1
|
Masarweh OM, Saad-Omer S, Rohr M, Meda N, Brenner N. Methicillin-Resistant Staphylococcus aureus Cellulitis Causing Meningitis From Hematogenous Dissemination: A Case Report. Cureus 2024; 16:e52969. [PMID: 38406170 PMCID: PMC10894443 DOI: 10.7759/cureus.52969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Methicillin-resistant Staphylococcus aureus meningitis is commonly associated with surgical procedures that closely interact with the central nervous system; however, hematogenous spread via bacteremia is rarely reported. Here, we present a case of methicillin-resistant Staphylococcus aureus meningitis as a complication of a diabetic foot infection that disseminated into a bloodstream infection causing infective endocarditis, discitis, vertebral osteomyelitis, and meningitis that was successfully treated with intravenous daptomycin and rifampin.
Collapse
Affiliation(s)
- Omar M Masarweh
- Internal Medicine, University of Central Florida, Kissimmee, USA
| | - Suhail Saad-Omer
- Internal Medicine, University of Central Florida, Kissimmee, USA
| | - Michael Rohr
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Neha Meda
- Internal Medicine, University of Central Florida, Kissimmee, USA
| | - Nicole Brenner
- Internal Medicine, University of Central Florida, Kissimmee, USA
| |
Collapse
|
2
|
van Soest TM, Søndermølle MB, Brouwer MC, Chekrouni N, Larsen AR, Petersen A, van Sorge NM, Nielsen H, van de Beek D, Bodilsen J. Community-acquired Staphylococcus aureus meningitis in adults. J Infect 2023; 86:239-244. [PMID: 36682629 DOI: 10.1016/j.jinf.2023.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Staphylococcus aureus is an uncommon cause of community-acquired bacterial meningitis. We aimed to describe patients with this disease. METHODS We evaluated clinical characteristics and outcome of adults with community-acquired S. aureus meningitis from prospective nationwide cohort studies from Denmark (2015-2020) and the Netherlands (2006-2021). Whole genome sequencing of S. aureus isolates was performed to evaluate the potential association between clonal complex and clinical characteristics. RESULTS We evaluated 111 episodes of community-acquired S. aureus meningitis: 65 from Denmark and 46 from the Netherlands. The median age was 66 years (interquartile range [IQR] 50-74) and 43 of 111 patients were female (39%). Concomitant infectious foci were found in 95 of 107 patients (89%), most commonly endocarditis (53 of 109 [49%]) and spondylodiscitis (43 of 109 [39%]). The triad of neck stiffness, altered mental status (Glasgow Coma Scale score <14), and fever was present in only 18 of 108 patients (17%). Surgery was performed in 14 of 33 patients (42%) with spondylodiscitis and 26 of 52 (50%) with endocarditis. A favorable outcome (Glasgow Outcome Scale score 5) occurred in 26 of 111 patients (23%), while 39 (35%) died. The most common bacterial clonal complexes (CC) were CC30 (16 [17%]), CC45 (16 [17%]), CC5 (12 [13%], and CC15 (10 [11%]); no associations between CCs and concomitant foci or outcome were found. CONCLUSIONS Community-acquired S. aureus meningitis is a severe disease with a high case fatality rate, occurring mainly in patients with concomitant endocarditis or spondylodiscitis.
Collapse
Affiliation(s)
- Thijs M van Soest
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands; European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
| | - Maria Birgitte Søndermølle
- European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands; European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
| | - Nora Chekrouni
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands; European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
| | | | | | - Nina M van Sorge
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Henrik Nielsen
- European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands; European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
| | - Jacob Bodilsen
- European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark.
| | | |
Collapse
|
3
|
Human Palatine Tonsils Are Linked to Alzheimer’s Disease through Function of Reservoir of Amyloid Beta Protein Associated with Bacterial Infection. Cells 2022; 11:cells11152285. [PMID: 35892582 PMCID: PMC9330135 DOI: 10.3390/cells11152285] [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: 05/20/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Amyloid-β (Aβ)-peptide production or deposition in the neuropathology of Alzheimer’s disease (AD) was shown to be caused by chronic inflammation that may be induced by infection, but the role of pathogenic-bacteria-related AD-associated Aβ is not yet clearly understood. In this study, we validated the hypothesis that there is a correlation between the Aβ-protein load and bacterial infection and that there are effects of bacteria, Staphylococcus aureus (S. aureus), on the Aβ load in the inflammatory environment of human tonsils. Here, we detected Aβ-peptide deposits in human tonsil tissue as well as tissue similar to tonsilloliths found in the olfactory cleft. Interestingly, we demonstrated for the first time the presence of Staphylococcus aureus (S. aureus) clustered around or embedded in the Aβ deposits. Notably, we showed that treatment with S. aureus upregulated the Aβ-protein load in cultures of human tonsil organoids and brain organoids, showing the new role of S. aureus in Aβ-protein aggregation. These findings suggest that a reservoir of Aβ and pathogenic bacteria may be a possible therapeutic target in human tonsils, supporting the treatment of antibiotics to prevent the deposition of Aβ peptides via the removal of pathogens in the intervention of AD pathogenesis.
Collapse
|
4
|
Argirova PK, Kalchev YI, Boev IP, Vatev NT, Murdjeva MA, Vartigova MS. A comparative study between children and adults with bacterial neuroinfections. Folia Med (Plovdiv) 2022; 64:408-414. [PMID: 35856101 DOI: 10.3897/folmed.64.e65456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract.
Collapse
Affiliation(s)
| | | | - Ivan P Boev
- Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | | |
Collapse
|
5
|
Antimicrobial responses of peripheral and central nervous system glia against Staphylococcus aureus. Sci Rep 2021; 11:10722. [PMID: 34021227 PMCID: PMC8140078 DOI: 10.1038/s41598-021-90252-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
Staphylococcus aureus infections of the central nervous system are serious and can be fatal. S. aureus is commonly present in the nasal cavity, and after injury to the nasal epithelium it can rapidly invade the brain via the olfactory nerve. The trigeminal nerve constitutes another potential route of brain infection. The glia of these nerves, olfactory ensheathing cells (OECs) and trigeminal nerve Schwann cells (TgSCs), as well as astrocytes populating the glia limitans layer, can phagocytose bacteria. Whilst some glial responses to S. aureus have been studied, the specific responses of different glial types are unknown. Here, we compared how primary mouse OECs, TgSCs, astrocytes and microglia responded to S. aureus. All glial types internalized the bacteria within phagolysosomes, and S. aureus-conjugated BioParticles could be tracked with subtle but significant differences in time-course of phagocytosis between glial types. Live bacteria could be isolated from all glia after 24 h in culture, and microglia, OECs and TgSCs exhibited better protection against intracellular S. aureus survival than astrocytes. All glial types responded to the bacteria by cytokine secretion. Overall, OECs secreted the lowest level of cytokines, suggesting that these cells, despite showing strong capacity for phagocytosis, have immunomodulatory functions that can be relevant for neural repair.
Collapse
|
6
|
Pintado V, Pazos R, Jiménez-Mejías ME, Rodríguez-Guardado A, Díaz-Pollán B, Cabellos C, García-Lechuz JM, Lora-Tamayo J, Domingo P, Muñez E, Domingo D, González-Romo F, Lepe-Jiménez JA, Rodríguez-Lucas C, Gil A, Pelegrín I, Chaves F, Pomar V, Ramos A, Alarcón T, Pérez-Cecilia E. Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains. J Hosp Infect 2018; 102:108-115. [PMID: 30448277 DOI: 10.1016/j.jhin.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/11/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear. AIMS To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy. METHODS Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors. RESULTS There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001). CONCLUSIONS Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.
Collapse
Affiliation(s)
- V Pintado
- Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - R Pazos
- Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Biomedical Sciences and Medicine, Universidade do Algarve, Faro, Portugal
| | - M E Jiménez-Mejías
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | | | - B Díaz-Pollán
- Infectious Diseases Unit/Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | - C Cabellos
- Infectious Diseases Service, Hospital Bellvitge, L'Hospitalet, Barcelona, Spain
| | - J M García-Lechuz
- Clinical Microbiology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain; Department of Clinical Microbiology, Hospital Gregorio Marañon, Madrid, Spain
| | - J Lora-Tamayo
- Internal Medicine Department, Hospital 12 de Octubre, Madrid, Spain
| | - P Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Muñez
- Infectious Diseases Unit, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - D Domingo
- Microbiology Service, Hospital de La Princesa, Madrid, Spain
| | - F González-Romo
- Clinical Microbiology Service, Hospital Clínico San Carlos, Madrid, Spain
| | - J A Lepe-Jiménez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - C Rodríguez-Lucas
- Infectious Diseases Unit, Hospital Central de Asturias, Oviedo, Spain
| | - A Gil
- Infectious Diseases Unit/Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | - I Pelegrín
- Infectious Diseases Service, Hospital Bellvitge, L'Hospitalet, Barcelona, Spain
| | - F Chaves
- Clinical Microbiology Department, Hospital 12 de Octubre, Madrid, Spain
| | - V Pomar
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Ramos
- Infectious Diseases Unit, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - T Alarcón
- Microbiology Service, Hospital de La Princesa, Madrid, Spain
| | - E Pérez-Cecilia
- Clinical Microbiology Service, Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|
7
|
Abstract
BACKGROUND Central nervous system (CNS) infections caused by Staphylococcus aureus are uncommon in pediatric patients. We review the epidemiology, clinical features and treatment in 68 patients with a S. aureus CNS infection evaluated at Texas Children's Hospital. METHODS Cases of CNS infection in children with positive cerebrospinal fluid cultures or spinal epidural abscess (SEA) for S. aureus at Texas Children's Hospital from 2001 to 2013 were reviewed. RESULTS Seventy cases of S. aureus CNS infection occurred in 68 patients. Forty-nine cases (70%) were secondary to a CNS device, 5 (7.1%) were postoperative meningitis, 9 (12.8%) were hematogenous meningitis and 7 (10%) were SEAs. Forty-seven (67.2%) were caused by methicillin-sensitive S. aureus (MSSA) and 23 (32.8%) by methicillin-resistant S. aureus (MRSA). Community-acquired infections were more often caused by MRSA that was clone USA300/pvl. Most patients were treated with nafcillin (MSSA) or vancomycin (MRSA) with or without rifampin. Among patients with MRSA infection, 50% had a serum vancomycin trough obtained with the median level being 10.6 μg/mL (range: 5.4-15.7 μg/mL). Only 1 death was associated with S. aureus infection. CONCLUSIONS The epidemiology of invasive of S. aureus infections continues to evolve with MSSA accounting for most of the infections in this series. The majority of cases were associated with neurosurgical procedures; however, hematogenous S. aureus meningitis and SEA occurred as community-acquired infections in patients without predisposing factors. Patients with MRSA CNS infections had a favorable response to vancomycin, but the beneficial effect of combination therapy or targeting vancomycin trough concentrations of 15-20 μg/mL remains unclear.
Collapse
|
8
|
Rajasekharreddy P, Rani PU, Mattapally S, Banerjee SK. Ultra-small silver nanoparticles induced ROS activated Toll-pathway against Staphylococcus aureus disease in silkworm model. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 77:990-1002. [PMID: 28532120 DOI: 10.1016/j.msec.2017.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 01/19/2023]
Abstract
The present study investigated the therapeutic action of flavonoids loaded silver nanoparticles (FLV-Ag NPs) on a silkworm, Bombyx mori L., larvae infected by the S. aureus, where an in vivo model system was used. FLV-Ag NPs were synthesized using a Ricinus communis L. leaf extracted flavonoid mixture in various concentrations. The reduction reaction was performed under a simple sunlight exposure condition. In the reduction process, quercetin and kaempferol loadings were also found. They were confirmed by UV-visible, TEM, XRD, XPS, DLS and FTIR spectroscopic techniques. TEM confirmed that the synthesized NPs were monodispersed and with an average size of 5.8nm±0.04. Initially, those synthesized FLV-Ag NPs were tested against S. aureus in in vitro by comparing their potential inhibitory activity with only flavonoids mixture (FLVs) and pure silver nanoparticles (Ag NPs). Furthermore, these FLV-Ag NPs were used to treat S. aureus infected B. mori larvae and the therapeutic efficacy was measured. Our results demonstrate that the FLV-Ag NPs are effective in curing the S. aureus infection through the induced expression of antimicrobial peptide genes, the enhanced oxidative enzyme levels, and the promoted phagocytosis of S. aureus by the haemocytes in silkworm larvae. On the basis of these results, it is proposed that the mechanism of the antimicrobial activity of FLV-Ag NPs involves the NPs-insect fat body cell association and a reactive oxygen species-mediated Toll-pathway.
Collapse
Affiliation(s)
- Pala Rajasekharreddy
- Biology and Biotechnology Division, CSIR-Indian Institute of Chemical Technology, Uppal Road, Hyderabad 500007, Telangana State, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-Indian Institute of Chemical Technology, Uppal Road, Hyderabad 500007, Telangana State, India.
| | - Pathipati Usha Rani
- Biology and Biotechnology Division, CSIR-Indian Institute of Chemical Technology, Uppal Road, Hyderabad 500007, Telangana State, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-Indian Institute of Chemical Technology, Uppal Road, Hyderabad 500007, Telangana State, India
| | - Saidulu Mattapally
- Academy of Scientific and Innovative Research (AcSIR), CSIR-Indian Institute of Chemical Technology, Uppal Road, Hyderabad 500007, Telangana State, India; Division of Medicinal Chemistry and Pharmacology, CSIR-Indian Institute of Chemical Technology, Hyderabad 500607, Telangana State, India
| | - Sanjay Kumar Banerjee
- Academy of Scientific and Innovative Research (AcSIR), CSIR-Indian Institute of Chemical Technology, Uppal Road, Hyderabad 500007, Telangana State, India; Division of Medicinal Chemistry and Pharmacology, CSIR-Indian Institute of Chemical Technology, Hyderabad 500607, Telangana State, India; Drug Discovery Research Center, Translational Health Science and Technology Institute (THSTI), Faridabad 121001, India
| |
Collapse
|
9
|
Baunbæk-Knudsen G, Sølling M, Farre A, Benfield T, Brandt CT. Improved outcome of bacterial meningitis associated with use of corticosteroid treatment. Infect Dis (Lond) 2015; 48:281-286. [PMID: 26559704 DOI: 10.3109/23744235.2015.1109705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this study was to evaluate the clinical outcome of patients with bacterial meningitis following the introduction of dexamethasone treatment in Denmark. Methods Adult patients with bacterial meningitis, admitted from 2003-2010 to two different university hospitals, were included retrospectively. Data at clinical presentation, Glasgow outcome scale (GOS), cerebrospinal fluid and blood biochemistry were collected. Relative risk (RR) with 95% confidence interval (CI) was computed by Cox proportional hazard regression analysis. Results One hundred and forty-seven patients were included in the study. The population had a median age of 62 years and 31% had an immunosuppressive co-morbidity. Eighty-nine patients had an unfavourable outcome (GOS score = 1-4). Adjuvant treatment with corticosteroids (RR = 0.48; 95% CI = 0.30-0.76) was associated with a favourable outcome (GOS score = 5), while altered mental status (RR = 2.36; 95% CI = 1.17-4.78) and age (RR = 1.03; 95% CI = 1.01-1.04) per year increment was associated with an unfavourable outcome. Adjuvant corticosteroid treatment did not affect short- or long-term survival. Short-term mortality was influenced by age (RR = 1.06; 95% CI = 1.04-1.09). Long-term mortality was influenced by age (RR = 1.06; 95% CI = 1.03-1.08) and female sex (RR = 1.81; 95% CI = 1.05-3.14). Conclusion This study indicated that adjuvant corticosteroid treatment in acute bacterial meningitis improves the outcome and can safely be administered in an elderly population with high levels of immunosuppressive co-morbidity.
Collapse
Affiliation(s)
- Gertrud Baunbæk-Knudsen
- a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark.,b Department of Infectious Diseases
| | - Mette Sølling
- a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark
| | - Annette Farre
- c Department of Clinical Biochemistry , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark
| | | | - Christian T Brandt
- a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark.,b Department of Infectious Diseases
| |
Collapse
|
10
|
Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603-61. [PMID: 26016486 PMCID: PMC4451395 DOI: 10.1128/cmr.00134-14] [Citation(s) in RCA: 2650] [Impact Index Per Article: 294.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.
Collapse
Affiliation(s)
- Steven Y C Tong
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Joshua S Davis
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Emily Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
11
|
Kumari VHB, Babu AR, Srinivas D, Siddaiah N, Somanna S. Methicillin-ResistantStaphylococcusaureus central nervous system infections – Analysis and outcome. Br J Neurosurg 2015; 29:413-8. [DOI: 10.3109/02688697.2015.1006168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
12
|
Shoji T, Hirai Y, Osawa M, Totsuka K. Cefazolin therapy for methicillin-susceptible Staphylococcus aureus bacteremia in Japan. J Infect Chemother 2014; 20:175-80. [DOI: 10.1016/j.jiac.2013.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 10/25/2022]
|
13
|
de Fátima Magalhães Acioly Mendizabal M, Bezerra PC, Guedes DL, Cabral DBC, de Barros Miranda-Filho D. Prognostic indicators in bacterial meningitis: a case–control study. Braz J Infect Dis 2013; 17:538-44. [PMID: 23835007 PMCID: PMC9425123 DOI: 10.1016/j.bjid.2013.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 12/02/2022] Open
Abstract
This was a case–control study to identify prognostic indicators of bacterial meningitis in a reference hospital in Pernambuco/Brazil. The data were collected from charts of 294 patients with bacterial meningitis between January 2000 and December 2004. Variables were grouped in biological, clinical, laboratory and etiologic agent/treatment. Variables selected in each step were grouped and adjusted for age. Two models were created: one containing clinical variables (clinical model) and other containing laboratory variables (laboratory model). In the clinical model the variables associated with death due to bacterial meningitis were dyspnea (p = 0.006), evidence of shock (p = 0.051), evidence of altered mental state (p = 0.000), absence of headache (p = 0.008), absence of vomiting (p = 0.052), and age ≥40 years old (p = 0.013). In the laboratory model, the variables associated with death due to bacterial meningitis were positive blood cultures (p = 0.073) and thrombocytopenia (p = 0.019). Identification of prognostic indicators soon after admission may allow early specific measures, like admission of patients with higher risk of death to Intensive Care Units.
Collapse
Affiliation(s)
| | | | | | | | - Demócrito de Barros Miranda-Filho
- Faculdade de Ciências Médicas, UPE, Recife, PE, Brazil
- Corresponding author at: Rua Santo Elias, 175, 1001, Espinheiro, Recife, PE, 52020-090, Brazil.
| |
Collapse
|
14
|
Abdallah SA, Al-Asfoor KK, Salama MF, Al-Awadi BM. Prospective Analysis Methicillin-resistant Staphylococcus aureus and its Risk Factors. J Glob Infect Dis 2013; 5:19-25. [PMID: 23599613 PMCID: PMC3628228 DOI: 10.4103/0974-777x.107170] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Since the early nineties, a new methicillin-resistant Staphylococcus aureus (MRSA) has existed in a form correlating with community health personnel. Community-acquired MRSA (CA-MRSA) could be differentiated from healthcare-associated MRSA (HA-MRSA) microbiologically, epidemiologically, and molecularly. Aims: To determine the prevalence, risk factors of MRSA infections in community and hospital. Settings: The incidence and risk factors for CA-MRSA and HA-MRSA among patients of medical, surgical, and pediatrics wards and ICU at a Kuwaiti teaching hospital between 1 March 2011 and 30 November 2011 were studied. Materials and Methods: Cultures for MRSA were taken from nasal (nostril), groin, axilla, wound, sputum, or throat, and the inguinal area in all enrolled patients upon admission. All preserved isolates were examined for their susceptibility to different types of antibiotics. Results and Conclusion: A total of 71 MRSA patients admitted to different hospital wards were examined. Among these patients, 52 (73.2%) were carriers of MRSA before they were admitted to the hospital. Nineteen patients (26.8%) were found to have acquired MRSA during their stay in the hospital. Twenty-nine patients (40.8%) were given mupirocin local skin antibiotic. Binomial and the t-test (paired) were used to compare the prevalence of CA-MRSA and HA-MRSA; significant correlation (P < 0.05) between the type of MRSA and different wards, sites, and lengths of hospital stay was found. The level of serum albumin that is routinely measured at hospital admission is a predictor to MRSA infection. This study suggests that S. aureus and MRSA should become a national priority for disease control to avoid outbreaks.
Collapse
Affiliation(s)
- Soad A Abdallah
- Department of Microbiology, General Science Unit, College of Nursing, PAAET, Kuwait ; On Tenured Leave from Women's College for Arts,Science and Education, Ain Shams University, Cairo, Egypt
| | | | | | | |
Collapse
|
15
|
Jover E, Tawk MY, Laventie BJ, Poulain B, Prévost G. Staphylococcal leukotoxins trigger free intracellular Ca(2+) rise in neurones, signalling through acidic stores and activation of store-operated channels. Cell Microbiol 2012; 15:742-58. [PMID: 23152983 PMCID: PMC3654557 DOI: 10.1111/cmi.12069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/18/2012] [Accepted: 11/06/2012] [Indexed: 12/31/2022]
Abstract
Headache, muscle aches and chest pain of mild to medium intensity are among the most common clinical symptoms in moderate Staphylococcus aureus infections, with severe infections usually associated with worsening pain symptoms. These nociceptive responses of the body raise the question of how bacterial infection impinges on the nervous system. Does S. aureus, or its released virulence factors, act directly on neurones? To address this issue, we evaluated the potential effects on neurones of certain bi-component leukotoxins, which are virulent factors released by the bacterium. The activity of four different leukotoxins was verified by measuring the release of glutamate from rat cerebellar granular neurones. The bi-component γ-haemolysin HlgC/HlgB was the most potent leukotoxin, initiating transient rises in intracellular Ca2+ concentration in cerebellar neurones and in primary sensory neurones from dorsal root ganglia, as probed with the Fura-2 Ca2+ indicator dye. Using pharmacological antagonists of receptors and Ca2+ channels, the variations in intracellular Ca2+ concentration were found independent of the activation of voltage-operatedCa2+ channels or glutamate receptors. Drugs targeting Sarco-Endoplasmic Reticulum Ca2+-ATPase (SERCA) or H+-ATPase and antagonists of the store-operated Ca2+ entry complex blunted, or significantly reduced, the leukotoxin-induced elevation in intracellular Ca2+. Moreover, activation of the ADP-ribosyl cyclase CD38 was also required to initiate the release of Ca2+ from acidic stores. These findings suggest that, prior to forming a pore at the plasma membrane, leukotoxin HlgC/HlgB triggers a multistep process which initiates the release of Ca2+ from lysosomes, modifies the steady-state level of reticular Ca2+ stores and finally activates the Store-Operated Calcium Entry complex.
Collapse
Affiliation(s)
- Emmanuel Jover
- INCI - UPR-CNRS 3212, Neurotransmission et sécrétion neuroendocrine, 5, rue Blaise Pascal, F- 67084 Strasbourg cedex, France. jover@inci-cnrs
| | | | | | | | | |
Collapse
|
16
|
Buechner D, Gelfand MS, Cleveland KO. Percutaneous transluminal angioplasty in a patient with vasospasm due to staphylococcal meningitis. J Neurosurg 2012; 117:103-6. [PMID: 22577745 DOI: 10.3171/2012.4.jns111549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arterial large vessel vasculopathy is an unusual complication of bacterial meningitis in adults that may result in cerebral ischemia and severe neurological sequelae. Previous therapy has included antimicrobials with no specific vascular interventions. The authors report their experience with a patient with bacterial meningitis who developed a vasculopathy with neurological deficits. Percutaneous intracranial intervention was used successfully with anatomical and functional improvement.
Collapse
Affiliation(s)
- David Buechner
- Department of Radiology, Methodist Healthcare of Memphis, University of Tennessee Health Science Center, Memphis, TN 38104, USA
| | | | | |
Collapse
|
17
|
De Alwis WR, Pakirisamy P, Wai San L, Xiaofen EC. A Study on Hand Contamination and Hand Washing Practices among Medical Students. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/251483] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Harmful microorganisms can be transferred to hands from contaminated surfaces people come into contact in daily life. Contaminated hands can transmit disease to one self as well as to others. A study was done to determine the extent to which hand hygiene practices and toilet door knobs contribute to the bacterial load of hands of toilet users in a medical school. Swabs were taken from a randomly selected sample of 60 medical students for bacterial count from both hands before and after toilet use and from door knobs of six toilets. Only 40 (66.7%) claimed they washed hands with soap. Significantly more females (83%) used soap to wash hands compared to males (50%). Bacterial load in the hands of both males and females showed an increase after toilet use. The increase was significant among male students. The dominant hand had a significantly higher bacterial load than the other. The mean bacterial load of male toilet door knobs (12 CFU/cm2) were significantly higher than of female toilet door knobs (2.5 CFU/cm2) (P<0.05). Staphylococcus aureus was isolated from the hands of 21 students. Toilets and washrooms should be designed so as to eliminate the sources of contamination of the hands.
Collapse
Affiliation(s)
- Watutantrige Ranjit De Alwis
- Division of Community Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Premalatha Pakirisamy
- Division of Community Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Lum Wai San
- Division of Community Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Evelyn Chen Xiaofen
- Division of Community Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| |
Collapse
|
18
|
van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin Microbiol Rev 2012; 25:362-86. [PMID: 22491776 PMCID: PMC3346297 DOI: 10.1128/cmr.05022-11] [Citation(s) in RCA: 614] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.
Collapse
Affiliation(s)
- Sebastian J van Hal
- Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service—Liverpool, South Western Sydney Local Health Network, Sydney, New South Wales, Australia.
| | | | | | | | | | | |
Collapse
|
19
|
Activity of sitafloxacin against extracellular and intracellular Staphylococcus aureus in vitro and in vivo: comparison with levofloxacin and moxifloxacin. J Antibiot (Tokyo) 2012; 65:229-36. [PMID: 22334239 DOI: 10.1038/ja.2012.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Antibiotic activity can differ depending on whether the bacterial target is extracellular or intracellular. To determine extracellular and intracellular activities of sitafloxacin (STX) against Staphylococcus aureus in comparison with levofloxacin (LVX) and moxifloxacin (MXF) in vivo and in vitro, three S. aureus strains (ATCC25923, 29213, 43300) were evaluated. MIC, MBC and mutant prevention concentration (MPC) of the test quinolone for S. aureus were determined by microdilution in broth, and intracellular activity was determined in RAW264.7 cells after phagocytosis of bacteria. Cellular quinolone accumulation was determined by HPLC. The time- and concentration-kill relationships were examined in vitro (in broth and in RAW264.7 cells, respectively) and in vivo by use of a mouse peritonitis model. The results showed that the activity of STX in broth cultures, including the MIC, MBC, MPC and the time- and concentration-kill relationships, were greater for STX than those for LVX and MXF. In particular, STX exhibited the strongest activity against intramacrophage S. aureus. The intracellular effects could be ranked in the following order as the mean change in the log10 number of cfu ml(-1) (log10 cfu ml(-1)) between treated and untreated mice: STX>LVX>MXF. It also showed that the dominant factor of intracellular activity in vivo was the frequency of doses. There was a poor correlation between the intracellular accumulation of the three different quinolones and the actual intracellular effect. The results of the intracellular and extracellular time- and concentration-kill relationships indicated that STX has the potential to display useful activity against extracellular and intracellular S. aureus.
Collapse
|
20
|
Pintado V, Pazos R, Jiménez-Mejías ME, Rodríguez-Guardado A, Gil A, García-Lechuz JM, Cabellos C, Chaves F, Domingo P, Ramos A, Pérez-Cecilia E, Domingo D. Methicillin-resistant Staphylococcus aureus meningitis in adults: a multicenter study of 86 cases. Medicine (Baltimore) 2012; 91:10-17. [PMID: 22198499 DOI: 10.1097/md.0b013e318243442b] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) meningitis is an uncommon disease, and little is known about its epidemiology, clinical features, therapy, and outcome. We performed a multicenter retrospective study of MRSA meningitis in adults. Eighty-six adult patients were included and the following data were obtained: underlying diseases, clinical presentation, analytical and microbiologic data, response to therapy, and outcome.There were 56 men (65%) and the mean age was 51.5 years; 54 of them (63%) had severe comorbidities. There were 78 cases of postoperative meningitis and 8 of spontaneous meningitis. The infection was nosocomial in 93% (80/86) of the cases. Among the 78 patients with postoperative meningitis, the most common predisposing conditions were cerebrospinal fluid (CSF) devices (74%), neurosurgery (45%), CSF leakage (17%), and head trauma (12%). Most patients had fever (89%), altered mental status (68%), headache (40%), and meningeal signs (29%). The most common CSF findings were pleocytosis (90%), elevated protein level (77%), and hypoglycorrhachia (30%). CSF Gram stain and blood cultures were positive in 49% (32/65) and 36% (16/45) of cases, respectively. An associated MRSA infection and polymicrobial meningitis appeared in 33% (28/86) and 23% (20/86) of cases, respectively. Antimicrobial therapy was given to 84 patients. Most of them received vancomycin (92%) either as monotherapy (64%) or in combination with other antibiotics (28%), for a median of 18 days. Overall 30-day mortality was 31% (27/86). Multivariate study identified 2 independent factors associated with mortality: spontaneous meningitis (odds ratio [OR], 21.4; 95% confidence interval [CI], 2.3-195.4; p = 0.007), and coma (OR, 9.7; 95% CI, 2.2-42.3; p = 0.002).In conclusion, MRSA is a relatively uncommon but serious disease. Although most cases are nosocomial infections appearing in neurosurgical patients, spontaneous meningitis may present as a community-onset infection in patients with severe comorbidities requiring frequent contact with the health care system. Most patients have a favorable response to vancomycin, but the beneficial effect of combined and intraventricular therapy, or alternative drugs, remains unclear. MRSA meningitis is associated with a high mortality, and the presence of spontaneous infection and coma are the most important prognostic factors.
Collapse
Affiliation(s)
- Vicente Pintado
- From Infectious Diseases Service (VP, RP), Hospital Ramón y Cajal, Madrid; Infectious Diseases Service (MEJ-M), Hospital Virgen del Rocío, Sevilla; Infectious Diseases Unit (AR-G), Hospital Central de Asturias, Oviedo; Department of Internal Medicine (AG), Hospital La Paz, Madrid; Department of Clinical Microbiology (JMG-L), Hospital Gregorio Marañón, Madrid; Infectious Diseases Service, Hospital Bellvitge (CC), L'Hospitalet de Llobregat, Barcelona; Microbiology Department (FC), Hospital Doce de Octubre, Madrid; Infectious Diseases Unit (PD), Hospital de la Santa Creu i Sant Pau, Barcelona; Infectious Diseases Unit (AR), Hospital Puerta de Hierro-Majadahonda, Madrid; Clinical Microbiology Service (EP-C), Hospital Clínico San Carlos, Madrid; Microbiology Service (DD), Hospital La Princesa, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Clinical Characteristics and Risk Factors for Mortality in Patients with Meningitis Caused by Staphylococcus aureus and Vancomycin Minimal Inhibitory Concentrations Against These Isolates. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:470-7. [DOI: 10.1016/s1684-1182(10)60073-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/25/2009] [Accepted: 08/31/2009] [Indexed: 10/18/2022]
|
22
|
Sheen TR, Ebrahimi CM, Hiemstra IH, Barlow SB, Peschel A, Doran KS. Penetration of the blood-brain barrier by Staphylococcus aureus: contribution of membrane-anchored lipoteichoic acid. J Mol Med (Berl) 2010; 88:633-9. [PMID: 20419283 DOI: 10.1007/s00109-010-0630-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/19/2010] [Accepted: 03/30/2010] [Indexed: 11/26/2022]
Abstract
Staphylococcus aureus is one of the most prevalent organisms responsible for nosocomial infections, and cases of community-acquired S. aureus infection have continued to increase despite widespread preventative measures. Pathologies attributed to S. aureus infection are diverse; ranging from dermal lesions to bacteremia, abscesses, and endocarditis. Reported cases of S. aureus-associated meningitis and brain abscesses have also increased in recent years, however, the precise mechanism whereby S. aureus leave the bloodstream and gain access to the central nervous system (CNS) are not known. Here we demonstrate for the first time that S. aureus efficiently adheres to and invades human brain microvascular endothelial cells (hBMEC), the single-cell layer which constitutes the blood-brain barrier (BBB). The addition of cytochalasin D, an actin microfilament aggregation inhibitor, strongly reduced bacterial invasion, suggesting an active hBMEC process is required for efficient staphylococcal uptake. Furthermore, mice injected with S. aureus exhibited significant levels of brain bacterial counts and histopathologic evidence of meningeal inflammation and brain abscess formation, indicating that S. aureus was able to breech the BBB in an experimental model of hematogenous meningitis. We found that a YpfP-deficient mutant, defective in lipoteichoic acid (LTA) membrane anchoring, exhibited a decreased ability to invade hBMEC and correlated to a reduced risk for the development of meningitis in vivo. Our results demonstrate that LTA-mediated penetration of the BBB may be a primary step in the pathogenesis of staphylococcal CNS disease.
Collapse
Affiliation(s)
- Tamsin R Sheen
- Department of Biology and Center for Microbial Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | | | | | | | | | | |
Collapse
|
23
|
Intra- and extracellular activities of dicloxacillin against Staphylococcus aureus in vivo and in vitro. Antimicrob Agents Chemother 2010; 54:2391-400. [PMID: 20308386 DOI: 10.1128/aac.01400-09] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Antibiotic treatment of Staphylococcus aureus infections is often problematic due to the slow response and recurrences. The intracellular persistence of the staphylococci offers a plausible explanation for the treatment difficulties because of the impaired intracellular efficacies of the antibiotics. The intra- and extracellular time- and concentration-kill relationships were examined in vitro with THP-1 cells and in vivo by use of a mouse peritonitis model. The in vivo model was further used to estimate the most predictive pharmacokinetic/pharmacodynamic (PK/PD) indices (the ratio of the maximum concentration of drug in plasma/MIC, the ratio of the area under the concentration-time curve/MIC, or the cumulative percentage of a 24-h period that the free [f] drug concentration exceeded the MIC under steady-state pharmacokinetic conditions [fT(MIC)]) for dicloxacillin (DCX) intra- and extracellularly. In general, DCX was found to have similar intracellular activities, regardless of the model used. Both models showed (i) the relative maximal efficacy (1-log-unit reduction in the numbers of CFU) of DCX intracellularly and (ii) the equal relative potency of DCX intra- and extracellularly, with the MIC being a good indicator of the overall response in both situations. Discordant results, based on data obtained different times after dosing, were obtained from the two models when the extracellular activity of DCX was measured, in which the in vitro model showed a considerable reduction in the number of CFU from that in the original inoculum (3-log-unit decrease in the number of CFU after 24 h), whereas the extracellular CFU reduction achieved in vivo after 4 h did not exceed 1 log unit. Multiple dosing of DCX in vivo revealed increased extra- and intracellular efficacies (2.5 log and 2 log units of reduction in the numbers of CFU after 24 h, respectively), confirming that DCX is a highly active antistaphylococcal antibiotic. PK/PD analysis revealed that fT(MIC) is the index that is the most predictive of the outcome of infection both intra- and extracellularly.
Collapse
|
24
|
Sandberg A, Jensen KS, Baudoux P, Van Bambeke F, Tulkens PM, Frimodt-Møller N. Intra- and extracellular activity of linezolid against Staphylococcus aureus in vivo and in vitro. J Antimicrob Chemother 2010; 65:962-73. [PMID: 20211859 DOI: 10.1093/jac/dkq052] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND AIMS Treatment of Staphylococcus aureus infections remains problematic (slow responses and frequent recurrences). Intracellular persistence of the S. aureus could explain those difficulties because of impaired intracellular efficacy of antibiotics. Our aim was to study linezolid for its intracellular activity. METHODS (i) Pharmacodynamic (PD) analysis of intracellular activity using in vitro (THP-1 macrophages) and in vivo (mouse peritonitis) models with determination of key dose-response parameters [maximal relative efficacy (E(max)), relative potency (EC(50)) and static concentration (C(static))] towards methicillin-susceptible S. aureus (ATCC 25923; clinical isolate) with linezolid MICs of 4 mg/L; (ii) pharmacokinetic (PK) analysis in uninfected mice for determination of C(max), AUC and half-life for total and free drug; and (iii) determination of the predictive PK/PD parameter (fT > MIC, fAUC(24)/MIC or fC(max)/MIC) for therapeutic outcome. RESULTS In vitro, linezolid showed an E(max) of approximately 1 log(10) cfu reduction compared with initial inoculum both intra- and extracellularly and an approximately 3-fold increased relative potency (lower EC(50) and C(static)) intracellularly. In vivo, the efficacy of linezolid was impaired (<0.5 log(10) reduction extracellularly; failure to reduce the cfu to less than the initial load intracellularly) with, however, an increased intracellular potency (lower EC(50)). Infection outcome correlated better with the fAUC(24)/MIC (R(2) = 55%) than with the fT > MIC parameter (R(2) = 51%) for the extracellular compartment, but no parameter emerged as significant for the intracellular compartment. CONCLUSIONS Linezolid exerts only a weak intracellular activity against the strains of S. aureus tested, even though, in contrast to most other antibiotics, its potency does not appear impaired in comparison with the extracellular activity.
Collapse
Affiliation(s)
- Anne Sandberg
- National Center for Antimicrobials & Infection Control, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen S, Denmark
| | | | | | | | | | | |
Collapse
|
25
|
Aguilar J, Urday-Cornejo V, Donabedian S, Perri M, Tibbetts R, Zervos M. Staphylococcus aureus meningitis: case series and literature review. Medicine (Baltimore) 2010; 89:117-125. [PMID: 20517182 DOI: 10.1097/md.0b013e3181d5453d] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Staphylococcus aureus meningitis is a challenging disease and little is known about its epidemiology. There are no established management guidelines. We retrospectively reviewed the clinical information, bacteriologic data, and outcomes of all 33 patients with cerebrospinal fluid (CSF) cultures positive for S aureus seen at a single urban teaching hospital from 1999 to 2008. Pulsed-field gel electrophoresis (PFGE) and polymerase chain reaction for staphylococcal cassette chromosome mec (SCCmec), accessory gene regulator (agr) typing, and Panton-Valentine leukocidin (PVL) loci were done on methicillin-resistant S aureus (MRSA) CSF isolates starting in 2005. S aureus caused 12 (36%) cases of postoperative and 21 (64%) cases of hematogenous meningitis. MRSA isolates were found in 6 (50%) cases of postoperative and 10 (48%) cases of hematogenous meningitis. Twelve (75%) of the 16 MRSA infections occurred in the last 5 years of the study. Hematogenous meningitis was associated with older age (p = 0.04), injection drug use (p < 0.01), community-acquired infection (p < 0.01), underlying disease (p = 0.01), staphylococcal infection outside the central nervous system (p = 0.01), altered mental status (p = 0.02), fever (p = 0.01), septic shock (p = 0.03), and bacteremia (p < 0.01). The analysis of the 9 MRSA isolates showed 3 PFGE types: 3 USA100 (33%), 5 USA300 (56%), and 1 USAnot100-1100 (11%). For SCCmec typing, there were 2 (22%) type II and 7 (78%) type IV. All USA300 strains were SCCmec IVa. For agr typing, there were 5 (56%) type I and 4 (44%) type II. Three isolates (33%) were positive for the PVL gene and were USA300 strains. Most patients received nafcillin or vancomycin with or without rifampin or trimethoprim/sulfamethoxazole for a mean period of 17 days (range, 1-42 d). Overall mortality was 36%, and it was associated with community-acquired infection (p = 0.02). Postoperative and hematogenous S aureus meningitis are distinct clinical syndromes. S aureus hematogenous meningitis has devastating clinical consequences and elevated mortality rates, especially if it is acquired in the community. The incidence of MRSA meningitis increased over the last 5 years of the study. Treatment of choice is nafcillin for methicillin-sensitive strains and vancomycin for MRSA strains. The addition of trimethoprim/sulfamethoxazole or rifampin to vancomycin is recommended in severe cases and community-acquired MRSA infections. Linezolid is also a good option due to its good CSF penetration and favorable case reports. The mortality rate is higher in infections acquired in the community.
Collapse
Affiliation(s)
- Javier Aguilar
- From Division of Infectious Diseases and Microbiology (JA, VUC, SD, MP,RT, MZ), Henry Ford Hospital, Detroit, Michigan; and Wayne State University School of Medicine (MZ), Detroit, Michigan
| | | | | | | | | | | |
Collapse
|
26
|
Pinet P, Denes E, Garnier F, Durox H, Ducroix-Roubertou S, Weinbreck P. [Community-acquired meningitis due to methicillin susceptible Staphylococcus aureus]. Med Mal Infect 2009; 40:156-60. [PMID: 19836176 DOI: 10.1016/j.medmal.2009.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/15/2009] [Accepted: 08/31/2009] [Indexed: 11/29/2022]
Abstract
UNLABELLED Meningitis due to Staphylococcus aureus is infrequent. MRSA is mainly found after neurosurgery, but MSSA may be involved in community-acquired meningitis. However, this kind of infection is not widely reported, despite its severity. METHODS We describe the characteristics of five patients hospitalized in our ward over a period of 18 months who presented with community-acquired meningitis due to MSSA. RESULTS The patients were three men and two women with a mean age of 62 years. One patient was immunosuppressed. Neurological signs were present at the onset for only two patients. In all cases, there were extraneurological localizations of the infection, mainly in bones (spondylodiscitis, epidural abscess, arthritis) but also lung infection. Three patients with meningeal inflammation also presented with confusion. CSF analysis revealed less than 950 white blood cells, hyper-CSF-proteins, and hypo-CSF-glucose. Bacteraemia was present in all patients. The source of infection was never determined. The evolution was good for all patients with a prolonged antibiotic course. The analysis of genetic determinants for three strains revealed the presence of TSST-1 which could account for the severity of the disease. CONCLUSION Community-acquired MSSA meningitis is a serious infection, occurring in patients without risk factors. Hematogenous dissemination leads to multiple tissue infection. A long course of antibiotics, with high doses, is needed to treat meningitis but also extraneurological localizations. The role of TSST-1 needs to be confirmed in other patients.
Collapse
Affiliation(s)
- P Pinet
- Service de maladies infectieuses et tropicales, CHU Dupuytren, avenue Martin-Luther-King, Limoges, France.
| | | | | | | | | | | |
Collapse
|
27
|
Plectasin shows intracellular activity against Staphylococcus aureus in human THP-1 monocytes and in a mouse peritonitis model. Antimicrob Agents Chemother 2009; 53:4801-8. [PMID: 19738011 DOI: 10.1128/aac.00685-09] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antimicrobial therapy of infections with Staphylococcus aureus can pose a challenge due to slow response to therapy and recurrence of infection. These treatment difficulties can partly be explained by intracellular survival of staphylococci, which is why the intracellular activity of antistaphylococcal compounds has received increased attention within recent years. The intracellular activity of plectasin, an antimicrobial peptide, against S. aureus was determined both in vitro and in vivo. In vitro studies using THP-1 monocytes showed that some intracellular antibacterial activity of plectasin was maintained (maximal relative efficacy [E(max)], 1.0- to 1.3-log reduction in CFU) even though efficacy was inferior to that of extracellular killing (E(max), >4.5-log CFU reduction). Animal studies included a novel use of the mouse peritonitis model, exploiting extra- and intracellular differentiation assays, and assessment of the correlations between activity and pharmacokinetic (PK) parameters. The intracellular activity of plectasin was in accordance with the in vitro studies, with an E(max) of a 1.1-log CFU reduction. The parameter most important for activity was fC(peak)/MIC, where fC(peak) is the free peak concentration. These findings stress the importance of performing studies of extra- and intracellular activity since these features cannot be predicted from traditional MIC and killing kinetic studies. Application of both the THP-1 and the mouse peritonitis models showed that the in vitro results were similar to findings in the in vivo model with respect to demonstration of intracellular activity. Therefore the in vitro model was a good screening model for intracellular activity. However, animal models should be applied if further information on activity, PK/pharmacodynamic parameters, and optimal dosing regimens is required.
Collapse
|
28
|
Fuglsang-Damgaard D, Pedersen G, Schønheyder HC. Positive blood cultures and diagnosis of bacterial meningitis in cases with negative culture of cerebrospinal fluid. ACTA ACUST UNITED AC 2009; 40:229-33. [PMID: 17907046 DOI: 10.1080/00365540701642161] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The diagnosis of bacterial meningitis may be established through positive blood cultures in cases with negative culture of cerebrospinal fluid (CSF). However, information is sparse regarding how often the aetiological diagnosis is determined by blood culture alone. Therefore, we undertook a retrospective study of patients with meningitis and a blood culture-based bacterial diagnosis in North Jutland County, Denmark in 1997-2005. Patients were included if they had 1) a microscopy- and culture-negative CSF specimen with a leukocyte count > or =100x10(6)/l and an erythrocyte count < or =10,000x10(6)/l and 2) a positive blood culture within an interval of 3 d. A total of 20 patients fulfilled these criteria: 7 with Streptococcus pneumoniae, 4 with Neisseria meningitidis, 4 with Staphylococcus aureus, and 5 with miscellaneous bacteria. Suitable antibiotic therapy was delayed up to 48 h after lumbar puncture, and in-hospital mortality was 25%. A discharge diagnosis of bacterial meningitis was missing in 6/20 cases, and 12/20 cases had not been reported to Danish health authorities. Thus, patients with CSF-culture negative bacterial meningitis are at risk of delayed therapy, a poor outcome, and incomplete notification to health authorities.
Collapse
Affiliation(s)
- David Fuglsang-Damgaard
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
| | | | | |
Collapse
|
29
|
Brouwer MC, Keizerweerd GD, De Gans J, Spanjaard L, Van De Beek D. Community acquired Staphylococcus aureus meningitis in adults. ACTA ACUST UNITED AC 2009; 41:375-7. [PMID: 19177261 DOI: 10.1080/00365540902744766] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present 9 patients with community acquired Staphylococcus aureus meningitis. Foci of infection outside the central nervous system were present in 8 (89%) patients, mostly endocarditis and pneumonia. Cardiorespiratory complications occurred frequently and 6 patients died (67%). Identification and treatment of the primary focus of infection should be a priority in these patients.
Collapse
Affiliation(s)
- Matthijs C Brouwer
- Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
30
|
Intracellular activity of antibiotics against Staphylococcus aureus in a mouse peritonitis model. Antimicrob Agents Chemother 2009; 53:1874-83. [PMID: 19223616 DOI: 10.1128/aac.01605-07] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antibiotic treatment of Staphylococcus aureus infections is often problematic due to the slow response to therapy and the high frequency of infection recurrence. The intracellular persistence of staphylococci has been recognized and could offer a good explanation for these treatment difficulties. Knowledge of the interplay between intracellular antibiotic activity and the overall outcome of infection is therefore important. Several intracellular in vitro models have been developed, but few experimental animal models have been published. The mouse peritonitis/sepsis model was used as the basic in vivo model exploring a quantitative ex vivo extra- and intracellular differentiation assay. The intracellular presence of S. aureus was documented by electron microscopy. Five antibiotics, dicloxacillin, cefuroxime, gentamicin, azithromycin, and rifampin (rifampicin), were tested in the new in vivo model; and the model was able to distinguish between their extra- and intracellular effects. The intracellular effects of the five antibiotics could be ranked as follows as the mean change in the log(10) number of CFU/ml (Delta log(10) CFU/ml) between treated and untreated mice after 4 h of treatment: dicloxacillin (3.70 Delta log(10) CFU/ml) > cefuroxime (3.56 Delta log(10) CFU/ml) > rifampin (1.86 Delta log(10) CFU/ml) > gentamicin (0.61 Delta log(10) CFU/ml) > azithromycin (0.21 Delta log(10) CFU/ml). We could also show that the important factors during testing of intracellular activity in vivo are the size, number, and frequency of doses; the time of exposure; and the timing between the start of infection and treatment. A poor correlation between the intracellular accumulation of the antibiotics and the actual intracellular effect was found. This stresses the importance of performing experimental studies, like those with the new in vivo model described here, to measure actual intracellular activity instead of making predictions based on cellular pharmacokinetic and MICs.
Collapse
|
31
|
SCORING SYSTEMS FOR PREDICTION OF MORTALITY IN PATIENTS WITH INTENSIVE CARE UNIT-ACQUIRED SEPSIS. Shock 2009; 31:146-50. [DOI: 10.1097/shk.0b013e318182f98f] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
32
|
Antibacterial and anti-PAF activity of lipid extracts from sea bass (Dicentrarchus labrax) and gilthead sea bream (Sparus aurata). Food Chem 2008; 111:433-8. [DOI: 10.1016/j.foodchem.2008.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 02/04/2008] [Accepted: 04/04/2008] [Indexed: 11/22/2022]
|
33
|
Kwon KT, Oh WS, Song JH, Chang HH, Jung SI, Kim SW, Ryu SY, Heo ST, Jung DS, Rhee JY, Shin SY, Ko KS, Peck KR, Lee NY. Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia. J Antimicrob Chemother 2007; 59:525-30. [PMID: 17213265 DOI: 10.1093/jac/dkl499] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate the impact of imipenem resistance on the mortality rate among patients with Acinetobacter bacteraemia. METHODS A retrospective, pairwise-matched (1:1), risk-adjusted (age, Pitt bacteraemia score) cohort study was performed at three tertiary care hospitals in Korea from January 2000 to June 2005. RESULTS Forty patients with imipenem non-susceptible Acinetobacter bacteraemia (INAB group) and 40 matched subjects (1:1 ratio) with imipenem-susceptible Acinetobacter bacteraemia (ISAB group) were included. Both groups had similar clinical features related to the severity of illness. The 30 day mortality rate was higher in the INAB group (57.5%) than the ISAB group (27.5%) (P = 0.007). The rate of discordant antimicrobial therapy was higher in the INAB group (65.0%) than the ISAB group (20.0%) (P < 0.001). The 30 day mortality rate was higher in the patients with discordant antimicrobial therapy (67.6%) than concordant antimicrobial therapy (23.9%) (P < 0.001). Multivariate analysis showed that age, the Pitt bacteraemia score, immunosuppressive status, and discordant antimicrobial therapy were independent risk factors for 30 day mortality among patients with Acinetobacter bacteraemia (P < 0.05). When discordant antimicrobial therapy was excluded in the multivariate analysis, the imipenem resistance was associated with 30 day mortality (P = 0.005). CONCLUSIONS Imipenem resistance has a significant impact on the mortality rate among patients with Acinetobacter bacteraemia, and this is mainly attributable to the higher rate of discordant antimicrobial therapy.
Collapse
Affiliation(s)
- Ki Tae Kwon
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Seoul 135-710, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|