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Monecke S, Boswihi S, Braun SD, Diezel C, Müller E, Reinicke M, Udo E, Ehricht R. Sequencing a CC239-MRSA-III with a novel composite SCC mec element from Kuwait. Eur J Clin Microbiol Infect Dis 2024; 43:1761-1775. [PMID: 38990431 DOI: 10.1007/s10096-024-04891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
Staphylococcus aureus CC239-MRSA-III is an ancient pandemic strain of hospital-associated, methicillin-resistant S. aureus that spread globally for decades and that still can be found in some parts of the world. In Kuwait, microarray-based surveillance identified from 2019 to 2022 a series of isolates of a hitherto unknown variant of this strain that carried a second set of recombinase genes, ccrA/B-2. To elucidate the structure of its SCCmec element, two isolates were subjected to nanopore sequencing. This revealed, in addition to ccrA/B-2, several SCC-associated genes including speG (spermidine N acetyltransferase) and a gene encoding a large "E-domain containing protein" (dubbed as edcP-SCC). This gene contained three regions consisting of multiple repeating units. In terms of sequence and structure it was similar but not identical to the biofilm-related aap gene from S. epidermidis. A review of published sequences identified edcP-SCC in eighteen genome sequences of S. aureus, S. epidermidis and S. capitis, and frequently it appears in a similar cluster of genes as in the strains sequenced herein. Isolates also carried a prophage with the adhesion factor sasX/sesI and aminoglycoside resistance genes. This is consistent with an affiliation to the "South-East Asian" Clade of CC239. The emergence of edcP-SCC and sasX-positive CC239 strain shows that, against a global trend towards community-associated MRSA, the ancient pandemic CC239 hospital strain still continues to evolve and to cause outbreaks.
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Affiliation(s)
- Stefan Monecke
- Leibniz Institute of Photonic Technology (IPHT), Leibniz Center for Photonics in Infection Research (LPI), Jena, Germany.
- InfectoGnostics Research Campus, Jena, Germany.
| | - Samar Boswihi
- Faculty of Medicine, Department of Microbiology, Kuwait University, Kuwait City, Kuwait
| | - Sascha D Braun
- Leibniz Institute of Photonic Technology (IPHT), Leibniz Center for Photonics in Infection Research (LPI), Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
| | - Celia Diezel
- Leibniz Institute of Photonic Technology (IPHT), Leibniz Center for Photonics in Infection Research (LPI), Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
| | - Elke Müller
- Leibniz Institute of Photonic Technology (IPHT), Leibniz Center for Photonics in Infection Research (LPI), Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
| | - Martin Reinicke
- Leibniz Institute of Photonic Technology (IPHT), Leibniz Center for Photonics in Infection Research (LPI), Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
| | - Edet Udo
- Faculty of Medicine, Department of Microbiology, Kuwait University, Kuwait City, Kuwait
| | - Ralf Ehricht
- Leibniz Institute of Photonic Technology (IPHT), Leibniz Center for Photonics in Infection Research (LPI), Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
- Institute of Physical Chemistry, Friedrich-Schiller University, Jena, Germany
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Abstract
HIV infection alters the skin microbiome and predisposes to a wide range of cutaneous infections, from atypical presentations of common skin infections to severe disseminated infections involving the skin that are AIDS-defining illnesses. Bacterial infection of the skin, most commonly caused by Staphylococcus aureus, occurs frequently and can result in bacteremia. Nontuberculous mycobacterial infections that are usually localized to the skin may disseminate, and guidance on the treatment of these infections is limited. Herpes simplex can be severe, and less common presentations such as herpetic sycosis and herpes vegetans have been reported. Severe herpes zoster, including disseminated infection, requires intravenous antiviral treatment. Viral warts can be particularly difficult to treat, and in atypical or treatment-resistant cases a biopsy should be considered. Superficial candidosis occurs very commonly in people living with HIV, and antifungal resistance is an increasing problem in non-albicans Candida species. Systemic infections carry a poor prognosis. In tropical settings the endemic mycoses including histoplasmosis are a problem for people living with HIV, and opportunistic infections can affect those with advanced HIV in all parts of the world. Most cutaneous infections can develop or worsen as a result of immune reconstitution in the weeks to months after starting antiretroviral therapy. Direct microscopic examination of clinical material can facilitate rapid diagnosis and treatment initiation, although culture is important to provide microbiological confirmation and guide treatment.
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Affiliation(s)
- David J Chandler
- Dermatology Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
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Esfandiary R, Saeedi P, Saffarian P, Halabian R, Fooladi AAI. Activated mesenchymal stem cells increase drug susceptibility of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Folia Microbiol (Praha) 2024; 69:145-154. [PMID: 37924430 DOI: 10.1007/s12223-023-01099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa are major causes of hospital-acquired infections and sepsis. Due to increasing antibiotic resistance, new treatments are needed. Mesenchymal stem cells (MSCs) have antimicrobial effects, which can be enhanced by preconditioning with antibiotics. This study investigated using antibiotics to strengthen MSCs against MRSA and P. aeruginosa. MSCs were preconditioned with linezolid, vancomycin, meropenem, or cephalosporin. Optimal antibiotic concentrations were determined by assessing MSC survival. Antimicrobial effects were measured by minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and antimicrobial peptide (AMP) gene expression. Optimal antibiotic concentrations for preconditioning MSCs without reducing viability were 1 μg/mL for linezolid, meropenem, and cephalosporin and 2 μg/mL for vancomycin. In MIC assays, MSCs preconditioned with linezolid, vancomycin, meropenem, or cephalosporin inhibited MRSA or P. aeruginosa growth at lower concentrations than non-preconditioned MSCs (p ≤ 0.001). In MBC assays, preconditioned MSCs showed enhanced bacterial clearance compared to non-preconditioned MSCs, especially when linezolid and vancomycin were used against MRSA (p ≤ 0.05). Preconditioned MSCs showed increased expression of genes encoding the antimicrobial peptide genes hepcidin and LL-37 compared to non-preconditioned MSCs. The highest hepcidin expression was seen with linezolid and vancomycin preconditioning (p ≤ 0.001). The highest LL-37 expression was with linezolid preconditioning (p ≤ 0.001). MSCs' preconditioning with linezolid, vancomycin, meropenem, or cephalosporin at optimal concentrations enhances their antimicrobial effects against MRSA and P. aeruginosa without compromising viability. This suggests preconditioned MSCs could be an effective adjuvant treatment for antibiotic-resistant infections. The mechanism may involve upregulation of AMP genes.
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Affiliation(s)
- Reza Esfandiary
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Bqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Pardis Saeedi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Bqiyatallah University of Medical Sciences, Tehran, Iran
| | - Parvaneh Saffarian
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Raheleh Halabian
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Bqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Bqiyatallah University of Medical Sciences, Tehran, Iran.
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Chen Y, Yang J, Wang Y, You J, Zhu W, Liu C, Luan Y, Li L, Li H. Community-associated methicillin-resistant Staphylococcus aureus infection of diabetic foot ulcers in an eastern diabetic foot center in a tertiary hospital in China: a retrospective study. BMC Infect Dis 2023; 23:652. [PMID: 37789270 PMCID: PMC10548623 DOI: 10.1186/s12879-023-08631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Diabetic foot concerns are a major public health problem. Methicillin-resistant Staphylococcus aureus (MRSA) plays a significant role in diabetic foot ulcers. Community-associated MRSA has become notorious for skin and skin soft tissue infections over the last two decades. This study investigated MRSA infection in diabetic foot patients at a tertiary hospital, focusing on the epidemiology and characteristics of community-associated MRSA. METHODS A total of 149 patients with diabetic foot infection whose culture results indicated Staphylococcus aureus as the source were selected. Epidemiological investigations, clinical characteristics, laboratory index records, antibiotic susceptibility analysis, and clinical outcome tracking were performed in all cases. Based on oxacillin resistance using the Vitek Compact 2 system, cases were divided into methicillin-sensitive Staphylococcus aureus and MRSA groups. Subgroup analysis of the MRSA group was performed in accordance with the Centers for Disease Control definition: community-associated MRSA and hospital-associated MRSA. RESULTS The MRSA group (n = 41, 27.5%) had a longer duration of ulcers and hospital stay and higher hospitalization costs than the methicillin-sensitive Staphylococcus aureus group (n = 108, 72.5%). According to the classification criteria of Infectious Diseases Society of America, the severity of infection in the community-associated MRSA group was higher than that in the hospital-associated MRSA group. The analysis of antimicrobial susceptibility of 41 MRSA isolates showed that the resistance rates to erythromycin, clindamycin, quinolone, gentamicin, tetracycline, and rifampicin were 78.0%, 68.3%, 31.7%, 17.1%, 9.8%, and 2.4%, respectively. All the MRSA strains were sensitive to linezolid, tigecycline, and vancomycin. The resistance rates to quinolones and gentamycin in the community-associated MRSA group (both 0%) were lower than those in the hospital-associated MRSA group. CONCLUSION Emergence of MRSA in diabetic foot ulcer was associated with a prolonged wound duration and increased consumption of medical resources. Community-associated MRSA strains predominated among MRSA isolates from diabetic foot wounds and caused more severe infections.
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Affiliation(s)
- Yixin Chen
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
| | - Jie Yang
- Department of Orthopedics, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
| | - Ying Wang
- Wound and Ostomy Care Clinic, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
| | - Jiaxing You
- Department of Orthopedics, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
| | - Weifen Zhu
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
| | - Chao Liu
- Department of Orthopedics, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
| | - Yi Luan
- Department of Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
| | - Lin Li
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
| | - Hong Li
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou, 310016 China
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Linz MS, Mattappallil A, Finkel D, Parker D. Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections. Antibiotics (Basel) 2023; 12:557. [PMID: 36978425 PMCID: PMC10044708 DOI: 10.3390/antibiotics12030557] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
The pathogenic bacterium Staphylococcus aureus is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) in the United States. Most S. aureus SSTIs are caused by the epidemic clone USA300 in the USA. These infections can be serious; in 2019, SSTIs with S. aureus were associated with an all-cause, age-standardized mortality rate of 0.5 globally. Clinical presentations of S. aureus SSTIs vary from superficial infections with local symptoms to monomicrobial necrotizing fasciitis, which can cause systemic manifestations and may lead to serious complications or death. In order to cause skin infections, S. aureus employs a host of virulence factors including cytolytic proteins, superantigenic factors, cell wall-anchored proteins, and molecules used for immune evasion. The immune response to S. aureus SSTIs involves initial responders such as keratinocytes and neutrophils, which are supported by dendritic cells and T-lymphocytes later during infection. Treatment for S. aureus SSTIs is usually oral therapy, with parenteral therapy reserved for severe presentations; it ranges from cephalosporins and penicillin agents such as oxacillin, which is generally used for methicillin-sensitive S. aureus (MSSA), to vancomycin for methicillin-resistant S. aureus (MRSA). Treatment challenges include adverse effects, risk for Clostridioides difficile infection, and potential for antibiotic resistance.
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Affiliation(s)
- Matthew S. Linz
- Department of Pathology, Immunology and Laboratory Medicine, Center for Immunity and Inflammation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Arun Mattappallil
- Department of Pharmaceutical Services, University Hospital, Newark, NJ 07103, USA
| | - Diana Finkel
- Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Dane Parker
- Department of Pathology, Immunology and Laboratory Medicine, Center for Immunity and Inflammation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
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Staphylococcus aureus Keratitis in Taiwan: Genotyping, Antibiotic Susceptibility, and Clinical Features. Int J Mol Sci 2022; 23:ijms231911703. [PMID: 36233005 PMCID: PMC9570272 DOI: 10.3390/ijms231911703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Staphylococcus aureus is an important pathogen for keratitis, a vision-threatening disease. We aimed to investigate the genotyping, antibiotic susceptibility, and clinical features of S. aureus keratitis, and to explore the possible role of Panton–Valentine leucocidin (PVL), a major virulence factor of S. aureus. We recruited 49 patients with culture-proven S. aureus keratitis between 2013 and 2017 at Chang Gung Memorial Hospital, Taiwan. PVL gene, multilocus sequence type (MLST), staphylococcal cassette chromosome mec (SCCmec), and pulsed-field gel electrophoresis (PFGE) were performed. Antibiotic susceptibility was verified using disk diffusion/E test. There were 49 patients with S. aureus keratitis; 17 (34.7%) were caused by methicillin-resistant S. aureus (MRSA) and 9 (18.4%) isolates had PVL genes. The predominant genotyping of MRSA isolates was CC59/PFGE type D/SCCmec VT/PVL (+). All methicillin-sensitive S. aureus (MSSA) and approximately 60% MRSA were susceptible to fluoroquinolones. No significant differences in clinical features, treatments, and visual outcomes were observed between MRSA/MSSA or PVL(+)/PVL(−) groups. In Taiwan, approximately one third of S. aureus keratitis was caused by MRSA, mainly community-associated MRSA. Although MRSA isolates were more resistant than MSSA, clinical characteristics were similar between two groups. Fluoroquinolones could be good empiric antibiotics for S. aureus keratitis.
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Evaluation of the Prevalence of mec A Gene in Staphylococcus aureus Strains Isolated from Clinical Specimens of Hospitals and Treatment Centers. PAJOUHAN SCIENTIFIC JOURNAL 2019. [DOI: 10.52547/psj.17.3.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Bahmani M, Taherikalani M, Khaksarian M, Rafieian-Kopaei M, Ashrafi B, Nazer M, Soroush S, Abbasi N, Rashidipour M. The synergistic effect of hydroalcoholic extracts of Origanum vulgare, Hypericum perforatum and their active components carvacrol and hypericin against Staphylococcus aureus. Future Sci OA 2019; 5:FSO371. [PMID: 30906567 PMCID: PMC6426173 DOI: 10.4155/fsoa-2018-0096] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022] Open
Abstract
AIM This study was designed to evaluate the synergistic activities of hydroalcoholic extracts of medicinal plants Origanum vulgare and Hypericum perforatum and their active components, carvacrol and hypericin against Staphylococcus aureus. METHODS The synergistic effects of the plants, as well as carvacrol and hypericin, were examined using a checkered method against S. aureus (ATCC 12600). RESULTS A fractional inhibitory concentration of 0.5 was obtained for combination of O. vulgare and H. perforatum and 0.49 for combination of the active ingredients carvacrol and hypericin, both of which indicated a synergistic effect. CONCLUSION This preliminary evaluation demonstrated a synergistic property of O. vulgare and H. perforatum extracts in treating S. aureus infection. This study indicates that combination of the plants, as well as combination of carvacrol and hypericin, might be used as a new antibacterial strategy against S. aureus.
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Affiliation(s)
- Mahmoud Bahmani
- Razi Herbal Medicines Research Center, Department of Medicinal Plants, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Morovat Taherikalani
- Razi Herbal Medicines Research Center & Department of Microbiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mojtaba Khaksarian
- Razi Herbal Medicines Research Center & Physiology Department, School of Medicine, Lorestan University of Medical Sciences, Khorrmabad, Iran
| | - Mahmoud Rafieian-Kopaei
- Medical Plants Research Center, Department of Pharmacology, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Behnam Ashrafi
- Razi Herbal Medicines Research Center, Department of Medicinal Plants, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammadreza Nazer
- Razi Herbal Medicines Research Center, Department of Medicinal Plants, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Setareh Soroush
- Razi Herbal Medicines Research Center & Department of Microbiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Naser Abbasi
- Biotechnology & Medicinal Plants Research Center, Department of Pharmacology, Ilam University of Medical Sciences, Ilam, Iran
| | - Marzieh Rashidipour
- Razi Herbal Medicines Research Center, Department of Medicinal Plants, Lorestan University of Medical Sciences, Khorramabad, Iran
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Bakthavatchalam YD, Ralph R, Veeraraghavan B, Babu P, Munusamy E. Evidence from an In Vitro Study: Is Oxacillin Plus Vancomycin a Better Choice for Heteroresistant Vancomycin-Intermediate Staphylococcus aureus? Infect Dis Ther 2019; 8:51-62. [PMID: 30460607 PMCID: PMC6374240 DOI: 10.1007/s40121-018-0224-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) bacteremia may result in clinical failure of vancomycin therapy, together with prolonged infection and hospitalization. This clinical problem has resulted in a search for more effective treatment options. The current study was designed to further investigate the synergistic effect of oxacillin plus vancomycin against methicillin-resistant S. aureus (MRSA) and hVISA using checkerboard and time-kill assays. METHODS Non-duplicate S. aureus isolates including hVISA (n = 29), MRSA (n = 10) and methicillin susceptible S. aureus (MSSA, n = 11) were used for combinational testing using checkerboard and time-kill assays. RESULTS Twenty-one isolates, 15 hVISA and 6 MRSA, showed synergy between oxacillin and vancomycin by checkerboard assay with fractional inhibitory concentration indices of ≤ 0.5. The addition of oxacillin to vancomycin resulted in a reduction in baseline vancomycin MIC from 1-2 to 0.06-0.5 µg/ml against MRSA and hVISA isolates. In the time-kill assay, the combination of oxacillin and vancomycin resulted in synergistic activity against hVISA (n = 23) and MRSA (n = 7) isolates. Regrowth was observed in six hVISA isolates exposed to combination in the time-kill assay, but none of them reached the original inoculum density at 24 h. All re-growth isolates showed a onefold increase in vancomycin MIC (from 1 to 2 µg/ml) and were re-confirmed as hVISA using the population-analysis profile experiment. Overall, for hVISA and MRSA, the combination of oxacillin plus vancomycin had greater antibacterial effect than each individual drug alone. CONCLUSION The present study showed the potential activity of vancomycin plus oxacillin combination against hVISA and MRSA isolates. Further, continued evaluation of this combination is warranted and may have therapeutic benefits in treating complicated MRSA infections.
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Affiliation(s)
| | - Ravikar Ralph
- Department of Medicine (Unit II), Christian Medical College, Vellore, Tamil Nadu, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
| | - Priyanka Babu
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Elakkiya Munusamy
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
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Haysom L, Cross M, Anastasas R, Moore E, Hampton S. Prevalence and Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Custodial Populations: A Systematic Review. JOURNAL OF CORRECTIONAL HEALTH CARE 2018; 24:197-213. [DOI: 10.1177/1078345818765271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Leigh Haysom
- Justice Health and Forensic Mental Health Network, Adolescent Health, NSW, Australia
| | - Melanie Cross
- Macquarie University, Sydney, New South Wales, Australia
| | | | - Elizabeth Moore
- Justice Health and Forensic Mental Health Network, Adolescent Health, NSW, Australia
| | - Stephen Hampton
- Justice Health and Forensic Mental Health Network, Medical Administration Unit, NSW, Australia
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Senok A, Somily A, Raji A, Gawlik D, Al-Shahrani F, Baqi S, Boswihi S, Skakni L, Udo EE, Weber S, Ehricht R, Monecke S. Diversity of methicillin-resistant Staphylococcus aureus CC22-MRSA-IV from Saudi Arabia and the Gulf region. Int J Infect Dis 2016; 51:31-35. [PMID: 27578204 DOI: 10.1016/j.ijid.2016.08.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES CC22-MRSA-IV, UK-EMRSA-15/Barnim EMRSA, is a common and pandemic strain of methicillin-resistant Staphylococcus aureus (MRSA) that has been found mainly in Western Europe, but also in other parts of the world including some Gulf countries. One suspected case of an infection with this strain in a patient who was admitted to the surgical unit in Riyadh, Kingdom of Saudi Arabia (KSA) was investigated in order to check whether this strain has reached KSA. METHODS Besides the index isolate, 46 additional isolates of CC22-MRSA-IV from patients from KSA, Abu Dhabi, Kuwait, and Germany (patients with a history of travel in the Middle East), were characterized by microarray hybridization. RESULTS The study revealed a regional presence of as many as six distinct 'strains' of CC22-MRSA-IV that could be distinguished based on carriage of SCCmec IV subtypes and virulence factors. No true UK-EMRSA-15/Barnim EMRSA was identified in Riyadh; all suspected isolates from Riyadh were assigned to other, albeit related strains. However, this strain was identified in Abu Dhabi and Kuwait. CONCLUSIONS CC22-MRSA-IV from KSA could be linked to other epidemic strains from the Middle East and possibly India, rather than to the Western European UK-EMRSA-15/Barnim EMRSA. High-resolution typing methods, including SCCmec subtyping, might help to differentiate related epidemic strains and to monitor routes of transmission.
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Affiliation(s)
- Abiola Senok
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ali Somily
- Department of Pathology and Laboratory Medicine, College of Medicine, King Khalid University Hospital and King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Adeola Raji
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Darius Gawlik
- Institute for Medical Microbiology and Hygiene (IMMH), Technische Universität Dresden, Dresden, Germany; Hamm-Lippstedt University, Hamm, Germany
| | - Fatimah Al-Shahrani
- Department of Medicine, Division of Infectious Diseases, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Shehla Baqi
- Department of Medicine, Division of Infectious Diseases, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Samar Boswihi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Leila Skakni
- Molecular Pathology Laboratory, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Edet E Udo
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Stefan Weber
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Ralf Ehricht
- Alere Technologies GmbH, Jena, Germany; InfectoGnostics Research Campus, Jena, Germany
| | - Stefan Monecke
- Institute for Medical Microbiology and Hygiene (IMMH), Technische Universität Dresden, Dresden, Germany; Alere Technologies GmbH, Jena, Germany; InfectoGnostics Research Campus, Jena, Germany.
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Phillips CJ, Wells NA, Martinello M, Smith S, Woodman RJ, Gordon DL. Optimizing the detection of methicillin-resistant Staphylococcus aureus with elevated vancomycin minimum inhibitory concentrations within the susceptible range. Infect Drug Resist 2016; 9:87-92. [PMID: 27330319 PMCID: PMC4898034 DOI: 10.2147/idr.s107961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Determination of vancomycin minimum inhibitory concentration (MIC) can influence the agent used to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We studied diagnostic accuracy using E-test and VITEK® 2 against a gold standard broth microdilution (BMD) methodology, the correlation between methods, and associations between vancomycin MIC and MRSA phenotype from clinical isolates. Methods MRSA isolates were obtained from April 2012 to December 2013. Vancomycin MIC values were determined prospectively on all isolates by gradient diffusion E-test and automated VITEK® 2. The Clinical and Laboratory Standards Institute reference BMD method was performed retrospectively on thawed frozen isolates. Diagnostic accuracy for detecting less susceptible strains was calculated at each MIC cutoff point for E-Test and VITEK® 2 using BMD ≥1 µg/mL as a standard. The correlation between methods was assessed using Spearman’s rho (ρ). The association between MRSA phenotype and MIC for the three methods was assessed using Fisher’s exact test. Results Of 148 MRSA isolates, all except one (E-test =3 µg/mL) were susceptible to vancomycin (MIC of ≤2 µg/mL) irrespective of methodology. MICs were ≥1.0 µg/mL for 9.5% of BMD, 50.0% for VITEK® 2, and 27.7% for E-test. Spearman’s ρ showed weak correlations between methods: 0.29 E-test vs VITEK® 2 (P=0.003), 0.27 E-test vs BMD (P=0.001), and 0.31 VITEK® 2 vs BMD (P=0.002). The optimal cutoff points for detecting BMD-defined less susceptible strains were ≥1.0 µg/mL for E-test and VITEK® 2. E-test sensitivity at this cutoff point was 0.85 and specificity 0.29, while VITEK® 2 sensitivity and specificity were 0.62 and 0.51, respectively. Multiresistant MRSA strains tended to have higher MIC values compared to nonmultiresistant MRSA or epidemic MRSA 15 phenotypes by E-test (Fisher’s exact P<0.001) and VITEK® 2 (Fisher’s exact P<0.001). Conclusion Overall diagnostic accuracy and correlations between MIC methods used in routine diagnostic laboratories and the gold standard BMD showed limited overall agreement. This study helps optimize guidance on the effective use of vancomycin.
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Affiliation(s)
- Cameron J Phillips
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia; Department of Microbiology and Infectious Diseases, School of Medicine, Flinders University, Adelaide, SA, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Nicholas A Wells
- SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marianne Martinello
- SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Simon Smith
- SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - David L Gordon
- Department of Microbiology and Infectious Diseases, School of Medicine, Flinders University, Adelaide, SA, Australia; SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, SA, Australia
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Yasmin M, El Hage H, Obeid R, El Haddad H, Zaarour M, Khalil A. Epidemiology of bloodstream infections caused by methicillin-resistant Staphylococcus aureus at a tertiary care hospital in New York. Am J Infect Control 2016; 44:41-6. [PMID: 26412481 DOI: 10.1016/j.ajic.2015.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND In the United States, bloodstream infections (BSIs) are predominated by Staphylococcus aureus. The proportion of community-acquired methicillin-resistant S aureus (MRSA) BSI is on the rise. The goal of this study is to explore the epidemiology of BSI caused by S aureus within Staten Island, New York. METHODS This is a case-case-control study from April 2012-October 2014. Cases were comprised of patients with BSI secondary to MRSA and methicillin-sensitive S aureus (MSSA). The control group contained patients who were hospitalized during the same time period as cases but did not develop infections during their stay. Two multivariable models compared each group of cases with the uninfected controls. RESULTS A total of 354 patients were analyzed. Infections were community acquired in 76% of cases. The major source of BSI was skin-related infections (n = 76). The first multivariable model showed that recent central venous catheter placement was an independent infection risk factor (odds ratio [OR] = 80.7; 95% confidence interval [CI], 2.2-3,014.1). In the second model, prior hospital stay >3 days (OR = 4.1; 95% CI, 1.5-5.7) and chronic kidney disease (OR = 3.0; 95% CI, 1.01-9.2) were uniquely associated with MSSA. Persistent bacteremia, recurrence, and other hospital-acquired infections were more likely with MRSA BSI than MSSA BSI. CONCLUSION Most infections were community acquired. The presence of a central venous catheter constituted a robust independent risk factor for MRSA BSI. Patients with MRSA BSI suffered worse outcomes than those with MSSA BSI.
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Davis JS, Sud A, O'Sullivan MVN, Robinson JO, Ferguson PE, Foo H, van Hal SJ, Ralph AP, Howden BP, Binks PM, Kirby A, Tong SYC. Combination of Vancomycin and β-Lactam Therapy for Methicillin-ResistantStaphylococcus aureusBacteremia: A Pilot Multicenter Randomized Controlled Trial. Clin Infect Dis 2015; 62:173-180. [DOI: 10.1093/cid/civ808] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/28/2015] [Indexed: 01/12/2023] Open
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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: 2785] [Impact Index Per Article: 309.4] [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.
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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
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Azim S, Nimmo GR, McLaws ML. Meticillin-resistant Staphylococcus aureus (MRSA) antibiogram: How inaccurate have our estimates been? J Glob Antimicrob Resist 2015; 3:80-84. [PMID: 27873674 DOI: 10.1016/j.jgar.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/22/2015] [Accepted: 02/09/2015] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to determine the accuracy of antimicrobial resistance patterns reported by the Australian Group on Antimicrobial Resistance (AGAR) established using surveys of just the first 100 Staphylococcus aureus isolates from each participating hospital. Patterns of resistance of a survey sample of S. aureus isolates collected prospectively from five Queensland hospitals participating in the AGAR biennial national survey, using the first 100 isolates diagnosed from each test year, were tested. Meticillin-resistant S. aureus (MRSA) antibiograms for five antimicrobials commonly used to treat outpatients established from a sample have underestimated the true level of resistance by 13-21 percentage points. Conversely, inpatient antibiograms have significantly overestimated the resistance level. Random selection of 100 isolates from all isolates did not provide valid resistance patterns for outpatients or inpatients. Nearly 50% of resistance demonstrated in all inpatient isolates and about 45% of resistance in all outpatient isolates was due to AUS-2/3-like, EMRSA-15-like and MRSA unclassified. In conclusion, testing S. aureus, and in particular MRSA, for resistance levels to commonly prescribed antimicrobials is under/over-estimated in Australia because of a faulty annual sampling method that failed to consider the effect of endemic phenotypes (AUS-2/3-like and EMRSA-15-like). MRSA represents one-third of all S. aureus AGAR isolates. Endemic phenotypes bias the antibiogram patterns when small consecutive sampling (first 100 samples) is used and this bias remains even when samples are selected at random. A minimum sample of 6 months of isolates must be used to accurately establish a national antibiogram.
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Affiliation(s)
- Syed Azim
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Graeme R Nimmo
- Microbiology, Pathology Queensland, Herston, QLD, Australia; Australian Group on Antimicrobial Resistance (AGAR), Perth, WA, Australia; School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia; Australian Group on Antimicrobial Resistance (AGAR), Perth, WA, Australia.
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Clonal Diversity of Meticillin-Resistant Staphylococcus aureus Isolated From Intensive Care Unit. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Choose wisely: Network, ontology and annotation resources for the analysis of Staphylococcus aureus omics data. Int J Med Microbiol 2015; 305:339-47. [DOI: 10.1016/j.ijmm.2015.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 01/21/2015] [Accepted: 02/09/2015] [Indexed: 01/25/2023] Open
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Stinear TP, Holt KE, Chua K, Stepnell J, Tuck KL, Coombs G, Harrison PF, Seemann T, Howden BP. Adaptive change inferred from genomic population analysis of the ST93 epidemic clone of community-associated methicillin-resistant Staphylococcus aureus. Genome Biol Evol 2015; 6:366-78. [PMID: 24482534 PMCID: PMC3942038 DOI: 10.1093/gbe/evu022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a major public health problem around the world. In Australia, ST93-IV[2B] is the dominant CA-MRSA clone and displays significantly greater virulence than other S. aureus. Here, we have examined the evolution of ST93 via genomic analysis of 12 MSSA and 44 MRSA ST93 isolates, collected from around Australia over a 17-year period. Comparative analysis revealed a core genome of 2.6 Mb, sharing greater than 99.7% nucleotide identity. The accessory genome was 0.45 Mb and comprised additional mobile DNA elements, harboring resistance to erythromycin, trimethoprim, and tetracycline. Phylogenetic inference revealed a molecular clock and suggested that a single clone of methicillin susceptible, Panton-Valentine leukocidin (PVL) positive, ST93 S. aureus likely spread from North Western Australia in the early 1970s, acquiring methicillin resistance at least twice in the mid 1990s. We also explored associations between genotype and important MRSA phenotypes including oxacillin MIC and production of exotoxins (α-hemolysin [Hla], δ-hemolysin [Hld], PSMα3, and PVL). High-level expression of Hla is a signature feature of ST93 and reduced expression in eight isolates was readily explained by mutations in the agr locus. However, subtle but significant decreases in Hld were also noted over time that coincided with decreasing oxacillin resistance and were independent of agr mutations. The evolution of ST93 S. aureus is thus associated with a reduction in both exotoxin expression and oxacillin MIC, suggesting MRSA ST93 isolates are under pressure for adaptive change.
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Affiliation(s)
- Timothy P Stinear
- Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
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20
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Harrington G, Watson K, Bailey M, Land G, Borrell S, Houston L, Kehoe R, Bass P, Cockroft E, Marshall C, Mijch A, Spelman D. Reduction in Hospitalwide Incidence of Infection or Colonization with Methicillin-ResistantStaphylococcus aureusWith Use of Antimicrobial Hand-Hygiene Gel and Statistical Process Control Charts. Infect Control Hosp Epidemiol 2015; 28:837-44. [PMID: 17564987 DOI: 10.1086/518844] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Accepted: 12/15/2006] [Indexed: 02/02/2023]
Abstract
Objective.To evaluate the impact of serial interventions on the incidence of methicillin-resistantStaphylococcus aureus(MRSA).Design.Longitudinal observational study before and after interventions.Setting.The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU).Interventions.A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures.Methods.Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period.Results.The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P= .047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P< .001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively.Conclusion.A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.
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Affiliation(s)
- Glenys Harrington
- Infection Control and Hospital Epidemiology Unit, Alfred Hospital, Melbourne, Victoria, Australia.
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Buick S, Joffe AM, Taylor G, Conly J. A consensus development conference model for establishing health policy for surveillance and screening of antimicrobial-resistant organisms. Clin Infect Dis 2014; 60:1095-101. [PMID: 25542896 DOI: 10.1093/cid/ciu1168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Canadian Consensus Development Conference on Surveillance and Screening for Antimicrobial-Resistant Organisms (AROs) was sponsored by the Alberta Ministry of Health to provide evidence to update policies for ARO screening in acute care settings. A rigorous evidence-based literature review completed before the conference concluded that that neither universal nor targeted screening of patients was associated with a reduction in hospital-acquired ARO colonization, infection, morbidity, or mortality. Leading international clinicians, scientists, academics, policy makers, and administrators presented current evidence and clinical experience, focusing on whether and how hospitals should screen patients for AROs as part of broader ARO control strategies. An unbiased and independent "jury" with a broad base of expertise from complementary disciplines considered the evidence and released a consensus statement of 22 recommendations. Policy highlights included developing an integrated "One Health" strategy, fully resourcing basic infection control practices, not performing universal screening, and focusing original research to determine what works.
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Affiliation(s)
| | - A Mark Joffe
- Infection Prevention and Control, Alberta Health Services Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton
| | - Geoffrey Taylor
- Infection Prevention and Control, Alberta Health Services Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton
| | - John Conly
- Infection Prevention and Control, Alberta Health Services Department of Medicine, Snyder Institute for Chronic Diseases and Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
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22
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Zhou YP, Wilder-Smith A, Hsu LY. The role of international travel in the spread of methicillin-resistant Staphylococcus aureus. J Travel Med 2014; 21:272-81. [PMID: 24894491 DOI: 10.1111/jtm.12133] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/18/2014] [Accepted: 02/19/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increasing international travel has facilitated the transmission of various multidrug-resistant bacteria-including methicillin-resistant Staphylococcus aureus (MRSA)-across continents. Individuals may acquire MRSA from the community, healthcare facilities, or even from animal exposure. Skin contact with colonized individuals, fomites, or animals during an overseas trip may result in either asymptomatic colonization or subsequent clinically significant MRSA disease. MRSA strains that harbor the Panton-Valentine leucocidin toxin are particularly associated with community transmission and may potentially have enhanced virulence resulting in serious skin and soft tissue infections or even necrotizing pneumonia. More importantly, secondary transmission events upon return from traveling have been documented, leading to potentially detrimental outbreaks within the community or the healthcare setting. We sought to review the existing literature relating to the role of various aspects of travel in the spread of MRSA. Risk factors for acquiring MRSA during travel together with the need for targeted screening of high-risk individuals will also be explored. METHODS Data for this article were identified via PubMed searches using a combination of search terms: "methicillin resistance," "MRSA," "livestock-associated MRSA," "community-associated MRSA," "travel," and "outbreak." The relevant articles were extensively perused to determine secondary sources of data. RESULTS AND CONCLUSIONS Our review of the current literature suggests that international travel plays a significant role in the transmission of MRSA, potentially contributing to the replacement of existing endemic MRSA with fitter and more transmissible strains. Therefore, selective and targeted screening of travelers with risk factors for MRSA colonization may be beneficial. Healthcare professionals and patients should be considered for screening if they were to return from endemic areas, with the former group decolonized before returning to patient care work, in order to reduce the transmission of MRSA to vulnerable patient populations.
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Affiliation(s)
- Yvonne P Zhou
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
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23
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Monecke S, Müller E, Dorneanu OS, Vremeră T, Ehricht R. Molecular typing of MRSA and of clinical Staphylococcus aureus isolates from Iaşi, Romania. PLoS One 2014; 9:e97833. [PMID: 24846009 PMCID: PMC4028265 DOI: 10.1371/journal.pone.0097833] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/24/2014] [Indexed: 02/06/2023] Open
Abstract
Romania is one of the countries with the highest prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the world. To obtain data on affiliation of MRSA to strains and clonal complexes and on the population of methicillin susceptible S. aureus (MSSA), clinical isolates from bloodstream infections, skin and soft tissue infections as well as from screening swabs were collected at hospitals in Ia?i, a city in the North-Eastern part of Romania. Isolates were characterised by microarray hybridisation. Nearly half of all isolates (47%), and about one third (34%) of bloodstream isolates were MRSA. The prevalence of the Panton-Valentine leukocidin (PVL) was also high (31% among MRSA, 14% among MSSA). The most common MRSA strain was a PVL-negative CC1-MRSA-IV that might have emerged locally, as a related MSSA was also common. PVL-positive CC8-MRSA-IV (“USA300”) and PVL-negative ST239-like MRSA-III were also frequently found while other MRSA strains were only sporadically detected. Among MSSA, PVL-positive CC121 as well as PVL-negative CC1, CC22 and CC45 predominated. Although this study provides only a snapshot of S. aureus/MRSA epidemiology in Romania, it confirms the high burden of MRSA and PVL on Romanian healthcare settings.
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Affiliation(s)
- Stefan Monecke
- Institute for Medical Microbiology and Hygiene, Medizinische Fakultät “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
- Alere Technologies GmbH, Jena, Germany
- * E-mail:
| | | | - Olivia Simona Dorneanu
- Microbiology Department, University of Medicine and Pharmacy “Grigore T. Popa” Iaşi, Iaşi, Romania
| | - Teodora Vremeră
- Microbiology Department, University of Medicine and Pharmacy “Grigore T. Popa” Iaşi, Iaşi, Romania
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Jenney A, Holt D, Ritika R, Southwell P, Pravin S, Buadromo E, Carapetis J, Tong S, Steer A. The clinical and molecular epidemiology of Staphylococcus aureus infections in Fiji. BMC Infect Dis 2014; 14:160. [PMID: 24655406 PMCID: PMC3998116 DOI: 10.1186/1471-2334-14-160] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 03/13/2014] [Indexed: 11/27/2022] Open
Abstract
Background There are few data describing the microbiology and genetic typing of Staphylococcus aureus that cause infections in developing countries. Methods In this study we observed S. aureus infections in Pacific Island nation of Fiji in both the community and hospital setting with an emphasis on clonal complex (CC) genotyping and antimicrobial susceptibility. Results S. aureus was commonly found in impetigo lesions of school children and was recovered from 57% of impetigo lesions frequently in conjunction with group A streptococcal infection. Methicillin-resistant S. aureus (MRSA) comprised 7% (20/299) of isolates and were all non-multi-resistant and all genotyped as CC1. In contrast, there was a diverse selection of 17 CCs among the 105 genotyped methicillin-susceptible S.aureus (MSSA) strains. Isolates of the rare, phylogenetically divergent and non-pigmented CC75 lineage (also called S.argenteus) were found in Fiji. From hospitalized patients the available 36 MRSA isolates from a 9-month period were represented by five CCs. The most common CCs were CC1 and CC239. CC1 is likely to be a community-acquired strain, reflecting what was found in the school children, whereas the CC239 is the very successful multi-drug resistant MRSA nosocomial lineage. Of 17 MSSA isolates, 59% carried genes for Panton-Valentine leukocidin. The S. aureus bacteraemia incidence rate of 50 per 100,000 population is among the highest reported in the literature and likely reflects the high overall burden of staphylococcal infections in this population. Conclusions S. aureus is an important cause of disease in Fiji and there is considerable genotypic diversity in community skin infections in Fijian schoolchildren. Community acquired- (CA)- MRSA is present at a relatively low prevalence (6.7%) and was solely to CC1 (CA-MRSA). The globally successful CC239 is also a significant pathogen in Fiji.
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Affiliation(s)
- Adam Jenney
- Fiji Group A Streptococcal Project, University of Melbourne, Victoria, Australia.
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25
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Nimmo GR, Bergh H, Nakos J, Whiley D, Marquess J, Huygens F, Paterson DL. Replacement of healthcare-associated MRSA by community-associated MRSA in Queensland: Confirmation by genotyping. J Infect 2013; 67:439-47. [DOI: 10.1016/j.jinf.2013.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/19/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
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Britton PN, Andresen DN. Paediatric community-associated Staphylococcus aureus: a retrospective cohort study. J Paediatr Child Health 2013; 49:754-9. [PMID: 23721234 DOI: 10.1111/jpc.12255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 11/27/2022]
Abstract
AIM We aimed to characterise the demographic and clinical features of paediatric community-associated Staphylococcus aureus (CA-SA) infection. We aimed to identify factors associated with methicillin-resistant S.aureus (MRSA) infection evident at the point of care with the potential to guide antibiotic choice. METHODS A retrospective chart review in 2008 of CA-SA infections at the Children's Hospital at Westmead (CHW), a 300-bed tertiary paediatric hospital in western Sydney, Australia. We calculate rates of MRSA and perform univariate and multivariate analysis for predictors of MRSA. RESULTS Of 431 patients with CA-SA infections, 19.3% were MRSA. In univariate analysis, MRSA was predicted by age greater than 1 year, Aboriginal race, rural/regional residence, previous history of skin and soft tissue infection (SSTI) or a family history of SSTI, at least 48 h of antibiotics active against methicillin-sensitive S.aureus (MSSA), invasive infection and abscess formation. In a multivariate analysis factors that independently predicted MRSA in the entire cohort, and in the non-invasive subgroup included abscess formation, a family history of staphylococcal infection or SSTI, Aboriginal ethnicity, at least 48 h of anti-MSSA antibiotics at presentation, presentation during spring and age greater than 1 year. CONCLUSIONS One fifth of CA-SA infections at our tertiary paediatric hospital in 2008 were MRSA. Several clinical and demographic factors evident at the point of care were highly significant predictors of CA-MRSA infection.
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Affiliation(s)
- Philip N Britton
- Department of Microbiology and Infectious Diseases, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
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First report of a sequence type 239 vancomycin-intermediate Staphylococcus aureus isolate in Mainland China. Diagn Microbiol Infect Dis 2013; 77:64-8. [DOI: 10.1016/j.diagmicrobio.2013.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/30/2013] [Accepted: 06/04/2013] [Indexed: 11/20/2022]
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Community-onset Staphylococcus aureus infections presenting to general practices in South-eastern Australia. Epidemiol Infect 2013; 142:501-11. [PMID: 23866772 DOI: 10.1017/s0950268813001581] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Community-acquired Staphylococcus aureus infections are a public health concern, yet little is known about infections that do not present to hospital. We identified community-onset S. aureus infections via specimens submitted to a community-based pathology service. Referring doctors confirmed eligibility and described infection site, severity and treatment. Isolates were characterized on antibiotic resistance, PFGE, MLST/SCCmec, and Panton-Valentine leukocidin (PVL), representing 106 community-onset infections; 34 non-multiresistant methicillin-resistant S. aureus (nmMRSA) (resistant to <3 non-β-lactam antibiotics), 15 multiply antibiotic-resistant MRSA (mMRSA) and 57 methicillin-sensitive S. aureus (MSSA). Most (93%) were skin and soft tissue infections. PVL genes were carried by 42% of nmMRSA isolates [95% confidence interval (CI) 26-61] and 15% of MSSA (95% CI 8-28). PVL was associated with infections of the trunk, head or neck (56·4% vs. 24·3%, P=0·005) in younger patients (23 vs. 52 years, P<0·001), and with boils or abscesses (OR 8·67, 95% CI 2·9-26·2), suggesting underlying differences in exposure and/or pathogenesis.
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Xie C, Taylor DM, Howden BP, Charles PGP. Comparison of the bacterial isolates and antibiotic resistance patterns of elderly nursing home and general community patients. Intern Med J 2013; 42:e157-64. [PMID: 21241444 DOI: 10.1111/j.1445-5994.2011.02436.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing home-acquired infections may differ from general community-acquired infections in bacteriology and antibiotic resistance. However, there are currently limited data on this topic in the Australian setting. AIMS To compare bacterial isolates and antibiotic resistance patterns, from pathology specimens of nursing home and community patients, and to comment on the suitability of empiric antibiotic guidelines for nursing home-acquired infection. METHODS This was a retrospective cohort study of patients, aged ≥ 65 years, who resided in either nursing homes or the general community. Patients with a hospital admission in the previous 28 days were excluded. Positive specimen cultures, collected between July 2003 and June 2008 in the Emergency Department and Outpatient Clinics of the Austin Hospital (Melbourne), were examined. The main outcome measures were the bacterial isolates, and their antibiotic resistance patterns, of patients from nursing homes and the general community. RESULTS Specimens of blood (638), sputum (425), urine (4044) and wound cultures (785) were examined. The bacteriology of blood culture isolates did not differ between the two groups (P= 0.3). However, the bacteriology of sputum, urine and wound cultures differed significantly between the groups (P= 0.025, P < 0.001, P= 0.004 respectively). There were also higher proportions of antibiotic resistance among some bacteria in nursing home patients, especially methicillin resistance among Staphylococcus aureus isolates across all specimen types, and resistance to several empiric antibiotics among Enterobacteriaceae isolates in urine cultures. CONCLUSION Empiric antibiotic guidelines appear adequate to treat nursing home-acquired septicaemia and pneumonia. However, guidelines for urinary tract infections and wound infections may need to be refined.
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Affiliation(s)
- C Xie
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
BACKGROUND Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is increasing in incidence and manifests as skin and soft tissue infections including furuncles. The majority of studies have focused on the epidemiology of single furuncles and not recurrent disease. There is a lack of data concerning the incidence of furunculosis outside the U.S.A. OBJECTIVES This report reviews the literature of recurrent furunculosis and the impact of CA-MRSA on the disease. METHODS Article citations were searched within PubMed. Search terms used were 'furunculosis', 'recurrent furunculosis', 'skin abscess' and 'recurrent boils'. Articles were discarded if they did not refer to furunculosis secondary to S. aureus. RESULTS A total of 1515 articles were initially retrieved with the term 'furunculosis', 77 with the term 'recurrent furunculosis', 2778 with the term 'skin abscess', and 1526 with the term 'recurrent boils'. After excluding articles not referring to S. aureus furunculosis, 86 articles were included for this review. CONCLUSIONS Furunculosis is increasing within the U.S.A. secondary to the CA-MRSA epidemic and the resistant organism's close association with the Panton-Valentine leucocidin (PVL) virulence factor. PVL is associated with follicular infections in general, having its strongest association with furunculosis and its recurrence. The majority of furuncles in the U.S.A. are caused by CA-MRSA, while elsewhere in the world they are caused by methicillin-sensitive S. aureus. Nasal carriage of S. aureus is the primary risk factor for recurrent furunculosis and occurs in 60% of individuals.
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Affiliation(s)
- M Demos
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Chu H, Zhao L, Zhang Z, Gui T, Han L, Ni Y. Antibiotic Resistance and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus from Lower Respiratory Tract: Multi-resistance and High Prevalence of SCCmec III Type. Cell Biochem Biophys 2013; 67:795-801. [DOI: 10.1007/s12013-013-9542-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fernandez S, de Vedia L, Lopez Furst MJ, Gardella N, Di Gregorio S, Ganaha MC, Prieto S, Carbone E, Lista N, Rotrying F, Stryjewski ME, Mollerach M. Methicillin-resistant Staphylococcus aureus ST30-SCCmec IVc clone as the major cause of community-acquired invasive infections in Argentina. INFECTION GENETICS AND EVOLUTION 2013; 14:401-5. [PMID: 23340226 DOI: 10.1016/j.meegid.2012.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have become a major concern worldwide. We conducted a prospective multicenter study of invasive CA-MRSA to evaluate clinical features and genotype of strains causing invasive infections in Argentina. A total of 55 patients with invasive CA-MRSA infections were included. Most patients (60%) had bloodstream infections, 42% required admission to intensive care unit and 16% died. No CA-MRSA isolates were multiresistant (resistant ⩾3 classes of antibiotics). All isolates carried Panton-Valentine leukocidin (PVL) genes and staphylococcal cassette chromosome (SCCmec) type IV. The majority CA-MRSA strains belonged to ST30 and had identical pulsed-field gel electrophoresis (PFGE) patterns, qualifying as a clonal dissemination of a highly transmissible strain. The main clone recovered from patients with CA-MRSA invasive infections was genotyped as pulsed-field gel electrophoresis type C-ST30, SCCmec type IVc-spa type 019, PVL positive. It has become predominant and replaced the previously described CA-MRSA clone (PFGE type A, ST5, SCCmec type IV, spa type 311).
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Affiliation(s)
- S Fernandez
- Cátedra de Microbiología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
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Community-associated meticillin-resistant Staphylococcus aureus carriage in hospitalized patients in tropical northern Australia. J Hosp Infect 2013; 83:205-11. [PMID: 23332351 DOI: 10.1016/j.jhin.2012.10.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 10/24/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) was first reported in remote Australian Aboriginal communities. It is a prominent clinical pathogen in northern Australia with potential for transmission within the local hospital setting. AIM To determine epidemiological characteristics of S. aureus carriage within the Royal Darwin Hospital. METHODS We screened two patient groups: an 'admission group' recruited within 48 h of admission; and an 'inpatient group' recruited five or more days after admission. S. aureus isolates were characterized by antibiotic susceptibility testing and genotyped by a multi-locus sequence type-based high-resolution melting scheme. FINDINGS S. aureus carriage on admission was 30.7% of 225 compared with 34.8% among 201 inpatients, with MRSA carriage of 2.2% and 18.9% respectively. We isolated CA-MRSA from 0.9% and 10.4%, and healthcare-associated (HCA)-MRSA from 1.3% and 9.0% of the admission and inpatient groups, respectively. Among the inpatient group, hospital-associated ST239 was the most common MRSA strain. CA-MRSA was represented by one clonal complex (CC) in the admission group (CC5) and seven CCs in the inpatient group (CC1, 93, 5, 6, 30, 75, 88). CONCLUSION Inpatient carriage of multiple CA-MRSA lineages suggests selection for and transmission within the hospital of not only typical HCA-MRSA, but also diverse CA-MRSA strains.
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Mignemi ME, Langdon NW, Schoenecker JG. Vitamin K-Dependent Coagulopathy in Pediatric Osteomyelitis: A Case Report. JBJS Case Connect 2013; 3:e21. [PMID: 29252326 DOI: 10.2106/jbjs.cc.l.00169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Megan E Mignemi
- Vanderbilt Orthopaedic Institute, Medical Center East, South Tower, Suite 4200, 1215 21st Avenue South, Nashville, TN 37232.
| | - Neal W Langdon
- Vanderbilt University School of Medicine, 215 Light Hall, Nashville, TN 37232.
| | - Jonathan G Schoenecker
- Vanderbilt Orthopaedic Institute, Monroe Carell Jr. Children's Hospital, 4202 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232.
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Shallcross LJ, Fragaszy E, Johnson AM, Hayward AC. The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2013; 13:43-54. [PMID: 23103172 PMCID: PMC3530297 DOI: 10.1016/s1473-3099(12)70238-4] [Citation(s) in RCA: 293] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Invasive community-onset staphylococcal disease has emerged worldwide associated with Panton-Valentine leucocidin (PVL) toxin. Whether PVL is pathogenic or an epidemiological marker is unclear. We investigate the role of PVL in disease, colonisation, and clinical outcome. METHODS We searched Medline and Embase for original research reporting the prevalence of PVL genes among Staphylococcus aureus pneumonia, bacteraemia, musculoskeletal infection, skin and soft-tissue infection, or colonisation published before Oct 1, 2011. We calculated odds ratios (ORs) to compare patients with PVL-positive colonisation and each infection relative to the odds of PVL-positive skin and soft-tissue infection. We did meta-analyses to estimate odds of infection or colonisation with a PVL-positive strain with fixed-effects or random-effects models, depending on the results of tests for heterogeneity. RESULTS Of 509 articles identified by our search strategy, 76 studies from 31 countries met our inclusion criteria. PVL strains are strongly associated with skin and soft-tissue infections, but are comparatively rare in pneumonia (OR 0·37, 95% CI 0·22-0·63), musculoskeletal infections (0·44, 0·19-0·99), bacteraemias (0·10, 0·06-0·18), and colonising strains (0·07, 0·01-0·31). PVL-positive skin and soft-tissue infections are more likely to be treated surgically than are PVL-negative infections, and children with PVL-positive musculoskeletal disease might have increased morbidity. For other forms of disease we identified no evidence that PVL affects outcome. INTERPRETATION PVL genes are consistently associated with skin and soft-tissue infections and are comparatively rare in invasive disease. This finding challenges the view that PVL mainly causes invasive disease with poor prognosis. Population-based studies are needed to define the role of PVL in mild, moderate, and severe disease and to inform control strategies. FUNDING None.
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Affiliation(s)
- Laura J Shallcross
- Research Department of Infection and Population Health, University College London, London, UK.
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Thompson J, Gündoğdu A, Stratton H, Katouli M. Antibiotic resistant Staphylococcus aureus
in hospital wastewaters and sewage treatment plants with special reference to methicillin-resistant Staphylococcus aureus
(MRSA). J Appl Microbiol 2012; 114:44-54. [DOI: 10.1111/jam.12037] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 09/22/2012] [Accepted: 09/23/2012] [Indexed: 01/19/2023]
Affiliation(s)
- J.M. Thompson
- Faculty of Science, Health and Education; University of the Sunshine Coast; Maroochydore QLD Australia
| | - A. Gündoğdu
- Faculty of Science, Health and Education; University of the Sunshine Coast; Maroochydore QLD Australia
| | - H.M. Stratton
- School of Biomolecular and Physical Sciences; Griffith University; Nathan Campus; Brisbane QLD Australia
- Smart Water Research Centre; Southport QLD Australia
| | - M. Katouli
- School of Biomolecular and Physical Sciences; Griffith University; Nathan Campus; Brisbane QLD Australia
- Smart Water Research Centre; Southport QLD Australia
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A multilevel model of methicillin-resistant Staphylococcus aureus acquisition within the hierarchy of an Australian tertiary hospital. Am J Infect Control 2012; 40:787-93. [PMID: 22336109 DOI: 10.1016/j.ajic.2011.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/14/2011] [Accepted: 10/17/2011] [Indexed: 11/24/2022]
Abstract
Hospitals without universal single room accommodations typically contain multibed cubicles within wards. In this study, we examined whether the variation in a patient's risk for acquiring methicillin-resistant Staphylococcus aureus (MRSA) in a major tertiary hospital was greatest at the bed, cubicle, or ward level, and quantified the risk of MRSA acquisition associated with exposure to MRSA-colonized/infected patients within the same bed, cubicle, and ward at differently distributed lag times. Nested tri-level hierarchical logistic regression models with random effects were used for non-multiresistant MRSA (nmMRSA) and multiresistant MRSA (mMRSA). The models were internally validated. Receiver operating characteristic curves were used to compare the models' predictive capability The odds of new nmMRSA acquisition were 6.06-fold (95% credible intervals [CrI], 3.93- to 9.34-fold) greater in bed-weeks when a nmMRSA-colonized/infected patient was in the same cubicle 2 weeks earlier. The odds of mMRSA acquisition were 5.12-fold (95% CrI, 4.02- to 6.51-fold) greater in bed-weeks when a colonized/infected patient was in the same ward 2 weeks earlier. The between-cluster variance was highest at the ward level. Patients were at greater risk if there was a colonized/infected patient in the same cubicle or ward 2 weeks earlier. Our findings indicate that focusing on the relevant cubicles and wards during this high-risk period can help target infection control resources more efficiently.
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Methicillin-Resistant Staphylococus aureus. Ophthalmology 2012; 119:1719-1719.e1; author reply 1720. [DOI: 10.1016/j.ophtha.2012.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/20/2012] [Indexed: 11/20/2022] Open
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Hewagama S, Spelman T, Einsiedel LJ. Staphylococcus aureus bacteraemia at Alice Springs Hospital, Central Australia, 2003-2006. Intern Med J 2012; 42:505-12. [DOI: 10.1111/j.1445-5994.2011.02449.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Tong SYC, Chen LF, Fowler VG. Colonization, pathogenicity, host susceptibility, and therapeutics for Staphylococcus aureus: what is the clinical relevance? Semin Immunopathol 2011; 34:185-200. [PMID: 22160374 DOI: 10.1007/s00281-011-0300-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 10/28/2011] [Indexed: 12/20/2022]
Abstract
Staphylococcus aureus is a human commensal that can also cause a broad spectrum of clinical disease. Factors associated with clinical disease are myriad and dynamic and include pathogen virulence, antimicrobial resistance, and host susceptibility. Additionally, infection control measures aimed at the environmental niches of S. aureus and therapeutic advances continue to impact upon the incidence and outcomes of staphylococcal infections. This review article focuses on the clinical relevance of advances in our understanding of staphylococcal colonization, virulence, host susceptibility, and therapeutics. Over the past decade key developments have arisen. First, rates of nosocomial methicillin-resistant S. aureus (MRSA) infections have significantly declined in many countries. Second, we have made great strides in our understanding of the molecular pathogenesis of S. aureus in general and community-associated MRSA in particular. Third, host risk factors for invasive staphylococcal infections, such as advancing age, increasing numbers of invasive medical interventions, and a growing proportion of patients with healthcare contact, remain dynamic. Finally, several new antimicrobial agents active against MRSA have become available for clinical use. Humans and S. aureus co-exist, and the dynamic interface between host, pathogen, and our attempts to influence these interactions will continue to rapidly change. Although progress has been made in the past decade, we are likely to face further surprises such as the recent waves of community-associated MRSA.
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Affiliation(s)
- Steven Y C Tong
- Division of Infectious Diseases and International Health, Duke University Medical Center, Box 102359, Durham, NC 27705, USA.
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Zanger P, Nurjadi D, Schleucher R, Scherbaum H, Wolz C, Kremsner PG, Schulte B. Import and Spread of Panton-Valentine Leukocidin–Positive Staphylococcus aureus Through Nasal Carriage and Skin Infections in Travelers Returning From the Tropics and Subtropics. Clin Infect Dis 2011; 54:483-92. [DOI: 10.1093/cid/cir822] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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42
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Le Maréchal C, Seyffert N, Jardin J, Hernandez D, Jan G, Rault L, Azevedo V, François P, Schrenzel J, van de Guchte M, Even S, Berkova N, Thiéry R, Fitzgerald JR, Vautor E, Le Loir Y. Molecular basis of virulence in Staphylococcus aureus mastitis. PLoS One 2011; 6:e27354. [PMID: 22096559 PMCID: PMC3214034 DOI: 10.1371/journal.pone.0027354] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 10/14/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND S. aureus is one of the main pathogens involved in ruminant mastitis worldwide. The severity of staphylococcal infection is highly variable, ranging from subclinical to gangrenous mastitis. This work represents an in-depth characterization of S. aureus mastitis isolates to identify bacterial factors involved in severity of mastitis infection. METHODOLOGY/PRINCIPAL FINDINGS We employed genomic, transcriptomic and proteomic approaches to comprehensively compare two clonally related S. aureus strains that reproducibly induce severe (strain O11) and milder (strain O46) mastitis in ewes. Variation in the content of mobile genetic elements, iron acquisition and metabolism, transcriptional regulation and exoprotein production was observed. In particular, O11 produced relatively high levels of exoproteins, including toxins and proteases known to be important in virulence. A characteristic we observed in other S. aureus strains isolated from clinical mastitis cases. CONCLUSIONS/SIGNIFICANCE Our data are consistent with a dose-dependant role of some staphylococcal factors in the hypervirulence of strains isolated from severe mastitis. Mobile genetic elements, transcriptional regulators, exoproteins and iron acquisition pathways constitute good targets for further research to define the underlying mechanisms of mastitis severity.
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Affiliation(s)
- Caroline Le Maréchal
- INRA, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- AGROCAMPUS OUEST, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- ANSES, Laboratoire de Sophia-Antipolis, Unité pathologie des ruminants, Sophia-Antipolis, France
| | - Nubia Seyffert
- INRA, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- AGROCAMPUS OUEST, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas (ICB), Departamento de Biologia Geral, Belo Horizonte, Minas Gerais, Brazil
| | - Julien Jardin
- INRA, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- AGROCAMPUS OUEST, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
| | - David Hernandez
- Genomic Research Laboratory, Service of Infectious Diseases, University of Geneva Hospitals HUG, Geneva, Switzerland
| | - Gwenaël Jan
- INRA, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- AGROCAMPUS OUEST, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
| | - Lucie Rault
- INRA, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- AGROCAMPUS OUEST, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
| | - Vasco Azevedo
- Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas (ICB), Departamento de Biologia Geral, Belo Horizonte, Minas Gerais, Brazil
| | - Patrice François
- Genomic Research Laboratory, Service of Infectious Diseases, University of Geneva Hospitals HUG, Geneva, Switzerland
| | - Jacques Schrenzel
- Genomic Research Laboratory, Service of Infectious Diseases, University of Geneva Hospitals HUG, Geneva, Switzerland
| | | | - Sergine Even
- INRA, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- AGROCAMPUS OUEST, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
| | - Nadia Berkova
- INRA, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- AGROCAMPUS OUEST, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
| | - Richard Thiéry
- ANSES, Laboratoire de Sophia-Antipolis, Unité pathologie des ruminants, Sophia-Antipolis, France
| | - J. Ross Fitzgerald
- The Roslin Institute and Centre for Infectious Diseases, Royal Dick School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Eric Vautor
- ANSES, Laboratoire de Sophia-Antipolis, Unité pathologie des ruminants, Sophia-Antipolis, France
| | - Yves Le Loir
- INRA, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
- AGROCAMPUS OUEST, UMR1253, Science et Technologie du Lait et de l'Œuf, Rennes, France
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Verwer PEB, Robinson JO, Coombs GW, Wijesuriya T, Murray RJ, Verbrugh HA, Riley T, Nouwen JL, Christiansen KJ. Prevalence of nasal methicillin-resistant Staphylococcus aureus colonization in healthcare workers in a Western Australian acute care hospital. Eur J Clin Microbiol Infect Dis 2011; 31:1067-72. [PMID: 21909648 DOI: 10.1007/s10096-011-1408-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/25/2011] [Indexed: 11/26/2022]
Abstract
Due to a longstanding comprehensive "search and destroy policy", methicillin-resistant Staphylococcus aureus (MRSA) is not endemic in Western Australian (WA) acute care hospitals. As the prevalence of MRSA in the community has increased, healthcare workers (HCW) are at risk of importing MRSA into hospitals. We aimed to determine the prevalence of and risk factors for nasal MRSA colonization in our HCW population. A period prevalence study was conducted at an 850-bed tertiary hospital. Basic demographics and a nasal swab were obtained. A total of 1,542 HCWs employed in our centre were screened for MRSA, of whom 3.4% (n = 52) were colonized. MRSA colonization was more common in patient care assistants (6.8%) and nurses (5.2%) than in allied health professionals (1.7%) and doctors (0.7%) (p < 0.01). Working in "high-risk" wards that cared for MRSA colonized/infected patients was the strongest risk factor for HCW MRSA colonization (p < 0.001). ST1-IV and ST78-IV (the most common community clones in the region) were the most frequently identified clones. In conclusion, MRSA colonization of HCWs occurs primarily in HCWs caring for patients colonized or infected with MRSA. Surveillance screening of HCWs should be regularly performed on wards with patients with high MRSA colonization prevalence to prevent further spread in the hospital.
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Affiliation(s)
- P E B Verwer
- Department of Medical Microbiology & Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
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Holt DC, Holden MTG, Tong SYC, Castillo-Ramirez S, Clarke L, Quail MA, Currie BJ, Parkhill J, Bentley SD, Feil EJ, Giffard PM. A very early-branching Staphylococcus aureus lineage lacking the carotenoid pigment staphyloxanthin. Genome Biol Evol 2011; 3:881-95. [PMID: 21813488 PMCID: PMC3175761 DOI: 10.1093/gbe/evr078] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Here we discuss the evolution of the northern Australian Staphylococcus aureus isolate MSHR1132 genome. MSHR1132 belongs to the divergent clonal complex 75 lineage. The average nucleotide divergence between orthologous genes in MSHR1132 and typical S. aureus is approximately sevenfold greater than the maximum divergence observed in this species to date. MSHR1132 has a small accessory genome, which includes the well-characterized genomic islands, νSAα and νSaβ, suggesting that these elements were acquired well before the expansion of the typical S. aureus population. Other mobile elements show mosaic structure (the prophage φSa3) or evidence of recent acquisition from a typical S. aureus lineage (SCCmec, ICE6013 and plasmid pMSHR1132). There are two differences in gene repertoire compared with typical S. aureus that may be significant clues as to the genetic basis underlying the successful emergence of S. aureus as a pathogen. First, MSHR1132 lacks the genes for production of staphyloxanthin, the carotenoid pigment that confers upon S. aureus its characteristic golden color and protects against oxidative stress. The lack of pigment was demonstrated in 126 of 126 CC75 isolates. Second, a mobile clustered regularly interspaced short palindromic repeat (CRISPR) element is inserted into orfX of MSHR1132. Although common in other staphylococcal species, these elements are very rare within S. aureus and may impact accessory genome acquisition. The CRISPR spacer sequences reveal a history of attempted invasion by known S. aureus mobile elements. There is a case for the creation of a new taxon to accommodate this and related isolates.
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Affiliation(s)
- Deborah C Holt
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Kotsimbos T, Cheng AC. Changing epidemiology of respiratory pathogens and the role of improved diagnostics. Respirology 2011; 16:873-5. [DOI: 10.1111/j.1440-1843.2011.02004.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lari AR, Pourmand MR, Ohadian Moghadam S, Abdossamadi Z, Namvar AE, Asghari B. Prevalence of PVL-Containing MRSA Isolates Among Hospital Staff Nasal Carriers. Lab Med 2011. [DOI: 10.1309/lman7hr6vjea3nmr] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kelley PG, Grabsch EA, Farrell J, Xie S, Montgomery J, Mayall B, Howden BP. Evaluation of the Xpert™ MRSA/SA Blood Culture assay for the detection of Staphylococcus aureus including strains with reduced vancomycin susceptibility from blood culture specimens. Diagn Microbiol Infect Dis 2011; 70:404-7. [PMID: 21497042 DOI: 10.1016/j.diagmicrobio.2011.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/15/2011] [Accepted: 02/17/2011] [Indexed: 12/16/2022]
Abstract
The Xpert MRSA/SA Blood Culture (BC) assay (Cepheid, Sunnyvale, CA) was prospectively compared to culture and found to have excellent specificity for both Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in BC specimens with a sensitivity of 75% (3/4) and 100% (17/17), respectively. Among 28 heterogeneous vancomycin-intermediate S. aureus (hVISA)/VISA spiked BCs, the assay correctly identified 84.6% VISA and 80% hVISA isolates as MRSA.
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Diversity of community acquired MRSA carrying the PVL gene in Queensland and New South Wales, Australia. Eur J Clin Microbiol Infect Dis 2011; 30:1163-7. [PMID: 21424382 DOI: 10.1007/s10096-011-1203-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
Abstract
Emergence and dissemination of community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) strains are being reported with increasing frequency in Australia and worldwide. These strains of CA-MRSA are genetically diverse and distinct in Australia. Genotyping of CA-MRSA using eight highly-discriminatory single nucleotide polymorphisms (SNPs) is a rapid and robust method for monitoring the dissemination of these strains in the community. In this study, a SNP genotyping method was used to investigate the molecular epidemiology of 249 community acquired non-multiresistant MRSA (nm-MRSA) isolates over a 12-month period from routine diagnostic specimens. A real-time PCR for the presence of Panton-Valentine leukocidin (PVL) was also performed on these isolates. The CA-MRSA isolates were sourced from a large private laboratory in Brisbane, Australia that serves a wide geographic region encompassing Queensland and Northern New South Wales. This study identified 16 different STs and 98% of the CA-MRSA isolates were positive for the PVL gene. The most common ST was ST93 with 41% of isolates testing positive for this clone.
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Whitby CR, Kaplan SL, Mason EO, Carrillo-Marquez M, Lamberth LB, Hammerman WA, Hultén KG. Staphylococcus aureus sinus infections in children. Int J Pediatr Otorhinolaryngol 2011; 75:118-21. [PMID: 21074863 DOI: 10.1016/j.ijporl.2010.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/13/2010] [Accepted: 10/14/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Staphylococcus aureus can cause sinusitis in children. The predominant MRSA clone in the United States, USA300, has been associated with skin and soft tissue as well as invasive diseases. USA300 has increased among CA methicillin-susceptible S. aureus (CA-MSSA) isolates. We describe the clinical characteristics of pediatric patients with S. aureus cultured from sinus specimens, treated at Texas Children's Hospital (TCH), and characterized their isolates by molecular methods. METHODS This was a retrospective study of children with endoscopic sinus surgery (ESS) cultures positive for S. aureus between 01/2005 and 12/2008 at TCH. Medical records were reviewed and associated S. aureus isolates were characterized by pulsed field gel electrophoresis (PFGE). Data were analyzed by Mann-Whitney U, Chi-square, Fisher's exact test, and Chi-square for trend. RESULTS We identified 56 patients with S. aureus sinus infections; 12 (21%) were MRSA. Seven of 12 (58%) MRSA vs. 5/44 (11%) MSSA were USA300 (p<0.01). All MRSA isolates were non-susceptible to erythromycin compared to 30% of MSSA (p<0.01); 75% of the USA300 strains were non-susceptible to erythromycin compared to 36% of the non-USA300 strains (p<0.04). Co-pathogens were isolated from 77% (43/56) of the patient specimens. Both MRSA and USA300 isolates were associated with Haemophilus influenzae co-isolation (p<0.05). Patients with USA300 strains were significantly younger (p=0.02) and more likely to experience snoring as a symptom associated with their sinusitis (p=0.03) than those infected with non-USA300 strains. Children with MRSA (4/12) tended to have a greater recurrence rate than children with MSSA isolates (5/44) (p=0.09). No significant differences were observed between groups for fever or complications such as neck cellulitis, nasal abscess, meningitis, subdural empyema, and orbital cellulitis. CONCLUSION MSSA was more commonly isolated than MRSA from sinus cultures of children who underwent ESS at TCH. The majority of ESS cultures positive for S. aureus, were mixed with other respiratory pathogens, principally H. influenzae. USA300 was the major clone among the MRSA sinusitis isolates, but was not associated with more complications than other S. aureus isolates.
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Affiliation(s)
- Crystal R Whitby
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA
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Chua K, Laurent F, Coombs G, Grayson ML, Howden BP. Not Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA)! A Clinician's Guide to Community MRSA - Its Evolving Antimicrobial Resistance and Implications for Therapy. Clin Infect Dis 2011; 52:99-114. [DOI: 10.1093/cid/ciq067] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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