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Stenhem M, Ortqvist A, Ringberg H, Larsson L, Olsson Liljequist B, Haeggman S, Kalin M, Ekdahl K. Imported methicillin-resistant Staphylococcus aureus, Sweden. Emerg Infect Dis 2010; 16:189-96. [PMID: 20113546 PMCID: PMC2957988 DOI: 10.3201/eid1602.081655] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Knowledge of different risks for infection will improve control measures. Countries such as Sweden that have a low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) offer the opportunity to discern and study transmission of imported cases of MRSA. We analyzed 444 imported cases of MRSA acquisition reported in Sweden during 2000–2003. Risk for MRSA in returning travelers ranged from 0.1 (95% confidence interval [CI] 0.01–0.4) per 1 million travelers to Nordic countries to 59.4 (95% CI 44.5–79.3) per 1 million travelers to North Africa and the Middle East. Most imported cases (246, 55%) were healthcare acquired, but regions with the highest risk for MRSA in travelers showed a correlation with community acquisition (r = 0.81, p = 0.001). Characteristic differences in MRSA strains acquired were dependent on the region from which they originated and whether they were community or healthcare acquired. Knowledge of differences in transmission of MRSA may improve control measures against imported cases.
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Affiliation(s)
- Mikael Stenhem
- Swedish Institute for Infectious Disease Control, Solna, Sweden
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202
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Genetic variation in Staphylococcus aureus surface and immune evasion genes is lineage associated: implications for vaccine design and host-pathogen interactions. BMC Microbiol 2010; 10:173. [PMID: 20550675 PMCID: PMC2905362 DOI: 10.1186/1471-2180-10-173] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 06/15/2010] [Indexed: 01/22/2023] Open
Abstract
Background S. aureus is a coloniser and pathogen of humans and mammals. Whole genome sequences of 58 strains of S. aureus in the public domain and data from multi-strain microarrays were compared to assess variation in the sequence of proteins known or putatively interacting with host. Results These included 24 surface proteins implicated in adhesion (ClfA, ClfB, Cna, Eap, Ebh, EbpS, FnBPA, FnBPB, IsaB, IsdA, IsdB, IsdH, SasB, SasC, SasD, SasF, SasG, SasH, SasK, SdrC, SdrD, SdrE, Spa and SraP) and 13 secreted proteins implicated in immune response evasion (Coa, Ecb, Efb, Emp, EsaC, EsxA, EssC, FLIPr, FLIPr like, Sbi, SCIN-B, SCIN-C, VWbp) located on the stable core genome. Many surface protein genes were missing or truncated, unlike immune evasion genes, and several distinct variants were identified. Domain variants were lineage specific. Unrelated lineages often possess the same sequence variant domains proving that horizontal transfer and recombination has contributed to their evolution. Surprisingly, sequenced strains from four animal S. aureus strains had surface and immune evasion proteins remarkably similar to those found in human strains, yet putative targets of these proteins vary substantially between different hosts. This suggests these proteins are not essential for virulence. However, the most variant protein domains were the putative functional regions and there is biological evidence that variants can be functional, arguing they do play a role. Conclusion Surface and immune evasion genes are candidates for S. aureus vaccines, and their distribution and functionality is key. Vaccines should contain cocktails of antigens representing all variants or they will not protect against naturally occurring S. aureus populations.
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203
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Molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus strains for clinical medicine. Arch Microbiol 2010; 192:603-17. [PMID: 20544179 DOI: 10.1007/s00203-010-0594-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 03/29/2010] [Accepted: 05/28/2010] [Indexed: 10/19/2022]
Abstract
Infections caused by methicillin-resistant S. aureus strains are mainly associated with a hospital setting. However, nowadays, the MRSA infections of non-hospitalized patients are observed more frequently. In order to distinguish them from hospital-associated methicillin-resistant S. aureus (HA-MRSA) strains, given them the name of community-associated methicillin-resistant S. aureus (CA-MRSA). CA-MRSA strains most commonly cause skin infections, but may lead to more severe diseases, and consequently the patient's death. The molecular markers of CA-MRSA strains are the presence of accessory gene regulator (agr) of group I or III, staphylococcal cassette chromosome mec (SCCmec) type IV, V or VII and genes encoding for Panton-Valentine leukocidin (PVL). In addition, CA-MRSA strains show resistance to beta-lactam antibiotics. Studies on the genetic elements of CA-MRSA strains have a key role in the unambiguous identification of strains, monitoring of infections, improving the treatment, work on new antimicrobial agents and understanding the evolution of these pathogens.
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204
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Baranovich T, Zaraket H, Shabana I, Nevzorova V, Turcutyuicov V, Suzuki H. Molecular characterization and susceptibility of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates from hospitals and the community in Vladivostok, Russia. Clin Microbiol Infect 2010; 16:575-82. [DOI: 10.1111/j.1469-0691.2009.02891.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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205
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Yao D, Yu FY, Qin ZQ, Chen C, He SS, Chen ZQ, Zhang XQ, Wang LX. Molecular characterization of Staphylococcus aureus isolates causing skin and soft tissue infections (SSTIs). BMC Infect Dis 2010; 10:133. [PMID: 20500885 PMCID: PMC2889999 DOI: 10.1186/1471-2334-10-133] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 05/26/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA), is an important cause of pyogenic skin and soft tissue infections (SSTIs). The aim of present study is to investigate the molecular characteristic of Staphylococcus aureus isolates isolated from the pus samples from the patients with purulent skin and soft tissue infections in Wenzhou, China. METHODS Between December 2002 and June 2008, a total of 111 nonduplicate S. aureus isolates were collected from the pus samples of the patients with SSTIs in a teaching hospital in Wenzhou, China. All the tested isolates were confirmed as S. aureus using a Staph SPA agglutination kit, Gram's stain and a Vitek-60 microbiology analyzer. The homology among the tested isolates was determined by pulsed-field gel electrophoresis (PFGE). Multilocus sequence typing (MLST) was used to determine the sequence types (STs) of the selected isolates. The genotypes of SCCmec were determined by a multiplex PCR in the MRSA isolates. Panton-Valentine leukocidin (PVL) genes and mecA were also determined by another multiplex PCR. RESULTS Among the 111 S. aureus isolates, 48 and 63 isolates were community-acquired and hospital-acquired respectively. Sixty isolates were confirmed as MRSA harboring mecA detected by PCR. A total of 32 PFGE clonal types were obtained by PFGE, with 10 predominant patterns (types A to J). Twenty-five different STs including ST398 and three novel STs were found among 51 selected isolates. The main STs were ST239, ST1018, ST59, ST7 and ST88. Of 60 MRSA isolates, SCCmec II, III, IV and SCCmec V were found in three, 50, three and two isolates, respectively. The positive rates of PVL genes in overall isolates, HA-isolates, CA-isolates, MRSA isolates and MSSA isolates were 23.4% (26/111), 20.6% (13/63), 27.1% (13/48), 21.7% (13/60) and 25.5% (13/51), respectively. Eight (33.3%, 8/24) of 24 CA-MRSA isolates and 5 (13.9%, 5/36) of 36 HA-MRSA isolates were positive for PVL genes. ST239-MRSA-SCCmecIII and ST1018-MRSA-SCCmecIII clones were found to be main clones and spread between community and hospital. CONCLUSION S. aureus isolates causing SSTIs showed considerable molecular heterogeneity and harbored high prevalence of PVL genes. Clonal spread was responsible for the dissemination of the isolates of S. aureus associated with SSTIs.
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Affiliation(s)
- Dan Yao
- Department of Respiratory Medicine, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou325000, China
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206
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Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide, and causes substantial morbidity and mortality. Health-care-associated MRSA infections arise in individuals with predisposing risk factors, such as surgery or presence of an indwelling medical device. By contrast, many community-associated MRSA (CA-MRSA) infections arise in otherwise healthy individuals who do not have such risk factors. Additionally, CA-MRSA infections are epidemic in some countries. These features suggest that CA-MRSA strains are more virulent and transmissible than are traditional hospital-associated MRSA strains. The restricted treatment options for CA-MRSA infections compound the effect of enhanced virulence and transmission. Although progress has been made towards understanding emergence of CA-MRSA, virulence, and treatment of infections, our knowledge remains incomplete. Here we review the most up-to-date knowledge and provide a perspective for the future prophylaxis or new treatments for CA-MRSA infections.
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Affiliation(s)
- Frank R DeLeo
- Laboratory of Human Bacterial Pathogenesis, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
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207
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Vandenesch F, Lina G, Gillet Y, Etienne J, Crémieux AC. [The end of the controversy: Panton Valentine is the culprit]. Med Sci (Paris) 2010; 25:984-6. [PMID: 19951679 DOI: 10.1051/medsci/20092511984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- François Vandenesch
- Centre national de référence des staphylocoques ; université Lyon 1 ; Inserm U851, IFR 128, 7, rue Guillaume Paradin, 69372 Lyon Cedex 08, France.
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208
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Casalegno JS, Escuret V, Celard M, Bouscambert M, Frobert E, Mekki Y, Lina G, Lina B. [Necrotizing community-acquired pneumonia secondary to influenza a (H1N1) super-infected by an invasive group A streptococcus]. Med Mal Infect 2010; 40:710-2. [PMID: 20400251 DOI: 10.1016/j.medmal.2010.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/11/2009] [Accepted: 02/12/2010] [Indexed: 11/28/2022]
Affiliation(s)
- J-S Casalegno
- HCL, Laboratoire de Virologie, Centre de Biologie et Pathologie Est, 59 Boulevard Pinel, 69677 Bron, France.
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209
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Otter JA, French GL. Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Europe. THE LANCET. INFECTIOUS DISEASES 2010; 10:227-39. [DOI: 10.1016/s1473-3099(10)70053-0] [Citation(s) in RCA: 231] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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210
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Antri K, Rouzic N, Boubekri I, Dauwalder O, Beloufa A, Ziane H, Djennane F, Neggazi M, Benhabyles B, Bes M, Tazir M, Étienne J, Ramdani-Bouguessa N. Forte prévalence des infections communautaires et nosocomiales à Staphylococus aureus résistant à la méticilline et portant le gène de la leucocidine de Panton-Valentine dans l’Algérois. ACTA ACUST UNITED AC 2010; 58:e15-20. [DOI: 10.1016/j.patbio.2009.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/12/2009] [Indexed: 12/16/2022]
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211
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Geng W, Yang Y, Wu D, Zhang W, Wang C, Shang Y, Zheng Y, Deng L, Fu Z, Li X, Yu S, Shen X. Community-acquired, methicillin-resistant Staphylococcus aureus isolated from children with community-onset pneumonia in China. Pediatr Pulmonol 2010; 45:387-94. [PMID: 20232474 DOI: 10.1002/ppul.21202] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) has been associated with morbidity and mortality in various countries. In this study, we characterized the molecular and clinical features of pediatric CA-MRSA pneumonia in China. Between June 2006 and February 2008, 55 previously healthy children confined in eight hospitals countrywide were found to be afflicted with CA-MRSA pneumonia. A total of 55 strains collected from these children were analyzed by multilocus sequence typing (MLST), Staphylococcus cassette chromosome mec (SCCmec) typing, and spa typing. The Panton-Valentine leukocidin (PVL) gene was also detected. Overall, nine STs were obtained, with ST59 (40.4%) established to be the most prevalent type. We first registered the new ST1409 from a child with necrotizing pneumonia. SCCmecIVa was the most predominant type, followed by SCCmec type V. Twelve spa types were identified, of which one new spa type, t5348, was first detected and registered. One typical livestock-associated spa type, t034, was found in a 4-month-old girl living in the countryside. We also found that 40% of those isolates were PVL-positive. In addition, the median age of the children in this study was 10 months. A total of 69% (38/55) of the children with community-acquired pneumonia (CAP) had preceding influenza or influenza-like illness, and three ST910-MRSA-IV strains (PVL gene-positive) were associated with severe necrosis. The results indicated that the recent CA-MRSA found in Chinese children with CAP was largely associated with the spread of the ST59-MRSA-IV clone, and most of the PVL-positive strains in this study did not cause necrotic cases.
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Affiliation(s)
- Wenjing Geng
- Beijing Children's Hospital Affiliated with Capital Medical University, Beijing, China
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212
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Toxin profiling of Staphylococcus aureus strains involved in varicella superinfection. J Clin Microbiol 2010; 48:1696-700. [PMID: 20305014 DOI: 10.1128/jcm.02018-09] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The most common complications of varicella are bacterial skin and soft tissue infections, generally due to Staphylococcus aureus and group A beta-hemolytic streptococci. The aim of this study was to characterize the toxin and antibiotic resistance profiles of S. aureus isolates involved in varicella complications. Between 2002 and 2007, the French Reference Centre for Staphylococci collected 58 S. aureus isolates involved in varicella superinfection. All the isolates were characterized by screening for 12 toxin genes, agr typing, and mecA gene detection; some isolates were also studied by spa typing, multilocus sequence typing (MLST), and resistance profiling. A major toxin gene was detected in 53% (31/58) of the isolates (genes for exfoliative toxins A and B, 17.2%; Panton-Valentine leukocidin gene, 8.6%; toxic shock syndrome toxin 1 gene, 27.6%). Most clinical manifestations were directly compatible with the classical activity of these toxins. Nineteen isolates (33%) were resistant to methicillin, and 12 of these isolates belonged to an emerging agr-2, ST5 clone that harbors the toxic shock syndrome toxin 1 gene. These data should be considered in the management and treatment of patients with varicella complicated by S. aureus superinfection. Antibiotics that decrease toxin production, such as clindamycin, may provide benefit, and their efficacy against bacterial superinfections in children with varicella should be studied.
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213
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Daskalaki M, Rojo P, Marin-Ferrer M, Barrios M, Otero JR, Chaves F. Panton-Valentine leukocidin-positive Staphylococcus aureus skin and soft tissue infections among children in an emergency department in Madrid, Spain. Clin Microbiol Infect 2010; 16:74-7. [PMID: 19519839 DOI: 10.1111/j.1469-0691.2009.02830.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fifty-three children who attended the emergency department with community-associated (CA) Staphylococcus aureus skin and soft tissue infections (SSTIs) were enrolled in the study. Seven cases of infection (13.2%) were due to methicillin-resistant S. aureus (MRSA). Twelve of 46 available isolates (26.1%) were Panton-Valentine leukocidin (PVL)-positive. PVL-positive S. aureus SSTIs were more frequently associated with abscesses and cellulitis (75% vs. 38%, p 0.028), and more commonly required incision and drainage (75% vs. 21%, p 0.001). Most PVL-positive CA-MRSA isolates belonged to a single multilocus sequence type (ST8). In contrast, PVL-positive methicillin-susceptible S. aureus isolates belonged to four different sequence types (ST8, ST30, ST80, ST120).
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Affiliation(s)
- M Daskalaki
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Avenida de Cordoba sn, Madrid, Spain
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214
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Falagas ME, Roussos N, Gkegkes ID, Rafailidis PI, Karageorgopoulos DE. Fosfomycin for the treatment of infections caused by Gram-positive cocci with advanced antimicrobial drug resistance: a review of microbiological, animal and clinical studies. Expert Opin Investig Drugs 2010; 18:921-44. [PMID: 19548851 DOI: 10.1517/13543780902967624] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The advancing antimicrobial drug resistance in Gram-positive cocci complicates the selection of appropriate therapy. The re-evaluation of older antibiotics may prove useful in expanding relevant therapeutic options. OBJECTIVE We sought to evaluate fosfomycin for the treatment of infections caused by methicillin-resistant staphylococci, vancomycin-resistant enterococci, and penicillin-non-susceptible pneumococci. METHODS We searched in PubMed, Scopus, and the Cochrane Library for studies evaluating the antimicrobial activity of fosfomycin against the above-mentioned pathogens, or the in vivo or clinical effectiveness of fosfomycin for the treatment of infections caused by these pathogens. RESULTS/CONCLUSIONS As reported in the identified studies, the susceptibility rate of methicillin-resistant Staphylococcus aureus to fosfomycin was > or = 90% in 12/22, and 50-90% in 7/22 studies; the cumulative susceptibility rate was 87.9% (4240/4892 isolates). The cumulative susceptibility rate of vancomycin-resistant enterococci to fosfomycin was 30.3% (183/604 isolates), and that of penicillin-non-susceptible pneumococci was 87.2% (191/219 isolates). Clinical data show that fosfomycin, primarily in combination regimens, has been associated with clinical success in 28/29 (96.6%) cases of infection (mainly pneumonia, bacteremia, and meningitis) by fosfomycin-susceptible isolates of methicillin-resistant S. aureus. The above data support further research on the role of fosfomycin against infections caused by Gram-positive cocci with advanced antimicrobial drug resistance.
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Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 15123 Marousi, Athens, Greece.
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215
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Del Giudice P, Hubiche P. Community-associated methicillin-resistant Staphylococcus aureus
and impetigo. Br J Dermatol 2010; 162:905; author reply 905-6. [DOI: 10.1111/j.1365-2133.2010.09655.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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216
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Rapid detection of Staphylococcus aureus Panton-Valentine leukocidin in clinical specimens by enzyme-linked immunosorbent assay and immunochromatographic tests. J Clin Microbiol 2010; 48:1384-90. [PMID: 20129971 DOI: 10.1128/jcm.02274-09] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus strains producing Panton-Valentine leukocidin (PVL) have been epidemiologically linked to specific human infections. To evaluate immunological tests that may be used to diagnose infections with PVL-producing strains, we prospectively collected pus, respiratory tract specimens, and joint fluid specimens from which S. aureus had been isolated in clinical laboratories in six countries. An enzyme-linked immunosorbent assay (ELISA) and an immunochromatographic test (ICT) targeting LukS-PV were performed directly with clinical samples for the detection of PVL. The same tests were applied to S. aureus culture supernatants. The corresponding S. aureus isolates were characterized by PCR for the presence of the PVL locus (lukS-PV and lukF-PV) and the mecA gene. A total of 185 samples from 144 skin infections, 23 bone and joint infections, and 18 lower respiratory tract infections were analyzed. By PCR, 72/185 S. aureus isolates were PVL locus positive (PVL(+)); 28 of these were also mecA positive. PVL was detected in the supernatants of all PVL(+) strains by both ELISA and an ICT, while no signal was observed with PVL-negative strains. The PVL concentrations in human clinical samples that grew PVL(+) strains ranged from 0 to 399 microg/ml by ELISA. By the use of 0.015 microg/ml of PVL as a cutoff value, PVL was detected in 65/72 (90%) of the clinical samples by ELISA. The sensitivity and specificity of the ELISA test were 90% and 100%, respectively. By the ICT, PVL was detected in 57/72 (79%) of the samples, and the sensitivity and specificity of ICT were 79% and 100%, respectively. PVL is expressed by S. aureus during human infection, and a PVL-specific ELISA and ICT could be reliable tests for the diagnosis of infections caused by PVL-producing strains.
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217
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Abstract
Until recently, reports on methicillin-resistant Staphylococcus aureus (MRSA) in food production animals were mainly limited to occasional detections in dairy cattle mastitis. However, since 2005 a MRSA clone, CC398, has been reported colonizing pigs, veal calves and broiler chickens and infecting dairy cows. Many aspects of its prevalence in pigs remain unclear. In other livestock, colonizing capacity and reservoir status still require elucidation. MRSA CC398 has also been detected in meat, but, as for other MRSA, the risk this poses is somewhat unclear. Currently, the most worrying aspect of MRSA CC398 appears to be its capacity to spread to humans. This might complicate MRSA control measures in human healthcare, urging research into risk factors and transmission routes. Although infections with MRSA CC398 are much less reported than carriage, more investigation into its pathogenic potential is required. Moreover, the origin and evolution of this clone remain unknown.
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218
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Ouchenane Z, Smati F, Rolain JM, Raoult D. Molecular characterization of methicillin-resistant Staphylococcus aureus isolates in Algeria. ACTA ACUST UNITED AC 2010; 59:e129-32. [DOI: 10.1016/j.patbio.2009.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 11/17/2009] [Indexed: 11/25/2022]
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219
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No evidence of colonization with community-acquired methicillin-resistant Staphylococcus aureus in HIV-1-infected men who have sex with men. Epidemiol Infect 2010; 138:738-42. [PMID: 20109264 DOI: 10.1017/s0950268810000130] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To assess the prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization in HIV-1-infected men who have sex with men (MSM), a cross-sectional study was conducted on 104 persons attending a large STI/HIV unit in Rome, Italy in the period June 2007-June 2008. Swabs obtained from both anterior nares and S. aureus isolates were characterized by phenotypic and genotypic methods. A total of 24 individuals (23.1%) were colonized with S. aureus but none carried MRSA. No statistically significant association between colonization with S. aureus and behavioural, clinical, virological or immunological characteristics was identified. This study indicates a lack of circulation of CA-MRSA in HIV-1-infected MSM in Italy and underscores large epidemiological differences between the USA and a European country, so that only locally conducted epidemiological studies can provide insight into the local circulation of CA-MRSA in general and selected populations.
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220
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Predominance and emergence of clones of hospital-acquired methicillin-resistant Staphylococcus aureus in Malaysia. J Clin Microbiol 2010; 48:867-72. [PMID: 20089756 DOI: 10.1128/jcm.01112-09] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We define the epidemiology of predominant and sporadic methicillin-resistant Staphylococcus aureus (MRSA) strains in a central teaching and referral hospital in Kuala Lumpur, Malaysia. This is done on the basis of spa sequencing, multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec) typing, and virulence gene profiling. During the period of study, the MRSA prevalence was 44.1%, and 389 MRSA strains were included. The prevalence of MRSA was found to be significantly higher in the patients of Indian ethnicity (P < 0.001). The majority (92.5%) of the isolates belonged to ST-239, spa type t037, and possessed the type III or IIIA SCCmec. The arginine catabolic mobile element (ACME) arcA gene was detected in three (1.05%) ST-239 isolates. We report the first identification of ACME arcA gene-positive ST-239. Apart from this predominant clone, six (1.5%) isolates of ST-22, with two related spa types (t032 and t4184) and a singleton (t3213), carrying type IVh SCCmec, were detected for the first time in Asia. A limited number of community-acquired (CA) MRSA strains were also detected. These included ST-188/t189 (2.1%), ST-1/t127 (2.3%), and ST-7/t091 (1%). Panton-Valentin leukocidin (PVL) was detected in all ST-1 and ST-188 strains and in 0.7% of the ST-239 isolates. The majority of the isolates carried agr I, except that ST-1 strains were agr III positive. Virulence genes seg and sei were seen only among ST-22 isolates. In conclusion, current results revealed the predominance of ST-239-SCCmec III/IIIA and the penetration of ST-22 with different virulence gene profiles. The emergence in Malaysia of novel clones of known epidemic and pathogenic potential should be taken seriously.
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221
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D'Agata EMC, Webb GF, Pressley J. Rapid Emergence of Co-colonization with Community-acquired and Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Strains in the Hospital Setting. MATHEMATICAL MODELLING OF NATURAL PHENOMENA 2010; 5:76-73. [PMID: 20740067 PMCID: PMC2927146 DOI: 10.1051/mmnp/20105306] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CA- MRSA), a novel strain of MRSA, has recently emerged and rapidly spread in the community. Invasion into the hospital setting with replacement of the hospital-acquired MRSA (HA-MRSA) has also been documented. Co-colonization with both CA-MRSA and HA-MRSA would have important clinical implications given differences in antimicrobial susceptibility profiles and the potential for exchange of genetic information. METHODS: A deterministic mathematical model was developed to characterize the transmission dynamics of HA-MRSA and CA-MRSA in the hospital setting and to quantify the emergence of co-colonization with both strains RESULTS: The model analysis shows that the state of co-colonization becomes endemic over time and that typically there is no competitive exclusion of either strain. Increasing the length of stay or rate of hospital entry among patients colonized with CA-MRSA leads to a rapid increase in the co-colonized state. Compared to MRSA decolonization strategy, improving hand hygiene compliance has the greatest impact on decreasing the prevalence of HA-MRSA, CA-MRSA and the co-colonized state. CONCLUSIONS: The model predicts that with the expanding community reservoir of CA-MRSA, the majority of hospitalized patients will become colonized with both CA-MRSA and HA-MRSA.
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Affiliation(s)
- E. M. C. D'Agata
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - G. F. Webb
- Department of Mathematics, Vanderbilt University, Nashville, TN 37240, USA
| | - J. Pressley
- Department of Mathematics, Vanderbilt University, Nashville, TN 37240, USA
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Deurenberg R, Beisser P, Visschers M, Driessen C, Stobberingh E. Molecular typing of methicillin-susceptible Staphylococcus aureus isolates collected in the Yogyakarta area in Indonesia, 2006. Clin Microbiol Infect 2010; 16:92-4. [DOI: 10.1111/j.1469-0691.2009.02799.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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223
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Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been recognized for over a decade, and usually refers to MRSA identified in previously healthy individuals with no recognized MRSA risk factors. Infections range from minor skin and soft tissue infections, through to severe pneumonia and necrotizing fasciitis. This review summarizes the current data on the epidemiology and molecular features of CA-MRSA, in addition to diagnosis and therapeutic measures. We also refer to current national guidelines for the management of these infections. Areas of agreement include the important genotypic and phenotypic differences of community MRSA strains compared with hospital strains. Areas of controversy include the precise epidemiological definition of community-acquired/associated MRSA. Fortunately, true CA-MRSA can be differentiated from hospital MRSA by molecular techniques, as discussed herein. Recent interest has focused on the changing epidemiology of CA-MRSA. Worldwide, CA-MRSA is now seen outside of the initial specific population groups, and in the USA, the successful USA300 community strain is beginning to spread back into hospitals. Reasons why USA300 remains relatively uncommon in Europe are unclear. Topics timely for research include the investigation of the epidemiology of infections and evolutionary genomics.
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Affiliation(s)
- Fiona J Cooke
- Clinical Microbiology and Public Health Laboratory, Health Protection Agency, Addenbrooke's Hospital, Cambridge CB2 0QW, UK
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224
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Huang V, Cheung CM, Kaatz GW, Rybak MJ. Evaluation of dalbavancin, tigecycline, minocycline, tetracycline, teicoplanin and vancomycin against community-associated and multidrug-resistant hospital-associated meticillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2010; 35:25-9. [DOI: 10.1016/j.ijantimicag.2009.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 08/19/2009] [Accepted: 08/20/2009] [Indexed: 11/29/2022]
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Webb GF, Horn MA, D’Agata EMC, Moellering RC, Ruan S. Competition of hospital-acquired and community-acquired methicillin-resistant Staphylococcus aureus strains in hospitals. JOURNAL OF BIOLOGICAL DYNAMICS 2010; 4:115-129. [PMID: 19587839 PMCID: PMC2706519 DOI: 10.1080/17513750903026411] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Recently, we [E.M.C. D’Agata, G.F. Webb, M.A. Horn, R.C. Moellering Jr., and S. Ruan, Modellingthe invasion of community-acquired methicillin-resistant Staphylococcus aureus into the hospital setting, Clin. Infect. Dis. 48 (2009), pp. 274–284] proposed a deterministic mathematical model to characterize the factors contributing to the replacement of hospital-acquired methicillin-resistant Staphylococcus aureus(HA-MRSA) with the community-acquired MRSA (CA-MRSA) and to quantify the effectiveness of interventionsaimed at limiting the spread of CA-MRSA in the hospital setting. Numerical simulations of the model strongly suggest that CA-MRSA will become the dominant MRSA strain in the hospital setting. In this companion paper, we provide steady-state analysis and more numerical simulations of the model. It is shown that when no colonized or infected patients enter the hospital, competitive exclusion of HA-MRSA by CA-MRSA will occur with increased severity of CA-MRSA infections resulting in longer hospitalizations and a larger in-hospital reservoir of CA-MRSA. Improving compliance with hand hygiene and decolonization of CA-MRSA carriers are effective control strategies.
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Affiliation(s)
- Glenn F. Webb
- Department of Mathematics, Vanderbilt University, Nashville, TN 37240, USA
| | - Mary Ann Horn
- Department of Mathematics, Vanderbilt University, Nashville, TN 37240, USA
- Division of Mathematical Sciences, National Science Foundation, Arlington, VA 22230, USA
| | - Erika M. C. D’Agata
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Robert C. Moellering
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shigui Ruan
- Department of Mathematics, University of Miami, Coral Gables, FL 33124-4250, USA
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Carvalho KS, Mamizuka EM, Gontijo Filho PP. Methicillin/Oxacillin-resistant Staphylococcus aureus as a hospital and public health threat in Brazil. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70014-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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228
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Cuny C, Friedrich A, Kozytska S, Layer F, Nübel U, Ohlsen K, Strommenger B, Walther B, Wieler L, Witte W. Emergence of methicillin-resistant Staphylococcus aureus (MRSA) in different animal species. Int J Med Microbiol 2009; 300:109-17. [PMID: 20005777 DOI: 10.1016/j.ijmm.2009.11.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The emergence of methicillin-resistant Staphylococcus aureus (MRSA) in animals such as horses, pet animals and productive livestock has raised questions of a probable human origin and in more general of host specificity of S. aureus. Particular clonal lineages are obviously specific for humans (e.g. ST15, ST25, ST45) and other for ruminants (e.g. ST151). MRSA associated with veterinary nosocomial infections (e.g. ST8 and ST254 in horses, ST22 in small animals) very likely have their origin in health care facilities. MRSA ST398 which became first known from widespread colonization in industrially raised pigs seems to have a limited host specificity and is able to colonize and to cause infections in various hosts. Mechanisms of host adaptation and their genomic background are poorly understood so far.
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Affiliation(s)
- Christiane Cuny
- Robert Koch Institute, Wernigerode Branch, Burgstrasse 37, 38855 Wernigerode, Germany
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229
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Segreti J. Empirical therapy for serious Gram-positive infections: making the right choice. Clin Microbiol Infect 2009; 15 Suppl 6:5-10. [DOI: 10.1111/j.1469-0691.2009.03061.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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230
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Familial furunculosis associated with community-acquired leukocidin-positive methicillin-susceptible Staphylococcus aureus ST152. J Clin Microbiol 2009; 48:329-32. [PMID: 19906900 DOI: 10.1128/jcm.00622-09] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Panton-Valentine leukocidin (PVL) is associated with staphylococcal skin and pulmonary infections. Community dissemination of PVL-producing Staphylococcus aureus strains constitutes a public health concern. Family transmission and spread of community-acquired leukocidin-positive methicillin-susceptible S. aureus ST152 isolates associated with severe clinical symptoms are herein described. Remarkably, ST152 isolates usually are methicillin resistant.
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231
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Lepelletier D, Andremont A, Choutet P. [Emerging multidrug-resistant microorganisms among travelers returning to France and persons repatriated from foreign hospitals]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2009; 193:1821-1833. [PMID: 20669547 PMCID: PMC7111033 DOI: 10.1016/s0001-4079(19)32416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Indexed: 05/29/2023]
Abstract
The spread of multidrug-resistant bacteria has become a major problem in France in recent years, owing to increasing antibiotic exposure, growing international exchanges, repatriation of hospitalized French patients, and treatment of French and foreign travelers in French hospitals. This article examines how different pathogens may become endemic in France.
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Affiliation(s)
- Jodi A. Lindsay
- Centre for Infection, Cellular and Molecular Medicine, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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233
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Lepelletier D, Andremont A, Choutet P. [Emerging multidrug-resistant microorganisms among travelers returning to France and persons repatriated from foreign hospitals]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2009; 193:1821-1832; discussion 1832-3. [PMID: 20669547 PMCID: PMC7111033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Indexed: 03/30/2024]
Abstract
The spread of multidrug-resistant bacteria has become a major problem in France in recent years, owing to increasing antibiotic exposure, growing international exchanges, repatriation of hospitalized French patients, and treatment of French and foreign travelers in French hospitals. This article examines how different pathogens may become endemic in France.
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234
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A histidine-to-arginine substitution in Panton-Valentine leukocidin from USA300 community-acquired methicillin-resistant Staphylococcus aureus does not impair its leukotoxicity. Infect Immun 2009; 78:260-4. [PMID: 19822649 DOI: 10.1128/iai.00843-09] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Panton-Valentine leukocidin (PVL) is a synergohymenotropic toxin (SHT) produced by Staphylococcus aureus. At present, there are conflicting reports on the leukotoxic activity of PVL and its consequent role as a virulence factor in USA300. In this work, we compared the cytolytic effects induced by wild-type PVL and those of PVL harboring a histidine-to-arginine substitution at amino acid 176 in the S. aureus USA300 strain. We also investigated the capacity of wild-type and H176R LukS-PV to recruit and form pores with the F components of other SHTs. For this purpose, we assayed polymorphonuclear neutrophils for leukotoxicity after incubation with either culture supernatants from strains bearing different PVL haplotypes or recombinant toxins from different types of SHT. We show here that the H176R variation in the PVL sequence causes no change in leukotoxicity and that the R variant is as efficient as wild-type PVL at inducing pore formation in leukocytes.
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Abstract
The evolution of new human and animal pathogenic strains of Staphylococcus aureus has been due to the accumulation of mobile genetic elements (MGE) encoding methicillin resistance and virulence factors into successful lineages. These include epidemic methicillin-resistant S. aureus in hospitals (EMRSA), community-associated MRSA (CA-MRSA), fully vancomycin-resistant MRSA (VRSA) and livestock-associated MRSA (LA-MRSA). The S. aureus population in humans is dominated by about ten S. aureus lineages while animals generally have different lineages. Individual isolates within each lineage have unique combination of MGE often encoding virulence and resistance genes. S. aureus evolves due to point mutation and selection, but also dramatically due to the horizontal transfer of these MGE between strains or from other species or genera. Horizontal transfer, by conjugation or transduction, can be blocked by S. aureus restriction modification systems which are lineage specific. Because of the mobility of MGE, there are prospects for increasingly virulent and resistant strains to emerge that could severely affect healthcare and agriculture more effectively than the current pathogens.
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Affiliation(s)
- Jodi A Lindsay
- Centre for Infection, Department of Cellular and Molecular Medicine, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
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236
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Ho PL, Cheng VCC, Chu CM. Antibiotic Resistance in Community-Acquired Pneumonia Caused by Streptococcus pneumoniae , Methicillin-Resistant Staphylococcus aureus , and Acinetobacter baumannii. Chest 2009; 136:1119-1127. [DOI: 10.1378/chest.09-0285] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Crémieux AC, Dumitrescu O, Lina G, Vallee C, Côté JF, Muffat-Joly M, Lilin T, Etienne J, Vandenesch F, Saleh-Mghir A. Panton-valentine leukocidin enhances the severity of community-associated methicillin-resistant Staphylococcus aureus rabbit osteomyelitis. PLoS One 2009; 4:e7204. [PMID: 19779608 PMCID: PMC2744873 DOI: 10.1371/journal.pone.0007204] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 08/14/2009] [Indexed: 12/04/2022] Open
Abstract
Background Extensive spread of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in the United States, and the concomitant increase in severe invasive staphylococcal infections, including osteomyelitis, in healthy children, has led to renewed interest in Panton-Valentine leukocidin (PVL). However, the pathogenetic role of PVL in staphylococcal infections remains controversial, possibly because it depends on the site of infection. Methodology/Principal Findings We compared the course of experimental rabbit osteomyelitis due to the PVL-positive CA-MRSA strain USA 300 (LAC) and its PVL-negative isogenic derivative (LACΔpvl), using a low and a high inoculum (8×105 and 4×108 CFU). With the low inoculum, bone infection was less frequent on day 7 (D7) and day 28 (D28) with LACΔpvl than with LAC (respectively 12/19 and 18/19 animals, p = 0.042). With the high inoculum of both strains, all the animals were infected on D7 and the infection persisted on D28 in almost every case. However, tibial bacterial counts and the serum CRP concentration fell significantly between D7 and D28 with LACΔpvl but not with LAC. Respectively 67% and 60% of LAC-infected rabbits had bone deformation and muscle/joint involvement on D7, compared to 0% and 7% of LACΔpvl-infected rabbits (p = 0.001 and p = 0.005 respectively). Between D0 and D28, the anti-PVL antibody titer increased significantly only with the high inoculum of LAC. Conclusions/Significance PVL appears to play a role in the persistence and rapid local extension of rabbit osteomyelitis, in keeping with the greater severity of human bone infections due to PVL-positive S. aureus. The possible therapeutic implications of these findings are discussed.
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Affiliation(s)
- Anne-Claude Crémieux
- Département de médecine aigüe, Hôpital Universitaire Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
- EA 3647, Faculté de Médecine Paris-Ile-de–France Ouest, Université Versailles Saint Quentin, Versailles, France
- * E-mail: (ACC); (FV)
| | - Oana Dumitrescu
- Inserm U851, Centre National de référence des Staphylocoques, Faculté Laennec, Université Lyon 1, Lyon, France
| | - Gerard Lina
- Inserm U851, Centre National de référence des Staphylocoques, Faculté Laennec, Université Lyon 1, Lyon, France
| | - Christian Vallee
- Service de radiologie, Hôpital Universitaire Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Jean-François Côté
- Service Anatomie Pathologique, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Martine Muffat-Joly
- Inserm IFR2-Centre d'Explorations Fonctionnelles Intégré, UFR de Médecine Paris 7, site Bichat, Paris, France
| | - Thomas Lilin
- Centre de Recherches Biomédicales, Ecole Nationale Vétérinaire d'Alfort, Maisons Alfort, France
| | - Jerome Etienne
- Inserm U851, Centre National de référence des Staphylocoques, Faculté Laennec, Université Lyon 1, Lyon, France
| | - François Vandenesch
- Inserm U851, Centre National de référence des Staphylocoques, Faculté Laennec, Université Lyon 1, Lyon, France
- * E-mail: (ACC); (FV)
| | - Azzam Saleh-Mghir
- EA 3647, Faculté de Médecine Paris-Ile-de–France Ouest, Université Versailles Saint Quentin, Versailles, France
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239
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Panton-Valentine leukocidin (PVL)-positive methicillin-susceptible and resistant Staphylococcus aureus in Taiwan: identification of oxacillin-susceptible mecA-positive methicillin-resistant S. aureus. Diagn Microbiol Infect Dis 2009; 65:351-7. [PMID: 19766426 DOI: 10.1016/j.diagmicrobio.2009.07.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 07/24/2009] [Accepted: 07/30/2009] [Indexed: 11/20/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) arises when methicillin-susceptible S. aureus (MSSA) acquires the staphylococcal cassette chromosome mec (SCCmec). Most pvl-positive MRSA in Taiwan belong to ST59 lineage and carry SCCmec V. The genetic profiles of 51 MSSA were compared with those of 80 MRSA from the same hospitals. Nine pvl-positive MSSA (oxacillin MIC < or = 2 microg/mL) shared >80% similarity in pulsed field gel electrophoresis pattern with 17 pvl-positive SCCmec V MRSA. Further investigation found that 5 of these 9 isolates were MRSA by cefoxitin and carried SCCmec V. All 26 pvl-positive isolates had very similar genetic profile (ST59, protein A clonal complex [spa-CC] c2:441/437, and agr group I). The success of the ST59:SCCmec V MRSA may be due in part to its heterogeneous and borderline resistance to methicillin, which may be missed by testing only oxacillin, with subsequent exposure to beta-lactams causing the emergence of more resistant subpopulations.
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240
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Orscheln RC, Hunstad DA, Fritz SA, Loughman JA, Mitchell K, Storch EK, Gaudreault M, Sellenriek PL, Armstrong JR, Mardis ER, Storch GA. contribution of genetically restricted, methicillin-susceptible strains to the ongoing epidemic of community-acquired Staphylococcus aureus infections. Clin Infect Dis 2009; 49:536-42. [PMID: 19589082 DOI: 10.1086/600881] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Within the current worldwide epidemic of community-acquired Staphylococcus aureus infections, attention has focused on the role of methicillin-resistant strains. We characterize methicillin-susceptible strains that also contribute to this epidemic. METHODS We tracked cultures from abscess specimens submitted to the microbiology laboratory at St. Louis Children's Hospital and examined Panton-Valentine leukocidin (PVL) genes in methicillin-susceptible S. aureus (MSSA) isolates. We further characterized some isolates by multilocus sequence typing, pulsed-field gel electrophoresis, antibiotic susceptibility, accessory gene regulator (agr) allele, and presence of the arcA gene of the arginine catabolic mobile element. RESULTS From 1999 to 2007, we detected a 250-fold increase in cultures of abscesses yielding methicillin-resistant S. aureus (MRSA) and a 5-fold increase in abscess cultures yielding MSSA. MSSA isolates from abscesses and wounds were more likely to encode PVL than isolates from other sources. In contrast to PVL-negative isolates of MSSA, which were genetically diverse, PVL-positive isolates were predominantly multilocus sequence typing type 8 and agr type 1. More than half of PVL-positive MSSA isolates were resistant to erythromycin and susceptible to clindamycin with the absence of inducible resistance, a pattern uncommon in PVL-negative MSSA but frequent in the USA300 clone of MRSA. In addition, pulsed-field gel electrophoresis of PVL-positive MSSA strains revealed the USA300 pattern. CONCLUSIONS In addition to methicillin-resistant strains, the current epidemic of S. aureus infections includes infections caused by methicillin-susceptible strains that are closely related genetically and share phenotypic characteristics other than susceptibility to methicillin. These findings suggest that factors other than methicillin resistance are driving the epidemic.
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Affiliation(s)
- Rachel C Orscheln
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Anwar S, Prince LR, Foster SJ, Whyte MKB, Sabroe I. The rise and rise of Staphylococcus aureus: laughing in the face of granulocytes. Clin Exp Immunol 2009; 157:216-24. [PMID: 19604261 DOI: 10.1111/j.1365-2249.2009.03950.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Recent developments in the study of host-pathogen interactions have fundamentally altered our understanding of the nature of Staphylococcus aureus infection, and previously held tenets regarding the role of the granulocyte are being cast aside. Novel mechanisms of pathogenesis are becoming evident, revealing the extent to which S. aureus can evade neutrophil responses successfully by resisting microbicides, surviving intracellularly and subverting cell death pathways. Developing a detailed understanding of these complex strategies is especially relevant in light of increasing staphylococcal virulence and antibiotic resistance, and the knowledge that dysfunctional neutrophil responses contribute materially to poor host outcomes. Unravelling the biology of these interactions is a challenging task, but one which may yield new strategies to address this, as yet, defiant organism.
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Affiliation(s)
- S Anwar
- Academic Unit of Respiratory Medicine, School of Medicine and Biomedical Sciences, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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242
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Budimir A, Deurenberg RH, Bosnjak Z, Stobberingh EE, Cetkovic H, Kalenic S. A variant of the Southern German clone of methicillin-resistant Staphylococcus aureus is predominant in Croatia. Clin Microbiol Infect 2009; 16:1077-83. [PMID: 19732087 DOI: 10.1111/j.1469-0691.2009.03042.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the present study was to investigate the antibiotic susceptibility patterns and molecular epidemiology of clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered in 24 hospitals in 20 cities in Croatia from October to December 2004. A total of 1815 consecutive S. aureus isolates were recovered, 248 of which were MRSA. The MRSA isolates were analysed using spa typing, multilocus sequence typing and SCCmec typing. Furthermore, the presence of Panton-Valentine leukocidin (PVL) genes was determined as a genetic marker for community-associated MRSA. The MRSA prevalence was 14%. Ninety-six per cent of the MRSA isolates were resistant to ciprofloxacin, 95% to clindamycin and azithromycin, 94% to gentamicin, and 93% to erythromycin. The majority of the MRSA isolates (78%) was associated with the ST111-MRSA-I clone. In addition, various other endemic MRSA clones were observed, such as the ST247-MRSA-I (4%), the ST45-MRSA-IV (2%), the ST5-MRSA-I (2%), the ST239-MRSA-III (2%), the ST5-MRSA-II (1%), the ST8-MRSA-IV (1%) and the ST5-MRSA-IV (<1%) clones. Furthermore, we observed one PVL-negative ST80-MRSA-IV isolate. Four PVL-positive MRSA isolates were found, associated with ST8-MRSA-IV, ST80-MRSA-IV and ST80-MRSA-I. The ST111-MRSA-I clone was predominant in Croatia. Future surveillance studies of MRSA are important to elucidate whether changes in the clonal distribution of MRSA will occur, and if the minor endemic MRSA clones observed in the present study will replace the ST111-MRSA-I clone on a large scale.
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Affiliation(s)
- A Budimir
- ) Department of Clinical and Molecular Microbiology, Clinical Hospital Centre Zagreb, Zagreb, Croatia
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243
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Bassetti M, Nicco E, Mikulska M. Why is community-associated MRSA spreading across the world and how will it change clinical practice? Int J Antimicrob Agents 2009; 34 Suppl 1:S15-9. [PMID: 19560669 DOI: 10.1016/s0924-8579(09)70544-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) emerged in 1960 and over the following 40 years was a problem confined largely to the healthcare setting. In the late 1990s the first US reports of so-called community-associated MRSA (CA-MRSA) infections appeared. CA-MRSA infections were defined as MRSA infections occurring in patients who had no identifiable predisposing risk factors, such as healthy children and young adults. CA-MRSA is associated with a novel genetic profile and phenotype; it is remarkably fit and capable of spreading within communities, it is virulent and is often susceptible to multiple narrow-spectrum antimicrobials other than beta-lactams. CA-MRSA infections involve predominantly skin and soft tissue; however, necrotizing pneumonia and necrotizing fasciitis have been described. At present, several reports suggest that CA-MRSA may be replacing the hospital-acquired MRSA strains (HA-MRSA), with potentially catastrophic consequences. Given the rapid spread and the high virulence of CA-MRSA, global strategies are needed. Prompt, appropriate treatment, guided by the site and type of infection and risk factors for HA-MRSA or CA-MRSA, increases the chances of a successful outcome and is urgently needed.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, S. Martino Hospital and University of Genoa School of Medicine, Genoa, Italy.
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244
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Abstract
Staphylococcus aureus is notorious for its ability to become resistant to antibiotics. Infections that are caused by antibiotic-resistant strains often occur in epidemic waves that are initiated by one or a few successful clones. Methicillin-resistant S. aureus (MRSA) features prominently in these epidemics. Historically associated with hospitals and other health care settings, MRSA has now emerged as a widespread cause of community infections. Community or community-associated MRSA (CA-MRSA) can spread rapidly among healthy individuals. Outbreaks of CA-MRSA infections have been reported worldwide, and CA-MRSA strains are now epidemic in the United States. Here, we review the molecular epidemiology of the epidemic waves of penicillin- and methicillin-resistant strains of S. aureus that have occurred since 1940, with a focus on the clinical and molecular epidemiology of CA-MRSA.
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Affiliation(s)
- Henry F Chambers
- Division of Infectious Diseases, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California 94110, USA.
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245
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Community-associated MRSA in the United Kingdom. J Infect 2009; 59:149-55. [DOI: 10.1016/j.jinf.2009.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 06/29/2009] [Accepted: 07/01/2009] [Indexed: 11/21/2022]
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246
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Rice LB. The clinical consequences of antimicrobial resistance. Curr Opin Microbiol 2009; 12:476-81. [PMID: 19716760 DOI: 10.1016/j.mib.2009.08.001] [Citation(s) in RCA: 189] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 08/03/2009] [Accepted: 08/03/2009] [Indexed: 11/28/2022]
Abstract
The continued evolution of antimicrobial resistance in the hospital and more recently in the community threatens to seriously compromise our ability to treat serious infections. The major success of the seven-valent Streptococcus pneumoniae vaccine at reducing both infection and resistance has been followed by the emergence of previously minor serotypes that express multiresistance. The almost universal activity of cephalosporins and fluoroquinolones against community Escherichia coli strains has been compromised by the spread of CTX-M beta-lactamase-producing, fluoroquinolone-resistant strains, and the emergence of community-onset methicillin-resistant Staphylococcus aureus, particularly in the United States, has forced us to re-think our empirical treatment guidelines for skin and soft-tissue infections. Finally, our most potent and reliable class of antibiotics, the carbapenems, is compromised by the growth, primarily in intensive care units, of multiresistant Klebsiella pneumoniae, Acinetobacter baumanni, and Pseudomonas aeruginosa. The lack of a robust pipeline of new agents, particularly against resistant Gram-negative bacteria, emphasizes the importance of optimizing our use of current antimicrobials and promoting strict adherence to established infection control practices.
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Affiliation(s)
- Louis B Rice
- Medical Service 111(W), Louis Stokes Cleveland VA Medical Center, 10701 East Blvd., Cleveland, OH 44106, USA.
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Cuny C, Nathaus R, Layer F, Strommenger B, Altmann D, Witte W. Nasal colonization of humans with methicillin-resistant Staphylococcus aureus (MRSA) CC398 with and without exposure to pigs. PLoS One 2009; 4:e6800. [PMID: 19710922 PMCID: PMC2728842 DOI: 10.1371/journal.pone.0006800] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 07/17/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies in several European countries and in North America revealed a frequent nasal colonization of livestock with MRSA CC398 and also in humans with direct professional exposure to colonized animals. The study presented here addresses the question of further transmission to non exposed humans. METHODS After selecting 47 farms with colonized pigs in different regions of Germany we sampled the nares of 113 humans working daily with pigs and of their 116 non exposed family members. The same was performed in 18 veterinarians attending pig farms and in 44 of their non exposed family members. For investigating transmission beyond families we samples the nares of 462 pupils attending a secondary school in a high density pig farming area. MRSA were detected by direct culture on selective agar. The isolates were typed by means of spa-sequence typing and classification of SCCmec elements. For attribution of spa sequence types to clonal lineages as defined by multi locus sequence typing we used the BURP algorithm. Antibiotic susceptibility testing was performed by microbroth dilution assay. RESULTS At the farms investigated 86% of humans exposed and only 4.3% of their family members were found to carry MRSA exhibiting spa-types corresponding to clonal complex CC398. Nasal colonization was also found in 45% of veterinarians caring for pig farms and in 9% of their non exposed family members. Multivariate analysis revealed that antibiotic usage prior to sampling beard no risk with respect to colonization. From 462 pupils only 3 were found colonized, all 3 were living on pig farms. CONCLUSION These results indicate that so far the dissemination of MRSA CC398 to non exposed humans is infrequent and probably does not reach beyond familial communities.
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Affiliation(s)
- Christiane Cuny
- Robert Koch Institute, Wernigerode Branc, Wernigerode, Germany
| | - Rolf Nathaus
- Rolf Nathaus, Veterinary Practice, Reken, Germany
| | - Franziska Layer
- Robert Koch Institute, Wernigerode Branc, Wernigerode, Germany
| | | | - Doris Altmann
- Robert Koch Institute, Division of Epidemiology, Berlin, Germany
| | - Wolfgang Witte
- Robert Koch Institute, Wernigerode Branc, Wernigerode, Germany
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Hawkey PM, Jones AM. The changing epidemiology of resistance. J Antimicrob Chemother 2009; 64 Suppl 1:i3-10. [DOI: 10.1093/jac/dkp256] [Citation(s) in RCA: 500] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stefani S, Bongiorno D, Cafiso V, Campanile F, Crapis M, Cristini F, Sartor A, Scarparo C, Spina D, Viale P. Pathotype and susceptibility profile of a community-acquired methicillin-resistant Staphylococcus aureus strain responsible for a case of severe pneumonia. Diagn Microbiol Infect Dis 2009; 63:100-4. [PMID: 19073304 DOI: 10.1016/j.diagmicrobio.2008.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 09/08/2008] [Accepted: 09/13/2008] [Indexed: 10/21/2022]
Abstract
Recent articles have described an increasing number of infections due to Panton-Valentine leukocidin PVL-positive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) worldwide. We report a case of necrotizing pneumonia successfully treated with levofloxacin in Italy, sustained by a PVL-positive CA-MRSA, belonging to ST88 and carrying a staphylococcal chromosomal cassette mec type V. Further molecular characterization of isolates revealed that they were PVL positive, belonged to the agr IV allele, possessed a capsular type 8, and had an almost complete pathotype composed of leukocidins and numerous adhesins. In addition, the strains were strong biofilm producers.
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Affiliation(s)
- Stefania Stefani
- Department of Microbiology, University of Catania, 95124 Catania (I), Italy.
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Petersson AC, Olsson-Liljequist B, Miörner H, Haeggman S. Evaluating the usefulness of spa typing, in comparison with pulsed-field gel electrophoresis, for epidemiological typing of methicillin-resistant Staphylococcus aureus in a low-prevalence region in Sweden 2000-2004. Clin Microbiol Infect 2009; 16:456-62. [PMID: 19624504 DOI: 10.1111/j.1469-0691.2009.02881.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The usefulness of spa typing was evaluated in relation to pulsed-field gel electrophoresis (PFGE), as a tool for epidemiological typing of methicillin-resistant Staphylococcus aureus (MRSA) in a low-prevalence region in southern Sweden. Bacterial isolates from 216 MRSA cases, newly identified in 2000-2004, were studied. The isolates were obtained from infected patients (31%), and from colonized individuals found by screening (69%). In total, 49 spa types and 73 PFGE patterns were identified. The discriminatory power of spa typing was lower (94.9 +/- 1.8%) than that of PFGE (97.3 +/- 1.2%). For two spa types (t002 and t008) the Panton-Valentine leukocidin results added useful discriminatory information. The most common spa types were t044 (n = 31; four PFGE patterns), t002 (n = 24; 10 PFGE patterns), t067 (n = 12; four PFGE patterns), t050 (n = 12; one PFGE pattern), and t324 (n = 11; one PFGE pattern). Epidemiological investigations identified 91 single cases and 39 transmission chains, each involving two to 13 cases. All the transmission chains were held together both by spa and PFGE typing. Among the 91 single-case isolates, 33 spa types and 50 PFGE patterns were unique (matchless) at the time of identification. The low prevalence of MRSA, the low number of outbreaks, and the wide spectrum of strains due to frequent acquisitions abroad (49% of the cases), makes spa typing a useful complement to epidemiological investigations in our setting. However, we still recommend the continued use of PFGE for further discrimination of isolates with identical spa types when epidemiological data can not exclude possible transmission.
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