Serratia marcescens isolated in 2005 from clinical specimens from patients with diminished immunity

Serratia marcescens is an important agent in hospital infections. The aim of this paper was to compare the resistance patterns of S. marcescens strains isolated during 1 year from patients of various wards of the Institute of Transplantology. The mechanisms of beta-lactam antibiotic resistance were of especial interest. We investigated the 81 strains of S. marcescens, isolated during 2005 from patients on 3 wards and 1 clinic of the Transplantation Institute. An unusually high resistance to most antibiotics was observed among S. marcescens strains. Extended spectrum beta-lactamases (ESBLs) were probably produced by 63.2% to 84.6% of strains, depending on the ward. Additionally, about 30% of them were probably derepressed AmpC producers. The patterns of resistance indicated that at least 2 resistant clones of S. marcescens spread among the patients. One of the clones demonstrated both ESBL and derepressed AmpC production and was susceptible only to carbapenems. The second, producing ESBL, was susceptible to piperacillin/tazobactam and carbapenems. All investigated strains were resistant to nitrofurantoin. Strains of the second group were rarely susceptible to other antibiotics: aminoglycosides, ciprofloxacin, cotrimoxazole, or fosfomycin.

[Antibiotic resistance of Staphylococcus aureus strains isolated in two different Warsaw hospitals]

S. aureus strains isolated in the same period from different specimens obtained from patients of two different hospitals were compared. The significant differences were observed in the frequency of resistance determinants between strains of these hospitals. The most important was the difference in the prevalence of MRSA. In the first hospital the percentage of MRSA was 40% whereas in the second one only 20%. The resistance to the other antibiotics was also compared, and independently from the compared group: MRSA, MSSA or all, the prevalence of resistance determinants was higher in the first hospital than in the second. Although the frequencies of MRSA in both investigated hospitals were relatively high comparing to the other European countries and in the first hospital even alarming, isolated MRSA strains are less resistant to other antibiotics than MRSA in other countries.

[Use of PCR for evaluating detection of coa and nuc genes in methicillin-resistant, coagulase-negative strains of Staphylococcus aureus (MRSA-CN)]

Strains showing a negative reaction in tube test for coagulase constitute 10 to 20% of all Staphylococcus aureus isolated from patients of Hospital of Infant Jesus in Warsaw. Most of them are MRSA. In 42 MRSA strains showing negative reaction for coagulase, the presence of coagulase (coa) and nuclease (nucA) genes was checked. Determination of whole cell DNA with PCR reaction was performed. The obtained results revealed that all 42 strains possessed gene nucA, but only 39 strains possessed the coa gene.

[Characteristics of the MRSA clone with reduced susceptibility to vancomycin]

The MIC of vancomycin was determined for all S. aureus strains isolated during 1997 in one hospital. MIC values for most isolates were in the range of 0.5-2 mg/l. In 18 strains, MIC was = 6 mg/L. All these strains were MRSA. Recently described VISA strains possessed MIC values for vancomycin equal or higher than 8 mg/l and such strains were not detected in the investigated group. Although strains with MIC = 6 mg/l are not VISA, but they are candidate for reduced vancomycin susceptibility, e.g. during therapy in compromised patients. Analysis of DNA of these strains by pulsed-field gel electrophoresis (PFGE) revealed that 15 of them shared a significant similarity, allowing to place them in the same group. The comparison data of phage patterns as well as antibiotic resistance patterns strongly suggest that all these strains were derivatives of a single clone.

[Sensitivity to vancomycin and teicoplanin of coagulase-negative staphylococci isolated from clinical specimens]

The frequency of resistance and elevated resistance to teicoplanin and vancomycin among 689 strains of coagulase-negative staphylococci isolated in one year from clinical specimens was determined. Using ATB.STAPH test, a resistance was shown mainly among strains of S. epidermidis and S. haemolyticus. The elevated resistance to teicoplanin was much more frequently observed than to vancomycin. About 27% of isolated strains of S. haemolyticus and 6.8% of S. epidermidis were classified as resistant. Among other species only single strains were recognised as resistant: one strain of S. xylosus, one of S. cohni and one of S. intermedius. 94.7% of S. epidermidis and 100% of S. haemolyticus strains classified as resistant to teicoplanin in ATB showed MIC values 14 mg/l. Moreover it was shown that 26.3% of these strains of S. epidermidis and 33.3% of S. haemolyticus had MBC of teicoplanin values equal to or higher than 32 mg/l.

[Genetic transfer of methycilline resistance in Staphylococus epidermidis and Staphylococcus aureus strains in mixed cultures]

In mixed cultures of staphylococci a transfer of the resistance to methicillin and penicillinase plasmids as well as tetracycline and chloramphenicol plasmids was investigated. It was shown that the resistance to methicillin was transferred in mixed cultures from one strain of S. aureus to another and from S. epidermidis to S. aureus. In both cases transfer of methicillin resistance required, the presence of penicillinase plasmid in recipient or donor strain. In the case of other markers transmission was independent. Moreover it was shown that the transfer of resistance genes in mixed cultures was mediated by bacteriophage of the serologic group A.

[Use of pulse-field electrophoresis for intraspecies differentiation of methycillin-resistant, coagulase-negative strains of Staphylococcus aureus (MRSA-CN)]

Strains showing a negative reaction in tube test for coagulase accounted 10 to 20% of all Staphylococcus aureus isolated from patients of PSK No. 1 in Warsaw. They are MRSA as well as MSSA strains. 37 coagulase-negative isolates of MRSA were examined using the method depending on digestion of whole cell DNA with SmaI enzyme and electrophoretic separation of the obtained fragments in the pulsed field (PFGE). It was shown that majority of the strains (26 from 37) had individual, unique patterns of bands. However, the two groups of strains were also observed showing a great similarity. The larger group contained 8 strains which were obtained from patients from different wards and the smaller group contained 3 strains obtained from patients from one hospital ward. The obtained results showed that among coagulase-negative MRSA strains are not only sporadic strains but also strains with probably epidemic properties, derived from different clones.

[Characteristics of penicillinase plasmids from Staphylococcus aureus strains]

Penicillinase plasmids are present in most MRSA strains. They are very varying in their genotype and phenotype they confer. Penicillinase plasmids were transduced from 80 hospital MRSA strains to NCTC 8325 and the phenotype as well as the incompatibility group of plasmid were determined. Resistance to cadmium (high and low level), resistance to organic and nonorganic mercury compounds, arsenate/arsenite/antimonium resistance, resistance to bismuth and hypersensitivity to bismuth, resistance to macrolides as well as beta-lactamase production and its inductibility were checked. Among the examined strains 20 different phenotypes of penicillinase plasmids were found. Patterns of penicillinase plasmids were compared to DNA patterns of the investigated strains after digestion with SmaI and separation in pulsed field electrophoresis (PFGE). It was shown that strains with the same PFGE pattern often differ in the type of their penicillinase plasmid. Determining of penicillinase plasmid phenotype could be useful in differentiating S. aureus strains sharing the same pattern of PFGE.

[Localization of genes conferring resistance to selected groups of antibiotics in methicillin-resistant strains of Staphylococcus aureus]

Localization of genes conferring resistance to MLS, tetracyclines, chloramphenicol, gentamycin and neomycin in 80 MRSA strains isolated from hospital specimens was determined. The obtained results were compared to DNA patterns of the examined strains after digestion with SmaI and separation in pulsed field electrophoresis (PFGE). It was shown that genes of resistance to MLS (ErmI+) in the case of 13 strains were located on chromosome and in the case of 37 strains on plasmids (16 strains had ErmI+ and 21 strains had ErmI-). Genes determining resistance to tetracyclines were localised on chromosome in the case of 39 (23 strains possessed TetK, 11 strains had TetM and 5 strains possessed both TetK and TetM determinants) and in the case of 32 strains on plasmids. Chloramphenicol resistance genes were localised on plasmids in all 30 resistant strains. Genes conferring resistance to gentamycin were present in 31 of the investigated strains on chromosome and in two strains on plasmids. Neomycin resistance genes were plasmid in 34 strains. It was shown that the localization of the resistance genes and the PFGE patterns of the investigated strains were highly correlated.

Coagulase-negative variants of methicillin-resistant Staphylococcus aureus subsp. aureus strains isolated from hospital specimens

At the Department of Clinical Bacteriology of Medical University of Warsaw, S. aureus strains displaying negative reactions in the coagulase tube-test were isolated with a relatively high frequency from clinical specimens. As many as seventeen of such strains all from different patients were isolated during 1994 among MRSA strains. Despite coagulase negativity all strains were positive in tests for clumping factor (CF), protein A and thermonuclease. Biochemical characteristics, phage patterns and antibiotic resistance characteristics of these strains were tested. Most of the coagulase-negative strains possessed a heterogenous type of methicillin resistance. Apart from methicillin most of them were resistant to many other antimicrobials. All were resistant to gentamicin, tetracyclines and macrolide-lincosamide-streptogramine B. An occurrence of coagulase-negative S. aureus strains may lead to problems in their identification and the necessity of an application of other methods like CF, protein A or biochemical reactions.

The genome of Staphylococcus aureus: a review

The genome of Staphylococcus aureus consists of a single circular chromosome (2.7-2.8 mbp) plus an assortment of extrachromosomal accessory genetic elements: conjugative and nonconjugative plasmids, mobile elements (IS, Tn, Hi), prophages and other variable elements. Plasmids (1-60 kbp) are classified into 4 classes and there are 15 known incompatibility groups. Mobile elements of the genome (0.8-18 kbp) appear in the chromosome or in plasmids of classes II and III. Prophages (45-60 kbp) are integrated in the bacterial chromosome, and they are UV- or mitomycin-inducible. Temperate bacteriophages of S. aureus are members of the Siphoviridae and the serological groups A, B and F occur most frequently. In the paper presented, the characteristics of chromosome, plasmids, transposons and other genetic elements of S. aureus genome are given and an alphabetical list of known genes of this species is included.

[Selected properties of Staphylococcus aureus strains using phenotype to show a lack of coagulase synthesis]

Eighteen of S. aureus strains isolated from clinical specimens and showing negative reaction for coagulase in conventional tube test were characterized by using five different methods: ID32 Staph, API Staph, Gpl-15, STAPH-ZYM (Rosco) and classical tube methods. The membership of all examined strains to S. aureus subsp. aureus was confirmed. None of the strains produced detectable amounts of coagulase but all of them produced protein A and clumping factor. All of them were typable with phages of the III lytic group and 11 of them possessed phage pattern characteristic of the 83A complex. All the investigated hospital strains were resistant to methicillin. Five showed homogenous and 13 heterogenous type of methicillin resistance. Moreover, all of them were resistant to tetracycline, gentamicin, tobramycin and kanamycin and to MLS group of antibiotics.

[Lysogenic conversion as a factor influencing tolerance to vancomycin in Staphylococcus aureus]

The standard, non-lysogenic, bacteriophage-free S. aureus NCTC 8325-4 strain was lysogenized with 15 different, obtained in our laboratory staphylokinase-converting bacteriophages belonging to serological groups A, B and F. MIC and MBC of vancomycin as well as the ratio of MBC to MIC were evaluated for all 15 lysogenic derivatives. The obtained results were compared with those for maternal strain. In the case of eight strains the ratio MBC/MIC showed the presence of tolerance to vancomycin (MBC/MIC > or = 32). Four of the vancomycin-tolerant derivatives were lysogenized with bacteriophages belonging to the serological group A, two were members of group B and two belonged to group F.

Epidemiology of methicillin-resistant Staphylococcus aureus in a Warsaw hospital

Methicillin-resistant Staphylococcus aureus (MRSA) isolates were collected during two eight-month periods in 1991 and 1994, respectively. In order to study the epidemiology, all 74 strains were characterized by phage-typing, antibiotic resistance patterns and DNA-restriction map after cleavage with SmaI enzyme, and pulsed-filed gel electrophoresis (PFGE). These investigations confirmed that MRSA in the hospital, 1991 and 1994, was not due to the spread of one or two clones, but by the simultaneous occurrence of a few well characterized strains and sporadic, occurring strains of different phage-types. Some of these might have developed from the more commonly occurring strains. Isolates from 1994 were more resistant to antibiotics in vitro, than the 1991 isolates. The typing results also indicated that whilst most of the MRSA strains in 1994 were different compared with those of 1991, some of the strains might have been present in both years. The PFGE-typing was more discriminatory and gave a higher typability than the phage-typing, especially among the multiply resistant isolates of MRSA from 1994. Among the less resistant strains the phage-typability was high and with only few exceptions, there was a good correlation between PFGE-type and phage-type.

[Production of staphylokinase and hemolysin by coagulase-negative staphylococcus]

The ability to staphylokinase production by the representative of the six of fifteen investigated species of staphylococci was detected: S. epidermidis, S. lentus, S. sciuri, S. lugdunensis, S. xylosus and S. hominis. The frequency of occurrence of this feature was different among the investigated species. Relatively, the least frequently this feature was observed with S. epidermis (2.3%) and S. xylosus (8.3%) strains. This property most frequently occurred among S. lentus--all the examined strains of this species produced staphylokinase. The hemolysins synthesis was shown among 13 of 15 investigated coagulase-negative species of staphylococci. The only two species of the examined representatives did not produce any hemolysin: S. hyicus and S. schleiferi. Complete correlation between staphylokinase synthesis and the absence of beta-hemolysin production was observed among strains: S. lugdunensis and S. lentus as with the lysogenic S. aureus strains with the double converting phages.

Location of the coagulase gene in Staphylococcus aureus

The localization of the coagulase gene in Staphylococcus aureus JM 750 strain was investigated. S. aureus JM 750 strain in contrast to other S. aureus strains shows instability of coagulase production. This strain contains the 23.5 kb penicillinase plasmid, determining beta-lactamase synthesis and resistance to heavy metal salts, and a larger plasmid greater than 100 kb in size, which was detectable only in coagulase positive variants. The results suggest the unparalleled, extrachromosomal localization of the coagulase gene in S. aureus JM 750 strain.