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Silva NC, de Souza MC, Tonini MAL, Schuenck RP. Dissemination of methicillin-resistant Staphylococcus aureus USA300 ST8/PVL- positive in breast infections in a Brazilian region. Diagn Microbiol Infect Dis 2023; 106:115919. [PMID: 36878139 DOI: 10.1016/j.diagmicrobio.2023.115919] [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: 10/19/2022] [Revised: 12/23/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
We aimed to analyze the molecular epidemiology of 46 methicillin-resistant Staphylococcus aureus (MRSA) isolated from breast infections. The USA300 lineage carrying SCCmecIVa, arginine catabolic mobile element, t008, ST8, and Panton-Valentine leukocidin genes was predominant (93%). This is the first study that describes the spread of the USA300 methicillin-resistant Staphylococcus aureus clone in breast infections in Brazil.
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Affiliation(s)
- Nayara Carvalho Silva
- Department of Pathology, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Maycon Carvalho de Souza
- Department of Pathology, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Ricardo Pinto Schuenck
- Department of Pathology, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil.
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Allport J, Choudhury R, Bruce-Wootton P, Reed M, Tate D, Malviya A. Efficacy of mupirocin, neomycin and octenidine for nasal Staphylococcus aureus decolonisation: a retrospective cohort study. Antimicrob Resist Infect Control 2022; 11:5. [PMID: 35012641 PMCID: PMC8744346 DOI: 10.1186/s13756-021-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/14/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) causes significant morbidity. Methicillin sensitive Staphylococcus aureus (MSSA) is the most frequent organism, and the majority are endogenous. Decolonisation reduces PJIs but there is a paucity of evidence comparing treatments. Aims; compare 3 nasal decolonisation treatments at (1) achieving MSSA decolonisation, (2) preventing PJI. METHODS Our hospital prospectively collected data on our MSSA decolonisation programme since 2013, including; all MSSA carriers, treatment received, MSSA status at time of surgery and all PJIs. Prior to 2017 MSSA carriers received nasal mupirocin or neomycin, from August 2017 until August 2019 nasal octenidine was used. RESULTS During the study period 15,958 primary hip and knee replacements were performed. 3200 (20.1%) were MSSA positive at preoperative screening and received decolonisation treatment, 698 mupirocin, 1210 neomycin and 1221 octenidine. Mupirocin (89.1%) and neomycin (90.9%) were more effective at decolonisation than octenidine (50.0%, P < 0.0001). There was no difference in PJI rates (P = 0.452). CONCLUSIONS Mupirocin and neomycin are more effective than octenidine at MSSA decolonisation. There was poor correlation between the MSSA status after treatment (on day of surgery) and PJI rates. Further research is needed to compare alternative MSSA decolonisation treatments.
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Affiliation(s)
- J Allport
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK.
| | - R Choudhury
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - P Bruce-Wootton
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - M Reed
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - D Tate
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - A Malviya
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
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Kang HM, Park KC, Park J, Park SH, Lee DG, Kim JH. Mupirocin and Chlorhexidine Genotypic Resistance Found in Staphylococcus aureus Isolated From Young Infants Below 90 Days Old: A Genetic Basis for Eradication Failure. Pediatr Infect Dis J 2021; 40:49-54. [PMID: 32925545 DOI: 10.1097/inf.0000000000002882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate the genetic characteristics associated with eradication failure of Staphylococcus aureus in infants below 90 days old. METHODS S. aureus isolated from clinical specimen cultures (blood, surgical tissue, or drainage, pus, etc.) and routine screening cultures in the neonatal intensive care unit (nasal and axillary skin swab) from patients below 90 days old were collected prospectively for 1 year, from August 2017 to July 2018. The isolates underwent typing and screening for genes associated with chlorhexidine (qacA/B), quaternary ammonium (smr), and mupirocin resistance (iles mutation, mupA, mupB), as well as Panton-Valentine leukocidin (PVL) toxin. RESULTS During the study period, 40 nonduplicate isolates were included for analyses, of which 70.0% were methicillin-resistant S. aureus (MRSA). Mupirocin resistance was found in 25% of the total isolates; 17.4% of the colonizers; and 35.3% of the pathogens (P = 0.196). Chlorhexidine resistance gene was found in 3 MRSA isolates colonized in the nares of preterm infants. All isolates harbored the disinfectant quaternary ammonium compound (QAC) resistance gene. PVL toxin gene was found in 57.5%, and the presence of PVL gene among colonizers and pathogens was similar (69.6% vs. 41.2%, P = 0.072). CONCLUSIONS Mupirocin, chlorhexidine, and QAC-resistant MRSAs harboring the PVL toxin gene were found in the nasal carriages of preterm infants. In this highly vulnerable patient population, one-fourth of the isolates harbored mupirocin-resistant genes, and all were resistant to QAC disinfectants. These strains are associated with persistence in both carriage and environmental reservoirs within the hospitals.
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Affiliation(s)
- Hyun Mi Kang
- From the Division of Infectious Diseases, Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Cheol Park
- Clinical Research Institute, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Joonhong Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Hyun Kim
- From the Division of Infectious Diseases, Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Molecular characterization of methicillin-resistant and methicillin-sensitive Staphylococcus aureus isolates from human milk samples in Brazil. Braz J Microbiol 2020; 51:1813-1817. [PMID: 32822004 DOI: 10.1007/s42770-020-00367-1] [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: 05/26/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
Human milk is the best nutrient for infants. The donor human milk is stored in a milk bank before pasteurization. However, the human milk is not sterile and could be colonized with different types of bacteria. Many studies have shown S. aureus to be the most prevalent potential pathogen detected in human milk. This study characterized 22 methicillin-resistant and methicillin-sensitive Staphylococcus aureus isolates from raw human milk for the presence of virulence genes and agr type. Moreover, the genotypic as identified characterization was realized. The presence of virulence genes sei, seg, sec, seh, and etb was identified in resistant and sensitive strains. We observed the predominance of agr type II. The presence of SCCmec IV (67%, 4/6) and V (33%, 2/6) characterized resistant strains as CA-MRSA. Endemic lineages detected (ST1635/CC5-t002, ST5/CC5-t002, ST72/CC5-t126, ST1/CC1-t127, ST45/CC45-t065, and ST398/t1451) could be related to epidemic clones, such as USA800/ST5, USA700/ST72, USA400/ST1, USA600/ST45, and ST398. This study made it possible to understand the characteristics of virulence and clonality of some strains that circulate in breast milk in our region. The discovery of human milk colonization by MSSA and MRSA strains with molecular characteristics similar to infectious clones spread globally demonstrates the importance of monitoring strains that can spread and cause serious infections.
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Lazar HL. Commentary: Compliance with the American Association for Thoracic Surgery guidelines will prevent sternal wound infections and minimize postoperative complications in cardiac surgery patients during the COVID-19 pandemic. J Thorac Cardiovasc Surg 2020; 160:e44-e48. [PMID: 32331816 PMCID: PMC7153516 DOI: 10.1016/j.jtcvs.2020.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Mass.
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Zheng S, Chung SJ, Sim HCJ, Chlebicka TM, Chan YH, Lim TP, Kwa LHA, Chlebicki MP. Impact of formulary interventions on the minimum inhibitory concentration of methicillin-resistant Staphylococcus aureus to mupirocin, chlorhexidine, and octenidine in a Singapore tertiary institution. Eur J Clin Microbiol Infect Dis 2020; 39:2397-2403. [PMID: 32712737 DOI: 10.1007/s10096-020-03995-5] [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: 06/01/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is an effective measure to prevent clinical infection but resistance is a concern. We aim to evaluate the impact of mupirocin (MUP) ointment formulary removal, plateauing use of chlorhexidine gluconate (CHG), and hospital-wide introduction of octenidine (OCT)-based products on the minimum inhibitory concentration (MIC) of MRSA to MUP, CHG, and OCT in our hospital. A prevalence study was conducted at three time points (TP) on consecutive MRSA screening isolates to evaluate for their MICs to MUP, CHG, and OCT using broth microdilution sensititre plates and detection of the ileS-2 gene encoding high-level MUP resistance in 2013 (pre-intervention TP1; n = 160), 2016 (early post-intervention TP2; n = 99) and 2017 (late post-intervention TP3; n = 76). Statistical analyses were performed using Chi square test with reference from TP1. There was a significant improvement in MUP susceptibility (MIC < 4 mcg/ml) from 71.9% (TP1) to 86.9% (TP2; p = 0.006) to 88.2% (TP3; p = 0.007). The prevalence of MUP high-level resistance (MIC > 256 mcg/ml) reduced from 25.0% (TP1) to 12.1% (TP2; p = 0.014) to 5.3% (TP3; p = 0.001). Likewise, the prevalence of isolates harboring the ileS-2 gene decreased from 28.1% (TP1) to 18.2% (TP2; p = 0.072) to 9.2% (TP3; p = 0.002). OCT MIC range remains stable at 0.5 to 1 mcg/ml across all three TPs. The proportion of isolates with reduced CHG susceptibility (MIC ≥ 4 mcg/ml) increased over the three TPs from 23.1 to 27.2% (p = 0.45) to 42.1% (p = 0.003). Active formulary regulations have an impact on the resistance profile of MRSA and can be used as a strategy to preserve the MRSA decolonization armamentarium.
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Affiliation(s)
- Shuwei Zheng
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore.
| | - S J Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - H C J Sim
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - T M Chlebicka
- University of New South Wales, Medicine, Sydney, Australia
| | - Y H Chan
- Biostatistics Unit, National University of Singapore, Singapore, Singapore
| | - T P Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - L H A Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - M P Chlebicki
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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Wangai FK, Masika MM, Maritim MC, Seaton RA. Methicillin-resistant Staphylococcus aureus (MRSA) in East Africa: red alert or red herring? BMC Infect Dis 2019; 19:596. [PMID: 31288757 PMCID: PMC6617662 DOI: 10.1186/s12879-019-4245-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is associated with significant morbidity and mortality and has resultant important economic and societal costs underscoring the need for accurate surveillance. In recent years, prevalence rates reported in East Africa have been inconsistent, sparking controversy and raising concern. METHODS We described antimicrobial susceptibility patterns of Staphylococcus aureus isolates cultured from patients within the Internal Medicine department of the largest public healthcare facility in East and Central Africa- the Kenyatta National Hospital (KNH) in Nairobi, Kenya. Routine antimicrobial susceptibility data from non-duplicate Staphylococcus aureus isolates cultured between the years 2014-2016 from the medical wards in KNH were reviewed. RESULTS Antimicrobial susceptibility data from a total of 187 Staphylococcus aureus isolates revealed an overall MRSA prevalence of 53.4%. Isolates remained highly susceptible to linezolid, tigecycline, teicoplanin and vancomycin. CONCLUSIONS The prevalence of MRSA was found to be much higher than that reported in private tertiary facilities in the same region. Careful interrogation of antimicrobial susceptibility results is important to uproot any red herrings and reserve genuine cause for alarm, as this has a critical bearing on health and economic outcomes for a population.
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Affiliation(s)
- Frederick K Wangai
- Unit of Clinical Infectious Diseases, Department of Clinical Medicine and Therapeutics, School of Medicine, College of Health Sciences-University of Nairobi, P.O. Box 19676, Nairobi, 00202, Kenya.
| | - Moses M Masika
- Department of Microbiology, School of Medicine, College of Health Sciences-University of Nairobi, P.O. Box 19676, Nairobi, 00202, Kenya
| | - Marybeth C Maritim
- Unit of Clinical Infectious Diseases, Department of Clinical Medicine and Therapeutics, School of Medicine, College of Health Sciences-University of Nairobi, P.O. Box 19676, Nairobi, 00202, Kenya
| | - R Andrew Seaton
- Consultant in Infectious Diseases and General Medicine, Antimicrobial Management Team Lead NHS Greater Glasgow and Clyde Health Board, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, United Kingdom
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de Carvalho SP, de Almeida JB, Andrade YMFS, Silva LSCD, Chamon RC, Santos KRND, Marques LM. Molecular characteristics of methicillin-resistant Staphylococcus aureus isolates from hospital and community environments in northeastern Brazil. Braz J Infect Dis 2019; 23:134-138. [PMID: 31103436 PMCID: PMC9425645 DOI: 10.1016/j.bjid.2019.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
Abstract
This study characterized 30 MRSA isolates from intensive care unit (ICU) environment and equipment surfaces and healthy children. The SCCmec types I, IVa and V were detected in HA-MRSA isolates while CA-MRSA showed the SCCmec type IVa and V. Most isolates were classified as agr group II. All isolates presented the sei gene, and only HA-MRSA were positive for etb e tst genes. Three genotypes were related to Pediatric (ST5/SCCmecIV) and Berlin (ST45/SCCmecIV) clones. The present study showed molecular similarity between CA- and HA-MRSA isolates in hospital and community settings in a Brazilian region.
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Affiliation(s)
- Suzi P de Carvalho
- Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Ilhéus, BA, Brazil
| | - Jéssica B de Almeida
- Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Ilhéus, BA, Brazil; Universidade Federal da Bahia, Instituto Multidisciplinar de Saúde, Vitória da Conquista, BA, Brazil
| | - Yasmin M F S Andrade
- Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Ilhéus, BA, Brazil; Universidade Federal da Bahia, Instituto Multidisciplinar de Saúde, Vitória da Conquista, BA, Brazil
| | - Lucas S C da Silva
- Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Ilhéus, BA, Brazil; Universidade Federal da Bahia, Instituto Multidisciplinar de Saúde, Vitória da Conquista, BA, Brazil
| | - Raiane C Chamon
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Rio de Janeiro, RJ, Brazil; Universidade Federal Fluminense, Faculdade de Medicina, Centro de Ciências Médicas, Rio de Janeiro, RJ, Brazil
| | - Kátia R N Dos Santos
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Rio de Janeiro, RJ, Brazil
| | - Lucas M Marques
- Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Ilhéus, BA, Brazil; Universidade Federal da Bahia, Instituto Multidisciplinar de Saúde, Vitória da Conquista, BA, Brazil.
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Damasco AP, Costa TMD, Morgado PGM, Guimarães LC, Cavalcante FS, Nouér SA, Santos KRND. Daptomycin and vancomycin non-susceptible methicillin-resistant Staphylococcus aureus clonal lineages from bloodstream infection in a Brazilian teaching hospital. Braz J Infect Dis 2019; 23:139-142. [PMID: 31028723 PMCID: PMC9425648 DOI: 10.1016/j.bjid.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/24/2019] [Accepted: 03/28/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION This study aimed to characterize Staphylococcus aureus isolates from bloodstream infections in patients attending a teaching hospital, between 2011 and 2015. METHODS The minimum inhibitory concentration for daptomycin, linezolid, oxacillin, teicoplanin, vancomycin, and trimethoprim/sulfamethoxazole was accessed by broth microdilution. SCCmec type and clonal profile were determined by molecular tests. Vancomycin heteroresistance was evaluated using screening tests and by population analysis profile/area under the curve. RESULTS Among 200 S. aureus isolates, 55 (27.5%) were MRSA, carrying SCCmec II (45.5%) or IV (54.5%). The most frequent MRSA lineages were USA100 (ST5-II) (45.5%) and USA800 (ST5-IV) (30.9%). Six isolates were confirmed as vancomycin heteroresistant, showing area under the curve ratio 1.1, 1.2 or 1.3 (four USA100, one USA800 and one USA1100 isolates). CONCLUSIONS Daptomycin and vancomycin non-susceptible MRSA clonal lineages were found in bloodstream infections over five years, highlighting the importance of continuous surveillance of multiresistant bacteria in hospitals.
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Affiliation(s)
- Andreia Paredes Damasco
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Médica, Rio de Janeiro, RJ, Brazil
| | - Thaina Miranda da Costa
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Médica, Rio de Janeiro, RJ, Brazil
| | - Priscylla Guimarães Migueres Morgado
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Médica, Rio de Janeiro, RJ, Brazil
| | - Lorrayne Cardoso Guimarães
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Médica, Rio de Janeiro, RJ, Brazil
| | | | - Simone Aranha Nouér
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brazil
| | - Kátia Regina Netto Dos Santos
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Médica, Rio de Janeiro, RJ, Brazil.
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Antimicrobial Resistance to Agents Used for Staphylococcus aureus Decolonization: Is There a Reason for Concern? Curr Infect Dis Rep 2018; 20:26. [PMID: 29882094 DOI: 10.1007/s11908-018-0630-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Chlorhexidine gluconate (CHG) and mupirocin are increasingly used for Staphylococcus aureus decolonization to prevent healthcare-associated infections; however, increased use of these agents has led to concerns for growing resistance and reduced efficacy. In this review, we describe current understanding of reduced susceptibility to CHG and mupirocin in S. aureus and their potential clinical implications. RECENT FINDINGS While emergence of S. aureus tolerant or resistant to topical antimicrobial agents used for decolonization is well described, the clinical impact of reduced susceptibility is not clear. Important challenges are that standardized methods of resistance testing and interpretation are not established, and the risk for selection for co- or cross-resistance using universal, as opposed to targeted decolonization, is unclear. Evidence continues to support S. aureus decolonization in certain patient groups, although further studies are needed to determine the long-term impact of CHG and mupirocin resistance on efficacy. Strategies to mitigate further development of reduced susceptibility and the consequences of selection pressures through universal decolonization on resistance will benefit from further investigation.
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Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev 2017; 30:827-860. [PMID: 28592405 DOI: 10.1128/cmr.00112-16] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.
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Joachim A, Moyo SJ, Nkinda L, Majigo M, Mmbaga E, Mbembati N, Aboud S, Lyamuya EF. Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Salaam, Tanzania. BMC Res Notes 2017; 10:417. [PMID: 28830510 PMCID: PMC5568238 DOI: 10.1186/s13104-017-2668-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/21/2017] [Indexed: 01/24/2023] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen responsible for hospital and community acquired infection. Colonization with MRSA is associated with a high risk of developing infection. This study aimed to determine the rate of MRSA carriage on admission and the associated risk factors among patients attending regional hospitals, in Dar es Salaam, Tanzania. Results A total of 258 patients were included in this study. Nasal swabs were collected on admission to the hospital and after 48 h of hospital stay for detection of MRSA. Of 258 patients enrolled, 89 (34.5%) were colonized with S. aureus and out them 22 (24.7%) were carriers of MRSA, giving an overall MRSA nasal carriage rate of 8.5% (22/258). One patient acquired MRSA while admitted in the hospital. Most of the S. aureus isolates 85 (95.5%) were resistant to penicillin. Resistance to gentamycin, ciprofloxacin, kanamycin, linezolid and mupirocin were 14.6, 11.2, 11.2, 3.4 and 1.1%, respectively. The prevalence of inducible clindamycin resistance, constitutive clindamycin resistance, MS phenotype (resistance to erythromycin alone), and multidrug resistance was 21.3, 3.4, 12.4, and 16.9%, respectively. We observed a statistically significant association between MRSA and multiple drugs resistance among S. aureus isolates (p = 0.001). Of the risk factors investigated none were statistically significant associated with MRSA. Conclusion There is a high prevalence of MRSA among patients on admission at the two municipal hospitals in Dar es Salaam. The high prevalence of MRSA and the increased rates of resistance to commonly used antimicrobials among MRSA isolates call for attention to the importance of including the screening of MRSA in our hospitals setting in order to prevent further spread of MRSA strains to other patients and to the communities. Control and prevention strategies should be emphasized including decolonization.
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Affiliation(s)
- Agricola Joachim
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
| | - Sabrina J Moyo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lillian Nkinda
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Elia Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Naboth Mbembati
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Eligius F Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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Bessa GR, Quinto VP, Machado DC, Lipnharski C, Weber MB, Bonamigo RR, D'Azevedo PA. Staphylococcus aureus resistance to topical antimicrobials in atopic dermatitis. An Bras Dermatol 2017; 91:604-610. [PMID: 27828633 PMCID: PMC5087218 DOI: 10.1590/abd1806-4841.20164860] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/04/2015] [Indexed: 11/21/2022] Open
Abstract
Background Topical antimicrobial drugs are indicated for limited superficial pyodermitis
treatment, although they are largely used as self-prescribed medication for
a variety of inflammatory dermatoses, including atopic dermatitis.
Monitoring bacterial susceptibility to these drugs is difficult, given the
paucity of laboratory standardization. Objective To evaluate the prevalence of Staphylococcus aureus topical
antimicrobial drug resistance in atopic dermatitis patients. Methods We conducted a cross-sectional study of children and adults diagnosed with
atopic dermatitis and S. aureus colonization. We used
miscellaneous literature reported breakpoints to define S.
aureus resistance to mupirocin, fusidic acid, gentamicin,
neomycin and bacitracin. Results A total of 91 patients were included and 100 S. aureus
isolates were analyzed. All strains were methicillin-susceptible S.
aureus. We found a low prevalence of mupirocin and fusidic acid
resistance (1.1% and 5.9%, respectively), but high levels of neomycin and
bacitracin resistance (42.6% and 100%, respectively). Fusidic acid
resistance was associated with more severe atopic dermatitis, demonstrated
by higher EASI scores (median 17.8 vs 5.7, p=.009). Our results also
corroborate the literature on the absence of cross-resistance between the
aminoglycosides neomycin and gentamicin. Conclusions Our data, in a southern Brazilian sample of AD patients, revealed a low
prevalence of mupirocin and fusidic acid resistance of S.
aureus atopic eczema colonizer strains. However, for neomycin
and bacitracin, which are commonly used topical antimicrobial drugs in
Brazil, high levels of resistance were identified. Further restrictions on
the use of these antimicrobials seem necessary to keep resistance as low as
possible.
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Affiliation(s)
- Giancarlo Rezende Bessa
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brazil.,Universidade Luterana do Brasil (ULBRA) - Canoas (RS), Brazil
| | - Vanessa Petry Quinto
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brazil
| | - Daiane Corrêa Machado
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brazil
| | - Caroline Lipnharski
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brazil
| | - Magda Blessmann Weber
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brazil
| | - Renan Rangel Bonamigo
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brazil
| | - Pedro Alves D'Azevedo
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brazil
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Novel Multiplex PCR Assay for Detection of Chlorhexidine-Quaternary Ammonium, Mupirocin, and Methicillin Resistance Genes, with Simultaneous Discrimination of Staphylococcus aureus from Coagulase-Negative Staphylococci. J Clin Microbiol 2017; 55:1857-1864. [PMID: 28381601 DOI: 10.1128/jcm.02488-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/25/2017] [Indexed: 12/31/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a clinically significant pathogen that is resistant to a wide variety of antibiotics and responsible for a large number of nosocomial infections worldwide. The Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention recently recommended the adoption of universal mupirocin-chlorhexidine decolonization of all admitted intensive care unit patients rather than MRSA screening with targeted treatments, which raises a serious concern about the selection of resistance to mupirocin and chlorhexidine in strains of staphylococci. Thus, a simple, rapid, and reliable approach is paramount in monitoring the prevalence of resistance to these agents. We developed a simple multiplex PCR assay capable of screening Staphylococcus isolates for the presence of antiseptic resistance genes for chlorhexidine and quaternary ammonium compounds, as well as mupirocin and methicillin resistance genes, while simultaneously discriminating S. aureus from coagulase-negative staphylococci (CoNS). The assay incorporates 7 PCR targets, including the Staphylococcus 16S rRNA gene (specifically detecting Staphylococcus spp.), nuc (distinguishing S. aureus from CoNS), mecA (distinguishing MRSA from methicillin-susceptible S. aureus), mupA and mupB (identifying high-level mupirocin resistance), and qac and smr (identifying chlorhexidine and quaternary ammonium resistance). Our assay demonstrated 100% sensitivity, specificity, and accuracy in a total of 23 variant antiseptic- and/or antibiotic-resistant control strains. Further validation of our assay using 378 randomly selected and previously well-characterized local clinical isolates confirmed its feasibility and practicality. This may prove to be a useful tool for multidrug-resistant Staphylococcus monitoring in clinical laboratories, particularly in the wake of increased chlorhexidine and mupirocin treatments.
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15
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Humphreys H, Becker K, Dohmen P, Petrosillo N, Spencer M, van Rijen M, Wechsler-Fördös A, Pujol M, Dubouix A, Garau J. Staphylococcus aureus and surgical site infections: benefits of screening and decolonization before surgery. J Hosp Infect 2016; 94:295-304. [DOI: 10.1016/j.jhin.2016.06.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/06/2016] [Indexed: 12/13/2022]
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16
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Epidemiology and microbiological characterization of clinical isolates of Staphylococcus aureus in a single healthcare region of the UK, 2015. Epidemiol Infect 2016; 145:386-396. [DOI: 10.1017/s0950268816002387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARYWe investigated the epidemiology and characterization of isolates of Staphylococcus aureus within the Yorkshire and Humber (YH) region in the UK. In July 2015, each laboratory within YH (n = 14) was assigned two consecutive days during which all clinical isolates of S. aureus were collected. Isolates were tested for antibiotic susceptibilities and the presence of genes encoding methicillin resistance (mecA and mecC), Panton–Valentine leukocidin (PVL) (lukS-PV), and efflux-mediated chlorhexidine resistance (qacA); isolates were also characterized by spa-types. Minimum inhibitory concentrations (MICs) to chlorhexidine were determined by the broth dilution method. Of 520 isolates collected, 6·2% were methicillin-resistant S. aureus (MRSA, all mecA-positive) and mupirocin resistance was low [0·8%, 95% confidence interval (CI) 0·3–2·0] and only found in MRSA. Carriage of the qacA gene was identified in 1·7% (95% CI 0·8–3·3) of isolates and 3·5% (95% CI 2·2–5·4) had a chlorhexidine MIC of 4 mg/l. The PVL gene was infrequent (3·7%, 95% CI 2·4–5·6). Genotyping identified 234 spa-types that mapped to 22 clonal complexes. Comparison of these current data with previous work suggest that the widespread use of staphylococcal decolonization regimens over the past decade or more has not had an adverse impact on resistance rates, PVL carriage or the prevalence of specific S. aureus lineages.
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da Costa TM, Morgado PGM, Cavalcante FS, Damasco AP, Nouér SA, dos Santos KRN. Clinical and Microbiological Characteristics of Heteroresistant and Vancomycin-Intermediate Staphylococcus aureus from Bloodstream Infections in a Brazilian Teaching Hospital. PLoS One 2016; 11:e0160506. [PMID: 27575698 PMCID: PMC5004871 DOI: 10.1371/journal.pone.0160506] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/20/2016] [Indexed: 01/11/2023] Open
Abstract
This study analyzed clinical and microbiological characteristics of heteroresistant (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA) from bloodstream infections (BSI) in a Brazilian teaching hospital, between 2011 and 2013. Minimum inhibitory concentrations (MIC) of antimicrobials were determined by broth microdilution method and SCCmec was detected by PCR. Isolates with a vancomycin MIC ≥ 2mg/L were cultured on BHI agar with 3, 4 or 6 mg/L (BHIa3, BHIa4 or BHIa6) of vancomycin and BHIa4 with casein (BHIa4ca). Macromethod Etest® and Etest® Glicopeptides Resistance Detection were also used. VISA and hVISA isolates were confirmed by the population analysis profile then typed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. Medical data from the patients were obtained from their medical records. Among 110 consecutive isolates, 31 (28%) were MRSA and carried the SCCmec type II (15 isolates) or IV (16 isolates). Vancomycin MIC50 and MIC90 were 1 and 2 mg/L, respectively. MRSA isolates had increased non-susceptibility to daptomycin (p = 0.0003). Six (5%) isolates were VISA, four of which were MRSA, three SCCmec type II/USA100/ST5 and one type IV/USA800/ST3192. One MRSA SCCmec II isolate grew on agar BHIa3, BHIa4 and BHIa4ca, and it was confirmed as hVISA. Among the six VISA isolates, five (83%) grew on BHIa3 and three (50%) on BHI4ca. Four of the six VISA isolates and the one hVISA isolate were from patients who had undergone dialysis. Thus, a possible dissemination of the SCCmec II/USA100/ST5 lineage may have occurred in the hospital comprising the VISA, hVISA and daptomycin non-susceptible S. aureus Brazilian isolates from health care associated bloodstream infections.
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Affiliation(s)
- Thaina Miranda da Costa
- Laboratório de Infecção Hospitalar, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Priscylla Guimarães Migueres Morgado
- Laboratório de Infecção Hospitalar, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Sampaio Cavalcante
- Laboratório de Infecção Hospitalar, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreia Paredes Damasco
- Laboratório de Infecção Hospitalar, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone Aranha Nouér
- Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kátia Regina Netto dos Santos
- Laboratório de Infecção Hospitalar, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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18
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Hetem DJ, Bootsma MCJ, Bonten MJM. Prevention of Surgical Site Infections: Decontamination With Mupirocin Based on Preoperative Screening for Staphylococcus aureus Carriers or Universal Decontamination? Clin Infect Dis 2015; 62:631-6. [PMID: 26658054 DOI: 10.1093/cid/civ990] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/24/2015] [Indexed: 02/01/2023] Open
Abstract
Perioperative decolonization of Staphylococcus aureus nasal carriers with mupirocin together with chlorhexidine body washing reduces the incidence of S. aureus surgical site infection. A targeted strategy, applied in S. aureus carriers only, is costly, and implementation may reduce effectiveness. Universal decolonization is more cost-effective but increases exposure of noncarriers to mupirocin and the risk of resistance to mupirocin in staphylococci. High-level mupirocin resistance in S. aureus can emerge through horizontal gene transfer originating from coagulase-negative staphylococci (CoNS) and through clonal transmission. The current evidence on the occurrence of high-level mupirocin resistance in S. aureus and CoNS, in combination with the results of mathematical modeling, strongly suggests that the increased selection of high-level mupirocin resistance in CoNS does not constitute an important risk for high-level mupirocin resistance in S. aureus. Compared with a targeted strategy, universal decolonization seems associated with an equally low risk of mupirocin resistance in S. aureus.
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Affiliation(s)
| | - Martin C J Bootsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht Department of Mathematics, Utrecht University, The Netherlands
| | - Marc J M Bonten
- Department of Clinical Microbiology Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
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19
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Chamon RC, Iorio NLP, da Silva Ribeiro S, Cavalcante FS, Dos Santos KRN. Molecular characterization of Staphylococcus aureus isolates carrying the Panton-Valentine leukocidin genes from Rio de Janeiro hospitals. Diagn Microbiol Infect Dis 2015; 83:331-4. [PMID: 26431830 DOI: 10.1016/j.diagmicrobio.2015.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/22/2015] [Accepted: 09/06/2015] [Indexed: 01/05/2023]
Abstract
In a collection of 50 pvl-positive Staphylococcus aureus isolates from 10 Rio de Janeiro hospitals, 18 (36%) were from bloodstream infections, and 31 (62%) carried the SCCmec IV. Among 25 (50%) isolates of the USA1100/ST30/CC30 lineage present in 8 hospitals, 1 isolate was characterized as vancomycin-intermediate S. aureus.
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Affiliation(s)
- Raiane Cardoso Chamon
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Natalia Lopes Pontes Iorio
- Departamento de Ciências Básicas, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil
| | - Sthefanie da Silva Ribeiro
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
PURPOSE OF REVIEW To describe the latest evidence for methicillin-resistant Staphylococcus aureus (MRSA) infection control strategies, with particular emphasis on active surveillance cultures with contact precautions and targeted decolonization, and their impact. RECENT FINDINGS Several major trials published last year questioned the effectiveness of universal screening and contact precautions in controlling MRSA. These trials generally recommend universal decolonization as part of bundles to control MRSA, especially in ICUs, with some even concluding that universal decolonization should replace active screening and contact precautions. However, emerging resistance to agents used for decolonization, such as mupirocin and chlorhexidine, is a major concern. Several other studies confirmed a combination of hand hygiene enhancement, screening, contact precaution and targeted decolonization as a more viable MRSA infection control strategy for specific population groups. SUMMARY Universal decolonization is an acceptable MRSA control strategy for intensive care units; however, close monitoring of chlorhexidine and mupirocin resistance is warranted. As a strategy, screening and contact precautions are suitable for hospital-wide MRSA control. Targeted decolonization is a proven measure for patients undergoing clean surgery. Enhancement of hand hygiene is a core measure regardless of the strategy.
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21
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Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA. J Antimicrob Chemother 2015; 70:2681-92. [DOI: 10.1093/jac/dkv169] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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22
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Linezolid-resistant Staphylococcus haemolyticus and Staphylococcus hominis: single and double mutations at the domain V of 23S rRNA among isolates from a Rio de Janeiro hospital. Diagn Microbiol Infect Dis 2014; 80:307-10. [PMID: 25294302 DOI: 10.1016/j.diagmicrobio.2014.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/19/2014] [Accepted: 09/12/2014] [Indexed: 11/21/2022]
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23
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Camus C, Sebille V, Legras A, Garo B, Renault A, Le Corre P, Donnio PY, Gacouin A, Perrotin D, Le Tulzo Y, Bellissant E. Mupirocin/chlorexidine to prevent methicillin-resistant Staphylococcus aureus infections: post hoc analysis of a placebo-controlled, randomized trial using mupirocin/chlorhexidine and polymyxin/tobramycin for the prevention of acquired infections in intubated patients. Infection 2014; 42:493-502. [PMID: 24464791 DOI: 10.1007/s15010-013-0581-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The reduction in acquired infections (AI) due to methicillin-resistant Staphylococcus aureus (MRSA) with the mupirocin/chlorhexidine (M/C) decontamination regimen has not been well studied in intubated patients. We performed post hoc analysis of a prior trial to assess the impact of M/C on MRSA AI and colonization. METHODS We conducted a multicenter, placebo-controlled, randomized, double-blind study with the primary aim to reduce all-cause AI. The two regimens used [topical polymyxin and tobramycin (P/T), nasal mupirocin with chlorhexidine body wash (M/C), or corresponding placebos for each regimen] were administered according to a 2 × 2 factorial design. Participants were intubated patients in the intensive care units of three French university hospitals. The patients enrolled in the study (n = 515) received either active P/T (n = 130), active M/C (n = 130), both active regimens (n = 129), or placebos only (n = 126) for the period of intubation and an additional 24 h. The incidence and incidence rates (per 1,000 study days) of MRSA AI were assessed. Due to the absence of a statistically significant interaction between the two regimens, analysis was performed at the margins by comparing all patient receiving M/C (n = 259) to all patients not receiving M/C (n = 256), and all patients receiving P/T (n = 259) to all patients not receiving P/T (n = 256). RESULTS Incidence [odds ratio (OR) 0.39, 95 % confidence interval (CI) (0.16-0.96), P = 0.04] and incidence rates [incidence rate ratio (IRR) 0.41, 95 % CI 0.17-0.97, P = 0.05] of MRSA AI were significantly lower with the use of M/C. We also observed an increase in the incidence (OR 2.50, 95 % CI 1.01-6.15, P = 0.05) and the incidence rate (IRR 2.90, 95 % CI 1.20-8.03, P = 0.03) of MRSA AI with the use of P/T. CONCLUSION Among our study cohort of intubated patients, the use of M/C significantly reduced MRSA AI.
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Affiliation(s)
- C Camus
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, Centre Hospitalier Universitaire (CHU) de Rennes, Université de Rennes 1, 2 rue Henri Le Guilloux, 35033, Rennes cedex, France,
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Cavalcante FS, Schuenck RP, Ferreira DC, da Costa CR, Nouér SA, dos Santos KRN. Meticillin-resistant Staphylococcus aureus: spread of specific lineages among patients in different wards at a Brazilian teaching hospital. J Hosp Infect 2013; 86:151-4. [PMID: 24433925 DOI: 10.1016/j.jhin.2013.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 12/04/2013] [Indexed: 11/17/2022]
Abstract
This study aimed to characterize meticillin-resistant Staphylococcus aureus (MRSA) lineages circulating in a Brazilian teaching hospital. MRSA isolates from nasal swabs were evaluated to assess antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec), Panton-Valentine leucocidin status, pulsed-field gel electrophoresis profile and multi-locus sequence type (MLST) analysis. Eighty-three MRSA isolates were analysed. SCCmec III (43.4%) and IV (49.4%) were predominant. ST1-IV (USA400) was more common in internal medicine (P = 0.002) whereas 'clone M' (SCCmec III) was more common in the medical and surgical intensive care unit (P = 0.004), and all isolates were ST5-IV (USA800) in dermatology (P < 0.001). These data improved the understanding of the MRSA epidemiology inside the hospital and helped to establish effective control measures.
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Affiliation(s)
- F S Cavalcante
- Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R P Schuenck
- Departamento de Patologia, Universidade Federal do Espirito Santo, Espirito Santo, Brazil
| | - D C Ferreira
- Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C R da Costa
- Hospital Universitário Clementino Fraga Filho e Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - S A Nouér
- Hospital Universitário Clementino Fraga Filho e Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - K R N dos Santos
- Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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25
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Hetem D, Bonten M. Clinical relevance of mupirocin resistance in Staphylococcus aureus. J Hosp Infect 2013; 85:249-56. [DOI: 10.1016/j.jhin.2013.09.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/01/2013] [Indexed: 10/26/2022]
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26
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Gottrup F, Apelqvist J, Bjarnsholt T, Cooper R, Moore Z, Peters E, Probst S. EWMA Document: Antimicrobials and Non-healing Wounds: Evidence, controversies and suggestions. J Wound Care 2013; 22:S1-89. [DOI: 10.12968/jowc.2013.22.sup5.s1] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- F Gottrup
- Professor of Surgery, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Apelqvist
- Senior Consultant, Associate Professor, Skåne University Hospital, Malmö, Sweden
| | - T Bjarnsholt
- Associate Professor, University of Copenhagen and Copenhagen University Hospital, Copenhagen, Denmark
| | - R Cooper
- Professor of Microbiology, Cardiff Metropolitan University, Cardiff, Wales, United Kingdom
| | - Z Moore
- Lecturer in Wound Healing & Tissue Repair, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E.J.G. Peters
- Internist- Infectious Diseases Specialist, VU University Medical Center, Amsterdam, the Netherlands
| | - S Probst
- Lecturer, Zurich University of Applied Sciences, Winterthur, Switzerland
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27
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Methicillin-resistant Staphylococcus aureus in Rio de Janeiro hospitals: dissemination of the USA400/ST1 and USA800/ST5 SCCmec type IV and USA100/ST5 SCCmec type II lineages in a public institution and polyclonal presence in a private one. Am J Infect Control 2013; 41:e21-6. [PMID: 23261682 DOI: 10.1016/j.ajic.2012.08.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) infections have changed since certain non-multiresistant MRSA lineages have emerged in hospitals. In this study, 99 MRSA isolates, 77 from a public and 22 from a private hospital, were characterized. METHODS Isolates were tested for antimicrobial susceptibility, whereas staphylococcal chromosomal cassette mec (SCCmec) typing and Panton-Valentine leukocidin genes were assessed by polymerase chain reaction. Pulsed-field gel electrophoresis and multilocus sequence typing analyses were carried out to determine the MRSA lineages. RESULTS High rates of resistance were found to erythromycin (96%), ciprofloxacin (93%), and clindamycin (90%). The SCCmec types found were as follows: type II (14.2%), III (62.6%), and IV (23.2%). Approximately 85% of type III isolates was related to the Brazilian epidemic clone in both hospitals. For type IV isolates, 94.4% were related to both USA400/ sequence type (ST) 1 and USA800/ST5 lineages in the public hospital, whereas the USA400/ST1, USA800/ST5, USA1100/ST30, and EMRSA (Epidemic MRSA)-15/ST22 lineages were detected in the private hospital. Among the SCCmec II isolates, approximately 85% were related to the USA100/ST5 lineage. Three MRSA isolates were positive to Panton-Valentine leukocidin genes. CONCLUSION The study showed that there was an emergence of USA400/ST1, USA800/ST5 SCCmec IV, and USA100/ST5 SCCmec II MRSA lineages in both hospitals. There was a dissemination of them in the public hospital and a polyclonal presence of the MRSA isolates in the private hospital. The spread of these lineages can be facilitated by the characteristics of the health institution.
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Rossi AM, Mariwalla K. Prophylactic and Empiric Use of Antibiotics in Dermatologic Surgery: A Review of the Literature and Practical Considerations. Dermatol Surg 2012; 38:1898-921. [DOI: 10.1111/j.1524-4725.2012.02524.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Staphylococcus haemolyticus as an important hospital pathogen and carrier of methicillin resistance genes. J Clin Microbiol 2011; 50:166-8. [PMID: 21976766 DOI: 10.1128/jcm.05563-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Phenotypic and molecular methods were used to characterize the antibiotic resistance of 64 clinical isolates of Staphylococcus haemolyticus. By PCR of the mecA gene, 87% were found to be methicillin resistant. Approximately 55% harbored staphylococcal cassette chromosome mec element (SCCmec) type V, and only one SCCmec type IV. Many isolates (75%) displayed multiresistance, and pulsotype analysis showed a high diversity.
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Talon D, Marion C, Thouverez M, Bertrand X. Mupirocin resistance is not an inevitable consequence of mupirocin use. J Hosp Infect 2011; 79:366-7. [PMID: 21968283 DOI: 10.1016/j.jhin.2011.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 08/05/2011] [Indexed: 11/30/2022]
Abstract
The rate of mupirocin resistance in meticillin-resistant Staphylococcus aureus (MRSA) in Besançon University Hospital is low with a decreasing trend, from 10% in 2004 to 3% in 2009. This trend in resistance paralleled mupirocin consumption. Genotyping results showed that this decrease was not linked to a change in MRSA clones. It appears that the way in which the mupirocin is used, rather than the volume, plays a role in the emergence of resistance and that its cautious use is likely to maintain the mupirocin resistance at a low level, thus preserving its efficacy.
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Affiliation(s)
- D Talon
- Service d'Hygiène Hospitalière Centre Hospitalier Universitaire Besançon, Besançon, France
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31
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Lee AS, Macedo-Vinas M, François P, Renzi G, Schrenzel J, Vernaz N, Pittet D, Harbarth S. Impact of Combined Low-Level Mupirocin and Genotypic Chlorhexidine Resistance on Persistent Methicillin-Resistant Staphylococcus aureus Carriage After Decolonization Therapy: A Case-control Study. Clin Infect Dis 2011; 52:1422-30. [DOI: 10.1093/cid/cir233] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee AS, Macedo-Vinas M, François P, Renzi G, Vernaz N, Schrenzel J, Pittet D, Harbarth S. Trends in mupirocin resistance in meticillin-resistant Staphylococcus aureus and mupirocin consumption at a tertiary care hospital. J Hosp Infect 2011; 77:360-2. [PMID: 21276638 DOI: 10.1016/j.jhin.2010.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 11/17/2010] [Indexed: 11/19/2022]
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do Carmo Ferreira N, Schuenck RP, dos Santos KRN, de Freire Bastos MDC, Giambiagi-deMarval M. Diversity of plasmids and transmission of high-level mupirocin mupA resistance gene in Staphylococcus haemolyticus. ACTA ACUST UNITED AC 2010; 61:147-52. [PMID: 21182545 DOI: 10.1111/j.1574-695x.2010.00756.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The coagulase-negative staphylococci are known for their ability to acquire resistance genes, which limits the choice of therapeutic options for the treatment of infections caused by these microorganisms. In this study, the diversity of high-level mupirocin resistance plasmids (Mup(R) ) was investigated in four strains of Staphylococcus haemolyticus belonging to different pulsed-field gel electrophoresis (PFGE) types or subtypes, isolated in a Brazilian hospital. These strains harbor the mupA gene in large plasmids. In addition, the presence of IS257 sequences flanking the mupA gene was also shown. Two isolates belonging to two different PFGE types exhibited a similar polymorphism for a fragment of the mupA gene and the closest proximal flanking copies of the IS257, suggesting horizontal transmission of S. haemolyticus mupirocin resistance plasmids in the environment and a role of this species as a reservoir of the mupA gene.
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Affiliation(s)
- Natália do Carmo Ferreira
- Departamento de Microbiologia Médica, Instituto de Microbiologia Prof. Paulo de Góes, Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, RJ, Brazil
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Investigation of the potential for mutational resistance to XF-73, retapamulin, mupirocin, fusidic acid, daptomycin, and vancomycin in methicillin-resistant Staphylococcus aureus isolates during a 55-passage study. Antimicrob Agents Chemother 2010; 55:1177-81. [PMID: 21149626 DOI: 10.1128/aac.01285-10] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
XF-73 is a dicationic porphyrin drug with rapid Gram-positive antibacterial activity currently undergoing clinical trials for the nasal decolonization of Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA). In multistep (55-passage) resistance selection studies in the presence of subinhibitory concentrations of XF-73, retapamulin, mupirocin, fusidic acid, and vancomycin against four Network on Antimicrobial Resistance in Staphylococcus aureus MRSA strains, there was no >4-fold increase in the MIC for XF-73 after 55 passages. In contrast, there was an increase in the MICs for retapamulin (from 0.25 μg/ml to 4 to 8 μg/ml), for mupirocin (from 0.12 μg/ml to 16 to 512 μg/ml), for fusidic acid (from 0.12 μg/ml to 256 μg/ml), and for vancomycin (from 1 μg/ml to 8 μg/ml in two of the four strains tested). Further investigations using S. aureus NRS384 (USA300) and daptomycin demonstrated a 64-fold increase in the MIC after 55 passages (from 0.5 μg/ml to 32 μg/ml) with a >4-fold increase in the MIC obtained after only five passages. Sequencing analysis of selected isolates confirmed previously reported point mutations associated with daptomycin resistance. No cross-resistance to XF-73 was observed with the daptomycin-resistant strains, suggesting that whereas the two drugs act on the bacterial cell membrane, their specific site of action differs. XF-73 thus represents the first in a new class of antibacterial drugs, which (unlike the comparator antibiotics) after 55 passages exhibited a ≤4-fold increase in MIC against the strains tested. Antibacterial drugs with a low propensity for inducing bacterial resistance are much needed for the prevention and treatment of multidrug-resistant bacteria both within and outside the hospital setting.
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Pereira EM, Oliveira FL, Schuenck RP, Zoletti GO, dos Santos KR. Detection ofStaphylococcus lugdunensisby a new species-specific PCR based on thefblgene. ACTA ACUST UNITED AC 2010; 58:295-8. [DOI: 10.1111/j.1574-695x.2009.00626.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Silva HDA, Pereira EM, Schuenck RP, Pinto RC, Abdallah VO, Santos KRN, Gontijo-Filho PP. Molecular surveillance of methicillin-susceptible Staphylococcus aureus at a neonatal intensive care unit in Brazil. Am J Infect Control 2009; 37:574-9. [PMID: 19181427 DOI: 10.1016/j.ajic.2008.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 09/30/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND We evaluated the relationship among hospital infection and colonization by methicillin-susceptible Staphylococcus aureus (MSSA), clonal spread, and associated risk factors in a neonatal intensive care unit (NICU) of the Uberlândia Federal University-affiliated hospital in Brazil. METHODS Between February 2004 and June 2005, a longitudinal surveillance study was carried out in an NICU with neonates presenting infections, through both the NNIS system and S aureus punctual colonization prevalence inquests. RESULTS The overall rate of infection incidence was 23/1000 patient-days. Of all the neonates assessed, 15 were infected and 15 colonized. Sepsis was the most frequent infection, whereas anterior nare was the most isolated site. Antibiotics use, central vascular catheter (CVC), and CVC use more than 7 days and its insertion by phlebotomy were the risk factors for colonization/infection. Molecular analysis showed polyclonal origin (12 genotypes), with predominance of a genotype ("B"), and clonal identity between colonization and infection samples. CONCLUSION The analysis by means of classical epidemiology and molecular techniques pointed out that methicillin-susceptible Staphylococcus aureus infections were associated with previous colonization by the pathogen, with evidence of horizontal transmission within the unit.
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Schuenck RP, Nouér SA, de Oliveira Winter C, Cavalcante FS, Scotti TD, Ferreira ALP, Giambiagi-de Marval M, Netto dos Santos KR. Polyclonal presence of non-multiresistant methicillin-resistant Staphylococcus aureus isolates carrying SCCmec IV in health care-associated infections in a hospital in Rio de Janeiro, Brazil. Diagn Microbiol Infect Dis 2009; 64:434-41. [DOI: 10.1016/j.diagmicrobio.2009.04.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 03/30/2009] [Accepted: 04/11/2009] [Indexed: 10/20/2022]
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Gould FK, Brindle R, Chadwick PR, Fraise AP, Hill S, Nathwani D, Ridgway GL, Spry MJ, Warren RE. Guidelines (2008) for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United Kingdom. J Antimicrob Chemother 2009; 63:849-61. [DOI: 10.1093/jac/dkp065] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Jones JC, Rogers TJ, Brookmeyer P, Dunne WM, Storch GA, Coopersmith CM, Fraser VJ, Warren DK. Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin Infect Dis 2007; 45:541-7. [PMID: 17682986 DOI: 10.1086/520663] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 05/23/2007] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) can be a precursor to serious infection, and decolonization with topical mupirocin has been studied as a means of preventing clinical infection. Mupirocin resistance in patients with MRSA has been reported, usually in the context of widespread mupirocin use. METHODS Patients admitted to a surgical intensive care unit (SICU) had nasal swab cultures for MRSA performed at admission, weekly, and at discharge in an active surveillance program. Collected MRSA isolates were tested for mupirocin resistance, and molecular analysis was performed. Clinical data on the characteristics and outcomes of the patients who stayed in the SICU for >48 h were collected prospectively. RESULTS Of the 302 MRSA isolates available for testing, 13.2% were resistant to mupirocin, with 8.6% having high-level resistance (minimum inhibitory concentration, >or=512 microg/mL) and 4.6% having low-level resistance (minimum inhibitory concentration, 8-256 microg/mL). Patients admitted to the SICU for >48 h who were colonized with mupirocin-resistant MRSA were more likely to have been admitted to our hospital during the previous year (P=.016), were older (P=.009), and had higher in-hospital mortality (16% vs. 33%; P=.027), compared with patients colonized with mupirocin-susceptible MRSA. Molecular analysis of the mupirocin-resistant isolates revealed that 72.5% of isolates contained staphylococcal cassette chromosome mec II. Repetitive sequence polymerase chain reaction typing revealed that high-level mupirocin resistance was present in multiple clonal groups. The rate of mupirocin use hospital-wide during the study period was 6.08 treatment-days per 1000 patient-days. CONCLUSIONS We documented a high rate of mupirocin resistance in MRSA isolates from SICU patients, despite low levels of in-hospital mupirocin use.
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Affiliation(s)
- Jeffrey C Jones
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Ochsner UA, Sun X, Jarvis T, Critchley I, Janjic N. Aminoacyl-tRNA synthetases: essential and still promising targets for new anti-infective agents. Expert Opin Investig Drugs 2007; 16:573-93. [PMID: 17461733 DOI: 10.1517/13543784.16.5.573] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The emergence of resistance to existing antibiotics demands the development of novel antimicrobial agents directed against novel targets. Historically, bacterial cell wall synthesis, protein, and DNA and RNA synthesis have been major targets of very successful classes of antibiotics such as beta-lactams, glycopeptides, macrolides, aminoglycosides, tetracyclines, rifampicins and quinolones. Recently, efforts have been made to develop novel agents against validated targets in these pathways but also against new, previously unexploited targets. The era of genomics has provided insights into novel targets in microbial pathogens. Among the less exploited--but still promising--targets is the family of 20 aminoacyl-tRNA synthetases (aaRSs), which are essential for protein synthesis. These targets have been validated in nature as aaRS inhibition has been shown as the specific mode of action for many natural antimicrobial agents synthesized by bacteria and fungi. Therefore, aaRSs have the potential to be targeted by novel agents either from synthetic or natural sources to yield specific and selective anti-infectives. Numerous high-throughput screening programs aimed at identifying aaRS inhibitors have been performed over the last 20 years. A large number of promising lead compounds have been identified but only a few agents have moved forward into clinical development. This review provides an update on the present strategies to develop novel aaRS inhibitors as anti-infective drugs.
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Affiliation(s)
- Urs A Ochsner
- Replidyne, Inc., 1450 Infinite Dr, Louisville, CO 80027, USA.
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Méan M, Mallaret MR, Andrini P, Recule C, Debillon T, Pavese P, Croizé J. A neonatal specialist with recurrent methicillin-resistant Staphylococcus aureus (MRSA) carriage implicated in the transmission of MRSA to newborns. Infect Control Hosp Epidemiol 2007; 28:625-8. [PMID: 17464930 DOI: 10.1086/513616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 08/08/2006] [Indexed: 11/04/2022]
Abstract
This study reports an investigation of outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization involving 17 newborns in the neonatal unit of a teaching hospital. A neonatal specialist colonized with MRSA that eventually became mupirocin-resistant was implicated as a recurrent source of transmission of MRSA to newborns.
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Affiliation(s)
- M Méan
- Unité d'Hygiène Hospitalière, Département de veille sanitaire, Centre Hospitalier Universitaire de Grenoble, BP217, 38043. Grenoble Cedex 9
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Falagas ME, Bliziotis IA, Fragoulis KN. Oral rifampin for eradication of Staphylococcus aureus carriage from healthy and sick populations: a systematic review of the evidence from comparative trials. Am J Infect Control 2007; 35:106-14. [PMID: 17327190 DOI: 10.1016/j.ajic.2006.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 09/01/2006] [Accepted: 09/06/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rifampin has been used for the eradication of Staphylococcus aureus (S. aureus) colonization in various populations of healthy and sick people. METHODS We performed a systematic review of the evidence from randomized and nonrandomized controlled trials that compared the effectiveness and safety of a rifampin-based regimen with another regimen in eradicating S. aureus colonization from healthy and sick people. RESULTS Nine comparative trials (6 of which were randomized controlled trials) were included in our analysis. S. aureus was eradicated more commonly in patients receiving rifampin-containing regimens compared to monotherapy with other systemic agents (ciprofloxacin, cloxacillin, minocycline, or vancomycin), both during early and late (>1 month after therapy) post treatment evaluations (odds ratio [OR] 46.2, 95% confidence interval [CI] 14.4-148, and OR 8.8, 95% CI 3.4-22.5 respectively, 4 studies included). There was no statistically significant difference between rifampin monotherapy and combinations of rifampin with other topical (bacitracin) or systemic (cloxacillin and minocycline) antibiotics in eradicating S. aureus both in early and late evaluations (OR 1.5, 95% CI 0.5-4.4, and OR 1.6, 95% CI 0.7-3.7, respectively, 3 studies included). Eradication of methicillin-resistant S. aureus (MRSA) varied according to the type and duration of the rifampin-containing regimen. It ranged from 25% for the combination of rifampin with trimethoprim/sulfamethoxazole for 5 days to 100% for the combination of oral rifampin and minocycline for 14 days. Discontinuation of rifampin due to drug-related toxicity was necessary in 2% of 282 studied patients. Development of resistance of S. aureus to rifampin during and after treatment with a regimen containing rifampin ranged from 0% to 40% (7 studies) and overall 17% of the 236 patients for whom relevant data was reported. CONCLUSION The available evidence suggests that oral rifampin is an effective agent for the eradication of S. aureus carriage. However, development of antimicrobial resistance during and after treatment with rifampin occurs in a considerable proportion of patients; using rifampin in combination with another antimicrobial agent may decrease this resistance.
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Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
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Vivoni AM, Diep BA, de Gouveia Magalhães AC, Santos KRN, Riley LW, Sensabaugh GF, Moreira BM. Clonal composition of Staphylococcus aureus isolates at a Brazilian university hospital: identification of international circulating lineages. J Clin Microbiol 2006; 44:1686-91. [PMID: 16672394 PMCID: PMC1479203 DOI: 10.1128/jcm.44.5.1686-1691.2006] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In only a few instances has the clonal composition of Staphylococcus aureus collections that include methicillin-susceptible S. aureus (MSSA) been extensively characterized. In order to investigate the clonal composition of MSSA and methicillin-resistant S. aureus (MRSA) and examine whether the infections diagnosed at our hospital were related to internationally distributed S. aureus lineages, we collected 89 clinical S. aureus isolates from patients at a public university hospital in Rio de Janeiro, Brazil, from September 1999 to June 2000. All S. aureus isolates were genotyped by pulsed-field gel electrophoresis and multilocus restriction fragment typing (MLRFT), and a subset (n = 17) was further characterized by multilocus sequence typing (MLST). The 34 MRSA isolates were additionally characterized by SCCmec typing. The MSSA population (n = 55) was grouped into 18 restriction fragment types (RFTs); of these, five RFTs accounted for 67% (37) of the MSSA isolates. MRSA isolates were clustered into only three RFTs (P = 0.02). The majority of MSSA RFTs were related to sequence type 30 (ST30) (12 isolates, 22%), ST1, ST188, and ST432 (6 isolates, 11% each). The predominant MRSA RFT comprised 31 (91%) of 34 isolates; four randomly selected isolates of this RFT were ST239, the previously described widely disseminated Brazilian clone. However, a fifth isolate belonging to this RFT was the ST644, a new single locus variant of ST239. By applying MLRFT and MLST, we found evidence for a clonal structure in MSSA isolates and detected the dissemination of MSSA clonal complexes 1, 5, 8, 30, and 45.
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Affiliation(s)
- Adriana Marcos Vivoni
- Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Falagas ME, Fragoulis KN, Bliziotis IA. Oral rifampin for prevention of S. aureus carriage-related infections in patients with renal failure--a meta-analysis of randomized controlled trials. Nephrol Dial Transplant 2006; 21:2536-42. [PMID: 16705024 DOI: 10.1093/ndt/gfl235] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rifampin has been studied as prophylaxis against Staphylococcus aureus-related infections in patients on dialysis. METHODS We performed a meta-analysis of randomized controlled trials (RCTs) that compared the effectiveness and safety of oral rifampin with another regimen or no therapy in reducing S. aureus-related infections in dialysis patients. RESULTS Four RCTs evaluated oral rifampin (administered for 5 days every 3 months, or for 5 days once) as prophylaxis in dialysis patients. Oral rifampin with or without bacitracin was associated with less access-site infections with S. aureus compared with no treatment (odds ratio = 0.16, 95% confidence intervals: 0.06-0.44, 3 RCTs). There was no difference between prophylaxis with oral rifampin and topical mupirocin applied at the catheter site, for all studied outcomes, in the RCT comparing these regimens. Withdrawal from the study due to drug-related toxicity occurred in 7/107 (6.6%) of the studied patients with renal failure. Development of resistance of S. aureus to rifampin ranged from 0 to 18.2% (reported in three out of four included RCTs). CONCLUSION Prophylactic use of oral rifampin reduces access-site infections with S. aureus in patients with renal failure undergoing dialysis. However, development of toxicity and antimicrobial resistance during the treatment with rifampin occur in considerable proportions of patients, limiting its use and supporting the guidelines that recommend the use of local antibiotics at the exit site, such as mupirocin, for these indications. The available data are rather limited and more studies should be performed to examine this important clinical question.
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Johnston BL, Conly JM. Central venous catheter-associated bloodstream infections in hemodialysis patients: Another patient safety bundle? THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2006; 17:99-102. [PMID: 18418482 PMCID: PMC2095061 DOI: 10.1155/2006/674670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In a previous issue ofThe Canadian Journal of Infectious Diseases & Medical Microbiology, we reviewed the 'Safer Healthcare Now!' campaign's focus on reducing central venous catheter (CVC)-associated bloodstream infections (BSIs) as a way of improving patient safety (1). This initiative is focused on preventing CVC-associated BSIs in intensive care units. However, other patient groups are also at risk for CVC-related BSIs, suggesting that there are other individuals who would benefit from preventive efforts. A 1996 hospital-wide survey of nosocomial bacteremia in an Israeli university hospital (2) found that 9% of infected patients were on chronic hemodialysis. Surveillance in 73 hospitals in England between 1997 and 2001 found a CVC BSI rate of 21/1000 nephrology patients at risk who were hospitalized in teaching hospitals (3). This rate was similar to that found in special care neonatal units, although not quite one-half that of patients in a general intensive care unit. In a population-based survey performed in the Calgary Health Region from 2000 to 2002 (4), hemodialysis (HD) posed the greatest risk (RR 208.7; 95% CI 142.9 to 296.3) for acquiring severe BSI.
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Affiliation(s)
- B Lynn Johnston
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia
| | - John M Conly
- Departments of Pathology and Laboratory Medicine, Medicine, and Microbiology and Infectious Diseases, Centre for Antimicrobial Resistance, University of Calgary, Calgary, Alberta
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Muto CA. Methicillin-resistant Staphylococcus aureus control: we didn't start the fire, but it's time to put it out. Infect Control Hosp Epidemiol 2006; 27:111-5. [PMID: 16465625 DOI: 10.1086/501489] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 01/20/2006] [Indexed: 12/30/2022]
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