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Rahmani Z, Hosseini SS, Bagheri P, Dadashi M, Haghighi M, Goudarzi M. Phenotypic and genotypic characterization of Staphylococcus aureus strains isolated from otitis externa: Emergence of CC30- spa t019-SCC mec IV carrying PVL as major genotype. Heliyon 2024; 10:e32002. [PMID: 38868027 PMCID: PMC11168311 DOI: 10.1016/j.heliyon.2024.e32002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
The increasing emergence of Staphylococcus aureus as the primary causative agent of otitis externa has been noted; however, detailed information regarding the molecular characteristics of these strains in Iran remains scarce. The current study aims to investigate both genotypic and phenotypic attributes of S. aureus strains implicated in ear infections. In the present work, we analyzed 60 S. aureus strains isolated from cases of otitis externa over a period of 45 months. The resistance patterns were determined using disk diffusion and microbroth dilution methods. All S. aureus isolates were confirmed by the nucA polymerase chain reaction assay, and their biofilm production was assessed by a microtiter plate assay. Molecular characterization of the isolates was performed using the staphylococcal cassette chromosome mec, multilocus sequence typing, and staphylococcus protein A typing methods. Overall, the results indicated that 44 out of 60 S. aureus isolates (73.3 %) were methicillin-resistant Staphylococcus aureus. Resistance to mupirocin and vancomycin was observed in 13.3 % and 1.7 % of the tested isolates, respectively. Furthermore, out of the 60 S. aureus isolates, 56 strains (93.4 %) were classified as positive biofilm strains at different levels. Twelve distinct clonal lineages were identified. The vast majority of S. aureus isolates belonged to CC30/ST30-MRSA IV/t019 (41.7 %). Among the 31 strong biofilm producers, the majority (64.5 %) belonged to CC30/ST30-MRSA IV/t019 clone. Biofilm negative isolates belonged to CC22/ST22 (2 isolates), CC8/ST585 (one isolate), and CC8/ST8 (one isolate). Our result revealed that about three-quarters of PVL-positive strains belonged to CC30/ST30. Our data confirmed the presence of MSSA strains among CC30/ST30 and CC22/ST22 isolates. The mupirocin resistant isolates (n = 8) belonged to CC8/ST585-MRSA III/t713 (37.5 %), CC8/ST239-MRSA III/t030 (25 %), CC8/ST8-MRSA IV/t008 (12.5 %), CC8/ST239-MRSA III/t037 (12.5 %), and CC22/ST22-MRSA IV/t790 (12.5 %) lineages. The VRSA strain belonged to the CC8/ST8-MRSA IV/t008 lineage, carrying the vanA determinant. iMLSB phenotypes (n = 14) were distributed across different lineages, including CC30/ST30-MRSA IV/t019 (21.5 %), CC30/ST30-MSSA/t021 (21.5 %), CC22/ST22-MSSA/t005 (14.3 %), CC8/ST239-MRSA III/t030 (14.3 %), CC22/ST22-MSSA/t1869 (7.1 %), CC22/ST22-MRSA IV/t790 (7.1 %), CC8/ST239-MRSA III/t037 (7.1 %), and CC1/ST772-MRSA IV/t10795 (7.1 %). These findings highlight significant genotypic diversity and high biofilm formation among our isolates. The frequent occurrence of the CC/ST30 clone in S. aureus strains isolated from otitis externa reflects the emergence of these lineages as a predominant clone in Iran, posing a significant public health concern.
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Affiliation(s)
- Zahra Rahmani
- Department of Otorhinolaryngology, Loghman Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Sareh Sadat Hosseini
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parmida Bagheri
- Department of Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti 7 University, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mehrdad Haghighi
- Department of Infectious Diseases, Imam Hossein Teaching and Medical Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Whelan L, Leal J, Barkema HW, Leslie M, McClure JA, Zhang K, May ER. Baseline prevalence of antimicrobial resistance in patients who develop a surgical site infection in hip and knee replacements: A brief report. Am J Infect Control 2023; 51:1449-1451. [PMID: 37353054 DOI: 10.1016/j.ajic.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
Prior to clean surgeries, decolonization with topical antimicrobials may lead to an increase in antimicrobial resistance. To provide a baseline prevalence of resistance to topical antimicrobials, in Alberta, specimens were collected from surgical site infections following hip and knee replacements. Among 81 samples with complex surgical site infections, in 43 specimens Staphylococcus species were isolated. Only coagulase-negative staphylococci isolates carried resistance genes with 10 carrying the gene qac and 6 carrying the MupA gene.
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Affiliation(s)
- Lindsay Whelan
- Departments of Community Health Sciences, University of Calgary, Strategic Clinical Network, Alberta Health Services, AMR-One Health Consortium, Calgary, Alberta, Canada.
| | - Jenine Leal
- Departments of Community Health Sciences, and Microbiology Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, O'Brien Institute for Public Health, University of Calgary, AMR-One Health Consortium, Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Herman W Barkema
- Department of Production Animal Health Faculty of Veterinary Medicine and Cumming School of Medicine, University of Calgary, AMR-One Health Consortium, One Health at UCalgary, University of Calgary Biostatistics Centre, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, and School of Public Policy, University of Calgary, AMR-One Health Consortium, Calgary, Alberta, Canada
| | - Myles Leslie
- Department of Community Health Sciences, Cumming School of Medicine, and School of Public Policy, University of Calgary, AMR-One Health Consortium, Calgary, Alberta, Canada
| | - Jo-Ann McClure
- Departments of Medicine, Centre for Antimicrobial Resistance, Alberta Health Services, Calgary/Alberta Provincial Laboratories/University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Departments of Medicine, Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Provincial Laboratories /University of Calgary, Calgary, Alberta, Canada; Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine, The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Elissa Rennert May
- Departments of Medicine, and Community Health Sciences, and Microbiology Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, University of Calgary, Calgary, Alberta, Canada; Departments of Medcine, O'Brien Institute for Public Health and Snyder Institute for Chronic Diseases, AMR-One Health Consortium, Calgary, Alberta, Canada
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Heinzinger LR, Pugh AR, Wagner JA, Otto M. Evaluating the Translational Potential of Bacteriocins as an Alternative Treatment for Staphylococcus aureus Infections in Animals and Humans. Antibiotics (Basel) 2023; 12:1256. [PMID: 37627676 PMCID: PMC10451987 DOI: 10.3390/antibiotics12081256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Antibiotic resistance remains a global threat to human and animal health. Staphylococcus aureus is an opportunistic pathogen that causes minor to life-threatening infections. The widespread use of antibiotics in the clinical, veterinary, and agricultural setting combined with the increasing prevalence of antibiotic-resistant S. aureus strains makes it abundantly clear that alternatives to antibiotics are urgently needed. Bacteriocins represent one potential alternative therapeutic. They are antimicrobial peptides that are produced by bacteria that are generally nontoxic and have a relatively narrow target spectrum, and they leave many commensals and most mammalian cells unperturbed. Multiple studies involving bacteriocins (e.g., nisin, epidermicin, mersacidin, and lysostaphin) have demonstrated their efficacy at eliminating or treating a wide variety of S. aureus infections in animal models. This review provides a comprehensive and updated evaluation of animal studies involving bacteriocins and highlights their translational potential. The strengths and limitations associated with bacteriocin treatments compared with traditional antibiotic therapies are evaluated, and the challenges that are involved with implementing novel therapeutics are discussed.
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Affiliation(s)
| | | | | | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20814, USA; (L.R.H.); (A.R.P.); (J.A.W.)
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Prakash R, Garg A, Arya R, Kumawat RK. Chronicity of high and low level mupirocin resistance in Staphylococcus aureus from 30 Indian hospitals. Sci Rep 2023; 13:10171. [PMID: 37349503 PMCID: PMC10287686 DOI: 10.1038/s41598-023-37399-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
Mupirocin is one of the most effective topically used antibiotic for the treatment of dermatitis, nasal carriage, decolonization of methicillin susceptible Staphylococcus aureus and eradication of methicillin resistant Staphylococcus aureus. Extensive use of this antibiotic has resulted in mupirocin resistance in Staphylococcus aureus which is a matter of concern. This study was conducted to evaluate the high and low level of mupirocin resistance in Staphylococcus aureus collected from various Indian hospitals. A total of 600 samples, of which 436 were pus specimens and 164 wound site swabs were collected from 30 Indian hospitals. Disc diffusion and agar dilution methods were used to test mupirocin susceptibility in methicillin resistant Staphylococcus aureus. Out of 600 Staphylococcus aureus isolates, 176 isolates (29.33%) were found to be methicillin resistant Staphylococcus aureus (MRSA). Out of 176 non-duplicate MRSA strains, 138 isolates were found to be mupirocin sensitive, 21 isolates had high level resistance whereas 17 isolates had low level resistance to mupirocin, which contributed 78.41%, 11.93% and 9.66% respectively. Multidrug resistant susceptibility was tested for all the MRSA with Cefuroxime, Cotrimoxazole and Vancomycin antibiotics. All the high and low level resistant strain were subjected to genome screening for mupA ileS gene respectively. mupA gene was found positive in all the high level resistant strain and out of 17 low level resistant strain, 16 strain were found point mutation in V588F of ileS gene. Overall, high rate of mupirocin resistance was found in the studied samples which might be a result of indiscriminate use of mupirocin in the population of studied region. This data emphasizes the urgent need for formulation of a well-defined and regulated guidelines for mupirocin use. Moreover, continuous surveillance is needed for the use of mupirocin and routine test should be performed to detect MRSA in patients and health care personnel to prevent MRSA infections.
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Affiliation(s)
- Rajni Prakash
- School of Biological Engineering and Life Sciences, Sobhit Deemed University, Meerut, Uttar Pradesh, India
| | - Amar Garg
- School of Biological Engineering and Life Sciences, Sobhit Deemed University, Meerut, Uttar Pradesh, India
| | - Riteshkumar Arya
- Department of Microbiology, Mehsana Urban Institute of Sciences, Ganpat University, Mehsana, Gujarat, India.
| | - R K Kumawat
- DNA Division, State Forensic Science Laboratory, Jaipur, Rajasthan, India
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Huang S, He J, Zhang Y, Su L, Tong L, Sun Y, Zhou M, Chen Z. The Correlation Between Biofilm-Forming Ability of Community-Acquired Methicillin-Resistant Staphylococcus aureus Isolated from the Respiratory Tract and Clinical Characteristics in Children. Infect Drug Resist 2022; 15:3657-3668. [PMID: 35855760 PMCID: PMC9288189 DOI: 10.2147/idr.s370755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/17/2022] [Indexed: 01/09/2023] Open
Abstract
Objective This study aimed to investigate the biofilm-forming ability, molecular typing, and antimicrobial resistance of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains isolated from the respiratory tract of children and their correlation with clinical characteristics. Methods All CA-MRSA strains were isolated from hospitalized children, and their presentation, molecular typing, antimicrobial susceptibility, and biofilm formation were investigated. The clinical characteristics were compared between the strong and weak biofilm producer groups. Results Fifty-three CA-MRSA strains were isolated from the respiratory samples of 53 children, with nearly half of them being young infants (0-12 months). Approximately, 88.7% (47/53) of the isolates were resistant to four or more antibiotics, mainly β-lactam antibiotics, lincosamides, and macrolides. Twelve sequence types (STs) and 20 subtypes of staphylococcal protein A (spa) typing were identified, with ST59-t437 (39.6%, 21/53) as the predominant subtype. All strains showed the ability to form biofilms. When compared to children with weak biofilm-forming CA-MRSA strains, those with strong biofilm-forming strains had higher proportions of lower respiratory tract infections (LRTI) (88.5% vs 59.3%), obvious cough symptoms (84.6% vs 51.9%), and severe chest imaging manifestations (76.9% vs 37.0%). Furthermore, a strong biofilm-forming ability significantly increased the risk of prolonged cough in children with LRTI (44.4% vs 14.3%), and a positive correlation between the duration of cough and the extent of biofilm formation was observed. Medical history investigation revealed that the strong biofilm-forming group had a much higher percentage of macrolides intake than the weak biofilm-forming group in the last month before admission (61.5% vs 14.8%). Conclusion ST59-t437 was the most prevalent clone in CA-MRSA respiratory isolates among the hospitalized children. All CA-MRSA strains formed biofilms. The stronger the biofilm-forming ability, the more serious and prolonged were the respiratory symptoms.
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Affiliation(s)
- Shumin Huang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Jing He
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Yiting Zhang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Lin Su
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Lin Tong
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Ying Sun
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Mingming Zhou
- National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China,Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China
| | - Zhimin Chen
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China,Correspondence: Zhimin Chen, Email
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New update on molecular diversity of clinical Staphylococcus aureus isolates in Iran: antimicrobial resistance, adhesion and virulence factors, biofilm formation and SCCmec typing. Mol Biol Rep 2022; 49:3099-3111. [PMID: 35064407 DOI: 10.1007/s11033-022-07140-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Staphylococcus aureus is often considered as a potential pathogen and resistant to a wide range of antibiotics. The pathogenicity of this bacterium is due to the presence of multiple virulence factors and the ability to form biofilm. SCCmec types I, II and III are mainly attributed to HA-MRSA, while SCCmec types IV and V have usually been reported in CA-MRSA infections. METHODS AND RESULTS In this study, we performed a cross-sectional study to determine the antimicrobial resistance, adhesion and virulence factors, biofilm formation and SCCmec typing of clinical S. aureus isolates in Iran. S. aureus isolates were identified using microbiological standard methods and antibiotic susceptibility tests were performed as described by the Clinical and Laboratory Standards Institute (CLSI) guidelines. Inducible resistance phenotype and biofilm formation were determined using D-test and tissue culture plate methods, respectively. Multiplex-PCRs were performed to detect adhesion and virulence factors, antibiotic resistance genes, biofilm formation and SCCmec typing by specific primers. Among 143 clinical samples, 67.8% were identified as MRSA. All isolates were susceptible to vancomycin. The prevalence of cMLSB, iMLSB and MS phenotypes were 61.1%, 22.2% and 14.8%, respectively. The TCP method revealed that 71.3% of isolates were able to form biofilm. The predominant virulence and inducible resistance genes in both MRSA and MSSA isolates were related to sea and ermC respectively. SCCmec type III was the predominant type. CONCLUSIONS Data show the high prevalence rates of virulence elements among S. aureus isolates, especially MRSA strains. This result might be attributed to antibiotic pressure, facilitating clonal selection.
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Soltani M, Hajikhani B, Zamani S, Haghighi M, Hashemi A, Nasiri MJ, Dadashi M, Pourhossein B, Goudarzi M. Molecular characterization of Staphylococcus aureus strains isolated from hospitalized patients based on coagulase gene polymorphism analysis: High frequency of vancomycin-intermediate S. aureus and the emergence of coagulase type II in Iran. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tayebi Z, Fazeli M, Hashemi A, Abdi S, Dadashi M, Nasiri MJ, Goudarzi M. Molecular characterization of invasive Staphylococcus aureus strains isolated from patients with diabetes in Iran: USA300 emerges as the major type. INFECTION GENETICS AND EVOLUTION 2020; 87:104679. [PMID: 33326876 DOI: 10.1016/j.meegid.2020.104679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/29/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023]
Abstract
There have been few studies focused on the molecular characterization of invasive Staphylococcus aureus strains in patients with diabetes in Iran. In the present study, 20 invasive S. aureus strains recovered from the patients with diabetes characterized by the virulence and resistance analysis, biofilm formation, staphylocoagulase (SC) typing, S. aureus protein A locus (spa) typing staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence typing (MLST). Virulence gene detection indicated a high prevalence of strains encoding the pvl genes (50%), a low prevalence of the tst and seg gene (each of them was 5%) and a markedly high prevalence of fnbB (95%), fnbA (85%), icaD (75%), icaA (65%). A total of 3 coagulase types (III, 85%; II, 10%; V, 5%), 2 agr types (I, 90%; II 10%) and 2 SCCmec types (IV, 65%; III, 35%) and four different clones namely ST8-MRSA-IV/t008 (50%) (USA300), ST239-MRSA-III/t030 (35%), ST5-MRSA-IV/t002 (10%), and ST45-MRSA-IV/t038 (5%) were detected in this study. Eighty-five percent of the isolates were biofilm producers. All the 4 high-level mupirocin resistance (HLMUPR) strains belonged to CC/ST8-MRSA-IV/t008 clone and carried mupA gene. Fusidic acid-resistant isolate belonged to ST239-SCCmec III/t030 clone. One vancomycin-intermediate resistance isolates was detected in our study, which belonged to ST5-MRSA-IVt002. Circulating clone in MRSA strains (USA300) isolated from the patients with diabetes highlighting the possibility of transmission of these microorganisms' clones between hospital, community, and environments. However, further studies require providing critical insights into the importance of continued controlling and treatment of S. aureus infections in patients with diabetes.
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Affiliation(s)
- Zahra Tayebi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Microbiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Maryam Fazeli
- Department of Virology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Abdi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Javad Nasiri
- 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.
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Blisse M, Idelevich EA, Becker K. Investigation of In-Vitro Adaptation toward Sodium Bituminosulfonate in Staphylococcus aureus. Microorganisms 2020; 8:microorganisms8121962. [PMID: 33322073 PMCID: PMC7763802 DOI: 10.3390/microorganisms8121962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/04/2022] Open
Abstract
The global increase in antimicrobial resistance has revived the interest in “old” substances with antimicrobial activity such as sodium bituminosulfonate. However, for those “old” compounds, scientific studies are still sparse and the ones available do not mostly meet the current standards. Since this compound is used for topical applications, investigation of a potential increase in minimal inhibitory concentrations (MICs) is of particular importance. For selection of phenotypes with decreased susceptibility, a collection of 30 genetically diverse methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) strains were cultured on bi-layered linear gradient agar plates containing sub-inhibitory concentrations of the active agents. The stability of phenotypes with increased MICs was determined by serial passage on agent-free medium. Within 10 passages, only slight and, in most cases, reversible increases in MSSA and MRSA MIC levels toward sodium bituminosulfonate were obtained. Fusidic acid, used as a control, showed exponential expansions in MIC based on mutations in the fusA gene (elongation factor G or EF-G) with no reduction during the recovery phase. The only marginal and largely reversible changes of S. aureus MICs after exposition to sodium bituminosulfonate indicate a low potential for resistance development.
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Affiliation(s)
- Marko Blisse
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (M.B.); (E.A.I.)
| | - Evgeny A. Idelevich
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (M.B.); (E.A.I.)
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (M.B.); (E.A.I.)
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-3834-86-5560
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Emergence and spread of coagulase type III and staphylococcal cassette chromosome mec type IV among mupirocin-resistant Staphylococcus aureus isolated from wound infections. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Principi N, Argentiero A, Neglia C, Gramegna A, Esposito S. New Antibiotics for the Treatment of Acute Bacterial Skin and Soft Tissue Infections in Pediatrics. Pharmaceuticals (Basel) 2020; 13:ph13110333. [PMID: 33113966 PMCID: PMC7690713 DOI: 10.3390/ph13110333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 01/28/2023] Open
Abstract
Acute bacterial skin and soft tissue infections (aSSTIs) are a large group of diseases that can involve exclusively the skin or also the underlying subcutaneous tissues, fascia, or muscles. Despite differences in the localization and severity, all these diseases are due mainly to Gram-positive bacteria, especially Staphylococcus aureus and Streptococcus pyogenes. aSSTI incidence increased considerably in the early years of this century due to the emergence and diffusion of community-acquired methicillin-resistant S. aureus (CA-MRSA). Despite the availability of antibiotics effective against CA-MRSA, problems of resistance to these drugs and risks of significant adverse events have emerged. In this paper, the present knowledge on the potential role new antibiotics for the treatment of pediatric aSSTIs is discussed. The most recent molecules that have been licensed for the treatment of aSSTIs include ozenoxacin (OZ), ceftaroline fosamil (CF), dalbavancin (DA), oritavancin (OR), tedizolid (TD), delafloxacin (DL), and omadacycline (OM). However, only OZ and CF have been licensed for use in children with aSSTIs, although the superiority of these antibiotics to those routinely used for the treatment of aSSTIs should be further demonstrated. Waiting for additional studies, OZ and CF should be prescribed for aSSTI treatment in the presence of the potential failure of old molecules.
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Affiliation(s)
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (A.A.); (C.N.)
| | - Cosimo Neglia
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (A.A.); (C.N.)
| | - Andrea Gramegna
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (A.A.); (C.N.)
- Correspondence: ; Tel.: +39-052-190-3524
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Goudarzi M, Tayebi Z, Dadashi M, Miri M, Amirpour A, Fazeli M. Characteristics of community-acquired methicillin-resistant Staphylococcus aureus associated with wound infections in Tehran, Iran: High prevalence of PVL+ t008 and the emergence of new spa types t657, t5348, and t437 in Iran. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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13
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Goudarzi M, Kobayashi N, Dadashi M, Pantůček R, Nasiri MJ, Fazeli M, Pouriran R, Goudarzi H, Miri M, Amirpour A, Seyedjavadi SS. Prevalence, Genetic Diversity, and Temporary Shifts of Inducible Clindamycin Resistance Staphylococcus aureus Clones in Tehran, Iran: A Molecular-Epidemiological Analysis From 2013 to 2018. Front Microbiol 2020; 11:663. [PMID: 32425898 PMCID: PMC7204094 DOI: 10.3389/fmicb.2020.00663] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/23/2020] [Indexed: 12/13/2022] Open
Abstract
The prevalence of Staphylococcus aureus as an aggressive pathogen resistant to multiple antibiotics causing nosocomial and community-acquired infections is increasing with limited therapeutic options. Macrolide-lincosamide streptogramin B (MLSB) family of antibiotics represents an important alternative therapy for staphylococcal infections. This study was conducted over a period of five years from August 2013 to July 2018 to investigate the prevalence and molecular epidemiology in Iran of inducible resistance in S. aureus. In the current study, 126 inducible methicillin-resistant S. aureus (MRSA) (n = 106) and methicillin-sensitive S. aureus (MSSA) (n = 20) isolates were characterized by in vitro susceptibility analysis, resistance and virulence encoding gene distribution, phenotypic and genotypic analysis of biofilm formation, prophage typing, S. aureus protein A locus (spa) typing, staphylocoagulase (SC) typing, staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence typing. Of the 126 isolates, 76 (60.3%) were classified as hospital onset, and 50 (39.7%) were classified as community onset (CO). Biofilm formation was observed in 97 strains (77%). A total of 14 sequence types (STs), 26 spa types, 7 coagulase types, 9 prophage types, 3 agr types (no agr IV), and 9 clonal complexes (CCs) were identified in this study. The prevalence of the inducible MLSB (iMLSB) S. aureus increased from 7.5% (25/335) to 21.7% (38/175) during the study period. The iMLSB MRSA isolates were distributed in nine CCs, whereas the MSSA isolates were less diverse, which mainly belonged to CC22 (7.95%) and CC30 (7.95%). High-level mupirocin-resistant strains belonged to ST85-SCCmec IV/t008 (n = 4), ST5-SCCmec IV/t002 (n = 4), ST239-SCCmec III/t631 (n = 2), and ST8-SCCmec IV/t064 (n = 2) clones, whereas low-level mupirocin-resistant strains belonged to ST15-SCCmec IV/t084 (n = 5), ST239-SCCmec III/t860 (n = 3), and ST22-SCCmec IV/t790 (n = 3) clones. All the fusidic acid–resistant iMLSB isolates were MRSA and belonged to ST15-SCCmec IV/t084 (n = 2), ST239-SCCmec III/t030 (n = 2), ST1-SCCmec V/t6811 (n = 1), ST80-SCCmec IV/t044 (n = 1), and ST59-SCCmec IV/t437 (n = 1). The CC22 that was predominant in 2013–2014 (36% of the isolates) had almost disappeared in 2017–2018, being replaced by the CC8, which represented 39.5% of the 2017–2018 isolates. This is the first description of temporal shifts of iMLSB S. aureus isolates in Iran that identifies predominant clones and treatment options for iMLSB S. aureus–related infections.
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Affiliation(s)
- Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nobumichi Kobayashi
- Department of Hygiene, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Roman Pantůček
- Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czechia
| | - Mohammad Javad Nasiri
- 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
| | - Ramin Pouriran
- 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
| | - Mirmohammad Miri
- Department of Critical Care and Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Amirpour
- Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Torrelo A, Grimalt R, Masramon X, Albareda López N, Zsolt I. Ozenoxacin, a New Effective and Safe Topical Treatment for Impetigo in Children and Adolescents. Dermatology 2020; 236:199-207. [PMID: 31958794 DOI: 10.1159/000504536] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/04/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Ozenoxacin is a topical antibiotic approved in Europe to treat non-bullous impetigo in adults and children aged ≥6 months. This analysis evaluated the efficacy and safety of ozenoxacin in paediatric patients by age group. METHODS Pooled data for patients aged 6 months to <18 years who had participated in a phase I or in two phase III clinical trials of ozenoxacin 1% cream were analysed by age group: 0.5-<2, 2-<6, 6-<12, and 12-<18 years. RESULTS The combined population comprised 529 patients with non-bullous impetigo treated with ozenoxacin (n = 239), vehicle (n = 201), or retapamulin as internal validation control (n = 89). Studies were well matched for extent and severity of impetigo and therapeutic schedule (twice daily application for 5 days). The clinical success rate after 5 days' treatment (day 6-7, end of therapy), and microbiological success rates after 3-4 days' treatment and at the end of therapy, were significantly higher with ozenoxacin than vehicle (p < 0.0001 for all comparisons). Clinical and bacterial eradication rates were higher with ozenoxacin than vehicle in each age group. No safety concerns were identified with ozenoxacin. One (0.3%) of 327 plasma samples exceeded the lower limit of quantification for ozenoxacin, but the low concentration indicated negligible systemic absorption. CONCLUSION This combined analysis supports the efficacy and safety of ozenoxacin administered twice daily for 5 days. Ozenoxacin 1% cream is a new option to consider for treatment of non-bullous impetigo in children aged 6 months to <18 years.
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Affiliation(s)
- Antonio Torrelo
- Department of Dermatology, Children's Hospital del Niño Jesús, Madrid, Spain
| | - Ramon Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Xavier Masramon
- SAIL (Servicio de Asesoría a la Investigación y Logística) SL, Barcelona, Spain
| | | | - Ilonka Zsolt
- Medical Department, Ferrer Internacional SA, Barcelona, Spain,
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15
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Eed EM, Ghonaim MM, Khalifa AS, Alzahrani KJ, Alsharif KF, Taha AA. Prevalence of mupirocin and chlorhexidine resistance among methicillin-resistant coagulase-negative staphylococci isolated during methicillin-resistant Staphylococcus aureus decolonization strategies. Am J Infect Control 2019; 47:1319-1323. [PMID: 31204092 DOI: 10.1016/j.ajic.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The widespread of methicillin-resistant Staphylococcus aureus (MRSA) antimicrobial decolonization in the clinical setting may lead to an increase in the prevalence of multiresistance to coagulase-negative staphylococci (CoNS) owing to their selection. This study aimed to investigate the impact of MRSA decolonization strategies, using mupirocin and chlorhexidine, on their CoNS susceptibility. METHODS A total of 312 CoNS isolates were collected before starting the decolonization protocols "baseline strains" (BLS) group, 330 isolates were collected after application of the targeted decolonization protocol "targeted decolonization strains" group, and 355 isolates were collected after application of the universal decolonization protocol "universal decolonization strains" group. Methicillin-resistant CoNS (MR-CoNS) were identified and tested for mupirocin and chlorhexidine susceptibilities. Heptaplex polymerase chain reaction assay was applied for simultaneous screening for chlorhexidine (CHX-R) and mupirocin resistance (Mu-R) genes. RESULTS Mu-R prevalence of MR-CoNS among the BLS group was considered moderate (9.1%); however, CHX-R in the BLS group was 5.8%, the rate of which significantly increased among the universal decolonization strains group. DISCUSSION Both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. The prevalence Mu-R rate didn't change significantly during either of the MRSA decolonization practices that may be due to the local nature of mupirocin application on the nasal mucosa only. In contrast CHX-R that was found to be significantly higher among the UDS group. CONCLUSIONS Our findings indicate that both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. Although the universal MRSA decolonization has superior efficacy in decolonization of CoNS, it may increase the risk of selecting CHX-R and Mu-R. In addition, other potential resistance genes should be studied.
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Affiliation(s)
- Emad M Eed
- Department of Medical Microbiology and Immunology, College of Medicine, Menoufia University, Menoufia, Egypt; Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.
| | - Mabrouk M Ghonaim
- Department of Medical Microbiology and Immunology, College of Medicine, Menoufia University, Menoufia, Egypt; Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Amany S Khalifa
- Department of Clinical Pathology, College of Medicine, Menoufia University, Menoufia, Egypt; Department of Clinical Pathology, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Khalid J Alzahrani
- Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Khalaf F Alsharif
- Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Aza A Taha
- Department of Public Health and Community Medicine, College of Medicine, Menoufia University, Menoufia, Egypt; Department of Family and Community Medicine, College of Medicine, Taif University, Saudi Arabia
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16
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Goudarzi M, Fazeli M, Pouriran R, Eslami G. Genotype Distribution of Panton-Valentine Leukocidin (PVL)-Positive Staphylococcus aureus Strains Isolated from Wound-Related Infections: a Three-Year Multi-Center Study in Tehran, Iran. Jpn J Infect Dis 2019; 72:306-311. [PMID: 31155598 DOI: 10.7883/yoken.jjid.2018.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The spread of Panton-Valentine leucocidin (PVL)-carrying S. aureus strains in patients with wound infections in both the community and hospitals is increasing in some areas of Iran. In the present study, we determined the molecular characteristics and distribution of PVL-producing S. aureus strains isolated from wound infections. Genes encoding resistance, toxins, and staphylococcal enterotoxins were analyzed by polymerase chain reaction assays. Genotyping was performed using multi-locus sequence typing. Aminoglycoside resistance genes including ant (4')-Ia (57.4%) and aac (6')-Ie/aph (2″) (45.7%) were the most prevalent genes in isolates. Staphylococcal enterotoxin type A, as the most frequent type, was present in 20.2% of isolates. Strains belonged to seven clonal complexes. The most frequent clonal complex was CC30 (ST30) (29.8%), followed by CC22 (ST22) (21.3%), CC8 (ST8 and ST931) (17%), CC88 (ST88) (10.6%), CC59 (ST59 and ST338) (8.5%), CC1 (ST772 and ST1) (7.5%), and CC15 (ST15) (5.3%). Our findings indicated an increasing trend of CC30, carrying a wide range of resistance and toxin genes, which could present an obstacle in the treatment of patients with wound infections. Further studies are required to investigate the carriage of resistance, the antibiotic susceptibility pattern, and toxins encoding genes in different molecular types.
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Affiliation(s)
- Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences
| | | | - Ramin Pouriran
- School of Medicine, Shahid Beheshti University of Medical Sciences
| | - Gita Eslami
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences
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Razeghi M, Saffarian P, Goudarzi M. Incidence of inducible clindamycin resistance and antibacterial resistance genes variability in clinical Staphylococcus aureus strains: A two-year multicenter study in Tehran, Iran. GENE REPORTS 2019. [DOI: 10.1016/j.genrep.2019.100411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Dadashi M, Hajikhani B, Darban-Sarokhalil D, van Belkum A, Goudarzi M. Mupirocin resistance in Staphylococcus aureus: A systematic review and meta-analysis. J Glob Antimicrob Resist 2019; 20:238-247. [PMID: 31442624 DOI: 10.1016/j.jgar.2019.07.032] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Staphylococcus aureus is one of the most common pathogens causing nosocomial and community-acquired infections associated with high morbidity and mortality. Mupirocin has been increasingly used for treatment of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) infections. The aim of this study was to determine the prevalence of mupirocin-resistant S. aureus (MuRSA), mupirocin-resistant MRSA (MuRMRSA), high-level MuRSA (HLMuRSA) and high-level MuRMRSA (HLMuRMRSA) worldwide. METHODS Online databases including Medline, Embase and Web of Science were searched (2000-2018) to identify studies addressing the prevalence of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA. STATA v. software was used to interpret the data. RESULTS Of the 2243 records identified from the databases, 30 and 63 studies fulfilled the eligibility criteria for MuRSA and MuRMRSA, respectively. Finally, 27 and 60 studies were included separately for HLMuRSA and HLMuRMRSA, respectively. The analyses revealed pooled and averaged prevalences of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA of 7.6% [95% confidence interval (CI) 6.2-9.0%], 13.8% (95% CI 12.0-15.6%), 8.5% (95% CI 6.3-10.7%) and 8.1% (95% CI 6.8-9.4%), respectively. CONCLUSION Overall, these results show a global increase in the prevalence of HLMuRSA and HLMuRMRSA among clinical S. aureus isolates over time. However, there was only a significant increase in the prevalence of MuRMRSA compared with the other categories, especially MuRSA. Since mupirocin remains the most effective antibiotic for MSSA and MRSA decolonisation both in patients and healthcare personnel, a reduction of its effectiveness presents a risk for invasive infection. Monitoring of mupirocin resistance development remains critical.
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Affiliation(s)
- 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
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alex van Belkum
- Data Analytics Unit, bioMérieux 3, La Balme-les-Grottes, France
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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19
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Goudarzi M, Kobayashi N, Hashemi A, Fazeli M, Navidinia M. Genetic Variability of Methicillin Resistant Staphylococcus Aureus Strains Isolated from Burns Patients. Osong Public Health Res Perspect 2019; 10:170-176. [PMID: 31263666 PMCID: PMC6590875 DOI: 10.24171/j.phrp.2019.10.3.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives Staphylococcus aureus is a nosocomial pathogen that provides a major challenge in the healthcare environment, especially in burns units where patients are particularly susceptible to infections. In this study, we sought to determine molecular types of S. aureus isolates collected from burns patients, based on staphylococcal protein A and coagulase gene polymorphisms. Methods Antibiotic susceptibility testing of 89 S. aureus strains isolated from burn wounds of patients was assessed using the Kirby-Bauer disk diffusion method. Strains were characterized by spa typing, coa typing, and resistance and toxin gene profiling. Results A total of 12 different spa types were identified with the majority being t790 (18%). Panton-Valentine leucocidin encoding genes were identified in spa types t044 (5.6%), t852 (2.2%) and t008 (2.2%). The most commonly detected antibiotic resistance gene was ant (4')-Ia (60.7%). Ten different coa types were detected and the majority of the tested isolates belonged to coa III (47.2%). All the high-level mupirocin-resistant and low-level mupirocin resistant strains belonged to coa type III. Conclusion The present study illustrated that despite the high frequency of coa III and spa t790 types, the genetic background of S. aureus strains in Iranian burns patients was diverse. The findings obtained are valuable in creating awareness of S. aureus infections within burns units.
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Affiliation(s)
- Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nobumichi Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ali Hashemi
- 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
| | - Masoumeh Navidinia
- School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Morrissey I, Cantón R, Vila J, Gargallo-Viola D, Zsolt I, Garcia-Castillo M, López Y. Microbiological profile of ozenoxacin. Future Microbiol 2019; 14:773-787. [DOI: 10.2217/fmb-2019-0089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore the antibacterial spectrum of ozenoxacin and compare its in vitro activity with that of other antibacterial agents. Materials & methods: In 2010, 10,054 isolates were collected from 128 centers worldwide. Minimum inhibitory concentrations against Gram-positive and Gram-negative isolates were determined for 23 and 13 antibacterial agents, respectively. Results: Ozenoxacin exhibited high in vitro activity against susceptible, and methicillin- or levofloxacin-resistant, Gram-positive bacteria. Ozenoxacin was one or two dilutions less active against Enterobacteriaceae isolates, except for Escherichia coli, than other quinolones. Conclusion: Ozenoxacin is a potent antimicrobial agent mainly against susceptible and resistant strains of Gram-positive isolates (staphylococci and streptococci), and shows activity against some Gram-negative isolates.
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Affiliation(s)
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Vila
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Service, Biomedical Diagnostic Center, Hospital Clinic, University of Barcelona, Spain
- Institute of Global Health of Barcelona (ISGlobal), Barcelona, Spain
| | | | - Ilonka Zsolt
- Medical Department, Ferrer Internacional, Barcelona, Spain
| | - Maria Garcia-Castillo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Yuly López
- Institute of Global Health of Barcelona (ISGlobal), Barcelona, Spain
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21
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Sakr A, Brégeon F, Rolain JM, Blin O. Staphylococcus aureus nasal decolonization strategies: a review. Expert Rev Anti Infect Ther 2019; 17:327-340. [PMID: 31012332 DOI: 10.1080/14787210.2019.1604220] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Staphylococcus aureus (S. aureus) infections are associated with increased morbidity, mortality and health-care costs. Persistent nasal carriage of S. aureus found in 10-30% of the general population, constitutes a risk factor for these infections. Nasal decolonization is one of the used strategies to prevent this risk in some situations. Areas covered: Mupirocin nasal ointment has been used for the nasal decolonization and prevention of staphylococcal infections in various settings like surgeries. However, rising rates of resistance to mupirocin require the development of new decolonization agents. In this review, we will discuss mupirocin, its origins, studies that proved its efficacy and the associated resistance, as well as other decolonization agents under investigation. Expert opinion: As some limitations exist to mupirocin use, further research for alternatives is encouraged. Some old approved antiseptics (chlorhexidine, povidone-iodine) or antibiotics (rifampicin, bacitracin) have been investigated for their efficacy in this indication. Other new agents (tea tree oil, retapamulin, LTX-109, XF-73, phages, lysostaphin, squalamine analogues, etc.) are being studied. Some of them are still in preclinical phases, and others have reached clinical trials, but further research is needed. Special interest should be given to single dose decolonization strategies and to molecules that do not select resistant strains.
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Affiliation(s)
- Adèle Sakr
- a R&D department , Biosqual SAS , Marseille , France
| | - Fabienne Brégeon
- b IRD, APHM, MEPHI, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie , Aix Marseille Univ , Marseille , France
| | - Jean-Marc Rolain
- b IRD, APHM, MEPHI, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie , Aix Marseille Univ , Marseille , France
| | - Olivier Blin
- c Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Pharmacologie intégrée et interface clinique et industriel , Institut de Neurosciences des Systèmes, UMR AMU-INSERM 1106 , Marseille , France
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22
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Goudarzi M, Fazeli M, Eslami G, Pouriran R. Genetic Diversity Analysis of Mupirocin-Resistant Staphylococcus aureus Clinical Isolates in Tehran Hospitals, Iran. Microb Drug Resist 2018; 25:558-566. [PMID: 30499764 DOI: 10.1089/mdr.2018.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Few studies describe the molecular characterization of mupirocin resistance in Staphylococcus aureus strains. In this study, we evaluated the characteristics of mupirocin resistance in S. aureus isolates for 1-year period in Tehran, Iran. In a cross-sectional study, we collected 51 unique mupirocin-resistant strains obtained from 648 S. aureus isolates. High- and low-level resistance were determined by minimum inhibitory concentration with broth microdilution method. Presence of the genes for resistance to antibiotics and toxins was detected by polymerase chain reaction assays. Genotyping was performed by S. aureus protein A (spa) and staphylococcal cassette chromosome mec (SCCmec) typing, whereas clones were determined by multilocus sequence typing. Among mupirocin-resistant isolates, methicillin-resistant S. aureus (MRSA) 23 (45.1%) and 28 (54.9%) isolates were classified as high- and low-level mupirocin resistance, respectively. Among the 51 tested strains 25 (49%) isolates were positive for mupA genes. Seven different clones were detected in this study. High-level mupirocin-resistant (HLMUPR) strains belonged to ST8-SCCmec IV/t064 (n = 10, 19.6%), ST5-SCCmec IV/t002 (n = 5, 9.8%), ST8-SCCmec IV/t008 (n = 4, 7.8%), and ST239-SCCmec III/t631 (n = 4, 7.8%) clones, while low-level mupirocin-resistant (LLMUPR) strains belonged to ST22-SCCmec IV/t790 (n = 11, 21.6%), ST239-SCCmec III/t860 (n = 9, 17.7%), and ST15-SCCmec IV/t084 (n = 8, 15.7%) clones. Two strains belonged to ST22-SCCmec IV/t790 clone, despite carrying mupA gene, and demonstrated LLMUPR phenotype. One ST8-SCCmecIV/t008 strain with HLMUPR was confirmed as Vancomycin-intermediate S. aureus strain. Our data demonstrated the need for thorough epidemiological monitoring and a routine mupirocin testing program to prevent and detect mupirocin resistance in MRSA.
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Affiliation(s)
- Mehdi Goudarzi
- 1 Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Fazeli
- 2 Department of Virology, Pasteur Institute of Iran, Tehran, Iran
| | - Gita Eslami
- 1 Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Pouriran
- 3 School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khoshnood S, Heidary M, Asadi A, Soleimani S, Motahar M, Savari M, Saki M, Abdi M. A review on mechanism of action, resistance, synergism, and clinical implications of mupirocin against Staphylococcus aureus. Biomed Pharmacother 2018; 109:1809-1818. [PMID: 30551435 DOI: 10.1016/j.biopha.2018.10.131] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 12/20/2022] Open
Abstract
Mupirocin (MUP), bactroban, or pseudomonic acid is a natural crotonic acid derivative drug extracted from Pseudomonas fluorescens which is produced by modular polyketide synthases. This antibiotic has a unique chemical structure and mechanism of action. It is a mixture of A-D pseudomonic acids and inhibits protein synthesis through binding to bacterial isoleucyl-tRNA synthetase. MUP is often prescribed to prevent skin and soft tissue infections caused by S. aureus isolates and where the MRSA isolates are epidemic, MUP may be used as a choice drug for nasal decolonization. It is also used for prevention of recurring infections and control the outbreaks. The emergence of MUP resistance has been increasing particularly among methicillin-resistant Staphylococcus aureus (MRSA) isolates in many parts of the world and such resistance is often related with MUP widespread uses. Although both low-level and high-level MUP resistance were reported among MRSA isolates, the rate of resistance is different in various geographic areas. In this review, we will report the global prevalence of MUP resistance, discuss synergism and mechanism of action of MUP, and provide new insights into the clinical use of this antibiotic.
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Affiliation(s)
- Saeed Khoshnood
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Heidary
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Arezoo Asadi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saleh Soleimani
- Department of Biology, Payame Noor University, Isfahan, Iran
| | - Moloudsadat Motahar
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Savari
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Saki
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahtab Abdi
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Schreiner M, Bäumler W, Eckl D, Späth A, König B, Eichner A. Photodynamic inactivation of bacteria to decolonize meticillin-resistant Staphylococcus aureus
from human skin. Br J Dermatol 2018; 179:1358-1367. [DOI: 10.1111/bjd.17152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 12/18/2022]
Affiliation(s)
- M. Schreiner
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - W. Bäumler
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - D.B. Eckl
- Institute of Microbiology; University of Regensburg; Regensburg Germany
| | - A. Späth
- TriOptoTec GmbH; Am Biopark 13 Regensburg Germany
| | - B. König
- Department of Organic Chemistry; University of Regensburg; Regensburg Germany
| | - A. Eichner
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
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Goudarzi M, Navidinia M, Beiranvand E, Goudarzi H. Phenotypic and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus Clones Carrying the Panton-Valentine Leukocidin Genes Disseminating in Iranian Hospitals. Microb Drug Resist 2018; 24:1543-1551. [PMID: 29894277 DOI: 10.1089/mdr.2018.0033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The spread of Panton-Valentine leukocidin (PVL)-carrying Staphylococcus aureus strains in both hospital and the community is a significant worldwide problem. The aim of the study was to investigate the clonal dissemination pattern of PVL-producing S. aureus strains isolated from hospitalized patients in Tehran, Iran. In this cross-sectional study, 70 PVL-carrying S. aureus strains were recovered from 240 clinical specimens and characterized by antibiotic susceptibility testing, agr typing, SCCmec typing, spa typing, multilocus sequence typing, and virulence and adhesion gene profiling. All the PVL-carrying S. aureus strains were confirmed as methicillin-resistant S. aureus (MRSA) and recovered from wounds (48.6%), blood (25.7%), exudate/pus (11.4%), sputum (8.6%), and body fluid (5.7%) samples. Among the 70 PVL-carrying S. aureus strains tested, 38 (54.3%) were positive for ant (4')-Ia gene, 27 (38.6%) for aac (6')-Ie/aph (2″), 13 (18.6%) for msr(A), 13 (18.6%) for erm(C), 13 (18.6%) for tet(M), 11 (15.7%) for erm(A), 10(14.3%) for msr(B), 9 (12.9%) for aph (3')-IIIa, 5 (7.1%) for mupA, and 2 (2.9%) for erm(B) genes. Five clonal complexes (CC) and nine different clones were detected in this study. The most frequent CC was CC22 (ST22) (42.8%) followed by CC30 (ST30) (21.5%), CC8 (ST8) (17.2%), CC1 (ST772) (11.4%), and CC80 (ST80) (7.1%). In this study, ST22-SCCmec IV/t852 was the predominant PVL-positive MRSA clone (20%), followed by ST8-SCCmec IV/t008 (17.2%), ST30-SCCmec IV/t019 (12.9%), ST22-SCCmec IV/t790 (11.4%), ST22-SCCmec IV/t005 (11.4%), ST30-SCCmec IV/t021 (8.6%), ST80-SCCmec IV/t044 (7.1%), ST772-SCCmec V/t657 (7.1%), and ST772-SCCmec V/t10795 (4.3%). Diversity in clonal types of PVL-carrying MRSA strains in our study supports the need to perform a systematic surveillance of PVL-positive MRSA strains.
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Affiliation(s)
- Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Navidinia
- School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Beiranvand
- Department of Biotechnology, Pasteur Institute of Iran, Tehran, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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26
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Six-Year Retrospective Review of Hospital Data on Antimicrobial Resistance Profile of Staphylococcus aureus Isolated from Skin Infections from a Single Institution in Greece. Antibiotics (Basel) 2017; 6:antibiotics6040039. [PMID: 29261121 PMCID: PMC5745482 DOI: 10.3390/antibiotics6040039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine the prevalence of resistant strains of Staphylococcus aureus (S. aureus) isolated from Skin and soft tissue infections (SSTI) to various antibiotics. Material and Methods: All culture-positive results for S. aureus from swabs taken from patients presenting at one Greek hospital with a skin infection between the years 2010–2015 were examined retrospectively. Bacterial cultures, identification of S. aureus and antimicrobial susceptibility testing were performed using the disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines and European Committee on Antimicrobial testing (EUCAST) breakpoints. EUCAST breakpoints were applied if no CLSI were available. Results: Of 2069 S. aureus isolates identified, 1845 (88%) were resistant to one or more antibiotics. The highest resistance was observed for benzylpenicillin (71.9%), followed by erythromycin (34.3%). Resistant strains to cefoxitin defined as MRSA (methicillin-resistant S. aureus) represented 21% of total isolates. Interestingly, resistance to fusidic acid was 22.9% and to mupirocin as high as 12.7%. Low rates were observed for minocycline, rifampicin and trimethoprim/sulfamethoxazole (SXT). Resistance to antibiotics remained relatively stable throughout the six-year period, with the exception of cefoxitin, fusidic acid and SXT. A high percentage of MRSA strains were resistant to erythromycin (60%), fusidic acid (46%), clindamycin (38%) and tetracycline (35.5%). Conclusions: Special attention is required in prescribing appropriate antibiotic therapeutic regimens, particularly for MRSA. These data on the susceptibility of S. aureus may be useful for guiding antibiotic treatment.
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Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev 2017; 30:827-860. [PMID: 28592405 DOI: 10.1128/cmr.00112-16] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.
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28
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Halliwell S, Warn P, Sattar A, Derrick JP, Upton M. A single dose of epidermicin NI01 is sufficient to eradicate MRSA from the nares of cotton rats. J Antimicrob Chemother 2017; 72:778-781. [PMID: 27999015 PMCID: PMC5400076 DOI: 10.1093/jac/dkw457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022] Open
Abstract
Objectives: To investigate the efficacy of a potent novel antimicrobial protein of mass 6 kDa, epidermicin NI01, for eradicating the nasal burden of MRSA in a cotton rat (Sigmodon hispidus) model. Methods: MRSA strain ATCC 43300 was used to establish a robust colonization of cotton rat nares. This model was used to evaluate the efficacy of topical 0.04% and 0.2% epidermicin NI01, administered twice daily for 3 days consecutively, and topical 0.8% epidermicin NI01 administered once, for reducing nasal MRSA burden. Control groups remained untreated or were administered vehicle only (0.5% hydroxypropylmethylcellulose) or 2% mupirocin twice daily for 3 days. The experiment was terminated at day 5 and MRSA quantitative counts were determined. Tissues recovered from animals treated with 0.2% epidermicin twice daily for 3 days were examined for histological changes. Results: Mupirocin treatment resulted in a reduction in burden of log10 (log R) of 2.59 cfu/nares compared with vehicle (P < 0.0001). Epidermicin NI01 administered once at 0.8% showed excellent efficacy, resulting in a log R of 2.10 cfu/nares (P = 0.0004), which was equivalent to mupirocin. Epidermicin NI01 administered at 0.2% or 0.04% twice daily for 3 days did not have a significant impact on the tissue burden recovered from the nares. Mild to marked histological abnormalities were noted, but these were determined to be reversible. Conclusion: A single dose of topical epidermicin NI01 was as effective as mupirocin administered twice daily for 3 days in eradication of MRSA from the nares of cotton rats. This justifies further development of epidermicin for this indication.
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Affiliation(s)
- Samantha Halliwell
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Peter Warn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Evotec (UK) Ltd, Manchester Science Park, Manchester, UK
| | - Abdul Sattar
- Evotec (UK) Ltd, Manchester Science Park, Manchester, UK
| | - Jeremy P Derrick
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mathew Upton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,School of Biomedical & Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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29
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Williams DM, Miller AO, Henry MW, Westrich GH, Ghomrawi HMK. Cost-Effectiveness of Staphylococcus aureus Decolonization Strategies in High-Risk Total Joint Arthroplasty Patients. J Arthroplasty 2017; 32:S91-S96. [PMID: 28341280 DOI: 10.1016/j.arth.2017.01.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/16/2017] [Accepted: 01/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The risk of prosthetic joint infection increases with Staphylococcus aureus colonization. The cost-effectiveness of decolonization is controversial. We evaluated cost-effectiveness decolonization protocols in high-risk arthroplasty patients. METHODS An analytical model evaluated risk under 3 protocols: 4 swabs, 2 swabs, and nasal swab alone. These were compared to no-screening and universal decolonization strategies. Cost-effectiveness was evaluated from the hospital, patient, and societal perspective. RESULTS Under base case conditions, universal decolonization and 4-swab strategies were most effective. The 2-swab and universal decolonization strategy were most cost-effective from patient and societal perspectives. From the hospital perspective, universal decolonization was the dominant strategy (much less costly and more effective). CONCLUSION S aureus decolonization may be cost-effective for reducing prosthetic joint infections in high-risk patients. These results may have important implications for treatment of patients and for cost containment in a bundled payment system.
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Affiliation(s)
- Devin M Williams
- Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Andy O Miller
- Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Michael W Henry
- Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Hassan M K Ghomrawi
- Healthcare Research Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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30
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Rajkumar S, Sistla S, Manoharan M, Sugumar M, Nagasundaram N, Parija SC, Ray P, Bakthavatchalam YD, Veeraraghavan B, Kapil A, Walia K, Ohri VC. Prevalence and genetic mechanisms of antimicrobial resistance in Staphylococcus species: A multicentre report of the indian council of medical research antimicrobial resistance surveillance network. Indian J Med Microbiol 2017; 35:53-60. [PMID: 28303819 DOI: 10.4103/ijmm.ijmm_16_427] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Routine surveillance of antimicrobial resistance (AMR) is an essential component of measures aimed to tackle the growing threat of resistant microbes in public health. This study presents a 1-year multicentre report on AMR in Staphylococcus species as part of Indian Council of Medical Research-AMR surveillance network. MATERIALS AND METHODS Staphylococcus species was routinely collected in the nodal and regional centres of the network and antimicrobial susceptibility testing was performed against a panel of antimicrobials. Minimum inhibitory concentration (MIC) values of vancomycin (VAN), daptomycin, tigecycline and linezolid (LNZ) against selected methicillin-resistant Staphylococcus aureus(MRSA) isolates were determined by E-test and MIC creep, if any, was determined. Resistant genotypes were determined by polymerase chain reaction for those isolates showing phenotypic resistance. RESULTS The prevalence of MRSA was found to be range from moderate (21%) to high (45%) among the centres with an overall prevalence of 37.3%. High prevalence of resistance was observed with commonly used antimicrobials such as ciprofloxacin and erythromycin in all the centres. Resistance to LNZ was not encountered except for a single case. Full-blown resistance to VAN in S. aureus was not observed; however, a few VAN-intermediate S. aureus isolates were documented. The most common species of coagulase negative staphylococci (CoNS) identified was Staphylococcus haemolyticus and Staphylococcus epidermidis. Resistance among CoNS was relatively higher than S. aureus. Most phenotypically resistant organisms possessed the corresponding resistance genes. CONCLUSION There were localised differences in the prevalence of resistance between the centres. The efficacy of the anti-MRSA antimicrobials was very high; however, almost all these antimicrobials showed evidence of creeping MIC.
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Affiliation(s)
- Sunanda Rajkumar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sujatha Sistla
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Meerabai Manoharan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Madhan Sugumar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Niveditha Nagasundaram
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Subhash Chandra Parija
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pallab Ray
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yamuna Devi Bakthavatchalam
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balaji Veeraraghavan
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamini Walia
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - V C Ohri
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Humphreys H, Becker K, Dohmen P, Petrosillo N, Spencer M, van Rijen M, Wechsler-Fördös A, Pujol M, Dubouix A, Garau J. Staphylococcus aureus and surgical site infections: benefits of screening and decolonization before surgery. J Hosp Infect 2016; 94:295-304. [DOI: 10.1016/j.jhin.2016.06.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/06/2016] [Indexed: 12/13/2022]
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32
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Espigares E, Moreno Roldan E, Espigares M, Abreu R, Castro B, Dib AL, Arias Á. Phenotypic Resistance to Disinfectants and Antibiotics in Methicillin-Resistant Staphylococcus aureus Strains Isolated from Pigs. Zoonoses Public Health 2016; 64:272-280. [PMID: 27762078 DOI: 10.1111/zph.12308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Indexed: 12/20/2022]
Abstract
The aim of this research was to study the phenotypic resistances to disinfectants and antibiotics in strains of methicillin-resistant Staphylococcus aureus (MRSA) obtained from Canary black pigs. Analyses were performed on 54 strains of MRSA, isolated in Canary black pigs from the province of Tenerife (Spain); all of them carried the mecA gene. The strains were isolated by means of nasal swab samples of healthy pigs, collected under veterinarian supervision. Bactericidal activity of antiseptics and disinfectants was tested by means of the dilution-neutralization method. Susceptibility to the disinfectants glutaraldehyde, peracetic acid and silver nitrate was assessed, as well as to the antiseptics chlorhexidine, benzalkonium chloride and povidone iodine. Susceptibility to a wide array of antibiotics representing the main groups was determined by means of the disc diffusion method. All the strains demonstrated susceptibility to the disinfectants tested at the recommended concentration, and even to dilutions equal to or lesser than 1/16. The most effective antiseptic and disinfectant were, respectively, chlorhexidine and silver nitrate. With regard to the antibiotics, the strains proved to be multiresistant. All presented phenotypic resistance to the β-lactam antibiotics ampicillin, penicillin and cefoxitin, as well as to numerous aminoglycosides, tetracycline and trimethoprim-sulfamethoxazole. It was also observed that 61.1% of the strains were carriers of plasmids. Our results underline that in the strains such as MRSA, which show multiple resistances to antibiotics, the antiseptics and disinfectants show great efficacy. Moreover, as other authors also suggest, for the treatment and prevention of infections caused by MRSA, the use of β-lactam and aminoglycoside antibiotics may be less effective.
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Affiliation(s)
- E Espigares
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - E Moreno Roldan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - M Espigares
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - R Abreu
- Department of Preventive Medicine and Public Health, University of La Laguna, Canary Islands, Spain
| | - B Castro
- University Hospital of Canary Islands, Tenerife Canary Islands, Spain
| | - A L Dib
- Laboratoire de Gestion de la Santé et Productions Animales-Institut des Sciences Vétérinaire El Khroub, Université des Frères Mentouri, Constantine, Algeria
| | - Á Arias
- Department of Preventive Medicine and Public Health, University of La Laguna, Canary Islands, Spain
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Gómez P, Casado C, Sáenz Y, Ruiz-Ripa L, Estepa V, Zarazaga M, Torres C. Diversity of species and antimicrobial resistance determinants of staphylococci in superficial waters in Spain. FEMS Microbiol Ecol 2016; 93:fiw208. [PMID: 27798063 DOI: 10.1093/femsec/fiw208] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 02/02/2023] Open
Abstract
The objectives were to determine the presence and diversity of staphylococcal species in surface waters in La Rioja region (Spain), and to characterize recovered isolates. Staphylococci were detected in 42 of 47 evaluable samples, and 72 isolates were obtained, of which 13 were coagulase-positive (CoPS) and 59 were coagulase-negative (CoNS). Twelve CoPS were identified as S. aureus and typed as follows (number of strains): t002/t502/ST5 (four), t10668/ST425 (one), t10712//ST1643 (one), t843/ST130 (one), t10855/ST2461 (one), t3369/ST2657 (one), t1166/ST133 (one), t8083/ST2049 (one) and t045/ST2460 (one); and one as S. pseudintermedius ST147. Virulence genes tst, cna and lukS/F-I were detected, and one strain showed the immune evasion cluster type F. Regarding CoNS, 12 different species were recovered (number of strains): S. epidermidis (11), S. vitulinus (10), S. sciuri (nine), S. fleurettii (seven), S. lentus (six), S. simulans (five), S. xylosus (four), S. chromogenes (two), S. hominis (two), and S. equorum, S. succinus and S. warneri (one each). Fourteen CoNS isolates presented a multidrug resistance phenotype, with the following resistance genes: blaZ, mecA, fusB, fusC, erm(C), mph(C), erm(A), msr(A)/(B), mph(C), ant(4')-Ia, tet(K), tet(L), catpc194 and str The high diversity of staphylococcal species, as well as multiple resistance and virulence genes, highlights the importance of surface waters as a temporary reservoir and source of transmission.
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Affiliation(s)
- Paula Gómez
- Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Cristina Casado
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Yolanda Sáenz
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Laura Ruiz-Ripa
- Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Vanesa Estepa
- Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Myriam Zarazaga
- Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Carmen Torres
- Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain .,Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
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Mahmoodzadeh Hosseini H, Kiyani N, Amin M, Hedayati Ch M, Imani Fooladi AA. Distribution of high-level mupirocin resistance among clinical MRSA. J Chemother 2016; 29:215-219. [PMID: 27376552 DOI: 10.1080/1120009x.2016.1201257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mupirocin is a topical antibiotic for methicillin-resistant Staphylococcus aureus (MRSA) decolonization in hospital settings and nursing homes and is used as a highly effective antibiotic against MRSA. In this study, we aimed to evaluate the frequency of high-level mupirocin-resistant (HLMR) strains among the MRSA subtypes. A total of 188 clinical MRSA isolates were collected from 2011 to 2014, and their susceptibility to antimicrobial agents and vancomycin resistance was evaluated using disc diffusion method and micro-dilution method, respectively. Furthermore, the presence of mecA, SSCmec, mupA and mupB was assessed by PCR. All isolates were multi-drug resistant (MDR) but 2 strains (1.06%) were resistant to mupirocin. Minimum inhibitory concentration (MIC) of vancomycin for 8 strains (4.7%) was higher than 2 μg/ml. Of 188 isolates, 188 (100%), 64 (34.04%), 8 (4.3%), 150 (79.8%), 26 (13.8%), 2 (1.06) and 2 (1.06%) isolates possessed mecA, SCCmec types I, II, III, IV, mupA and mupB genes, respectively. Our data showed that despite infection control policy enforced by health care committee, the rate of mupirocin resistance among MRSA strains is continuously rising.
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Affiliation(s)
| | - Nasibeh Kiyani
- b Faculty of Biotechnology, Branch Tehran-Shargh , Payame Noor University , Tehran , Iran
| | - Mohsen Amin
- c Faculty of Pharmacy, Department of Drug and Food Control , Tehran University of Medical Sciences , Tehran , Iran
| | - Mojtaba Hedayati Ch
- d Department of Microbiology, Parasitology, and Immunology , Guilan University of Medical Sciences , Rasht , Iran
| | - Abbas Ali Imani Fooladi
- a Applied Microbiology Research Center , Baqiyatallah University of Medical Sciences , Tehran , Iran
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Fang H, Fröding I, Gian B, Hæggman S, Tollström UB, Ullberg M, Nord CE. Methicillin-resistant Staphylococcus aureus in Stockholm, Sweden: Molecular epidemiology and antimicrobial susceptibilities to ceftaroline, linezolid, mupirocin and vancomycin in 2014. J Glob Antimicrob Resist 2016; 5:31-5. [PMID: 27436463 DOI: 10.1016/j.jgar.2016.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 11/16/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a public health problem worldwide. The aim of the present study was to investigate the molecular epidemiology and antimicrobial susceptibilities of MRSA strains in Stockholm, Sweden in 2014. Pulsed-field gel electrophoresis (PFGE) was used to characterise the strains. Antimicrobial susceptibilities to ceftaroline, linezolid and mupirocin were determined by the disc diffusion method. Etest was used to determine vancomycin susceptibility and to confirm resistance to ceftaroline, mupirocin and linezolid in non-susceptible strains. High-level ceftaroline-resistant strains [minimum inhibitory concentration (MIC)≥4mg/L] were confirmed by the broth microdilution method. spa typing was carried out on strains that were non-susceptible to the antibiotics tested. In total, 743 consecutive non-duplicate MRSA strains recovered in Stockholm in 2014 were investigated. PFGE analysis of the isolates revealed a population with 271 different PFGE patterns and three non-typeable strains. No PFGE type accounted for >10% of all strains. The most common PFGE types were MRSA-00-02 (6.9%) and MRSA-05-02 (4.6%). MRSA-05-02 is a USA300-like strain. The antimicrobial susceptibilities of the strains were as follows: ceftaroline, 98.5%; linezolid, 100%; mupirocin, 99.3%; and vancomycin, 100%. Two strains with spa t001 displayed ceftaroline MICs of 4mg/L. Three strains with spa types t002, t064 and t437 showed high-level mupirocin resistance (MIC>1024mg/L). In conclusion, there was a diverse genetic population among the MRSA isolates and no predominant genotype was found. This study identified a few strains with high-level ceftaroline resistance, high-level mupirocin resistance and high-risk genotypes.
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Affiliation(s)
- Hong Fang
- Department of Clinical Microbiology, Karolinska University Hospital, Karolinska Institute, SE-141 86 Stockholm, Sweden
| | - Inga Fröding
- Department of Clinical Microbiology, Karolinska University Hospital, Karolinska Institute, SE-141 86 Stockholm, Sweden
| | - Boisan Gian
- Department of Clinical Microbiology, Karolinska University Hospital, Karolinska Institute, SE-141 86 Stockholm, Sweden
| | - Sara Hæggman
- Department of Microbiology, Public Health Agency of Sweden, SE-171 82 Solna, Sweden
| | | | - Måns Ullberg
- Department of Clinical Microbiology, Karolinska University Hospital, Karolinska Institute, SE-141 86 Stockholm, Sweden
| | - Carl Erik Nord
- Department of Clinical Microbiology, Karolinska University Hospital, Karolinska Institute, SE-141 86 Stockholm, Sweden.
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Magro E, Graillon T, Lassave J, Castinetti F, Boissonneau S, Tabouret E, Fuentes S, Velly L, Gras R, Dufour H. Complications Related to the Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Macroadenomas in 300 Consecutive Patients. World Neurosurg 2016; 89:442-53. [PMID: 26902781 DOI: 10.1016/j.wneu.2016.02.059] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To analyze complications of endoscopic transsphenoidal surgery (ETS) for nonfunctioning pituitary macroadenomas (NFPAs). METHODS A retrospective study of 300 NFPAs was performed. Complications and factors that could influence these complications were analyzed. RESULTS Visual and pituitary functions worsened in 2.4% and 13.7% of cases, respectively. Postoperative diabetes insipidus was permanent in 6.2% of cases. Postoperative meningitis occurred in 3.3% of patients. Meningitis was strongly associated with intraoperative cerebrospinal fluid (CSF) leaks (P = 0.01), postoperative CSF leaks (P = 0.0001), and operation times longer than 1 hour (P = 0.023). Detection of Staphylococcus aureus and preoperative treatment with mupirocin in the nostrils did not impact the occurrence of meningitis. Two patients with meningitis died (unique causes of death). Postoperative CSF leaks occurred in 2.7% of cases and were associated with intraoperative CSF leaks (P = 0.007) and permanent diabetes insipidus (P = 0.028). The rate of CSF leak decreased from 4% to 0.8% (P = 0.048) after we moved from a soft to hard reconstruction of the sella. The rate of postoperative epistaxis decreased from 6.7% to 1.25% after we stopped using monopolar coagulation (P = 0.013). CONCLUSIONS ETS permits a wide view, allowing good conditions for a satisfactory resection in the majority of NFPAs. Some pitfalls of endoscopy can lead to complications that improve with modification of the operative technique (i.e., CSF leak and postoperative epistaxis). This study confirms an acceptable rate of complications associated with ETS.
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Affiliation(s)
- Elsa Magro
- Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France
| | - Thomas Graillon
- Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France
| | - Jerome Lassave
- Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France
| | - Frederic Castinetti
- Department of Endocrinology, CHU de la Conception, Université de la méditérannée, Marseille, France
| | - Sebastien Boissonneau
- Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France
| | - Emline Tabouret
- Department of Neuro-oncology, CHU de la Timone, Université de la méditérannée, Marseille, France
| | - Stéphane Fuentes
- Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France
| | - Lionel Velly
- Intensive Care Unit, CHU de la Timone, Université de la méditérannée, Marseille, France
| | - Regis Gras
- Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France.
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Susceptibility trends including emergence of linezolid resistance among coagulase-negative staphylococci and meticillin-resistant Staphylococcus aureus from invasive infections. Int J Antimicrob Agents 2015; 46:622-30. [DOI: 10.1016/j.ijantimicag.2015.07.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022]
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Nagant C, Deplano A, Nonhoff C, De Mendonça R, Roisin S, Dodémont M, Denis O. Low prevalence of mupirocin resistance in Belgian Staphylococcus aureus isolates collected during a 10 year nationwide surveillance. J Antimicrob Chemother 2015; 71:266-7. [PMID: 26377863 DOI: 10.1093/jac/dkv286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carole Nagant
- National Reference Centre for Staphylococcus aureus, Microbiology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ariane Deplano
- National Reference Centre for Staphylococcus aureus, Microbiology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Claire Nonhoff
- National Reference Centre for Staphylococcus aureus, Microbiology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ricardo De Mendonça
- National Reference Centre for Staphylococcus aureus, Microbiology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Sandrine Roisin
- National Reference Centre for Staphylococcus aureus, Microbiology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Dodémont
- National Reference Centre for Staphylococcus aureus, Microbiology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Denis
- National Reference Centre for Staphylococcus aureus, Microbiology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Hughes J, Stabler R, Gaunt M, Karadag T, Desai N, Betley J, Ioannou A, Aryee A, Hearn P, Marbach H, Patel A, Otter JA, Edgeworth JD, Tosas Auguet O. Clonal variation in high- and low-level phenotypic and genotypic mupirocin resistance of MRSA isolates in south-east London. J Antimicrob Chemother 2015; 70:3191-9. [PMID: 26316381 DOI: 10.1093/jac/dkv248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Both low-level mupirocin resistance (LMR) and high-level mupirocin resistance (HMR) have been identified. The aim of this study was to determine the epidemiology of LMR and HMR in MRSA isolates at five hospitals that have used mupirocin for targeted decolonization as part of successful institutional control programmes. METHODS All MRSA identified in three microbiology laboratories serving five central and south-east London hospitals and surrounding communities between November 2011 and February 2012 were included. HMR and LMR were determined by disc diffusion testing. WGS was used to derive multilocus sequence types (MLSTs) and the presence of HMR and LMR resistance determinants. RESULTS Prevalence of either HMR or LMR amongst first healthcare episode isolates from 795 identified patients was 9.69% (95% CI 7.72-11.96); LMR was 6.29% (95% CI 4.70-8.21) and HMR was 3.40% (95% CI 2.25-4.90). Mupirocin resistance was not significantly different in isolates identified from inpatients at each microbiology laboratory, but was more common in genotypically defined 'hospital' rather than 'community' isolates (OR 3.17, 95% CI 1.36-9.30, P = 0.002). LMR was associated with inpatient stay, previous history of MRSA and age ≥65 years; HMR was associated with age ≥65 years and residential postcode outside London. LMR and HMR varied by clone, with both being low in the dominant UK MRSA clone ST22 compared with ST8, ST36 and ST239/241 for LMR and with ST8 and ST36 for HMR. V588F mutation and mupA carriage had high specificity (>97%) and area under the curve (>83%) to discriminate phenotypic mupirocin resistance, but uncertainty around the sensitivity point estimate was large (95% CI 52.50%-94.44%). Mutations in or near the mupA gene were found in eight isolates that carried mupA but were not HMR. CONCLUSIONS Mupirocin resistance was identified in <10% of patients and varied significantly by clone, implying that changes in clonal epidemiology may have an important role in determining the prevalence of resistance in conjunction with selection due to mupirocin use.
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Affiliation(s)
- John Hughes
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Stabler
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Gaunt
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Tacim Karadag
- Department of Microbiology, Lewisham and Greenwich NHS Trust, London, UK
| | - Nergish Desai
- Department of Microbiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jason Betley
- Illumina Cambridge Limited, Chesterford Research Park, Little Chesterford, Essex, UK
| | - Avgousta Ioannou
- Illumina Cambridge Limited, Chesterford Research Park, Little Chesterford, Essex, UK
| | - Anna Aryee
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Pasco Hearn
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Helene Marbach
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amita Patel
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan A Otter
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Olga Tosas Auguet
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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Murugesan S, Perumal N, Mahalingam SP, Dilliappan SK, Krishnan P. Analysis of Antibiotic Resistance Genes and its Associated SCCmec Types among Nasal Carriage of Methicillin Resistant Coagulase Negative Staphylococci from Community Settings, Chennai, Southern India. J Clin Diagn Res 2015; 9:DC01-5. [PMID: 26435940 DOI: 10.7860/jcdr/2015/11733.6307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/30/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study was designed to find the distribution of SCCmec types and the various antibiotic resistance genes amongst MR-CoNS isolates from asymptomatic individuals. MATERIALS AND METHODS A total of 145 nasal swabs were collected from asymptomatic healthy individuals from community settings. Identification and speciation of CoNS were done by standard biochemical methods. Screening of methicillin resistance (mecA gene) and detection of various antibiotic resistant genes were done using multiplex PCR method. SCCmec types (I - V) were determined using multiplex PCR. RESULTS 50 (44.6%) isolates were found to be methicillin resistant both by cefoxitin method and multiplex PCR. S. epidermidis (40%) was the predominant species followed by S. haemolyticus (28%), S. hominis (20%) and S. warneri (12%). Highest resistance was shown for cotrimoxazole (26%), followed by ciprofloxacin (24%), tetracycline (20%), erythromycin (18%), fusidic acid (10%) and mupirocin (6%). Among SCCmec types, 44 isolates showed single type, including type I (30%), type IV (24%), type II (18%), type V (14%) and type III (2%). 6 isolates showed two types, III+IV (n= 2), II+V (n=2), IV+V (n=1) and type I+V (n=1). CONCLUSION In conclusion, to the best of our knowledge, this is the first study in India to study the distribution of antibiotic resistant genes and SCCmec types among MR-CoNS from community settings. This study highlights high prevalence of MR-CoNS in community and its role in harbouring genetically diverse SCCmec elements as antibiotic resistance determinant.
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Affiliation(s)
- Saravanan Murugesan
- Research Scholar, Department of Microbiology, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras , Taramani, Chennai, India
| | - Nagaraj Perumal
- Research Scholar, Department of Microbiology, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras , Taramani, Chennai, India
| | - Surya Prakash Mahalingam
- Project Trainee, Department of Microbiology, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras , Taramani, Chennai, India
| | - Selva Kumar Dilliappan
- Project Trainee, Department of Microbiology, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras , Taramani, Chennai, India
| | - Padma Krishnan
- Assistant Professor, Department of Microbiology, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras , Taramani, Chennai, India
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Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA. J Antimicrob Chemother 2015; 70:2681-92. [DOI: 10.1093/jac/dkv169] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Mupirocin Resistance in Isolates of Staphylococcus spp. from Nasal Swabs in a Tertiary Hospital in France. J Clin Microbiol 2015; 53:2713-5. [PMID: 26019208 DOI: 10.1128/jcm.00274-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/16/2015] [Indexed: 11/20/2022] Open
Abstract
Mupirocin is a topical antibiotic largely used to eradicate staphylococcal nasal carriage. Here, we investigated the prevalence of mupirocin-resistant Staphylococcus aureus and coagulase-negative staphylococcal isolates recovered from patients in different wards in a hospital (Lyon, France), which were determined both phenotypically with an Epsilometer test (Etest) and genetically by PCR for mupA and mupB.
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Antonov NK, Garzon MC, Morel KD, Whittier S, Planet PJ, Lauren CT. High prevalence of mupirocin resistance in Staphylococcus aureus isolates from a pediatric population. Antimicrob Agents Chemother 2015; 59:3350-6. [PMID: 25824213 PMCID: PMC4432188 DOI: 10.1128/aac.00079-15] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/19/2015] [Indexed: 02/08/2023] Open
Abstract
Topical mupirocin is used widely to treat skin and soft tissue infections and to eradicate nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). Few studies to date have characterized the rates of S. aureus mupirocin resistance in pediatric populations. We retrospectively studied 358 unique S. aureus isolates obtained from 249 children seen in a predominantly outpatient setting by the Division of Pediatric Dermatology at a major academic center in New York City between 1 May 2012 and 17 September 2013. Mupirocin resistance rates and the associated risk factors were determined using a logistic regression analysis. In our patient population, 19.3% of patients had mupirocin-resistant S. aureus isolates at the time of their first culture, and 22.1% of patients with S. aureus infection had a mupirocin-resistant isolate at some time during the study period. Overall, 31.3% of all S. aureus isolates collected during the study period were resistant to mupirocin. Prior mupirocin use was strongly correlated (odds ratio [OR] = 26.5; P = <0.001) with mupirocin resistance. Additional risk factors for mupirocin resistance included methicillin resistance, atopic dermatitis (AD), epidermolysis bullosa (EB), immunosuppression, and residence in northern Manhattan and the Bronx. Resistance to mupirocin is widespread in children with dermatologic complaints in the New York City area, and given the strong association with mupirocin exposure, it is likely that mupirocin use contributes to the increased resistance. Routine mupirocin testing may be important for MRSA decolonization strategies or the treatment of minor skin infections in children.
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Affiliation(s)
- Nina K. Antonov
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Maria C. Garzon
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Kimberly D. Morel
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Susan Whittier
- Department of Clinical Microbiology, Columbia University Medical Center, New York, New York, USA
| | - Paul J. Planet
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
- Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, New York, USA
| | - Christine T. Lauren
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
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Huang SS, Septimus E, Avery TR, Lee GM, Hickok J, Weinstein RA, Moody J, Hayden MK, Perlin JB, Platt R, Ray GT. Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. Infect Control Hosp Epidemiol 2014; 35 Suppl 3:S23-31. [PMID: 25222894 PMCID: PMC10920056 DOI: 10.1086/677819] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients). DESIGN Cost analysis using decision modeling. METHODS We developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature. RESULTS In the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions. CONCLUSIONS A strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization.
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Affiliation(s)
- Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Orange, California
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Hernández-Porto M, Castro B, Ramos MJ, Arias A, Aguirre-Jaime A, Lecuona M. Risk factors for development of methicillin-resistant Staphylococcus aureus-positive clinical culture in nasal carriers after decolonization treatment. Am J Infect Control 2014; 42:e75-9. [PMID: 24855930 DOI: 10.1016/j.ajic.2014.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/08/2014] [Accepted: 03/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Active surveillance systems are effective in reducing health care-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Nonetheless, some patients develop MRSA infection despite control measures. We tried to identify risk factors related to the appearance of MRSA at sites other than the nasal fossa in patients who were nasal carriers of MRSA. METHODS A retrospective case-control study was conducted in an active surveillance program for MRSA between January 2009 and December 2010 at a Spanish teaching hospital. Cases were patients with MRSA in the anterior nares and a length of stay of at least 5 days who developed MRSA-positive clinical culture after decolonization treatment had started. Controls were patients with the same characteristics as the case group, except that they did not develop MRSA-positive clinical culture as verified by negative clinical cultures. RESULTS After intrinsic and extrinsic risk factors were analyzed, the emergence of mupirocin-resistant MRSA clones after decolonization treatment, and residence in a nursing home were marginally significant in the univariate analysis. The detection of the emergence of mupirocin-resistant MRSA clones was independently associated with the detection of MRSA in other clinical locations. CONCLUSIONS In an active surveillance program for MRSA it is important to determine the mupirocin susceptibility of the isolates to determine appropriate treatment and to verify negativity after decolonizing treatment has been completed.
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Affiliation(s)
- Miriam Hernández-Porto
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain.
| | - Beatriz Castro
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
| | - Maria Jose Ramos
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
| | - Angeles Arias
- Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Canary Islands, Spain
| | - Armando Aguirre-Jaime
- Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria Carretera del Rosario, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Maria Lecuona
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
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Hetem D, Bonten M. Clinical relevance of mupirocin resistance in Staphylococcus aureus. J Hosp Infect 2013; 85:249-56. [DOI: 10.1016/j.jhin.2013.09.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/01/2013] [Indexed: 10/26/2022]
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Draft Genome Sequence of Strain SA_ST125_MupR of Methicillin-Resistant Staphylococcus aureus ST125, a Major Clone in Spain. GENOME ANNOUNCEMENTS 2013; 1:1/4/e00588-13. [PMID: 23929481 PMCID: PMC3738897 DOI: 10.1128/genomea.00588-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Here, we report the draft genome sequence of a methicillin-resistant Staphylococcus aureus (MRSA) strain with high-level mupirocin resistance (SA_ST125_MupR), isolated from a patient with recurrent bacteremia. This strain belonged to sequence type ST125, which was responsible for more than 50% of the health care-associated infections caused by MRSA in Spain.
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48
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The Yin and Yang of pre-operative screening for meticillin resistant and sensitive Staphylococcus aureus (MRSA and MSSA): Does the extra effort and cost of suppression reduce surgical site infections? ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.wndm.2013.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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49
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Padilla Ortega B. [Methicillin-resistant Staphylococus aureus and health-care workers]. Enferm Infecc Microbiol Clin 2013; 31:497-9. [PMID: 23732045 DOI: 10.1016/j.eimc.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 04/11/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Belén Padilla Ortega
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, España.
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