Nosocomial transmission of community-acquired methicillin-resistant Staphylococcus aureus in a well-infant nursery of a teaching hospital

Staphylococcal Scalded Skin Syndrome in Neonates: Case Series and Overview of Outbreaks

Skin and soft tissue infections caused by Staphylococcus aureus (S. aureus) cover a wide spectrum of diseases in neonates, including staphylococcal scalded skin syndrome (SSSS). We describe a representative case of SSSS in neonatal twins, which despite recurrence showed a mild clinical disease course. This case was part of a small outbreak on a neonatal intensive care unit and therefore exemplifies the existence of neonatal outbreaks with skin and soft tissue infections by S. aureus. Diagnosis is generally based on the clinical picture and response to antibiotics, but can be aided by histology and cultures. Sequence-based molecular techniques are available to evaluate typing and virulence of S. aureus in outbreak or surveillance settings. The pillars of treatment are antibiotics and supportive care. Methicillin resistance remains a topic of concern, especially in outbreak settings. Our overview of numerous outbreaks of neonatal S. aureus skin infections underlines the importance of outbreak management strategies, including screening to identify the source of the outbreak, and limiting exposure through hygienic measures and establishment of physical boundaries.

Rare Vesiculopustular Eruptions of the Neonatal Period

Numerous disorders present with vesiculopustular eruptions in the neonatal period, ranging from benign to life-threatening. Accurate and prompt diagnosis is imperative to avoid unnecessary testing and treatment for benign eruptions, while allowing for adequate treatment of potentially fatal disorders. In this review, we highlight several rare blistering diseases of the newborn. A diagnostic approach is outlined to provide clinicians with a framework for approaching a neonate with vesicles, pustules, or ulcers.

Dominance of community-associated methicillin-resistant Staphylococcus aureus clones in a maternity hospital

Background

Methicillin- resistant Staphylococcus aureus (MRSA) is a major pathogen causing healthcare- and community- acquired infections. The purpose of this study was to characterize MRSA isolated at the Maternity Hospital between 2006 and 2011 for their genetic relatedness.

Materials and methods

The MRSA isolates were investigated using a combination of antibiogram, Staphylococcal chromosome cassette mec (SCCmec) and spa typing to determine their relatedness to MRSA isolated in other Kuwait hospitals. The isolates were also investigated for the carriage of genes for Pantone valentine Leukocidin (PVL).

Results

A total of 103 MRSA obtained from 64 neonates, 17 adult patients and 12 healthcare workers. The isolates were resistant to Kanamycin (46.6%), gentamicin (40.8%), trimethoprim (32%), ciprofloxacin (22.3%), fusidic acid (16.5%), tetracycline (19.4%), erythromycin (15.5%), clindamycin (15.5%), streptomycin (11.6%) high-level mupirocin (2.9%) and chloramphenicol (0.9%). Twenty (19.4%) of the isolates were multiresistant. Thirty-one (30.0%) isolates were positive for PVL. Molecular typing revealed the presence of 11 clonal complexes and 23 clones with ST5-V-t002, (N = 22), ST22-IV-t223 (N = 18), ST22-IV-t852 (N = 10), ST80-IV-t044 (N = 7), ST5-V-t688 (N = 5), ST772-V-t657 (N = 5) and ST239-III-t860 (N = 4) constituting 66.9% of the isolates. Other clones were isolated sporadically. The number of MRSA isolates increased from two in 2006 to 22 in 2011 with a peak of 43 in 2008.

Conclusion

The study revealed a high prevalence of community-associated MRSA Maternity hospital. The MRSA population consisted of known strains, such as ST239-III-t680, ST22-IV-t223/t852 and ST80-IV-t044, that were reported previously in Kuwait and novel strains such as ST5-V-t002, and several sporadic strains obtained for the first time in the Maternity hospital. This study has provided an initial data which will serve as a platform for future comparative studies on the distribution of MRSA clones in the Maternity hospital in Kuwait.

Methicillin-Resistant Staphylococcus Aureus in Saudi Arabia: Genotypes Distribution Review

Methicillin-resistant Staphylococcus Aureus (MRSA) infections in hospital have obviously imposed a significant burden of morbidity and mortality, and strain on healthcare resources. Here, we review the genotype distribution of these pathogens in the Kingdom of Saudi Arabia (KSA). A PubMed literature search (until May 2014) specified 12 articles that characterized MRSA clones in KSA. Only two regions (Riyadh and Damamm) were represented in ten articles. Data from these articles showed that the pandemic Vienna/Hungarian/Brazilian clone (CC8/ST239-III) is the most frequent in Saudi regions (Riyadh and Damamm). Several other clones such as Barnim/UK-EMRSA-15 (CC22-IV), Southwest Pacific clone (ST30-IV) and European community-associated-MRSA clone (CC80-IV) have been detected in the Riyadh region. A variety of MRSA clones is beginning to circulate in Saudi hospitals. Continued collection and molecular characterization of MRSA is crucial for the effective prevention and treatment.

Community-genotype strains of methicillin-resistant Staphylococcus aureus with high-level mupirocin resistance in a neonatal intensive care unit

AIM

The aim of this study was to investigate the genotypes of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MR-MRSA) isolates in our neonatal intensive care unit (NICU) and their potential source.

STUDY DESIGN

One hundred one MRSA isolates obtained from 59 inborn and 42 outborn infants were identified and their antimicrobial susceptibility determined. Using pulse-field gel electrophoresis (PFGE) analysis, MR-MRSA isolates obtained from the neonatal patients in the NICU were compared with those from adult hospitalized in the same hospital and with community-associated MRSA (CA-MRSA) isolates recovered from different hospitals in Korea.

RESULTS

Overall, 47% of CA-MRSA and 79% of healthcare-associated MRSA isolates exhibited high-level mupirocin resistance (HLMR). Forty-five percent of the outborn infants were considered to have CA-MRSA at the time of admission to our NICU. Most HLMR-MRSA isolates from neonates were grouped into a single cluster by PFGE analysis, and which included CA-MRSA isolates with HLMR recovered from outborn infants who were already colonized when they were transferred to our NICU. They belonged to the same PFGE group as the community-genotype strains isolated from different hospitals in Korea. HLMR-MRSA isolates from adults patients were classified as different clones. None of the attending staff in the NICU were nasal carriers.

CONCLUSION

Community-genotype strains of MRSA with HLMR may be imported to our NICU through obstetrics clinics and contribute to MRSA colonization or infection in facilities with a high rate of admission of outborn infants.

Infectious diseases in the Arabian Peninsula and Egypt

Infectious diseases are important causes of morbidity and mortality globally. Epidemiologically, differences in the patterns of infectious diseases and antimicrobial resistance exist across diverse geographical regions. In this review on infectious diseases in the Arabian Peninsula and Egypt, the epidemiology of tuberculosis, malaria and human immunodeficiency virus (HIV) infections will be addressed. The challenges of the hepatitis C epidemic in Egypt and the epidemiology of this infection across the region will be reviewed. In recent years, we have seen dengue endemicity become established, with major outbreaks in parts of the region. Emerging data also indicate that, across the region, there is an increasing burden of antibiotic resistance, with endemicity in healthcare settings and dissemination into the community. New challenges include the emergence of the Alkhurma haemorrhagic fever virus in Saudi Arabia. The annual Hajj pilgrimage in Saudi Arabia serves as a model for the control of infectious disease in mass gatherings. As most of these countries constantly experience a uniquely dynamic population influx in the form of expatriate workers, tourists, or pilgrims, concerted regional and international collaboration to address these public health concerns in a region that lies at the crossroads for the global spread of infectious pathogens is imperative.