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Nakano Y, Murata M, Matsumoto Y, Toyoda K, Ota A, Yamasaki S, Otakeno H, Yokoo K, Shimono N. Clinical characteristics and factors related to infection with SCCmec type II and IV Methicillin-resistant Staphylococcus aureus in a Japanese secondary care facility: a single-center retrospective study. J Glob Antimicrob Resist 2022; 31:355-362. [PMID: 36372183 DOI: 10.1016/j.jgar.2022.11.003] [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: 06/03/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Differences in virulence genes, including psm-mec, which is a phenol-soluble modulin-mec (PSM-mec) encoding gene, of predominant staphylococcal cassette chromosome mec (SCCmec) types II and IV Methicillin-resistant Staphylococcus aureus (MRSA) may contribute to the virulence and clinical features of MRSA in Japan. We aimed to clarify the clinical characteristics and risk factors of infection among SCCmec types II and IV MRSA isolates from a Japanese secondary acute care hospital. METHODS We analysed 58 SCCmec type II and 83 SCCmec type IV MRSA isolates collected from blood, central venous catheter tips, deep or superficial tissues, and sputum. RESULTS SCCmec type II MRSA risk factors for progression to infection were seb, enterotoxin gene cluster, psm-mec mutation, and vancomycin minimum inhibitory concentrations (MIC) of 1 or 2 mg/L as virulence factors (adjusted odds ratio [aOR] = 11.8; 95% confidence interval [CI]: 2.49-77.7; P = 0.004); solid tumour was a host factor (aOR = 25.9; 95% CI: 3.66-300; P = 0.003). SCCmec type IV MRSA risk factors were sea, cna, and vancomycin MIC of 1 or 2 mg/L as virulence factors (aOR = 3.14; 95% CI: 1.06-10.6; P = 0.049) and intravascular indwelling catheter as host factors (aOR = 3.78; 95% CI: 1.03-14.5; P = 0.045). Compared with SCCmec type II, SCCmec type IV MRSA resulted in more frequent bloodstream infections and higher Sequential Organ Failure Assessment scores. CONCLUSION We found that factors related to virulence genes and bacteriological and host characteristics are associated with SCCmec types II and IV MRSA infection and severity. These risk factors may be useful criteria for designing infection control programs.
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Affiliation(s)
- Yuki Nakano
- Department of Environmental Medicine and Infectious Disease, Kyushu University, Higashi-Ku, Fukuoka, Japan; Department of Pharmacy, Saiseikai Futsukaichi Hospital, Chikushino, Fukuoka, Japan
| | - Masayuki Murata
- Department of Environmental Medicine and Infectious Disease, Kyushu University, Higashi-Ku, Fukuoka, Japan; Department of General Internal Medicine, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan; Center for the Study of Global Infection, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan.
| | - Yuji Matsumoto
- Department of Environmental Medicine and Infectious Disease, Kyushu University, Higashi-Ku, Fukuoka, Japan; Department of General Internal Medicine, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan; Center for the Study of Global Infection, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan
| | - Kazuhiro Toyoda
- Department of General Internal Medicine, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan; Center for the Study of Global Infection, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan
| | - Azusa Ota
- Department of Environmental Medicine and Infectious Disease, Kyushu University, Higashi-Ku, Fukuoka, Japan; Department of General Internal Medicine, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan; Center for the Study of Global Infection, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan
| | - Sho Yamasaki
- Department of Environmental Medicine and Infectious Disease, Kyushu University, Higashi-Ku, Fukuoka, Japan; Department of General Internal Medicine, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan
| | - Hisao Otakeno
- Department of Pharmacy, Saiseikai Futsukaichi Hospital, Chikushino, Fukuoka, Japan
| | - Kenjo Yokoo
- Department of Pharmacy, Saiseikai Futsukaichi Hospital, Chikushino, Fukuoka, Japan
| | - Nobuyuki Shimono
- Department of General Internal Medicine, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan; Center for the Study of Global Infection, Kyushu University Hospital, Higashi-Ku, Fukuoka, Japan
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Ortwine JK, Bhavan K. Morbidity, mortality, and management of methicillin-resistant S. aureus bacteremia in the USA: update on antibacterial choices and understanding. Hosp Pract (1995) 2018; 46:64-72. [PMID: 29400119 DOI: 10.1080/21548331.2018.1435128] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with significant healthcare costs, morbidity, and mortality in the United States. Complications of MRSA bacteremia include infective endocarditis, osteomyelitis, and sepsis, all of which are difficult to treat. Time to effective therapy and antibacterial choice greatly affect patient outcomes. Vancomycin and daptomycin remain first-line therapies; however, reports of vancomycin-associated treatment failure and reduced daptomycin susceptibility highlight the need to define alternative strategies for MRSA bacteremia treatment. In addition, several patient- and pathogen-specific factors influence the outcomes of MRSA bacteremia. It is, therefore, critical to explore the interaction between host- and pathogen-specific factors and its effect on MRSA bacteremia pathogenesis and mortality. This review discusses the factors that drive the development of MRSA bacteremia and examines alternative treatment strategies.
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Affiliation(s)
- Jessica K Ortwine
- a Infectious Diseases/Antimicrobial Stewardship Clinical Pharmacist, Department of Pharmacy Services , Parkland Health and Hospital System , Dallas , TX , USA
| | - Kavita Bhavan
- b Department of Internal Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA
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Association between Accessory Gene Regulator Polymorphism and Mortality among Critically Ill Patients Receiving Vancomycin for Nosocomial MRSA Bacteremia: A Cohort Study. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:8163456. [PMID: 27366180 PMCID: PMC4904565 DOI: 10.1155/2016/8163456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/23/2015] [Indexed: 12/02/2022]
Abstract
Background. Polymorphism of the accessory gene regulator group II (agr) in methicillin-resistant Staphylococcus aureus (MRSA) is predictive of vancomycin failure therapy. Nevertheless, the impact of group II agr expression on mortality of patients with severe MRSA infections is not well established. Objective. The goal of our study was to evaluate the association between agr polymorphism and all-cause in-hospital mortality among critically ill patients receiving vancomycin for nosocomial MRSA bacteremia. Methods. All patients with documented bacteremia by MRSA requiring treatment in the ICU between May 2009 and November 2011 were included in the study. Cox proportional hazards regression was performed to evaluate whether agr polymorphism was associated with all-cause in-hospital mortality. Covariates included age, APACHE II score, initial C-reactive protein plasma levels, initial serum creatinine levels, vancomycin minimum inhibitory concentration, vancomycin serum levels, and time to effective antibiotic administration. Results. The prevalence of group I and group II agr expression was 52.4% and 47.6%, respectively. Bacteremia by MRSA group III or group IV agr was not documented in our patients. The mean APACHE II of the study population was 24.3 (standard deviation 8.5). The overall cohort mortality was 66.6% (14 patients). After multivariate analysis, initial plasma C-reactive protein levels (P = 0.01), initial serum creatinine levels (P = 0.008), and expression of group II agr (P = 0.006) were positively associated with all-cause in-hospital mortality. Patients with bacteremia by MRSA with group II agr expression had their risk of death increased by 12.6 times when compared with those with bacteremia by MRSA with group I agr expression. Conclusion. Group II agr polymorphism is associated with an increase in mortality in critically ill patients with bacteremia by MRSA treated with vancomycin.
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agr dysfunction affects staphylococcal cassette chromosome mec type-dependent clinical outcomes in methicillin-resistant Staphylococcus aureus bacteremia. Antimicrob Agents Chemother 2015; 59:3125-32. [PMID: 25779574 DOI: 10.1128/aac.04962-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/05/2015] [Indexed: 12/30/2022] Open
Abstract
Staphylococcal cassette chromosome mec element (SCCmec) type-dependent clinical outcomes may vary due to geographical variation in the presence of virulence determinants. We compared the microbiological factors and mortality attributed to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia between SCCmec types II/III and type IV. All episodes of MRSA bacteremia in a tertiary-care hospital (South Korea) over a 4.5-year period were reviewed. We studied the microbiological factors associated with all blood MRSA isolates, including spa type, agr type, agr dysfunction, and the genes for Panton-Valentine leukocidin (PVL) and phenol-soluble modulin (PSM)-mec, in addition to SCCmec type. Of 195 cases, 137 involved SCCmec types II/III, and 58 involved type IV. The mortality attributed to MRSA bacteremia was less frequent among the SCCmec type IV (5/58) than that among types II/III (39/137, P = 0.002). This difference remained significant when adjusted for clinical factors (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.04 to 0.49; P = 0.002). Of the microbiological factors tested, agr dysfunction was the only significant factor that showed different positivity between the SCCmec types, and it was independently associated with MRSA bacteremia-attributed mortality (aOR, 4.71; 95% CI, 1.72 to 12.92; P = 0.003). SCCmec type IV is associated with lower MRSA bacteremia-attributed mortality than are types II/III, which might be explained by the high rate of agr dysfunction in SCCmec types II/III in South Korea.
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López-Cebral R, Romero-Caamaño V, Seijo B, Alvarez-Lorenzo C, Martín-Pastor M, Concheiro Á, Landin M, Sanchez A. Spermidine Cross-Linked Hydrogels as a Controlled Release Biomimetic Approach for Cloxacillin. Mol Pharm 2014; 11:2358-71. [DOI: 10.1021/mp500067z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Rita López-Cebral
- Department
of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
| | - Vanessa Romero-Caamaño
- Department
of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
| | - Begoña Seijo
- Department
of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
- Molecular
Image Group, University of Santiago de Compostela Clinical Hospital, Travesía
da Choupana, 15706 Santiago de Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Department
of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
| | - Manuel Martín-Pastor
- Nuclear
Magnetic Resonance Unit, University of Santiago de Compostela, Campus
Vida, 15706 Santiago
de Compostela, Spain
| | - Ángel Concheiro
- Department
of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
| | - Mariana Landin
- Department
of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
| | - Alejandro Sanchez
- Department
of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
- Molecular
Image Group, University of Santiago de Compostela Clinical Hospital, Travesía
da Choupana, 15706 Santiago de Compostela, Spain
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