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Preda M, Mihai MM, Popa LI, Dițu LM, Holban AM, Manolescu LSC, Popa GL, Muntean AA, Gheorghe I, Chifiriuc CM, Popa MI. Phenotypic and genotypic virulence features of staphylococcal strains isolated from difficult-to-treat skin and soft tissue infections. PLoS One 2021; 16:e0246478. [PMID: 33529240 PMCID: PMC7853507 DOI: 10.1371/journal.pone.0246478] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/19/2021] [Indexed: 12/04/2022] Open
Abstract
Chronic infections represent an important burden on the healthcare system and have a significant impact on the patients’ quality of life. While Staphylococcus spp. are commensal bacteria, they can become pathogenic, leading to various types of infections. In this study we aimed to characterize the virulence profiles of staphylococcal strains involved in difficult-to-treat skin and soft tissue infections, from both phenotypic and genotypic points of view. Phenotypic ability of the strains to secrete soluble virulence factors was assessed by a culturing dependent assay and their capacity to develop biofilms on inert substrate was screened by an adapted crystal violet microtiter method. We also tested the presence of several virulence genes by PCR. Most of the studied strains were isolated from purulent secretions of acne lesions and frequently secreted two or three soluble virulence factors. Most frequently secreted soluble virulence factors were caseinase (89%), lipase (71%) and lecithinase (67%). Almost half of the strains produced a well-represented biofilm. The molecular characterization showed the presence of the genes cna, hlg, clfA, and clfB. Staphylococcal strains that produce difficult-to-treat skin and soft tissue infections seem to be characterized by an enhanced ability to produce different soluble virulence factors and to develop biofilms in vitro. Further studies need to be developed in other Staphylococcus spp. infections in order to confirm this hypothesis.
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Affiliation(s)
- Mădălina Preda
- Department of Microbiology, Parasitology and Virology, Faculty of Midwives and Nursing, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania
- ‘Cantacuzino’ National Medico-Military Research and Development Institute, Bucharest, Romania
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania
- Department of Dermatology, ‘Elias’ University Emergency Hospital, Bucharest, Romania
- * E-mail: (MMM); (LIP)
| | - Laura Ioana Popa
- Department of Bioinformatics, The National Institute of Research and Development for Biological Sciences, Bucharest, Romania
- Research Institute of the University of Bucharest (ICUB), Bucharest, Romania
- * E-mail: (MMM); (LIP)
| | - Lia-Mara Dițu
- Research Institute of the University of Bucharest (ICUB), Bucharest, Romania
- Department of Microbiology, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Alina Maria Holban
- Research Institute of the University of Bucharest (ICUB), Bucharest, Romania
- Department of Microbiology, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Loredana Sabina Cornelia Manolescu
- Department of Microbiology, Parasitology and Virology, Faculty of Midwives and Nursing, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriela-Loredana Popa
- Department of Microbiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Irina Gheorghe
- Research Institute of the University of Bucharest (ICUB), Bucharest, Romania
- Department of Microbiology, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Carmen Mariana Chifiriuc
- Research Institute of the University of Bucharest (ICUB), Bucharest, Romania
- Department of Microbiology, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Mircea-Ioan Popa
- ‘Cantacuzino’ National Medico-Military Research and Development Institute, Bucharest, Romania
- Department of Microbiology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania
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Aryee A, Edgeworth JD. Carriage, Clinical Microbiology and Transmission of Staphylococcus aureus. Curr Top Microbiol Immunol 2016; 409:1-19. [PMID: 27097812 DOI: 10.1007/82_2016_5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Staphylococcus aureus is one of the most important bacterial pathogens in clinical practice and a major diagnostic focus for the routine microbiology laboratory. It is carried as a harmless commensal in up to two-thirds of the population at any one time predominantly not only in the anterior nares, but also in multiple other sites such as the groin, axilla, throat, perineum, vagina and rectum. It colonizes skin breach sites, such as ulcers and wounds, and causes superficial and deep skin and soft tissue infections and life-threatening deep seated infections particularly endocarditis and osteomyelitis. S. aureus is constantly evolving through mutation and uptake of mobile genetic elements that confer increasing resistance and virulence. Since the 1960s, hospitals have had to contend with emergence of methicillin-resistant S. aureus (MRSA) strains that spread better in hospitals than methicillin-susceptible S. aureus (MSSA) and are harder to treat. Since the 1980s, distinct community MRSA strains have also emerged that cause severe skin and respiratory infections. Conventional identification of MSSA and MRSA in the microbiology laboratory involves microscopy, culture and biochemical analysis that for most samples is straightforward but slow, taking at least 48 h. This delay has significant consequences for individual patient care and public health, through inadequate or excessive empiric antibiotic use, and failure to implement appropriate infection control measures for MRSA-colonized patients during those first 48 h. This unmet need has driven development of rapid molecular diagnostics that either complement or replace conventional culture techniques in the laboratory, or can be placed in the clinical environment as point-of-care (POC) devices. These new technologies provide results to clinicians anything from within an hour to 24 h, depending on sample and clinical setting, and should transform management of patients with S. aureus and other bacterial diseases; however, uptake is often slow due to the disruptive effect of new technologies, costs of transition and uncertainty of the optimal solution given successive advances. More evidence of the health economic, clinical and antimicrobial resistance benefit will help support introduction of these new technologies. Finally, preventing MRSA transmission has been a priority for healthcare organizations for many years. There have been significant recent reductions in transmission following local and national campaigns to re-enforce basic and heightened infection control interventions such as universal hand hygiene, barrier nursing, decolonization and isolation of MRSA-colonized patients detected through routine culture or screening policies. Developments in whole genome sequencing are providing greater insight into reservoirs and routes of transmission that should help better target interventions to ensure sustainable control of endemic strains and to identify and prevent emergence of new strains.
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Affiliation(s)
- Anna Aryee
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's and St. Thomas' NHS Foundation Trust, 5th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jonathan D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's and St. Thomas' NHS Foundation Trust, 5th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK.
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Rukumani DV, Kamar AA, Ardita DR, Nee TS, Yusof YM, Sekaran SD, Shankar EM. Recalcitrant coagulase‐negative methicillin‐sensitive Staphylococcus aureus in an extremely low‐birth‐weight pre‐term infant with thrombocytopaenia. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.004242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Devi V. Rukumani
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Azanna A. Kamar
- Neonatology Unit, Department of Paediatrics, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Dewi R. Ardita
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Tang S. Nee
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Yasim M. Yusof
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Shamala D. Sekaran
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Esaki M. Shankar
- Tropical Infectious Disease Research and Education Center (TIDREC), Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
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Abstract
Bacteriological analysis of milk samples from quarters of a dairy cow suffering from subclinical mastitis yielded two isolates of Staphylococcus aureus which gave a negative reaction in the standard coagulase test. Both isolates were also clumping factor and thermonuclease negative, and gave a negative reaction in the Staphaurex® test. The isolates were identified by using commercial biochemical systems, and by PCR analysis of different staphylococcal cell surface protein and exoprotein genes. Further molecular identification of the isolates, which included sequencing of the 16S rRNA gene and RT-PCR of coagulase (coa), clumping-factor (clfA) and thermonuclease (nuc) genes, was consistent with the diagnosis phenotypically 'coagulase-negative variant of Staph. aureus'. The fact that coagulase-negative Staph. aureus variants can occur in the context of intramammary infections in cattle may result in the incorrect diagnosis 'coagulase-negative staphylococci (CNS)' in routine mastitis diagnostic, at least in rare cases. To fully ensure correct species diagnosis, sequencing of the 16S rRNA gene and amplification of specific genes such as coa is necessary in these cases.
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Krasuski A, Michnowska-Swincow E, Jarzembowski T. Cytidine deamination assay to differentiate Staphylococcus aureus from other staphylococci. Lett Appl Microbiol 2007; 45:497-503. [PMID: 17868316 DOI: 10.1111/j.1472-765x.2007.02218.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Adoption of the property of cytidine (cytosine-beta-d-riboside) deamination in staphylococci to distinguish Staphylococcus aureus from other staphylococci. METHODS AND RESULTS A total of 560 staphylococcal strains were examined. The test demonstrated a sensitivity of 97.1% and a specificity of 98.8%. Of the 249 S. aureus strains (115 oxacillin-resistant) 58 strains were coagulase-negative S. aureus and another 16 strains were clumping factor-negative S. aureus. The 74 deficient S. aureus strains were identified by 16S rRNA gene sequencing and further investigated by spa typing and 13 spa types were found. CONCLUSIONS The cytidine deaminase test (CDT) is useful especially for distinguishing coagulase- and clumping factor-negative S. aureus from other staphylococci and the results correlated well with 16S rRNA sequencing and the polymerase chain reaction (PCR) amplification of the nuc gene. SIGNIFICANCE AND IMPACT OF THE STUDY Cytidine deamination assay differentiates S. aureus from other staphylococci. This method is fast (6 h) and reliable in distinguishing between non-S. aureus and the defective (coagulase-negative, clumping factor-negative) S. aureus isolates which could have major consequences for therapy.
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Affiliation(s)
- A Krasuski
- Department of Medical Microbiology, Medical University of Gdańsk, Do Studzienki 38, Gdańsk, Poland.
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Garbacz K, Piechowicz L, Galiński J. [Characteristics of clumping factor- and protein A-negative methicillin-resistant Staphylococcus aureus identified in Poland]. Med Mal Infect 2006; 36:469-72. [PMID: 17011150 DOI: 10.1016/j.medmal.2006.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/21/2006] [Indexed: 10/24/2022]
Abstract
AIM The aim of this study was to investigate the phenotypic and genotypic properties of clumping factor- and protein A- negative MRSA. METHODS Two hundred ninety-four strains were studied. The production of protein A was determined by immunoblotting, clumping factor (CF) and coagulase by conventional tests with rabbit plasma. The presence of nuc gene and mecA gene was identified by PCR. The presence of clfA and spa genes was determined for CF- and protein A-negative strains and then phage typing was performed using two sets of phages and gene typing by RFLP of the spa gene. RESULTS Sixteen (5.4%) CF- and protein A-negative MRSA were isolated. All of them produced coagulase and thermostable nuclease (except for one). nuc, mecA, spa and clfA genes were observed in all strains. The same RLFP pattern, but with different phage types and resistance profiles to antibiotics, was observed in all strains. CONCLUSIONS CF- and protein A-negative methicillin resistant S. aureus isolated in Poland do not come from a single clone and the absence of CF and protein A is not caused by the deletion of clfA and spa genes.
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Affiliation(s)
- K Garbacz
- Institut de Microbiologie Médicale de l'Académie de Médecine de Gdańsk, 38, ul. Do Studzienki, 80-227 Gdańsk, Pologne.
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Smole SC, Aronson E, Durbin A, Brecher SM, Arbeit RD. Sensitivity and specificity of an improved rapid latex agglutination test for identification of methicillin-sensitive and -resistant Staphylococcus aureus isolates. J Clin Microbiol 1998; 36:1109-12. [PMID: 9542948 PMCID: PMC104700 DOI: 10.1128/jcm.36.4.1109-1112.1998] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The performance of a second-generation rapid agglutination kit, Slidex Staph Plus (SSP; bioMérieux), was compared to those of the Slidex Staph (SS; bioMérieux), Staphaurex (SRX; Murex Diagnostics), and BBL Staphyloslide (BBL; Becton Dickinson) kits by using 508 clinical isolates composed of 150 methicillin-sensitive Staphylococcus aureus (MSSA) organisms, 154 methicillin-resistant S. aureus (MRSA) organisms, and 204 non-S. aureus Staphylococcus spp. Of the 508 isolates tested, 75% were fresh clinical isolates, with the remainder taken from five different freezer collections. All four agglutination tests had comparable sensitivities for MSSA and MRSA. However, the SS kit was significantly less specific (93.1%) than the three other tests (P > 0.05, McNemar test). These results demonstrate that the new rapid latex agglutination kit, SSP, was more specific for the identification of S. aureus than the previous version and performed comparably to the SRX and BBL kits.
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Affiliation(s)
- S C Smole
- Department of Medicine, Boston University School of Medicine, Boston Veterans Affairs Medical Center, Massachusetts 02130, USA
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Zbinden R, Müller F, Brun F, von Graevenitz A. Detection of clumping factor-positive Staphylococcus lugdunensis by Staphaurex Plus®. J Microbiol Methods 1997. [DOI: 10.1016/s0167-7012(97)00090-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mahoudeau I, Delabranche X, Prevost G, Monteil H, Piemont Y. Frequency of isolation of Staphylococcus intermedius from humans. J Clin Microbiol 1997; 35:2153-4. [PMID: 9230402 PMCID: PMC229923 DOI: 10.1128/jcm.35.8.2153-2154.1997] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We collected 3,397 consecutive isolates of coagulase-positive staphylococci from various specimens of hospitalized patients. All were retrospectively classified as Staphylococcus aureus, except two which were identified as S. intermedius: one isolated from the nasal flora of a healthy carrier and the other isolated from pleural fluid, probably as a sample contaminant.
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Affiliation(s)
- I Mahoudeau
- Institut de Bactériologie, Faculté de Médecine, Université Louis Pasteur, Strasbourg, France
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Personne P, Bes M, Lina G, Vandenesch F, Brun Y, Etienne J. Comparative performances of six agglutination kits assessed by using typical and atypical strains of Staphylococcus aureus. J Clin Microbiol 1997; 35:1138-40. [PMID: 9114395 PMCID: PMC232717 DOI: 10.1128/jcm.35.5.1138-1140.1997] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Six commercial agglutination tests designed for the identification of Staphylococcus aureus were compared by using a strain collection which included 512 staphylococci representing 33 species (318 isolates of Staphylococcus aureus [including 144 oxacillin resistant], 46 S. epidermidis isolates, 15 S. haemolyticus isolates, 12 S. saprophyticus isolates, 29 S. schleiferi isolates, 30 S. lugdunensis isolates, and 62 other coagulase-negative staphylococci). This group also included a proportion of strains with unusual phenotypes (e.g., 19 coagulase-negative S. aureus isolates, 26 clumping factor-negative S. aureus isolates, and 4 S. aureus isolates each with a double deficiency). The overall sensitivity for identification of typical and atypical S. aureus was high with the Staphaurex Plus test (Murex Biotech) (99.7%), the Pastorex Staph Plus test (Sanofi Diagnostics Pasteur) (99.7%), and the Slidex Staph Plus test (bioMérieux) (100%). The overall rate of specificity was affected by the unusual inclusion in this study of a high proportion of non-S. aureus species, such as S. lugdunensis and S. schleiferi, which express a clumping factor and therefore produce a positive result with the agglutination tests.
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Affiliation(s)
- P Personne
- Centre National de Référence des Staphylocoques, UPRES EA1655, Faculté de Médecine, Lyon, France
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Kampf G, Weist K, Swidsinski S, Kegel M, Rüden H. Comparison of screening methods to identify methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1997; 16:301-7. [PMID: 9177964 DOI: 10.1007/bf01695635] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Screening methods to identify methicillin-resistant Staphylococcus aureus (MRSA) were compared using 96 isolates representing 17 distinct clones. The sensitivity of four commercial agglutination tests was determined in comparison to the tube coagulation test, and the results related to the presence of the coagulase gene. The broth screening test, agar dilution test and disc diffusion test were carried out, and the results related to the presence of the mecA gene. Mannitol salt agar and Iso-Sensitest agar with varying salt supplements were used. All agglutination tests had high rates of detection of Staphylococcus aureus (95.8-99.0%). Resistance in mecA gene-positive Staphylococcus aureus isolates was correctly detected by the oxacillin broth test, the agar dilution test and the disc diffusion test on mannitol salt agar, whereas on Iso-Sensitest agar detection rates were lower (between 68.5% and 94.4%, depending on the salt supplement). Incubation of the Iso-Sensitest plates for 48 hours significantly improved the rate of detection of resistance, but increased the major error rate up to 71.4%. MecA gene-positive Staphylococcus aureus isolates not detected by the disc diffusion test on Iso-Sensitest agar had significantly lower oxacillin minimal inhibitory concentration values and were significantly less resistant to a variety of antibiotics. Thus, mannitol salt agar might be a suitable medium for use in the disc diffusion and agar dilution test to detect resistance to oxacillin in Staphylococcus aureus.
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Affiliation(s)
- G Kampf
- Institut für Hygiene, Freie Universität Berlin, Germany
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Vandenesch F, Célard M, Arpin D, Bes M, Greenland T, Etienne J. Catheter-related bacteremia associated with coagulase-positive Staphylococcus intermedius. J Clin Microbiol 1995; 33:2508-10. [PMID: 7494062 PMCID: PMC228460 DOI: 10.1128/jcm.33.9.2508-2510.1995] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We report a case of catheter-related bacteremia in a 63-year-old patient caused by Staphylococcus intermedius. Clinical resolution of the infection was obtained after removal of the intravenous device and antibiotic treatment. This observation emphasizes the risk of confusion between S. intermedius and Staphylococcus aureus if only a coagulase test is done.
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Affiliation(s)
- F Vandenesch
- Département de Recherche en Bactériologie Médicale (EA 1655), Faculté de Médecine Alexis Carrel, Lyon, France
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