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Chen Z, Li J, Wan Y, Bai R, Wang W, Gao X, Li D, Hu Q, Li Y, Ruan BH. Rapid High-Throughput Assay Identified Gemcitabine and Derivatives As Potent Inhibitors Against Multidrug-Resistant Staphylococcus aureus. Assay Drug Dev Technol 2022; 20:175-182. [DOI: 10.1089/adt.2022.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhao Chen
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China
| | - Jinxiu Li
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China
| | - Yue Wan
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China
| | - Ruisong Bai
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China
| | - Wenjuan Wang
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China
| | - Xuan Gao
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China
| | - Di Li
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China
| | - Qingfeng Hu
- Clinical Diagnostic Lab, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yong Li
- Hangzhou Simbiospharma Co. Ltd., Hangzhou, China
| | - Benfang Helen Ruan
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China
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Achek R, El-Adawy H, Hotzel H, Hendam A, Tomaso H, Ehricht R, Neubauer H, Nabi I, Hamdi TM, Monecke S. Molecular Characterization of Staphylococcus aureus Isolated from Human and Food Samples in Northern Algeria. Pathogens 2021; 10:pathogens10101276. [PMID: 34684225 PMCID: PMC8537606 DOI: 10.3390/pathogens10101276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Abstract
Staphylococcus aureus is a commensal resident of the skin and nasal cavities of humans and can cause various infections. Some toxigenic strains can contaminate food matrices and cause foodborne intoxications. The present study aimed to provide relevant information (clonal complex lineages, agr types, virulence and antimicrobial resistance-associated genes) based on DNA microarray analyses as well as the origins and dissemination of several circulating clones of 60 Staphylococcus aureus isolated from food matrices (n = 24), clinical samples (n = 20), and nasal carriers (n = 16) in northern Algeria. Staphylococcus aureus were genotyped into 14 different clonal complexes. Out of 60 S. aureus, 13 and 10 isolates belonged to CC1-MSSA and CC97-MSSA, respectively. The CC 80-MRSA-IV was the predominant S. aureus strain in clinical isolates. The accessory gene regulator allele agr group III was mainly found among clinical isolates (70.4%). Panton–Valentine leukocidin genes lukF/lukS-PV were detected in 13.3% of isolates that all belonged to CC80-MRSA. The lukF/S-hlg, hlgA, and hla genes encoding for hemolysins and leucocidin components were detected in all Staphylococcusaureus isolates. Clinical and food isolates harbored more often the antibiotic resistance genes markers. Seventeen (28.3%) methicillin-resistant Staphylococcus aureus carrying the mecA gene localized on a SCCmec type IV element were identified. The penicillinase operon (blaZ/I/R) was found in 71.7% (43/60) of isolates. Food isolates belonging to CC97-MSSA carried several antibiotic resistance genes (blaZ, ermB, aphA3, sat, tetM, and tetK). The results of this study showed that all clones were found in their typical host, but interestingly, some nasal carriers had isolates assigned to CC705 thought to be absent in humans. The detection of MRSA strains among food isolates should be considered as a potential public health risk. Therefore, controlling the antibiotics prescription for a rational use in human and animal infections is mandatory.
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Affiliation(s)
- Rachid Achek
- Faculty of Nature and Life and Earth Sciences, Djilali-Bounaama University, Soufay, Khemis-Miliana 44225, Algeria;
- Laboratory of Food Hygiene and Quality Assurance System, High National Veterinary School, Oued Smar, Algiers 16059, Algeria;
| | - Hosny El-Adawy
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (H.H.); (H.T.); (H.N.)
- Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh 35516, Egypt
- Correspondence:
| | - Helmut Hotzel
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (H.H.); (H.T.); (H.N.)
| | - Ashraf Hendam
- Climate Change Information Center, Renewable Energy and Expert Systems (CCICREES), Agricultural Research Center, 9 Algamaa Street, Giza 12619, Egypt;
| | - Herbert Tomaso
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (H.H.); (H.T.); (H.N.)
| | - Ralf Ehricht
- Leibniz Institute of Photonic Technology (IPHT), 07745 Jena, Germany; (R.E.); (S.M.)
- InfectoGnostics Research Campus Jena e. V., 07743 Jena, Germany
- Institute of Physical Chemistry, Friedrich Schiller University Jena, 07743 Jena, Germany
| | - Heinrich Neubauer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (H.H.); (H.T.); (H.N.)
| | - Ibrahim Nabi
- Faculty of Sciences, Yahia Farès University, Urban Pole, Médéa 26000, Algeria;
| | - Taha Mossadak Hamdi
- Laboratory of Food Hygiene and Quality Assurance System, High National Veterinary School, Oued Smar, Algiers 16059, Algeria;
| | - Stefan Monecke
- Leibniz Institute of Photonic Technology (IPHT), 07745 Jena, Germany; (R.E.); (S.M.)
- InfectoGnostics Research Campus Jena e. V., 07743 Jena, Germany
- Institute for Medical Microbiology and Virology, Dresden University Hospital, 01307 Dresden, Germany
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3
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Low-cost colorimetric diagnostic screening assay for methicillin resistant Staphylococcus aureus. Talanta 2021; 225:121946. [PMID: 33592701 DOI: 10.1016/j.talanta.2020.121946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/11/2022]
Abstract
The timely diagnosis of MRSA in clinical samples helps to reduce the attendant morbidity/mortality associated with infection due to the organism. The early institution of appropriate therapy or deployment of infection control protocols are dependent on a timely report from the microbiology laboratory. Various assays currently used in the identification of MRSA are associated with inherent shortcomings, thus there is a need to explore newer diagnostic frontiers that can eliminate some of these short comings at a relatively cheap, timely, specific and sensitive manner. We present in this study a MRSA specific optical immunosensor to detect the presence of the pathogen on contaminated surface using control and patient strains. Results revealed a detection limits of 103 CFU mL-1 upon visual observation, and 29 CFU mL-1 as determined by the linear regression equation, following the use of ImageJ to quantify activated cotton swab color intensity. The specificity of the sensor was examined by blind testing a panel of non-MRSA bacteria (E. coli, S. aureus and S. epidermis). Negative visual read-out was observed for all tested non-specific bacteria except for MRSA. Assay takes an average of 5 min and presents a powerful point-of-care diagnostic platform for the detection of MRSA.
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4
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Abstract
Multilocus sequence typing (MLST) has been successfully used to differentiate and trace the bacterial species and pathogens that cause outbreaks or epidemics of infectious diseases. MLST provides a powerful solution for molecular epidemiological characterization of bacterial strains, including Staphylococcus aureus, by using the sequences of the internal region of seven housekeeping genes. In previous studies, we utilized MLST to analyze the genotypes of S. aureus isolates from pediatric patients with cystic fibrosis and revealed three prevalent ST types, including ST5, ST30, and ST8 in these isolates. In this chapter, we describe a detailed procedure of MLST for genotyping S. aureus.
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5
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Álvarez-Martínez FJ, Barrajón-Catalán E, Encinar JA, Rodríguez-Díaz JC, Micol V. Antimicrobial Capacity of Plant Polyphenols against Gram-positive Bacteria: A Comprehensive Review. Curr Med Chem 2020; 27:2576-2606. [PMID: 30295182 DOI: 10.2174/0929867325666181008115650] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/17/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multi-drug-resistant bacteria such as Methicillin-Resistant Staphylococcus aureus (MRSA) disseminate rapidly amongst patients in healthcare facilities and suppose an increasingly important cause of community-associated infections and associated mortality. The development of effective therapeutic options against resistant bacteria is a public health priority. Plant polyphenols are structurally diverse compounds that have been used for centuries for medicinal purposes, including infections treatment and possess, not only antimicrobial activity, but also antioxidant, anti-inflammatory and anticancer activities among others. Based on the existing evidence on the polyphenols' antibacterial capacity, polyphenols may be postulated as an alternative or complementary therapy for infectious diseases. OBJECTIVE To review the antimicrobial activity of plant polyphenols against Gram-positive bacteria, especially against S. aureus and its resistant strains. Determine the main bacterial molecular targets of polyphenols and their potential mechanism of action. METHODOLOGY The most relevant reports on plant polyphenols' antibacterial activity and their putative molecular targets were studied. We also performed virtual screening of thousand different polyphenols against proteins involved in the peptidoglycan biosynthesis to find potential valuable bioactive compounds. The bibliographic information used in this review was obtained from MEDLINE via PubMed. RESULTS Several polyphenols: phenolic acids, flavonoids (especially flavonols), tannins, lignans, stilbenes and combinations of these in botanical mixtures, have exhibited significant antibacterial activity against resistant and non-resistant Gram-positive bacteria at low μg/mL range MIC values. Their mechanism of action is quite diverse, targeting cell wall, lipid membrane, membrane receptors and ion channels, bacteria metabolites and biofilm formation. Synergic effects were also demonstrated for some combinations of polyphenols and antibiotics. CONCLUSION Plant polyphenols mean a promising source of antibacterial agents, either alone or in combination with existing antibiotics, for the development of new antibiotic therapies.
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Affiliation(s)
- Francisco Javier Álvarez-Martínez
- Instituto de Biologia Molecular y Celular (IBMC) and Instituto de Investigacion, Desarrollo e Innovacion en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernandez; 03202 Elche, Spain
| | - Enrique Barrajón-Catalán
- Instituto de Biologia Molecular y Celular (IBMC) and Instituto de Investigacion, Desarrollo e Innovacion en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernandez; 03202 Elche, Spain
| | - José Antonio Encinar
- Instituto de Biologia Molecular y Celular (IBMC) and Instituto de Investigacion, Desarrollo e Innovacion en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernandez; 03202 Elche, Spain
| | - Juan Carlos Rodríguez-Díaz
- Microbiology Section, University General Hospital of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante 03010, Spain
| | - Vicente Micol
- Instituto de Biologia Molecular y Celular (IBMC) and Instituto de Investigacion, Desarrollo e Innovacion en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernandez; 03202 Elche, Spain.,CIBER, Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (CB12/03/30038), Spain
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6
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Valliammai A, Selvaraj A, Yuvashree U, Aravindraja C, Karutha Pandian S. sarA-Dependent Antibiofilm Activity of Thymol Enhances the Antibacterial Efficacy of Rifampicin Against Staphylococcus aureus. Front Microbiol 2020; 11:1744. [PMID: 32849374 PMCID: PMC7410925 DOI: 10.3389/fmicb.2020.01744] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a serious human pathogen which has been listed as a high-priority multi-drug resistance pathogen by the World Health Organization (WHO). Persistent MRSA infections are often associated with biofilm formation and resistance to conventional antimicrobial therapy. Inhibiting the surface adherence and the virulence of the bacterium is the current alternative approach without affecting growth to reduce the possibility of resistance development. Although numerous antibiofilm agents have been identified, their mode of action remains unclear. Combining two drugs with different modes of action will improve the efficiency of the treatment strategy against MRSA. The present study was aimed to decipher the molecular mechanism underlying the antibiofilm activity of thymol against MRSA and assess the ability of thymol to improve the antibacterial activity of rifampicin. Thymol significantly inhibited 88% of MRSA biofilm formation at 100 μg/ml and reduced the surface adherence of MRSA on glass, stainless steel, and titanium surface coated with human plasma as evidenced by microscopic analyses. qPCR analysis of global virulence regulatory genes and biofilm assay with S. aureus wild type, ΔsarA, and Δagr strains revealed the sarA-mediated antibiofilm activity of thymol and inhibition of sarA-controlled virulence factors. Congo red assay and erythrocyte lysis assay further confirmed the reduction in polysaccharide intracellular adhesin and hemolysin. Importantly, thymol enhanced the antibacterial and the biofilm eradication efficiency of rifampicin against MRSA and also reduced the formation of persisters. Thus, the present study reveals the sarA-dependent antibiofilm efficacy of MRSA and suggests thymol as the promising combinatorial candidate in potentiating the antibacterial activity of rifampicin against persistent MRSA infections.
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Affiliation(s)
| | | | | | - Chairmandurai Aravindraja
- Department of Biotechnology, Alagappa University, Karaikudi, India.,Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, United States
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Abstract
Traditional antimicrobial susceptibility test methods for detection of S. aureus resistant to oxacillin (MRSA) such as disk diffusion, broth microdilution, and oxacillin screen plate require 18-24 h of incubation after having the organism growing in pure culture. Rapid and accurate identification of MRSA isolates is essential not only for patient care, but also for effective infection control programs to limit the spread of MRSA. In the last few years, several commercial rapid tests for detection of MRSA directly from nasal and wound swabs, as well as from positive blood cultures, have been developed for use in clinical laboratories. Chromogenic agar plates and real-time PCR and other molecular tests are gaining popularity as MRSA screening tests because they have the advantage of a lower turnaround time than that of traditional culture and susceptibility testing and they are capable of detecting MRSA directly from nasal and wound swabs, allowing rapid identification of colonized or infected patients. In addition, molecular methods able to detect and differentiate S. aureus and MRSA (SA/MRSA) directly from blood cultures are becoming a useful tool for rapid detection of bacteremia caused by MSSA and MRSA. This review focuses on the procedures for performing testing using rapid methods currently available for detection of MRSA directly from clinical specimens.
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8
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Li K, Mohammed MAA, Zhou Y, Tu H, Zhang J, Liu C, Chen Z, Burns R, Hu D, Ruso JM, Tang Z, Liu Z. Recent progress in the development of immobilized penicillin G acylase for chemical and industrial applications: A mini‐review. POLYM ADVAN TECHNOL 2019. [DOI: 10.1002/pat.4791] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ke Li
- State Key Laboratory of Gansu Advanced Non‐ferrous Metal MaterialsLanzhou University of Technology Lanzhou China
- School of Materials Science and EngineeringLanzhou University of Technology Lanzhou China
| | - Monier Alhadi Abdelrahman Mohammed
- State Key Laboratory of Gansu Advanced Non‐ferrous Metal MaterialsLanzhou University of Technology Lanzhou China
- School of Materials Science and EngineeringLanzhou University of Technology Lanzhou China
| | - Yongshan Zhou
- State Key Laboratory of Gansu Advanced Non‐ferrous Metal MaterialsLanzhou University of Technology Lanzhou China
- School of Materials Science and EngineeringLanzhou University of Technology Lanzhou China
| | - Hongyi Tu
- State Key Laboratory of Gansu Advanced Non‐ferrous Metal MaterialsLanzhou University of Technology Lanzhou China
- School of Materials Science and EngineeringLanzhou University of Technology Lanzhou China
| | - Jiachen Zhang
- State Key Laboratory of Gansu Advanced Non‐ferrous Metal MaterialsLanzhou University of Technology Lanzhou China
- School of Materials Science and EngineeringLanzhou University of Technology Lanzhou China
| | - Chunli Liu
- State Key Laboratory of Gansu Advanced Non‐ferrous Metal MaterialsLanzhou University of Technology Lanzhou China
- School of Materials Science and EngineeringLanzhou University of Technology Lanzhou China
| | - Zhenbin Chen
- State Key Laboratory of Gansu Advanced Non‐ferrous Metal MaterialsLanzhou University of Technology Lanzhou China
- School of Materials Science and EngineeringLanzhou University of Technology Lanzhou China
| | - Robert Burns
- Department of Physics and EngineeringFrostburg State University Frostburg Maryland
| | - Dongdong Hu
- State Key Laboratory of Chemical EngineeringEast China University of Science and Technology Shanghai China
| | - Juan M. Ruso
- Soft Matter and Molecular Biophysics Group, Department of Applied PhysicsUniversity of Santiago de Compostela Santiago de Compostela Spain
| | - Zhenghua Tang
- Guangzhou Key Laboratory for Surface Chemistry of Energy MaterialsNew Energy Research Institute School of Environment and Energy, South China University of Technology, Guangzhou Higher Education Mega Centre Guangzhou China
- Guangdong Engineering and Technology Research Center for Surface Chemistry of Energy MaterialsSchool of Environment and Energy South China University of Technology, Guangzhou Higher Education Mega Center Guangzhou China
| | - Zhen Liu
- Department of Physics and EngineeringFrostburg State University Frostburg Maryland
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9
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Xiong F, Dai X, Li YX, Wei R, An L, Wang Y, Chen Z. Effects of the antimicrobial peptide L12 against multidrug‑resistant Staphylococcus aureus. Mol Med Rep 2019; 19:3337-3344. [PMID: 30816474 DOI: 10.3892/mmr.2019.9988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/03/2018] [Indexed: 11/06/2022] Open
Abstract
Methicillin‑resistant Staphylococcus aureus (S. aureus; MRSA) is one of the most common bacterial pathogens and MRSA infections are characterized by high mortality rates. Antimicrobial peptides are considered one of the most promising drugs for the treatment of resistant strains of S. aureus. The present study aimed to examine the antimicrobial activity of L12 against numerous bacterial species using the broth microdilution method. Furthermore, the synergistic effect of L12 combined with various antibacterial drugs was tested, and its antibacterial mechanism was investigated by a checkerboard assay. The alterations in bacterial morphology were detected by electron microscopy, and biofilm formation and removal were tested by crystal violet staining. The present results suggested that L12 affected the growth of gram‑positive strains, particularly S. aureus. Electron microscopy analysis suggested that L12 may target the cell membrane, and L12 increased the antibacterial activity of vancomycin and levofloxacin, exerting a synergistic effect. However, the minimal inhibitory concentrations (MICs) of L12 were not correlated with antibiotic resistance, the strains resistant to more antibiotics were not more resistant to L12. A sub‑MIC of L12 was able to inhibit biofilm formation in a dose‑dependent manner; however, concentrations of L12 ≤10 times the MIC were not sufficient to degrade previously formed biofilm. Collectively, the present study suggested that L12 may represent a novel potential therapeutic molecule for the treatment of S. aureus infections.
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Affiliation(s)
- Fu Xiong
- Department of Pulmonology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, P.R. China
| | - Xiaotian Dai
- Department of Pulmonology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, P.R. China
| | - Yu-Xue Li
- Department of Respiratory Medicine, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050011, P.R. China
| | - Rui Wei
- Department of Respiratory Medicine, North China University of Science and Technology of Clinical Medicine, Tangshan, Hebei 063000, P.R. China
| | - Li An
- Department of Nanlou Pulmonology and National Clinical Research Center of Geriatrics Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Yajuan Wang
- Department of Nanlou Pulmonology and National Clinical Research Center of Geriatrics Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Zhenhong Chen
- Department of Nanlou Pulmonology and National Clinical Research Center of Geriatrics Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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10
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Complex Clonal Diversity of Staphylococcus aureus Nasal Colonization among Community Personnel, Healthcare Workers, and Clinical Students in the Eastern Province, Saudi Arabia. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4208762. [PMID: 30662908 PMCID: PMC6312594 DOI: 10.1155/2018/4208762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/26/2018] [Indexed: 01/19/2023]
Abstract
Here, 210 healthy participants including community personnel (70), clinical students (68), and healthcare workers (HCWs) (72) from the eastern region of Saudi Arabia were studied. Sixty-three Staphylococcus aureus isolates were obtained from the nares of 37% of the community personnel and 26% of the clinical students and HCWs. Methicillin-resistant S. aureus (MRSA) was found in 16% (10 isolates) of the 63 isolates; six were from HCWs. Molecular characterization revealed high clonal diversity among the isolates, with 19 different spa types, 12 clonal complexes (CCs), and seven sequence types (STs) detected. The most common strain type was USA900, CC15, and t084, seen in 11 methicillin-susceptible S. aureus (MSSA) isolates. Moreover, three novel spa types in six isolates and one novel ST in two isolates were identified, most from HCWs. Interestingly, 29 isolates were mecA positive by PCR, whereas only 10 isolates were MRSA by disk diffusion (cefoxitin resistant). Of the 19 MSSA mecA-positive isolates, 16 were PBP2a negative, leaving three unique isolates from HCWs that were mecA and PBP2a positive yet cefoxitin susceptible. Our findings highlight the importance of phenotypically and genotypically characterizing S. aureus strains isolated from healthy communities to monitor the risk of possible cross-transmission to hospitalized patients. The identified strains showed a clonal lineage relationship with previously reported S. aureus and MRSA strains acquired from hospital settings.
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11
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Teillaud JL, Regard L, Martin C, Sibéril S, Burgel PR. Exploring the Role of Tertiary Lymphoid Structures Using a Mouse Model of Bacteria-Infected Lungs. Methods Mol Biol 2018; 1845:223-239. [PMID: 30141016 DOI: 10.1007/978-1-4939-8709-2_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Animal models can be helpful tools for deciphering the generation, maintenance, and role of tertiary lymphoid structures (TLS) during infections or tumor development. We describe here the establishment of a persistent lung infection in immune-competent mice by intratracheal instillation of agarose beads containing Pseudomonas aeruginosa or Staphylococcus aureus bacteria. After instillation, animals develop a chronic pulmonary infection, marked by the presence of TLS. This experimental setting allows the study of the function of TLS induced by bacteria encountered in patients with cystic fibrosis (CF) as P. aeruginosa and S. aureus are the two main bacterial strains that infect bronchi of adult CF patients. Additionally, we describe also how to manipulate the immune response in these infected animals by targeting immune cells involved in TLS function. Overall, this approach makes it possible to explore the role of chronic inflammation in the induction and maintenance of TLS in infected tissues.
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Affiliation(s)
- Jean-Luc Teillaud
- Cordeliers Research Center, Laboratory "Cancer, immune Control and Escape", Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Paris Cedex 06, France. .,Cordeliers Research Center, Paris Descartes University, Sorbonne Paris Cité, UMRS 1138, Paris, France. .,Cordeliers Research Center, Sorbonne University, UMRS 1138, Paris, France.
| | - Lucile Regard
- Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, UPRES EA 2511, Paris, France.,Service de Pneumologie et Service de Physiologie, Hôpital Cochin, AP-HP, Paris, France
| | - Clémence Martin
- Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, UPRES EA 2511, Paris, France.,Service de Pneumologie et Service de Physiologie, Hôpital Cochin, AP-HP, Paris, France
| | - Sophie Sibéril
- Cordeliers Research Center, Laboratory "Cancer, immune Control and Escape", Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Paris Cedex 06, France.,Cordeliers Research Center, Paris Descartes University, Sorbonne Paris Cité, UMRS 1138, Paris, France.,Cordeliers Research Center, Sorbonne University, UMRS 1138, Paris, France
| | - Pierre-Régis Burgel
- Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, UPRES EA 2511, Paris, France.,Service de Pneumologie et Service de Physiologie, Hôpital Cochin, AP-HP, Paris, France
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12
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Espigares E, Moreno Roldan E, Espigares M, Abreu R, Castro B, Dib AL, Arias Á. Phenotypic Resistance to Disinfectants and Antibiotics in Methicillin-Resistant Staphylococcus aureus Strains Isolated from Pigs. Zoonoses Public Health 2016; 64:272-280. [PMID: 27762078 DOI: 10.1111/zph.12308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Indexed: 12/20/2022]
Abstract
The aim of this research was to study the phenotypic resistances to disinfectants and antibiotics in strains of methicillin-resistant Staphylococcus aureus (MRSA) obtained from Canary black pigs. Analyses were performed on 54 strains of MRSA, isolated in Canary black pigs from the province of Tenerife (Spain); all of them carried the mecA gene. The strains were isolated by means of nasal swab samples of healthy pigs, collected under veterinarian supervision. Bactericidal activity of antiseptics and disinfectants was tested by means of the dilution-neutralization method. Susceptibility to the disinfectants glutaraldehyde, peracetic acid and silver nitrate was assessed, as well as to the antiseptics chlorhexidine, benzalkonium chloride and povidone iodine. Susceptibility to a wide array of antibiotics representing the main groups was determined by means of the disc diffusion method. All the strains demonstrated susceptibility to the disinfectants tested at the recommended concentration, and even to dilutions equal to or lesser than 1/16. The most effective antiseptic and disinfectant were, respectively, chlorhexidine and silver nitrate. With regard to the antibiotics, the strains proved to be multiresistant. All presented phenotypic resistance to the β-lactam antibiotics ampicillin, penicillin and cefoxitin, as well as to numerous aminoglycosides, tetracycline and trimethoprim-sulfamethoxazole. It was also observed that 61.1% of the strains were carriers of plasmids. Our results underline that in the strains such as MRSA, which show multiple resistances to antibiotics, the antiseptics and disinfectants show great efficacy. Moreover, as other authors also suggest, for the treatment and prevention of infections caused by MRSA, the use of β-lactam and aminoglycoside antibiotics may be less effective.
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Affiliation(s)
- E Espigares
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - E Moreno Roldan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - M Espigares
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - R Abreu
- Department of Preventive Medicine and Public Health, University of La Laguna, Canary Islands, Spain
| | - B Castro
- University Hospital of Canary Islands, Tenerife Canary Islands, Spain
| | - A L Dib
- Laboratoire de Gestion de la Santé et Productions Animales-Institut des Sciences Vétérinaire El Khroub, Université des Frères Mentouri, Constantine, Algeria
| | - Á Arias
- Department of Preventive Medicine and Public Health, University of La Laguna, Canary Islands, Spain
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13
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Cuny C, Witte W. MRSA in equine hospitals and its significance for infections in humans. Vet Microbiol 2016; 200:59-64. [PMID: 26869097 DOI: 10.1016/j.vetmic.2016.01.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 11/18/2022]
Abstract
MRSA infections in equine clinics were reported from Northern America, Europe, Australia, and Japan. The majority of nosocomial infections in horses is obviously associated with particular MRSA clonal lineages. As already observed for epidemic MRSA in human hospitals more than 10 years ago, a dynamics of MRSA clonal lineages is also observed in European equine clinics: clonal lineages belonging to clonal complex (CC) 8 are on the retreat whereas MRSA attributed to CC398 become increasingly prevalent. The majority of CC398 isolates belong to a subpopulation which is particularly associated with equine hospitals as indicated by molecular typing. When emerging in equine clinics, MRSA from horses were also found as nasal colonizers of veterinary personnel. MRSA exhibiting the typing characteristics of MRSA known from equine clinics are obviously rare among MRSA from infections in humans. Although rare so far epidemic MRSA from human hospitals (HA-MRSA, e.g., ST22, ST225) have been isolated from nosocomial infections in horses and need particular attention in further surveillance.
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Affiliation(s)
- Christiane Cuny
- Robert Koch Institute, Wernigerode Branch Burgstrasse, 3738855 Wernigerode, Germany.
| | - Wolfgang Witte
- Robert Koch Institute, Wernigerode Branch Burgstrasse, 3738855 Wernigerode, Germany
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Mehraj J, Witte W, Akmatov MK, Layer F, Werner G, Krause G. Epidemiology of Staphylococcus aureus Nasal Carriage Patterns in the Community. Curr Top Microbiol Immunol 2016; 398:55-87. [PMID: 27370344 DOI: 10.1007/82_2016_497] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
Staphylococcus aureus (S. aureus) is a Gram-positive opportunistic pathogen that colonizes frequently and asymptomatically the anterior nares of humans and animals. It can cause different kinds of infections and is considered to be an important nosocomial pathogen. Nasal carriage of S. aureus can be permanent or intermittent and may build the reservoir for autogenous infections and cross-transmission to other individuals. Most of the studies on the epidemiology of S. aureus performed in the past were focused on the emergence and dissemination of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. There are, however, a number of more recent epidemiological studies have aimed at analysing carriage patterns over time in the community settings providing new insights on risk factors for colonization and important data for the development of strategies to prevent infections. This chapter aims to give a review of current epidemiological studies on S. aureus carriage patterns in the general community and put them into perspective with recent, yet unpublished, investigations on the S. aureus epidemiology in the general population in northern Germany.
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Affiliation(s)
- Jaishri Mehraj
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Brunswick, Germany.,Hannover Medical School, Hannover, Germany
| | - Wolfgang Witte
- The Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Brunswick, Germany.,TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Franziska Layer
- The Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Guido Werner
- The Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Brunswick, Germany. .,Hannover Medical School, Hannover, Germany.
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Cuny C, Abdelbary MMH, Köck R, Layer F, Scheidemann W, Werner G, Witte W. Methicillin-resistant Staphylococcus aureus from infections in horses in Germany are frequent colonizers of veterinarians but rare among MRSA from infections in humans. One Health 2015; 2:11-17. [PMID: 28616471 PMCID: PMC5441336 DOI: 10.1016/j.onehlt.2015.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/13/2015] [Accepted: 11/20/2015] [Indexed: 11/27/2022] Open
Abstract
A total of 272 methicillin-resistant Staphylococcus aureus (MRSA) from equine infections originating from 17 equine hospitals and 39 veterinary practices in Germany as well as 67 isolates from personnel working at equine clinics were subjected to molecular typing. The majority of isolates from horses was attributed to clonal complex (CC) 398 (82.7%). Within CC398, 66% of isolates belonged to a subpopulation (clade) of CC398, which is associated with equine clinics. MRSA attributed to CC8 (ST254, t009, t036, SCCmecIV; ST8, t064, SCCmecIV) were less frequent (16.5%). Single isolates were attributed to ST1, CC22, ST130, and ST1660. The emergence of MRSA CC22 and ST130 in horses was not reported so far. Nasal MRSA colonization was found in 19.5% of veterinary personnel with occupational exposure to horses. The typing characteristics of these isolates corresponded to isolates from equine infections. Comparing typing characteristics of equine isolates with those of a substantial number of isolates from human infections typed at the German Reference Center for Staphylococci and Enterococci (2006–2014; n = 10864) yielded that the proportion of isolates exhibiting characteristics of MRSA from equine medicine is very low (< 0.5%). As this low proportion was also found among MRSA originating from nasal screenings of human carriers not suffering from a staphylococcal infection (n = 5546) transmission of MRSA from equine clinics to the community seems to be rare so far.
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Affiliation(s)
- Christiane Cuny
- Robert Koch-Institute, German Reference Center for Staphylococci and Enterococci, Wernigerode, Burgstraße 37, 38855 Wernigerode, Germany
| | - Mohamed M H Abdelbary
- Robert Koch-Institute, German Reference Center for Staphylococci and Enterococci, Wernigerode, Burgstraße 37, 38855 Wernigerode, Germany
| | - Robin Köck
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149 Münster, Germany
| | - Franziska Layer
- Robert Koch-Institute, German Reference Center for Staphylococci and Enterococci, Wernigerode, Burgstraße 37, 38855 Wernigerode, Germany
| | - Wolfgang Scheidemann
- Tierärztliche Klinik für Pferde, Domäne Karthaus, Weddern 16c, 48249 Dülmen Dülmen, Germany
| | - Guido Werner
- Robert Koch-Institute, German Reference Center for Staphylococci and Enterococci, Wernigerode, Burgstraße 37, 38855 Wernigerode, Germany
| | - Wolfgang Witte
- Robert Koch-Institute, German Reference Center for Staphylococci and Enterococci, Wernigerode, Burgstraße 37, 38855 Wernigerode, Germany
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Cuny C, Wieler LH, Witte W. Livestock-Associated MRSA: The Impact on Humans. Antibiotics (Basel) 2015; 4:521-43. [PMID: 27025639 PMCID: PMC4790311 DOI: 10.3390/antibiotics4040521] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
During the past 25 years an increase in the prevalence of methicillin-resistant Staphylococcus aureus (HA-MRSA) was recorded worldwide. Additionally, MRSA infections may occur outside and independent of hospitals, caused by community associated MRSA (CA-MRSA). In Germany, we found that at least 10% of these sporadic infections are due to livestock-associated MRSA (LA-MRSA), which is initially associated with livestock. The majority of these MRSA cases are attributed to clonal complex CC398. LA-MRSA CC398 colonizes the animals asymptomatically in about half of conventional pig farms. For about 77%-86% of humans with occupational exposure to pigs, nasal carriage has been reported; it can be lost when exposure is interrupted. Among family members living at the same farms, only 4%-5% are colonized. Spread beyond this group of people is less frequent. The prevalence of LA-MRSA in livestock seems to be influenced by farm size, farming systems, usage of disinfectants, and in-feed zinc. LA-MRSA CC398 is able to cause the same kind of infections in humans as S. aureus and MRSA in general. It can be introduced to hospitals and cause nosocomial infections such as postoperative surgical site infections, ventilator associated pneumonia, septicemia, and infections after joint replacement. For this reason, screening for MRSA colonization at hospital admittance is recommended for farmers and veterinarians with livestock contacts. Intrahospital dissemination, typical for HA-MRSA in the absence of sufficient hygiene, has only rarely been observed for LA-MRSA to date. The proportion of LA-MRSA among all MRSA from nosocomial infections is about 3% across Germany. In geographical areas with a comparatively high density of conventional farms, LA-MRSA accounts for up to 10% of MRSA from septicemia and 15% of MRSA from wound infections. As known from comparative genome analysis, LA-MRSA has evolved from human-adapted methicillin-susceptible S. aureus, and the jump to livestock was obviously associated with several genetic changes. Reversion of the genetic changes and readaptation to humans bears a potential health risk and requires tight surveillance. Although most LA-MRSA (>80%) is resistant to several antibiotics, there are still sufficient treatment options.
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Affiliation(s)
- Christiane Cuny
- Robert Koch Institute,Wernigerode Branch, 38855 Wernigerode, Germany.
| | - Lothar H Wieler
- Robert Koch Institute, Main Institute, 13353 Berlin, Germany.
| | - Wolfgang Witte
- Robert Koch Institute,Wernigerode Branch, 38855 Wernigerode, Germany.
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Bonaccorsi P, Barattucci A, Papalia T, Criseo G, Faggio C, Romeo O. Pyrimidine-derived disulfides as potential antimicrobial agents: synthesis and evaluation in vitro. J Sulphur Chem 2015. [DOI: 10.1080/17415993.2015.1024679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Paola Bonaccorsi
- Dipartimento di Scienze Chimiche, Università degli Studi di Messina, viale F. Stagno d'Alcontres 31, vill. S. Agata, 98166 Messina, Italy
| | - Anna Barattucci
- Dipartimento di Scienze Chimiche, Università degli Studi di Messina, viale F. Stagno d'Alcontres 31, vill. S. Agata, 98166 Messina, Italy
| | - Teresa Papalia
- Dipartimento di Scienze del Farmaco e dei Prodotti per la Salute, Università degli Studi di Messina, Polo Universitario, viale SS. Annunziata, 98168 Messina, Italy
| | - Giuseppe Criseo
- Dipartimento di Scienze Biologiche e Ambientali, Università degli Studi di Messina, viale F. Stagno d'Alcontres 31, vill. S. Agata, 98166 Messina, Italy
| | - Caterina Faggio
- Dipartimento di Scienze Biologiche e Ambientali, Università degli Studi di Messina, viale F. Stagno d'Alcontres 31, vill. S. Agata, 98166 Messina, Italy
| | - Orazio Romeo
- Dipartimento di Scienze Biologiche e Ambientali, Università degli Studi di Messina, viale F. Stagno d'Alcontres 31, vill. S. Agata, 98166 Messina, Italy
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Oropharyngeal and nasal Staphylococcus aureus carriage by healthy children. BMC Infect Dis 2014; 14:723. [PMID: 25551464 PMCID: PMC4299802 DOI: 10.1186/s12879-014-0723-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/17/2014] [Indexed: 01/22/2023] Open
Abstract
Background As healthy children are the main reservoir of respiratory pathogens and the main cause of bacterial diffusion in the community, it could be interesting to investigate the type of screening that should be used during the early years of life in order to obtain a more precise estimate of Staphylococcus aureus circulation. The aim of this study was to evaluate oropharyngeal and nasal S. aureus carriage in otherwise healthy children and adolescents aged 6–17 years. Methods The oropharyngeal and nasal samples were collected in December 2013 from 497 healthy students attending five randomly selected schools in Milan, Italy, using an ESwab kit, and S. aureus was identified using the RIDA®GENE methicillin-resistant S. aureus (MRSA) system. Results Two hundred and sixty-four subjects (53.1%) were identified as S. aureus carriers: 129 (25.9%) oropharyngeal carriers and 195 (39.2%) nasal carriers, of whom 60 (12.1%) were both oropharyngeal and nasal carriers. Oropharyngeal carriage increased with age (p < 0.001), whereas nasal carriage decreased. There was little or no agreement between oropharyngeal and nasal carriage in any of the age groups. MRSA was identified in only three cases (0.6%), always in nasal samples. There were no differences between the carriers and non-carriers in terms of the distribution of age, gender, ethnicity, the number of siblings in the household, exposure to passive smoking, previous clinical history, allergic sensitisation, or previous influenza, pneumococcal and meningococcal vaccinations. The frequency of male children was higher among the subjects with positive nasal and oropharyngeal swabs (66.7%) than among those with positive oropharyngeal swabs alone (46.4%; p = 0.02). Conclusions The oropharyngeal carriage of mainly methicillin-sensitive S. aureus is frequent in otherwise healthy children, including a relatively high proportion of those without nasal colonisation. These findings highlight the importance of adding throat to nasal screening when monitoring the circulation of S. aureus in the community.
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Champion AE, Goodwin TA, Brolinson PG, Werre SR, Prater MR, Inzana TJ. Prevalence and characterization of methicillin-resistant Staphylococcus aureus isolates from healthy university student athletes. Ann Clin Microbiol Antimicrob 2014; 13:33. [PMID: 25085442 PMCID: PMC4362218 DOI: 10.1186/s12941-014-0033-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has been increasing in the general population, and there is concern that close or physical contact, such as in professional and collegiate sports, may increase spread of MRSA. We sought to determine the prevalence of MRSA colonization of male and female athletes from 9 different sports at a major, Division I University during a 12-week period, and determine the USA and SCCmec type from select isolates. METHODS Swabs for culture of MRSA were obtained from nasal, axillary, and inguinal sites from healthy, asymptomatic student athletes and support staff each week for 12 weeks. Select MRSA isolates were typed by pulsed field gel electrophoresis (PFGE), and the genes encoding for MecA, cassette chromosome recombinase (Ccr), and several toxins were determined by multiplex polymerase chain reaction (PCR). Discrepant results were clarified by multi-locus sequence typing (MLST) and spa typing. RESULTS Thirty-five percent (78/223) of test subjects were positive for MRSA during the study period, resulting in isolation of 139 MRSA isolates. However, 47% (37/78) of MRSA-positive participants carried MRSA in axillary or inguinal sites, but not in the anterior nares. There was significant correlation between MRSA carriage and participation in wrestling (76%, 19/25; adjusted odds ratio 29.7, 95% CI 5.8-151.5) and baseball (44%, 17/39; adjusted odds ratio 4.4, 95% CI 1.1- 17.4), compared with a staff prevalence of 18.1% (4/22), but other factors were not examined. Multiplex PCR analysis indicated that of the 32 isolates examined 26 could be typed, and all of these carried the SCCmec type IV cassette. PFGE typing identified USA types 300, 400, 500, 700, and 800. However, one isolate was not a known USA type, but was identified as a novel ST951 by MLST, and as spa type t216. Of the strains typed from the same individual, there was consistency, but also variation and alternation of the SCCmec and spa types isolated from individual subjects. Various staphylococcal toxin genes were identified in 31 of the 32 isolates analyzed. CONCLUSIONS Colonization by MRSA was greater in some student athletes than the average carriage rate for the general population, and only 53% of MRSA carriers were identified by nasal cultures. Carriage of MRSA clones on the same individual and transmission to contacts could vary over time, indicating colonization can be a dynamic process that may be difficult to control.
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Affiliation(s)
- Anna E Champion
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA.
| | - Thomas A Goodwin
- Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - P Gunnar Brolinson
- Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - Stephen R Werre
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA.
| | - M Renee Prater
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA. .,Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - Thomas J Inzana
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA. .,Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Life Sciences 1, 970 Washington St. SW, Blacksburg, VA, 24061, USA.
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