Phages for methicillin-resistant Staphylococcus aureus: an international trial

An internationally agreed and validated set of phages is used worldwide for the typing of strains of Staphylococcus aureus of human origin. However, because of the sometimes reduced susceptibility of methicillin-resistant strains (MRSA) to these phages, some of the national typing centres use locally isolated and characterized sets of experimental phages. In this trial, 42 such phages were distributed to 6 centres and tested against 744 isolates of MRSA with the intention of defining a phage set to augment the international set. The use of these experimental phages increased the percentage typability from 75% with the international set to 93% and the number of identifiable lytic patterns from 192 to 424. A subset of 10 experimental phages was selected. When this subset was compared with the experimental panel, the typability rate was 91% and 370 distinct patterns were obtained. This subset of phages has been distributed for international trial.

Slime formation as a marker of serious infection with methicillin-resistant Staphylococcus aureus

Strains of methicillin-resistant Staphylococcus aureus (MRSA) are potential pathogens in patients undergoing major surgery and in patients who are immunocompromised. Some MRSA produce a viscous extracellular slime that may interfere with immune function. In this study, slime formation by MRSA was examined in cases of nosocomial infection by this pathogen at a single hospital. The antibacterial resistance, phage and enterotoxin characteristics of strains isolated from patients with fatal infections were determined. MRSA strains were classified as those associated with fatal infection; causing progressive infection; causing superficial infection; and those isolated from the nasal cavity of the health-care professionals as a control group. The incidence of slime formation was highest in the MRSA associated with fatal infection. The incidence of slime formation in the control group was significantly lower than that in the other groups. Results suggest that slime formation by MRSA may be associated with a more severe infection. Rapid identification of slime-forming MRSA may facilitate the initiation of appropriate treatment and improve the patient's prognosis.

Molecular and phage typing of Staphylococcus aureus harbouring cryptic conjugative plasmids

The spread of antibiotic resistant-bacterial pathogens in a hospital could be due to the spread of a resistant strain or the spread of a resistance plasmid among unrelated strains. In this study the relatedness of Staphylococcus aureus isolates carrying identical cryptic conjugative plasmids was determined by a combination of resistance profiles, plasmid patterns, pulsed field gel electrophoresis of SmaI digested chromosomal DNA and phage typing. Results of the different typing techniques were in agreement to one another and demonstrated that the isolates were of three different types. The results suggested that a cryptic conjugative plasmid had spread to different S. aureus isolates in the hospital. This is an example of plasmid spread as opposed to strain spread.

Development of a phage typing system for Staphylococcus hyicus

Bacteriophages were released by 98% of 100 Staphylococcus hyicus strains studied after treatment with mitomycin C. Twenty-three phages with different lytic spectra were included in a phage typing system and used for typing S. hyicus. On a test-set of 100 epidemiologically unrelated S. hyicus strains isolated from Danish pig herds, the phages were able to type 92% of the strains, producing 16 different phage types. Reproducibility of the phage typing system after subculture of the strains and using fresh phage stock was 96%. Typability ranged from 52 to 80% when typing porcine strains originating from other countries. Although phages were isolated from porcine skin strains exclusively, the system produced phage types in S. hyicus strains of bovine origin. Ten strains of S. aureus and S. chromogens were not typable by these phages. Strains belonging to one phage type (A/B/C/W) were isolated significantly more often from piglets with exudative epidermidis than from healthy piglets. The phage typing system described appears to be a valuable tool in diagnosis of exudative epidermidis in pigs, and furthermore, might be of value in epidemiological studies of S. hyicus.

Phage pattern and antibiotic resistance pattern of coagulase-negative staphylococci obtained from immunocompromised patients

A total of 152 coagulase-negative staphylococcal strains were isolated from clinical samples of 14 patients hospitalized after bone-marrow transplantation in a specialized hospital ward in Hungary, during an 18-month period between 1987 and 1989. Two species, Staphylococcus epidermidis and Staphylococcus haemolyticus, predominated (each, 45%). Using Pulverer and co-workers' phage set for typing, 68% of the isolates were typable; 16 phage patterns were observed. A characteristic long pattern with phages Ph10/Ph13/Ph15/U4/U15/U16/U20/U33 /U46 appeared only in S. epidermidis, among 5 of 11 colonized patients (8.5% of all strains). Single lysis with phage Ph13 was observed in 7 of the 14 patients (49% of all strains), in species S. capitis, S. epidermidis, S. haemolyticus, S. hominis, and S. warneri. In S. haemolyticus, non-typable strains predominated (66%); this character occurred only in 2% among other species. The strains colonizing the immunocompromised patients differed from each other in phage pattern, antibiotic resistance pattern, and/or slime production. No hospital infection was suggested. On the other hand, high incidence of two well-definable phage patterns raises some relationship between phage receptors or some regulatory systems in phage multiplication and factors responsible for special colonization as common surface properties.

Epidemiological studies of penicillin resistance in Danish Staphylococcus aureus strains in the period 1977-1990

During the period 1977-1990 the frequency of penicillin resistance increased from 78.7 to 87.5% among a total of 278,193 Danish Staphylococcus aureus strains from hospitalized patients. By combining these data with phage-type patterns the increase was shown to be caused by 1) the introduction and spread of mainly resistant strains of type 95 and the 94,96 complex; 2) an increased occurrence of strains of group II which during the observation period became more frequently penicillin resistant; and 3) a gradual disappearance of strains of group III and the 83A complex which showed a decreasing degree of penicillin resistance. During the observation period community acquired strains reached nearly the same level of penicillin resistance as the hospital-acquired strains, and the frequency of penicillin resistance did not increase during hospitalization among the predominant strains of type 95, group II and the 94,96 complex. S. aureus isolated from airways had a higher frequency of penicillin resistance mainly caused by increasing amount of penicillin resistant strains of group II. Strains from urine had a lower frequency of penicillin resistance. The total antibiotic consumption and the usage of beta-lactam antibiotics remained nearly unchanged during the observation period. The frequent use of beta-lactam antibiotics for airway infections might explain the possible selection of penicillin resistant strains of group II.

Spread of Staphylococcus aureus strains of phage-type 95 in Denmark 1968–1989

The spread of Staphylococcus aureus strains of phage-type 95 was traced retrospectively in Denmark by the review of more than 15,000 S. aureus bacteraemia isolates (1957-88) and from data collected by phage-typing of c. 260,000 isolates from all body sites (1977-89). The first two type 95 strains had been isolated from blood in 1968, and after an interval of 3 years there was a steady increase of bacteraemia strains all over Denmark. From 1977 to 1989 the incidence of type 95 strains among isolates from all body sites increased from 3.8 to 18.8%. Different patterns of increase were recorded in 13 major hospitals and in various clinical departments of two hospitals and these were further analysed. Conjunctival swabs gave the highest percentage of type 95 strains and those from abscesses gave the lowest percentage. Of the type 95 bacteraemia strains 90.4% were resistant to penicillin, but neither methicillin nor gentamicin resistance was recorded.

[Differentiation of methicillin-resistant strains of Staphylococcus aureus by prophage specificity]

By inducing with mitomycin C the following phages were isolated from all the tested 32 methicillin resistant strains of S. aureus: the serogroup B phage was isolated from 2 strains, the serogroup B and F phages were isolated from 5 strains and the serogroup F phage was isolated from 25 strains. The phages were divided into 5 groups by the antiphage immunity. In group 1 of the phages 4 additional phages were specified. By the specificity of the prophages in the cultures all the strains were divided into 5 groups. Group 1 of the cultures was divided into 5 subgroups (A, B, C, D and E).

Bacteriophage 604: a marker phage for multi-resistant Staphylococcus aureus in Australia

Of 28 multi-resistant isolates of Staphylococcus aureus collected during 1986 from hospitals in major cities around Australia, 27 were found to contain the same prophage (denoted phage 604). Hospital isolates carrying three or fewer resistance markers, and community isolates carrying one or no resistance markers, did not carry this prophage. Phage 604 does not confer antibiotic resistance on its lysogens, nor does it increase virulence in chick embryo assays. Phage 604 appears to be a correlate of antibiotic multi-resistance in S. aureus in Australia, and may provide a molecular marker for incipiently epidemic strains of this bacterium in Australian hospitals.

[The action of phage 52A on energy processes in Staphylococcus aureus]

Phage infection leads to the dissipation of the transmembrane difference of electric potentials, measured by the adsorption of lipophilic permeant ions of tetraphenyl phosphonium, in staphylococci. Besides, the reversible stimulation of cell respiration processes is observed. The duration of these effects is comparable with the period of the injection of phage DNA, equal to 2-3 minutes.

Nontypeable bacteriophage patterns of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak

Of 93 strains of Staphylococcus aureus isolated from inpatient wards of Ismailia General Hospital, 48 (51%) were proven to be methicillin resistant (MR). Of these MR S. aureus strains, 44 were isolated from patients and 4 were isolated from healthy carriers, who were newly arrived interns working in the same wards. Bacteriophage patterns of MR S. aureus were identified by using routine test dilution (RTD) and 100-fold dilutions (100 RTD) of phages. Of these 48 strains, 37 (75%) (33 from patients and 4 from interns) were nontypeable when using RTD and 100 RTD of phages. Of the other 11 strains, 8 were nontypeable by RTD of phages, but 5 of them had the phage pattern D11/1136 when tested by 100 RTD. Three strains had the phage pattern 3A/3C/55/71, and three strains had different phage patterns, 29/81, 96, and 95/D11. The finding of colonization with virulent MR S. aureus strains in interns working on the wards in which these patients were located suggested that new strategies for control of MR S. aureus nosocomial infections must be considered and evaluated.

Staphylococcus aureus bacteriophages mediating the simultaneous lysogenic conversion of beta-lysin, staphylokinase and enterotoxin A: molecular mechanism of triple conversion

A new group of serotype F bacteriophages of Staphylococcus aureus has been found which mediates the simultaneous triple-lysogenic conversion of enterotoxin A, staphylokinase and beta-lysin. The phages were recovered fro methicillin-resistant strains of S. aureus isolated in Irish hospitals between 1971 and 1988 and from strain PS42-D, which has been used as the propagating strain for the S. aureus typing phage 42D since before 1965. The molecular mechanism of triple conversion mediated by three of these phages was determined by molecular cloning, restriction endonuclease site mapping and hybridization analysis, and compared with the mechanism of beta-lysin and staphylokinase conversion mediated by the serotype F, double-converting phase phi 13. THe genetic determinants mediating expression of enterotoxin A (entA) and staphylokinase (sak) were cloned from the DNA of the triple-converting phage and expression of the cloned determinants detected in Escherichia coli and S. aureus. The entA and sak determinants were closely linked in the phage DNA adjacent to the phage attachment site (attP) in each case and furthermore, the sak determinant of phage phi 13 was also located near its attP. The restriction maps of the entA-, sak- and attP-containing DNA regions of the three triple-converting phages were very similar to each other and to the corresponding sak- and attP- containing DNA region of phage phi 13. Hybridization analysis using a cloned beta-lysin determinant (hlb) and cloned attP-containing DNA fragments as probes demonstrated that beta-lysin conversion mediated by the triple-converting phages and phage phi 13 was caused by insertional inactivation of the chromosomally encoded hlb determinant by orientation-specific integration of phage DNA following lysogenization.

Supplementary phages for the investigation of strains of methicillin-resistant Staphylococcus aureus

Nineteen experimental phages were derived by mitomycin-C induction from methicillin-resistant strains of Staphylococcus aureus collected world-wide. They were assessed for their ability to distinguish isolates of a methicillin-resistant strain of S. aureus epidemic in the London area from other British strains, both sensitive and resistant to methicillin. The experimental phages were most active against strains of phage groups III and I + III. One phage was related to the phages of lytic group I. A typing pattern common to isolates of the epidemic strain was identified and used as an aid in the recognition of this strain. Ten of the phages were retained for further study.

Lysogenicity of methicillin-resistant strains of Staphylococcus aureus

The lysogenic status of 23 strains of methicillin-resistant Staphylococcus aureus, isolated at the Royal Prince Alfred Hospital, Sydney, since 1980, was studied. Twenty strains, belonging to the four predominant phage types isolated in this hospital, carried the same lysogenic phage which we have designated C. Three other phages were isolated from five strains belonging to phage type 84/85/90. The presence of phage C had little effect on the phage-typing pattern of the strains. Similarly, lysogenization with the other three phages did not result in a significant change in phage-typing patterns. However, when strain 1489, isolated in 1969, was lysogenized with these three phages, there was a change in phage-typing pattern. Lysogenization of this strain with phage 47T resulted in a marked loss of sensitivity to both group-I and group-III phages. The lysogenic status of these methicillin-resistant strains of S. aureus was compared with that of strains isolated between 1967 and 1970. There was no evidence that the strains isolated recently were either related to, or derived from, the earlier ones.

[New bacteriophages of Staphylococcus epidermidis: evaluation of their epidemiological value]

Coagulase-negative staphylococci, and in particular Staphylococcus epidermidis, are now being recognized as causing human infections with increasing frequency; the absence of an internationally accepted system of phage-typing for coagulase-negative staphylococci led us to isolate new phages. Fifty strains of S. epidermidis isolated from human infections were induced with mitomycin C: eight phages (41, 63, 118-II, 138, 245, 336, 392 and 550) were isolated. These phages were propagated on five different strains of S. epidermidis. Their phages were propagated on five different strains of S. epidermidis. Their lytic activity as studied on 561 strains. Phages 336, 392 and 550 had a different host-range and different propagative strains; they typed 93% of the strains susceptible to the 8 phages. The other phages had an activity similar to that of phage 336. Twenty-one per cent of non-epidemic strains were susceptible to at least one of the three phages. The reproducibility, specificity and discriminatory power of these phages suggest they may be a useful addition to previously recognized phages.

A hospital-wide outbreak of septicemia due to a few strains of Staphylococcus aureus

During a 6-month period at Walter Reed Army Hospital the monthly attack rate of Staphylococcus aureus bacteremia increased to 3.8 +/- 0.5 (mean +/- SEM) from 2.5 +/- 0.2 cases per 1,000 dispositions for the previous 48 months (P less than 0.05). A predominant phage pattern, designated S, was found in 12 (39%) of 31 bacteremic isolates typed and another strain, delta, was associated with four catheter-related infections. Two other strains also accounted for infections. Patients with isolates of the S phage pattern had a higher mortality (59%) than patients with non-S isolates (37%). Thirty-eight per cent of S. aureus carriers among hospital personnel harbored S or delta strains. Limitation of intravascular devices, strict handwashing, and the use of gloves were associated with a significant decrease in the incidence of S. aureus bacteremia to 1.9 +/- 0.5/1,000 dispositions over the next 6 months (P less than 0.05). S and delta strains were reduced to 20% of these isolates despite their persistence in 32% of staphylococcal carriers upon reculture of personnel. We conclude that S. aureus persists as an important pathogen in the hospitals, and that phage typing S. aureus isolates remains an important tool in hospital epidemiology. The presence of multiple S. aureus strains causing this outbreak and the extent of their dissemination among patients and personnel reported here emphasizes the need to reevaluate strategies of nosocomial staphylococcal control.

Toxic shock syndrome and lysogeny in Staphylococcus aureus

Lysogeny, or the presence of temperate bacteriophage, was demonstrated, by means of two Staphylococcus aureus indicator strains, in 11 of 12 strains of S. aureus isolated from patients with toxic shock syndrome. Only 1 of 18 strains of S. aureus that were not associated with toxic shock syndrome showed the presence of bacteriophage. A laboratory strain of S. aureus was lysogenized by bacteriophage from two of the toxic shock-associated strains. These results add support to the theory that lysogeny by one or more bacteriophage in certain strains of S. aureus may be responsible for the pathogenesis of toxic shock syndrome.

Quantitation of pathogenic potential of Staphylococcus aureus

Numerical estimates of the pathogenicity of Staphylococcus aureus strains were made for phage-typed strains from a relative incidence of significant to nonsignificant isolates from hospital patients. For a specific phage-patterned strain, the number of isolates from significant (wounds, abscesses, blood, etc.) sites was divided by the number of isolates from nonsignificant (respiratory tract, body surfaces, etc.) sites. This value, multiplied by 100, was the index of infection potential (IIP). IIP values for the S. aureus strains studied ranged from a low of 8 to a high of 50. The average IIP for all phage-patterned strains that occurred 50 or more times was 20. There was an inverse relationship between length of the phage pattern (number of the 26 typing phages that lysed the strain) and pathogenicity. Those strains with shorter phage patterns had higher IIP values and were more pathogenic. Strains lysed by one phage had an average IIP of 27, whereas those lysed by 18 phages had an average IIP of 14.

Isolation of bacteriophages for typing staphylococcus intermedius isolated from pigeons

Attempts to isolate phages for typing Staphylococcus intermedius isolated from pigeons were made. Five phages were isolated from the lysogenic strains and the nostrils of pigeons, and were used for typing 50 strains isolated from pigeons in Japan, Belgium and Czechoslovakia. Thirty-one (62.0%) of the 50 strains were typed at either routine test dilution (RTD) or 100 X RTD into 8 phage patterns. A total of 122 strains of S. intermedius isolated from dogs, horses, mink and foxes were subjected to phage typing with pigeon phages, with the result that 10 (8.2%) of the 122 strains were typable. S. aureus and S. epidermidis, 59 and 58 strains, respectively, were resistant to lysis due to the pigeon phages. The experimental phages were considerably specific for S. intermedius isolated from pigeons.