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Sood G, Dougherty G, Martin J, Beranek E, Landrum BM, Qasba S, Patel M, Wilson C, Miller A, Sulkowski M, Bennett RG, Sears CL, Schuster A, Galai N. Is neighborhood deprivation index a risk factor for Staphylococcus aureus infections? Am J Infect Control 2023; 51:1314-1320. [PMID: 37478909 DOI: 10.1016/j.ajic.2023.07.001] [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: 03/21/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND We assessed the association between neighborhood area deprivation index (ADI) and community-onset (co) and hospital-onset (ho) Staphylococcus aureus infection. METHODS Demographic and clinical characteristics of patients admitted to 5 adult hospitals in the mid-Atlantic between 2016 and 2018 were obtained. The association of ADI with methicillin-resistant (MRSA) and methicillin-sensitive (MSSA) S aureus infections was assessed using logistic regression models adjusting for severity of illness and days of admission. RESULTS Overall, increasing ADI was associated with higher odds of co- and ho-MRSA and MSSA infection. In univariate analysis, Black race was associated with 44% greater odds of ho-MRSA infection (odds ratio [OR] 1.44; 95% CI 1.18-1.76) and Asian race (co-MRSA OR 0.355; Confidence Interval (CI) 0.240-0.525; co-MSSA OR 0.718; CI 0.557-0.928) and unknown race (co-MRSA OR 0.470; CI 0.365-0.606; co-MSSA OR 0.699; CI 0.577-0.848) was associated with lower odds of co-MSSA and co-MRSA infections. When both race and ADI were included in the model, Black race was no longer associated with ho-MRSA infections whereas Asian and unknown race remained associated with lower odds of co-MRSA and co-MSSA infection. In the multivariable logistic regression, ADI was consistently associated with increased odds of S aureus infection (co-MRSA OR 1.132; CI 1.064-1.205; co-MSSA OR 1.089; CI 1.030-1.15; ho-MRSA OR 1.29; CI 1.16-1.43: ho-MSSA OR 1.215; CI 1.096-1.346). CONCLUSIONS The area deprivation index is associated with community and hospital-onset MRSA and MSSA infections.
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Affiliation(s)
- Geeta Sood
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Geoff Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Health Services Cost Review Commission, MD
| | | | | | - B Mark Landrum
- Department of Medicine, Howard County General Hospital, Columbia, MD
| | - Sonia Qasba
- Department of Medicine, Suburban Hospital, Bethesda, MD
| | - Mayank Patel
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | | | | | - Mark Sulkowski
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Richard G Bennett
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Cynthia L Sears
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Statistics, University of Haifa, Mt. Carmel, Israel
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Impact of the WHO Integrated Stewardship Policy on the Control of Methicillin-Resistant Staphyloccus aureus and Third-Generation Cephalosporin-Resistant Escherichia coli: Using a Mathematical Modeling Approach. Bull Math Biol 2022; 84:97. [PMID: 35931917 DOI: 10.1007/s11538-022-01051-1] [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: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/02/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) and third-generation cephalosporin-resistant Escherichia coli (3GCREc) are community and hospital-associated pathogens causing serious infections among populations by infiltrating into hospitals and surrounding environment. These main multi-drug resistant or antimicrobial resistance (AMR) bacterial pathogens are threats to human health if not properly tackled and controlled. Tackling antimicrobial resistance (AMR) is one of the issues for the World Health Organization (WHO) to design a comprehensive set of interventions which also helps to achieve the end results of the developing indicators proposed by the same organization. A deterministic mathematical model is developed and studied to investigate the impact of the WHO policy on integrated antimicrobial stewardship activities to use effective protection measures to control the spread of AMR diseases such as MRSA and 3GCREc in hospital settings by incorporating the contribution of the healthcare workers in a hospital and the environment in the transmission dynamics of the diseases. The model also takes into account the parameters describing various intervention measures and is used to quantify their contribution in containing the diseases. The impact of combinations of various possible control measures on the overall dynamics of the disease under study is investigated. The model analysis suggests that the contribution of the interventions: screening and isolating the newly admitted patients, improving the hygiene in hospital settings, decolonizing the pathogen carriers, and increasing the frequency of disinfecting the hospital environment are effective tools to contain the disease from invading the population. The study revealed that without any intervention, the diseases will continue to be a major cause of morbidity and mortality in the affected communities. In addition, the study indicates that a coordinated implementation of the integrated control measures suggested by WHO is more effective in curtailing the spread of the diseases than piecemeal strategies. Numerical experiments are provided to support the theoretical analysis.
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3
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Folate Functionalized Lipid Nanoparticles for Targeted Therapy of Methicillin-Resistant Staphylococcus aureus. Pharmaceutics 2021; 13:pharmaceutics13111791. [PMID: 34834208 PMCID: PMC8617750 DOI: 10.3390/pharmaceutics13111791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/27/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA), commonly called a superbug, is a highly alarming antibiotic-resistant population of Staphylococcus aureus (S. aureus) bacteria. Vancomycin (VAN) was first approved by the FDA in 1988, and it is still regarded as the treatment of choice for MRSA. The efficacy of VAN treatment has become less effective due to the development of VAN resistance in MRSA and the potential for nephrotoxicity. This study aims to improve the efficacy of VAN treatment by identifying the folate receptor for MRSA infected tissues and developing folate decorated lipid nanoparticles containing VAN (LVAN). In comparison to conventional VAN, LVAN showed a higher bactericidal effect and a superior ability to inhibit biofilm in MRSA with an enhanced accumulation in MRSA infected thigh tissues and a reduced accumulation in kidney. The results suggested that LVAN is a promising candidate to overcome the current limitations of bacterial resistance and adverse side effects in kidneys found in VAN.
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4
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Chueahiran S, Yindee J, Boonkham P, Suanpairintr N, Chanchaithong P. Methicillin-Resistant Staphylococcus aureus Clonal Complex 398 as a Major MRSA Lineage in Dogs and Cats in Thailand. Antibiotics (Basel) 2021; 10:antibiotics10030243. [PMID: 33671008 PMCID: PMC7997496 DOI: 10.3390/antibiotics10030243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to present molecular and antimicrobial resistance characteristics of methicillin-resistant Staphylococcus aureus (MRSA) clonal complex (CC) 398 isolated from diseased dogs and cats in Thailand. A total of 20 MRSA isolates of 134 Staphylococcus aureus isolated from canine and feline clinical samples during 2017-2020 were CC398, consisting of sequence type (ST) 398 (18 isolates), ST5926 (1 isolate), and ST6563 (1 isolate) by multilocus sequence typing. spa t034 and staphylococcal cassette chromosome mec (SCCmec) V were predominantly associated with ST398. Intraclonal differentiation was present by additional spa (t1255, t4653), non-detectable spa, composite SCCmec with a hybrid of ccrA1B1+ccrC and class A mec complex, and DNA fingerprints by pulsed-field gel electrophoresis. The isolates essentially carried antimicrobial resistance genes, mediating multiple resistance to β-lactams (mecA, blaZ), tetracyclines [tet(M)], aminoglycosides [aac(6')-Ie-aph(2')-Ia], and trimethoprim (dfr). Livestock-associated MRSA ST398 resistance genes including lnu(B), lsa(E), spw, fexA, and tet(L) were heterogeneously found and lost in subpopulation, with the absence or presence of additional erm(A), erm(B), and ileS2 genes that corresponded to resistance phenotypes. As only a single CC398 was detected with the presence of intraclonal variation, CC398 seems to be the successful MRSA clone colonizing in small animals as a pet-associated MRSA in Thailand.
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Affiliation(s)
- Surawit Chueahiran
- Department of Veterinary Microbiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand; (S.C.); (J.Y.)
| | - Jitrapa Yindee
- Department of Veterinary Microbiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand; (S.C.); (J.Y.)
| | - Pongthai Boonkham
- Veterinary Diagnostic Laboratory, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Nipattra Suanpairintr
- Department of Pharmacology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Pattrarat Chanchaithong
- Department of Veterinary Microbiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand; (S.C.); (J.Y.)
- Research Unit in Microbial Food Safety and Antimicrobial Resistance, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence:
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5
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Martins KB, Olmedo DWV, Paz MM, Ramos DF. Staphylococcus aureus and its Effects on the Prognosis of Bronchiectasis. Microb Drug Resist 2020; 27:823-834. [PMID: 33232626 DOI: 10.1089/mdr.2020.0352] [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] [Indexed: 10/22/2022] Open
Abstract
Bronchiectasis, which is an abnormal and irreversible dilation of one or several bronchial segments, causes significant morbidity and impaired quality of life to patients, mainly as the result of recurrent and chronic respiratory infections. Staphylococcus aureus is a microorganism known for its high infectious potential related to the production of molecules with great pathogenic power, such as enzymes, toxins, adhesins, and biofilm, which determine the degree of severity of systemic symptoms and can induce exacerbated immune response. This review highlighted the clinical significance of S. aureus colonization/infection in bronchiectasis patients, since little is known about it, despite its increasing frequency of isolation and potential serious morbidity.
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Affiliation(s)
- Katheryne Benini Martins
- Núcleo de Pesquisa em Microbiologia Médica (NUPEMM), Universidade Federal do Rio Grande-FURG, Rio Grande, Rio Grande do Sul, Brazil.,Post-graduate Program in Health Sciences-School of Medicine, Universidade Federal do Rio Grande-FURG, Rio Grande, Rio Grande do Sul, Brazil
| | - Daniel Wenceslau Votto Olmedo
- Núcleo de Pesquisa em Microbiologia Médica (NUPEMM), Universidade Federal do Rio Grande-FURG, Rio Grande, Rio Grande do Sul, Brazil.,Post-graduate Program in Health Sciences-School of Medicine, Universidade Federal do Rio Grande-FURG, Rio Grande, Rio Grande do Sul, Brazil
| | - Milene Machado Paz
- Núcleo de Pesquisa em Microbiologia Médica (NUPEMM), Universidade Federal do Rio Grande-FURG, Rio Grande, Rio Grande do Sul, Brazil.,Post-graduate Program in Health Sciences-School of Medicine, Universidade Federal do Rio Grande-FURG, Rio Grande, Rio Grande do Sul, Brazil
| | - Daniela Fernandes Ramos
- Núcleo de Pesquisa em Microbiologia Médica (NUPEMM), Universidade Federal do Rio Grande-FURG, Rio Grande, Rio Grande do Sul, Brazil.,Post-graduate Program in Health Sciences-School of Medicine, Universidade Federal do Rio Grande-FURG, Rio Grande, Rio Grande do Sul, Brazil
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6
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Niek WK, Teh CSJ, Idris N, Sit PS, Lee YQ, Thong KL, Sri La Sri Ponnampalavanar S. Methicillin-resistant Staphylococcus aureus bacteraemia, 2003-2015: Comparative evaluation of changing trends in molecular epidemiology and clinical outcomes of infections. INFECTION GENETICS AND EVOLUTION 2020; 85:104567. [PMID: 32980576 DOI: 10.1016/j.meegid.2020.104567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a prominent pathogen causing invasive infections such as bacteraemia. The continued excessive use of antibiotics to treat MRSA infections has resulted in the evolution of antimicrobial resistant of S. aureus. This study aims to perform a comparative evaluation of changing trends in molecular epidemiology of MRSA and clinical characteristics of patients. This study shows that ST22-MRSA-IV has gradually replaced ST239-MRSA-III as the predominant MRSA clone in the tertiary teaching hospital studied. Independent predictors of mortality among patients included devices in situ at the time of infection, pre-exposure to macrolides, catheter-related bloodstream infection and mono-microbial infection. Hence, our study affirmed community-associated MRSA, which was previously identified from individuals without any exposure to healthcare settings, has now emerged in healthcare settings, causing healthcare-associated MRSA infections.
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Affiliation(s)
- Wen Kiong Niek
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia..
| | - Nuryana Idris
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Pik San Sit
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yee Qing Lee
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kwai Lin Thong
- NANOCAT Research Centre, University of Malaya, 50603, Kuala Lumpur, Malaysia
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7
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Joo EJ, Park DA, Kang CI, Chung DR, Song JH, Lee SM, Peck KR. Reevaluation of the impact of methicillin-resistance on outcomes in patients with Staphylococcus aureus bacteremia and endocarditis. Korean J Intern Med 2019; 34:1347-1362. [PMID: 29347812 PMCID: PMC6823568 DOI: 10.3904/kjim.2017.098] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/08/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/AIMS Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals, and has recently emerged in the community. The impact of methicillin-resistance on mortality and medical costs for patients with S. aureus bacteremia (SAB) requires reevaluation. METHODS We searched studies with SAB or endocarditis using electronic databases including Ovid-Medline, Embase-Medline, and Cochrane Library, as well as five local databases for published studies during the period January 2000 to September 2011. RESULTS A total of 2,841 studies were identified, 62 of which involved 17,563 adult subjects and were selected as eligible. A significant increase in overall mortality associated with MRSA, compared to that with methicillin-susceptible S. aureus (MSSA), was evidenced by an odds ratio (OR) of 1.95 (95% confidence interval [CI], 1.73 to 2.21; p < 0.01). In 13 endocarditis studies, MRSA increased the risk of mortality, with an OR of 2.65 (95% CI, 1.46 to 4.80). When three studies, which compared mortality rates between CA-MRSA and CA-MSSA, were combined, the risk of methicillin-resistance increased 3.23-fold compared to MSSA (95% CI, 1.25 to 8.34). The length of hospital stay in the MRSA group was 10 days longer than that in the MSSA group (95% CI, 3.36 to 16.70). Of six studies that reported medical costs, two were included in the analysis, which estimated medical costs to be $9,954.58 (95% CI, 8,951.99 to 10,957.17). CONCLUSION MRSA is still associated with increased mortality, longer hospital stays and medical costs, compared with MSSA in SAB in studies published since the year 2000.
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Affiliation(s)
- Eun-Jeong Joo
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ah Park
- Office of Health Technology Evaluation, National Evidence-based Healthcare Collaboration Agency, Seoul, Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hoon Song
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Moo Lee
- Office of Health Technology Evaluation, National Evidence-based Healthcare Collaboration Agency, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Kyong Ran Peck, M.D. Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-0329 Fax: +82-2-3410-0064 E-mail:
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8
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Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev 2018; 31:e00020-18. [PMID: 30209034 PMCID: PMC6148192 DOI: 10.1128/cmr.00020-18] [Citation(s) in RCA: 736] [Impact Index Per Article: 122.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus, a major human pathogen, has a collection of virulence factors and the ability to acquire resistance to most antibiotics. This ability is further augmented by constant emergence of new clones, making S. aureus a "superbug." Clinical use of methicillin has led to the appearance of methicillin-resistant S. aureus (MRSA). The past few decades have witnessed the existence of new MRSA clones. Unlike traditional MRSA residing in hospitals, the new clones can invade community settings and infect people without predisposing risk factors. This evolution continues with the buildup of the MRSA reservoir in companion and food animals. This review focuses on imparting a better understanding of MRSA evolution and its molecular characterization and epidemiology. We first describe the origin of MRSA, with emphasis on the diverse nature of staphylococcal cassette chromosome mec (SCCmec). mecA and its new homologues (mecB, mecC, and mecD), SCCmec types (13 SCCmec types have been discovered to date), and their classification criteria are discussed. The review then describes various typing methods applied to study the molecular epidemiology and evolutionary nature of MRSA. Starting with the historical methods and continuing to the advanced whole-genome approaches, typing of collections of MRSA has shed light on the origin, spread, and evolutionary pathways of MRSA clones.
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Affiliation(s)
- Sahreena Lakhundi
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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9
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Melese ZT, Mwalili SM, Orwa GO. Threshold dynamics of the Transmission of Antibiotic-Resistant Infections. Biosystems 2018; 171:80-92. [PMID: 29953912 DOI: 10.1016/j.biosystems.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/18/2018] [Accepted: 06/22/2018] [Indexed: 11/16/2022]
Abstract
Despite numerous studies conducted, multidrug-resistant infections such as methicillin-resistant Staphylococcus aureus (MRSE) and vancomycin-resistant enterococci (VRE) are still increasing in hospitals, and yet continued to be the important challenges of worldwide health. Mathematical modeling gives an insightful information in policy and decision making to control the transmission and spread of these infections globally. We formulated and analyse a mathematical model to characterise the transmission co-dynamics of hospital-acquired MRSE (HA-MRSA) and community-acquired MRSE (CA-MRSA) and to investigate the long run competitiveness of the two strains in hospital. Numerical simulations are carried out to explore the basic reproduction numbers for the two strains so as to determine the dominant strain in the future in hospital setting. Under some conditions, invasion reproduction numbers are also applied to determine the uniform persistence of the two strains. We further performed sensitivity analysis to examine the influence of model parameters on the transmission and spread of the the strains, thereby determine the effective intervention strategies that reduce the overflow of the infections in hospital setting. To support theoretical findings qualitatively, graphical representations are provided.
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Affiliation(s)
- Zinabu Teka Melese
- Pan African University Institute for Basic Sciences, Technology and Innovation, Nairobi, Kenya.
| | - S M Mwalili
- Department of Statistics and Actuarial Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | - G O Orwa
- Department of Statistics and Actuarial Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
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10
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Joo EJ, Chung DR, Kim SH, Baek JY, Lee NY, Cho SY, Ha YE, Kang CI, Peck KR, Song JH. Emergence of Community-Genotype Methicillin-Resistant Staphylococcus aureus in Korean Hospitals: Clinical Characteristics of Nosocomial Infections by Community-Genotype Strain. Infect Chemother 2017; 49:109-116. [PMID: 28608660 PMCID: PMC5500265 DOI: 10.3947/ic.2017.49.2.109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/15/2017] [Indexed: 01/23/2023] Open
Abstract
Background As community-genotype methicillin-resistant Staphylococcus aureus (MRSA) strains spread into hospitals, the genotypes of the MRSA strains causing hospital-acquired (HA) infections have become more diverse. We describe clinical characteristics of nosocomial MRSA infections by a community-genotype of sequence type (ST) 72. Materials and Methods A case-control study was designed among patients with HA-MRSA infections. Forty patients with infections caused by ST72-MRSA SCCmec type IV were selected as cases. Cases were matched to the controls with 106 patients infected with ST5/ST239 MRSA, which are representative hospital genotypes in Korea. Results Patients infected with ST72 isolates were younger than those with ST5/ST239 isolates. Female gender predominated among ST72 MRSA group compared to ST5/ST239 MRSA group. Solid tumor was a more frequent underlying disease in MRSA infections by ST72 isolates, whereas underlying renal, lung, heart, and neurologic diseases were more frequently found in those by ST5/ST239 isolates. The most common type of infection was pneumonia in both ST72 and ST5/ST239 groups (45.0% vs. 51.9%), followed by skin and soft tissue infection (SSTI). Female gender and underlying solid tumor were identified to be independent predictors for MRSA infections by ST72 isolates. All-cause mortality rates (20.0% vs. 30.2%) were not different between the groups. Conclusion A community-genotype MRSA, ST72 isolate has emerged as a nosocomial pathogen presenting as hospital-acquired pneumonia and SSTI. Although differences in underlying disorders were found, the distribution of infection type and mortality rate did not differ between the groups.
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Affiliation(s)
- Eun Jeong Joo
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea.
| | - So Hyun Kim
- Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
| | - Jin Yang Baek
- Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Eun Ha
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol In Kang
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Song
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
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11
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Ding W, Webb GF. Optimal control applied to community-acquired methicillin-resistant Staphylococcus aureus in hospitals. JOURNAL OF BIOLOGICAL DYNAMICS 2017; 11:65-78. [PMID: 26916119 DOI: 10.1080/17513758.2016.1151564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Optimal control methods are applied to a deterministic mathematical model to characterize the factors contributing to the replacement of hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), and quantify the effectiveness of three interventions aimed at limiting the spread of CA-MRSA in healthcare settings. Characterizations of the optimal control strategies are established, and numerical simulations are provided to illustrate the results.
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Affiliation(s)
- Wandi Ding
- a Department of Mathematical Sciences and Computational Science Program , Middle Tennessee State University , Murfreesboro , USA
| | - Glenn F Webb
- b Department of Mathematics , Vanderbilt University , Nashville , USA
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12
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Joo EJ, Choi JY, Chung DR, Song JH, Ko KS. Characteristics of the community-genotype sequence type 72 methicillin-resistant Staphylococcus aureus isolates that underlie their persistence in hospitals. J Microbiol 2016; 54:445-50. [PMID: 27225462 DOI: 10.1007/s12275-016-6157-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
Panton-Valentine leukocidin-negative methicillin-resistant Staphylococcus aureus (MRSA) clone ST72, known as a major community-associated MRSA in Korea, has emerged as an important pathogen in hospitals. To understand bacterial properties that underlie transformation of this clone into a nosocomial pathogen, we compared characteristics of the community-genotype ST72 MRSA isolates with those of ST5 and ST239 MRSA, which have been predominant nosocomial MRSA clones in Korea. Several genes associated with adhesion and virulence were absent or rarely found in ST72 isolates. Many ST72 isolates (70.1%) belonged to agr group I, but the agr group of other ST72 isolates could not be determined. As indicated by d-hemolysin production, ST72 isolates expressed fully functional agr, whereas agr dysfunction was observed in ST5 and ST239 isolates. In the biofilm formation assay, no upregulation of biofilm-forming activity of ST72 MRSA was detected. However, ST72 isolates demonstrated persistence under hypotonic and desiccating conditions (survival rates 72.3% and 33.9%, respectively), which was similar to characteristics of ST5 or ST239 isolates. ST72- MRSA isolates showed low virulence, but properties of their functional agr system could facilitate their spread in hospitals. In conclusion, tolerance to stressful environments, e.g., hypotonic and dry conditions, may also contribute to survival of the community-associated MRSA clones in healthcare facilities.
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Affiliation(s)
- Eun-Jeong Joo
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Republic of Korea
| | - Ji-Young Choi
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, 16419, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea.,Asia-Pacific Foundation for Infectious Diseases (APFID), Seoul, 06351, Republic of Korea
| | - Jae-Hoon Song
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea.,Asia-Pacific Foundation for Infectious Diseases (APFID), Seoul, 06351, Republic of Korea
| | - Kwan Soo Ko
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, 16419, Republic of Korea. .,Asia-Pacific Foundation for Infectious Diseases (APFID), Seoul, 06351, Republic of Korea.
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Pokhrel RH, Aung MS, Thapa B, Chaudhary R, Mishra SK, Kawaguchiya M, Urushibara N, Kobayashi N. Detection of ST772 Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus (Bengal Bay clone) and ST22 S. aureus isolates with a genetic variant of elastin binding protein in Nepal. New Microbes New Infect 2016; 11:20-7. [PMID: 27014464 PMCID: PMC4789347 DOI: 10.1016/j.nmni.2016.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 11/25/2022] Open
Abstract
Genetic characteristics were analysed for recent clinical isolates of methicillin-resistant and -susceptible Staphylococcus aureus (MRSA and MSSA respectively) in Kathmandu, Nepal. MRSA isolates harbouring Panton-Valentine leukocidin (PVL) genes were classified into ST1, ST22 and ST88 with SCCmec-IV and ST772 with SCCmec-V (Bengal Bay clone), while PVL-positive MSSA into ST22, ST30 and ST772. ST22 isolates (PVL-positive MRSA and MSSA, PVL-negative MRSA) possessed a variant of elastin binding protein gene (ebpS) with an internal deletion of 180 bp, which was similar to that reported for ST121 S. aureus previously outside Nepal. Phylogenetic analysis indicated that the ebpS variant in ST22 might have occurred independently of ST121 strains. This is the first report of ST772 PVL-positive MRSA in Nepal and detection of the deletion variant of ebpS in ST22 S. aureus.
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Affiliation(s)
- R H Pokhrel
- Genesis Laboratory and Research, Tribhuvan University, Kathmandu, Nepal
| | - M S Aung
- Sapporo Medical University, Sapporo, Japan
| | - B Thapa
- Genesis Laboratory and Research, Tribhuvan University, Kathmandu, Nepal
| | - R Chaudhary
- Nepal Army Institute of Health Sciences, Tribhuvan University, Kathmandu, Nepal
| | - S K Mishra
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Aung M, Zi H, Nwe K, Maw W, Aung M, Min W, Nyein N, Kawaguchiya M, Urushibara N, Sumi A, Kobayashi N. Drug resistance and genetic characteristics of clinical isolates of staphylococci in Myanmar: high prevalence of PVL among methicillin-susceptible Staphylococcus aureus belonging to various sequence types. New Microbes New Infect 2016; 10:58-65. [PMID: 27257489 PMCID: PMC4877606 DOI: 10.1016/j.nmni.2015.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/29/2015] [Indexed: 11/17/2022] Open
Abstract
Prevalence, drug resistance and genetic characteristics were analysed for a total of 128 clinical isolates of staphylococci obtained from a tertiary hospital in Myanmar. The dominant species were S. aureus (39%) and S. haemolyticus (35%), followed by S. epidermidis (6%) and S. saprophyticus (5%). The majority of S. haemolyticus isolates (71.1%) harboured mecA, showing high resistance rates to ampicillin, cephalosporins, erythromycin and levofloxacin, while methicillin-resistant S. aureus (MRSA) was only 8% (four isolates) among S. aureus with type IV SCCmec. Panton-Valentine leukocidin (PVL) genes were detected in 20 isolates of S. aureus (40%), among which only one isolate was MRSA belonging to sequence type (ST) 88/agr-III/coa-IIIa, and the other 19 methicillin-susceptible S. aureus (MSSA) isolates were classified into six STs (ST88, ST121, ST1153, ST1155, ST1930, ST3206). An ST1153 MSSA isolate with PVL was revealed to belong to a novel coa type, XIIIa. ST121 S. aureus was the most common in the PVL-positive MSSA (47%, 9/19), harbouring genes of bone sialoprotein and variant of elastin binding protein as a distinctive feature. Although PVL-positive MSSA was susceptible to most of the antimicrobial agents examined, ST1930 isolates were resistant to erythromycin and levofloxacin. ST59 PVL-negative MRSA and MSSA had more resistance genes than other MRSA and PVL-positive MSSA, showing resistance to more antimicrobial agents. This study indicated higher prevalence of mecA associated with multiple drug resistance in S. haemolyticus than in S. aureus, and dissemination of PVL genes to multiple clones of MSSA, with ST121 being dominant, among hospital isolates in Myanmar.
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Affiliation(s)
- M.S. Aung
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - H. Zi
- Department of Microbiology, University of Medicine 2, Yangon, Myanmar
| | - K.M. Nwe
- National Health Laboratory, Yangon, Myanmar
| | - W.W. Maw
- Department of Microbiology, University of Medicine 2, Yangon, Myanmar
| | - M.T. Aung
- Pathology Department, Microbiology Section, North Okkalapa General Hospital, Yangon, Myanmar
| | - W.W. Min
- Department of Microbiology, University of Medicine Magway, Magway, Myanmar
| | - N. Nyein
- Department of Microbiology, University of Medicine, Mandalay, Myanmar
| | - M. Kawaguchiya
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - N. Urushibara
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - A. Sumi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - N. Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
- Corresponding author: N. Kobayashi, Department of Hygiene, Sapporo Medical University School of Medicine, S-1 W-17, Chuo-ku, Sapporo 060-8556, Japan
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Park SH, Park C, Yoo JH, Choi SM, Choi JH, Shin HH, Lee DG, Lee S, Kim J, Choi SE, Kwon YM, Shin WS. Emergence of Community-Associated Methicillin-ResistantStaphylococcus aureusStrains as a Cause of Healthcare-Associated Bloodstream Infections in Korea. Infect Control Hosp Epidemiol 2015; 30:146-55. [DOI: 10.1086/593953] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.The prevalence of community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) strains causing bloodstream infection (BSI) has not been studied in Korea.Objective.We sought to determine the prevalence of CA-MRSA strains among isolates recovered from patients with MRSA BSIs and to explore epidemiological changes in Korea. We also sought to evaluate clinical characteristics relevant to the development of healthcare-associated BSIs.Methods.We prospectively collected consecutive MRSA isolates from patients with BSI at 4 hospitals from July 1 through November 30, 2007, and we also included MRSA isolates recovered from culture of blood samples collected during a previous year (October 1, 2004 through September 30, 2005) at a different hospital. Molecular typing studies were performed, including pulsed-field gel electrophoresis (PFGE), multilocus sequence typing,Staphylococcusprotein A (spa) typing, and staphylococcal cassette chromosomemec(SCCmec) typing. We compared the clinical characteristics and outcomes of patients with healthcare-associated BSI due to CA-MRSA strains with those of patients with healthcare-associated BSI due to healthcare-associated MRSA (HA-MRSA) strains.Results.There were 76 cases of MRSA BSI, of which 4 (5.3%) were community-associated and 72 (94.7%) were healthcare-associated. Among the 72 HA-MRSA BSIs, 18 (25%) were community onset, and 54 (75%) were hospital onset. PFGE type D-ST72–spaB-SCCmectype IVA MRSA, the predominant genotype of CA-MRSA in Korea, accounted for 19 (25%) of all 76 MRSA BSIs, including 17 (23.6%) of 72 HA-MRSA BSIs and 11 (20.8%) of 53 hospital-onset HA-MRSA BSIs. Patients with healthcare-associated BSIs due to CA-MRSA strains carrying SCCmectype IVA tended to have fewer healthcare-associated risk factors, compared with patients with healthcare-associated BSIs due to HA-MRSA strains carrying other SCCmectypes. The presence of a central venous catheter or other invasive device was the only independent factor differentiating patients infected with hospital-associated genotype strains from patients infected with other strains. Clinical outcomes were similar between both groups.Conclusions.CA-MRSA strains are emerging as a major cause of BSI in healthcare settings in Korea. This changing epidemiology of MRSA poses a challenge to public health and infection control in hospital settings.
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Stryjewski ME, Corey GR. Methicillin-resistant Staphylococcus aureus: an evolving pathogen. Clin Infect Dis 2014; 58 Suppl 1:S10-9. [PMID: 24343827 DOI: 10.1093/cid/cit613] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The horizontal transmission of methicillin resistance to Staphylococcus aureus (MRSA) in hospital and community settings, and growing prevalence of these strains, presents a significant clinical challenge to the management of serious infections worldwide. While infection control initiatives have stemmed the rising prevalence, MRSA remains a significant pathogen. More recently, evidence that MRSA is becoming resistant to glycopeptides and newer therapies raises concern about the use of these therapies in clinical practice. Vancomycin resistance has become evident in select clinical settings through rising MICs, growing awareness of heteroresistance, and emergence of intermediate-resistant and fully resistant strains. While resistance to linezolid and daptomycin remains low overall, point mutations leading to resistance have been described for linezolid, and horizontal transmission of cfr-mediated resistance to linezolid has been reported in clinical isolates. These resistance trends for newer therapies highlight the ongoing need for new and more potent antimicrobial therapies.
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Affiliation(s)
- Martin E Stryjewski
- Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Buenos Aires, Argentina
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Cardinal P, Anderson JC, Carlson JC, Low JE, Challis JK, Beattie SA, Bartel CN, Elliott AD, Montero OF, Lokesh S, Favreau A, Kozlova TA, Knapp CW, Hanson ML, Wong CS. Macrophytes may not contribute significantly to removal of nutrients, pharmaceuticals, and antibiotic resistance in model surface constructed wetlands. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 482-483:294-304. [PMID: 24657374 DOI: 10.1016/j.scitotenv.2014.02.095] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 06/03/2023]
Abstract
Outdoor shallow wetland mesocosms, designed to simulate surface constructed wetlands to improve lagoon wastewater treatment, were used to assess the role of macrophytes in the dissipation of wastewater nutrients, selected pharmaceuticals, and antibiotic resistance genes (ARGs). Specifically, mesocosms were established with or without populations of Typha spp. (cattails), Myriophyllum sibiricum (northern water milfoil), and Utricularia vulgaris (bladderwort). Following macrophyte establishment, mesocosms were seeded with ARG-bearing organisms from a local wastewater lagoon, and treated with a single pulse of artificial municipal wastewater with or without carbamazepine, clofibric acid, fluoxetine, and naproxen (each at 7.6μg/L), as well as sulfamethoxazole and sulfapyridine (each at 150μg/L). Rates of pharmaceutical dissipation over 28d ranged from 0.073 to 3.0d(-1), corresponding to half-lives of 0.23 to 9.4d. Based on calculated rate constants, observed dissipation rates were consistent with photodegradation driving clofibric acid, naproxen, sulfamethoxazole, and sulfapyridine removal, and with sorption also contributing to carbamazepine and fluoxetine loss. Of the seven gene determinants assayed, only two genes for both beta-lactam resistance (blaCTX and blaTEM) and sulfonamide resistance (sulI and sulII) were found in sufficient quantity for monitoring. Genes disappeared relatively rapidly from the water column, with half-lives ranging from 2.1 to 99d. In contrast, detected gene levels did not change in the sediment, with the exception of sulI, which increased after 28d in pharmaceutical-treated systems. These shallow wetland mesocosms were able to dissipate wastewater contaminants rapidly. However, no significant enhancement in removal of nutrients or pharmaceuticals was observed in mesocosms with extensive aquatic plant communities. This was likely due to three factors: first, use of naïve systems with an unchallenged capacity for nutrient assimilation and contaminant removal; second, nutrient sequestration by ubiquitous filamentous algae; and third, dominance of photolytic processes in the removal of pharmaceuticals, which overshadowed putative plant-related processes.
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Affiliation(s)
- Pascal Cardinal
- Department of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Julie C Anderson
- Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Jules C Carlson
- Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Jennifer E Low
- Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Jonathan K Challis
- Department of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Sarah A Beattie
- Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Caitlin N Bartel
- Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Ashley D Elliott
- Department of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Oscar F Montero
- Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Department of Environmental Engineering, Costa Rica Institute of Technology, Cartago 30101, Costa Rica; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Sheetal Lokesh
- Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Alex Favreau
- Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Tatiana A Kozlova
- Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Charles W Knapp
- Department of Civil & Environmental Engineering, University of Strathclyde, Glasgow, Scotland G1 1XJ, United Kingdom
| | - Mark L Hanson
- Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Charles S Wong
- Department of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; Richardson College for the Environment, Department of Environmental Studies and Sciences, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada; Richardson College for the Environment, Department of Chemistry, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada.
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Rahimi F, Katouli M, Pourshafie MR. Characteristics of hospital- and community-acquired meticillin-resistant Staphylococcus aureus in Tehran, Iran. J Med Microbiol 2014; 63:796-804. [PMID: 24648470 DOI: 10.1099/jmm.0.070722-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Staphylococcus aureus is a leading cause of hospital-acquired (HA) and community-acquired (CA) infections worldwide. Recently, S. aureus strains resistant to meticillin (MRSA) have become established within both communities. We isolated 314 isolates of MRSA from hospitalized patients in a referral hospital (HA isolates) and 268 isolates from its outpatient clinic (CA isolates) in Tehran, Iran, between February 2008 and December 2010. These isolates were tested for their susceptibility to 17 antibiotics and typed using the PhPlate system. The diversity in the structures of staphylococcal cassette chromosome mec (SCCmec) elements and ccr types was also detected using a multiplex-PCR assay and isolates were examined for the presence of different classes of prophages. Whilst all isolates were resistant to penicillin, the HA isolates were significantly more resistant to all other antibiotics tested than the CA isolates. Isolates carrying only SCCmec type III and ccr type 3 were dominant (91 %), but 20 % of the CA isolates belonging to less prevalent types carried only SCCmec types IVa, c and ccr type 2. These isolates also carried pvl genes and contained SGA prophage type. Our results indicate that whilst the dominant clonal groups of HA- and CA-MRSA belong to SCCmec type III and carry ccr type 3 genes, several distinct but less prevalent types of CA-MRSA carrying SCCmec type IVa, c and type 2 ccr are also found in Tehran. These strains carry pvl genes and the SGA prophage type, a characteristic that might be used as a marker for detection of CA-MRSA in this country.
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Affiliation(s)
- Fateh Rahimi
- Department of Microbiology, Faculty of Science, University of Isfahan, Iran
| | - Mohammad Katouli
- Genecology Research Centre, Faculty of Science, Health and Education and Engineering, University of the Sunshine Coast, Queensland, Australia
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Loffler CA, MacDougall C. Update on prevalence and treatment of methicillin-resistantStaphylococcus aureusinfections. Expert Rev Anti Infect Ther 2014; 5:961-81. [DOI: 10.1586/14787210.5.6.961] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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20
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Gomez E, Chiang T, Hogan PA, Myers DE, Huang DB. Methicillin-Resistant <i>Staphylococcus aureus</i> SCC<i>mec</i> Type and Its Association with Clinical Presentation, Severity, and Length of Stay among Patients with Complicated Skin and Skin Structure Infections. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/aid.2014.42017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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DELORENZE GN, HORBERG MA, SILVERBERG MJ, TSAI A, QUESENBERRY CP, BAXTER R. Trends in annual incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in HIV-infected and HIV-uninfected patients. Epidemiol Infect 2013; 141:2392-402. [PMID: 23419708 PMCID: PMC9151362 DOI: 10.1017/s0950268813000228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 11/06/2022] Open
Abstract
We describe trends in incidence rates of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected and HIV-uninfected patients enrolled in a large northern California Health Plan, and the ratio of MRSA to methicillin-susceptible S. aureus (MSSA) case counts. Between 1995 and 2010, 1549 MRSA infections were diagnosed in 14060 HIV-infected patients (11·0%) compared to 89546 MRSA infections in 6597396 HIV-uninfected patients (1·4%) (P = 0·00). A steady rise in MRSA infection rates began in 1995 in HIV-uninfected patients, peaking at 396·5 infections/100000 person-years in 2007. A more rapid rise in MRSA infection rates occurred in the HIV-infected group after 2000, peaking at 3592·8 infections/100000 in 2005. A declining trend in MRSA rates may have begun in 2008-2009. Comparing the ratio of MRSA to MSSA case counts, we observed that HIV-infected patients shouldered a greater burden of MRSA infection during most years of study follow-up compared to HIV-uninfected patients.
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Affiliation(s)
- G. N. DELORENZE
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - M. A. HORBERG
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - M. J. SILVERBERG
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - A. TSAI
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - C. P. QUESENBERRY
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - R. BAXTER
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
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Hu J, Ma XX, Tian Y, Pang L, Cui LZ, Shang H. Reduced vancomycin susceptibility found in methicillin-resistant and methicillin-sensitive Staphylococcus aureus clinical isolates in Northeast China. PLoS One 2013; 8:e73300. [PMID: 24069184 PMCID: PMC3772004 DOI: 10.1371/journal.pone.0073300] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/18/2013] [Indexed: 11/18/2022] Open
Abstract
Background Strains of Staphylococcus aureus with an intermediate level of resistance to vancomycin (vancomycin-intermediate S. aureus, or VISA) or which contain subpopulations of mixed susceptibility (heterogeneous VISA, or hVISA) have been reported worldwide. However, the prevalence of VISA and hVISA infections in Northeast China is unknown. From 2007 through 2010, we surveyed the vancomycin susceptibility of methicillin-resistant and methicillin-sensitive S. aureus (MRSA and MSSA, respectively) clinical isolates in Northeast China. Methods S. aureus clinical isolates (369 MRSA and 388 MSSA) were screened for hVISA and VISA on brain heart infusion agar containing 3 μg/mL vancomycin, and their identity confirmed using a modified population analysis profile-area under the curve method and broth microdilution. All hVISA and VISA isolates were characterized genotypically and phenotypically. Results Ten percent and 0.5 percent of the isolates were hVISA and VISA, respectively. The proportion of hVISA among MSSA isolates for the entire study period was 4.1%, but increased significantly year-by-year, from 1.2% in 2007 to 7.2% in 2010. The predominant sources of hVISA and VISA isolates were sputum (56.3%), pus (18.8%), and blood (8.8%). Molecular typing of hVISA and VISA strains revealed that, taken together, 80% contained the accessory gene regulator (agr) group II, and of these, 85.7% of the MR-hVISA and MR-VISA strains were staphylococcal cassette chromosome mec (SCCmec) type II. The adherence ability of all hVISA and VISA strains was reduced compared with that of vancomycin-susceptible strains, shown by biofilm assay. Conclusions The percentage of hVISA strains was high and increased each year. The proportion of hVISA among MSSA specifically also increased significantly each year. In isolates collected from diverse infection sites, hVISA and VISA strains were found predominantly in sputum, pus, and blood, in descending order. Testing for vancomycin susceptibility should include both MRSA and MSSA isolates collected from different clinical sites.
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Affiliation(s)
- Jian Hu
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
- Department of Clinical Laboratory, Yixing Hospital of Traditional Chinese Medicine, Yixing, Jiangsu, People's Republic of China
| | - Xiao Xue Ma
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Yuan Tian
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Long Pang
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Long Zhu Cui
- Research Center for Anti-infectious Drugs, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Hong Shang
- Department of Clinical Laboratory, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
- * E-mail:
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Antimicrobial susceptibility of Staphylococcus aureus and molecular epidemiology of meticillin-resistant S. aureus isolated from Australian hospital inpatients: Report from the Australian Group on Antimicrobial Resistance 2011 Staphylococcus aureus Surveillance Programme. J Glob Antimicrob Resist 2013; 1:149-156. [DOI: 10.1016/j.jgar.2013.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/25/2013] [Accepted: 04/15/2013] [Indexed: 11/23/2022] Open
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Papanas N, Mani R. Advances in Infections and Wound Healing for the Diabetic Foot. INT J LOW EXTR WOUND 2013; 12:83-6. [DOI: 10.1177/1534734613490507] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Raj Mani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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25
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Feng SH, Chu YJ, Wang PH, Jun X, Min D, Li XM. Risk Factors and Gene Type for Infections of MRSA in Diabetic Foot Patients in Tianjin, China. INT J LOW EXTR WOUND 2013; 12:106-12. [DOI: 10.1177/1534734613489991] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective was to study risk factors and gene type of DF patients infected with MRSA. A total of 429 DF patients were recruited. The patients with S aureus infections were divided into MRSA and MSSA groups. MRSA were genotyped by SCCmec. pvl and lukE-lukD were detected. A total of 559 pathogens were isolated from them, with G+ bacteria firstly(59.0%), followed G- bacilli (37.7%) and true fungi (3.3%). The 3 most frequently isolated pathogens were S aureus (35.2%), S epidermidis (12.3%), and Pseudomonas aeruginosa (11.2%). SCCmec III MRSA and SCCmec IVa MRSA had the same antibacterial spectrum. mecA positive rate was 100%. lukE-lukD and pvl positive rates were 100% and 0%, respectively. 28 strains belonged to SCCmec III and the others belonged to SCCmec IVa. The G+ cocci were the main pathogens, S aureus and S epidermidis were predominant among them. Antibiotic usage in 6 months prior to hospitalization, long course of ulcer, osteomyelitis and hypoproteinemia are risk factors for MRSA. SCCmec IVa is high in proportion to MRSA isolates, suggesting that CA-MRSA has become major pathogen of DF infection. All the MRSA were harboring lukE-lukD, which has been reported to present poor leucotoxin compared to pvl, and may be a response to atypical local inflammatory reaction in DF infection.
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Affiliation(s)
- Shu-Hong Feng
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Yue-Jie Chu
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Peng-Hua Wang
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xu Jun
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Ding Min
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xue-Mei Li
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
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Hudson LO, Murphy CR, Spratt BG, Enright MC, Elkins K, Nguyen C, Terpstra L, Gombosev A, Kim D, Hannah P, Mikhail L, Alexander R, Moore DF, Huang SS. Diversity of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from inpatients of 30 hospitals in Orange County, California. PLoS One 2013; 8:e62117. [PMID: 23637976 PMCID: PMC3634754 DOI: 10.1371/journal.pone.0062117] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 03/18/2013] [Indexed: 11/28/2022] Open
Abstract
There is a need for a regional assessment of the frequency and diversity of MRSA to determine major circulating clones and the extent to which community and healthcare MRSA reservoirs have mixed. We conducted a prospective cohort study of inpatients in Orange County, California, systematically collecting clinical MRSA isolates from 30 hospitals, to assess MRSA diversity and distribution. All isolates were characterized by spa typing, with selective PFGE and MLST to relate spa types with major MRSA clones. We collected 2,246 MRSA isolates from hospital inpatients. This translated to 91/10,000 inpatients with MRSA and an Orange County population estimate of MRSA inpatient clinical cultures of 86/100,000 people. spa type genetic diversity was heterogeneous between hospitals, and relatively high overall (72%). USA300 (t008/ST8), USA100 (t002/ST5) and a previously reported USA100 variant (t242/ST5) were the dominant clones across all Orange County hospitals, representing 83% of isolates. Fifteen hospitals isolated more t008 (USA300) isolates than t002/242 (USA100) isolates, and 12 hospitals isolated more t242 isolates than t002 isolates. The majority of isolates were imported into hospitals. Community-based infection control strategies may still be helpful in stemming the influx of traditionally community-associated strains, particularly USA300, into the healthcare setting.
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Affiliation(s)
- Lyndsey O. Hudson
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Courtney R. Murphy
- School of Social Ecology and Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Brian G. Spratt
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- * E-mail:
| | - Mark C. Enright
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Kristen Elkins
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Christopher Nguyen
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Leah Terpstra
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Adrijana Gombosev
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Diane Kim
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Paul Hannah
- Orange County Health Care Agency, Santa Ana, California, United States of America
| | - Lydia Mikhail
- Orange County Health Care Agency, Santa Ana, California, United States of America
| | - Richard Alexander
- Orange County Health Care Agency, Santa Ana, California, United States of America
| | - Douglas F. Moore
- Orange County Health Care Agency, Santa Ana, California, United States of America
| | - Susan S. Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, United States of America
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Rodrigues MVP, Fortaleza CMCB, Riboli DFM, Rocha RS, Rocha C, da Cunha MDLRDS. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in a burn unit from Brazil. Burns 2013; 39:1242-9. [PMID: 23597850 DOI: 10.1016/j.burns.2013.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/13/2013] [Accepted: 02/13/2013] [Indexed: 11/25/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) poses a threat for patients in burn units. Studies that mix epidemiological designs with molecular typing may contribute to the development of strategies for MRSA control. We conducted a study including: molecular characterization of Staphylococcal Chromosome Cassette mecA (SCCmec), strain typing with pulsed field gel electrophoresis (PFGE) and detection of virulence genes, altogether with a case-case-control study that assessed risk factors for MRSA and for methicillin-susceptible S. aureus (MSSA), using S. aureus negative patients as controls. Strains were collected from clinical and surveillance cultures from October 2006 through March 2009. MRSA was isolated from 96 patients. Most isolates (94.8%) harbored SCCmec type III. SCCmec type IV was identified in isolates from four patients. In only one case it could be epidemiologically characterized as "community-associated". PFGE typing identified 36 coexisting MRSA clones. When compared to MSSA (38 isolates), MRSA isolates were more likely to harbor two virulence genes: tst and lukPV. Previous stay in other hospital and admission to Intensive Care Unit were independent risk factors for both MRSA and MSSA, while the number of burn wound excisions was significantly related with the former (OR=6.80, 95%CI=3.54-13.07). In conclusion, our study found polyclonal endemicity of MRSA in a burn unit, possibly related to importing of strains from other hospitals. Also, it pointed out to a role of surgical procedures in the dissemination of MRSA strains.
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Affiliation(s)
- Marcus Vinicius Pimenta Rodrigues
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu, Unesp - Univ Estadual Paulista (São Paulo State University), Botucatu city, São Paulo State, Brazil
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Buntaran L, Hatta M, Sultan AR, Dwiyanti R, Sabir M. Sccmec type II gene is common among clinical isolates of methicillin-resistant Staphylococcus aureus in Jakarta, Indonesia. BMC Res Notes 2013; 6:110. [PMID: 23522081 PMCID: PMC3637602 DOI: 10.1186/1756-0500-6-110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 03/18/2013] [Indexed: 12/02/2022] Open
Abstract
Background Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) is a strain of MRSA that can cause infections in patients in the community, in which these patients had no previous risk factors for MRSA infection and the patient received 72 hours prior to infection when admitted to hospital. This study aims to determine and compare the characteristics of epidemiological, clinical, and molecular biology of CA-MRSA with HA-MRSA. Methods A total of 11 clinical strains of Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Stapylococcus aureus (MSSA) were collected from 2 hospitals in Jakarta, Indonesia in 2012. SCCmec typing was performed by multiplex polymerase chain reaction (PCR) and the presence of six genes (vraR, vraG, vraA, vraF,fruA, and fruB) associated with vancomycin resistance was examined by simple PCR analysis. Results We found three strains of community-acquired MRSA with SCCmec type II and one strain of hospital-acquired MRSA with SCCmec type IV. The other seven strains did not contain mecA genes and SCCmec. Plasmid pUB110 was found in one strain of community-acquired MRSA and two strains of hospital-acquired MRSA. vraA genes were present in 9 of the 11 strains, vraF in 4, vraG in 5, and vraR in 4. Note worthily, three quarters of strains without pUB110 contained vraR and vraF, and 70% contained vraA, whereas 60% of strains with pUB110 contained vraG. Conclusion Based on these results, we should be concerned about the possibility of transition from MRSA strains sensitive to vancomycin in VISA strains of MRSA strains obtained in clinical trials. But first we need to look the existence of natural VISA or hVISA among these MRSA strains.
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Affiliation(s)
- Latre Buntaran
- Department of Microbiology, RSAB Harapan Kita, Jakarta, Indonesia
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Bootsma MCJ, Bonten MJM. Editorial Commentary: Unraveling the Dynamics of Community-Associated Methicillin-Resistant Staphylococcus aureus. Clin Infect Dis 2013; 56:1075-7. [DOI: 10.1093/cid/cit013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Shallcross LJ, Fragaszy E, Johnson AM, Hayward AC. The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2013; 13:43-54. [PMID: 23103172 PMCID: PMC3530297 DOI: 10.1016/s1473-3099(12)70238-4] [Citation(s) in RCA: 290] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Invasive community-onset staphylococcal disease has emerged worldwide associated with Panton-Valentine leucocidin (PVL) toxin. Whether PVL is pathogenic or an epidemiological marker is unclear. We investigate the role of PVL in disease, colonisation, and clinical outcome. METHODS We searched Medline and Embase for original research reporting the prevalence of PVL genes among Staphylococcus aureus pneumonia, bacteraemia, musculoskeletal infection, skin and soft-tissue infection, or colonisation published before Oct 1, 2011. We calculated odds ratios (ORs) to compare patients with PVL-positive colonisation and each infection relative to the odds of PVL-positive skin and soft-tissue infection. We did meta-analyses to estimate odds of infection or colonisation with a PVL-positive strain with fixed-effects or random-effects models, depending on the results of tests for heterogeneity. RESULTS Of 509 articles identified by our search strategy, 76 studies from 31 countries met our inclusion criteria. PVL strains are strongly associated with skin and soft-tissue infections, but are comparatively rare in pneumonia (OR 0·37, 95% CI 0·22-0·63), musculoskeletal infections (0·44, 0·19-0·99), bacteraemias (0·10, 0·06-0·18), and colonising strains (0·07, 0·01-0·31). PVL-positive skin and soft-tissue infections are more likely to be treated surgically than are PVL-negative infections, and children with PVL-positive musculoskeletal disease might have increased morbidity. For other forms of disease we identified no evidence that PVL affects outcome. INTERPRETATION PVL genes are consistently associated with skin and soft-tissue infections and are comparatively rare in invasive disease. This finding challenges the view that PVL mainly causes invasive disease with poor prognosis. Population-based studies are needed to define the role of PVL in mild, moderate, and severe disease and to inform control strategies. FUNDING None.
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Affiliation(s)
- Laura J Shallcross
- Research Department of Infection and Population Health, University College London, London, UK.
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Han JH, Edelstein PH, Bilker WB, Lautenbach E. The effect of staphylococcal cassette chromosome mec (SCCmec) type on clinical outcomes in methicillin-resistant Staphylococcus aureus bacteremia. J Infect 2013; 66:41-7. [PMID: 22960078 PMCID: PMC3518704 DOI: 10.1016/j.jinf.2012.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 08/31/2012] [Accepted: 09/02/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The impact of staphylococcal cassette chromosome mec (SCCmec) type on mortality in methicillin-resistant Staphylococcus aureus (MRSA) infections remains unclear. The objective of this study was to determine the association between SCCmec type and mortality in MRSA bacteremia. METHODS A cohort study of patients who were hospitalized with MRSA bacteremia was conducted within a university health system. A multivariable logistic regression model was developed to evaluate the association of SCCmec type with 30-day in-hospital mortality. RESULTS Thirty-four of a total of 184 patients with MRSA bacteremia died, resulting in a mortality rate of 18.5%. Adjusted risk factors for 30-day mortality included APRDRG Risk of Mortality score (odds ratio [OR], 5.33; 95% confidence interval [CI], 2.28-12.4; P<0.001), white blood cell count (OR, 1.09; 95% CI, 1.03-1.15; P=0.002), and malignancy (OR, 3.25; 95% CI, 1.17-9.02; P=0.02). On multivariable analyses, SCCmec II was not significantly associated with mortality in patients with MRSA bacteremia (OR, 1.85; 95% CI, 0.69-4.92; P=0.22). CONCLUSIONS Mortality in MRSA bacteremia was independent of SCCmec type. SCCmec type II is most likely a marker for disease severity rather than a direct mediator of mortality. Further research is needed to elucidate the factors associated with poor clinical outcomes in MRSA infections.
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Affiliation(s)
- Jennifer H Han
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, 19104, USA.
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A comparison of clinical outcomes between healthcare-associated infections due to community-associated methicillin-resistant Staphylococcus aureus strains and healthcare-associated methicillin-resistant S. aureus strains. Epidemiol Infect 2012; 141:2140-8. [PMID: 23217979 DOI: 10.1017/s0950268812002634] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There are limited data examining whether outcomes of methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) are worse when caused by community-associated (CA) strains compared to HA strains. We reviewed all patients' charts at our institution from 1999 to 2009 that had MRSA first isolated only after 72 h of hospitalization (n=724). Of these, 384 patients had a MRSA-HAI according to CDC criteria. Treatment failure was similar in those infected with a phenotypically CA-MRSA strain compared to a phenotypically HA-MRSA strain (23% vs. 15%, P=0.10) as was 30-day mortality (16% vs. 19%, P=0.57). Independent risk factors associated with (P<0.05) treatment failure were higher Charlson Comorbidity Index, higher APACHE II score, and no anti-MRSA treatment. These factors were also associated with 30-day mortality, as were female gender, older age, MRSA bloodstream infection, MRSA pneumonia, and HIV. Our findings suggest that clinical and host factors, not MRSA strain type, predict treatment failure and death in hospitalized patients with MRSA-HAIs.
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Han JH, Edelstein PH, Lautenbach E. Reduced vancomycin susceptibility and staphylococcal cassette chromosome mec (SCCmec) type distribution in methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2012; 67:2346-9. [PMID: 22761330 DOI: 10.1093/jac/dks255] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Recent epidemiological evidence suggests that genotypic and phenotypic characteristics that have typically distinguished community-associated methicillin-resistant Staphylococcus aureus (MRSA) and healthcare-associated MRSA strains may be evolving. The objective of this study was to examine the association between reduced vancomycin susceptibility (RVS) and staphylococcal cassette chromosome mec (SCCmec) type in MRSA bloodstream isolates. METHODS A cohort study of patients who were hospitalized from 2007 to 2009 with S. aureus bacteraemia was conducted within a university health system. Bivariable analyses were conducted to determine the association between RVS and SCCmec type, as well as other microbiological characteristics including Panton-Valentine leucocidin, accessory gene regulator (agr) dysfunction and vancomycin heteroresistance. RESULTS A total of 188 patients with MRSA bacteraemia were identified: 116 (61.7%) and 72 (38.3%) patients had infections due to healthcare-associated MRSA and community-associated MRSA, respectively. As defined by a vancomycin Etest MIC > 1.0 mg/L, the prevalence of RVS was 40.4%. Isolates with RVS were significantly more likely to be associated with SCCmec II compared with isolates without RVS (74.7% and 47.3%, respectively, P < 0.001), but not with Panton-Valentine leucocidin (P = 0.10), agr dysfunction (P = 0.19) or healthcare-associated infection (P = 0.36). CONCLUSIONS The results of our study demonstrate important microbiological characteristics among MRSA isolates characterized by RVS, including a significant association between SCCmec II and elevated vancomycin MIC. It is clear that the clinical and molecular epidemiology of MRSA is evolving, and further understanding of factors determining virulence will be important for the elucidation of optimal treatment approaches for associated infections.
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Affiliation(s)
- Jennifer H Han
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Otter JA, French GL. Community-associated meticillin-resistant Staphylococcus aureus: the case for a genotypic definition. J Hosp Infect 2012; 81:143-8. [PMID: 22622448 DOI: 10.1016/j.jhin.2012.04.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 04/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND New distinct strains of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) have emerged as a cause of infection in previously healthy individuals in community settings. It is important to identify CA-MRSA for clinical management, epidemiological analysis, infection prevention and control, and regulatory reporting, but definitions and nomenclature of these strains are confused. AIM To review attempts to define CA-MRSA and propose a new definition. METHODS Non-systematic review. FINDINGS Epidemiological definitions were useful for differentiating CA-MRSA and healthcare-associated (HA)-MRSA strain types in the past. However, although HA-MRSA strain types are rarely transmitted in the community, CA-MRSA strains have started to be transmitted in healthcare facilities, so epidemiological definitions are breaking down. CA-MRSA are community strains of S. aureus that have acquired the meticillin resistance gene, mecA. They are distinct from HA-MRSA and should be defined genetically. This may be done by combining genotypic typing by multi-locus sequence or spa with analysis of the staphylococcal cassette chromosome mec. Carriage of Panton-Valentine leukocidin or antimicrobial susceptibility profiles can be useful indicators of CA-MRSA but should not be used for their definition. CONCLUSION For full assessment of their epidemiology, MRSA infections should be characterized as: (1) caused by HA- or CA-MRSA strain types; (2) acquired in community or healthcare settings; and (3) onset in the community or healthcare facility.
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Affiliation(s)
- J A Otter
- Centre for Clinical Infection and Diagnostic Research (CIDR), Department of Infections Diseases, King's College London School of Medicine, London, UK.
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Abstract
Meticillin-resistant Staphylococcus aureus causes an evolving clinical presentation of pneumonia. Health-care-acquired infection differs from community-associated disease, with important implications for treatment. Current antibiotics are less than ideal, and broader management strategies are crucial to prevent complacency.
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Affiliation(s)
- B Edwards
- Department of Medical Microbiology, Southern General Hospital, Glasgow G51 4TF
| | - IM Gould
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen
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Joo EJ, Chung D, Ha Y, Park S, Kang SJ, Kim S, Kang CI, Peck K, Lee N, Ko K, Song JH. Community-associated Panton–Valentine leukocidin-negative meticillin-resistant Staphylococcus aureus clone (ST72-MRSA-IV) causing healthcare-associated pneumonia and surgical site infection in Korea. J Hosp Infect 2012; 81:149-55. [DOI: 10.1016/j.jhin.2012.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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Lam SW, Bauer SR, Neuner EA. Predictors of septic shock in patients with methicillin-resistant Staphylococcus aureus bacteremia. Int J Infect Dis 2012; 16:e453-6. [DOI: 10.1016/j.ijid.2012.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 02/02/2012] [Indexed: 01/01/2023] Open
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Chu C, Yu C, Lee Y, Su Y. Genetically divergent methicillin-resistant Staphylococcus aureus and sec-dependent mastitis of dairy goats in Taiwan. BMC Vet Res 2012; 8:39. [PMID: 22455622 PMCID: PMC3353860 DOI: 10.1186/1746-6148-8-39] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 03/29/2012] [Indexed: 12/02/2022] Open
Abstract
Background Widespread in the environment, Staphylococcus spp. infect animals and humans as normal flora or pathogens. By extending our recent report of multi-drug resistant (MDR) S. aureus in dairy goats, this study investigated the staphylococcal infection and characterized the MDR-S. aureus and methicillin-resistant S. aureus (MRSA) isolates collected from goats in 2008 to elucidate the appearance of MRSA in goats and the mastitis associated staphylococcus enterotoxin (SE) types. A total of 555 samples were collected from six goat parts and three environmental sources among four dairy goat farms in southern Taiwan. Coagulase-positive and negative Staphylococcus spp. (CPS and CNS, respectively) were also identified. Furthermore, predominant SE genes of nine enterotoxin genes sea through sej along with antimicrobial resistance and genetic variations were determined. Results In total, 137 staphylococcal strains were identified and found predominantly in milk, and in the vagina, anus, and nasal cavity. The most prevalent species was S. lentus, followed by S. aureus, S. epidermidis, and S. xylosus. Enterotoxin genes were not identified in any CNS isolates, however sec and see were identified only in S. aureus associated with mastitis in goat. In compared to the isolates from 2006 to 2007, 27 S. aureus isolates from 2008 were found to be more resistant to ampicillin, cephalothin, oxacillin, oxytetracycline, penicillin G, and tetracycline. Eleven MRSA isolates were identified and belonged to SCCmec type III (nine isolates) as the major type and SCCmec type II (two isolates). These MRSA isolates revealed pulse-field gel electrophoresis (PFGE) pattern A (five isolates), C (one isolate), and D (one isolate) of human isolates. The other two isolates without pulsotypes belonged to ST59. Conclusion The prevalence and infection sites of CNS differed from those of CPS. Genetic analyses indicated that genetic divergence, possible zoonotic transfer of MRSA, and the involvement of sec as important virulence factors for of S. aureus that lead to mastitis in goats.
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Affiliation(s)
- Chishih Chu
- Department of Microbiology, Immunology, and Biopharmaceuticals, National Chiayi University, Chiayi 60004, Taiwan
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A Multivariable Model to Classify Methicillin-Resistant Staphylococcus aureus Infections as Health Care or Community Associated. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e31823c49b6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Changchien CH, Chen YY, Chen SW, Chen WL, Tsay JG, Chu C. Retrospective study of necrotizing fasciitis and characterization of its associated methicillin-resistant Staphylococcus aureus in Taiwan. BMC Infect Dis 2011; 11:297. [PMID: 22040231 PMCID: PMC3221646 DOI: 10.1186/1471-2334-11-297] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 10/31/2011] [Indexed: 12/23/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a prevalent pathogen of necrotizing fasciitis (NF) in Taiwan. A four-year NF cases and clinical and genetic differences between hospital acquired (HA)- and community-acquired (CA)-MRSA infection and isolates were investigated. Methods A retrospective study of 247 NF cases in 2004-2008 and antimicrobial susceptibilities, staphylococcal chromosomal cassette mec (SCCmec) types, pulsed field gel electrophoresis (PFGE) patterns, virulence factors, and multilocus sequence typing (MLST) of 16 NF-associated MRSA in 2008 were also evaluated. Results In 247 cases, 42 microbial species were identified. S. aureus was the major prevalent pathogen and MRSA accounted for 19.8% of NF cases. Most patients had many coexisting medical conditions, including diabetes mellitus, followed by hypertension, chronic azotemia and chronic hepatic disease in order of decreasing prevalence. Patients with MRSA infection tended to have more severe clinical outcomes in terms of amputation rate (p < 0.05) and reconstruction rate (p = 0.001) than those with methicillin-sensitive S. aureus or non-S. aureus infection. NF patients infected by HA-MRSA had a significantly higher amputation rate, comorbidity, C-reactive protein level, and involvement of lower extremity than those infected by CA-MRSA. In addition to over 90% of MRSA resistant to erythromycin and clindamycin, HA-MRSA was more resistant than CA-MRSA to trimethoprim-sulfamethoxazole (45.8% vs. 4%). ST59/pulsotype C/SCCmec IV and ST239/pulsotype A/SCCmec III isolates were the most prevalent CA- and HA-MRSA, respectively in 16 isolates obtained in 2008. In contrast to the gene for γ-hemolysin found in all MRSA, the gene for Panton-Valentine leukocidin was only identified in ST59 MRSA isolates. Other three virulence factors TSST-1, ETA, and ETB were occasionally identified in MRSA isolates tested. Conclusion NF patients with MRSA infection, especially HA-MRSA infection, had more severe clinical outcomes than those infected by other microbial. The prevalent NF-associated MRSA clones in Taiwan differed distinctly from the most predominant NF-associated USA300 CA-MRSA clone in the USA. Initial empiric antimicrobials with a broad coverage for MRSA should be considered in the treatment of NF patients in an endemic area.
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Affiliation(s)
- Chih-Hsuan Changchien
- Department of Microbiology, Immunology, and Biopharmaceuticals, National Chiayi University, No 300, University Road, Chiayi, 60004, Taiwan, ROC
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Kuo SC, Chiang MC, Lee WS, Chen LY, Wu HS, Yu KW, Fung CP, Wang FD. Comparison of microbiological and clinical characteristics based on SCCmec typing in patients with community-onset meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Int J Antimicrob Agents 2011; 39:22-6. [PMID: 21982834 DOI: 10.1016/j.ijantimicag.2011.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 11/16/2022]
Abstract
Molecular identification methods based on the staphylococcal cassette chromosome mec (SCCmec) genotype are more reliable than clinical risk factors and demographic data for differentiating community-acquired and healthcare-associated (HCA) meticillin-resistant Staphylococcus aureus (MRSA). However, patients with community-onset (CO) MRSA infections, defined as a culture-positive sample obtained <48h after admission and from patients with HCA risk factors, have been infrequently studied. This study compared the clinical profiles of different SCCmec genotypes in this group of patients. From 2004 to 2008, the clinical profiles of 122 non-repetitive patients with CO-MRSA infections at a tertiary medical centre in Taiwan were retrospectively recorded and the molecular characteristics of the isolates were examined. The proportion of SCCmec IV/V genotypes increased from 9.5% to 35.3% from 2004 to 2008. There were no differences in demographic data, underlying diseases, invasive procedures or outcomes between the SCCmec II/III and IV/V groups, except that patients with SCCmec II/III genotypes tended to have more HCA risk factors (3.1 vs. 2.4; P=0.008). Multivariate logistic regression analysis revealed that having at least four HCA risk factors was independently associated with SCCmec II/III. The sensitivity of recovering SCCmec IV/V genotypes from patients with less than four HCA risk factors was 89.3%. This study revealed the emergence of SCCmec IV/V genotypes in CO-MRSA infections. Although the clinical characteristic boundaries between SCCmec II/III and IV/V diminished, having at least four HCA risk factors made the presence of SCCmec IV/V genotypes less likely in patients with CO-MRSA infections.
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Affiliation(s)
- Shu-Chen Kuo
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201 Sec. 2 Shih-Pai Road, Taipei, Taiwan
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Kao TM, Wang JT, Weng CM, Chen YC, Chang SC. In vitro activity of linezolid, tigecycline, and daptomycin on methicillin-resistant Staphylococcus aureus blood isolates from adult patients, 2006–2008: Stratified analysis by vancomycin MIC. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:346-51. [DOI: 10.1016/j.jmii.2011.01.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/20/2010] [Accepted: 08/05/2010] [Indexed: 10/18/2022]
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Predictors of relapse of methicillin-resistant Staphylococcus aureus bacteremia after treatment with vancomycin. J Clin Microbiol 2011; 49:3669-72. [PMID: 21865420 DOI: 10.1128/jcm.05287-11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The risk factors for relapse of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia after vancomycin treatment are unknown. Diversilab typing was used to classify recurrent bacteremia as relapse or reinfection. Bacteremia for >7 days and staphylococcal cassette chromosome mec element (SCCmec) type II were independently associated with relapse of MRSA bacteremia after vancomycin treatment.
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Otter JA, French GL. Community-associated meticillin-resistant Staphylococcus aureus strains as a cause of healthcare-associated infection. J Hosp Infect 2011; 79:189-93. [PMID: 21741111 DOI: 10.1016/j.jhin.2011.04.028] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/26/2011] [Indexed: 11/28/2022]
Abstract
Community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) was first noticed as a cause of infection in community-based individuals without healthcare contact. As the global epidemic of CA-MRSA has continued, CA-MRSA strain types have begun to emerge as a cause of healthcare-associated infections (HAIs) and hospital outbreaks have occurred worldwide. In areas where CA-MRSA clones have become established with high prevalence, for example USA300 (ST8-IV) in the USA, CA-MRSA are beginning to supplant or overtake traditional healthcare-associated MRSA strains as causes of HAI. The emergence of CA-MRSA as a cause of HAI puts a wider group of hospitalised patients, healthcare workers and their community contacts potentially at risk of MRSA infection. It also exposes CA-MRSA strains to the selective pressure of antibiotic use in hospitals, potentially resulting in increased antibiotic resistance, challenges traditional definitions of CA-MRSA and hampers control efforts due to the constant re-introduction of MRSA from an emerging community reservoir. There is thus an urgent need to clarify the definitions, prevalence and epidemiology of CA-MRSA and to develop systems for the identification and control of these organisms in the community, in hospitals and other healthcare facilities, and at the community-hospital interface.
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Affiliation(s)
- J A Otter
- Directorate of Infection, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Yamaki J, Lee M, Shriner KA, Wong-Beringer A. Can clinical and molecular epidemiologic parameters guide empiric treatment with vancomycin for methicillin-resistant Staphylococcus aureus infections? Diagn Microbiol Infect Dis 2011; 70:124-30. [DOI: 10.1016/j.diagmicrobio.2010.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/01/2010] [Accepted: 12/04/2010] [Indexed: 11/16/2022]
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Universal MRSA nasal surveillance: characterization of outcomes at a tertiary care center and implications for infection control. South Med J 2010; 103:1084-91. [PMID: 20926991 DOI: 10.1097/smj.0b013e3181f69235] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recognition of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage by active surveillance cultures has been widely debated. Our institution implemented universal nasal screening by polymerase chain reaction (PCR) for MRSA and isolation of screen positive patients in December 2007. Here we present data about the correlation between screen positivity and subsequent development of infection and the impact of isolation on surgical site infection rates. METHODS This was a retrospective, observational study from January 1, 2008, through June 30, 2008, on all inpatient admissions with a nasal MRSA PCR screen. Genotype of 15 MRSA blood isolates was determined utilizing the Diversilab® (bioMérieux, Hazelwood, MO) system. A phenotypic rule was deduced and utilized for analyzing all MRSA clinical isolates. RESULTS 5375 patients were screened at ≤48 hours following admission. 581 MRSA positive nasal carriers (10.80%) were identified. 496 (85.3%) were asymptomatic MRSA nasal carriers. There were a total of 158 MRSA clinical infections. 85 (14.6%) MRSA nasal carriers had clinical infection. Of the 4794 (89.1%) non-nasally colonized patients, 73 (1.5%) had MRSA clinical infection. MRSA surgical site infection rate remained unchanged during the intervention period. Phenotypic predictive rule inferred 59.8% community-acquired MRSA (CA-MRSA) infections and 40% hospital-acquired MRSA (HA-MRSA) infections. CONCLUSIONS Our study showed a positive correlation between having a nasal screen positivity and subsequent development of infection. Isolation of MRSA screen positive patients alone as an intervention did not reduce the surgical site infection rates. Since most of our isolates are CA-MRSA, our institution is implementing several new interventions to further reduce the incidence of HA-MRSA conditions.
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Santos HB, Machado DP, Camey SA, Kuchenbecker RS, Barth AL, Wagner MB. Prevalence and acquisition of MRSA amongst patients admitted to a tertiary-care hospital in Brazil. BMC Infect Dis 2010; 10:328. [PMID: 21073755 PMCID: PMC2992537 DOI: 10.1186/1471-2334-10-328] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 11/14/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are few studies in Brazil that address baseline prevalence of MRSA colonization and associated risk factors at hospital admission, or the incidence of nosocomial colonization. We report a prospective study in a tertiary-care, university-affiliated hospital to implement a new MRSA control policy at the institution. METHODS A cohort of randomly selected patients admitted to emergency and clinical wards at our hospital was followed until discharge. Nasal swabs were taken for identification of MRSA-colonized patients and detection of SCCmecA in positive cultures, at admission and weekly thereafter. Multivariate analysis using a log-binomial analysis was used to identify risk factors for colonization. RESULTS After screening 297 adult patients and 176 pediatric patients, the prevalence of MRSA at admission was 6.1% (95%CI, 3.6% to 9.4%), in the adult population and 2.3% (95%CI, 0.6% to 5.7%), for children. From multivariate analysis, the risk factors associated with colonization in adults were: age above 60 years (P = 0.019) and hospitalization in the previous year (P = 0.022). Incidence analysis was performed in 276 MRSA-negative patients (175 adults and 101 children). Acquisition rate was 5.5/1,000 patient-days for adults (95%CI, 3.4 to 8.5/1,000 patients-days), and 1.1/1,000 patient-days for children (95%CI, 0.1 to 4.0/1,000 patients-days). CONCLUSIONS The identification of MRSA carriers is a step towards establishing a control policy for MRSA, and helps to identify measures needed to reduce colonization pressure and to decrease the high acquisition rate in hospitalized patients.
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Affiliation(s)
- Helena B Santos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Suzi A Camey
- Instituto de Matemática- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo S Kuchenbecker
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Afonso L Barth
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mário B Wagner
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Carey AJ, Long SS. Staphylococcus aureus: a continuously evolving and formidable pathogen in the neonatal intensive care unit. Clin Perinatol 2010; 37:535-46. [PMID: 20813269 DOI: 10.1016/j.clp.2010.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Staphylococcus aureus is a continuously evolving and formidable pathogen that has been a problem for both healthy and sick neonates for decades. Much focus over the past 20 years has been on hospital-associated methicillin-resistant S aureus (HA-MRSA); however, a global epidemic because of virulent community-associated MRSA (CA-MRSA) that has no "fitness cost" for carrying antibiotic-resistance genes has moved into neonatal intensive care units (NICUs). Recently, methicillin-susceptible S aureus has adopted some of the virulence factors of CA-MRSA and is an increasingly common cause of hospital-acquired infections in NICUs. This article reviews the changing epidemiology, clinical manifestations, and treatment of S aureus in neonates.
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Affiliation(s)
- Alison J Carey
- Division of Neonatology, St Christopher's Hospital for Children, 3601 A Street, Philadelphia, PA 19134, USA.
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Clinical, microbiologic, and genetic determinants of persistent methicillin-resistant Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis 2010; 67:228-33. [DOI: 10.1016/j.diagmicrobio.2010.02.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/22/2010] [Accepted: 02/27/2010] [Indexed: 11/30/2022]
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Pressley J, D'Agata EMC, Webb GF. The effect of co-colonization with community-acquired and hospital-acquired methicillin-resistant Staphylococcus aureus strains on competitive exclusion. J Theor Biol 2010; 264:645-56. [PMID: 20347850 PMCID: PMC2874575 DOI: 10.1016/j.jtbi.2010.03.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 01/07/2010] [Accepted: 03/24/2010] [Indexed: 01/10/2023]
Abstract
We investigate the in-hospital transmission dynamics of two methicillin-resistant Staphylococcus aureus (MRSA) strains: hospital-acquired methicillin resistant S. aureus (HA-MRSA) and community-acquired methicillin-resistant S. aureus (CA-MRSA). Under the assumption that patients can only be colonized with one strain of MRSA at a time, global results show that competitive exclusion occurs between HA-MRSA and CA-MRSA strains; the strain with the larger basic reproduction ratio will become endemic while the other is extinguished due to competition. Because new studies suggest that patients can be concurrently colonized with multiple strains of MRSA, we extend the model to allow patients to be co-colonized with HA-MRSA and CA-MRSA. Using the extended model, we explore the effect of co-colonization on competitive exclusion by determining the invasion reproduction ratios of the boundary equilibria. In contrast to results derived from the assumption that co-colonization does not occur, the extended model rarely exhibits competitive exclusion. More commonly, both strains become endemic in the hospital. When transmission rates are assumed equal and decolonization measures act equally on all strains, competitive exclusion never occurs. Other interesting phenomena are exhibited. For example, solutions can tend toward a co-existence equilibrium, even when the basic reproduction ratio of one of the strains is less than one.
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Affiliation(s)
- Joanna Pressley
- Department of Mathematics, Vanderbilt University, 1326 Stevenson Center, Nashville, TN 37240, USA.
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