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Rehman TU, Aslam R, Aqib AI, Mohsin M, Manzoor A, Shoaib M, Naseer MA, Hasan A, Sattar H, Fakhar-E-Alam Kulyar M, Muzammil I, Yao W. Phylogeny of hospital acquired MRSA, and its comparative phenotypic clinico-epidemiology with vancomycin resistant S. aureus (VRSA). Microb Pathog 2020; 149:104537. [PMID: 32980474 DOI: 10.1016/j.micpath.2020.104537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
Staphylococcus aureus is emerging as complicated pathogen because of its wide-ranging origin, multiple variants, and compromised antibiotic susceptibilities. Current study was planned to find lineage of hospital acquired methicillin resistant Staphylococcus aureus (HA-MRSA), and its comparative phenotypic clinico-epidemiology with vancomycin resistant S. aureus (VRSA). A total of (n = 200) samples were aseptically collected from wound, nose, and cerebrospinal fluid of patients from metropolitan and rural background hospitals along with on spot filling in of questionnaire. Phylogenetic analysis of HA-MRSA was identified by targeting mecA gene in S. aureus. At optimal tree branch length of 1.91 and evolutionary distance 0.1, high level sequence similarity (97%-99%) was observed with different strains of S. aureus isolated from both human and animal. Non-descriptive statistics at 5% probability found 61% S. aureus, while 43.44% of them were HA-MRSA, 92.62% VRSA, and 42.62% were both MRSA and VRSA. Among assumed risk factors, use of antibiotics, venous catheterization, chronic disease, pre-hospital visits, and ICU admitted patients showed significant association (p<0.05) with pathogen. HA-MRSA was 37.50%, 80%, and 37.50% sensitive to chloramphenicol, gentamicin, and oxacillin, respectively. While <50% of VRSA were sensitive against oxacillin, enoxacin, and chloramphenicol. A significant difference (p<0.05) of percentage responses of MRSA and VRSA at resistant, intermediate, and sensitive cadre against all antibiotics except chloramphenicol was obvious in this study. The Current study concluded higher prevalence of MRSA & VRSA, significant association of risk factors, limiting antibiotic susceptibility profile, and genetic transfer at animal-human interface which suggests further studies cum preventive strategies to be planned.
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Affiliation(s)
- Tayyab Ur Rehman
- Institute of Microbiology, University of Agriculture, Agriculture, Faisalabad, 38000, Pakistan
| | - Rizwan Aslam
- Institute of Microbiology, University of Agriculture, Agriculture, Faisalabad, 38000, Pakistan
| | - Amjad Islam Aqib
- Department of Medicine, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, 63100, Pakistan.
| | - Mashkoor Mohsin
- Institute of Microbiology, University of Agriculture, Agriculture, Faisalabad, 38000, Pakistan
| | - Asad Manzoor
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, 38000, Pakistan
| | - Muhammad Shoaib
- Institute of Microbiology, University of Agriculture, Agriculture, Faisalabad, 38000, Pakistan
| | - Muhammad Aamir Naseer
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, 38000, Pakistan
| | - Ali Hasan
- Institute of Microbiology, University of Agriculture, Agriculture, Faisalabad, 38000, Pakistan
| | - Huma Sattar
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | | | - Iqra Muzammil
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, 38000, Pakistan
| | - Wangyuan Yao
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, PR China.
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Burden of perianal Staphylococcus aureus colonization in nursing home residents increases transmission to healthcare worker gowns and gloves. Infect Control Hosp Epidemiol 2020; 41:1396-1401. [PMID: 32762778 DOI: 10.1017/ice.2020.336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the effect of the burden of Staphylococcus aureus colonization of nursing home residents on the risk of S. aureus transmission to healthcare worker (HCW) gowns and gloves. DESIGN Multicenter prospective cohort study. SETTING AND PARTICIPANTS Residents and HCWs from 13 community-based nursing homes in Maryland and Michigan. METHODS Residents were cultured for S. aureus at the anterior nares and perianal skin. The S. aureus burden was estimated by quantitative polymerase chain reaction detecting the nuc gene. HCWs wore gowns and gloves during usual care activities; gowns and gloves were swabbed and then cultured for the presence of S. aureus. RESULTS In total, 403 residents were enrolled; 169 were colonized with methicillin-resistant S. aureus (MRSA) or methicillin-sensitive S. aureus (MSSA) and comprised the study population; 232 were not colonized and thus were excluded from this analysis; and 2 were withdrawn prior to being swabbed. After multivariable analysis, perianal colonization with S. aureus conferred the greatest odds for transmission to HCW gowns and gloves, and the odds increased with increasing burden of colonization: adjusted odds ratio (aOR), 2.1 (95% CI, 1.3-3.5) for low-level colonization and aOR 5.2 (95% CI, 3.1-8.7) for high level colonization. CONCLUSIONS Among nursing home patients colonized with S. aureus, the risk of transmission to HCW gowns and gloves was greater from those colonized with greater quantities of S. aureus on the perianal skin. Our findings inform future infection control practices for both MRSA and MSSA in nursing homes.
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Shankar N, Soe PM, Tam CC. Prevalence and risk of acquisition of methicillin-resistant Staphylococcus aureus among households: A systematic review. Int J Infect Dis 2020; 92:105-113. [DOI: 10.1016/j.ijid.2020.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022] Open
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Distinct virulent network between healthcare- and community-associated Staphylococcus aureus based on proteomic analysis. Clin Proteomics 2018; 15:2. [PMID: 29321722 PMCID: PMC5757299 DOI: 10.1186/s12014-017-9178-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/22/2017] [Indexed: 12/18/2022] Open
Abstract
Background Staphylococcus aureus (S. aureus or SA) is a leading cause of healthcare-associated (HA-) and community-associated (CA) infection. HA-SA isolates usually cause nosocomial pneumonia, bloodstream infections, catheter-related urinary tract infections, etc. On the other hand, CA-SA isolates usually cause highly fatal diseases, such as SSTIs as well as post influenza necrotic hemorrhagic pneumonia. The differences of the infection types are partially due to the unique characteristics between HA-SA and CA-SA isolates. For example, HA-SA isolates showed strong adherence to host epithelial cells, while CA-SA isolates displayed higher virulence due to the increased activity of the important quorum-sensing system accessory gene regulator (agr). Thus, the aim of this study was to characterize the proteomic difference between HA-SA and CA-SA lineage. Methods In this study, the extracted peptides from those representative strains were analyzed by LC-MS/MS. The protein-protein interaction network was constructed by bioinformatics and their expressions were verified by RT-PCR and Western blot. Results We demonstrated that Agr system (AgrA and AgrC) and its interactive factors (PhoP, SrrB, YycG, SarX, SigB and ClpP) based on the protein–protein interaction network were expressed significantly higher in the epidemic Chinese CA-SA lineage ST398 compared to HA-SA lineage ST239 by LC-MS/MS. We further verified the increased transcription of all these genes in ST398 by RT-PCR, suggesting that the higher expression of these genes/proteins probably play role in the acute infection of CA-SA. Moreover, surface-related proteins (FnbpA, SpA, Atl, ClfA, IsaA, IsaB, LtaS, SsaA and Cna) that are repressed by the Agr system have significantly higher expression in the epidemic Chinese HA-SA clone ST239 in comparison to CA-SA lineage ST398 by LC-MS/MS. Furthermore, we confirmed the significantly increased expression of two important adhesive proteins (Atl and ClfA) in ST239 by Western blot, which may contribute to the durative infection of HA-SA. Conclusion The results suggest that the different proteomic profile, at least partially, contribute to the pathogenic differences between HA-SA and CA-SA. Electronic supplementary material The online version of this article (10.1186/s12014-017-9178-5) contains supplementary material, which is available to authorized users.
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Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, Chang PK, O'Neill PJ, Mollen KP, Huston JM, Diaz JJ, Prince JM. The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection. Surg Infect (Larchmt) 2017; 18:1-76. [PMID: 28085573 DOI: 10.1089/sur.2016.261] [Citation(s) in RCA: 331] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations. METHODS Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published since 2008. These publications and additional materials published before 2008 were reviewed by the task force as a whole or by individual subgroups as to relevance to individual questions. Recommendations were developed by a process of iterative consensus, with all task force members voting to accept or reject each recommendation. Grading was based on the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) system; the quality of the evidence was graded as high, moderate, or weak, and the strength of the recommendation was graded as strong or weak. Review of the document was performed by members of the SIS who were not on the task force. After responses were made to all critiques, the document was approved as an official guideline of the SIS by the Executive Council. RESULTS This guideline summarizes the current recommendations developed by the task force on the treatment of patients who have IAI. Evidence-based recommendations have been made regarding risk assessment in individual patients; source control; the timing, selection, and duration of antimicrobial therapy; and suggested approaches to patients who fail initial therapy. Additional recommendations related to the treatment of pediatric patients with IAI have been included. SUMMARY The current recommendations of the SIS regarding the treatment of patients with IAI are provided in this guideline.
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Affiliation(s)
- John E Mazuski
- 1 Department of Surgery, Washington University School of Medicine , Saint Louis, Missouri
| | | | - Addison K May
- 3 Department of Surgery, Vanderbilt University , Nashville, Tennessee
| | - Robert G Sawyer
- 4 Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Evan P Nadler
- 5 Division of Pediatric Surgery, Children's National Medical Center , Washington, DC
| | - Matthew R Rosengart
- 6 Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Phillip K Chang
- 7 Department of Surgery, University of Kentucky , Lexington, Kentucky
| | | | - Kevin P Mollen
- 9 Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jared M Huston
- 10 Department of Surgery, Hofstra Northwell School of Medicine , Hempstead, New York
| | - Jose J Diaz
- 11 Department of Surgery, University of Maryland School of Medicine , Baltimore, Maryland
| | - Jose M Prince
- 12 Departments of Surgery and Pediatrics, Hofstra-Northwell School of Medicine , Hempstead, New York
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Factores de riesgo asociados a infecciones por bacterias multirresistentes derivadas de la atención en salud en una institución hospitalaria de la ciudad de Medellín 2011-2014. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jeremiah CJ, Kandiah JP, Spelman DW, Giffard PM, Coombs GW, Jenney AW, Tong SY. Differing epidemiology of two major healthcare-associated meticillin-resistant Staphylococcus aureus clones. J Hosp Infect 2015; 92:183-90. [PMID: 26778134 DOI: 10.1016/j.jhin.2015.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/20/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Two meticillin-resistant Staphylococcus aureus (MRSA) clones, sequence type (ST) 22 and ST239, have successfully spread globally. Across Australia, ST22 has supplanted ST239 as the main healthcare-associated MRSA. To understand the reasons underlying this shift, the epidemiology and clinical features of infections due to ST22 and ST239 MRSA isolates from a tertiary hospital in Melbourne, Australia were compared. METHODS Over six months, consecutive MRSA isolates with clinical data were collected from specimens referred to Alfred Health Pathology (AHP). Isolates were genotyped by a multi-locus-sequence-typing-based high-resolution melting method. FINDINGS Three hundred and twenty-eight of 1079 (30%) S. aureus isolated by AHP were MRSA. Of these, 313 were genotyped; 78 (25%) were clonal complex (CC) 22 (representing ST22) and 142 (45%) were CC239 (representing ST239). Common clinical syndromes included skin or soft tissue, respiratory tract and osteo-articular infections. On multi-variate logistic regression, compared with CC239, CC22 was associated with older patients [adjusted odds ratio (aOR) 1.04 for each year increase, 95% confidence interval (CI) 1.02-1.07)], and patients from subacute hospitals (aOR 2.7, 95% CI 1.2-5.8) or long-term care facilities (LTCFs; aOR 5.5, 95% CI 2.0-14.5). Median time from patient admission to MRSA isolation was nine days for CC239 and one day for CC22 (P < 0.01). MRSA strain epidemiology varied according to hospital unit. CONCLUSIONS CC22 and CC239 MRSA have differing ecological niches. CC22 is associated with elderly patients in LTCFs, and CC239 is associated with nosocomial acquisition. Infection control strategies involving LTCFs and their residents will likely be required to achieve continued MRSA control.
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Affiliation(s)
- C J Jeremiah
- Department of Infectious Diseases, St Vincent's Hospital, Fitzroy, VIC, Australia; Department of Medicine, The Northern Hospital, Epping, VIC, Australia.
| | | | - D W Spelman
- Department of Infectious Diseases and Microbiology, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - P M Giffard
- Menzies School of Health Research, Casuarina, NT, Australia
| | - G W Coombs
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine-WA, Royal Perth Hospital, Perth, WA, Australia; Australian Collaborating Centre for Enterococcus and Staphylococcus Species Typing and Research, School of Veterinary and Life Sciences, Murdoch University and School of Biomedical Sciences, Curtin University, Perth, WA, Australia
| | - A W Jenney
- Department of Infectious Diseases and Microbiology, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - S Y Tong
- Menzies School of Health Research, Casuarina, NT, Australia; Royal Darwin Hospital, Casuarina, NT, Australia
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Yao Z, Peng Y, Chen X, Bi J, Li Y, Ye X, Shi J. Healthcare Associated Infections of Methicillin-Resistant Staphylococcus aureus: A Case-Control-Control Study. PLoS One 2015; 10:e0140604. [PMID: 26470023 PMCID: PMC4607165 DOI: 10.1371/journal.pone.0140604] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/27/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most widespread and dangerous pathogens in healthcare settings. We carried out this case-control-control study at a tertiary care hospital in Guangzhou, China, to examine the antimicrobial susceptibility patterns, risk factors and clinical outcomes of MRSA infections. METHODS A total of 57 MRSA patients, 116 methicillin-susceptible Staphylococcus aureus (MSSA) patients and 102 S. aureus negative patients were included in this study. We applied the disk diffusion method to compare the antimicrobial susceptibilities of 18 antibiotics between MRSA and MSSA isolates. Risk factors of MRSA infections were evaluated using univariate and multivariate logistic regression models. We used Cox proportional hazards models and logistic regression analysis to assess the hospital stay duration and fatality for patients with MRSA infections. RESULTS The MRSA group had significantly higher resistance rates for most drugs tested compared with the MSSA group. Using MSSA patients as controls, the following independent risk factors of MRSA infections were identified: 3 or more prior hospitalizations (OR 2.8, 95% CI 1.3-5.8, P = 0.007), chronic obstructive pulmonary disease (OR 5.9, 95% CI 1.7-20.7, P = 0.006), and use of a respirator (OR 3.6, 95% CI 1.0-12.9, P = 0.046). With the S. aureus negative patients as controls, use of a respirator (OR 3.8, 95% CI 1.0-13.9, P = 0.047) and tracheal intubation (OR 8.2, 95% CI 1.5-45.1, P = 0.016) were significant risk factors for MRSA infections. MRSA patients had a longer hospital stay duration and higher fatality in comparison with those in the two control groups. CONCLUSIONS MRSA infections substantially increase hospital stay duration and fatality. Thus, MRSA infections are serious issues in this healthcare setting and should receive more attention from clinicians.
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Affiliation(s)
- Zhenjiang Yao
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China
- * E-mail:
| | - Yang Peng
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaofeng Chen
- Division of Infectious Diseases, The People’s Hospital of Meizhou, Meizhou, China
| | - Jiaqi Bi
- Department of Environmental and School Health, Shajing Health Inspection Institute, Shenzhen, China
| | - Ying Li
- Division of Environmental Health, Public Health Laboratory Center, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaohua Ye
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jing Shi
- Department of Preventive Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
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Epstein L, Mu Y, Belflower R, Scott J, Ray S, Dumyati G, Felsen C, Petit S, Yousey-Hindes K, Nadle J, Pasutti L, Lynfield R, Warnke L, Schaffner W, Leib K, Kallen AJ, Fridkin SK, Lessa FC. Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus Infection After Recent Discharge From an Acute-Care Hospitalization, 2011-2013. Clin Infect Dis 2015; 62:45-52. [PMID: 26338787 DOI: 10.1093/cid/civ777] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/21/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Significant progress has been made in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections among hospitalized patients. However, the decreases in invasive MRSA infections among recently discharged patients have been less substantial. To inform prevention strategies, we assessed risk factors for invasive MRSA infection after acute-care hospitalizations. METHODS We conducted a prospective, matched case-control study. A case was defined as MRSA cultured from a normally sterile body site in a patient discharged from a hospital within the prior 12 weeks. Eligible case patients were identified from 15 hospitals across 6 US states. For each case patient, 2 controls were matched for hospital, month of discharge, and age group. Medical record reviews and telephone interviews were performed. Conditional logistic regression was used to identify independent risk factors for postdischarge invasive MRSA. RESULTS From 1 February 2011 through 31 March 2013, 194 case patients and 388 matched controls were enrolled. The median time between hospital discharge and positive culture was 23 days (range, 1-83 days). Factors independently associated with postdischarge MRSA infection included MRSA colonization (matched odds ratio [mOR], 7.71; 95% confidence interval [CI], 3.60-16.51), discharge to a nursing home (mOR, 2.65; 95% CI, 1.41-4.99), presence of a chronic wound during the postdischarge period (mOR, 4.41; 95% CI, 2.14-9.09), and discharge with a central venous catheter (mOR, 2.16; 95% CI, 1.13-4.99) or a different invasive device (mOR, 3.03; 95% CI, 1.24-7.39) in place. CONCLUSIONS Prevention efforts should target patients with MRSA colonization or those with invasive devices or chronic wounds at hospital discharge. In addition, MRSA prevention efforts in nursing homes are warranted.
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Affiliation(s)
- Lauren Epstein
- Division of Healthcare Quality Promotion Epidemic Intelligence Service, Centers for Disease Control and Prevention
| | - Yi Mu
- Division of Healthcare Quality Promotion
| | | | | | - Susan Ray
- Emory University School of Medicine, Atlanta Georgia Emerging Infections Program, Decatur
| | | | | | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | | | | | | | | | | | - William Schaffner
- Vanderbilt University School of Medicine Tennessee Emerging Infections Program, Nashville
| | - Karen Leib
- Vanderbilt University School of Medicine Tennessee Emerging Infections Program, Nashville
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Dryden M, Baguneid M, Eckmann C, Corman S, Stephens J, Solem C, Li J, Charbonneau C, Baillon-Plot N, Haider S. Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections. Clin Microbiol Infect 2015. [PMID: 26198368 DOI: 10.1016/j.cmi.2015.03.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus affects 284 million adults worldwide and is increasing in prevalence. Accelerated atherosclerosis in patients with diabetes mellitus contributes an increased risk of developing cardiovascular diseases including peripheral vascular disease (PVD). Immune dysfunction, diabetic neuropathy and poor circulation in patients with diabetes mellitus, especially those with PVD, place these patients at high risk for many types of typical and atypical infections. Complicated skin and soft-tissue infections (cSSTIs) are of particular concern because skin breakdown in patients with advanced diabetes mellitus and PVD provides a portal of entry for bacteria. Patients with diabetes mellitus are more likely to be hospitalized with cSSTIs and to experience related complications than patients without diabetes mellitus. Patients with PVD requiring lower extremity bypass are also at high risk of surgical site and graft infections. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative pathogen in cSSTIs, and may be a significant contributor to surgical site infections, especially in patients who are colonized with MRSA on hospital admission. Patients with cSSTIs and diabetes mellitus or PVD experience lower clinical success rates than patients without these comorbidities, and may also have a longer length of hospital stay and higher risk of adverse drug events. Clinicians should be vigilant in recognizing the potential for infection with multi-drug-resistant organisms, especially MRSA, in these populations and initiating therapy with appropriate antibiotics.
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Affiliation(s)
- M Dryden
- Hampshire Hospitals NHS Foundation Trust, Coitbury House Friarsgate, Winchester, UK
| | - M Baguneid
- Department of Vascular Surgery, University Hospital of South Manchester NHS, Manchester, UK
| | - C Eckmann
- Klinikum Peine, Academic Hospital of Medical University Hannover, Peine, Germany
| | - S Corman
- Pharmerit International, Bethesda, MD, USA
| | - J Stephens
- Pharmerit International, Bethesda, MD, USA.
| | - C Solem
- Pharmerit International, Bethesda, MD, USA
| | - J Li
- Pfizer Inc., San Diego, CA, USA
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Healthcare- and Community-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) and Fatal Pneumonia with Pediatric Deaths in Krasnoyarsk, Siberian Russia: Unique MRSA's Multiple Virulence Factors, Genome, and Stepwise Evolution. PLoS One 2015; 10:e0128017. [PMID: 26047024 PMCID: PMC4457420 DOI: 10.1371/journal.pone.0128017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/21/2015] [Indexed: 12/25/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common multidrug-resistant (MDR) pathogen. We herein discussed MRSA and its infections in Krasnoyarsk, Siberian Russia between 2007 and 2011. The incidence of MRSA in 3,662 subjects was 22.0% and 2.9% for healthcare- and community-associated MRSA (HA- and CA-MRSA), respectively. The 15-day mortality rates for MRSA hospital- and community-acquired pneumonia (HAP and CAP) were 6.5% and 50%, respectively. MRSA CAP cases included pediatric deaths; of the MRSA pneumonia episodes available, ≥27.3% were associated with bacteremia. Most cases of HA-MRSA examined exhibited ST239/spa3(t037)/SCCmecIII.1.1.2 (designated as ST239Kras), while all CA-MRSA cases examined were ST8/spa1(t008)/SCCmecIV.3.1.1(IVc) (designated as ST8Kras). ST239Kras and ST8Kras strongly expressed cytolytic peptide (phenol-soluble modulin α, PSMα; and δ-hemolysin, Hld) genes, similar to CA-MRSA. ST239Kras pneumonia may have been attributed to a unique set of multiple virulence factors (MVFs): toxic shock syndrome toxin-1 (TSST-1), elevated PSMα/Hld expression, α-hemolysin, the staphylococcal enterotoxin SEK/SEQ, the immune evasion factor SCIN/SAK, and collagen adhesin. Regarding ST8Kras, SEA was included in MVFs, some of which were common to ST239Kras. The ST239Kras (strain OC3) genome contained: a completely unique phage, φSa7-like (W), with no att repetition; S. aureus pathogenicity island SaPI2R, the first TSST-1 gene-positive (tst+) SaPI in the ST239 lineage; and a super copy of IS256 (≥22 copies/genome). ST239Kras carried the Brazilian SCCmecIII.1.1.2 and United Kingdom-type tst. ST239Kras and ST8Kras were MDR, with the same levofloxacin resistance mutations; small, but transmissible chloramphenicol resistance plasmids spread widely enough to not be ignored. These results suggest that novel MDR and MVF+ HA- and CA-MRSA (ST239Kras and ST8Kras) emerged in Siberian Russia (Krasnoyarsk) associated with fatal pneumonia, and also with ST239Kras, a new (Siberian Russian) clade of the ST239 lineage, which was created through stepwise evolution during its potential transmission route of Brazil-Europe-Russia/Krasnoyarsk, thereby selective advantages from unique MVFs and the MDR.
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Mackay WG, Smith K, Williams C, Chalmers C, Masterton R. A review of infection control in community healthcare: new challenges but old foes. Eur J Clin Microbiol Infect Dis 2014; 33:2121-30. [PMID: 24993151 PMCID: PMC7087687 DOI: 10.1007/s10096-014-2191-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/20/2014] [Indexed: 02/04/2023]
Abstract
The demographics of the healthcare population are changing, with an ever-greater proportion of people being treated outside the traditional hospital setting through community healthcare. This shift in the way that healthcare is delivered raises new concerns over community healthcare-associated infections (HCAIs). A literature search between 2000 and December 2013 was conducted in databases including PubMed, SciVerse ScienceDirect and Google Scholar. National and international guideline and policy documents were searched using Google. Many terms were used in the literature searches, including ‘nosocomial’, ‘healthcare infection’, ‘community’ and ‘nursing home’. The rates of HCAI in community healthcare are similar to the rates found in the acute hospital setting, but the types of infection differ, with a greater focus on urinary tract infections (UTIs) in the community and ventilator-associated pneumonias in the hospital setting. Patients who acquire a community HCAI are more likely to exhibit reduced physical condition, have increased levels of morbidity and have higher mortality rates than individuals without infection. Infection control programmes have been developed worldwide to reduce the rates of hospital HCAIs. Such interventions are equally as valid in the community, but how best to implement them and their subsequent impact are much less well understood. The future is clear: HCAIs in the community are going to become an ever-increasing burden and it is critical that our approach to these infections is brought quickly in line with present hospital sector standards.
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Affiliation(s)
- W G Mackay
- University of the West of Scotland, Kilmarnock, Ayrshire, UK,
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Hernández-Porto M, Castro B, Ramos MJ, Arias A, Aguirre-Jaime A, Lecuona M. Risk factors for development of methicillin-resistant Staphylococcus aureus-positive clinical culture in nasal carriers after decolonization treatment. Am J Infect Control 2014; 42:e75-9. [PMID: 24855930 DOI: 10.1016/j.ajic.2014.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/08/2014] [Accepted: 03/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Active surveillance systems are effective in reducing health care-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Nonetheless, some patients develop MRSA infection despite control measures. We tried to identify risk factors related to the appearance of MRSA at sites other than the nasal fossa in patients who were nasal carriers of MRSA. METHODS A retrospective case-control study was conducted in an active surveillance program for MRSA between January 2009 and December 2010 at a Spanish teaching hospital. Cases were patients with MRSA in the anterior nares and a length of stay of at least 5 days who developed MRSA-positive clinical culture after decolonization treatment had started. Controls were patients with the same characteristics as the case group, except that they did not develop MRSA-positive clinical culture as verified by negative clinical cultures. RESULTS After intrinsic and extrinsic risk factors were analyzed, the emergence of mupirocin-resistant MRSA clones after decolonization treatment, and residence in a nursing home were marginally significant in the univariate analysis. The detection of the emergence of mupirocin-resistant MRSA clones was independently associated with the detection of MRSA in other clinical locations. CONCLUSIONS In an active surveillance program for MRSA it is important to determine the mupirocin susceptibility of the isolates to determine appropriate treatment and to verify negativity after decolonizing treatment has been completed.
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Affiliation(s)
- Miriam Hernández-Porto
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain.
| | - Beatriz Castro
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
| | - Maria Jose Ramos
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
| | - Angeles Arias
- Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Canary Islands, Spain
| | - Armando Aguirre-Jaime
- Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria Carretera del Rosario, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Maria Lecuona
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
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Brown AF, Leech JM, Rogers TR, McLoughlin RM. Staphylococcus aureus Colonization: Modulation of Host Immune Response and Impact on Human Vaccine Design. Front Immunol 2014; 4:507. [PMID: 24409186 PMCID: PMC3884195 DOI: 10.3389/fimmu.2013.00507] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/21/2013] [Indexed: 12/15/2022] Open
Abstract
In apparent contrast to its invasive potential Staphylococcus aureus colonizes the anterior nares of 20–80% of the human population. The relationship between host and microbe appears particularly individualized and colonization status seems somehow predetermined. After decolonization, persistent carriers often become re-colonized with their prior S. aureus strain, whereas non-carriers resist experimental colonization. Efforts to identify factors facilitating colonization have thus far largely focused on the microorganism rather than on the human host. The host responds to S. aureus nasal colonization via local expression of anti-microbial peptides, lipids, and cytokines. Interplay with the co-existing microbiota also influences colonization and immune regulation. Transient or persistent S. aureus colonization induces specific systemic immune responses. Humoral responses are the most studied of these and little is known of cellular responses induced by colonization. Intriguingly, colonized patients who develop bacteremia may have a lower S. aureus-attributable mortality than their non-colonized counterparts. This could imply a staphylococcal-specific immune “priming” or immunomodulation occurring as a consequence of colonization and impacting on the outcome of infection. This has yet to be fully explored. An effective vaccine remains elusive. Anti-S. aureus vaccine strategies may need to drive both humoral and cellular immune responses to confer efficient protection. Understanding the influence of colonization on adaptive response is essential to intelligent vaccine design, and may determine the efficacy of vaccine-mediated immunity. Clinical trials should consider colonization status and the resulting impact of this on individual patient responses. We urgently need an increased appreciation of colonization and its modulation of host immunity.
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Affiliation(s)
- Aisling F Brown
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute , Dublin , Ireland
| | - John M Leech
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute , Dublin , Ireland
| | - Thomas R Rogers
- Sir Patrick Dun Laboratory, Department of Clinical Microbiology, Trinity College Dublin, St James's Hospital , Dublin , Ireland
| | - Rachel M McLoughlin
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute , Dublin , Ireland
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15
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Stenehjem E, Rimland D. MRSA nasal colonization burden and risk of MRSA infection. Am J Infect Control 2013; 41:405-10. [PMID: 23261345 DOI: 10.1016/j.ajic.2012.07.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 07/14/2012] [Accepted: 07/16/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Staphylococcus aureus nasal colonization burden has been identified as a risk factor for infection. This study evaluates methicillin-resistant S aureus (MRSA) nasal burden, as defined by the cycle threshold (Ct) and risk of subsequent infection. METHODS In a retrospective cohort study, United States veterans were classified into 3 MRSA nasal colonization groups: noncarriers, low burden (Ct > 24 cycles), and high burden (Ct ≤ 24 cycles). MRSA infections were identified prospectively, and clinical information was obtained by chart review. Multivariate logistic regression assessed the association of MRSA nasal burden and risk of MRSA infection. RESULTS During 4-years of follow-up, 4.3% of noncarriers, 18.5% of low burden, and 17.2% of high burden developed a MRSA infection. In multivariate analysis, MRSA nasal colonization was a risk factor for MRSA infection (P = .008) with low burden (risk ratio [RR], 3.62; 95% confidence interval [CI]: 1.47-8.93) and high burden (RR, 2.71; 95% CI: 0.95-7.72) associated with subsequent MRSA infection when compared with noncarriers. When compared with low burden, high burden nasal carriers were not at increased risk of infection (RR, 0.75; 95% CI 0.36-1.55). CONCLUSION MRSA nasal colonization was a risk factor for MRSA infection. High nasal burden of MRSA did not increase the risk of infection.
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16
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Khokhlova O, Tomita Y, Hung WC, Takano T, Iwao Y, Higuchi W, Nishiyama A, Reva I, Yamamoto T. Elderly infection in the community due to ST5/SCCmecII methicillin-resistant Staphylococcus aureus (the New York/Japan clone) in Japan: Panton-Valentine leukocidin-negative necrotizing pneumonia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012. [PMID: 23201322 DOI: 10.1016/j.jmii.2012.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An 89-year-old man suffered from and died of necrotizing pneumonia with rapid progression and cavity formation due to methicillin-resistant Staphylococcus aureus (MRSA). He was at no risk for hospital-acquired MRSA infection. His MRSA exhibited genotype ST5/spa2(t002)/agr2/SCCmecII/coagulaseII and was negative for Panton-Valentine leukocidin, indicating the New York/Japan clone (the predominant epidemic hospital-acquired MRSA clone in Japan). However, this strain expressed the cytolytic peptide (phenol-soluble modulin or δ-hemolysin) genes at high level, similar to USA300 (the most common community-acquired MRSA in the United States), indicating a variant of the New York/Japan clone with an important feature of community-acquired MRSA.
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Affiliation(s)
- Olga Khokhlova
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yusuke Tomita
- Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Wei-Chun Hung
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tomomi Takano
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuhisa Iwao
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Wataru Higuchi
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akihito Nishiyama
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ivan Reva
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuo Yamamoto
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan.
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17
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Hergenröder H, Mielke M, Höller C, Herr C. [Methicillin-resistant Staphylococcus aureus (MRSA) in medical rehabilitation. Draft of a model hygiene plan]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:1453-64. [PMID: 23114445 DOI: 10.1007/s00103-012-1554-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Rehabilitation facilities often apply the same standards for management of methicillin-resistant Staphylococcus aureus (MRSA) carriers as acute care hospitals. This makes it difficult to ensure access to the facilities and adequate rehabilitation for carriers. A working group of the Bavarian state committee for multiresistant pathogens addressed these problems by a systematic review of literature, expert group meetings and evaluation of existing hygiene plans. Thereby a model hygiene plan for rehabilitation facilities concerning management of MRSA carriers was derived. The management is based on physician risk assessment blending standards applied in acute and long-term care facilities. For rehabilitation typical risk scenario examples of risk analyses are given. The preventive measures are based on the respective objectives of protection. The risk analysis which gives the basis for the model hygiene plan described in this paper gives equal weight to two main objectives of protection: infection control and medical rehabilitation.
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Affiliation(s)
- H Hergenröder
- Landratsamt Miesbach, Wendelsteinstrasse 1, Miesbach, Germany.
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18
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Bergström A, Gustafsson C, Leander M, Fredriksson M, Grönlund U, Trowald-Wigh G. Occurrence of methicillin-resistant Staphylococci in surgically treated dogs and the environment in a Swedish animal hospital. J Small Anim Pract 2012; 53:404-10. [DOI: 10.1111/j.1748-5827.2012.01238.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A. Bergström
- University Animal Hospital; Box 7040; SE-750 07; Uppsala; Sweden
| | - C. Gustafsson
- Department of Biomedical Sciences and Veterinary Public Health, Division of Bacteriology and Food Safety; Swedish University of Agricultural Sciences; Box 7009; SE-750 07; Uppsala; Sweden
| | - M. Leander
- Department of Biomedical Sciences and Veterinary Public Health, Division of Bacteriology and Food Safety; Swedish University of Agricultural Sciences; Box 7009; SE-750 07; Uppsala; Sweden
| | - M. Fredriksson
- Department of Biomedical Sciences and Veterinary Public Health, Division of Bacteriology and Food Safety; Swedish University of Agricultural Sciences; Box 7009; SE-750 07; Uppsala; Sweden
| | - U. Grönlund
- Department of Animal Health and Antimicrobial Strategies; National Veterinary Institute (SVA); SE-75189; Uppsala; Sweden
| | - G. Trowald-Wigh
- Department of Biomedical Sciences and Veterinary Public Health, Division of Bacteriology and Food Safety; Swedish University of Agricultural Sciences; Box 7009; SE-750 07; Uppsala; Sweden
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19
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Tong SYC, Chen LF, Fowler VG. Colonization, pathogenicity, host susceptibility, and therapeutics for Staphylococcus aureus: what is the clinical relevance? Semin Immunopathol 2011; 34:185-200. [PMID: 22160374 DOI: 10.1007/s00281-011-0300-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 10/28/2011] [Indexed: 12/20/2022]
Abstract
Staphylococcus aureus is a human commensal that can also cause a broad spectrum of clinical disease. Factors associated with clinical disease are myriad and dynamic and include pathogen virulence, antimicrobial resistance, and host susceptibility. Additionally, infection control measures aimed at the environmental niches of S. aureus and therapeutic advances continue to impact upon the incidence and outcomes of staphylococcal infections. This review article focuses on the clinical relevance of advances in our understanding of staphylococcal colonization, virulence, host susceptibility, and therapeutics. Over the past decade key developments have arisen. First, rates of nosocomial methicillin-resistant S. aureus (MRSA) infections have significantly declined in many countries. Second, we have made great strides in our understanding of the molecular pathogenesis of S. aureus in general and community-associated MRSA in particular. Third, host risk factors for invasive staphylococcal infections, such as advancing age, increasing numbers of invasive medical interventions, and a growing proportion of patients with healthcare contact, remain dynamic. Finally, several new antimicrobial agents active against MRSA have become available for clinical use. Humans and S. aureus co-exist, and the dynamic interface between host, pathogen, and our attempts to influence these interactions will continue to rapidly change. Although progress has been made in the past decade, we are likely to face further surprises such as the recent waves of community-associated MRSA.
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Affiliation(s)
- Steven Y C Tong
- Division of Infectious Diseases and International Health, Duke University Medical Center, Box 102359, Durham, NC 27705, USA.
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