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Hajikhani B, Goudarzi M, Kakavandi S, Amini S, Zamani S, van Belkum A, Goudarzi H, Dadashi M. The global prevalence of fusidic acid resistance in clinical isolates of Staphylococcus aureus: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2021; 10:75. [PMID: 33933162 PMCID: PMC8088720 DOI: 10.1186/s13756-021-00943-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIM Staphylococcus aureus (S. aureus) is one of the most common pathogens causing nosocomial and community-acquired infections with high morbidity and mortality rates. Fusidic acid has been increasingly used for the treatment of infections due to methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA). The present study aimed to determine the precise prevalence of fusidic acid resistant MRSA (FRMRSA), fusidic acid resistant MSSA (FRMSSA), and total fusidic acid resistant S. aureus (FRSA) on a global scale. METHODS Several international databases including Medline, Embase, and the Web of Sciences were searched (2000-2020) to discern studies addressing the prevalence of FRSA, FRMRSA, and FRMSSA. STATA (version14) software was used to interpret the data. RESULTS Of the 1446 records identified from the databases, 215 studies fulfilled the eligibility criteria for the detection of FRSA (208 studies), FRMRSA (143 studies), and FRMSSA (71 studies). The analyses manifested that the global prevalence of FRSA, FRMRSA, and FRMSSA was 0.5%, 2.6% and 6.7%, respectively. CONCLUSION This meta-analysis describes an increasing incidence of FRSA, FRMSSA, and FRMRSA. These results indicate the need for prudent prescription of fusidic acid to stop or diminish the incidence of fusidic acid resistance as well as the development of strategies for monitoring the efficacy of fusidic acid use.
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Affiliation(s)
- Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sareh Kakavandi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sana Amini
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Zamani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alex van Belkum
- Data Analytics Unit, bioMérieux 3, Route de Port Michaud, La Balme Les Grottes, France
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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Boloki HA, Al-Musaileem WF, AlFouzan W, Verghese T, Udo EE. Fusidic Acid Resistance Determinants in Methicillin-Resistant Staphylococcus aureus Isolated in Kuwait Hospitals. Med Princ Pract 2021; 30:542-549. [PMID: 34348297 PMCID: PMC8740012 DOI: 10.1159/000518408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the genetic determinants of fusidic acid (FA) resistance in MRSA isolated from patients in Kuwait hospitals. METHODS The minimum inhibitory concentration (MIC) of FA was tested with E-test strips. Genetic determinants of FA were determined by PCR and DNA microarray. Staphylococcal protein A gene (spa) typing and DNA microarray analysis were used to study their genetic backgrounds. RESULTS The FA MIC ranged from 2 mg/L to >256 mg/L. Of the 97 isolates, 79 (81.4%) harbored fusC, 14 isolates harbored fusA mutations (fusA), and 4 isolates harbored fusB. Isolates with fusA mutations expressed high FA MIC (MIC >256 mg/L), whereas those with fusC and fusB expressed low FA MIC (MIC 2-16 mg/L). The isolates belonged to 23 spa types and 12 clonal complexes (CCs). The major spa types were t688 (n = 25), t311 (n = 14), t860 (n = 8), and t127 (n = 6) which constituted 54.6% of the isolates. The 12 CCs were CC1, CC5, CC8, CC15, CC22, CC80, CC88, and CC97 with CC5 (45.6%) and CC97 (13.2%) as the dominant CCs. CONCLUSIONS The MRSA isolates belonged to diverse genetic backgrounds with the majority carrying the fusC resistance determinants. The high prevalence of FA resistance belonging to diverse genetic backgrounds warrants a review of FA usage in the country to preserve its therapeutic benefits.
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Tahmasbi F, Sheikhi R, Ashraf A, Mojtahedi A. Biofilm formation and molecular characterization of methicillin-resistant Staphylococcus aureus strains isolated from the patients, personnel, air and environment of ICUs. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jiang AM, Shi X, Liu N, Gao H, Ren MD, Zheng XQ, Fu X, Liang X, Ruan ZP, Yao Y, Tian T. Nosocomial infections due to multidrug-resistant bacteria in cancer patients: a six-year retrospective study of an oncology Center in Western China. BMC Infect Dis 2020; 20:452. [PMID: 32600270 PMCID: PMC7324970 DOI: 10.1186/s12879-020-05181-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. This study aimed to evaluate the characteristics, antibiotic resistance patterns, and prognosis of nosocomial infections due to multidrug-resistant (MDR) bacteria in cancer patients. METHODS This retrospective observational study analyzed cancer patients with nosocomial infections caused by MDR from August 2013 to May 2019. The extracted clinical data were recorded in a standardized form and compared based on the survival status of the patients after infection and during hospitalization. The data were analyzed using independent samples t-test, Chi-square test, and binary logistic regression. P-values < 0.05 were considered significant. RESULTS One thousand eight patients developed nosocomial infections during hospitalization, with MDR strains detected in 257 patients. Urinary tract infection (38.1%), respiratory tract infection (26.8%), and bloodstream infection (BSI) (12.5%) were the most common infection types. Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) (72.8%) members were the most frequently isolated MDR strains, followed by Acinetobacter baumannii (11.7%), and Stenotrophomonas maltophilia (6.2%). The results of multivariate regression analysis revealed that smoking history, intrapleural/abdominal infusion history within 30 days, the presence of an indwelling urinary catheter, length of hospitalization, and hemoglobin were independent factors for in-hospital mortality in the study population. The isolated MDR bacteria exhibited high rates of sensitivity to amikacin, meropenem, and imipenem. CONCLUSIONS The burden of nosocomial infections due to MDR bacteria is considerably high in oncological patients, with ESBL-PE being the most predominant causative pathogen. Our findings suggest that amikacin and carbapenems actively against more than 89.7% of MDR isolates. The precise management of MDR bacterial infections in cancer patients may improve the prognosis of these individuals.
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Affiliation(s)
- Ai-Min Jiang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xin Shi
- School of Public Health, Xi'an Jiaotong University Health Science Center, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Na Liu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Huan Gao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Meng-Di Ren
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xiao-Qiang Zheng
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xiao Fu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xuan Liang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Zhi-Ping Ruan
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Tao Tian
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
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Abdulgader SM, Lentswe T, Whitelaw A, Newton-Foot M. The prevalence and molecular mechanisms of mupirocin resistance in Staphylococcus aureus isolates from a Hospital in Cape Town, South Africa. Antimicrob Resist Infect Control 2020; 9:47. [PMID: 32169102 PMCID: PMC7071584 DOI: 10.1186/s13756-020-00707-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022] Open
Abstract
Background Antimicrobial resistance is an increasingly serious problem in public health globally. Monitoring resistance levels within healthcare and community settings is critical to combat its ongoing increase. This study aimed to describe the rates and molecular mechanisms of mupirocin resistance in clinical Staphylococcus aureus isolates from Tygerberg Hospital, and to describe its association with strain types. Methods We retrospectively selected 212 S. aureus isolates which were identified from blood samples and pus swabs during the years 2009–2011 and 2015–2017. The isolates were identified using conventional microbiological methods and genotyping was done using spa typing. Cefoxitin (30 μg) disc diffusion and the two disc strategy (5 μg and 200 μg) were used to determine susceptibility to methicillin and mupirocin, respectively. Isolates with high-level resistance were screened for the plasmid mediated genes mupA and mupB by PCR, and sequencing of the ileS gene was done for all isolates exhibiting low-level resistance to describe the mutations associated with this phenotype. Chi-square test was used to assess the associations between mupirocin resistance and S. aureus genotypes. Results Of 212 S. aureus isolates, 12% (n = 25) were resistant to mupirocin, and 44% (n = 93) were methicillin resistant. Strain typing identified 73 spa types with spa t045 being the most predominant constituting 11% of the isolates. High-level mupirocin resistance was observed in 2% (n = 5), and low-level resistance in 9% (n = 20) of the isolates. The prevalence of high-level mupirocin resistance amongst MRSA and MSSA was 4 and 1% respectively, while the prevalence of low-level mupirocin resistance was significantly higher in MRSA (18%) compared to MSSA (3%), (p = 0.032). mupA was the only resistance determinant for high-level resistance, and the IleS mutation V588F was identified in 95% of the isolates which showed low-level resistance. A significant association was observed between spa type t032 and high-level mupirocin resistance, and types t037 and t012 and low-level resistance (p < 0.0001). Conclusion The study reported higher rates of low-level mupirocin resistance compared to high-level resistance, and in our setting, mupirocin resistance was driven by certain genotypes. Our study advocates for the continuous screening for mupirocin resistance in S. aureus in clinical settings to better guide treatment and prescribing practices.
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Affiliation(s)
- Shima M Abdulgader
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS, Tygerberg Hospital, Francie van Zijl Drive, PO Box 241; Cape Town, Tygerberg, 8000, South Africa.
| | - Tshepiso Lentswe
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS, Tygerberg Hospital, Francie van Zijl Drive, PO Box 241; Cape Town, Tygerberg, 8000, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS, Tygerberg Hospital, Francie van Zijl Drive, PO Box 241; Cape Town, Tygerberg, 8000, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Mae Newton-Foot
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS, Tygerberg Hospital, Francie van Zijl Drive, PO Box 241; Cape Town, Tygerberg, 8000, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Goudarzi M, Fazeli M, Eslami G, Pouriran R, Hajikhani B, Dadashi M. Genetic Diversity Analysis of Methicillin-resistant Staphylococcus aureus Strains Isolated from Intensive Care Unit in Iran. Oman Med J 2019; 34:118-125. [PMID: 30918605 PMCID: PMC6425056 DOI: 10.5001/omj.2019.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives Staphylococcus aureus has emerged as a major public health concern. It is a common pathogen in high-risk hospital intensive care units (ICUs). We analyzed the molecular characteristics on the SCCmec and spa genes of S. aureus isolates gathered from ICUs. The antibiotic resistance patterns and carriage of resistance and virulence determinants were also identified. Methods In this cross-sectional study, 84 non-duplicated S. aureus strains isolated from ICU patients in were genotyped using SCCmec and spa typing. The Kirby-Bauer disk diffusion and micro-broth dilution methods were used to determine resistance patterns. Virulence and resistance gene profiling were also determined using the polymerase chain reaction technique. Results All isolates were methicillin-resistant S. aureus and belonged to seven spa types: t388 (36.9%), t852 (14.3%), t924 (13.1%), t790 (11.9%), t064 (10.7%), t037 (9.5%), and t084 (3.6%). They differed in the carriage of resistance and toxin genes. The most common SCCmec type was III detected in 50 isolates (59.5%), followed by type IV in 34 isolates (40.5%). The pvl gene was detected in 14.3% (n = 12) of isolates, of which 66.7% (n = 8) belonged to t852 and 33.3% (n = 4) belonged to t790. Among the tested strains, 9.5% (n = 8) carried the mupA gene and belonged to the t064 spa type. Conclusions The data revealed a high resistance rate to antibiotics, which could be a threat to ICU patients. It is necessary to detect antimicrobial resistance and resistance and toxin-encoding of gene profiles in different molecular types.
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Affiliation(s)
- Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Fazeli
- Department of Virology, Pasteur Institute of Iran, Tehran, Iran
| | - Gita Eslami
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Pouriran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Milovanovic T, Dumic I, Veličkovic J, Lalosevic MS, Nikolic V, Palibrk I. Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia. BMC Infect Dis 2019; 19:141. [PMID: 30755176 PMCID: PMC6373165 DOI: 10.1186/s12879-019-3761-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 01/30/2019] [Indexed: 12/14/2022] Open
Abstract
Background Cirrhosis-associated immune dysfunction syndrome (CAIDS) has been identified in patients with liver cirrhosis (LC), predisposing them to a wide variety of infections. In patients with LC, healthcare-associated infections involving multi-drug resistant (MDR) bacteria have increased significantly over the last decades. Among them, hospital-acquired urinary tract infections (HA-UTI) are the most common. This study aimed to investigate the rates of antimicrobial resistance among patients with LC and HA-UTI and to determine risk factors associated with their development among patients hospitalized in tertiary care facility in Serbia. Methods This retrospective study included 65 hospitalized patients with LC who had developed HA-UTI. We examined the epidemiology of these infections concerning resistance to the most commonly used antimicrobials and patient-specific risk factors associated with HA-UTI development by MDR pathogens. Results The most frequently isolated organisms were Enterococcus spp. (n = 34, 52.3%), Klebsiella spp. (n = 10, 15.4%), and E.coli (n = 6, 9.2%). Thirty-five isolates (53.8%) were identified as MDR, and 30 (46.2%) were non-MDR.We found a statistically significant difference in the distribution of MDR and non-MDR strains, based on Gram staining, with the majority of Gram-negative pathogens being MDR (p = 0.005). We identified age ≥ 65 years (p = 0.007), previous use of cephalosporins as empiric therapy (p = 0.042), and the presence of hepatic encephalopathy (p = 0.011) as independent risk factors for the development of MDR UTIs. Conclusion This is the first study from Serbia and the Balkans concerning the changing epidemiology of MDR UTI in patients with LC. Our study showed that more than half of HA-UTI was caused by MDR and the most common pathogen was Enterococcus spp. The overall resistance to ceftriaxone was 92%. Our findings underscore the need for institutions to individualize protocols for treatment of hospital-acquired infections, particularly in immunocompromised populations.
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Affiliation(s)
- Tamara Milovanovic
- School of Medicine, University of Belgrade, Belgrade, Serbia. .,Department of Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Igor Dumic
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.,Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jelena Veličkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Anesthesiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milica Stojkovic Lalosevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Ivan Palibrk
- Department of Anesthesiology, Clinical Center of Serbia, Belgrade, Serbia
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Shittu AO, Kaba M, Abdulgader SM, Ajao YO, Abiola MO, Olatimehin AO. Mupirocin-resistant Staphylococcus aureus in Africa: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2018; 7:101. [PMID: 30147868 PMCID: PMC6094907 DOI: 10.1186/s13756-018-0382-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mupirocin is widely used for nasal decolonization of Staphylococcus aureus to prevent subsequent staphylococcal infection in patients and healthcare personnel. However, the prolonged and unrestricted use has led to the emergence of mupirocin-resistant (mupR) S. aureus. The aim of this systematic review was to investigate the prevalence, phenotypic and molecular characteristics, and geographic spread of mupR S. aureus in Africa. Methods We examined five electronic databases (EBSCOhost, Google Scholar, ISI Web of Science, MEDLINE, and Scopus) for relevant English articles on screening for mupR S. aureus from various samples in Africa. In addition, we performed random effects meta-analysis of proportions to determine the pooled prevalence of mupR S. aureus in Africa. The search was conducted until 3 August 2016. Results We identified 43 eligible studies of which 11 (26%) were obtained only through Google Scholar. Most of the eligible studies (28/43; 65%) were conducted in Nigeria (10/43; 23%), Egypt (7/43; 16%), South Africa (6/43; 14%) and Tunisia (5/43; 12%). Overall, screening for mupR S. aureus was described in only 12 of 54 (22%) African countries. The disk diffusion method was the widely used technique (67%; 29/43) for the detection of mupR S. aureus in Africa. The mupA-positive S. aureus isolates were identified in five studies conducted in Egypt (n = 2), South Africa (n = 2), and Nigeria (n = 1). Low-level resistance (LmupR) and high-level resistance (HmupR) were both reported in six human studies from South Africa (n = 3), Egypt (n = 2) and Libya (n = 1). Data on mupR-MRSA was available in 11 studies from five countries, including Egypt, Ghana, Libya, Nigeria and South Africa. The pooled prevalence (based on 11 human studies) of mupR S. aureus in Africa was 14% (95% CI =6.8 to 23.2%). The proportion of mupA-positive S. aureus in Africa ranged between 0.5 and 8%. Furthermore, the frequency of S. aureus isolates that exhibited LmupR, HmupR and mupR-MRSA in Africa were 4 and 47%, 0.5 and 38%, 5 and 50%, respectively. Conclusions The prevalence of mupR S. aureus in Africa (14%) is worrisome and there is a need for data on administration and use of mupirocin. The disk diffusion method which is widely utilized in Africa could be an important method for the screening and identification of mupR S. aureus. Moreover, we advocate for surveillance studies with appropriate guidelines for screening mupR S. aureus in Africa.
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Affiliation(s)
- Adebayo O. Shittu
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shima M. Abdulgader
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Yewande O. Ajao
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Mujibat O. Abiola
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
| | - Ayodele O. Olatimehin
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State 22005 Nigeria
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Alhussaini MS. Methicillin-resistant Staphylococcus aureus Nasal Carriage Among Patients Admitted at Shaqra General Hospital in Saudi Arabia. Pak J Biol Sci 2017; 19:233-238. [PMID: 29023028 DOI: 10.3923/pjbs.2016.233.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Methicillin-resistant Staphylococcus aureus (MRSA) have been causing increasing problems in hospitals and nursing homes worldwide. Limited number of studies in Saudi Arabia has attempted to investigate infection and risk factors associated with nosocomial acquired MRSA. The present study was undertaken to determine the occurrence, prevalence, antibiotic susceptibility pattern and genetic characteristics of MRSA among admitted cases at Shaqra General Hospital (Saudi Arabia). METHODOLOGY This study was conducted from October, 2014 to March, 2015. Nasal swabs were taken from 220 patients (105 males and 115 females) admitted at Shaqra General Hospital. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test and mannitol salt agar fermentation. Antibiotic susceptibility testing of MRSA was performed with standard disk diffusion method. All methicillin-resistant isolates were examined for the existence of the mecA gene by PCR technique. RESULTS Of the 220 patients, 90 (40.91%) were found to be nasal carriers of S. aureus. Among these 90 S. aureus isolates, 48 (21.82%) were MRSA. A statistically significant difference was only found for antibiotics usage between those with and without MRSA colonization. Antibiotic susceptibility pattern of isolated MRSA showed high susceptibility to vancomycin, linezolid, rifampicin, teicoplanin, complete resistance to penicillin, ampicillin, oxacillin and cefoxitin and intermediate resistance to amikacin, ciprofloxacin, teicoplanin, tetracycline and vancomycin. CONCLUSION A high prevalence of multidrug-resistant MRSA nasal carriage was found. 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.
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Affiliation(s)
- Mohammed S Alhussaini
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Shaqra University, Saudi Arabia
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Tang YT, Cao R, Xiao N, Li ZS, Wang R, Zou JM, Pei J. Molecular epidemiology and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus isolates in Xiangyang, China. J Glob Antimicrob Resist 2017; 12:31-36. [PMID: 28887291 DOI: 10.1016/j.jgar.2017.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 07/22/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) is a public health problem worldwide. This study aimed to investigate the antimicrobial susceptibility and molecular epidemiological characteristics of MRSA strains in Xiangyang, China, during 2012-2014. METHODS Eighty non-duplicate S. aureus isolates from clinical specimens were collected from four tertiary hospitals. MRSA strains were identified and were tested for antibacterial susceptibility. Staphylococcal cassette chromosome mec (SCCmec) typing, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and staphylococcal protein A (spa) typing were performed to explore molecular characteristics. RESULTS Among the 80 S. aureus isolates, 43 MRSA (53.8%) were detected. MRSA strains exhibited resistance against non-β-lactam antibiotics to varying degrees. SCCmec type III was the predominant type (39/43; 90.7%), and the remainder were SCCmec type IVa (4/43; 9.3%). Thirteen MLST types were found, mainly ST239 (12/43; 27.9%) and ST59 (7/43; 16.3%). Fifteen spa types were found, mainly t437 (13/43; 30.2%) and t030 (6/43; 14.0%). PFGE grouped the 43 MRSA isolates into five types. SCCmecIII-ST239-t030/t632 and SCCmecIII-ST59/ST338-t437 were the dominant epidemic clones in this region. ST239-t030/t632/t037 was the epidemic clone with the most serious drug resistance. CONCLUSIONS This region presented a high MRSA rate and the MRSA isolates demonstrated strong antimicrobial resistance. The existence of four strains of community-acquired MRSA (SCCmec type IVa) indicated the dissemination of MRSA strains from the community to hospitals. The epidemic situation and drug resistance of MRSA should be regularly monitored. Effective measures should be adopted to prevent and control the occurrence of infection in hospitals.
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Affiliation(s)
- Yi-Tong Tang
- Medical College of Hubei University of Arts and Science, 296 Long Zhong Road, Xiangyang, China.
| | - Rui Cao
- Maternal and Child Health Care Hospital of Dongguan, Dongguan, China
| | - Na Xiao
- Medical College of Hubei University of Arts and Science, 296 Long Zhong Road, Xiangyang, China
| | - Zhi-Shan Li
- Medical College of Hubei University of Arts and Science, 296 Long Zhong Road, Xiangyang, China; The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.
| | - Rong Wang
- The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Jiu-Ming Zou
- The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Jiao Pei
- The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Abouelfetouh A, Kassem M, Naguib M, El-Nakeeb M. Investigation and Treatment of Fusidic Acid Resistance Among Methicillin-Resistant Staphylococcal Isolates from Egypt. Microb Drug Resist 2017; 23:8-17. [DOI: 10.1089/mdr.2015.0336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Alaa Abouelfetouh
- Department of Microbiology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Mervat Kassem
- Department of Microbiology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Marwa Naguib
- Department of Microbiology, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Moustafa El-Nakeeb
- Department of Microbiology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Omuse G, Van Zyl KN, Hoek K, Abdulgader S, Kariuki S, Whitelaw A, Revathi G. Molecular characterization of Staphylococcus aureus isolates from various healthcare institutions in Nairobi, Kenya: a cross sectional study. Ann Clin Microbiol Antimicrob 2016; 15:51. [PMID: 27647271 PMCID: PMC5029008 DOI: 10.1186/s12941-016-0171-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/13/2016] [Indexed: 01/23/2023] Open
Abstract
Background Staphylococcus aureus (S. aureus) has established itself over the years as a major cause of morbidity and mortality both within the community and in healthcare settings. Methicillin resistant S. aureus (MRSA) in particular has been a major cause of nosocomial infections resulting in significant increase in healthcare costs. In Africa, the MRSA prevalence has been shown to vary across different countries. In order to better understand the epidemiology of MRSA in a setting, it is important to define its population structure using molecular tools as different clones have been found to predominate in certain geographical locations. Methods We carried out PFGE, MLST, SCCmec and spa typing of selected S. aureus isolates from a private and public referral hospital in Nairobi, Kenya. Results A total of 93 S. aureus isolates were grouped into 19 PFGE clonal complexes (A–S) and 12 singletons. From these, 55 (32 MRSA and 23 MSSA) representative isolates from each PFGE clonal complex and all singletons were spa typed. There were 18 different MRSA spa types and 22 MSSA spa types. The predominant MRSA spa type was t037 comprising 40.6 % (13/32) of all MRSA. In contrast, the MSSA were quite heterogeneous, only 2 out of 23 MSSA shared the same spa type. Two new MRSA spa types (t13149 and t13150) and 3 new MSSA spa types (t13182, t13193 and t13194) were identified. The predominant clonal complex was CC 5 which included multi-locus sequence types 1, 8 and 241. Conclusion In contrast to previous studies published from Kenya, there’s marked genetic diversity amongst clinical MRSA isolates in Nairobi including the presence of well-known epidemic MRSA clones. Given that these clones are resident within our referral hospitals, adherence to strict infection control measures needs to be ensured to reduce morbidity and mortality associated with hospital acquired MRSA infections.
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Affiliation(s)
- Geoffrey Omuse
- Department of Pathology, Aga Khan University Hospital Nairobi, P.O. Box 30270-00100, Nairobi, Kenya.
| | - Kristien Nel Van Zyl
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, P. O. Box 19063, Western Cape, South Africa
| | - Kim Hoek
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, P. O. Box 19063, Western Cape, South Africa
| | - Shima Abdulgader
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa, P.O. Box 7925, Cape Town, South Africa
| | - Samuel Kariuki
- Center of Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Andrew Whitelaw
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, P. O. Box 19063, Western Cape, South Africa
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University Hospital Nairobi, P.O. Box 30270-00100, Nairobi, Kenya
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Distribution of spa Types, Integrons and Associated Gene Cassettes in Staphylococcus aureus Strains Isolated From Intensive Care Units of Hospitals in Tehran, Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2016. [DOI: 10.5812/archcid.38813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ridenour GA, Wong ES, Call MA, Climo MW. Duration of Colonization with Methicillin-ResistantStaphylococcus aureusAmong Patients in the Intensive Care Unit: Implications for Intervention. Infect Control Hosp Epidemiol 2016; 27:271-8. [PMID: 16532415 DOI: 10.1086/500649] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 08/01/2005] [Indexed: 11/03/2022]
Abstract
Objectives.To determine the duration of methicillin-resistantStaphylococcus aureus(MRSA) colonization or infection before entry and during hospitalization in the intensive care unit (ICU) and the characteristics of patients who tested positive for MRSA.Design.Prospective observational cohort survey.Setting.A combined medical and coronary care ICU with 16 single-bed rooms in a 427-bed tertiary care Veteran Affairs Medical CenterPatients.A total of 720 ICU patients associated with 845 ICU admissions were followed up for the detection of MRSA from January 13, 2003, to October 12, 2003. MRSA colonization was detected in patients by using active surveillance cultures (ASCs) of nasal swab specimens obtained within 48 hours of ICU entry and 3 times weekly thereafter. The duration of colonization during ICU stay and before ICU entry was calculated after a review of surveillance culture results, clinical culture results, and medical history.Results.Ninety-three (11.0%) of 845 ICU admissions involved patients who were colonized with MRSA at the time of ICU entry, and 21 admissions (2.5%) involved patients who acquired MRSA during ICU stay. ASCs were positive for MRSA in 84 (73.6%) of the 114 admissions associated with MRSA positivity and were the sole means of identifying MRSA in 50 cases (43.8%). More than half of the MRSA-associated admissions involved patients who were transferred from hospital wards. The total bed-days of care for 38 admissions involving patients who tested positive for MRSA before ICU entry (1131 days) was nearly 20% higher than the total bed-days of care for all admissions associated with MRSA positivity (970 days). Admissions involving MRSA-positive patients were associated with a longer length of hospitalization before ICU entry (P<.001), longer length of ICU stay (P<.001), longer overall length of hospitalization (P<.001), and greater inpatient mortality than admissions involving MRSA-negative patients (P<.001). A total of 22.8% of all bed-care days were dedicated to MRSA-positive patients in the ICU, and 55 (48.2%) of 114 admissions associated with MRSA positivity involved patients who were colonized for the duration of their ICU stay.Conclusions.In our unit, ASCs were an effective means to identify MRSA colonization among patients admitted to the ICU. Unfortunately, the majority of identified patients had long durations of stay in our own hospital before ICU entry, with prolonged MRSA colonization. Enhanced efforts to control MRSA will have to account for the prevalence of MRSA within hospital wards and to direct control efforts at these patients in the future.
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Affiliation(s)
- Glenn A Ridenour
- Division of Infectious Disease, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, 23249, USA
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Goudarzi M, Goudarzi H, Sá Figueiredo AM, Udo EE, Fazeli M, Asadzadeh M, Seyedjavadi SS. Molecular Characterization of Methicillin Resistant Staphylococcus aureus Strains Isolated from Intensive Care Units in Iran: ST22-SCCmec IV/t790 Emerges as the Major Clone. PLoS One 2016; 11:e0155529. [PMID: 27171373 PMCID: PMC4865093 DOI: 10.1371/journal.pone.0155529] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/29/2016] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The emergence of methicillin-resistant Staphylococcus aureus (MRSA) in different patient populations is a major public health concern. This study determined the prevalence and distribution of circulating molecular types of MRSA in hospitalized patients in ICU of hospitals in Tehran. MATERIALS AND METHODS A total of 70 MRSA isolates were collected from patients in eight hospitals. Antimicrobial resistance patterns were determined using the disk diffusion method. The presence of toxin encoding genes and the vancomycin resistance gene were determined by PCR. The MRSA isolates were further analyzed using multi-locus sequence, spa, SCCmec, and agr typing. RESULTS The MRSA prevalence was 93.3%. Antimicrobial susceptibility testing revealed a high resistance rate (97.1%) to ampicillin and penicillin. The rate of resistance to the majority of antibiotics tested was 30% to 71.4%. Two isolates belonging to the ST22-SCCmec IV/t790 clone (MIC ≥ 8 μg/ml) had intermediate resistance to vancomycin. The majority of MRSA isolates (24.3%) were associated with the ST22-SCCmec IV/t790 clone; the other MRSA clones were ST859-SCCmec IV/t969 (18.6%), ST239-SCCmec III/t037 (17.1%), and ST291-SCCmec IV/t030 (8.6%). CONCLUSIONS The circulating MRSA strains in Iranian hospitals were genetically diverse with a relatively high prevalence of the ST22-SCCmec IV/t790 clone. These findings support the need for future surveillance studies on MRSA to better elucidate the distribution of existing MRSA clones and detect emergence of new MRSA clones.
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Affiliation(s)
- Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Agnes Marie Sá Figueiredo
- Departamento de Microbiologia Medica, Instituto de Microbiologia Paulo de Goes, Centro de Ciencias da Saude, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edet E. Udo
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Maryam Fazeli
- WHO Collaborating Center for Reference and Research on Rabies, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Asadzadeh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Ma L, Wang Y, Wang M, Tian Y, Kang W, Liu H, Wang H, Dou J, Zhou C. Effective antimicrobial activity of Cbf-14, derived from a cathelin-like domain, against penicillin-resistant bacteria. Biomaterials 2016; 87:32-45. [DOI: 10.1016/j.biomaterials.2016.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 12/26/2022]
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Santosaningsih D, Santoso S, Budayanti NS, Suata K, Lestari ES, Wahjono H, Djamal A, Kuntaman K, van Belkum A, Laurens M, Snijders SV, Willemse-Erix D, Goessens WH, Verbrugh HA, Severin JA. Characterisation of clinical Staphylococcus aureus isolates harbouring mecA or Panton-Valentine leukocidin genes from four tertiary care hospitals in Indonesia. Trop Med Int Health 2016; 21:610-8. [PMID: 26970318 DOI: 10.1111/tmi.12692] [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] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To determine the prevalence, antimicrobial susceptibility profiles and clonal distribution of either methicillin-resistant Staphylococcus aureus (MRSA) or Panton-Valentine leukocidin (PVL)-positive S. aureus obtained from clinical cultures in Indonesian hospitals. METHODS S. aureus isolates from clinical cultures of patients in four tertiary care hospitals in Denpasar, Malang, Padang and Semarang were included. We assessed the antimicrobial susceptibility profiles using the Vitek2(®) system, determined the presence of the mecA gene and genes encoding PVL using PCR and analysed the clonal relatedness with Raman spectroscopy. SCCmec typing was performed for all MRSA isolates. Multilocus sequence typing (MLST) was performed for a subset of isolates. RESULTS In total, 259 S. aureus strains were collected. Of these, 17/259 (6.6%) and 48/259 (18.5%) were MRSA and PVL-positive methicillin-susceptible S. aureus (MSSA), respectively. The prevalence of MRSA and PVL-positive MSSA ranged between 2.5-8.9% and 9.5-29.1%, respectively and depended on geographic origin. PVL-positive MRSA were not detected. Raman spectroscopy of the strains revealed multiple Raman types with two predominant clusters. We also showed possible transmission of a ST239-MRSA-SCCmec type III strain and a ST121 PVL-positive MSSA in one of the hospitals. CONCLUSIONS We showed that MRSA and PVL-positive MSSA are of clinical importance in Indonesian hospitals. A national surveillance system should be set-up to further monitor this. To reduce the prevalence of MRSA in Indonesian hospitals, a bundle of intervention measures is highly recommended.
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Affiliation(s)
- Dewi Santosaningsih
- Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr.Saiful Anwar Hospital, Malang, Indonesia
| | - Sanarto Santoso
- Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr.Saiful Anwar Hospital, Malang, Indonesia
| | - Nyoman S Budayanti
- Department of Microbiology, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia
| | - Ketut Suata
- Department of Microbiology, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia
| | - Endang S Lestari
- Department of Microbiology, Faculty of Medicine, Diponegoro University/Dr.Kariadi Hospital, Semarang, Indonesia
| | - Hendro Wahjono
- Department of Microbiology, Faculty of Medicine, Diponegoro University/Dr.Kariadi Hospital, Semarang, Indonesia
| | - Aziz Djamal
- Department of Microbiology, Faculty of Medicine, Andalas University/Dr.M.Djamil Hospital, Padang, Indonesia
| | - Kuntaman Kuntaman
- Department of Microbiology, Faculty of Medicine, Airlangga University/Dr.Soetomo Hospital, Surabaya, Indonesia
| | - Alex van Belkum
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Microbiology Unit, Biomérieux, Inc., La Balme, France
| | - Mitchell Laurens
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.,BaseClear BV, Leiden, the Netherlands
| | - Susan V Snijders
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Diana Willemse-Erix
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Molecular Diagnostics, Jeroen Bosch Hospital, Tilburg, the Netherlands
| | - Wil H Goessens
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Henri A Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Antibiotic Resistance of Commensal Staphylococcus aureus and Coagulase-Negative Staphylococci in an International Cohort of Surgeons: A Prospective Point-Prevalence Study. PLoS One 2016; 11:e0148437. [PMID: 26840492 PMCID: PMC4739597 DOI: 10.1371/journal.pone.0148437] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 01/18/2016] [Indexed: 12/24/2022] Open
Abstract
Nasal colonization with antibiotic resistant bacteria represents both a risk factor for the colonized individual and their immediate contacts. Despite the fact that healthcare workers such as orthopedic surgeons are at a critical interface between the healthcare environment and an at-risk patient population, the prevalence of antibiotic resistant bacteria within the surgical profession remains unclear. This study offers a snapshot of the rate of nasal colonization of orthopedic surgeons with multi-resistant staphylococci including methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS). We performed a prospective, observational study obtained at a single time point in late 2013. The participants were active orthopedic, spine and head & neck surgeons from 75 countries. The prevalence of nasal carriage of the different bacteria and the corresponding 95% confidence interval were calculated. From a cohort of 1,166 surgeons, we found an average S. aureus nasal colonization rate of 28.0% (CI 25.4;30.6) and MRSA rate of 2.0% (CI 1.3;2.9), although significant regional variations were observed. The highest rates of MRSA colonization were found in Asia (6.1%), Africa (5.1%) and Central America (4.8%). There was no MRSA carriage detected within our population of 79 surgeons working in North America, and a low (0.6%) MRSA rate in 657 surgeons working in Europe. High rates of MRCoNS nasal carriage were also observed (21.4% overall), with a similar geographic distribution. Recent use of systemic antibiotics was associated with higher rates of carriage of resistant staphylococci. In conclusion, orthopedic surgeons are colonized by S. aureus and MRSA at broadly equivalent rates to the general population. Crucially, geographic differences were observed, which may be partially accounted for by varying antimicrobial stewardship practices between the regions. The elevated rates of resistance within the coagulase-negative staphylococci are of concern, due to the increasing awareness of their importance in hospital acquired and device-associated infection.
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Merli M, Lucidi C, Di Gregorio V, Falcone M, Giannelli V, Lattanzi B, Giusto M, Ceccarelli G, Farcomeni A, Riggio O, Venditti M. The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey. PLoS One 2015; 10:e0127448. [PMID: 25996499 PMCID: PMC4440761 DOI: 10.1371/journal.pone.0127448] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 04/15/2015] [Indexed: 12/18/2022] Open
Abstract
Background The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment. Aim Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients. Methods All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes. Results One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections. Conclusions Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential.
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Affiliation(s)
- Manuela Merli
- Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Rome, Italy
- * E-mail:
| | - Cristina Lucidi
- Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Vincenza Di Gregorio
- Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Marco Falcone
- Department of Infectious disease, “Sapienza” University of Rome, Rome, Italy
| | - Valerio Giannelli
- Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Barbara Lattanzi
- Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Michela Giusto
- Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Rome, Italy
| | | | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Statistics Section, “Sapienza” University of Rome, Rome, Italy
| | - Oliviero Riggio
- Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Mario Venditti
- Department of Infectious disease, “Sapienza” University of Rome, Rome, Italy
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Stinear TP, Holt KE, Chua K, Stepnell J, Tuck KL, Coombs G, Harrison PF, Seemann T, Howden BP. Adaptive change inferred from genomic population analysis of the ST93 epidemic clone of community-associated methicillin-resistant Staphylococcus aureus. Genome Biol Evol 2015; 6:366-78. [PMID: 24482534 PMCID: PMC3942038 DOI: 10.1093/gbe/evu022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a major public health problem around the world. In Australia, ST93-IV[2B] is the dominant CA-MRSA clone and displays significantly greater virulence than other S. aureus. Here, we have examined the evolution of ST93 via genomic analysis of 12 MSSA and 44 MRSA ST93 isolates, collected from around Australia over a 17-year period. Comparative analysis revealed a core genome of 2.6 Mb, sharing greater than 99.7% nucleotide identity. The accessory genome was 0.45 Mb and comprised additional mobile DNA elements, harboring resistance to erythromycin, trimethoprim, and tetracycline. Phylogenetic inference revealed a molecular clock and suggested that a single clone of methicillin susceptible, Panton-Valentine leukocidin (PVL) positive, ST93 S. aureus likely spread from North Western Australia in the early 1970s, acquiring methicillin resistance at least twice in the mid 1990s. We also explored associations between genotype and important MRSA phenotypes including oxacillin MIC and production of exotoxins (α-hemolysin [Hla], δ-hemolysin [Hld], PSMα3, and PVL). High-level expression of Hla is a signature feature of ST93 and reduced expression in eight isolates was readily explained by mutations in the agr locus. However, subtle but significant decreases in Hld were also noted over time that coincided with decreasing oxacillin resistance and were independent of agr mutations. The evolution of ST93 S. aureus is thus associated with a reduction in both exotoxin expression and oxacillin MIC, suggesting MRSA ST93 isolates are under pressure for adaptive change.
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Affiliation(s)
- Timothy P Stinear
- Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
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Mah FS, Davidson R, Holland EJ, Hovanesian J, John T, Kanellopoulos J, Shamie N, Starr C, Vroman D, Kim T. Current knowledge about and recommendations for ocular methicillin-resistant Staphylococcus aureus. J Cataract Refract Surg 2014; 40:1894-908. [PMID: 25442885 DOI: 10.1016/j.jcrs.2014.09.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Staphylococcus aureus is the most important and common pathogen that infects patients following cataract surgery, laser in situ keratomileusis, and photorefractive keratectomy. It is reported to be the second most common pathogen causing bacterial keratitis around the world. Of special concern are increasing reports of postoperative methicillin-resistant S aureus (MRSA) infection. For example, MRSA wound infections have been reported with clear corneal phacoemulsification wounds, penetrating keratoplasty, lamellar keratoplasty, and following ex vivo epithelial transplantation associated with amniotic membrane grafts. These and other data suggest that MRSA has become increasingly prevalent worldwide. In this article, we review the current medical literature and describe the current challenge of ocular MRSA infections. Recommendations are made based on an evidence-based review to identify, treat, and possibly reduce the overall problem of this organism. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Santosaningsih D, Santoso S, Budayanti NS, Kuntaman K, Lestari ES, Farida H, Hapsari R, Hadi P, Winarto W, Milheiriço C, Maquelin K, Willemse-Erix D, van Belkum A, Severin JA, Verbrugh HA. Epidemiology of Staphylococcus aureus harboring the mecA or Panton-Valentine leukocidin genes in hospitals in Java and Bali, Indonesia. Am J Trop Med Hyg 2014; 90:728-34. [PMID: 24567320 DOI: 10.4269/ajtmh.13-0734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Data of Staphylococcus aureus carriage in Indonesian hospitals are scarce. Therefore, the epidemiology of S. aureus among surgery patients in three academic hospitals in Indonesia was studied. In total, 366 of 1,502 (24.4%) patients carried S. aureus. The methicillin-resistant S. aureus (MRSA) carriage rate was 4.3%, whereas 1.5% of the patients carried Panton-Valentine leukocidin (PVL)-positive methicillin-sensitive S. aureus (MSSA). Semarang and Malang city (odds ratio [OR] 9.4 and OR 9.0), being male (OR 2.4), hospitalization for more than 5 days (OR 11.708), and antibiotic therapy during hospitalization (OR 2.6) were independent determinants for MRSA carriage, whereas prior hospitalization (OR 2.5) was the only one risk factor for PVL-positive MSSA carriage. Typing of MRSA strains by Raman spectroscopy showed three large clusters assigned type 21, 24, and 38, all corresponding to ST239-MRSA-SCCmec type III. In conclusion, MRSA and PVL-positive MSSA are present among patients in surgical wards in Indonesian academic hospitals.
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Affiliation(s)
- Dewi Santosaningsih
- Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar Hospital, Malang, Indonesia; Department of Microbiology, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia; Department of Microbiology, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia; Department of Microbiology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia; Laboratory of Molecular Genetics, Instituto de Tecnologia Quimica e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal; Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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Ishaq MS, Hussain MM, Siddique Afridi M, Ali G, Khattak M, Ahmad S, Shakirullah. In vitro phytochemical, antibacterial, and antifungal activities of leaf, stem, and root extracts of Adiantum capillus veneris. ScientificWorldJournal 2014; 2014:269793. [PMID: 24592156 PMCID: PMC3925560 DOI: 10.1155/2014/269793] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/24/2013] [Indexed: 11/24/2022] Open
Abstract
Adiantum capillus veneris is a medicinally essential plant used for the treatment of diverse infectious diseases. The study of phytochemical and antimicrobial activities of the plant extracts against multidrug-resistant (MDR) bacteria and medically important fungi is of immense significance. Extracts from the leaves, stems, and roots of Adiantum capillus veneris were extracted with water, methanol, ethanol, ethyl acetate, and hexane and screened for their antimicrobial activity against ten MDR bacterial strains and five fungal strains isolated from clinical and water samples. Ash, moisture, and extractive values were determined according to standard protocols. FTIR (Fourier transform infrared Spectroscopy) studies were performed on different phytochemicals isolated from the extracts of Adiantum capillus Veneris. Phytochemical analysis showed the presence of flavonoids, alkaloids, tannins, saponins, cardiac glycosides, terpenoids, steroids, and reducing sugars. Water, methanol, and ethanol extracts of leaves, stems, and roots showed significant antibacterial and antifungal activities against most of the MDR bacterial and fungal strains. This study concluded that extracts of Adiantum capillus veneris have valuable phytochemicals and significant activities against most of the MDR bacterial strains and medically important fungal strains.
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Affiliation(s)
- Muhammad Saqib Ishaq
- Department of Microbiology, Faculty of Life Sciences, Abasyn University, Peshawar 25000, Pakistan
| | - Muhammad Medrar Hussain
- Department of Microbiology, Faculty of Life Sciences, Abasyn University, Peshawar 25000, Pakistan
| | | | - Ghadir Ali
- Department of Microbiology, Faculty of Life Sciences, Abasyn University, Peshawar 25000, Pakistan
| | - Mahrukh Khattak
- Department of Microbiology, Shaheed Benazir Bhutto Women University, Peshawar 25000, Pakistan
| | - Sohail Ahmad
- Department of Chemistry, Kohat University of Science and Technology, Kohat 26000, Pakistan
| | - Shakirullah
- Department of Microbiology, Faculty of Life Sciences, Abasyn University, Peshawar 25000, Pakistan
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Strommenger B, Bartels MD, Kurt K, Layer F, Rohde SM, Boye K, Westh H, Witte W, De Lencastre H, Nübel U. Evolution of methicillin-resistant Staphylococcus aureus towards increasing resistance. J Antimicrob Chemother 2013; 69:616-22. [PMID: 24150844 DOI: 10.1093/jac/dkt413] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To elucidate the evolutionary history of Staphylococcus aureus clonal complex (CC) 8, which encompasses several globally distributed epidemic lineages, including hospital-associated methicillin-resistant S. aureus (MRSA) and the highly prevalent community-associated MRSA clone USA300. METHODS We reconstructed the phylogeny of S. aureus CC8 by mutation discovery at 112 genetic housekeeping loci from each of 174 isolates, sampled on five continents between 1957 and 2008. The distribution of antimicrobial resistance traits and of diverse mobile genetic elements was investigated in relation to the isolates' phylogeny. RESULTS Our analyses revealed the existence of nine phylogenetic clades within CC8. We identified at least eight independent events of methicillin resistance acquisition in CC8 and dated the origin of a methicillin-resistant progenitor of the notorious USA300 clone to the mid-1970s. Of the S. aureus isolates in our collection, 88% carried plasmidic rep gene sequences, with up to five different rep genes in individual isolates and a total of eight rep families. Mapping the plasmid content onto the isolates' phylogeny illustrated the stable carriage over decades of some plasmids and the more volatile nature of others. Strikingly, we observed trends of increasing antibiotic resistance during the evolution of several lineages, including USA300. CONCLUSIONS We propose a model for the evolution of S. aureus CC8, involving a split into at least nine phylogenetic lineages and a subsequent series of acquisitions and losses of mobile genetic elements that carry diverse virulence and antimicrobial resistance traits. The evolution of MRSA USA300 towards resistance to additional antibiotic classes is of major concern.
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Affiliation(s)
- Birgit Strommenger
- National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
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Naidoo R, Nuttall J, Whitelaw A, Eley B. Epidemiology of Staphylococcus aureus bacteraemia at a tertiary children's hospital in Cape Town, South Africa. PLoS One 2013; 8:e78396. [PMID: 24167621 PMCID: PMC3805599 DOI: 10.1371/journal.pone.0078396] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/11/2013] [Indexed: 11/18/2022] Open
Abstract
Background Staphylococcus aureus is an important pathogen in paediatric patients with bloodstream infections. The epidemiology of S. aureus bacteraemia, however, has not been well documented in children in South Africa. Methods A retrospective study was conducted at a children’s hospital in Cape Town, South Africa, to investigate the epidemiology of S. aureus bacteraemia from 2007-2011. The incidence, clinical presentation, risk factors, management and outcomes of methicillin sensitive S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) bacteraemia were compared. Results Over the five year study period, 365 episodes of S. aureus bacteraemia were identified. The annual incidence was 3.28 cases per 1000 hospital admissions. MRSA was responsible for 26% of S. aureus bacteraemia and 72% of nosocomial infections. Only six possible cases of community-acquired MRSA infections were described. MSSA bacteraemia was more likely to present as pulmonary and bone or joint infections, while bacteraemia without a source was the most common presentation with MRSA. Infants, children with malnutrition, and residents of long-term care facilities were at highest risk for MRSA bacteraemia. The overall case fatality rate for S. aureus bacteraemia was 8.8% over five years, with MRSA being the only significant risk factor for mortality. Conclusion The incidence of S. aureus bacteraemia and MRSA bacteraemia in children has remained stable over the past five years. MRSA is a predominantly nosocomial pathogen in children with S. aureus bacteraemia in Cape Town, South Africa.
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Affiliation(s)
- Reené Naidoo
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Whitelaw
- National Health Laboratory Services, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Zhang L, Dong WF, Sun HB. Multifunctional superparamagnetic iron oxide nanoparticles: design, synthesis and biomedical photonic applications. NANOSCALE 2013; 5:7664-7684. [PMID: 23877222 DOI: 10.1039/c3nr01616a] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Superparamagnetic iron oxide nanoparticles (SPIONs) have shown great promise in biomedical applications. In this review, we summarize the recent advances in the design and fabrication of core-shell and hetero-structured SPIONs and further outline some exciting developments and progresses of these multifunctional SPIONs for diagnosis, multimodality imaging, therapy, and biophotonics.
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Affiliation(s)
- Lu Zhang
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, 2699 Qianjin Street, Changchun 130012, China
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Spoor LE, McAdam PR, Weinert LA, Rambaut A, Hasman H, Aarestrup FM, Kearns AM, Larsen AR, Skov RL, Fitzgerald JR. Livestock origin for a human pandemic clone of community-associated methicillin-resistant Staphylococcus aureus. mBio 2013; 4:e00356-13. [PMID: 23943757 PMCID: PMC3747577 DOI: 10.1128/mbio.00356-13%0a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 06/14/2013] [Indexed: 11/19/2023] Open
Abstract
UNLABELLED The importance of livestock as a source of bacterial pathogens with the potential for epidemic spread in human populations is unclear. In recent years, there has been a global increase in community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections of healthy humans, but an understanding of the different evolutionary origins of CA-MRSA clones and the basis for their recent expansion is lacking. Here, using a high-resolution phylogenetic approach, we report the discovery of two emergent clones of human epidemic CA-MRSA which resulted from independent livestock-to-human host jumps by the major bovine S. aureus complex, CC97. Of note, one of the new clones was isolated from human infections on four continents, demonstrating its global dissemination since the host jump occurred over 40 years ago. The emergence of both human S. aureus clones coincided with the independent acquisition of mobile genetic elements encoding antimicrobial resistance and human-specific mediators of immune evasion, consistent with an important role for these genetic events in the capacity to survive and transmit among human populations. In conclusion, we provide evidence that livestock represent a reservoir for the emergence of new human-pathogenic S. aureus clones with the capacity for pandemic spread. These findings have major public health implications highlighting the importance of surveillance for early identification of emergent clones and improved transmission control measures at the human-livestock interface. IMPORTANCE Animals are the major source of new pathogens affecting humans. However, the potential for pathogenic bacteria that originally were found in animals to switch hosts and become widely established in human populations is not clear. Here, we report the discovery of emergent clones of methicillin-resistant Staphylococcus aureus (MRSA) that originated in livestock and switched to humans, followed by host-adaptive evolution and epidemic spread in global human populations. Our findings demonstrate that livestock can act as a reservoir for the emergence of new human bacterial clones with potential for pandemic spread, highlighting the potential role of surveillance and biosecurity measures in the agricultural setting for preventing the emergence of new human pathogens.
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Affiliation(s)
- Laura E. Spoor
- The Roslin Institute and Edinburgh Infectious Diseases, University of Edinburgh, Easter Bush, Midlothian, United Kingdom
| | - Paul R. McAdam
- The Roslin Institute and Edinburgh Infectious Diseases, University of Edinburgh, Easter Bush, Midlothian, United Kingdom
| | - Lucy A. Weinert
- University of Cambridge, Department of Veterinary Medicine, Cambridge, United Kingdom
| | - Andrew Rambaut
- Institute of Evolutionary Biology, Ashworth Laboratories, University of Edinburgh, Edinburgh, United Kingdom
| | - Henrik Hasman
- National Food Institute, Technical University of Denmark (DTU), Lyngby, Denmark
| | - Frank M. Aarestrup
- National Food Institute, Technical University of Denmark (DTU), Lyngby, Denmark
| | - Angela M. Kearns
- Microbiology Services, Colindale, Health Protection Agency, London, United Kingdom
| | - Anders R. Larsen
- Department of Antimicrobial Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark
| | - Robert L. Skov
- Department of Antimicrobial Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark
| | - J. Ross Fitzgerald
- The Roslin Institute and Edinburgh Infectious Diseases, University of Edinburgh, Easter Bush, Midlothian, United Kingdom
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Livestock origin for a human pandemic clone of community-associated methicillin-resistant Staphylococcus aureus. mBio 2013; 4:mBio.00356-13. [PMID: 23943757 PMCID: PMC3747577 DOI: 10.1128/mbio.00356-13] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The importance of livestock as a source of bacterial pathogens with the potential for epidemic spread in human populations is unclear. In recent years, there has been a global increase in community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections of healthy humans, but an understanding of the different evolutionary origins of CA-MRSA clones and the basis for their recent expansion is lacking. Here, using a high-resolution phylogenetic approach, we report the discovery of two emergent clones of human epidemic CA-MRSA which resulted from independent livestock-to-human host jumps by the major bovine S. aureus complex, CC97. Of note, one of the new clones was isolated from human infections on four continents, demonstrating its global dissemination since the host jump occurred over 40 years ago. The emergence of both human S. aureus clones coincided with the independent acquisition of mobile genetic elements encoding antimicrobial resistance and human-specific mediators of immune evasion, consistent with an important role for these genetic events in the capacity to survive and transmit among human populations. In conclusion, we provide evidence that livestock represent a reservoir for the emergence of new human-pathogenic S. aureus clones with the capacity for pandemic spread. These findings have major public health implications highlighting the importance of surveillance for early identification of emergent clones and improved transmission control measures at the human-livestock interface. Animals are the major source of new pathogens affecting humans. However, the potential for pathogenic bacteria that originally were found in animals to switch hosts and become widely established in human populations is not clear. Here, we report the discovery of emergent clones of methicillin-resistant Staphylococcus aureus (MRSA) that originated in livestock and switched to humans, followed by host-adaptive evolution and epidemic spread in global human populations. Our findings demonstrate that livestock can act as a reservoir for the emergence of new human bacterial clones with potential for pandemic spread, highlighting the potential role of surveillance and biosecurity measures in the agricultural setting for preventing the emergence of new human pathogens.
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Egyir B, Guardabassi L, Nielsen SS, Larsen J, Addo KK, Newman MJ, Larsen AR. Prevalence of nasal carriage and diversity of Staphylococcus aureus among inpatients and hospital staff at Korle Bu Teaching Hospital, Ghana. J Glob Antimicrob Resist 2013; 1:189-193. [PMID: 27873611 DOI: 10.1016/j.jgar.2013.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/21/2013] [Accepted: 05/31/2013] [Indexed: 11/28/2022] Open
Abstract
There is a paucity of data on Staphylococcus aureus epidemiology in Africa. Prevalence of nasal carriage and genetic diversity of S. aureus were determined among hospital staff (HS) and inpatients (IP) at the largest hospital in Ghana. In total, 632 nasal swabs were obtained from 452 IP and 180 HS in the Child Health Department (CHD) and Surgical Department (SD). S. aureus carriage prevalences were 13.9% in IP and 23.3% in HS. The chance of being a carrier was higher in HS (P=0.005) and IP staying ≤7 days in hospital (P=0.007). Resistance to penicillin (93%), tetracycline (28%) and fusidic acid (12%) was more common than for other agents (<5%). A higher chance of multidrug-resistant S. aureus carriage was observed among IP compared with HS (P=0.01). High genetic diversity was shown by spa typing, with 55 spa types found among 105 isolates; the predominant spa types were t355 (10%) and t084 (10%). MRSA was detected in six IP with an overall carriage prevalence of ca. 1.3%, but not in HS. All three MRSA isolates from SD belonged to ST88-SCCmec IV, and two of them displayed the same spa type and antibiograms; three MRSA isolates from CHD belonged to distinct lineages (ST88-SCCmec IV, ST8-SCCmec V and ST72-SCCmec V). Altogether, these data indicate a high diversity of S. aureus, low levels of MRSA carriage, and a higher chance of nasal carriage of multidrug-resistant S. aureus among IP compared with HS in this hospital.
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Affiliation(s)
- Beverly Egyir
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark; Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Bacteriology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana.
| | - Luca Guardabassi
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Søren Saxmose Nielsen
- Department of Large Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jesper Larsen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Kennedy Kwasi Addo
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | - Anders Rhod Larsen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Allahverdiyev AM, Kon KV, Abamor ES, Bagirova M, Rafailovich M. Coping with antibiotic resistance: combining nanoparticles with antibiotics and other antimicrobial agents. Expert Rev Anti Infect Ther 2012; 9:1035-52. [PMID: 22029522 DOI: 10.1586/eri.11.121] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The worldwide escalation of bacterial resistance to conventional medical antibiotics is a serious concern for modern medicine. High prevalence of multidrug-resistant bacteria among bacteria-based infections decreases effectiveness of current treatments and causes thousands of deaths. New improvements in present methods and novel strategies are urgently needed to cope with this problem. Owing to their antibacterial activities, metallic nanoparticles represent an effective solution for overcoming bacterial resistance. However, metallic nanoparticles are toxic, which causes restrictions in their use. Recent studies have shown that combining nanoparticles with antibiotics not only reduces the toxicity of both agents towards human cells by decreasing the requirement for high dosages but also enhances their bactericidal properties. Combining antibiotics with nanoparticles also restores their ability to destroy bacteria that have acquired resistance to them. Furthermore, nanoparticles tagged with antibiotics have been shown to increase the concentration of antibiotics at the site of bacterium-antibiotic interaction, and to facilitate binding of antibiotics to bacteria. Likewise, combining nanoparticles with antimicrobial peptides and essential oils generates genuine synergy against bacterial resistance. In this article, we aim to summarize recent studies on interactions between nanoparticles and antibiotics, as well as other antibacterial agents to formulate new prospects for future studies. Based on the promising data that demonstrated the synergistic effects of antimicrobial agents with nanoparticles, we believe that this combination is a potential candidate for more research into treatments for antibiotic-resistant bacteria.
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Rogers BA, Aminzadeh Z, Hayashi Y, Paterson DL. Country-to-country transfer of patients and the risk of multi-resistant bacterial infection. Clin Infect Dis 2011; 53:49-56. [PMID: 21653302 DOI: 10.1093/cid/cir273] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Management of patients with a history of healthcare contact in multiple countries is now a reality for many clinicians. Leisure tourism, the burgeoning industry of medical tourism, military conflict, natural disasters, and changing patterns of human migration may all contribute to this emerging epidemiological trend. Such individuals may be both vectors and victims of healthcare-associated infection with multiresistant bacteria. Current literature describes intercountry transfer of multiresistant Acinetobacter spp and Klebsiella pneumoniae (including Klebsiella pneumoniae carbapenemase- and New Delhi metallo-β-lactamase-producing strains), methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and hypervirulent Clostridium difficile. Introduction of such organisms to new locations has led to their dissemination within hospitals. Healthcare institutions should have sound infection prevention strategies to mitigate the risk of dissemination of multiresistant organisms from patients who have been admitted to hospitals in other countries. Clinicians may also need to individualize empiric prescribing patterns to reflect the risk of multiresistant organisms in these patients.
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Affiliation(s)
- Benjamin A Rogers
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia.
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Mendoza N, Tyring SK. Emerging drugs for complicated skin and skin-structure infections. Expert Opin Emerg Drugs 2010; 15:509-20. [PMID: 20557269 DOI: 10.1517/14728214.2010.497486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED IMPORTANCE OF THE FILED: With the worldwide surge of MRSA, skin and skin-structure infection (SSTI) treatment has become a challenge for physicians. Cultures and antibiotic susceptibility tests for SSTIs are the rule due to the implication in morbidity and mortality rates associated with MRSA infections. The need for new antibiotics is evident and the effort to decrease antibiotic resistance is a world priority. AREAS COVERED IN THIS REVIEW This manuscript accesses the actual treatments and the developing of antibiotics for MRSA SSTIs. WHAT THE READER WILL GAIN This is a review of the data on the available and emerging treatments for MRSA SSTIs. TAKE HOME MESSAGE There is an unmet medical need for new antibiotics in the new millennium. As physicians, we must assure all appropriate procedures are completed in order to reduce the bacterial resistance, especially for MRSA.
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Affiliation(s)
- Natalia Mendoza
- Center for Clinical Studies, 6655 Travis Suite 120, Houston, TX 77030, USA.
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Horasan ES, Ersoz G, Horoz M, Göksu M, Karacorlu S, Kaya A. Risk factors for infections caused by multidrug-resistant bacteria in patients with solid tumours. ACTA ACUST UNITED AC 2010; 43:107-11. [PMID: 21080767 DOI: 10.3109/00365548.2010.534500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We aimed to determine the risk factors for healthcare-associated infections (HCAI) caused by multidrug-resistant (MDR) bacteria in patients with solid tumours. METHODS This retrospective study was performed in the Department of Clinical Microbiology and Infectious Diseases, Mersin Teaching and Research Medical Centre, between January 2004 and December 2008. SPSS version 11.5 program package was used for the statistical analyses. RESULTS A total of 145 patients who had an HCAI were analyzed; 62% of the patients were male and their median age was 57.7 ± 16 y and median Charlson co-morbidity score was 4.94 ± 1.2. During the study period, 83 MDR bacteria were isolated from HCAIs that developed in 70 (48.3%) patients. In multiple binary logistic regression analysis, duration of hospital stay (odds ratio (OR) 1.041, 95% confidence interval (CI) 1.007-1.077; p = 0.019), surgery (OR 3.115, 95% CI 1.288-7.535; p = 0.012), use of glycopeptides (OR 5.394, 95% CI 1.960-14.850; p = 0.001), and use of third-generation cephalosporins (OR 5.521, 95% CI 2.017-15.110; p = 0.001) were found to be independent risk factors for the development of an MDR infection. CONCLUSIONS Among hospitalized patients with a solid tumour, HCAIs caused by MDR bacteria occurred more frequently in patients undergoing surgery, receiving third-generation cephalosporins and glycopeptide antibiotics, and having a prolonged hospital stay.
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Affiliation(s)
- Elif Sahin Horasan
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Mersin University, 33079 Mersin, Turkey.
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Molecular characterization of clinical methicillin-resistant Staphylococcus aureus isolates in South Africa. J Clin Microbiol 2010; 48:4608-11. [PMID: 20881169 DOI: 10.1128/jcm.01704-10] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Eighty-two percent of 320 clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates from various infection sites collected throughout South Africa were separated into five major globally prevalent clusters by SmaI pulsed-field gel electrophoresis, spa, and SCCmec typing. Only one Panton-Valentine leukocidin-positive isolate was detected. This is the first detailed MRSA epidemiology study for the whole country.
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Horvath A, Rozgonyi F, Pesti N, Kocsis E, Malmos G, Kristof K, Nagy K, Lagler H, Presterl E, Stich K, Gattringer R, Kotolacsi G, Cekovska Z, Graninger W. Quantitative differences in antibiotic resistance between methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains isolated in Hungary, Austria and Macedonia. J Chemother 2010; 22:246-53. [PMID: 20685628 DOI: 10.1179/joc.2010.22.4.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this study was to compare the quantitative susceptibility of methicillin-resistant and -susceptible Staphylococcus aureus (MRSA and MSSA) strains from three European countries to nine antistaphylococcal agents. The antibiotic susceptibility of 274 MRSA and 284 MSSA strains from Hungary, Austria and macedonia was tested by the broth microdilution method. The clonal relationship of strains was determined by pulsed-field gel electrophoresis. Intermediate susceptibility to vancomycin appeared in Macedonian MRSA strains. Macedonian MRSA strains had high-level amikacin and gentamicin resistance. MSSA strains generally were susceptible to all drugs at minimum inhibitory concentrations (MIC(50)) except for gentamicin resistance in Macedonian strains. In Hungary and Austria a common antibiotic resistance phenotype of MRSA predominated, while in macedonia three other phenotypes were also prevalent. Geographical differences in the resistance of S. aureus are still high. Since resistance levels of MRSA and MSSA strains differ extensively, they should be considered separately for antibiotic resistance analysis.
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Affiliation(s)
- A Horvath
- Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
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Field D, Quigley L, O'Connor PM, Rea MC, Daly K, Cotter PD, Hill C, Ross RP. Studies with bioengineered Nisin peptides highlight the broad-spectrum potency of Nisin V. Microb Biotechnol 2010; 3:473-86. [PMID: 21255345 PMCID: PMC3815813 DOI: 10.1111/j.1751-7915.2010.00184.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/15/2010] [Indexed: 12/20/2022] Open
Abstract
Nisin A is the most thoroughly investigated member of the lantibiotic family of antimicrobial peptides. In addition to a long history of safe use as a food antimicrobial, its activity against multi-drug resistant pathogens has resulted in a renewed interest in applying nisin as a chemotherapeutic to treat bacterial infections. The wealth of Nisin-related information that has been generated has also led to the development of the biotechnological capacity to engineer novel Nisin variants with a view to improving the function and physicochemical properties of this already potent peptide. However, the identification of bioengineered Nisin derivatives with enhanced antimicrobial activity against Gram-positive targets is a recent event. In this study, we created stable producers of the most promising derivatives of Nisin A generated to date [M21V (hereafter Nisin V) and K22T (hereafter Nisin T)] and assessed their potency against a range of drug-resistant clinical, veterinary and food pathogens. Nisin T exhibited increased activity against all veterinary isolates, including streptococci and staphylococci, and against a number of multi-drug resistant clinical isolates including MRSA, but not vancomycin-resistant enterococci. In contrast, Nisin V displayed increased potency against all targets tested including hVISA strains and the hyper-virulent Clostridium difficile ribotype 027 and against important food pathogens such as Listeria monocytogenes and Bacillus cereus. Significantly, this enhanced activity was validated in a model food system against L. monocytogenes. We conclude that Nisin V possesses significant potential as a novel preservative or chemotherapeutic compound.
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Affiliation(s)
- Des Field
- Department of Microbiology, University College Cork, Cork, Ireland
| | - Lisa Quigley
- Department of Microbiology, University College Cork, Cork, Ireland
| | | | - Mary C. Rea
- Teagasc, Moorepark Food Research Centre, Fermoy, Co. Cork, Ireland
| | - Karen Daly
- Department of Microbiology, University College Cork, Cork, Ireland
| | - Paul D. Cotter
- Teagasc, Moorepark Food Research Centre, Fermoy, Co. Cork, Ireland
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
| | - Colin Hill
- Department of Microbiology, University College Cork, Cork, Ireland
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
| | - R. Paul Ross
- Teagasc, Moorepark Food Research Centre, Fermoy, Co. Cork, Ireland
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
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Stenhem M, Ortqvist A, Ringberg H, Larsson L, Olsson Liljequist B, Haeggman S, Kalin M, Ekdahl K. Imported methicillin-resistant Staphylococcus aureus, Sweden. Emerg Infect Dis 2010; 16:189-96. [PMID: 20113546 PMCID: PMC2957988 DOI: 10.3201/eid1602.081655] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Knowledge of different risks for infection will improve control measures. Countries such as Sweden that have a low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) offer the opportunity to discern and study transmission of imported cases of MRSA. We analyzed 444 imported cases of MRSA acquisition reported in Sweden during 2000–2003. Risk for MRSA in returning travelers ranged from 0.1 (95% confidence interval [CI] 0.01–0.4) per 1 million travelers to Nordic countries to 59.4 (95% CI 44.5–79.3) per 1 million travelers to North Africa and the Middle East. Most imported cases (246, 55%) were healthcare acquired, but regions with the highest risk for MRSA in travelers showed a correlation with community acquisition (r = 0.81, p = 0.001). Characteristic differences in MRSA strains acquired were dependent on the region from which they originated and whether they were community or healthcare acquired. Knowledge of differences in transmission of MRSA may improve control measures against imported cases.
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Affiliation(s)
- Mikael Stenhem
- Swedish Institute for Infectious Disease Control, Solna, Sweden
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Picot S, Rakotomalala RS, Farny K, Simac C, Michault A. [Evolution of resistance to antibiotics from 1997 to 2005 in the Reunion Island]. Med Mal Infect 2010; 40:617-24. [PMID: 20570074 DOI: 10.1016/j.medmal.2010.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 02/22/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The groupe hospitalier Sud Reunion (GHSR) is a 1130-bed hospital center, located on the Reunion Island, (Indian Ocean). We studied the profiles of antibiotic resistance in 2005, and compared those with previous data collected in 1997-1998, and with Metropolitan France and European data. MATERIAL AND METHODOLOGY All bacteriological strains isolated from diagnostic samples in 2005 were analyzed according to CA-SFM recommendations. RESULTS Since 1997, the rates of resistance to enterobacteria (betalactam, aminoside, quinolone, trimethoprim-sulfamethoxazole), Pseudomonas aeruginosa (ticarcillin, amikacin, ciprofloxacin, fosfomycin), Acinetobacter baumanii (amikacin) has decreased significantly. The rate of methicillin-resistant Staphylococcus aureus (1997: 3.6 %, 2005: 13.4 %) has increased but less than in Metropolitan France. The rate of Streptococcuspneumonia with decreased susceptibility to penicillin has increased (1997: 25.5 %, 2005: 42.9 %), as for Haemophilusinfluenzae which present an important increase of betalactam resistance (1997: 15.5 %, 2005: 37.8 %). CONCLUSION By comparing our data to 1997 and Metropolitan French data, it seems that the GHSR has managed to protect its hospital-based microbial ecology. However, community germs showed increasing resistance, probably because of an increasing antibiotic pressure, but with resistance rates often inferior to Metropolitan French ones.
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Affiliation(s)
- S Picot
- Laboratoire de bactériologie-parasito-virologie et hygiène, groupe hospitalier Sud-Réunion/CHR, BP 350, 97448 Saint-Pierre cedex, France.
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Soares Magalhães RJ, Loeffler A, Lindsay J, Rich M, Roberts L, Smith H, Lloyd DH, Pfeiffer DU. Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in dogs and cats: a case-control study. Vet Res 2010; 41:55. [PMID: 20423695 PMCID: PMC2879574 DOI: 10.1051/vetres/2010028] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 04/26/2010] [Indexed: 01/18/2023] Open
Abstract
Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in dogs and cats were investigated in an unmatched case-control study. A total of 197 animals from 150 veterinary practices across the United Kingdom was enrolled, including 105 MRSA cases and 92 controls with methicillin-susceptible S. aureus (MSSA) infection. The association of owners and veterinarian staff with the human healthcare sector (HCS) and animal-related characteristics such as signalment, antimicrobial and immunosuppressive therapy, and surgery were evaluated as putative risk factors using logistic regression. We found that significant risk factors for MRSA infection were the number of antimicrobial courses (p=0.005), number of days admitted to veterinary clinics (p=0.003) and having received surgical implants (p=0.001). In addition, the odds of contact with humans which had been ill and admitted to hospital (p=0.062) were higher in MRSA infected pets than in MSSA controls. The risk factors identified in this study highlight the need to increase vigilance towards identification of companion animal groups at risk and to advocate responsible and judicious use of antimicrobials in small animal practice.
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Affiliation(s)
- Ricardo Jorge Soares Magalhães
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom.
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Bouza E. New therapeutic choices for infections caused by methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2010; 15 Suppl 7:44-52. [PMID: 19951334 DOI: 10.1111/j.1469-0691.2009.03091.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In recent years, a marked increase in the incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has occurred in many countries. This review addresses the effectiveness and limitations of drugs classically used for the treatment of MRSA, e.g. vancomycin, and also newer anti-MRSA antimicrobials, e.g. second-generation glycolipopeptides, tigecycline, and beta-lactams.
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Affiliation(s)
- E Bouza
- Servicio de Microbiología Clínica y E. Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutenste, Madrid, and Ciber de Enfermedades Respiratories (CIBERES), Spain.
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Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications. Clin Microbiol Rev 2010; 23:99-139. [PMID: 20065327 DOI: 10.1128/cmr.00042-09] [Citation(s) in RCA: 656] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The emergence of vancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) over the past decade has provided a challenge to diagnostic microbiologists to detect these strains, clinicians treating patients with infections due to these strains, and researchers attempting to understand the resistance mechanisms. Recent data show that these strains have been detected globally and in many cases are associated with glycopeptide treatment failure; however, more rigorous clinical studies are required to clearly define the contribution of hVISA to glycopeptide treatment outcomes. It is now becoming clear that sequential point mutations in key global regulatory genes contribute to the hVISA and VISA phenotypes, which are associated predominately with cell wall thickening and restricted vancomycin access to its site of activity in the division septum; however, the phenotypic features of these strains can vary because the mutations leading to resistance can vary. Interestingly, changes in the staphylococcal surface and expression of agr are likely to impact host-pathogen interactions in hVISA and VISA infections. Given the subtleties of vancomycin susceptibility testing against S. aureus, it is imperative that diagnostic laboratories use well-standardized methods and have a framework for detecting reduced vancomycin susceptibility in S. aureus.
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Cooccurrence of predominant Panton-Valentine leukocidin-positive sequence type (ST) 152 and multidrug-resistant ST 241 Staphylococcus aureus clones in Nigerian hospitals. J Clin Microbiol 2009; 47:3000-3. [PMID: 19605575 DOI: 10.1128/jcm.01119-09] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Ninety-six clinical isolates of Staphylococcus aureus from Nigeria were characterized phenotypically and genetically. Twelve multidrug-resistant methicillin (meticillin)-resistant S. aureus (MRSA) isolates carrying a new staphylococcal cassette chromosome mec element and a high proportion of Panton-Valentine leukocidin (PVL)-positive methicillin-susceptible S. aureus (MSSA) isolates were observed. The cooccurrence of multidrug-resistant MRSA and PVL-positive MSSA isolates entails the risk of emergence of a multidrug-resistant PVL-positive MRSA clone.
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Askarian M, Zeinalzadeh A, Japoni A, Alborzi A, Memish ZA. Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi Hospital, Shiraz, Iran. Int J Infect Dis 2009; 13:e241-7. [PMID: 19269873 DOI: 10.1016/j.ijid.2008.11.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 10/28/2008] [Accepted: 11/17/2008] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers (HCWs) at Namazi Hospital, Shiraz, Iran. METHODS This cross-sectional study was conducted from July to November 2006. Nasal swabs were taken from 600 randomly selected HCWs. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test, and mannitol salt agar fermentation. To analyze sensitivity patterns of MRSA strains more precisely, minimum inhibitory concentrations (MICs) of antibiotics were determined by the E-test method. All methicillin-resistant isolates were examined for the existence of the mecA gene by total DNA extraction and PCR. RESULTS The prevalence of nasal carriage of methicillin-sensitive S. aureus (MSSA) was 25.7% and of MRSA was 5.3%, with the highest nasal carriage of MRSA in surgical wards and the emergency department. There was no significant difference between the sexes (p=0.247), age (p=0.817), and years of healthcare service (p=0.15) with regard to the nasal carriage of MRSA and MSSA. In the univariate analysis, a statistically significant difference was only found for occupation (p=0.032) between the carriage of MSSA and MRSA. In the multivariate analysis, the occupation 'nurse' was independently associated with MRSA carriage (p=0.012, odds ratio 3.6, 95% confidence interval 1.3-9.7). The highest resistance rate for both gentamicin and clindamycin (69%) was noted among the MRSA strains. None of the MRSA strains were resistant to mupirocin, linezolid, fusidic acid, or vancomycin. The existence of the mecA gene in all 32 methicillin-resistant isolates was observed by PCR. CONCLUSIONS This study revealed the prevalence of nasal carriage of S. aureus strains among HCWs to be lower than that found in other studies from Iran. The antibiotic susceptibility patterns also differed, perhaps as a result of the excessive use of antibiotics at our hospital. Only the occupation of nurse was an independent risk factor for MRSA carriage.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, Shiraz University of Medical Sciences, PO Box 71345-1737, Shiraz, Iran.
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A model of the complex response of Staphylococcus aureus to methicillin. J Theor Biol 2008; 257:438-45. [PMID: 19135063 DOI: 10.1016/j.jtbi.2008.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/24/2008] [Accepted: 12/02/2008] [Indexed: 11/23/2022]
Abstract
It is widely accepted that beta-lactam antimicrobials cause cell death through a mechanism that interferes with cell wall synthesis. Later studies have also revealed that beta-lactams modify the autolysis function (the natural process of self-exfoliation of the cell wall) of cells. The dynamic equilibrium between growth and autolysis is perturbed by the presence of the antimicrobial. Studies with Staphylococcus aureus to determine the minimum inhibitory concentration (MIC) have revealed complex responses to methicillin exposure. The organism exhibits four qualitatively different responses: homogeneous sensitivity, homogeneous resistance, heterogeneous resistance and the so-called 'Eagle-effect'. A mathematical model is presented that links antimicrobial action on the molecular level with the overall response of the cell population to antimicrobial exposure. The cell population is modeled as a probability density function F(x,t) that depends on cell wall thickness x and time t. The function F(x,t) is the solution to a Fokker-Planck equation. The fixed point solutions are perturbed by the antimicrobial load and the advection of F(x,t) depends on the rates of cell wall synthesis, autolysis and the antimicrobial concentration. Solutions of the Fokker-Planck model are presented for all four qualitative responses of S. aureus to methicillin exposure.
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Edmiston Jr CE, Krepel CJ, Wilson PJ, Grahn BF, Sadenwasser PJ, Welter DL, Seabrook GR. Reducing the risk of surgical site infections: embracing basic and innovative risk reduction strategies. ACTA ACUST UNITED AC 2008. [DOI: 10.1071/hi08033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Szabó J, Dombrádi Z, Dobay O, Orosi P, Kónya J, Nagy K, Rozgonyi F. Phenotypic and genetic characterisation of methicillin-resistant Staphylococcus aureus strains isolated from the university hospitals of Debrecen. Eur J Clin Microbiol Infect Dis 2008; 28:129-36. [DOI: 10.1007/s10096-008-0588-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 06/16/2008] [Indexed: 11/28/2022]
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In vitro activity of ceftobiprole, linezolid, tigecycline, and 23 other antimicrobial agents against Staphylococcus aureus isolates in China. Diagn Microbiol Infect Dis 2008; 62:226-9. [DOI: 10.1016/j.diagmicrobio.2008.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 05/27/2008] [Accepted: 06/01/2008] [Indexed: 11/18/2022]
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Genomic analysis reveals a point mutation in the two-component sensor gene graS that leads to intermediate vancomycin resistance in clinical Staphylococcus aureus. Antimicrob Agents Chemother 2008; 52:3755-62. [PMID: 18644967 DOI: 10.1128/aac.01613-07] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA), once restricted to hospitals, is spreading rapidly through the wider community. Resistance to vancomycin, the principal drug used to treat MRSA infections, has only recently emerged, is mainly low level, and characteristically appears during vancomycin therapy (vancomycin-intermediate S. aureus [VISA] and hetero-resistant VISA). This phenomenon suggests the adaptation of MRSA through mutation, although defining the mutations leading to resistance in clinical isolates has been difficult. We studied a vancomycin-susceptible clinical MRSA isolate (MIC of 1 microg/ml) and compared it with an isogenic blood culture isolate from the same patient, despite 42 days of vancomycin treatment (MIC of 4 microg/ml). A whole-genome sequencing approach allowed the nearly complete assembly of the genome sequences of the two isolates and revealed only six nucleotide substitutions in the VISA strain compared with the parent strain. One mutation occurred in graS, encoding a putative two-component regulatory sensor, leading to a change from a polar to a nonpolar amino acid (T136I) in the conserved histidine region of the predicted protein. Replacing the graS allele of the vancomycin-susceptible parent strain with the graS allele from the VISA derivative resulted in increased vancomycin resistance at a level between those of the vancomycin-susceptible S. aureus and VISA clinical isolates, confirming a role for graRS in VISA. Our study suggests that MRSA is able to develop clinically significant vancomycin resistance via a single point mutation, and the two-component regulatory system graRS is a key mediator of this resistance. However, additional mutations are likely required to express the full VISA phenotype.
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Grohs P. [Trends in Staphylococcus aureus antimicrobials susceptibilities: is methicillin still a relevant multiresistance marker?]. ACTA ACUST UNITED AC 2008; 57:1-8. [PMID: 18586411 DOI: 10.1016/j.patbio.2008.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 05/16/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recent change was noted in S. aureus epidemiology, especially for none multiresistant methicillinresistant S. aureus (MRSA) and for multiresistant methicillin-susceptible S. aureus (MSSA). So, a six-year retrospective study was conducted to follow trends in antimicrobials resistance and to determine if methicillin remained a relevant multiresistant marker. METHODS All S. aureus isolates (duplicates excluded) isolated between 2001 and 2006 in a French 800-beds-teaching-hospital were included in the study. RESULTS Four thousand four hundred and fifty-five isolates providing from 3602 patients were identified between 2001 and 2006. MRSA rate and incidence for 1000 hospitalization-days significantly decreased from 34.7 to 22.6% and 1.3 to 0.6% respectively (p < 0.001). Significant decrease was observed for multiresistant MRSA (72.9 to 46.3%, p < 0.001), while no change was observed for multiresistant MSSA (2.9 to 3.4%). Among the 186 different antibiotic patterns isolated, four MRSA-phenotypes significantly decreased whereas two MSSA-phenotypes significantly increased. The main MRSA phenotype, resistant to kanamycin, tobramycin, macrolides-lincosamides-streptograminesB, and fluoroquinolones, significantly decreased from 11.9 to 5.9% (p < 0.001). Glycopeptide Intermediate S. aureus (GISA) phenotypes disappeared. CONCLUSION At this date, methicillin remains in our institution a relevant marker of multiresistance but trend is changing.
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Affiliation(s)
- P Grohs
- Service de microbiologie, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75908 Paris cedex 15, France.
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