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Gulone L, Di Gregorio S, Morales M, Haim MS, García S, Perazzi B, Famiglietti A, Mollerach M. The Changing Epidemiology and Antimicrobial Susceptibility of Staphylococcus aureus Isolated from Blood Cultures in a University Hospital from Argentina. Microb Drug Resist 2024; 30:109-117. [PMID: 38133499 DOI: 10.1089/mdr.2023.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections worldwide. In this study, we demonstrated changes in SAB epidemiology in an Argentinean University Hospital during an 8-year period (2009-2016). A total of 326 S. aureus clinical isolates were recovered in three periods: P1: 2009-2010, P2: 2012-2014, and P3: 2015-2016. Among these, 127 were methicillin-resistant S. aureus (MRSA) and were characterized by phenotypic and molecular methods. We hereby report a significant decline in multiple drug resistance among MRSA isolates associated with an increase in SCCmec IV between the three periods. A diversity of MRSA-IV clones (mainly ST30-MRSA-IV, ST5-MRSA-IV, and ST8-MRSA-IV) replaced between 2009 and 2016 the previous prevalent MRSA clone causing bloodstream infections at this hospital (ST5-MRSA-I). MRSA population structure continued to diversify between P2 and P3. Notably, ST8-MRSA-IV-t008 related to USA300 was first detected during P2, and ST8-MRSA-IV together with ST30-MRSA-IV related to the Southwest Pacific clone were the more prevalent MRSA genotypes circulating during P3.
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Affiliation(s)
- Lucía Gulone
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sabrina Di Gregorio
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Maia Morales
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Sol Haim
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Susana García
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Beatriz Perazzi
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Angela Famiglietti
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marta Mollerach
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
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2
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Westgeest AC, Lambregts MMC, Ruffin F, Korn RE, Webster ME, Kair JL, Parsons JB, Maskarinec SA, Kaplan S, Dekkers OM, de Boer MGJ, Fowler VG, Thaden JT. Female Sex and Mortality in Patients with Staphylococcus aureus Bacteremia: A Systematic Review and Meta-analysis. JAMA Netw Open 2024; 7:e240473. [PMID: 38411961 PMCID: PMC10900971 DOI: 10.1001/jamanetworkopen.2024.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Importance Staphylococcus aureus is the leading cause of death due to bacterial bloodstream infection. Female sex has been identified as a risk factor for mortality in S aureus bacteremia (SAB) in some studies, but not in others. Objective To determine whether female sex is associated with increased mortality risk in SAB. Data Sources MEDLINE, Embase, and Web of Science were searched from inception to April 26, 2023. Study Selection Included studies met the following criteria: (1) randomized or observational studies evaluating adults with SAB, (2) included 200 or more patients, (3) reported mortality at or before 90 days following SAB, and (4) reported mortality stratified by sex. Studies on specific subpopulations (eg, dialysis, intensive care units, cancer patients) and studies that included patients with bacteremia by various microorganisms that did not report SAB-specific data were excluded. Data Extraction and Synthesis Data extraction and quality assessment were performed by 1 reviewer and verified by a second reviewer. Risk of bias and quality were assessed with the Newcastle-Ottawa Quality Assessment Scale. Mortality data were combined as odds ratios (ORs). Main Outcome and Measures Mortality at or before 90-day following SAB, stratified by sex. Results From 5339 studies retrieved, 89 were included (132 582 patients; 50 258 female [37.9%], 82 324 male [62.1%]). Unadjusted mortality data were available from 81 studies (109 828 patients) and showed increased mortality in female patients compared with male patients (pooled OR, 1.12; 95% CI, 1.06-1.18). Adjusted mortality data accounting for additional patient characteristics and treatment variables were available from 32 studies (95 469 patients) and revealed a similarly increased mortality risk in female relative to male patients (pooled adjusted OR, 1.18; 95% CI, 1.11-1.27). No evidence of publication bias was encountered. Conclusions and Relevance In this systematic review and meta-analysis, female patients with SAB had higher mortality risk than males in both unadjusted and adjusted analyses. Further research is needed to study the potential underlying mechanisms.
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Affiliation(s)
- Annette C. Westgeest
- Division of Infectious Diseases, Duke University, Durham, North Carolina
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Merel M. C. Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Felicia Ruffin
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Rachel E. Korn
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Maren E. Webster
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jackson L. Kair
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Joshua B. Parsons
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | | | - Samantha Kaplan
- Medical Center Library and Archives, Duke University, Durham, North Carolina
| | - Olaf M. Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark G. J. de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Vance G. Fowler
- Division of Infectious Diseases, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Joshua T. Thaden
- Division of Infectious Diseases, Duke University, Durham, North Carolina
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Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic Review and Meta-analysis of Deaths Attributable to Antimicrobial Resistance, Latin America. Emerg Infect Dis 2023; 29:2335-2344. [PMID: 37877573 PMCID: PMC10617342 DOI: 10.3201/eid2911.230753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Antimicrobial resistance is a pressing global health concern, leading to 4.95 million deaths in 2019. We conducted a systematic review and meta-analysis to assess the lethality attributed to infections caused by multidrug-resistant organisms (MDROs) in Latin America and the Caribbean. A comprehensive search of major databases retrieved relevant studies from 2000-2022. We included 54 observational studies, primarily from Brazil, Argentina, and Colombia. The most commonly studied organism was methicillin-resistant Staphylococcus aureus. The overall unadjusted case fatality rate related to MDROs was 45.0%; higher adjusted lethality was observed in persons infected with MDROs than in those infected with other pathogens (adjusted odds ratio 1.93, 95% CI 1.58-2.37). A higher lethality rate was seen in patients who did not receive appropriate empirical treatment (odds ratio 2.27, 95% CI 1.44-3.56). These findings underscore the increased lethality associated with antimicrobial resistance in Latin America and the Caribbean.
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García C, Hinostroza N, Gordillo V, Inchaustegui ML, Astocondor L, Chincha O, Alejos S, Olivera M, Bojórquez-Fernández D, Concha-Velasco F, Vásquez N, Castaneda-Sabogal A, Sullón P, Fernández V, Villegas-Chiroque M, López E, Hueda-Zavaleta M, Vidaurre A, Bocángel C, Barco E, Paricahua E, Zervos M, Jacobs J, Krapp F. Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Hospitalized Patients in Peru. Am J Trop Med Hyg 2023; 109:1118-1121. [PMID: 37722664 PMCID: PMC10622478 DOI: 10.4269/ajtmh.23-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/16/2023] [Indexed: 09/20/2023] Open
Abstract
There is a knowledge gap in the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) causing bloodstream infections (BSIs) in Peru. Through a surveillance study in 13 hospitals of 10 Peruvian regions (2017-2019), we assessed the proportion of MRSA among S. aureus BSIs as well as the molecular typing of the isolates. A total of 166 S. aureus isolates were collected, and 36.1% of them were MRSA. Of note, MRSA isolates with phenotypic and genetic characteristics of the hospital-associated Chilean-Cordobes clone (multidrug-resistant SCCmec I, non-Panton-Valentine leukocidin [PVL] producers) were most commonly found (70%), five isolates with genetic characteristics of community-associated MRSA (CA-MRSA)-SCCmec IV, PVL-producer-(8.3%) were seen in three separate regions. These results demonstrate that hospital-associated MRSA is the most frequent MRSA found in patients with BSIs in Peru. They also show the emergence of S. aureus with genetic characteristics of CA-MRSA. Further studies are needed to evaluate the extension of CA-MRSA dissemination in Peru.
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Affiliation(s)
- Coralith García
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru
| | - Noemí Hinostroza
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Valeria Gordillo
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Lizeth Astocondor
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Omayra Chincha
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru
| | - Saúl Alejos
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marco Olivera
- Servicio de Infectología y Medicina Tropical, Hospital María Auxiliadora, Lima, Peru
| | | | - Fátima Concha-Velasco
- Departamento de Medicina, Hospital Antonio Lorena, Cusco, Peru
- Escuela Profesional de Medicina Humana, Universidad Nacional San Antonio Abad del Cusco, Cusco, Peru
| | - Nancy Vásquez
- Departamento de Apoyo al Diagnóstico, Hospital Antonio Lorena, Cusco, Peru
| | - Alex Castaneda-Sabogal
- Departamento de Medicina, Hospital Base Víctor Lazarte Echegaray de EsSalud, La Libertad, Peru
- Facultad de Medicina Humana, Universidad Privada Antenor Orrego, Trujillo, Peru
| | - Pedro Sullón
- Departamento de Especilaidades Médicas, Hospital Hipólito Unanue, Lima, Peru
| | - Víctor Fernández
- Departamento de Medicina, Hospital Belén de Trujillo, La Libertad, Peru
| | | | - Enrique López
- Departamento de Medicina Hospital Regional de Loreto Felipe Santiago Arriola Iglesias, Loreto, Peru
| | - Miguel Hueda-Zavaleta
- Faculty of Health Sciences, Universidad Privada de Tacna, Tacna, Peru
- Departamento de Medicina, Hospital III Daniel Alcides Carrión–EsSalud Tacna, Tacna, Peru
| | - Ana Vidaurre
- Departamento de Medicina, Hospital III EsSalud Chimbote, Ancash, Peru
| | - César Bocángel
- Departamento de Medicina Hospital Goyeneche de Arequipa, Arequipa, Peru
| | - Evelyn Barco
- Departamento de Patología Clínica, Hospital Regional II-2 José Alfredo Mendoza Olavarría, Tumbes, Peru
| | - Eduardo Paricahua
- Departamento de Medicina, Hospital Santa Rosa de Puerto Maldonado, Madre de Dios, Peru
| | - Marcus Zervos
- Infectious Disease Division, Henry Ford Health System, Detroit, Michigan
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Fiorella Krapp
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
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Martínez JRW, Planet PJ, Spencer-Sandino M, Rivas L, Díaz L, Moustafa AM, Quesille-Villalobos A, Riquelme-Neira R, Alcalde-Rico M, Hanson B, Carvajal LP, Rincón S, Reyes J, Lam M, Calderon JF, Araos R, García P, Arias CA, Munita JM. Dynamics of the MRSA Population in a Chilean Hospital: a Phylogenomic Analysis (2000-2016). Microbiol Spectr 2023; 11:e0535122. [PMID: 37338398 PMCID: PMC10433796 DOI: 10.1128/spectrum.05351-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023] Open
Abstract
The global dissemination of methicillin-resistant Staphylococcus aureus (MRSA) is associated with the emergence and establishment of clones in specific geographic areas. The Chilean-Cordobes clone (ChC) (ST5-SCCmecI) has been the predominant MRSA clone in Chile since its first description in 1998, despite the report of other emerging MRSA clones in recent years. Here, we characterize the evolutionary history of MRSA from 2000 to 2016 in a Chilean tertiary health care center using phylogenomic analyses. We sequenced 469 MRSA isolates collected between 2000 and 2016. We evaluated the temporal trends of the circulating clones and performed a phylogenomic reconstruction to characterize the clonal dynamics. We found a significant increase in the diversity and richness of sequence types (STs; Spearman r = 0.8748, P < 0.0001) with a Shannon diversity index increasing from 0.221 in the year 2000 to 1.33 in 2016, and an effective diversity (Hill number; q = 2) increasing from 1.12 to 2.71. The temporal trend analysis revealed that in the period 2000 to 2003 most of the isolates (94.2%; n = 98) belonged to the ChC clone. However, since then, the frequency of the ChC clone has decreased over time, accounting for 52% of the collection in the 2013 to 2016 period. This decline was accompanied by the rise of two emerging MRSA lineages, ST105-SCCmecII and ST72-SCCmecVI. In conclusion, the ChC clone remains the most frequent MRSA lineage, but this lineage is gradually being replaced by several emerging clones, the most important of which is clone ST105-SCCmecII. To the best of our knowledge, this is the largest study of MRSA clonal dynamics performed in South America. IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health pathogen that disseminates through the emergence of successful dominant clones in specific geographic regions. Knowledge of the dissemination and molecular epidemiology of MRSA in Latin America is scarce and is largely based on small studies or more limited typing techniques that lack the resolution to represent an accurate description of the genomic landscape. We used whole-genome sequencing to study 469 MRSA isolates collected between 2000 and 2016 in Chile providing the largest and most detailed study of clonal dynamics of MRSA in South America to date. We found a significant increase in the diversity of MRSA clones circulating over the 17-year study period. Additionally, we describe the emergence of two novel clones (ST105-SCCmecII and ST72-SCCmecVI), which have been gradually increasing in frequency over time. Our results drastically improve our understanding of the dissemination and update our knowledge about MRSA in Latin America.
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Affiliation(s)
- José R. W. Martínez
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
| | - Paul J. Planet
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- American Museum of Natural History, New York, New York, USA
| | - Maria Spencer-Sandino
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
| | - Lina Rivas
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
| | - Lorena Díaz
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - Ahmed M. Moustafa
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ana Quesille-Villalobos
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
| | - Roberto Riquelme-Neira
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Núcleo de Investigaciones Aplicadas en Ciencias Veterinarias y Agronómicas, Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Santiago, Chile
| | - Manuel Alcalde-Rico
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Grupo de Resistencia a los Antibióticos en Bacterias Patógenas y Ambientales (GRABPA), Pontificia Univ. Católica de Valparaíso, Valparaiso, Chile
| | - Blake Hanson
- Center for Antimicrobial Resistance and Microbial Genomics, Univ. of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Lina P. Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - Sandra Rincón
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - Marusella Lam
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan F. Calderon
- Centro de Genética y Genómica Instituto de Ciencias e Innovación en Medicina Facultad de Medicina Clínica Alemana Universidad Del Desarrollo, Santiago, Chile
- Research Center for the Development of Novel Therapeutic Alternatives for Alcohol Use Disorders, Santiago, Chile
| | - Rafael Araos
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
| | - Patricia García
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - César A. Arias
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institution, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - José M. Munita
- Genomics & Resistant Microbes (GeRM), ICIM, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Hospital Padre Hurtado, Santiago, Chile
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Martínez JRW, Planet PJ, Maria SS, Lina R, Lorena D, Ana QV, Roberto RN, Manuel AR, Blake H, Carvajal LP, Sandra R, Jinnethe R, Marusella L, Rafael A, Patricia G, Arias CA, Munita JM. Dynamics of the MRSA Population in A Chilean Hospital: A Phylogenomic Analysis (2000-2016). BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.06.526811. [PMID: 36798318 PMCID: PMC9934535 DOI: 10.1101/2023.02.06.526811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The global dissemination of methicillin-resistant Staphylococcus aureus (MRSA) is associated with the emergence and establishment of clones in specific geographic areas. The Chilean-Cordobes clone (ChC) (ST5-SCC mec I) has been the predominant MRSA clone in Chile since its first description in 1998, despite the report of other emerging MRSA clones in the last years. Here, we characterize the evolutionary history of MRSA from 2000 to 2016 in a Chilean tertiary healthcare center using phylogenomic analyses. We sequenced 469 MRSA isolates collected between 2000-2016 in a tertiary healthcare center in Chile. We evaluated the temporal trends of the circulating clones and performed a phylogenomic reconstruction to characterize the clonal dynamics. We found a significant increase in the diversity and richness of sequence types (STs; Spearman r=0.8748, p<0.0001) with a Shannon diversity index increasing from 0.221 in the year 2000 to 1.33 in 2016. The temporal trend analysis revealed that in the period 2000-2003 most of the isolates (94.2%; n=98) belonged to the ChC clone. However, since then, the frequency of the ChC clone has decreased over time, accounting for 52% of the collection in the 2013-2016 period. This decline was accompanied by the rise of two emerging MRSA lineages, ST105-SCC mec II and ST72-SCC mec VI. In conclusion, the ChC clone remains the most frequent MRSA lineage in Chile. However, this lineage is gradually being replaced by several emerging clones, the most important of which is clone ST105-SCC mec II. To the best of our knowledge, this is the largest study of MRSA clonal dynamics performed in South America. Importance Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health pathogen that disseminates through the emergence of successful dominant clones in specific geographic regions. Knowledge of the dissemination and molecular epidemiology of MRSA in Latin America is scarce and is largely based on small studies or classical typing techniques with several limitations to depict an accurate description of their genomic landscape. We used whole-genome sequencing to study 469 MRSA isolates collected between 2000-2016 in Chile to provide the largest and most detailed study of clonal dynamics of MRSA carried out in South America to date. We found a significant increase in the diversity of MRSA clones circulating over the 17-year study period. Additionally, we describe the emergence of two novel clones (ST105-SCCmecII and ST72-SCCmecVI), which have been gradually increasing their frequency over time. Our results drastically improve our understanding of the dissemination and update our knowledge about MRSA in Latin America.
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7
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Riche CVW, Cassol R, Falci DR, Ramirez M, Dias CAG. Epidemiology and risk factors for mortality among methicillin-resistant Staphylococcus aureus bacteremic patients in Southern Brazil. PLoS One 2023; 18:e0283774. [PMID: 37053222 PMCID: PMC10101390 DOI: 10.1371/journal.pone.0283774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
This study aimed to evaluate the epidemiology and 30-day mortality of adult patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. We retrospectively reviewed the demographic and clinical data of adult patients with S. aureus bloodstream infections (BSI), admitted to a tertiary public teaching medical center in Porto Alegre, Southern Brazil, from January 2014 to December 2019. A total of 928 patients with S. aureus BSI were identified in the study period (68.5 per 100,000 patient-years), and the proportion of MRSA isolates was 22% (19-27%). Thus, 199 patients were included in the analyses. The median age was 62 (IQR: 51-74) years, Charlson Comorbidity Index (CCI) median was 5 (IQR: 3-6), the Pitt bacteremia score (PBS) median was 1 (IQR: 1-4), and the most common site of infection was skin and soft tissue (26%). Most infections were hospital-acquired (54%), empirical anti-MRSA treatment was initiated in 34% of the cases, and in 44% vancomycin minimum inhibitory concentration was 1.5mg/L or above. Sixty-two (31.2%) patients died up to 30 days after the bacteremia episode. Patients with more comorbid conditions (higher CCI; aOR 1.222, p = 0.006) and a more severe presentation (higher PBS; aOR 1.726, p<0.001) were independently associated with mortality. Empiric antimicrobial therapy with an anti-MRSA regimen was associated with reduced mortality (aOR 0.319, p = 0.016). Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI in a population with a high incidence of S. aureus bacteremia. Empiric treatment with an anti-MRSA drug was a protective factor. No significant variation in the incidence of S. aureus BSI was recorded throughout the period.
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Affiliation(s)
- Cezar Vinícius Würdig Riche
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renato Cassol
- Serviço de Controle de Infecção, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Diego Rodrigues Falci
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mario Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cícero Armídio Gomes Dias
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Rocha PK, Rickard CM, Gales AC, Sincero TCM, Ray-Barruel G, Ullman AJ, Dalcin CB, Pedreira MLG. Disinfection of needleless connectors to reduce Staphylococcus aureus bacterial load. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S26-S31. [PMID: 36306235 DOI: 10.12968/bjon.2022.31.19.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
HIGHLIGHTS Compare effectiveness of chemical disinfectants in reducing S. aureus. Five disinfectants reduced the bacterial load, especially chlorhexidine solutions. Focus on Brazilian clinical practice of needleless connector disinfection. PURPOSE This study aimed to gain further knowledge about the comparative effectiveness of chemical disinfectants in reducing the bacterial load of NCs inoculated with S. aureus. METHODS Disinfection of needleless connectors was undertaken in vitro against S. aureus comparing 70% isopropyl alcohol (IPA), 70% ethanol, 0.5% and 2% chlorhexidine in 70% IPA applied with gauze, and 70% IPA single-use cap (Site-Scrub®). RESULTS All disinfectants reduced the bacterial load (P<0.001), especially the chlorhexidine solutions. Mechanical friction should follow guidelines. CONCLUSION This study found that all tested disinfectants effectively reduced the bacterial load and more clinical studies must be developed with a focus on the Brazilian clinical practice of needleless connector disinfection.
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Affiliation(s)
- Patrícia Kuerten Rocha
- Universidade Federal de Santa Catarina, Nursing Department, Paediatric Area, Gepesca Laboratory, Florianópolis, Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia; Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
| | - Ana Cristina Gales
- Universidade Federal de São Paulo, Paulista School of Medicine, Internal Medicine Department, Division of Infectious Diseases, Alert Laboratory, São Paulo, Brazil
| | - Thaís Cristine Marques Sincero
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil; Universidade Federal de Santa Catarina, Health Sciences Centre, Clinical Analysis Department, Molecular Microbiology Laboratory, Florianópolis, Brazil
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, Australia; QEII Jubilee Hospital, Brisbane, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia; Queensland Children's Hospital, Brisbane, Australia
| | - Camila Biazus Dalcin
- Universidade Federal de Santa Catarina, Nursing Department, Paediatric Area, Gepesca Laboratory, Florianópolis, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasília, Brazil
| | - Mavilde L Gonçalves Pedreira
- National Council for Scientific and Technological Development (CNPq), Brazil; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Universidade Federal de São Paulo, Paediatric Nursing Department, LEEnf Laboratory, SEGTEC Research Group, Sao Paulo, Brazil
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Bai AD, Lo CK, Komorowski AS, Suresh M, Guo K, Garg A, Tandon P, Senecal J, Corpo OD, Stefanova I, Fogarty C, Butler-Laporte G, McDonald EG, Cheng MP, Morris AM, Loeb M, Lee TC. Staphylococcus aureus bacteremia mortality across country income groups: A secondary analysis of a systematic review. Int J Infect Dis 2022; 122:405-411. [PMID: 35728748 DOI: 10.1016/j.ijid.2022.06.026] [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: 03/24/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Staphylococcus aureus bacteremia (SAB) is a common infection worldwide. We compared SAB mortality in low- and middle-income countries (LMIC) versus high-income countries (HIC) in a meta-analysis. METHODS We searched MEDLINE, Embase, and Cochrane Database of Systematic Reviews from 1991-2021 and included observational, single-country studies on patients with positive blood cultures for S. aureus. The main outcome was the proportion of patients with SAB who died in the hospital. A generalized linear mixed random-effects model was used to pool estimates, and a meta-regression was used to adjust for study-level characteristics. RESULTS A total of 332 studies involving 517,671 patients in 39 countries were included. No study was conducted in a low-income country. Only 33 (10%) studies were performed in middle-income countries (MIC), which described 6,216 patients. The pooled in-hospital mortality was 32.4% (95% confidence interval [CI] 27.2%-38.2%, T2 = 0.3063) in MIC and 22.3% (95% CI 20.1%-24.6%, T2 = 0.3257) in HIC. In a meta-regression model, MIC had higher in-hospital mortality (adjusted odds ratio 1.37, 95% CI 1.11-1.71; P = 0.0042) than HIC. CONCLUSION In SAB studies, LMIC are poorly represented. In-hospital mortality was significantly higher in MIC than in HIC. Research should be conducted in LMIC to characterize differences in care processes driving the mortality gap.
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Affiliation(s)
- Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Carson Kl Lo
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Adam S Komorowski
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mallika Suresh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Guo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Akhil Garg
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Pranav Tandon
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julien Senecal
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Olivier Del Corpo
- Department of Medicine, Division of Experimental Medicine, Division of Infectious Diseases, McGill University, Montréal, QC, Canada
| | - Isabella Stefanova
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Clare Fogarty
- McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | - Guillaume Butler-Laporte
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Matthew P Cheng
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada
| | - Andrew M Morris
- Division of Infectious Diseases, Department of Medicine, Sinai Health, University Health Network, and the University of Toronto, Toronto, Canada
| | - Mark Loeb
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Todd C Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Québec, Canada
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10
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Loftus MJ, Young-Sharma TE, Wati S, Badoordeen GZ, Blakeway LV, Byers SM, Cheng AC, Jenney AW, Naidu R, Prasad A, Prasad V, Tudravu L, Vakatawa T, van Gorp E, Wisniewski JA, Rafai E, Stewardson AJ, Peleg AY. Epidemiology, antimicrobial resistance and outcomes of Staphylococcus aureus bacteraemia in a tertiary hospital in Fiji: A prospective cohort study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 22:100438. [PMID: 35373162 PMCID: PMC8969155 DOI: 10.1016/j.lanwpc.2022.100438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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11
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Bai AD, Lo CKL, Komorowski AS, Suresh M, Guo K, Garg A, Tandon P, Senecal J, Del Corpo O, Stefanova I, Fogarty C, Butler-Laporte G, McDonald EG, Cheng MP, Morris AM, Loeb M, Lee TC. What Is the Optimal Follow-up Length for Mortality in Staphylococcus aureus Bacteremia? Observations From a Systematic Review of Attributable Mortality. Open Forum Infect Dis 2022; 9:ofac096. [PMID: 35415199 PMCID: PMC8995072 DOI: 10.1093/ofid/ofac096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/19/2022] [Indexed: 11/14/2022] Open
Abstract
Background Deaths following Staphylococcus aureus bacteremia (SAB) may be related or unrelated to the infection. In SAB therapeutics research, the length of follow-up should be optimized to capture most attributable deaths and minimize nonattributable deaths. We performed a secondary analysis of a systematic review to describe attributable mortality in SAB over time. Methods We systematically searched Medline, Embase, and Cochrane Database of Systematic Reviews from 1 January 1991 to 7 May 2021 for human observational studies of SAB. To be included in this secondary analysis, the study must have reported attributable mortality. Two reviewers extracted study data and assessed risk of bias independently. Pooling of study estimates was not performed due to heterogeneity in the definition of attributable deaths. Results Twenty-four observational cohort studies were included. The median proportion of all-cause deaths that were attributable to SAB was 77% (interquartile range [IQR], 72%–89%) at 1 month and 62% (IQR, 58%–75%) at 3 months. At 1 year, this proportion was 57% in 1 study. In 2 studies that described the rate of increase in mortality over time, 2-week follow-up captured 68 of 79 (86%) and 48 of 57 (84%) attributable deaths that occurred by 3 months. By comparison, 1-month follow-up captured 54 of 57 (95%) and 56 of 60 (93%) attributable deaths that occurred by 3 months in 2 studies. Conclusions The proportion of deaths that are attributable to SAB decreases as follow-up lengthens. Follow-up duration between 1 and 3 months seems optimal if evaluating processes of care that impact SAB mortality. Clinical Trials Registration PROSPERO CRD42021253891.
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Affiliation(s)
- Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carson K L Lo
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Adam S Komorowski
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mallika Suresh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Guo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Akhil Garg
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Pranav Tandon
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julien Senecal
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Olivier Del Corpo
- Department of Medicine, Division of Experimental Medicine, Division of Infectious Diseases, McGill University, Montreal, Quebec, Canada
| | - Isabella Stefanova
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Clare Fogarty
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Guillaume Butler-Laporte
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Matthew P Cheng
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew M Morris
- Division of Infectious Diseases, Department of Medicine, Sinai Health, University Health Network, and the University of Toronto, Toronto, Ontario, Canada
| | - Mark Loeb
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Todd C Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
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12
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Zhang X, Li Y, Tao Y, Ding Y, Shao X, Li W. Epidemiology and Drug Resistance of Neonatal Bloodstream Infection Pathogens in East China Children’s Medical Center From 2016 to 2020. Front Microbiol 2022; 13:820577. [PMID: 35359735 PMCID: PMC8961284 DOI: 10.3389/fmicb.2022.820577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction To analyze the pathogen distribution and drug resistance of newborns with bloodstream infection (BSI) to help clinicians choose the appropriate empirical antibiotic therapy for clinical infection control. Methods A total of 707 neonatal BSI cases were retrospectively analyzed. The bacteria in blood culture-positive samples were cultured, identified, and analyzed for drug sensitivity by routine methods. Statistical software was used to compare and analyze the basic data, pathogenic information, and drug resistance of the main bacteria. Results The 5-year average positive rate of neonatal blood culture was 2.50%. The number of specimens submitted for inspection in 2020 significantly decreased. The top five infectious pathogens with the highest proportion were coagulase-negative Staphylococcus (67.35%), of which Staphylococcus epidermidis had the highest proportion (31.26%), followed by Escherichia coli (12.87%), Klebsiella pneumoniae (9.05%), Streptococcus agalactiae (8.63%), and Staphylococcus aureus (3.25%). Gram-positive (G+) bacteria were dominant, accounting for 69.45%. The main G+ bacteria had a higher rate of resistance to erythromycin and penicillin G. The main Gram-negative (G–) bacteria had a high resistance rate to a variety of antibacterial drugs, especially cephalosporin antibiotics. The overall resistance of K. pneumoniae was higher than that of E. coli. The top two fungi detected were Candida parapsilosis and Candida albicans. C. parapsilosis did not appear to be resistant to antibiotics, while C. albicans was resistant to multiple antibiotics. The type of microbial infection had a statistically significant difference in the positive rate among the age at delivery and wards (p < 0.05). There were significant differences in the detection of fungi among these groups (p < 0.05). The positive rate of G+ bacteria in the term newborns was significantly higher than that in the preterm newborns (p < 0.05). Preterm newborns are more susceptible to pneumonia. Conclusion G+ bacteria are the main pathogens of neonatal BSI. Preterm newborns are more likely to be infected with G– bacteria. E. coli and K. pneumoniae are the most common G– bacteria, and both have a high resistance rate to a variety of antibacterial drugs. According to the distribution characteristics and drug resistance, it is very important to select antibiotics reasonably.
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13
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Thomson P, García P, Miles J, Isla D, Yáñez C, Santibáñez R, Núñez A, Flores-Yáñez C, del Río C, Cuadra F. Isolation and Identification of Staphylococcus Species Obtained from Healthy Companion Animals and Humans. Vet Sci 2022; 9:vetsci9020079. [PMID: 35202332 PMCID: PMC8879518 DOI: 10.3390/vetsci9020079] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 01/20/2023] Open
Abstract
The close contact between people and their pets has generated the exchange of skin microbiota, accompanied by bacteria that present resistance to antibiotics. Staphylococcus spp., opportunistic pathogens present in the skin and mucosa of mammals, have had their importance recognized in human and veterinary medicine. The objectives of this study were to identify Staphylococcus spp. present in isolates from the nostrils of healthy humans, dogs and cats as well as to determine their phenotype of resistance to methicillin. Strain identification was performed by MALDI-TOF mass spectrometry and antimicrobial susceptibility was determined using a disk diffusion assay for 12 antibiotics. Sixty humans (veterinary and technicians), sixty dogs and sixty cats were sampled; of them, 61.6%, 56.6% and 46.6%, respectively, carried Staphylococcus spp. in their nostrils, and only two people carried two different species of Staphylococcus in the only anatomical site sampled. A methicillin-resistant phenotype was present in 48.7% of the humans, 26.5% of the dogs and 57.1% of the cats, and sampled. These results demonstrate the presence of Staphylococcus spp. strains resistant to methicillin in personnel who work in contact with animals, as well as in dogs and cats that entered the same hospital or veterinary clinic, which alerts us to the potential transfer of these strains to or between people, dogs and/or cats.
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Affiliation(s)
- Pamela Thomson
- Laboratorio de Microbiología Clínica y Microbioma, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8370134, Chile; (C.d.R.); (F.C.)
- Correspondence: ; Tel.: +56-227-703-688
| | - Patricia García
- Departamento de Laboratorios Clínicos, Facultad de Medicina, Pontificia Universidad Católica, Santiago 8940000, Chile; (P.G.); (J.M.); (D.I.); (C.Y.)
| | - Jorge Miles
- Departamento de Laboratorios Clínicos, Facultad de Medicina, Pontificia Universidad Católica, Santiago 8940000, Chile; (P.G.); (J.M.); (D.I.); (C.Y.)
| | - David Isla
- Departamento de Laboratorios Clínicos, Facultad de Medicina, Pontificia Universidad Católica, Santiago 8940000, Chile; (P.G.); (J.M.); (D.I.); (C.Y.)
| | - Camilo Yáñez
- Departamento de Laboratorios Clínicos, Facultad de Medicina, Pontificia Universidad Católica, Santiago 8940000, Chile; (P.G.); (J.M.); (D.I.); (C.Y.)
| | - Rodrigo Santibáñez
- Departamento de Ingeniería Química y Bioprocesos, Facultad de Ingeniería, Pontificia Universidad Católica, Santiago 8940000, Chile;
| | - Andrea Núñez
- Facultad de Medicina Veterinaria y Agronomía, Universidad de las Américas, Santiago 7500975, Chile;
| | | | - Camila del Río
- Laboratorio de Microbiología Clínica y Microbioma, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8370134, Chile; (C.d.R.); (F.C.)
| | - Françoise Cuadra
- Laboratorio de Microbiología Clínica y Microbioma, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8370134, Chile; (C.d.R.); (F.C.)
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Briones-Claudett KH, Briones-Claudett MH, Martinez Armijo EA, Martinez Alvarez ME, Briones Zamora KH, Briones Marquez DC, Icaza-Freire AP, Grunauer M. Cavitary Pneumonia Due to Methicillin-Resistant Staphylococcus aureus in a Non-Immunocompromised Patient After an Endoscopy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930136. [PMID: 34253705 PMCID: PMC8286802 DOI: 10.12659/ajcr.930136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Male, 32-year-old Final Diagnosis: Pneumonia due methicillin-resistant Staphylococcus aureus (MRSA) Symptoms: Hypoxemia • tonic-clonic seizures Medication: — Clinical Procedure: Bronchoalveolar lavage • lumbar puncture Specialty: Critical Care Medicine • Pulmonology
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Affiliation(s)
- Killen H Briones-Claudett
- Faculty of Medical Sciences, University of Guayaquil, Guayaquil, Ecuador.,Physiology and Respiratory Center Briones-Claudett, Guayaquil, Ecuador.,Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | - Mónica H Briones-Claudett
- Physiology and Respiratory Center Briones-Claudett, Guayaquil, Ecuador.,Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | | | | | - Killen H Briones Zamora
- Physiology and Respiratory Center Briones-Claudett, Guayaquil, Ecuador.,Faculty of Medical Sciences, Universidad Espíritu Santo, Samborondon, Ecuador
| | | | | | - Michelle Grunauer
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.,Critical Care Unit, Hospital de los Valles, Quito, Ecuador
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15
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Vazquez-Rosas GJ, Merida-Vieyra J, Aparicio-Ozores G, Lara-Hernandez A, De Colsa A, Aquino-Andrade A. Molecular Characterization of Staphylococcus aureus Obtained from Blood Cultures of Paediatric Patients Treated in a Tertiary Care Hospital in Mexico. Infect Drug Resist 2021; 14:1545-1556. [PMID: 33911882 PMCID: PMC8071697 DOI: 10.2147/idr.s302416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/05/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Staphylococcus aureus is one of the main causative agents of hospital-acquired (HA) infections. In Mexico, information about the characteristics of clinical S. aureus isolates is limited. Our aim was to characterize S. aureus strains obtained from blood cultures of paediatric patients treated in a tertiary care hospital. Materials and Methods We analysed 249 S. aureus isolates over the period from 2006 to 2019, and their resistance profiles were determined. The isolates were classified into methicillin-resistant S. aureus (MRSA) or methicillin-sensitive S. aureus (MSSA). Staphylococcal cassettes chromosome mec (SCCmec) were detected. Virulence genes (cna, clfA, clfB, eta, etb, fnbA, fnbB, hla, pvl, sec, and tsst) were amplified, and their clonal relationships were established by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and clonal complex (CC) typing. We reviewed one hundred medical files to collect clinical information. Results Thirty-eight percent of the isolates were MRSA and showed an expanded profile of resistance to other non-beta-lactam antibiotics, while MSSA strains presented a reduced resistance profile. SCCmec-II was the most frequent element (86.3%). Eight virulence factors were detected in MSSA and six in MRSA. The pvl gene was detected in four MRSA-SCCmec-IV isolates (P≤0.0001). MRSA isolates were distributed among 14 clones and were classified into 15 sequence types (ST); the most frequent was ST1011 (17%). The most common CC in MRSA was CC5 (69%, P≤0.0001), and in MSSA, it was CC30 (30%, P≤0.0001). Eighty-seven percent of MRSA isolates were HA-MRSA, and 13% were community-acquired MRSA (CA-MRSA). Of 21 HA-MRSA isolates, 17 had SCCmec-II, while two CA-MRSA isolates had SCCmec-IV. Of MSSA isolates, 77% were derived from HA infections and 23% from CA infections. Conclusion MSSA isolates had more virulence factors. MRSA isolates were resistant to more non-beta-lactam antibiotics, and those with SCCmec-IV expressed a greater variety of virulence factors. Most S. aureus isolates belonged to CC5.
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Affiliation(s)
- Guillermo Jose Vazquez-Rosas
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico.,Medical Bacteriology Laboratory, Instituto Politecnico Nacional, Mexico City, Mexico
| | - Jocelin Merida-Vieyra
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Agustin De Colsa
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico.,Department of Paediatric Infectious Diseases, Instituto Nacional de Pediatria, Mexico City, Mexico
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16
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Implications of Antibiotic Use during the COVID-19 Pandemic: The Example of Associated Antimicrobial Resistance in Latin America. Antibiotics (Basel) 2021; 10:antibiotics10030328. [PMID: 33804758 PMCID: PMC8003854 DOI: 10.3390/antibiotics10030328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
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Leme RCP, Bispo PJM, Salles MJ. Community-genotype methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Latin America: a systematic review. Braz J Infect Dis 2021; 25:101539. [PMID: 33607082 PMCID: PMC9392117 DOI: 10.1016/j.bjid.2021.101539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/07/2020] [Accepted: 12/26/2020] [Indexed: 11/19/2022] Open
Abstract
Background Community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) emerged in the 1990s as a global community pathogen primarily involved in skin and soft tissue infections (SSTIs) and pneumonia. To date, the CG-MRSA SSTI burden in Latin America (LA) has not been assessed. Objective The main objective of this study was to report the rate and genotypes of community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) causing community-onset skin and soft tissue infections (CO-SSTIs) in LA over the last two decades. In addition, this research determined relevant data related to SSTIs due to CG-MRSA, including risk factors, other invasive diseases, and mortality. Data sources Relevant literature was searched and extracted from five major databases: Embase, PubMed, LILACS, SciELO, and Web of Science. Methods A systematic review was performed, and a narrative review was constructed. Results An analysis of 11 studies identified epidemiological data across LA, with Argentina presenting the highest percentage of SSTIs caused by CG-MRSA (88%). Other countries had rates of CG-MRSA infection ranging from 0 to 51%. Brazil had one of the lowest rates of CG-MRSA SSTI (4.5–25%). In Argentina, being younger than 50 years of age and having purulent lesions were predictive factors for CG-MRSA CO-SSTIs. In addition, the predominant genetic lineages in LA belonged to sequence types 8, 30, and 5 (ST8, ST30, and ST5). Conclusion There are significant regional differences in the rates of CG-MRSA causing CO-SSTIs. It is not possible to conclude whether or not CG-MRSA CO-SSTIs resulted in more severe SSTI presentations or in a higher mortality rate.
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Affiliation(s)
- Rodrigo Cuiabano Paes Leme
- Universidade Federal de São Paulo (UNIFESP), Departamento de Doenças Infecciosas, Laboratório Especial de Microbiologia Clínica (LEMC), São Paulo, SP, Brazil.
| | - Paulo José Martins Bispo
- Harvard Medical School, Infectious Diseases Institute, Department of Ophthalmology, Massachusetts, United States
| | - Mauro José Salles
- Universidade Federal de São Paulo (UNIFESP), Departamento de Doenças Infecciosas, Laboratório Especial de Microbiologia Clínica (LEMC), São Paulo, SP, Brazil; Santa Casa de São Paulo, Faculdade de Ciências Médicas, São Paulo, SP, Brazil
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18
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Schwalb A, Cachay R, de la Flor A, García C, Seas C. Adherence to standards of care and mortality in the management of Staphylococcus aureus bacteraemia in Peru: A prospective cohort study. Int J Infect Dis 2020; 96:601-606. [PMID: 32505877 DOI: 10.1016/j.ijid.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite high mortality rates, physicians can alter the course of the Staphylococcus aureus bacteraemia (SAB) by following recommended standards of care. We aim to assess the adherence of these guidelines and their impact on mortality. METHODS Substudy from a prospective cohort of hospitalized patients with SAB from three hospitals from Peru. Hazard ratios were calculated using Cox proportional regression to evaluate the association between 30-day mortality and the performance of standards of care: removal of central venous catheters (CVC), follow-up blood cultures, echocardiography, correct duration, and appropriate definitive antibiotic therapy. RESULTS 150 cases of SAB were evaluated; 61.33% were MRSA. 30-day attributable mortality was 22.39%. CVC removal was done in 42.86% of patients. Follow-up blood cultures and echocardiograms were performed in 8% and 29.33% of cases, respectively. 81.33% of cases had appropriate empirical treatment, however, only 22.41% of MSSA cases were given appropriate definitive treatment, compared to 93.47% of MRSA. The adjusted regression for all-cause mortality found a substantial decrease in hazards when removing CVC (aHR 0.28, 95% CI: 0.10 - 0.74) and instituting appropriate definitive treatment (aHR 0.27, 95% CI: 0.08 - 0.86), while adjusting for standards of care, qPitt bacteraemia score, comorbidities, and methicillin susceptibility; similar results were found in the attributable mortality model (aHR 0.24, 95% CI: 0.08 - 0.70 and aHR 0.21, 95% CI: 0.06 - 0.71, respectively). CONCLUSIONS Deficient adherence to standards of care was observed, especially definitive treatment for MSSA. CVC removal and the use of appropriate definitive antibiotic therapy reduced the hazard mortality of SAB.
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Affiliation(s)
- Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Rodrigo Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Coralith García
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Cayetano Heredia, Lima, Peru
| | - Carlos Seas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Cayetano Heredia, Lima, Peru
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Phylogenetic and Molecular Profile of Staphylococcus aureus Isolated from Bloodstream Infections in Northeast Brazil. Microorganisms 2019; 7:microorganisms7070210. [PMID: 31336623 PMCID: PMC6680844 DOI: 10.3390/microorganisms7070210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/16/2022] Open
Abstract
Staphylococcus aureus is a notorious human pathogen associated with serious nosocomial and community-acquired infections, such as pneumonia, meningitis, endocarditis, toxic shock syndrome, and sepsis, among others. The objective of this study was to investigate the molecular profile, antimicrobial resistance, and clonal diversity of S. aureus isolated from the bloodstream. The determination of the minimum inhibitory concentration (MIC) of the antimicrobial was performed by an automated method. The presence of several virulence and resistance genes was evaluated by PCR. In addition, multilocus sequence typing (MLST) was used to analyze the clonal diversity of S. aureus. A high resistance to oxacillin (78%), clindamycin (78%), erythromycin (70%), ciprofloxacin (61%), and gentamicin (52%) was observed among the isolates. In most of them, the following virulence genes were detected: hlb (83%), ebpS (61%), icaA (57%), fnbpA (17%), and clfA (13%). Only one isolate carried the pvl gene. MLST analysis identified five new sequence types (STs): 5429, 5430, 5431, 5432, and 5433, as well as another seven-ST5, ST97, ST398, ST101, ST30, ST461, and ST2779-among the remaining strains. These seven STs and the four new STs are clustered in four clonal complexes: CC1, CC2, CC7, and CC17. Phylogenetic analysis showed the genetic relationship of the five new ST strains with another 18 strains. Altogether, these analyses indicate the horizontal transfer acquisition of virulence factor genes and multidrug resistance.
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20
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Misch EA, Andes DR. Bacterial Infections in the Stem Cell Transplant Recipient and Hematologic Malignancy Patient. Infect Dis Clin North Am 2019; 33:399-445. [DOI: 10.1016/j.idc.2019.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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21
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Huang L, Zhang R, Hu Y, Zhou H, Cao J, Lv H, Chen S, Ding S, Chen G. Epidemiology and risk factors of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci infections in Zhejiang China from 2015 to 2017. Antimicrob Resist Infect Control 2019; 8:90. [PMID: 31164979 PMCID: PMC6543620 DOI: 10.1186/s13756-019-0539-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/13/2019] [Indexed: 11/22/2022] Open
Abstract
Background Gram-positive bacteria are dangerous and challenging agents of infection due to their increasing resistance to antibiotics. We aim to analyse the epidemiology and risk factors of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in Zhejiang China. Methods Gram-positive bacteria (including S. aureus, Enterococcus faecalis and Enterococcus faecium) were collected from eighty-six hospitals of eleven cities in Zhejiang China from 2015 to 2017. The detection rates of MRSA and VRE infection were calculated for the non-duplicated isolate according to year, region, hospital level, patient age, specimen type and patient category. Meanwhile, the detected resistances of MRSA, E. faecalis and E. faecium to different antibiotics from 2015 to 2017 were compared. The risk factors and the differences in MRSA and VRE detection rates were compared using odds ratio (OR) with 95% confidence interval (95% CI) and Chi-square test respectively. Results From 2015 to 2017, the detection rates of MRSA and VRE decreased gradually. The cities with the highest MRSA and VRE detection rates tended to be adjacent; for example, the neighbouring cities Hangzhou and Quzhou had simultaneously high rates of MRSA and VRE infection. Patients from IIIA hospital who were older than 75 years and in the intensive care unit (ICU) were most at risk. No vancomycin-resistant isolate was found in MRSA. Resistance of E. faecalis and E. faecium to vancomycin and linezolid decreased slightly and then maintained a low level. Conclusions The detection rates of MRSA and VRE stayed at moderate and low levels during the three year period of this study, while local dissemination was found in MRSA and VRE isolates. Sustained surveillance is necessary to prevent the spread or clonal dissemination of drug-resistant strains in Zhejiang China.
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Affiliation(s)
- Lin Huang
- 1Department of Clinical Microbiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009 People's Republic of China
| | - Rong Zhang
- 1Department of Clinical Microbiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009 People's Republic of China
| | - Yanyan Hu
- 1Department of Clinical Microbiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009 People's Republic of China
| | - Hongwei Zhou
- 1Department of Clinical Microbiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009 People's Republic of China
| | - Junmin Cao
- 2Zhejiang Provincial Hospital of TCM, Hangzhou, 310006 Zhejiang China
| | - Huoyang Lv
- Centre of Laboratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014 Zhejiang China
| | - Shi Chen
- Hangzhou Third Hospital, Hangzhou, 310009 Zhejiang China
| | - Shibiao Ding
- 5Hangzhou Red Cross Hospital, Hangzhou, 310003 Zhejiang China
| | - Gongxiang Chen
- 1Department of Clinical Microbiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009 People's Republic of China
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A molecular epidemiological investigation of methicillin-susceptible Staphylococcus aureus causing bloodstream infections in Ireland, 2006–2017. Eur J Clin Microbiol Infect Dis 2019; 38:927-936. [DOI: 10.1007/s10096-019-03523-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/27/2019] [Indexed: 01/28/2023]
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23
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Vásquez Hoyos P, Soto F, Pinzón D, González D, Peña C. Caracterización de pacientes pediatricos con hemocultivos positivos del servicio de cuidado intensivo pediátrico del Hospital San José Bogotá, abril 2012 a 2017. INFECTIO 2019. [DOI: 10.22354/in.v23i2.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introducción: El cultivo de la sangre es el método más utilizado en la búsqueda de infecciones del paciente pediátrico porque orienta la terapia antimicrobiana.Objetivo: Determinar la incidencia de hemocultivos positivos y su caracterización microbiológica en pacientes de cuidado intensivo pediátrico del Hospital de San José, Bogotá-Colombia.Materiales y métodos: Descripción de hemocultivos positivos en pacientes pediátricos de la unidad desde abril de 2012 a 2017. Se determinó la incidencia de hemocultivos positivos y se describió la población estudiada y los gérmenes aislados incluido su perfil de antibiograma.Resultados: Ingresaron 1773 pacientes a la UCIP, 241 pacientes (13,6%) fueron hemocultivados, de los cuales 80 (33,2%) fueron positivos, pero 50% de estos fueron catalogados como contaminaciones. La mediana de edad fue de 21 meses, con 64% de sexo masculino. El 57% fue ventilado y 45% tuvieron un catéter central. La mortalidad fue de 15,4%. La patología más frecuentemente fue respiratoria (75%). De los gérmenes no contaminantes el más frecuente aislado fue Staphylococcus aureus (30%), seguido de Klebsiella pneumoniae (17,5%) y Streptococcus pneumoniae (17,5%). El germen contaminante más frecuente fue Staphylococcus epidermidis (47,5%).Conclusión: La frecuencia de hemocultivos positivos es baja y es frecuente que se aíslen gérmenes contaminantes. El patrón fue similar a lo reportado por la red GREBO.
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24
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Duarte FC, Danelli T, Tavares ER, Morguette AEB, Kerbauy G, Grion CMC, Yamauchi LM, Perugini MRE, Yamada-Ogatta SF. Fatal sepsis caused by mecA-positive oxacillin-susceptible Staphylococcus aureus: First report in a tertiary hospital of southern Brazil. J Infect Chemother 2018; 25:293-297. [PMID: 30482697 DOI: 10.1016/j.jiac.2018.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/11/2018] [Accepted: 09/19/2018] [Indexed: 11/17/2022]
Abstract
mecA-positive oxacillin phenotypically susceptible Staphylococcus aureus (OS-MRSA) is increasingly reported worldwide. This bacterium poses a therapeutic threat, as it can be misidentified as an oxacillin-susceptible organism by phenotypic methods that are routinely used in the majority of clinical microbiology laboratories. Herein, we report the first case of fatal sepsis in a 43-year-old female patient caused by an OS-MRSA SCCmec type IVa/ST1/CC1 in a tertiary hospital in southern Brazil, which highlights the difficulties involved in diagnosing this bacterium. Blood cultures and phenotypic susceptibility tests on admission yielded a penicillin-resistant S. aureus. Although vancomycin therapy was initiated, this antibacterial was replaced by oxacillin, based on the susceptibility result. However, the clinical conditions of the patient deteriorated rapidly evolving to fatal septic shock. Clinical microbiology laboratories should consider the use of additional tests to accurately distinguish between various antimicrobial phenotypes of S. aureus.
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Affiliation(s)
- Felipe Crepaldi Duarte
- Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Departamento de Patologia, Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Brazil
| | - Tiago Danelli
- Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Departamento de Patologia, Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Brazil
| | - Eliandro Reis Tavares
- Bolsista do Programa Nacional de Pós-Doutorado do Programa de Pós-graduação em Microbiologia, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil; Laboratório de Biologia Molecular de Microrganismos, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil
| | - Ana Elisa Belotto Morguette
- Laboratório de Biologia Molecular de Microrganismos, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil
| | - Gilselena Kerbauy
- Departamento de Enfermagem, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Brazil
| | | | - Lucy Megumi Yamauchi
- Laboratório de Biologia Molecular de Microrganismos, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil; Programa de Pós-graduação em Microbiologia, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil
| | - Marcia Regina Eches Perugini
- Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Departamento de Patologia, Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Brazil; Laboratório de Microbiologia Clínica, Departamento de Patologia, Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Brazil.
| | - Sueli Fumie Yamada-Ogatta
- Programa de Mestrado em Fisiopatologia Clínica e Laboratorial, Departamento de Patologia, Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Brazil; Laboratório de Biologia Molecular de Microrganismos, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil; Programa de Pós-graduação em Microbiologia, Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil.
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25
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Miller WR, Seas C, Carvajal LP, Diaz L, Echeverri AM, Ferro C, Rios R, Porras P, Luna C, Gotuzzo E, Munita JM, Nannini E, Carcamo C, Reyes J, Arias CA. The Cefazolin Inoculum Effect Is Associated With Increased Mortality in Methicillin-Susceptible Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2018; 5:ofy123. [PMID: 29977970 PMCID: PMC6007512 DOI: 10.1093/ofid/ofy123] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/23/2018] [Indexed: 12/15/2022] Open
Abstract
Background Recent studies have favored the use of cefazolin over nafcillin for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. The clinical influence of the cefazolin inoculum effect (CzIE) in the effectiveness of cephalosporins for severe MSSA infections has not been evaluated. Methods We prospectively included patients from 3 Argentinian hospitals with S. aureus bacteremia. Cefazolin minimum inhibitory concentrations (MICs) were determined at standard (105 colony-forming units [CFU]/mL) and high (107 CFU/mL) inoculum. The CzIE was defined as an increase of MIC to ≥16 µg/mL when tested at high inoculum. Whole-genome sequencing was performed in all isolates. Results A total of 77 patients, contributing 89 MSSA isolates, were included in the study; 42 patients (54.5%) had isolates with the CzIE. In univariate analysis, patients with MSSA exhibiting the CzIE had increased 30-day mortality (P = .034) and were more likely to have catheter-associated or unknown source of bacteremia (P = .033) compared with patients infected with MSSA isolates without the CzIE. No statistically significant difference between the groups was observed in age, clinical illness severity, place of acquisition (community vs hospital), or presence of endocarditis. The CzIE remained associated with increased 30-day mortality in multivariate analysis (risk ratio, 2.65; 95% confidence interval, 1.10–6.42; P = .03). MSSA genomes displayed a high degree of heterogeneity, and the CzIE was not associated with a specific lineage. Conclusions In patients with MSSA bacteremia where cephalosporins are used as firstline therapy, the CzIE was associated with increased 30-day mortality. Clinicians should be cautious when using cefazolin as firstline therapy for these infections.
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Affiliation(s)
- William R Miller
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Division of Infectious Diseases, Department of Internal Medicine, Houston, Texas
| | - Carlos Seas
- Hospital Cayetano Heredia and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lina P Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Lorena Diaz
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Aura M Echeverri
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Carolina Ferro
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Rafael Rios
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Paola Porras
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Carlos Luna
- Pulmonary Division, Department of Medicine, Jose de San Martin Hospital, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Gotuzzo
- Hospital Cayetano Heredia and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jose M Munita
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Genomics and Resistant Microbes (GeRM) group, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Esteban Nannini
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Cesar Carcamo
- Hospital Cayetano Heredia and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jinnethe Reyes
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Division of Infectious Diseases, Department of Internal Medicine, Houston, Texas.,Department of Microbiology and Molecular Genetics, UTHealth McGovern Medical School, Houston, Texas.,Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
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