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Molecular Epidemiology of Staphylococcus aureus and MRSA in Bedridden Patients and Residents of Long-Term Care Facilities. Antibiotics (Basel) 2022; 11:antibiotics11111526. [PMID: 36358181 PMCID: PMC9686811 DOI: 10.3390/antibiotics11111526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
At present, multidrug-resistant microorganisms are already responsible for community-acquired infections. Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious public health risk worldwide because of the rapid spread and diversification of pandemic clones that are characterized by increasing virulence and antimicrobial resistance. The aim of this study was to identify the prevalence and factors associated with nasal, oral and rectal carriage of S. aureus and MRSA in bedridden patients and residents of long-term care facilities for the elderly (LTCFs) in Botucatu, SP, Brazil. Nasal, oral and rectal swab isolates obtained from 226 LTCF residents or home-bedridden patients between 2017 and 2018 were submitted to susceptibility testing, detection of the mecA gene, SCCmec characterization, and molecular typing by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Logistic regression analysis was used to identify risk factors associated with the presence of S. aureus and MRSA. The prevalence of S. aureus and MRSA was 33.6% (n = 76) and 8% (n = 18), respectively. At the nine LTCFs studied, the prevalence of S. aureus ranged from 16.6% to 85.7% and that of MRSA from 13.3% to 25%. Living in an LTCF, male gender, a history of surgeries, and a high Charlson Comorbidity Index score were risk factors associated with S. aureus carriage, while MRSA carriage was positively associated with male gender. This study showed a high prevalence of S. aureus among elderly residents of small (<15 residents) and medium-sized (15−49 residents) LTCFs and a higher prevalence of MRSA in the oropharynx.
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Kasela M, Grzegorczyk A, Nowakowicz-Dębek B, Malm A. The Prevalence of Virulence Determinants and Antibiotic Resistance Patterns in Methicillin-Resistant Staphylococcus aureus in a Nursing Home in Poland. Pathogens 2021; 10:pathogens10040427. [PMID: 33916758 PMCID: PMC8065860 DOI: 10.3390/pathogens10040427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Nursing homes (NH) contribute to the regional spread of methicillin-resistant Staphylococcus aureus (MRSA). Moreover, residents are vulnerable to the colonization and subsequent infection of MRSA etiology. We aimed at investigating the molecular and phenotypic characteristics of 21 MRSA collected from the residents and personnel in an NH (Lublin, Poland) during 2018. All MRSA were screened for 20 genes encoding virulence determinants (sea-see, eta, etb, tst, lukS-F-PV, eno, cna, ebpS, fib, bbp, fnbA, fnbB, icaADBC) and for resistance to 18 antimicrobials. To establish the relatedness and clonal complexes of MRSA in NH we applied multiple-locus variable-number tandem-repeat fingerprinting (MLVF), pulse field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and staphylococcal cassette chromosome mec (SCCmec) typing. We identified four sequence types (ST) among two clonal complexes (CC): ST (CC22) known as EMRSA-15 as well as three novel STs—ST6295 (CC8), ST6293 (CC8) and ST6294. All tested MRSA were negative for sec, eta, etb, lukS-F-PV, bbp and ebpS genes. The most prevalent gene encoding toxin was sed (52.4%; n = 11/21), and adhesins were eno and fnbA (100%). Only 9.5% (n = 2/21) of MRSA were classified as multidrug-resistant. The emergence of novel MRSA with a unique virulence and the presence of epidemic clone EMRSA-15 creates challenges for controlling the spread of MRSA in NH.
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Affiliation(s)
- Martyna Kasela
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (A.M.)
- Correspondence:
| | - Agnieszka Grzegorczyk
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (A.M.)
| | - Bożena Nowakowicz-Dębek
- Department of Animal Hygiene and Environmental Hazards, University of Life Sciences in Lublin, 20-950 Lublin, Poland;
| | - Anna Malm
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (A.M.)
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Kasela M, Grzegorczyk A, Korona-Głowniak I, Ossowski M, Nowakowicz-Dębek B, Malm A. Transmission and Long-Term Colonization Patterns of Staphylococcus aureus in a Nursing Home. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218073. [PMID: 33147811 PMCID: PMC7672560 DOI: 10.3390/ijerph17218073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 01/07/2023]
Abstract
Nursing homes might create an environment favorable for the transmission of Staphylococcus aureus because of the presence of hospitalized elderly, overcrowding and close contacts among people. We aimed at identifying risk factors for S. aureus colonization and determining the genetic relatedness of isolates demonstrating transmission among people. We investigated 736 swab samples from 92 residents and personnel for the presence of S. aureus. Swabs from anterior nares and throat were collected quarterly (2018) in a nursing home located in Poland. Genotyping was conducted using the multi-locus variable number of tandem repeats fingerprinting (MLVF) method. We observed high seasonal variation in the proportion of participants colonized with methicillin-resistant Staphylococcus aureus (MRSA) strains (0% to 13.5%). A multivariate analysis revealed that residents aged more than 85 years old are at risk for becoming intermittent S. aureus carriers (p = 0.013). The MLVF analysis revealed a high genetic diversity among methicillin-sensitive S. aureus (MSSA) strains and close genetic relatedness between MRSA strains. We proved the advanced aged were predisposed to intermittent S. aureus carriage. Genotyping revealed the transmission of S. aureus among the participants living in a closed environment. A high genetic relatedness among isolated MRSA suggests its clonal spread in the nursing home.
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Affiliation(s)
- Martyna Kasela
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (I.K.-G.); (A.M.)
- Correspondence:
| | - Agnieszka Grzegorczyk
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (I.K.-G.); (A.M.)
| | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (I.K.-G.); (A.M.)
| | - Mateusz Ossowski
- Department of Animal Hygiene and Environmental Hazards, University of Life Sciences in Lublin, 20-950 Lublin, Poland; (M.O.); (B.N.-D.)
| | - Bożena Nowakowicz-Dębek
- Department of Animal Hygiene and Environmental Hazards, University of Life Sciences in Lublin, 20-950 Lublin, Poland; (M.O.); (B.N.-D.)
| | - Anna Malm
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (I.K.-G.); (A.M.)
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Hijazi K, Joshi C, Gould IM. Challenges and opportunities for antimicrobial stewardship in resource-rich and resource-limited countries. Expert Rev Anti Infect Ther 2019; 17:621-634. [PMID: 31282277 DOI: 10.1080/14787210.2019.1640602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Inappropriate prescription practices, patient and provider knowledge and attitudes, variable availability of diagnostic and surveillance systems, and the unrestricted use of antimicrobials in animals and plants are contributory factors to the global crisis of antimicrobial resistance (AMR). Areas covered: Notwithstanding that interventions to revert AMR should be tailored to the socio-politico-economic landscape, there is a global consensus for the implementation and enhancement of antimicrobial stewardship strategies. Yet the implementation of Antimicrobial Stewardship Programs (ASPs) remains relatively limited within healthcare settings and faces complex challenges in resource-limited countries. The current review summarizes the limitations of current ASPs, translation challenges in resource-limited countries, and potential solutions. Expert opinion: Suboptimal ASP implementation in hospitals is multifactorial. Restriction of antimicrobial use should be informed by risk-benefit analyses, including the potential for substitute prescribing, and displacement of selection pressures. Thresholds in population use of antibiotics above which AMR increases may provide quantitative targets for ASPs. Horizontal and vertical collaborations involving policymakers and the general public are of paramount importance. While impactful prescribing changes require sustained engagement of the public and health-care professionals, we warn against over-estimating the benefits of behavioral interventions. We advocate for population-level stewardship interventions in addition to investment in structural factors that will aid ASP implementation.
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Affiliation(s)
- Karolin Hijazi
- a Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen , Aberdeen , UK
| | - Chaitanya Joshi
- b Department of Medical Microbiology, Aberdeen Royal Infirmary , Aberdeen , UK
| | - Ian M Gould
- b Department of Medical Microbiology, Aberdeen Royal Infirmary , Aberdeen , UK
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Saeed K, Gould I, Esposito S, Ahmad-Saeed N, Ahmed SS, Alp E, Bal AM, Bassetti M, Bonnet E, Chan M, Coombs G, Dancer SJ, David MZ, De Simone G, Dryden M, Guardabassi L, Hanitsch LG, Hijazi K, Krüger R, Lee A, Leistner R, Pagliano P, Righi E, Schneider-Burrus S, Skov RL, Tattevin P, Van Wamel W, Vos MC, Voss A. Panton-Valentine leukocidin-positive Staphylococcus aureus: a position statement from the International Society of Chemotherapy. Int J Antimicrob Agents 2017; 51:16-25. [PMID: 29174420 DOI: 10.1016/j.ijantimicag.2017.11.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/11/2017] [Accepted: 11/09/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Kordo Saeed
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke & Winchester, UK and University of Southampton Medical School, Southampton, UK.
| | - Ian Gould
- Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - Silvano Esposito
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Nusreen Ahmad-Saeed
- Public Health England-Southampton and University of Southampton, Southampton, UK
| | - Salman Shaheer Ahmed
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Abhijit M Bal
- Department of Microbiology, University Hospital Crosshouse, NHS Ayrshire & Arran & Honorary Clinical Senior Lecturer Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Eric Bonnet
- Department of Infectious Diseases, Hôpital Joseph Ducuing, Toulouse, France
| | - Monica Chan
- Department of Infectious Diseases, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore and Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
| | - Geoffrey Coombs
- School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| | | | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Giuseppe De Simone
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Matthew Dryden
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke & Winchester, UK and University of Southampton Medical School, Southampton, UK; Rare and Imported Pathogens Department, Public Health England, UK
| | - Luca Guardabassi
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Leif G Hanitsch
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karolin Hijazi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Renate Krüger
- Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andie Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Pasquale Pagliano
- AORN dei Colli, D. Cotugno Hospital, Department of Infectious Diseases, Naples, Italy
| | - Elda Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | | | - Robert Leo Skov
- MVZ Synlab, Leverkusen, Department of Clinical Microbiology, Leverkusen, Germany and Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 35033 Rennes cedex, France
| | - Willem Van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Centre and Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Chmielarczyk A, Pomorska-Wesołowska M, Szczypta A, Romaniszyn D, Pobiega M, Wójkowska-Mach J. Molecular analysis of meticillin-resistant Staphylococcus aureus strains isolated from different types of infections from patients hospitalized in 12 regional, non-teaching hospitals in southern Poland. J Hosp Infect 2017; 95:259-267. [DOI: 10.1016/j.jhin.2016.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/27/2016] [Indexed: 12/14/2022]
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Wille H, Dauchy FA, Desclaux A, Dutronc H, Vareil MO, Dubois V, Vital JM, Dupon M. Efficacy of debridement, antibiotic therapy and implant retention within three months during postoperative instrumented spine infections. Infect Dis (Lond) 2016; 49:261-267. [PMID: 27866452 DOI: 10.1080/23744235.2016.1255351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Postoperative instrumented spine infection (PISI) is a severe complication of invasive spine procedures. METHODS Retrospective study of patients treated for PISI between 1st January 2008 and 31st December 2012 in a French University Hospital. The objectives of this study were to describe the outcome of patients treated with debridement-irrigation, antibiotic therapy and implant retention (DAIR) within three months after the occurrence of PISI and to identify factors associated with relapse. RESULTS Among 4290 patients who underwent spinal arthrodesis surgery during the 5-year study period, 129 had PISI treated by debridement-irrigation in the first three months (3.0%, 95% confidence interval [95%CI]: 2.5-3.5). Fifty-two (40%) were female and the median age was 57 years. Fourteen patients (10.8%) had diabetes and 73 (56.6%) had a BMI (Body Mass Index) ≥25 kg/m2. Staphylocccus aureus, enterobacteria or polymicrobial infections were identified in 44.0, 18.0 and 13.0% of cases, respectively. One hundred and six patients (82.2%) and one hundred and twenty-one patients (93.8%) were cured after one DAIR and after two DAIR, respectively. In multivariate logistic analysis, polymicrobial infection was associated with relapse (Odd Ratio [OR] = 3.81; 95%CI: 1.06-13.66; p = .03), while a BMI ≥25 kg/m2 was a protective factor (OR =0.25; 95%CI: 0.07-0.89; p = .03). CONCLUSION DAIR may be effective for PISI when performed within the first 3 months after onset of infection. Relapses are significantly associated with polymicrobial infection and negatively associated with moderate overweight. These results need to be confirmed in future prospective studies.
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Affiliation(s)
- Heidi Wille
- a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France.,b Department of Infectious and Tropical Diseases , Centre Hospitalier de la Côte Basque , Bayonne , France
| | - Frédéric-Antoine Dauchy
- a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France
| | - Arnaud Desclaux
- a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France
| | - Hervé Dutronc
- a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France
| | - Marc-Olivier Vareil
- a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France.,b Department of Infectious and Tropical Diseases , Centre Hospitalier de la Côte Basque , Bayonne , France
| | - Véronique Dubois
- c Laboratory of Microbiology , University Hospital of Bordeaux , Bordeaux , France
| | - Jean-Marc Vital
- d Spine Unit One, Orthopaedic Surgery , University Hospital of Bordeaux , Bordeaux , France
| | - Michel Dupon
- a Department of Infectious and Tropical Diseases , University Hospital of Bordeaux, Centre de Référence Infections Ostéo-articulaires, Hôpital Pellegrin , Bordeaux , France
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Kampf G. Acquired resistance to chlorhexidine – is it time to establish an ‘antiseptic stewardship’ initiative? J Hosp Infect 2016; 94:213-227. [DOI: 10.1016/j.jhin.2016.08.018] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/18/2016] [Indexed: 01/12/2023]
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