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Crepin DM, Chavignon M, Verhoeven PO, Laurent F, Josse J, Butin M. Staphylococcus capitis: insights into epidemiology, virulence, and antimicrobial resistance of a clinically relevant bacterial species. Clin Microbiol Rev 2024:e0011823. [PMID: 38899876 DOI: 10.1128/cmr.00118-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
SUMMARYStaphylococcus capitis is divided into two subspecies, S. capitis subsp. ureolyticus (renamed urealyticus in 1992; ATCC 49326) and S. capitis subsp. capitis (ATCC 27840), and fits with the archetype of clinically relevant coagulase-negative staphylococci (CoNS). S. capitis is a commensal bacterium of the skin in humans, which must be considered an opportunistic pathogen of interest particularly as soon as it is identified in a clinically relevant specimen from an immunocompromised patient. Several studies have highlighted the potential determinants underlying S. capitis pathogenicity, resistance profiles, and virulence factors. In addition, mobile genetic element acquisitions and mutations contribute to S. capitis genome adaptation to its environment. Over the past decades, antibiotic resistance has been identified for S. capitis in almost all the families of the currently available antibiotics and is related to the emergence of multidrug-resistant clones of high clinical significance. The present review summarizes the current knowledge concerning the taxonomic position of S. capitis among staphylococci, the involvement of this species in human colonization and diseases, the virulence factors supporting its pathogenicity, and the phenotypic and genomic antimicrobial resistance profiles of this species.
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Affiliation(s)
- Deborah M Crepin
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Marie Chavignon
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Paul O Verhoeven
- CIRI, Centre International de Recherche en Infectiologie, GIMAP Team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Faculté de Médecine, Université Jean Monnet, St-Etienne, France
- Service des agents infectieux et d'hygiène, Centre Hospitalier Universitaire de St-Etienne, St-Etienne, France
| | - Frédéric Laurent
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Josse
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Marine Butin
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
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Romero LC, Silva LP, Teixeira NB, de Camargo KV, Del Masso Pereira MA, Corrente JE, Pereira VC, Ribeiro de Souza da Cunha MDL. Staphylococcus capitis Bloodstream Isolates: Investigation of Clonal Relationship, Resistance Profile, Virulence and Biofilm Formation. Antibiotics (Basel) 2024; 13:147. [PMID: 38391533 PMCID: PMC10885910 DOI: 10.3390/antibiotics13020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Staphylococcus capitis has been recognized as a relevant opportunistic pathogen, particularly its persistence in neonatal ICUs around the world. Therefore, the aim of this study was to describe the epidemiological profile of clinical isolates of S. capitis and to characterize the factors involved in the persistence and pathogenesis of these strains isolated from blood cultures collected in a hospital in the interior of the state of São Paulo, Brazil. A total of 141 S. capitis strains were submitted to detection of the mecA gene and SCCmec typing by multiplex PCR. Genes involved in biofilm production and genes encoding enterotoxins and hemolysins were detected by conventional PCR. Biofilm formation was evaluated by the polystyrene plate adherence test and phenotypic resistance was investigated by the disk diffusion method. Finally, pulsed-field gel electrophoresis (PFGE) was used to analyze the clonal relationship between isolates. The mecA gene was detected in 99 (70.2%) isolates, with this percentage reaching 100% in the neonatal ICU. SCCmec type III was the most prevalent type, detected in 31 (31.3%) isolates and co-occurrence of SCCmec was also observed. In vitro biofilm formation was detected in 46 (32.6%) isolates but was not correlated with the presence of the ica operon genes. Furthermore, biofilm production in ICU isolates was favored by hyperosmotic conditions, which are common in ICUs because of the frequent parenteral nutrition. Analysis of the clonal relationship between the isolates investigated in the present study confirms a homogeneous profile of S. capitis and the persistence of clones that are prevalent in the neonatal ICU and disseminated across the hospital. This study highlights the adaptation of isolates to specific hospital environments and their high clonality.
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Affiliation(s)
- Letícia Calixto Romero
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil
| | - Lucas Porangaba Silva
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil
| | - Nathalia Bibiana Teixeira
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil
| | - Karen Vilegas de Camargo
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil
| | | | - José Eduardo Corrente
- Department of Biostatistics, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-900, Brazil
| | - Valéria Cataneli Pereira
- Microbiology Laboratory, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 18618-970, Brazil
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Szekat C, Josten M, Rickmeyer J, Crüsemann M, Bierbaum G. A Staphylococcus capitis strain with unusual bacteriocin production. Microb Biotechnol 2023; 16:2181-2193. [PMID: 37850940 PMCID: PMC10616647 DOI: 10.1111/1751-7915.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
Staphylococcus capitis is a member of the human and mammal skin microbiomes and is considered less harmful than Staphylococcus aureus. S. capitis subsp. urealyticus BN2 was isolated from a cat and expressed strong antibacterial activity against a range of Gram-positive species, most notably including S. aureus strains with resistance to methicillin (MRSA) and strains with intermediate resistance to vancomycin (VISA). These latter strains are normally relatively resistant to bacteriocins, due to cell wall and cell membrane modifications. Genomic sequencing showed that the strain harboured at least two complete gene clusters for biosynthesis of antagonistic substances. The complete biosynthetic gene cluster of the well-known lantibiotic gallidermin was encoded on a large plasmid and the mature peptide was present in isopropanol cell extracts. In addition, a chromosomal island contained a novel non-ribosomal peptide synthetase (NRPS) gene cluster. Accidental deletion of two NRPS modules and partial purification of the anti-VISA activity showed that this novel bacteriocin represents a complex of differently decorated, non-ribosomal peptides. Additionally, a number of phenol-soluble modulins (PSMs) was detected by mass spectrometry of whole cells. Producing these compounds, the strain was able to outcompete several S. aureus strains, including MRSA and VISA, in tube cultures.
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Affiliation(s)
- Christiane Szekat
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
| | - Michaele Josten
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
| | - Jasmin Rickmeyer
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
| | - Max Crüsemann
- Institute of Pharmaceutical BiologyUniversity of BonnBonnGermany
| | - Gabriele Bierbaum
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
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4
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Felgate H, Sethi D, Faust K, Kiy C, Härtel C, Rupp J, Clifford R, Dean R, Tremlett C, Wain J, Langridge G, Clarke P, Page AJ, Webber MA. Characterisation of neonatal Staphylococcus capitis NRCS-A isolates compared with non NRCS-A Staphylococcus capitis from neonates and adults. Microb Genom 2023; 9:001106. [PMID: 37791541 PMCID: PMC10634448 DOI: 10.1099/mgen.0.001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Staphylococcus capitis is a frequent cause of late-onset sepsis in neonates admitted to Neonatal Intensive Care Units (NICU). One clone of S. capitis, NRCS-A has been isolated from NICUs globally although the reasons for the global success of this clone are not well understood.We analysed a collection of S. capitis colonising babies admitted to two NICUs, one in the UK and one in Germany as well as corresponding pathological clinical isolates. Genome analysis identified a population structure of three groups; non-NRCS-A isolates, NRCS-A isolates, and a group of 'proto NRCS-A' - isolates closely related to NRCS-A but not associated with neonatal infection. All bloodstream isolates belonged to the NRCS-A group and were indistinguishable from strains carried on the skin or in the gut. NRCS-A isolates showed increased tolerance to chlorhexidine and antibiotics relative to the other S. capitis as well as enhanced ability to grow at higher pH values. Analysis of the pangenome of 138 isolates identified characteristic nsr and tarJ genes in both the NRCS-A and proto groups. A CRISPR-cas system was only seen in NRCS-A isolates which also showed enrichment of genes for metal acquisition and transport.We found evidence for transmission of S. capitis NRCS-A within NICU, with related isolates shared between babies and multiple acquisitions by some babies. Our data show NRCS-A strains commonly colonise uninfected babies in NICU representing a potential reservoir for potential infection. This work provides more evidence that adaptation to survive in the gut and on skin facilitates spread of NRCS-A, and that metal acquisition and tolerance may be important to the biology of NRCS-A. Understanding how NRCS-A survives in NICUs can help develop infection control procedures against this clone.
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Affiliation(s)
- Heather Felgate
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Dheeraj Sethi
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | - Kirsten Faust
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Cemsid Kiy
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Rebecca Clifford
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Rachael Dean
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | | | - John Wain
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Gemma Langridge
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Paul Clarke
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | - Andrew J. Page
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
| | - Mark A. Webber
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
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Moore G, Barry A, Carter J, Ready J, Wan Y, Elsayed M, Haill C, Khashu M, Williams OM, Brown CS, Demirjian A, Ready D. Detection, survival, and persistence of Staphylococcus capitis NRCS-A in neonatal units in England. J Hosp Infect 2023; 140:8-14. [PMID: 37487793 DOI: 10.1016/j.jhin.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The multidrug-resistant Staphylococcus capitis clone, NRCS-A, is increasingly associated with late-onset sepsis in low birthweight newborns in neonatal intensive care units (NICUs) in England and globally. Understanding where this bacterium survives and persists within the NICU environment is key to developing and implementing effective control measures. AIM To investigate the potential for S. capitis to colonize surfaces within NICUs. METHODS Surface swabs were collected from four NICUs with and without known NRCS-A colonizations/infections present at the time of sampling. Samples were cultured and S. capitis isolates analysed via whole-genome sequencing. Survival of NRCS-A on plastic surfaces was assessed over time and compared to that of non-NRCS-A isolates. The bactericidal activity of commonly used chemical disinfectants against S. capitis was assessed. FINDINGS Of 173 surfaces sampled, 40 (21.1%) harboured S. capitis with 30 isolates (75%) being NRCS-A. Whereas S. capitis was recovered from surfaces across the NICU, the NRCS-A clone was rarely recovered from outside the immediate neonatal bedspace. Incubators and other bedside equipment were contaminated with NRCS-A regardless of clinical case detection. In the absence of cleaning, S. capitis was able to survive for three days with minimal losses in viability (<0.5 log10 reduction). Sodium troclosene and a QAC-based detergent/disinfectant reduced S. capitis to below detectable levels. CONCLUSION S. capitis NRCS-A can be readily recovered from the NICU environment, even in units with no recent reported clinical cases of S. capitis infection, highlighting a need for appropriate national guidance on cleaning within the neonatal care environment.
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Affiliation(s)
- G Moore
- UK Health Security Agency, UK.
| | - A Barry
- UK Health Security Agency, UK
| | | | - J Ready
- UK Health Security Agency, UK
| | - Y Wan
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - M Elsayed
- Royal United Hospital, Bath NHS Foundation Trust, Bath, UK; Southmead Hospital, North Bristol Trust, Bristol, UK
| | - C Haill
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Khashu
- University Hospitals Dorset, Poole, UK
| | - O M Williams
- UK Health Security Agency, UK; Bristol Royal Infirmary, Bristol NHS Foundation Trust, UK
| | - C S Brown
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - A Demirjian
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - D Ready
- UK Health Security Agency, UK; Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Brescini L, Fioriti S, Coccitto SN, Cinthi M, Mingoia M, Cirioni O, Giacometti A, Giovanetti E, Morroni G, Brenciani A. Genomic Analysis of a Linezolid-Resistant Staphylococcus capitis Causing Bacteremia: Report from a University Hospital in Central Italy. Microb Drug Resist 2023; 29:388-391. [PMID: 37222764 DOI: 10.1089/mdr.2022.0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Although coagulase negative staphylococci are rarely associated with complicated diseases, in some cases they cause life-threatening infections. Here we described a clinical case of a bacteremia due to a methicillin- and linezolid-resistant Staphylococcus capitis in a patient previously treated with linezolid. Whole genome sequencing revealed the common mutation G2576T in all rDNA 23S alleles and several acquired resistance genes. Moreover, the isolate was epidemiologically distant from the NRCS-A clade, usually responsible for nosocomial infections in neonatal intensive care units. Our findings further confirm the ability of minor staphylococci to acquire antibiotic resistances and challenge the treatment of these infections.
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Affiliation(s)
- Lucia Brescini
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Simona Fioriti
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Sonia N Coccitto
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Marzia Cinthi
- Unit of Microbiology, Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Marina Mingoia
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Oscar Cirioni
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Eleonora Giovanetti
- Unit of Microbiology, Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Morroni
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
| | - Andrea Brenciani
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy
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Heath V, Cloutman-Green E, Watkin S, Karlikowska M, Ready D, Hatcher J, Pearce-Smith N, Brown C, Demirjian A. Staphylococcus capitis: Review of Its Role in Infections and Outbreaks. Antibiotics (Basel) 2023; 12:antibiotics12040669. [PMID: 37107031 PMCID: PMC10135222 DOI: 10.3390/antibiotics12040669] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
In June 2021, a national incident team was formed due to an increased detection of Staphylococcus capitis in samples from hospitalised infants. Staphylococcus capitis has been known to cause outbreaks in neonatal units across the globe, but the extent of the UK spread was unclear. A literature review was undertaken to support case identification, clinical management and environmental infection control. A literature search was undertaken on multiple databases from inception to 24 May 2021, using keywords such as “Staphylococcus capitis”, “NRCS-A”, “S. capitis”, “neonate”, “newborn” and “neonatal intensive care unit” (NICU). After screening, 223 articles of relevance were included. Results show incidences of S. capitis outbreaks have frequently been associated with the outbreak clone (NRCS-A) and environmental sources. The NRCS-A harbours a multidrug resistance profile that includes resistance to beta-lactam antibiotics and aminoglycosides, with several papers noting resistance or heteroresistance to vancomycin. The NRCS-A clone also harbours a novel SCCmec-SCCcad/ars/cop composite island and increased vancomycin resistance. The S. capitis NRCS-A clone has been detected for decades, but the reasons for the potentially increased frequency are unclear, as are the most effective interventions to manage outbreaks associated with this clone. This supports the need for improvements in environmental control and decontamination strategies to prevent transmission.
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Westberg R, Stegger M, Söderquist B. Molecular Epidemiology of Neonatal-Associated Staphylococcus haemolyticus Reveals Endemic Outbreak. Microbiol Spectr 2022; 10:e0245222. [PMID: 36314976 PMCID: PMC9769988 DOI: 10.1128/spectrum.02452-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Staphylococcus haemolyticus is a major cause of late-onset sepsis in neonates, and endemic clones are often multidrug-resistant. The bacteria can also act as a genetic reservoir for more pathogenic bacteria. Molecular epidemiology is important in understanding bacterial pathogenicity and preventing infection. To describe the molecular epidemiology of S. haemolyticus isolated from neonatal blood cultures at a Swedish neonatal intensive care unit (NICU) over 4 decades, including antibiotic resistance genes (ARGs), virulence factors, and comparison to international isolates. Isolates were whole-genome sequenced, and single nucleotide polymorphisms in the core genome were used to map the relatedness. The occurrence of previously described ARGs and virulence genes were investigated. Disc diffusion and gradient tests were used to determine phenotypic resistance. The results revealed a clonal outbreak of S. haemolyticus at this NICU during the 1990s. Multidrug resistance was present in 28 (82%) of all isolates and concomitant resistance to aminoglycoside and methicillin occurred in 27 (79%). No isolates were vancomycin resistant. Genes encoding ARGs and virulence factors occurred frequently. The isolates in the outbreak were more homogenous in their genotypic and phenotypic patterns. Genotypic and phenotypic resistance combinations were consistent. Pathogenic traits previously described in S. haemolyticus occurred frequently in the present isolates, perhaps due to the hospital selection pressure resulting in epidemiological success. The clonal outbreak revealed by this study emphasizes the importance of adhering to hygiene procedures in order to prevent future endemic outbreaks. IMPORTANCE This study investigated the relatedness of Staphylococcus haemolyticus isolated from neonatal blood and revealed a clonal outbreak in the 1990s at a Swedish neonatal intensive care unit. The outbreak clone has earlier been isolated in Japan and Norway. Virulence and antibiotic resistance genes previously associated with clinical S. haemolyticus were frequently occuring in the present study as well. The majority of the isolates were multidrug-resistant. These traits should be considered important for S. haemolyticus epidemiological success and are probably caused by the hospital selection pressure. Thus, this study emphasizes the importance of restrictive antibiotic use and following the hygiene procedures, to prevent further antibiotic resistance spread and future endemic outbreaks.
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Affiliation(s)
- Ronja Westberg
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marc Stegger
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Chavignon M, Coignet L, Bonhomme M, Bergot M, Tristan A, Verhoeven P, Josse J, Laurent F, Butin M. Environmental Persistence of Staphylococcus capitis NRCS-A in Neonatal Intensive Care Units: Role of Biofilm Formation, Desiccation, and Disinfectant Tolerance. Microbiol Spectr 2022; 10:e0421522. [PMID: 36409142 PMCID: PMC9769769 DOI: 10.1128/spectrum.04215-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
The clone Staphylococcus capitis NRCS-A is responsible for late-onset sepsis in neonatal intensive care units (NICUs) worldwide. Over time, this clone has evolved into three subgroups that are increasingly adapted to the NICU environment. This study aimed to decipher the mechanisms involved in NRCS-A persistence in NICUs. Twenty-six S. capitis strains belonging to each of the three NRCS-A clone subgroups and two other non-NRCS-A groups from neonates (alpha clone) or from adult patients ("other strains") were compared based on growth kinetics and ability to form biofilm as well as tolerance to desiccation and to different disinfectants. S. capitis biofilm formation was enhanced in rich medium and decreased under conditions of nutrient stress for all strains. However, under conditions of nutrient stress, NRCS-A strains presented an enhanced ability to adhere and form a thin biofilm containing more viable and culturable bacteria (mean 5.7 log10 CFU) than the strains from alpha clone (mean, 1.1 log10 CFU) and the "other strains" (mean, 4.2 log10 CFU) (P < 0.0001). The biofilm is composed of bacterial aggregates with a matrix mainly composed of polysaccharides. The NRCS-A clone also showed better persistence after a 48-h desiccation. However, disinfectant tolerance was not enhanced in the NRCS-A clone in comparison with that of strains from adult patients. In conclusion, the ability to form biofilm under nutrient stress and to survive desiccation are two major advantages for clone NRCS-A that could explain its ability to persist and settle in the specific environment of NICU settings. IMPORTANCE Neonatal intensive care units (NICUs) host extremely fragile newborns, including preterm neonates. These patients are very susceptible to nosocomial infections, with coagulase-negative staphylococci being the species most frequently involved. In particular, a Staphylococcus capitis clone named NRCS-A has emerged worldwide specifically in NICUs and is responsible for severe nosocomial sepsis in preterm neonates. This clone is specifically adapted to the NICU environment and is able to colonize and maintain on NICU surfaces. The present work explored the mechanisms involved in the persistence of the NRCS-A clone in the NICU environment despite strict hygiene measures. The ability to produce biofilm under nutritional stress and to resist desiccation appear to be the two main advantages of NRCS-A in comparison with other strains. These findings are pivotal to provide clues for subsequent development of targeted methods to combat NRCS-A and to stop its dissemination.
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Affiliation(s)
- Marie Chavignon
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Ludivine Coignet
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Mélanie Bonhomme
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Marine Bergot
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Anne Tristan
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Paul Verhoeven
- Centre International de Recherche en Infectiologie (CIRI), Team GIMAP (Groupe sur l’Immunité des Muqueuses et Agents Pathogènes), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jérôme Josse
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Frédéric Laurent
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Marine Butin
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
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10
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Chavignon M, Kolenda C, Medina M, Bonhomme M, Blazere L, Legendre T, Tristan A, Laurent F, Butin M. Bacteriophage-based decontamination to control environmental colonization by Staphylococcus capitis in neonatal intensive care units: An in vitro proof-of-concept. Front Cell Infect Microbiol 2022; 12:1060825. [DOI: 10.3389/fcimb.2022.1060825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
IntroductionIn neonatal intensive care units (NICUs), the standard chemical-based disinfection procedures do not allow a complete eradication of pathogens from environmental surfaces. In particular, the clone Staphylococcus capitis NRCS-A, a significant pathogen in neonates, was shown to colonize neonatal incubators. The aim of this study was to evaluate the in vitro effect of a bacteriophage cocktail on NRCS-A eradication.MethodsThree bacteriophages were isolated, genetically characterized and assessed for their host range using a collection of representative clinical strains (n=31) belonging to the clone NRCS-A. The efficacy of a cocktail including these three bacteriophages to eradicate the reference strain S. capitis NRCS-A CR01 was determined in comparison or in combination with the chemical disinfectant Surfanios Premium on either dry inoculum or biofilm-embedded bacteria. The emergence of bacterial resistance against the bacteriophages alone or in cocktail was evaluated by growth kinetics.ResultsThe three bacteriophages belonged to two families and genera, namely Herelleviridae/Kayvirus for V1SC01 and V1SC04 and Rountreeviridae/Andhravirus for V1SC05. They were active against 17, 25 and 16 of the 31 tested strains respectively. Bacteriophage cocktails decreased the bacterial inoculum of both dry spots and biofilms, with a dose dependent effect. The sequential treatment with bacteriophages then Surfanios Premium did not show enhanced efficacy. No bacterial resistance was observed when using the bacteriophage cocktail.DiscussionThis study established a proof-of-concept for the use of bacteriophages to fight against S. capitis NRCS-A. Further investigations are needed using a larger bacterial collection and in real-life conditions before being able to use such technology in NICUs
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11
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Chong CE, Bengtsson RJ, Horsburgh MJ. Comparative genomics of Staphylococcus capitis reveals species determinants. Front Microbiol 2022; 13:1005949. [PMID: 36246238 PMCID: PMC9563023 DOI: 10.3389/fmicb.2022.1005949] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022] Open
Abstract
Staphylococcus capitis is primarily described as a human skin commensal but is now emergent as an opportunistic pathogen isolated from the bloodstream and prosthetic joint infections, and neonatal intensive care unit (NICU)-associated sepsis. We used comparative genomic analyses of S. capitis to provide new insights into commensal scalp isolates from varying skin states (healthy, dandruff lesional, and non-lesional), and to expand our current knowledge of the species populations (scalp isolates, n = 59; other skin isolates, n = 7; publicly available isolates, n = 120). A highly recombinogenic population structure was revealed, with genomes including the presence of a range of previously described staphylococcal virulence factors, cell wall-associated proteins, and two-component systems. Genomic differences between the two described S. capitis subspecies were explored, which revealed the determinants associated exclusively with each subspecies. The subspecies ureolyticus was distinguished from subspecies capitis based on the differences in antimicrobial resistance genes, β-lactam resistance genes, and β-class phenol soluble modulins and gene clusters linked to biofilm formation and survival on skin. This study will aid further research into the classification of S. capitis and virulence-linked phylogroups to monitor the spread and evolution of S. capitis.
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12
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Trends in Occurrence and Phenotypic Resistance of Coagulase-Negative Staphylococci (CoNS) Found in Human Blood in the Northern Netherlands between 2013 and 2019. Microorganisms 2022; 10:microorganisms10091801. [PMID: 36144403 PMCID: PMC9506452 DOI: 10.3390/microorganisms10091801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: For years, coagulase-negative staphylococci (CoNS) were not considered a cause of bloodstream infections (BSIs) and were often regarded as contamination. However, the association of CoNS with nosocomial infections is increasingly recognized. The identification of more than 40 different CoNS species has been driven by the introduction of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. Yet, treatment guidelines consider CoNS as a whole group, despite increasing antibiotic resistance (ABR) in CoNS. This retrospective study provides an in-depth data analysis of CoNS isolates found in human blood culture isolates between 2013 and 2019 in the entire region of the Northern Netherlands. Methods: In total, 10,796 patients were included that were hospitalized in one of the 15 hospitals in the region, leading to 14,992 CoNS isolates for (ABR) data analysis. CoNS accounted for 27.6% of all available 71,632 blood culture isolates. EUCAST Expert rules were applied to correct for errors in antibiotic test results. Results: A total of 27 different CoNS species were found. Major differences were observed in occurrence and ABR profiles. The top five species covered 97.1% of all included isolates: S. epidermidis, S. hominis, S. capitis, S. haemolyticus, and S. warneri. Regarding ABR, methicillin resistance was most frequently detected in S. haemolyticus (72%), S. cohnii (65%), and S. epidermidis (62%). S. epidermidis and S. haemolyticus showed 50–80% resistance to teicoplanin and macrolides while resistance to these agents remained lower than 10% in most other CoNS species. Conclusion: These differences are often neglected in national guideline development, prompting a focus on ‘ABR-safe’ agents such as glycopeptides. In conclusion, this multi-year, full-region approach to extensively assess the trends in both the occurrence and phenotypic resistance of CoNS species could be used for evaluating treatment policies and understanding more about these important but still too often neglected pathogens.
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13
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Genetic Characterization of Staphylococcus aureus, Staphylococcus argenteus, and Coagulase-Negative Staphylococci Colonizing Oral Cavity and Hand of Healthy Adults in Northern Japan. Pathogens 2022; 11:pathogens11080849. [PMID: 36014970 PMCID: PMC9413425 DOI: 10.3390/pathogens11080849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
The spread of methicillin resistance and virulence among staphylococci in the community poses a public health concern. In this study, we investigated the prevalence of Staphylococcus species colonizing the oral cavity and hand (skin) of healthy university students and their phenotypic and genetic characteristics in northern Japan. Among a total of 332 subjects, 6 and 110 methicillin-resistant and susceptible Staphylococcus aureus (MRSA and MSSA, respectively) isolates were recovered from 105 subjects. MRSA isolates were genotyped as CC5, CC8, CC45, and CC59 with SCCmec-IIa or IV, among which an isolate of ST6562 (single-locus variant of ST8) harbored SCCmec-IVa, PVL genes and ACME-I, which are the same traits as the USA300 clone. ST1223 S. argenteus was isolated from the oral cavity and hand of a single student. Coagulase-negative Staphylococcus (CoNS) was recovered from 154 subjects (172 isolates), and classified into 17 species, with S. capitis being the most common (38%), followed by S. warneri (24%) and S. epidermidis (15%), including nine mecA-positive isolates. S. capitis was differentiated into seven clusters/subclusters, and genetic factors associated with the NRCS-A clone (nsr, tarJ, ebh) were detected in 10–21% of isolates. The colonization of the USA300-like MRSA variant and S. capitis with the traits of the NRCS-A clone in healthy individuals was noteworthy.
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14
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Marr I, Swe K, Henderson A, Lacey JA, Carter GP, Ferguson JK. Cefazolin susceptibility of coagulase-negative staphylococci (CoNS) causing late-onset neonatal bacteraemia. J Antimicrob Chemother 2022; 77:338-344. [PMID: 34791307 DOI: 10.1093/jac/dkab402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/06/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND CoNS bacteraemia causes significant neonatal morbidity. Previous work has suggested that β-lactam antibiotics vary in their binding affinity to PBP2a (produced by the mecA gene) present in most CoNS. OBJECTIVES We evaluated cefazolin MICs for CoNS isolated in an Australian neonatal ICU (NICU) and correlated them with isolate genotype and phenotype. METHODS Significant blood isolates from 2009 to 2017 were speciated and underwent broth microdilution testing for cefazolin, cefoxitin, oxacillin and flucloxacillin. Correlation with mecA presence and PBP2a expression was evaluated. A selection of Staphylococcus capitis isolates underwent WGS. RESULTS The CoNS (n = 99) isolates were confirmed as S. capitis (n = 57), Staphylococcus epidermidis (n = 32), Staphylococcus haemolyticus (n = 2) and Staphylococcus warneri (n = 8). The MIC of cefazolin was ≤2 mg/L for 30% of isolates and 75% had an MIC of ≤8 mg/L (MIC90 = 16 mg/L). This contrasted with MIC90s of cefoxitin, oxacillin and flucloxacillin, which were all ≥32 mg/L. WGS found a number of S. capitis isolates closely related to the globally established NRCS-A clone. CONCLUSIONS CoNS displayed distinctly lower MIC values of cefazolin than of other agents tested. MIC variation may be related to binding affinity of PBP2a or regulation of expression of mecA by mecR1-mecI functional genes. Further, NRCS-A S. capitis strains were present in this Australian NICU before and after the unit underwent physical relocation, which raised questions about a common environmental source. It is considered justified to conduct a randomized clinical trial that assesses cefazolin versus vancomycin for management of late-onset neonatal sepsis.
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Affiliation(s)
- I Marr
- Infectious Disease Department, The Canberra Hospital, ACT, Australia
| | - K Swe
- Infectious Disease Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - A Henderson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - J A Lacey
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia
| | - G P Carter
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia
| | - J K Ferguson
- Infectious Disease Department, John Hunter Hospital, Newcastle, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
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15
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Sethi DK, Felgate H, Diaz M, Faust K, Kiy C, Clarke P, Härtel C, Rupp J, Webber MA. Chlorhexidine gluconate usage is associated with antiseptic tolerance in staphylococci from the neonatal intensive care unit. JAC Antimicrob Resist 2021; 3:dlab173. [PMID: 34806010 PMCID: PMC8599896 DOI: 10.1093/jacamr/dlab173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022] Open
Abstract
Background Intravascular catheters are essential for care in Neonatal Intensive Care Units (NICUs) but predispose infants to catheter-associated infections including late-onset sepsis, commonly caused by CoNS. Antiseptics are applied to prevent infection with chlorhexidine (CHG) and octenidine (OCT) the most common agents used. Objectives To investigate the association between antiseptic use and bacterial susceptibility. Methods CoNS isolates were collected from two NICUs with differing antiseptic regimens: Norwich, UK (using CHG) and Lubeck, Germany (using OCT). CoNS were isolated from different body sites of babies upon admission, and weekly thereafter. Antiseptic susceptibility testing was performed, and a selection underwent genome sequencing. Results A total of 1274 isolates were collected. UK isolates (n = 863) were significantly less susceptible than German isolates (n = 411) to both CHG (mean MIC: 20.1 mg/L versus 8.9 mg/L) and OCT (mean MIC: 2.3 mg/L versus 1.6 mg/L). UK isolates taken on admission were more susceptible to CHG than subsequent isolates. No cross-resistance between the agents was seen. Genome sequencing of 122 CoNS showed the most common species to be Staphylococcus epidermidis and Staphylococcus haemolyticus and phylogenetic analysis suggested antiseptic tolerance evolved multiple times in independent lineages. There was no evidence of dominant antiseptic tolerant clones and carriage of genes previously implicated in antimicrobial susceptibility (qac, smr, norA/B), did not correlate with CHG or OCT susceptibility. Conclusions Long-term CHG use may select for CHG and OCT tolerance in CoNS. This highlights the different potential for separate antiseptic regimens to select for resistance development. This could be an important factor in developing future infection control policies.
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Affiliation(s)
- Dheeraj K Sethi
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK.,Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Heather Felgate
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK
| | - Maria Diaz
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK
| | - Kirstin Faust
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Cemsid Kiy
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Paul Clarke
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK.,Neonatal Unit, Norfolk and Norwich University Hospital (NNUH), Norwich NR4 7UY, UK
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Mark A Webber
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK.,Norwich Medical School, University of East Anglia (UEA), Norwich, UK
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16
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Viability-Resolved Metagenomics Reveals Antagonistic Colonization Dynamics of Staphylococcus epidermidis Strains on Preterm Infant Skin. mSphere 2021; 6:e0053821. [PMID: 34523979 PMCID: PMC8550141 DOI: 10.1128/msphere.00538-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Preterm infants are at increased risk of infections caused by coagulase-negative staphylococci (CoNS) that colonize skin. Technical barriers in sequencing low-microbial-biomass skin swabs from preterm infants hinder attempts to gain a strain-level understanding of CoNS colonization dynamics within their developing skin microbiome. Here, the microbiome of five skin sites and available stool was studied from four preterm infants hospitalized over their first 2 months of life. We used propidium monoazide treatment of samples to enrich for the viable microbiome and metagenomic shotgun sequencing to resolve species and strains. The microbiome of different skin sites overlapped with each other, was dominated by the CoNS species Staphylococcus epidermidis and Staphylococcus capitis, and was distinct from stool. Species diversity on skin increased over time despite antibiotic exposure. Evidence of antagonism between the most common S. epidermidis strains, ST2 and ST59, included negative relationships for species correlation networks and in situ replication rates and that ST2 colonized skin earlier but was often replaced by ST59 over time. Experiments done with reference isolates showed that ST2 produced more biofilm than ST59 on plastic surfaces, which was reduced in mixed culture. We also discovered that a rare S. epidermidis strain, ST5, grew rapidly in stool in association with Stenotrophomonas maltophilia from a suspected episode of infection. Viability treatment of samples and moderate throughput shotgun sequencing provides strain-level information about CoNS colonization dynamics of preterm infant skin that ultimately might be exploited to prevent infections. IMPORTANCE The skin is a habitat for microbes that commonly infect preterm infants, but the use of sequencing for fine-scale study of the microbial communities of skin that develop in these infants has been limited by technical barriers. We treated skin swabs of preterm infants with a photoreactive dye that eliminates DNA from nonviable microbes and then sequenced the remaining DNA. We found that two strains of the most common species, Staphylococcus epidermidis, showed an antagonistic relationship on skin by cooccurring with different species, replicating fastest in different samples, and dominating skin sites at different times. Representatives of these strains also differed in their ability to stick to plastic surfaces—an important pathogenicity trait of this species. Our study shows the feasibility of gaining detailed information about strain colonization dynamics from this difficult-to-sequence body site of preterm infants, which might be used to guide novel approaches to prevent infections.
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17
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Kalbermatter C, Fernandez Trigo N, Christensen S, Ganal-Vonarburg SC. Maternal Microbiota, Early Life Colonization and Breast Milk Drive Immune Development in the Newborn. Front Immunol 2021; 12:683022. [PMID: 34054875 PMCID: PMC8158941 DOI: 10.3389/fimmu.2021.683022] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
The innate immune system is the oldest protection strategy that is conserved across all organisms. Although having an unspecific action, it is the first and fastest defense mechanism against pathogens. Development of predominantly the adaptive immune system takes place after birth. However, some key components of the innate immune system evolve during the prenatal period of life, which endows the newborn with the ability to mount an immune response against pathogenic invaders directly after birth. Undoubtedly, the crosstalk between maternal immune cells, antibodies, dietary antigens, and microbial metabolites originating from the maternal microbiota are the key players in preparing the neonate’s immunity to the outer world. Birth represents the biggest substantial environmental change in life, where the newborn leaves the protective amniotic sac and is exposed for the first time to a countless variety of microbes. Colonization of all body surfaces commences, including skin, lung, and gastrointestinal tract, leading to the establishment of the commensal microbiota and the maturation of the newborn immune system, and hence lifelong health. Pregnancy, birth, and the consumption of breast milk shape the immune development in coordination with maternal and newborn microbiota. Discrepancies in these fine-tuned microbiota interactions during each developmental stage can have long-term effects on disease susceptibility, such as metabolic syndrome, childhood asthma, or autoimmune type 1 diabetes. In this review, we will give an overview of the recent studies by discussing the multifaceted emergence of the newborn innate immune development in line with the importance of maternal and early life microbiota exposure and breast milk intake.
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Affiliation(s)
- Cristina Kalbermatter
- Universitätsklinik für Viszerale Chirurgie und Medizin, Inselspital, Bern University Hospital, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Nerea Fernandez Trigo
- Universitätsklinik für Viszerale Chirurgie und Medizin, Inselspital, Bern University Hospital, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Sandro Christensen
- Universitätsklinik für Viszerale Chirurgie und Medizin, Inselspital, Bern University Hospital, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Stephanie C Ganal-Vonarburg
- Universitätsklinik für Viszerale Chirurgie und Medizin, Inselspital, Bern University Hospital, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
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18
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Tevell S, Baig S, Hellmark B, Martins Simoes P, Wirth T, Butin M, Nilsdotter-Augustinsson Å, Söderquist B, Stegger M. Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infections. Sci Rep 2020; 10:22389. [PMID: 33372186 PMCID: PMC7769963 DOI: 10.1038/s41598-020-79225-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022] Open
Abstract
Staphylococcus capitis is a coagulase-negative staphylococcus that has been described primarily as causing bloodstream infections in neonatal intensive care units (NICUs), but has also recently been described in prosthetic joint infections (PJIs). The multidrug-resistant S. capitis subsp. urealyticus clone NRCS-A, comprising three sublineages, is prevalent in NICUs across the world, but its impact on other patient groups such as those suffering from PJIs or among adults planned for arthroplasty is unknown. Genome sequencing and subsequent analysis were performed on a Swedish collection of PJI isolates (n = 21), nasal commensals from patients planned to undergo arthroplasty (n = 20), NICU blood isolates (n = 9), operating theatre air isolates (n = 4), and reference strains (n = 2), in conjunction with an international strain collection (n = 248). The NRCS-A Outbreak sublineage containing the composite type V SCCmec-SCCcad/ars/cop element was present in PJIs across three Swedish hospitals. However, it was not found among nasal carrier strains, where the less virulent S. capitis subsp. capitis was most prevalent. The presence of the NRCS-A Outbreak clone in adult patients with PJIs demonstrates that dissemination occurs beyond NICUs. As this clone has several properties which facilitate invasive infections in patients with medical implants or immunosuppression, such as biofilm forming ability and multidrug resistance including heterogeneous glycopeptide-intermediate susceptibility, further research is needed to understand the reservoirs and distribution of this hospital-associated pathogen.
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Affiliation(s)
- Staffan Tevell
- Department of Infectious Diseases, Karlstad Hospital and Centre for Clinical Research and Education, Värmland County Council, SE-65182, Karlstad, Sweden. .,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Sharmin Baig
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Bengt Hellmark
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patricia Martins Simoes
- Department of Bacteriology, Institute for Infectious Agents, National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France.,Centre International de Référence en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS, University of Lyon, Lyon, France
| | - Thierry Wirth
- Institut de Systématique, Evolution, Biodiversité (ISYEB), UMR-CNRS 7205, Muséum National d'Histoire Naturelle, CNRS, EPHE, Sorbonne Université, Paris, France.,École Pratique des Hautes Études, PSL Université, Paris, France
| | - Marine Butin
- Centre International de Référence en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS, University of Lyon, Lyon, France.,Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Åsa Nilsdotter-Augustinsson
- Division of Inflammation and Infection, Department of Infectious Diseases, Linköping University, Norrköping, Sweden.,Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marc Stegger
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
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Oh Y, Oh KW, Lim G. Routine scrubbing reduced central line associated bloodstream infection in NICU. Am J Infect Control 2020; 48:1179-1183. [PMID: 32312594 DOI: 10.1016/j.ajic.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The main aim of this study was to estimate the effectiveness of routine scrubbing by change of the incidence of central line-associated bloodstream infections (CLABSI). METHODS We surveyed cultures from the NICU environment in December 2017. We found that areas close to infants harbored more bacteria. We implemented routine scrubbing to control sites with the most bacteria starting from January 2018. We retrospectively reviewed and compared the data between the pre (2017) and post (2018) intervention periods. RESULTS A total of 916 infants were included; 10 CLABSI episodes were identified, 9 and 1 episodes in the pre- and postintervention periods, respectively. We found that the incidence of CLABSI decreased significantly among all admitted infants (P = .006) and also among very low birth weight infants (P = .085). The number of CLABSI cases per 1,000 central line days decreased from 1.89 in 2017 to 0.23 in 2018 (P = .018). The most common bacterial species found in the cultures established from the NICU environment were identical to the CLABSI-causing coagulase-negative Staphylococcus. CONCLUSIONS Routine scrubbing significantly reduced CLABSI in the NICU.
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Yu X, Zheng B, Xiao F, Jin Y, Guo L, Xu H, Luo Q, Xiao Y. Effect of Short-Term Antimicrobial Therapy on the Tolerance and Antibiotic Resistance of Multidrug-Resistant Staphylococcus capitis. Infect Drug Resist 2020; 13:2017-2026. [PMID: 32636655 PMCID: PMC7335296 DOI: 10.2147/idr.s254141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background Bacteria undergo adaptive mutation in the host. However, the specific effect of antimicrobial use on bacterial evolution and genome mutations related to bacterial survival within a patient is unclear. Materials and Methods Three S. capitis strains were sequentially isolated from cerebrospinal fluid of a clinical inpatient. Antimicrobial susceptibility, growth rate, biofilm formation and whole blood survival of these strains were measured. Relative fitness was calculated. The virulence was examined in the Galleria mellonella model. Whole-genome sequencing and in silico analysis were performed to explore the genetic mechanisms of the changes in antimicrobial resistance phenotype. Hypothetical proteins are cloned, expressed and characterized by detection the susceptibility to gentamycin. Results The first isolate was susceptible to rifampin (MIC=0.25 μg/mL), resistant to gentamicin (MIC=16 μg/mL), while the later two isolates were resistant to rifampin (MIC >64 μg/mL), susceptible to gentamicin (MIC=4 μg/mL). For the latter two strains, compared to the first, frameshift mutation in a hypothetical protein encoding gene and base substitutions (in genes saeR, moaA and rpoB) were discovered. The mutation of rpoB gene caused rifampicin resistance. Mutations in saeR, moaA and hypothetical gene are associated with changes in other biological traits. Amino acid sequence-based structure and function identification of the hypothetical protein indicated that a mutation in the encoding gene might be associated with altered aminoglycoside susceptibility. Growth curve showed that the later two isolates grew faster than the first isolate with a positive fitness advantage of 13.5%, and 14.8%, accordingly. Biofilm form ability and whole blood survival of the derivative mutants were also enhanced. No significant differences of virulence in the G. mellonella model were observed. Conclusion We report here for the first time that short-term clinical antibiotic use was associated with resistance mutations, collateral sensitivity, and positive in vivo fitness advantages to S. capitis during infection.
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Affiliation(s)
- Xiao Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Beiwen Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Feng Xiao
- Neurosurgery Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Ye Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Lihua Guo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Hao Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Qixia Luo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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21
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Decalonne M, Dos Santos S, Gimenes R, Goube F, Abadie G, Aberrane S, Ambrogi V, Baron R, Barthelemy P, Bauvin I, Belmonte O, Benabid E, Ammar RB, Yahia SBH, Berrouane Y, Berthelot P, Beuchee A, Bille E, Bolot P, Bordes-Couecou S, Bouissou A, Bourdon S, Bourgeois-Nicolaos N, Boyer S, Cattoen C, Cattoir V, Chaplain C, Chatelet C, Claudinon A, Chautemps N, Cormier H, Coroller-Bec C, Cotte B, De Chillaz C, Dauwalder O, Davy A, Delorme M, Demasure M, Desfrere L, Drancourt M, Dupin C, Faraut-Derouin V, Florentin A, Forget V, Fortineau N, Foucan T, Frange P, Gambarotto K, Gascoin G, Gibert L, Gilquin J, Glanard A, Grando J, Gravet A, Guinard J, Hery-Arnaud G, Huart C, Idri N, Jellimann JM, Join-Lambert O, Joron S, Jouvencel P, Kempf M, Ketterer-Martinon S, Khecharem M, Klosowski S, Labbe F, Lacazette A, Lapeyre F, Larche J, Larroude P, Le Pourhiennec A, Le Sache N, Ledru S, Lefebvre A, Legeay C, Lemann F, Lesteven C, Levast-Raffin M, Leyssene D, Ligi I, Lozniewski A, Lureau P, Mallaval FO, Malpote E, Marret S, Martres P, Menard G, Menvielle L, Mereghetti L, Merle V, Minery P, Morange V, Mourdie J, Muggeo A, Nakhleh J, Noulard MN, Olive C, Patural H, Penn P, Petitfrere M, Pozetto B, Riviere B, Robine A, Ceschin CR, Ruimy R, Siali A, Soive S, Slimani S, Trentesaux AS, Trivier D, Vandenbussche C, Villeneuve L, Werner E, Le Vu S, Van Der Mee-Marquet N. Staphylococcus capitis isolated from bloodstream infections: a nationwide 3-month survey in 38 neonatal intensive care units. Eur J Clin Microbiol Infect Dis 2020; 39:2185-2194. [PMID: 32519215 PMCID: PMC7561542 DOI: 10.1007/s10096-020-03925-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/03/2020] [Indexed: 11/24/2022]
Abstract
To increase the knowledge about S. capitis in the neonatal setting, we conducted a nationwide 3-month survey in 38 neonatal intensive care units (NICUs) covering 56.6% of French NICU beds. We demonstrated 14.2% of S. capitis BSI (S.capBSI) among nosocomial BSIs. S.capBSI incidence rate was 0.59 per 1000 patient-days. A total of 55.0% of the S.capBSIs were late onset catheter-related BSIs. The S. capitis strains infected preterm babies (median gestational age 26 weeks, median birth weight 855 g). They were resistant to methicillin and aminoglycosides and belonged to the NRCS-A clone. Evolution was favorable in all but one case, following vancomycin treatment.
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Affiliation(s)
- Marie Decalonne
- SPIADI, CPIAS CVDL, Hôpital Bretonneau, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Sandra Dos Santos
- Cellule d'Epidémiologie Régionale des Infections Nosocomiales, CPIAS CVDL, Service de Bactériologie-Virologie-Hygiène, Hôpital Trousseau, CHRU, 37044, Tours, France
| | - Rémi Gimenes
- SPIADI, CPIAS CVDL, Hôpital Bretonneau, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Florent Goube
- SPIADI, CPIAS CVDL, Hôpital Bretonneau, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Géraldine Abadie
- Service de réanimation néonatale, Centre Hospitalier Universitaire Félix Guyon, 97400, Saint Denis de la Réunion, France
| | - Saïd Aberrane
- Laboratoire de Microbiologie, Centre Hospitalier Inter-Communal, 94010, Créteil, France
| | - Vanina Ambrogi
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 31059, Toulouse, France
| | - Raoul Baron
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 29609, Brest, France
| | - Patrick Barthelemy
- Équipe opérationnelle d'hygiène, Hôpital de la Conception, APHM, 13005, Marseille, France
| | - Isabelle Bauvin
- Service de réanimation néonatale, Centre Hospitalier, 64000, Pau, France
| | - Olivier Belmonte
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Félix Guyon, 97400, Saint Denis de la Réunion, France
| | - Emilie Benabid
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 95300, Pontoise, France
| | - Rafik Ben Ammar
- Service de réanimation néonatale, Centre Hospitalier Universitaire Antoine-Béclère, APHP, 92140, Clamart, France
| | | | - Yasmina Berrouane
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 06200, Nice, France
| | - Philippe Berthelot
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 42055, Saint Etienne, France
| | - Alain Beuchee
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 35000, Rennes, France
| | - Emmanuelle Bille
- Laboratoire de Microbiologie clinique, Hôpital universitaire Necker-Enfants malades, APHP, 75015, Paris, France
| | - Pascal Bolot
- Service de réanimation néonatale, Centre Hospitalier Delafontaine, 93205, Saint Denis, France
| | | | - Antoine Bouissou
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Sandra Bourdon
- Équipe opérationnelle d'hygiène, Centre Hospitalier du Havre, 76290, Montivilliers, France
| | - Nadège Bourgeois-Nicolaos
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Antoine-Béclère, APHP, 92140, Clamart, France
| | - Sophie Boyer
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Charles Nicolle, 76000, Rouen, France
| | - Christian Cattoen
- Laboratoire de Microbiologie, Centre Hospitalier, 59300, Valenciennes, France
| | - Vincent Cattoir
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 35000, Rennes, France
| | - Chantal Chaplain
- Laboratoire de Microbiologie, Centre Hospitalier Delafontaine, 93205, Saint Denis, France
| | - Céline Chatelet
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 62300, Lens, France
| | - Aurore Claudinon
- Laboratoire de Microbiologie, Centre Hospitalier, 95107, Argenteuil, France
| | - Nathalie Chautemps
- Service de réanimation néonatale, Centre Hospitalier Métropole Savoie-Site de Chambéry, 73 011, Chambéry, France
| | - Hélène Cormier
- UPLIN, Centre Hospitalier Universitaire, 49933, Angers, France
| | | | | | - Carole De Chillaz
- Service de Néonatalogie et Réanimation néonatale, Hôpital universitaire Necker-Enfants malades, APHP, 75015, Paris, France
| | - Olivier Dauwalder
- Laboratoire de Microbiologie, Hôpitaux Civils de Lyon, 69677, Bron, France
| | - Aude Davy
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 22000, Saint Brieuc, France
| | - Martine Delorme
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 79021, Niort, France
| | - Maryvonne Demasure
- Équipe opérationnelle d'hygiène, Centre Hospitalier Régional, 45100, Orléans, France
| | - Luc Desfrere
- Service de réanimation néonatale, Centre Hospitalier Universitaire, Hôpital Louis-Mourier, APHP, 92700, Colombes, France
| | - Michel Drancourt
- Laboratoire de Microbiologie, Hôpital de la Conception, APHM, 13005, Marseille, France
| | - Clarisse Dupin
- Laboratoire de Microbiologie, Centre Hospitalier, 22000, Saint Brieuc, France
| | - Véronique Faraut-Derouin
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire Antoine-Béclère, APHP, 92140, Clamart, France
| | - Arnaud Florentin
- Service d'hygiène et d'analyses environnementales (SHAE), Hôpitaux de Brabois, 54035, Nancy, France
| | - Virginie Forget
- Équipe opérationnelle d'hygiène, Centre Hospitalier Métropole Savoie-Site de Chambéry, 73 011, Chambéry, France
| | - Nicolas Fortineau
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, Kremlin Bicêtre, APHP, 94275, Le Kremlin Bicêtre, France
| | - Tania Foucan
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 97159, Pointe-à-Pitre, France
| | - Pierre Frange
- Laboratoire de Microbiologie clinique, Hôpital universitaire Necker-Enfants malades, APHP, 75015, Paris, France.,Équipe opérationnelle d'hygiène, Hôpital universitaire Necker-Enfants malades, APHP, 75015, Paris, France
| | - Karine Gambarotto
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire Félix Guyon, 97400, Saint Denis de la Réunion, France
| | - Géraldine Gascoin
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 49933, Angers, France
| | - Laure Gibert
- Équipe opérationnelle d'hygiène, Centre Hospitalier du Havre, 76290, Montivilliers, France
| | - Jacques Gilquin
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 81100, Castres, France
| | - Audrey Glanard
- Équipe opérationnelle d'hygiène, Centre Hospitalier Delafontaine, 93205, Saint Denis, France
| | - Jacqueline Grando
- Équipe opérationnelle d'hygiène, Hôpitaux Civils de Lyon, 69677, Bron, France
| | - Alain Gravet
- Laboratoire de Microbiologie, Centre Hospitalier, 68100, Mulhouse, France
| | - Jérôme Guinard
- Laboratoire de Microbiologie, Centre Hospitalier Régional, 45100, Orléans, France
| | - Geneviève Hery-Arnaud
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 29609, Brest, France
| | - Claire Huart
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 59300, Valenciennes, France
| | - Nadia Idri
- Équipe opérationnelle d'hygiène, Hôpital Louis-Mourier, APHP, 92700, Colombes, France.,Laboratoire de Microbiologie, Hôpital Louis-Mourier, APHP, 92700, Colombes, France
| | - Jean-Marc Jellimann
- Service de réanimation néonatale, Centre Hospitalier Universitaire, Hôpitaux de Brabois, 54035, Nancy, France
| | - Olivier Join-Lambert
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 14000, Caen, France
| | - Sylvie Joron
- Service d'hygiène, Centre Hospitalier, 62100, Calais, France
| | - Philippe Jouvencel
- Service de réanimation néonatale, Centre Hospitalier, 64100, Bayonne, France
| | - Marie Kempf
- Laboratoire de Bactériologie-Hygiène Institut de Biologie en Santé, CRCINA Inserm U1232, Université d'Angers, Centre Hospitalier Universitaire, 49933, Angers, France
| | - Sophie Ketterer-Martinon
- Service de réanimation néonatale et réanimation pédiatrique, Centre Hospitalier Universitaire de Martinique, 97261, Fort de France, France
| | - Mouna Khecharem
- Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire, Kremlin Bicêtre, APHP, 94275, Le Kremlin Bicêtre, France
| | - Serge Klosowski
- Service de réanimation néonatale, Centre Hospitalier, 62300, Lens, France
| | - Franck Labbe
- Laboratoire de Microbiologie, Centre Hospitalier du Havre, 76290, Montivilliers, France
| | - Adeline Lacazette
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 97159, Pointe-à-Pitre, France
| | - Fabrice Lapeyre
- Service de réanimation néonatale, Centre Hospitalier, 59300, Valenciennes, France
| | | | - Peggy Larroude
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 64000, Pau, France
| | | | - Nolwenn Le Sache
- Service de réanimation néonatale, Centre Hospitalier Universitaire, Kremlin Bicêtre, APHP, 94275, Le Kremlin Bicêtre, France
| | - Sylvie Ledru
- Laboratoire de Microbiologie, Centre Hospitalier, 62300, Lens, France
| | - Annick Lefebvre
- Équipe opérationnelle d'hygiène, Université de Reims Champagne-Ardenne, 51100, Reims, France
| | - Clément Legeay
- UPLIN, Centre Hospitalier Universitaire, 49933, Angers, France
| | - Florence Lemann
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 95107, Argenteuil, France
| | - Claire Lesteven
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 14000, Caen, France
| | - Marion Levast-Raffin
- Laboratoire de Biologie Médicale, Centre Hospitalier Métropole Savoie-Site de Chambéry, 73 011, Chambéry, France
| | - David Leyssene
- Laboratoire de Microbiologie, Centre Hospitalier, 64100, Bayonne, France
| | - Isabelle Ligi
- Service de réanimation néonatale, Centre Hospitalier Universitaire, Hôpital de la Conception, APHM, 13005, Marseille, France
| | - Alain Lozniewski
- Laboratoire de Microbiologie, Hôpitaux de Brabois, 54035, Nancy, France
| | - Pierre Lureau
- Laboratoire de Microbiologie, Centre Hospitalier, 79021, Niort, France
| | - Franck-Olivier Mallaval
- Équipe opérationnelle d'hygiène, Centre Hospitalier Métropole Savoie-Site de Chambéry, 73 011, Chambéry, France
| | - Edith Malpote
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 97159, Pointe-à-Pitre, France
| | - Stéphane Marret
- Service de réanimation néonatale, Centre Hospitalier Universitaire Charles Nicolle, 76000, Rouen, France
| | - Pascale Martres
- Laboratoire de Microbiologie, Centre Hospitalier, 95300, Pontoise, France
| | - Guillaume Menard
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 35000, Rennes, France
| | - Laura Menvielle
- Service de réanimation néonatale et réanimation pédiatrique, Centre Hospitalier Universitaire, Hôpital Robert Debré, Inserm UMR-S 1250 P3Cell, Université de Reims Champagne-Ardenne, 51100, Reims, France
| | - Laurent Mereghetti
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Véronique Merle
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire Charles Nicolle, 76000, Rouen, France
| | - Pascale Minery
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 68100, Mulhouse, France
| | - Virginie Morange
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire, 37044, Tours, France
| | - Julien Mourdie
- Service de réanimation néonatale, Centre Hospitalier du Havre, 76290, Montivilliers, France
| | - Anaelle Muggeo
- Laboratoire de Bactériologie, Université de Reims Champagne-Ardenne, 51100, Reims, France
| | - Jean Nakhleh
- Service de réanimation néonatale, Centre Hospitalier, 68100, Mulhouse, France
| | | | - Claude Olive
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire de Martinique, 97261, Fort de France, France
| | - Hugues Patural
- Service de réanimation néonatale, Centre Hospitalier Universitaire, 42055, Saint Etienne, France
| | - Pascale Penn
- Laboratoire de Microbiologie, Centre Hospitalier, 72000, Le Mans, France
| | | | - Bruno Pozetto
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 42055, Saint Etienne, France
| | - Brigitte Riviere
- Laboratoire de Microbiologie, Centre Hospitalier, 81100, Castres, France
| | - Audrey Robine
- Service de réanimation néonatale, Centre Hospitalier, 72000, Le Mans, France
| | | | - Raymond Ruimy
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire, 06200, Nice, France
| | - Amine Siali
- Équipe opérationnelle d'hygiène, Centre Hospitalier Inter-Communal, 94010, Créteil, France
| | - Stéphanie Soive
- Service de réanimation néonatale, Centre Hospitalier, 22000, Saint Brieuc, France
| | - Souad Slimani
- Équipe opérationnelle d'hygiène, Centre Hospitalier Universitaire de Martinique, 97261, Fort de France, France
| | | | - Dominique Trivier
- Équipe opérationnelle d'hygiène, Centre Hospitalier, 62300, Lens, France
| | | | | | - Evelyne Werner
- Service de réanimation néonatale, Centre Hospitalier Régional, 45100, Orléans, France
| | - Stéphane Le Vu
- Agence Santé Publique France, 94415, Saint Maurice, France
| | - Nathalie Van Der Mee-Marquet
- SPIADI, CPIAS CVDL, Hôpital Bretonneau, Centre Hospitalier Universitaire, 37044, Tours, France. .,Cellule d'Epidémiologie Régionale des Infections Nosocomiales, CPIAS CVDL, Service de Bactériologie-Virologie-Hygiène, Hôpital Trousseau, CHRU, 37044, Tours, France.
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22
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Nicolosi D, Cinà D, Di Naso C, D’Angeli F, Salmeri M, Genovese C. Antimicrobial Resistance Profiling of Coagulase-Negative Staphylococci in a Referral Center in South Italy: A Surveillance Study. Open Microbiol J 2020. [DOI: 10.2174/1874285802014010091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background:
CoNS are part of the normal flora of the skin, upper respiratory tract and human intestine. CoNS are able to colonize host tissues or inert materials such as prosthetics, heart valves, pacemakers, and urinary and venous catheters. They can also internalize in host cells, thus eluding immune defenses and attack by antibiotics.
Objective:
In this study, we collected the epidemiological data and determined the antibiotic susceptibility of 828 CoNS, collected in Garibaldi Hospital (Catania, Italy) between January 2016 and October 2018.
Methods:
Strains were evaluated by determining the Minimum Inhibitory Concentration (MIC) using the broth microdilution method, according to the guidelines of the Clinical and Laboratory Standards Institute. The antibiotic sensitivity pattern of CoNS against eighteen antibiotics was determined.
Results:
For all the 828 clinical isolates, varying resistance rates were observed: ampicillin (87%), penicillin (86%), amoxicillin-clavulanate (71%), oxacillin (70%), erythromycin (69%), azithromycin (68%), levofloxacin (55%), ciprofloxacin (54%), gentamycin (47%), moxifloxacin (42%), trimethoprim-sulfamethoxazole (30%), clindamycin (28%), tetracycline (24%), rifampicin (20%), quinupristin-dalfopristin (synercid) (4%). No strains investigated demonstrated resistance to teicoplanin, vancomycin and linezolid.
Conclusion:
Our results highlight the importance of monitoring the evolution of CoNS resistance in order to implement control measures and reduce the risk of spread in the population.
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23
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Qu Y, Li Y, Cameron DR, Easton CD, Zhu X, Zhu M, Salwiczek M, Muir BW, Thissen H, Daley A, Forsythe JS, Peleg AY, Lithgow T. Hyperosmotic Infusion and Oxidized Surfaces Are Essential for Biofilm Formation of Staphylococcus capitis From the Neonatal Intensive Care Unit. Front Microbiol 2020; 11:920. [PMID: 32477314 PMCID: PMC7237634 DOI: 10.3389/fmicb.2020.00920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/17/2020] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus capitis is an opportunistic pathogen often implicated in bloodstream infections in the neonatal intensive care unit (NICU). This is assisted by its ability to form biofilms on indwelling central venous catheters (CVC), which are highly resistant to antibiotics and the immune system. We sought to understand the fundamentals of biofilm formation by S. capitis in the NICU, using seventeen clinical isolates including the endemic NRCS-A clone and assessing nine commercial and two modified polystyrene surfaces. S. capitis clinical isolates from the NICU initiated biofilm formation only in response to hyperosmotic conditions, followed by a developmental progression driven by icaADBC expression to establish mature biofilms, with polysaccharide being their major extracellular polymer substance (EPS) matrix component. Physicochemical features of the biomaterial surface, and in particular the level of the element oxygen present on the surface, significantly influenced biofilm development of S. capitis. A lack of highly oxidized carbon species on the surface prevented the immobilization of S. capitis EPS and the formation of mature biofilms. This information provides guidance in regard to the preparation of hyperosmolar total parenteral nutrition and the engineering of CVC surfaces that can minimize the risk of catheter-related bloodstream infections caused by S. capitis in the NICU.
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Affiliation(s)
- Yue Qu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Yali Li
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia.,Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia
| | - David R Cameron
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Christopher D Easton
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Xuebo Zhu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minli Zhu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mario Salwiczek
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Benjamin W Muir
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Helmut Thissen
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Andrew Daley
- Department of Microbiology, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - John S Forsythe
- Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia
| | - Anton Y Peleg
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Trevor Lithgow
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
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24
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Niche specialization and spread of Staphylococcus capitis involved in neonatal sepsis. Nat Microbiol 2020; 5:735-745. [PMID: 32341568 DOI: 10.1038/s41564-020-0676-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
The multidrug-resistant Staphylococcus capitis NRCS-A clone is responsible for sepsis in preterm infants in neonatal intensive care units (NICUs) worldwide. Here, to retrace the spread of this clone and to identify drivers of its specific success, we investigated a representative collection of 250 S. capitis isolates from adults and newborns. Bayesian analyses confirmed the spread of the NRCS-A clone and enabled us to date its emergence in the late 1960s and its expansion during the 1980s, coinciding with the establishment of NICUs and the increasing use of vancomycin in these units, respectively. This dynamic was accompanied by the acquisition of mutations in antimicrobial resistance- and bacteriocin-encoding genes. Furthermore, combined statistical tools and a genome-wide association study convergently point to vancomycin resistance as a major driver of NRCS-A success. We also identified another S. capitis subclade (alpha clade) that emerged independently, showing parallel evolution towards NICU specialization and non-susceptibility to vancomycin, indicating convergent evolution in NICU-associated pathogens. These findings illustrate how the broad use of antibiotics can repeatedly lead initially commensal drug-susceptible bacteria to evolve into multidrug-resistant clones that are able to successfully spread worldwide and become pathogenic for highly vulnerable patients.
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25
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Thorn LM, Ussher JE, Broadbent RS, Manning JM, Sharples KJ, Crump JA. Risk factors for Staphylococcus capitis pulsotype NRCS-A colonisation among premature neonates in the neonatal intensive care unit of a tertiary-care hospital: a retrospective case-control study. Infect Prev Pract 2020; 2:100057. [PMID: 34368703 PMCID: PMC8335916 DOI: 10.1016/j.infpip.2020.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/12/2020] [Indexed: 11/01/2022] Open
Abstract
Background A S. capitis strain called NRCS-A (S. capitis NRCS-A) has emerged as a cause of bloodstream infections and sepsis in neonatal intensive care units (NICUs) worldwide. Aim To identify risk factors for S. capitis NRCS-A colonisation among neonates, Dunedin Hospital NICU, Dunedin, New Zealand, from September 2013 through March 2015. Methods Weekly axillary swabs categorised eligible neonates as a case or a control. A case was defined as a week ending with a neonate's first positive swab for S. capitis NRCS-A and a control as a week in which a neonate remained negative. Weekly exposures were abstracted from hospital medical records. Analyses were performed using conditional logistic regression. Findings The median (range) gestational age at birth of participants was 32.7 (23.1-41.3) weeks. Participants contributed 26 weeks of case data and 177 weeks of control data. On adjusted analysis compared with matched controls, cases had higher odds of requiring invasive mechanical ventilation (OR 3.6, 95% CI: 1.1-11.6, p=0.035) and of a patent ductus arteriosus (PDA) (OR 3.0, 95% CI: 1.0-9.0, p=0.044). Cases had lower odds of being part of a multiple birth (OR 0.24, 95% CI 0.08-0.73, p=0.001), having an area of inflamed skin (OR 0.31, 95% CI: 0.13-0.75, p=0.009), and specifically an area of inflamed axillary skin (OR 0.08, 95% CI: 0.01-0.50, p=0.006). Conclusions We found that premature neonates with invasive mechanical ventilation and PDA had greater odds for S. capitis NRCS-A colonisation. Transmission may be mediated by increased staff contact, but prospective research is needed to confirm this.
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Affiliation(s)
- Louise M Thorn
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James E Ussher
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand.,Southern Community Laboratories, Dunedin, New Zealand
| | - Roland S Broadbent
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Juliet M Manning
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Katrina J Sharples
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand.,Centre for International Health, University of Otago, New Zealand
| | - John A Crump
- Centre for International Health, University of Otago, New Zealand
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2CS-CHX T Operon Signature of Chlorhexidine Tolerance among Enterococcus faecium Isolates. Appl Environ Microbiol 2019; 85:AEM.01589-19. [PMID: 31562170 DOI: 10.1128/aem.01589-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/20/2019] [Indexed: 11/20/2022] Open
Abstract
Chlorhexidine (CHX) is a broad-spectrum antiseptic widely used in community and clinical contexts for many years that has recently acquired higher relevance in nosocomial infection control worldwide. Despite this, CHX tolerance among Enterococcus faecium bacteria, representing one of the leading agents causing nosocomial infections, has been poorly understood. This study provides new phenotypic and molecular data for better identification of CHX-tolerant E. faecium subpopulations in community and clinical contexts. The chlorhexidine MIC (MICCHX) distribution of 106 E. faecium isolates suggested the occurrence of tolerant subpopulations in diverse sources (human, animal, food, environment) and phylogenomic backgrounds (clades A1/A2/B), with predominance in clade A1. They carried a specific variant of the 2CS-CHXT operon, identified here. It encodes glucose and amino acid-polyamine-organocation family transporters, besides the DNA-binding response regulator ChtR, with a P102H mutation previously described only in CHX-tolerant clade A1 E. faecium, and the ChtS sensor. 2CS-CHXT seems to be associated with three regulons modulating diverse bacterial biological functions. Combined data from normal MIC distribution and 2CS-CHXT operon characterization support a tentative epidemiological cutoff (ECOFF) of 8 mg/liter to CHX, which is useful to detect tolerant E. faecium populations in future surveillance studies. The spread of tolerant E. faecium in diverse epidemiological backgrounds calls for the prudent use of CHX in multiple contexts.IMPORTANCE Chlorhexidine is one of the substances included in the World Health Organization's list of essential medicines, which comprises the safest and most effective medicines needed in global health systems. Although it has been widely applied as a disinfectant and antiseptic in health care (skin, hands, mouthwashes, eye drops) since the 1950s, its use in hospitals to prevent nosocomial infections has increased worldwide in recent years. Here, we provide a comprehensive study on chlorhexidine tolerance among strains of Enterococcus faecium, one of the leading nosocomial agents worldwide, and identify a novel 2CS-CHXT operon as a signature of tolerant strains occurring in diverse phylogenomic groups. Our data allowed for the proposal of a tentative epidemiological cutoff of 8 mg/liter, which is useful to detect tolerant E. faecium populations in surveillance studies in community and clinical contexts. The prediction of 2CS-CHXT regulons will also facilitate the design of future experimental studies to better uncover chlorhexidine tolerance among E. faecium bacteria.
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Butin M, Dumont Y, Monteix A, Raphard A, Roques C, Martins Simoes P, Picaud JC, Laurent F. Sources and reservoirs of Staphylococcus capitis NRCS-A inside a NICU. Antimicrob Resist Infect Control 2019; 8:157. [PMID: 31636900 PMCID: PMC6798403 DOI: 10.1186/s13756-019-0616-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/01/2019] [Indexed: 12/23/2022] Open
Abstract
Background The methicillin-resistant clone Staphylococcus capitis NRCS-A, involved in sepsis in neonatal intensive care units (NICUs) worldwide, is able to persist and spread in NICUs, suggesting the presence of reservoirs inside each setting. The purpose of the present study was to identify these reservoirs and to investigate the cycle of transmission of NRCS-A in one NICU. Methods In a single institution study, NRCS-A was sought in 106 consecutive vaginal samples of pregnant women to identify a potential source of NRCS-A importation into the NICU. Additionally NICU caregivers and environmental including incubators were tested to identify putative secondary reservoirs. Finally, the efficacy of disinfection procedure in the elimination of NRCS-A from incubators was evaluated. Results No S. capitis was isolated from vaginal samples of pregnant women. Three of the 21 tested caregivers (14%) carried S. capitis on their hands, but none remain positive after a five-day wash-out period outside NICU. Moreover, the clone NRCS-A persisted during six consecutive weeks in the NICU environment, but none of the sampled sites was constantly contaminated. Finally in our before/after disinfection study, all of 16 incubators were colonized before disinfection and 10 (62%) incubators remained colonized with NRCS-A after the disinfection procedure. Conclusions The partial ineffectiveness of incubators’ disinfection procedures is responsible for persistence of NRCS-A inside a NICU, and the passive hand contamination of caregivers could be involved in the inter-patient transmission of S. capitis.
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Affiliation(s)
- Marine Butin
- 1Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie, 69364 Lyon Cedex 07, France.,2Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69500 Bron, France
| | - Yann Dumont
- 3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France
| | - Alice Monteix
- 3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France
| | - Aurane Raphard
- 3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France
| | - Christine Roques
- Laboratoire de Génie Chimique UMR 5503, Université de Toulouse, CNRS, INPT, UPS, Faculté des Sciences Pharmaceutiques, 35 chemin des maraîchers, 31062 Toulouse cedex 4, France
| | - Patricia Martins Simoes
- 1Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie, 69364 Lyon Cedex 07, France.,3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France
| | - Jean-Charles Picaud
- 5Réanimation Néonatale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France.,6CarMeN, INSERM U1060, INRA U1397, Université de Lyon, 165 Chemin du Grand Revoyet, 69310 Pierre Bénite, France
| | - Frédéric Laurent
- 1Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie, 69364 Lyon Cedex 07, France.,3Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104 grande rue de la Croix Rousse, 69004 Lyon, France.,7Département de Microbiologie et Mycologie, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, Université de Lyon, 6 Avenue Rockefeller, 69008 Lyon, France
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Genomic analysis of Staphylococcus capitis isolated from blood cultures in neonates at a neonatal intensive care unit in Sweden. Eur J Clin Microbiol Infect Dis 2019; 38:2069-2075. [PMID: 31396832 PMCID: PMC6800862 DOI: 10.1007/s10096-019-03647-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/15/2019] [Indexed: 12/04/2022]
Abstract
Emergence of a genetically distinct, multidrug-resistant Staphylococcus capitis clone (NRCS-A) present in neonatal intensive care units has recently been extensively reported. The aims of the present study were to investigate which clones of S. capitis isolated from blood in a Swedish neonatal intensive care unit (NICU) have been present since 1987 and to investigate whether the NRCS-A clone has disseminated in Sweden. All S. capitis isolates from blood cultures of neonates (≤ 28 days of age) between 1987 and 2017 (n = 46) were whole-genome sequenced, and core genome multilocus sequence typing (cgMLST) was performed. Single-nucleotide polymorphism (SNP)-based phylogenetic relationships between the S. capitis isolates and in silico predictions of presence of genetic traits specific to the NRCS-A clone were identified. Furthermore, antibiotic susceptibility testing, including screening for heterogeneous glycopeptide-intermediate resistance, was performed. Thirty-five isolates clustered closely to the isolates previously determined as belonging to the NRCS-A clone and had fewer than 81 core genome loci differences out of 1063. Twenty-one of these isolates were multidrug resistant. The NRCS-A clone was found in 2001. Six pairs of isolates had differences of fewer than two SNPs. Genetic traits associated with the NRCS-A clone such as nsr, ebh, tarJ, and CRISPR were found in all 35 isolates. The increasing incidence of S. capitis blood cultures of neonates is predominantly represented by the NRSC-A clone at our NICU in Sweden. Furthermore, there were indications of transmission between cases; adherence to basic hygiene procedures and surveillance measures are thus warranted.
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Ory J, Cazaban M, Richaud-Morel B, Di Maio M, Dunyach-Remy C, Pantel A, Sotto A, Laurent F, Lavigne JP, Butin M. Successful implementation of infection control measure in a neonatal intensive care unit to combat the spread of pathogenic multidrug resistant Staphylococcus capitis. Antimicrob Resist Infect Control 2019; 8:57. [PMID: 30962919 PMCID: PMC6437968 DOI: 10.1186/s13756-019-0512-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Once present in a neonatal intensive care unit (NICU), multidrug resistant Staphylococcus capitis NRCS-A is able to settle and diffuse. Objective The objective of this study was to evaluate the impact of infection control (IC) interventions to reduce the spread of Staphylococcus capitis NRCS-A in a NICU. Methods Between December 2012 and December 2017, all patients presenting positive sampling (blood, skin or catheter) to S. capitis were included, and clinical data were recorded from electronic clinical charts. The IC team has continually implemented measures of control infections (hand hygiene, standard precautions, patient contact isolation and disinfection of the inanimate environment). From May 2015, a steam cleaner was implemented in the cleaning procedure instead of disinfectant to disinfect heating tables and incubators. Four periods were determined: Period 1 (P1) before steam cleaner acquisition; Period 2 (P2) after implementation steam cleaner; Period 3 (P3) when the steam cleaner had broken down, and Period 4 (P4) when the steam cleaner was functional again. The consumption of antibiotics and the epidemiology of infections inside the NICU were investigated during the study period. Results During the studied period, 37 infants were infected or colonized by S. capitis. The incidences of infection or colonization by S. capitis were P1 = 1.04‰, P2 = 0.55‰, P3 = 3.95 ‰ and P4 = 0‰ and were significantly different between P1-P3 and P2-P4 (p < 0.001). During the different periods, antibiotics consumption and bacterial epidemiology of the ward were stable. Conclusions The use of steam vapor system was associated with a significantly decreased incidence of S. capitis NRCS-A infection or colonization and could constitute an effective and safe procedure to control and eradicate its diffusion inside NICUs.
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Affiliation(s)
- Jérôme Ory
- 1Department of Infection Control, Equipe Opérationnelle d'Hygiène, Place du Professeur Robert Debré, University Hospital Nîmes, Nîmes, France
| | - Michel Cazaban
- 1Department of Infection Control, Equipe Opérationnelle d'Hygiène, Place du Professeur Robert Debré, University Hospital Nîmes, Nîmes, France
| | - Brigitte Richaud-Morel
- 1Department of Infection Control, Equipe Opérationnelle d'Hygiène, Place du Professeur Robert Debré, University Hospital Nîmes, Nîmes, France
| | - Massimo Di Maio
- 2Department of Neonatalogy, University Hospital Nîmes, Nîmes, France
| | - Catherine Dunyach-Remy
- 3Bacterial virulence and Infectious Diseases, INSERM, Department of Microbiology, Université de Montpellier, University Hospital Nîmes, Nîmes cedex 02, 30908 Nîmes, France
| | - Alix Pantel
- 3Bacterial virulence and Infectious Diseases, INSERM, Department of Microbiology, Université de Montpellier, University Hospital Nîmes, Nîmes cedex 02, 30908 Nîmes, France
| | - Albert Sotto
- 4Department of Infectious Diseases, Bacterial virulence and Infectious Diseases, INSERM, Université de Montpellier, University Hospital Nîmes, Nîmes, France
| | - Frédéric Laurent
- 5International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, Lyon, France.,Institute of Infectious Agents, Lyon, France.,National Reference Center for Staphylococci, Lyon, France.,8Department of Microbiology-Mycology, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, University of Lyon, Lyon, France
| | - Jean-Philippe Lavigne
- 3Bacterial virulence and Infectious Diseases, INSERM, Department of Microbiology, Université de Montpellier, University Hospital Nîmes, Nîmes cedex 02, 30908 Nîmes, France
| | - Marine Butin
- 5International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, Lyon, France.,Institute of Infectious Agents, Lyon, France.,National Reference Center for Staphylococci, Lyon, France.,8Department of Microbiology-Mycology, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, University of Lyon, Lyon, France
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Laurent F, Butin M. Staphylococcus capitis and NRCS-A clone: the story of an unrecognized pathogen in neonatal intensive care units. Clin Microbiol Infect 2019; 25:1081-1085. [PMID: 30928561 DOI: 10.1016/j.cmi.2019.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/07/2019] [Accepted: 03/09/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND In neonatal intensive care units (NICUs), nosocomial late-onset sepsis (LOS), mostly due to coagulase negative staphylococci, constitute a major cause of death or impairment. Staphylococcus capitis, usually considered as a poorly virulent species, has been reported as a cause of LOS. OBJECTIVES To review data regarding S. capitis neonatal LOS and the features of isolates involved. SOURCES PubMed was searched up to August 2018 to retrieve studies on the topic; the keywords used were 'S. capitis', 'neonate', 'neonatal ICU', 'bloodstream infection' and 'late onset sepsis'. CONTENT Published data highlight the worldwide endemicity of a single S. capitis clone, named NRCS-A, specifically involved in LOS. NRCS-A harbours a multidrug resistance profile (including resistance to the usual first-line antibiotics used in NICUs). It is also able to adapt under vancomycin selective pressure that could confer an advantage for its implantation and dissemination in NICUs where this selective pressure is high. Moreover, a severe morbidity has been observed in NRCS-A-related LOS. The NICU environment, and especially incubators, constitute reservoirs of NRCS-A from which it could diffuse inside the setting. Finally, the virulome and resistome of S. capitis NRCS-A contain many genes potentially implicated in its specific epidemiology and pathophysiology, including the gene nsr that may be involved in its fitness and implantation in neonatal gut flora. IMPLICATIONS S. capitis must be considered as a true pathogen in neonates. The decreased susceptibility to vancomycin may be involved in failure of vancomycin therapy. Further studies are needed to better manage its diffusion inside each NICU but also worldwide.
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Affiliation(s)
- F Laurent
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie 69364 Lyon Cedex 07, France; Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France; Département de Microbiologie et Mycologie, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, Université de Lyon, 6 Avenue Rockefeller, 69008 Lyon, France
| | - M Butin
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 46 Allée d'Italie 69364 Lyon Cedex 07, France; Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Bd Pinel 69500 Bron, France.
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