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Kumari R, Rathi R, Pathak SR, Dalal V. Computational investigation of potent inhibitors against YsxC: structure-based pharmacophore modeling, molecular docking, molecular dynamics, and binding free energy. J Biomol Struct Dyn 2023; 41:930-941. [PMID: 34913841 DOI: 10.1080/07391102.2021.2015446] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In S. aureus, ribosome biogenesis GTP-binding (YsxC), a GTPase interacts with 50S subunit and 30S subunit of ribosome, and β' subunit of RNA polymerase and played an important role in protein synthesis. For the identification of potent lead molecules, we have conducted pharmacophore modeling by consideration of pharmacophore features of GTP among YsxC-GTP complex. Virtual screening and molecular docking results displayed that five pharmacokinetic and ADMET filtered molecules-ZINC000006424138, ZINC000095502032, ZINC000225415132, ZINC000095475800, and ZINC000012990761-had higher binding affinities than GTP with YsxC. All the identified molecules shared similar pharmacophore features of GTP and were stabilized via hydrogen bonds and hydrophobic interactions with YsxC. Molecular dynamics analysis revealed that YsxC-inhibitor(s) complexes were lesser dynamics and higher stable than YsxC-GTP complex. Molecular Mechanics/Poisson-Boltzmann Surface Area (MMPBSA) results confirmed that identified molecules bound at the active site (Arg33, Ser34, Asn35, Val36, Lys38, Ser39, Thr40, Thr54, Ser55, Pro58, Lys60, Thr61, Thr144, Lys145, Ser178, and Ile179) of YsxC and formed the lower energy (-190.32 ± 3.46 to -217.03 ± 2.55 kJ/mol) complexes than YsxC-GTP (-157.16 ± 2.89 kJ/mol) complex. The identified molecules in this study can be further tested and utilized to design novel antimicrobial agents for S. aureus.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Reena Kumari
- Department of Mathematics and Statistics, Swami Vivekanand Subharti University, Meerut, India
| | - Ravi Rathi
- Amity School of Applied Sciences, Amity University Haryana, Haryana, India
| | - Seema R Pathak
- Amity School of Applied Sciences, Amity University Haryana, Haryana, India
| | - Vikram Dalal
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
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Singh V, Dhankhar P, Dalal V, Tomar S, Golemi-Kotra D, Kumar P. Drug-Repurposing Approach To Combat Staphylococcus aureus: Biomolecular and Binding Interaction Study. ACS OMEGA 2022; 7:38448-38458. [PMID: 36340146 PMCID: PMC9631409 DOI: 10.1021/acsomega.2c03671] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/04/2022] [Indexed: 05/15/2023]
Abstract
Staphylococcus aureus is considered as one of the most widespread bacterial pathogens and continues to be a prevalent cause of mortality and morbidity across the globe. FmtA is a key factor linked with methicillin resistance in S. aureus. Consequently, new antibacterial compounds are crucial to combat S. aureus resistance. Here, we present the virtual screening of a set of compounds against the available crystal structure of FmtA. The findings indicate that gemifloxacin, paromomycin, streptomycin, and tobramycin were the top-ranked potential drug molecules based on the binding affinity. Furthermore, these drug molecules were analyzed with molecular dynamics simulations, which showed that the identified molecules formed highly stable FmtA-inhibitor(s) complexes. Molecular mechanics Poisson-Boltzmann surface area and quantum mechanics/molecular mechanics calculations suggested that the active site residues (Ser127, Lys130, Tyr211, and Asp213) of FmtA are crucial for the interaction with the inhibitor(s) to form stable protein-inhibitor(s) complexes. Moreover, fluorescence- and isothermal calorimetry-based binding studies showed that all the molecules possess dissociation constant values in the micromolar scale, revealing a strong binding affinity with FmtAΔ80, leading to stable protein-drug(s) complexes. The findings of this study present potential beginning points for the rational development of advanced, safe, and efficacious antibacterial agents targeting FmtA.
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Affiliation(s)
- Vishakha Singh
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Roorkee, Roorkee247667, India
| | - Poonam Dhankhar
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Roorkee, Roorkee247667, India
| | - Vikram Dalal
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Roorkee, Roorkee247667, India
| | - Shailly Tomar
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Roorkee, Roorkee247667, India
| | - Dasantila Golemi-Kotra
- Department
of Biology, York University, 4700 Keele Street, TorontoM3J 1P3, Ontario, Canada
| | - Pravindra Kumar
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Roorkee, Roorkee247667, India
- ; . Tel.: +91-1332-286286
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Dalal V, Dhankhar P, Singh V, Singh V, Rakhaminov G, Golemi-Kotra D, Kumar P. Structure-Based Identification of Potential Drugs Against FmtA of Staphylococcus aureus: Virtual Screening, Molecular Dynamics, MM-GBSA, and QM/MM. Protein J 2021; 40:148-165. [PMID: 33421024 DOI: 10.1007/s10930-020-09953-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/15/2022]
Abstract
Staphylococcus aureus is resistant to β-lactam antibiotics and causes several skin diseases to life-threatening diseases. FmtA is found to be one of the main factors involved in methicillin resistance in S. aureus. FmtA exhibits an esterase activity that removes the D-Ala from teichoic acid. Teichoic acids played a significant role in cell wall synthesis, cell division, colonization, biofilm formation, virulence, antibiotic resistance, and pathogenesis. The virtual screening of drug molecules against the crystal structure of FmtA was performed and the binding affinities of top three molecules (ofloxacin, roflumilast, and furazolidone) were predicted using molecular docking. The presence of positive potential and electron affinity regions in screened drug molecules by DFT analysis illustrated that these molecules are reactive in nature. The protein-ligand complexes were subjected to molecular dynamics simulation. Molecular dynamics analysis such as RMSD, RMSF, Rg, SASA, PCA, and FEL results suggested that FmtA-drug(s) complexes are stable. MM-GBSA binding affinity and QM/MM results (ΔG, ΔH, and ΔS) revealed that active site residues (Ser127, Lys130, Tyr211, Asp213, and Asn343) of FmtA played an essential for the binding of the drug(s) to form a lower energy stable protein-ligand complexes. FmtAΔ42 was purified using cation exchange and gel filtration chromatography. Fluorescence spectroscopy and circular dichroism results showed that interactions of drugs with FmtAΔ42 affect the tertiary structure and increase the thermostability of the protein. The screened molecules need to be tested and could be further modified to develop the antimicrobial compounds against S. aureus.
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Affiliation(s)
- Vikram Dalal
- Department of Biotechnology, IIT Roorkee, Roorkee, Uttrakhand, 247667, India
| | - Poonam Dhankhar
- Department of Biotechnology, IIT Roorkee, Roorkee, Uttrakhand, 247667, India
| | - Vishakha Singh
- Department of Biotechnology, IIT Roorkee, Roorkee, Uttrakhand, 247667, India
| | - Vishakha Singh
- Department of Biotechnology, IIT Roorkee, Roorkee, Uttrakhand, 247667, India
| | - Gaddy Rakhaminov
- Department of Biology, York University, 4700 Keele Street, Toronto, Canada
| | | | - Pravindra Kumar
- Department of Biotechnology, IIT Roorkee, Roorkee, Uttrakhand, 247667, India.
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Community-based cluster of methicillin-resistant Staphylococcus aureus in Manitoba. Can J Infect Dis 2011; 12:149-52. [PMID: 18159332 DOI: 10.1155/2001/136953] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/1999] [Accepted: 06/22/2000] [Indexed: 11/17/2022] Open
Abstract
A community-based, single strain cluster of methicillin-resistant Staphylococcus aureus (MRSA) is described. The cluster of cases was identified in a small rural community in southwestern Manitoba, although some spread of the MRSA strain to neighbouring communities was observed. The majority of people were otherwise healthy, had no contact with the hospital system and did not fit the profile of those at risk for MRSA infection.
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Kim BN. Oral Agents for the Treatment of Orthopedic Infections Caused by Methicillin-resistant Staphylococci. Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.4.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Baek-Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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6
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Chaibenjawong P, Foster SJ. Desiccation tolerance in Staphylococcus aureus. Arch Microbiol 2010; 193:125-35. [PMID: 21088825 DOI: 10.1007/s00203-010-0653-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/22/2010] [Accepted: 11/05/2010] [Indexed: 12/20/2022]
Abstract
Staphylococcus aureus is a multidrug-resistant pathogen that not only causes a diverse array of human diseases, but also is able to survive in potentially dry and stressful environments, such as the human nose, on skin and on inanimate surfaces such as clothing and surfaces. This study investigated parameters governing desiccation tolerance of S. aureus and identified several components involved in the process. Initially, the role of environmental parameters such as temperature, growth phase, cell density, desiccation time and protectants in desiccation tolerance were determined. This established a robust model of desiccation tolerance in which S. aureus has the ability to survive on dry plastic surfaces for more than 1,097 days. Using a combination of a random screen and defined mutants, clpX, sigB and yjbH were identified as being required for desiccation tolerance. ClpX is a part of the ATP-dependent ClpXP protease, important for protein turnover, and YjbH has a proposed linked function. SigB is an accessory sigma factor with a role in generalized stress resistance. Understanding the molecular mechanisms that govern desiccation tolerance may determine the break points to be exploited to prevent the spread of this dangerous pathogen in hospitals and communities.
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Affiliation(s)
- Plykaeow Chaibenjawong
- Department of Molecular Biology and Biotechnology, Krebs Institute, University of Sheffield, Sheffield S10 2TN, UK
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Esposito S, Leone S, Petta E, Noviello S, Ianniello F. Treatment options for skin and soft tissue infections caused by meticillin-resistant Staphylococcus aureus:oralvs.parenteral; home vs. hospital. Int J Antimicrob Agents 2009; 34 Suppl 1:S30-5. [PMID: 19560673 DOI: 10.1016/s0924-8579(09)70547-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although meticillin-resistant Staphylococcus aureus (MRSA) is recognized as a significant cause of nosocomial infections, it is also becoming an increasingly common cause of infections in the community. Overall, the most common infections caused by MRSA are those involving the skin and skin structures. These infections are difficult to treat and are associated with high morbidity and substantial cost. This article summarizes the current oral and parenteral therapeutic options, of which there are several, and the optimal site of care for the management of these infections. Defining the severity of the illness is central to improving the decision-making process about the route of administration and site of care.
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Affiliation(s)
- Silvano Esposito
- Department of Infectious Diseases, Second University of Naples, Naples, Italy.
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Enoch D, Karas J, Aliyu S. Oral antimicrobial options for the treatment of skin and soft-tissue infections caused by meticillin-resistant Staphylococcus aureus (MRSA) in the UK. Int J Antimicrob Agents 2009; 33:497-502. [DOI: 10.1016/j.ijantimicag.2008.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 10/01/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
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The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus. J Infect Public Health 2008; 1:78-100. [PMID: 20701849 DOI: 10.1016/j.jiph.2008.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 10/03/2008] [Accepted: 10/06/2008] [Indexed: 11/23/2022] Open
Abstract
Healthcare workers may acquire methicillin-resistant Staphylococcus aureus (MRSA) from patients, both hospital and home environments, other healthcare workers, family and public acquaintances, and pets. There is a consensus of case reports and series which now strongly support the role for MRSA-carrying healthcare personnel to serve as a reservoir and as a vehicle of spread within healthcare settings. Carriage may occur at a number of body sites and for short, intermediate, and long terms. A number of approaches have been taken to interrupt the linkage of staff-patient spread, but most emphasis has been placed on handwashing and the treatment of staff MRSA carriers. The importance of healthcare workers in transmission has been viewed with varying degrees of interest, and several logistical problems have arisen when healthcare worker screening is brought to the forefront. There is now considerable support for the screening and treatment of healthcare workers, but it is suggested that the intensity of any such approach must consider available resources, the nature of the outbreak, and the strength of epidemiological associations. The task of assessing healthcare personnel carriage in any context should be shaped with due regard to national and international guidelines, should be honed and practiced according to local needs and experience, and must be patient-oriented.
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Barnes TA, Jinks A. Meticillin-resistant Staphylococcus aureus: the modern-day challenge. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2008; 17:1012-1018. [PMID: 19062453 DOI: 10.12968/bjon.2008.17.16.31066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
There are numerous resistant microorganisms but meticillin-resistant Staphylococcus aureus (MRSA) is probably the most notorious. MRSA is a resistant variation of the common bacterium, Staphylococcus aureus, that has developed the ability to survive treatment with a number of beta-lactam antibiotics, including meticillin. The focus of this article is a narrative literature review concerning the challenge that MRSA presents to nurses and other healthcare workers. A historical overview of antimicrobial resistance and the origins of MRSA are given, together with the factors involved in the persistence of antimicrobial resistance. The relevant microbiology, pathogenesis and epidemiology of MRSA will be discussed to provide a detailed rationale for the contemporary management of this persistent, resistant organism.
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11
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Andersen BM, Rasch M, Syversen G. Is an increase of MRSA in Oslo, Norway, associated with changed infection control policy? J Infect 2008; 55:531-8. [PMID: 18029021 DOI: 10.1016/j.jinf.2007.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 09/13/2007] [Accepted: 09/15/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The objective was to describe the prevalence of MRSA in Oslo, Norway, before and after introduction of a new National MRSA Control Guideline. METHODS From 1993 to 2006, we prospectively collected clinical and microbiological data on all MRSA cases in Oslo, Norway. Two MRSA guidelines; a strict Ullevål Standard MRSA Guideline and a less strict National MRSA Control Guideline were compared. RESULTS During 1993-2006, 358 MRSA cases were registered in Oslo; 43.9% detected in Ullevål University Hospital, 21.2% in nursing homes, and 18.7% in primary healthcare. One out of three (30.4%) were import-associated, and one out of ten (11.2%) were healthcare personnel. From 2004 on, a new National MRSA Control Guideline was introduced in primary healthcare, served by the community infection control. From 2004 on, there was a 4-6-fold increase of MRSA in primary healthcare (p = 0.038) and nursing homes (p = 0.005). Increase of MRSA cases at Ullevål (p < 0.001) was import-associated or from outbreaks in primary healthcare. There was no increase of internal spread in the hospital. CONCLUSION These data indicate that perhaps a less strict national MRSA infection control guideline in Norway may be associated with the 4-6-fold increase of MRSA cases in the community after 2003.
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Affiliation(s)
- Bjørg Marit Andersen
- aDepartment of Hospital Infections, Ullevål University Hospital, 0407 Oslo, Norway.
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12
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Fan X, Liu Y, Smith D, Konermann L, Siu KWM, Golemi-Kotra D. Diversity of penicillin-binding proteins. Resistance factor FmtA of Staphylococcus aureus. J Biol Chem 2007; 282:35143-52. [PMID: 17925392 DOI: 10.1074/jbc.m706296200] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Antibiotic-resistant Staphylococcus aureus is a major concern to public health. Methicillin-resistant S. aureus strains are completely resistant to all beta-lactams antibiotics. One of the main factors involved in methicillin resistance in S. aureus is the penicillin-binding protein, PBP2a. This protein is insensitive to inactivation by beta-lactam antibiotics such as methicillin. Although other proteins are implicated in high and homogeneous levels of methicillin resistance, the functions of these other proteins remain elusive. Herein, we report for the first time on the putative function of one of these proteins, FmtA. This protein specifically interacts with beta-lactam antibiotics forming covalently bound complexes. The serine residue present in the sequence motif Ser-X-X-Lys (which is conserved among penicillin-binding proteins and beta-lactamases) is the active-site nucleophile during the formation of acyl-enzyme species. FmtA has a low binding affinity for beta-lactams, and it experiences a slow acylation rate, suggesting that this protein is intrinsically resistant to beta-lactam inactivation. We found that FmtA undergoes conformational changes in presence of beta-lactams that may be essential to the beta-lactam resistance mechanism. FmtA binds to peptidoglycan in vitro. Our findings suggest that FmtA is a penicillin-binding protein, and as such, it may compensate for suppressed peptidoglycan biosynthesis under beta-lactam induced cell wall stress conditions.
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Affiliation(s)
- Xin Fan
- Department of Chemistry, York University, Toronto, Ontario M3J 1P3, Canada
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Jensen JUS, Jensen ET, Larsen AR, Meyer M, Junker L, Rønne T, Skov R, Jepsen OB, Andersen LP. Control of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a day-care institution. J Hosp Infect 2006; 63:84-92. [PMID: 16542758 DOI: 10.1016/j.jhin.2005.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 10/18/2005] [Indexed: 11/25/2022]
Abstract
This article describes an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in two institutions for multi-handicapped children in Copenhagen. The aim of the study was to determine whether it was possible to eradicate MRSA in a setting with multi-handicapped children and staff where there was a high degree of physical interaction. This was a prospective interventional uncontrolled cohort study that took place from January 2003 to March 2005. All individuals in close contact with the two institutions and/or in close contact with an MRSA-colonized subject from the outbreak were included in the study: 38 children, 60 staff members and 12 close relatives of colonized subjects. Infection control measures included screening all individuals. When MRSA infection or colonization was found, an attempt was made to eradicate MRSA, staff education was undertaken and attempts were made to determine the route of transmission. Eleven individuals were found to be positive for MRSA (10.0%). All isolates were identical by pulsed-field gel electrophoresis and harboured the staphylococcal cassette chromosome mec (SCCmec) type IV. All colonized and infected individuals were associated with a single room in one of the institutions. MRSA was eradicated from all the colonized and infected subjects. This study shows that it is possible to control an MRSA outbreak in institutions for multi-handicapped children where there is a high degree of physical contact.
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Affiliation(s)
- J-U S Jensen
- Department of Clinical Microbiology 9301, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Howden BP, Grayson ML. Dumb and Dumber--The Potential Waste of a Useful Antistaphylococcal Agent: Emerging Fusidic Acid Resistance in Staphylococcus aureus. Clin Infect Dis 2006; 42:394-400. [PMID: 16392088 DOI: 10.1086/499365] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 10/16/2005] [Indexed: 11/03/2022] Open
Abstract
Fusidic acid has activity against a range of pathogens but has mainly been used to treat staphylococcal infections. Fusidic acid monotherapy, especially topical preparations, has been strongly associated with the emergence of fusidic acid resistance among both methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus. Key resistance determinants include mutations in the fusA gene, which encodes elongation factor G, and plasmid-mediated resistance (i.e., acquisition of resistance gene fusB). Clonal outbreaks of fusidic acid-resistant S. aureus have been noted throughout the United Kingdom and Europe, such that the efficacy of fusidic acid is threatened. Fusidic acid in combination with other agents, such as rifampicin, has proven effective for difficult-to-treat MRSA infections and provides a convenient oral alternative to oxazolidinones. Ensuring that systemic fusidic acid is always used in combination and that the use of topical fusidic acid is either abolished or restricted will be vital if we are to prevent the loss of this potentially useful agent.
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Affiliation(s)
- Benjamin P Howden
- Infectious Diseases Department, Austin Health, Heidelberg, Victoria, 3084, Australia
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15
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Ringberg H, Cathrine Petersson A, Walder M, Hugo Johansson PJ. The throat: an important site for MRSA colonization. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2006; 38:888-93. [PMID: 17008233 DOI: 10.1080/00365540600740546] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In order to evaluate the value of bacterial cultures taken from the throat, 266 patients with MRSA were retrospectively assessed. At the time when MRSA was first detected in the patient, the most frequent sites positive for MRSA were a skin lesion (110 patients, 41%), the anterior nares (109 patients, 41%), and the throat (102 patients, 38%). In 26%, 17%, and 17% of the patients, a skin lesion, the anterior nares, and the throat, respectively, were the only site where MRSA was seen. In 123 patients cultured for MRSA because of a close contact with an already known MRSA patient, 65 patients (53%) were positive for MRSA in their throat and in 40 patients (33%), throat was the only sample site with MRSA at the time when the patient was found to be MRSA positive. 146 of the 266 patients (55%) were colonized with MRSA in the throat any time throughout the period they were MRSA positive. We conclude that throat is an important reservoir for MRSA and that samples taken from the throat should be included in screening patients for MRSA.
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Affiliation(s)
- Håkan Ringberg
- Regional Centre for Communicable Disease Control, Skåne County, Lund University Hospital, Lund, Sweden
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16
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Gould IM. The clinical significance of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2005; 61:277-82. [PMID: 16216384 DOI: 10.1016/j.jhin.2005.06.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Accepted: 06/07/2005] [Indexed: 11/27/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for the largest outbreak of hospital-acquired infection (HAI) that the world has ever seen. It is not replacing methicillin-susceptible S. aureus (MSSA), but seems largely to be an additional burden of HAI with double the mortality of MSSA infections, at least in the bacteraemic form. It is often highly transmissible and carriage seems to lead to clinical infection much more frequently than with MSSA carriage. Additional screening for MRSA needs to be performed, not only to establish the size of the problem and to allow initiation of decolonization measures to prevent the onset of clinical disease, but also to allow implementation of infection control precautions that will be necessary to control the epidemic. MRSA is a huge clinical burden that is causing great public and political concern. Current treatments are suboptimal. Control measures are likely to be effective and cost saving if they have a broad enough base, and should be implemented without further delay.
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Affiliation(s)
- I M Gould
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, UK.
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17
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18
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Johnson AP, Pearson A, Duckworth G. Surveillance and epidemiology of MRSA bacteraemia in the UK. J Antimicrob Chemother 2005; 56:455-62. [PMID: 16046464 DOI: 10.1093/jac/dki266] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Surveillance of bacteraemia caused by methicillin-resistant Staphylococcus aureus (MRSA) in the UK has involved collection of data from hospital microbiology laboratories via several mechanisms, including a voluntary reporting scheme that has been operational in England and Wales since 1989 and mandatory reporting schemes that have been running independently in England, Wales, Scotland and Northern Ireland since 2001. In addition, surveillance schemes involving panels of participating sentinel laboratories that submit isolates for centralized susceptibility testing, such as the Bacteraemia Resistance Surveillance Programme run by the BSAC, have also been established. Each of these data sources have particular advantages, but they also have their individual limitations, with the result that they each give an incomplete picture if considered in isolation. However, by pooling the findings from these different but complementary surveillance programmes, a much more comprehensive and credible picture of the problem posed by MRSA is produced. These schemes have shown both a dramatic rise in the total numbers of cases of S. aureus bacteraemia reported annually and an increase in the proportion of such cases that involve MRSA (from 2% in 1990 to >40% in the early 2000s), although the most recent data indicate a slight reversal of these trends. Characterization of isolates of MRSA shows a marked temporal relationship between the rise in MRSA bacteraemias and the emergence and spread of two strains of epidemic MRSA, EMRSA-15 and EMRSA-16. Surveillance and control of MRSA infection continue to be high profile and further developments to the mandatory surveillance system in England are likely in the near future.
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Affiliation(s)
- Alan P Johnson
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, Communicable Disease Surveillance Centre, HPA Centre for Infections, Colindale, London NW9 5EQ, UK.
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Wang JT, Chen YC, Yang TL, Chang SC. Molecular epidemiology and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus in Taiwan. Diagn Microbiol Infect Dis 2002; 42:199-203. [PMID: 11929692 DOI: 10.1016/s0732-8893(01)00351-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has become an important nosocomial pathogen and has increased frequency in the past 20 years. It is highly transmissible between wards, hospitals, and cities. In most major hospitals in Taiwan, MRSA accounts for more than 60% of the S. aureus isolates. Whether there is a predominant strain, which is spread over the whole of Taiwan has not yet been studied. We collected 208 sequential clinical isolates of MRSA from 22 hospitals: seven in northern Taiwan, seven in western Taiwan, five in southern Taiwan, and three in eastern Taiwan during a three-month period in 1998. Using pulsed-field gel electrophoresis, 112 MRSA isolates were shown to belong to one major type,--type C, and this type was shown to have spread widely across all of Taiwan. Ninety-six isolates belonged to 20 other minor types. Most MRSA isolates of this major type were multi-drug resistant and only susceptible to vancomycin and rifampin. We concluded that the high prevalence of MRSA in Taiwan was partly due to the spreading of a predominant strain and most of them were multi-drug resistant. This might imply that more effort should be made to control the spread of MRSA in Taiwan.
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Affiliation(s)
- Jann-Tay Wang
- Section of Infectious diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Tronel H, Huc B, Bertrand X, Thouverez M, Marchal A, Talon D. Aspects épidémiologiques de Staphylococcus aureus résistant à la méticilline dans un centre hospitalier de taille moyenne. Med Mal Infect 2002. [DOI: 10.1016/s0399-077x(02)00359-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Scudeller L, Leoncini O, Boni S, Navarra A, Rezzani A, Verdirosi S, Maserati R. MRSA carriage: the relationship between community and healthcare setting. A study in an Italian hospital. J Hosp Infect 2000; 46:222-9. [PMID: 11073732 DOI: 10.1053/jhin.2000.0806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
From May 1997 to June 1998, all patients admitted to the study institution were screened at entry for MRSA carriage (both colonization and infection). Eighty-six MRSA carriers were identified; of these, 85 were nasal carriers. Risk factors were compared to those of 86 controls. Although the vast majority of both carriers and controls had at least one previous hospital stay, carriers were less likely than controls to be referred from a community setting, and had resided within the community for a shorter time before the current admission. The number of underlying conditions was comparable in the two groups, but those infected were more likely to have cancer than the controls. While community-acquired MRSA carriage is rare, exposure to a health care setting (particularly if repeated) within six months from the current admission, is a risk factor for MRSA carriage and introduction of the organism into an institution.
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Affiliation(s)
- L Scudeller
- IRCCS Policlinico San Matteo, Istituto di Clinica delle Malattie Infettive, Pavia
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22
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Stone SP. Soil, seed and climate: developing a strategy for prevention and management of infections in UK nursing homes. J Hosp Infect 1999; 43 Suppl:S29-38. [PMID: 10658756 DOI: 10.1016/s0195-6701(99)90063-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Most studies of nursing home (NH) infections come from the USA and very few from the UK. USA studies lead us to anticipate a rate of 7 infections per 1000 patient days with a point prevalence as high as 16% in UK NH residents. Pneumonia, skin and urine infections would be the most frequent, followed by enteric infection and bacteraemia. Colonization with resistant organisms is increasing in UK NH residents (e.g., MRSA in 4-17%). Surveillance studies are needed in UK NHs to report incidence of infection, residents' characteristics, existence of and adherence to above standards and policies. Trials of effectiveness of different infection control programmes and of NH vs hospital management are required. Management of infection may be a useful marker of quality of care in NHs and therefore of interest to health and local authorities.
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Affiliation(s)
- S P Stone
- Health Services for Elderly People, Royal Free Hospital, London
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Cox RA, Bowie PE. Methicillin-resistant Staphylococcus aureus colonization in nursing home residents: a prevalence study in Northamptonshire. J Hosp Infect 1999; 43:115-22. [PMID: 10549311 DOI: 10.1053/jhin.1999.0633] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A prevalence study of methicillin-resistant Staphylococcus aureus (MRSA) colonization was carried out in 17 nursing homes in Northamptonshire over a 20-month period. Thirteen of 275 residents swabbed (4.7%) were found to be colonized and six of the 17 homes (35%) had colonized residents. Only two homes had more than one colonized resident. Individual risk factors for colonization were gender (male) and the presence of skin ulcers and sores. There were no significant risk factors identified for homes. Spread may have occurred in the two homes which had more than one colonized resident. Both these homes had the epidemic strain EMRSA-15 whereas three of the four homes with a single colonized resident had EMRSA-16. It is suggested that homes with residents colonized with EMRSA-16 may be able to prevent spread by adherence to good infection control procedures but that this may not be adequate to prevent spread of EMRSA-15.
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Affiliation(s)
- R A Cox
- Department of Medical Microbiology, Kettering General Hospital NHS Trust, Northants
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24
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Whitby M. Fusidic acid in the treatment of methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 1999; 12 Suppl 2:S67-71. [PMID: 10528788 DOI: 10.1016/s0924-8579(98)00075-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The emergence of MRSA in the 1960s coincided with the introduction of fusidic acid. Since that time, the antibiotic has been widely used against this organism, both in the 1960s and 1970s and against the more modern multi-resistant version of the 1980s and 1990s. Although showing potent in vitro activity, experimental in vivo and in vitro investigations have demonstrated disappointing results. Clinical efficacy has been demonstrated in a series of small studies and case reports, particularly when fusidic acid is used in combination for the treatment of MRSA carriage. Given the widespread use of fusidic acid against MRSA, published evidence supporting its efficacy is limited and does not support the use of the agent as monotherapy.
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Affiliation(s)
- M Whitby
- Department of Infectious Diseases, Infection Control and Sexual Health, Princess Alexandra Hospital, Brisbane, Qld, Australia.
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25
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Urdez-Hernández E, Sifuentes-Osornio J, Calva JJ, Villalobos-Zapata Y. Epidemiological and biological characteristics of methicillin-resistant staphylococcal infections in a Mexican hospital. Arch Med Res 1999; 30:325-31. [PMID: 10573636 DOI: 10.1016/s0188-0128(99)00031-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) has spread worldwide since 1960. However, there is little information concerning methicillin-resistant coagulase-negative staphylococci (MRCNS) infections. METHODS In order to study the clinical and epidemiological characteristics of methicillin-resistant staphylococci (MRS) infections and to determine the relationship between MRS and both synergistic hemolysis (SH) and slime production (SP), a laboratory-based survey and non-matched case-control study were carried out at a tertiary-care center in Mexico City. In regard to patients, from May 1991 to October 1992, 46 cases of MRS infection and 86 patients (controls) infected by methicillin-susceptible staphylococci (MSS) were included. Clinical and epidemiologic variables were analyzed. The isolates were identified and tested for antimicrobial susceptibility by standard methods. An MIC of oxacillin > or = 8 micrograms/mL was defined as an MRS. RESULTS During the study, 94 nosocomial staphylococcal infections were diagnosed: S. aureus, 35 and CNS, 59; 43 (45.7%) by MRS (rate of MRS infections was 1.12 per 100 in-patients); 2 MRSA; 41 MRCNS, and only 19 were symptomatic. Three infections were community-acquired, including one MRSA and two MRCNS. After multivariate analysis, the significant risk factors were previous antimicrobial therapy (p = 0.013) and catheter-related (p = 0.009) and urinary-tract source (p = 0.0001). Forty-nine percent of MRS showed SH while only 15% of MSS (p < 0.001) showed SH, especially in 10/10 MR-S. hemolyticus. Additionally, 48% of MRCNS showed SP, as did 18% of MSCNS (p = 0.019), particularly in 15/20 MR-S. epidermidis. Of all MRS isolates, 38% showed a homogeneous phenotype, a trait associated with multi-drug resistance (p < 0.01) and SH (p < 0.001). CONCLUSIONS CNS predominated as the cause of MRS infections in our setting. The homogenous phenotype was associated with SH and multi-drug resistance.
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Affiliation(s)
- E Urdez-Hernández
- Departamento de Enfermedades Infecciosas, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F., Mexico
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Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of nosocomial infections. Healthcare professionals in the United States should develop programs to prevent transmission of this organism within their institutions. Aggressive control efforts are justified for several reasons: (1) the incidence of nosocomial MRSA reflects the general effectiveness of infection control practice; (2) MRSA do not replace susceptible strains but instead increase the overall rate of nosocomial S. aureus infections; (3) MRSA infections cause substantial morbidity and mortality; (4) serious MRSA infections must be treated with vancomycin. Thus, in hospitals with high rates of MRSA, use of this antimicrobial agent increases, which in turn may increase the risk for selecting vancomycin-resistant enterococci. Hospitals have used numerous different approaches to control nosocomial spread of MRSA. Staff should choose a control method based on the prevalence of MRSA in their institution and in their referring facilities, the rate of nosocomial transmission of MRSA in their hospital, the risk factors present in their patient population, the reservoirs and modes of transmission specific to their hospital, and their resources. Any MRSA control plan must stress adherence to basic infection control measures, such as hand washing and contact isolation precautions. In addition, decolonization of patients and staff, control of antimicrobial use, surveillance cultures, and molecular typing may be helpful adjuncts.
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Affiliation(s)
- L A Herwaldt
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242-1081, USA
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Perry C. Three major issues in infection control. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 1998; 7:946-8, 950, 952. [PMID: 9830905 DOI: 10.12968/bjon.1998.7.16.5607] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In considering the three major issues in infection control the author decided upon education and empowerment, community practices, and research availability and application as they span a range of infection control practices and healthcare settings. Education and empowerment of staff is needed to ensure safe practice. This requires collaboration between education providers and infection control personnel and should be available to all disciplines of staff. Infection control needs to be seamless across the primary and secondary care interface and must include infection prevention advice to the population in general. Evidence relating to infection control is either lacking or not achievable. When it is available, it is not always implemented because of lack of resources.
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Affiliation(s)
- C Perry
- Southmead Health Services (NHS) Trust
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Abstract
Increasing numbers of elderly people are being treated in hospitals and are at particular risk of acquiring infections. The incidence, risk factors and types of hospital-acquired infection (HAI) in the elderly are reviewed. Special reference is made to urinary tract infections, respiratory tract infections, gastrointestinal infections including Clostridium difficile, bacteraemia, skin and soft tissue infections and infections with antibiotic-resistant organisms.
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Affiliation(s)
- M E Taylor
- Public Health Laboratory, Withington Hospital, West Didsbury, Manchester, UK
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Namnyak S, Adhami Z, Wilmore M, Keynes H, Hampton K, Mercieca E, Roker K. Methicillin-resistant Staphylococcus aureus: a questionnaire and microbiological survey of nursing and residential homes in Barking, Havering and Brentwood. J Infect 1998; 36:67-72. [PMID: 9515672 DOI: 10.1016/s0163-4453(98)93234-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The study determined the policies and procedures for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) and its prevalence among nursing and residential homes, and evaluated whether certain home characteristics such as bed size, staffing level, and type of home are related to the prevalence of MRSA. A 21-questionnaire survey, with primarily categorical responses, was mailed to the home managers of all the 121 nursing and residential homes in the district, following which a simple, stratified random sample of 28 (23.14%) homes was taken and all agreeing residents screened from multiple sites for MRSA. Seventy-seven (63.6%) homes returned a completed questionnaire, 13 (46.4%) of whom agreed to participate in the microbiological study. The response rates for returning questionnaires and agreeing to participate in the microbiological study were similar for nursing and residential homes (65% vs. 60%; 67% vs. 40%; P = 0.12; P = 0.62), respectively. Nursing homes had a mean bed size of 30 (95% Confidence Interval (CI) 17-43), not significantly different from residential homes of 23 (95% CI 18-27; P = 0.26). The nursing homes employed a mean of 8.6 (95% CI 4.7-12.5) staff nurses per home; significantly higher than residential homes with a mean of 1.6 (95% CI 0.3-2.8; P = 0.006). No significant differences in mean number of home care assistants employed per home (22.8; 95% CI 12.4-33.13; and 14.4; 95% CI 11.83-16.90; P = 0.098, for nursing and residential homes, respectively) were observed. None of the homes had employed infection control practitioners. Only four (6.8%) of the responding homes stated that MRSA was a problem. Nursing homes were not significantly more likely to have admission policies for colonized person than residential homes (10/13 vs. 40/55, P = 1.00). Of the fifty-five (71.4%) homes who had admission policies, 40 (72.7%) stated that persons colonized/infected with MRSA would not be accepted, while 12 (21.8%) would accept such persons in single-room isolation and/or barrier nursing. Greater proportions of residential homes than nursing homes would not accept admission of persons with documented MRSA colonization (30/35 vs. 4/10, P = 0.007). Four (9.1%) homes (three nursing) had identified a total of five residents colonized/infected with MRSA in 5 years prior to the survey. Two hundred and forty-six residents were screened (552 sites), two (0.81%) of whom were found to be colonized in the nose (one resident) and in the groin (two residents) with MRSA, giving a 2-month weighted point prevalence rate of 0.14% (95% CI 0.01-0.26%). We conclude that in our district the nursing staffing levels and control measures vary widely within these homes, while the prevalence of residents who are colonized/infected with MRSA is lower than in other areas. We suggest that the exclusion admission policy for MRSA positive patients should be abandoned and targeted infection control programmes be instituted.
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Affiliation(s)
- S Namnyak
- Barking and Havering Health Authority, and Department of Medical Microbiology, Havering Hospitals NHS Trust, Harold Wood Hospital, Romford, UK
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30
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Chambers HF. Methicillin resistance in staphylococci: molecular and biochemical basis and clinical implications. Clin Microbiol Rev 1997; 10:781-91. [PMID: 9336672 PMCID: PMC172944 DOI: 10.1128/cmr.10.4.781] [Citation(s) in RCA: 607] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Methicillin resistance in staphylococci is determined by mec, composed of 50 kb or more of DNA found only in methicillin-resistant strains. mec contains mecA, the gene for penicillin-binding protein 2a (PBP 2a); mecI and mecR1, regulatory genes controlling mecA expression; and numerous other elements and resistance determinants. A distinctive feature of methicillin resistance is its heterogeneous expression. Borderline resistance, a low-level type of resistance to methicillin exhibited by strains lacking mecA, is associated with modifications in native PBPs, beta-lactamase hyperproduction, or possibly a methicillinase. The resistance phenotype is influenced by numerous factors, including mec and beta-lactamase (bla) regulatory elements, fem factors, and yet to be identified chromosomal loci. The heterogeneous nature of methicillin resistance confounds susceptibility testing. Methodologies based on the detection of mecA are the most accurate. Vancomycin is the drug of choice for treatment of infection caused by methicillin-resistant strains. PBP 2a confers cross-resistance to most currently available beta-lactam antibiotics. Investigational agents that bind PBP 2a at low concentrations appear promising but have not been tested in humans. Alternatives to vancomycin are few due to the multiple drug resistances typical of methicillin-resistant staphylococci.
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Affiliation(s)
- H F Chambers
- Medical Service, San Francisco General Hospital 94143, USA.
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31
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van Belkum A, van Leeuwen W, Verkooyen R, Saçilik SC, Cokmus C, Verbrugh H. Dissemination of a single clone of methicillin-resistant Staphylococcus aureus among Turkish hospitals. J Clin Microbiol 1997; 35:978-81. [PMID: 9157167 PMCID: PMC229715 DOI: 10.1128/jcm.35.4.978-981.1997] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A collection of 39 methicillin-resistant Staphylococcus aureus (MRSA) stains derived from six different hospitals in Ankara and one hospital in Barsa, Turkey, were analyzed by multiple genotyping. In agreement with the other genotyping assays, pulsed-field gel electrophoresis of DNA macrorestriction fragments identified genetic homogeneity among all MRSA isolates studies. It is concluded that a major clone of MRSA has spread through a large part of Turkey, causing longitudinally persistent colonization in all of the institutions surveyed.
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Affiliation(s)
- A van Belkum
- Department of Medical Microbiology & Infectious Diseases, University Hospital Rotterdam, The Netherlands.
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Johnson Z, Fitzpatrick P, Hayes C, Sayers G, Pelly H, McDonnell B, Thornton L, Buttimer J. National survey of MRSA: Ireland, 1995. J Hosp Infect 1997; 35:175-84. [PMID: 9093916 DOI: 10.1016/s0195-6701(97)90205-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The objective of this survey was to obtain an indication of the size of the methicillin-resistant Staphylococcus aureus (MRSA) problem in Ireland prior to introducing national MRSA control guidelines. A survey of all microbiology laboratories in Ireland was carried out over two weeks in Spring 1995. For patients from whom MRSA was isolated during the study period standard demographic and clinical data were requested and period prevalence/1000 discharges was calculated. All 45 microbiology laboratories surveyed responded. MRSA was isolated from 448 patients during the two-week period. The period prevalence of MRSA was 16.5/1000 discharges. Males aged > or = 65 had the highest rate (50/1000 discharges). Half of all isolates were from patients in surgical or medical wards, but 4% were from community-based sources such as GPs, nursing homes and hospices. Thirty-two percent of MRSA patients were infected rather than colonized. MRSA is clearly a significant problem in Ireland. While it is largely a hospital problem at present, the increasing trend towards day procedures and shorter hospital stay means that infection will increase in the community.
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Affiliation(s)
- Z Johnson
- Health Information Unit, Eastern Health Board, Dublin, Ireland
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Lepelletier D, Regnier B, Richet H. Contrôle des infections à germes multirésistants dans les hôpitaux français à travers la surveillance du Staphylococcus aureus résistant à la méticilline (SARM). Med Mal Infect 1997. [DOI: 10.1016/s0399-077x(97)80016-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hobson RP, MacKenzie FM, Gould IM. An outbreak of multiply-resistant Klebsiella pneumoniae in the Grampian region of Scotland. J Hosp Infect 1996; 33:249-62. [PMID: 8864938 DOI: 10.1016/s0195-6701(96)90011-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A predominantly hospital-based outbreak of multiply-resistant Klebsiella pneumoniae capsular type K2 (MRK) expressing expanded spectrum betalactamase (ESBL) activity and fully sensitive only to the carbapenems and amikacin is described. The organism was isolated from 283 patients between March 1992 and September 1995. The outbreak started in the intensive care unit (ICU) of a major acute hospital and spread through surgical wards, a medical ward, a geriatric unit in a separate hospital and various other local hospitals. Environmental screening revealed extensive ward contamination. The decline of the outbreak after the spring of 1995 coincided with the re-emphasis of standard infection control procedures and the launch of a works programme aimed at addressing underlying sites of environmental contamination. Of the 283 cases, 166 (59.0%) were detected through a specially instigated case finding programme. The MRK caused 11 cases of septicaemia, two postoperative intra-abdominal abscesses, one case of postoperative meningitis, 102 cases of urinary tract infection and 28 wound infections and was isolated from the respiratory tracts of five patients with ventilator associated pneumonia. The difficulty in controlling the outbreak is ascribed to heavy environmental contamination, frequent inter- and intra-hospital patient transfers and prolonged carriage of the outbreak strain.
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Affiliation(s)
- R P Hobson
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, UK
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35
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Phillips E, Young T. Methicillin-resistant Staphylococcus aureus and wound management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 1995; 4:1345-9. [PMID: 8696106 DOI: 10.12968/bjon.1995.4.22.1345] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing in the UK. MRSA is mainly transmitted via the hands of health-care workers. MRSA can cause colonization or infections. MRSA infections can be fatal.
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