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Microbiological Monitoring in the System of Epidemiological Surveillance of Purulent-Septic Infections in a Multidisciplinary Hospital. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.5.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of the research was to study epidemiological manifestations and etiological structure of sepsis in a multidisciplinary hospital for children.Materials and methods. An analysis of cases of 85 patients with a diagnosis of sepsis hospitalized in a multidisciplinary hospital at the regional level (Irkutsk) for the period 2013–2018 was carried out.Results and discussion. The most affected age groups are children under one year old (23.5 %) and from one year to two years (29.4 %). During the study period, 572 bacterial and fungal cultures, represented by 19 types of microorganisms, playing a leading role in the formation of the microbial ecology of the hospital, were isolated from patients with GPSI. In the structure of the GPSI microflora, gram-negative microorganisms are found in 49.8 % of cases, grampositive microbiota – in 30.1 %, fungi account for one fifth of all positive findings. A. baumannii and P. aeruginosa were sown more often from blood, sputum and abdominal cavity, and S. aureus and A. baumannii were the most frequent pathogens from wounds. The largest number of enterococci is isolated from urine.Conclusions. The etiological factor in the development of nosocomial GPSI in most cases is gram-negative microorganisms – A. baumanii (39.9 %), P. aeruginosa (20.7 %), K. pneumoniae (23.1 %). At the same time, in recent years, fungi have become increasingly important in the etiology of septic conditions.
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Pereira-Franchi EPL, Barreira MRN, da Costa NDSLM, Riboli DFM, Abraão LM, Martins KB, Victória C, Cunha MDLRDSD. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in the Brazilian primary health care system. Trop Med Int Health 2019; 24:339-347. [PMID: 30549385 DOI: 10.1111/tmi.13192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the molecular epidemiology and to georeference Staphylococcus aureus isolated from wounds and nares of patients seen at Basic Health Units (BHUs) of a Brazilian city. METHODS Observational, cross-sectional study conducted from 2010 to 2013. A total of 119 S. aureus strains isolated from the wounds and nares of 88 patients were studied. The isolates were characterised by identifying virulence genes encoding enterotoxins A-E, haemolysins α, β and δ, exfoliatins A, B and D, biofilm production, Panton-Valentine Leukocidin and toxic shock syndrome toxin 1, and by pulsed-field gel electrophoresis (PFGE), multilocus sequence and spa typing. RESULTS Eighteen methicillin-resistant Staphylococcus aureus (MRSA) (6 SCCmec type II and 12 SCCmec type IV) and 101 (85%) MSSA were identified. PFGE typing resulted in the formation of eight clusters, with STs 1, 5, 8, 30, 188, 1176 and 1635 and spa type t002 being the predominant types among MSSA. The 18 MRSA belonged to STs 5, 8 and 1176 and spa types t002 and t062. CONCLUSION The results demonstrate widespread dissemination of MSSA and MRSA clones carrying haemolysin, biofilm and toxin genes. Kernel density estimation revealed the highest density of S. aureus in the 4, 5 and 8 BHUs.
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Affiliation(s)
- Eliane Patricia Lino Pereira-Franchi
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Maria Rachel Nogueira Barreira
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Natália de Sousa Lima Moreira da Costa
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Danilo Flávio Moraes Riboli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Ligia Maria Abraão
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil.,Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Katheryne Benini Martins
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Cassiano Victória
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinaria e Zootecnia, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
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Sousa M, Silva N, Manageiro V, Ramos S, Coelho A, Gonçalves D, Caniça M, Torres C, Igrejas G, Poeta P. First report on MRSA CC398 recovered from wild boars in the north of Portugal. Are we facing a problem? THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 596-597:26-31. [PMID: 28412568 DOI: 10.1016/j.scitotenv.2017.04.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 05/25/2023]
Abstract
The aim of the present study was to evaluate the resistance of Staphylococcus aureus recovered from wild boars, to analyze their genetic lineages, and to investigate the susceptibility to oxacillin. Samples from mouth and nose of 45 wild boars (Sus scrofa) were collected during hunt activity from November 2012 to January 2013 in the North of Portugal. S. aureus isolates were recovered from 30 of these samples (33%); one isolate/sample was further studied. The susceptibility of the isolates was tested by disk-diffusion test against 14 antimicrobial agents and minimal inhibitory concentration was used to test oxacillin according to EUCAST guidelines. The genetic lineages of S. aureus were characterized by agr-typing, spa-typing and MLST. From the 30 isolates, 18 S. aureus were susceptible to all antibiotics tested and 7 presented resistance to one or more of the following antibiotics: penicillin (n=3), oxacillin (n=4), cefoxitin (n=1), clindamycin (n=2), gentamicin (n=1), fusidic acid (n=1), ciprofloxacin (n=2), tetracycline (n=1) and linezolid (n=1). One MRSA CC398 (spa-type t899) isolate was detected (oxacillin MIC=32mg/L and mecA-positive), which presented resistance to penicillin, tetracycline, and ciprofloxacin and contained the genes of immune evasion cluster (IEC) system (type B). The 29 methicillin-susceptible isolates were typed as ST1 (t1533), ST133 (t3583), ST1643 (t10712), ST2328 (t3750) and the new STs (3220, 3222, 3223, 3224) associated to new spa-types t14311 and t14312. The agr-types I, II, III and IV were identified. It is a matter of concern when MRSA and some specific lineages of S. aureus are taken as commensal habitants of the skin and nose of wild animals and are characterized with resistance to various antimicrobial agents in clinical use.
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Affiliation(s)
- Margarida Sousa
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Veterinary and Animal Science Research Center (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; Functional Genomics and Proteomics Unit, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections (NRL-AR/HAI), National Institute of Health Doutor Ricardo Jorge (NIH), Lisboa, Portugal; Faculty of Science and Technology, Department of Food and Agriculture, University of La Rioja (UR), Logroño, Spain
| | - Nuno Silva
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, Scotland, UK
| | - Vera Manageiro
- National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections (NRL-AR/HAI), National Institute of Health Doutor Ricardo Jorge (NIH), Lisboa, Portugal; Centre for the Study of Animal Sciences (CECA/ICETA), University of Oporto, Oporto, Portugal
| | - Sónia Ramos
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Veterinary and Animal Science Research Center (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - António Coelho
- Forest Association of Trás-os-Montes and Alto Douro (AFTM), Vila Real, Portugal
| | - David Gonçalves
- Research Centre in Biodiversity and Genetic Resources of the University of Porto (CIBIO), Vairão, Portugal
| | - Manuela Caniça
- National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections (NRL-AR/HAI), National Institute of Health Doutor Ricardo Jorge (NIH), Lisboa, Portugal; Centre for the Study of Animal Sciences (CECA/ICETA), University of Oporto, Oporto, Portugal
| | - Carmen Torres
- Faculty of Science and Technology, Department of Food and Agriculture, University of La Rioja (UR), Logroño, Spain
| | - Gilberto Igrejas
- Functional Genomics and Proteomics Unit, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; Department of Genetics and Biotechnology, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; UCIBIO-REQUIMTE, Chemistry Department, Faculty of Science and Technology, University NOVA of Lisbon, Lisbon, Caparica, Portugal; Biology Department, Sciences Faculty, University of Porto (UP), Portugal
| | - Patrícia Poeta
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; UCIBIO-REQUIMTE, Chemistry Department, Faculty of Science and Technology, University NOVA of Lisbon, Lisbon, Caparica, Portugal; Biology Department, Sciences Faculty, University of Porto (UP), Portugal.
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Rajendra Santosh AB, Ogle OE, Williams D, Woodbine EF. Epidemiology of Oral and Maxillofacial Infections. Dent Clin North Am 2017; 61:217-233. [PMID: 28317563 DOI: 10.1016/j.cden.2016.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Dental caries and periodontal disease are the most common dental infections and are constantly increasing worldwide. Distribution, occurrence of dental caries, gingivitis, periodontitis, odontogenic infections, antibiotic resistance, oral mucosal infections, and microbe-related oral cancer are important to understand the public impact and methods of controlling such disease. Distribution of human papilloma virus and human immunodeficiency virus -related oral cancers in the US population is presented.
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Affiliation(s)
- Arvind Babu Rajendra Santosh
- Dentistry Programme, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston 7, Jamaica, West Indies.
| | - Orrett E Ogle
- Atlanta, GA, USA; Dentistry Program, The University of the West Indies, Mona, Jamaica, West Indies; Oral and Maxillofacial Surgery, Woodhull Hospital, Brooklyn, NY, USA
| | - Dwight Williams
- Oral and Maxillofacial Surgery, Woodhull Hospital, Brooklyn, NY, USA
| | - Edward F Woodbine
- Department of Dentistry/Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA
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Genotyping of Methicillin Resistant Staphylococcus aureus Strains Isolated from Hospitalized Children. Int J Pediatr 2014; 2014:314316. [PMID: 25404947 PMCID: PMC4227395 DOI: 10.1155/2014/314316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
Community associated methicillin resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen increasingly reported to cause skin and soft tissue infections for children. The emergence of highly virulencet CA-MRSA strains in the immunodeficiency of young children seemed to be the basic explanation of the increased incidence of CA-MRSA infections among this population. The subjects of this study were 8 patients hospitalized in the Pediatric Department at the University Hospital of Monastir. The patients were young children (aged from 12 days to 18 months) who were suffering from MRSA skin infections; two of them had the infections within 72 h of their admission. The isolates were classified as community isolates as they all carried the staphylococcal cassette chromosome mec (SCCmec) IV and pvl genes. Epidemiological techniques, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), were applied to investigate CA-MRSA strains. Analysis of molecular data revealed that MRSA strains were related according to PFGE patterns and they belonged to a single clone ST80. Antimicrobial susceptibility tests showed that all strains were resistant to kanamycin and 2 strains were resistant to erythromycin.
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Sousa M, Silva N, Igrejas G, Silva F, Sargo R, Alegria N, Benito D, Gómez P, Lozano C, Gómez-Sanz E, Torres C, Caniça M, Poeta P. Antimicrobial resistance determinants in Staphylococcus spp. recovered from birds of prey in Portugal. Vet Microbiol 2014; 171:436-40. [PMID: 24679961 DOI: 10.1016/j.vetmic.2014.02.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 01/09/2023]
Abstract
Antibiotic resistance among wild animals represent an emerging public health concern. The objective of this study was to analyze the staphylococcal nasal microbiota in birds of prey and their content in antimicrobial resistance determinants. Nasal samples from 16 birds of prey were collected, swabs were dipped and incubated into BHI broth [6.5% NaCl] and later seeded on manitol salt agar and oxacillin-resistance screening agar base media. Staphylococcal colonies were isolated from both media and were identified by biochemical and molecular methods. Susceptibility testing to 18 antimicrobial agents was performed by disk-diffusion method. Six of the 16 tested animals carried staphylococci (37.5%) and 7 isolates of the following species were recovered: Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Staphylococcus sciuri rodentium, Staphylococcus cohnii urealitycum, and Staphylococcus gallinarum. The S. aureus isolate was penicillin-resistant (with blaZ gene) but methicillin-susceptible and was ascribed to spa-type t012, sequence-type ST30 and agr-type III. The S. epidermidis isolate carried blaZ, mecA, mrs(A/B), mphC, tet(K), drfA, and fusC genes, ica operon, and was typed as ST35. The genes ant6'-Ia, tet(K), tet(L), dfrG, cat221, cat194, and cat223 were detected in S. saprophyticus or S. gallinarum isolates. Birds of prey seem to be a natural reservoir of S. aureus and coagulase-negative staphylococci resistant to multiple antibiotics. Due to the convergence between habitats, the contact between wildlife, other animals and humans is now more common and this involves an increased possibility of interchange of these microorganisms in the different ecosystems.
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Affiliation(s)
- Margarida Sousa
- Department of Animal and Veterinary Sciences (CECAV), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Institute for Biotechnology and Bioengineering, Center for Genomics and Biotechnology (IBB-CGB), UTAD, Portugal; Department of Food and Agriculture (FCEAI), University of La Rioja, Logroño, Spain; National Institute of Health Dr. Ricardo Jorge (INSA), Lisboa, Portugal
| | - Nuno Silva
- Department of Animal and Veterinary Sciences (CECAV), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - Gilberto Igrejas
- Institute for Biotechnology and Bioengineering, Center for Genomics and Biotechnology (IBB-CGB), UTAD, Portugal
| | - Filipe Silva
- Wild birds' Recovering Center (CRAS), UTAD, Vila Real, Portugal
| | - Roberto Sargo
- Wild birds' Recovering Center (CRAS), UTAD, Vila Real, Portugal
| | - Nuno Alegria
- Department of Animal and Veterinary Sciences (CECAV), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - Daniel Benito
- Department of Food and Agriculture (FCEAI), University of La Rioja, Logroño, Spain
| | - Paula Gómez
- Department of Food and Agriculture (FCEAI), University of La Rioja, Logroño, Spain
| | - Carmen Lozano
- Department of Food and Agriculture (FCEAI), University of La Rioja, Logroño, Spain
| | - Elena Gómez-Sanz
- Department of Food and Agriculture (FCEAI), University of La Rioja, Logroño, Spain
| | - Carmen Torres
- Department of Food and Agriculture (FCEAI), University of La Rioja, Logroño, Spain
| | - Manuela Caniça
- National Institute of Health Dr. Ricardo Jorge (INSA), Lisboa, Portugal
| | - Patrícia Poeta
- Department of Animal and Veterinary Sciences (CECAV), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal.
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Abstract
The approach to common skin and soft tissue infections (SSTIs) was previously well understood. However, the recent emergence of community-associated methicillin resistant Staphyloccocus aureus as a common pathogen has changed the epidemiology of these infections and has led clinicians to alter their practice and treatment of SSTI. This article discusses the present epidemiology of SSTI and community-acquired methicillin-resistant Staphylococcus aureus, evidence-based approach to incision and drainage, the utility of adjuvant antibiotic therapy after abscess drainage, and current antimicrobial approach to cellulitis and nondrained SSTIs. Methods to reduce transmission and recurrence of SSTI through decolonization strategies are also discussed.
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Affiliation(s)
- Rakesh D Mistry
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box B251, Aurora, CO 80045, USA.
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Abstract
Pediatric cervical lymphadenopathy is a challenging medical condition for the patient, family, and physician. There are a wide variety of causes for cervical lymphadenopathy and an understanding of these causes is paramount in determining the most appropriate workup and management. A thorough history and physical examination are important in narrowing the differential diagnosis. Diagnostic studies and imaging studies play an important role as well. This article reviews the common causes of lymphadenopathy, and presents a methodical approach to a patient with cervical lymphadenopathy.
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Methicillin-resistant Staphylococcus aureus colonization is not associated with higher rate of admission to pediatric intensive care unit. Am J Emerg Med 2013; 31:727-9. [DOI: 10.1016/j.ajem.2012.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 11/30/2022] Open
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Methicillin-Resistant Staphylococcus aureus Infections in Human Immunodeficiency Virus-Infected Children and Adolescents. AIDS Res Treat 2012; 2012:627974. [PMID: 23008761 PMCID: PMC3447349 DOI: 10.1155/2012/627974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/05/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Methicillin-resistant Staphylococcus aureus (MRSA) infection incidence has increased in healthy US children. Our objective was to evaluate MRSA incidence and correlates in HIV-infected youth. Methods. The CDC-sponsored LEGACY study is a US multicenter chart abstraction study of HIV-infected youth. We identified MRSA infections among participants with ≥1 visit during 2006. We used bivariate and multivariable analyses to compare sociodemographic and HIV clinical factors between MRSA cases and noncases. Results. Fourteen MRSA infections (1 invasive, 12 soft tissue, 1 indeterminate) occurred among 1,813 subjects (11.1 infections/1,000 patient-years (PY), 95% CI: 11.06–11.14). Most (86%) isolates were clindamycin susceptible. Compared with noncases, MRSA cases were more likely older (17 versus 14 years), black (100% versus 69%), behaviorally HIV infected (43% versus 17%), and in Maryland (43% versus 7%) and had viral loads (VL) >1000 copies/mL (86% versus 51%) and lower mean CD4% (18% versus 27%) (all P < 0.05). In multivariate analysis, independent risk factors were Maryland care site (adjusted odds ratio (aOR) = 9.0), VL >1000 copies/mL (aOR = 5.9), and black race (aOR undefined). Conclusions. MRSA occurred at a rate of 11.1 infections/1,000 PY in HIV-infected youth but invasive disease was uncommon. Geographic location, black race, and increased VL, but not immunosuppression, were independently associated with MRSA risk.
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Sola C, Paganini H, Egea AL, Moyano AJ, Garnero A, Kevric I, Culasso C, Vindel A, Lopardo H, Bocco JL. Spread of epidemic MRSA-ST5-IV clone encoding PVL as a major cause of community onset staphylococcal infections in Argentinean children. PLoS One 2012; 7:e30487. [PMID: 22291965 PMCID: PMC3264586 DOI: 10.1371/journal.pone.0030487] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 12/19/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community-associated methicillin-resistant Staphylococcus aureus-(CA-MRSA) strains have emerged in Argentina. We investigated the clinical and molecular evolution of community-onset MRSA infections (CO-MRSA) in children of Córdoba, Argentina, 2005-2008. Additionally, data from 2007 were compared with the epidemiology of these infections in other regions of the country. METHODOLOGY/PRINCIPAL FINDINGS Two datasets were used: i) lab-based prospective surveillance of CA-MRSA isolates from 3 Córdoba pediatric hospitals-(CBAH1-H3) in 2007-2008 (compared to previously published data of 2005) and ii) a sampling of CO-MRSA from a study involving both, healthcare-associated community-onset-(HACO) infections in children with risk-factors for healthcare-associated infections-(HRFs), and CA-MRSA infections in patients without HRFs detected in multiple centers of Argentina in 2007. Molecular typing was performed on the CA-MRSA-(n: 99) isolates from the CBAH1-H3-dataset and on the HACO-MRSA-(n: 51) and CA-MRSA-(n: 213) isolates from other regions. Between 2005-2008, the annual proportion of CA-MRSA/CA-S. aureus in Córdoba hospitals increased from 25% to 49%, P<0.01. Total CA-MRSA infections increased 3.6 fold-(5.1 to 18.6 cases/100,000 annual-visits, P<0.0001), associated with an important increase of invasive CA-MRSA infections-(8.5 fold). In all regions analyzed, a single genotype prevailed in both CA-MRSA (82%) and HACO-MRSA(57%), which showed pulsed-field-gel electrophoresis-(PFGE)-type-"I", sequence-type-5-(ST5), SCCmec-type-IVa, spa-t311, and was positive for PVL. The second clone, pulsotype-N/ST30/CC30/SCCmecIVc/t019/PVL(+), accounted for 11.5% of total CA-MRSA infections. Importantly, the first 4 isolates of Argentina belonging to South American-USA300 clone-(USA300/ST8/CC8/SCCmecIVc/t008/PVL(+)/ACME(-)) were detected. We also demonstrated that a HA-MRSA clone-(pulsotype-C/ST100/CC5) caused 2% and 10% of CA-MRSA and HACO-MRSA infections respectively and was associated with a SCCmec type closely related to SCCmecIV(2B&5). CONCLUSIONS/SIGNIFICANCE The dissemination of epidemic MRSA clone, ST5-IV-PVL(+) was the main cause of increasing staphylococcal community-onset infections in Argentinean children (2003-2008), conversely to other countries. The predominance of this clone, which has capacity to express the h-VISA phenotype, in healthcare-associated community-onset cases suggests that it has infiltrated into hospital-settings.
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Affiliation(s)
- Claudia Sola
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Hugo Paganini
- Hospital de Pediatría “Prof. Dr.Juan P. Garrahan”, Autonomous city of Buenos Aires (ACBA), Argentina
| | - Ana L. Egea
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Alejandro J. Moyano
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Analia Garnero
- Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Argentina
| | - Ines Kevric
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Catalina Culasso
- Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Argentina
| | - Ana Vindel
- Laboratorio de Infecciones Nosocomiales, Instituto de Salud Carlos III, Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | | | - Horacio Lopardo
- Hospital de Pediatría “Prof. Dr.Juan P. Garrahan”, Autonomous city of Buenos Aires (ACBA), Argentina
| | - José L. Bocco
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- * E-mail:
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Alvarellos CP, Carames LC, Castro SP, Garcia PA, Pi On JT, Fernandez MA. Usefulness of the restriction-modification test plus staphylococcal cassette chromosome mec types and Panton-Valentine leukocidin encoding phages to identify Staphylococcus aureus methicillin-resistant clones. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2011; 43:943-946. [PMID: 21696251 DOI: 10.3109/00365548.2011.589078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We studied the usefulness of the restriction-modification (RM) test, staphylococcal cassette chromosome (SCC) mec types, and Panton-Valentine leukocidin (PVL)-encoding phages to identify Staphylococcus aureus methicillin-resistant lineages and to differentiate clones that belong to the same lineage. A total of 108 methicillin-resistant S. aureus (MRSA) strains were characterized by pulsed-field gel electrophoresis (PFGE)--multi-locus sequence typing (MLST)--spa-typing. The RM correctly identified the lineages CC5, CC8, CC30, and CC398, but not CC25 and CC72. The SCCmec and RM combined analysis allowed differentiation between MLST types within the same lineage. Only 5 MRSA strains were PVL-positive. Four PVL-positive USA300 isolates carried elongated-head type PVL-encoding phages, while the sequence type (ST)-30 strain carried an icosahedral-head phage. The combination of the RM test method, SCCmec types, and PVL phage identification could be useful for MRSA typing purposes.
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Aneja RK, Varughese-Aneja R, Vetterly CG, Carcillo JA. Antibiotic therapy in neonatal and pediatric septic shock. Curr Infect Dis Rep 2011; 13:433-41. [PMID: 21732046 DOI: 10.1007/s11908-011-0197-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Severe sepsis accounts for nearly 4,500 deaths (mortality rate 10%), and is responsible for nearly $2 billion annual healthcare expenditure in the United States. Early and speedy treatment of critically ill septic patients can halt or reduce the likelihood of physiologic progression to multi-system organ failure. A cornerstone of this therapeutic strategy is antibiotic administration. In this review, we discuss the empirical treatment strategies for the treatment of early and late neonatal sepsis, along with pediatric sepsis. Furthermore, we discuss the rationale that underlies the adoption of such treatment strategies. The present article also discusses the emergence of multi-drug organisms as the causative agents for sepsis, i.e. methicillin-resistant Staphylococcus aureus (MRSA), resistant enterococci and Klebsiella pneumoniae carbapenemases (KPC).
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Affiliation(s)
- Rajesh K Aneja
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, 15224, USA,
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Milstone AM, Goldner BW, Ross T, Shepard JW, Carroll KC, Perl TM. Methicillin-resistant Staphylococcus aureus colonization and risk of subsequent infection in critically ill children: importance of preventing nosocomial methicillin-resistant Staphylococcus aureus transmission. Clin Infect Dis 2011; 53:853-9. [PMID: 21878424 DOI: 10.1093/cid/cir547] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) colonization is a predictor of subsequent infection in hospitalized adults. The risk of subsequent MRSA infections in hospitalized children colonized with MRSA is unknown. METHODS Children admitted to an academic medical center's pediatric intensive care unit between March 2007 and March 2010 were included in the study. Anterior naris swabs were cultured to identify children with MRSA colonization at admission. Laboratory databases were queried and National Healthcare Safety Network definitions applied to identify patients with MRSA infections during their hospitalization or after discharge. RESULTS The MRSA admission prevalence among 3140 children was 4.9%. Overall, 56 children (1.8%) developed an MRSA infection, including 13 (8.5%) colonized on admission and 43 (1.4%) not colonized on admission (relative risk [RR], 5.9; 95% confidence interval [CI], 3.4-10.1). Of those, 10 children (0.3%) developed an MRSA infection during their hospitalization, including 3 of 153 children (1.9%) colonized on admission and 7 of 2987 children (0.2%) not colonized on admission (RR, 8.4; 95% CI, 2.7-25.8). African-Americans and those with public health insurance were more likely to get a subsequent infection (P < .01 and P = .03, respectively). We found that 15 children acquired MRSA colonization in the pediatric intensive care unit, and 7 (47%) developed a subsequent MRSA infection. CONCLUSIONS MRSA colonization is a risk factor for subsequent MRSA infection in children. Although MRSA colonized children may have lower risks of subsequent infection than adults, children who acquire MRSA in the hospital have similarly high rates of infection. Preventing transmission of MRSA in hospitalized children should remain a priority.
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Affiliation(s)
- Aaron M Milstone
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Lari AR, Pourmand MR, Ohadian Moghadam S, Abdossamadi Z, Namvar AE, Asghari B. Prevalence of PVL-Containing MRSA Isolates Among Hospital Staff Nasal Carriers. Lab Med 2011. [DOI: 10.1309/lman7hr6vjea3nmr] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Emergency department treatment failures for skin infections in the era of community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Emerg Care 2011; 27:21-6. [PMID: 21178810 DOI: 10.1097/pec.0b013e318203ca1c] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite rapidly increasing incidence of skin and soft tissue infections (SSTIs) presenting to emergency departments (EDs), outcome data for these infections are limited. METHODS This is a retrospective cohort study of children with culture-positive SSTI, managed as outpatients from a large pediatric ED in the year 2006. The primary outcome was treatment failure, defined as presence of 1 or more of the following: (1) change in antibiotic owing to poor clinical response, (2) subsequent incision and drainage, or (3) hospitalization. Demographics, isolated pathogens, and therapeutics were also assessed. To accurately capture the outcome of interest, only children who are observed in the hospital-based primary care network were included. RESULTS Among 148 eligible subjects, there were 158 SSTIs including 131 abscesses, 19 folliculitis, and 8 cellulitis. Mean age was 9.1 ± 6.2 years, 41.2% were male, and 94.6% were African American. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated in 66%, methicillin-sensitive S. aureus (MSSA) in 21%, and others in 13%. Outcome data were available for 144 subjects (97.2%). Emergency department treatment failure rate was 7.6% (95% confidence interval, 3.3%-12.0%); 10 of 11 failures were abscesses. Only S. aureus produced treatment failure and occurred in 13.3% of MSSA and 6.4% MRSA infections (odds ratio, 1.9; 95% CI, 0.5-7.1). An antibiotic to which the organism was sensitive was prescribed for 9 (81.8%) of 11 treatment failures and did not differ between MRSA and MSSA; appropriate antibiotics were used in 91.5% of treatment successes. CONCLUSIONS The rate of ED treatment failure for SSTI is low and is more likely to occur with S. aureus infection, irrespective of methicillin resistance or appropriate antibiotic therapy.
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Barnes BE, Sampson DA. A literature review on community-acquired methicillin-resistant Staphylococcus aureus in the United States: Clinical information for primary care nurse practitioners. ACTA ACUST UNITED AC 2010; 23:23-32. [DOI: 10.1111/j.1745-7599.2010.00571.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Wolf J, Daley AJ, Tilse MH, Nimmo GR, Bell S, Howell AJ, Keil AD, Lawrence A, Curtis N. Antibiotic susceptibility patterns of Staphylococcus aureus isolates from Australian children. J Paediatr Child Health 2010; 46:404-11. [PMID: 20546101 DOI: 10.1111/j.1440-1754.2010.01751.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Staphylococcus aureus is an important cause of serious illness in children. Antibiotic resistance is an international problem and affects initial antibiotic choice. We aimed to describe susceptibility patterns of S. aureus isolates from Australian children to inform optimal empiric treatment of staphylococcal infections in this population. METHODS We analysed susceptibility data for all S. aureus isolates from children at Australian tertiary paediatric hospitals in 2006. Susceptibility rates were compared between hospitals and states, and with published studies of S. aureus isolates from Australian adults. RESULTS Overall, the proportion of methicillin-resistant S. aureus (MRSA) in Australian children was low (9.8%), and in each state it was less than for the comparable adult population. There were significant differences in susceptibility patterns between different states. Most MRSA isolates were susceptible to clindamycin (73%) and all isolates were reported as susceptible to vancomycin. Susceptibility patterns for isolates from bacteraemic patients were similar to those for isolates from all patients. CONCLUSIONS These data support current Australian recommendations for the use of flucloxacillin or a first-generation cephalosporin as initial treatment of non-life-threatening staphylococcal infections. However, broad spectrum antibiotic therapy including agents that are effective against MRSA should be considered for more serious infections. Appropriate specimens should be collected for susceptibility testing to enable directed treatment for MRSA and other resistant organisms. This study highlights the importance of using local, age-specific data in planning antibiotic treatment guidelines, as results vary substantially from city to city and between adults and children.
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Affiliation(s)
- Joshua Wolf
- Infectious Diseases Unit, Department of General Medicine, University of Melbourne, Victoria, Australia.
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David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010; 23:616-87. [PMID: 20610826 PMCID: PMC2901661 DOI: 10.1128/cmr.00081-09] [Citation(s) in RCA: 1351] [Impact Index Per Article: 96.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.
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Affiliation(s)
- Michael Z David
- Department of Pediatrics and Department of Medicine, the University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637, USA.
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Long CB, Madan RP, Herold BC. Diagnosis and management of community-associated MRSA infections in children. Expert Rev Anti Infect Ther 2010; 8:183-95. [PMID: 20109048 DOI: 10.1586/eri.09.127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The history of antibiotic resistance in Staphylococcus aureus spans more than half a century. Methicillin-resistant S. aureus (MRSA) has emerged as an almost ubiquitous pathogen in both the community and hospital settings. The predominant clone responsible for community-associated MRSA, USA300, is a highly successful pathogen, as demonstrated by its rapid global spread and associated morbidity and mortality. The management of MRSA infections in pediatric patients is complicated by the limited number of effective antibiotics that have been well-studied in children. The gold standard antimicrobial, vancomycin, has several shortcomings that have prompted the development of newer agents for the treatment of MRSA disease. Moreover, the emergence of vancomycin-intermediate or -resistant S. aureus, while uncommon, portends a potential new era of resistance that will require research and development of the next generation of antibiotics that act by novel mechanisms.
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Affiliation(s)
- Caroline B Long
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Forchheimer 702D, Bronx, NY 10471, USA.
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Milstone AM, Carroll KC, Ross T, Shangraw KA, Perl TM. Community-associated methicillin-resistant Staphylococcus aureus strains in pediatric intensive care unit. Emerg Infect Dis 2010; 16:647-55. [PMID: 20350379 PMCID: PMC3321932 DOI: 10.3201/eid1604.090107] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Virulent community-associated methicillin-resistant Staphylococcus-aureus (CA-MRSA) strains have spread rapidly in the United States. To characterize the degree to which CA-MRSA strains are imported into and transmitted in pediatric intensive care units (PICU), we performed a retrospective study of children admitted to The Johns Hopkins Hospital PICU, March 1, 2007-May 31, 2008. We found that 72 (6%) of 1,674 PICU patients were colonized with MRSA. MRSA-colonized patients were more likely to be younger (median age 3 years vs. 5 years; p = 0.02) and African American (p<0.001) and to have been hospitalized within 12 months (p<0.001) than were noncolonized patients. MRSA isolates from 66 (92%) colonized patients were fingerprinted; 40 (61%) were genotypically CA-MRSA strains. CA-MRSA strains were isolated from 50% of patients who became colonized with MRSA and caused the only hospital-acquired MRSA catheter-associated bloodstream infection in the cohort. Epidemic CA-MRSA strains are becoming endemic to PICUs, can be transmitted to hospitalized children, and can cause invasive hospital-acquired infections. Further appraisal of MRSA control is needed.
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Affiliation(s)
- Aaron M Milstone
- Department of Pediatric Infectious Diseases, The Johns Hopkins University School of Medicine, 200 N Wolfe St, Rubenstein 3141, Baltimore, MD 21287, USA.
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Han LZ, Ho PL, Ni YX, Zhang H, Jiang YQ, Chu HQ, Sun Y, Zhang YB. Panton-Valentine leukocidin-positive MRSA, Shanghai. Emerg Infect Dis 2010; 16:731-3. [PMID: 20350407 PMCID: PMC3321931 DOI: 10.3201/eid1604.081324] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ortega-Loayza AG, Diamantis SA, Gilligan P, Morrell DS. Characterization of Staphylococcus aureus cutaneous infections in a pediatric dermatology tertiary health care outpatient facility. J Am Acad Dermatol 2010; 62:804-11. [DOI: 10.1016/j.jaad.2009.07.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 07/07/2009] [Accepted: 07/13/2009] [Indexed: 01/13/2023]
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Claudius I, Baraff LJ. Pediatric Emergencies Associated with Fever. Emerg Med Clin North Am 2010; 28:67-84, vii-viii. [DOI: 10.1016/j.emc.2009.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mistry RD, Weisz K, Scott HF, Alpern ER. Emergency management of pediatric skin and soft tissue infections in the community-associated methicillin-resistant Staphylococcus aureus era. Acad Emerg Med 2010; 17:187-93. [PMID: 20370748 DOI: 10.1111/j.1553-2712.2009.00652.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Skin and soft tissue infections (SSTIs) are increasing in incidence, yet there is no consensus regarding management of these infections in the era of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). This study sought to describe current pediatric emergency physician (PEP) management of commonly presenting skin infections. METHODS This was a cross-sectional survey of subscribers to the American Academy of Pediatrics Section on Emergency Medicine (AAP SoEM) list-serv. Enrollment occurred via the list-serv over a 3-month period. Vignettes of equivocal SSTI, cellulitis, and skin abscess were presented to participants, and knowledge, diagnostic, and therapeutic approaches were assessed. RESULTS In total, 366 of 606 (60.3%) list-serv members responded. The mean (+/- standard deviation [SD]) duration of practice was 13.6 (+/-7.9) years, and 88.6% practiced in a pediatric emergency department. Most respondents (72.7%) preferred clinical diagnosis alone for equivocal SSTI, as opposed to invasive or imaging modalities. For outpatient cellulitis, PEPs selected clindamycin (30.6%), trimethoprim-sulfa (27.0%), and first-generation cephalosporins (22.7%); methicillin-sensitive S. aureus (MSSA) was routinely covered, but many regimens failed to cover CA-MRSA (32.5%) or group A streptococcus (27.0%). For skin abscesses, spontaneous discharge (67.5%) was rated the most important factor in electing to perform a drainage procedure; fever (19.9%) and patient age (13.1%) were the lowest. PEPs elected to prescribe trimethoprim-sulfamethoxazole (TMP-Sx; 50.0%) or clindamycin (32.7%) after drainage; only 5% selected CA-MRSA-inactive agents. All PEPs suspected CA-MRSA as the etiology of skin abscesses, and many attributed sepsis (22.1%) and invasive pneumonia (20.5%) to CA-MRSA, as opposed to MSSA. However, 23.9% remained unaware of local CA-MRSA prevalence for even common infections. CONCLUSIONS Practice variation exists among PEPs for management of SSTI. These results can be used to measure changes in SSTI practices as standardized approaches are delineated.
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Affiliation(s)
- Rakesh D Mistry
- Department of Pediatrics and the Division of Emergency Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Incidence of invasive community-onset Staphylococcus aureus infections in children in Central New York. J Pediatr 2010; 156:152-154.e1. [PMID: 20006767 DOI: 10.1016/j.jpeds.2009.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 06/11/2009] [Accepted: 07/08/2009] [Indexed: 11/21/2022]
Abstract
We determined the incidence of invasive community-onset Staphylococcus aureus infections, clinical characteristics, and antibiotic susceptibilities in 128 hospitalized children in central New York. The prevalence of invasive S aureus infections in our institution remained <1% between 1996 and 2006, although the proportion of methicillin-resistant S aureus infections significantly increased.
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Burke RE, Halpern MS, Baron EJ, Gutierrez K. Pediatric and neonatal Staphylococcus aureus bacteremia: epidemiology, risk factors, and outcome. Infect Control Hosp Epidemiol 2009; 30:636-44. [PMID: 19496643 DOI: 10.1086/597521] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the impact of methicillin-resistant Staphylococcus aureus on the prevalence of S. aureus bloodstream infection among children. METHODS Retrospective analysis of demographic data, risk factors for infection, and clinical outcomes for children (age, less than 18 years) with S. aureus bacteremia hospitalized at a children's hospital during 2001-2006. RESULTS We identified 164 episodes of S. aureus bacteremia among 151 children. The prevalence of bacteremia due to methicillin-susceptible S. aureus during 2001-2003 was approximately the same as that during 2004-2006 (29 and 30 cases, respectively, per 10,000 hospitalized children [hereafter, "per 10,000 hospitalizations"]), but the prevalence of bacteremia due to methicillin-resistant S. aureus increased from 4 to 11 cases, respectively, per 10,000 hospitalizations (P=.015). A total of 48% of infections involved children who had S. aureus-positive blood cultures less than 3 days after hospital admission. Seventy-four percent of these children had a preexisting comorbidity. When the prevalence of S. aureus bacteremia was stratified by race, sex, or age, neonates hospitalized at birth and Hispanic children had significantly reduced risks of infection. Children younger than 1 year of age (excluding neonates hospitalized at birth) had an increased prevalence of hospital-onset S. aureus bacteremia. There was a disproportionate increase in the risk of S. aureus bacteremia for each additional week of hospitalization among children with hospital-onset S. aureus bacteremia. Children with methicillin-resistant S. aureus bacteremia had a longer hospital stay, were transferred to another facility at a greater rate than they were discharged home, and had a greater mortality rate, compared with children with methicillin-susceptible S. aureus bacteremia. CONCLUSION This study documents the prevalence of S. aureus bacteremia among children with a high risk for acquiring this infection, and it describes populations of children who are at higher risk for bacteremia due to either methicillin-susceptible or methicillin-resistant S. aureus. Methods to improve prevention of S. aureus bacteremia are needed for children with healthcare-associated risk factors for S. aureus bacteremia.
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Affiliation(s)
- Robert E Burke
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Stevens-Johnson syndrome and toxic epidermal necrolysis: consequence of treatment of an emerging pathogen. Pediatr Emerg Care 2009; 25:519-22. [PMID: 19687711 DOI: 10.1097/pec.0b013e3181b0a49a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) secondary to trimethoprim-sulfamethoxazole (TMP-Sx) therapy for presumed community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Although the association between SJS/TEN and the sulfonamide class of antibiotics is well established, the increasing prevalence of CA-MRSA has left practitioners with limited regimens to effectively treat skin and soft tissue infections (SSTIs) in the outpatient setting. In the case of SSTIs, alternative treatment of these infections should be considered, especially when the bacterial pathogen is unknown. Future investigations evaluating the efficacy of adjunctive antibiotics for purulent SSTIs and monitoring the incidence of SJS/TEN in the era of CA-MRSA are necessary to reduce unnecessary use of sulfonamide drugs. The potential development of SJS/TEN, a severe life-threatening illness, emphasizes the need for judicious use of TMP-Sx and close monitoring and follow-up for patients who were given TMP-Sx for SSTIs.
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Pappas G, Athanasoulia AP, Matthaiou DK, Falagas ME. Trimethoprim-sulfamethoxazole for methicillin-resistant Staphylococcus aureus: a forgotten alternative? J Chemother 2009; 21:115-26. [PMID: 19423463 DOI: 10.1179/joc.2009.21.2.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a growing infectious concern, mainly in the context of its rapid adaptation to novel antibiotic options for its treatment and the growing morbidity, mortality, and healthcare costs associated with its emergence. the authors sought to investigate whether an older antibiotic, such as trimethoprim-sulfamethoxazole (SXT), may have a role in treating MRSA-related infections, according to the available literature on the subject. The authors reviewed literature data on: resistance of MRSA to SXT worldwide in recent years, efficacy of SXT for MRSA decolonization or prophylaxis from MRSA infections, and clinical therapeutic efficacy of SXT in treating mild or severe community-acquired or hospital-acquired MRSA infections. Resistance varies worldwide, in general being low in the industrialized world and higher in developing countries. SXT is one of the numerous understudied options for MRSA decolonization and is growingly recognized as potentially effective in preventing MRSA infections in certain settings. Limited data on its therapeutic efficacy are encouraging, at least for mild, community-acquired infections. SXT may represent a cost-effective alternative weapon against MRSA. Its utility against this increasingly threatening pathogen need clarification through further clinical trials.
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Affiliation(s)
- G Pappas
- Institute of Continuing Medical Education of Ioannina, Greece.
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Kairam N, Silverman ME, Salo DF, Baorto E, Lee B, Amato CS. Cutaneous methicillin-resistant Staphylococcus aureus in a suburban community hospital pediatric emergency department. J Emerg Med 2009; 41:460-5. [PMID: 19592187 DOI: 10.1016/j.jemermed.2009.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 03/10/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies on methicillin-resistant Staphylococcus aureus (MRSA) infections have typically focused on pediatric and adult populations at urban tertiary care hospitals. Limited data exist on MRSA rates in skin and soft tissue infections (SSTI) in suburban community hospital pediatric emergency departments (PED). OBJECTIVES To describe the prevalence of MRSA in SSTIs in a contemporary suburban community hospital PED population. METHODS Patients 0-21 years old with SSTI wound cultures who were seen at our PED from 2003-2007 were studied. Data analyzed included type of infection (abscess vs. non-abscess), site of infection, and culture results. Chi-squared and t-tests were used as appropriate; p < 0.05 was considered significant. RESULTS During the study period, 204 cultures were obtained for SSTIs, 11 of which were contaminants. The subjects had a mean age of 12.9 years (SD 6.8 years); 60% were male. The prevalence of MRSA was 27%; MRSA was present in 30% of abscesses vs. 2.2% of non-abscess SSTI (p < 0.005). By year, the prevalence of MRSA was 10% in 2003, 31% in 2004, 33% in 2005, 31% in 2006, and 29% in 2007. No differences between MRSA and non-MRSA infections were present for gender, age, or site of infection. CONCLUSIONS At our suburban community hospital pediatric ED, MRSA was present in 30% of all SSTI wound cultures; MRSA was unlikely with non-abscess SSTI. Our overall MRSA prevalence data among SSTIs are consistent with previously published reports in pediatric ED populations but may be less than those reported in the adult literature.
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Affiliation(s)
- Neeraja Kairam
- Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey 07960, USA
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Elliott DJ, Zaoutis TE, Troxel AB, Loh A, Keren R. Empiric antimicrobial therapy for pediatric skin and soft-tissue infections in the era of methicillin-resistant Staphylococcus aureus. Pediatrics 2009; 123:e959-66. [PMID: 19470525 DOI: 10.1542/peds.2008-2428] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to compare the clinical effectiveness of monotherapy with beta-lactams, clindamycin, or trimethoprim-sulfamethoxazole in the outpatient management of nondrained noncultured skin and soft-tissue infections (SSTIs), in a methicillin-resistant Staphylococcus aureus (MRSA)-endemic region. METHODS A retrospective, nested, case-control trial was conducted with a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region. All subjects were treated as outpatients with oral monotherapy for nondrained noncultured SSTIs between January 2004 and March 2007. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, change in antibiotic, or second antibiotic prescription within 28 days. RESULTS Of 2096 children with nondrained noncultured SSTIs, 104 (5.0%) were identified as experiencing treatment failure and were matched to 480 control subjects. Compared with beta-lactam therapy, clindamycin was equally effective but trimethoprim-sulfamethoxazole was associated with an increased risk of failure. Other factors independently associated with failure included initial treatment in the emergency department, presence or history of fever, and presence of either induration or a small abscess. CONCLUSIONS Compared with beta-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with nondrained noncultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, beta-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections.
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Affiliation(s)
- Daniel J Elliott
- Christiana Care Health System, Christiana Hospital, Room 4B01, 4755 Ogletown-Stanton Rd, Newark, DE 19718, USA.
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Delgado S, Arroyo R, Jiménez E, Marín ML, del Campo R, Fernández L, Rodríguez JM. Staphylococcus epidermidis strains isolated from breast milk of women suffering infectious mastitis: potential virulence traits and resistance to antibiotics. BMC Microbiol 2009; 9:82. [PMID: 19422689 PMCID: PMC2685400 DOI: 10.1186/1471-2180-9-82] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 05/07/2009] [Indexed: 11/17/2022] Open
Abstract
Background Although Staphylococcus aureus is considered the main etiological agent of infectious mastitis, recent studies have suggested that coagulase-negative staphylococci (CNS) may also play an important role in such infections. The aims of this work were to isolate staphylococci from milk of women with lactational mastitis, to select and characterize the CNS isolates, and to compare such properties with those displayed by CNS strains isolated from milk of healthy women. Results The milk of 30 women was collected and bacterial growth was noted in 27 of them, of which Staphylococcus epidermidis was isolated from 26 patients and S. aureus from 8. Among the 270 staphylococcal isolates recovered from milk of women with mastitis, 200 were identified as Staphylococcus epidermidis by phenotypic assays, species-specific PCR and PCR sequencing. They were typified by pulsed field gel electrophoresis (PFGE) genotyping. The PFGE profiles of the S. epidermidis strains were compared with those of 105 isolates from milk of healthy women. A representative of the 76 different PFGE profiles was selected to study the incidence of virulence factors and antibiotic resistance. The number of strains that contained the biofilm-related icaD gene and that showed resistance to oxacillin, erythromycin, clindamycin and mupirocin was significantly higher among the strains isolated from mastitic milk. Conclusion S. epidermidis may be a frequent but largely underrated cause of infectious mastitis in lactating women. The resistance to diverse antibiotics and a higher ability to form biofilms found among the strains isolated from milk of women suffering mastitis may explain the chronic and/or recurrent nature of this infectious condition.
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Affiliation(s)
- Susana Delgado
- Dpt. Nutrición, Bromatología y Tecnología de Alimentos, Universidad Complutense de Madrid, 28040 Madrid, Spain.
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Matouskova I, Janout V. Current knowledge of methicillin-resistant Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 152:191-202. [PMID: 19219207 DOI: 10.5507/bp.2008.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bacterial strains that are oxacillin and methicillin-resistant, historically termed methicillin-resistant Staphylococcus aureus (MRSA) are resistant to all beta-lactam agents, including cephalosporins and carbapenems. MRSA are pathogenic and have a number of virulence factors that enable them to result in disease. They are transmissible and important causes of nosocomial infections worldwide. An MRSA outbreak can occur when one strain is transmitted to other patients or through close contacts of infected persons in the community. Hospital-associated MRSA (HA-MRSA) isolates are also frequent causes of healthcare-associated bloodstream and catheter-related infections. Community-associated MRSA (CA-MRSA) isolates are often only resistant to beta-lactam agents and erythromycin but they are an emerging cause of community-associated infections, especially skin and soft tissue infections (SSTI) and necrotizing pneumonia. METHODS Current possibilities for detecting MRSA strains in the laboratory are reviewed and discussed in the context of the recent literature. RESULTS AND CONCLUSION The active surveillance and prevention of MRSA occurrence and spreading in hospitals are discussed in the context of recent literature.
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Affiliation(s)
- Ivanka Matouskova
- Department of Preventive Medicine, Faculty of Medicine and Dentistry, Palacky University, Hnevotinska 3, Olomouc, Czech Republic.
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Newland JG, Kearns GL. Treatment strategies for methicillin-resistant Staphylococcus aureus infections in pediatrics. Paediatr Drugs 2009; 10:367-78. [PMID: 18998747 DOI: 10.2165/0148581-200810060-00004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Staphylococcus aureus is an important pathogen that frequently causes clinical disease in children. A wide array of illnesses can be caused by this common pathogen ranging from non-invasive skin infections to severe, life-threatening sepsis. Additionally, as antibacterials have been used to eradicate S. aureus, it has developed resistance to these important therapeutic agents. Methicillin-resistant S. aureus (MRSA) has become an increasing problem in pediatric patients over the past decade. In this review, we discuss the epidemiology, pathogenesis, and treatment options available in treating MRSA infections in children. Specifically, we address the importance of abscess drainage in the treatment of skin and soft tissue infections, the most common clinical manifestation of MRSA infections, and highlight the various agents that are available for treating this common infection. In severe, life-threatening invasive MRSA infections the primary therapeutic option is vancomycin. In cases of MRSA toxic shock syndrome the addition of clindamycin is necessary. In other invasive MRSA infections, such as pneumonia and musculoskeletal infections, the empiric treatment of choice is clindamycin. Finally, newer agents and additional treatment options are discussed.
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Affiliation(s)
- Jason G Newland
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri, USA.
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Hersh AL, Weintrub PS, Cabana MD. Antibiotic selection for purulent skin and soft-tissue infections in ambulatory care: a decision-analytic approach. Acad Pediatr 2009; 9:179-84. [PMID: 19450778 PMCID: PMC4394390 DOI: 10.1016/j.acap.2009.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/03/2009] [Accepted: 02/05/2009] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has caused a nationwide epidemic of skin and soft-tissue infections in ambulatory pediatrics. Antibiotic treatment recommendations suggest incorporating local epidemiology for the prevalence of CA-MRSA. We sought to identify the antibiotic strategy with the highest probability of activity and to identify threshold values for epidemiologic variables including bacterial prevalence and antibiotic resistance. METHODS We used decision analysis to evaluate 3 empiric antibiotic strategies: clindamycin, trimethoprim/sulfamethoxazole (T/S), and cephalexin. We calculated the probability of activity against the bacteria causing the infection (CA-MRSA, methicillin-sensitive S. aureus and group A Streptococcus [GAS]) by incorporating estimates of prevalence and antibiotic resistance to determine the optimal strategy. Sensitivity analysis was used to identify thresholds for prevalence and antibiotic resistance where 2 strategies were equal. RESULTS Clindamycin (0.95) and T/S (0.89) had substantially higher probability of activity than cephalexin (0.28) using baseline estimates for bacterial prevalence and antibiotic resistance. Cephalexin was the optimal antibiotic only when CA-MRSA prevalence was <10%. The probability of activity for clindamycin and T/S was highly sensitive to changes in the values for bacterial prevalence (both CA-MRSA and GAS) and CA-MRSA resistance to clindamycin. CONCLUSIONS Empiric treatment of skin and soft-tissue infections with either clindamycin or T/S maximizes the probability that the antibiotic will be active when CA-MRSA prevalence is >10%. Deciding between T/S and clindamycin requires consideration of antibiotic resistance and prevalence of GAS. This model can be customized to local communities and illustrates the importance of ongoing epidemiologic surveillance in primary care settings.
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Affiliation(s)
- Adam L. Hersh
- Division of Pediatric Infectious Diseases, University of California, San Francisco,Division of General Pediatrics, University of California, San Francisco
| | - Peggy S. Weintrub
- Division of Pediatric Infectious Diseases, University of California, San Francisco
| | - Michael D. Cabana
- Division of General Pediatrics, University of California, San Francisco
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Ghanem G, Hachem RY, Chemaly RF, Dvorak T, Hulten K, Graviss L, Raad II. The role of molecular methods in the prevention of nosocomial methicillin-resistant Staphylococcus aureus clusters in cancer patients. Am J Infect Control 2008; 36:656-60. [PMID: 18834742 DOI: 10.1016/j.ajic.2008.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 02/29/2008] [Accepted: 03/01/2008] [Indexed: 11/25/2022]
Abstract
In 2002, an increased incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) in our institution triggered a conventional investigation that failed to identify a common source. Molecular typing of the 70 nosocomial MRSA isolates obtained identified a predominant health care-associated clone A in the first trimester. Aggressive infection control measures led to a significant decrease in the number of isolates per 10,000 hospital days between the first trimester and the last 2 trimesters of 2003 (6.4 vs 3.8; P = .04). This was attributed to a decrease in clone A: SCCmec II, USA100, PVL gene-negative (2.3 per 10.000 patient-days vs 0.1 per 10,000 patient-days; P = .004). However, in 2003, 23% of the nosocomial isolates were SCCmec IV, USA300, PVL gene-positive. At that time, molecular methods allowed the detection and prevention of a nosocomial MRSA outbreak caused by a health care-associated clone; however, the community strains (SCCmec IV) have become a frequent cause of nosocomial infection in our institution.
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Kollef M, Napolitano L, Solomkin J, Wunderink R, Bae I, Fowler V, Balk R, Stevens D, Rahal J, Shorr A, Linden P, Micek S. Health Care–Associated Infection (HAI): A Critical Appraisal of the Emerging Threat—Proceedings of the HAI Summit. Clin Infect Dis 2008; 47 Suppl 2:S55-99; quiz S100-1. [DOI: 10.1086/590937] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Sdougkos G, Chini V, Papanastasiou DA, Christodoulou G, Stamatakis E, Vris A, Christodoulidi I, Protopapadakis G, Spiliopoulou I. Community-associated Staphylococcus aureus infections and nasal carriage among children: molecular microbial data and clinical characteristics. Clin Microbiol Infect 2008; 14:995-1001. [PMID: 18808423 DOI: 10.1111/j.1469-0691.2008.02064.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An increasing number of infections caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carrying the Panton-Valentine leukocidin (PVL) genes was recently identified in Greece. In the present study, 170 patients with S. aureus infections and 123 uninfected children (<15 years old) who had been tested for nasal carriage were evaluated during a 2-year period. The MecA, PVL and superantigen family genes, and MRSA clones, were investigated by molecular methods. Sites of infection and laboratory findings for patients were recorded. The results were compared and statistically analysed. Among 123 uninfected children 73 (59%) carried S. aureus, including four MRSA strains. Of these, three MRSA and three methicillin-sensitive S. aureus (MSSA) strains were PVL-positive (p <0.0001). Ninety-six patients (96/170) exhibited skin and soft-tissue infections (SSTIs), and 74 exhibited invasive infections. The incidence of staphylococcal infections increased during July to September each year. In total, 110 S. aureus isolates were PVL-positive (81 from SSTIs and 29 from invasive infections, p <0.0001). Ninety-nine out of 106 MRSA (93%) isolates from 170 patients carried the PVL genes (p <0.0001); 97 belonged to the clonal complex CC80. Leukocyte and polymorphonuclear cell counts were higher among children with MRSA infections (p <0.005). MSSA predominated among patients with invasive infections (43/74), and carried mainly genes of the superantigen family. Children <5 years of age showed a higher risk of MRSA infection. The present study demonstrates that infections due to PVL-positive CA-MRSA spread easily among children, and SSTIs can lead to invasive infections. Nasal colonization may be an additional factor contributing to the emergence of CA-MRSA.
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Affiliation(s)
- G Sdougkos
- Department of Orthopaedics, Karamandaneion Children's Hospital, Patras, Greece
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39
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Suh L, Coffin S, Leckerman KH, Gelfand JM, Honig PJ, Yan AC. Methicillin-resistant Staphylococcus aureus colonization in children with atopic dermatitis. Pediatr Dermatol 2008; 25:528-34. [PMID: 18950393 DOI: 10.1111/j.1525-1470.2008.00768.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children with atopic dermatitis are more frequently colonized with Staphylococcus aureus than children without atopic dermatitis. However, little epidemiological data exist regarding the prevalence of methicillin-resistant S. aureus among children with atopic dermatitis. Recent studies have revealed an increasing prevalence of community-associated methicillin-resistant S. aureus among patients presenting to hospitals with serious bacterial infections, particularly those with cutaneous and soft tissue infections. As many atopic dermatitis patients are treated empirically with antibiotics for secondary skin infections, an understanding of the epidemiology of bacterial colonization and superinfection is essential for directing proper treatment in the atopic patient population. This study investigates the prevalence of risk factors for community-associated, methicillin-resistant S. aureus colonization among pediatric atopic dermatitis patients encountered at an academic pediatric dermatology clinic. An observational cross-sectional study was conducted at the Children's Hospital of Philadelphia in which 54 patients previously diagnosed with atopic dermatitis were enrolled. A detailed patient questionnaire, a complete cutaneous examination, and an evaluation of eczema severity according to the Eczema Area and Severity Index were completed at the time of enrollment. Bacterial cultures from the skin and nares were obtained to determine the frequency of colonization with either methicillin-sensitive S. aureus or methicillin-resistant S. aureus. Although most atopic dermatitis patients studied were colonized with S. aureus (43/54 [80%]), methicillin-resistant S. aureus was isolated from only seven atopic dermatitis patients (7/43 [16%]). Patients colonized with S. aureus were more likely to be male, to have been previously hospitalized, to have used a topical calcineurin inhibitor in combination with a topical steroid, and less likely to have used topical antibiotics. Bivariable analysis, however, revealed that only previous hospitalization was independently associated with an increased risk of methicillin-resistant S. aureus colonization. We observed that 80% of atopic dermatitis patients were colonized with S. aureus, and that of these patients, 16% of colonized patients were colonized with a methicillin-resistant strain. Methicillin-resistant S. aureus colonization was found to be significantly associated with previous hospitalization. Evidence also indicates that topical calcineurin inhibitors used in conjunction with topical steroids is associated with increased S. aureus colonization, while topical antibiotic use appears to decrease S. aureus colonization.
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Affiliation(s)
- Liza Suh
- Department of Pediatrics, University of California-San Francisco, San Francisco, California, USA
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Laurens MB, Becker RM, Johnson JK, Wolf JS, Kotloff KL. MRSA with progression from otitis media and sphenoid sinusitis to clival osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent 10-year-old patient. Int J Pediatr Otorhinolaryngol 2008; 72:945-51. [PMID: 18472169 DOI: 10.1016/j.ijporl.2008.02.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 02/25/2008] [Accepted: 02/28/2008] [Indexed: 11/19/2022]
Abstract
A previously healthy 10-year-old patient with headache, otalgia, and hearing loss was diagnosed with pachymeningitis and methicillin-resistant Staphylococcus aureus otitis media and bacteremia. Despite antimicrobial therapy, intracranial extension progressed, including clival osteomyelitis, sphenoid sinusitis, cavernous sinus inflammation and cranial nerve palsies, until the sphenoid sinus was drained. This case exemplifies an aggressive MRSA intracranial infection that advanced despite antibiotic therapy.
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Affiliation(s)
- Matthew B Laurens
- Department of Pediatrics, Division of Infectious Disease and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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So TY, Farrington E. Community-acquired methicillin-resistant Staphylococcus aureus infection in the pediatric population. J Pediatr Health Care 2008; 22:211-7; quiz 218-20. [PMID: 18590865 DOI: 10.1016/j.pedhc.2008.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 04/24/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Tsz-Yin So
- University of North Carolina Hospitals, Chapel Hill, NC 27514, USA.
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42
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Niniou I, Vourli S, Lebessi E, Foustoukou M, Vatopoulos A, Pasparakis DG, Kafetzis DA, Tsolia MN. Clinical and molecular epidemiology of community-acquired, methicillin-resistant Staphylococcus aureus infections in children in central Greece. Eur J Clin Microbiol Infect Dis 2008; 27:831-7. [DOI: 10.1007/s10096-008-0513-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 03/25/2008] [Indexed: 11/30/2022]
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Al-Rawahi GN, Reynolds S, Porter SD, Forrester L, Kishi L, Chong T, Bowie WR, Doyle PW. Community-associated CMRSA-10 (USA-300) is the predominant strain among methicillin-resistant Staphylococcus aureus strains causing skin and soft tissue infections in patients presenting to the emergency department of a Canadian tertiary care hospital. J Emerg Med 2008; 38:6-11. [PMID: 18325716 DOI: 10.1016/j.jemermed.2007.09.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 06/01/2007] [Accepted: 09/28/2007] [Indexed: 11/25/2022]
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen first described among individuals with no contact with health care facilities. The purpose of this study was to determine the proportion of CA-MRSA, defined by pulsed field gel electrophoresis (PFGE), in MRSA skin and soft tissue infections presenting to the Emergency Department (ED). We also aimed to describe the laboratory and clinical characteristics of CA-MRSA infections. From June 1, 2001 to May 30, 2005, MRSA isolates from skin and soft tissue infections presenting to the ED were reviewed. They were characterized by antibiotic susceptibilities and PFGE, and the presence of staphylococcal cassette chromosome (SCC) mec type IVa and Panton-Valentine leukocidin (PVL) genes was assessed on representative isolates. The medical records were reviewed to define risk factors. There were 95 isolates available for analysis, of which 58 (61%) were CMRSA-10 (USA-300), the predominant clone from 2003 onward. All representative isolates (24%) tested in this group had PVL genes and SCCmec type IVa. Their antibiogram showed 100% susceptibility to trimethoprim-sulfamethoxazole, rifampin, and fusidic acid, and 79% to clindamycin. Clinical comparison of CMRSA-10 vs. hospital PFGE type strains showed 22% vs. 60%, respectively, for recent antibiotic use (p < 0.0001), 26% vs. 6%, respectively, for intravenous drug use (p < 0.05), and 57% vs. 6%, respectively, for soft tissue abscess (p < 0.001). CMRSA-10 is a major pathogen in skin and soft tissue abscesses in our ED. It has a characteristic susceptibility, and was associated with intravenous drug use, but not with recent antibiotic usage.
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Affiliation(s)
- Ghada N Al-Rawahi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia
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44
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Stone A, Saiman L. Update on the epidemiology and management of Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus, in patients with cystic fibrosis. Curr Opin Pulm Med 2007; 13:515-21. [PMID: 17901758 DOI: 10.1097/mcp.0b013e3282efbbac] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Staphylococcus aureus is one of the first and most common pathogens to be isolated from the respiratory tract of patients with cystic fibrosis. The prevalence of respiratory tract colonization/infection with both methicillin-susceptible and methicillin-resistant S. aureus has increased over the past decade. The clinical significance of colonization/infection with these pathogens is variable, leading to numerous therapeutic strategies: primary prophylaxis, eradication, treatment of cystic fiboris pulmonary exacerbations, and treatment of methicillin-resistant S. aureus. RECENT FINDINGS Studies have demonstrated increased prevalence of S. aureus in clinical laboratories that use selective media. Additionally, small colony variant S. aureus has been associated with persistent infection, co-infection with Pseudomonas aeruginosa, and frequent courses of antibiotics, but this phenotype may be difficult to identify in clinical laboratories. Increased prevalence of methicillin-resistant S. aureus has led to use of oral and inhaled antibiotics in attempts to eradicate this pathogen; these studies have yielded variable results. SUMMARY The epidemiology of S. aureus in cystic fibrosis has changed. Studies are needed to assess the clinical significance of the increased prevalence of both methicillin-susceptible and methicillin-resistant S. aureus, and whether primary prophylaxis or new treatment/eradication protocols are effective.
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Affiliation(s)
- Anne Stone
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital, New York, New York 10032, USA.
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45
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Malik ZA, Litman N. Perinephric abscess caused by community-acquired methicillin resistant Staphylococcus aureus. Pediatr Infect Dis J 2007; 26:764. [PMID: 17848900 DOI: 10.1097/inf.0b013e3180986ea5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Fergie J, Purcell K. The epidemic of methicillin-resistant Staphylococcus aureus colonization and infection in children: effects on the community, health systems, and physician practices. Pediatr Ann 2007; 36:404-12. [PMID: 17691624 DOI: 10.3928/0090-4481-20070701-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jaime Fergie
- Driscoll Children's Hospital, Corpus Christi, TX 78411, USA.
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47
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Hubiche T, Duchemin D, Lehours P, Boralevi F, Taïeb A, Léauté-Labrèze C. Profil de résistance de Staphylococcus aureus dans les infections cutanées de l’enfant. Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)89306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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Heininger U, Datta F, Gervaix A, Schaad UB, Berger C, Vaudaux B, Aebi C, Hitzler M, Kind C, Gnehm HE, Frei R. Prevalence of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) in children a multicenter cross-sectional study. Pediatr Infect Dis J 2007; 26:544-6. [PMID: 17529877 DOI: 10.1097/inf.0b013e31804d244a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this cross-sectional multicenter study, we determined the rate of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) in children admitted to 9 training hospitals in Switzerland during 1 month. From 1337 patients, 1363 nasal swabs were obtained (mean age 6.1 years, median 4.7 years, interquartile range 1.3-10.4 years) and 562 (41.3%) grew S. aureus. Only one isolate was MRSA (0.18%) which encoded mecA and femA genes as well as SCCmec type IV, whereas Panton-Valentine leukocidin (PVL) was absent.
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Paintsil E. Pediatric community-acquired methicillin-resistant Staphylococcus aureus infection and colonization: trends and management. Curr Opin Pediatr 2007; 19:75-82. [PMID: 17224666 DOI: 10.1097/mop.0b013e32801261c9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The scourge of community-acquired methicillin-resistant Staphylococcus aureus in pediatrics continues unabated. This review provides information on changes in epidemiology, therapeutic considerations, and measures to control the epidemic. RECENT FINDINGS The epidemiology and clinical manifestations of methicillin-resistant S. aureus have undergone important changes that pose challenges in recognition, diagnosis, and treatment for the pediatrician. Community-acquired methicillin-resistant S. aureus used to be predominantly associated with localized disease among previously healthy children; however, there are recent reports of more invasive and severe diseases with some fatalities. The antibiotic susceptibility pattern is also changing with some community-acquired methicillin-resistant S. aureus having resistance patterns indistinguishable from that of hospital-acquired methicillin-resistant S. aureus. Thus the choice of antibiotics is becoming even more challenging in pediatrics, with an already-limited armamentarium of antibiotics. The management of common skin diseases such as furunculosis and boils now requires close collaboration between the general pediatrician and the infectious diseases specialist. SUMMARY As the burden of community-acquired methicillin-resistant S. aureus disease continues to increase, pediatricians must have a high index of suspicion and must institute appropriate antimicrobial therapy based on community or regional antibiotic susceptibility of community-acquired methicillin-resistant S. aureus. There is an urgent need for effective infection control programs, including active surveillance components, to help curb the epidemic.
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Affiliation(s)
- Elijah Paintsil
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
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50
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Drew RH. Emerging Options for Treatment of Invasive, Multidrug-ResistantStaphylococcus aureusInfections. Pharmacotherapy 2007; 27:227-49. [PMID: 17253914 DOI: 10.1592/phco.27.2.227] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Limited established treatment options exist for the treatment of serious, invasive infections caused by multidrug-resistant Staphylococcus aureus, most notably nosocomially acquired methicillin-resistant S. aureus (MRSA). Although vancomycin represents the gold standard for therapy of such invasive infections, reports of increasing in vitro resistance to vancomycin, combined with reports of clinical failures (with this and other antistaphylococcal agents), underscore the need for alternative therapies. Older agents with favorable in vitro activity available in both oral and intravenous dose forms include trimethoprim-sulfamethoxazole and clindamycin. Limited clinical data exist to support their routine use as initial therapy in the treatment of invasive disease. However, these and other options (e.g., tetracyclines) are being reexplored in the setting of increasing concern over MRSA acquired in the community setting. Newer treatment options for MRSA include linezolid, quinupristin-dalfopristin, daptomycin, and tigecycline. With the exception of linezolid, these newer agents require intravenous administration. Combination therapy may be considered in select invasive diseases refractory to standard monotherapies. These diseases include infections such as endocarditis, meningitis, and prosthetic device infections. Additional alternatives to vancomycin are under clinical investigation. Those in later stages of development include oritavancin, dalbavancin, telavancin, and ceftobiprole.
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Affiliation(s)
- Richard H Drew
- Duke University School of Medicine, Durham, North Carolina, USA.
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