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Lépine N, Bras-Cachinho J, Couratin E, Lemaire C, Chaufour L, Junchat A, Lartigue MF. Investigation of a linezolid-resistant Staphylococcus epidermidis outbreak in a French hospital: phenotypic, genotypic, and clinical characterization. Front Microbiol 2024; 15:1455945. [PMID: 39323891 PMCID: PMC11422107 DOI: 10.3389/fmicb.2024.1455945] [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] [Received: 06/27/2024] [Accepted: 08/19/2024] [Indexed: 09/27/2024] Open
Abstract
Purpose We aimed to retrospectively investigate an outbreak of linezolid-resistant Staphylococcus epidermidis (LRSE), at Tours University Hospital between 2017 and 2021. Methods Twenty of the 34 LRSE isolates were included in the study. Antimicrobial susceptibility testing was performed using the disk diffusion method and MICs of last-resort antibiotics were determined using broth microdilution or Etest®. Seventeen of the 20 resistant strains were sent to the French National Reference Centre for Staphylococci to determine the mechanism of resistance to linezolid. The clonal relationship between LRSE strains was assessed by PFGE and the sequence type determined by MLST. We retrospectively evaluated a new typing tool, IR-Biotyper®, and compared its results to PFGE to evaluate its relevance for S. epidermidis typing. Medical records were reviewed, and antibiotic consumption was determined. Search for a cross transmission was performed. Results All LRSE strains showed high levels of resistance to linezolid (MICs ≥ 256 mg/L) and were multi-drug resistant. Linezolid resistance was associated with the 23S rRNA G2576T mutation and none of the 17 strains analyzed carried the cfr gene. Ninety-five percent of the 20 LRSE studied strains were genetically related and belonged to sequence-type ST2. The dendrogram obtained from IR-Biotyper® showed 87% congruence with the PFGE analysis. Prior to isolation of the LRSE strain, 70% of patients received linezolid. No patients stayed successively in the same room. Conclusion Linezolid exposure may promote the survival and spread of LRSE strains. At Tours University Hospital, acquisition of the resistant clone may also have been triggered by hand-to-hand transmission by healthcare workers. In addition, IR-Biotyper® is a promising typing tool for the study of clonal outbreaks due to its low cost and short turnaround time, although further studies are needed to assess the optimal analytical parameters for routine use.
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Affiliation(s)
- Nadège Lépine
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
- ISP, UMR1282, Université de Tours, INRAe, Tours, France
| | - José Bras-Cachinho
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Eva Couratin
- Equipe Opérationnelle d'Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Coralie Lemaire
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
- ISP, UMR1282, Université de Tours, INRAe, Tours, France
| | - Laura Chaufour
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Armelle Junchat
- Equipe Opérationnelle d'Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Marie-Frédérique Lartigue
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
- ISP, UMR1282, Université de Tours, INRAe, Tours, France
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2
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Trends in Occurrence and Phenotypic Resistance of Coagulase-Negative Staphylococci (CoNS) Found in Human Blood in the Northern Netherlands between 2013 and 2019. Microorganisms 2022; 10:microorganisms10091801. [PMID: 36144403 PMCID: PMC9506452 DOI: 10.3390/microorganisms10091801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: For years, coagulase-negative staphylococci (CoNS) were not considered a cause of bloodstream infections (BSIs) and were often regarded as contamination. However, the association of CoNS with nosocomial infections is increasingly recognized. The identification of more than 40 different CoNS species has been driven by the introduction of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. Yet, treatment guidelines consider CoNS as a whole group, despite increasing antibiotic resistance (ABR) in CoNS. This retrospective study provides an in-depth data analysis of CoNS isolates found in human blood culture isolates between 2013 and 2019 in the entire region of the Northern Netherlands. Methods: In total, 10,796 patients were included that were hospitalized in one of the 15 hospitals in the region, leading to 14,992 CoNS isolates for (ABR) data analysis. CoNS accounted for 27.6% of all available 71,632 blood culture isolates. EUCAST Expert rules were applied to correct for errors in antibiotic test results. Results: A total of 27 different CoNS species were found. Major differences were observed in occurrence and ABR profiles. The top five species covered 97.1% of all included isolates: S. epidermidis, S. hominis, S. capitis, S. haemolyticus, and S. warneri. Regarding ABR, methicillin resistance was most frequently detected in S. haemolyticus (72%), S. cohnii (65%), and S. epidermidis (62%). S. epidermidis and S. haemolyticus showed 50–80% resistance to teicoplanin and macrolides while resistance to these agents remained lower than 10% in most other CoNS species. Conclusion: These differences are often neglected in national guideline development, prompting a focus on ‘ABR-safe’ agents such as glycopeptides. In conclusion, this multi-year, full-region approach to extensively assess the trends in both the occurrence and phenotypic resistance of CoNS species could be used for evaluating treatment policies and understanding more about these important but still too often neglected pathogens.
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3
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Hadano Y, Hijikata T, Miura A, Fujii S, Awaya Y. Staphylococcus pettenkoferi bacteremia in a tertiary care hospital in Japan: Report of three cases. J Infect Chemother 2022; 28:1424-1426. [PMID: 35724914 DOI: 10.1016/j.jiac.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
Staphylococcus pettenkoferi is a coagulase-negative staphylococci (CoNS) species first isolated in 2002. Human infections caused by S. pettenkoferi are rare. We herein report three cases of S. pettenkoferi bacteremia in a tertiary care hospital in Japan. Staphylococcus pettenkoferi can be a causative pathogen of catheter related blood stream infection including complicated infection, and unknown source of bacteremia. All of the patients presented with fever and shaking chills, and good clinical outcome. Further research is needed to determine the role of this organism as a pathogen and frequency.
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Affiliation(s)
- Yoshiro Hadano
- Antimicrobial Stewardship Team, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan; Division of Infection Control and Prevention, Shimane University Hospital, Izumo Shimane, Japan.
| | - Toshiyuki Hijikata
- Department of Emergency Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan; Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Kanagawa, Japan
| | - Ayako Miura
- Department of Clinical Laboratory, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Shigeo Fujii
- Department of Clinical Laboratory, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Yukikazu Awaya
- Department of Pulmonary Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan; Department of General Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
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4
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Gisriel SD, Jacobs JW. The first reported case of Staphylococcus pettenkoferi prosthetic joint infection. Microbes Infect 2022; 24:104978. [PMID: 35421570 DOI: 10.1016/j.micinf.2022.104978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
Staphylococcus aureus and Staphylococcus epidermidis are among the most frequent causes of prosthetic joint infections (PJIs). Staphylococcus pettenkoferi, a coagulase-negative Staphylococcal species first described in 2002, has been detected in fewer than 20 patients with true infection (15 cases of bacteremia and 1 case of osteomyelitis). This organism has never been implicated in a PJI, likely owing in part to the difficulty in identification via biochemical methods. S. pettenkoferi is almost universally reported to be a contaminant when detected. We report the first case of a PJI caused by S. pettenkoferi, highlighting its infectious potential in specific patient populations.
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Affiliation(s)
- Savanah D Gisriel
- Departments of Laboratory Medicine and Pathology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA.
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5
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Staphylococcus pettenkoferi Bacteremia in an American Intensive Care Unit. Case Rep Infect Dis 2021; 2021:5235691. [PMID: 34631179 PMCID: PMC8494585 DOI: 10.1155/2021/5235691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Coagulase-negative staphylococci (CoNS) are considered the most common cause of nosocomial bloodstream infections; yet, these species are frequently designated as contaminants in the absence of systemic signs and symptoms of infection. Immunocompromised patients or those with prosthetic devices are at increased risk for clinically significant bacteremia. With the advent of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) in clinical practice, there has been improved specificity of CoNS isolate identification and further elucidation of underrecognized pathogenic species. Staphylococcus pettenkoferi was a novel CoNS species first identified in 2002 and thought to be misdiagnosed as other CoNS due to limitations in biochemical identification. There is increasing identification of S. pettenkoferi isolates; however, there are limited case reports of clinically significant S. pettenkoferi bacteremia and no reported cases within the United States. We present the first known case of S. pettenkoferi from an American intensive care unit.
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Bouiller K, Ilic D, Wicky PH, Cholley P, Chirouze C, Bertrand X. Spread of clonal linezolid-resistant Staphylococcus epidermidis in an intensive care unit associated with linezolid exposure. Eur J Clin Microbiol Infect Dis 2020; 39:1271-1277. [PMID: 32060752 DOI: 10.1007/s10096-020-03842-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/05/2020] [Indexed: 10/23/2022]
Abstract
The aim of the study was to determine factors associated with spread of linezolid (LNZ)-resistant Staphylococcus epidermidis isolates in a surgical intensive care unit (ICU). A case-control study was conducted in one French adult surgical ICU. From January 2012 to December 2016, patients with at least a single positive LNZ-resistant S. epidermidis blood culture were matched to control with LNZ-susceptible S. epidermidis blood culture in a 1:4 manner. Cases were compared to controls regarding baseline clinical characteristics and LNZ exposure before positive blood culture. Bacterial isolates were genotyped by using pulsed-field gel electrophoresis (PFGE) and MLST. We identified 13 LNZ-resistant S. epidermidis isolates, 1 in 2012, 3 in 2014, 6 in 2015, and 3 in 2016. LNZ use increased steadily from 8 DDDs/100 patient days in 2010 to 19 in 2013 and further decrease by more of 50% in 2015 and 2016. The only independent risk factors associated to LNZ-resistant S. epidermidis isolation were length of stay in ICU before infection (OR 1.45; 95% CI 1.07-1.98), prior exposure to LNZ (OR 109; 95% CI 3.9-3034), and Charlson comorbidities score (OR 3.19; 95% CI 1.11-9.14). PFGE typing showed that all LNZ-resistant isolates were clonal belonging to ST2 and that LNZ-susceptible isolates were highly diverse. We report herein that previous exposure to LNZ substantially increased the risk of occurrence of LNZ resistance in S. epidermidis even in the case of clonal spread of LNZ-resistant isolates. These findings highlight the need for reducing the use of LNZ to preserve its efficacy in the future.
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Affiliation(s)
- Kevin Bouiller
- Department of Infectious diseases, Service de maladies infectieuses, university hospital of Besancon, 3 bd Alexandre Fleming, 25030, Besancon, France. .,UMR CNRS 6249 chrono-environnement, University of Bourgogne Franche-Comté, Besancon, France.
| | - Dejan Ilic
- Surgical intensive care unit, university hospital of Besancon, Besancon, France
| | - Paul Henry Wicky
- Department of Infectious diseases, Service de maladies infectieuses, university hospital of Besancon, 3 bd Alexandre Fleming, 25030, Besancon, France
| | - Pascal Cholley
- Hospital hygiene department, university hospital of Besancon, Besancon, France
| | - Catherine Chirouze
- Department of Infectious diseases, Service de maladies infectieuses, university hospital of Besancon, 3 bd Alexandre Fleming, 25030, Besancon, France.,UMR CNRS 6249 chrono-environnement, University of Bourgogne Franche-Comté, Besancon, France
| | - Xavier Bertrand
- UMR CNRS 6249 chrono-environnement, University of Bourgogne Franche-Comté, Besancon, France.,Hospital hygiene department, university hospital of Besancon, Besancon, France
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7
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Layer F, Vourli S, Karavasilis V, Strommenger B, Dafopoulou K, Tsakris A, Werner G, Pournaras S. Dissemination of linezolid-dependent, linezolid-resistant Staphylococcus epidermidis clinical isolates belonging to CC5 in German hospitals. J Antimicrob Chemother 2019; 73:1181-1184. [PMID: 29360979 DOI: 10.1093/jac/dkx524] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/14/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives Linezolid-resistant Staphylococcus epidermidis (LRSE) and linezolid-dependent ST22 strains have been shown to predominate in tertiary care facilities all over Greece. We report herein the dissemination of ST22 but also ST2, ST5 and ST168 linezolid-dependent LRSE clones in four unrelated German hospitals. Methods Fourteen LRSE clinical isolates recovered during 2012-14 from five distantly located German hospitals were tested by for MIC determination broth microdilution and Etest, PCR/sequencing for cfr and for mutations in 23S rRNA, rplC, rplD and rplV genes, MLST, PFGE and growth curves without and with linezolid at 16 and 32 mg/L. Results Most (11, 78.6%) isolates had linezolid MICs >256 mg/L. Five isolates carried the cfr gene. Eight isolates belonged to ST22, two isolates each to ST168 and ST2 and one isolate each to ST5 and ST23. Ten isolates [seven belonging to ST22 and one to each of ST2, ST5 and ST168; all these STs belong to clonal complex (CC) 5] exhibited linezolid-dependent growth, growing significantly faster in linezolid-containing broth. Four isolates were non-dependent (one belonging to each of ST22, ST2, ST23 and ST168). Four isolates came from three different hospitals, whereas four and six isolates were recovered during outbreaks of LRSE in two distinct hospitals. Conclusions The multi-clonal dissemination of CC5 linezolid-dependent LRSE throughout German hospitals along with the clonal expansion of ST22 linezolid-dependent LRSE in Greek hospitals is of particular concern. It is plausible that this characteristic is inherent and provides a selective advantage to CC5 LRSE under linezolid pressure, contributing to their dissemination throughout hospitals in these countries.
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Affiliation(s)
- Franziska Layer
- Robert Koch Institute, Department of Infectious Diseases, National Centre for Staphylococci and Enterococci, Wernigerode, Germany
| | - Sophia Vourli
- Laboratory of Clinical Microbiology, ATTIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Birgit Strommenger
- Robert Koch Institute, Department of Infectious Diseases, National Centre for Staphylococci and Enterococci, Wernigerode, Germany
| | - Konstantina Dafopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanassios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Guido Werner
- Robert Koch Institute, Department of Infectious Diseases, National Centre for Staphylococci and Enterococci, Wernigerode, Germany
| | - Spyros Pournaras
- Laboratory of Clinical Microbiology, ATTIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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8
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Dortet L, Glaser P, Kassis-Chikhani N, Girlich D, Ichai P, Boudon M, Samuel D, Creton E, Imanci D, Bonnin R, Fortineau N, Naas T. Long-lasting successful dissemination of resistance to oxazolidinones in MDR Staphylococcus epidermidis clinical isolates in a tertiary care hospital in France. J Antimicrob Chemother 2018; 73:41-51. [PMID: 29092052 PMCID: PMC5890688 DOI: 10.1093/jac/dkx370] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/10/2017] [Indexed: 01/16/2023] Open
Abstract
Objectives Patient- and procedure-related changes in modern medicine have turned CoNS into one of the major nosocomial pathogens. Treatments of CoNS infections are challenging owing to the large proportion of MDR strains and oxazolidinones often remain the last active antimicrobial molecules. Here, we have investigated a long-lasting outbreak (2010-13) due to methicillin- and linezolid-resistant (LR) CoNS (n = 168), involving 72 carriers and 49 infected patients. Methods Antimicrobial susceptibilities were tested by the disc diffusion method and MICs were determined by broth microdilution or Etest. The clonal relationship of LR Staphylococcus epidermidis (LRSE) was first determined using a semi-automated repetitive element palindromic PCR (rep-PCR) method. Then, WGS was performed on all cfr-positive LRSE (n = 30) and LRSE isolates representative of each rep-PCR-defined clone (n = 17). Self-transferability of cfr-carrying plasmids was analysed by filter-mating experiments. Results This outbreak was caused by the dissemination of three clones (ST2, ST5 and ST22) of LRSE. In these clones, linezolid resistance was caused by (i) mutations in the chromosome-located genes encoding the 23S RNA and L3 and L4 ribosomal proteins, but also by (ii) the dissemination of two different self-conjugative plasmids carrying the cfr gene encoding a 23S RNA methylase. By monitoring linezolid prescriptions in two neighbouring hospitals, we highlighted that the spread of LR-CoNS was strongly associated with linezolid use. Conclusions Physicians should be aware that plasmid-encoded linezolid resistance has started to disseminate among CoNS and that rational use of oxazolidinones is critical to preserve these molecules as efficient treatment options for MDR Gram-positive pathogens.
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Affiliation(s)
- Laurent Dortet
- Department of Bacteriology-Parasitology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Philippe Glaser
- Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France.,UMR 3525, CNRS, 75015 Paris, France
| | - Najiby Kassis-Chikhani
- Department of Hygiene, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Delphine Girlich
- EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Philippe Ichai
- Intensive Care Unit, Hepatobiliary Center, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Marc Boudon
- Intensive Care Unit, Hepatobiliary Center, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Didier Samuel
- Intensive Care Unit, Hepatobiliary Center, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Elodie Creton
- EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Dilek Imanci
- Department of Molecular Genetics and Hormonology, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Rémy Bonnin
- EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Nicolas Fortineau
- Department of Bacteriology-Parasitology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Thierry Naas
- Department of Bacteriology-Parasitology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
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Månsson E, Hellmark B, Stegger M, Skytt Andersen P, Sundqvist M, Söderquist B. Genomic relatedness of Staphylococcus pettenkoferi isolates of different origins. J Med Microbiol 2017; 66:601-608. [PMID: 28530888 PMCID: PMC5817227 DOI: 10.1099/jmm.0.000472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose The aim of the study was to characterize clinical and environmental Staphylococcus pettenkoferi isolates with regard to genomic diversity and antibiotic susceptibility pattern. Repetitive-sequence-based PCR and core genome phylogenetic analysis of whole-genome sequencing (WGS) data verified the presence of distinct clades comprising closely related S. pettenkoferi isolates from different geographical locations and origins. Methodology Phylogenetic relationships between 25 S. pettenkoferi isolates collected from blood cultures and intra-operative air sampling were determined by repetitive-sequence-based PCR typing and analysis of ~157 000 SNPs identified in the core genome after WGS. Antibiotic susceptibility testing and tests for biofilm production (microtitre plate assay) were performed. Results Repetitive-sequence-based PCR as well as WGS data demonstrated the close relatedness of clinically significant blood culture isolates to probable contaminants, as well as to environmental isolates. Antibiotic-susceptibility testing demonstrated a low level of antimicrobial resistance. The mecA gene was present in two cefoxitin-resistant isolates. No isolates were found to produce biofilm. Conclusion Close genomic relatedness of S. pettenkoferi isolates from different geographical locations and origins were found within clades, but with substantial genomic difference between the two major clades. The ecological niche of S. pettenkoferi remains unconfirmed, but the presence of S. pettenkoferi in the air of the operating field favours the suggestion of a role in skin flora. Identification of S. pettenkoferi in clinical samples should, in a majority of cases, most likely be regarded as a probable contamination, and its role as a possible pathogen in immunocompromised hosts remains to be clarified.
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Affiliation(s)
- Emeli Månsson
- Centre for Clinical Research, Hospital of Västmanland Västerås, SE-721 89 Västerås, Sweden.,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
| | - Bengt Hellmark
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
| | - Marc Stegger
- Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | | | - Martin Sundqvist
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
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Rouard C, Aslangul E, Rivière A, Deback C, Butel MJ, Doucet-Populaire F, Bourgeois-Nicolaos N. Mutation in the L3 Ribosomal Protein Could Be Associated with Risk of Selection of High-Level Linezolid-ResistantStaphylococcus epidermidisStrains. Microb Drug Resist 2017; 23:462-467. [DOI: 10.1089/mdr.2016.0137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Caroline Rouard
- Service de Bactériologie-Hygiène, APHP, Hôpital Antoine Béclère, Clamart Cedex, France
- Unité Bactéries Pathogènes et Santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France
| | - Elisabeth Aslangul
- Service de Médecine Interne, APHP, Hôpital Louis Mourier, Colombes, France
- Université Paris Diderot, Paris, France
| | - Alexandre Rivière
- Service de Bactériologie-Hygiène, APHP, Hôpital Antoine Béclère, Clamart Cedex, France
| | - Claire Deback
- Service de Virologie-Hygiène, APHP, Hôpital Paul Brousse, Villejuif, France
- INSERM UMR-S996, Université Paris Sud, Clamart, France
| | - Marie-José Butel
- EA4065, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Florence Doucet-Populaire
- Service de Bactériologie-Hygiène, APHP, Hôpital Antoine Béclère, Clamart Cedex, France
- Unité Bactéries Pathogènes et Santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France
| | - Nadège Bourgeois-Nicolaos
- Service de Bactériologie-Hygiène, APHP, Hôpital Antoine Béclère, Clamart Cedex, France
- Unité Bactéries Pathogènes et Santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France
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Susceptibility trends including emergence of linezolid resistance among coagulase-negative staphylococci and meticillin-resistant Staphylococcus aureus from invasive infections. Int J Antimicrob Agents 2015; 46:622-30. [DOI: 10.1016/j.ijantimicag.2015.07.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022]
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Bender J, Strommenger B, Steglich M, Zimmermann O, Fenner I, Lensing C, Dagwadordsch U, Kekulé AS, Werner G, Layer F. Linezolid resistance in clinical isolates of Staphylococcus epidermidis from German hospitals and characterization of two cfr-carrying plasmids. J Antimicrob Chemother 2015; 70:1630-8. [PMID: 25740949 DOI: 10.1093/jac/dkv025] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/21/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study was a detailed investigation of Staphylococcus epidermidis clinical isolates exhibiting linezolid resistance. METHODS Thirty-six linezolid-resistant S. epidermidis from eight German hospitals, including isolates from suspected hospital-associated outbreaks between January 2012 and April 2013, were analysed with respect to their antimicrobial susceptibility and the presence of cfr and/or mutations in the 23S rRNA, rplC, rplD and rplV genes. Relatedness of isolates was estimated by MLST and SmaI macrorestriction analysis. Characterization of cfr plasmids was carried out by means of Illumina sequencing. RESULTS The MICs of linezolid varied substantially between the isolates. No apparent correlation was detected between the level of resistance, the presence of cfr and ribosomal target site mutations. S. epidermidis isolates from two hospitals were confirmed as clonally related, indicating the spread of the respective clone over a period of 1 year. Next-generation sequencing revealed two different categories of cfr-expressing plasmids, both of them varying in genetic arrangement and composition from previously published cfr plasmids: p12-00322-like plasmids showed incorporation of cfr into a pGO1-like backbone and displayed capabilities for intra- and inter-species conjugational transfer. CONCLUSIONS To date, linezolid-resistant S. epidermidis have rarely been isolated from human clinical sources in Germany. Here, we describe the emergence and outbreaks of these strains. We detected previously described and novel point mutations in the 23S ribosomal genes. The cfr gene was only present in six isolates. However, this is the first known description of cfr incorporation into conjugative vectors; under selective pressure, these vectors could give reasonable cause for concern.
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Affiliation(s)
- Jennifer Bender
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Birgit Strommenger
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Matthias Steglich
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Ortrud Zimmermann
- Institute of Medical Microbiology, University Medical Centre Göttingen, Kreuzbergring 57, 37075 Göttingen, Germany
| | - Ines Fenner
- MVZ Labor Fenner und Kollegen, Bergstraße 14, 20095 Hamburg, Germany
| | - Carmen Lensing
- MVZ Labor Fenner und Kollegen, Bergstraße 14, 20095 Hamburg, Germany
| | - Urantschimeg Dagwadordsch
- Institute of Medical Microbiology, Martin Luther University Halle/Wittenberg, Magdeburger Straße 6, 06112 Halle, Germany
| | - Alexander S Kekulé
- Institute of Medical Microbiology, Martin Luther University Halle/Wittenberg, Magdeburger Straße 6, 06112 Halle, Germany
| | - Guido Werner
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Franziska Layer
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
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Karavasilis V, Zarkotou O, Panopoulou M, Kachrimanidou M, Themeli-Digalaki K, Stylianakis A, Gennimata V, Ntokou E, Stathopoulos C, Tsakris A, Pournaras S. Wide dissemination of linezolid-resistant Staphylococcus epidermidis in Greece is associated with a linezolid-dependent ST22 clone. J Antimicrob Chemother 2015; 70:1625-9. [PMID: 25712317 DOI: 10.1093/jac/dkv028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/25/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Dependence on linezolid was recently described as significant growth acceleration of linezolid-resistant Staphylococcus epidermidis (LRSE) isolates upon linezolid exposure. We investigated the possible contribution of linezolid dependence to LRSE dissemination in Greece. METHODS Linezolid resistance rates were estimated in six tertiary hospitals located throughout Greece between 2011 and 2013. Sixty-three randomly selected LRSE recovered in these hospitals during this period were studied. Growth curve analysis was conducted with and without linezolid. Clonality of the isolates was investigated by PFGE and MLST. RESULTS During the study period, the LRSE rate in the participating hospitals rose significantly from 6.9% to 9% (P = 0.006); the increase was more prominent in ICUs (from 15.1% to 20.9%; P = 0.005). Forty-seven (74.6%) of the 63 LRSE, derived from all study hospitals, clearly exhibited linezolid dependence, growing significantly faster in the presence of 16 and 32 mg/L linezolid. Of note, 61 (96.8%) LRSE exhibited a single macrorestriction pattern and belonged to ST22, which included all linezolid-dependent LRSE. The remaining two LRSE belonged to unique STs. Five of six linezolid-dependent isolates tested also exhibited linezolid dependence upon exposure to 8 mg/L linezolid. Interestingly, five of six ST22 linezolid-non-dependent isolates tested developed linezolid dependence when linezolid exposure preceded growth analysis. CONCLUSIONS The rapid LRSE dissemination in Greek hospitals threatens linezolid activity. The observation that most LRSE belonged to ST22 and expressed dependence on linezolid clearly implies that the spread of linezolid resistance should have been driven by this trait, which provided the LRSE with a selective advantage under linezolid pressure.
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Affiliation(s)
- Vasilios Karavasilis
- Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | | | - Maria Panopoulou
- Department of Microbiology, Medical School, University of Thrace, Alexandroupolis, Greece
| | - Melina Kachrimanidou
- Department of Microbiology, Medical School, Aristotelian University of Thessaloniki, Thesaloniki, Greece
| | | | | | - Vassiliki Gennimata
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Eleni Ntokou
- Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | | | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Spyros Pournaras
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
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Park S, Chung HS, Lee M. Clinical and microbiological characteristics of six Staphylococcus pettenkoferi isolates from blood samples. Ann Lab Med 2015; 35:250-3. [PMID: 25729730 PMCID: PMC4330178 DOI: 10.3343/alm.2015.35.2.250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/19/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
Abstract
Coagulase-negative staphylococci (CoNS) are reported to be the leading cause of nosocomial bloodstream infections. Staphylococcus pettenkoferi is a novel member of CoNS that was first isolated from the human blood and bursitis wound in 2002. We have reported cases of 6 S. pettenkoferi strains isolated from blood specimens, including one pathogen and 5 contaminants and catheter colonizers. Brucker Biotyper (Brucker Daltonics, Bremen, Germany) and molecular typing with 16S rRNA gene sequencing confirmed the 6 isolates as S. pettenkoferi. The conventional phenotypic identification of these isolates is not reliable owing to their inconsistent biochemical characteristics. Five of the 6 isolates were found to be resistant to oxacillin, and all isolates showed susceptibility to vancomycin and linezolid. For accurate identification of this novel species, advanced methods by using Brucker Biotyper or molecular methods such as 16S rRNA gene sequencing are required.
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Affiliation(s)
- Sholhui Park
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hae-Sun Chung
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Miae Lee
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Abstract
The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.
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Affiliation(s)
- Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Christine Heilmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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The emergence of linezolid resistance among Enterococci in intestinal microbiota of treated patients is unrelated to individual pharmacokinetic characteristics. Antimicrob Agents Chemother 2014; 58:2681-7. [PMID: 24566182 DOI: 10.1128/aac.02251-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Linezolid is an antimicrobial agent for the treatment of multiresistant Gram-positive infections. We assessed the impact of linezolid on the microbiota and the emergence of resistance and investigated its relationship with plasma pharmacokinetics of the antibiotic. Twenty-eight patients were treated for the first time with linezolid administered orally (n = 17) or parenterally (n = 11) at 600 mg twice a day. Linezolid plasma pharmacokinetic analysis was performed on day 7. Colonization by fecal enterococci, pharyngeal streptococci, and nasal staphylococci were assessed using selective media with or without supplemental linezolid. The resistance to linezolid was characterized. The treatment led to a decrease of enterococci, staphylococci, and streptococci in the fecal (P = 0.03), nasal, and pharyngeal (P < 0.01) microbiotas. The appearance of resistant strains was observed only in enterococci from the fecal microbiota between the 7th and 21st days of treatment in four patients (14.3%). The resistance was mainly due for the first time to the mutation G2447T in the 23S rRNA gene. No pharmacokinetic parameters were significantly different between the patients, regardless of the appearance of resistance. The emergence of linezolid resistance during treatment was observed only in the intestinal microbiota and unrelated to pharmacokinetic parameters. However, colonization by Gram-positive bacteria was reduced as a result of treatment in all microbiotas.
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Identification and characterization of methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus pettenkoferi from a small animal clinic. Vet Microbiol 2013; 167:680-5. [PMID: 23992797 DOI: 10.1016/j.vetmic.2013.07.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/21/2013] [Accepted: 07/24/2013] [Indexed: 11/21/2022]
Abstract
The aim of this study was to isolate and characterize methicillin-resistant staphylococci (MRS) in a small animal clinic and to investigate their distribution and possible transmission. Swabs (n=72) were taken from hospitalized pets, the environment and employees of a small animal clinic and screened for the presence of MRS. The staphylococcal species was confirmed biochemically or by 16S rDNA sequencing. Susceptibility to antimicrobial agents was tested by broth dilution. The presence of mecA and other resistance genes was confirmed by PCR. Molecular typing of the isolates followed standard procedures. In total, 34 MRS belonging to the four species Staphylococcus aureus (n=5), Staphylococcus epidermidis (n=21), Staphylococcus haemolyticus (n=6) or Staphylococcus pettenkoferi (n=2) were isolated. All isolates were multidrug-resistant with resistance to at least three classes of antimicrobial agents. Among the five methicillin-resistant S. aureus (MRSA) isolates, four belonged to the clonal complex CC398; two of them were isolated from cats, the remaining two from pet cages. Overall, the MRS isolates differed in their characteristics, except for one S. epidermidis clone (n=9) isolated from hospitalized cats without clinical staphylococcal infections, pet cages, the clinic environment as well as from a healthy employee. This MRSE clone was resistant to 10 classes of antimicrobial agents, including aminocyclitols, β-lactams, fluoroquinolones, lincosamides, macrolides, phenicols, pleuromutilins, sulfonamides, tetracyclines and trimethoprim. These findings suggest a possible transmission of specific MRS isolates between animal patients, employees and the clinic environment.
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