of antimicrobial resistance plays another integral part. This overview will focus on studies at the human-animal interface with respect to livestock farming and to companion animals, as well as on staphylococci in wildlife. In this context transmissions of staphylococci and of antimicrobial resistance genes between animals and humans are of particular significance.
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Affiliation(s)
- Christiane Cuny
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, National Reference Centre for Staphylococci and Enterococci, Wernigerode Branch, 38855 Wernigerode, Germany.
| | - Franziska Layer-Nicolaou
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, National Reference Centre for Staphylococci and Enterococci, Wernigerode Branch, 38855 Wernigerode, Germany
| | - Guido Werner
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, National Reference Centre for Staphylococci and Enterococci, Wernigerode Branch, 38855 Wernigerode, Germany
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12
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Sator T, Binder H, Payr S, Pichler L, Frenzel S, Hajdu S, Presterl E, Tiefenboeck TM. Surgical site infection after trochanteric and subtrochanteric fractures: a single centre retrospective analysis. Sci Rep 2024; 14:579. [PMID: 38182868 PMCID: PMC10770179 DOI: 10.1038/s41598-024-51180-x] [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: 05/22/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024] Open
Abstract
Surgical site infection (SSI) following osteosynthesis of trochanteric or subtrochanteric fractures is a rare but serious complication with incidence rate ranging from 1 to 3%. SSIs are associated with higher mortality and increased length of hospital stay resulting in higher healthcare costs and loss of life quality. In this retrospective analysis all patients with SSI following osteosynthesis of trochanteric or subtrochanteric fractures at the Department of Trauma Surgery were identified. We included all surgical procedures performed from 1992 to 2018, using data from electronic health records and SSI-Trauma-Registry. The aim was to describe epidemiological data, as well as to identify parameters correlating with the occurrence of SSI and mortality. Of 2753 patients, 53 (1.9%) developed SSI. Longer operative time was demonstrated among patients with SSI (P = 0.008). Mortality during the first postoperative year was significantly higher in the SSI group (32.1% vs. 19.1%; P = 0.018), with detection of methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA; HR 4.13, CI 95% 1.24-13.80; P = 0.021) or Enterococcus spp. (HR 5.58, CI 95% 1.67-18.65; P = 0.005) being independent risk factors. Male sex (HR 2.25, 95% CI 1.86-2.73; P < 0.001) and higher mean age (HR 1.05, 95% CI 1.04-1.06; P < 0.001) were found to be predictors for 1-year mortality in non-infected patients. SSI rate was low with 1.9% and longer duration of surgery was associated with infection. Patients with SSI had a higher 1-year mortality, with detection of MSSA, MRSA and enterococci significantly increasing the risk of dying. Male sex and higher age were risk factors for one-year mortality in patients without SSI.
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Affiliation(s)
- Thomas Sator
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Harald Binder
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stephan Payr
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lorenz Pichler
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stephan Frenzel
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Manfred Tiefenboeck
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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13
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Okwu MU, Akpoka AO, Mitsan O, Izevbuwa OE, Osamede A, Tkadlec J. High Frequency of Methicillin-Resistant and Multidrug-Resistant Strains of Staphylococcus aureus Colonizing Students in Okada, Edo State, Nigeria. Microb Drug Resist 2023; 29:516-522. [PMID: 37713290 DOI: 10.1089/mdr.2023.0001] [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: 09/17/2023] Open
Abstract
Staphylococcus aureus is one of the most common bacterial pathogens, often asymptomatically colonizing healthy people, but capable of causing fatal disease. The ability to treat S. aureus infections is limited by the rapid spread of multidrug-resistant strains. This study aimed to determine the prevalence of S. aureus carriage among students from Okada, Edo State, Nigeria, to analyze the antibiotic resistance patterns and molecular characteristics of S. aureus isolates. One hundred healthy students from Okada, Nigeria, were tested for nasal colonization by S. aureus. Isolates were identified using standard microbiological methods. The susceptibilities of the isolates to a panel of 22 antimicrobials were tested. spa and staphylococcal cassette chromosome mec typing were performed. The prevalence of S. aureus and methicillin-resistant S. aureus (MRSA) among the students was 23% and 6%, respectively. Of the six (26.1%; 6/23) MRSA isolates detected, CC88-MRSA-IVa (n = 2) and CC7-MRSA-V (n = 2) were the most frequent clones. The CC7-MRSA-V isolates were resistant to multiple antimicrobials. Overall, resistance to beta-lactams, tetracyclines, fluoroquinolones, and aminoglycosides was detected among the S. aureus and MRSA isolates. The high prevalence of MRSA and methicillin-susceptible isolates with resistance to multiple antimicrobial classes observed among the students is an alarming finding. This study indicated the circulation of resistant clones of S. aureus in Nigerian educational institutions and the community.
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Affiliation(s)
- Maureen Uchechukwu Okwu
- Department of Biological Sciences (Microbiology), College of Natural and Applied Sciences, Igbinedion University Okada, Okada, Edo State, Nigeria
| | - Augustine Obhioze Akpoka
- Department of Biological Sciences (Microbiology), College of Natural and Applied Sciences, Igbinedion University Okada, Okada, Edo State, Nigeria
| | - Olley Mitsan
- Department of Laboratory Medicine, Igbinedion University Teaching Hospital, Okada, Edo State, Nigeria
| | - Osazee Ekundayo Izevbuwa
- Department of Biological Sciences (Microbiology), College of Natural and Applied Sciences, Igbinedion University Okada, Okada, Edo State, Nigeria
| | - Anita Osamede
- Department of Biological Sciences (Microbiology), College of Natural and Applied Sciences, Igbinedion University Okada, Okada, Edo State, Nigeria
| | - Jan Tkadlec
- Department of Medical Microbiology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
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14
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Suárez-Bustamante Huélamo M, Alonso-Cadenas JA, Cortés BG, Goikoetxea IG, Hernández-Bou S, de la Torre Espí M. Staphylococcus aureus Bacteremia in the Pediatric Emergency Department and Predictors of Poor Outcome. Pediatr Infect Dis J 2023; 42:954-959. [PMID: 37523577 DOI: 10.1097/inf.0000000000004053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Staphylococcus aureus has become the leading cause of bacteremia among previously healthy children older than 5 years. METHODS We aimed to describe the infants presenting to pediatric emergency departments and diagnosed with S. aureus bacteremia (SAB) and identify predictors (clinical and laboratory variables) of poor outcome (complications, sequelae or death). We performed an observational study and subanalysis of a multicenter prospective registry, including every patient under the age of 18 years with a positive blood culture obtained at any of the 22 participating Spanish pediatric emergency departments between 2011 and 2016. We considered chronic diseases, immunosuppressive treatment and the presence of mechanical devices as risk factors for SAB. RESULTS Of the 229 patients with SAB, 176 (76.9%) were previously healthy, 192 (83.8%) had a normal pediatric assessment triangle and 158 (69.0%) had an associated focal infection (mainly osteoarticular infection, skin and soft tissue infection and pneumonia). Fifty-three patients (23.1%) had 1 or more risk factors for SAB. Thirty-one (13.5%) presented a poor outcome, including 4 deaths (1.7%). A poor outcome was more common in patients with SAB risk factors [odds ratio (OR): 7.0; 95% CI: 3.2-15.4], abnormal PAT (OR: 5.9; 95% CI: 2.6-13.3), elevated procalcitonin (OR: 1.2; 95% CI: 1.05-1.3) and C-reactive protein, the latter being the only independent predictor of poor outcome (OR: 1.01; 95% CI: 1.01-1.02). CONCLUSIONS Overall, children with SAB are previously healthy, appear well, and have an associated focal infection. One of 7 had a poor outcome, with C-reactive protein being the only predictor identified.
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Affiliation(s)
| | | | - Borja Gómez Cortés
- Pediatric Emergency Department, Hospital Cruces (Barakaldo), Vizcaya, Spain
| | | | - Susanna Hernández-Bou
- Pediatric Emergency Department, Hospital Sant Joan de Déu de Barcelona (Esplugues de Llobregat), Barcelona, Spain
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15
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Smith M, Herwaldt L. Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU. Am J Infect Control 2023; 51:A64-A71. [PMID: 37890955 DOI: 10.1016/j.ajic.2023.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units. METHODS We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited. DISCUSSION/CONCLUSIONS Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.
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Affiliation(s)
- Matthew Smith
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA.
| | - Loreen Herwaldt
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
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16
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Serigstad S, Knoop ST, Markussen DL, Ulvestad E, Bjørneklett RO, Ebbesen MH, Kommedal Ø, Grewal HMS. Diagnostic utility of oropharyngeal swabs as an alternative to lower respiratory tract samples for PCR-based syndromic testing in patients with community-acquired pneumonia. J Clin Microbiol 2023; 61:e0050523. [PMID: 37585220 PMCID: PMC10512787 DOI: 10.1128/jcm.00505-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/06/2023] [Indexed: 08/17/2023] Open
Abstract
Syndromic PCR-based analysis of lower respiratory tract (LRT) samples in patients with community-acquired pneumonia (CAP) improves the bacterial yield and time-to-results compared to culture-based methods. However, obtaining adequate sputum samples can be challenging and is frequently not prioritized in the emergency department (ED). In this study, we assess the concordance of microbiological detections between oropharyngeal- (OP) and LRT samples from patients presenting to the ED with CAP using a syndromic PCR-based respiratory panel [Biofire FilmArray Pneumonia plus (FAP plus)]. Paired OP- and high-quality LRT samples were collected from 103 patients with confirmed CAP, who had been included in a randomized controlled trial (NCT04660084) or a subsequent observational study at Haukeland University Hospital, and analyzed using the FAP plus. The LRT samples were obtained mainly by sputum induction (88%). Using the LRT samples as a reference standard, the positive percent agreement (PPA), negative percent agreement (NPA), and overall percent agreement for the most common bacterial pathogens in CAP, Streptococcus pneumoniae and Haemophilus influenzae, were 85%, 99% and 95%, and 86%, 98% and 93%, respectively. For Moraxella catarrhalis, the PPA was lower (74%), while the NPA was 100%. For bacteria that are less likely causes of uncomplicated CAP (e.g., Staphylococcus aureus and Enterobacterales) the results were more divergent. In conclusion, the FAP plus detects the most common CAP pathogens S. pneumoniae and H. influenzae from OP samples with high PPAs and excellent NPAs when compared with LRT samples. For these pathogens, the PPAs for OP samples were higher than previous reports for nasopharyngeal samples. This suggests that analysis of OP samples with syndromic PCR panels could represent an alternative approach for rapid microbiological testing in the ED, especially in patients where LRT samples are difficult to obtain. Divergent results for bacteria that are less likely to cause uncomplicated CAP do, however, emphasize the need for clinical evaluation of positive test results.
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Affiliation(s)
- Sondre Serigstad
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Siri T. Knoop
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Dagfinn L. Markussen
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
| | - Elling Ulvestad
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Rune O. Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Marit H. Ebbesen
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Kommedal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Harleen M. S. Grewal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
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17
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Leclerc Q, Clements A, Dunn H, Hatcher J, Lindsay JA, Grandjean L, Knight GM. Quantifying patient- and hospital-level antimicrobial resistance dynamics in Staphylococcus aureus from routinely collected data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.15.23285946. [PMID: 36824943 PMCID: PMC9949191 DOI: 10.1101/2023.02.15.23285946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Antimicrobial resistance (AMR) to all antibiotic classes has been found in the pathogen Staphylococcus aureus . The reported prevalence of these resistances vary, driven by within-host AMR evolution at the patient level, and between-host transmission at the hospital level. Without dense longitudinal sampling, pragmatic analysis of AMR dynamics at multiple levels using routine surveillance data is essential to inform control measures. We explored S. aureus AMR diversity in 70,000 isolates from a UK paediatric hospital between 2000-2020, using electronic datasets containing multiple routinely collected isolates per patient with phenotypic antibiograms, hospitalisation information, and antibiotic consumption. At the hospital-level, the proportion of isolates that were meticillin-resistant (MRSA) increased between 2014-2020 from 25 to 50%, before sharply decreasing to 30%, likely due to a change in inpatient demographics. Temporal trends in the proportion of isolates resistant to different antibiotics were often correlated in MRSA, but independent in meticillin-susceptible S. aureus . Ciprofloxacin resistance in MRSA decreased from 70% to 40% of tested isolates between 2007-2020, likely linked to a national policy to reduce fluoroquinolone usage in 2007. At the patient level, we identified frequent AMR diversity, with 4% of patients ever positive for S. aureus simultaneously carrying, at some point, multiple isolates with different resistances. We detected changes over time in AMR diversity in 3% of patients ever positive for S. aureus . These changes equally represented gain and loss of resistance. Within this routinely collected dataset, we found that 65% of changes in resistance within a patient’s S. aureus population could not be explained by antibiotic exposure or between-patient transmission of bacteria, suggesting that within-host evolution via frequent gain and loss of AMR genes may be responsible for these changing AMR profiles. Our study highlights the value of exploring existing routine surveillance data to determine underlying mechanisms of AMR. These insights may substantially improve our understanding of the importance of antibiotic exposure variation, and the success of single S. aureus clones.
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Affiliation(s)
- Quentin Leclerc
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Public Health, London School of Hygiene & Tropical Medicine, UK
- Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, UK
- Institute for Infection & Immunity, St George’s University of London, UK
| | - Alastair Clements
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Public Health, London School of Hygiene & Tropical Medicine, UK
- Institute for Infection & Immunity, St George’s University of London, UK
| | | | | | - Jodi A Lindsay
- Institute for Infection & Immunity, St George’s University of London, UK
| | - Louis Grandjean
- Department of Infection, Immunity & Inflammation, Institute of Child Health, University College London, UK
| | - Gwenan M Knight
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Public Health, London School of Hygiene & Tropical Medicine, UK
- Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, UK
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18
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Bouiller K, Zeggay A, Gbaguidi-Haore H, Hocquet D, Chirouze C, Bertrand X. Epidemiology and risk factors of nasal carriage of Staphylococcus aureus CC398 in two distinct cohorts in France. Front Microbiol 2022; 13:1068420. [PMID: 36605518 PMCID: PMC9807596 DOI: 10.3389/fmicb.2022.1068420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background We aimed to determine the prevalence and factors associated with nasal carriage of Staphylococcus aureus CC398 in the community and among hospitalized patients. Methods We conducted a prospective cohort study in a French university hospital and a cross-sectional study in the surrounding region. Results From June 2019 to July 2020, 591 healthy blood donors (HBDs) and 647 hospitalized patients (HPs) were included. S. aureus CC398 was more prevalent in HBDs than in HPs (7.3% [5.3-9.7] vs. 3.8% [2.4-5.5], p = 0.006). Among S. aureus nasal carriers, the prevalence of CC398 isolates was 24.6% in HBDs and 18.3% in HPs (p = 0.19). No MRSA belonged to CC398. In multivariate analysis, prior antibiotic intake in the past year (OR 3.11 [1.37-7.06]) and active smoking (OR 3.01 [1.00-9.05]) were associated with S. aureus CC398 nasal carriage in the HBD cohort. A history of neurological disease was associated with nasal carriage (OR = 5.43 [1.21-24.2]), whereas an age between 82 and 90 years (OR 0.11 [0.02-0.54]) and diabetes (OR 0.18 [0.04-0.85]) were protective factors in the HP cohort. Contact with livestock was not a risk factor in either cohort. Conclusion The prevalence of MSSA CC398 was higher in the community than hospitalized patients. Factors associated with nasal carriage of MSSA CC398 were primarily related to general preconditions. No environmental sources of exposure were identified.
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Affiliation(s)
- Kevin Bouiller
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France,UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,*Correspondence: Kevin Bouiller,
| | - Abdeljalil Zeggay
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France
| | - Houssein Gbaguidi-Haore
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
| | - Didier Hocquet
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
| | - Catherine Chirouze
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France,UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
| | - Xavier Bertrand
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
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19
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Zhao N, Cheng D, Yang Z, Liu Y, Wang Y, Jian Y, Wang H, Li M, Bae T, Liu Q. Virulence adaption to environment promotes the age-dependent nasal colonization of Staphylococcus aureus. Emerg Microbes Infect 2022; 11:1402-1415. [PMID: 35508433 PMCID: PMC9132443 DOI: 10.1080/22221751.2022.2074316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
Staphylococcus aureus is an important human commensal bacteria colonizing the human body, especially the nasal cavity. The nasal carriage can be a source of S. aureus bacteremia. However, the bacterial factors contributing to nasal colonization are not completely understood. By analysing S. aureus strains from the nasal cavity of the children, young adults, and seniors, we found that the low activity of the SaeRS two-component system (TCS) is an important determinant for S. aureus to colonize in seniors. The senior group isolates of S. aureus showed a rather distinct sequence type composition as compared with other age group isolates. The senior group isolates showed not only a lower gene carriage of enterotoxins a, c, and q but also lower hemolytic activity against human red blood cells. Of regulators affecting hemolysin production (i.e. agr, saeRS, rot, rsp, and sarS), only the SaeRS TCS showed an age-dependent decrease of activity. The decreased virulence and better colonization ability of the senior group isolates of S. aureus were confirmed in the mouse model. The senior group isolates showed the lowest survival and the best adhesion and colonizing ability. Also, the senior nasal secretions supported S. aureus survival better than the child and young adult nasal secretions. These results indicated that the senior nasal cavity favours colonization of S. aureus with higher adhesion and lower virulence, to which the reduced SaeRS TCS activity contributes. Taken together, our results illustrate an example of bacterial adaptation to the changing host environment.
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Affiliation(s)
- Na Zhao
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Danhong Cheng
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Ziyu Yang
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yao Liu
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yanan Wang
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Ying Jian
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Hua Wang
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Min Li
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Taeok Bae
- Department of Microbiology and Immunology, Indiana University School of Medicine-Northwest, Gary, IN, USA
| | - Qian Liu
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
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20
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Leclerc QJ, Lindsay JA, Knight GM. Modelling the synergistic effect of bacteriophage and antibiotics on bacteria: Killers and drivers of resistance evolution. PLoS Comput Biol 2022; 18:e1010746. [PMID: 36449520 PMCID: PMC9744316 DOI: 10.1371/journal.pcbi.1010746] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/12/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
Bacteriophage (phage) are bacterial predators that can also spread antimicrobial resistance (AMR) genes between bacteria by generalised transduction. Phage are often present alongside antibiotics in the environment, yet evidence of their joint killing effect on bacteria is conflicted, and the dynamics of transduction in such systems are unknown. Here, we combine in vitro data and mathematical modelling to identify conditions where phage and antibiotics act in synergy to remove bacteria or drive AMR evolution. We adapt a published model of phage-bacteria dynamics, including transduction, to add the pharmacodynamics of erythromycin and tetracycline, parameterised from new in vitro data. We simulate a system where two strains of Staphylococcus aureus are present at stationary phase, each carrying either an erythromycin or tetracycline resistance gene, and where multidrug-resistant bacteria can be generated by transduction only. We determine rates of bacterial clearance and multidrug-resistant bacteria appearance, when either or both antibiotics and phage are present at varying timings and concentrations. Although phage and antibiotics act in synergy to kill bacteria, by reducing bacterial growth antibiotics reduce phage production. A low concentration of phage introduced shortly after antibiotics fails to replicate and exert a strong killing pressure on bacteria, instead generating multidrug-resistant bacteria by transduction which are then selected for by the antibiotics. Multidrug-resistant bacteria numbers were highest when antibiotics and phage were introduced simultaneously. The interaction between phage and antibiotics leads to a trade-off between a slower clearing rate of bacteria (if antibiotics are added before phage), and a higher risk of multidrug-resistance evolution (if phage are added before antibiotics), exacerbated by low concentrations of phage or antibiotics. Our results form hypotheses to guide future experimental and clinical work on the impact of phage on AMR evolution, notably for studies of phage therapy which should investigate varying timings and concentrations of phage and antibiotics.
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Affiliation(s)
- Quentin J. Leclerc
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
- * E-mail: ,
| | - Jodi A. Lindsay
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Gwenan M. Knight
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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21
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Stallard S, Savioli F, McConnachie A, Norrie J, Dudman K, Morrow ES, Romics L. Antibiotic prophylaxis in breast cancer surgery (PAUS trial): randomised clinical double-blind parallel-group multicentre superiority trial. Br J Surg 2022; 109:1224-1231. [PMID: 35932230 PMCID: PMC10364710 DOI: 10.1093/bjs/znac280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/08/2022] [Accepted: 07/19/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Participants were patients with invasive breast cancer undergoing primary surgery. The aim was to test whether a single dose of amoxicillin-clavulanic acid would reduce wound infection at 30 days postoperatively, and to identify risk factors for infection. METHODS Participants were randomised to either a single bolus of 1.2 g intravenous amoxicillin-clavulanic acid after the induction of anaesthesia (intervention) or no antibiotic (control). The primary outcome was the incidence of wound infection at 30 days postoperatively. RESULTS There were 871 evaluable patients. Of these, 438 received prophylactic antibiotic and 433 served as controls. Seventy-one (16.2 per cent) patients in the intervention group developed a wound infection by 30 days, while there were 83 (19.2 per cent) infections in the control group. This was not statistically significant (odds ratio (OR) 0.82, 95 per cent c.i. 0.58 to 1.15; P = 0.250). The risk of infection increased for every 5 kg/m2 of BMI (OR 1.29, 95 per cent c.i. 1.10 to 1.52; P = 0.003). Patients who were preoperative carriers of Staphylococcus aureus had an increased risk of postoperative wound infection; however, there was no benefit of preoperative antibiotics for patients with either a high BMI or who were carriers of S. aureus. CONCLUSION There was no statistically significant or clinically meaningful reduction in wound infection at 30 days following breast cancer surgery in patients who received a single dose of amoxicillin-clavulanic acid preoperatively. REGISTRATION NUMBER N0399145605 (National Research Register).
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Affiliation(s)
- Sheila Stallard
- Gartnavel General Hospital, Gartnavel General Hospital, Glasgow, UK
| | - Francesca Savioli
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - John Norrie
- Usher Institute, College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - Elizabeth S Morrow
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Laszlo Romics
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.,New Victoria Hospital, Glasgow, UK
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22
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Antonucci R, Cuzzolin L, Locci C, Dessole F, Capobianco G. Use of Azithromycin in Pregnancy: More Doubts than Certainties. Clin Drug Investig 2022; 42:921-935. [PMID: 36152269 PMCID: PMC9510245 DOI: 10.1007/s40261-022-01203-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/30/2022]
Abstract
Macrolides such as azithromycin are commonly prescribed antibiotics during pregnancy. The good oral bioavailability and transplacental transfer of azithromycin make this drug suitable for the treatment of sexually transmitted diseases, toxoplasmosis, and malaria. Moreover, azithromycin is useful both in the management of preterm pre-labor rupture of membranes and in the adjunctive prophylaxis for cesarean delivery. The aim of this comprehensive narrative review is to critically analyze and summarize the available literature on the main aspects of azithromycin use in pregnant women, with a special focus on adverse offspring outcomes associated with prenatal exposure to the drug. References for this review were identified through searches of MEDLINE, PubMed, and EMBASE. Fetal and neonatal outcomes following prenatal azithromycin exposure have been investigated in several studies, yielding conflicting results. Increased risks of spontaneous miscarriage, major congenital malformations, cardiovascular malformations, digestive system malformations, preterm birth, and low birth weight have been reported in some studies but not in others. Currently, there is no conclusive evidence to support that azithromycin use by pregnant women causes adverse outcomes in their offspring. Therefore, this agent should only be used during pregnancy when clinically indicated, if the benefits of treatment are expected to outweigh the potential risks.
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Affiliation(s)
- Roberto Antonucci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
| | - Laura Cuzzolin
- Department of Diagnostics and Public Health-Section of Pharmacology, University of Verona, Verona, Italy
| | - Cristian Locci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Francesco Dessole
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
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23
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Allen VB, Bechman K, Klein JL. Bloodstream infections in Injecting drug users: A 15 year prospective single-centre study. CLINICAL INFECTION IN PRACTICE 2022. [DOI: 10.1016/j.clinpr.2022.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Espindola R, Vella V, Benito N, Mur I, Tedeschi S, Rossi N, Hendriks JGE, Sorlí L, Murillo O, Scarborough M, Scarborough C, Kluytmans J, Ferrari MC, Pletz MW, Mcnamara I, Escudero-Sanchez R, Arvieux C, Batailler C, Dauchy FA, Liu WY, Lora-Tamayo J, Praena J, Ustianowski A, Cinconze E, Pellegrini M, Bagnoli F, Rodríguez-Baño J, Del Toro MD. Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: a multinational matched case-control study. Clin Microbiol Infect 2022; 28:1359-1366. [PMID: 35597508 DOI: 10.1016/j.cmi.2022.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aim to identify the preoperative and perioperative risk factors associated with post-surgical Staphylococcus aureus prosthetic joint infections (PJI) and to develop and validate risk-scoring systems, to allow a better identification of high-risk patients for more efficient targeted interventions. METHODS We performed a multicenter matched case-control study of patients who underwent a primary hip and knee arthroplasty from 2014 to 2016. Two multivariable models by logistic regression were performed, one for the preoperative and one for perioperative variables; predictive scores also were developed and validated in an external cohort. RESULTS In total, 130 cases and 386 controls were included. The variables independently associated with S. aureus-PJI in the preoperative period were (adjusted OR; 95% CI): body mass index >30 kg/m2 (3.0; 1.9 to 4.8), resident in a long-term care facility (2.8; 1.05 to 7.5), fracture as reason for arthroplasty (2.7; 1.4 to 5.03), skin disorders (2.5; 0.9 to 7.04), previous surgery in the index joint (2.4; 1.3 to 4.4), male sex (1.9; 1.2 to 2.9) and American Society of Anesthesiologists index score 3 to 4 (1.8; 1.2 to 2.9). The area under the receiver operating characteristic curve was 0.73 (95% CI 0.68 to 0.78). In perioperative model, the risk factors were the previous ones plus surgical antibiotic prophylaxis administered out of the first 60 minutes before incision (5.9; 2.1 to 16.2), wound drainage for >72 hours after arthroplasty (4.5; 1.9 to 19.4) and use of metal bearing material versus ceramic (1.9; 1.1 to 3.3). The area under the receiver operating characteristic curve was 0.78 (95% CI 0.72 to 0.83). The predictive scores developed were validated in the external cohort. DISCUSSION Predictive scores for S. aureus-PJI were developed and validated; this information would be useful for implementation of specific preventive measures.
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Affiliation(s)
- Reinaldo Espindola
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | | | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau/Sant Pau Institute for Biomedical Research; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau/Sant Pau Institute for Biomedical Research; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sara Tedeschi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Nicolò Rossi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | - Luisa Sorlí
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Pompeu Fabra, Barcelona, Spain
| | - Oscar Murillo
- Servicio de Enfermedades Infecciosas, Hospital Universitari Bellvitge. IDIBELL, Barcelona, Spain
| | | | | | | | | | | | - Iain Mcnamara
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Cedric Arvieux
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Cecile Batailler
- Orthopedic Surgery department, Croix Rousse Hospital, Lyon, France
| | | | - Wai-Yan Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Julia Praena
- Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | | | | | | | | | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Dolores Del Toro
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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25
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Serigstad S, Markussen DL, Ritz C, Ebbesen MH, Knoop ST, Kommedal Ø, Heggelund L, Ulvestad E, Bjørneklett RO, Grewal HMS. The changing spectrum of microbial aetiology of respiratory tract infections in hospitalized patients before and during the COVID-19 pandemic. BMC Infect Dis 2022; 22:763. [PMID: 36180842 PMCID: PMC9523652 DOI: 10.1186/s12879-022-07732-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID-19 pandemic was met with strict containment measures. We hypothesized that societal infection control measures would impact the number of hospital admissions for respiratory tract infections, as well as, the spectrum of pathogens detected in patients with suspected community acquired pneumonia (CAP). Methods This study is based on aggregated surveillance data from electronic health records of patients admitted to the hospitals in Bergen Hospital Trust from January 2017 through June 2021, as well as, two prospective studies of patients with suspected CAP conducted prior to and during the COVID-19 pandemic (pre-COVID cohort versus COVID cohort, respectively). In the prospective cohorts, microbiological detections were ascertained by comprehensive PCR-testing in lower respiratory tract specimens. Mann–Whitney’s U test was used to analyse continuous variables. Fisher’s exact test was used for analysing categorical data. The number of admissions before and during the outbreak of SARS-CoV-2 was compared using two-sample t-tests on logarithmic transformed values. Results Admissions for respiratory tract infections declined after the outbreak of SARS-CoV-2 (p < 0.001). The pre-COVID and the COVID cohorts comprised 96 and 80 patients, respectively. The proportion of viruses detected in the COVID cohort was significantly lower compared with the pre-COVID cohort [21% vs 36%, difference of 14%, 95% CI 4% to 26%; p = 0.012], and the proportion of bacterial- and viral co-detections was less than half in the COVID cohort compared with the pre-COVID cohort (19% vs 45%, difference of 26%, 95% CI 13% to 41%; p < 0.001). The proportion of bacteria detected was similar (p = 0.162), however, a difference in the bacterial spectrum was observed in the two cohorts. Haemophilus influenzae was the most frequent bacterial detection in both cohorts, followed by Streptococcus pneumoniae in the pre-COVID and Staphylococcus aureus in the COVID cohort. Conclusion During the first year of the COVID-19 pandemic, the number of admissions with pneumonia and the microbiological detections in patients with suspected CAP, differed from the preceding year. This suggests that infection control measures related to COVID-19 restrictions have an overall and specific impact on respiratory tract infections, beyond reducing the spread of SARS-CoV-2. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07732-5.
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Affiliation(s)
- Sondre Serigstad
- Emergency Care Clinic, Haukeland University Hospital, 5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, 5021, Bergen, Norway. .,Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.
| | | | - Christian Ritz
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,National Institute of Public Health, University of Southern Denmark, 1455, Copenhagen, Denmark
| | - Marit H Ebbesen
- Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Siri T Knoop
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Øyvind Kommedal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Lars Heggelund
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,Department of Internal Medicine, Vestre Viken Hospital Trust, 3004, Drammen, Norway
| | - Elling Ulvestad
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Rune O Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, 5021, Bergen, Norway
| | - Harleen M S Grewal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway. .,Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway.
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26
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Rakonjac B, Lepšanović Z, Šuljagić V, Jovčić B, Kojić M, Larsen AR, Đurić M, Ćirković I. Predominance of t355/ST152/SCCmec V clonal type among PVL-positive MRSA isolates in a tertiary care hospital in Belgrade, Serbia. PLoS One 2022; 17:e0273474. [PMID: 36074767 PMCID: PMC9455871 DOI: 10.1371/journal.pone.0273474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is continually changing. Frequency of genotypes typical for community-associated MRSA (CA-MRSA) is increasing in hospitals, as well as resistance to antimicrobial agents. Moreover, different clones predominate in different geographic regions, and temporal shifts occur in the predominant clonal type. The aim of this study was to estimate the prevalence of MRSA, CA-MRSA and PVL-positive MRSA isolates from patients hospitalised in the Military Medical Academy (MMA) and from outpatients, and to perform genotyping of PVL-positive MRSA isolates. MRSA isolates were obtained by standard microbiological techniques. PVL-positive MRSA were detected by single PCR. Determination of SCCmec types in MRSA isolates was done using multiplex PCR and genotyping of PVL-positive MRSA by PFGE, MLST and spa typing. The prevalence of MRSA among S. aureus isolates from different clinical specimens was 43.4%. In outpatients the prevalence of MRSA was 3.2%. SCCmec types specific for CA-MRSA were found in 26% of MRSA isolates from hospitalised patients. In groups, hospitalised patients and outpatients, the prevalence of PVL-positive MRSA isolates was 4%, and all of them harboured SCCmec type V genetic element. PFGE revealed minor differences between four groups of PVL-positive MRSA isolates, but all of them belonged to ST152, and all except one were of the t355 spa type. High prevalence of MRSA and CA-MRSA in MMA, especially the presence of PVL-positive CA-MRSA, represent a serious health threat for patients. Genotype t355/ST152/SCCmec V is the dominant MRSA clone among PVL-positive CA-MRSA.
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Affiliation(s)
| | - Zorica Lepšanović
- Military Medical Academy, Belgrade, Serbia
- Medical Faculty, University of Defence, Belgrade, Serbia
| | - Vesna Šuljagić
- Military Medical Academy, Belgrade, Serbia
- Medical Faculty, University of Defence, Belgrade, Serbia
| | - Branko Jovčić
- Institute of Molecular Genetics and Genetic Engineering, Univerity of Belgrade, Belgrade, Serbia
| | - Milan Kojić
- Institute of Molecular Genetics and Genetic Engineering, Univerity of Belgrade, Belgrade, Serbia
| | - Anders Rhod Larsen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Ivana Ćirković
- University of Belgrade-Faculty of Medicine, Institute of Microbiology and Immunology, Belgrade, Serbia
- * E-mail:
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27
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Garriga Ferrer-Bergua L, Borrull Senra AM, Pérez Velasco C, Montero Valladares C, Collazo Vallduriola I, Moya Villanueva S, Velasco Zúñiga R, Pérez Alba M, de la Torre Espí M. Rate of methicillin-resistant Staphylococcus aureus in pediatric emergency departments in Spain. An Pediatr (Barc) 2022; 97:95-102. [PMID: 35788335 DOI: 10.1016/j.anpede.2021.06.015] [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: 05/12/2021] [Accepted: 06/17/2021] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION Staphylococcus aureus is a common germ in bacterial infections in children. The rate of methicillin-resistant S. aureus (MRSA) is increasing lately. OBJECTIVES The main aim is to know the rate of positive cultures to MRSA in Spanish pediatric emergency departments. The secondary aims are to analyse the risk factors for MRSA isolation (patient origin, history of hospitalization or surgery in the previous 90 days, antibiotherapy in the previous 60 days, presence of comorbidity, invasive devices, prior MRSA isolation) and to analyse the morbidity of these infections. METHODOLOGY Retrospective multicenter study (07/01/2017-06/30/2018) with review of patient histories with isolation of S. aureus in samples of any origin obtained in 8 pediatric emergency departments of the Infectious Diseases Working Group of the Spanish Society of pediatric Emergencies. RESULTS During this period, S. aureus was detected in 403 patients (average age 75.8 ± 59.2 months; 54.8% male): 28.8% hospital-related infections (HRI) and 71.2% community-related infections (CRI). Overall, MRSA rate was 16.6% (95% CI: 13-20.2%); 18.1% in HRI and 16.2% in CRI (p > 0.05). The highest rates of MRSA were obtained in skin abscesses (29.3%, CI 95%: 21.8-36.8%), patients not born in Spain (52%; CI 95%: 32-72%) or patients with a previous MRSA infection (90%; CI 95% 71.4-100%). 167 (41%) patients were admitted, 12 (3%) had complications and 4 (1%) suffered sequels. There were no deaths. CONCLUSIONS The overall MRSA rate was one in 6 staphylococcal infections. Higher MRSA rates were detected in samples of suppurating skin injuries and in foreign children or in children with a history of previous MRSA infection. In suppurative skin lesions, early drainage is essential and the change to an antibiotic with MRSA coverage should be considered if the evolution is inadequate.
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Mekuriya E, Manilal A, Aklilu A, Woldemariam M, Hailu T, Wasihun B. Methicillin-resistant Staphylococcus aureus colonization among medicine and health science students, Arba Minch University, Ethiopia. Sci Rep 2022; 12:10161. [PMID: 35715485 PMCID: PMC9205900 DOI: 10.1038/s41598-022-14212-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022] Open
Abstract
Individuals with Methicillin-Resistant Staphylococcus aureus (MRSA) colonized nasal cavities were at greater risk of developing the infection and can serve as potential reservoirs of transmission. Aim of this study is to determine the extent of nasal carriage and associated factors linked to MRSA in medical and health science students of Arba Minch University (AMU), Ethiopia, who are much prone. An institution based cross-sectional study was conducted at AMU from 01st August through 30th November, 2020 by means of a systematic sampling technique using a structured questionnaire. Nasal swabs samples were collected and S. aureus were identified following standard microbiological methods. Methicillin resistance was tested using cefoxitin disk and antimicrobial susceptibility tests were performed by Kirby-Bauer disk diffusion. Biofilm forming ability was phenotypically detected by micro-titer plate assay. Descriptive statistics and multivariable logistic regression analysis were done by Statistical Package for Social Service (SPSS) version 25. The overall prevalence of Staphylococcus aureus and MRSA were 27.1% (70/258) and 7.4% (19/258) respectively. Methicillin-Resistant S. aureus carriage were higher among medical interns, 16.9% (11/65). Isolates in general were co-resistant to antibiotics, such as trimethoprim-sulfamethoxazole (63.2%) and tetracycline (48.4%). Multidrug resistance (MDR) were observed among 52.6% (10/19) of the isolates. Besides, 31.4% (6/19) of MRSA were biofilm producers and all of them were MDR. Multivariable analysis showed that mean exposure for > 2 years to hospital settings [p = 0.048, AOR: 4.99, 95% CI 1.01–24.66] and the habit of sharing clothing and sports equipment [p = 0.017, AOR: 5.43, 95% CI 1.35–21.83] were statistically significant. The overall prevalence of nasal colonized MRSA among students were comparatively lower than that observed in other studies done in Ethiopia itself. An alarming factor is that, 60% of MDR-MRSA were biofilm producers.
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Affiliation(s)
- Ermiyas Mekuriya
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aseer Manilal
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Addis Aklilu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Melat Woldemariam
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tadiwos Hailu
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Biresaw Wasihun
- Department of Midwifery, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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29
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Functional in-vitro evaluation of the non-specific effects of BCG vaccination in a randomised controlled clinical study. Sci Rep 2022; 12:7808. [PMID: 35552463 PMCID: PMC9096342 DOI: 10.1038/s41598-022-11748-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/19/2022] [Indexed: 11/09/2022] Open
Abstract
Bacille Calmette-Guérin (BCG), the only currently licenced tuberculosis vaccine, may exert beneficial non-specific effects (NSE) in reducing infant mortality. We conducted a randomised controlled clinical study in healthy UK adults to evaluate potential NSE using functional in-vitro growth inhibition assays (GIAs) as a surrogate of protection from four bacteria implicated in infant mortality. Volunteers were randomised to receive BCG intradermally (n = 27) or to be unvaccinated (n = 8) and were followed up for 84 days; laboratory staff were blinded until completion of the final visit. Using GIAs based on peripheral blood mononuclear cells, we observed a significant reduction in the growth of the Gram-negative bacteria Escherichia coli and Klebsiella pneumonia following BCG vaccination, but no effect for the Gram-positive bacteria Staphylococcus aureus and Streptococcus agalactiae. There was a modest association between S. aureus nasal carriage and growth of S. aureus in the GIA. Our findings support a causal link between BCG vaccination and improved ability to control growth of heterologous bacteria. Unbiased assays such as GIAs are potentially useful tools for the assessment of non-specific as well as specific effects of TB vaccines. This study was funded by the Bill and Melinda Gates Foundation and registered with ClinicalTrials.gov (NCT02380508, 05/03/2015; completed).
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Abstract
Bacteriophage (phage) are both predators and evolutionary drivers for bacteria, notably contributing to the spread of antimicrobial resistance (AMR) genes by generalized transduction. Our current understanding of this complex relationship is limited. We used an interdisciplinary approach to quantify how these interacting dynamics can lead to the evolution of multidrug-resistant bacteria. We cocultured two strains of methicillin-resistant Staphylococcus aureus, each harboring a different antibiotic resistance gene, with generalized transducing phage. After a growth phase of 8 h, bacteria and phage surprisingly coexisted at a stable equilibrium in our culture, the level of which was dependent on the starting concentration of phage. We detected double-resistant bacteria as early as 7 h, indicating that transduction of AMR genes had occurred. We developed multiple mathematical models of the bacteria and phage relationship and found that phage-bacteria dynamics were best captured by a model in which phage burst size decreases as the bacteria population reaches stationary phase and where phage predation is frequency-dependent. We estimated that one in every 108 new phage generated was a transducing phage carrying an AMR gene and that double-resistant bacteria were always predominantly generated by transduction rather than by growth. Our results suggest a shift in how we understand and model phage-bacteria dynamics. Although rates of generalized transduction could be interpreted as too rare to be significant, they are sufficient in our system to consistently lead to the evolution of multidrug-resistant bacteria. Currently, the potential of phage to contribute to the growing burden of AMR is likely underestimated. IMPORTANCE Bacteriophage (phage), viruses that can infect and kill bacteria, are being investigated through phage therapy as a potential solution to the threat of antimicrobial resistance (AMR). In reality, however, phage are also natural drivers of bacterial evolution by transduction when they accidentally carry nonphage DNA between bacteria. Using laboratory work and mathematical models, we show that transduction leads to evolution of multidrug-resistant bacteria in less than 8 h and that phage production decreases when bacterial growth decreases, allowing bacteria and phage to coexist at stable equilibria. The joint dynamics of phage predation and transduction lead to complex interactions with bacteria, which must be clarified to prevent phage from contributing to the spread of AMR.
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Monteith AJ, Miller JM, Beavers WN, Juttukonda LJ, Skaar EP. Increased Dietary Manganese Impairs Neutrophil Extracellular Trap Formation Rendering Neutrophils Ineffective at Combating Staphylococcus aureus. Infect Immun 2022; 90:e0068521. [PMID: 35191757 PMCID: PMC8929375 DOI: 10.1128/iai.00685-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Dietary metals can modify the risk to infection. Previously, we demonstrated that heightened dietary manganese (Mn) during systemic Staphylococcus aureus infection increases S. aureus virulence. However, immune cells also operate in these same environments and the effect of dietary Mn on neutrophil function in vivo has not been assessed. This study reveals that increased concentrations of Mn impairs mitochondrial respiration and superoxide production in neutrophils responding to S. aureus. As a result, high Mn accelerates primary degranulation, while impairing suicidal neutrophil extracellular trap (NET) formation, which decreases bactericidal activity. In vivo, elevated dietary Mn accumulated extracellularly in the heart, indicating that excess Mn may be more bioavailable in the heart. Coinciding with this phenotype, neutrophil function in the heart was most impacted by a high Mn diet, as neutrophils produced lower levels of mitochondrial superoxide and underwent less suicidal NET formation. Consistent with an ineffective neutrophil response when mice are on a high Mn diet, S. aureus burdens were increased in the heart and mice were more susceptible to systemic infection. Therefore, elevated dietary Mn not only affects S. aureus but also renders neutrophils less capable of restricting staphylococcal infection.
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Affiliation(s)
- Andrew J. Monteith
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanette M. Miller
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William N. Beavers
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | - Lillian J. Juttukonda
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric P. Skaar
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Infection, Immunology, & Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Gowler CD, Slayton RB, Reddy SC, O’Hagan JJ. Improving mathematical modeling of interventions to prevent healthcare-associated infections by interrupting transmission or pathogens: How common modeling assumptions about colonized individuals impact intervention effectiveness estimates. PLoS One 2022; 17:e0264344. [PMID: 35226689 PMCID: PMC8884501 DOI: 10.1371/journal.pone.0264344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/08/2022] [Indexed: 12/03/2022] Open
Abstract
Mathematical models are used to gauge the impact of interventions for healthcare-associated infections. As with any analytic method, such models require many assumptions. Two common assumptions are that asymptomatically colonized individuals are more likely to be hospitalized and that they spend longer in the hospital per admission because of their colonization status. These assumptions have no biological basis and could impact the estimated effects of interventions in unintended ways. Therefore, we developed a model of methicillin-resistant Staphylococcus aureus transmission to explicitly evaluate the impact of these assumptions. We found that assuming that asymptomatically colonized individuals were more likely to be admitted to the hospital or spend longer in the hospital than uncolonized individuals biased results compared to a more realistic model that did not make either assumption. Results were heavily biased when estimating the impact of an intervention that directly reduced transmission in a hospital. In contrast, results were moderately biased when estimating the impact of an intervention that decolonized hospital patients. Our findings can inform choices modelers face when constructing models of healthcare-associated infection interventions and thereby improve their validity.
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Affiliation(s)
- Camden D. Gowler
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rachel B. Slayton
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sujan C. Reddy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Justin J. O’Hagan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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Dorcheh FA, Balmeh N, Sanjari S. In-silico investigation of antibacterial herbal compounds in order to find new antibiotic against Staphylococcus aureus and its resistant subtypes. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2021.100843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Valverde Villar AM, Gutiérrez Del Álamo Oms J, Neira Borrajo I, de Miguel Fernández S, Flox Benítez P, Llopis Miró R. Screening of MRSA colonization in patients undergoing total joint arthroplasty. J Infect Prev 2021; 22:283-288. [PMID: 34880951 DOI: 10.1177/17571774211013410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Periprosthetic infection is commonly caused by Staphylococcus aureus and, if resistant to methicillin (MRSA), is associated with increase in severity and costs to patient and healthcare systems. MRSA colonizes 1-5% of the population, therefore using a screening and decolonisation protocol the risk of periprosthetic infection could be reduced. The objective of our study is to report the results of a preoperative MRSA screening and management protocol utilised at our hospital. Methods All patients undergoing a total joint arthroplasty at our hospital were preoperatively screened for MRSA colonization with swab samples of five different locations. Exposure to risk factors were investigated in colonised patients and they were treated for 5 days prior surgery with nasal mupirocin, chlorhexidine sponges and oral tablets. Results During the 48 months of the study, MRSA colonisation was identified in 22 (1.01%) of 2188 patients operated. The culture was positive only in the nasal swab in 55 patients. In five patients the nasal culture was negative, but they had another positive swab culture (three in the groin and two perianal). None of the patients reported a history of recent antibiotic treatment or hospitalization. Conclusion At our institution, the prevalence of MRSA colonisation is 1.01% in patients undergoing hip and knee arthroplasty. Interestingly, our screening protocol included samples from five different anatomic locations, and it is important to highlight that we found patients with negative nares culture and positive cultures in other locations. Therefore, the number of carriers may be underdiagnosed if only nasal samples are obtained. Level of evidence IV.
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Affiliation(s)
- A M Valverde Villar
- Department of Orthopaedic Surgery, Hospital Universitario Santa Cristina, Madrid, Spain
| | | | - I Neira Borrajo
- Department of Orthopaedic Surgery, Hospital Universitario Santa Cristina, Madrid, Spain
| | - S de Miguel Fernández
- Department of Clinical Analysis, Hospital Universitario Santa Cristina, Madrid, Spain
| | - P Flox Benítez
- Department of Pharmacy, Hospital Universitario Santa Cristina, Madrid, Spain
| | - R Llopis Miró
- Department of Orthopaedic Surgery, Hospital Universitario Santa Cristina, Madrid, Spain
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Nikinmaa S, Podonyi A, Raivio P, Meurman J, Sorsa T, Rantala J, Kankuri E, Tauriainen T, Pätilä T. Daily Administered Dual-Light Photodynamic Therapy Provides a Sustained Antibacterial Effect on Staphylococcus aureus. Antibiotics (Basel) 2021; 10:antibiotics10101240. [PMID: 34680821 PMCID: PMC8533018 DOI: 10.3390/antibiotics10101240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 01/12/2023] Open
Abstract
New means to reduce excessive antibiotic use are urgently needed. This study tested dual-light aPDT against Staphylococcus aureus biofilm with different relative ratios of light energy with indocyanine green. We applied single-light aPDT (810 nm aPDT, 405 aBL) or dual-light aPDT (simultaneous 810 nm aPDT and 405 nm aBL), in both cases, together with the ICG photosensitizer with constant energy of 100 or 200 J/cm2. Single-dose light exposures were given after one-day, three-day, or six-day biofilm incubations. A repeated daily dose of identical light energy was applied during biofilm incubations for the three- and six-day biofilms. Using 100 J/cm2 light energy against the one-day biofilm, the dual-light aPDT consisting of more than half of aBL was the most effective. On a three-day maturated biofilm, single-dose exposure to aPDT or dual-light aPDT was more effective than aBL alone. With total light energy of 200 J/cm2, all dual-light treatments were effective. Dual-light aPDT improves the bactericidal effect on Staphylococcus aureus biofilm compared to aPDT or aBL and provides a sustained effect. An increase in the relative ratio of aBL strengthens the antibacterial effect, mainly when the treatment is repeatedly applied. Thus, the light components' energy ratio is essential with dual-light.
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Affiliation(s)
- Sakari Nikinmaa
- Department of Neuroscience and Biomedical Engineering, Aalto University, 02150 Espoo, Finland;
- Koite Health Oy, 02150 Espoo, Finland;
| | - Anna Podonyi
- Department of Cardiac Surgery, University Hospital Southampton, Southampton SO16 6YD, Hampshire, UK;
| | - Peter Raivio
- Heart and Lung Center, Meilahti Hospital, 00290 Helsinki, Finland; (P.R.); (T.T.)
| | - Jukka Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00290 Helsinki, Finland; (J.M.); (T.S.)
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00290 Helsinki, Finland; (J.M.); (T.S.)
| | | | - Esko Kankuri
- Department of Pharmacology, University of Helsinki, 00290 Helsinki, Finland;
| | - Tuomas Tauriainen
- Heart and Lung Center, Meilahti Hospital, 00290 Helsinki, Finland; (P.R.); (T.T.)
- Department of Congenital Heart Surgery and Organ Transplantation, New Children’s Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Tommi Pätilä
- Department of Neuroscience and Biomedical Engineering, Aalto University, 02150 Espoo, Finland;
- Koite Health Oy, 02150 Espoo, Finland;
- Department of Congenital Heart Surgery and Organ Transplantation, New Children’s Hospital, University of Helsinki, 00290 Helsinki, Finland
- Correspondence: ; Tel.: +358-50-427-2291; Fax: +358-94-717-4479
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Maktabi S, Gharibi D, Hormozi T. Detection of Enterotoxin A Gene ( sea) and Determination of Different Biotypes of Staphylococcus Aureus Isolates From Milk and Cheese in Khuzestan Province, Iran. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2021. [DOI: 10.34172/ijep.2021.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: There has been a growing concern about the potential transmission of Staphylococcus aureus strains among human and animal species through the consumption and handling of foods of animal origin. Objective: The present study aimed to determine the source and possible route of milk and dairy contamination in Khuzestan province of Iran. Materials and Methods: A total of 150 raw cow’s milk and 50 traditional cheese samples were collected from local markets in different cities of Khuzestan province, Iran. Presumptive colonies on Baird Parker Agar were subjected to the Polymerase Chain Reaction assay in order to identify the Staphylococcus genus, thermonuclease gene specific for S. aureus, enterotoxigenic gene (sea), and coa gene for coagulase gene. Moreover, biotyping of S. aureus strains was implemented based on Devriese’s system, and the antibiotic susceptibility testing (five antibiotics) was carried out. Results: Overall, 80 Staphylococcus spp. was isolated from the samples. The PCR was performed and, as the result, 23 S. aureus were confirmed, out of which 2 isolates (8.6%) belonged to the human ecovar and 17 isolates (73.9%) belonged to the non-host specific (NHS) biotype, whereas 4 isolates (17.3%) remained unclassified. Furthermore, sea gene and coagulase genes were detected in 3 and 22 isolates, respectively. The rates for contamination with S. aureus in milk and in cheese were 15% (19 samples) and 8% (4 samples), respectively. Overall, 4%, 9%, 17%, 35%, and 56% of isolates were found resistant to gentamicin, erythromycin, oxacillin, trimethoprim, and penicillin, respectively. Conclusion: The local milk and cheese supplied in the given area were contaminated with antibiotic-resistant and enterotoxigenic staphylococci. Therefore, it was recommended that the supply chain of these materials should be carefully monitored in order to prevent the complications caused by the contamination with these ecovars.
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Affiliation(s)
- Siavash Maktabi
- Department of Food Hygiene, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Dariush Gharibi
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Taherah Hormozi
- Graduated from Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Iran
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Nijsingh N, Munthe C, Lindblom A, Åhrén C. Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable? Monash Bioeth Rev 2021; 38:72-90. [PMID: 32356217 PMCID: PMC7749868 DOI: 10.1007/s40592-020-00113-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.
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Affiliation(s)
- Niels Nijsingh
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden. .,Department of Philosophy, Linguistics and Theory of Science (FLoV), University of Gothenburg, Gothenburg, Sweden. .,Institute for Ethics, History and Theory of Medicine, Ludwig-Maximilians University, Lessingstr. 2, 80336, Munich, Germany.
| | - Christian Munthe
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Philosophy, Linguistics and Theory of Science (FLoV), University of Gothenburg, Gothenburg, Sweden
| | - Anna Lindblom
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Åhrén
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden.,Swedish Strategic Program Against Antimicrobial Resistance (Strama), Region Västra Götaland, Gothenburg, Sweden
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Abdullahi IN, Lozano C, Ruiz-Ripa L, Fernández-Fernández R, Zarazaga M, Torres C. Ecology and Genetic Lineages of Nasal Staphylococcus aureus and MRSA Carriage in Healthy Persons with or without Animal-Related Occupational Risks of Colonization: A Review of Global Reports. Pathogens 2021; 10:1000. [PMID: 34451464 PMCID: PMC8400700 DOI: 10.3390/pathogens10081000] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 01/16/2023] Open
Abstract
In this conceptual review, we thoroughly searched for appropriate English articles on nasal staphylococci carriage among healthy people with no reported risk of colonization (Group A), food handlers (Group B), veterinarians (Group C), and livestock farmers (Group D) published between 2000 and 2021. Random-effects analyses of proportions were performed to determine the pooled prevalence of S. aureus, MRSA, MRSA-CC398, and MSSA-CC398, as well as the prevalence of PVL-positive S. aureus from all eligible studies. A total of 166 eligible papers were evaluated for Groups A/B/C/D (n = 58/31/26/51). The pooled prevalence of S. aureus and MRSA in healthy humans of Groups A to D were 15.9, 7.8, 34.9, and 27.1%, and 0.8, 0.9, 8.6, and 13.5%, respectively. The pooled prevalence of MRSA-CC398 nasal carriage among healthy humans was as follows: Group A/B (<0.05%), Group C (1.4%), Group D (5.4%); and the following among Group D: pig farmers (8.4%) and dairy farmers (4.7%). The pooled prevalence of CC398 lineage among the MSSA and MRSA isolates from studies of the four groups were Group A (2.9 and 6.9%), B (1.5 and 0.0%), C (47.6% in MRSA), and D (11.5 and 58.8%). Moreover, MSSA-CC398 isolates of Groups A and B were mostly of spa-t571 (animal-independent clade), while those of Groups C and D were spa-t011 and t034. The MRSA-CC398 was predominately of t011 and t034 in all the groups (with few other spa-types, livestock-associated clades). The pooled prevalence of MSSA and MRSA isolates carrying the PVL encoding genes were 11.5 and 9.6% (ranges: 0.0-76.9 and 0.0-28.6%), respectively. Moreover, one PVL-positive MSSA-t011-CC398 isolate was detected in Group A. Contact with livestock and veterinary practice seems to increase the risk of carrying MRSA-CC398, but not in food handlers. Thus, this emphasizes the need for integrated molecular epidemiology of zoonotic staphylococci.
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Affiliation(s)
| | | | | | | | | | - Carmen Torres
- Area of Biochemistry and Molecular Biology, University of La Rioja, Madre de Dios 53, 26006 Logroño, Spain; (I.N.A.); (C.L.); (L.R.-R.); (R.F.-F.); (M.Z.)
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Maraldi M, Lisi M, Moretti G, Sponchioni M, Moscatelli D. Health care-associated infections: Controlled delivery of cationic antiseptics from polymeric excipients. Int J Pharm 2021; 607:120956. [PMID: 34333024 DOI: 10.1016/j.ijpharm.2021.120956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Nowadays, the treatment of health care-associated infections represents a serious issue, due to the increasing number of bacterial strains resistant to traditional antibiotics. The use of antiseptics like quaternary ammonium salts and biguanides is a viable alternative to face these life-threatening infections. However, their inherent toxicity as well as the necessity of providing a sustained release to avoid the formation of pathogen biofilms are compelling obstacles towards their assessment in the hospitals. Within this framework, the role of polymeric drug delivery systems is fundamental to overcome the aforementioned problems. Biocompatibility, biodegradability and excipient-drug interactions are crucial properties determining the efficacy of the formulation. In this work, we provide an in-depth analysis of the polymer drug delivery systems that have been developed or are under development for the sustained release of positively charged antiseptics, highlighting the crucial characteristics that allowed to achieve the most relevant therapeutic effects. We reported and compared natural occurring polymers and synthetic carriers to show their pros and cons and applicability in the treatment of health care-associated infections. Then, the discussion is focused on a particularly relevant class of materials adopted for the scope, represented by polyesters, which gave rise, due to their biodegradability, to the field of resorbable drug delivery devices. Finally, a specific analysis on the effect of the polymer functionalization over the formulation performances for the different types of polymeric carriers is presented.
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Affiliation(s)
- Matteo Maraldi
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Via Luigi Mancinelli 7, 20131 Milano, Italy
| | - Marco Lisi
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Via Luigi Mancinelli 7, 20131 Milano, Italy
| | - Giacomo Moretti
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Via Luigi Mancinelli 7, 20131 Milano, Italy
| | - Mattia Sponchioni
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Via Luigi Mancinelli 7, 20131 Milano, Italy.
| | - Davide Moscatelli
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Via Luigi Mancinelli 7, 20131 Milano, Italy
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Garriga Ferrer-Bergua L, Borrull Senra AM, Pérez Velasco C, Montero Valladares C, Collazo Vallduriola I, Moya Villanueva S, Velasco Zúñiga R, Pérez Alba M, de la Torre Espí M. [Rate of methicillin-resistant Staphylococcus aureus in pediatric emergency departments in Spain]. An Pediatr (Barc) 2021; 97:S1695-4033(21)00223-X. [PMID: 34289947 DOI: 10.1016/j.anpedi.2021.06.013] [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: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Staphylococcusaureus (S. aureus) is a common germ present in bacterial infections in children. Lately, the rate of methicillin-resistant S. aureus (MRSA) is increasing. OBJECTIVES The main aim of this study is to know the rate of positive cultures to MRSA in Spanish pediatric emergency departments. The secondary aims are to analyze the risk factors for MRSA isolation (patient origin, history of hospitalization or surgery in the previous 90 days, antibiotherapy in the previous 60 days, presence of comorbidity, invasive devices, prior MRSA isolation) and to analyze the morbidity of these infections. METHODOLOGY Retrospective multicenter study (07/01/2017-06/30/2018) with review of patient histories with isolation of S. aureus in samples of any origin obtained in 8 pediatric emergency departments of the Infectious Diseases Working Group of the Spanish Society of Pediatric Emergencies. RESULTS During this period, S. aureus was detected in 403 patients (average age 75.8±59.2 months; 54.8% male): 28.8% hospital-related infections and 71.2% community-related infections. Overall, MRSA rate was 16.6% (95% CI: 13-20.2%); 18.1% in hospital-related infections and 16.2% in community-related infections (P>.05). The highest rates of MRSA were obtained in skin abscesses (29.3%, 95% CI: 21.8-36.8%), patients not born in Spain (52%; 95% CI: 32-72%) or patients with a previous MRSA infection (90%; 95% CI: 71.4-100%). 167 (41%) patients were admitted, 12 (3%) had complications and 4 (1%) suffered sequels. There were no deaths. CONCLUSIONS The overall MRSA rate was one in six staphylococcal infections. Higher MRSA rates were detected in samples of suppurating skin injuries and in foreign children or in children with a history of previous MRSA infection. In suppurative skin lesions, early drainage is essential and the change to an antibiotic with MRSA coverage should be considered if the evolution is inadequate.
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Lerche N, Holtfreter S, Walther B, Semmler T, Al'Sholui F, Dancer SJ, Daeschlein G, Hübner NO, Bröker BM, Papke R, Kohlmann T, Baguhl R, Seifert U, Kramer A. Staphylococcus aureus nasal colonization among dental health care workers in Northern Germany (StaphDent study). Int J Med Microbiol 2021; 311:151524. [PMID: 34371345 DOI: 10.1016/j.ijmm.2021.151524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/10/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) can colonize dental patients and students, however, studies on the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) among dental health care workers (DHCW) including use of personal protective equipment (PPE) are scarce. We conducted an observational study (StaphDent study) to (I) determine the prevalence of MRSA and MSSA colonization in DHCW in the region of Mecklenburg Western-Pomerania, Germany, (II) resolve the S. aureus population structure to gain hints on possible transmission events between co-workers, and (III) clarify use of PPE. Nasal swabs were obtained from dentists (n = 149), dental assistants (n = 297) and other dental practice staff (n = 38). Clonal relatedness of MSSA isolates was investigated using spa typing and, in some cases, whole genome sequencing (WGS). PPE use was assessed by questionnaire. While 22.3% (108/485) of the participants were colonized with MSSA, MRSA was not detected. MSSA prevalence was not associated with size of dental practices, gender, age, or duration of employment. The identified 61 spa types grouped into 17 clonal complexes and four sequence types. Most spa types (n = 47) were identified only once. In ten dental practices one spa type occurred twice. WGS data analysis confirmed a close clonal relationship for 4/10 isolate pairs. PPE was regularly used by most dentists and assistants. To conclude, the failure to recover MRSA from DHCW reflects the low MRSA prevalence in this region. Widespread PPE use suggests adherence to routine hygiene protocols. Compared to other regional HCW MRSA rates the consequent usage of PPE seems to be protective.
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Affiliation(s)
- Nadine Lerche
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Silva Holtfreter
- Institute of Immunology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Birgit Walther
- ZBS 4, Advanced Light and Electron Microscopy, Robert Koch Institute, Seestraße 10, DE-13353, Berlin, Germany.
| | - Torsten Semmler
- Microbial Genomics (NG1), Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Fawaz Al'Sholui
- Institute of Immunology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, G75 8RG, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, EH11 4BN, UK.
| | - Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Nils-Olaf Hübner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany; Central Unit for Infection Prevention and Control, University Medicine Greifswald, 17475, Greifswald, Germany.
| | - Barbara M Bröker
- Institute of Immunology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Roald Papke
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Thomas Kohlmann
- Institute for Community Medicine, Methodical Subdivision, University Medicine Greifswald, Walther-Rathenau-Str. 48, DE-17475, Greifswald, Germany.
| | - Romy Baguhl
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Ulrike Seifert
- Friedrich Loeffler Institute of Medical Microbiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
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The association between antimicrobial resistance and HIV infection: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:846-853. [PMID: 33813126 DOI: 10.1016/j.cmi.2021.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) are at increased risk of infections with resistant organisms due to more frequent healthcare utilization. Our objective was to investigate the association between HIV and antimicrobial resistance (AMR). METHODS We searched MEDLINE, EMBASE, Web of Science, LILACS and African Journals Online. Studies were eligible if they reported on AMR for colonization or infection with bacterial pathogens (excluding mycobacteria and bacteria causing sexually transmitted infections) and were stratified by HIV status, species and antimicrobials tested. Pooled odds ratios were used to evaluate the association between HIV and resistance. RESULTS In total, 92 studies published between 1995 and 2020 were identified. The studies included the following organisms: Staphylococcusaureus (n = 47), Streptococcus pneumoniae (n = 28), Escherichia coli (n = 6) and other Gram-negative bacteria. PLWH had a 2.12 (95%CI 1.36-3.30) higher odds for colonization and 1.90 (95%CI 1.45-2.48) higher odds for infection with methicillin-resistant S. aureus, a 2.28 (95%CI 1.75-2.97) higher odds of infection with S. pneumoniae with decreased penicillin susceptibility, and a 1.59 (95%CI 0.83-3.05) higher odds of resistance to third-generation cephalosporins in E. coli and Klebsiella pneumoniae. CONCLUSION This review shows an increased risk of AMR in PLWH across a range of bacterial pathogens and multiple drug classes. The lack of laboratory capacity for identifying AMR, and limited access to alternative treatment options in countries with the highest burden of HIV, highlight the need for more research on AMR in PLWH. Overall, the quality of studies was moderate or low, which may impact the findings of this review.
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Ceccarelli F, Lo Presti A, Olivieri G, Angeletti S, Perricone C, Garufi C, Iaiani G, De Florio L, Antonelli F, De Cesaris M, Giordano A, Amori L, Spinelli FR, Alessandri C, Valesini G, Ciccozzi M, Conti F. Genetic diversity of Staphylococcus aureus influences disease phenotype of systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:958-966. [PMID: 32995882 DOI: 10.1093/rheumatology/keaa519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/06/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We investigated the genetic diversity, molecular epidemiology and evolutionary dynamics of Staphylococcus aureus (SA) isolated from SLE patients by means of phylogenetic analysis. METHODS Consecutive SLE patients (ACR 1997 criteria) were enrolled: clinical/laboratory data were collected and nasal swab for SA identification was performed. On the basis of the translation elongation factor (tuf) gene, a phylogenetic analysis was performed to investigate relationships and to assess significant clades. Selective pressure analysis was used to investigate the evolution of the SA tuf gene. The gene sequences from non-SLE individuals, downloaded from the GenBank database, were compared through phylogenetic analysis with the tuf gene from SLE patients. RESULTS We enrolled 118 patients [M/F 10/108; median (interquartile range (IQR)) age 45.5 (13.2) years; median (IQR) disease duration 120 (144) months]. Twenty-four patients (20.3%) were SA carriers (SA+), three of them MRSA. SA+ SLE showed significantly higher SLEDAI-2k values [SA+: median (IQR) 2 (3.75); SA-: 0 (2); P = 0.04]. The phylogenetic analysis, restricted to 21 non-MRSA SA+, revealed a statistically supported larger clade (A, n = 17) and a smaller one (B, n = 4). Patients located in clade A showed a significantly higher prevalence of joint involvement (88.2%) in comparison with clade B (50.0%, P < 0.0001) and SA- (62.7%, P < 0.0001). Haematological manifestations were significantly more frequent in clade A (64.7%) compared with B (50.0%, P = 0.004). CONCLUSION We suggest a possible role of SA nasal carriage status in SLE disease activity. Moreover, our findings support the hypothesis that bacterial genetic variants may be associated with specific disease features.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
| | | | - Giulio Olivieri
- Lupus Clinic, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University campus Bio-Medico of Rome, Rome, Italy
| | - Carlo Perricone
- Dipartimento di Medicina, Sezione di Reumatologia, Università degli Studi di Perugia, Perugia, Italy
| | - Cristina Garufi
- Lupus Clinic, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
| | - Giancarlo Iaiani
- DAI Malattie Infettive e Tropicali, Azienda Policlinico Umberto I, Rome, Italy
| | - Lucia De Florio
- Unit of Clinical Laboratory Science, University campus Bio-Medico of Rome, Rome, Italy
| | - Francesca Antonelli
- Unit of Clinical Laboratory Science, University campus Bio-Medico of Rome, Rome, Italy
| | - Marina De Cesaris
- Unit of Clinical Laboratory Science, University campus Bio-Medico of Rome, Rome, Italy
| | | | - Luigino Amori
- UOC Microbiologia e Virologia, Azienda Policlinico Umberto I, Rome, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
| | - Guido Valesini
- Lupus Clinic, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University campus Bio-Medico of Rome, Rome, Italy
| | - Fabrizio Conti
- Lupus Clinic, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
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Stergianou D, Tzanetakou V, Argyropoulou M, Kanni T, Bagos PG, Giamarellos-Bourboulis EJ. Staphylococcus aureus Carriage in Hidradenitis Suppurativa: Impact on Response to Adalimumab. Dermatology 2021; 237:372-377. [PMID: 33401280 DOI: 10.1159/000512617] [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] [Received: 06/18/2020] [Accepted: 10/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several patients with hidradenitis suppurativa (HS) present flare-ups during treatment with adalimumab (ADA), the cause of which is not clear. ADA is the only FDA-approved biologic for the therapy of moderate-to-severe HS. A previous study of our group has shown that Staphylococcus aureus stimulation of whole blood affects the production of human β-defensin 2 and modulates HS severity. It is, therefore, hypothesized, that carriage of S. aureus may drive HS flare-ups. OBJECTIVE To explore the association between carriage of S. aureus and loss of response to ADA. PATIENTS AND METHODS Among patients with moderate-to-severe HS without carriage of S. aureus at start of treatment with ADA, we investigated for carriage of S. aureus from the nares when flare-ups occurred. Flare-ups were pre-defined as at least 25% increase of inflammatory lesions (sum of inflammatory nodules and abscesses) from baseline. Samplings were also done after completion of 12 weeks of ADA treatment from all patients who did not present flare-ups. Clinical response to ADA was assessed by the HS Clinical Response score (HiSCR). RESULTS Thirty-nine patients were studied; 24 with Hurley II stage HS and 15 with Hurley III stage HS. Twenty-nine patients achieved HiSCR after 12 weeks of treatment without any flare-ups; 10 patients had flare-ups and failed HiSCR. Three (10.3%) and 5 (50%) patients, respectively, had nasal carriage of S. aureus (odds ratio 8.67; 95% CI 1.54-48.49; p = 0.014). Among 32 patients reaching follow-up week 48, 20 patients achieved HiSCR and 12 had flare-ups leading to ADA failure; 2 (10%) and 5 (41.7%) patients, respectively, had positive culture for S. aureus (odds ratio 6.42; 95% CI 1.00-41.20; p = 0.05). CONCLUSION Nasal carriage of S. aureus may be associated with loss of response to ADA. Findings need confirmation in larger series of patients.
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Affiliation(s)
- Dimitra Stergianou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vassiliki Tzanetakou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Argyropoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodora Kanni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Pantelis G Bagos
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
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Del Rosal T, Méndez-Echevarría A, Garcia-Vera C, Escosa-Garcia L, Agud M, Chaves F, Román F, Gutierrez-Fernandez J, Ruiz de Gopegui E, Ruiz-Carrascoso G, Ruiz-Gallego MDC, Bernet A, Quevedo SM, Fernández-Verdugo AM, Díez-Sebastian J, Calvo C. Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study. Infect Drug Resist 2020; 13:4643-4651. [PMID: 33380814 PMCID: PMC7767716 DOI: 10.2147/idr.s282880] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children. Methods Cross-sectional study of patients <14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018. Results A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9–35.1) and 1.44% (95% CI 0.9–2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥5 years (OR 1.10, 95% CI 1.07–1.12), male sex (OR 1.43, 95% CI 1.17–1.76), urban setting (OR 1.46, 95% CI 1.08–1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093–1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57–8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p<0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin. Conclusions The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.
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Affiliation(s)
- Teresa Del Rosal
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Ana Méndez-Echevarría
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Cesar Garcia-Vera
- "José Ramón Muñoz Fernández" Health Care Center, Aragón Health Service, Zaragoza, Spain
| | - Luis Escosa-Garcia
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Martin Agud
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Chaves
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Federico Román
- Laboratory of Nosocomial Infections, Department of Bacteriology, CNM, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Enrique Ruiz de Gopegui
- Department of Clinical Microbiology, Hospital Universitari Son Espases. Servicio de Microbiología, Palma de Mallorca, Spain
| | | | | | - Albert Bernet
- Section of Microbiology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Sara Maria Quevedo
- Department of Microbiology, Hospital Universitario Severo Ochoa, Leganes, Spain
| | | | | | - Cristina Calvo
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
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Abrha S, Tesfaye W, Thomas J. Intolerable Burden of Impetigo in Endemic Settings: A Review of the Current State of Play and Future Directions for Alternative Treatments. Antibiotics (Basel) 2020; 9:E909. [PMID: 33333955 PMCID: PMC7765423 DOI: 10.3390/antibiotics9120909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/22/2023] Open
Abstract
Impetigo (school sores) is a common superficial bacterial skin infection affecting around 162 million children worldwide, with the highest burden in Australian Aboriginal children. While impetigo itself is treatable, if left untreated, it can lead to life-threatening conditions, such as chronic heart and kidney diseases. Topical antibiotics are often considered the treatment of choice for impetigo, but the clinical efficacy of these treatments is declining at an alarming rate due to the rapid emergence and spread of resistant bacteria. In remote settings in Australia, topical antibiotics are no longer used for impetigo due to the troubling rise of antimicrobial resistance, demanding the use of oral and injectable antibiotic therapies. However, widespread use of these agents not only contributes to existing resistance, but also associated with adverse consequences for individuals and communities. These underscore the urgent need to reinvigorate the antibiotic discovery and alternative impetigo therapies in these settings. This review discusses the current impetigo treatment challenges in endemic settings in Australia and explores potential alternative antimicrobial therapies. The goals are to promote intensified research programs to facilitate effective use of currently available treatments, as well as developing new alternatives for impetigo.
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Affiliation(s)
- Solomon Abrha
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
- Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle 7000, Ethiopia
| | - Wubshet Tesfaye
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
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Three-Dimensional In Vitro Staphylococcus aureus Abscess Communities Display Antibiotic Tolerance and Protection from Neutrophil Clearance. Infect Immun 2020; 88:IAI.00293-20. [PMID: 32817328 DOI: 10.1128/iai.00293-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022] Open
Abstract
Staphylococcus aureus is a prominent human pathogen in bone and soft-tissue infections. Pathophysiology involves abscess formation, which consists of central staphylococcal abscess communities (SACs), surrounded by a fibrin pseudocapsule and infiltrating immune cells. Protection against the ingress of immune cells such as neutrophils, or tolerance to antibiotics, remains largely unknown for SACs and is limited by the lack of availability of in vitro models. We describe a three-dimensional in vitro model of SACs grown in a human plasma-supplemented collagen gel. The in vitro SACs reached their maximum size by 24 h and elaborated a fibrin pseudocapsule, as confirmed by electron and immunofluorescence microscopy. The in vitro SACs tolerated 100× the MIC of gentamicin alone and in combination with rifampin, while planktonic controls and mechanically dispersed SACs were efficiently killed. To simulate a host response, SACs were exposed to differentiated PLB-985 neutrophil-like (dPLB) cells and to primary human neutrophils at an early stage of SAC formation or after maturation at 24 h. Both cell types were unable to clear mature in vitro SACs, but dPLB cells prevented SAC growth upon early exposure before pseudocapsule maturation. Neutrophil exposure after plasmin pretreatment of the SACs resulted in a significant decrease in the number of bacteria within the SACs. The in vitro SAC model mimics key in vivo features, offers a new tool to study host-pathogen interactions and drug efficacy assessment, and has revealed the functionality of the S. aureus pseudocapsule in protecting the bacteria from host phagocytic responses and antibiotics.
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Meijs AP, Hengeveld PD, Dierikx CM, Maassen CBM, de Greeff SC, de Haan A, Bosch T, van Duijkeren E. Prolonged carriage of (livestock-associated) MRSA in individuals without professional livestock contact. J Antimicrob Chemother 2020; 75:1405-1409. [DOI: 10.1093/jac/dkaa045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To investigate prolonged carriage of MRSA in adults from the general population living in a livestock-dense area, using WGS.
Methods
A cross-sectional study during 2014–15 among 2492 adults without professional livestock contact identified 14 (0.6%) nasal MRSA carriers, 10 of which carried livestock-associated (LA)-MRSA of multiple-locus variable-number tandem repeat analysis (MLVA) complex (MC) 398. Two years later, 12 MRSA-positive and 88 MRSA-negative participants provided a second nasal swab and filled in a short questionnaire. Isolates from persons who were MRSA positive at both timepoints were compared using MLVA and isolates with the same MLVA type were sequenced. The WGS data were used for core-genome MLST (cgMLST) and resistome analysis, including sequenced isolates from the national MRSA surveillance.
Results
All MRSA-negative persons tested negative again, while 6 of the 12 initially MRSA-positive persons tested positive again. MLVA revealed that isolate pairs from five individuals had the same MLVA type, of which three were LA-MRSA. cgMLST showed that the distance between these isolate pairs ranged between 3 and 13 genes, while the minimum distance to unrelated isolates from the national MRSA surveillance was 38 genes. Moreover, the resistome present in the five isolate pairs was identical within each pair. None of the prolonged carriers was hospitalized during the 3 months before the sampling moment and none of them with LA-MRSA had contact with livestock in this period.
Conclusions
Prolonged carriage of MRSA, including LA-MRSA, can be demonstrated after more than 30 months in persons without professional livestock contact.
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Affiliation(s)
- Anouk P Meijs
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Paul D Hengeveld
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cindy M Dierikx
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Catharina B M Maassen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Angela de Haan
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Thijs Bosch
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Engeline van Duijkeren
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Williamson S, Merritt J, De Benedetto A. Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br J Dermatol 2020; 182:47-54. [PMID: 30895603 DOI: 10.1111/bjd.17896] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a multifactorial and complex disease, characterized by an impaired skin barrier function and abnormal immune response. Many elderly patients present with pruritus and xerosis to dermatology, allergy and primary care clinics, and there is a lack of information available to clinicians regarding the proper diagnosis and management of these patients. Although the elderly are described as having a distinct presentation of AD and important comorbidities, most investigations and clinical care guidelines pertaining to AD do not include patients aged 60 years and older as a separate group from younger adults. OBJECTIVES To summarize current information on pathophysiology, diagnosis and management of AD in the elderly population and identify areas of insufficient information to be explored in future investigations. METHODS We carried out a systematic review of published literature, which assessed changes in the skin barrier and immune function with ageing and current information available for physicians to use in the diagnosis and treatment of AD in elderly patients. RESULTS Many age-related changes overlap with key hallmarks observed in AD, most notably a decline in skin barrier function, dysregulation of the innate immune system, and skewing of adaptive immunity to a type-2 T helper cell response, in addition to increased Staphylococcus aureus infection. CONCLUSIONS While general physiological alterations with ageing overlap with key features of AD, a research gap exists regarding specific ageing-related changes in AD disease development. More knowledge about AD in the elderly is needed to establish firm diagnostic and treatment methodologies. What's already known about this topic? Atopic dermatitis (AD) is a common inflammatory skin disease that causes significant burden worldwide. Recently, elderly patients have been considered a subgroup of patients with distinct AD manifestation. Limited studies have characterized the clinical presentation and role of IgE-mediated allergy in elderly patients with AD. What does this study add? This review offers a summary of age-related skin and immune alterations that correspond to pathogenic changes noted in patients with AD. The role of itch, environmental factors and skin microbiota in AD disease presentation in ageing patients is explored.
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Affiliation(s)
- S Williamson
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, U.S.A
| | - J Merritt
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, U.S.A
| | - A De Benedetto
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, U.S.A
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Katoulis A, Koumaki V, Efthymiou O, Koumaki D, Dimitroulia E, Voudouri M, Voudouri A, Bozi E, Tsakris A. Staphylococcus aureus Carriage Status in Patients with Hidradenitis Suppurativa: An Observational Cohort Study in a Tertiary Referral Hospital in Athens, Greece. Dermatology 2019; 236:31-36. [PMID: 31801143 DOI: 10.1159/000504537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, recurrent, auto-inflammatory disease that affects the pilosebaceous unit in apocrine gland-bearing areas. Bacteria are thought to play a role in the development and progression of disease. In addition, antibiotics are frequently used as first-line management for HS. We sought to determine the carriage status of Staphylococcus aureus and its resistance to antibiotics among patients with HS in a tertiary referral hospital in Athens, Greece. METHODS In this observational cohort study, 68 consecutive patients attending the HS clinic of "Attikon" General University Hospital in Athens, Greece, during a 9-month period were enrolled. All patients had not received any antibiotic therapy for any reason during the previous 3 months before enrollment. Nasal and oropharyngeal samplingwere obtained, and specimens were tested for the presence of S. aureus.Antibiotic susceptibility testing was performed using the VITEK 2 system. Standard statistical tests, descriptive statistics tests, and χ2 and Pearson correlation tests were performed, using IBM SPSS Statistics 25.The level of significance was set at a pvalue <0.05. RESULTS Sixty-eight patients with HS were studied. There were 44 females (64.7%) and 24 males (35.3%). The mean age was 36.63 ± 13.0 (IQR = 21), and the mean age at onset of disease was 23.90 ± 11.53 (IQR = 14). The mean duration of disease was 12.74 ± 10.20 years (IQR = 15). Fifteen (22.1%) of the patients were Hurley stage I, 22 (32.4%) were Hurley stage II, and 31 (45.6%) were Hurley stage III. S. aureus carriage was detected in 17 patients (25%). Six of them (35.3%) had MRSA strains. There was an increased prevalence of S. aureus colonization (p = 0.058) and MRSA (p = 0.101) in Hurley stage III patients, but this result was not statistically significant. CONCLUSIONS We found a 25% prevalence of S. aureus colonization (17/68 patients) and a 35.3% prevalence of MRSA (6/17) among our HS patients. There was an increased prevalence of S. aureusand MRSA positivity in HS patients with Hurley stage III. Further studies are needed to clarify the possible clinical significance of S. aureus carriage in the disease development and progression as well as in the treatment outcome.
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Affiliation(s)
- Alexander Katoulis
- "Attikon" General University Hospital, National and Kapodistrian University of Athens, Medical School, Hidradenitis Suppurativa Clinic, 2nd Department of Dermatology and Venereology, Athens, Greece,
| | - Vasiliki Koumaki
- National and Kapodistrian University of Athens, Medical School of Athens, Microbiology Department, Athens, Greece
| | - Ourania Efthymiou
- "Attikon" General University Hospital, National and Kapodistrian University of Athens, Medical School, Hidradenitis Suppurativa Clinic, 2nd Department of Dermatology and Venereology, Athens, Greece
| | - Dimitra Koumaki
- "Attikon" General University Hospital, National and Kapodistrian University of Athens, Medical School, Hidradenitis Suppurativa Clinic, 2nd Department of Dermatology and Venereology, Athens, Greece
| | - Evangelia Dimitroulia
- National and Kapodistrian University of Athens, Medical School of Athens, Microbiology Department, Athens, Greece
| | - Maria Voudouri
- "Attikon" General University Hospital, National and Kapodistrian University of Athens, Medical School, Hidradenitis Suppurativa Clinic, 2nd Department of Dermatology and Venereology, Athens, Greece
| | - Alexandra Voudouri
- "Attikon" General University Hospital, National and Kapodistrian University of Athens, Medical School, Hidradenitis Suppurativa Clinic, 2nd Department of Dermatology and Venereology, Athens, Greece
| | - Evangelia Bozi
- "Attikon" General University Hospital, National and Kapodistrian University of Athens, Medical School, Hidradenitis Suppurativa Clinic, 2nd Department of Dermatology and Venereology, Athens, Greece
| | - Athanasios Tsakris
- National and Kapodistrian University of Athens, Medical School of Athens, Microbiology Department, Athens, Greece
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