Characterization and antimicrobial susceptibility of coagulase-negative staphylococci isolated from clinical samples

Non-aureus staphylococci and mammaliicocci (NASM): their role in bovine mastitis and One Health

Non-aureus staphylococci (NAS) are gaining importance in mastitis and public health, and some NAS have been reclassified as mammaliicocci (NASM). Bovine milk production has a major influence on the world economy, being an essential source of income for small, medium and large producers, and bovine mastitis caused by NASM can cause an economic impact. Mastitis generates financial losses due to reduced revenue, increased veterinary costs and expenses associated with animal slaughter. However, it is also a public health issue involving animal health and welfare, human health and the ecosystem. Furthermore, it is an increasingly common infection caused by NASM, including antimicrobial-resistant strains. Despite all these adverse effects that NASM can cause, some studies also point to its protective role against mastitis. Therefore, this review article addresses the negative and positive aspects that NASM can cause in bovine mastitis, the virulence of the disease and resistance factors that make it difficult to treat and, through the One Health approach, presents a holistic view of how mastitis caused by NASM can affect both animal and human health at one and the same time.

Alteration of indicator gut microbiota in patients with chronic sinusitis

BACKGROUND

Many factors influence the composition of the sinus microflora. The microbial balance is most disturbed by the use of antibacterial agents. Superinfections caused by more than one pathogen may then occur. Despite treatment, including surgery and long-term antibiotic therapy, many patients with sinusitis do not experience significant relief from their symptoms. It has been hypothesized that an imbalance in the gut microbiota may also be responsible for the chronicity of sinusitis. Our goal was therefore to identify selected gut indicator bacteria that play a role in immunity in patients with chronic sinusitis. In addition, compare the number of selected bacteria in two groups of patients: with chronic sinusitis and with chronic rhinosinusitis (CRS) with concomitant diseases and/or symptoms other than CRS.

RESULTS

Significantly decreased numbers of Bifidobacterium spp. and Faecalibacterium prauznitzi bacteria were observed in patients from the G1 group. The majority of patients from this group (12 out of 13) had a significantly decreased number of Bifidobacterium and Akkermansia muciniphila bacteria, which are involved in the nutrition and regeneration of gut epithelium cells and have anti-inflammatory properties. In group G2 (patients with chronic sinusitis and symptoms of comorbidities) a decreased number of F. prausnitzii, Bifidobacterium spp., A. muciniphila and Lactobacillus spp. bacteria was observed. A small percentage of patients in this group showed overgrowth of yeast-like fungi.

CONCLUSION

Although the more research is needed, possibly the gut microbiota indicator bacteria number analyses might enable to plan personalized prebiotic and probiotic treatment, which could support intestine microbiota and mucosal immunity patients suffering from chronic sinusitis.

Teicoplanin-Resistant Coagulase-Negative Staphylococci: Do the Current Susceptibility Testing Methods Reliably Detect This Elusive Phenotype?

Coagulase-negative staphylococci (CoNS), members of the skin commensal microbiota, are increasingly associated with local or systemic infections due to a shift in patient populations in recent decades. Subsequently, more CoNS strains have been subjected to antibiotic susceptibility testing (AST), thus leading to the increased detection of teicoplanin resistance. However, data concerning teicoplanin resistance among CoNS strains remain limited, heterogeneous, and inconclusive. We collected 162 consecutive CoNS strains identified using Vitek-2 as teicoplanin-resistant and tested them with a range of AST methods. The results of standard and high inoculum broth microdilution (sBMD; hBMD), agar dilution (AD) after 24 h and 48 h incubation, standard and macrogradient diffusion strip (sGDT, MET), screening agar, and disc diffusion were compared to assess their robustness and to establish a diagnostic algorithm to detect teicoplanin resistance. sBMD was used as the reference method, and the lowest number of strains were teicoplanin-resistant using this method. sGDT and disc diffusion generated similar results to sBMD. Compared with sBMD, AD-24 h generated the lowest number of false teicoplanin-resistant strains, followed by hBMD, AD-48 h, and Vitek-2. sGDT, a fast, easy, affordable method in diagnostic settings, generated the highest rate of false teicoplanin-susceptible strains. Vitek-2 testing produced the highest number of teicoplanin-resistant strains. Only in two strains was the initial Vitek-2 teicoplanin resistance confirmed using five other AST methods. In conclusion, the different antibiotic susceptibility testing methods generated inconsistent, inconclusive, and discrepant results, thus making it difficult to establish a diagnostic algorithm for suspected teicoplanin resistance. Teicoplanin testing proved to be challenging and easily influenced by technical factors. This study aimed not only to raise awareness of teicoplanin resistance testing but also of the need for future studies focusing on the clinical efficacy of teicoplanin in relation to its susceptibility results.

Emerging vancomycin-non susceptible coagulase negative Staphylococci associated with skin and soft tissue infections

Backgrounds

Observable emergence of Vancomycin-Non susceptible Coagulase-negative Staphylococci (VNS-CoNS) associated with skin and soft tissue infections spreading among the urban and rural populace is gradually intensifying severe complications. The isolated VNS-CoNS were evaluated with Matrix-assisted Laser Desorption/ionization Time of Flight Mass Spectrometry (MALDI ToF MS) for species characterization and pan-antimicrobial resistance pattern.

Methods

Out of 256 clinical samples collected including pus, abscess, ear swabs, eye swabs, and aspirates, 91 CoNS isolates were biotyped and further characterized with MALDI-TOF MS. Staphylococci marker genes, Vancomycin susceptibility, and biofilm assays were performed.

Results

Of 91 CoNS isolates, S.cohnii (2.3%), S.condimentii (3.4%), S. saprophyticus (6.7%), and S.scuri (21.1%) were characterized with MALDI-TOF with significant detection rate (99.4%; CI 95, 0.775–0.997, positive predictive values, 90.2%) compared to lower biotyping detection rate (p = 0.001). Hemolytic VNS-CoNS lacked nuc, pvl and spa genes from wound, ear, and aspirates of more 0.83 MARI clustered into a separate phylo-diverse group and were widely distributed in urban and peri-urban locations. MALDI TOF–MS yielded a high discriminatory potential of AUC-ROC score of 0.963 with true-positivity prediction. VNS-CoNS of MIC ≥ 16 µg/mL were observed among all the ages with significant resistance at 25th and 75th quartiles. More than 10.5% of CoNS expressed multi-antibiotic resistance with more than 8 µg/mL vancomycin cut-off values (p < 0.05).

Conclusion

Antibiotic resistant CoNS should be considered significant pathogens rather than contaminant. Biofilm producing VNS-S. sciuri and S. condimentii are potential strains with high pathological tropism for skin, soft tissues and wound infections, and these strains require urgent surveillance in peri-urban and rural communities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12941-022-00516-4.

Constitutive and Inducible Clindamycin Resistance Frequencies among Staphylococcus sp. Coagulase Negative Isolates in Al-Basrah Governorate, Iraq

Background

Antibiotics called macrolide, lincosamide and streptogramin B (MLS_B) are being used to treat staphylococci infections. Multiple pathways that impart resistance to MLS_B antibiotics have been confirmed to cause clinical failure. The present work aimed to determine the frequency of constitutive and inducible clindamycin resistant among coagulase-negative staphylococci (CoNS) isolates of different clinical samples in Al-Basrah governorate, Iraq.

Methods

The 28 CoNS, traditional techniques and the Vitek®2 system were used to identify the isolates. The disk diffusion technique was used to detect methicillin resistance and antibiotic sensitivity patterns via cefoxitin, gentamicin, ciprofloxacin, amikacin, teicoplanin, linezolid, doxycycline and vancomycin disks. Erythromycin and clindamycin antibiotic disks was used to detect the inducible and constitutive clindamycin resistance as well as a D-test according to CLSI guidelines.

Results

Among 28 CoNS isolated, the Staphylococcus aureus 11(39.29%), Staphylococcus epidermidis 7(25 %), Staphylococcus haemolyticus 4(14.29%) and Staphylococcus saprophyticus 3 (10.71%) were predominant isolated species. Out of 28 CoNS isolates, 15(53.57%) were methicillin resistant coagulase-negative staphylococci (MRCoNS) isolates and 13(46.43%) were methicillin sensitive coagulase-negative staphylococci (MSCoNS) isolates. The 15(53.57%) isolates out of 28 CoNS, showed erythromycin resistance while 6(40%) isolates out of 15 CoNS, showed inducible macrolide-lincosamide-streptogramin B (iMLS_B) and 2(13.3%) of CONS isolated showed constitutive macrolide-lincosamide-streptogramin B (cMLS_B).

Conclusion

In order to achive the best result in choosing the suitable treatment and avoiding the loses the money and time, it is better to use the D-test for inducible clindamycin resistance in the daily routine work of antibiotic susceptibility testing in hospital and private clinical laboratories.

Isolation and Identification of Biofilm-Producing, Drug-Resistant Coagulase Negative Staphylococci from a Hospital Environment in Northern Philippines

Healthcare-associated infections (HCAIs) are considered adverse outcomes of confinement in a healthcare facility. Biofilm-producing, drug-resistant bacteria have further aggravated the problem with HCAIs. This study determined the prevalence, antibiotic susceptibility, and biofilm phenotype of coagulase-negative staphylococci (CoNS) isolated from a hospital environment in Northern Philippines. The identification of CoNS species and the determination of antibiotic susceptibility were done using an automated assay. Biofilm production was detected using tissue culture plate (TCP) and Congo red agar (CRA) methods. Out of 220 surfaces and 26 air samples collected, 103 (41.9%) CoNS strains were isolated, predominated by S. epidermidis with 30.1% prevalence. The medical ward was found to have the highest prevalence of CoNS at 64%. The CoNS isolates exhibited a variable resistance profile; the highest was found against penicillin (97.1%) and oxacillin (54.3%). Isolates manifesting resistance to linezolid and vancomycin were also detected. From the 103 CoNS isolates, 52 (50.5%) biofilm producers were detected using the TCP method, and 39 (37.9%) were detected by the CRA method. Statistically significant difference was found between the biofilm biomass and the slime-producing pattern. This study revealed the prevalence of biofilm-producing, drug-resistant strains of CoNS in a Level 3 hospital in Northern Philippines. This warrants further enhancement of infection prevention and control programs to avert the emergence of more biofilm-producing, drug-resistant bacterial strains that could pose formidable threats to public health.

Virulence Factors in Coagulase-Negative Staphylococci

Coagulase-negative staphylococci (CoNS) have emerged as major pathogens in healthcare-associated facilities, being S. epidermidis, S. haemolyticus and, more recently, S. lugdunensis, the most clinically relevant species. Despite being less virulent than the well-studied pathogen S. aureus, the number of CoNS strains sequenced is constantly increasing and, with that, the number of virulence factors identified in those strains. In this regard, biofilm formation is considered the most important. Besides virulence factors, the presence of several antibiotic-resistance genes identified in CoNS is worrisome and makes treatment very challenging. In this review, we analyzed the different aspects involved in CoNS virulence and their impact on health and food.

Novel Treatments and Preventative Strategies Against Food-Poisoning Caused by Staphylococcal Species

Staphylococcal infections are a widespread cause of disease in humans. In particular, S. aureus is a major causative agent of infection in clinical medicine. In addition, these bacteria can produce a high number of staphylococcal enterotoxins (SE) that may cause food intoxications. Apart from S. aureus, many coagulase-negative Staphylococcus spp. could be the source of food contamination. Thus, there is an active research work focused on developing novel preventative interventions based on food supplements to reduce the impact of staphylococcal food poisoning. Interestingly, many plant-derived compounds, such as polyphenols, flavonoids, or terpenoids, show significant antimicrobial activity against staphylococci, and therefore these compounds could be crucial to reduce the incidence of food intoxication in humans. Here, we reviewed the most promising strategies developed to prevent staphylococcal food poisoning.

Prevalence and distribution of resistance and enterotoxins/enterotoxin-like genes in different clinical isolates of coagulase-negative Staphylococcus

Background

Coagulase-negative staphylococcus (CoNS) is considered to be the major reservoirs for genes facilitating the evolution of S. aureus as a successful pathogen. The present study aimed to determine the occurrence of genes conferring resistance to fluoroquinolone, determining of the prevalence of insertion sequence elements IS256, IS257 and different superantigens (SAgs) among CoNS isolates obtained from various clinical sources.

Materials and methods

The current study conducted on a total of the 91 CoNS species recovered from clinical specimens in Hamadan hospitals in western Iran in 2017–2019. The antimicrobial susceptibility testing was performed using disk diffusion method and the presence of the IS256 and IS257, genes conferring resistance to fluoroquinolone and enterotoxins/enterotoxin-like encoding genes were investigated by polymerase chain reaction (PCR) method.

Results

Among genes encoding classic enterotoxins, sec was the most frequent which was carried by 48.4% of the 91 isolates, followed by seb in 27.5% of the isolates. None of the CoNS isolates was found to be positive to enterotoxin-like encoding genes. In 11(12%) of all isolates that were phenotypically resistant to levofloxacin, 9 isolates (81.8%) were positive for gyrB, 8 isolates (72.7%) were positive for gyrA, 8 isolates (72.7%) harbored grlB and 7 isolates (63.6%) were found to carry grlA. The IS256 and IS257 were identified in 31.8% and 74.7% of the isolates, respectively. The results of statistical analysis showed a significant association between the occurrence of staphylococcal enterotoxins (SEs) encoding genes and antimicrobial resistance.

Conclusion

Antimicrobial resistant determinants and SEs are co-present in clinical CoNS isolates that confer selective advantage for colonization and survival in hospital settings. The coexistence of insertion elements and antibiotic resistance indicate their role in pathogenesis and infectious diseases.

Antibiotic Resistance and mecA Gene Characterization of Coagulase-negative Staphylococci Isolated from Clinical Samples in Nepal

Background

Coagulase-negative Staphylococci (CoNS) are a significant cause of hospital-acquired and foreign-body-related infections. We conducted this research to assess methicillin susceptibility of CoNS by disc diffusion, agar dilution, and polymerase chain reaction (PCR) methods and to assess the antimicrobial susceptibility pattern.

Methods

We received 123 CoNS isolates from different specimens including blood, endotracheal tube, and central venous catheter. We performed sample processing, identification, and characterization following standard guidelines. Antimicrobial susceptibility was tested based on clinical and laboratory standards institute guidelines. We detected methicillin-resistant coagulase-negative staphylococci (MRCoNS) through mecA gene, disc diffusion method, and agar dilution method and compared the accuracy with PCR as reference.

Results

We detected eight species of CoNS with Staphylococcus epidermidis as the most common. Most of the samples were received from the intensive care unit and blood was the dominant specimen followed by endotracheal-tube aspirate. Seventy-one percentage of isolates were methicillin-resistant by PCR method; disc diffusion and agar dilution method detected methicillin resistance with an accuracy of 96.7% and 98.3%, respectively. Antimicrobial susceptibility revealed an association between the different origins of samples, and also among the types of sample. Similarly, a comparison of the degree of resistance of antimicrobial agents between mecA gene positive and negative isolates showed significant differences. Vancomycin, linezolid, and teicoplanin are still effective for treating MRCoNS.

Conclusion

CoNS are a crucial cause of human infections especially in an intensive care unit setup where the use of devices is common. Disc diffusion and agar dilution are reliable for the detection of MRCoNS. The degree of antimicrobial resistance is much higher in organisms obtained from intensive care unit and foreign-body-related infections.

Evolution of Antibiotic Resistance of Coagulase-Negative Staphylococci Isolated from Healthy Turkeys in Egypt: First Report of Linezolid Resistance

Coagulase-negative staphylococci (CoNS) are gaining much attention as causative agents of serious nosocomial infections in humans. This study aimed to determine the prevalence and phenotypic antimicrobial resistance of CoNS as well as the presence of resistance-associated genes in CoNS isolated from turkey farms in Egypt. Two hundred and fifty cloacal swabs were collected from apparently healthy turkeys in Egypt. Suspected isolates were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The susceptibility testing of CoNS isolates against 20 antimicrobial agents was performed using the broth microdilution test. The presence of resistance-associated genes like mecA, vanA, blaZ, erm(A), erm(B), erm(C), aac-aphD, optrA, valS, and cfr was determined. Thirty-nine CoNS were identified. All isolates were phenotypically resistant to trimethoprim/sulfamethoxazole, penicillin, ampicillin, and tetracycline. The resistance rates to erythromycin, chloramphenicol, oxacillin, daptomycin, and tigecycline were 97.4%, 94.9%, 92.3%, 89.7%, and 87.2%, respectively. Thirty-one isolates were resistant to linezolid (79.5%). Low resistance rate was detected for both imipenem and vancomycin (12.8%). The erm(C) gene was identified in all erythromycin phenotypically resistant isolates, whereas two resistant isolates possessed three resistance-conferring genes erm(A), erm(B), and erm(C). The cfr and optrA genes were detected in 11 (35.5%) and 12 (38.7%) of the 31 linezolid-resistant isolates. The mecA, aac-aphD, and blaZ genes were identified in 22.2%, 41.9%, and 2.6% of phenotypically resistant isolates to oxacillin, gentamicin, and penicillin, respectively. This is the first study revealing the correlation between linezolid resistance and presence of cfr and optrA genes in CoNS isolates from Egypt, and it can help to improve knowledge about the linezolid resistance mechanism.

Novel photodynamic coating reduces the bioburden on near-patient surfaces thereby reducing the risk for onward pathogen transmission: a field study in two hospitals

BACKGROUND

Near-patient surfaces are recognized as a source for hospital-acquired infections. Such surfaces act as reservoirs for microbial contamination by which pathogens can be transmitted from colonized or infected patients to susceptible patients. Routine disinfection of surfaces only results in a temporal elimination of pathogens, and recontamination inevitably occurs shortly between disinfections.

AIM

A novel antimicrobial coating based on photodynamics was tested under laboratory conditions and subsequently in a field study in two hospitals under real-life conditions.

METHODS

Identical surfaces received a photodynamic or control coating. Bacterial counts [colony-forming units (cfu)/cm²) were assessed regularly for up to 6 months.

FINDINGS

The laboratory study revealed a mean reduction of several human pathogens of up to 4.0 ± 0.3 log₁₀. The field study in near-patient environments demonstrated mean bacterial values of 6.1 ± 24.7 cfu/cm² on all control coatings. Photodynamic coatings showed a significantly lower mean value of 1.9 ± 2.8 cfu/cm² (P<0.001). When considering benchmarks of 2.5 cfu/cm² or 5 cfu/cm², the relative risk for high bacterial counts on surfaces was reduced by 48% (odds ratio 0.38, P<0.001) or 67% (odds ratio 0.27, P<0.001), respectively.

CONCLUSION

Photodynamic coatings provide a significant and lasting reduction of bacterial counts on near-patient surfaces, particularly for high bacterial loads, in addition to routine hygiene. The promising results of this proof-of-concept study highlight the need for further studies to determine how this novel technology is correlated with the frequency of hospital-acquired infections.