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Wang WY, Chen YH, Lee YL, Chiu CF, Tsao SM. Comparative Analysis of Two Commercial Automated Systems with Agar Dilution for Oxacillin Susceptibility and Their Association with Genotypes of Invasive Staphylococcus aureus Isolates (2011-2021). Infect Drug Resist 2024; 17:1121-1129. [PMID: 38525473 PMCID: PMC10961015 DOI: 10.2147/idr.s445211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Background Determining oxacillin susceptibility using reference methods and automated systems is crucial for treating invasive infections caused by Staphylococcus aureus. This study compares the oxacillin susceptibility results from the two automated systems with agar dilution and correlates them with genotypes of invasive S. aureus. Methods Non-duplicate S. aureus invasive isolates were collected over an 11-year period. The oxacillin susceptibility was determined with Phoenix 100 (Jan 2011 to Aug 2018) or Vitek 2 (Sep 2018 to Dec 2021), and susceptibility for oxacillin and cefoxitin was determined with agar dilution. Methicillin-resistant S. aureus (MRSA) was confirmed with mecA existence, and the genotype was determined using SCCmec. The association between genotype and antibiotic susceptibility using two automated systems and agar dilution was evaluated. Results A total of 842 invasive S. aureus, including 443 mecA+ MRSA and 399 mecA- MSSA, were collected. The susceptibility rates of oxacillin determined by two automated systems and agar dilution were 68.8% (76.8% for Phoenix 100 and 57.6% for Vitek 2) and 54.0%, respectively. When compared with the oxacillin susceptibility using agar dilution, the categorical agreement for Phoenix 100 and Vitek 2 were 0.46% and 0.88%, respectively (p < 0.001). One hundred and forty-three isolates were misinterpreted as oxacillin-susceptible S. aureus (OSSA) using automated systems while comparing with agar dilution, among which molecularly community-associated MRSA (CA-MRSA) outnumbered healthcare-associated MRSA (HA-MRSA) (99 vs 34, p < 0.001). There were 70 mecA+ OSSA (OS-MRSA) using agar dilution, among which 42 harbored SCCmec types were predominantly categorized as CA-MRSA (38, p < 0.001). Conclusion The categorical agreement of Vitek 2 in determining oxacillin susceptibility and predicting mecA existence is comparable with agar dilution, whereas Phoenix 100 is not. Most of those ORSA determined by agar dilution but misinterpreted as OSSA by automated systems and OS-MRSA are categorized as CA-MRSA.
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Affiliation(s)
- Wei-Yao Wang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Hsin Chen
- Department of Nephrology, Taichung Tzu Chi Hospital, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Artificial Intelligence and Data Science, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Lin Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chen-Feng Chiu
- Department of Internal Medicine, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Shih-Ming Tsao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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2
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Alidrisi DA, Alharthi W, Alfawaz T. Invasive Community-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA) Infection in Children: A Report of Five Cases and Literature Review. Cureus 2023; 15:e37974. [PMID: 37223206 PMCID: PMC10202042 DOI: 10.7759/cureus.37974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Staphylococcus aureus developed resistance against most antibiotics; the most known resistant form is methicillin-resistant Staphylococcus aureus (MRSA), which can be acquired either from healthcare facilities or the community. The prevalence of hospital-acquired MRSA is higher than community-acquired MRSA (CA-MRSA). CA-MRSA has become an emerging infection and has been increasingly reported recently. Usually, CA-MRSA presents with skin and soft tissue infection but can cause severe invasive infection with significant morbidity. Invasive CA-MRSA needs rapid and aggressive treatment to prevent complications. For MRSA bacteremia that is persistent despite appropriate treatment, the possibility of metastatic invasive infection should be thought of. In this case series, we describe five pediatric cases of different age groups that had different presentations for invasive CA-MRSA infection. This report aims to highlight that physicians should be aware of the growing role of CA-MRSA in pediatrics; they should be meticulous in treating patients with CA-MRSA, and be aware of the complications of this disease and the appropriate empiric and target antibiotics regimen for such infections.
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Affiliation(s)
- Dhuha A Alidrisi
- Pediatric Infectious Diseases, Security Forces Hospital Makkah, Makkah, SAU
| | - Waad Alharthi
- Pediatric Infectious Diseases, King Fahad Specialist Hospital, Dammam, SAU
| | - Tariq Alfawaz
- Pediatric Infectious Diseases, King Fahad Medical City, Riyadh, SAU
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Panton-Valentine leukocidin-positive novel sequence type 5959 community-acquired methicillin-resistant Staphylococcus aureus meningitis complicated by cerebral infarction in a 1-month-old infant. J Infect Chemother 2020; 27:103-106. [PMID: 32988732 DOI: 10.1016/j.jiac.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/22/2022]
Abstract
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has become a pathogen of major importance in pediatric patients. CA-MRSA can cause skin and soft tissue infection in children and young active adults with no predisposing factors, and life-threatening infections such as meningitis or necrotizing pneumonia have been reported. We report here a case of CA-MRSA meningitis complicated by acute left middle cerebral artery (MCA) infarction and necrotizing pneumonia in a previously healthy 1-month-old Vietnamese boy. He was firstly treated with vancomycin, but changed to linezolid because of persistent fever and low vancomycin trough level. He recovered successfully with residual right-sided hemiparesis. The mode of transmission of CA-MRSA and the mechanism of cerebral infarction (thrombotic or embolic) were unknown. The isolate was genotyped as staphylococcal cassette chromosome (SCC) mec type V with a novel sequence type (ST) 5959 harboring the Panton-Valentine leukocidin (PVL) gene. ST 5959 is a double locus variant of ST 59, which is a major PVL-positive CA-MRSA strain isolated in invasive disease in Asian countries. This case report may serve as a warning about the dissemination of PVL-positive CA-MRSA in and around Japan, with the possibility of causing serious life-threatening disease. The potential of linezolid for the treatment of MRSA meningitis as one of the alternative MRSA therapeutic drugs is also discussed.
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Comparison of molecular epidemiology of bloodstream methicillin-resistant Staphylococcus aureus isolates between a new and an old hospital in central Taiwan. Int J Infect Dis 2018; 79:162-168. [PMID: 30528665 DOI: 10.1016/j.ijid.2018.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To compare the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolates between an old, urban hospital and a new, rural hospital over the same time period. METHODS The molecular characteristics of 398 MRSA bloodstream isolates collected between 2007 and 2013 from two hospitals in Taiwan were analyzed retrospectively; 202 isolates were from the old hospital and 196 from the new hospital (opened in 2007). RESULTS The rate of resistance to multiple antibiotics was significantly higher in the old hospital (93%) than in the new hospital (81%) (p<0.001). Genetic community-associated MRSA carrying staphylococcal cassette chromosome (SCC) type IV or V accounted for 58% of all MRSA isolates in the new hospital, significantly higher than the rate in the old hospital (p=0.018). The rate of spa t037-SCCmec III MRSA was significantly lower in the new hospital than in the old hospital (p=0.02). A significant decreasing trend in spa t002-SCCmec II MRSA isolates was observed in the old hospital (p=0.006), while the proportion of spa t037-SCCmec III MRSA decreased significantly in the new hospital (41.7% to 26.1%, p=0.022). CONCLUSIONS The rate of multiple antibiotic resistance and the molecular characteristics of MRSA differed significantly between the old and new hospitals and changed over time.
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Relationship between nasal Carrier isolates and clinical isolates in children with Staphylococcus aureus infections. Microb Pathog 2018; 127:233-238. [PMID: 30502517 DOI: 10.1016/j.micpath.2018.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 11/05/2018] [Accepted: 11/22/2018] [Indexed: 12/14/2022]
Abstract
AIM To assess the relationship between Staphylococcus aureus (S. aureus) strains colonizing the anterior nares and clinical isolate colonizing other, non-nasal infectious sites in children with S. aureus infections. METHODS Fifty-six hospitalized children with S. aureus infection were screened and 22 pairs of nasal carrier isolates and non-nasal clinical isolates were characterized by polymerase chain reaction (PCR) assay for the detection of methicillin resistance (mecA) gene, Panton-Valentine leukocidin virulence (PVL) gene, and multilocus sequence typing (MLST) for the purpose of identifying sequence types of S. aureus. RESULTS In this study, Sequence Type (ST) 59 was found to be the predominant clonal type in the nasal carrier isolates, with statistically significant differences in positive mecA and PVL expression compared with other STs. In general, there was consistence between the STs detected in the nose and other, non-nasal sites for each patient (Kappa = 0.950), where 19 pairs (86.4%) of colonization isolates and their corresponding non-nasal clinical isolates were indistinguishable in mecA, PVL, and ST expression. CONCLUSION ST59 is reported here as a dominant and virulent methicillin-resistant S. aureus (MRSA) clone which may has become a leading sequence type among virulent MRSAs in Sichuan area. Overall there is a strong correlation between colonization and infection in pediatric patients that may be genetically indistinguishable and endogenous. Therefore, nasal swabs as a routine test for children, the elimination of nasal carriage may be considered as a prevention strategy for some systemic S. aureus infections.
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He X, Xie M, Li S, Ye J, Peng Q, Ma Q, Lu X, Zhong B. Antimicrobial resistance in bacterial pathogens among hospitalized children with community acquired lower respiratory tract infections in Dongguan, China (2011-2016). BMC Infect Dis 2017; 17:614. [PMID: 28893195 PMCID: PMC5594502 DOI: 10.1186/s12879-017-2710-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/31/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Bacterial pathogens are a major cause of childhood community acquired lower respiratory tract infections (CA-LRTIs), and few data described the impact of antimicrobial resistance on children with CA-LRTIs. This study aims to investigate the antimicrobial resistance in common bacterial agents among hospitalized children with CA-LRTIs between 2011 and 2016 in Dongguan, China. METHODS Sputum samples were collected from hospitalized children (0-5 years old) with CA-LRTIs in Dongguan Children's Hospital. Bacterial pathogens were detected using traditional culture methods, and disc diffusion tests were used to determine antibiotic resistance. RESULTS Among the 2360 samples analyzed, 342 (14.5%) were positive for bacterial infection. The most prevalent pathogen was MSSA (2.3%), followed by MRSA (1.5%), E. coli (1.7%), E. coli ESBLs (1.2%), K. pneumonia ESBLs (1.5%), K. pneumonia (1.4%) and S. pneumonia (1.3%). Of the hospitalized patients with bacteria causing of CA-LRTIs, 90.1% were less than 1-year-old. MSSA and MRSA were more commonly isolated in infants less than 3 months. E. coli, K. pneumonia and K. pneumonia ESBLs were more common bacteria causing CA-LRTIs in infants less than 1 month. Resistance levels to penicillins, fluoroquinolones, macrolides, cephalosporins, carbapenems and vancomycin varied in different bacteria. CONCLUSIONS S. aureus, E coli and K. pneumonia were the common bacterial isolates recovered from chidren with CA-LTRIs during 2011-2015. Age group of under 1 year old was at a high risk of bacterial infections. Many isolates showed antibiotic resistance level was associated with antibiotic usage in clinic. Increasing surveillance of antibiotic resistance is urgently needed and develops better strategies to cure the antibiotic abuse in China.
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Affiliation(s)
- Xiaoguang He
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Mingyu Xie
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Siping Li
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Junqin Ye
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Qi Peng
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Qiang Ma
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Xiaomei Lu
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China. .,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China. .,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China.
| | - Baimao Zhong
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China. .,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China. .,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China.
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7
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Alzomor O, Alfawaz T, Alshahrani D. Invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in children: case series and literature review. Int J Pediatr Adolesc Med 2017; 4:119-123. [PMID: 30805514 PMCID: PMC6372568 DOI: 10.1016/j.ijpam.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/08/2017] [Accepted: 07/11/2017] [Indexed: 12/31/2022]
Abstract
The majority of CA-MRSA infections present as skin and soft tissue infections such as abscesses or cellulitis. However, CA-MRSA can cause invasive infections such as joint infections, necrotizing pneumonia or septicemia. Here we describe five cases with CA-MRSA bacteremia complicated with osteoarticular infection, necrotizing pneumonia, and infective endocarditis. We report these case series to outline the spectrum of invasive CA-MRSA diseases and to demonstrate clinical outcome. Early proper intervention with regular revisiting the empirical treatment based on local susceptibility data is crucial. More data on the risk factors for acquiring and spread of CA-MRSA in children are required.
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Affiliation(s)
- Omar Alzomor
- Section of Pediatric Infectious Diseases, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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8
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Bakthavatchalam YD, Nabarro LEB, Ralph R, Veeraraghavan B. Diagnosis and management of Panton-Valentine leukocidin toxin associated Staphylococcus aureus infection: an update. Virulence 2017:0. [PMID: 28783418 DOI: 10.1080/21505594.2017.1362532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The incidence of invasive Staphylococcus aureus (SA) infection has increased in the past decade and is associated with poor outcomes and high mortality rates. Of all the virulence factors, Panton-Valentine Leukocidin (PVL) has received the greatest attention. PVL producing SA strains are more likely to produce severe skin and soft tissue infections (SSTIs) and necrotizing pneumonia. This review focuses on the current evidence on PVL-SA virulence, epidemiology, clinical disease and treatment with relevance to healthcare in India.
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Affiliation(s)
| | - Laura E B Nabarro
- a Department of Clinical Microbiology , Christian Medical College , Vellore - 632004 , India
| | - Ravikar Ralph
- b Department of Medicine (unit II) , Christian Medical College , Vellore - 632004 , India
| | - Balaji Veeraraghavan
- a Department of Clinical Microbiology , Christian Medical College , Vellore - 632004 , India
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9
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Monecke S, Gavier-Widén D, Hotzel H, Peters M, Guenther S, Lazaris A, Loncaric I, Müller E, Reissig A, Ruppelt-Lorz A, Shore AC, Walter B, Coleman DC, Ehricht R. Diversity of Staphylococcus aureus Isolates in European Wildlife. PLoS One 2016; 11:e0168433. [PMID: 27992523 PMCID: PMC5161505 DOI: 10.1371/journal.pone.0168433] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/01/2016] [Indexed: 11/19/2022] Open
Abstract
Staphylococcus aureus is a well-known colonizer and cause of infection among animals and it has been described from numerous domestic and wild animal species. The aim of the present study was to investigate the molecular epidemiology of S. aureus in a convenience sample of European wildlife and to review what previously has been observed in the subject field. 124 S. aureus isolates were collected from wildlife in Germany, Austria and Sweden; they were characterized by DNA microarray hybridization and, for isolates with novel hybridization patterns, by multilocus sequence typing (MLST). The isolates were assigned to 29 clonal complexes and singleton sequence types (CC1, CC5, CC6, CC7, CC8, CC9, CC12, CC15, CC22, CC25, CC30, CC49, CC59, CC88, CC97, CC130, CC133, CC398, ST425, CC599, CC692, CC707, ST890, CC1956, ST2425, CC2671, ST2691, CC2767 and ST2963), some of which (ST2425, ST2691, ST2963) were not described previously. Resistance rates in wildlife strains were rather low and mecA-MRSA isolates were rare (n = 6). mecC-MRSA (n = 8) were identified from a fox, a fallow deer, hares and hedgehogs. The common cattle-associated lineages CC479 and CC705 were not detected in wildlife in the present study while, in contrast, a third common cattle lineage, CC97, was found to be common among cervids. No Staphylococcus argenteus or Staphylococcus schweitzeri-like isolates were found. Systematic studies are required to monitor the possible transmission of human- and livestock-associated S. aureus/MRSA to wildlife and vice versa as well as the possible transmission, by unprotected contact to animals. The prevalence of S. aureus/MRSA in wildlife as well as its population structures in different wildlife host species warrants further investigation.
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Affiliation(s)
- Stefan Monecke
- Institute for Medical Microbiology and Hygiene (IMMH), Technical University of Dresden, Dresden, Germany
- Alere Technologies GmbH, Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
- * E-mail:
| | - Dolores Gavier-Widén
- Department of Pathology and Wildlife Disease, National Veterinary Institute (SVA), Uppsala, Sweden
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences (SLU), Uppsala, Sweden
| | - Helmut Hotzel
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - Martin Peters
- Chemisches und Veterinäruntersuchungsamt Westfalen, Standort Arnsberg, Arnsberg, Germany
| | - Sebastian Guenther
- Institute of Microbiology and Epizootics, Veterinary Faculty, Freie Universität Berlin, Berlin, Germany
| | - Alexandros Lazaris
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Igor Loncaric
- Institute of Microbiology, University of Veterinary Medicine, Vienna, Austria
| | - Elke Müller
- Alere Technologies GmbH, Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
| | - Annett Reissig
- Alere Technologies GmbH, Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
| | - Antje Ruppelt-Lorz
- Institute for Medical Microbiology and Hygiene (IMMH), Technical University of Dresden, Dresden, Germany
| | - Anna C. Shore
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Birgit Walter
- Institute of Microbiology and Epizootics, Veterinary Faculty, Freie Universität Berlin, Berlin, Germany
| | - David C. Coleman
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Ralf Ehricht
- Alere Technologies GmbH, Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
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Song JH, Huh K, Chung DR. Community-Acquired Pneumonia in the Asia-Pacific Region. Semin Respir Crit Care Med 2016; 37:839-854. [PMID: 27960208 PMCID: PMC7171710 DOI: 10.1055/s-0036-1592075] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity worldwide. Aging population, dense urbanization, and poor access to health care make the Asia-Pacific region vulnerable to CAP. The high incidence of CAP poses a significant health and economic burden in this region. Common etiologic agents in other global regions including Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae, Staphylococcus aureus, and respiratory viruses are also the most prevalent pathogens in the Asia-Pacific region. But the higher incidence of Klebsiella pneumoniae and the presence of Burkholderia pseudomallei are unique to the region. The high prevalence of antimicrobial resistance in S. pneumoniae and M. pneumoniae has been raising the need for more prudent use of antibiotics. Emergence and spread of community-acquired methicillin-resistant S. aureus deserve attention, while the risk has not reached significant level yet in cases of CAP. Given a clinical and socioeconomic importance of CAP, further effort to better understand the epidemiology and impact of CAP is warranted in the Asia-Pacific region.
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Affiliation(s)
- Jae-Hoon Song
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Huh K, Chung DR. Changing epidemiology of community-associated methicillin-resistant Staphylococcus aureus in the Asia-Pacific region. Expert Rev Anti Infect Ther 2016; 14:1007-1022. [PMID: 27645549 DOI: 10.1080/14787210.2016.1236684] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become an important threat to public health in the Asia-Pacific region, which is characterized by a large population and relatively insufficient resources. Better understanding on the current status of CA-MRSA in the region is of paramount importance. Areas covered: This article reviews the published literatures on the prevalence, molecular epidemiology, colonization, and hospital spread of CA-MRSA. Expert commentary: The burden of CA-MRSA has been increasing in the past two decades. The molecular epidemiology of CA-MRSA in the Asia-Pacific region shows a marked diversity in each country. Still, some strains - multilocus sequence type (MLST) ST59, ST30, ST72, ST8, and ST772 - are unique clones that have successfully established themselves as predominant, often spreading into nosocomial settings. More coordinated and comprehensive surveillance to understand the true epidemiology of CA-MRSA in the Asia-Pacific region is urgently needed.
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Affiliation(s)
- Kyungmin Huh
- a Division of Infectious Diseases, Department of Internal Medicine , Armed Forces Capital Hospital , Seongnam , Korea
| | - Doo Ryeon Chung
- b Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea
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12
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Emergence of Panton-Valentine leukocidin-positive ST59 methicillin-susceptible Staphylococcus aureus with high cytolytic peptide expression in association with community-acquired pediatric osteomyelitis complicated by pulmonary embolism. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 48:565-73. [DOI: 10.1016/j.jmii.2014.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/19/2014] [Accepted: 04/23/2014] [Indexed: 11/20/2022]
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13
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Chang CJ, Chen NC, Lao CK, Huang YC. Nasal Staphylococcus aureus and Methicillin-Resistant S. aureus Carriage among Janitors Working in Hospitals in Northern Taiwan. PLoS One 2015; 10:e0138971. [PMID: 26407070 PMCID: PMC4583260 DOI: 10.1371/journal.pone.0138971] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/08/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is an important cause of infection, and brings additional concern with methicillin resistance. In addition, nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization rates among health care workers are higher than that for general population. To determine the prevalence rate and risk factors for the colonization of S. aureus, including MRSA, among janitors working in hospitals in northern Taiwan, we conducted this study. METHODS Between June and August, 2014, a total of 186 janitors, 111 working in hospitals and 75 working in non-medical institutions, were recruited. Specimens were obtained from the nares of the subjects for the detection of S. aureus, with a questionnaire completed for each subject. All the S. aureus isolates, including MRSA and methicillin-susceptible S. aureus (MSSA), were further molecularly characterized. RESULTS The nasal carriage rate of S. aureus was 15.3% for hospital janitors and 13.3% for non-medical janitors. The carriage rate of MRSA was 3.6% for hospital janitors and 1.3% for non-medical janitors. No statistically significant difference was found in the nasal carriage rate of S. aureus (p = 0.707) and MRSA (p = 0.65) between hospital janitors and non-medical janitors. Hospital janitors working in hospital more than 6 years and cleaning microbiologic laboratories were significantly associated with nasal S. aureus colonization. All 5 MRSA isolates carried either staphylococcal cassette chromosome type IV or V and three of them belonged to sequence type (ST) 59, the community clone prevailing in Taiwan. Of the 22 MSSA isolates, six pulsotypes were identified, with one major type for 14 isolates (shared by five STs) and another type for 4 isolates (all belonged to ST 188). CONCLUSION Exposure to the hospital environment may not increase the nasal carriage rate of S. aureus, including MRSA, among janitors in hospitals in Taiwan. However, for janitors in the hospital setting, working for more than six years in hospital and cleaning laboratories may be risks factors for carrying S. aureus.
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Affiliation(s)
- Chun-Jui Chang
- Department of Medicine, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Ning-Chun Chen
- Department of Medicine, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Chong-Kei Lao
- Department of Medicine, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Department of Medicine, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
- * E-mail:
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Glasner C, Pluister G, Westh H, Arends JP, Empel J, Giles E, Laurent F, Layer F, Marstein L, Matussek A, Mellmann A, Pérez-Vásquez M, Ungvári E, Yan X, Žemličková H, Grundmann H, van Dijl JM. Staphylococcus aureus spa type t437: identification of the most dominant community-associated clone from Asia across Europe. Clin Microbiol Infect 2014; 21:163.e1-8. [PMID: 25658555 DOI: 10.1016/j.cmi.2014.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/12/2014] [Accepted: 09/11/2014] [Indexed: 11/28/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) belonging to the multilocus sequence type clonal complex 59 (MLST CC59) is the predominant community-associated MRSA clone in Asia. This clone, which is primarily linked with the spa type t437, has so far only been reported in low numbers among large epidemiological studies in Europe. Nevertheless, the overall numbers identified in some Northern European reference laboratories have increased during the past decade. To determine whether the S. aureus t437 clone is present in other European countries, and to assess its genetic diversity across Europe, we analysed 147 S. aureus t437 isolates from 11 European countries collected over a period of 11 years using multiple locus variable number tandem repeat fingerprinting/analysis (MLVF/MLVA) and MLST. Additionally 16 S. aureus t437 isolates from healthy carriers and patients from China were included. Most isolates were shown to be monophyletic with 98% of the isolates belonging to the single MLVA complex 621, to which nearly all included isolates from China also belonged. More importantly, all MLST-typed isolates belonged to CC59. Our study implies that the European S. aureus t437 population represents a genetically tight cluster, irrespective of the year, country and site of isolation. This underpins the view that S. aureus CC59 has been introduced into several European countries, not being restricted to particular geographical regions or specific host environments. The European S. aureus t437 isolates thus bear the general hallmarks of a high-risk clone.
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Affiliation(s)
- C Glasner
- Department of Medical Microbiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - G Pluister
- Bacterial Surveillance and Response, Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - H Westh
- Department of Clinical Microbiology, Hvidovre Hospital, Hvidovre, Denmark; Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J P Arends
- Department of Medical Microbiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - J Empel
- Department of Molecular Microbiology National Medicines Institute, Warsaw, Poland
| | - E Giles
- Department of Microbiology, Scottish MRSA Reference Laboratory, Glasgow, United Kingdom
| | - F Laurent
- Centre National de Référence des Staphylocoques, Université de Lyon, INSERM U851, Lyon, France
| | - F Layer
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode, Germany
| | - L Marstein
- Department of Medical Microbiology, MRSA Reference Laboratory, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - A Matussek
- Department of Laboratory Services, County Hospital Ryhov, Jönköping, Sweden
| | - A Mellmann
- Institute for Hygiene University Hospital Münster, Münster, Germany
| | - M Pérez-Vásquez
- Servicio de Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - E Ungvári
- Department of Phage Typing and Molecular Epidemiology, National Center for Epidemiology, Budapest, Hungary
| | - X Yan
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - H Žemličková
- National Institute of Public Health, Prague, Czech Republic
| | - H Grundmann
- Department of Medical Microbiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - J M van Dijl
- Department of Medical Microbiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
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15
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Kuo CY, Huang YC, Huang DTN, Chi H, Lu CY, Chang LY, Chi CY, Ho YH, Huang YC, Liu CC, Huang LM. Prevalence and molecular characterization of Staphylococcus aureus colonization among neonatal intensive care units in Taiwan. Neonatology 2014; 105:142-8. [PMID: 24356303 DOI: 10.1159/000356733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Staphylococcus aureus, particularly methicillin-resistant (MRSA), is an important pathogen in neonatal intensive care units (NICUs). Carriage of S. aureus is a significant risk factor for subsequent infection. OBJECTIVES To determine the current status of MRSA prevalence among NICU-hospitalized infants in Taiwan, we conducted this pilot island-wide survey. METHODS On two designated dates in 2011, each patient who stayed in the NICUs of 7 participating hospitals was included. Nasal and umbilical swabs were obtained and sent for detection of S. aureus. The prevalence and risk factors for MRSA carriage were analyzed. MRSA strains were tested for antimicrobial susceptibility and underwent molecular characterization. RESULTS A total of 251 subjects were included. The overall prevalence of S. aureus and MRSA carriage was 13 and 4.4%, respectively. Previous skin and soft tissue infection was the only predictor in multivariate analysis (OR 40.36; 95% CI 2.32-702.64; p = 0.011). Among 11 MRSA isolates, 3 pulsotypes were identified, with one major type (73%). Nine isolates carried a type IV staphylococcal chromosomal cassette, and 2 carried the type VT. All but one MRSA isolate belonged to linage sequence type 59, the community clone in Taiwan. CONCLUSIONS On a designated date, 4.4% of the infants staying in NICUs in Taiwan carried almost genetically identical community strains of MRSA. MRSA colonization in these infants was significantly associated with previous skin and soft tissue infection.
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Affiliation(s)
- Chen-Yen Kuo
- Taiwan Pediatric Infectious Diseases Alliance, Chang Gung University, Taoyuan, Taiwan
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16
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Qiao Y, Dong F, Song W, Wang L, Yang Y, Shen X. Hospital- and community-associated methicillin-resistant Staphylococcus aureus: a 6-year surveillance study of invasive infections in Chinese children. Acta Paediatr 2013; 102:1081-6. [PMID: 23937684 DOI: 10.1111/apa.12386] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
AIM To investigate and compare the characteristics of invasive hospital-associated (HA) and community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections in Chinese children. METHODS Clinical data on 59 paediatric patients with invasive MRSA isolated from the normally sterile sites between 2006 and 2011 were obtained from the clinical MRSA surveillance database of Beijing Children's Hospital. The molecular characteristics of the invasive MRSA strains were then analysed. RESULTS Invasive MRSA infections rose from 0.89 per 10 000 admissions in 2006 to 3.75 in 2011, with a notable increase in invasive CA-MRSA infections from 0 to 2.43 over the same period. The median age of the CA patients (n = 29) was 0.33 years, compared with 1.17 years for the HA patients (n = 30). Multisite infection, severe pneumonia and empyema were found in 55.2%, 73.1% and 61.5% of CA children and in 30%, 32% and 24% of HA patients, respectively. ST59-MRSA-IVa accounted for 40.7% of all isolates and the Panton-Valentine leukocidin (PVL) gene carriage rate was significantly higher in patients with necrotizing pneumonia and osteoarthritis than in those with other diseases. CONCLUSION The incidence of paediatric invasive MRSA infection, particularly CA-MRSA infection, increased in Chinese children between 2006 and 2011. The invasive infections caused by CA-MRSA occurred more frequently in younger children with more severe pneumonia or empyema.
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Affiliation(s)
- Yanhong Qiao
- Key laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University) Ministry of Education; Beijing Pediatric Research Institute; Beijing Children's Hospital; Capital Medical University; Beijing; China
| | - Fang Dong
- Department of Bacteriology; Beijing Children's Hospital; Capital Medical University; Beijing; China
| | - Wenqi Song
- Department of Bacteriology; Beijing Children's Hospital; Capital Medical University; Beijing; China
| | - Lijuan Wang
- Key laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University) Ministry of Education; Beijing Pediatric Research Institute; Beijing Children's Hospital; Capital Medical University; Beijing; China
| | - Yonghong Yang
- Key laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University) Ministry of Education; Beijing Pediatric Research Institute; Beijing Children's Hospital; Capital Medical University; Beijing; China
| | - Xuzhuang Shen
- Key laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University) Ministry of Education; Beijing Pediatric Research Institute; Beijing Children's Hospital; Capital Medical University; Beijing; China
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Chen CJ, Unger C, Hoffmann W, Lindsay JA, Huang YC, Götz F. Characterization and comparison of 2 distinct epidemic community-associated methicillin-resistant Staphylococcus aureus clones of ST59 lineage. PLoS One 2013; 8:e63210. [PMID: 24039691 PMCID: PMC3764004 DOI: 10.1371/journal.pone.0063210] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 04/02/2013] [Indexed: 02/06/2023] Open
Abstract
Sequence type (ST) 59 is an epidemic lineage of community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) isolates. Taiwanese CA-MRSA isolates belong to ST59 and can be grouped into 2 distinct clones, a virulent Taiwan clone and a commensal Asian-Pacific clone. The Taiwan clone carries the Panton–Valentine leukocidin (PVL) genes and the staphylococcal chromosomal cassette mec (SCCmec) VT, and is frequently isolated from patients with severe disease. The Asian-Pacific clone is PVL-negative, carries SCCmec IV, and a frequent colonizer of healthy children. Isolates of both clones were characterized by their ability to adhere to respiratory A549 cells, cytotoxicity to human neutrophils, and nasal colonization of a murine and murine sepsis models. Genome variation was determined by polymerase chain reaction of selected virulence factors and by multi-strain whole genome microarray. Additionally, the expression of selected factors was compared between the 2 clones. The Taiwan clone showed a much higher cytotoxicity to the human neutrophils and caused more severe septic infections with a high mortality rate in the murine model. The clones were indistinguishable in their adhesion to A549 cells and persistence of murine nasal colonization. The microarray data revealed that the Taiwan clone had lost the ø3-prophage that integrates into the β-hemolysin gene and includes staphylokinase- and enterotoxin P-encoding genes, but had retained the genes for human immune evasion, scn and chps. Production of the virulence factors did not differ significantly in the 2 clonal groups, although more α-toxin was expressed in Taiwan clone isolates from pneumonia patients. In conclusion, the Taiwan CA-MRSA clone was distinguished by enhanced virulence in both humans and an animal infection model. The evolutionary acquisition of PVL, the higher expression of α-toxin, and possibly the loss of a large portion of the β-hemolysin-converting prophage likely contribute to its higher pathogenic potential than the Asian-Pacific clone.
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Affiliation(s)
- Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
| | - Clemens Unger
- Institut für Tropenmedizin, Wilhelmstraße 27, Tübingen, Germany
| | | | - Jodi A. Lindsay
- Department of Cellular & Molecular Medicine, St George’s, University of London, Cranmer Terrace, London, United Kingdom
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Friedrich Götz
- Department of Microbial Genetics, Faculty of Biology, University of Tübingen, Tübingen, Germany
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Chuang YY, Huang YC. Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Asia. THE LANCET. INFECTIOUS DISEASES 2013; 13:698-708. [PMID: 23827369 DOI: 10.1016/s1473-3099(13)70136-1] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In Asia, most reports on the epidemiology of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) are from developed countries, with few data from resource-limited countries, not because of low actual prevalence, but probably because of scarce diagnostic facilities. The rate of MRSA in all community-associated S. aureus infections in Asian countries ranges from 2·5% to 39%. Unlike the predominance of USA300-sequence type (ST) 8 staphylococcal cassette chromosome mec (SCCmec) type IV in the USA, the molecular epidemiology of CA-MRSA in Asia is characterised by clonal heterogeneity, similar to that in Europe. The emergence of CA-MRSA is a threat in both community and hospital settings because such strains are now more prevalent than are health-care-associated MRSA (HA-MRSA) strains. Many epidemic clones are in circulation in Asia and with scarce data available, concern has arisen that CA-MRSA could have devastating results if it becomes epidemic in resource-poor regions. The epidemiology of CA-MRSA in Asia is closely linked with the health of both developing and developed countries. The present situation of CA-MRSA in Asia is important not only for local public health, but also to provide a better understanding of the successful epidemic clones of this global pathogen.
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Affiliation(s)
- Yu-Yu Chuang
- Department of Pediatrics, St Mary's Hospital, Luodong, Taiwan
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Lei TH, Huang YC, Chu YC, Lee CY, Lien R. Orbital cellulitis caused by community-associated methicillin-resistant Staphylococcus aureus in a previously healthy neonate. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 46:136-8. [DOI: 10.1016/j.jmii.2012.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/27/2011] [Accepted: 01/04/2012] [Indexed: 11/26/2022]
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Vardakas KZ, Kontopidis I, Gkegkes ID, Rafailidis PI, Falagas ME. Incidence, characteristics, and outcomes of patients with bone and joint infections due to community-associated methicillin-resistant Staphylococcus aureus: a systematic review. Eur J Clin Microbiol Infect Dis 2013; 32:711-21. [DOI: 10.1007/s10096-012-1807-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
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21
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Community-associated methicillin-resistant Staphylococcus aureus necrotizing pneumonia in a healthy neonate. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012. [PMID: 23182276 DOI: 10.1016/j.jmii.2012.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The number of cases of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia has increased since the late 1990s, with skin and soft tissue infections predominant among neonates. Herein, we present a rare case of CA-MRSA necrotizing pneumonia with empyema following respiratory syncytial virus (RSV) infection in a healthy neonate. Despite prompt vancomycin treatment, the disease worsened and finally we had to perform pneumonectomy. This case highlights the possibility of emerging CA-MRSA-related invasive disease among neonates.
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Lee CY, Chang TM, Lin CJ, Huang YC. Infective endocarditis caused by community-associated methicillin-resistant Staphylococcus aureus in a previously healthy preschool child. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 47:257-60. [PMID: 22575428 DOI: 10.1016/j.jmii.2012.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 02/22/2012] [Accepted: 02/24/2012] [Indexed: 12/25/2022]
Abstract
Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) has been increasingly reported recently and has become an emerging pathogen of infective endocarditis (IE) in adults, but still rarely reported in children. A previously healthy preschool child without any heart anomaly developed IE and pneumonia with pleural effusion. Blood cultures repeatedly yielded MRSA and did not become negative until 13 days after a teicoplanin-containing regimen was administered. In total, a 4-week intravenous antibiotic therapy and an additional 8-week oral antibiotic therapy were given. The patient recovered uneventfully. All five MRSA blood isolates were molecularly characterized and shared common characteristics, which were consistent with those of the endemic CA-MRSA clone in Taiwan. This case highlights that physicians should be aware of the growing role of CA-MRSA in childhood IE and should meticulously choose an appropriate empiric antibiotic regimen for such a severe disease.
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Affiliation(s)
- Chun-Yi Lee
- Department of Pediatrics, Chang-Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Tung-Ming Chang
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Chao-Jen Lin
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Yhu-Chering Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan; Chang Gung University, College of Medicine, Kweishan, Taoyuan, Taiwan.
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Necrotizing fasciitis caused by Staphylococcus aureus: the emergence of methicillin-resistant strains. Ann Plast Surg 2012; 67:632-6. [PMID: 21407055 DOI: 10.1097/sap.0b013e31820b372b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Staphylococcus aureus is an uncommon causative agent of monomicrobial necrotizing fasciitis, but we have noted several cases over the years. The patients treated for necrotizing fasciitis between January 1998 and December 2008 in our institution were identified, and their medical records were reviewed. Of 105 necrotizing fasciitis cases during the study period, 18 were caused by monomicrobial S. aureus infection (17%). The median age was 62 years (range, 12-81 years). Among this cohort, 10 patients had coexisting medical conditions or risk factors, including diabetes and hypertension. Lower limbs and upper limbs are the most commonly involved sites. Among the bacterial isolates from these cases, 8 were methicillin-sensitive S. aureus (MSSA) and 10 were methicillin-resistant S. aureus (MRSA). One patient died in the MSSA group, and 5 patients died in the MRSA group. The mortality rate and other clinical characteristics were not significantly different between the 2 groups. However, all MRSA necrotizing fasciitis developed after the year 2000, and it was significantly different from MSSA necrotizing fasciitis that predominantly took place before the year 2000. In conclusion, S. aureus is an important pathogen of monomicrobial necrotizing fasciitis, and MRSA has emerged as the predominant causative agent in recent years. Therefore, MRSA-directed antibiotic therapy should be considered when treating patients suspected with necrotizing fasciitis in endemic areas.
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Wang WY, Chiueh TS, Sun JR, Tsao SM, Lu JJ. Molecular typing and phenotype characterization of methicillin-resistant Staphylococcus aureus isolates from blood in Taiwan. PLoS One 2012; 7:e30394. [PMID: 22291948 PMCID: PMC3264593 DOI: 10.1371/journal.pone.0030394] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/20/2011] [Indexed: 11/18/2022] Open
Abstract
Background Staphylococcus aureus causes a variety of severe infections such as bacteremia and sepsis. At present, 60–80% of S. aureus isolates from Taiwan are methicillin resistant (MRSA). It has been shown that certain MRSA clones circulate worldwide. The goals of this study were to identify MRSA clones in Taiwan and to correlate the molecular types of isolates with their phenotypes. Methods A total of 157 MRSA isolates from bacteremic patients were collected from nine medical centers. They were typed based on polymorphisms in agr, SCCmec, MLST, spa, and dru. Phenotypes characterized included Panton-Valentine leucocidin (pvl), inducible macrolide-lincosamide-streptogramin B resistance (MLSBi), vancomycin (VA) and daptomycin (DAP) minimal inhibitory concentrations (MIC), and superantigenic toxin gene profiles. Difference between two consecutive samples was determined by Mann-Whitney-U test, and difference between two categorical variables was determined by Fisher's exact test. Results Four major MRSA clone complexes CC1, CC5, CC8, and CC59 were found, including 4 CC1, 9 CC5, 111 CC8, and 28 CC59 isolates. These clones had the following molecular types: CC1: SCCmecIV and ST573; CC5: SCCmecII and ST5; CC8: SCCmecIII, ST239, and ST241, and CC59: SCCmecIV, SCCmecVT, ST59, and ST338. The toxin gene profiles of these clones were CC1: sec-seg-(sei)-sell-selm-(seln)-selo; CC5: sec-seg-sei-sell-selm-(seln)-selp-tst1; CC8: sea-selk-selq, and CC59: seb-selk-selq. Most isolates with SCCmecVT, ST59, spat437, and dru11 types were pvl+ (13 isolates), while multidrug resistance (≥4 antimicrobials) were associated with SCCmecIII, ST239, spa t037, agrI, and dru14 (119 isolates) (p<0.001). One hundred and twenty four isolates with the following molecular types had higher VA MIC: SCCmecII and SCCmecIII; ST5, ST239, and ST241; spa t002, t037, and t421; dru4, dru10, dru12, dru13, and dru14 (p<0.05). No particular molecular types were found to be associated with MLSBi phenotype. Conclusions Four major MRSA clone complexes were found in Taiwan. Further studies are needed to delineate the evolution of MRSA isolates.
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Affiliation(s)
- Wei-Yao Wang
- Graduate Institute of Medical Science, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Division of Infectious Disease, Fong-Yuan Hospital, Taichung, Taiwan, Republic of China
| | - Tzong-Shi Chiueh
- Graduate Institute of Medical Science, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Division of Clinical Pathology, Department of Pathology, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Jun-Ren Sun
- Graduate Institute of Medical Science, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Division of Clinical Pathology, Department of Pathology, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Shin-Ming Tsao
- Division of Clinical Microbiology and Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Jang-Jih Lu
- Graduate Institute of Medical Science, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, Republic of China
- Department of Laboratory Medicine, Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
- * E-mail:
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Hsiao CH, Chuang CC, Tan HY, Ma DHK, Lin KK, Chang CJ, Huang YC. Methicillin-resistant Staphylococcus aureus ocular infection: a 10-year hospital-based study. Ophthalmology 2011; 119:522-7. [PMID: 22176801 DOI: 10.1016/j.ophtha.2011.08.038] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 08/22/2011] [Accepted: 08/22/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To characterize the patient demographics, clinical features, and antibiotic susceptibility of ocular infections caused by methicillin-resistant Staphylococcus aureus (MRSA), including community-associated (CA) and healthcare-associated (HA) isolates. DESIGN Retrospective, observational study. PARTICIPANTS Patients (n = 519) with culture-proven S. aureus ocular infections seen between January 1, 1999, and December 31, 2008, in Chang Gung Memorial Hospital. METHODS Data collected included patient demographics and clinical information. Antibiotic susceptibility was verified by disc diffusion method. MAIN OUTCOME MEASURES Proportion of MRSA in S. aureus ocular infections and the clinical characteristics, diagnoses, and antibiotic susceptibility patterns of CA-MRSA versus HA-MRSA ocular infections. RESULTS We identified 274 patients with MRSA ocular infections, which comprised 181 CA-MRSA and 93 HA-MRSA isolates. The average rate of MRSA in S. aureus infections was 52.8% with a stable trend, whereas the annual ratio of CA-MRSA in ocular MRSA infections averaged 66.1% and tended to increase over the 10-year interval. Patients with ocular CA-MRSA were younger. Lid and lacrimal system disorders were more common, but keratitis, endophthalmitis, and wound infection were less common among CA-MRSA cases than HA-MRSA cases. Both CA-MRSA and HA-MRSA isolates were resistant to clindamycin and erythromycin, but CA-MRSA was more susceptible to sulfamethoxazole/trimethoprim. CONCLUSIONS Community-associated MRSA is an important pathogen of ocular infections; CA-MRSA and HA-MRSA ocular infections differ demographically and clinically, but both strains were multi-resistant in Chang Gung Memorial Hospital, one of the biggest referral centers in Taiwan. In a country with a high prevalence of MRSA, ophthalmologists should be aware of such epidemiologic information.
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Affiliation(s)
- Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
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Huang YC, Lien RI, Su LH, Chou YH, Lin TY. Successful control of methicillin-resistant Staphylococcus aureus in endemic neonatal intensive care units--a 7-year campaign. PLoS One 2011; 6:e23001. [PMID: 21857979 PMCID: PMC3155524 DOI: 10.1371/journal.pone.0023001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 07/05/2011] [Indexed: 11/19/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important nosocomial pathogens in the intensive care unit (ICU) worldwide, including Taiwan. Since 1997, our neonatal ICUs (NICUs) had become endemic for MRSA. Methodology/Principal Findings To control MRSA spread in our NICUs, we implemented a series of infection control measures stepwise, including reinforcement of hand hygiene since January 2000, augmentation of aseptic care over the insertion site of central venous catheter since July 2001, introduction of alcohol-based handrubs since April 2003, surveillance culture for MRSA and cohort care for the colonized patients between March 2003 and February 2004, and surveillance culture with subsequent decolonization of MRSA between August 2005 and July 2006. After implementation of these measures, MRSA healthcare-associated infection (HAI) density reduced by 92%, from 5.47 episodes per 1000 patient-days in 1999 to 0.45 episodes per 1000 patient-days in 2006; MRSA bloodstream infection reduced from 40 cases in 1999 to only one case in 2006. Compared to those obtained during the period of surveillance culture without decolonization, both rates of MRSA colonization (8.6% vs. 41%, p<0.001) and infection (1.1% vs. 12%, p<0.001) decreased significantly during the period of surveillance and decolonization. Molecular analysis of the clinical isolates during the study period showed that the endemic clone, which dominated between 1998 and 2005, almost disappeared in 2006, while the community clones increased significantly in 2006–2007. Conclusion/Significance Through infection control measures, MRSA HAIs can be successfully controlled, even in areas with high levels of endemic MRSA infections such as our NICUs.
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Affiliation(s)
- Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.
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Lo WT, Wang CC. Panton-Valentine leukocidin in the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Pediatr Neonatol 2011; 52:59-65. [PMID: 21524624 DOI: 10.1016/j.pedneo.2011.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 05/17/2010] [Accepted: 06/22/2010] [Indexed: 11/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen that causes serious infectious diseases and was endemic in hospitals by the late 1960s. Beginning with its first report in the late 1990s, the rapid emergence of community-associated MRSA (CA-MRSA) worldwide responsible for a wide spectrum of diseases ranging from minor skin infections to fatal necrotizing pneumonia has been found in previously healthy individuals without established risk factors for MRSA acquisition. Recently, various virulence determinants unique to CA-MRSA have been uncovered, which explain how the pathogen spreads easily and causes severe CA-MRSA infections among humans. However, the role of Panton-Valentine leukocidin (PVL) in the pathogenesis of CA-MRSA infection is currently a matter of much debate because of conflicting data from epidemiologic studies of CA-MRSA infections and various murine disease models. Identifying specialized pathogenic traits of CA-MRSA and the concerted regulation of these factors remains a challenge that will foster development of vaccines and therapies designed to control CA-MRSA infections. This review focuses on the current status of molecular epidemiology associated with CA-MRSA in Taiwan and progresses toward understanding the enhanced virulence properties of CA-MRSA, with an emphasis on the role of Panton-Valentine leukocidin.
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Affiliation(s)
- Wen-Tsung Lo
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Community-associated meticillin-resistant Staphylococcus aureus in children in Taiwan, 2000s. Int J Antimicrob Agents 2011; 38:2-8. [PMID: 21397461 DOI: 10.1016/j.ijantimicag.2011.01.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 01/17/2011] [Indexed: 11/21/2022]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) has been increasingly identified as the major cause of community-associated (CA) infections in previously healthy hosts since the late 1990s. CA-MRSA strains were recognised as a novel pathogen that is genetically different from healthcare-associated MRSA, and five major epidemic clones have been identified worldwide. In Taiwan, a significantly increasing rate of MRSA carriage and infection amongst healthy subjects was observed in the past decade. Up to 9.5% of healthy Taiwanese children carried MRSA in the nares and >50% of paediatric CA S. aureus infections were MRSA. The adult population was also affected, but this was relatively limited. The majority of CA-MRSA isolates in Taiwan belonged to the sequence type (ST) 59 lineage, defined by multilocus sequence typing, and were multiresistant to non-β-lactams. The clone of ST59 lineage can be further classified into at least two major clones by pulsed-field gel electrophoresis (PFGE) typing, staphylococcal chromosomal cassette mec (SCCmec) elements and Panton-Valentine leukocidin (PVL) genes. The clone characterised as ST59/PFGE type C/SCCmec IV/PVL-negative was prevalent amongst the colonising isolates, whereas ST59/PFGE type D/SCCmec V(T)/PVL-positive was prevalent amongst the clinical isolates. Evidence suggested that the ST59 CA-MRSA clone was not only circulating in Taiwan but also in other areas of the world. In this article, the current status of CA-MRSA in Taiwan was extensively reviewed. The information provided here is not only important for local public health but can also enhance a general understanding of the successful epidemic clones of CA-MRSA worldwide.
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Changes in the nasal colonization with methicillin-resistant Staphylococcus aureus in children: 2004-2009. PLoS One 2010; 5:e15791. [PMID: 21209954 PMCID: PMC3012095 DOI: 10.1371/journal.pone.0015791] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 11/29/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is an important cause of infection, particularly in persons colonized with this organism. This study compared the annual prevalence and microbiological characteristics of methicillin-resistant S. aureus (MRSA) nasal colonization in Taiwanese children from 2004 through 2009. Risk factors for MRSA were determined for the overall study period. METHODS Children from birth to ≤14 years of age presenting for health maintenance visits or attending 1 of 57 kindergartens were recruited. Nasal swabs were obtained, and a questionnaire was administered. The prevalence and microbiological characteristics of MRSA colonization were also calculated for two 3-year periods: 2004-2006 and 2007-2009. RESULTS Cultures of the anterior nares were positive for S. aureus in 824 (25.8%) of the 3,200 children, and MRSA colonization was found in 371 (11.6%) children. The prevalence of S. aureus colonization decreased from 28.1% in 2004-2006 to 23.3% in 2007-2009 (p<0.01), whereas the prevalence of MRSA colonization increased from 8.1% to 15.1% during this period (p<0.0001). Multivariate analysis revealed that the independent risk factors for MRSA carriage were different for male and female children, and also among age groups. Most MRSA isolates belonged to sequence type 59 (ST59) (86.3%); however, a multiresistant MRSA clone with ST338 background emerged in 2007-2009. Ten (62.5%) of the 16 MRSA isolates expressed the genotypic profile ST338/staphylococcal cassette chromosome mec V(T)/Panton-Valentine leukocidin-positive/staphylococcal enterotoxin B-positive, and differed only in their antimicrobial susceptibility patterns. CONCLUSION The prevalence of nasal colonization by MRSA increased among healthy Taiwanese children from 2004-2006 to 2007-2009, despite an overall decrease in the prevalence of nasal colonization by S. aureus. A multiresistant MRSA clone characterized as ST338 was identified from these children.
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Chen CJ, Su LH, Lin TY, Huang YC. Molecular analysis of repeated methicillin-resistant Staphylococcus aureus infections in children. PLoS One 2010; 5:e14431. [PMID: 21203439 PMCID: PMC3010989 DOI: 10.1371/journal.pone.0014431] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 12/07/2010] [Indexed: 12/22/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen that causes severe morbidity and mortality in hospitalized patients. It is unclear whether repeated MRSA infections in pediatric patients are caused by relapse of previous infecting strains or by acquiring new strains from extrinsic sources. The study aimed to define the genetic relatedness of MRSA isolates from children with repeated infections. Methodology/Principal Findings Children with multiple MRSA infections during 2004–2006 were identified in a teaching hospital. Repeated infections were confirmed by chart review and the responsible isolates were genotyped and screened for Panton-Valentine leukocidin (PVL) genes. Two consecutive episodes comprised an infection pair, and strain relatedness was defined for each pair as indistinguishable, highly related, or distinct if the isolates were of the same subtype, the same genotype, or different genotype, respectively. A total of 114 episodes comprising 66 infection pairs were identified in 48 children. The interval of infection pairs ranged from 15 days to 346 days, with a median duration of 57.5 days. Genotypings classified all isolates into 7 genotypes and 31 subtypes. Of 66 pairs, 46 (69.7%), 13 (19.7%) and 7 (10.6%) pairs were caused by indistinguishable, highly related and distinct strains, respectively. Subsequent infections caused by indistinguishable strains were more common for PVL-positive strains (17/18, 94.4%) than for PVL-negative strains (29/48, 60.4%, P = 0.007). The strain relatedness was not affected by the durations of interval between infections. Conclusions/Significance Most repeated MRSA infections in children are caused by indistinguishable strains even after a long period of interval, suggesting that persistent carriage and relapse of initial infecting strains were responsible for the majority of recurrent MRSA infections.
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Affiliation(s)
- Chih-Jung Chen
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Pediatric Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lin-Hui Su
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzou-Yien Lin
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Pediatric Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Pediatric Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Wang JT, Liao CH, Fang CT, Chie WC, Lai MS, Lauderdale TL, Chang SC. Incidence of and risk factors for community-associated methicillin-resistant Staphylococcus aureus acquired infection or colonization in intensive-care-unit patients. J Clin Microbiol 2010; 48:4439-44. [PMID: 20926713 PMCID: PMC3008468 DOI: 10.1128/jcm.00784-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 09/13/2010] [Accepted: 09/24/2010] [Indexed: 11/20/2022] Open
Abstract
The incidence of and risk factors for acquiring community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) among patients staying in intensive care units (ICUs) remain unclear. We enrolled patients staying in two ICUs at the Far Eastern Memorial Hospital during the period of 1 September 2008 to 30 September 2009 to clarify this issue. Surveillance cultures for MRSA were taken from nostril, sputum or throat, axillae, and the inguinal area in all enrolled patients upon admission to the ICU, every 3 days thereafter, and on the day of discharge from the ICU. For each MRSA isolate, we performed multilocus sequence typing, identified the type of staphylococcal cassette chromosome mec, detected the presence of the Panton-Valentine leukocidin gene, and conducted drug susceptibility tests. Among the 1,906 patients who were screened, 203 patients were carriers of MRSA before their admission to the ICU; 81 patients acquired MRSA during their stay in the ICU, including 31 who acquired CA-MRSA. The incidence rates of newly acquired MRSA and CA-MRSA during the ICU stay were 7.9 and 3.0 per 1,000 patient-days, respectively. Prior usage of antipseudomonal penicillins and antifungals and the presence of a nasogastric tube were found to be independent risk factors for acquiring CA-MRSA during the ICU stay when data for CA-MRSA carriers and patients without carriage of MRSA were compared (P=0.0035, 0.0330, and 0.0262, respectively). Prior usage of carbapenems was found to be a protective factor against acquiring CA-MRSA when data for patients with CA-MRSA and those with health care-associated MRSA acquired during ICU stay were compared (P=0.0240).
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Affiliation(s)
- Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County 220, Taiwan, Graduate Institute of Epidemiology, Graduate Institute of Preventive Medicine, College of Public Health, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan, Division of Clinical Research, National Health Research Institute, Zhunan 350, Taiwan
| | - Chun-Hsing Liao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County 220, Taiwan, Graduate Institute of Epidemiology, Graduate Institute of Preventive Medicine, College of Public Health, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan, Division of Clinical Research, National Health Research Institute, Zhunan 350, Taiwan
| | - Chi-Tai Fang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County 220, Taiwan, Graduate Institute of Epidemiology, Graduate Institute of Preventive Medicine, College of Public Health, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan, Division of Clinical Research, National Health Research Institute, Zhunan 350, Taiwan
| | - Wei-Chu Chie
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County 220, Taiwan, Graduate Institute of Epidemiology, Graduate Institute of Preventive Medicine, College of Public Health, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan, Division of Clinical Research, National Health Research Institute, Zhunan 350, Taiwan
| | - Mei-Shu Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County 220, Taiwan, Graduate Institute of Epidemiology, Graduate Institute of Preventive Medicine, College of Public Health, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan, Division of Clinical Research, National Health Research Institute, Zhunan 350, Taiwan
| | - Tsai-Ling Lauderdale
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County 220, Taiwan, Graduate Institute of Epidemiology, Graduate Institute of Preventive Medicine, College of Public Health, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan, Division of Clinical Research, National Health Research Institute, Zhunan 350, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County 220, Taiwan, Graduate Institute of Epidemiology, Graduate Institute of Preventive Medicine, College of Public Health, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan, Division of Clinical Research, National Health Research Institute, Zhunan 350, Taiwan
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Factors associated with nasal colonization of methicillin-resistant Staphylococcus aureus among healthy children in Taiwan. J Clin Microbiol 2010; 49:131-7. [PMID: 21084507 DOI: 10.1128/jcm.01774-10] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has been identified as a major cause of community-associated (CA) S. aureus infections in the past decade. The main reservoir in the community for MRSA and the factors contributing to its worldwide spread remain poorly defined. Between July 2005 and June 2008, a total of 6,057 healthy children 2 to 60 months of age were screened for carriage of S. aureus and Streptococcus pneumoniae in Taiwan. The prevalence and epidemiological factors influencing MRSA carriage were determined. MRSA strains were tested for antimicrobial susceptibility and underwent molecular characterization. The overall prevalences of MRSA and S. aureus carriage were 7.8% and 23.2%, respectively. A majority (88%) of MRSA isolates belonged to a common Asian-Pacific CA-MRSA lineage, multilocus sequence type 59, and were resistant to multiple non-beta-lactam antibiotics. The carriage rate of MRSA was higher among subjects 2 to 6 months old (P < 0.0001), residing in northern Taiwan (P = 0.0003), and enrolled later in the study (P < 0.0001). MRSA colonization was associated with the number of children in the family (adjusted odds ratio [aOR], 1.114; 95% confidence interval [CI], 1.002 to 1.240; P = 0.0463) and day care attendance (aOR, 1.530; 95% CI, 1.201 to 1.949; P = 0.0006). Breast feeding (P < 0.0001) and colonization with S. pneumoniae (P = 0.0170) were protective against MRSA colonization. We concluded that epidemic CA-MRSA strains increasingly colonized Taiwanese children between 2005 and 2008. The carriage rate varied significantly across different demographical features. Crowding was an independent environmental risk factor that might accelerate CA-MRSA transmission in the community.
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Wang JT, Wang JL, Fang CT, Chie WC, Lai MS, Lauderdale TL, Weng CM, Chang SC. Risk factors for mortality of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection: with investigation of the potential role of community-associated MRSA strains. J Infect 2010; 61:449-57. [PMID: 20875455 DOI: 10.1016/j.jinf.2010.09.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 09/17/2010] [Accepted: 09/17/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The difference in the outcomes of nosocomial bloodstream infection (BSI) caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains and healthcare-associated MRSA (HA-MRSA) strains remains unclear. METHODS From January 1, 2006 to December 31, 2008, all adult patients hospitalized at National Taiwan University Hospital with nosocomial MRSA BSI were analyzed. Available MRSA isolates were submitted for subsequent microbiologic studies to determine whether they belonged to CA-MRSA strains. RESULTS In total, 308 patients were enrolled and 253 MRSA isolates were available. Forty-seven isolates belonged to CA-MRSA strains. The all-cause mortality rates on Day 14 and Day 30 were 19.8% and 30.5%, respectively, and were not different between those caused by CA-MRSA and HA-MRSA strains. The independent risk factors for Day 14 mortality were septic shock, thrombocytopenia, and an inadequate serum trough level of vancomycin (p = <0.0001, 0.0003, and 0.0381, respectively). Those for Day 30 mortality were septic shock, anemia, thrombocytopenia, presence of underlying malignancies, and MRSA isolates with a vancomycin minimum inhibitory concentration of 2 mg/L (p = <0.0001, 0.0425, 0.0007, 0.0098, and 0.0012, respectively). CONCLUSIONS The mortality rates of nosocomial MRSA BSI were not different between that caused by CA-MRSA and HA-MRSA strains.
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Affiliation(s)
- Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan
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David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010; 23:616-87. [PMID: 20610826 PMCID: PMC2901661 DOI: 10.1128/cmr.00081-09] [Citation(s) in RCA: 1350] [Impact Index Per Article: 96.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.
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Affiliation(s)
- Michael Z David
- Department of Pediatrics and Department of Medicine, the University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637, USA.
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Wang JT, Liao CH, Fang CT, Chie WC, Lai MS, Lauderdale TL, Lee WS, Huang JH, Chang SC. Prevalence of and risk factors for colonization by methicillin-resistant Staphylococcus aureus among adults in community settings in Taiwan. J Clin Microbiol 2009; 47:2957-63. [PMID: 19625471 PMCID: PMC2738089 DOI: 10.1128/jcm.00853-09] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 06/13/2009] [Accepted: 07/15/2009] [Indexed: 01/23/2023] Open
Abstract
In order to determine the prevalence of methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) colonization among adults in community settings in Taiwan and identify its risk factors, we conducted the present study. For a 3-month period, we enrolled all adults who attended mandatory health examinations at three medical centers and signed the informed consent. Nasal swabs were taken for the isolation of S. aureus. For each MRSA isolate, we performed multilocus sequence typing, identification of the staphylococcal cassette chromosome mec, tests for the presence of the Panton-Valentine leukocidin gene, and tests for drug susceptibilities. Risk factors for MRSA colonization were determined. The results indicated that the MRSA colonization rate among adults in the community settings in Taiwan was 3.8% (119/3,098). Most MRSA isolates belonged to sequence type 59 (84.0%). Independent risk factors for MRSA colonization included the presence of household members less than 7 years old (P < 0.0001) and the use of antibiotics within the past year (P = 0.0031). Smoking appeared to be protective against MRSA colonization (P < 0.0001).
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Affiliation(s)
- Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan
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Abstract
We recruited a total of 499 mothers and their 501 newborn babies to investigate whether infants acquire Staphylococcus aureus from their mothers. Of the 22 mother-baby paired S. aureus isolates, 11 (50%) paired isolates were unrelated, 1 pair related, and 10 pairs (45%) indistinguishable. Newborn babies acquire S. aureus colonization soon after birth either from the environment or their mothers.
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Fan J, Shu M, Zhang G, Zhou W, Jiang Y, Zhu Y, Chen G, Peacock SJ, Wan C, Pan W, Feil EJ. Biogeography and virulence of Staphylococcus aureus. PLoS One 2009; 4:e6216. [PMID: 19593449 PMCID: PMC2705676 DOI: 10.1371/journal.pone.0006216] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 06/06/2009] [Indexed: 01/23/2023] Open
Abstract
Background Staphylococcus aureus is commonly carried asymptomatically in the human anterior nares and occasionally enters the bloodstream to cause invasive disease. Much of the global diversity of S. aureus remains uncharacterised, and is not clear how disease propensity varies between strains, and between host populations. Methodology We compared 147 isolates recovered from five kindergartens in Chengdu, China, with 51 isolates contemporaneously recovered from cases of pediatric infection from the main hospital serving this community. The samples were characterised by MLST, the presence/absence of PVL, and antibiotic resistance profiling. Principal Findings Genotype frequencies within individual kindergartens differ, but the sample recovered from cases of disease shows a general enrichment of certain MLST genotypes and PVL positive isolates. Genotypes under-represented in the disease sample tend to correspond to a single sequence cluster, and this cluster is more common in China than in other parts of the world. Conclusions/Significance Virulence propensity likely reflects a synergy between variation in the core genome (MLST) and accessory genome (PVL). By combining evidence form biogeography and virulence we demonstrate the existence of a “native” clade in West China which has lowered virulence, possibility due to acquired host immunity.
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Affiliation(s)
- Juan Fan
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan, the People's Republic of China
| | - Min Shu
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan, the People's Republic of China
| | - Ge Zhang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wei Zhou
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan, the People's Republic of China
| | - Yongmei Jiang
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan, the People's Republic of China
| | - Yu Zhu
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan, the People's Republic of China
| | - Guihua Chen
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan, the People's Republic of China
| | - Sharon J. Peacock
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Chaomin Wan
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan, the People's Republic of China
- * E-mail: (CW); (WP); (EJF)
| | - Wubin Pan
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, the People's Republic of China
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, People's Republic of China
- Crown Bioscience, Inc. (Beijing), Light Muller Building, ChangPing Science Park, Beijing, the People's Republic of China
- * E-mail: (CW); (WP); (EJF)
| | - Edward J. Feil
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
- * E-mail: (CW); (WP); (EJF)
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Lin CC, Wang JL, Lin CY, Chen SY, Wang JT, Wu KD, Chang SC. Reply to Tsai et al. Infect Control Hosp Epidemiol 2009. [DOI: 10.1086/600091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Clinical and molecular epidemiology of ciprofloxacin-susceptible MRSA encoding PVL in England and Wales. Eur J Clin Microbiol Infect Dis 2009; 28:1113-21. [DOI: 10.1007/s10096-009-0757-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 05/10/2009] [Indexed: 10/20/2022]
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Nascimento-Carvalho CM, Lyra TG, Alves NN, Caldas RM, Barberino MG. Resistance to Methicillin and Other Antimicrobials Among Community-Acquired and Nosocomial Staphylococcus aureus Strains in a Pediatric Teaching Hospital in Salvador, Northeast Brazil. Microb Drug Resist 2008; 14:129-31. [DOI: 10.1089/mdr.2008.0790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Ticiana G. Lyra
- Department of Pediatrics, School of Medicine, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Noraney N. Alves
- Bacteriology Laboratories, University Hospital (UFBA), Salvador, Bahia, Brazil
| | - Renilza M. Caldas
- Bacteriology Laboratories, University Hospital (UFBA), Salvador, Bahia, Brazil
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