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Wozniak TM, Cuningham W, Buchanan S, Coulter S, Baird RW, Nimmo GR, Blyth CC, Tong SYC, Currie BJ, Ralph AP. Geospatial epidemiology of Staphylococcus aureus in a tropical setting: an enabling digital surveillance platform. Sci Rep 2020; 10:13169. [PMID: 32759953 PMCID: PMC7406509 DOI: 10.1038/s41598-020-69312-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/03/2020] [Indexed: 01/21/2023] Open
Abstract
Delivery of information to clinicians on evolving antimicrobial susceptibility needs to be accurate for the local needs, up-to-date and readily available at point of care. In northern Australia, bacterial infection rates are high but resistance to first- and second-line antibiotics is poorly described and currently-available datasets exclude primary healthcare data. We aimed to develop an online geospatial and interactive platform for aggregating, analysing and disseminating data on regional bacterial pathogen susceptibility. We report the epidemiology of Staphylococcus aureus as an example of the power of digital platforms to tackle the growing spread of antimicrobial resistance in a high-burden, geographically-sparse region and beyond. We developed an online geospatial platform called HOTspots that visualises antimicrobial susceptibility patterns and temporal trends. Data on clinically-important bacteria and their antibiotic susceptibility profiles were sought from retrospectively identified clinical specimens submitted to three participating pathology providers (96 unique tertiary and primary healthcare centres, n = 1,006,238 tests) between January 2008 and December 2017. Here we present data on S. aureus only. Data were available on specimen type, date and location of collection. Regions from the Australian Bureau of Statistics were used to provide spatial localisation. The online platform provides an engaging visual representation of spatial heterogeneity, demonstrating striking geographical variation in S. aureus susceptibility across northern Australia. Methicillin resistance rates vary from 46% in the west to 26% in the east. Plots generated by the platform show temporal trends in proportions of S. aureus resistant to methicillin and other antimicrobials across the three jurisdictions of northern Australia. A quarter of all, and up to 35% of methicillin-resistant S. aureus (MRSA) blood isolates in parts of the northern Australia were resistant to inducible-clindamycin. Clindamycin resistance rates in MRSA are worryingly high in regions of northern Australia and are a local impediment to empirical use of this agent for community MRSA. Visualising routinely collected laboratory data with digital platforms, allows clinicians, public health physicians and guideline developers to monitor and respond to antimicrobial resistance in a timely manner. Deployment of this platform into clinical practice supports national and global efforts to innovate traditional disease surveillance systems with the use of digital technology and to provide practical solutions to reducing the threat of antimicrobial resistance.
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Affiliation(s)
- T M Wozniak
- Menzies School of Health Research, Global & Tropical Health, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - W Cuningham
- Menzies School of Health Research, Global & Tropical Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - S Buchanan
- Menzies School of Health Research, Global & Tropical Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - S Coulter
- Queensland Health, Communicable Diseases Branch, Brisbane, Queensland, Australia
| | - R W Baird
- Territory Pathology, Northern Territory Government, Darwin, Northern Territory, Australia
| | - G R Nimmo
- Pathology Queensland Central Laboratory, Griffith University School of Medicine, Brisbane, Queensland, Australia
| | - C C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - S Y C Tong
- Menzies School of Health Research, Global & Tropical Health, Charles Darwin University, Darwin, Northern Territory, Australia.,Victorian Infectious Disease Service, The Royal Melbourne Hospital and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - B J Currie
- Menzies School of Health Research, Global & Tropical Health, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - A P Ralph
- Menzies School of Health Research, Global & Tropical Health, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Boan P, Tan HL, Pearson J, Coombs G, Heath CH, Robinson JO. Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study. BMC Infect Dis 2015; 15:10. [PMID: 25572896 PMCID: PMC4297412 DOI: 10.1186/s12879-014-0742-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022] Open
Abstract
Background Panton Valentine Leukocidin (PVL) has been associated with invasive Staphylococcus aureus soft tissue and pneumonic infections. Methods From September 2007 to January 2009 at Royal Perth Hospital we tested for the PVL gene in S. aureus isolates from an invasive site, a suspected PVL-related soft tissue infection and all MRSA isolates. We could access medical records for 141 PVL positive (PVL + ve) infections and compared these to a control group comprised of 148 PVL negative (PVL-ve) infections. Results In the PVL + ve group 62 isolates were MRSA (48 were ST93-MRSA-IV) and 79 isolates were methicillin-sensitive S. aureus, and in the PVL-ve group 56 were MRSA (50 were WA-MRSA strains) and 92 were methicillin-sensitive S. aureus. We found the presence of PVL to be significantly associated with younger age, aboriginality, intravenous drug use, community acquisition, shorter length of hospital stay and lower mortality at 1 year. Overall PVL + ve infections more often required surgical intervention (73.0% versus 44.6%, p < 0.001) and were less often polymicrobial (8.5% versus 41.2%, p < 0.001). PVL + ve isolates were more often susceptible to clindamycin (87.9% versus 73.0%, p = 0.002). Conclusions This study demonstrates that PVL + ve infections are associated with a distinct clinical picture, predominantly pyogenic skin and soft tissue infections often requiring surgery, disproportionately affecting patients who are younger, indigenous or with fewer health-care risk factors.
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Affiliation(s)
- Peter Boan
- Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia.
| | - Hui-Leen Tan
- Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. .,Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia.
| | - Julie Pearson
- Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. .,Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia.
| | - Geoffrey Coombs
- Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. .,Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia.
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia.
| | - James Owen Robinson
- Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. .,Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia.
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Abstract
BACKGROUND Pyomyositis, usually associated with tropical climates, occurs less commonly in temperate regions and is most often caused by Staphylococcus aureus. Several community-acquired methicillin-resistant S. aureus (CA-MRSA) clones have emerged in Queensland since the beginning of the century, and they now account for a significant proportion of invasive staphylococcal infection. This study aims to describe trends in the rate of presentation, and the clinical and diagnostic features of pyomyositis, and to determine if trends are attributed to the emergence of CA-MRSA or other factors. METHODS A 10-year retrospective cohort study of all patients presenting to Mater Children's Hospital in Brisbane, Queensland, with pyomyositis between July 2002 and July 2012, was conducted. Data were collected for clinical features, microbiology, diagnostic tests, management and outcome. Trends in incidence, and clinical and diagnostic features of pyomyositis were analyzed. RESULTS Thirty-four cases of pyomyositis were identified. There was a male predominance (79%), and the vertebro-pelvic muscles were most often affected. The rate of pyomyositis increased significantly during the study period from a rate of 2.04 cases per 10,000 emergency department admissions in the first quarter of the study, to 8.73 cases per 10,000 in the final quarter (peak rate 13.5 cases per 10,000 in 2008). A causative organism was identified in 22 cases, most commonly methicillin-susceptible S. aureus with CA-MRSA identified in 4 cases. Patients who required surgical intervention had longer hospital admission, longer time to resolution of inflammatory markers and a higher risk of complication at follow-up. CONCLUSION This study demonstrates an increasing incidence of pyomyositis in a temperate region, which is not attributable to the emergence of CA-MRSA. The reasons for this change in incidence are not clear.
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Williamson D, Coombs G, Nimmo G. Staphylococcus aureus ‘Down Under’: contemporary epidemiology of S. aureus in Australia, New Zealand, and the South West Pacific. Clin Microbiol Infect 2014; 20:597-604. [DOI: 10.1111/1469-0691.12702] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 12/31/2022]
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Nimmo GR, Bergh H, Nakos J, Whiley D, Marquess J, Huygens F, Paterson DL. Replacement of healthcare-associated MRSA by community-associated MRSA in Queensland: Confirmation by genotyping. J Infect 2013; 67:439-47. [DOI: 10.1016/j.jinf.2013.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/19/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
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Hayashi Y, Vaska VL, Baba H, Nimmo GR, Davis L, Paterson DL. Influenza-associated bacterial pathogens in patients with 2009 influenza A (H1N1) infection: impact of community-associated methicillin-resistant Staphylococcus aureus in Queensland, Australia. Intern Med J 2013; 42:755-60. [PMID: 21981384 DOI: 10.1111/j.1445-5994.2011.02602.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Secondary bacterial pneumonia due to community onset methicillin-resistant Staphylococcus aureus (MRSA) has become a highly publicised cause of influenza-associated death. There is a risk that case reports of fatal outcomes with post-influenza MRSA pneumonia may unduly influence antibiotic prescribing. AIMS The aim of this study was to demonstrate the incidence of community-onset MRSA pneumonia in 2009 H1N1 influenza patients. METHODS The microbiology records of patients positive for influenza A (H1N1) in 2009 were reviewed for positive blood or respiratory tract cultures and urinary pneumococcal antigen results within a Queensland database. Patients with such positive results within 48 h of hospital admission and a positive H1N1 influenza result in the prior 6 weeks were included. RESULTS In 2009, 4491 laboratory-confirmed pandemic influenza A (H1N1) infections were detected. Fifty patients (1.1% of the H1N1 cohort) who were hospitalised with H1N1 and who had a bacterial respiratory tract pathogen were identified. Streptococcus pneumoniae (16 patients; 32%), Staphylococcus aureus (13 patients; 26%) and Haemophilus influenzae (9 patients; 18%) were the most commonly cultured organisms. Of the cohort of 4491 patients, MRSA was detected in only two patients, both of whom were admitted to intensive care units and survived after prolonged admissions. CONCLUSIONS Influenza-associated community-onset MRSA pneumonia was infrequently identified in the 2009 H1N1 season in Queensland, despite community-onset MRSA skin and soft tissue infections being very common. Although post-influenza MRSA pneumonia is of great concern, its influence on empiric-prescribing guidelines should take into account its incidence relative to other secondary bacterial pathogens.
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Affiliation(s)
- Y Hayashi
- The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Australia.
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Marquess J, Hu W, Nimmo GR, Clements ACA. Spatial analysis of community-onset Staphylococcus aureus bacteremia in Queensland, Australia. Infect Control Hosp Epidemiol 2013; 34:291-8. [PMID: 23388364 DOI: 10.1086/669522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate and describe the relationship between indigenous Australian populations, residential aged care services, and community-onset Staphylococcus aureus bacteremia (SAB) among patients admitted to public hospitals in Queensland, Australia. DESIGN Ecological study. METHODS We used administrative healthcare data linked to microbiology results from patients with SAB admitted to Queensland public hospitals from 2005 through 2010 to identify community-onset infections. Data about indigenous Australian population and residential aged care services at the local government area level were obtained from the Queensland Office of Economic and Statistical Research. Associations between community-onset SAB and indigenous Australian population and residential aged care services were calculated using Poisson regression models in a Bayesian framework. Choropleth maps were used to describe the spatial patterns of SAB risk. RESULTS We observed a 21% increase in relative risk (RR) of bacteremia with methicillin-susceptible S. aureus (MSSA; RR, 1.21 [95% credible interval, 1.15-1.26]) and a 24% increase in RR with nonmultiresistant methicillin-resistant S. aureus (nmMRSA; RR, 1.24 [95% credible interval, 1.13-1.34]) with a 10% increase in the indigenous Australian population proportion. There was no significant association between RR of SAB and the number of residential aged care services. Areas with the highest RR for nmMRSA and MSSA bacteremia were identified in the northern and western regions of Queensland. CONCLUSIONS The RR of community-onset SAB varied spatially across Queensland. There was increased RR of community-onset SAB with nmMRSA and MSSA in areas of Queensland with increased indigenous population proportions. Additional research should be undertaken to understand other factors that increase the risk of infection due to this organism.
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Affiliation(s)
- John Marquess
- Centre for Healthcare Related Infection Surveillance and Prevention, Herston, Brisbane, Queensland, Australia
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Shallcross LJ, Fragaszy E, Johnson AM, Hayward AC. The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2013; 13:43-54. [PMID: 23103172 PMCID: PMC3530297 DOI: 10.1016/s1473-3099(12)70238-4] [Citation(s) in RCA: 293] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Invasive community-onset staphylococcal disease has emerged worldwide associated with Panton-Valentine leucocidin (PVL) toxin. Whether PVL is pathogenic or an epidemiological marker is unclear. We investigate the role of PVL in disease, colonisation, and clinical outcome. METHODS We searched Medline and Embase for original research reporting the prevalence of PVL genes among Staphylococcus aureus pneumonia, bacteraemia, musculoskeletal infection, skin and soft-tissue infection, or colonisation published before Oct 1, 2011. We calculated odds ratios (ORs) to compare patients with PVL-positive colonisation and each infection relative to the odds of PVL-positive skin and soft-tissue infection. We did meta-analyses to estimate odds of infection or colonisation with a PVL-positive strain with fixed-effects or random-effects models, depending on the results of tests for heterogeneity. RESULTS Of 509 articles identified by our search strategy, 76 studies from 31 countries met our inclusion criteria. PVL strains are strongly associated with skin and soft-tissue infections, but are comparatively rare in pneumonia (OR 0·37, 95% CI 0·22-0·63), musculoskeletal infections (0·44, 0·19-0·99), bacteraemias (0·10, 0·06-0·18), and colonising strains (0·07, 0·01-0·31). PVL-positive skin and soft-tissue infections are more likely to be treated surgically than are PVL-negative infections, and children with PVL-positive musculoskeletal disease might have increased morbidity. For other forms of disease we identified no evidence that PVL affects outcome. INTERPRETATION PVL genes are consistently associated with skin and soft-tissue infections and are comparatively rare in invasive disease. This finding challenges the view that PVL mainly causes invasive disease with poor prognosis. Population-based studies are needed to define the role of PVL in mild, moderate, and severe disease and to inform control strategies. FUNDING None.
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Affiliation(s)
- Laura J Shallcross
- Research Department of Infection and Population Health, University College London, London, UK.
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Nimmo G. USA300 abroad: global spread of a virulent strain of community-associated methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2012; 18:725-34. [DOI: 10.1111/j.1469-0691.2012.03822.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Panton-Valentine leukocidin-associated Staphylococcus aureus necrotizing pneumonia in infants: a report of four cases and review of the literature. Eur J Pediatr 2012; 171:711-7. [PMID: 22159957 DOI: 10.1007/s00431-011-1651-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
Abstract
Four children under 16 months of age presented within an 18-month period with severe, rapidly progressive Panton-Valentine leukocidin-associated ST93 Staphylococcus aureus necrotizing pneumonia. Two of the cases that required extracorporeal membranous oxygenation and proved fatal had poor prognostic features of leukopenia, rash and pulmonary haemorrhage. All four cases had recent contact with S. aureus infection in a family member. Reported cases of S. aureus necrotizing pneumonia in infants are reviewed, and approach to management is discussed.
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Tong SYC, Chen LF, Fowler VG. Colonization, pathogenicity, host susceptibility, and therapeutics for Staphylococcus aureus: what is the clinical relevance? Semin Immunopathol 2011; 34:185-200. [PMID: 22160374 DOI: 10.1007/s00281-011-0300-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 10/28/2011] [Indexed: 12/20/2022]
Abstract
Staphylococcus aureus is a human commensal that can also cause a broad spectrum of clinical disease. Factors associated with clinical disease are myriad and dynamic and include pathogen virulence, antimicrobial resistance, and host susceptibility. Additionally, infection control measures aimed at the environmental niches of S. aureus and therapeutic advances continue to impact upon the incidence and outcomes of staphylococcal infections. This review article focuses on the clinical relevance of advances in our understanding of staphylococcal colonization, virulence, host susceptibility, and therapeutics. Over the past decade key developments have arisen. First, rates of nosocomial methicillin-resistant S. aureus (MRSA) infections have significantly declined in many countries. Second, we have made great strides in our understanding of the molecular pathogenesis of S. aureus in general and community-associated MRSA in particular. Third, host risk factors for invasive staphylococcal infections, such as advancing age, increasing numbers of invasive medical interventions, and a growing proportion of patients with healthcare contact, remain dynamic. Finally, several new antimicrobial agents active against MRSA have become available for clinical use. Humans and S. aureus co-exist, and the dynamic interface between host, pathogen, and our attempts to influence these interactions will continue to rapidly change. Although progress has been made in the past decade, we are likely to face further surprises such as the recent waves of community-associated MRSA.
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Affiliation(s)
- Steven Y C Tong
- Division of Infectious Diseases and International Health, Duke University Medical Center, Box 102359, Durham, NC 27705, USA.
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Community-associated methicillin-resistant Staphylococcus aureus causing orbital cellulitis in Australian children. Pediatr Infect Dis J 2011; 30:1003-6. [PMID: 21681121 DOI: 10.1097/inf.0b013e318224fda5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Community-associated methicillin-resistant Staphylococcus aureus has only emerged recently as a cause of serious ocular infections in several different countries. At a tertiary pediatric hospital in Brisbane, Australia, community-associated methicillin-resistant S. aureus orbital cellulitis was first noted in 2009. Since then, it has caused 4 of 9 such infections.
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Edelstein M, Kearns A, Cordery R. Panton-Valentine Leukocidin associated Staphylococcus aureus infections in London, England: Clinical and socio-demographic characterisation, management, burden of disease and associated costs. J Infect Public Health 2011; 4:145-53. [DOI: 10.1016/j.jiph.2011.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 04/10/2011] [Accepted: 04/10/2011] [Indexed: 11/27/2022] Open
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Increases in Australian cutaneous abscess hospitalisations: 1999–2008. Eur J Clin Microbiol Infect Dis 2011; 31:93-6. [DOI: 10.1007/s10096-011-1281-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 04/18/2011] [Indexed: 01/11/2023]
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