1
|
Furuya H, Ogura K, Takemoto N, Watanabe S, Yamazaki A, Ogai K, Sugama J, Okamoto S. A multilocus sequence typing method of Staphylococcus aureus DNAs in a sample from human skin. Microbiol Immunol 2023; 67:438-446. [PMID: 37574717 DOI: 10.1111/1348-0421.13094] [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: 04/07/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
The skin and mucous membranes are the primary sites of Staphylococcus aureus colonization, particularly those of health care personnel and patients in long-term care centers. We found that S. aureus colonized with a higher abundance ratio on skins which had recovered from pressure injury (PI) than on normal skins in our earlier research on the skin microbiota of bedridden patients. Multilocus sequence typing (MLST) is a useful tool for typing S. aureus isolated from clinical specimens. However, the MLST approach cannot be used in microbiota DNA owing to the contamination from other bacteria species. In this study, we developed a multiplex-nested PCR method to determine S. aureus MLST in samples collected from human skins. The seven pairs of forward and reverse primers were designed in the upstream and downstream regions, which were conserved specifically in S. aureus. The first amplifications of the seven pairs were conducted in a multiplex assay. The samples were diluted and applied to conventional PCR for MLST. We confirmed that the method amplified the seven allele sequences of S. aureus specifically in the presence of untargeted DNAs from human and other skin commensal bacteria. Using this assay, we succeeded in typing sequence types (STs) of S. aureus in the DNA samples derived from the skins healed from PI. Peaks obtained by Sanger sequencing showed that each sample contained one ST, which were mainly categorized into clonal complex 1 (CC1) or CC5. We propose that this culture-free approach may be used in detecting S. aureus in clinical specimens without isolation.
Collapse
Affiliation(s)
- Hiroka Furuya
- Department of Clinical Laboratory Science, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kohei Ogura
- Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Ishikawa, Japan
- Laboratory of Basic and Applied Molecular Biotechnology, Division of Food Science and Biotechnology, Graduate School of Agriculture, Kyoto University, Kyoto, Gokasho, Japan
| | - Norihiko Takemoto
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Shinjuku-ku, Japan
| | - Shinya Watanabe
- Division of Bacteriology, Department of Infection and Immunity, Faculty of Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Ayaka Yamazaki
- Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuhiro Ogai
- AI Hospital/Macro Signal Dynamics Research and Development Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junko Sugama
- Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake, Aichi, Japan
| | - Shigefumi Okamoto
- Department of Clinical Laboratory Science, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Ishikawa, Japan
| |
Collapse
|
2
|
Popovich KJ, Aureden K, Ham DC, Harris AD, Hessels AJ, Huang SS, Maragakis LL, Milstone AM, Moody J, Yokoe D, Calfee DP. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:1039-1067. [PMID: 37381690 PMCID: PMC10369222 DOI: 10.1017/ice.2023.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
Collapse
Affiliation(s)
- Kyle J. Popovich
- Department of Internal Medicine, RUSH Medical College, Chicago, Illinois
| | - Kathy Aureden
- Infection Prevention, Advocate Aurora Health, Downers Grove, Illinois
| | - D. Cal Ham
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anthony D. Harris
- Health Care Outcomes Research, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amanda J. Hessels
- Columbia School of Nursing, New York, New York
- Hackensack Meridian Health, Edison, New Jersey
| | - Susan S. Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Moody
- Infection Prevention, HCA Healthcare, Nashville, Tennessee
| | - Deborah Yokoe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
- Transplant Infectious Diseases, UCSF Medical Center, San Francisco, California
| | - David P. Calfee
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| |
Collapse
|
3
|
Coia JE, Wilson JA, Bak A, Marsden GL, Shimonovich M, Loveday HP, Humphreys H, Wigglesworth N, Demirjian A, Brooks J, Butcher L, Price JR, Ritchie L, Newsholme W, Enoch DA, Bostock J, Cann M, Wilson APR. Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2021; 118S:S1-S39. [PMID: 34757174 DOI: 10.1016/j.jhin.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Affiliation(s)
- J E Coia
- Department of Clinical Microbiology, Hospital South West Jutland, Esbjerg, Denmark; Department of Regional Health Research IRS, University of Southern Denmark, Denmark; Healthcare Infection Society, London, UK
| | - J A Wilson
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - A Bak
- Healthcare Infection Society, London, UK.
| | | | - M Shimonovich
- Healthcare Infection Society, London, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - H P Loveday
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - H Humphreys
- Healthcare Infection Society, London, UK; Department of Clinical Microbiology, The Royal College of Surgeons, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - N Wigglesworth
- Infection Prevention Society, Seafield, UK; East Kent Hospitals University, NHS Foundation Trust, Canterbury, UK
| | - A Demirjian
- Healthcare-associated Infection and Antimicrobial Resistance, Public Health England, London, UK; Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Brooks
- Infection Prevention Society, Seafield, UK; University Hospital Southampton NHS Foundation Trust, UK
| | - L Butcher
- Infection Prevention Society, Seafield, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - J R Price
- Healthcare Infection Society, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - L Ritchie
- Healthcare Infection Society, London, UK; NHS England and NHS Improvement, London, UK
| | - W Newsholme
- Healthcare Infection Society, London, UK; Guy's and St Thomas' NHS Foundation Trust, UK
| | - D A Enoch
- Healthcare Infection Society, London, UK; Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke's Hospital, Cambridge, UK
| | | | - M Cann
- Lay Member, UK; MRSA Action UK, Preston, UK
| | - A P R Wilson
- Healthcare Infection Society, London, UK; University College London Hospitals NHS Foundation Trust, UK.
| |
Collapse
|
4
|
Manara S, Pasolli E, Dolce D, Ravenni N, Campana S, Armanini F, Asnicar F, Mengoni A, Galli L, Montagnani C, Venturini E, Rota-Stabelli O, Grandi G, Taccetti G, Segata N. Whole-genome epidemiology, characterisation, and phylogenetic reconstruction of Staphylococcus aureus strains in a paediatric hospital. Genome Med 2018; 10:82. [PMID: 30424799 PMCID: PMC6234625 DOI: 10.1186/s13073-018-0593-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/29/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is an opportunistic pathogen and a leading cause of nosocomial infections. It can acquire resistance to all the antibiotics that entered the clinics to date, and the World Health Organization defined it as a high-priority pathogen for research and development of new antibiotics. A deeper understanding of the genetic variability of S. aureus in clinical settings would lead to a better comprehension of its pathogenic potential and improved strategies to contrast its virulence and resistance. However, the number of comprehensive studies addressing clinical cohorts of S. aureus infections by simultaneously looking at the epidemiology, phylogenetic reconstruction, genomic characterisation, and transmission pathways of infective clones is currently low, thus limiting global surveillance and epidemiological monitoring. METHODS We applied whole-genome shotgun sequencing (WGS) to 184 S. aureus isolates from 135 patients treated in different operative units of an Italian paediatric hospital over a timespan of 3 years, including both methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) from different infection types. We typed known and unknown clones from their genomes by multilocus sequence typing (MLST), Staphylococcal Cassette Chromosome mec (SCCmec), Staphylococcal protein A gene (spa), and Panton-Valentine Leukocidin (PVL), and we inferred their whole-genome phylogeny. We explored the prevalence of virulence and antibiotic resistance genes in our cohort, and the conservation of genes encoding vaccine candidates. We also performed a timed phylogenetic investigation for a potential outbreak of a newly emerging nosocomial clone. RESULTS The phylogeny of the 135 single-patient S. aureus isolates showed a high level of diversity, including 80 different lineages, and co-presence of local, global, livestock-associated, and hypervirulent clones. Five of these clones do not have representative genomes in public databases. Variability in the epidemiology is mirrored by variability in the SCCmec cassettes, with some novel variants of the type IV cassette carrying extra antibiotic resistances. Virulence and resistance genes were unevenly distributed across different clones and infection types, with highly resistant and lowly virulent clones showing strong association with chronic diseases, and highly virulent strains only reported in acute infections. Antigens included in vaccine formulations undergoing clinical trials were conserved at different levels in our cohort, with only a few highly prevalent genes fully conserved, potentially explaining the difficulty of developing a vaccine against S. aureus. We also found a recently diverged ST1-SCCmecIV-t127 PVL- clone suspected to be hospital-specific, but time-resolved integrative phylogenetic analysis refuted this hypothesis and suggested that this quickly emerging lineage was acquired independently by patients. CONCLUSIONS Whole genome sequencing allowed us to study the epidemiology and genomic repertoire of S. aureus in a clinical setting and provided evidence of its often underestimated complexity. Some virulence factors and clones are specific of disease types, but the variability and dispensability of many antigens considered for vaccine development together with the quickly changing epidemiology of S. aureus makes it very challenging to develop full-coverage therapies and vaccines. Expanding WGS-based surveillance of S. aureus to many more hospitals would allow the identification of specific strains representing the main burden of infection and therefore reassessing the efforts for the discovery of new treatments and clinical practices.
Collapse
Affiliation(s)
- Serena Manara
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | - Edoardo Pasolli
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | - Daniela Dolce
- Cystic Fibrosis Center, Interdisciplinary Specialist Department, Anna Meyer Children's University Hospital, Florence, Italy
| | - Novella Ravenni
- Cystic Fibrosis Center, Interdisciplinary Specialist Department, Anna Meyer Children's University Hospital, Florence, Italy
| | - Silvia Campana
- Cystic Fibrosis Center, Interdisciplinary Specialist Department, Anna Meyer Children's University Hospital, Florence, Italy
| | | | | | - Alessio Mengoni
- Department of Biology, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
- Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Carlotta Montagnani
- Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elisabetta Venturini
- Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Omar Rota-Stabelli
- Department of Sustainable Agro-Ecosystems and Bioresources, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Guido Grandi
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | - Giovanni Taccetti
- Cystic Fibrosis Center, Interdisciplinary Specialist Department, Anna Meyer Children's University Hospital, Florence, Italy
| | - Nicola Segata
- Centre for Integrative Biology, University of Trento, Trento, Italy.
| |
Collapse
|
5
|
Challagundla L, Reyes J, Rafiqullah I, Sordelli DO, Echaniz-Aviles G, Velazquez-Meza ME, Castillo-Ramírez S, Fittipaldi N, Feldgarden M, Chapman SB, Calderwood MS, Carvajal LP, Rincon S, Hanson B, Planet PJ, Arias CA, Diaz L, Robinson DA. Phylogenomic Classification and the Evolution of Clonal Complex 5 Methicillin-Resistant Staphylococcus aureus in the Western Hemisphere. Front Microbiol 2018; 9:1901. [PMID: 30186248 PMCID: PMC6113392 DOI: 10.3389/fmicb.2018.01901] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/27/2018] [Indexed: 12/30/2022] Open
Abstract
Clonal complex 5 methicillin-resistant Staphylococcus aureus (CC5-MRSA) includes multiple prevalent clones that cause hospital-associated infections in the Western Hemisphere. Here, we present a phylogenomic study of these MRSA to reveal their phylogeny, spatial and temporal population structure, and the evolution of selected traits. We studied 598 genome sequences, including 409 newly generated sequences, from 11 countries in Central, North, and South America, and references from Asia and Europe. An early-branching CC5-Basal clade is well-dispersed geographically, is methicillin-susceptible and MRSA predominantly of ST5-IV such as the USA800 clone, and includes separate subclades for avian and porcine strains. In the early 1970s and early 1960s, respectively, two clades appeared that subsequently underwent major expansions in the Western Hemisphere: a CC5-I clade in South America and a CC5-II clade largely in Central and North America. The CC5-I clade includes the ST5-I Chilean/Cordobes clone, and the ST228-I South German clone as an early offshoot, but is distinct from other ST5-I clones from Europe that nest within CC5-Basal. The CC5-II clade includes divergent strains of the ST5-II USA100 clone, various other clones, and most known vancomycin-resistant strains of S. aureus, but is distinct from ST5-II strain N315 from Japan that nests within CC5-Basal. The recombination rate of CC5 was much lower than has been reported for other S. aureus genetic backgrounds, which indicates that recurrence of vancomycin resistance in CC5 is not likely due to an enhanced promiscuity. An increased number of antibiotic resistances and decreased number of toxins with distance from the CC5 tree root were observed. Of note, the expansions of the CC5-I and CC5-II clades in the Western Hemisphere were preceded by convergent gains of resistance to fluoroquinolone, macrolide, and lincosamide antibiotics, and convergent losses of the staphylococcal enterotoxin p (sep) gene from the immune evasion gene cluster of phage ϕSa3. Unique losses of surface proteins were also noted for these two clades. In summary, our study has determined the relationships of different clades and clones of CC5 and has revealed genomic changes for increased antibiotic resistance and decreased virulence associated with the expansions of these MRSA in the Western Hemisphere.
Collapse
Affiliation(s)
- Lavanya Challagundla
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Daniel O. Sordelli
- Instituto de Investigaciones en Microbiología y Parasitología Médica, Universidad de Buenos Aires and Consejo Nacional de Investigaciones Ciencias y Tecnicas, Buenos Aires, Argentina
| | | | | | - Santiago Castillo-Ramírez
- Programa de Genómica Evolutiva, Centro de Ciencias Génomicas, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Nahuel Fittipaldi
- Public Health Ontario Laboratory, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Michael Feldgarden
- National Center for Biotechnology Information, National Institutes of Health, Bethesda, MD, United States
| | | | - Michael S. Calderwood
- Section of Infectious Disease and International Health, Dartmouth–Hitchcock Medical Center, Lebanon, NH, United States
| | - Lina P. Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Sandra Rincon
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Blake Hanson
- Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
- Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Paul J. Planet
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Cesar A. Arias
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
- Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
- Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Lorena Diaz
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - D. Ashley Robinson
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, United States
| |
Collapse
|
6
|
Zurita J, Barba P, Ortega-Paredes D, Mora M, Rivadeneira S. Local circulating clones of Staphylococcus aureus in Ecuador. Braz J Infect Dis 2016; 20:525-533. [PMID: 27638417 PMCID: PMC9427608 DOI: 10.1016/j.bjid.2016.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/22/2016] [Accepted: 08/02/2016] [Indexed: 01/18/2023] Open
Abstract
The spread of pandemic Staphylococcus aureus clones, mainly methicillin-resistant S. aureus (MRSA), must be kept under surveillance to assemble an accurate, local epidemiological analysis. In Ecuador, the prevalence of the USA300 Latin American variant clone (USA300-LV) is well known; however, there is little information about other circulating clones. The aim of this work was to identify the sequence types (ST) using a Multiple-Locus Variable number tandem repeat Analysis 14-locus genotyping approach. We analyzed 132 S. aureus strains that were recovered from 2005 to 2013 and isolated in several clinical settings in Quito, Ecuador. MRSA isolates composed 46.97% (62/132) of the study population. Within MRSA, 37 isolates were related to the USA300-LV clone (ST8-MRSA-IV, Panton-Valentine Leukocidin [PVL] +) and 10 were related to the Brazilian clone (ST239-MRSA-III, PVL−). Additionally, two isolates (ST5-MRSA-II, PVL−) were related to the New York/Japan clone. One isolate was related to the Pediatric clone (ST5-MRSA-IV, PVL−), one isolate (ST45-MRSA-II, PVL−) was related to the USA600 clone, and one (ST22-MRSA-IV, PVL−) was related to the epidemic UK-EMRSA-15 clone. Moreover, the most prevalent MSSA sequence types were ST8 (11 isolates), ST45 (8 isolates), ST30 (8 isolates), ST5 (7 isolates) and ST22 (6 isolates). Additionally, we found one isolate that was related to the livestock associated S. aureus clone ST398. We conclude that in addition to the high prevalence of clone LV-ST8-MRSA-IV, other epidemic clones are circulating in Quito, such as the Brazilian, Pediatric and New York/Japan clones. The USA600 and UK-EMRSA-15 clones, which were not previously described in Ecuador, were also found. Moreover, we found evidence of the presence of the livestock associated clone ST398 in a hospital environment.
Collapse
Affiliation(s)
- Jeannete Zurita
- Pontificia Universidad Católica del Ecuador, Facultad de Medicina, Quito, Ecuador; Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador.
| | - Pedro Barba
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - David Ortega-Paredes
- Pontificia Universidad Católica del Ecuador, Facultad de Medicina, Quito, Ecuador; Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Marcelo Mora
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | | |
Collapse
|
7
|
Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S108-32. [DOI: 10.1017/s0899823x00193882] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistantStaphylococcus aureus(MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Collapse
|
8
|
Groves MD, Crouch B, Coombs GW, Jordan D, Pang S, Barton MD, Giffard P, Abraham S, Trott DJ. Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolated from Australian Veterinarians. PLoS One 2016; 11:e0146034. [PMID: 26735694 PMCID: PMC4703204 DOI: 10.1371/journal.pone.0146034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/12/2015] [Indexed: 11/19/2022] Open
Abstract
This work investigated the molecular epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) isolated from veterinarians in Australia in 2009. The collection (n = 44) was subjected to extensive molecular typing (MLST, spa, SCCmec, dru, PFGE, virulence and antimicrobial resistance genotyping) and antimicrobial resistance phenotyping by disk diffusion. MRSA was isolated from Australian veterinarians representing various occupational emphases. The isolate collection was dominated by MRSA strains belonging to clonal complex (CC) 8 and multilocus sequence type (ST) 22. CC8 MRSA (ST8-IV [2B], spa t064; and ST612-IV [2B], spa variable,) were strongly associated with equine practice veterinarians (OR = 17.5, 95% CI = 3.3–92.5, P < 0.001) and were often resistant to gentamicin and rifampicin. ST22-IV [2B], spa variable, were strongly associated with companion animal practice veterinarians (OR = 52.5, 95% CI = 5.2–532.7, P < 0.001) and were resistant to ciprofloxacin. A single pig practice veterinarian carried ST398-V [5C2], spa t1451. Equine practice and companion animal practice veterinarians frequently carried multiresistant-CC8 and ST22 MRSA, respectively, whereas only a single swine specialist carried MRSA ST398. The presence of these strains in veterinarians may be associated with specific antimicrobial administration practices in each animal species.
Collapse
Affiliation(s)
- Mitchell D. Groves
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
| | - Bethany Crouch
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Geoffrey W. Coombs
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- Department of Microbiology, Path West Laboratory Medicine, WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Jordan
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- New South Wales Department of Primary Industries, Wollongbar, New South Wales, Australia
| | - Stanley Pang
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- Department of Microbiology, Path West Laboratory Medicine, WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mary D. Barton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Phil Giffard
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Sam Abraham
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- * E-mail: (SA); (DT)
| | - Darren J. Trott
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
- * E-mail: (SA); (DT)
| |
Collapse
|
9
|
A clonal complex 12 methicillin-resistant Staphylococcus aureus strain, West Australian MRSA-59, harbors a novel pseudo-SCCmec element. Antimicrob Agents Chemother 2015; 59:7142-4. [PMID: 26349822 DOI: 10.1128/aac.01745-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/28/2015] [Indexed: 01/23/2023] Open
Abstract
A West Australian methicillin-resistant Staphylococcus aureus strain (WA MRSA-59) was characterized by microarray and sequencing. Its pseudo-staphylococcal cassette chromosome mec (SCCmec) element comprised dcs, Q9XB68-dcs, mvaS-SCC, Q5HJW6, dru, ugpQ, ydeM, mecA-mecR-mecI, txbi mecI, tnp IS431, copA2-mco (copper resistance), ydhK, arsC-arsB-arsR (arsenic resistance), open reading frame PT43, and per-2. Recombinase genes, xylR (mecR2), and PSM-mec (phenol-soluble modulin) were absent. We suggest that mec complex A should be split into two subtypes. One harbors PSM-mec and xylR (mecR2). It is found in SCCmec types II, III, and VIII. The second subtype, described herein, is present in WA MRSA-59 and some coagulase-negative staphylococci.
Collapse
|
10
|
Belfroid E, Hautvast JLA, Hilbink M, Timen A, Hulscher MEJL. Selection of key recommendations for quality indicators describing good quality outbreak response. BMC Infect Dis 2015; 15:166. [PMID: 25888491 PMCID: PMC4397715 DOI: 10.1186/s12879-015-0896-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 09/30/2014] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The performance of recommended control measures is necessary for quick and uniform infectious disease outbreak control. To assess whether these procedures are performed, a valid set of quality indicators (QIs) is required. The goal of this study was to select a set of key recommendations that can be systematically translated into QIs to measure the quality of infectious disease outbreak response from the perspective of disaster emergency responders and infectious disease control professionals. METHODS Applying the Rand modified Delphi procedure, the following steps were taken to systematically select a set of key recommendations: extraction of recommendations from relevant literature; appraisal of the recommendations in terms of relevance through questionnaires to experts; expert meeting to discuss recommendations; prioritization of recommendations through a second questionnaire; and final expert meeting to approve the selected set. Infectious disease physicians and nurses, policymakers and communication experts participated in the expert group (n=48). RESULTS In total, 54 national and international publications were systematically searched for recommendations, yielding over 200 recommendations. The Rand modified Delphi procedure resulted in a set of 65 key recommendations. The key recommendations were categorized into 10 domains describing the whole response pathway from outbreak recognition to aftercare. CONCLUSION This study provides a set of key recommendations that represents 'good quality of response to an infectious disease outbreak'. These key recommendations can be systematically translated into QIs. Organizations and professionals involved in outbreak control can use these QIs to monitor the quality of response to infectious disease outbreaks and to assess in which domains improvement is needed.
Collapse
Affiliation(s)
- Evelien Belfroid
- Radboud university medical center, Radboud Institute for Health Sciences, Academic Collaborative Centre AMPHI, Department of Primary and Community Care, PO box 9101, 6500 HB, Nijmegen, The Netherlands. .,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands. .,National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.
| | - Jeannine L A Hautvast
- Radboud university medical center, Radboud Institute for Health Sciences, Academic Collaborative Centre AMPHI, Department of Primary and Community Care, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Mirrian Hilbink
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Aura Timen
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
11
|
Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, Aureden K, Huang SS, Maragakis LL, Yokoe DS. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:772-96. [PMID: 24915205 DOI: 10.1086/676534] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
12
|
O'Brien FG, Ramsay JP, Monecke S, Coombs GW, Robinson OJ, Htet Z, Alshaikh FAM, Grubb WB. Staphylococcus aureus plasmids without mobilization genes are mobilized by a novel conjugative plasmid from community isolates. J Antimicrob Chemother 2014; 70:649-52. [PMID: 25411186 DOI: 10.1093/jac/dku454] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe a family of conjugative plasmids isolated from colonizing community Staphylococcus aureus and determine their ability to mobilize unrelated antimicrobial resistance/virulence plasmids, not encoding mobilization functions. METHODS Plasmid pWBG749 was labelled with Tn551 (pWBG749e) to enable laboratory manipulation. Plasmid pWBG749e was conjugated into S. aureus of seven different lineages that harboured unrelated plasmids and mobilization experiments were performed. Plasmids were screened by EcoRI restriction and hybridization with probes prepared from unique pWBG749 conjugation genes. RESULTS Conjugative plasmids pWBG745, pWBG748 and pWBG749 belong to the same conjugative-plasmid family as the vancomycin resistance plasmid pBRZ01. Plasmid pWBG749e mobilized five unrelated plasmids. Mobilized plasmid pWBG744 is a pIB485-family plasmid that was also found in international S. aureus. CONCLUSIONS Plasmid pWBG749e can mobilize unrelated S. aureus plasmids whose means of dissemination have not previously been understood.
Collapse
Affiliation(s)
- F G O'Brien
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, Faculty of Health Sciences, School of Biomedical Sciences, Curtin University, Perth, WA, Australia
| | - J P Ramsay
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, Faculty of Health Sciences, School of Biomedical Sciences, Curtin University, Perth, WA, Australia School of Biomedical Sciences, CHIRI Biosciences Research Precinct, Curtin University, Perth, WA, Australia
| | - S Monecke
- Institute for Medical Microbiology and Hygiene, Medizinische Fakultät 'Carl Gustav Carus', Technische Universität Dresden, Dresden, Germany Alere Technologies GmbH, Jena, Germany
| | - G W Coombs
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, Faculty of Health Sciences, School of Biomedical Sciences, Curtin University, Perth, WA, Australia Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, WA, Australia
| | - O J Robinson
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, Faculty of Health Sciences, School of Biomedical Sciences, Curtin University, Perth, WA, Australia Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, WA, Australia
| | - Z Htet
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, WA, Australia
| | - F A M Alshaikh
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, Faculty of Health Sciences, School of Biomedical Sciences, Curtin University, Perth, WA, Australia
| | - W B Grubb
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, Faculty of Health Sciences, School of Biomedical Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
13
|
Larsen J, David MZ, Vos MC, Coombs GW, Grundmann H, Harbarth S, Voss A, Skov RL. Preventing the introduction of meticillin-resistant Staphylococcus aureus into hospitals. J Glob Antimicrob Resist 2014; 2:260-268. [PMID: 27873685 DOI: 10.1016/j.jgar.2014.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/16/2014] [Accepted: 09/21/2014] [Indexed: 11/28/2022] Open
Abstract
The objective of this review was to provide an up-to-date account of the interventions used to prevent the introduction of meticillin-resistant Staphylococcus aureus (MRSA) from the expanding community and livestock reservoirs into hospitals in the USA, Denmark, The Netherlands and Western Australia. A review of existing literature and local guidelines for the management of MRSA in hospitals was performed. In Denmark, The Netherlands and Western Australia, where the prevalence of MRSA is relatively low, targeted admission screening and isolation of predefined high-risk populations have been used for several decades to successfully control MRSA in the hospital. Furthermore, in Denmark and The Netherlands, all identified MRSA carriers undergo routine decolonisation, whereas only carriers of particularly transmissible or virulent MRSA clones are subjected to decolonisation in Western Australia. In the USA, which continues to be a high-prevalence MRSA country, policies vary by state and even by hospital, and whilst guidelines from professional organisations provide a framework for infection control practices, these guidelines lack the authority of a legislative mandate. In conclusion, the changing epidemiology of MRSA, exemplified by the recent emergence of MRSA in the community and in food animals, makes it increasingly difficult to accurately identify specific high-risk groups to screen for MRSA carriage. Understanding the changing epidemiology of MRSA in a local as well as global context is fundamental to prevent the introduction of MRSA into hospitals.
Collapse
Affiliation(s)
- Jesper Larsen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen S, Denmark.
| | - Michael Z David
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Geoffrey W Coombs
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, Curtin University, Perth, WA, Australia; Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Hajo Grundmann
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan Harbarth
- Infection Control Program and Division of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Robert L Skov
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen S, Denmark
| |
Collapse
|
14
|
Hart J, Christiansen KJ, Lee R, Heath CH, Coombs GW, Robinson JO. Increased EMRSA-15 health-care worker colonization demonstrated in retrospective review of EMRSA hospital outbreaks. Antimicrob Resist Infect Control 2014; 3:7. [PMID: 24588849 PMCID: PMC3944736 DOI: 10.1186/2047-2994-3-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/16/2014] [Indexed: 12/05/2022] Open
Abstract
Background Health care worker (HCW) colonization with methicillin resistant Staphylococcus aureus (MRSA) is a documented cause of hospital outbreaks and contributes to ongoing transmission. At Royal Perth Hospital (RPH) it had been anecdotally noted that the increasing prevalence of EMRSA-15 appeared to be associated with increased HCW colonization compared with Aus2/3-EMRSA. Hence we compared HCW colonization rates during outbreaks of EMRSA-15 and Aus2/3-EMRSA at a single institution. Methods We performed a retrospective review of EMRSA-15 and Aus2/3-EMRSA outbreaks from 2000–2009 at RPH, a quaternary hospital in Western Australia. Outbreak files were reviewed and relevant data extracted. Results Ten EMRSA-15 outbreaks were compared with seven Aus2/3 outbreaks. The number of patients colonized was similar between EMRSA-15 and Aus2/3-EMRSA outbreaks (median 7 [range 3–20] and 11 [5–26], respectively; P = 0.07) but the number of HCWs colonized was significantly higher in EMRSA-15 outbreaks compared to Aus2/3-EMRSA outbreaks (median 4 [range 0–15] and 2 [1-3], respectively; P = 0.013). The percentage of HCWs colonized was also higher in EMRSA-15 outbreaks versus Aus2/3-EMRSA outbreaks (median 3.4% [range 0–5.5%] and 0.81% [0.56–2.2%], respectively; P = 0.013). Conclusions This study demonstrates a higher level of HCW colonization during EMRSA-15 outbreaks compared with Aus2/3-EMRSA outbreaks. This finding suggests that MRSA vary in their ability to colonize HCWs and contribute to outbreaks. MRSA type should be determined during outbreaks and future research should investigate the mechanisms by which EMRSA-15 contributes to increased HCW colonization.
Collapse
Affiliation(s)
- Julie Hart
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
| | | | | | | | | | | |
Collapse
|
15
|
Surveillance of methicillin-resistant Staphylococcus aureus causing nosocomial infections in five medical centers of Monterrey, Nuevo León, México from 2005-2009. Arch Med Res 2013; 44:570-4. [PMID: 24051038 DOI: 10.1016/j.arcmed.2013.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 08/23/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Staphylococcus aureus is a principal cause of human bacterial infection worldwide. The dissemination of antibiotic resistance among S. aureus strains is very import in the treatment of Staphylococcal infections. We undertook this study to identify methicillin-resistant Staphylococcus aureus (MRSA) clones responsible for nosocomial infection in five medical centers in Monterrey, Nuevo León (N.L.), México from 2005-2009. METHODS One hundred ninety MRSA strains collected from 2005-2009 from five hospitals affiliated with the Instituto Mexicano del Seguro Social (IMSS) in Monterrey, N.L., México were characterized by antimicrobial susceptibility, pulsed field gel electrophoresis (PFGE) and Staphylococcal Cassette Chromosome mec (SCCmec) typing. RESULTS Only one clone was present in the five hospitals (clone C); this clone is strongly associated with the New York-Japan clone (SCCmec II) with a broad resistance profile. CONCLUSIONS This study clearly documented the high ability for dissemination and the persistence of the New York-Japan clone in these centers.
Collapse
|
16
|
Antimicrobial susceptibility of Staphylococcus aureus and molecular epidemiology of meticillin-resistant S. aureus isolated from Australian hospital inpatients: Report from the Australian Group on Antimicrobial Resistance 2011 Staphylococcus aureus Surveillance Programme. J Glob Antimicrob Resist 2013; 1:149-156. [DOI: 10.1016/j.jgar.2013.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/25/2013] [Accepted: 04/15/2013] [Indexed: 11/23/2022] Open
|
17
|
A new local variant (ST764) of the globally disseminated ST5 lineage of hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) carrying the virulence determinants of community-associated MRSA. Antimicrob Agents Chemother 2013; 57:1589-95. [PMID: 23318800 DOI: 10.1128/aac.01147-12] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The ST5 lineage of methicillin-resistant Staphylococcus aureus (MRSA) is one of the most globally disseminated hospital-associated MRSA (HA-MRSA) lineages. We isolated a new local variant (designated ST764) over at least 5 years that causes invasive infections, including necrotizing fasciitis, and is carried by medical students, as well as household members. Analysis of the genome sequence of one isolate compared to that of the reference ST5 strain revealed that ST764 had acquired virulence traits similar to those of community-associated MRSA (CA-MRSA) through the acquisition of two new mobile genetic elements, ACMEII and SaPInn54, which carried ACME arcA and the staphylococcal enterotoxin B gene (seb), respectively, and through enhanced expression of cytolytic peptide genes, although ST764 was negative for Panton-Valentine leukocidin. Other differences between ST764 and ST5 included the acquisition of an ACMEII-related cassette (cJR1), prophage φ2NN54, and streptococcal Tn5251 and decreased numbers of copies of Tn554. As for superantigen genes, although the two possessed seg, sei, sem, sen, and seo, ST764 lacked tst, sec, sel, and sep. The data suggest that ST764 MRSA is a novel hybrid variant of ST5 HA-MRSA with the characteristics of CA-MRSA and that the evolution of ST764 includes multiple steps, e.g., acquisition of novel or nonstaphylococcal mobile elements.
Collapse
|
18
|
Molecular epidemiology and characterisation of MRSA isolates from Trinidad and Tobago. Eur J Clin Microbiol Infect Dis 2011; 31:1497-500. [DOI: 10.1007/s10096-011-1469-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
|
19
|
Coombs GW, Monecke S, Pearson JC, Tan HL, Chew YK, Wilson L, Ehricht R, O'Brien FG, Christiansen KJ. Evolution and diversity of community-associated methicillin-resistant Staphylococcus aureus in a geographical region. BMC Microbiol 2011; 11:215. [PMID: 21955438 PMCID: PMC3197503 DOI: 10.1186/1471-2180-11-215] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/29/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was first reported in remote regions of Western Australia and is now the predominant MRSA isolated in the state. The objective of this study is to determine the genetic relatedness of Western Australian CA-MRSA clones within different multilocus sequence type (MLST) clonal clusters providing an insight into the frequency of S. aureus SCCmec acquisition within a region. RESULTS The CA-MRSA population in Western Australia is genetically diverse consisting of 83 unique pulsed-field gel electrophoresis strains from which 46 MLSTs have been characterised. Forty five of these sequence types are from 18 MLST clonal clusters and two singletons. While SCCmec IV and V are the predominant SCCmec elements, SCCmec VIII and several novel and composite SCCmec elements are present. The emergence of MRSA in diverse S. aureus clonal clusters suggests horizontal transmission of the SCCmec element has occurred on multiple occasions. Furthermore DNA microarray and spa typing suggests horizontal transfer of SCCmec elements has also occurred within the same CC. For many single and double locus variant CA-MRSA clones only a few isolates have been detected. CONCLUSIONS Although multiple CA-MRSA clones have evolved in the Western Australian community only three clones have successfully adapted to the Western Australian community environment. These data suggest the successful evolution of a CA-MRSA clone may not only depend on the mobility of the SCCmec element but also on other genetic determinants.
Collapse
Affiliation(s)
- Geoffrey W Coombs
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research. PathWest Laboratory Medicine - WA, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000 Australia
- School of Biomedical Sciences. Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6000 Australia
| | - Stefan Monecke
- Alere Technologies GmbH, Löbstedter Straße 103-105, D-07749 Jena, Germany
| | - Julie C Pearson
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research. PathWest Laboratory Medicine - WA, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000 Australia
| | - Hui-leen Tan
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research. PathWest Laboratory Medicine - WA, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000 Australia
| | - Yi-Kong Chew
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research. PathWest Laboratory Medicine - WA, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000 Australia
| | - Lynne Wilson
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research. PathWest Laboratory Medicine - WA, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000 Australia
| | - Ralf Ehricht
- Alere Technologies GmbH, Löbstedter Straße 103-105, D-07749 Jena, Germany
| | - Frances G O'Brien
- School of Biomedical Sciences. Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6000 Australia
| | - Keryn J Christiansen
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research. PathWest Laboratory Medicine - WA, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000 Australia
- School of Biomedical Sciences. Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6000 Australia
| |
Collapse
|
20
|
Verwer PEB, Robinson JO, Coombs GW, Wijesuriya T, Murray RJ, Verbrugh HA, Riley T, Nouwen JL, Christiansen KJ. Prevalence of nasal methicillin-resistant Staphylococcus aureus colonization in healthcare workers in a Western Australian acute care hospital. Eur J Clin Microbiol Infect Dis 2011; 31:1067-72. [PMID: 21909648 DOI: 10.1007/s10096-011-1408-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/25/2011] [Indexed: 11/26/2022]
Abstract
Due to a longstanding comprehensive "search and destroy policy", methicillin-resistant Staphylococcus aureus (MRSA) is not endemic in Western Australian (WA) acute care hospitals. As the prevalence of MRSA in the community has increased, healthcare workers (HCW) are at risk of importing MRSA into hospitals. We aimed to determine the prevalence of and risk factors for nasal MRSA colonization in our HCW population. A period prevalence study was conducted at an 850-bed tertiary hospital. Basic demographics and a nasal swab were obtained. A total of 1,542 HCWs employed in our centre were screened for MRSA, of whom 3.4% (n = 52) were colonized. MRSA colonization was more common in patient care assistants (6.8%) and nurses (5.2%) than in allied health professionals (1.7%) and doctors (0.7%) (p < 0.01). Working in "high-risk" wards that cared for MRSA colonized/infected patients was the strongest risk factor for HCW MRSA colonization (p < 0.001). ST1-IV and ST78-IV (the most common community clones in the region) were the most frequently identified clones. In conclusion, MRSA colonization of HCWs occurs primarily in HCWs caring for patients colonized or infected with MRSA. Surveillance screening of HCWs should be regularly performed on wards with patients with high MRSA colonization prevalence to prevent further spread in the hospital.
Collapse
Affiliation(s)
- P E B Verwer
- Department of Medical Microbiology & Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Monecke S, Coombs G, Shore AC, Coleman DC, Akpaka P, Borg M, Chow H, Ip M, Jatzwauk L, Jonas D, Kadlec K, Kearns A, Laurent F, O'Brien FG, Pearson J, Ruppelt A, Schwarz S, Scicluna E, Slickers P, Tan HL, Weber S, Ehricht R. A field guide to pandemic, epidemic and sporadic clones of methicillin-resistant Staphylococcus aureus. PLoS One 2011; 6:e17936. [PMID: 21494333 PMCID: PMC3071808 DOI: 10.1371/journal.pone.0017936] [Citation(s) in RCA: 629] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/16/2011] [Indexed: 01/28/2023] Open
Abstract
In recent years, methicillin-resistant Staphylococcus aureus
(MRSA) have become a truly global challenge. In addition to the long-known
healthcare-associated clones, novel strains have also emerged outside of the
hospital settings, in the community as well as in livestock. The emergence and
spread of virulent clones expressing Panton-Valentine leukocidin (PVL) is an
additional cause for concern. In order to provide an overview of pandemic,
epidemic and sporadic strains, more than 3,000 clinical and veterinary isolates
of MRSA mainly from Germany, the United Kingdom, Ireland, France, Malta, Abu
Dhabi, Hong Kong, Australia, Trinidad & Tobago as well as some reference
strains from the United States have been genotyped by DNA microarray analysis.
This technique allowed the assignment of the MRSA isolates to 34 distinct
lineages which can be clearly defined based on non-mobile genes. The results
were in accordance with data from multilocus sequence typing. More than 100
different strains were distinguished based on affiliation to these lineages,
SCCmec type and the presence or absence of PVL. These
strains are described here mainly with regard to clinically relevant
antimicrobial resistance- and virulence-associated markers, but also in relation
to epidemiology and geographic distribution. The findings of the study show a
high level of biodiversity among MRSA, especially among strains harbouring
SCCmec IV and V elements. The data also indicate a high
rate of genetic recombination in MRSA involving SCC elements, bacteriophages or
other mobile genetic elements and large-scale chromosomal replacements.
Collapse
Affiliation(s)
- Stefan Monecke
- Institute for Medical Microbiology and Hygiene, Technical University of Dresden, Dresden, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Hawkins G, Stewart S, Blatchford O, Reilly J. Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence. J Hosp Infect 2011; 77:285-9. [PMID: 21292349 DOI: 10.1016/j.jhin.2010.09.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) is considered endemic in the UK National Health Service (NHS), and routine MRSA screening of hospital inpatients has recently been introduced in both Scotland and England. The UK National Screening Committee states that public pressure for widening the eligibility criteria of a proposed screening programme should be anticipated and any related decisions scientifically justifiable. A literature review was conducted to examine whether MRSA screening in Scotland should be expanded to include the routine screening of healthcare workers (HCWs). There are no published prevalence studies reporting the overall MRSA carriage rate in HCWs in NHS hospitals. Estimates of HCW carriage from the worldwide literature vary widely depending on the country, hospital specialty and setting (endemic, non-endemic or outbreak). Recent studies conducted in endemic hospital settings report non-outbreak carriage rates of 0-15%. The role of HCW carriage in the transmission of MRSA is not well understood. Persistent carriage could act as a reservoir for infection and HCWs have been implicated as the source in a number of published outbreak reports. There are no published controlled trials examining the impact of routine HCW screening as an intervention in the prevention and control of MRSA infections in the endemic hospital setting. Most of the evidence for HCW screening comes from outbreak reports where the outbreak was brought to an end following the introduction of staff screening as part of a suite of infection control measures. Further research is required before a recommendation could be made to introduce routine MRSA screening of HCWs in the NHS in Scotland.
Collapse
Affiliation(s)
- G Hawkins
- Health Protection Scotland, Glasgow, UK.
| | | | | | | |
Collapse
|
23
|
First outbreak of PVL-positive nonmultiresistant MRSA in a neonatal ICU in Australia: comparison of MALDI-TOF and SNP-plus-binary gene typing. Eur J Clin Microbiol Infect Dis 2010; 29:1311-4. [PMID: 20549528 DOI: 10.1007/s10096-010-0995-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 05/29/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this brief report is to describe the first outbreak of a community-associated nonmultiresistant and PVL-positive MRSA strain (CC30) in a neonatal intensive care unit in Australia. The utility of matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF-MS) for microbial typing is compared with single nucleotide polymorphism (SNP) plus binary gene analysis. The composite correlation index analysis of the MALDI-TOF-MS data demonstrated the similar inter-strain relatedness found with the SNP-plus-binary gene typing used to confirm the outbreak. The evolving spread of MRSA emphasizes the importance of surveillance, infection control vigilance and the ongoing investigation of rapid typing methods for MRSA.
Collapse
|
24
|
Silva AMD, Carvalho MJD, Canini SRMDS, Cruz EDDA, Simões CLAP, Gir E. Methicillin resistant Staphylococcus aureus: knowledge and factors related to the nursing team’s adherence to preventive measures. Rev Lat Am Enfermagem 2010; 18:346-51. [DOI: 10.1590/s0104-11692010000300008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 12/21/2009] [Indexed: 11/22/2022] Open
Abstract
This study evaluated the knowledge of a nursing team from a public hospital in the state of São Paulo, Brazil concerning preventive measures recommended in the care delivered to patients colonized with Methicillin Resistant Staphylococcus Aureus (MRSA) and, through the Health Beliefs Model, identified the factors influencing adherence or non-adherence to preventive measures. A total of 318 professionals from different units participated in the study. According to the analysis, the nursing team’s knowledge and perception of MRSA susceptibility was limited, which indicates the need for actions to improve the understanding of preventive measures employed in the care delivered to patients colonized or infected by this microorganism.
Collapse
|
25
|
Coombs GW, Monecke S, Ehricht R, Slickers P, Pearson JC, Tan HL, Christiansen KJ, O'Brien FG. Differentiation of clonal complex 59 community-associated methicillin-resistant Staphylococcus aureus in Western Australia. Antimicrob Agents Chemother 2010; 54:1914-21. [PMID: 20211891 PMCID: PMC2863625 DOI: 10.1128/aac.01287-09] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 12/11/2009] [Accepted: 03/01/2010] [Indexed: 11/20/2022] Open
Abstract
Clonal complex 59 (CC59) community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains were characterized using pulsed-field gel electrophoresis, spa typing, multilocus sequence typing, diagnostic DNA microarrays, and PCRs targeting staphylococcal cassette chromosome mec (SCCmec) elements and Panton-Valentine leukocidin (PVL). Six distinct groups within CC59 were characterized. At least seven different variants of SCCmec elements were identified (IVa [2B], IVb [2B], IVd [2B], IV variant [2B], IVa [2B&5], V variant [5C2], and V [5C2&5]). (The structural type is indicated by a Roman numeral, with a lowercase letter indicating the subtype, and the ccr complex and the mec complex are indicated by an Arabic numeral and an uppercase letter, respectively. Where there is an extra ccr element, this is indicated by "&" and an Arabic numeral designating the ccr type.) The first group is similar to the American sequence type 59 (ST59) MRSA-IV CA-MRSA strain USA1000. The second group includes a PVL-negative ST87 strain with an SCCmec element of subtype IVb (2B). The third group comprises PVL-variable ST59 MRSA-IV strains harboring multiple SCCmec IV subtypes. PVL-negative ST59 MRSA strains with multiple or composite SCCmec elements (IVa [2B&5]) form the fourth group. Group 5 corresponds to the internationally known "Taiwan clone," a PVL-positive strain with a variant SCCmec element (V [5C2&5]). This strain proved to be the most common CC59 MRSA strain isolated in Western Australia. Finally, group 6 encompasses the ST59 MRSA-V variant (5C2). The differentiation of CC59 into groups and strains indicates a rapid evolution and spread of SCCmec elements. Observed differences between groups of strains as well as intrastrain variability within a group facilitate the tracing of their spread.
Collapse
Affiliation(s)
- Geoffrey W Coombs
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, Western Australia, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:66-73. [PMID: 19225308 DOI: 10.1097/moo.0b013e32832406ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Ozaki K, Takano M, Higuchi W, Takano T, Yabe S, Nitahara Y, Nishiyama A, Yamamoto T. Genotypes, intrafamilial transmission, and virulence potential of nasal methicillin-resistant Staphylococcus aureus from children in the community. J Infect Chemother 2009; 15:84-91. [PMID: 19396517 DOI: 10.1007/s10156-009-0668-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
Pediatric outpatients and healthy children in the community were examined for nasal methicillin-resistant Staphylococcus aureus (MRSA) in Japan. MRSA isolation frequencies were 0.7% (3/426) and 3.7% (5/136), respectively, in pediatric outpatients and healthy children in the community (overall frequency, 1.4%). The frequency of MRSA isolation was higher in children 5-9 years of age compared with the other age groups. All eight MRSA strains isolated were Panton-Valentine leukocidin-negative. Of these, three with the genotype multilocus sequence type (ST) 8/spa606/SCCmecIV (2 cases) and ST88/spa999/SCCmecIV/exfoliative toxin A gene (eta) were identical or similar to MRSA from bullous impetigo, determined by pulsed-field gel electrophoresis. One strain with ST764 (ST5 variant)/spa2/SCCmecII/staphylococcal enterotoxin B gene seb2 (seb variant) was similar to MRSA from bacteremia, and one with ST5/spa2/SCCmecII was the Pandemic New York/Japan clone. The remaining three strains, with ST22/spa998/SCCmecI, ST380/spa799/SCCmecIV, and ST857/spa416/SCCmecII, have not been identified. All MRSA strains were resistant to one or more non-beta-lactam antibiotics, and the ST5 and ST764 strains were multidrug-resistant. Family analysis demonstrated parent-to-child transmission (for ST8 and ST764), as well as acquisition from outside the family (for ST8 and ST380). The data suggest that young school-age children have a higher carriage rate of nasal MRSA than children of other ages, and that not only community-acquired MRSA strains but also MRSA strains with characteristics of hospital-acquired MRSA are spreading in the community.
Collapse
Affiliation(s)
- Kyoko Ozaki
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, 757 Ichibanchou, Asahimachidori, Niigata, 951-8510, Japan
| | | | | | | | | | | | | | | |
Collapse
|
28
|
de Carvalho MJ, Pimenta FC, Hayashida M, Gir E, da Silva AM, Barbosa CP, da Silva Canini SRM, Santiago S. Prevalence of methicillin-resistant and methicillin-susceptible s. aureus in the saliva of health professionals. Clinics (Sao Paulo) 2009; 64:295-302. [PMID: 19488585 PMCID: PMC2694463 DOI: 10.1590/s1807-59322009000400005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 12/23/2008] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION S. aureus is one of the main agents of nosocomial infection and is sometimes difficult to treat with currently available active antimicrobials. PURPOSE To analyze the prevalence of methicillin-susceptible S.aureus (MSSA) and methicillin-resistant S. aureus (MRSA) as well as the MRSA antimicrobial susceptibility profile isolated in the saliva of health professionals at a large public education hospital. MATERIALS AND METHODS The project was approved by the research and ethics committee of the institution under study. Three samples of saliva from 340 health professionals were collected. The saliva analysis used to identify S. aureus was based on mannitol fermentation tests, catalase production, coagulase, DNAse, and lecithinase. In order to detect MRSA, samples were submitted to the disk diffusion test and the oxacillin agar screening test. In order to identify the minimum inhibitory concentration, the Etest technique was used. RESULTS The prevalence of MSSA was 43.5% (148/340), and MRSA was 4.1% (14/340). MRSA detected by the diffusion disk test, was 100% resistant to penicillin and oxacillin, 92.9% resistant to erythromycin, 57.1% resistant to clindamycin, 42.9% resistant to ciprofloxacin and 57.1% resistant to cefoxetin. CONCLUSION This subject is important for both the education of health professionals and for preventative measures. Standard and contact-precautions should be employed in professional practice.
Collapse
Affiliation(s)
- Milton Jorge de Carvalho
- Department of Gynecology and Obstetrics, College of Medicine of the ABC - Santo Andre/SP, Brazil
| | - Fabiana Cristina Pimenta
- Centers for Disease Control and Prevention - Atlanta, GA, USA
- Federal University of Goiás - Goiás, Brazil
| | - Miyeko Hayashida
- Ribeirão Preto College of Nursing, University of São Paulo - Ribeirão Preto/SP, Brazil
| | - Elucir Gir
- Ribeirão Preto College of Nursing, University of São Paulo - Ribeirão Preto/SP, Brazil
- , Phone: 55 16 3602.3414
| | | | - Caio Parente Barbosa
- Department of Gynecology and Obstetrics, College of Medicine of the ABC - Santo Andre/SP, Brazil
| | | | | |
Collapse
|
29
|
Murray RJ, Pearson JC, Coombs GW, Flexman JP, Golledge CL, Speers DJ, Dyer JR, McLellan DG, Reilly M, Bell JM, Bowen SF, Christiansen KJ. Outbreak of invasive methicillin-resistant Staphylococcus aureus infection associated with acupuncture and joint injection. Infect Control Hosp Epidemiol 2008; 29:859-65. [PMID: 18684094 DOI: 10.1086/590260] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner. SETTING A medical practitioner's office and 4 hospitals in Perth, Western Australia. PATIENTS Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner. METHODS We performed a prospective and retrospective outbreak investigation, including MRSA colonization surveillance, environmental sampling for MRSA, and detailed molecular typing of MRSA isolates. We performed an infection control audit of the medical practitioner's premises and practices and administered MRSA decolonization therapy to the medical practitioner. RESULTS Eight cases of invasive MRSA infection were identified. Seven cases occurred as a cluster in May 2004; another case (identified retrospectively) occurred approximately 15 months earlier in February 2003. The primary sites of infection were the neck, shoulder, lower back, and hip: 5 patients had septic arthritis and bursitis, and 3 had pyomyositis; 3 patients had bacteremia, including 1 patient with possible endocarditis. The medical practitioner was found to be colonized with the same MRSA clone [ST22-MRSA-IV (EMRSA-15)] at 2 time points: shortly after the first case of infection in March 2003 and again in May 2004. After the medical practitioner's premises and practices were audited and he himself received MRSA decolonization therapy, no further cases were identified. CONCLUSIONS This outbreak most likely resulted from a breakdown in sterile technique during percutaneous needle procedures, resulting in the transmission of MRSA from the medical practitioner to the patients. This report demonstrates the importance of surveillance and molecular typing in the identification and control of outbreaks of MRSA infection.
Collapse
Affiliation(s)
- R J Murray
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA-Royal Perth Hospital, West Perth, Perth, Western Australia.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Novel characteristics of community-acquired methicillin-resistant Staphylococcus aureus strains belonging to multilocus sequence type 59 in Taiwan. Antimicrob Agents Chemother 2007; 52:837-45. [PMID: 18086843 DOI: 10.1128/aac.01001-07] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains, which often produce Panton-Valentine leucocidin (PVL), are increasingly noted worldwide. In this study, we examined 42 MRSA strains (25 PVL-positive [PVL+] strains and 17 PVL-negative [PVL(-)] strains) isolated in Taiwan for their molecular characteristics. The PVL+ MRSA strains included CA-MRSA strains with multilocus sequence type (ST) 59 (major PVL+ MRSA in Taiwan), its variants, and worldwide CA-MRSA ST30 strains. The PVL(-) MRSA strains included the pandemic Hungarian MRSA ST239 strain, the Hungarian MRSA ST239 variant, MRSA ST59 (largely hospital-acquired MRSA strains) and its variants, the pandemic New York/Japan MRSA ST5 strain (Japanese type), and the MRSA ST8 strain. The major PVL+ CA-MRSA ST59 strain possessed a tetracycline resistance-conferring (tetK positive) penicillinase plasmid and a drug resistance gene cluster (a possible composite transposon) for multidrug resistance. Moreover, it carried a novel staphylococcal cassette chromosome mec (SCCmec) with two distinct ccrC genes (ccrC2-C8). This SCCmec (previously named SCCmec type V(T)) was tentatively designated SCCmec type VII. Sequencing of the PVL genes revealed the polymorphisms, and the PVL+ CA-MRSA ST59 strain possessed the ST59-specific PVL gene sequence. The data suggest that a significant amount of clonal spread is occurring in Taiwan and that the major PVL+ CA-MRSA ST59 Taiwan strain exhibits unique genetic characteristics, such as a novel SCCmec type and an ST59-specific PVL gene sequence.
Collapse
|