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Watkin S, Cloutman-Green E, Kiernan M, Ciric L. Trends in viable microbial bioburden on surfaces within a paediatric bone marrow transplant unit. J Hosp Infect 2024; 148:167-177. [PMID: 38621514 DOI: 10.1016/j.jhin.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Despite their role being historically overlooked, environmental surfaces have been shown to play a key role in the transmission of pathogens causative of healthcare-associated infection. To guide infection prevention and control (IPC) interventions and inform clinical risk assessments, more needs to be known about microbial surface bioburdens. AIM To identify the trends in culturable bacterial contamination across communal touch sites over time in a hospital setting. METHODS Swab samples were collected over nine weeks from 22 communal touch sites in a paediatric bone marrow transplant unit. Samples were cultured on Columbia blood agar and aerobic colony counts (ACC) per 100 cm2 were established for each site. Individual colony morphologies were grouped and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or 16s rDNA sequencing. FINDINGS Highest mean counts were observed for sites associated with ward management activity and computer devices (3.29 and 2.97 ACC/100 cm2 respectively). A nurses' station keyboard had high mean ACC/100 cm2 counts (10.67) and diversity, while laundry controls had high mean ACC/100 cm2 counts (4.70) and low diversity. Micrococcus luteus was identified in all sampling groups. Clinical staff usage sites were contaminated with similar proportions of skin and environmental flora (52.19-46.59% respectively), but sites associated with parental activities were predominantly contaminated by environmental microflora (86.53%). CONCLUSION The trends observed suggest patterns in microbial loading based on site activities, surface types and user groups. Improved understanding of environmental surface contamination could help support results interpretation and IPC interventions, improving patient safety.
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Affiliation(s)
- S Watkin
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK.
| | - E Cloutman-Green
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK; Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Kiernan
- Richard Wells Research Centre, University of West London, London, UK
| | - L Ciric
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK
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2
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Wei M, Knight SAB, Fazelinia H, Spruce L, Roof J, Chu E, Kim DY, Bhanap P, Walsh J, Flowers L, Zhu J, Grice EA. An exploration of mechanisms underlying Desemzia incerta colonization resistance to methicillin-resistant Staphylococcus aureus on the skin. mSphere 2024; 9:e0063623. [PMID: 38415632 PMCID: PMC10964421 DOI: 10.1128/msphere.00636-23] [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: 10/20/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
Colonization of human skin and nares by methicillin-resistant Staphylococcus aureus (MRSA) leads to the community spread of MRSA. This spread is exacerbated by the transfer of MRSA between humans and livestock, particularly swine. Here, we capitalized on the shared features between human and porcine skin, including shared MRSA colonization, to study novel bacterial mediators of MRSA colonization resistance. We focused on the poorly studied bacterial species Desemzia incerta, which we found to exert antimicrobial activity through a secreted product and exhibited colonization resistance against MRSA in an in vivo murine skin model. Using parallel genomic and biochemical investigation, we discovered that D. incerta secretes an antimicrobial protein. Sequential protein purification and proteomics analysis identified 24 candidate inhibitory proteins, including a promising peptidoglycan hydrolase candidate. Aided by transcriptional analysis of D. incerta and MRSA cocultures, we found that exposure to D. incerta leads to decreased MRSA biofilm production. These results emphasize the value of exploring microbial communities across a spectrum of hosts, which can lead to novel therapeutic agents as well as an increased understanding of microbial competition.IMPORTANCEMethicillin-resistant Staphylococcus aureus (MRSA) causes a significant healthcare burden and can be spread to the human population via livestock transmission. Members of the skin microbiome can prevent MRSA colonization via a poorly understood phenomenon known as colonization resistance. Here, we studied the colonization resistance of S. aureus by bacterial inhibitors previously identified from a porcine skin model. We identify a pig skin commensal, Desemzia incerta, that reduced MRSA colonization in a murine model. We employ a combination of genomic, proteomic, and transcriptomic analyses to explore the mechanisms of inhibition between D. incerta and S. aureus. We identify 24 candidate antimicrobial proteins secreted by D. incerta that could be responsible for its antimicrobial activity. We also find that exposure to D. incerta leads to decreased S. aureus biofilm formation. These findings show that the livestock transmission of MRSA can be exploited to uncover novel mechanisms of MRSA colonization resistance.
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Affiliation(s)
- Monica Wei
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Simon A. B. Knight
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hossein Fazelinia
- Children’s Hospital of Philadelphia, Proteomics Core Facility, Philadelphia, Pennsylvania, USA
| | - Lynn Spruce
- Children’s Hospital of Philadelphia, Proteomics Core Facility, Philadelphia, Pennsylvania, USA
| | - Jennifer Roof
- Children’s Hospital of Philadelphia, Proteomics Core Facility, Philadelphia, Pennsylvania, USA
| | - Emily Chu
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel Y. Kim
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Preeti Bhanap
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jasmine Walsh
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Laurice Flowers
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jun Zhu
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elizabeth A. Grice
- Department of Dermatology and Microbiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Chakrawarti A, Casey CL, Burk A, Mugabi R, Ochoa A, Barlow JW. An observational study demonstrates human-adapted Staphylococcus aureus strains have a higher frequency of antibiotic resistance compared to cattle-adapted strains isolated from dairy farms making farmstead cheese. BMC Vet Res 2024; 20:75. [PMID: 38409123 PMCID: PMC10898128 DOI: 10.1186/s12917-024-03910-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/04/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Staphylococcus aureus is a multi-host zoonotic pathogen causing human and livestock diseases. Dairy farms that make artisan cheese have distinctive concerns for S. aureus control. Antimicrobial-resistant (AMR) S. aureus is a public and animal health concern. There is a need to study the population structure of AMR S. aureus at the human-animal interface and understand the path of zoonotic transmission. This cross-sectional observational study aimed to assess the genetic diversity and AMR patterns of S. aureus isolated from cattle and humans on conventional and organic Vermont dairy farms that produce and sell farmstead cheese. RESULTS A convenience sample of 19 dairy farms in Vermont was enrolled, and 160 S. aureus isolates were collected from cow quarter milk (CQM), bulk tank milk (BTM), human-hand and -nasal swabs. After deduplication, 89 isolates were used for the analysis. Sequence types (STs) were determined by multilocus sequence typing and cataloged to the PubMLST database. Nine defined and five novel STs were identified. For BTM and CQM samples, six STs were identified within cow-adapted CC97 and CC151. Two human-adapted STs were isolated from BTM and CQM. Seven human-adapted clonal complexes with eight STs were identified from human samples. One cow-adapted ST was isolated from a human. Antimicrobial susceptibility of the isolates was tested using disc diffusion and broth microdilution methods. Approximately 27% of the isolates were beta-lactam resistant and blaZ gene-positive. S. aureus isolates from human swabs were more likely to carry blaZ compared to isolates from CQM or BTM. S. aureus isolated from cows and humans on the same farm belonged to different STs. CONCLUSION Humans were more likely to carry beta-lactam-resistant S. aureus compared to cows, and on organic farms only human-adapted blaZ positive STs were isolated from BTM. Moreover, we identified potential spillover events of S. aureus sequence types between host species. The presence of penicillin-resistant-human-adapted S. aureus on both organic and conventional dairy farms highlights a "One Health" concern at the junction of public and animal health requiring further surveillance.
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Affiliation(s)
- Ashma Chakrawarti
- Department of Animal and Veterinary Sciences, University of Vermont, Burlington, VT, USA
| | - Christine L Casey
- Kentucky Department of Fish and Wildlife Resources, Frankfort, KY, USA
| | - Ariela Burk
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert Mugabi
- Department of Veterinary Diagnostic & Production Animal Medicine, Iowa State University, Ames, IA, USA
| | | | - John W Barlow
- Department of Animal and Veterinary Sciences, University of Vermont, Burlington, VT, USA.
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Houtak G, Bouras G, Nepal R, Shaghayegh G, Cooksley C, Psaltis AJ, Wormald PJ, Vreugde S. The intra-host evolutionary landscape and pathoadaptation of persistent Staphylococcus aureus in chronic rhinosinusitis. Microb Genom 2023; 9. [PMID: 38010322 DOI: 10.1099/mgen.0.001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a common chronic sinonasal mucosal inflammation associated with Staphylococcus aureus biofilm and relapsing infections. This study aimed to determine rates of S. aureus persistence and pathoadaptation in CRS patients by investigating the genomic relatedness and antibiotic resistance/tolerance in longitudinally collected S. aureus clinical isolates. A total of 68 S. aureus paired isolates (34 pairs) were sourced from 34 CRS patients at least 6 months apart. Isolates were grown into 48 h biofilms and tested for tolerance to antibiotics. A hybrid sequencing strategy was used to obtain high-quality reference-grade assemblies of all isolates. Single nucleotide variants (SNV) divergence in the core genome and sequence type clustering were used to analyse the relatedness of the isolate pairs. Single nucleotide and structural genome variations, plasmid similarity, and plasmid copy numbers between pairs were examined. Our analysis revealed that 41 % (14/34 pairs) of S. aureus isolates were persistent, while 59 % (20/34 pairs) were non-persistent. Persistent isolates showed episode-specific mutational changes over time with a bias towards events in genes involved in adhesion to the host and mobile genetic elements such as plasmids, prophages, and insertion sequences. Furthermore, a significant increase in the copy number of conserved plasmids of persistent strains was observed. This was accompanied by a significant increase in biofilm tolerance against all tested antibiotics, which was linked to a significant increase in biofilm biomass over time, indicating a potential biofilm pathoadaptive process in persistent isolates. In conclusion, our study provides important insights into the mutational changes during S. aureus persistence in CRS patients highlighting potential pathoadaptive mechanisms in S. aureus persistent isolates culminating in increased biofilm biomass.
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Affiliation(s)
- Ghais Houtak
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Department of Surgery - Otolaryngology Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, Australia
| | - George Bouras
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Department of Surgery - Otolaryngology Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, Australia
| | - Roshan Nepal
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Department of Surgery - Otolaryngology Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, Australia
| | - Gohar Shaghayegh
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Department of Surgery - Otolaryngology Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, Australia
| | - Clare Cooksley
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Department of Surgery - Otolaryngology Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, Australia
| | - Alkis James Psaltis
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Department of Surgery - Otolaryngology Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, Australia
| | - Peter-John Wormald
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Department of Surgery - Otolaryngology Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, Australia
| | - Sarah Vreugde
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Department of Surgery - Otolaryngology Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, Australia
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5
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Wei M, Knight SA, Fazelinia H, Spruce L, Roof J, Chu E, Walsh J, Flowers L, Kim DY, Zhu J, Grice EA. An exploration of mechanisms underlying Desemzia incerta colonization resistance to methicillin-resistant Staphylococcus aureus on the skin. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.11.561853. [PMID: 37873232 PMCID: PMC10592716 DOI: 10.1101/2023.10.11.561853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Colonization of human skin and nares by methicillin-resistant Staphylococcus aureus (MRSA) leads to community spread of MRSA. This spread is exacerbated by transfer of MRSA between humans and livestock, particularly swine. Here we capitalized on the shared features between human and porcine skin, including shared MRSA colonization, to study novel bacterial mediators of MRSA colonization resistance. We focused on the poorly studied bacterial species Desemzia incerta, which we found to exert antimicrobial activity through a secreted product and exhibited colonization resistance against MRSA in an in vivo murine skin model. Using parallel genomic and biochemical investigation, we discovered that D. incerta secretes an antimicrobial protein. Sequential protein purification and proteomics analysis identified 24 candidate inhibitory proteins, including a promising peptidoglycan hydrolase candidate. Aided by transcriptional analysis of D. incerta and MRSA cocultures, we found that exposure to D. incerta leads to decreased MRSA biofilm production. These results emphasize the value in exploring microbial communities across a spectrum of hosts, which can lead to novel therapeutic agents as well as increased understanding of microbial competition.
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Affiliation(s)
- Monica Wei
- University of Pennsylvania, Perelman School of Medicine, Department of Dermatology and Microbiology, Philadelphia, Pennsylvania, USA
| | - Simon Ab Knight
- University of Pennsylvania, Perelman School of Medicine, Department of Dermatology and Microbiology, Philadelphia, Pennsylvania, USA
| | - Hossein Fazelinia
- Children's Hospital of Philadelphia, Proteomics Core Facility, Philadelphia, Pennsylvania, USA
| | - Lynn Spruce
- Children's Hospital of Philadelphia, Proteomics Core Facility, Philadelphia, Pennsylvania, USA
| | - Jennifer Roof
- Children's Hospital of Philadelphia, Proteomics Core Facility, Philadelphia, Pennsylvania, USA
| | - Emily Chu
- University of Pennsylvania, Perelman School of Medicine, Department of Dermatology and Microbiology, Philadelphia, Pennsylvania, USA
| | - Jasmine Walsh
- University of Pennsylvania, Perelman School of Medicine, Department of Dermatology and Microbiology, Philadelphia, Pennsylvania, USA
| | - Laurice Flowers
- University of Pennsylvania, Perelman School of Medicine, Department of Dermatology and Microbiology, Philadelphia, Pennsylvania, USA
| | - Daniel Y Kim
- University of Pennsylvania, Perelman School of Medicine, Department of Dermatology and Microbiology, Philadelphia, Pennsylvania, USA
| | - Jun Zhu
- University of Pennsylvania, Perelman School of Medicine, Department of Dermatology and Microbiology, Philadelphia, Pennsylvania, USA
| | - Elizabeth A Grice
- University of Pennsylvania, Perelman School of Medicine, Department of Dermatology and Microbiology, Philadelphia, Pennsylvania, USA
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6
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Szymankiewicz M, Jarzynka S, Koryszewska-Bagińska A, Nowikiewicz T. The Impact of Nasal Staphylococcus aureus Carriage on Surgical-Site Infections after Immediate Breast Reconstruction: Risk Factors and Biofilm Formation Potential. Med Sci Monit 2023; 29:e940898. [PMID: 37700508 PMCID: PMC10504855 DOI: 10.12659/msm.940898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Despite the benefits of implant-based breast reconstruction in patients with breast cancer, the procedure can be complicated by surgical site infections (SSI). This study aimed to evaluate the association between nasal carriage of Staphylococcus aureus strains and the incidence of SSI among patients who underwent reconstructive procedures. We also assessed the ability of colonizing S. aureus strains to form biofilm. MATERIAL AND METHODS Medical data from 124 patients with 132 post-mastectomy breast reconstructions performed at the Oncology Center in Bydgoszcz, Poland, between June 2020 and August 2021 were analyzed. A 90-day incidence of SSI was found in 7/132 reconstructions (5.3%). The study group included 132 reconstructions, and was divided into those with infection (n=7) and without infection (n=125). Between-group differences were assessed using the t test for continuous variables and chi-square test for categorical variables. Biofilm formation among 32 S. aureus strains was determined by using quantitative and qualitative assays. RESULTS There were no significant differences in relation to the patients' S. aureus colonization status. Infections occurred both in patients colonized and not colonized with S. aureus. S. aureus nasal carriage did not affect the rate of SSI at 90 days after surgery. About 97.0% of the strains had a strong capacity for biofilm formation. CONCLUSIONS There was no association between nasal carriage of strains of S. aureus and the incidence of SSI. However, further investigations on a larger group of patients and longer observation time are needed to investigate this potential risk factor in detail.
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Affiliation(s)
- Maria Szymankiewicz
- Department of Microbiology, Prof. F. Łukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Sylwia Jarzynka
- Department of Medical Biology, Medical University of Warsaw, Warsaw, Poland
| | | | - Tomasz Nowikiewicz
- Department of Surgical Oncology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- Department of Clinical Breast Cancer and Reconstructive Surgery, Prof. F. Łukaszczyk Oncology Centre, Bydgoszcz, Poland
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Kasela M, Ossowski M, Dzikoń E, Ignatiuk K, Wlazło Ł, Malm A. The Epidemiology of Animal-Associated Methicillin-Resistant Staphylococcus aureus. Antibiotics (Basel) 2023; 12:1079. [PMID: 37370398 DOI: 10.3390/antibiotics12061079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) remains an important etiological factor of human and animal infectious diseases, causing significant economic losses not only in human healthcare but also in the large-scale farming sector. The constantly changing epidemiology of MRSA observed globally affects animal welfare and raises concerns for public health. High MRSA colonization rates in livestock raise questions about the meaning of reservoirs and possible transmission pathways, while the prevalence of MRSA colonization and infection rates among companion animals vary and might affect human health in multiple ways. We present the main findings concerning the circulation of animal-associated MRSA (AA-MRSA) in the environment and factors influencing the direction, mechanisms, and routes of its transmission. Studies have shown it that S. aureus is a multi-host bacterial pathogen; however, its adaptation mechanisms enabling it to colonize and infect both animal and human hosts are still rarely discussed. Finally, we elaborate on the most successful strategies and programs applied limiting the circulation of AA-MRSA among animals and humans. Although MRSA strains colonizing animals rarely infect humans, they undergo host-adaptive evolution enabling them to spread and persist in human populations.
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Affiliation(s)
- Martyna Kasela
- Department of Pharmaceutical Microbiology, Medical University of Lublin, Chodzki Street 1, 20-093 Lublin, Poland
| | - Mateusz Ossowski
- Department of Animal Hygiene and Environmental Hazards, University of Life Sciences in Lublin, Akademicka 13, 20-950 Lublin, Poland
| | - Ewelina Dzikoń
- Student's Scientific Circle, Department of Pharmaceutical Microbiology, Medical University of Lublin, Chodzki Street 1, 20-093 Lublin, Poland
| | - Katarzyna Ignatiuk
- Student's Scientific Circle, Department of Pharmaceutical Microbiology, Medical University of Lublin, Chodzki Street 1, 20-093 Lublin, Poland
| | - Łukasz Wlazło
- Department of Animal Hygiene and Environmental Hazards, University of Life Sciences in Lublin, Akademicka 13, 20-950 Lublin, Poland
| | - Anna Malm
- Department of Pharmaceutical Microbiology, Medical University of Lublin, Chodzki Street 1, 20-093 Lublin, Poland
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8
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Sun J, Yuan Y, Cai L, Zeng M, Li X, Yao F, Chen W, Huang Y, Shafiq M, Xie Q, Zhang Q, Wong N, Wang Z, Jiao X. Metagenomic evidence for antibiotics-driven co-evolution of microbial community, resistome and mobilome in hospital sewage. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 327:121539. [PMID: 37019259 DOI: 10.1016/j.envpol.2023.121539] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
Overconsumption of antibiotics is an immediate cause for the emergence of antimicrobial resistance (AMR) and antibiotic resistant bacteria (ARB), though its environmental impact remains inadequately clarified. There is an urgent need to dissect the complex links underpinning the dynamic co-evolution of ARB and their resistome and mobilome in hospital sewage. Metagenomic and bioinformatic methods were employed to analyze the microbial community, resistome and mobilome in hospital sewage, in relation to data on clinical antibiotic use collected from a tertiary-care hospital. In this study, resistome (1,568 antibiotic resistance genes, ARGs, corresponding to 29 antibiotic types/subtypes) and mobilome (247 types of mobile genetic elements, MGEs) were identified. Networks connecting co-occurring ARGs with MGEs encompass 176 nodes and 578 edges, in which over 19 types of ARGs had significant correlations with MGEs. Prescribed dosage and time-dependent antibiotic consumption were associated with the abundance and distributions of ARGs, and conjugative transfer of ARGs via MGEs. Variation partitioning analyses show that effects of conjugative transfer were most likely the main contributors to transient propagation and persistence of AMR. We have presented the first evidence supporting idea that use of clinical antibiotics is a potent driving force for the development of co-evolving resistome and mobilome, which in turn supports the growth and evolution of ARB in hospital sewage. The use of clinical antibiotics calls for greater attention in antibiotic stewardship and management.
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Affiliation(s)
- Jiayu Sun
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, 515041, China; Guangdong Province Center for Disease Control and Prevention, Guangzhou, 511400, China
| | - Yumeng Yuan
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, 515041, China
| | - Leshan Cai
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China; Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, 515041, China
| | - Mi Zeng
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, 515041, China
| | - Xin Li
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, 515041, China
| | - Fen Yao
- Department of Pharmacology, Shantou University Medical College, Shantou, 515041, China
| | - Weidong Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Yuanchun Huang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Muhammad Shafiq
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, 515041, China
| | - Qingdong Xie
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, 515041, China
| | - Qiaoxin Zhang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Naikei Wong
- Department of Pharmacology, Shantou University Medical College, Shantou, 515041, China
| | - Zhen Wang
- Guangdong Provincial Key Laboratory of Marine Biotechnology, Shantou University, Shantou, 515041, China
| | - Xiaoyang Jiao
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, 515041, China; Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, 515041, China.
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9
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Martínez DA, Cai J, Lin G, Goodman KE, Paul R, Lessler J, Levin SR, Toerper M, Simner PJ, Milstone AM, Klein EY. Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU. J Hosp Infect 2023; 136:1-7. [PMID: 36907332 PMCID: PMC10315994 DOI: 10.1016/j.jhin.2023.02.016] [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: 08/22/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited. OBJECTIVE To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization. DESIGN, SETTING AND PARTICIPANTS CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI). EXPOSURES The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions. MAIN OUTCOMES AND MEASURES The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition). RESULTS Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29). CONCLUSIONS AND RELEVANCE In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.
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Affiliation(s)
- D A Martínez
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - J Cai
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - G Lin
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
| | - K E Goodman
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - R Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - J Lessler
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S R Levin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M Toerper
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P J Simner
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - A M Milstone
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - E Y Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Disease Dynamics, Economics and Policy, Washington, DC, USA; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Campos J, Pires MF, Sousa M, Campos C, da Costa CFFA, Sampaio-Maia B. Unveiling the Relevance of the Oral Cavity as a Staphylococcus aureus Colonization Site and Potential Source of Antimicrobial Resistance. Pathogens 2023; 12:765. [PMID: 37375455 DOI: 10.3390/pathogens12060765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Staphylococcus aureus is both a human commensal and a pathogen, that causes serious nosocomial and community-acquired infections. Despite nostrils being considered its preferred host habitat, the oral cavity has been demonstrated to be an ideal starting point for auto-infection and transmission. The antibiotic resistance assessment of S. aureus is a priority and is often reported in clinical settings. This study aimed to explore the prevalence and antimicrobial susceptibility of S. aureus in the oral and nasal cavities of healthy individuals. The participants (n = 101) were subjected to a demographic and clinical background survey, a caries evaluation, and to oral and nasal swabbing. Swabs were cultured in differential/selective media and S. aureus isolates were identified (MALDI-TOF MS) and tested for antibiotic susceptibility (EUCAST/CLSI). Similar S. aureus prevalence was found exclusively on nasal (13.9%) or oral (12.0%) habitats, whereas 9.9% of the population were simultaneous nasal and oral carriers. In oro-nasal cavities, similar antibiotic resistance rates (83.3-81.5%), including MDR (20.8-29.6%), were observed. Notably, 60% (6/10) of the simultaneous nasal and oral carriers exhibited different antibiotic resistance profiles between cavities. This study demonstrates the relevance of the oral cavity as an independent colonization site for S. aureus and as a potential source of antimicrobial resistance, a role which has been widely neglected so far.
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Affiliation(s)
- Joana Campos
- INEB-Instituto Nacional de Engenharia Biomédica, 4200-135 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Mariana Faria Pires
- Faculdade de Medicina Dentária, Universidade do Porto, 4200-393 Porto, Portugal
| | - Marta Sousa
- Faculdade de Medicina Dentária, Universidade do Porto, 4200-393 Porto, Portugal
| | - Carla Campos
- Instituto Português de Oncologia do Porto Francisco Gentil, 4200-072 Porto, Portugal
- Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal
| | - Carolina Fernandes Ferreira Alves da Costa
- INEB-Instituto Nacional de Engenharia Biomédica, 4200-135 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Benedita Sampaio-Maia
- INEB-Instituto Nacional de Engenharia Biomédica, 4200-135 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Faculdade de Medicina Dentária, Universidade do Porto, 4200-393 Porto, Portugal
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11
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Adediran TY, Hitchcock S, Johnson JK, Stine OC, Leekha S, Thom KA, Liang Y, Rasko DA, Harris AD. Molecular concordance of methicillin-resistant Staphylococcus aureus isolates from healthcare workers and patients. Infect Control Hosp Epidemiol 2023; 44:578-588. [PMID: 36177884 PMCID: PMC10060437 DOI: 10.1017/ice.2022.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a significant nosocomial pathogen in the ICU. MRSA contamination of healthcare personnel (HCP) gloves and gowns after providing care to patients with MRSA occurs at a rate of 14%-16% in the ICU setting. Little is known about whether the MRSA isolates identified on HCP gown and gloves following patient care activities are the same as MRSA isolates identified as colonizing or infecting the patient. METHODS From a multisite cohort of 388 independent patient MRSA isolates and their corresponding HCP gown and glove isolates, we selected 91 isolates pairs using a probability to proportion size (PPS) sampling method. To determine whether the patient and HCP gown or gloves isolates were genetically similar, we used 5 comparative genomic typing methods: phylogenetic analysis, spa typing, multilocus sequence typing (MLST), large-scale BLAST score ratio (LSBSR), and single-nucleotide variant (SNV) analysis. RESULTS We identified that 56 (61.5%) of isolate pairs were genetically similar at least by 4 of the methods. Comparably, the spa typing and the LSBSR analyses revealed that >75% of the examined isolate pairs were concordant, with the thresholds established for each analysis. CONCLUSIONS Many of the patient MRSA isolates were genetically similar to those on the HCP gown or gloves following a patient care activity. This finding indicates that the patient is often the primary source of the MRSA isolates transmitted to the HCP, which can potentially be spread to other patients or hospital settings through HCP vectors. These results have important implications because they provide additional evidence for hospitals considering ending the use of contact precautions (gloves and gowns) for MRSA patients.
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Affiliation(s)
- Timileyin Y. Adediran
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephanie Hitchcock
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - J. Kristie Johnson
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - O. Colin Stine
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kerri A. Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - David A. Rasko
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anthony D. Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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12
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Myers F. Letter to the editor. Am J Infect Control 2023; 51:600-601. [PMID: 36736899 DOI: 10.1016/j.ajic.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Frank Myers
- University of California San Diego Health System, San Diego, CA.
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13
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Ostrowski P, Masiuk H, Kulig P, Skoryk A, Wcisłek A, Jursa-Kulesza J, Sarna A, Sławiński M, Kotowski M, Tejchman K, Kotfis K, Sieńko J. Medical Face Masks Do Not Affect Acid-Base Balance Yet Might Facilitate the Transmission of Staphylococcus aureus in Hospital Settings during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2474. [PMID: 36767840 PMCID: PMC9915457 DOI: 10.3390/ijerph20032474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Due to the SARS-CoV-2 coronavirus pandemic, the wearing of masks has become a common phenomenon. Most of the undesirable effects of using a protective face covering are usually related to the prolonged time of its wearing, and the adverse consequences of face coverings should be considered two-fold. The aim of the study was to evaluate the rate of contamination of the three types of face coverings (surgical, N95, and FFP2 masks) with the microorganism-aerobic bacteria, yeasts, and molds-after the 3 h exposure time. The study aimed to investigate the effects of wearing FFP2 masks (KN95) on respiratory function and the acid-base balance of the human body. RESULTS The presence of S. aureus was confirmed in both nasal carriers and non-carriers which may demonstrate the cross-contamination and spread of this bacterium via hands. S. aureus was found on external and internal surfaces of face masks of each type, and therefore could also be transmitted via hands from external sources. The 3 h exposure time is not sufficient for Gram-negative rods and mold contamination. Moreover, there were no significant differences in most of the parameters studied between the first and second examinations, both in spirometry and capillary blood gas analysis (p > 0.05).
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Affiliation(s)
- Piotr Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Helena Masiuk
- Independent Laboratory of Medical Microbiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Piotr Kulig
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Anastasiia Skoryk
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Wcisłek
- Independent Laboratory of Medical Microbiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Joanna Jursa-Kulesza
- Independent Laboratory of Medical Microbiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Angela Sarna
- Department of Laboratory Diagnostics, Public Clinical Hospital No. 2, 70-111 Szczecin, Poland
| | - Michał Sławiński
- Department of Laboratory Diagnostics, Public Clinical Hospital No. 2, 70-111 Szczecin, Poland
| | - Maciej Kotowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Karol Tejchman
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Jerzy Sieńko
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
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Methicillin-Resistant and Biofilm-Producing Staphylococcus aureus in Nasal Carriage among Health Care Workers and Medical Students. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:8424486. [PMID: 36644335 PMCID: PMC9833899 DOI: 10.1155/2023/8424486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 01/06/2023]
Abstract
Antimicrobial resistance (AMR) is a global threat. It has been portrayed as a slow tsunami. Multidrug resistance and extensive drug resistance exacerbate the already-existing AMR problem. The aim of the study was to access the colonization of methicillin-resistant and biofilm-producing Staphylococcus aureus among healthcare workers (HCWs) and medical students (MSs). A cross-sectional study was designed. A total of 352 participants (176 were HCWs and 176 were MSs) were enrolled from different hospitals and medical colleges in Kathmandu, Nepal. Nasal cavity swab samples were collected and inoculated on Mannitol salt agar at standard in-vitro environmental conditions. Isolates were identified based on colony characteristics, staining properties, and biochemical tests. Identified isolates were tested for antibiotic susceptibility and biofilm production. Out of 352 participants, 65.3% were S. aureus carriers; among the carriers, 52.2% were HCWs and 47.8% were MSs. Of the total isolates, 47.4% isolates were methicillin-resistant S. aureus (MRSA) and 73.9% isolates were multidrug-resistant (MDR). Among MDR isolates, out of 109 MRSA isolates, 86.2% were MDR and out of 121 MSSA isolates, 62.8% were MDR where isolates were mainly resistant to erythromycin. In addition, 68.7% isolates were biofilm-forming; the results were similar in both MRSA and MSSA. Variables such as profession and educational level showed statistical significance (p < 0.05) with MRSA, MSSA, and biofilm producers. In conclusion, asymptomatic colonization of healthcare workers by drug-resistant S. aureus is increasing at alarming rates. This reflects the lack of proper hygiene practice as well as improper disinfection of workplace of study population.
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Kholaseh S, Derakhshan S, Abedini M. A comparative study on antibiotic resistance and virulence properties of Staphylococcus aureus isolated from hospitalized patients and hospital environment. Am J Infect Control 2022:S0196-6553(22)00868-9. [PMID: 36566986 DOI: 10.1016/j.ajic.2022.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We compared the characteristics of clinical Staphylococcus aureus and S. aureus isolated from environmental surfaces in 3 hospitals. METHODS Clinical S. aureus isolates were collected from hospitalized patients. Environmental surfaces were sampled from the rooms of patients infected with S. aureus. After identifying rooms with the target organism, 3-5 high-touch surfaces in patient care areas were sampled using swabs before room cleaning by environmental services. S. aureus isolates were subjected to genotyping, antimicrobial susceptibility testing, and virulence determinant screening. The isolates were analyzed for integron content and sequences of variable region amplification products. RESULTS There were epidemiologically unrelated 79 clinical and 62 environmental S. aureus isolates. Overall, 11.4% of clinical and 59.7% of environmental isolates were methicillin-resistant. The environmental and clinical S. aureus exhibited very different virulence profiles: 79% of the environmental isolates were negative for virulence genes compared to 2.5% of clinical isolates (P < .001). Environmental isolates were more resistant to antibiotics compared to clinical isolates. Class 1 integrons were only detected in 7 of 62 environmental isolates, of which 3 isolates had integrons with cysteine synthase cassette, 1 had aadA1, and 1 had an unknown cassette. CONCLUSION These data indicate the different characteristics between environmental and clinical S. aureus, which may reflect different reservoirs from which the 2 groups acquired the strains.
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Affiliation(s)
- Sareh Kholaseh
- Student Research Committee, Kurdistan University of Medical Sciences, Kurdistan, Sanandaj, Iran
| | - Safoura Derakhshan
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Kurdistan, Sanandaj, Iran; Lung Diseases and Allergy Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Kurdistan, Sanandaj, Iran.
| | - Masoumeh Abedini
- Department of Infectious Diseases, Kurdistan University of Medical Sciences, Kurdistan, Sanandaj, Iran
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16
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Lorenz G. [Diagnostic predictive value of liver biopsy for clinical aspects]. ZEITSCHRIFT FUR ARZTLICHE FORTBILDUNG 2022; 72:793-6. [PMID: 362741 PMCID: PMC9736764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The quest for improved diagnosis and treatment in home health care models has led to the development of wearable medical devices for remote vital signs monitoring. An accurate signal and a high diagnostic yield are critical for the cost-effectiveness of wearable health care monitoring systems and their widespread application in resource-constrained environments. Despite technological advances, the information acquired by these devices can be contaminated by motion artifacts (MA) leading to misdiagnosis or repeated procedures with increases in associated costs. This makes it necessary to develop methods to improve the quality of the signal acquired by these devices. Objective We aimed to present a novel method for electrocardiogram (ECG) signal denoising to reduce MA. We aimed to analyze the method’s performance and to compare its performance to that of existing approaches. Methods We present the novel Redundant denoising Independent Component Analysis method for ECG signal denoising based on the redundant and simultaneous acquisition of ECG signals and movement information, multichannel processing, and performance assessment considering the information contained in the signal waveform. The method is based on data including ECG signals from the patient’s chest and back, the acquisition of triaxial movement signals from inertial measurement units, a reference signal synthesized from an autoregressive model, and the separation of interest and noise sources through multichannel independent component analysis. Results The proposed method significantly reduced MA, showing better performance and introducing a smaller distortion in the interest signal compared with other methods. Finally, the performance of the proposed method was compared to that of wavelet shrinkage and wavelet independent component analysis through the assessment of signal-to-noise ratio, dynamic time warping, and a proposed index based on the signal waveform evaluation with an ensemble average ECG. Conclusions Our novel ECG denoising method is a contribution to converting wearable devices into medical monitoring tools that can be used to support the remote diagnosis and monitoring of cardiovascular diseases. A more accurate signal substantially improves the diagnostic yield of wearable devices. A better yield improves the devices’ cost-effectiveness and contributes to their widespread application.
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17
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Castaño Usuga FA, Gissel C, Hernández AM. Motion Artifact Reduction in Electrocardiogram Signals Through a Redundant Denoising Independent Component Analysis Method for Wearable Health Care Monitoring Systems: Algorithm Development and Validation. JMIR Med Inform 2022; 10:e40826. [DOI: 10.2196/40826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background
The quest for improved diagnosis and treatment in home health care models has led to the development of wearable medical devices for remote vital signs monitoring. An accurate signal and a high diagnostic yield are critical for the cost-effectiveness of wearable health care monitoring systems and their widespread application in resource-constrained environments. Despite technological advances, the information acquired by these devices can be contaminated by motion artifacts (MA) leading to misdiagnosis or repeated procedures with increases in associated costs. This makes it necessary to develop methods to improve the quality of the signal acquired by these devices.
Objective
We aimed to present a novel method for electrocardiogram (ECG) signal denoising to reduce MA. We aimed to analyze the method’s performance and to compare its performance to that of existing approaches.
Methods
We present the novel Redundant denoising Independent Component Analysis method for ECG signal denoising based on the redundant and simultaneous acquisition of ECG signals and movement information, multichannel processing, and performance assessment considering the information contained in the signal waveform. The method is based on data including ECG signals from the patient’s chest and back, the acquisition of triaxial movement signals from inertial measurement units, a reference signal synthesized from an autoregressive model, and the separation of interest and noise sources through multichannel independent component analysis.
Results
The proposed method significantly reduced MA, showing better performance and introducing a smaller distortion in the interest signal compared with other methods. Finally, the performance of the proposed method was compared to that of wavelet shrinkage and wavelet independent component analysis through the assessment of signal-to-noise ratio, dynamic time warping, and a proposed index based on the signal waveform evaluation with an ensemble average ECG.
Conclusions
Our novel ECG denoising method is a contribution to converting wearable devices into medical monitoring tools that can be used to support the remote diagnosis and monitoring of cardiovascular diseases. A more accurate signal substantially improves the diagnostic yield of wearable devices. A better yield improves the devices’ cost-effectiveness and contributes to their widespread application.
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18
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Hare D, Meaney C, Powell J, Slevin B, O' Brien B, Power L, O' Connell N, De Gascun C, Dunne C, Stapleton P. Repeated transmission of SARS-CoV-2 in an overcrowded Irish emergency department elucidated by whole-genome sequencing. J Hosp Infect 2022; 126:1-9. [PMID: 35562074 PMCID: PMC9088210 DOI: 10.1016/j.jhin.2022.04.015] [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: 03/11/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 01/11/2023]
Abstract
AIM To provide a detailed genomic-epidemiological description of a complex multi-ward SARS-CoV-2 outbreak, which originated in the crowded emergency department (ED) in our hospital during the third wave of the COVID-19 pandemic, and was elucidated promptly by local whole-genome sequencing (WGS). METHODS SARS-CoV-2 was detected by reverse transcriptase real-time polymerase chain reaction on viral RNA extracted from nasopharyngeal swabs. WGS was performed using an Oxford MinION Mk1C instrument following the ARTIC v3 sequencing protocol. High-quality consensus genomes were assembled with the artic-ncov2019 bioinformatics pipeline and viral phylogenetic trees were built, inferred by maximum-likelihood. Clusters were defined using a threshold of 0-1 single nucleotide polymorphisms (SNPs) between epidemiologically linked sequences. RESULTS In April 2021, outbreaks of COVID-19 were declared on two wards at University Hospital Limerick after 4 healthcare-associated SARS-CoV-2 infections were detected by post-admission surveillance testing. Contact tracing identified 12 further connected cases; all with direct or indirect links to the ED 'COVID Zone'. All sequences were assigned to the Pangolin B.1.1.7 lineage by WGS, and SNP-level analysis revealed two distinct but simultaneous clusters of infections. Repeated transmission in the ED was demonstrated, involving patients accommodated on trolleys in crowded areas, resulting in multiple generations of infections across three inpatient hospital wards and subsequently to the local community. These findings informed mitigation efforts to prevent cross-transmission in the ED. CONCLUSION Cross-transmission of SARS-CoV-2 occurred repeatedly in an overcrowded emergency department. Viral WGS elucidated complex viral transmission networks in our hospital and informed infection, prevention and control practice.
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Affiliation(s)
- D. Hare
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland,UCD National Virus Reference Laboratory, University College Dublin, Dublin, Ireland,Corresponding author. Address: Department of Clinical Microbiology University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland
| | - C. Meaney
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland
| | - J. Powell
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland,Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - B. Slevin
- Department of Infection, Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - B. O' Brien
- Department of Infection, Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - L. Power
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland
| | - N.H. O' Connell
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C.F. De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - C.P. Dunne
- School of Medicine, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - P.J. Stapleton
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland
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Laceb ZM, Diene SM, Lalaoui R, Kihal M, Chergui FH, Rolain JM, Hadjadj L. Genetic Diversity and Virulence Profile of Methicillin and Inducible Clindamycin-Resistant Staphylococcus aureus Isolates in Western Algeria. Antibiotics (Basel) 2022; 11:antibiotics11070971. [PMID: 35884225 PMCID: PMC9312111 DOI: 10.3390/antibiotics11070971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
Staphylococcusaureus causes a wide range of life-threatening infections. In this study, we determined its prevalence in the hospital environment and investigated nasal carriage among healthcare workers and patients admitted to a hospital in western Algeria. A total of 550 specimens were collected. An antibiogram was performed and the genes encoding resistance to methicillin, inducible clindamycin and toxins were sought among the 92 S. aureus isolates. The spread of clones with a methicillin- and/or clindamycin-resistance phenotype between these ecosystems was studied using genomic analysis. A prevalence of 27%, 30% and 13% of S. aureus (including 2.7%, 5% and 1.25% of MRSA) in patients, healthcare workers and the hospital environment were observed, respectively. The presence of the mecA, erm, pvl and tsst-1 genes was detected in 10.9%, 17.4%, 7.6% and 18.5% of samples, respectively. Sequencing allowed us to identify seven sequence types, including three MRSA-IV-ST6, two MRSA-IV-ST80-PVL+, two MRSA-IV-ST22-TSST-1, two MRSA-V-ST5, and one MRSA-IV-ST398, as well as many virulence genes. Here, we reported that both the hospital environment and nasal carriage may be reservoirs contributing to the spread of the same pathogenic clone persisting over time. The circulation of different pathogenic clones of MRSA, MSSA, and iMLSB, as well as the emergence of at-risk ST398 clones should be monitored.
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Affiliation(s)
- Zahoua Mentfakh Laceb
- Laboratoire de Biotechnologies, Environnement et Santé, Faculté des Sciences de la Nature et de la Vie, Université de Blida 01, BP270 Route Soumaa, Blida 09000, Algeria; (Z.M.L.); (F.H.C.)
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France; (S.M.D.); (R.L.); (J.-M.R.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Seydina M. Diene
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France; (S.M.D.); (R.L.); (J.-M.R.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Rym Lalaoui
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France; (S.M.D.); (R.L.); (J.-M.R.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Mabrouk Kihal
- Laboratoire de Microbiologie Appliquée, Université Ahmed Ben Bella Oran1, BP1524 El M’naouer, Oran 31000, Algeria;
| | - Fella Hamaidi Chergui
- Laboratoire de Biotechnologies, Environnement et Santé, Faculté des Sciences de la Nature et de la Vie, Université de Blida 01, BP270 Route Soumaa, Blida 09000, Algeria; (Z.M.L.); (F.H.C.)
| | - Jean-Marc Rolain
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France; (S.M.D.); (R.L.); (J.-M.R.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Linda Hadjadj
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France; (S.M.D.); (R.L.); (J.-M.R.)
- IHU Méditerranée Infection, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-8613-6930
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Desta K, Aklillu E, Gebrehiwot Y, Enquselassie F, Cantillon D, Al-Hassan L, Price JR, Newport MJ, Davey G, Woldeamanuel Y. High Levels of Methicillin-Resistant Staphylococcus aureus Carriage Among Healthcare Workers at a Teaching Hospital in Addis Ababa Ethiopia: First Evidence Using mecA Detection. Infect Drug Resist 2022; 15:3135-3147. [PMID: 35747330 PMCID: PMC9211743 DOI: 10.2147/idr.s360123] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Staphylococcus aureus is a major human pathogen and causes healthcare and community-acquired infection. Data on the extent of MRSA colonization among health-care workers (HCWs) in sub-Saharan Africa are limited. Hence, we determined the burden of MRSA colonisation among HCWs and administrative staff in Tikur Anbessa Specialised Hospital (TASH), College of Health Sciences (CHS), Addis Ababa University, Ethiopia. Methods Using a cross-sectional study design, participants were screened for MRSA colonisation between June 2018 and August 2019 using nasal swabs. The swabs were analysed using standard laboratory methods including antibiotic resistance gene, mecA. Anonymised sociodemographic data were collected by pretested questionnaires to evaluate HCWs factors associated with MRSA carriage. Results A total of 588 HCWs and 468 administrative staff were screened for MRSA. Women were over-represented. Overall, 49.1% (289/588) of HCWs were nurses and 25% (117/468) of the administrative staff were cleaners or laundry workers. Overall, 138 S. aureus isolates were retrieved from the nasal swabs of both groups (16.3%, 96/588 from HCWs). The burden of MRSA colonisation was 4.8% (28/580, 95% CI: 3.1–6.5%) among HCWs compared to 0.2% (1/468, 95% CI: 0.18–0.6%) of administrative staff (p value <0.05). The majority of S. aureus and all MRSA isolates were resistant to penicillin. Isolates from HCWs were more resistant to tested antibiotics than administrative staff (P-value <0.05). Conclusion This is the first report in Ethiopia on MRSA colonization using mecA and revealed that; (i) overall carriage rates of MRSA in HCWs are comparable with observations reported in some other countries and (ii) HCWs exhibit a higher burden of MRSA carriage than administrative staff. Our data support strategic screening of MRSA and antimicrobial stewardship for better intervention measures.
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Affiliation(s)
- Kassu Desta
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences (CHS), Addis Ababa University (AAU), Addis Ababa, Ethiopia.,Department of Medical Laboratory Sciences, CHS, AAU, Addis Ababa, Ethiopia
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska, Sweden
| | - Yirgu Gebrehiwot
- Department of Obstetrics and Gynecology, School of Medicine, CHS, AAU, Addis Ababa, Ethiopia
| | | | - Daire Cantillon
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Leena Al-Hassan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - James R Price
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Melanie J Newport
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Gail Davey
- School of Public Health, CHS, AAU, Addis Ababa, Ethiopia.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Yimtubezenash Woldeamanuel
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences (CHS), Addis Ababa University (AAU), Addis Ababa, Ethiopia
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21
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Cui M, Ali T, Li J, Song L, Shen S, Li T, Zhang C, Cheng M, Zhao Q, Wang H. New clues about the global MRSA ST398: Emergence of MRSA ST398 from pigs in Qinghai, China. Int J Food Microbiol 2022; 378:109820. [PMID: 35752017 DOI: 10.1016/j.ijfoodmicro.2022.109820] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/04/2022] [Accepted: 06/15/2022] [Indexed: 10/18/2022]
Abstract
This study, a part of the China national surveillance program on antimicrobial resistance in zoonotic bacteria, was to determine the phenotypic and genomic characteristics of endemic pig-associated Staphylococcus aureus ST398 strains in China. A total of 68 (48.9 %) S. aureus strains were recovered from 139 samples collected from two pig farms and one slaughterhouse in Qinghai province. Genomic characterization of All S. aureus strains was performed by WGS and their evolutionary relationships were assessed by phylogenetic analysis. Their susceptibilities to antimicrobials were determined using the broth dilution method. All S. aureus strains consisted of 41 ST398-t571 MSSA, 26 ST398-t011 MRSA and 1 ST5-t002 MRSA. Among these, ST398 was frequently identified in 67 S. aureus strains, suggesting that ST398 was a frequent source of MRSA and MSSA infections in Qinghai province and its possibility of transmission between individuals in pigs from farms and slaughterhouse. Meanwhile, Livestock-associated-MRSA ST398 in our study was establishing closely evolutionary relationships with MRSA ST 398 in Europe and Australia. The clues about closely relatedness of the global S. aureus ST398 underscore the potential public health risk of S. aureus ST398 in the pork supply chain and offer significant guidance for veterinary and human health.
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Affiliation(s)
- Mingquan Cui
- China Institute of Veterinary Drug Control, Beijing, P.R. China; Key Laboratory of Animal Antimicrobial Resistance Surveillance, Ministry of Agriculture and Rural Affairs, P.R. China.
| | - Tariq Ali
- Veterianry Research Institute Peshawar, Khyber Pakhtunkhwa, Pakistan; The University of Agriculture, Peshawar, Pakistan
| | - Jiyun Li
- Hunan Agricultural University, Changsha, P.R. China
| | - Li Song
- China Institute of Veterinary Drug Control, Beijing, P.R. China
| | - Shan Shen
- Yantai Ludong Hospital (Shandong Provincial Hospital Group), Yantai, P.R. China
| | - Ting Li
- China Institute of Veterinary Drug Control, Beijing, P.R. China; Key Laboratory of Animal Antimicrobial Resistance Surveillance, Ministry of Agriculture and Rural Affairs, P.R. China
| | - Chunping Zhang
- China Institute of Veterinary Drug Control, Beijing, P.R. China; Key Laboratory of Animal Antimicrobial Resistance Surveillance, Ministry of Agriculture and Rural Affairs, P.R. China
| | - Min Cheng
- China Institute of Veterinary Drug Control, Beijing, P.R. China; Key Laboratory of Animal Antimicrobial Resistance Surveillance, Ministry of Agriculture and Rural Affairs, P.R. China
| | - Qi Zhao
- China Institute of Veterinary Drug Control, Beijing, P.R. China; Key Laboratory of Animal Antimicrobial Resistance Surveillance, Ministry of Agriculture and Rural Affairs, P.R. China
| | - Hejia Wang
- China Institute of Veterinary Drug Control, Beijing, P.R. China; Key Laboratory of Animal Antimicrobial Resistance Surveillance, Ministry of Agriculture and Rural Affairs, P.R. China.
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22
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Bacterial Community and Genomic Analysis of Carbapenem-Resistant Acinetobacter baumannii Isolates from the Environment of a Health Care Facility in the Western Region of Saudi Arabia. Pharmaceuticals (Basel) 2022; 15:ph15050611. [PMID: 35631436 PMCID: PMC9145440 DOI: 10.3390/ph15050611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
The escalating transmission of hospital-acquired infections, especially those due to antimicrobial-resistant bacteria, is a major health challenge worldwide. In this study, a culturomic analysis of bacterial community in a tertiary care hospital in the western region of Saudi Arabia is performed using environmental samples. The genome sequencing of four Acinetobacter baumannii was performed on isolates recovered from an intensive care unit (ICU) environment and clinical samples. A total of 361 bacterial isolates from surface and air samples were identified by MALDI-TOF technique or 16S rRNA gene sequencing. The isolates were classified into 70 distinct species, including ESKAPE pathogens. Resistance in Gram-positive isolates was mainly found to be against benzylpenicillin, azithromycin, ampicillin, and trimethoprim/sulfamethoxazole. Carbapenem- and multidrug-resistant isolates of A. baumannii and Klebsiella pneumonia were found on the ICU surfaces. Genome sequencing revealed that the carbapenem-resistant A. baumannii isolate from ICU environment was linked with those of clinical origin. The isolate Ab133-HEnv was classified as a novel sequence type (ST2528) based on a new allele of Oxf_gdhB-286. Three beta-lactam-antibiotic-resistance genes, blaADC-25, blaOXA-23, and blaOXA-66, were found in most of the analyzed genomes. Collectively, the results of this study highlight the spread of antimicrobial-resistant nosocomial pathogens in a health care facility in Saudi Arabia.
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23
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Kalu IC, Kao CM, Fritz SA. Management and Prevention of Staphylococcus aureus Infections in Children. Infect Dis Clin North Am 2022; 36:73-100. [PMID: 35168715 PMCID: PMC9901217 DOI: 10.1016/j.idc.2021.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Staphylococcus aureus is a common skin commensal with the potential to cause severe infections resulting in significant morbidity and mortality. Up to 30% of individuals are colonized with S aureus, though infection typically does not occur without skin barrier disruption. Infection management includes promptly addressing the source of infection, including sites of metastatic infection, and initiation of effective antibiotics, which should be selected based on local antibiotic susceptibility patterns. Given that S aureus colonization is a risk factor for infection, preventive strategies are aimed at optimizing hygiene measures and decolonization regimens for outpatients and critically ill children with prolonged hospitalizations.
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Affiliation(s)
| | | | - Stephanie A. Fritz
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
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24
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Eyre DW. Infection prevention and control insights from a decade of pathogen whole-genome sequencing. J Hosp Infect 2022; 122:180-186. [PMID: 35157991 PMCID: PMC8837474 DOI: 10.1016/j.jhin.2022.01.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 12/13/2022]
Abstract
Pathogen whole-genome sequencing has become an important tool for understanding the transmission and epidemiology of infectious diseases. It has improved our understanding of sources of infection and transmission routes for important healthcare-associated pathogens, including Clostridioides difficile and Staphylococcus aureus. Transmission from known infected or colonized patients in hospitals may explain fewer cases than previously thought and multiple introductions of these pathogens from the community may play a greater a role. The findings have had important implications for infection prevention and control. Sequencing has identified heterogeneity within pathogen species, with some subtypes transmitting and persisting in hospitals better than others. It has identified sources of infection in healthcare-associated outbreaks of food-borne pathogens, Candida auris and Mycobacterium chimera, as well as individuals or groups involved in transmission and historical sources of infection. SARS-CoV-2 sequencing has been central to tracking variants during the COVID-19 pandemic and has helped understand transmission to and from patients and healthcare workers despite prevention efforts. Metagenomic sequencing is an emerging technology for culture-independent diagnosis of infection and antimicrobial resistance. In future, sequencing is likely to become more accessible and widely available. Real-time use in hospitals may allow infection prevention and control teams to identify transmission and to target interventions. It may also provide surveillance and infection control benchmarking. Attention to ethical and wellbeing issues arising from sequencing identifying individuals involved in transmission is important. Pathogen whole-genome sequencing has provided an incredible new lens to understand the epidemiology of healthcare-associated infection and to better control and prevent these infections.
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Affiliation(s)
- D W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK; National Institiute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK; Oxford University Hospitals, Oxford, UK.
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25
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Ababneh Q, Abulaila S, Jaradat Z. Isolation of extensively drug resistant Acinetobacter baumannii from environmental surfaces inside intensive care units. Am J Infect Control 2022; 50:159-165. [PMID: 34520789 DOI: 10.1016/j.ajic.2021.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acinetobacter baumannii is a nosocomial pathogen that has emerged as a major threat in the health-care settings, particularly intensive care units (ICUs). The aim of this study was to investigate the prevalence of A. baumannii in the environment of intensive care and emergency units in 4 hospitals in Jordan. METHODS A total of 311 surface and 26 air samples were collected from 6 different ICUs and 2 emergency units. Examined high-touch surfaces included bed rails, sinks, food tables, trolley handles, ventilator inlets, blankets, sheets, door handles, light switches, bedside tables and drawers, curtains, normal saline stands and neonatal incubators. A. baumannii isolates were identified by CHROMagar and confirmed using 2 different PCR assays. All obtained isolates were characterized for their antibiotic resistance phenotypes, biofilm formation capacities and were typed by multi-locus sequence typing. RESULTS Of the 337 samples, 24 A. baumannii isolates were recovered, mostly from surfaces in the internal medicine ICUs. Among the 24 isolates, 10 isolates were classified as extensively-resistant (XDR), harbored the blaOXA-23 like gene and able to form biofilms with varying capacities. ST2 was the most frequent sequence type, with all ST2 isolates classified as XDRs. CONCLUSIONS Our results showed that high-touch surfaces of adult and pediatric ICUs were contaminated with XDR A. baumannii isolates. Therefore, the cleaning practices of the surfaces and equipment surrounding ICU patients should be optimized, and health-care workers should continuously wash their hands and change their gloves constantly to control the spread of this pathogen.
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Affiliation(s)
- Qutaiba Ababneh
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sally Abulaila
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad Jaradat
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
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26
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Healthcare worker associated outbreak of Panton-Valentine Leucocidin producing meticillin-sensitive Staphylococcus aureus in a large Neonatal Unit in London: successful targeted suppression therapy following failure of mass suppression therapy. J Hosp Infect 2022; 122:148-156. [PMID: 35033613 DOI: 10.1016/j.jhin.2021.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Staphylococcus aureus is a leading cause of healthcare associated infection and outbreaks have been associated with neonatal units and colonisation of healthcare workers. AIM To describe an outbreak of Panton-Valentine Leucocidin producing meticillin-sensitive Staphylococcus aureus (PVL-MSSA) in a Neonatal Intensive Care Unit (NICU). METHODS Multi-disciplinary outbreak control investigation RESULTS: Over a period of 16 months, 7 neonates were identified as positive for PVL-MSSA. Isolates were identified in blood cultures (2 patients), nasopharyngeal aspirate (1 patient) and rectal screening swabs (4 patients). Epidemiological and whole genome sequencing data suggested a long-term carrier as the most likely source. Despite two rounds of mass suppression therapy of staff, using chlorhexidine initially, then octenidine-based regimens, positive patients continued to be identified. Staff screening subsequently identified one healthcare worker colonised with the outbreak strain of PVL-MSSA who underwent enhanced screening and further suppression therapy. No further cases have been identified to date. Compliance with mass suppression therapy was >95% and a post administration staff satisfaction survey showed the majority of staff agreed with the steps taken with low rates of adverse reactions. CONCLUSION Staphylococcus aureus outbreaks are commonly associated with colonisation of healthcare workers and are challenging to manage within environments such as neonatal units. Our study highlights the utility of whole genome sequencing in identifying and mapping an outbreak. We recommend that targeted staff screening should be considered early in similar outbreaks. In our setting mass suppression therapy was not an effective strategy despite a high level of staff engagement and compliance.
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27
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D’Orazio B, Ramachandran J, Khalida C, Gonzalez J, Kost RG, Vasquez KS, Evering TH, Holder T, Hassen GW, Hammock R, Nguyen R, Davis R, Millan K, Johnson V, Parola C, Coller BS, Tobin JN. Stakeholder Engagement In a Comparative Effectiveness/Implementation Study to Prevent Staphylococcus Aureus Infection Recurrence: CA-MRSA Project (CAMP2). Prog Community Health Partnersh 2022; 16:45-60. [PMID: 35342110 PMCID: PMC9930995 DOI: 10.1353/cpr.2022.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Methicillin-resistant or methicillin-sensitive Staphylococcus aureus skin and soft tissue infections pose serious clinical and public health challenges. Few protocols exist for outpatient education, decolonization and decontamination. OBJECTIVES This trial implemented infection prevention protocols in homes via community health workers/Promotoras. METHODS We engaged clinicians, patient stakeholders, clinical and laboratory researchers, New York-based federally qualified health centers and community hospital emergency departments. The Clinician and Patient Stakeholder Advisory Committee (CPSAC) convened in person and remotely for shared decision-making and trial oversight. RESULTS The intervention trial consented participants with skin and soft tissue infections from Methicillin-resistant Staphylococcus aureus or methicillin-sensitive Staphylococcus aureus, completed home visits, obtained surveillance cultures from index patients and household members and sampled household environmental surfaces at baseline and three months. LESSONS LEARNED The retention of the CPSAC during the trial demonstrated high levels of engagement. CONCLUSIONS CPSAC was highly effective throughout design and execution by troubleshooting recruitment and home visit challenges.
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Affiliation(s)
| | - Jessica Ramachandran
- Clinical Directors Network (CDN),Metropolitan Hospital/New York City Health + Hospitals
| | | | - Johana Gonzalez
- Clinical Directors Network (CDN),Metropolitan Hospital/New York City Health + Hospitals
| | - Rhonda G. Kost
- The Rockefeller University Center for Clinical and Translational Science
| | | | - Teresa H. Evering
- The Rockefeller University Center for Clinical and Translational Science
| | | | | | | | | | - Ronette Davis
- Coney Island Hospital/New York City Health + Hospitals
| | - Keenan Millan
- NYU Lutheran Family Health Center and Medical Center (NYU Langone at Brooklyn)
| | - Van Johnson
- Metropolitan Hospital/New York City Health + Hospitals
| | | | - Barry S. Coller
- The Rockefeller University Center for Clinical and Translational Science
| | - Jonathan N. Tobin
- Clinical Directors Network (CDN),The Rockefeller University Center for Clinical and Translational Science
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28
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Sundermann AJ, Chen J, Kumar P, Ayres AM, Cho ST, Ezeonwuka C, Griffith MP, Miller JK, Mustapha MM, Pasculle AW, Saul MI, Shutt KA, Srinivasa V, Waggle K, Snyder DJ, Cooper VS, Van Tyne D, Snyder GM, Marsh JW, Dubrawski A, Roberts MS, Harrison LH. Whole Genome Sequencing Surveillance and Machine Learning of the Electronic Health Record for Enhanced Healthcare Outbreak Detection. Clin Infect Dis 2021; 75:476-482. [PMID: 34791136 PMCID: PMC9427134 DOI: 10.1093/cid/ciab946] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most hospitals use traditional infection prevention (IP) methods for outbreak detection. We developed the Enhanced Detection System for Healthcare-Associated Transmission (EDS-HAT), which combines whole genome sequencing (WGS) surveillance and machine learning (ML) of the electronic health record (EHR) to identify undetected outbreaks and the responsible transmission routes, respectively. METHODS We performed WGS surveillance of healthcare-associated bacterial pathogens from November 2016 to November 2018. EHR ML was used to identify the transmission routes for WGS-detected outbreaks, which were investigated by an IP expert. Potential infections prevented were estimated and compared to traditional IP practice during the same period. RESULTS Of 3,165 isolates, there were 2,752 unique patient isolates in 99 clusters involving 297 (10.8%) patient isolates were identified by WGS; clusters ranged from 2-14 patients. At least one transmission route was detected for 65.7% of clusters. During the same time, traditional IP investigation prompted WGS for 15 suspected outbreaks involving 133 patients, for which transmission events were identified for 5 (3.8%). If EDS-HAT had been running in real-time, 25-63 transmissions could have been prevented. EDS-HAT was found to be cost-saving and more effective than traditional IP practice, with overall savings of $192,408 - $692,532. CONCLUSION EDS-HAT detected multiple outbreaks not identified using traditional IP methods, correctly identified the transmission routes for most outbreaks, and would save the hospital substantial costs. Traditional IP practice misidentified outbreaks for which transmission did not occur. WGS surveillance combined with EHR ML has the potential to save costs and enhance patient safety.
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Affiliation(s)
- Alexander J Sundermann
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jieshi Chen
- Auton Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Praveen Kumar
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashley M Ayres
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Shu-Ting Cho
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chinelo Ezeonwuka
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marissa P Griffith
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James K Miller
- Auton Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Mustapha M Mustapha
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - A William Pasculle
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Melissa I Saul
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kathleen A Shutt
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Vatsala Srinivasa
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kady Waggle
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel J Snyder
- Department of Microbiology and Molecular Genetics, and Center for Evolutionary Biology and Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA
| | - Vaughn S Cooper
- Department of Microbiology and Molecular Genetics, and Center for Evolutionary Biology and Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA
| | - Daria Van Tyne
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Graham M Snyder
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Jane W Marsh
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Artur Dubrawski
- Auton Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Mark S Roberts
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lee H Harrison
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Balamohan A, Beachy J, Kohn N, Rubin LG. Risk factors for nosocomial methicillin resistant Staphylococcus aureus (MRSA) colonization in a neonatal intensive care unit: A Case-control study. Am J Infect Control 2021; 49:1408-1413. [PMID: 33940064 DOI: 10.1016/j.ajic.2021.04.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
AIM To determine risk factors for MRSA colonization in a Level IV Neonatal Intensive Care Unit (NICU) independent of length of stay and gestational age in the context of a persistently circulating MRSA clone. DESIGN Retrospective matched case-control study. SETTING Level IV NICU PATIENTS: Infants admitted between April 4,2017- March 31,2018. METHODS Based on weekly surveillance cultures, infants who acquired MRSA were matched 1:1 with MRSA-negative control infants by duration of exposure (length of stay) and gestational age to determine risk factors for acquisition. RESULTS Fifty case infants were matched with controls. Isolates from 45 of the 50 cases were mupirocin-resistant and related by pulse-field gel electrophoresis. On matched univariable analysis, the following were significantly associated with a risk for MRSA acquisition: 1.Bed location in the acute area(P = 0.03), 2.Requirement of any level of respiratory support during the week prior to MRSA detection(P = 0.04), 3.Higher ATP pass rate (a measure of effectiveness of cleaning) during the week of and week prior(P = 0.01), 4.Higher MRSA colonization pressure during the week of and week prior(P< 0.0001), 5.Not having a hearing test during the time between the previous negative culture and MRSA acquisition(P = 0.01). A multivariable conditional logistic regression model (that excluded ATP pass rate) found that only colonization pressure was associated with acquisition of MRSA colonization. CONCLUSIONS In an outbreak setting, MRSA colonization pressure is significantly associated with MRSA acquisition in the NICU independent of length of stay and gestational age.
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30
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Laager M, Cooper BS, Eyre DW. Probabilistic modelling of effects of antibiotics and calendar time on transmission of healthcare-associated infection. Sci Rep 2021; 11:21417. [PMID: 34725404 PMCID: PMC8560804 DOI: 10.1038/s41598-021-00748-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
Healthcare-associated infection and antimicrobial resistance are major concerns. However, the extent to which antibiotic exposure affects transmission and detection of infections such as MRSA is unclear. Additionally, temporal trends are typically reported in terms of changes in incidence, rather than analysing underling transmission processes. We present a data-augmented Markov chain Monte Carlo approach for inferring changing transmission parameters over time, screening test sensitivity, and the effect of antibiotics on detection and transmission. We expand a basic model to allow use of typing information when inferring sources of infections. Using simulated data, we show that the algorithms are accurate, well-calibrated and able to identify antibiotic effects in sufficiently large datasets. We apply the models to study MRSA transmission in an intensive care unit in Oxford, UK with 7924 admissions over 10 years. We find that falls in MRSA incidence over time were associated with decreases in both the number of patients admitted to the ICU colonised with MRSA and in transmission rates. In our inference model, the data were not informative about the effect of antibiotics on risk of transmission or acquisition of MRSA, a consequence of the limited number of possible transmission events in the data. Our approach has potential to be applied to a range of healthcare-associated infections and settings and could be applied to study the impact of other potential risk factors for transmission. Evidence generated could be used to direct infection control interventions.
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Affiliation(s)
- Mirjam Laager
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Ben S Cooper
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Awad M, Yosri M, Abdel-Aziz MM, Younis AM, Sidkey NM. Assessment of the Antibacterial Potential of Biosynthesized Silver Nanoparticles Combined with Vancomycin Against Methicillin-Resistant Staphylococcus aureus-Induced Infection in Rats. Biol Trace Elem Res 2021; 199:4225-4236. [PMID: 33389618 DOI: 10.1007/s12011-020-02561-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is considered one of the most serious multidrug-resistant bacteria worldwide. MRSA resistance to methicillin antibiotics made vancomycin, the acceptable treatment option. Silver nanoparticles (Ag-NPs) are among the well-known antibacterial substances showing multimode antibacterial action. Therefore, Ag-NPs are appropriate applicants for use in combination with vancomycin in order to augment its antibacterial action. This study aimed to biosynthesize silver nanoparticles and to evaluate its antibacterial activity against MRSA alone and when combined with vancomycin both in vitro and in vivo. Agaricus bisporus is used to reduce the silver nitrate salts in solution to yield silver nanoparticles which was characterized by UV-visible spectrophotometric analysis that shows maximum absorption at 420 nm as a preliminary confirmation for nanoparticles synthesis, Energy-Dispersive Analysis of X-ray (EDX) which confirms the crystalline nature of silver nanoparticles and transmission electron microscopy (TEM) image shows the particles in spherical form with mean size 27.45 nm. The synthesized silver nanoparticles were tested for antibacterial activity against MRSA, and the synergetic effects of the combination of silver nanoparticles and vancomycin were evaluated. The results showed a strong synergistic antibacterial effect between Ag-NPs and vancomycin in vitro with fractional inhibitory concentration 0.37 and in vivo against MRSA strain. The result revealed that mycosynthesized silver nanoparticles (NPs) enhance the in vitro and in vivo antibacterial activity of vancomycin against MRSA. These results suggested that sliver nanoparticles have an effective antibacterial activity against MRSA count, histopathology, and liver enzymes as well as protective immune response specially when combined with vancomycin in the lungs of infected rats with MRSA.
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Affiliation(s)
- Mohammed Awad
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo, 11841, Egypt
| | - Mohamed Yosri
- The Regional Center for Mycology and Biotechnology, Al-Azhar University, Nasr City, Cairo, 11787, Egypt.
| | - Marwa M Abdel-Aziz
- The Regional Center for Mycology and Biotechnology, Al-Azhar University, Nasr City, Cairo, 11787, Egypt
| | - Ahmed M Younis
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo, 11841, Egypt
| | - Nagwa M Sidkey
- Botany and Microbiology Department, Faculty of Science (Girls), Al-Azhar University, Nasr City, Cairo, Egypt
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32
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Richa, Kushwaha N, Negi S, Kumar A, Zangrando E, Kataria R, Saini V. Synthesis, characterization and utility of a series of novel copper(II) complexes as excellent surface disinfectants against nosocomial infections. Dalton Trans 2021; 50:13699-13711. [PMID: 34013925 DOI: 10.1039/d1dt00199j] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nosocomial infections are among the major public health concerns, especially during the ongoing Covid19 pandemic. There is a great demand for novel chemical agents that are capable of killing specific pathogens or augmenting the efficiency of existing disinfectants. Herein, we report the synthesis and comprehensive characterization (through FT-IR, HR-MS, SEM, TGA-DSC, CV, UV and SCXRD analyses) of six novel copper(II) complexes, [CuL(4X-An)] (5a-5d), [CuL(An)] (5e), and [CuL(benzhydrylamine)] (5f), and their evaluation as anti-microbial agents against WHO priority pathogens, confirming their possible use in hospital settings. The compounds were synthesized with a Schiff base (H2L) obtained by the condensation reaction of 3-acetyl-6-methyl-2H-pyran-2,4(3H)-dione (DHA) and benzohydrazide and further addition of different p-substituted aniline (An) molecules. Single crystal structure analyses revealed that the aniline derivatives are isostructural to the copper atom in a square planar coordination, while the benzhydrylamine complex forms a dimer (5f), with a square pyramidal coordination geometry for the metal. Time-kill kinetics and reduced microbial recovery studies revealed excellent bactericidal action against Staphylococcus aureus and Enterococcus faecalis. Particularly, the novel compound 5f significantly reduced microbial recovery compared to ethanol-based sanitisers. In fact, addition of 5f to 70% ethanol remarkably synergized the killing with >6-log reduction in microbial burden. Overall, our novel compounds would increase the disinfection efficacy in hospitals and industries, thereby improving the efficiency and minimizing the risk of infections.
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Affiliation(s)
- Richa
- Department of Chemistry & Centre of Advance Studies in Chemistry, Panjab University, Chandigarh, 160014, India.
| | - Namrata Kushwaha
- Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
| | - Sheetal Negi
- Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
| | - Ajay Kumar
- Department of Chemistry & Centre of Advance Studies in Chemistry, Panjab University, Chandigarh, 160014, India.
| | - Ennio Zangrando
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Trieste 34127, Italy
| | - Ramesh Kataria
- Department of Chemistry & Centre of Advance Studies in Chemistry, Panjab University, Chandigarh, 160014, India.
| | - Vikram Saini
- Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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Young BC, Eyre DW, Kendrick S, White C, Smith S, Beveridge G, Nonnenmacher T, Ichofu F, Hillier J, Oakley S, Diamond I, Rourke E, Dawe F, Day I, Davies L, Staite P, Lacey A, McCrae J, Jones F, Kelly J, Bankiewicz U, Tunkel S, Ovens R, Chapman D, Bhalla V, Marks P, Hicks N, Fowler T, Hopkins S, Yardley L, Peto TEA. Daily testing for contacts of individuals with SARS-CoV-2 infection and attendance and SARS-CoV-2 transmission in English secondary schools and colleges: an open-label, cluster-randomised trial. Lancet 2021; 398:1217-1229. [PMID: 34534517 PMCID: PMC8439620 DOI: 10.1016/s0140-6736(21)01908-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND School-based COVID-19 contacts in England have been asked to self-isolate at home, missing key educational opportunities. We trialled daily testing of contacts as an alternative to assess whether this resulted in similar control of transmission, while allowing more school attendance. METHODS We did an open-label, cluster-randomised, controlled trial in secondary schools and further education colleges in England. Schools were randomly assigned (1:1) to self-isolation of school-based COVID-19 contacts for 10 days (control) or to voluntary daily lateral flow device (LFD) testing for 7 days with LFD-negative contacts remaining at school (intervention). Randomisation was stratified according to school type and size, presence of a sixth form, presence of residential students, and proportion of students eligible for free school meals. Group assignment was not masked during procedures or analysis. Coprimary outcomes in all students and staff were COVID-19-related school absence and symptomatic PCR-confirmed COVID-19, adjusted for community case rates, to estimate within-school transmission (non-inferiority margin <50% relative increase). Analyses were done on an intention-to-treat basis using quasi-Poisson regression, also estimating complier average causal effects (CACE). This trial is registered with the ISRCTN registry, ISRCTN18100261. FINDINGS Between March 18 and May 4, 2021, 204 schools were taken through the consent process, during which three decided not to participate further. 201 schools were randomly assigned (control group n=99, intervention group n=102) in the 10-week study (April 19-May 10, 2021), which continued until the pre-appointed stop date (June 27, 2021). 76 control group schools and 86 intervention group schools actively participated; additional national data allowed most non-participating schools to be included in analysis of coprimary outcomes. 2432 (42·4%) of 5763 intervention group contacts participated in daily contact testing. There were 657 symptomatic PCR-confirmed infections during 7 782 537 days-at-risk (59·1 per 100 000 per week) in the control group and 740 during 8 379 749 days-at-risk (61·8 per 100 000 per week) in the intervention group (intention-to-treat adjusted incidence rate ratio [aIRR] 0·96 [95% CI 0·75-1·22]; p=0·72; CACE aIRR 0·86 [0·55-1·34]). Among students and staff, there were 59 422 (1·62%) COVID-19-related absences during 3 659 017 person-school-days in the control group and 51 541 (1·34%) during 3 845 208 person-school-days in the intervention group (intention-to-treat aIRR 0·80 [95% CI 0·54-1·19]; p=0·27; CACE aIRR 0·61 [0·30-1·23]). INTERPRETATION Daily contact testing of school-based contacts was non-inferior to self-isolation for control of COVID-19 transmission, with similar rates of symptomatic infections among students and staff with both approaches. Infection rates in school-based contacts were low, with very few school contacts testing positive. Daily contact testing should be considered for implementation as a safe alternative to home isolation following school-based exposures. FUNDING UK Government Department of Health and Social Care.
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Affiliation(s)
| | - David W Eyre
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK; Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Chris White
- Department of Health and Social Care, London, UK
| | | | | | | | - Fegor Ichofu
- Department of Health and Social Care, London, UK
| | | | - Sarah Oakley
- Microbiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Fiona Dawe
- Office for National Statistics, Newport, UK
| | - Ieuan Day
- Office for National Statistics, Newport, UK
| | | | | | | | | | | | | | | | - Sarah Tunkel
- Department of Health and Social Care, London, UK
| | | | | | | | - Peter Marks
- Department of Health and Social Care, London, UK
| | - Nick Hicks
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Department of Health and Social Care, London, UK; Public Health England, London, UK
| | - Tom Fowler
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Lucy Yardley
- Health Protection Research Unit in Behavioural Science, University of Bristol, Bristol, UK; School of Psychology, University of Southampton, Southampton, UK
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
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Lumley SF, Constantinides B, Sanderson N, Rodger G, Street TL, Swann J, Chau KK, O'Donnell D, Warren F, Hoosdally S, O'Donnell AM, Walker TM, Stoesser NE, Butcher L, Peto TE, Crook DW, Jeffery K, Matthews PC, Eyre DW. Epidemiological data and genome sequencing reveals that nosocomial transmission of SARS-CoV-2 is underestimated and mostly mediated by a small number of highly infectious individuals. J Infect 2021; 83:473-482. [PMID: 34332019 PMCID: PMC8316632 DOI: 10.1016/j.jinf.2021.07.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Despite robust efforts, patients and staff acquire SARS-CoV-2 infection in hospitals. We investigated whether whole-genome sequencing enhanced the epidemiological investigation of healthcare-associated SARS-CoV-2 acquisition. METHODS From 17-November-2020 to 5-January-2021, 803 inpatients and 329 staff were diagnosed with SARS-CoV-2 infection at four Oxfordshire hospitals. We classified cases using epidemiological definitions, looked for a potential source for each nosocomial infection, and evaluated genomic evidence supporting transmission. RESULTS Using national epidemiological definitions, 109/803(14%) inpatient infections were classified as definite/probable nosocomial, 615(77%) as community-acquired and 79(10%) as indeterminate. There was strong epidemiological evidence to support definite/probable cases as nosocomial. Many indeterminate cases were likely infected in hospital: 53/79(67%) had a prior-negative PCR and 75(95%) contact with a potential source. 89/615(11% of all 803 patients) with apparent community-onset had a recent hospital exposure. Within 764 samples sequenced 607 genomic clusters were identified (>1 SNP distinct). Only 43/607(7%) clusters contained evidence of onward transmission (subsequent cases within ≤ 1 SNP). 20/21 epidemiologically-identified outbreaks contained multiple genomic introductions. Most (80%) nosocomial acquisition occurred in rapid super-spreading events in settings with a mix of COVID-19 and non-COVID-19 patients. CONCLUSIONS Current surveillance definitions underestimate nosocomial acquisition. Most nosocomial transmission occurs from a relatively limited number of highly infectious individuals.
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Affiliation(s)
- Sheila F Lumley
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust etc.; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom.
| | - Bede Constantinides
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas Sanderson
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Gillian Rodger
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Teresa L Street
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jeremy Swann
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Kevin K Chau
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Denise O'Donnell
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Fiona Warren
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust etc
| | - Sarah Hoosdally
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom
| | - Anne-Marie O'Donnell
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust etc.; Nuffield Department of Population Health, University of Oxford, Oxford, Unit ed Kingdom
| | - Timothy M Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nicole E Stoesser
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust etc.; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom
| | - Lisa Butcher
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust etc
| | - Tim Ea Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom
| | - Katie Jeffery
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust etc
| | - Philippa C Matthews
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust etc.; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom
| | - David W Eyre
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom; Nuffield Department of Population Health, University of Oxford, Oxford, Unit ed Kingdom; Big Data Institute, University of Oxford, Oxford, United Kingdom
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Unnikrishnan B, Gultom IS, Tseng YT, Chang HT, Huang CC. Controlling morphology evolution of titanium oxide-gold nanourchin for photocatalytic degradation of dyes and photoinactivation of bacteria in the infected wound. J Colloid Interface Sci 2021; 598:260-273. [PMID: 33901851 DOI: 10.1016/j.jcis.2021.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
We report a one-pot, room-temperature, morphology-controlled synthesis of titanium oxide (TiOx)-gold nanocomposites (TiOx-Au NCs) using HAuCl4 and TiCl3 as precursors, and catechin as reducing agent. TiOx-Au NCs have a range of morphologies from star-like to urchin-like shape depending on the concentration of TiCl3 in the reaction mixture. The urchin-shaped TiOx-Au NCs exhibited excellent photocatalytic activity toward dye degradation due to strong light absorption, plasmon-induced excitation, high conductivity of the gold, and reduced hole-electron pair recombination. TiOx-Au NCs have the advantage of a wide range of light absorption and surface plasmon absorption-mediated excitation due to their abundant gold spikes, which enabled the degradation of dyes over 97% in 60 min, using a xenon lamp as a light source. In addition, TiOx-Au NCs are highly efficient for the photoinactivation of Escherichia coli and methicillin-resistant Staphylococcus aureus (MRSA), and Candida albicans through the photodynamic generation of reactive oxygen species (ROS) and damage to the bacterial membrane. The catechin derivatives on the NCs effectively promoted curing MRSA infected wounds in rats through inducing collagen synthesis, migration of keratinocytes, and neovascularization.
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Affiliation(s)
- Binesh Unnikrishnan
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan
| | - Irma Suryani Gultom
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan
| | - Yu-Ting Tseng
- Department of Chemistry, National Taiwan University, Taipei, Taiwan
| | - Huan-Tsung Chang
- Department of Chemistry, National Taiwan University, Taipei, Taiwan.
| | - Chih-Ching Huang
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan; Center of Excellence for the Oceans, National Taiwan Ocean University, Keelung 20224, Taiwan; School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
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36
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Baroja I, Guerra S, Coral-Almeida M, Ruíz A, Galarza JM, de Waard JH, Bastidas-Caldes C. Methicillin-Resistant Staphylococcus aureus Nasal Colonization Among Health Care Workers of a Tertiary Hospital in Ecuador and Associated Risk Factors. Infect Drug Resist 2021; 14:3433-3440. [PMID: 34471363 PMCID: PMC8403571 DOI: 10.2147/idr.s326148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to most of the commonly used antibiotics and is therefore a public health issue. Colonization with MRSA is a risk factor for infection or transmission. Purpose To determine the prevalence of colonization with Staphylococcus aureus (SA) and MRSA strains in health care workers (HCWs) at a tertiary hospital in Ecuador and to determine the risk factors associated with carriage. Methods Out of a cohort of 3800 HCWs, 481 individuals from different hospital departments were randomly selected, and a single nasal swab was collected. Detection of SA and MRSA was carried out with the LightCycler® MRSA Advanced Test. A questionnaire was performed that gathered demographic and occupational information of the participants to determine risk factors for MRSA colonization. Statistical analysis was performed with univariate and multivariate analysis and the R-software version 4.0.2. Results Colonization with SA and MRSA occurred in respectively 23.7% (95% CI, 22.7–24.6) and 5% (95% CI, 3.39–7.58) of the individuals. The multivariate analysis showed that being older in age (OD 1.09) and being male (OD 2.78) were risk factors for SA and MRSA colonization (p-value < 0.001). Previous use of antibiotics or the use of nasal ointments diminished the colonization rates of SA (24% versus 3.7% and 10.1% respectively). Conclusion About 20% of the HCWs who were colonized with SA were colonized with MRSA, representing a risk for nosocomial infections and hospital outbreaks. Active monitoring and a decolonization treatment of the HCWs can reduce these risks.
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Affiliation(s)
- Isabel Baroja
- Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador.,Unidad Técnica de Genética Molecular, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador
| | - Sara Guerra
- Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador.,Unidad Técnica de Genética Molecular, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador
| | - Marco Coral-Almeida
- Grupo de Bio-Quimioinformatica, Facultad de Ciencias de la Salud, Universidad de Las Américas, Quito, Ecuador
| | - Alejandra Ruíz
- Unidad Técnica de Genética Molecular, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador.,IESS Quito Sur General Hospital, Institutional Coordination of Epidemiological Surveillance and Infectology, Molecular Microbiology, Quito, Ecuador.,Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Juan Miguel Galarza
- Unidad Técnica de Genética Molecular, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador.,Unidad de Biociencias, Gerencia de Molecular y Oncodiagnóstico, SIMED S.A., Quito, Ecuador
| | - Jacobus H de Waard
- One Health Research Group, Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador
| | - Carlos Bastidas-Caldes
- Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador.,One Health Research Group, Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador.,Programa de Doctorado en Salud Pública y Animal, Universidad de Extremadura, Extremadura, España
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Nurjadi D, Eichel VM, Tabatabai P, Klein S, Last K, Mutters NT, Pöschl J, Zanger P, Heeg K, Boutin S. Surveillance for Colonization, Transmission, and Infection With Methicillin-Susceptible Staphylococcus aureus in a Neonatal Intensive Care Unit. JAMA Netw Open 2021; 4:e2124938. [PMID: 34515783 PMCID: PMC8438598 DOI: 10.1001/jamanetworkopen.2021.24938] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Staphylococcus aureus is one of the leading causes of infections in neonatal intensive care units (NICUs). Most studies in this patient group focus on methicillin-resistant S aureus or the outbreak setting, whereas data for methicillin-susceptible S aureus are limited. OBJECTIVES To identify risk factors for S aureus colonization and infections in hospitalized newborns and to investigate S aureus transmission and its dynamics in a nonoutbreak setting. DESIGN, SETTING, AND PARTICIPANTS This monocentric cohort study in a tertiary NICU in Heidelberg, Germany, enrolled all hospitalized neonates (n = 590) with at least 1 nasal screening swab positive for S aureus. Data were collected from January 1, 2018, to December 31, 2019. EXPOSURES Weekly screening for S aureus colonization was performed for all newborns until discharge. MAIN OUTCOMES AND MEASURES The primary end point was any S aureus infection until hospital discharge. Transmission of S aureus and performance of routine typing to detect transmissions were defined as the secondary outcomes of the study. RESULTS In total, 590 newborns were enrolled (276 [46.8%] female and 314 [53.2%] male; 220 [37.3%] with birthweight <1500 g; 477 [80.8%] preterm; 449 [76.1%] singletons; 419 [71.5%] delivered via cesarean section). The median length of stay was 26 (range, 10-62) days. Overall, 135 infants (22.9%) were colonized by S aureus at some time during their hospital stay. The median time to first detection was 17 (interquartile range, 11-37) days. The overall incidence of S aureus infection was 1.7% (10 of 590). Low birth weight (<1500 g [odds ratio, 9.3; 95% CI, 5.9-14.6; P < .001]) and longer hospital stay (odds ratio, 2.3; 95% CI, 1.9-2.7; P < .001) were associated with colonization. Nasal carriage was significantly associated with S aureus infection (odds ratio, 8.2; 95% CI, 2.1-32.3; P = .002). A total of 123 of 135 colonization isolates were sequenced. All recoverable infection isolates (4 of 7) of newborns with colonization were genetically identical to the colonizing isolate. Whole-genome sequencing indicated 23 potential transmission clusters. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that nasal colonization is a relevant risk factor for S aureus infection in a nonoutbreak NICU setting. In colonized newborns, infection and colonization isolates were genetically identical, suggesting that eradication of colonization may be a useful measure to prevent infection. Further investigations are necessary to validate and assess the generalizability of our findings.
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Affiliation(s)
- Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Vanessa M. Eichel
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrik Tabatabai
- Department of Neonatology, Heidelberg University Children’s Hospital, Heidelberg, Germany
| | - Sabrina Klein
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Last
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Nico T. Mutters
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Johannes Pöschl
- Department of Neonatology, Heidelberg University Children’s Hospital, Heidelberg, Germany
| | - Philipp Zanger
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Heeg
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Sébastien Boutin
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
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38
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Liang B, Liang X, Gao F, Long Y, Mai J, Ai X, Wang J, Gao X, Xiong Z, Liang Z, Zhang C, Gong S, Zhou Z. Active Surveillance, Drug Resistance, and Genotypic Profiling of Staphylococcus aureus Among School-Age Children in China. Front Med (Lausanne) 2021; 8:701494. [PMID: 34447764 PMCID: PMC8382981 DOI: 10.3389/fmed.2021.701494] [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] [Received: 04/28/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022] Open
Abstract
Methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization predisposes individuals for endogenous infections and is a major threat to children. Recently, oxacillin/cefoxitin-susceptible mecA-positive S. aureus (OS-MRSA) has been reported worldwide. Herein, a prospective, cross-sectional study was conducted across five schools, representing three educational stages, in Guangzhou, China. Nasal swabs from 2,375 students were cultured for S. aureus and all isolates were subjected to antibiotic susceptibility testing phenotypically and confirmed by femB and mecA genetic detection; all the isolates were classified as MSSA, MRSA, or OS-MRSA. All strains were also analyzed by multi-locus sequence typing. Among the 2,375 swabs, S. aureus was detected in 744 children (31.3%, 95% CI: 25.9–36.7%), of whom 72 had MRSA (3.0%, 95% CI: 0.6–5.4%) and 4 had OS-MRSA (0.2%, 95% CI: 0.1–0.3%), of which an oxacillin- and cefoxitin-susceptible MRSA strain was identified. The prevalence of S. aureus and MRSA was higher in younger children. The highest percentage of drug resistance of the S. aureus isolates (n = 744) was to penicillin (85.5%), followed by erythromycin (43.3%) and clidamycin (41.0%). The most prevalent sequence types (STs) were ST30, ST45, and ST188 in MSSA, accounting for 38.7% of the total isolates, whereas ST45, ST59, and ST338 accounted for 74.6% of the MRSA isolates and ST338 accounted for 50.0% of the OS-MRSA isolates. The MRSA and OS-MRSA isolates (n = 76) were grouped into three clades and one singleton, with clonal complex (CC) 45 as the most predominant linkage. The top nine multi-locus sequence typing-based CCs (CC30, CC45, CC5, CC1, CC15, CC944, CC398, CC59, CC7) represented 86.7% of all S. aureus isolates. All CC30 isolates were resistant to erythromycin and clidamycin, and almost all these isolates were also resistant to penicillin (99.2%). The CC45 and CC59 isolates exhibited high resistance rates to oxacillin at 31.5 and 59.0%, respectively. This study provides updated data valuable for designing effective control strategies to mitigate the burden of disease and to improve the adequacy of empirical antimicrobial treatments for potentially harmful infections.
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Affiliation(s)
- Bingshao Liang
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyun Liang
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fei Gao
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yan Long
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jialiang Mai
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaolan Ai
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jielin Wang
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiurong Gao
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhile Xiong
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhuwei Liang
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chao Zhang
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Sitang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhenwen Zhou
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Laboratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
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Yayan EH, Demırel Öner P, Coşkun Şımşek D, Zengın M. Hand Microbial Flora of Hospitalized Children at the Beginning of Hospitalization and Before Discharge: A Cross-Sectional Study. Ethiop J Health Sci 2021; 30:875-880. [PMID: 33883831 PMCID: PMC8047244 DOI: 10.4314/ejhs.v30i6.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Hospital infections in pediatric units increase the length of hospital stay and the use of antibiotics, and this causes exposure to more procedures. This study was aimed to determine the microorganisms represented in the hand flora of pediatric patients at the beginning of hospitalization and before discharge. Methods The study was designed as a prospective cross-sectional study. This prospective study was performed with 124 pediatric patients. After completion of the admission procedures, an initial sample was taken from the hands of the hospitalized patients. Another sample was taken from the patients just before discharging. Results Growth of coagulase-negative staphylococcus (CNS) was observed in the culture samples of 28 patients. Cultures from 23 patients showed different microorganisms such as Staphylococcus aureus, Escherichia coli, and S. epidermis. Examination of final discharge cultures showed CNS in 43 patients, S. aureus in 5 patients, E. coli in 8 patients, Acinetobacter baumannii in 11 patients, and Kocuria rhizophila, K. kristinae, Candida spp., Pseudomonas spp., and Enterococcus in 1 patient. Conclusion The cultures from samples obtained at discharge showed the presence of antibiotic-resistant pathogenic microorganisms causing healthcare associated infection.
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Affiliation(s)
- Emriye Hilal Yayan
- Department of Child Health and Diseases Nursing, Nursing Faculty, İnönü University, Malatya, Turkey. orcid.org/0000-0003-0075-4171
| | - Pınar Demırel Öner
- Elazığ Fethi Sekin City Hospital, Elazığ, Turkey orcid.org/0000-0001-9592-5986
| | - Didem Coşkun Şımşek
- Department of Child Health and Diseases Nursing, Health Sciences Faculty, Fırat University, Elazığ, Turkey orcid.org/0000-0003-0364-5667
| | - Mürşide Zengın
- Department of Child Health and Diseases Nursing, Health Sciences Faculty, Adıyaman University, Adıyaman, Turkey. https://orcid.org/0000-0003-1453-6028
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40
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Sundermann AJ, Chen J, Miller JK, Saul MI, Shutt KA, Griffith MP, Mustapha MM, Ezeonwuka C, Waggle K, Srinivasa V, Kumar P, Pasculle AW, Ayres AM, Snyder GM, Cooper VS, Van Tyne D, Marsh JW, Dubrawski AW, Harrison LH. Outbreak of Pseudomonas aeruginosa Infections from a Contaminated Gastroscope Detected by Whole Genome Sequencing Surveillance. Clin Infect Dis 2021; 73:e638-e642. [PMID: 33367518 DOI: 10.1093/cid/ciaa1887] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Traditional methods of outbreak investigations utilize reactive whole genome sequencing (WGS) to confirm or refute the outbreak. We have implemented WGS surveillance and a machine learning (ML) algorithm for the electronic health record (EHR) to retrospectively detect previously unidentified outbreaks and to determine the responsible transmission routes. METHODS We performed WGS surveillance to identify and characterize clusters of genetically-related Pseudomonas aeruginosa infections during a 24-month period. ML of the EHR was used to identify potential transmission routes. A manual review of the EHR was performed by an infection preventionist to determine the most likely route and results were compared to the ML algorithm. RESULTS We identified a cluster of 6 genetically related P. aeruginosa cases that occurred during a 7-month period. The ML algorithm identified gastroscopy as a potential transmission route for 4 of the 6 patients. Manual EHR review confirmed gastroscopy as the most likely route for 5 patients. This transmission route was confirmed by identification of a genetically-related P. aeruginosa incidentally cultured from a gastroscope used on 4of the 5 patients. Three infections, 2 of which were blood stream infections, could have been prevented if the ML algorithm had been running in real-time. CONCLUSIONS WGS surveillance combined with a ML algorithm of the EHR identified a previously undetected outbreak of gastroscope-associated P. aeruginosa infections. These results underscore the value of WGS surveillance and ML of the EHR for enhancing outbreak detection in hospitals and preventing serious infections.
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Affiliation(s)
- Alexander J Sundermann
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | - Jieshi Chen
- Anton Laboratory, Carnegie Mellon University
| | | | - Melissa I Saul
- Department of Medicine, University of Pittsburgh School of Medicine
| | - Kathleen A Shutt
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | - Marissa P Griffith
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | - Mustapha M Mustapha
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | - Chinelo Ezeonwuka
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | - Kady Waggle
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | - Vatsala Srinivasa
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | - Praveen Kumar
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh
| | | | - Ashley M Ayres
- Department of Infection Prevention and Control, University of Pittsburgh Medical Center
| | - Graham M Snyder
- Division of Infectious Diseases, University of Pittsburgh School of Medicine.,Department of Infection Prevention and Control, University of Pittsburgh Medical Center
| | - Vaughn S Cooper
- Department of Microbiology and Molecular Genetics, and Center for Evolutionary Biology and Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daria Van Tyne
- Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | - Jane W Marsh
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
| | | | - Lee H Harrison
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh.,Division of Infectious Diseases, University of Pittsburgh School of Medicine
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Comparative study of Staphylococcus aureus from burn patients and healthcare workers in a burn center, Yazd, Iran. Wien Med Wochenschr 2021; 172:256-260. [PMID: 34338909 DOI: 10.1007/s10354-021-00863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Healthcare workers (HCWs) are proposed as the potential source of transmission of Staphylococcus aureus to hospitalized patients, especially in burn units. This study aimed to investigate S. aureus from burn wound infections and those from the nose of HCWs in terms of antibiotic resistance, the presence of Panton-Valentine leucocidin-encoding gene (pvl) and the arginine catabolic mobile element (ACME), and the ability for biofilm formation. Also, the genetic diversity of isolates was assessed using staphylococcal protein A (spa) typing and staphylococcal cassette chromosome mec (SCCmec) typing. Overall, regarding the studied factors, significant differences were found neither between isolates from patients and HCWs nor between methicillin-resistant and methicillin-susceptible isolates (except for multidrug resistance which was significantly higher in MRSA). The most frequent SCCmec types were type I and III. ACME-arcA was only detected in isolates from patients and similarly the presence of ACME-opp3 was the most prevalent in this group. The presence of common clonal complexes among patient isolates and more importantly between isolates from patients and HCWs is warning. The high prevalence of virulence factors, both in MRSA and MSSA, emphasizes the importance of MSSA in burn centers. Finding no significant difference in the presence of virulence-associated factors between isolates from patients and HCWs demonstrates the need to take HCWs into account as important reservoirs.
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Price JR, Yokoyama M, Cole K, Sweetman J, Behar L, Stoneham S, Cantillon D, Waddell SJ, Hyde J, Alam R, Crook D, Paul J, Llewelyn MJ. Undetected carriage explains apparent Staphylococcus aureus acquisition in a non-outbreak healthcare setting. J Infect 2021; 83:332-338. [PMID: 34303737 DOI: 10.1016/j.jinf.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Previous studies have been unable to identify patient or staff reservoirs for the majority of the nosocomial S. aureus acquisitions which occur in the presence of good infection control practice. We set out to establish the extent to which undetected pre-existing carriage explains apparent nosocomial S. aureus acquisition. METHODS Over two years elective cardiothoracic admissions were screened for S. aureus carriage before and during hospital admission. Routine screening (nose/groin/wound sampling), was supplemented by sampling additional body sites (axilla/throat/rectum) and culture-based methods optimised to detect fastidious phenotypes (small colony variants, cell wall deficient variants) and molecular identification by PCR. RESULTS 35% of participants (53/151) were S. aureus carriers according to routine pre-healthcare screening; increasing to 42% (63/151) when additional body sites and enhanced cultures were employed. 71% (5/7) of apparent acquisitions were explained by pre-existing carriage using augmented measures. Enhanced culture identified a minority of colonised individuals (3/151 including 1 MRSA carrier) who were undetected by routine and additional screening cultures. 4/14 (29%) participants who became culture-negative during admission had S. aureus genomic material detected at discharge. CONCLUSIONS Conventional sampling under-estimates carriage of S. aureus and this explains the majority of apparent S. aureus acquisitions among elective cardiothoracic patients.
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Affiliation(s)
- James R Price
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Maho Yokoyama
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Kevin Cole
- Public Health England, Royal Sussex County Hospital, Brighton, BN2 5BE, United Kingdom.
| | - Jonathan Sweetman
- Clinical Investigation Research Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BE, United Kingdom.
| | - Laura Behar
- Clinical Investigation Research Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BE, United Kingdom.
| | - Simon Stoneham
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Daire Cantillon
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Simon J Waddell
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Jonathan Hyde
- Clinical Investigation Research Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BE, United Kingdom.
| | - Ruhina Alam
- Clinical Investigation Research Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BE, United Kingdom.
| | - Derrick Crook
- Department of Experimental Medicine, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.
| | - John Paul
- Public Health England, Royal Sussex County Hospital, Brighton, BN2 5BE, United Kingdom.
| | - Martin J Llewelyn
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
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Richter SM, Barnard TG. Adaptation of the WHO Hand Hygiene Observation Form for Application in Optometry Training Facilities. CLINICAL OPTOMETRY 2021; 13:227-234. [PMID: 34326677 PMCID: PMC8315776 DOI: 10.2147/opto.s304315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The link between hand and surface hygiene and the spread of disease has been reported by various studies and understanding the appropriate use of hand hygiene is important in healthcare. The World Health Organization (WHO) introduced the "My Five Moments for Hand Hygiene" model to educate healthcare workers about the importance of hand hygiene to stop the spread of disease. OBJECTIVE The objectives of this paper were to determine if the WHO Hand Hygiene Observation Form could be used to monitor for hand and personal hygiene practices of Optometry students, and what their actual hygiene practices are in an Optometry training facility in South Africa. METHODS This cross-sectional study was performed at an Optometry training facility in South Africa using third (n=32) and fourth year (n=39) students. The Hand Hygiene Knowledge Questionnaire for Health Care Workers by the WHO was used to determine their knowledge regarding hand hygiene. After completing the questionnaire, participants were observed in the clinic while consulting patients to determine the hand and surface hygiene practices they apply. RESULTS The WHO hand hygiene observation rubric was not appropriate to evaluate hand and surface hygiene in Optometry facilities. The adapted observation rubric created was a better tool to evaluate student hygiene practices and was able to record which hand or surface hygiene were missed when presented with such opportunities. Although 90.1% of the students knew that germs could be transferred to the patients via hands, only 46.5% routinely used an alcohol-based hand sanitizer. CONCLUSION This observation rubric developed during this study can assist in creating awareness with students about their own hand and surface hygiene deficiencies when interacting with patients.
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Affiliation(s)
- Susarah Maria Richter
- Department of Optometry, University of Johannesburg, Johannesburg, South Africa
- Water and Health Research Centre, University of Johannesburg, Johannesburg, South Africa
| | - Tobias George Barnard
- Water and Health Research Centre, University of Johannesburg, Johannesburg, South Africa
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Ward-level factors associated with methicillin-resistant Staphylococcus aureus acquisition-an electronic medical records study in Singapore. PLoS One 2021; 16:e0254852. [PMID: 34292998 PMCID: PMC8297767 DOI: 10.1371/journal.pone.0254852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Methicillin-Resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide. Intrahospital transfers may impact MRSA acquisition risk experienced by patients. In this study, we investigated ward characteristics and connectivity that are associated with MRSA acquisition. Methods We analysed electronic medical records on patient transfers and MRSA screening of in-patients at an acute-care tertiary hospital in Singapore to investigate whether ward characteristics and connectivity within a network of in-patient wards were associated with MRSA acquisition rates over a period of four years. Results Most patient transfers concentrated in a stable core network of wards. Factors associated with increased rate of MRSA acquisition were MRSA prevalence among patients transferred from other wards (rate ratio (RR): 7.74 [95% confidence interval (CI): 3.88, 15.44], additional 5 percentage point), critical care ward (RR: 1.72 [95% CI: 1.09, 2.70]) and presence of MRSA cohorting beds (RR: 1.39 [95% CI: 1.03, 1.90]. Oncology ward (RR: 0.66 [95% CI: 0.46, 0.94]) (compared to medical ward), and median length of stay (RR: 0.70 [95% CI: 0.55, 0.90], additional 1.5 days) were associated with lower acquisition rates. In addition, we found evidence of interaction between MRSA prevalence among patients transferred from other wards and weighted in-degree although the latter was not associated with MRSA acquisition after controlling for confounders. Conclusion Wards with higher MRSA prevalence among patients transferred from other wards were more likely to have higher MRSA acquisition rate. Its effect further increased in wards receiving greater number of patients. In addition, critical care ward, presence of MRSA cohorting beds, ward specialty, and median length of stay were associated with MRSA acquisition.
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45
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Lerche N, Holtfreter S, Walther B, Semmler T, Al'Sholui F, Dancer SJ, Daeschlein G, Hübner NO, Bröker BM, Papke R, Kohlmann T, Baguhl R, Seifert U, Kramer A. Staphylococcus aureus nasal colonization among dental health care workers in Northern Germany (StaphDent study). Int J Med Microbiol 2021; 311:151524. [PMID: 34371345 DOI: 10.1016/j.ijmm.2021.151524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/10/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) can colonize dental patients and students, however, studies on the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) among dental health care workers (DHCW) including use of personal protective equipment (PPE) are scarce. We conducted an observational study (StaphDent study) to (I) determine the prevalence of MRSA and MSSA colonization in DHCW in the region of Mecklenburg Western-Pomerania, Germany, (II) resolve the S. aureus population structure to gain hints on possible transmission events between co-workers, and (III) clarify use of PPE. Nasal swabs were obtained from dentists (n = 149), dental assistants (n = 297) and other dental practice staff (n = 38). Clonal relatedness of MSSA isolates was investigated using spa typing and, in some cases, whole genome sequencing (WGS). PPE use was assessed by questionnaire. While 22.3% (108/485) of the participants were colonized with MSSA, MRSA was not detected. MSSA prevalence was not associated with size of dental practices, gender, age, or duration of employment. The identified 61 spa types grouped into 17 clonal complexes and four sequence types. Most spa types (n = 47) were identified only once. In ten dental practices one spa type occurred twice. WGS data analysis confirmed a close clonal relationship for 4/10 isolate pairs. PPE was regularly used by most dentists and assistants. To conclude, the failure to recover MRSA from DHCW reflects the low MRSA prevalence in this region. Widespread PPE use suggests adherence to routine hygiene protocols. Compared to other regional HCW MRSA rates the consequent usage of PPE seems to be protective.
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Affiliation(s)
- Nadine Lerche
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Silva Holtfreter
- Institute of Immunology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Birgit Walther
- ZBS 4, Advanced Light and Electron Microscopy, Robert Koch Institute, Seestraße 10, DE-13353, Berlin, Germany.
| | - Torsten Semmler
- Microbial Genomics (NG1), Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Fawaz Al'Sholui
- Institute of Immunology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, G75 8RG, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, EH11 4BN, UK.
| | - Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Nils-Olaf Hübner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany; Central Unit for Infection Prevention and Control, University Medicine Greifswald, 17475, Greifswald, Germany.
| | - Barbara M Bröker
- Institute of Immunology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Roald Papke
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Thomas Kohlmann
- Institute for Community Medicine, Methodical Subdivision, University Medicine Greifswald, Walther-Rathenau-Str. 48, DE-17475, Greifswald, Germany.
| | - Romy Baguhl
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Ulrike Seifert
- Friedrich Loeffler Institute of Medical Microbiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, DE-17475, Greifswald, Germany.
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Gatt YE, Margalit H. Common Adaptive Strategies Underlie Within-Host Evolution of Bacterial Pathogens. Mol Biol Evol 2021; 38:1101-1121. [PMID: 33118035 PMCID: PMC7947768 DOI: 10.1093/molbev/msaa278] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Within-host adaptation is a hallmark of chronic bacterial infections, involving substantial genomic changes. Recent large-scale genomic data from prolonged infections allow the examination of adaptive strategies employed by different pathogens and open the door to investigate whether they converge toward similar strategies. Here, we compiled extensive data of whole-genome sequences of bacterial isolates belonging to miscellaneous species sampled at sequential time points during clinical infections. Analysis of these data revealed that different species share some common adaptive strategies, achieved by mutating various genes. Although the same genes were often mutated in several strains within a species, different genes related to the same pathway, structure, or function were changed in other species utilizing the same adaptive strategy (e.g., mutating flagellar genes). Strategies exploited by various bacterial species were often predicted to be driven by the host immune system, a powerful selective pressure that is not species specific. Remarkably, we find adaptive strategies identified previously within single species to be ubiquitous. Two striking examples are shifts from siderophore-based to heme-based iron scavenging (previously shown for Pseudomonas aeruginosa) and changes in glycerol-phosphate metabolism (previously shown to decrease sensitivity to antibiotics in Mycobacterium tuberculosis). Virulence factors were often adaptively affected in different species, indicating shifts from acute to chronic virulence and virulence attenuation during infection. Our study presents a global view on common within-host adaptive strategies employed by different bacterial species and provides a rich resource for further studying these processes.
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Affiliation(s)
- Yair E Gatt
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hanah Margalit
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Yu CH, Shen S, Huang KYA, Huang YC. The trend of environmental and clinical methicillin-resistant Staphylococcus aureus in a hospital in Taiwan: Impact of USA300. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:241-248. [PMID: 34175242 DOI: 10.1016/j.jmii.2021.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/22/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The environment may facilitate transmission of health care-associated methicillin-resistant Staphylococcus aureus (MRSA) and the pathogen is frequently shed by patients. However, the molecular characteristics and genetic relatedness between clinical and environmental MRSA isolates remain largely unclear in the clinical setting. METHODS A total of 100 hospitalized patients with MRSA infection and 25 hospitalized patients without MRSA infection were enrolled in a medical center, Taiwan in 2019. Environmental and clinical MRSA isolates were characterized by antibiotic susceptibility testing and molecular methods. RESULTS In the study, we detected 17 MRSA isolates in the environment that surrounded 15 MRSA-infected patients and one environmental MRSA isolate from one patient without MRSA infection. The molecular analysis revealed a high genetic diversity within either environmental or clinical MRSA isolates, while the USA300 clone (pulsotype AI, SCCmec IV, ST8, PVL-positive) accounts for 39% (7/18) of environmental and 33% (7/21) of clinical MRSA isolates. Moreover, 13 of the 15 MRSA-infected patients had identical paired clinical-environmental MRSA isolates, which exhibited indistinguishable genetic relatedness and highly similar antibiotic susceptibility phenotype, suggesting a possible transmission cycle of MRSA in the hospital. CONCLUSIONS The environmental MRSA was closely linked to MRSA isolated from patients, suggesting that the environment may act as a reservoir of MRSA. Besides, the USA300 MRSA has become a major clone in the hospital setting. An effective and rigorous approach to environmental cleaning and decontamination is suggested to eradicate MRSA in the hospital.
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Affiliation(s)
- Chen-Hsin Yu
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Sing Shen
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Kuan-Ying A Huang
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.
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Popovich KJ, Green SJ, Okamoto K, Rhee Y, Hayden MK, Schoeny M, Snitkin ES, Weinstein RA. MRSA Transmission in Intensive Care Units: Genomic Analysis of Patients, Their Environments, and Healthcare Workers. Clin Infect Dis 2021; 72:1879-1887. [PMID: 32505135 PMCID: PMC8315036 DOI: 10.1093/cid/ciaa731] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA)-and now USA300 MRSA-is a significant intensive care unit (ICU) pathogen; healthcare worker (HCW) contamination may lead to patient cross-transmission. METHODS From September 2015 to February 2016, to study the spread of MRSA, we enrolled HCWs in 4 adult ICUs caring for patients on MRSA contact precautions. Samples were collected from patient body sites and high-touch surfaces in patient rooms. HCW hands, gloves, and personal protective equipment were sampled pre/post-patient encounter. Whole genome sequencing (WGS) was used to compare isolates from patients, HCWs, and environment. RESULTS There were 413 MRSA isolates sequenced (38% USA300, 52% USA100) from 66 patient encounters. Six of 66 HCWs were contaminated with MRSA prior to room entry. Isolates from a single patient encounter were typically either USA100 or USA300; in 8 (12%) encounters both USA300 and USA100 were isolated. WGS demonstrated that isolates from patients, HCWs, and environment often were genetically similar, although there was substantial between-encounter diversity. Strikingly, there were 5 USA100 and 1 USA300 clusters that contained similar strains (<22 single-nucleotide variants [SNVs], with most <10 SNVs) within the cluster despite coming from different encounters, suggesting intra- and inter-ICU spread of strains, that is, 4 of these genomic clusters were from encounters in the same ICU; 5 of 6 clusters occurred within 1 week. CONCLUSIONS We demonstrated frequent spread of MRSA USA300 and USA100 strains among patients, environment, and HCWs. WGS identified possible spread within and even between ICUs. Future analysis with detailed contact tracing in conjunction with genomic data may further elucidate pathways of MRSA spread and points for intervention.
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Affiliation(s)
- Kyle J Popovich
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Stefan J Green
- Genome Research Core, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoona Rhee
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Mary K Hayden
- Division of Infectious Disease, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Schoeny
- Community, Systems, and Mental Health Nursing Rush University Medical Center, Chicago, Illinois, USA
| | - Evan S Snitkin
- Department of Microbiology and Immunology and Division of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert A Weinstein
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
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49
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Cole K, Atkins B, Llewelyn M, Paul J. Genomic investigation of clinically significant coagulase-negative staphylococci. J Med Microbiol 2021; 70. [PMID: 33704043 DOI: 10.1099/jmm.0.001337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction. Coagulase-negative staphylococci have been recognized both as emerging pathogens and contaminants of clinical samples. High-resolution genomic investigation may provide insights into their clinical significance.Aims. To review the literature regarding coagulase-negative staphylococcal infection and the utility of genomic methods to aid diagnosis and management, and to identify promising areas for future research.Methodology. We searched Google Scholar with the terms (Staphylococcus) AND (sequencing OR (infection)). We prioritized papers that addressed coagulase-negative staphylococci, genomic analysis, or infection.Results. A number of studies have investigated specimen-related, phenotypic and genetic factors associated with colonization, infection and virulence, but diagnosis remains problematic.Conclusion. Genomic investigation provides insights into the genetic diversity and natural history of colonization and infection. Such information allows the development of new methodologies to identify and compare relatedness and predict antimicrobial resistance. Future clinical studies that employ suitable sampling frames coupled with the application of high-resolution whole-genome sequencing may aid the development of more discriminatory diagnostic approaches to coagulase-staphylococcal infection.
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Affiliation(s)
- Kevin Cole
- Brighton and Sussex Medical School, Brighton, UK.,Public Health England Collaborating Centre, Royal Sussex County Hospital, Brighton, UK
| | | | - Martin Llewelyn
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - John Paul
- Public Health England Collaborating Centre, Royal Sussex County Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
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50
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Tsegaye MM, Chouhan G, Fentie M, Tyagi P, Nand P. Therapeutic Potential of Green Synthesized Metallic Nanoparticles against Staphylococcus aureus. Curr Drug Res Rev 2021; 13:172-183. [PMID: 33634763 DOI: 10.2174/2589977513666210226123920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/08/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The recent treatment challenges posed by the widespread emergence of pathogenic Multidrug-Resistant (MDR) bacterial strains are a cause of huge health troubles worldwide. Infections caused by MDR organisms are associated with longer period of hospitalization, increased mortality, and inflated healthcare costs. Staphylococcus aureus is one of these MDR organisms identified as an urgent threat to human health by the World Health Organization. Infections caused by S. aureus may range from simple cutaneous infestations to life threatening bacteremia. S. aureus infections get easily escalated in severely ill, hospitalized and or immunocompromised patients with incapacitated immune system. Also, in HIV-positive patients S. aureus ranks amongst one of the most common comorbidities where it can further worsen a patient's health condition. At present anti-staphylococcal therapy is reliant typically on chemotherapeutics that are gathering resistance and pose unfavorable side-effects. Thus, newer drugs are required that can bridge these shortcomings and aid effective control against S. aureus. OBJECTIVE In this review, we summarize drug resistance exhibited by S. aureus and lacunae in current anti-staphylococcal therapy, nanoparticles as an alternative therapeutic modality. The focus lays on various green synthesized nanoparticles, their mode of action and application as potent antibacterial compounds against S. aureus. CONCLUSION Use of nanoparticles as anti-bacterial drugs has gained momentum in recent past and green synthesized nanoparticles, which involves microorganisms and plants or their byproducts for synthesis of nanoparticles offer a potent, as well as environment friendly solution in warfare against MDR bacte.
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Affiliation(s)
- Meron Moges Tsegaye
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Knowledge Park III, Greater Noida, Uttar Pradesh. India
| | - Garima Chouhan
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Knowledge Park III, Greater Noida, Uttar Pradesh. India
| | - Molla Fentie
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Knowledge Park III, Greater Noida, Uttar Pradesh. India
| | - Priya Tyagi
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Knowledge Park III, Greater Noida, Uttar Pradesh. India
| | - Parma Nand
- School of Engineering and Technology, Sharda University, Knowledge Park III, Greater Noida, Uttar Pradesh. India
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