1
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Bastien S, Meyers S, Salgado-Pabón W, Giulieri SG, Rasigade JP, Liesenborghs L, Kinney KJ, Couzon F, Martins-Simoes P, Moing VL, Duval X, Holmes NE, Bruun NE, Skov R, Howden BP, Fowler VG, Verhamme P, Andersen PS, Bouchiat C, Moreau K, Vandenesch F. All Staphylococcus aureus bacteraemia-inducing strains can cause infective endocarditis: Results of GWAS and experimental animal studies. J Infect 2023; 86:123-133. [PMID: 36603774 PMCID: PMC10399548 DOI: 10.1016/j.jinf.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/21/2022] [Accepted: 12/24/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed at determining whether specific S. aureus strains cause infective endocarditis (IE) in the course of Staphylococcus aureus bacteraemia (SAB). METHODS A genome-wide association study (GWAS) including 924 S. aureus genomes from IE (274) and non-IE (650) SAB patients from international cohorts was conducted, and a subset of strains was tested with two experimental animal models of IE, one investigating the early step of bacterial adhesion to inflamed mice valves, the second evaluating the local and systemic developmental process of IE on mechanically-damaged rabbit valves. RESULTS The genetic profile of S. aureus IE and non-IE SAB strains did not differ when considering single nucleotide polymorphisms, coding sequences, and k-mers analysed in GWAS. In the murine inflammation-induced IE model, no difference was observed between IE and non-IE SAB strains both in terms of adhesion to the cardiac valves and in the propensity to cause IE; in the mechanical IE-induced rabbit model, there was no difference between IE and non-IE SAB strains regarding the vegetation size and CFU. CONCLUSION All strains of S. aureus isolated from SAB patients must be considered as capable of causing this common and lethal infection once they have accessed the bloodstream.
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Affiliation(s)
- Sylvère Bastien
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - Severien Meyers
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Wilmara Salgado-Pabón
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, USA
| | - Stefano G Giulieri
- Department of Microbiology and Immunology and Department of Infectious Diseases, The University of Melbourne at the Doherty Institute for Infection and Immunity; Victorian Infectious Disease Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Jean-Phillipe Rasigade
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, F-69004, Lyon, France
| | - Laurens Liesenborghs
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Kyle J Kinney
- Department of Microbiology and Immunology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Florence Couzon
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - Patricia Martins-Simoes
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, F-69004, Lyon, France
| | | | - Xavier Duval
- Hôpital Bichat Claude Bernard, AP-HP, Paris, France; Inserm CIC 1425, Inserm UMR-1137 IAME, Cité Paris University, UFR de Médecine-Bichat, Paris, France
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Niels Eske Bruun
- Clinical Institute, Copenhagen and Aalborg University, Aalborg, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Zealand, Denmark
| | - Robert Skov
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Benjamin P Howden
- Department of Microbiology and Immunology and Department of Infectious Diseases, The University of Melbourne at the Doherty Institute for Infection and Immunity; Victorian Infectious Disease Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Vance G Fowler
- Duke University Medical Center, Durham, NC USA; Duke Clinical Research Institute, Durham, NC USA
| | - Peter Verhamme
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Paal Skytt Andersen
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Coralie Bouchiat
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, F-69004, Lyon, France
| | - Karen Moreau
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - François Vandenesch
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, F-69004, Lyon, France.
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2
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Rodrigues Lopes I, Alcantara LM, Silva RJ, Josse J, Vega EP, Cabrerizo AM, Bonhomme M, Lopez D, Laurent F, Vandenesch F, Mano M, Eulalio A. Microscopy-based phenotypic profiling of infection by Staphylococcus aureus clinical isolates reveals intracellular lifestyle as a prevalent feature. Nat Commun 2022; 13:7174. [PMID: 36418309 PMCID: PMC9684519 DOI: 10.1038/s41467-022-34790-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
Staphylococcus aureus is increasingly recognized as a facultative intracellular pathogen, although the significance and pervasiveness of its intracellular lifestyle remain controversial. Here, we applied fluorescence microscopy-based infection assays and automated image analysis to profile the interaction of 191 S. aureus isolates from patients with bone/joint infections, bacteremia, and infective endocarditis, with four host cell types, at five times post-infection. This multiparametric analysis revealed that almost all isolates are internalized and that a large fraction replicate and persist within host cells, presenting distinct infection profiles in non-professional vs. professional phagocytes. Phenotypic clustering highlighted interesting sub-groups, including one comprising isolates exhibiting high intracellular replication and inducing delayed host death in vitro and in vivo. These isolates are deficient for the cysteine protease staphopain A. This study establishes S. aureus intracellular lifestyle as a prevalent feature of infection, with potential implications for the effective treatment of staphylococcal infections.
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Affiliation(s)
- Ines Rodrigues Lopes
- grid.8051.c0000 0000 9511 4342RNA & Infection Laboratory, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Functional Genomics and RNA-based Therapeutics Laboratory, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
| | - Laura Maria Alcantara
- grid.8051.c0000 0000 9511 4342RNA & Infection Laboratory, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
| | - Ricardo Jorge Silva
- grid.8051.c0000 0000 9511 4342Functional Genomics and RNA-based Therapeutics Laboratory, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
| | - Jerome Josse
- grid.15140.310000 0001 2175 9188Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Elena Pedrero Vega
- grid.4711.30000 0001 2183 4846National Centre for Biotechnology, Spanish National Research Council (CNB-CSIC), Madrid, Spain
| | - Ana Marina Cabrerizo
- grid.4711.30000 0001 2183 4846National Centre for Biotechnology, Spanish National Research Council (CNB-CSIC), Madrid, Spain
| | - Melanie Bonhomme
- grid.15140.310000 0001 2175 9188Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Daniel Lopez
- grid.4711.30000 0001 2183 4846National Centre for Biotechnology, Spanish National Research Council (CNB-CSIC), Madrid, Spain
| | - Frederic Laurent
- grid.15140.310000 0001 2175 9188Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France ,grid.413852.90000 0001 2163 3825Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Francois Vandenesch
- grid.15140.310000 0001 2175 9188Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France ,grid.413852.90000 0001 2163 3825Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Miguel Mano
- grid.8051.c0000 0000 9511 4342Functional Genomics and RNA-based Therapeutics Laboratory, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Department of Life Sciences, University of Coimbra, Coimbra, Portugal ,grid.13097.3c0000 0001 2322 6764British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - Ana Eulalio
- grid.8051.c0000 0000 9511 4342RNA & Infection Laboratory, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal ,grid.7311.40000000123236065Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal ,grid.7445.20000 0001 2113 8111Department of Life Sciences, Imperial College London, London, United Kingdom
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3
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Schweizer TA, Andreoni F, Acevedo C, Scheier TC, Heggli I, Maggio EM, Eberhard N, Brugger SD, Dudli S, Zinkernagel AS. Intervertebral disc cell chondroptosis elicits neutrophil response in Staphylococcus aureus spondylodiscitis. Front Immunol 2022; 13:908211. [PMID: 35967370 PMCID: PMC9366608 DOI: 10.3389/fimmu.2022.908211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
To understand the pathophysiology of spondylodiscitis due to Staphylococcus aureus, an emerging infectious disease of the intervertebral disc (IVD) and vertebral body with a high complication rate, we combined clinical insights and experimental approaches. Clinical data and histological material of nine patients suffering from S. aureus spondylodiscitis were retrospectively collected at a single center. To mirror the clinical findings experimentally, we developed a novel porcine ex vivo model mimicking acute S. aureus spondylodiscitis and assessed the interaction between S. aureus and IVD cells within their native environment. In addition, the inflammatory features underlying this interaction were assessed in primary human IVD cells. Finally, mirroring the clinical findings, we assessed primary human neutrophils for their ability to respond to secreted inflammatory modulators of IVD cells upon the S. aureus challenge. Acute S. aureus spondylodiscitis in patients was characterized by tissue necrosis and neutrophil infiltration. Additionally, the presence of empty IVD cells’ lacunae was observed. This was mirrored in the ex vivo porcine model, where S. aureus induced extensive IVD cell death, leading to empty lacunae. Concomitant engagement of the apoptotic and pyroptotic cell death pathways was observed in primary human IVD cells, resulting in cytokine release. Among the released cytokines, functionally intact neutrophil-priming as well as broad pro- and anti-inflammatory cytokines which are known for their involvement in IVD degeneration were found. In patients as well as ex vivo in a novel porcine model, S. aureus IVD infection caused IVD cell death, resulting in empty lacunae, which was accompanied by the release of inflammatory markers and recruitment of neutrophils. These findings offer valuable insights into the important role of inflammatory IVD cell death during spondylodiscitis and potential future therapeutic approaches.
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Affiliation(s)
- Tiziano A. Schweizer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Federica Andreoni
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas C. Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Irina Heggli
- Center of Experimental Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ewerton Marques Maggio
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nadia Eberhard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio D. Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Dudli
- Center of Experimental Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
- *Correspondence: Annelies S. Zinkernagel,
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4
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Forecasting Staphylococcus aureus Infections Using Genome-Wide Association Studies, Machine Learning, and Transcriptomic Approaches. mSystems 2022; 7:e0037822. [PMID: 35862809 PMCID: PMC9426533 DOI: 10.1128/msystems.00378-22] [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] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus is a major human and animal pathogen, colonizing diverse ecological niches within its hosts. Predicting whether an isolate will infect a specific host and its subsequent clinical fate remains unknown. In this study, we investigated the S. aureus pangenome using a curated set of 356 strains, spanning a wide range of hosts, origins, and clinical display and antibiotic resistance profiles. We used genome-wide association study (GWAS) and random forest (RF) algorithms to discriminate strains based on their origins and clinical sources. Here, we show that the presence of sak and scn can discriminate strains based on their host specificity, while other genes such as mecA are often associated with virulent outcomes. Both GWAS and RF indicated the importance of intergenic regions (IGRs) and coding DNA sequence (CDS) but not sRNAs in forecasting an outcome. Additional transcriptomic analyses performed on the most prevalent clonal complex 8 (CC8) clonal types, in media mimicking nasal colonization or bacteremia, indicated three RNAs as potential RNA markers to forecast infection, followed by 30 others that could serve as infection severity predictors. Our report shows that genetic association and transcriptomics are complementary approaches that will be combined in a single analytical framework to improve our understanding of bacterial pathogenesis and ultimately identify potential predictive molecular markers. IMPORTANCE Predicting the outcome of bacterial colonization and infections, based on extensive genomic and transcriptomic data from a given pathogen, would be of substantial help for clinicians in treating and curing patients. In this report, genome-wide association studies and random forest algorithms have defined gene combinations that differentiate human from animal strains, colonization from diseases, and nonsevere from severe diseases, while it revealed the importance of IGRs and CDS, but not small RNAs (sRNAs), in anticipating an outcome. In addition, transcriptomic analyses performed on the most prevalent clonal types, in media mimicking either nasal colonization or bacteremia, revealed significant differences and therefore potent RNA markers. Overall, the use of both genomic and transcriptomic data in a single analytical framework can enhance our understanding of bacterial pathogenesis.
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5
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Kinney KJ, Stach JM, Kulhankova K, Brown M, Salgado-Pabón W. Vegetation Formation in Staphylococcus Aureus Endocarditis Inversely Correlates With RNAIII and sarA Expression in Invasive Clonal Complex 5 Isolates. Front Cell Infect Microbiol 2022; 12:925914. [PMID: 35860377 PMCID: PMC9289551 DOI: 10.3389/fcimb.2022.925914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/14/2022] [Indexed: 01/29/2023] Open
Abstract
Infective endocarditis (IE) is one of the most feared and lethal diseases caused by Staphylococcus aureus. Once established, the infection is fast-progressing and tissue destructive. S. aureus of the clonal complex 5 (CC5) commonly cause IE yet are severely understudied. IE results from bacterial colonization and formation of tissue biofilms (known as vegetations) on injured or inflamed cardiac endothelium. S. aureus IE is promoted by adhesins, coagulases, and superantigens, with the exotoxins and exoenzymes likely contributing to tissue destruction and dissemination. Expression of the large repertoire of virulence factors required for IE and sequelae is controlled by complex regulatory networks. We investigated the temporal expression of the global regulators agr (RNAIII), rot, sarS, sarA, sigB, and mgrA in 8 invasive CC5 isolates and established intrinsic expression patterns associated with IE outcomes. We show that vegetation formation, as tested in the rabbit model of IE, inversely correlates with RNAIII and sarA expression during growth in Todd-Hewitt broth (TH). Large vegetations with severe sequelae arise from strains with high-level expression of colonization factors but slower transition towards expression of the exotoxins. Overall, strains proficient in vegetation formation, a hallmark of IE, exhibit lower expression of RNAIII and sarA. Simultaneous high expression of RNAIII, sarA, sigB, and mgrA is the one phenotype assessed in this study that fails to promote IE. Thus, RNAIII and sarA expression that provides for rheostat control of colonization and virulence genes, rather than an on and off switch, promote both vegetation formation and lethal sepsis.
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Affiliation(s)
- Kyle J. Kinney
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Jessica M. Stach
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Katarina Kulhankova
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Matthew Brown
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Wilmara Salgado-Pabón
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, United States,Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, United States,*Correspondence: Wilmara Salgado-Pabón,
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6
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Albloshi AMK, Alqumber MAA. Infective endocarditis: Role of molecular techniques in early diagnosis. Saudi J Biol Sci 2021; 28:6844-6852. [PMID: 34866984 PMCID: PMC8626217 DOI: 10.1016/j.sjbs.2021.07.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE), a heart valve infection primarily caused by bacteria such as streptococci or staphylococci, causes significant morbidity and mortality. Despite the long-term use of broad-spectrum antimicrobials, the infection is often difficult to manage. The latest diagnostic modalities for IE are discussed in this study. Blood culture use in pathogen identification can lead to loss of precious time as well as generation of false negative reports. The first steps in diagnosis are blood cultures and echocardiography, but molecular techniques can be extremely useful and may be used for an accurate and early diagnosis.
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Affiliation(s)
| | - Mohammed A A Alqumber
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Albaha University, Saudi Arabia
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7
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Bencardino D, Amagliani G, Brandi G. Carriage of Staphylococcus aureus among food handlers: An ongoing challenge in public health. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.108362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Jiang F, Shi Y, Zou X, Han J, Han S. In cellulo synthesis of dendrimeric sensors for fluorescence-on imaging of bacterial phagocytosis. J Mater Chem B 2021; 10:4800-4809. [PMID: 34761795 DOI: 10.1039/d1tb02012a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Methods for optical tracking of pathogen-host interactions are of biomedical significance. We herein have reported a high molecular weight pH sensor (Den-pH) that is assembled in bacteria and then stably trapped in bacteria irrespective of bacterial membrane potentials. Endowed with acidity-triggered red fluorescence, Den-pH allows signal-on tracking of S. aureus in phagocytosis by macrophages. Intra-bacterial formation of multifunctional optical probes, which offers the advantage of overcoming the liability of conventional potential-sensitive dyes to dissipate from stressed bacteria, offers a new tool to study stressed pathogens.
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Affiliation(s)
- Feng Jiang
- State Key Laboratory for Physical Chemistry of Solid Surfaces, Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Innovation Center for Cell Signaling Network, Xiamen University, Xiamen 361005, China.
| | - Yilong Shi
- State key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signalling Network, School of Life Sciences, Xiamen University, Xiamen 361005, China
| | - Xiaoxue Zou
- State Key Laboratory for Physical Chemistry of Solid Surfaces, Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Innovation Center for Cell Signaling Network, Xiamen University, Xiamen 361005, China.
| | - Jiahuai Han
- State key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signalling Network, School of Life Sciences, Xiamen University, Xiamen 361005, China
| | - Shoufa Han
- State Key Laboratory for Physical Chemistry of Solid Surfaces, Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Innovation Center for Cell Signaling Network, Xiamen University, Xiamen 361005, China.
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9
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Schwarz C, Töre Y, Hoesker V, Ameling S, Grün K, Völker U, Schulze PC, Franz M, Faber C, Schaumburg F, Niemann S, Hoerr V. Host-pathogen interactions of clinical S. aureus isolates to induce infective endocarditis. Virulence 2021; 12:2073-2087. [PMID: 34490828 PMCID: PMC8425731 DOI: 10.1080/21505594.2021.1960107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
To evaluate potential pathomechanisms in the induction of infective endocarditis (IE), 34 Staphylococcus aureus (S. aureus) isolates, collected from patients with S. aureus endocarditis and from healthy individuals were investigated both in vitro and in vivo. S. aureus isolates were tested in vitro for their cytotoxicity, invasion and the association with platelets. Virulence factor expression profiles and cellular response were additionally investigated and tested for correlation with the ability of S. aureus to induce vegetations on the aortic valves in vivo. In an animal model of IE valvular conspicuity was assessed by in vivo magnetic resonance imaging at 9.4 T, histology and enrichment gene expression analysis. All S. aureus isolates tested in vivo caused a reliable infection and inflammation of the aortic valves, but could not be differentiated and categorized according to the measured in vitro virulence profiles and cytotoxicity. Results from in vitro assays did not correlate with the severity of IE. However, the isolates differed substantially in the activation and inhibition of pathways connected to the extracellular matrix and inflammatory response. Thus, comprehensive approaches of host-pathogen interactions and corresponding immune pathways are needed for the evaluation of the pathogenic capacity of bacteria. An improved understanding of the interaction between virulence factors and immune response in S. aureus infective endocarditis would offer novel possibilities for the development of therapeutic strategies and specific diagnostic imaging markers.
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Affiliation(s)
- Christian Schwarz
- Translational Research Imaging Center, Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Yasemin Töre
- Translational Research Imaging Center, Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Vanessa Hoesker
- Translational Research Imaging Center, Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Sabine Ameling
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Katja Grün
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | | | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Cornelius Faber
- Translational Research Imaging Center, Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
| | - Silke Niemann
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
| | - Verena Hoerr
- Translational Research Imaging Center, Clinic for Radiology, University Hospital Muenster, Muenster, Germany.,Institute of Medical Microbiology, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.,Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
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10
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Genotypic and Phenotypic Characterization of Staphylococcus aureus Isolates from the Respiratory Tract in Mechanically-Ventilated Patients. Toxins (Basel) 2021; 13:toxins13020122. [PMID: 33562023 PMCID: PMC7915691 DOI: 10.3390/toxins13020122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022] Open
Abstract
Staphylococcus aureus is a commensal and frequent colonizer of the upper respiratory tract. When mechanical ventilation disrupts natural defenses, S. aureus is frequently isolated from the lower airways, but distinguishing between colonization and infection is difficult. The objectives of this study were (1) to investigate the bacterial genome sequence in consecutive isolates in order to identify changes related to the pathological adaptation to the lower respiratory tract and (2) to explore the relationship between specific phenotypic and genotypic features with the patient’s study group, persistence of the clinical isolate and clinical outcome. A set of 94 clinical isolates were selected and corresponded to 34 patients that were classified as having pneumonia (10), tracheobronchitis (11) and bronchial colonization (13). Clinical strains were phenotypically characterized by conventional identification and susceptibility testing methods. Isolates underwent whole genome sequencing using Illumina HiSeq4000. Genotypic characterization was performed with an in-house pipeline (BacterialTyper). Genomic variation arising within-host was determined by comparing mapped sequences and de novo assemblies. Virulence factors important in staphylococcal colonization and infection were characterized using previously established functional assays. (1) Toxin production was assessed using a THP-1 cytotoxicity assay, which reports on the gross cytotoxicity of individual isolates. In addition, we investigated the expression of the major virulence factor, alpha-toxin (Hla) by Western blot. (2) Adhesion to the important extracellular matrix molecule, fibronectin, was determined using a standardized microtitre plate assay. Finally, invasion experiments using THP-1 and A539 cell lines and selected clinical strains were also performed. Repeated isolation of S. aureus from endotracheal aspirate usually reflects persistence of the same strain. Within-host variation is detectable in this setting, but it shows no evidence of pathological adaptation related to virulence, resistance or niche adaptations. Cytotoxicity was variable among isolates with 14 strains showing no cytotoxicity, with these latter presenting an unaltered Fn binding capacity. No changes on cytotoxicity were reported when comparing study groups. Fn binding capacity was reported for almost all strains, with the exception of two strains that presented the lowest values. Strains isolated from patients with pneumonia presented a lower capacity of adhesion in comparison to those isolated during tracheobronchitis (p = 0.002). Hla was detected in 71 strains (75.5%), with most of the producer strains in pneumonia and bronchial colonization group (p = 0.06). In our cohort, Hla expression (presence or absence) in sequential isolates was usually preserved (70%) although in seven cases the expression varied over time. No relationship was found between low cytotoxicity and intracellular persistence in invasion experiments. In our study population, persistent S. aureus isolation from airways in ventilated patients does not reflect pathological adaptation. There is an important diversity of sequence types. Cytotoxicity is variable among strains, but no association with study groups was found, whereas isolates from patients with pneumonia had lower adhesion capability. Favorable clinical outcome correlated with increased bacterial adhesion in vitro. Most of the strains isolated from the lower airways were Hla producers and no correlation with an adverse outcome was reported. The identification of microbial factors that contribute to virulence is relevant to optimize patient management during lower respiratory tract infections.
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11
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Staphylococcal Enterotoxins and Toxic Shock Syndrome Toxin-1 and Their Association among Bacteremic and Infective Endocarditis Patients in Egypt. BIOMED RESEARCH INTERNATIONAL 2021; 2020:6981095. [PMID: 33381576 PMCID: PMC7762650 DOI: 10.1155/2020/6981095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/04/2020] [Accepted: 12/12/2020] [Indexed: 02/07/2023]
Abstract
Purpose Infective endocarditis (IE) is a major complication in patients with bacteremia of Staphylococcus (S.) aureus infection. Our aim was to determine the association of the major Staphylococcal superantigens (SAgs), including Staphylococcal enterotoxins (SEs) and toxic shock syndrome toxin-1 (TSST-1), among hospitalized patients diagnosed with bacteremia and those with IE. Methods This study was conducted on 88 patients; of these, 84 (95.5%) had two positive blood cultures. Eighteen out of the 84 patients (21.4%) were diagnosed based on the modified Duke criteria by a cardiologist to have IE. The recovered isolates were screened phenotypically using ELISA followed by molecular analysis of sea, seb, sec, sed, see, and tsst-1, the major SAg coding genes, and the obtained findings were statistically analyzed. Results Phenotypic screening for SE production of 26 selected Staphylococci (15 isolated from the IE patients (10 S. aureus and 5 coagulase negative staphylococci (CoNS)) and 11 from bacteremic patients (10 S. aureus and 1 CoNS)) using ELISA revealed that 12/26 (46%) isolates were SE producers. PCR analysis showed that 19 (73%) isolates were PCR positive for SAg genes with the highest prevalence of the sea gene (79%), followed by seb (63%) and tsst-1 (21%). The least frequent gene was sed (5.3%). Statistical correlations between bacteremic and IE isolates with respect to prevalence of SAgs showed no significant difference (P value = 0.139, effect size = 0.572) indicating no specific association between any of the detected SAgs and IE. Conclusion There is high prevalence of SEs among clinical isolates of Staphylococci recovered from patients suffering bacteremia and those with IE. No significant difference was found among Staphylococcal isolates recovered from patients with bacteremia or IE regarding both phenotypic and genotypic detection of the tested SAgs.
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12
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Kim CJ, Song KH, Choe PG, Park WB, Kim ES, Park KU, Kim NJ, Park KH, Kwak YG, Cheon S, Jang HC, Kim YK, Lee SH, Kiem SM, Lee S, Kim HB, Oh MD. The microbiological characteristics of Staphylococcus aureus isolated from patients with native valve infective endocarditis. Virulence 2020; 10:948-956. [PMID: 31718473 PMCID: PMC8647854 DOI: 10.1080/21505594.2019.1685631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The microbiological characteristics of Staphylococcus aureus causing infective endocarditis (IE) have not been investigated thoroughly. We compared the characteristics of S. aureus isolates from patients with and without IE. Cases of S. aureus bacteremia (SAB) were collected from 10 hospitals over 7 years. Cases of native valve IE were matched with non-IE controls according to the following criteria: central-line-associated infection, community-acquired infection, methicillin susceptibility, and if possible, the primary site of infection. Genes coding virulence factors were analyzed using multiplex polymerase chain reactions. Fibrinogen and fibronectin-binding properties were assessed using in vitro binding assays. The fibronectin-binding protein A gene (fnbpA) was sequenced. Of 2,365 cases of SAB, 92 had IE. After matching, 37 pairs of S. aureus isolates from the IE cases and non-IE controls were compared; fnbpA was detected in 91.9% of the IE isolates and 100% of the non-IE isolates (p = 0.24). While the fibrinogen binding ratio was similar (1.07 ± 0.33 vs. 1.08 ± 0.26, p = 0.89), the fibronectin-binding ratio was significantly higher in the IE-group (1.31 ± 0.42 vs. 1.06 ± 0.31, p = 0.01). The proportions of major single-nucleotide polymorphisms in fnbpA were as follows: E652D (2.9% vs. 2.7%), H782Q (65.6% vs. 60.6%), and K786N (65.6% vs. 72.7%). The fibronectin-binding ratio was positively correlated with the number of SNPs present in IE cases (p < 0.001) but not in the non-IE controls (p = 0.124). Fibronectin-binding might play a key role in SAB IE. However, the degree of binding may be mediated by genetic variability between isolates.
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Affiliation(s)
- Chung-Jong Kim
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Shinhye Cheon
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejon, Republic of Korea
| | - Hee-Chang Jang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sung-Min Kiem
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Shinwon Lee
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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13
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Genetic Characterization of Methicillin-Resistant Staphylococcus aureus Isolates from Human Bloodstream Infections: Detection of MLS B Resistance. Antibiotics (Basel) 2020; 9:antibiotics9070375. [PMID: 32635147 PMCID: PMC7400445 DOI: 10.3390/antibiotics9070375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
In this study we aimed to characterize antimicrobial resistance in methicillin-resistant Staphylococcus aureus (MRSA) isolated from bloodstream infections as well as the associated genetic lineages of the isolates. Sixteen MRSA isolates were recovered from bacteremia samples from inpatients between 2016 and 2019. The antimicrobial susceptibility of these isolates was tested by the Kirby–Bauer disk diffusion method against 14 antimicrobial agents. To determine the macrolide–lincosamide–streptogramin B (MLSB) resistance phenotype of the isolates, erythromycin-resistant isolates were assessed by double-disk diffusion (D-test). The resistance and virulence genes were screened by polymerase chain reaction (PCR). All isolates were characterized by multilocus sequence typing (MLST), spa typing, staphylococcal chromosomal cassette mec (SCCmec) typing, and accessory gene regulator (agr) typing. Isolates showed resistance to cefoxitin, penicillin, ciprofloxacin, erythromycin, fusidic acid, clindamycin, and aminoglycosides, confirmed by the presence of the blaZ, ermA, ermC, mphC, msrA/B, aac(6’)-Ie-aph(2’’)-Ia, and ant(4’)-Ia genes. Three isolates were Panton–Valentine-leukocidin-positive. Most strains (n = 12) presented an inducible MLSB phenotype. The isolates were ascribed to eight spa-types (t747, t002, t020, t1084, t008, t10682, t18526, and t1370) and four MLSTs (ST22, ST5, ST105, and ST8). Overall, most (n = 12) MRSA isolates had a multidrug-resistance profile with inducible MLSB phenotypes and belonged to epidemic MRSA clones.
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14
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Baude J, Bastien S, Gillet Y, Leblanc P, Itzek A, Tristan A, Bes M, Duguez S, Moreau K, Diep BA, Norrby-Teglund A, Henry T, Vandenesch F. Necrotizing Soft Tissue Infection Staphylococcus aureus but not S. pyogenes Isolates Display High Rates of Internalization and Cytotoxicity Toward Human Myoblasts. J Infect Dis 2020; 220:710-719. [PMID: 31001627 DOI: 10.1093/infdis/jiz167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/08/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) caused by group A Streptococcus (GAS) and occasionally by Staphylococcus aureus (SA) frequently involve the deep fascia and often lead to muscle necrosis. METHODS To assess the pathogenicity of GAS and S. aureus for muscles in comparison to keratinocytes, adhesion and invasion of NSTI-GAS and NSTI-SA isolates were assessed in these cells. Bloodstream infections (BSI-SA) and noninvasive coagulase-negative staphylococci (CNS) isolates were used as controls. RESULTS NSTI-SA and BSI-SA exhibited stronger internalization into human keratinocytes and myoblasts than NSTI-GAS or CNS. S. aureus internalization reached over 30% in human myoblasts due to a higher percentage of infected myoblasts (>11%) as compared to keratinocytes (<3%). Higher cytotoxicity for myoblasts of NSTI-SA as compared to BSI-SA was attributed to higher levels of psmα and RNAIII transcripts in NSTI-SA. However, the 2 groups were not discriminated at the genomic level. The cellular basis of high internalization rate in myoblasts was attributed to higher expression of α5β1 integrin in myoblasts. Major contribution of FnbpAB-integrin α5β1 pathway to internalization was confirmed by isogenic mutants. CONCLUSIONS Our findings suggest a factor in NSTI-SA severity is the strong invasiveness of S. aureus in muscle cells, a property not shared by NSTI-GAS isolates.
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Affiliation(s)
- Jessica Baude
- Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1, CNRS, UMR5308; Lyon, France
| | - Sylvère Bastien
- Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1, CNRS, UMR5308; Lyon, France
| | - Yves Gillet
- Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1, CNRS, UMR5308; Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, France
| | - Pascal Leblanc
- NeuroMyoGene Institute, Université de Lyon, CNRS UMR5310, INSERM U1217, France
| | - Andreas Itzek
- Helmholtz-Zentrum für Infektionsforschung GmbH, Braunschweig, Germany
| | - Anne Tristan
- Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1, CNRS, UMR5308; Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, France
| | - Michèle Bes
- Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1, CNRS, UMR5308; Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, France
| | - Stephanie Duguez
- Northern Ireland Center for Stratified Medicine, Biomedical Sciences Research Institute, Londonderry, United Kingdom
| | - Karen Moreau
- Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1, CNRS, UMR5308; Lyon, France
| | - Binh An Diep
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco
| | - Anna Norrby-Teglund
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Thomas Henry
- Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1, CNRS, UMR5308; Lyon, France
| | - François Vandenesch
- Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1, CNRS, UMR5308; Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, France
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15
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Petrovic Fabijan A, Lin RCY, Ho J, Maddocks S, Ben Zakour NL, Iredell JR. Safety of bacteriophage therapy in severe Staphylococcus aureus infection. Nat Microbiol 2020; 5:465-472. [PMID: 32066959 DOI: 10.1038/s41564-019-0634-z] [Citation(s) in RCA: 212] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022]
Abstract
In this single-arm non-comparative trial, 13 patients in an Australian hospital with severe Staphylococcus aureus infections were intravenously administered a good manufacturing practice-quality preparation of three Myoviridae bacteriophages (AB-SA01) as adjunctive therapy. AB-SA01 was intravenously administered twice daily for 14 d and the clinical, haematological and blood biochemical parameters of the recipients were monitored for 90 d. The primary outcome was the assessment of safety and tolerability (that is, pain and redness at the infusion site and systemic adverse reactions, such as fever, tachycardia, hypotension, diarrhoea or abdominal pain and the development of renal or hepatic dysfunction). No adverse reactions were reported, and our data indicate that AB-SA01 administered in this way is safe in severe S. aureus infections, including infective endocarditis and septic shock. Future controlled trials will be needed to determine the efficacy of AB-SA01 but no phage resistance evolved in vivo and the measurements of bacterial and phage kinetics in blood samples suggest that 12 h dosing of 109 plaque-forming units may be a rational basis for further studies.
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Affiliation(s)
- Aleksandra Petrovic Fabijan
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ruby C Y Lin
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia.,School of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Josephine Ho
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Susan Maddocks
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia.,School of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nouri L Ben Zakour
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,School of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan R Iredell
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia. .,Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia. .,School of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
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16
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Bajaj T, Karapetians A, Karapetians N, Duong H, Heidari A. Methicillin resistant Staphylococcus aureus infective endocarditis presenting as neutrophilic meningoencephalitis. AME Case Rep 2020; 4:4. [PMID: 32206750 DOI: 10.21037/acr.2019.11.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/21/2019] [Indexed: 11/06/2022]
Abstract
Infective endocarditis (IE) with Staphylococcus aureus is associated with intravenous drug abuse or infected cardiac devices and commonly presents with non-specific constitutional symptoms. A 53-year-old female presented to the hospital with back pain, altered mental status, fever, and tachycardia. Due to patient's lethargy and decline in respiratory effort, she was intubated and lumbar puncture was performed that revealed neutrophil-predominant leukocytosis of the cerebrospinal fluid. The patient was empirically started on ceftriaxone and vancomycin, and blood cultures were positive for methicillin resistant Staphylococcus aureus (MRSA). A chest X-ray demonstrated pulmonary congestion and an implanted pacemaker; furthermore, a transesophageal echocardiogram (TEE) revealed a vegetation on the atrial lead of the pacemaker. As the patient's condition improved after a few days, she was extubated and was able to provide a clear history. The source of her infection was a pus pocket around her pacemaker which was placed two months prior to her admission. As expected, the infection resolved with proper source control and antibiotic therapy.
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Affiliation(s)
- Tushar Bajaj
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA
| | - Anthony Karapetians
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA
| | - Natalie Karapetians
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA.,Department of Medicine, American University of the Caribbean School of Medicine, Pembroke Pines, FL, USA
| | - Hanh Duong
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA.,Department of Medicine, Ross University School of Medicine, Miramar, FL, USA
| | - Arash Heidari
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA
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17
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Horino T, Hori S. Metastatic infection during Staphylococcus aureus bacteremia. J Infect Chemother 2019; 26:162-169. [PMID: 31676266 DOI: 10.1016/j.jiac.2019.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/25/2019] [Accepted: 10/03/2019] [Indexed: 12/17/2022]
Abstract
Staphylococcus aureus causes various infections, including skin and soft tissue infections and pneumonia via both, community-associated and nosocomial infection. These infectious diseases can lead to bacteremia, and may subsequently result in metastatic infections in several cases. Metastatic infections are critical complications in patients with S. aureus bacteremia, since the optimal duration of the antimicrobial treatment differs in patients with and without metastatic infection. Notably, two weeks of antimicrobial treatment is recommended in case of uncomplicated S. aureus bacteremia, whereas in patients with S. aureus bacteremia-associated endocarditis or vertebral osteomyelitis, six weeks of antimicrobial administration is vital. In addition, misdiagnosis or insufficient treatment in metastatic infection is associated with poor prognosis, functional disability, and relapse. Although echocardiography is recommended to examine endocarditis in the patients with S. aureus bacteremia, it remains unclear which patients should undergo additional examinations, such as CT and MRI, to detect the presence of other metastatic infections. Clinical studies have revealed that permanent foreign body and persistent bacteremia are predictive factors for metastatic infections, and experimental studies have demonstrated that the virulence factors of S. aureus, such as fnbA and clfA, are associated with endocarditis; however, these factors are not proven to increase the risk of metastatic infections. In this review, we assessed the incidence, predictive factors, diagnosis, and treatment for metastatic infections during S. aureus bacteremia.
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Affiliation(s)
- Tetsuya Horino
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Japan.
| | - Seiji Hori
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Japan
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18
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Hannachi N, Habib G, Camoin-Jau L. Aspirin Effect on Staphylococcus aureus-Platelet Interactions During Infectious Endocarditis. Front Med (Lausanne) 2019; 6:217. [PMID: 31681776 PMCID: PMC6803506 DOI: 10.3389/fmed.2019.00217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
Infectious endocarditis (IE) is a rare disease associated with high mortality and morbidity rate. The platelet–bacterial interaction presents the cornerstone of the development of endocardial vegetation. The epidemiology of IE has undergone profound changes between the last and the new decade, with Staphylococcus aureus becoming the main incriminated species. Despite improvements in antibiotic and surgical therapies, embolic disorders remain highly associated with IE that can be fatal. Antiplatelet drugs have been widely proposed to overcome embolic events associated with IE. This proposal has been supported by numerous in vitro, experimental, and clinical studies. However, other studies have yielded conflicting results. In this review, we focus on the effect of aspirin on the genesis of S. aureus endocarditic vegetation, as well as on the management of embolic and hemorrhagic events related to it, starting by its influence on the platelet–bacteria interaction.
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Affiliation(s)
- Nadji Hannachi
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Gilbert Habib
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, Marseille, France.,Département de Cardiologie, Hôpital de la Timone, AP-HM, Marseille, France
| | - Laurence Camoin-Jau
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, Marseille, France.,Laboratoire d'Hématologie, Hôpital de la Timone, APHM, Marseille, France
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19
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Falcón R, Mateo E, Oltra R, Giménez E, Albert E, Torres I, Navarro D. Vancomycin MICs and risk of complicated bacteremia by glycopeptide-susceptible Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 2019; 38:903-912. [PMID: 30729396 DOI: 10.1007/s10096-019-03500-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
Vancomycin (VAN) minimum inhibitory concentrations (MICs) at the upper end of the susceptible range for Staphylococcus aureus (S. aureus), as measured by the Etest method, have been associated with poor clinical outcomes of S. aureus bloodstream infections, as has the isolate's genetic background. Here, we assessed the impact of VAN MICs, as determined by a broth microdilution method (BMD) that incorporates incremental VAN concentrations between the conventional log2 dilutions, isolate susceptibility to killing by human phagocytes, acting as a surrogate marker for bacterial cell wall thickness, and S. aureus genetic composition, on the development of complicated S. aureus bacteremia (SAB). We carried out a retrospective, observational single-center cohort study of 148 consecutive patients with SAB caused by methicillin-susceptible (MSSA) isolates (n = 113) or methicillin-resistant (MRSA) isolates (n = 35). S. aureus isolates were genotyped using a commercially available DNA microarray. Overall, VAN MICs of S. aureus isolates taken from complicated and uncomplicated SAB were comparable, irrespective of the testing method (P = 0.19 with BMD, and P = 0.94 with Etest). Likewise, S. aureus isolates in both comparison groups had the same susceptibility to killing by human phagocytes (P = 0.5). Among the genes screened by the S. aureus DNA array, only Sec and Sel were differentially present among S. aureus isolates in both groups (overrepresented in those causing complications) and their presence was associated independently with complicated SAB in multivariate models adjusted for potentially relevant clinical covariates. Separate analysis of MSSA SAB episodes yielded similar results.
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Affiliation(s)
- Rocío Falcón
- Microbiology Service, Fundación INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Eva Mateo
- Microbiology Service, Fundación INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Rosa Oltra
- Unit of Infectious Diseases, Fundación INCLIVA, Hospital Clínico Universitario, Valencia, Spain
| | - Estela Giménez
- Microbiology Service, Fundación INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service, Fundación INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Ignacio Torres
- Microbiology Service, Fundación INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - David Navarro
- Microbiology Service, Fundación INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.
- Department of Microbiology, School of Medicine, University of Valencia, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.
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20
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Lilje B, Rasmussen RV, Dahl A, Stegger M, Skov RL, Fowler VG, Ng KL, Kiil K, Larsen AR, Petersen A, Johansen HK, Schønheyder HC, Arpi M, Rosenvinge FS, Korup E, Høst U, Hassager C, Gill SUA, Hansen TF, Johannesen TB, Smit J, Søgaard P, Skytt Andersen P, Eske-Bruun N. Whole-genome sequencing of bloodstream Staphylococcus aureus isolates does not distinguish bacteraemia from endocarditis. Microb Genom 2019; 3. [PMID: 29208121 PMCID: PMC5729915 DOI: 10.1099/mgen.0.000138] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Most Staphylococcus aureus isolates can cause invasive disease given the right circumstances, but it is unknown if some isolates are more likely to cause severe infections than others. S. aureus bloodstream isolates from 120 patients with definite infective endocarditis and 121 with S. aureus bacteraemia without infective endocarditis underwent whole-genome sequencing. Genome-wide association analysis was performed using a variety of bioinformatics approaches including SNP analysis, accessory genome analysis and k-mer based analysis. Core and accessory genome analyses found no association with either of the two clinical groups. In this study, the genome sequences of S. aureus bloodstream isolates did not discriminate between bacteraemia and infective endocarditis. Based on our study and the current literature, it is not convincing that a specific S. aureus genotype is clearly associated to infective endocarditis in patients with S. aureus bacteraemia.
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Affiliation(s)
- Berit Lilje
- 1Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Rasmus Vedby Rasmussen
- 2Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Anders Dahl
- 2Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Marc Stegger
- 1Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Robert Leo Skov
- 1Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Vance G Fowler
- 3Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Kim Lee Ng
- 1Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Kristoffer Kiil
- 1Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Rhod Larsen
- 1Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Andreas Petersen
- 1Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Helle Krogh Johansen
- 4Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Carl Schønheyder
- 5Department of Clinical Microbiology, Aalborg University Hospital, Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Magnus Arpi
- 6Department of Clinical Microbiology, Copenhagen University Hospital, Herlev-Gentofte, Herlev, Denmark
| | | | - Eva Korup
- 8Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Høst
- 2Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Christian Hassager
- 9Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Thomas Fritz Hansen
- 2Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Thor Bech Johannesen
- 2Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Jesper Smit
- 11Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Søgaard
- 12Department of Cardiology, Clinical Institute, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | - Paal Skytt Andersen
- 13Department of Animal and Veterinary Sciences, University of Copenhagen, Copenhagen, Denmark.,14Translational Genomics North, Flagstaff, USA.,1Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Niels Eske-Bruun
- 15Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Clinical Institute, Aalborg University, Copenhagen, Aalborg, Denmark
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21
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Bonar EA, Bukowski M, Hydzik M, Jankowska U, Kedracka-Krok S, Groborz M, Dubin G, Akkerboom V, Miedzobrodzki J, Sabat AJ, Friedrich AW, Wladyka B. Joint Genomic and Proteomic Analysis Identifies Meta-Trait Characteristics of Virulent and Non-virulent Staphylococcus aureus Strains. Front Cell Infect Microbiol 2018; 8:313. [PMID: 30237986 PMCID: PMC6136393 DOI: 10.3389/fcimb.2018.00313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/16/2018] [Indexed: 12/18/2022] Open
Abstract
Staphylococcus aureus is an opportunistic pathogen of humans and warm-blooded animals and presents a growing threat in terms of multi-drug resistance. Despite numerous studies, the basis of staphylococcal virulence and switching between commensal and pathogenic phenotypes is not fully understood. Using genomics, we show here that S. aureus strains exhibiting virulent (VIR) and non-virulent (NVIR) phenotypes in a chicken embryo infection model genetically fall into two separate groups, with the VIR group being much more cohesive than the NVIR group. Significantly, the genes encoding known staphylococcal virulence factors, such as clumping factors, are either found in different allelic variants in the genomes of NVIR strains (compared to VIR strains) or are inactive pseudogenes. Moreover, the pyruvate carboxylase and gamma-aminobutyrate permease genes, which were previously linked with virulence, are pseudogenized in NVIR strain ch22. Further, we use comprehensive proteomics tools to characterize strains that show opposing phenotypes in a chicken embryo virulence model. VIR strain CH21 had an elevated level of diapolycopene oxygenase involved in staphyloxanthin production (protection against free radicals) and expressed a higher level of immunoglobulin-binding protein Sbi on its surface compared to NVIR strain ch22. Furthermore, joint genomic and proteomic approaches linked the elevated production of superoxide dismutase and DNA-binding protein by NVIR strain ch22 with gene duplications.
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Affiliation(s)
- Emilia A Bonar
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Michal Bukowski
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Marcin Hydzik
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Urszula Jankowska
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Sylwia Kedracka-Krok
- Department of Physical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Magdalena Groborz
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Grzegorz Dubin
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland.,Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Viktoria Akkerboom
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jacek Miedzobrodzki
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Artur J Sabat
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alexander W Friedrich
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Benedykt Wladyka
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
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22
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Comparación de las características y curso clínico de la endocarditis infecciosa por Staphylococcus aureus meticilino sensible versus meticilino resistente. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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23
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Rasigade JP, Leclère A, Alla F, Tessier A, Bes M, Lechiche C, Vernet-Garnier V, Laouénan C, Vandenesch F, Leport C. Staphylococcus aureus CC30 Lineage and Absence of sed, j, r-Harboring Plasmid Predict Embolism in Infective Endocarditis. Front Cell Infect Microbiol 2018; 8:187. [PMID: 29938201 PMCID: PMC6003251 DOI: 10.3389/fcimb.2018.00187] [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: 12/18/2017] [Accepted: 05/14/2018] [Indexed: 12/28/2022] Open
Abstract
Staphylococcus aureus induces severe infective endocarditis (IE) where embolic complications are a major cause of death. Risk factors for embolism have been reported such as a younger age or larger IE vegetations, while methicillin resistance conferred by the mecA gene appeared as a protective factor. It is unclear, however, whether embolism is influenced by other S. aureus characteristics such as clonal complex (CC) or virulence pattern. We examined clinical and microbiological predictors of embolism in a prospective multicentric cohort of 98 French patients with monomicrobial S. aureus IE. The genomic contents of causative isolates were characterized using DNA array. To preserve statistical power, genotypic predictors were restricted to CC, secreted virulence factors and virulence regulators. Multivariate regularized logistic regression identified three independent predictors of embolism. Patients at higher risk were younger than the cohort median age of 62.5 y (adjusted odds ratio [OR] 0.14; 95% confidence interval [CI] 0.05-0.36). S. aureus characteristics predicting embolism were a CC30 genetic background (adjusted OR 9.734; 95% CI 1.53-192.8) and the absence of pIB485-like plasmid-borne enterotoxin-encoding genes sed, sej, and ser (sedjr; adjusted OR 0.07; 95% CI 0.004-0.457). CC30 S. aureus has been repeatedly reported to exhibit enhanced fitness in bloodstream infections, which might impact its ability to cause embolism. sedjr-encoded enterotoxins, whose superantigenic activity is unlikely to protect against embolism, possibly acted as a proxy to others genes of the pIB485-like plasmid found in genetically unrelated isolates from mostly embolism-free patients. mecA did not independently predict embolism but was strongly associated with sedjr. This mecA-sedjr association might have driven previous reports of a negative association of mecA and embolism. Collectively, our results suggest that the influence of S. aureus genotypic features on the risk of embolism may be stronger than previously suspected and independent of clinical risk factors.
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Affiliation(s)
- Jean-Philippe Rasigade
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, ENS de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Amélie Leclère
- UMR-1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR-1137, Paris, France
| | - François Alla
- CIC-1433 Epidémiologie Clinique, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Nancy, Nancy, France.,EA4360, Apemac, Université de Lorraine, Nancy, France
| | - Adrien Tessier
- UMR-1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR-1137, Paris, France
| | - Michèle Bes
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, ENS de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Catherine Lechiche
- Service de Maladies Infectieuses et Tropicales Centre Hospitalier Universitaire de Nîmes Caremeau, Nîmes, France
| | - Véronique Vernet-Garnier
- Faculté de Médecine EA 4687 Université de Reims Champagne Ardenne, Reims, France.,Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Reims Robert Debré, Reims, France
| | - Cédric Laouénan
- UMR-1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR-1137, Paris, France.,Service de Biostatistiques, Hôpital Bichat, AP-HP, Paris, France
| | - François Vandenesch
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, ENS de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Catherine Leport
- UMR-1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR-1137, Paris, France.,Unité de Coordination du Risque Épidémique et Biologique, AP-HP, Paris, France
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24
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Bouiller K, Laborde C, Aho SL, Hocquet D, Pechinot A, Le Moing V, Bertrand X, Piroth L, Chirouze C. No effect of vancomycin MIC ≥ 1.5 mg/L on treatment outcome in methicillin-susceptible Staphylococcus aureus bacteraemia. Int J Antimicrob Agents 2018; 51:721-726. [DOI: 10.1016/j.ijantimicag.2017.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
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25
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Viedma E, Pérez-Montarelo D, Villa J, Muñoz-Gallego I, Larrosa N, Fernández-Hidalgo N, Gavaldà J, Almirante B, Chaves F. Sub-inhibitory concentrations of oxacillin modify the expression of agr locus in Staphylococcus aureus clinical strains belonging to different clonal complexes. BMC Infect Dis 2018; 18:177. [PMID: 29661157 PMCID: PMC5902860 DOI: 10.1186/s12879-018-3088-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/05/2018] [Indexed: 02/08/2023] Open
Abstract
Background The ability of Staphylococcus aureus to invade tissues and cause an infectious disease is the result of a multi-factorial process supported by the huge number of virulence factors inherent to this microorganism tightly regulated by the accessory gene regulator (agr). During antimicrobial therapy bacteria may be exposed to sub-inhibitory concentrations (subMICs) of antibiotics that may trigger transcriptional changes that may have an impact on the pathogenesis of infection. The objective of this study was to investigate the effect of oxacillin sub-MICs on agr system expression as the key component in the regulation of virulence in methicillin-susceptible (MSSA) and -resistant S. aureus (MRSA) strains. Furthermore, we studied the genetic basis of the agr locus and their potential association with the expression levels. Methods We have examined the expression of RNAIII and agrA mRNA as biomarkers for agr expression in the presence and absence of oxacillin subMICs in 10 MSSA and 4 MRSA clinical strains belonging to 5 clonal complexes (CC45-agrI, CC8-agrI, CC5-agrII, CC15-agrII and CC30-agrIII) causing endovascular complications. The DNA sequences of agr locus were obtained by whole genome sequencing. Results Our results revealed that exposure to subMICs of oxacillin had an impact on agr locus expression modifying the relative levels of expression with increases in 11 strains and with decreases in 3 strains. Thereby, the exposure to subMICs of oxacillin resulted in higher levels of expression of agr in CC15 and CC45 and lower levels in CC30. We also observed the presence of mutations in agrC and agrA in 13/14 strains with similar mutation profiles among strains within individual CCs except for strains of CC5. Although, agr expression levels differed among strains within CCs, the presence of these mutations was associated with differences in agr expression levels in most cases. Conclusions Changes in agr expression induced by exposure to oxacillin subMICs should be considered because they could lead to changes in the virulence modulation and have an adverse effect on the course of infection, especially in certain clonal complexes. Electronic supplementary material The online version of this article (10.1186/s12879-018-3088-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther Viedma
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | - Jennifer Villa
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Muñoz-Gallego
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Nieves Larrosa
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Joan Gavaldà
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Benito Almirante
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Fernando Chaves
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
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26
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Moreau K, Clemenceau A, Le Moing V, Messika-Zeitoun D, Andersen PS, Bruun NE, Skov RL, Couzon F, Bouchiat C, Erpelding ML, van Belkum A, Bossé Y, Duval X, Vandenesch F. Human Genetic Susceptibility to Native Valve Staphylococcus aureus Endocarditis in Patients With S. aureus Bacteremia: Genome-Wide Association Study. Front Microbiol 2018; 9:640. [PMID: 29670602 PMCID: PMC5893849 DOI: 10.3389/fmicb.2018.00640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/19/2018] [Indexed: 01/26/2023] Open
Abstract
Staphylococcus aureus infective endocarditis (SaIE) is a severe complication of S. aureus bacteremia (SAB) occurring in up to 22% of patients. Bacterial genetic factors and host conditions for SaIE have been intensely studied before; however, to date no study has focused on predisposing host genetic factors to SaIE. The present study aimed to identify genetic polymorphisms associated with SaIE by a Genome-Wide Association Study (GWAS) of 67 patients with definite native valve SaIE (cases) and 72 matched native valve patients with SAB but without IE (controls). All patients were enrolled in the VIRSTA cohort (Le Moing et al., 2015) study. Four single nucleotide polymorphisms (SNPs) located on chromosome 3 were associated with SaIE (P < 1 × 10-5) without reaching conventional genome-wide significance. For all, the frequency of the minor allele was lower in cases than in controls, suggesting a protective effect of the minor allele against SaIE. The same association was observed using an independent Danish verification cohort of SAB with (n = 57) and without (n = 123) IE. Ex vivo analysis of aortic valve tissues revealed that SaIE associated SNPs mentioned above were associated with significantly higher mRNA expression levels of SLC7A14, a predicted cationic amino acid transporter protein. Taken together, our results suggest an IE-protective effect of SNPs on chromosome 3 during the course of SAB. The effects of protective minor alleles may be mediated by increasing expression levels of SLC7A14 in valve tissues. We conclude that occurrence of SaIE may be the combination of a well-adapted bacterial genotype to a susceptible host.
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Affiliation(s)
- Karen Moreau
- International Center for Infectiology Research, CNRS UMR5308, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Lyon, France
| | - Alisson Clemenceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Quebec City, QC, Canada
| | - Vincent Le Moing
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier, Universitaire de Montpellier, Montpellier, France
| | - David Messika-Zeitoun
- Department of Cardiology, AP-HP, Bichat Hospital, Paris, France.,INSERM U698 and University Paris 7, Paris, France
| | | | - Niels E Bruun
- Statens Serum Institut, Copenhagen, Denmark.,Clinical Institute, Aalborg University, Aalborg, Denmark
| | | | - Florence Couzon
- International Center for Infectiology Research, CNRS UMR5308, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Lyon, France
| | - Coralie Bouchiat
- International Center for Infectiology Research, CNRS UMR5308, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Lyon, France.,Centre National de Référence des Staphylocoques, Centre de Biologie Est, Hospices Civils de Lyon, Lyon, France
| | - Marie L Erpelding
- INSERM, CIC-1433 Clinical Epidemiology, CHRU Nancy, University of Lorraine, Nancy, France
| | - Alex van Belkum
- Data Analytics Unit, bioMerieux, La Balme-les-Grottes, France
| | - Yohan Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Quebec City, QC, Canada.,Département de Médecine Moléculaire, Université Laval, Quebec City, QC, Canada
| | - Xavier Duval
- INSERM, UMR1138 IAME, CIC 1425, Université Paris Diderot, Paris, France.,AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Francois Vandenesch
- International Center for Infectiology Research, CNRS UMR5308, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Lyon, France.,Centre National de Référence des Staphylocoques, Centre de Biologie Est, Hospices Civils de Lyon, Lyon, France
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27
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Oppegaard O, Mylvaganam H, Skrede S, Kittang BR. Exploring the arthritogenicity of Streptococcus dysgalactiae subspecies equisimilis. BMC Microbiol 2018; 18:17. [PMID: 29482512 PMCID: PMC5828338 DOI: 10.1186/s12866-018-1160-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the past decades, Streptococcus dysgalactiae subspecies equisimilis (SDSE) has been increasingly recognized as an important human pathogen. Osteoarticular infections is one of the predominant disease manifestations of SDSE, but the pathogenetic rationale for its arthritogenicity has yet to be unravelled. We aimed to explore if the rising incidence of osteoarticular infections caused by this pathogen in our region emanated from clonal expansion of strains with enhanced tropism for bone and joint tissue components or orthopaedic implants. RESULTS Twenty-nine SDSE-isolates associated with osteoarticular infections were retrospectively identified. Their genomic content and affinity for fibronectin, collagen and stainless steel were compared to 24 temporally and geographically matched SDSE blood culture isolates obtained from patients without bone or joint infections. Despite a thorough genetic and phenotypic dissection, neither the presence or absence of any single gene, nor the binding abilities of the SDSE isolates, were predictive of clinical entity. SNP analysis revealed a heterogenous population, and a correlation between phylogenetic relationships and disease manifestation was not evident. However, we identified a strong concordance between phenotypic binding abilities and genetic variations in the pilus-region, also denoted as the FCT-region (Fibronectin binding, Collagen binding and T-antigen). This observation could be related to the ample and varied repertoire of putative adhesins residing within this region, including proteins predicted to adhere to fibronectin and collagen, as well as fibrinogen. CONCLUSIONS SDSE strains associated with osteoarticular infections do not emanate from subpopulation characterized by distinct genetic or phenotypic traits. The genetic architecture of the pilus region was predictive of the adhesive properties of the SDSE-isolates, but its role in tissue tropism needs further investigation. To the best of our knowledge, this is the first comprehensive characterization of the genetic landscape of the SDSE pilus region.
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Affiliation(s)
- Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Haima Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Steinar Skrede
- Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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28
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Lattwein KR, Shekhar H, van Wamel WJB, Gonzalez T, Herr AB, Holland CK, Kooiman K. An in vitro proof-of-principle study of sonobactericide. Sci Rep 2018; 8:3411. [PMID: 29467474 PMCID: PMC5821825 DOI: 10.1038/s41598-018-21648-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/06/2018] [Indexed: 12/24/2022] Open
Abstract
Infective endocarditis (IE) is associated with high morbidity and mortality rates. The predominant bacteria causing IE is Staphylococcus aureus (S. aureus), which can bind to existing thrombi on heart valves and generate vegetations (biofilms). In this in vitro flow study, we evaluated sonobactericide as a novel strategy to treat IE, using ultrasound and an ultrasound contrast agent with or without other therapeutics. We developed a model of IE biofilm using human whole-blood clots infected with patient-derived S. aureus (infected clots). Histology and live-cell imaging revealed a biofilm layer of fibrin-embedded living Staphylococci around a dense erythrocyte core. Infected clots were treated under flow for 30 minutes and degradation was assessed by time-lapse microscopy imaging. Treatments consisted of either continuous plasma flow alone or with different combinations of therapeutics: oxacillin (antibiotic), recombinant tissue plasminogen activator (rt-PA; thrombolytic), intermittent continuous-wave low-frequency ultrasound (120-kHz, 0.44 MPa peak-to-peak pressure), and an ultrasound contrast agent (Definity). Infected clots exposed to the combination of oxacillin, rt-PA, ultrasound, and Definity achieved 99.3 ± 1.7% loss, which was greater than the other treatment arms. Effluent size measurements suggested low likelihood of emboli formation. These results support the continued investigation of sonobactericide as a therapeutic strategy for IE.
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Affiliation(s)
- Kirby R Lattwein
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC, Room Ee2302, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA. .,Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - Himanshu Shekhar
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Willem J B van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Tammy Gonzalez
- Cincinnati Children's Hospital Medical Center, Division of Immunobiology, Center for Systems Immunology, and Division of Infectious Diseases, Cincinnati, Ohio, USA
| | - Andrew B Herr
- Cincinnati Children's Hospital Medical Center, Division of Immunobiology, Center for Systems Immunology, and Division of Infectious Diseases, Cincinnati, Ohio, USA
| | - Christy K Holland
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Klazina Kooiman
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC, Room Ee2302, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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29
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Spa type distribution in MRSA and MSSA bacteremias and association of spa clonal complexes with the clinical characteristics of bacteremia. Eur J Clin Microbiol Infect Dis 2018; 37:937-943. [PMID: 29428976 DOI: 10.1007/s10096-018-3210-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/02/2018] [Indexed: 01/30/2023]
Abstract
The genetic distribution of invasive methicillin-susceptible (MSSA) and resistant S. aureus (MRSA) strains has to be addressed in order to target infection control strategies. A large MRSA epidemic caused by a certain MRSA strain (spa type 067) broke out in 2001 in our health district. We wanted to investigate the current spa type distribution in MRSA and MSSA bacteremias and assess the potential association of spa clonal complexes (spaCC) with the clinical characteristics of S. aureus bacteremia. One hundred nine invasive MRSA isolates and 353 invasive MSSA isolates were spa typed and grouped into clonal complexes (spaCC). Spa type distribution was compared to that of colonizing MRSA strains. Spa type and spaCC data linked to clinical information on the course of bacteremic cases was used to search for differences in virulence between strains. Spa type distribution in MRSA is less heterogenic than in MSSA. t067 dominates both in MRSA colonisations and in invasive findings. Among MSSA, no such dominating strains were found. Of spaCCs, mortality was the highest in spaCC 067 (25.6%). SpaCC 008 was more often associated with endocarditis than other CCs (22.7 vs 5.8%, p = 0.013), spaCC 2133 with skin infections (68.4 vs 36.4%, p = 0.007), and spaCC 012 with foreign body infections (25.0 vs 9.3%, p = 0.029) than other clonal complexes. A single successful strain can explain the major proportion of MRSA among S. aureus bacteremias. Certain spaCCs showed association with certain clinical characteristics. These findings suggest that S. aureus strains differ in their virulence and invasiveness.
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Abegaz TM, Bhagavathula AS, Gebreyohannes EA, Mekonnen AB, Abebe TB. Short- and long-term outcomes in infective endocarditis patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17:291. [PMID: 29233094 PMCID: PMC5728061 DOI: 10.1186/s12872-017-0729-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022] Open
Abstract
Background Despite advances in medical knowledge, technology and antimicrobial therapy, infective endocarditis (IE) is still associated with devastating outcomes. No reviews have yet assessed the outcomes of IE patients undergoing short- and long-term outcome evaluation, such as all-cause mortality and IE-related complications. We conducted a systematic review and meta-analysis to examine the short- and long-term mortality, as well as IE-related complications in patients with definite IE. Methods A computerized systematic literature search was carried out in PubMed, Scopus and Google Scholar from 2000 to August, 2016. Included studies were published studies in English that assessed short-and long-term mortality for adult IE patients. Pooled estimations with 95% confidence interval (CI) were calculated with DerSimonian-Laird (DL) random-effects model. Sensitivity and subgroup analyses were also performed. Publication bias was evaluated using inspection of funnel plots and statistical tests. Results Twenty five observational studies (retrospective, 14; prospective, 11) including 22,382 patients were identified. The overall pooled mortality estimates for IE patients who underwent short- and long-term follow-up were 20% (95% CI: 18.0–23.0, P < 0.01) and 37% (95% CI: 27.0–48.0, P < 0.01), respectively. The pooled prevalence of cardiac complications in patients with IE was found to be 39% (95%CI: 32.0–46.0) while septic embolism and renal complications accounted for 25% (95% CI: 20.0–31) and 19% (95% CI: 14.0–25.0) (all P < 0.01), respectively. Conclusion Irrespective of the follow-up period, a significantly higher mortality rate was reported in IE patients, and the burden of IE-related complications were immense. Further research is needed to assess the determinants of overall mortality in IE patients, as well as well-designed observational studies to conform our results. Electronic supplementary material The online version of this article (10.1186/s12872-017-0729-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tadesse Melaku Abegaz
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemayehu B Mekonnen
- Medication Safety Chair, College of Pharmacy, King Saud University, Riadh, Saudi Arabia
| | - Tamrat Befekadu Abebe
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Master's Program in Health Economics, Policy and Managment; Student; Department of Learning, Informatics, Managent and Ethics, Karolinska Institutet, Solna, Sweden
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Velázquez-Meza ME, Mendoza-Olazarán S, Echániz-Aviles G, Camacho-Ortiz A, Martínez-Reséndez MF, Valero-Moreno V, Garza-González E. Chlorhexidine whole-body washing of patients reduces methicillin-resistant Staphylococcus aureus and has a direct effect on the distribution of the ST5-MRSA-II (New York/Japan) clone. J Med Microbiol 2017; 66:721-728. [DOI: 10.1099/jmm.0.000487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Soraya Mendoza-Olazarán
- Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Gabriela Echániz-Aviles
- Departamento de Evaluación de Vacunas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Adrián Camacho-Ortiz
- Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Michel Fernando Martínez-Reséndez
- Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Vanessa Valero-Moreno
- Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Elvira Garza-González
- Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Pressman GS, Rodriguez-Ziccardi M, Gartman CH, Obasare E, Melendres E, Arguello V, Bhalla V. Mitral Annular Calcification as a Possible Nidus for Endocarditis: A Descriptive Series with Bacteriological Differences Noted. J Am Soc Echocardiogr 2017; 30:572-578. [DOI: 10.1016/j.echo.2017.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Indexed: 12/12/2022]
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Pérez-Montarelo D, Viedma E, Murcia M, Muñoz-Gallego I, Larrosa N, Brañas P, Fernández-Hidalgo N, Gavaldà J, Almirante B, Chaves F. Pathogenic Characteristics of Staphylococcus aureus Endovascular Infection Isolates from Different Clonal Complexes. Front Microbiol 2017; 8:917. [PMID: 28579985 PMCID: PMC5437158 DOI: 10.3389/fmicb.2017.00917] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/04/2017] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus is a major cause of bacteremia and, even with appropriate clinical management, causes high morbidity, and mortality due to its involvement in endovascular complications and metastatic infections. Through different pathogenic in vivo and in vitro models we investigated the behavior of S. aureus most relevant clonal complexes (CCs) causing endovascular complications. We analyzed 14 S. aureus strains representing CC5, CC8, CC15, CC30, and CC45 that caused endovascular complications, including methicillin susceptible and resistant isolates and strains with different functionality of the agr global regulator. Their adherence to collagen, interaction with the endothelium, resistance to immune attack, capacity to form biofilm and virulence in the Galleria mellonella model were analyzed. CC30 and CC45 showed greater adhesion to collagen and CC8 showed a trend towards higher rate of intracellular persistence in endothelial cells. All CCs exhibited similar tolerance to neutrophil antimicrobial peptide hNP-1 and were capable of forming biofilms under static conditions. The virulence assay in the G. mellonella model demonstrated that CC15 and CC30 were the most and least virulent, respectively. The analysis of the genomic sequences of the most relevant virulence genes identified some CC15 specific gene patterns (absence of enterotoxins and sak gene) and variants (mainly in leucocidins and proteases), but did not reveal any gene or variant that could be responsible for the increased virulence detected for CC15 strains. Even though all the CCs were capable of causing endovascular complications, our results showed that different CCs are likely to produce these complications through different mechanisms which, if confirmed in more sophisticated models, would indicate the need to more specific management and therapeutic approaches.
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Affiliation(s)
- Dafne Pérez-Montarelo
- Department of Microbiology, Instituto de Investigación Hospital de OctubreMadrid, Spain
| | - Esther Viedma
- Department of Microbiology, Instituto de Investigación Hospital de OctubreMadrid, Spain
| | - Mercedes Murcia
- Department of Microbiology, Instituto de Investigación Hospital de OctubreMadrid, Spain
| | - Irene Muñoz-Gallego
- Department of Microbiology, Instituto de Investigación Hospital de OctubreMadrid, Spain
| | - Nieves Larrosa
- Department of Microbiology, Hospital Universitari Vall d'hebron, Universitat Autónoma de BarcelonaBarcelona, Spain
| | - Patricia Brañas
- Department of Microbiology, Instituto de Investigación Hospital de OctubreMadrid, Spain
| | - Nuria Fernández-Hidalgo
- Department of Infectious Diseases, Hospital Universitari Vall d'hebron, Universitat Autónoma de BarcelonaBarcelona, Spain
| | - Joan Gavaldà
- Department of Infectious Diseases, Hospital Universitari Vall d'hebron, Universitat Autónoma de BarcelonaBarcelona, Spain
| | - Benito Almirante
- Department of Infectious Diseases, Hospital Universitari Vall d'hebron, Universitat Autónoma de BarcelonaBarcelona, Spain
| | - Fernando Chaves
- Department of Microbiology, Instituto de Investigación Hospital de OctubreMadrid, Spain
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San-Juan R, Pérez-Montarelo D, Viedma E, Lalueza A, Fortún J, Loza E, Pujol M, Ardanuy C, Morales I, de Cueto M, Resino-Foz E, Morales-Cartagena MA, Fernández-Ruiz M, Rico A, Romero MP, Fernández de Mera M, López-Medrano F, Orellana MÁ, Aguado JM, Chaves F. Pathogen-related factors affecting outcome of catheter-related bacteremia due to methicillin-susceptible Staphylococcus aureus in a Spanish multicenter study. Eur J Clin Microbiol Infect Dis 2017; 36:1757-1765. [PMID: 28477236 DOI: 10.1007/s10096-017-2989-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 11/24/2022]
Abstract
Even with appropriate clinical management, complicated methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bacteremia (CRB) is frequent. We investigated the influence of molecular characteristics of MSSA strains on the risk of complicated bacteremia (CB) in MSSA-CRB. A multicenter prospective study was conducted in Spain between 2011 and 2014 on MSSA-CRB. Optimized protocol-guided clinical management was required. CB included endocarditis, septic thrombophlebitis, persistent bacteremia and/or end-organ hematogenous spread. Molecular typing, agr functionality and DNA microarray analysis of virulence factors were performed in all MSSA isolates. Out of 83 MSSA-CRB episodes included, 26 (31.3%) developed CB. MSSA isolates belonged to 16 clonal complexes (CCs), with CC30 (32.5%), CC5 (15.7%) and CC45 (13.3) being the most common. Comparison between MSSA isolates in episodes with or without CB revealed no differences regarding agr type and functionality. However, our results showed that CC15 and the presence of genes like cna, chp and cap8 were associated with the development of CB. The multivariate analysis highlighted that the presence of cna (Hazard ratio 2.9; 95% CI 1.14-7.6) was associated with the development of CB. Our results suggest that particular CCs and specific genes may influence the outcome of MSSA-CRB.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain.
| | - D Pérez-Montarelo
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| | - E Viedma
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| | - A Lalueza
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital Ramón y Cajal, Madrid, Spain
| | - E Loza
- Department of Microbiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - M Pujol
- Department of Infectious Diseases, University Hospital Bellvitge, Universidad de Barcelona-IDIBELL, Barcelona, Spain
| | - C Ardanuy
- Department of Microbiology, University Hospital Bellvitge, Universidad de Barcelona-IDIBELL, Barcelona, Spain
| | - I Morales
- Department of Infectious Diseases, University Hospital Virgen de la Macarena, Seville, Spain
| | - M de Cueto
- Department of Microbiology, University Hospital Virgen de la Macarena, Seville, Spain
| | - E Resino-Foz
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - M A Morales-Cartagena
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - A Rico
- Unit of Infectious Diseases, University Hospital La Paz, Madrid, Spain
| | - M P Romero
- Department of Microbiology, University Hospital La Paz, Madrid, Spain
| | - M Fernández de Mera
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - M Á Orellana
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain
| | - F Chaves
- Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain
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Giulieri SG, Holmes NE, Stinear TP, Howden BP. Use of bacterial whole-genome sequencing to understand and improve the management of invasive Staphylococcus aureus infections. Expert Rev Anti Infect Ther 2016; 14:1023-1036. [PMID: 27626511 DOI: 10.1080/14787210.2016.1233815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Management of invasive Staphylococcus aureus infections is complex. Dramatic improvements in bacterial whole genome sequencing (WGS) offer new opportunities for personalising the treatment of S. aureus infections. Areas covered: We address recent achievements in S. aureus genomics, describe genetic determinants of antibiotic resistance and summarise studies that have defined molecular characteristics associated with risk and outcome of S. aureus invasive infections. Potential clinical use of WGS for resistance prediction, infection outcome stratification and management of persistent /relapsing infections is critically discussed. Expert commentary: WGS is not only providing invaluable information to track the emergence and spread of important S. aureus clones, but also allows rapid determination of resistance genotypes in the clinical environment. An evolving opportunity is to infer clinically important outcomes and optimal therapeutic approaches from widely available S. aureus genome data, with the goal of individualizing management of invasive S. aureus infections.
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Affiliation(s)
- Stefano G Giulieri
- a Microbiological Diagnostic Unit Public Health Laboratory , Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne , Melbourne , Australia.,b Infectious Diseases Service , Department of Medicine, Lausanne University Hospital , Lausanne , Switzerland
| | - Natasha E Holmes
- c Infectious Diseases Department , Austin Health , Heidelberg , Australia
| | - Timothy P Stinear
- d Doherty Applied Microbial Genomics , Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne , Melbourne , Australia.,e Department of Microbiology and Immunology , The University of Melbourne at the Peter Doherty Institute for Infection and Immunity , Melbourne , Australia
| | - Benjamin P Howden
- a Microbiological Diagnostic Unit Public Health Laboratory , Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne , Melbourne , Australia.,c Infectious Diseases Department , Austin Health , Heidelberg , Australia.,e Department of Microbiology and Immunology , The University of Melbourne at the Peter Doherty Institute for Infection and Immunity , Melbourne , Australia
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Reduced pro-inflammatory responses to Staphylococcus aureus bloodstream infection and low prevalence of enterotoxin genes in isolates from patients on haemodialysis. Eur J Clin Microbiol Infect Dis 2016; 36:33-42. [PMID: 27638007 DOI: 10.1007/s10096-016-2767-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022]
Abstract
Patients with end-stage renal failure undergo regular haemodialysis (HD) and often develop episodes of Staphylococcus aureus bloodstream infection (BSI), which can re-occur. However, clinically, patients on HD, with S. aureus BSI, respond well to treatment, rarely developing overt signs of sepsis. We investigated the contributions of bacterial virulence and cytokine responses to the clinical course of S. aureus BSI in HD and non-HD patients. Seventy patients were recruited, including 27 (38.6 %) patients on HD. Isolates were spa-typed and virulence and antimicrobial resistance gene carriage was investigated using DNA microarray analysis. Four inflammatory cytokines, IL-6, RANTES, GROγ and leptin, were measured in patient plasma on the day of diagnosis and after 7 days. There was no significant difference in the prevalence of genotypes or antimicrobial resistance genes in S. aureus isolates from HD compared to non-HD patients. The enterotoxin gene cluster (containing staphylococcal enterotoxins seg, sei, sem, sen, seo and seu) was significantly less prevalent among BSI isolates from HD patients compared to non-HD patients. Comparing inflammatory cytokine response to S. aureus BSI in HD patients to non-HD patients, IL-6 and GROγ were significantly lower (p = 0.021 and p = 0.001, respectively) in HD patients compared to other patients on the day of diagnosis and RANTES levels were significantly lower (p = 0.025) in HD patients on day 7 following diagnosis. Lowered cytokine responses in HD patients and a reduced potential for super-antigen production by infecting isolates may partly explain the favourable clinical responses to episodes of S. aureus BSI in HD patients that we noted clinically.
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Braquet P, Alla F, Cornu C, Goehringer F, Piroth L, Chirouze C, Revest M, Lechiche C, Duval X, Le Moing V. Factors associated with 12 week case-fatality in Staphylococcus aureus bacteraemia: a prospective cohort study. Clin Microbiol Infect 2016; 22:948.e1-948.e7. [PMID: 27515395 DOI: 10.1016/j.cmi.2016.07.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/24/2016] [Accepted: 07/31/2016] [Indexed: 12/21/2022]
Abstract
Staphylococcus aureus bacteraemia (SAB) is a frequent and deadly disease. Given the lack of a randomized trial, optimal first-line antibiotic treatment is still debated. Our aim was to identify prognostic factors in SAB patients and to analyse the impact of first-line antibiotics. The VIRSTA prospective cohort study was conducted in eight tertiary care centres in France. Consecutive incident adults in whom a blood culture drawn in participating centres grew S. aureus between April 2009 and October 2011 were prospectively followed for 12 weeks. Factors associated with 12-week case-fatality were identified by multivariate logistic regression. We enrolled 2091 patients and analysed survival in 1972 (median age 67.8 years, interquartile range 55.5-78.9; females 692/1972, 35.1%). SAB was nosocomial or healthcare-related in 1372/1972 (69.6%) of cases and the primary focus was unknown in 414/1972 (21.0%) of cases. Week 12 case-fatality rate was 671/1972 (34.0%). The main independent prognostic factors on multivariate analysis were age (adjusted OR by 10-year increment 1.56; 95% CI 1.44-1.69), septic shock (OR 5.11; 95% CI 3.84-6.80), metastatic cancer (OR 4.28; 95% CI 2.88-6.38), and unknown primary focus (OR 2.62; 95% CI 2.02-3.41). In the 1538 patients with methicillin-sensitive S. aureus (MSSA) bacteraemia, first-line empiric antistaphylococcal penicillins (OR 0.40; 95% CI 0.17-0.95) and vancomycin (OR 0.37; 95% CI 0.17-0.83), alone or combined with an aminoglycoside, were associated with better outcome compared with other antibiotics. There are few modifiable prognostic factors for SAB. Initiating empiric antibiotics with antistaphylococcal penicillins or vancomycin may be associated with better outcome in MSSA bacteraemia.
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Affiliation(s)
- P Braquet
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche sur le Développement, Montpellier, France.
| | - F Alla
- Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, Nancy, France; INSERM, CIC-EC, CIE6, Nancy, France; CHU Nancy, Nancy, France
| | - C Cornu
- INSERM, CIC1407, Lyon, France; CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon, UMR 5558, Lyon, France
| | - F Goehringer
- Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Nancy, France
| | - L Piroth
- CHU de Dijon, UMR 1347-MERS, Université de Bourgogne, Dijon, France
| | - C Chirouze
- UMR CNRS 6249 Chrono-environnement, Université de Bourgogne Franche-Comté, CHU de Besançon, Besançon, France
| | - M Revest
- Infectious Diseases and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, France
| | - C Lechiche
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - X Duval
- Université Paris Diderot Sorbonne, Paris, France; IAME, INSERM, UMR 1137, CIC 1425, Paris, France; AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - V Le Moing
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche sur le Développement, Montpellier, France.
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DNA microarray analysis of Staphylococcus aureus causing bloodstream infection: bacterial genes associated with mortality? Eur J Clin Microbiol Infect Dis 2016; 35:1285-95. [PMID: 27177754 DOI: 10.1007/s10096-016-2663-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/24/2016] [Indexed: 01/07/2023]
Abstract
Providing evidence for microbial genetic determinants' impact on outcome in Staphylococcus aureus bloodstream infections (SABSI) is challenging due to the complex and dynamic microbe-host interaction. Our recent population-based prospective study reported an association between the S. aureus clonal complex (CC) 30 genotype and mortality in SABSI patients. This follow-up investigation aimed to examine the genetic profiles of the SABSI isolates and test the hypothesis that specific genetic characteristics in S. aureus are associated with mortality. SABSI isolates (n = 305) and S. aureus CC30 isolates from asymptomatic nasal carriers (n = 38) were characterised by DNA microarray analysis and spa typing. Fisher's exact test, least absolute shrinkage and selection operator (LASSO) and elastic net regressions were performed to discern within four groups defined by patient outcome and characteristics. No specific S. aureus genetic determinants were found to be associated with mortality in SABSI patients. By applying LASSO and elastic net regressions, we found evidence suggesting that agrIII and cna were positively and setC (=selX) and seh were negatively associated with S. aureus CC30 versus non-CC30 isolates. The genes chp and sak, encoding immune evasion molecules, were found in higher frequencies in CC30 SABSI isolates compared to CC30 carrier isolates, indicating a higher virulence potential. In conclusion, no specific S. aureus genes were found to be associated with mortality by DNA microarray analysis and state-of-the-art statistical analyses. The next natural step is to test the hypothesis in larger samples with higher resolution methods, like whole genome sequencing.
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