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Bujňáková D, Karahutová L. Molecular characteristics and antibiotic resistance of Staphylococcus aureus and Staphylococcus haemolyticus isolated from bovine mastitis. Res Vet Sci 2024; 177:105365. [PMID: 39053094 DOI: 10.1016/j.rvsc.2024.105365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/27/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
Staphylococci are classified as one of the pathogens causing bovine mastitis that can pose not only an economic loss to the dairy farms, but a serious public-health threat based on their zoonotic potential. We focused to monitor phenotypes of the isolated strains of Staphylococcus aureus (S. aureus) and Staphylococcus haemolyticus (S. haemolyticus) from milk of cows with clinical mastitis, including antibiotic resistance, biofilm forming ability and the presence of biofilm- and toxin- related genes. From a total of 191 milk samples were identified as S. aureus - 12% (22 isolates) and S. haemolyticus - 6% (12 isolates). Automatic interpreted reading of the antibiogram evaluated potentially 12 isolates as methicillin-resistant S. aureus and methicillin-resistant coagulase-negative Staphylococci. Genotypically, the isolates were positive for blaZ and negative for mecA and mecC. Others important mechanisms were inducible macrolide-lincosamide-streptogramin B (iMLSB) resistance with presence of msrA, ermC, vgaA. The most detected biofilm-associated and toxins genes were clfA, sdrD, sdrE, fnbpB, bbp, isdA, isdB, hla and see. S. aureus isolates were subjected to spa typing. It turned out that despite the strains coming from different farms, they were either resistant or sensitive to antibiotic, were all of the same spa-type t 10035. Our findings revealed the presence iMLSB, which, to our best knowledge, were described in Slovakian bovine staphylococci rarely. The majority of isolates were multidrug-resistant and carried multiple virulence genes, posing a potential public-health risk.
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Affiliation(s)
- Dobroslava Bujňáková
- Institute of Animal Physiology, Centre of Biosciences of the Slovak Academy of Sciences, Šoltésovej 4/6, 040 01 Košice, Slovak Republic
| | - Lívia Karahutová
- Institute of Animal Physiology, Centre of Biosciences of the Slovak Academy of Sciences, Šoltésovej 4/6, 040 01 Košice, Slovak Republic.
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2
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MacFadyen AC, Paterson GK. Methicillin resistance in Staphylococcus pseudintermedius encoded within novel staphylococcal cassette chromosome mec (SCCmec) variants. J Antimicrob Chemother 2024; 79:1303-1308. [PMID: 38564255 PMCID: PMC11144489 DOI: 10.1093/jac/dkae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Staphylococcus pseudintermedius is a common opportunistic pathogen of companion dogs and an occasional human pathogen. Treatment is hampered by antimicrobial resistance including methicillin resistance encoded by mecA within the mobile genetic element SCCmec. OBJECTIVES SCCmec elements are diverse, especially in non-Staphyloccocus aureus staphylococci, and novel variants are likely to be present in S. pseudintermedius. The aim was to characterize the SCCmec elements found in four canine clinical isolates of S. pseudintermedius. MATERIAL AND METHODS Isolates were whole-genome sequenced and SCCmec elements were assembled, annotated and compared to known SCCmec types. RESULTS AND DISCUSSION Two novel SSCmec are present in these isolates. SCCmec7017-61515 is characterized by a novel combination of a Class A mec gene complex and a type 5 ccr previously only described in composite SCCmec elements. The other three isolates share a novel composite SCCmec with features of SCCmec types IV and VI. CONCLUSIONS S. pseudintermedius is a reservoir of novel SSCmec elements that has implications for understanding antimicrobial resistant in veterinary and human medicine.
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Affiliation(s)
- A C MacFadyen
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush, Midlothian EH25 9RG, UK
| | - G K Paterson
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush, Midlothian EH25 9RG, UK
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3
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Jiang JH, Cameron DR, Nethercott C, Aires-de-Sousa M, Peleg AY. Virulence attributes of successful methicillin-resistant Staphylococcus aureus lineages. Clin Microbiol Rev 2023; 36:e0014822. [PMID: 37982596 PMCID: PMC10732075 DOI: 10.1128/cmr.00148-22] [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] [Indexed: 11/21/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of severe and often fatal infections. MRSA epidemics have occurred in waves, whereby a previously successful lineage has been replaced by a more fit and better adapted lineage. Selection pressures in both hospital and community settings are not uniform across the globe, which has resulted in geographically distinct epidemiology. This review focuses on the mechanisms that trigger the establishment and maintenance of current, dominant MRSA lineages across the globe. While the important role of antibiotic resistance will be mentioned throughout, factors which influence the capacity of S. aureus to colonize and cause disease within a host will be the primary focus of this review. We show that while MRSA possesses a diverse arsenal of toxins including alpha-toxin, the success of a lineage involves more than just producing toxins that damage the host. Success is often attributed to the acquisition or loss of genetic elements involved in colonization and niche adaptation such as the arginine catabolic mobile element, as well as the activity of regulatory systems, and shift metabolism accordingly (e.g., the accessory genome regulator, agr). Understanding exactly how specific MRSA clones cause prolonged epidemics may reveal targets for therapies, whereby both core (e.g., the alpha toxin) and acquired virulence factors (e.g., the Panton-Valentine leukocidin) may be nullified using anti-virulence strategies.
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Affiliation(s)
- Jhih-Hang Jiang
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David R. Cameron
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Cara Nethercott
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Marta Aires-de-Sousa
- Laboratory of Molecular Genetics, Institutode Tecnologia Químicae Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal
- Escola Superior de Saúde da Cruz Vermelha Portuguesa-Lisboa (ESSCVP-Lisboa), Lisbon, Portugal
| | - Anton Y. Peleg
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre to Impact Antimicrobial Resistance, Monash University, Clayton, Melbourne, Victoria, Australia
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4
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Hess KA, Kooda K, Shirley JD, Schuetz AN, Abu Saleh O, Stevens RW. Failure of mecA/mecC PCR Testing to Accurately Predict Oxacillin Resistance in a Patient with Staphylococcus aureus Infective Endocarditis. Antimicrob Agents Chemother 2023; 67:e0043723. [PMID: 37341623 PMCID: PMC10583684 DOI: 10.1128/aac.00437-23] [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: 03/31/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
Genotypic testing for mecA/mecC is heavily relied upon for rapid optimization of antimicrobial therapy in infections due to Staphylococcus aureus. Little is known regarding optimal reporting and/or therapy for patients demonstrating lack of genotypic evidence of mecA or mecC but phenotypic oxacillin resistance. We report a case of a 77-year-old patient with S. aureus bloodstream infection and infective endocarditis with discordance between mecA/mecC genotypic results and phenotypic susceptibility testing.
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Affiliation(s)
- Kyle A. Hess
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Kirstin Kooda
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua D. Shirley
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Audrey N. Schuetz
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan W. Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
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5
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Lade H, Kim JS. Molecular Determinants of β-Lactam Resistance in Methicillin-Resistant Staphylococcus aureus (MRSA): An Updated Review. Antibiotics (Basel) 2023; 12:1362. [PMID: 37760659 PMCID: PMC10525618 DOI: 10.3390/antibiotics12091362] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
The development of antibiotic resistance in Staphylococcus aureus, particularly in methicillin-resistant S. aureus (MRSA), has become a significant health concern worldwide. The acquired mecA gene encodes penicillin-binding protein 2a (PBP2a), which takes over the activities of endogenous PBPs and, due to its low affinity for β-lactam antibiotics, is the main determinant of MRSA. In addition to PBP2a, other genetic factors that regulate cell wall synthesis, cell signaling pathways, and metabolism are required to develop high-level β-lactam resistance in MRSA. Although several genetic factors that modulate β-lactam resistance have been identified, it remains unclear how they alter PBP2a expression and affect antibiotic resistance. This review describes the molecular determinants of β-lactam resistance in MRSA, with a focus on recent developments in our understanding of the role of mecA-encoded PBP2a and on other genetic factors that modulate the level of β-lactam resistance. Understanding the molecular determinants of β-lactam resistance can aid in developing novel strategies to combat MRSA.
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Affiliation(s)
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea;
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6
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Gherardi G. Staphylococcus aureus Infection: Pathogenesis and Antimicrobial Resistance. Int J Mol Sci 2023; 24:ijms24098182. [PMID: 37175886 PMCID: PMC10179453 DOI: 10.3390/ijms24098182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Staphylococcus aureus, a Gram-positive, coagulase-positive pathogen belonging to the family Staphylococcaceae with a spherical shape that forms grape-like clusters, is a commensal that is often present asymptomatically on parts of the human body [...].
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Affiliation(s)
- Giovanni Gherardi
- Clinical Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Applied Microbiological Science Unit, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
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7
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Oluduro AO, Adesiyan YM, Omoboye OO, Odeyemi AT. Phenotypic and molecular characterization of Staphylococcus aureus from mobile phones in Nigeria. AIMS Microbiol 2023; 9:402-418. [PMID: 37649800 PMCID: PMC10462460 DOI: 10.3934/microbiol.2023021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 09/01/2023] Open
Abstract
The presence of Staphylococcus aureus, a normal human flora on cellphones of different professionals in Ile-Ife was investigated with a view to determining their antibiotic susceptibility profile and nature of resistance and virulence genes. One hundred swab samples were collected aseptically from mobile phones of various users based on their profession. Surfaces of the mobile phones were swabbed and the streak plate method was used to isolate colonies showing characteristic golden yellow on mannitol salt agar plates. These isolates were further identified using standard microbiological methods. The antibiotic susceptibility of the isolates was determined using Kirby-Bauer's disk diffusion technique. Molecular detection of nuc, mecA and pvl genes in some isolates was carried out by polymerase chain reaction technique. All the 36 isolates obtained in this study were 100% resistant to amoxicillin and augmentin; the isolates also displayed 55.6%, 44.4% and 41.7% resistance to ceftriazone, erythromycin and chloramphenicol, respectively. Based on resistance to oxacillin, prevalence of methicillin resistant Staphylococcus aureus (MRSA) was 11.1%. Only one S. aureus was positive for plasmid analysis. MecA gene was genetically confirmed in four (4) out of the 16 suspected phenotypic MRSA strains, nuc gene was confirmed in all 28 isolates investigated, while there was no pvl gene in the strains investigated. Mobile phones harbor multiple antibiotics resistant S. aureus, which are responsible for important diseases in humans and could be difficult to manage with antibiotics thereby posing serious health risks.
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Affiliation(s)
- Anthonia O. Oluduro
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - Yetunde M. Adesiyan
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - Olumide O. Omoboye
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - Adebowale T. Odeyemi
- Landmark University SDG Groups 2 and 3; Department of Food Sciences and Microbiology, Landmark University, Omu-Aran, Kwara State, Nigeria
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8
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Baran A, Kwiatkowska A, Potocki L. Antibiotics and Bacterial Resistance-A Short Story of an Endless Arms Race. Int J Mol Sci 2023; 24:ijms24065777. [PMID: 36982857 PMCID: PMC10056106 DOI: 10.3390/ijms24065777] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Despite the undisputed development of medicine, antibiotics still serve as first-choice drugs for patients with infectious disorders. The widespread use of antibiotics results from a wide spectrum of their actions encompassing mechanisms responsible for: the inhibition of bacterial cell wall biosynthesis, the disruption of cell membrane integrity, the suppression of nucleic acids and/or proteins synthesis, as well as disturbances of metabolic processes. However, the widespread availability of antibiotics, accompanied by their overprescription, acts as a double-edged sword, since the overuse and/or misuse of antibiotics leads to a growing number of multidrug-resistant microbes. This, in turn, has recently emerged as a global public health challenge facing both clinicians and their patients. In addition to intrinsic resistance, bacteria can acquire resistance to particular antimicrobial agents through the transfer of genetic material conferring resistance. Amongst the most common bacterial resistance strategies are: drug target site changes, increased cell wall permeability to antibiotics, antibiotic inactivation, and efflux pumps. A better understanding of the interplay between the mechanisms of antibiotic actions and bacterial defense strategies against particular antimicrobial agents is crucial for developing new drugs or drug combinations. Herein, we provide a brief overview of the current nanomedicine-based strategies that aim to improve the efficacy of antibiotics.
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Affiliation(s)
- Aleksandra Baran
- Department of Biotechnology, College of Natural Sciences, University of Rzeszów, Pigonia 1, 35-310 Rzeszow, Poland
| | - Aleksandra Kwiatkowska
- Institute of Physical Culture Studies, College of Medical Sciences, University of Rzeszów, ul. Towarnickiego 3, 35-959 Rzeszów, Poland
| | - Leszek Potocki
- Department of Biotechnology, College of Natural Sciences, University of Rzeszów, Pigonia 1, 35-310 Rzeszow, Poland
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9
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Zaher HA, El Baz S, Alothaim AS, Alsalamah SA, Alghonaim MI, Alawam AS, Eraqi MM. Molecular Basis of Methicillin and Vancomycin Resistance in Staphylococcus aureus from Cattle, Sheep Carcasses and Slaughterhouse Workers. Antibiotics (Basel) 2023; 12:antibiotics12020205. [PMID: 36830115 PMCID: PMC9952529 DOI: 10.3390/antibiotics12020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023] Open
Abstract
Staphylococcus aureus (S. aureus) is a serious infection-causing pathogen in humans and animal. In particular, methicillin-resistant S. aureus (MRSA) is considered one of the major life-threatening pathogens due to its rapid resistance to several antibiotics in clinical practice. MRSA strains have recently been isolated in a number of animals utilized in food production processes, and these species are thought to be the important sources of the spread of infection and disease in both humans and animals. The main objective of the current study was to assess the prevalence of drug-resistant S. aureus, particularly vancomycin-resistant S. aureus (VRSA) and MRSA, by molecular methods. To address this issue, a total of three hundred samples (200 meat samples from cattle and sheep carcasses (100 of each), 50 hand swabs, and 50 stool samples from abattoir workers) were obtained from slaughterhouses in Egypt provinces. In total, 19% S. aureus was isolated by standard culture techniques, and the antibiotic resistance was confirmed genotypically by amplification nucA gen. Characteristic resistance genes were identified by PCR with incidence of 31.5%, 19.3%, 8.7%, and 7% for the mecA, VanA, ermA, and tet L genes, respectively, while the aac6-aph gene was not found in any of the isolates. In this study, the virulence genes responsible for S. aureus' resistance to antibiotics had the highest potential for infection or disease transmission to animal carcasses, slaughterhouse workers, and meat products.
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Affiliation(s)
- Hanan A. Zaher
- Food Hygiene and Control Department, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Shimaa El Baz
- Department of Hygiene and Zoonoses, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Abdulaziz S. Alothaim
- Department of Biology, College of Science in Zulfi, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Sulaiman A. Alsalamah
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh 11623, Saudi Arabia
| | - Mohammed Ibrahim Alghonaim
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh 11623, Saudi Arabia
| | - Abdullah S. Alawam
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh 11623, Saudi Arabia
| | - Mostafa M. Eraqi
- Department of Biology, College of Science in Zulfi, Majmaah University, Majmaah 11952, Saudi Arabia
- Microbiology and Immunology Department, Veterinary Research Institute, National Research Centre, Dokki, Giza 12622, Egypt
- Correspondence: ; Tel.: +966-565709849
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10
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Development of a Real-Time Recombinase-Aided Amplification Method to Rapidly Detect Methicillin-Resistant Staphylococcus aureus. Microorganisms 2022; 10:microorganisms10122351. [PMID: 36557604 PMCID: PMC9784193 DOI: 10.3390/microorganisms10122351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/03/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
Methicillin-resistant staphylococcus aureus (MRSA) is a major pathogen responsible for human hospital and community-onset diseases and severe invasive livestock infections. Rapid detection of MRSA is essential to control the spread of MRSA. Conventional identification methods and antibacterial susceptibility tests of MRSA are time-consuming. The commonly used qPCR assay also has the disadvantages of being complicated and expensive, restricting its application in resource-limited clinical laboratories. Here, a real-time fluorescent recombinase-assisted amplification (RAA) assay targeting the most conserved regions within the mecA gene of MRSA was developed and evaluated to detect MRSA. The detection limit of this assay was determined to be 10 copies/reaction of positive plasmids. The established RAA assay showed high specificity for MRSA detection without cross-reactivities with other clinically relevant bacteria. The diagnostic performance of real-time RAA was evaluated using 67 clinical S. aureus isolates from dairy farms, which were detected in parallel using the TaqMan probe qPCR assay. The results showed that 56 and 54 samples tested positive for MRSA by RAA and qPCR, respectively. The overall agreement between both assays was 97.01% (65/67), with a kappa value of 0.9517 (p < 0.001). Further linear regression analysis demonstrated that the detection results between the two assays were significantly correlated (R2 = 0.9012, p < 0.0001), indicating that this RAA assay possesses similar detection performance to the qPCR assay. In conclusion, our newly established RAA assay is a time-saving and convenient diagnostic tool suitable for MRSA detection and screening.
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11
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Lade H, Joo HS, Kim JS. Molecular Basis of Non-β-Lactam Antibiotics Resistance in Staphylococcus aureus. Antibiotics (Basel) 2022; 11:1378. [PMID: 36290036 PMCID: PMC9598170 DOI: 10.3390/antibiotics11101378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/22/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most successful human pathogens with the potential to cause significant morbidity and mortality. MRSA has acquired resistance to almost all β-lactam antibiotics, including the new-generation cephalosporins, and is often also resistant to multiple other antibiotic classes. The expression of penicillin-binding protein 2a (PBP2a) is the primary basis for β-lactams resistance by MRSA, but it is coupled with other resistance mechanisms, conferring resistance to non-β-lactam antibiotics. The multiplicity of resistance mechanisms includes target modification, enzymatic drug inactivation, and decreased antibiotic uptake or efflux. This review highlights the molecular basis of resistance to non-β-lactam antibiotics recommended to treat MRSA infections such as macrolides, lincosamides, aminoglycosides, glycopeptides, oxazolidinones, lipopeptides, and others. A thorough understanding of the molecular and biochemical basis of antibiotic resistance in clinical isolates could help in developing promising therapies and molecular detection methods of antibiotic resistance.
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Affiliation(s)
- Harshad Lade
- Department of Laboratory Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, Korea
| | - Hwang-Soo Joo
- Department of Biotechnology, College of Engineering, Duksung Women’s University, Seoul 01369, Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, Korea
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12
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Sultana S, Parvin R, Parvin MS, Islam MT, Bari ASM, Chowdhury EH. Prevalence of Methicillin and β−Lactamase Resistant Pathogens Associated with Oral and Periodontal Disease of Children in Mymensingh, Bangladesh. Pathogens 2022; 11:pathogens11080890. [PMID: 36015011 PMCID: PMC9414569 DOI: 10.3390/pathogens11080890] [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: 07/03/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Oral and periodontal diseases (OPD) is considered one of the main problems of dentistry worldwide. This study aimed to estimate the prevalence of oral and periodontal pathogenic bacteria along with their antimicrobial resistance pattern in 131 children patients aged between 4–10 years who attended in Mymensingh Medical College Hospital during October 2019 to March 2020. OPD pathogens were identified through isolation, cultural and biochemical properties, and nucleic acid detection. The isolates were subjected to antimicrobial susceptibility to 12 antibiotics commonly used in dentistry. In addition, the isolates were analyzed molecularly for the presence of six virulence and three antibacterial resistance genes. Five pathogens were identified, of which Staphylococcus aureus (S. aureus) (49%) and S. salivarius (46%) were noticed frequently; other bacteria included S. mutans (16.8%), S. sobrinus (0.8%) and L. fermentum (13.7%). The virulence genes—clumping factor A (clfA) was detected in 62.5% isolates of S. aureus, and gelatinase enzyme E (gelE) gene was detected in 5% isolates of S. salivarius, while other virulence genes were not detected. All the tested isolates were multidrug-resistant. The overall prevalence of MDR S. aureus, Streptococcus spp. and L. fermentum was 92.2%, 95.1% and 100%, respectively. It was observed that a high proportion of isolates were found resistant to 5–8 antibiotics. A majority of S. aureus, Streptococcus spp., and L. fermentum isolates tested positive for the β−lactamase resistance genes blaTEM and cfxA, as well as the methicillin resistance gene mecA. Phylogenetically, the resistance genes showed variable genetic character among Bangladeshi bacterial pathogens. In conclusion, S. aureus and S. salivarius were major OPD pathogens in patients attended in Mymensingh Medical College Hospital of Bangladesh, and most were Beta-lactam and methicillin resistant.
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Affiliation(s)
- Sharmin Sultana
- Department of Pathology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Rokshana Parvin
- Department of Pathology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Mst. Sonia Parvin
- Population Medicine and AMR Laboratory, Department of Medicine, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Md. Taohidul Islam
- Population Medicine and AMR Laboratory, Department of Medicine, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Abu Saleh Mahfuzul Bari
- Department of Pathology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Emdadul Haque Chowdhury
- Department of Pathology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
- Correspondence:
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13
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Prior CD, Moodley A, Karama M, Malahlela MN, Leisewitz A. Prevalence of methicillin resistance in
Staphylococcus pseudintermedius
isolates from dogs with skin and ear infections in South Africa. J S Afr Vet Assoc 2022. [DOI: 10.36303/jsava.2022.93.1.505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- CD Prior
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria,
South Africa
| | - A Moodley
- International Livestock Research Institute,
Kenya
| | - M Karama
- Veterinary Public Health Section, Faculty of Veterinary Science, University of Pretoria,
South Africa
| | - MN Malahlela
- Veterinary Public Health Section, Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria,
South Africa
| | - A Leisewitz
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria,
South Africa
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14
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Recent Developments in Methicillin-Resistant Staphylococcus aureus (MRSA) Treatment: A Review. Antibiotics (Basel) 2022; 11:antibiotics11050606. [PMID: 35625250 PMCID: PMC9137690 DOI: 10.3390/antibiotics11050606] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022] Open
Abstract
Staphylococcus aureus (S. aureus) is a Gram-positive bacterium that may cause life-threatening diseases and some minor infections in living organisms. However, it shows notorious effects when it becomes resistant to antibiotics. Strain variants of bacteria, viruses, fungi, and parasites that have become resistant to existing multiple antimicrobials are termed as superbugs. Methicillin is a semisynthetic antibiotic drug that was used to inhibit staphylococci pathogens. The S. aureus resistant to methicillin is known as methicillin-resistant Staphylococcus aureus (MRSA), which became a superbug due to its defiant activity against the antibiotics and medications most commonly used to treat major and minor infections. Successful MRSA infection management involves rapid identification of the infected site, culture and susceptibility tests, evidence-based treatment, and appropriate preventive protocols. This review describes the clinical management of MRSA pathogenesis, recent developments in rapid diagnosis, and antimicrobial treatment choices for MRSA.
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15
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Uehara Y. Current Status of Staphylococcal Cassette Chromosome mec (SCC mec). Antibiotics (Basel) 2022; 11:antibiotics11010086. [PMID: 35052963 PMCID: PMC8772726 DOI: 10.3390/antibiotics11010086] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/18/2022] Open
Abstract
Staphylococcal cassette chromosome mec (SCCmec) typing was established in the 2000s and has been employed as a tool for the molecular epidemiology of methicillin-resistant Staphylococcus aureus, as well as the evolution investigation of Staphylococcus species. Molecular cloning and the conventional sequencing of SCCmec have been adopted to verify the presence and structure of a novel SCCmec type, while convenient PCR-based SCCmec identification methods have been used in practical settings for many years. In addition, whole-genome sequencing has been widely used, and various SCCmec and similar structures have been recently identified in various species. The current status of the SCCmec types, SCCmec subtypes, rules for nomenclature, and multiple methods for identifying SCCmec types and subtypes were summarized in this review, according to the perspective of the International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements.
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Affiliation(s)
- Yuki Uehara
- Department of Microbiology, Faculty of Medicine, Juntendo University, Tokyo 113-0033, Japan; or ; Tel.: +81-3-3541-5151
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo 113-0033, Japan
- Department of Clinical Laboratory, St. Luke’s International Hospital, Tokyo 104-8560, Japan
- Department of Infectious Diseases, St. Luke’s International Hospital, Tokyo 104-8560, Japan
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16
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Sobur MA, Islam MS, Haque ZF, Orubu ESF, Toniolo A, Choudhury MA, Rahman MT. Higher seasonal temperature enhances the occurrence of methicillin resistance of Staphylococcus aureus in house flies (Musca domestica) under hospital and environmental settings. Folia Microbiol (Praha) 2021; 67:109-119. [PMID: 34569031 DOI: 10.1007/s12223-021-00922-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
Antimicrobial resistance (AMR) emergence in commensal and pathogenic bacteria is a global health issue. House flies (Musca domestica) are considered as biological and mechanical vectors for pathogens causing nosocomial infections, including methicillin-resistant Staphylococcus aureus (MRSA). However, the prevalence of antimicrobial resistance and the role of temperature on the occurrence of Staphylococcus aureus and MRSA in house flies in a hospital environment have not been studied. A total of 400 house flies were collected in winter and summer from four hospital-associated areas in Mymensingh, Bangladesh. Detection of S. aureus and MRSA in flies was done by culturing, staining, and PCR methods targeting nuc and mec genes (mecA and mecC), respectively. Disc diffusion test was used to detect resistance phenotype against six antimicrobials. Logistic regression models were constructed to assess the effect of temperature on the frequency of antimicrobial resistance, and on the presence of the nuc and mecA genes, and location of samples in and around a hospital environment. By PCR, S. aureus was detected in 208 (52%) samples. High frequencies of resistance (≥ 80% of isolates) to amoxicillin, azithromycin, and oxacillin were observed by disk diffusion test. Increase in temperature had a positive effect on the occurrence of S. aureus and MRSA isolates as well as on their resistance to individual and multiple antimicrobials. Among the study areas, hospital premises had increased odds of having S. aureus. Increased temperature of summer significantly increased the occurrence of MRSA in house flies in and around the hospital environment, which might pose a human and animal health risk.
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Affiliation(s)
- Md Abdus Sobur
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Md Saiful Islam
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Zobayda Farzana Haque
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Ebiowei Samuel F Orubu
- Institute for Health System Innovation and Policy, Boston University, 180 Riverway, Boston, MA, 02215, USA
| | - Antonio Toniolo
- Global Virus Network, University of Insubria, 21100, Varese, Italy
| | - Md Abu Choudhury
- Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan, Queensland, 4111, Australia
| | - Md Tanvir Rahman
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh.
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17
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Dhungel S, Rijal KR, Yadav B, Dhungel B, Adhikari N, Shrestha UT, Adhikari B, Banjara MR, Ghimire P. Methicillin-Resistant Staphylococcus aureus (MRSA): Prevalence, Antimicrobial Susceptibility Pattern, and Detection of mecA Gene among Cardiac Patients from a Tertiary Care Heart Center in Kathmandu, Nepal. Infect Dis (Lond) 2021; 14:11786337211037355. [PMID: 34483665 PMCID: PMC8414605 DOI: 10.1177/11786337211037355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Methicillin Resistant Staphylococcus aureus (MRSA) is a
significant human pathogen associated with nosocomial infections.
mecA in the S. aureus is a marker of
MRSA. The main objective of this study was to detect mecA
and vanA genes conferring resistance in S.
aureus among cardiac patients attending Sahid Gangalal National
Heart Centre (SGNHC), Kathmandu, Nepal between May and November 2019. Methods: A total of 524 clinical samples (blood, urine, sputum) were collected and
processed. Bacterial isolates were tested for antimicrobial susceptibility
test (AST) and screening for MRSA was carried out by cefoxitin disc
diffusion method. Minimum inhibitory concentration (MIC) of vancomycin for
MRSA was established by agar dilution method and chromosomal DNA was
extracted and used in polymerase chain reaction targeting the
mecA and vanA genes. Results: Out of 524 specimens, 27.5% (144/524) showed bacterial growth. Among 144
culture positive isolates, S. aureus (27.1%; 39/144) was
the predominant bacteria. Among 39 S. aureus isolates, all
isolates were found resistant to penicillin followed by erythromycin (94.9%;
37/39), gentamicin (94.9%; 37/39) and cefoxitin (87.2%; 34/39). Out of 39
S. aureus, 87.2% (34/39) were MRSA. Among 34 MRSA, 8.8%
(3/34) were vancomycin intermediate S. aureus (VISA). None
of the MRSA was resistant to vancomycin. All of the 3 VISA isolates were
obtained from inpatients. Of 39 S. aureus, 82.1% (32/39)
harbored mecA gene. Similarly, the entire VISA isolates and
94.1% (32/34) of the MRSA isolates were tested positive for
mecA gene. Conclusions: High prevalence of MRSA among the cardiac patients indicates the increasing
burden of drug resistance among bacterial isolates. Since infection control
is the crucial step in coping with the burgeoning antimicrobial resistance
in the country, augmentation of diagnostic facilities with routine
monitoring of drug resistance is recommended.
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Affiliation(s)
- Sajina Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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18
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Patel JS, Norambuena J, Al-Tameemi H, Ahn YM, Perryman AL, Wang X, Daher SS, Occi J, Russo R, Park S, Zimmerman M, Ho HP, Perlin DS, Dartois V, Ekins S, Kumar P, Connell N, Boyd JM, Freundlich JS. Bayesian Modeling and Intrabacterial Drug Metabolism Applied to Drug-Resistant Staphylococcus aureus. ACS Infect Dis 2021; 7:2508-2521. [PMID: 34342426 DOI: 10.1021/acsinfecdis.1c00265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We present the application of Bayesian modeling to identify chemical tools and/or drug discovery entities pertinent to drug-resistant Staphylococcus aureus infections. The quinoline JSF-3151 was predicted by modeling and then empirically demonstrated to be active against in vitro cultured clinical methicillin- and vancomycin-resistant strains while also exhibiting efficacy in a mouse peritonitis model of methicillin-resistant S. aureus infection. We highlight the utility of an intrabacterial drug metabolism (IBDM) approach to probe the mechanism by which JSF-3151 is transformed within the bacteria. We also identify and then validate two mechanisms of resistance in S. aureus: one mechanism involves increased expression of a lipocalin protein, and the other arises from the loss of function of an azoreductase. The computational and experimental approaches, discovery of an antibacterial agent, and elucidated resistance mechanisms collectively hold promise to advance our understanding of therapeutic regimens for drug-resistant S. aureus.
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Affiliation(s)
- Jimmy S. Patel
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers University − New Jersey Medical School, 185 South Orange Ave, Newark, New Jersey 07103, United States
| | - Javiera Norambuena
- Department of Biochemistry and Microbiology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey 08901, United States
| | - Hassan Al-Tameemi
- Department of Biochemistry and Microbiology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey 08901, United States
| | - Yong-Mo Ahn
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers University − New Jersey Medical School, 185 South Orange Ave, Newark, New Jersey 07103, United States
| | - Alexander L. Perryman
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers University − New Jersey Medical School, 185 South Orange Ave, Newark, New Jersey 07103, United States
| | - Xin Wang
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers University − New Jersey Medical School, 185 South Orange Ave, Newark, New Jersey 07103, United States
| | - Samer S. Daher
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers University − New Jersey Medical School, 185 South Orange Ave, Newark, New Jersey 07103, United States
| | - James Occi
- Department of Medicine, Center for Emerging and Re-emerging Pathogens, Rutgers University − New Jersey Medical School, Newark, New Jersey 07103, United States
| | - Riccardo Russo
- Department of Medicine, Center for Emerging and Re-emerging Pathogens, Rutgers University − New Jersey Medical School, Newark, New Jersey 07103, United States
| | - Steven Park
- Public Health Research Institute, Rutgers University − New Jersey Medical School, 225 Warren St, Newark, New Jersey 07103, United States
| | - Matthew Zimmerman
- Public Health Research Institute, Rutgers University − New Jersey Medical School, 225 Warren St, Newark, New Jersey 07103, United States
| | - Hsin-Pin Ho
- Public Health Research Institute, Rutgers University − New Jersey Medical School, 225 Warren St, Newark, New Jersey 07103, United States
| | - David S. Perlin
- Public Health Research Institute, Rutgers University − New Jersey Medical School, 225 Warren St, Newark, New Jersey 07103, United States
| | - Véronique Dartois
- Public Health Research Institute, Rutgers University − New Jersey Medical School, 225 Warren St, Newark, New Jersey 07103, United States
| | - Sean Ekins
- Collaborations in Chemistry, 5616 Hilltop Needmore Road, Fuquay-Varina, North Carolina 27526, United States
| | - Pradeep Kumar
- Department of Medicine, Center for Emerging and Re-emerging Pathogens, Rutgers University − New Jersey Medical School, Newark, New Jersey 07103, United States
| | - Nancy Connell
- Department of Medicine, Center for Emerging and Re-emerging Pathogens, Rutgers University − New Jersey Medical School, Newark, New Jersey 07103, United States
| | - Jeffrey M. Boyd
- Department of Biochemistry and Microbiology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey 08901, United States
| | - Joel S. Freundlich
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers University − New Jersey Medical School, 185 South Orange Ave, Newark, New Jersey 07103, United States
- Department of Medicine, Center for Emerging and Re-emerging Pathogens, Rutgers University − New Jersey Medical School, Newark, New Jersey 07103, United States
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19
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Regecová I, Výrostková J, Zigo F, Gregová G, Kováčová M. Detection of Antimicrobial Resistance of Bacteria Staphylococcus chromogenes Isolated from Sheep's Milk and Cheese. Antibiotics (Basel) 2021; 10:antibiotics10050570. [PMID: 34066038 PMCID: PMC8150534 DOI: 10.3390/antibiotics10050570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022] Open
Abstract
Antimicrobial and multidrug resistance is detected in nonaureus staphylococci, including Staphylococcus chromogenes, which commonly causes intramammary infections. Recent clinical studies point to the presence of methicillin-resistant S. chromogenes. Therefore, this study aims to determine the prevalence of this species in samples of sheep‘s milk and cheeses made from them. Isolates were identified by polymerase chain reaction and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI–TOF). A total of 208 staphylococcal isolates were identified. Of these, 18% were identified as S. chromogenes. The antimicrobial resistance of the identified isolates was determined using the agar dilution method against penicillin, ceftaroline, teicoplanin, gentamicin, erythromycin, tetracycline, and ofloxacin. The highest resistance was found to penicillin (95%), tetracycline (86%), and oxacillin (81%). The highest sensitivity was confirmed for gentamicin (55%). The study also confirmed the presence of methicillin resistant staphylococcal isolates (30%) based on the phenotypic manifestation of antimicrobial resistance and detection of the presence of the mecA gene. The study shows that the tested isolates (62%) were multidrug resistant. Resistance to two antibiotics was most often found (39%).
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Affiliation(s)
- Ivana Regecová
- Department of Food Hygiene, Technology and Safety, The University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81 Košice, Slovakia; (I.R.); (M.K.)
| | - Jana Výrostková
- Department of Food Hygiene, Technology and Safety, The University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81 Košice, Slovakia; (I.R.); (M.K.)
- Correspondence:
| | - František Zigo
- Department of Animal Nutrition and Husbandry, The University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81 Košice, Slovakia;
| | - Gabriela Gregová
- Department of Public Veterinary Medicine and Animal Welfare, The University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81 Košice, Slovakia;
| | - Mariana Kováčová
- Department of Food Hygiene, Technology and Safety, The University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81 Košice, Slovakia; (I.R.); (M.K.)
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20
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Lade H, Kim JS. Bacterial Targets of Antibiotics in Methicillin-Resistant Staphylococcus aureus. Antibiotics (Basel) 2021; 10:398. [PMID: 33917043 PMCID: PMC8067735 DOI: 10.3390/antibiotics10040398] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/17/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent bacterial pathogens and continues to be a leading cause of morbidity and mortality worldwide. MRSA is a commensal bacterium in humans and is transmitted in both community and healthcare settings. Successful treatment remains a challenge, and a search for new targets of antibiotics is required to ensure that MRSA infections can be effectively treated in the future. Most antibiotics in clinical use selectively target one or more biochemical processes essential for S. aureus viability, e.g., cell wall synthesis, protein synthesis (translation), DNA replication, RNA synthesis (transcription), or metabolic processes, such as folic acid synthesis. In this review, we briefly describe the mechanism of action of antibiotics from different classes and discuss insights into the well-established primary targets in S. aureus. Further, several components of bacterial cellular processes, such as teichoic acid, aminoacyl-tRNA synthetases, the lipid II cycle, auxiliary factors of β-lactam resistance, two-component systems, and the accessory gene regulator quorum sensing system, are discussed as promising targets for novel antibiotics. A greater molecular understanding of the bacterial targets of antibiotics has the potential to reveal novel therapeutic strategies or identify agents against antibiotic-resistant pathogens.
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Affiliation(s)
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea;
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21
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França A, Gaio V, Lopes N, Melo LDR. Virulence Factors in Coagulase-Negative Staphylococci. Pathogens 2021; 10:170. [PMID: 33557202 PMCID: PMC7913919 DOI: 10.3390/pathogens10020170] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022] Open
Abstract
Coagulase-negative staphylococci (CoNS) have emerged as major pathogens in healthcare-associated facilities, being S. epidermidis, S. haemolyticus and, more recently, S. lugdunensis, the most clinically relevant species. Despite being less virulent than the well-studied pathogen S. aureus, the number of CoNS strains sequenced is constantly increasing and, with that, the number of virulence factors identified in those strains. In this regard, biofilm formation is considered the most important. Besides virulence factors, the presence of several antibiotic-resistance genes identified in CoNS is worrisome and makes treatment very challenging. In this review, we analyzed the different aspects involved in CoNS virulence and their impact on health and food.
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Affiliation(s)
- Angela França
- Laboratory of Research in Biofilms Rosário Oliveira, Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; (V.G.); (N.L.)
| | | | | | - Luís D. R. Melo
- Laboratory of Research in Biofilms Rosário Oliveira, Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; (V.G.); (N.L.)
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22
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Comparative characterisation of human and ovine non- aureus staphylococci isolated in Sardinia (Italy) for antimicrobial susceptibility profiles and resistance genes. Epidemiol Infect 2021; 149:e45. [PMID: 33509310 PMCID: PMC8060810 DOI: 10.1017/s0950268821000212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We present the comparative characterisation of 195 non-aureus staphylococci (NAS) isolates obtained from sheep (n = 125) and humans (n = 70) in Sardinia, Italy, identified at the species level by gap gene polymerase chain reaction (PCR) followed by restriction fragment length polymorphism analysis with AluI. Isolates were tested phenotypically with a disc diffusion method and genotypically by PCR, for resistance to 11 antimicrobial agents including cationic antiseptic agents. Among the ovine isolates, Staphylococcus epidermidis (n = 57), S. chromogenes (n = 29), S. haemolyticus (n = 17), S. simulans (n = 8) and S. caprae (n = 6) were the most prevalent species, while among human isolates, S. haemolyticus (n = 28) and S. epidermidis (n = 26) were predominant, followed by S. lugdunensis and S. hominis (n = 4). Of the 125 ovine isolates, 79 (63.2%) did not carry any of the resistance genes tested, while the remainder carried resistance genes for at least one antibiotic. The highest resistance rates among ovine isolates were recorded against tetracycline (20.8%), and penicillin (15.2%); none was resistant to methicillin and two exhibited multidrug resistance (MDR); one of which was positive for the antiseptic resistance smr gene. By contrast, most human isolates (59/70, 84.3%) were resistant to ⩾1 antimicrobials, and 41 (58.6%) were MDR. All 52 (74.3%) penicillin-resistant isolates possessed the blaZ gene, and 33 of 70 (47.1%) harboured the mec gene; of these, seven were characterised by the Staphylococcal Chromosomal Cassette (SCCmec) type IV, 6 the type V, 5 of type III and one representative each of type I and type II. The majority (57.1%) was erythromycin-resistant and 17 isolates carried only the efflux msrA gene, 11 the methylase ermC gene and an equal number harboured both of the latter genes. Moreover, 23 (32.8%) were tetracycline-resistant and all but one possessed only the efflux tetK gene. qacA/B and smr genes were detected in 27 (38.6%) and 18 (25.7%) human NAS, respectively. These results underline a marked difference in species distribution and antimicrobial resistance between ovine and human-derived NAS.
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23
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Kranjec C, Morales Angeles D, Torrissen Mårli M, Fernández L, García P, Kjos M, Diep DB. Staphylococcal Biofilms: Challenges and Novel Therapeutic Perspectives. Antibiotics (Basel) 2021; 10:131. [PMID: 33573022 PMCID: PMC7911828 DOI: 10.3390/antibiotics10020131] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 12/14/2022] Open
Abstract
Staphylococci, like Staphylococcus aureus and S. epidermidis, are common colonizers of the human microbiota. While being harmless in many cases, many virulence factors result in them being opportunistic pathogens and one of the major causes of hospital-acquired infections worldwide. One of these virulence factors is the ability to form biofilms-three-dimensional communities of microorganisms embedded in an extracellular polymeric matrix (EPS). The EPS is composed of polysaccharides, proteins and extracellular DNA, and is finely regulated in response to environmental conditions. This structured environment protects the embedded bacteria from the human immune system and decreases their susceptibility to antimicrobials, making infections caused by staphylococci particularly difficult to treat. With the rise of antibiotic-resistant staphylococci, together with difficulty in removing biofilms, there is a great need for new treatment strategies. The purpose of this review is to provide an overview of our current knowledge of the stages of biofilm development and what difficulties may arise when trying to eradicate staphylococcal biofilms. Furthermore, we look into promising targets and therapeutic methods, including bacteriocins and phage-derived antibiofilm approaches.
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Affiliation(s)
- Christian Kranjec
- Faculty of Chemistry, Biotechnology and Food Science, The Norwegian University of Life Sciences, 1432 Ås, Norway; (C.K.); (D.M.A.); (M.T.M.)
| | - Danae Morales Angeles
- Faculty of Chemistry, Biotechnology and Food Science, The Norwegian University of Life Sciences, 1432 Ås, Norway; (C.K.); (D.M.A.); (M.T.M.)
| | - Marita Torrissen Mårli
- Faculty of Chemistry, Biotechnology and Food Science, The Norwegian University of Life Sciences, 1432 Ås, Norway; (C.K.); (D.M.A.); (M.T.M.)
| | - Lucía Fernández
- Department of Technology and Biotechnology of Dairy Products, Dairy Research Institute of Asturias (IPLA-CSIC), 33300 Villaviciosa, Spain; (L.F.); (P.G.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Pilar García
- Department of Technology and Biotechnology of Dairy Products, Dairy Research Institute of Asturias (IPLA-CSIC), 33300 Villaviciosa, Spain; (L.F.); (P.G.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Morten Kjos
- Faculty of Chemistry, Biotechnology and Food Science, The Norwegian University of Life Sciences, 1432 Ås, Norway; (C.K.); (D.M.A.); (M.T.M.)
| | - Dzung B. Diep
- Faculty of Chemistry, Biotechnology and Food Science, The Norwegian University of Life Sciences, 1432 Ås, Norway; (C.K.); (D.M.A.); (M.T.M.)
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24
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Rapid Detection of Methicillin-Resistant Staphylococcus aureus Directly from Blood for the Diagnosis of Bloodstream Infections: A Mini-Review. Diagnostics (Basel) 2020; 10:diagnostics10100830. [PMID: 33076535 PMCID: PMC7602724 DOI: 10.3390/diagnostics10100830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022] Open
Abstract
Staphylococcus aureus represents a major human pathogen able to cause a number of infections, especially bloodstream infections (BSI). Clinical use of methicillin has led to the emergence of methicillin-resistant S. aureus (MRSA) and MRSA-BSI have been reported to be associated with high morbidity and mortality. Clinical diagnosis of BSI is based on the results from blood culture that, although considered the gold standard method, is time-consuming. For this reason, rapid diagnostic tests to identify the presence of methicillin-susceptible S. aureus (MSSA) and MRSA isolates directly in blood cultures are being used with increasing frequency to rapidly commence targeted antimicrobial therapy, also in the light of antimicrobial stewardship efforts. Here, we review and report the most common rapid non-molecular and molecular methods currently available to detect the presence of MRSA directly from blood.
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25
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Willing S, Dyer E, Schneewind O, Missiakas D. FmhA and FmhC of Staphylococcus aureus incorporate serine residues into peptidoglycan cross-bridges. J Biol Chem 2020; 295:13664-13676. [PMID: 32759309 PMCID: PMC7521636 DOI: 10.1074/jbc.ra120.014371] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/03/2020] [Indexed: 12/16/2022] Open
Abstract
Staphylococcal peptidoglycan is characterized by pentaglycine cross-bridges that are cross-linked between adjacent wall peptides by penicillin-binding proteins to confer robustness and flexibility. In Staphylococcus aureus, pentaglycine cross-bridges are synthesized by three proteins: FemX adds the first glycine, and the homodimers FemA and FemB sequentially add two Gly-Gly dipeptides. Occasionally, serine residues are also incorporated into the cross-bridges by enzymes that have heretofore not been identified. Here, we show that the FemA/FemB homologues FmhA and FmhC pair with FemA and FemB to incorporate Gly-Ser dipeptides into cross-bridges and to confer resistance to lysostaphin, a secreted bacteriocin that cleaves the pentaglycine cross-bridge. FmhA incorporates serine residues at positions 3 and 5 of the cross-bridge. In contrast, FmhC incorporates a single serine at position 5. Serine incorporation also lowers resistance toward oxacillin, an antibiotic that targets penicillin-binding proteins, in both methicillin-sensitive and methicillin-resistant strains of S. aureus FmhC is encoded by a gene immediately adjacent to lytN, which specifies a hydrolase that cleaves the bond between the fifth glycine of cross-bridges and the alanine of the adjacent stem peptide. In this manner, LytN facilitates the separation of daughter cells. Cell wall damage induced upon lytN overexpression can be alleviated by overexpression of fmhC. Together, these observations suggest that FmhA and FmhC generate peptidoglycan cross-bridges with unique serine patterns that provide protection from endogenous murein hydrolases governing cell division and from bacteriocins produced by microbial competitors.
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Affiliation(s)
- Stephanie Willing
- Department of Microbiology, University of Chicago, Chicago, Illinois, USA
| | - Emma Dyer
- Department of Microbiology, University of Chicago, Chicago, Illinois, USA
| | - Olaf Schneewind
- Department of Microbiology, University of Chicago, Chicago, Illinois, USA
| | - Dominique Missiakas
- Department of Microbiology, University of Chicago, Chicago, Illinois, USA; Howard Taylor Ricketts Laboratory, Argonne National Laboratory, Lemont, Illinois, USA.
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26
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Dettweiler M, Melander RJ, Porras G, Risener C, Marquez L, Samarakoon T, Melander C, Quave CL. A Clerodane Diterpene from Callicarpa americana Resensitizes Methicillin-Resistant Staphylococcus aureus to β-Lactam Antibiotics. ACS Infect Dis 2020; 6:1667-1673. [PMID: 32579326 DOI: 10.1021/acsinfecdis.0c00307] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The rise of antibiotic resistance presents a significant healthcare challenge and precludes the use of many otherwise valuable antibiotics. One potential solution to this problem is the use of antibiotics in combination with resistance-modifying agents, compounds that act synergistically with existing antibiotics to resensitize previously resistant bacteria. In this study, 12(S),16ξ-dihydroxycleroda-3,13-dien-15,16-olide, a clerodane diterpene isolated from the medicinal plant Callicarpa americana, was found to synergize with oxacillin against methicillin-resistant Staphylococcus aureus. This synergy was confirmed by checkerboard (fractional inhibitory concentration index (FICI) = 0.125) and time-kill assays, with a subinhibitory dose of 12(S),16ξ-dihydroxycleroda-3,13-dien-15,16-olide causing the effective concentration of oxacillin to fall below the susceptibility breakpoint for S. aureus, a >32-fold decrease in both cases.
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Affiliation(s)
- Micah Dettweiler
- Emory University, Department of Dermatology, 615 Michael Street, Whitehead 105L, Atlanta, Georgia 30322, United States
| | - Roberta J. Melander
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556, United States
| | - Gina Porras
- Emory University, Center for the Study of Human Health, 1557 Dickey Drive, Anthropology 306, Atlanta, Georgia 30322, United States
| | - Caitlin Risener
- Emory University, Molecular and Systems Pharmacology Program, 615 Michael Street, Whitehead 115, Atlanta, Georgia 30322, United States
| | - Lewis Marquez
- Emory University, Molecular and Systems Pharmacology Program, 615 Michael Street, Whitehead 115, Atlanta, Georgia 30322, United States
| | - Tharanga Samarakoon
- Emory University Herbarium, 1462 Clifton Road, Atlanta, Georgia 30322, United States
| | - Christian Melander
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556, United States
| | - Cassandra L. Quave
- Emory University, Department of Dermatology, 615 Michael Street, Whitehead 105L, Atlanta, Georgia 30322, United States
- Emory University, Center for the Study of Human Health, 1557 Dickey Drive, Anthropology 306, Atlanta, Georgia 30322, United States
- Emory University, Molecular and Systems Pharmacology Program, 615 Michael Street, Whitehead 115, Atlanta, Georgia 30322, United States
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Cevidanes A, Esperón F, Di Cataldo S, Neves E, Sallaberry-Pincheira N, Millán J. Antimicrobial resistance genes in Andean foxes inhabiting anthropized landscapes in central Chile. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 724:138247. [PMID: 32268291 DOI: 10.1016/j.scitotenv.2020.138247] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
Antimicrobial resistance (AMR) is considered an emerging public health problem. Greater AMR development rate is associated with "antibiotic-using" environments. Wildlife thriving in anthropized landscapes could be good indicators of the burden of AMR and antibiotic resistance genes (ARGs) in these areas. The aim of this study was to determine the presence and load of ARGs in fecal swabs of wild Andean foxes (Lycalopex culpaeus) from anthropized landscapes of central Chile. DNA was extracted from samples of 72 foxes; 22 ARGs encoding resistance against 8 antibiotic groups were evaluated using qPCR. Eighteen of the 22 ARGs were found and tet(Q) (65.3%; 15/72 of the samples) was the most common gene detected. Almost half of the foxes presented a 'multiresistant microbiome' (i.e. at least three ARG encoding resistance to different groups of antimicrobials). Prevalence of tet(Q) was higher in the cold-humid season than in the warm-dry season, but not for other genes. Up to 15 and 13 ARGs were detected in the fecal samples from two additional foxes that were kept 6 and 11 days, respectively, in a clinical environment (Wildlife Rescue Center) and received antibiotic treatment. Some of the ARGs detected (e.g. mecA and blaCTX-M) in the present study are of particular concern from the public health perspective. Wild foxes seem to be good sentinels for ARG environmental burden in highly anthropized environments of central Chile.
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Affiliation(s)
- Aitor Cevidanes
- PhD Program in Conservation Medicine, Facultad de Ciencias de la Vida, Universidad Andres Bello, República 252, Santiago, Chile.
| | - Fernando Esperón
- Grupo de Epidemiología y Sanidad Ambiental, Centro de Investigación en Sanidad Animal (INIA-CISA), Madrid, Spain.
| | - Sophia Di Cataldo
- PhD Program in Conservation Medicine, Facultad de Ciencias de la Vida, Universidad Andres Bello, República 252, Santiago, Chile
| | - Elena Neves
- Grupo de Epidemiología y Sanidad Ambiental, Centro de Investigación en Sanidad Animal (INIA-CISA), Madrid, Spain
| | - Nicole Sallaberry-Pincheira
- Unidad de Rehabilitación de Fauna Silvestre, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, República 252, Santiago, Chile
| | - Javier Millán
- Facultad de Ciencias de la Vida, Universidad Andres Bello, República 440, Santiago, Chile; Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Miguel Servet 177, 50013 Zaragoza, Spain; Fundación ARAID, Avda. de Ranillas, 50018 Zaragoza, Spain
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28
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van Geelen L, Kaschani F, Sazzadeh SS, Adeniyi ET, Meier D, Proksch P, Pfeffer K, Kaiser M, Ioerger TR, Kalscheuer R. Natural brominated phenoxyphenols kill persistent and biofilm-incorporated cells of MRSA and other pathogenic bacteria. Appl Microbiol Biotechnol 2020; 104:5985-5998. [PMID: 32418125 PMCID: PMC8217011 DOI: 10.1007/s00253-020-10654-4] [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: 02/03/2020] [Revised: 04/25/2020] [Accepted: 04/29/2020] [Indexed: 01/02/2023]
Abstract
Due to a high unresponsiveness to chemotherapy, biofilm formation is an important medical problem that frequently occurs during infection with many bacterial pathogens. In this study, the marine sponge-derived natural compounds 4,6-dibromo-2-(2',4'-dibromophenoxy)phenol and 3,4,6-tribromo-2-(2',4'-dibromophenoxy)phenol were found to exhibit broad antibacterial activity against medically relevant gram-positive and gram-negative pathogens. The compounds were not only bactericidal against both replicating and stationary phase-persistent planktonic cells of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa; they also killed biofilm-incorporated cells of both species while not affecting biofilm structural integrity. Moreover, these compounds were active against carbapenemase-producing Enterobacter sp. This simultaneous activity of compounds against different growth forms of both gram-positive and gram-negative bacteria is rare. Genome sequencing of spontaneous resistant mutants and proteome analysis suggest that resistance is mediated by downregulation of the bacterial EIIBC phosphotransferase components scrA and mtlA in MRSA likely leading to a lower uptake of the molecules. Due to their only moderate cytotoxicity against human cell lines, phenoxyphenols provide an interesting new scaffold for development of antimicrobial agents with activity against planktonic cells, persisters and biofilm-incoporated cells of ESKAPE pathogens. KEY POINTS: • Brominated phenoxyphenols kill actively replicating and biofilm-incorporated bacteria. • Phosphotransferase systems mediate uptake of brominated phenoxyphenols. • Downregulation of phosphotransferase systems mediate resistance.
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Affiliation(s)
- Lasse van Geelen
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Farnusch Kaschani
- Center of Medical Biotechnology, Chemical Biology, University Duisburg-Essen, Duisburg, Germany
| | - Shabnam S Sazzadeh
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Emmanuel T Adeniyi
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Dieter Meier
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Peter Proksch
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Klaus Pfeffer
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Markus Kaiser
- Center of Medical Biotechnology, Chemical Biology, University Duisburg-Essen, Duisburg, Germany
| | - Thomas R Ioerger
- Department of Computer Science, Texas A&M University, College Station, TX, USA
| | - Rainer Kalscheuer
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany.
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29
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Ibrahim YM, Abu El-Wafa WM. Evaluation of fosfomycin combined with vancomycin against vancomycin-resistant coagulase negative staphylococci. J Chemother 2020; 32:411-419. [DOI: 10.1080/1120009x.2020.1761638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Yasser Musa Ibrahim
- Department of Microbiology, General Division of Basic Medical Sciences, National Organization for Drug Control and Research (NODCAR), Giza, Egypt
| | - Wael Mohamed Abu El-Wafa
- Department of Microbiology, General Division of Basic Medical Sciences, National Organization for Drug Control and Research (NODCAR), Giza, Egypt
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30
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Potluri PR, Rajendran VK, Sunna A, Wang Y. Rapid and specific duplex detection of methicillin-resistant Staphylococcus aureus genes by surface-enhanced Raman spectroscopy. Analyst 2020; 145:2789-2794. [PMID: 32101179 DOI: 10.1039/c9an01959f] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is considered to be one of the important hospital-acquired pathogens. MRSA is also commonly associated with hospital-acquired infections and mortality. Quantitative and precise detection of MRSA is essential for rapid diagnosis and subsequent effective disease management strategies. We herein developed a highly specific method for rapid MRSA detection that combines surface-enhanced Raman spectroscopy (SERS) nanotags and polymerase chain reaction (PCR). SERS provided the sensitivity and spectral multiplexing capability while PCR provided the specificity required for the assay. The method was tested by the simultaneous detection of two MRSA specific genes (mecA and femA) amplified from genomic DNA isolated from clinical specimens. Magnetic isolation and rapid duplex detection were performed to obtain a detectable signal down to 104 input copies within 80 min. This demonstrated the potential of the SERS-PCR based approach for the accurate identification of MRSA at an early-diagnosis stage. This study also provides an alternative approach to the existing methods for detecting clinical targets without compromising sensitivity and selectivity, and with minimal handling steps. We thus believe that this approach will find a broad application in clinical applications.
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Affiliation(s)
- Phani R Potluri
- Department of Molecular Sciences, Macquarie University, Sydney, Australia.
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31
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Ahmad A, Majaz S, Nouroz F. Two-component systems regulate ABC transporters in antimicrobial peptide production, immunity and resistance. Microbiology (Reading) 2020; 166:4-20. [DOI: 10.1099/mic.0.000823] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Bacteria offer resistance to a broad range of antibiotics by activating their export channels of ATP-binding cassette transporters. These transporters perform a central role in vital processes of self-immunity, antibiotic transport and resistance. The majority of ATP-binding cassette transporters are capable of detecting the presence of antibiotics in an external vicinity and are tightly regulated by two-component systems. The presence of an extracellular loop and an adjacent location of both the transporter and two-component system offers serious assistance to induce a quick and specific response against antibiotics. Both systems have demonstrated their ability of sensing such agents, however, the exact mechanism is not yet fully established. This review highlighted the three key functions of antibiotic resistance, transport and self-immunity of ATP-binding cassette transporters and an adjacent two-component regulatory system.
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Affiliation(s)
- Ashfaq Ahmad
- Department of Bioinformatics, Hazara University, Mansehra, KPK, Pakistan
| | - Sidra Majaz
- Department of Bioinformatics, Hazara University, Mansehra, KPK, Pakistan
| | - Faisal Nouroz
- Department of Bioinformatics, Hazara University, Mansehra, KPK, Pakistan
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32
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Sivakumar M, Dubal ZB, Kumar A, Bhilegaonkar K, Vinodh Kumar OR, Kumar S, Kadwalia A, Shagufta B, Grace MR, Ramees TP, Dwivedi A. Virulent methicillin resistant Staphylococcus aureus (MRSA) in street vended foods. Journal of Food Science and Technology 2019; 56:1116-1126. [PMID: 30956291 DOI: 10.1007/s13197-019-03572-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 12/20/2018] [Accepted: 01/01/2019] [Indexed: 01/21/2023]
Abstract
Street foods are one of the important sources of foodborne infections and Staphylococcus aureus is an important infectious agent transmitted through various sources including street foods. The methicillin-resistant S. aureus (MRSA) are of public health significance, hence the study was taken to assess the street foods as a source of MRSA, for which 430 street vended foods of animal origin (meat, milk, eggs and their products) and associated environmental samples were processed for isolation and characterization. A total of 52 (12.1%) S. aureus were isolated and resistant was observed to oxacillin (36.5%), cefoxitin (25%) and penicillin G (82.7%) by disc diffusion test. On genotypic screening, mecA and blaZ have detected in 17.3% and 69.2% isolates, respectively. The virulence typing identified nuc, coa, clfA, spA, FnbA and enterotoxin A (sea) genes in 100%, 96.2%, 30.8%, 55.8, 50% and 7.7% isolates, respectively. Genetic diversity among the isolates was observed by enterobacterial repetitive intergenic consensus PCR with a D value of 0.77. The presence of virulent MRSA in street vended foods trigger the public health concern and emphasis to educate the consumers and street food vendors about quality and safety of such foods.
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Affiliation(s)
- M Sivakumar
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - Zunjar B Dubal
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - Ashok Kumar
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - Kiran Bhilegaonkar
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - Obli Rajendran Vinodh Kumar
- 2Division of Epidemiology, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - Suman Kumar
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - Anukampa Kadwalia
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - Bi Shagufta
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - M R Grace
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - T P Ramees
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
| | - Anamika Dwivedi
- 1Division of Veterinary Public Health, ICAR-Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, UP 243 122 India
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33
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Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev 2018; 31:e00020-18. [PMID: 30209034 PMCID: PMC6148192 DOI: 10.1128/cmr.00020-18] [Citation(s) in RCA: 783] [Impact Index Per Article: 130.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus, a major human pathogen, has a collection of virulence factors and the ability to acquire resistance to most antibiotics. This ability is further augmented by constant emergence of new clones, making S. aureus a "superbug." Clinical use of methicillin has led to the appearance of methicillin-resistant S. aureus (MRSA). The past few decades have witnessed the existence of new MRSA clones. Unlike traditional MRSA residing in hospitals, the new clones can invade community settings and infect people without predisposing risk factors. This evolution continues with the buildup of the MRSA reservoir in companion and food animals. This review focuses on imparting a better understanding of MRSA evolution and its molecular characterization and epidemiology. We first describe the origin of MRSA, with emphasis on the diverse nature of staphylococcal cassette chromosome mec (SCCmec). mecA and its new homologues (mecB, mecC, and mecD), SCCmec types (13 SCCmec types have been discovered to date), and their classification criteria are discussed. The review then describes various typing methods applied to study the molecular epidemiology and evolutionary nature of MRSA. Starting with the historical methods and continuing to the advanced whole-genome approaches, typing of collections of MRSA has shed light on the origin, spread, and evolutionary pathways of MRSA clones.
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Affiliation(s)
- Sahreena Lakhundi
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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34
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Walker DD, David MZ, Catalano D, Daum R, Gluth MB. In Vitro Susceptibility of Ciprofloxacin-Resistant Methicillin-Resistant Staphylococcus aureus to Ototopical Therapy. Otolaryngol Head Neck Surg 2018. [DOI: 10.1177/0194599818762382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David D. Walker
- Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Michael Z. David
- Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
- Section of Infectious Disease, Department of Pediatrics, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Dominic Catalano
- Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Robert Daum
- Section of Infectious Disease, Department of Pediatrics, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Michael B. Gluth
- Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
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35
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Pinheiro L, Mello PL, Abraão LM, Corrente JE, Lourdes Rs Cunha MD. Evaluation of reference values for phenotypic tests to detect oxacillin resistance in coagulase-negative staphylococci. Future Microbiol 2018. [PMID: 29521121 DOI: 10.2217/fmb-2017-0221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate the adequacy of the disc-diffusion test and E-test® compared with detection of mecA for coagulase-negative staphylococci isolated from blood cultures, nasal swabs and wounds. RESULTS Agreement between all techniques was observed in 65.7% of cases. The greatest discrepancy between mecA/susceptible E-test was observed for non-epidermidis species. A resistance breakpoint ≤19 mm using the oxacillin disc was found to best classify all coagulase-negative staphylococci isolates; Staphylococcus epidermidis, ≤19 mm (oxacillin) and ≤27 mm (cefoxitin); Staphylococcus haemolyticus and Staphylococcus capitis, ≤21 mm (oxacillin) and ≤18 mm (cefoxitin); Staphylococcus warneri, MICs ≥0.75 mg/l. CONCLUSION Although no longer recommended by the Clinical Laboratory Standards Institute, we observed some cases in which only the oxacillin disc-diffusion test detected resistance. The discrepancy between phenotypic tests and mecA is probably due to heterogeneity and borderline resistance.
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Affiliation(s)
- Luiza Pinheiro
- Department of Microbiology & Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil.,Departament of Anatomic Pathology, Instituto Lauro de Souza Lima, Bauru 17034-971, Brazil
| | - Priscila L Mello
- Department of Microbiology & Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil
| | - Ligia M Abraão
- Department of Microbiology & Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil
| | - José Eduardo Corrente
- Department of Biostatistics, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil
| | - Maria de Lourdes Rs Cunha
- Department of Microbiology & Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil
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36
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Hryniewicz MM, Garbacz K. Borderline oxacillin-resistant Staphylococcus aureus (BORSA) – a more common problem than expected? J Med Microbiol 2017; 66:1367-1373. [DOI: 10.1099/jmm.0.000585] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Maria M. Hryniewicz
- Department of Oral Microbiology, Medical University of Gdansk, Dębowa 25, 80-204 Gdansk, Poland
| | - Katarzyna Garbacz
- Department of Oral Microbiology, Medical University of Gdansk, Dębowa 25, 80-204 Gdansk, Poland
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37
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Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract. Microbiol Spectr 2017; 4. [PMID: 27227294 DOI: 10.1128/microbiolspec.uti-0012-2012] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Gram-positive bacteria are a common cause of urinary-tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI.
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Lobanovska M, Pilla G. Penicillin's Discovery and Antibiotic Resistance: Lessons for the Future? THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2017; 90:135-145. [PMID: 28356901 PMCID: PMC5369031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Undoubtedly, the discovery of penicillin is one of the greatest milestones in modern medicine. 2016 marks the 75th anniversary of the first systemic administration of penicillin in humans, and is therefore an occasion to reflect upon the extraordinary impact that penicillin has had on the lives of millions of people since. This perspective presents a historical account of the discovery of the wonder drug, describes the biological nature of penicillin, and considers lessons that can be learned from the golden era of antibiotic research, which took place between the 1940s and 1960s. Looking back at the history of penicillin might help us to relive this journey to find new treatments and antimicrobial agents. This is particularly relevant today as the emergence of multiple drug resistant bacteria poses a global threat, and joint efforts are needed to combat the rise and spread of resistance.
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Affiliation(s)
- Mariya
Lobanovska
- To whom all correspondence should be addressed: Mariya Lobanovska, ; Giulia Pilla,
| | - Giulia Pilla
- To whom all correspondence should be addressed: Mariya Lobanovska, ; Giulia Pilla,
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39
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Schaefer K, Matano LM, Qiao Y, Kahne D, Walker S. In vitro reconstitution demonstrates the cell wall ligase activity of LCP proteins. Nat Chem Biol 2017; 13:396-401. [PMID: 28166208 DOI: 10.1038/nchembio.2302] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
Sacculus is a peptidoglycan (PG) matrix that protects bacteria from osmotic lysis. In Gram-positive organisms, the sacculus is densely functionalized with glycopolymers important for survival, but the way in which assembly occurs is not known. In Staphylococcus aureus, three LCP (LytR-CpsA-Psr) family members have been implicated in attaching the major glycopolymer wall teichoic acid (WTA) to PG, but ligase activity has not been demonstrated for these or any other LCP proteins. Using WTA and PG substrates produced chemoenzymatically, we show that all three proteins can transfer WTA precursors to nascent PGs, establishing that LCP proteins are PG-glycopolymer ligases. Although all S. aureus LCP proteins have the capacity to attach WTA to PG, we show that their cellular functions are not redundant. Strains lacking lcpA have phenotypes similar to those of WTA-null strains, indicating that this is the most important WTA ligase. This work provides a foundation for studying how LCP enzymes participate in cell wall assembly.
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Affiliation(s)
- Kaitlin Schaefer
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts, USA.,Department of Microbiology and Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Leigh M Matano
- Department of Microbiology and Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuan Qiao
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts, USA.,Department of Microbiology and Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Kahne
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Suzanne Walker
- Department of Microbiology and Immunology, Harvard Medical School, Boston, Massachusetts, USA
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Fowoyo PT, Ogunbanwo ST. Antimicrobial resistance in coagulase-negative staphylococci from Nigerian traditional fermented foods. Ann Clin Microbiol Antimicrob 2017; 16:4. [PMID: 28137277 PMCID: PMC5282922 DOI: 10.1186/s12941-017-0181-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/25/2017] [Indexed: 11/12/2022] Open
Abstract
Background Coagulase-negative staphylococci have become increasingly recognized as the etiological agent of some infections. A significant characteristic of coagulase-negative staphylococci especially strains isolated from animals and clinical samples is their resistance to routinely used antibiotics although, resistant strains isolated from fermented foods have not been fully reported. Methods A total of two hundred and fifty-five CoNS isolates were subjected to antimicrobial susceptibility test using the disc diffusion technique. The minimum inhibitory concentration of the isolates to the tested antibiotics was determined using the microbroth dilution method. Methicillin resistant strains were confirmed by detection of methicillin resistant genes (mecA) and also employing cefoxitin screening test. Results The isolates were confirmed to be methicillin resistant by the detection of mecA genes and the cefoxitin screening test. The isolates demonstrated appreciable resistance to ampicillin (86.7%), sulfomethoxazole–trimethoprim (74.9%), amoxicillin–clavulanic acid (52.5%) and oxacillin (35.7%). Methicillin resistance was exhibited by 13 out of the 255 isolates although no mecA gene was detected. It was also observed that the methicillin resistant isolates were prevalent in these traditional foods; iru, kindirmo, nono and wara. Conclusion This study has ameliorated the incidence of multiple antibiotic resistant coagulase-negative staphylococci in Nigerian fermented foods and if not tackled adequately might lead to horizontal transfer of antibiotic resistance from food to man.
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Affiliation(s)
- P T Fowoyo
- Biosciences Department, Salem University, P.M.B. 1060, Lokoja, Kogi State, Nigeria.
| | - S T Ogunbanwo
- Microbiology Department, University of Ibadan, Ibadan, Oyo State, Nigeria
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41
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Matano LM, Morris HG, Wood BM, Meredith TC, Walker S. Accelerating the discovery of antibacterial compounds using pathway-directed whole cell screening. Bioorg Med Chem 2016; 24:6307-6314. [PMID: 27594549 PMCID: PMC5180449 DOI: 10.1016/j.bmc.2016.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/28/2016] [Accepted: 08/03/2016] [Indexed: 12/17/2022]
Abstract
Since the introduction of penicillin into the clinic in 1942, antibiotics have saved the lives of millions of people around the world. While penicillin and other traditional broad spectrum antibiotics were effective as monotherapies, the inexorable spread of antibiotic resistance has made alternative therapeutic approaches necessary. Compound combinations are increasingly seen as attractive options. Such combinations may include: lethal compounds; synthetically lethal compounds; or administering a lethal compound with a nonlethal compound that targets a virulence factor or a resistance factor. Regardless of the therapeutic strategy, high throughput screening is a key approach to discover potential leads. Unfortunately, the discovery of biologically active compounds that inhibit a desired pathway can be a very slow process, and an inordinate amount of time is often spent following up on compounds that do not have the desired biological activity. Here we describe a pathway-directed high throughput screening paradigm that combines the advantages of target-based and whole cell screens while minimizing the disadvantages. By exploiting this paradigm, it is possible to rapidly identify biologically active compounds that inhibit a pathway of interest. We describe some previous successful applications of this paradigm and report the discovery of a new class of d-alanylation inhibitors that may be useful as components of compound combinations to treat methicillin-resistant Staphylococcus aureus (MRSA).
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Affiliation(s)
- Leigh M Matano
- Department of Microbiology and Immunobiology, 4 Blackfan Circle, Boston, MA 02115, USA
| | - Heidi G Morris
- Department of Microbiology and Immunobiology, 4 Blackfan Circle, Boston, MA 02115, USA
| | - B McKay Wood
- Department of Microbiology and Immunobiology, 4 Blackfan Circle, Boston, MA 02115, USA
| | - Timothy C Meredith
- Department of Biochemistry and Molecular Biology, 206 South Frear Laboratory, University Park, PA 16802, USA.
| | - Suzanne Walker
- Department of Microbiology and Immunobiology, 4 Blackfan Circle, Boston, MA 02115, USA.
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Lee SH, Wang H, Labroli M, Koseoglu S, Zuck P, Mayhood T, Gill C, Mann P, Sher X, Ha S, Yang SW, Mandal M, Yang C, Liang L, Tan Z, Tawa P, Hou Y, Kuvelkar R, DeVito K, Wen X, Xiao J, Batchlett M, Balibar CJ, Liu J, Xiao J, Murgolo N, Garlisi CG, Sheth PR, Flattery A, Su J, Tan C, Roemer T. TarO-specific inhibitors of wall teichoic acid biosynthesis restore β-lactam efficacy against methicillin-resistant staphylococci. Sci Transl Med 2016; 8:329ra32. [PMID: 26962156 DOI: 10.1126/scitranslmed.aad7364] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The widespread emergence of methicillin-resistant Staphylococcus aureus (MRSA) has dramatically eroded the efficacy of current β-lactam antibiotics and created an urgent need for new treatment options. We report an S. aureus phenotypic screening strategy involving chemical suppression of the growth inhibitory consequences of depleting late-stage wall teichoic acid biosynthesis. This enabled us to identify early-stage pathway-specific inhibitors of wall teichoic acid biosynthesis predicted to be chemically synergistic with β-lactams. We demonstrated by genetic and biochemical means that each of the new chemical series discovered, herein named tarocin A and tarocin B, inhibited the first step in wall teichoic acid biosynthesis (TarO). Tarocins do not have intrinsic bioactivity but rather demonstrated potent bactericidal synergy in combination with broad-spectrum β-lactam antibiotics against diverse clinical isolates of methicillin-resistant staphylococci as well as robust efficacy in a murine infection model of MRSA. Tarocins and other inhibitors of wall teichoic acid biosynthesis may provide a rational strategy to develop Gram-positive bactericidal β-lactam combination agents active against methicillin-resistant staphylococci.
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Affiliation(s)
- Sang Ho Lee
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Hao Wang
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Marc Labroli
- Merck Research Laboratories, West Point, PA 19486, USA
| | | | - Paul Zuck
- Merck Research Laboratories, West Point, PA 19486, USA
| | - Todd Mayhood
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Charles Gill
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Paul Mann
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Xinwei Sher
- Merck Research Laboratories, Boston, MA 02115, USA
| | - Sookhee Ha
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Shu-Wei Yang
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Mihir Mandal
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | | | - Lianzhu Liang
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Zheng Tan
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Paul Tawa
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Yan Hou
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | | | | | - Xiujuan Wen
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Jing Xiao
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | | | | | - Jenny Liu
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Jianying Xiao
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | | | | | - Payal R Sheth
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Amy Flattery
- Merck Research Laboratories, Kenilworth, NJ 07033, USA
| | - Jing Su
- Merck Research Laboratories, Kenilworth, NJ 07033, USA.
| | | | - Terry Roemer
- Merck Research Laboratories, Kenilworth, NJ 07033, USA.
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Staphylococcal chromosomal cassettes mec (SCCmec): A mobile genetic element in methicillin-resistant Staphylococcus aureus. Microb Pathog 2016; 101:56-67. [PMID: 27836760 DOI: 10.1016/j.micpath.2016.10.028] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 11/23/2022]
Abstract
Considered to be a potential "superbug", methicillin-resistant Staphylococcus aureus (MRSA) has been one of the major recent infectious pathogens and thus poses a challenge to hospital infection control. The mobile genetic element staphylococcal chromosomal cassette mec (SCCmec) carries both the mecA or mecC gene, encoding for a novel specific penicillin-binding protein (PBP2a), and site-specific recombinase genes ccrAB or/and ccrC. In MRSA, the acquisition of SCCmec leads to the resistance to the β-lactam antibiotics. As SCCmec plays a core role in the antimicrobial resistance characteristics, molecular epidemiology and evolution of MRSA, a thorough summary and comprehensive understanding of the prevalence and structural characteristics of SCCmec may aid in global surveillance, implementation and investigation on MRSA isolates, as well as further development of preventive and therapeutic approaches. Consequently, this review is aimed at describing the history, prevalence, types and subtypes, and current typing methods of SCCmec, with the focus on the typical structures of the SCCmec cassette.
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Missiakas D, Schneewind O. Staphylococcus aureus vaccines: Deviating from the carol. J Exp Med 2016; 213:1645-53. [PMID: 27526714 PMCID: PMC4995089 DOI: 10.1084/jem.20160569] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/29/2016] [Indexed: 12/27/2022] Open
Abstract
Staphylococcus aureus, a commensal of the human nasopharynx and skin, also causes invasive disease, most frequently skin and soft tissue infections. Invasive disease caused by drug-resistant strains, designated MRSA (methicillin-resistant S. aureus), is associated with failure of antibiotic therapy and elevated mortality. Here we review polysaccharide-conjugate and subunit vaccines that were designed to prevent S. aureus infection in patients at risk of bacteremia or surgical wound infection but failed to reach their clinical endpoints. We also discuss vaccines with ongoing trials for combinations of polysaccharide-conjugates and subunits. S. aureus colonization and invasive disease are not associated with the development of protective immune responses, which is attributable to a large spectrum of immune evasion factors. Two evasive strategies, assembly of protective fibrin shields via coagulases and protein A-mediated B cell superantigen activity, are discussed as possible vaccine targets. Although correlates for protective immunity are not yet known, opsonophagocytic killing of staphylococci by phagocytic cells offers opportunities to establish such criteria.
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Affiliation(s)
| | - Olaf Schneewind
- Department of Microbiology, University of Chicago, Chicago, IL 60637
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45
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Classic Spotlight: Molecular Biology of Methicillin Resistance in Staphylococcus aureus. J Bacteriol 2016; 198:1903. [PMID: 27354105 DOI: 10.1128/jb.00277-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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46
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Negi B, Kumar D, Kumbukgolla W, Jayaweera S, Ponnan P, Singh R, Agarwal S, Rawat DS. Anti-methicillin resistant Staphylococcus aureus activity, synergism with oxacillin and molecular docking studies of metronidazole-triazole hybrids. Eur J Med Chem 2016; 115:426-37. [DOI: 10.1016/j.ejmech.2016.03.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/12/2016] [Accepted: 03/16/2016] [Indexed: 01/09/2023]
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Bouchami O, de Lencastre H, Miragaia M. Impact of Insertion Sequences and Recombination on the Population Structure of Staphylococcus haemolyticus. PLoS One 2016; 11:e0156653. [PMID: 27249649 PMCID: PMC4889114 DOI: 10.1371/journal.pone.0156653] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/17/2016] [Indexed: 12/11/2022] Open
Abstract
Staphylococcus haemolyticus is one of the most common pathogens associated with medical-device related infections, but its molecular epidemiology is poorly explored. In the current study, we aimed to better understand the genetic mechanisms contributing to S. haemolyticus diversity in the hospital environment and their impact on the population structure and clinical relevant phenotypic traits. The analysis of a representative S. haemolyticus collection by multilocus sequence typing (MLST) has identified a single highly prevalent and diverse genetic lineage of nosocomial S. haemolyticus clonal complex (CC) 29 accounting for 91% of the collection of isolates disseminated worldwide. The examination of the sequence changes at MLST loci during clonal diversification showed that recombination had a higher impact than mutation in shaping the S. haemolyticus population. Also, we ascertained that another mechanism contributing significantly to clonal diversification and adaptation was mediated by insertion sequence (IS) elements. We found that all nosocomial S. haemolyticus, belonging to different STs, were rich in IS1272 copies, as determined by Southern hybridization of macrorestriction patterns. In particular, we observed that the chromosome of a S. haemolyticus strain within CC29 was highly unstable during serial growth in vitro which paralleled with IS1272 transposition events and changes in clinically relevant phenotypic traits namely, mannitol fermentation, susceptibility to beta-lactams, biofilm formation and hemolysis. Our results suggest that recombination and IS transposition might be a strategy of adaptation, evolution and pathogenicity of the major S. haemolyticus prevalent lineage in the hospital environment.
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Affiliation(s)
- Ons Bouchami
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica (ITQB) António Xavier, Oeiras, Portugal
- Laboratory of Bacterial Evolution and Molecular Epidemiology, Instituto de Tecnologia Química e Biológica (ITQB) António Xavier, Oeiras, Portugal
| | - Herminia de Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica (ITQB) António Xavier, Oeiras, Portugal
- Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, New York, United States of America
| | - Maria Miragaia
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica (ITQB) António Xavier, Oeiras, Portugal
- Laboratory of Bacterial Evolution and Molecular Epidemiology, Instituto de Tecnologia Química e Biológica (ITQB) António Xavier, Oeiras, Portugal
- * E-mail:
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48
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Karmakar A, Dua P, Ghosh C. Biochemical and Molecular Analysis of Staphylococcus aureus Clinical Isolates from Hospitalized Patients. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2016; 2016:9041636. [PMID: 27366185 PMCID: PMC4904573 DOI: 10.1155/2016/9041636] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/29/2016] [Accepted: 04/10/2016] [Indexed: 11/17/2022]
Abstract
Staphylococcus aureus is opportunistic human as well as animal pathogen that causes a variety of diseases. A total of 100 Staphylococcus aureus isolates were obtained from clinical samples derived from hospitalized patients. The presumptive Staphylococcus aureus clinical isolates were identified phenotypically by different biochemical tests. Molecular identification was done by PCR using species specific 16S rRNA primer pairs and finally 100 isolates were found to be positive as Staphylococcus aureus. Screened isolates were further analyzed by several microbiological diagnostics tests including gelatin hydrolysis, protease, and lipase tests. It was found that 78%, 81%, and 51% isolates were positive for gelatin hydrolysis, protease, and lipase activities, respectively. Antibiogram analysis of isolated Staphylococcus aureus strains with respect to different antimicrobial agents revealed resistance pattern ranging from 57 to 96%. Our study also shows 70% strains to be MRSA, 54.3% as VRSA, and 54.3% as both MRSA and VRSA. All the identified isolates were subjected to detection of mecA, nuc, and hlb genes and 70%, 84%, and 40% were found to harbour mecA, nuc, and hlb genes, respectively. The current investigation is highly important and informative for the high level multidrug resistant Staphylococcus aureus infections inclusive also of methicillin and vancomycin.
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Affiliation(s)
- Amit Karmakar
- Microbiology Laboratory, Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, West Bengal 721102, India
| | - Parimal Dua
- Microbiology Laboratory, Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, West Bengal 721102, India
| | - Chandradipa Ghosh
- Microbiology Laboratory, Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, West Bengal 721102, India
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49
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Chen X, Shang F, Meng Y, Li L, Cui Y, Zhang M, Qi K, Xue T. Ethanol extract of Sanguisorba officinalis L. inhibits biofilm formation of methicillin-resistant Staphylococcus aureus in an ica-dependent manner. J Dairy Sci 2015; 98:8486-91. [PMID: 26454299 DOI: 10.3168/jds.2015-9899] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/22/2015] [Indexed: 11/19/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen that shows resistance to many antibiotics and is usually associated with serious infections. Having the ability for biofilm formation increases resistance to antibiotics. Sanguisorba officinalis L. is a perennial plant that is distributed in the northern districts of China and has been used as a traditional Chinese medicine. In this study, the effect of S. officinalis on MRSA strain SA3 isolated from a dairy cow with mastitis was evaluated by testing the growth and biofilm formation ability of MRSA cultured with or without ethanol extracts of S. officinalis. The results showed that the ethanol extract of S. officinalis strongly inhibited the biofilm formation of MRSA. With a confocal laser scanning microscope system, we observed that the biofilm structure of the test group with the addition of S. officinalis appeared looser and had less biomass compared with the control group without S. officinalis. Furthermore, we found that the transcript levels of the icaADBC operon remarkably decreased upon addition of the ethanol extract of S. officinalis, indicating that S. officinalis inhibits biofilm formation of MRSA in an ica-dependent manner.
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Affiliation(s)
- Xiaolin Chen
- School of Life Sciences, Anhui Agricultural University, Hefei, Anhui 230036, China
| | - Fei Shang
- School of Life Sciences, Anhui Agricultural University, Hefei, Anhui 230036, China
| | - Yajing Meng
- School of Life Sciences, Anhui Agricultural University, Hefei, Anhui 230036, China
| | - Long Li
- School of Life Sciences, Anhui Agricultural University, Hefei, Anhui 230036, China
| | - Yunmei Cui
- School of Sciences, Anhui Agricultural University, Hefei, Anhui 230036, China
| | - Ming Zhang
- School of Life Sciences, Anhui Agricultural University, Hefei, Anhui 230036, China
| | - Kezong Qi
- College of Animal Science and Technology, Anhui Agricultural University, Hefei, Anhui 230036, China.
| | - Ting Xue
- School of Life Sciences, Anhui Agricultural University, Hefei, Anhui 230036, China.
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50
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Joffe D, Goulding F, Langelier K, Magyar G, McCurdy L, Milstein M, Nielsen K, Villemaire S. Prevalence of methicillin-resistant staphylococci in canine pyoderma cases in primary care veterinary practices in Canada: A preliminary study. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2015; 56:1084-6. [PMID: 26483585 PMCID: PMC4572828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pyoderma in dogs is most commonly caused by Staphylococcus spp., and significant emergence of methicillin resistance in staphylococcal pyoderma has been reported. This preliminary study of the prevalence of methicillin resistance in canine pyoderma cases in Canadian primary care veterinary practices revealed that methicillin-resistant Staphylococcus spp. were present in 12.1% of 149 staphylococcal positive skin culture cases.
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Affiliation(s)
- Daniel Joffe
- Calgary Animal Referral and Emergency Centre, 7140-12th Street SE, Calgary, Alberta T2H 2Y4 (Joffe); Shawnessy South Pet Hospital, 144, 70 Shawville Blvd. SW, Calgary, Alberta T2Y 2Z3 (Goulding); Island Veterinary Hospital, 1800 Bowen Road, Nanaimo, British Columbia V9S 5W4 (Langelier); Burlington Animal Hospital, 1231 Guelph Line, Burlington, Ontario L7P 2T1 (Magyar); Harvest Hills Veterinary Clinic, 711, 500 Country Hills Blvd. NE, Calgary, Alberta T3K 4Y7 (McCurdy); Blueridge-Cove Animal Hospital, 165 Riverside Drive W, North Vancouver, British Columbia V7H 1T6 (Milstein); Pretoria Pet Hospital, 16 Pretoria Avenue, Ottawa, Ontario K1S 1W7 (Nielsen); Hôpital Vétérinaire St-Eustache, 281 rue Hector-Lanthier, Saint-Eustache, Québec J7P 5R1 (Villemaire)
| | - Fiona Goulding
- Calgary Animal Referral and Emergency Centre, 7140-12th Street SE, Calgary, Alberta T2H 2Y4 (Joffe); Shawnessy South Pet Hospital, 144, 70 Shawville Blvd. SW, Calgary, Alberta T2Y 2Z3 (Goulding); Island Veterinary Hospital, 1800 Bowen Road, Nanaimo, British Columbia V9S 5W4 (Langelier); Burlington Animal Hospital, 1231 Guelph Line, Burlington, Ontario L7P 2T1 (Magyar); Harvest Hills Veterinary Clinic, 711, 500 Country Hills Blvd. NE, Calgary, Alberta T3K 4Y7 (McCurdy); Blueridge-Cove Animal Hospital, 165 Riverside Drive W, North Vancouver, British Columbia V7H 1T6 (Milstein); Pretoria Pet Hospital, 16 Pretoria Avenue, Ottawa, Ontario K1S 1W7 (Nielsen); Hôpital Vétérinaire St-Eustache, 281 rue Hector-Lanthier, Saint-Eustache, Québec J7P 5R1 (Villemaire)
| | - Ken Langelier
- Calgary Animal Referral and Emergency Centre, 7140-12th Street SE, Calgary, Alberta T2H 2Y4 (Joffe); Shawnessy South Pet Hospital, 144, 70 Shawville Blvd. SW, Calgary, Alberta T2Y 2Z3 (Goulding); Island Veterinary Hospital, 1800 Bowen Road, Nanaimo, British Columbia V9S 5W4 (Langelier); Burlington Animal Hospital, 1231 Guelph Line, Burlington, Ontario L7P 2T1 (Magyar); Harvest Hills Veterinary Clinic, 711, 500 Country Hills Blvd. NE, Calgary, Alberta T3K 4Y7 (McCurdy); Blueridge-Cove Animal Hospital, 165 Riverside Drive W, North Vancouver, British Columbia V7H 1T6 (Milstein); Pretoria Pet Hospital, 16 Pretoria Avenue, Ottawa, Ontario K1S 1W7 (Nielsen); Hôpital Vétérinaire St-Eustache, 281 rue Hector-Lanthier, Saint-Eustache, Québec J7P 5R1 (Villemaire)
| | - Gabor Magyar
- Calgary Animal Referral and Emergency Centre, 7140-12th Street SE, Calgary, Alberta T2H 2Y4 (Joffe); Shawnessy South Pet Hospital, 144, 70 Shawville Blvd. SW, Calgary, Alberta T2Y 2Z3 (Goulding); Island Veterinary Hospital, 1800 Bowen Road, Nanaimo, British Columbia V9S 5W4 (Langelier); Burlington Animal Hospital, 1231 Guelph Line, Burlington, Ontario L7P 2T1 (Magyar); Harvest Hills Veterinary Clinic, 711, 500 Country Hills Blvd. NE, Calgary, Alberta T3K 4Y7 (McCurdy); Blueridge-Cove Animal Hospital, 165 Riverside Drive W, North Vancouver, British Columbia V7H 1T6 (Milstein); Pretoria Pet Hospital, 16 Pretoria Avenue, Ottawa, Ontario K1S 1W7 (Nielsen); Hôpital Vétérinaire St-Eustache, 281 rue Hector-Lanthier, Saint-Eustache, Québec J7P 5R1 (Villemaire)
| | - Les McCurdy
- Calgary Animal Referral and Emergency Centre, 7140-12th Street SE, Calgary, Alberta T2H 2Y4 (Joffe); Shawnessy South Pet Hospital, 144, 70 Shawville Blvd. SW, Calgary, Alberta T2Y 2Z3 (Goulding); Island Veterinary Hospital, 1800 Bowen Road, Nanaimo, British Columbia V9S 5W4 (Langelier); Burlington Animal Hospital, 1231 Guelph Line, Burlington, Ontario L7P 2T1 (Magyar); Harvest Hills Veterinary Clinic, 711, 500 Country Hills Blvd. NE, Calgary, Alberta T3K 4Y7 (McCurdy); Blueridge-Cove Animal Hospital, 165 Riverside Drive W, North Vancouver, British Columbia V7H 1T6 (Milstein); Pretoria Pet Hospital, 16 Pretoria Avenue, Ottawa, Ontario K1S 1W7 (Nielsen); Hôpital Vétérinaire St-Eustache, 281 rue Hector-Lanthier, Saint-Eustache, Québec J7P 5R1 (Villemaire)
| | - Moe Milstein
- Calgary Animal Referral and Emergency Centre, 7140-12th Street SE, Calgary, Alberta T2H 2Y4 (Joffe); Shawnessy South Pet Hospital, 144, 70 Shawville Blvd. SW, Calgary, Alberta T2Y 2Z3 (Goulding); Island Veterinary Hospital, 1800 Bowen Road, Nanaimo, British Columbia V9S 5W4 (Langelier); Burlington Animal Hospital, 1231 Guelph Line, Burlington, Ontario L7P 2T1 (Magyar); Harvest Hills Veterinary Clinic, 711, 500 Country Hills Blvd. NE, Calgary, Alberta T3K 4Y7 (McCurdy); Blueridge-Cove Animal Hospital, 165 Riverside Drive W, North Vancouver, British Columbia V7H 1T6 (Milstein); Pretoria Pet Hospital, 16 Pretoria Avenue, Ottawa, Ontario K1S 1W7 (Nielsen); Hôpital Vétérinaire St-Eustache, 281 rue Hector-Lanthier, Saint-Eustache, Québec J7P 5R1 (Villemaire)
| | - Kia Nielsen
- Calgary Animal Referral and Emergency Centre, 7140-12th Street SE, Calgary, Alberta T2H 2Y4 (Joffe); Shawnessy South Pet Hospital, 144, 70 Shawville Blvd. SW, Calgary, Alberta T2Y 2Z3 (Goulding); Island Veterinary Hospital, 1800 Bowen Road, Nanaimo, British Columbia V9S 5W4 (Langelier); Burlington Animal Hospital, 1231 Guelph Line, Burlington, Ontario L7P 2T1 (Magyar); Harvest Hills Veterinary Clinic, 711, 500 Country Hills Blvd. NE, Calgary, Alberta T3K 4Y7 (McCurdy); Blueridge-Cove Animal Hospital, 165 Riverside Drive W, North Vancouver, British Columbia V7H 1T6 (Milstein); Pretoria Pet Hospital, 16 Pretoria Avenue, Ottawa, Ontario K1S 1W7 (Nielsen); Hôpital Vétérinaire St-Eustache, 281 rue Hector-Lanthier, Saint-Eustache, Québec J7P 5R1 (Villemaire)
| | - Stephanie Villemaire
- Calgary Animal Referral and Emergency Centre, 7140-12th Street SE, Calgary, Alberta T2H 2Y4 (Joffe); Shawnessy South Pet Hospital, 144, 70 Shawville Blvd. SW, Calgary, Alberta T2Y 2Z3 (Goulding); Island Veterinary Hospital, 1800 Bowen Road, Nanaimo, British Columbia V9S 5W4 (Langelier); Burlington Animal Hospital, 1231 Guelph Line, Burlington, Ontario L7P 2T1 (Magyar); Harvest Hills Veterinary Clinic, 711, 500 Country Hills Blvd. NE, Calgary, Alberta T3K 4Y7 (McCurdy); Blueridge-Cove Animal Hospital, 165 Riverside Drive W, North Vancouver, British Columbia V7H 1T6 (Milstein); Pretoria Pet Hospital, 16 Pretoria Avenue, Ottawa, Ontario K1S 1W7 (Nielsen); Hôpital Vétérinaire St-Eustache, 281 rue Hector-Lanthier, Saint-Eustache, Québec J7P 5R1 (Villemaire)
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