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García-Castillo M, Hernández-García M, Correa A, Coppi M, Griener T, Fritsche T, Pitart C, Sampaio J, Seifert H, Wake K, Wootton M, Vila J, Cantón R. In vitro activity of ozenoxacin against Staphylococcus aureus and Streptococcus pyogenes clinical isolates recovered in a worldwide multicentre study (2020-2022). JAC Antimicrob Resist 2024; 6:dlae088. [PMID: 38872714 PMCID: PMC11170484 DOI: 10.1093/jacamr/dlae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Objectives We performed a multicentre study (2020-2022) to compare the in vitro activity of ozenoxacin and comparator agents against Staphylococcus aureus and Streptococcus pyogenes clinical isolates from skin and soft-tissue infections (SSTI). Methods A total of 1725 isolates (1454 S. aureus and 271 S. pyogenes) were collected in 10 centres from eight countries between January 2020 and December 2022. Antimicrobial susceptibility testing was determined (microdilution-SENSITITRE). Results were interpreted following European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2023 (clinical breakpoints, ECOFF) and CLSI criteria. Results Ozenoxacin exhibited high in vitro activity against S. aureus (MIC50/90 = 0.002/0.12 mg/L) and S. pyogenes (MIC50/90 = 0.015/0.03 mg/L), inhibiting 99% of the isolates at MIC ≤ 0.5 mg/L and at MIC ≤ 0.06, respectively. The most active comparators against S. aureus were retapamulin (MIC90 = 0.12 mg/L), fusidic acid (MIC90 = 0.25 mg/L) and mupirocin (MIC90 = 0.5 mg/L); and against S. pyogenes were retapamulin (MIC90 = 0.03 mg/L), clindamycin (MIC90 = 0.12 mg/L) and mupirocin (MIC90 = 0.25 mg/L). Ciprofloxacin and methicillin resistant rates for S. aureus were 31.3% (455/1454) and 41% (598/1454), respectively. Additionally, 62% (373/598) of the MRSA were also ciprofloxacin non-susceptible, whereas only 10% (23/271) of the MSSA were ciprofloxacin resistant. Ozenoxacin was more active against ciprofloxacin-susceptible S. aureus than against ciprofloxacin-resistant isolates, and showed a slightly higher MIC in MRSA isolates than in MSSA. However, ozenoxacin activity was comparable in both ciprofloxacin-resistant MSSA and MRSA subsets. On the other hand, ozenoxacin had similar activity in ciprofloxacin-susceptible and resistant S. pyogenes isolates. Conclusions Ozenoxacin is a potent antimicrobial agent of topic use against Gram-positive bacteria causing SSTI, including MRSA isolates non-susceptible to ciprofloxacin.
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Affiliation(s)
- María García-Castillo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto Salud Carlos III, Madrid, Spain
| | - Marta Hernández-García
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto Salud Carlos III, Madrid, Spain
| | - Adriana Correa
- Clínica Imbanaco Grupo Quirón Salud, Cali, Valle del Cauca, Colombia
- Universidad Santiago de Cali, Cali, Valle del Cauca, Colombia
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Thomas Griener
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, Alberta, Canada
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Fritsche
- Division of Laboratory Medicine, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Cristina Pitart
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Clinic, Barcelona, Spain
| | - Jorge Sampaio
- Department of Clinical and Toxicological Analyses, School of Pharmacy, University of São Paulo, São Paulo, Brazil
| | - Harald Seifert
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Institute of Translational Research, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Karen Wake
- Canadian Antimicrobial Resistance Alliance, Health Sciences Centre University of Manitoba, Manitoba, Canada
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - Jordi Vila
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Clinic, Barcelona, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto Salud Carlos III, Madrid, Spain
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Yin N, Michel C, Makki N, Deplano A, Milis A, Prevost B, Miendje-Deyi VY, Hallin M, Martiny D. Emergence and spread of a mupirocin-resistant variant of the European epidemic fusidic acid-resistant impetigo clone of Staphylococcus aureus, Belgium, 2013 to 2023. Euro Surveill 2024; 29:2300668. [PMID: 38726693 PMCID: PMC11083972 DOI: 10.2807/1560-7917.es.2024.29.19.2300668] [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: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 05/12/2024] Open
Abstract
BackgroundAntimicrobial resistance to mupirocin and fusidic acid, which are used for treatment of skin infections caused by Staphylococcus aureus, is of concern.AimTo investigate resistance to fusidic acid and mupirocin in meticillin-susceptible S. aureus (MSSA) from community-acquired skin and soft tissue infections (SSTIs) in Belgium.MethodsWe collected 2013-2023 data on fusidic acid and mupirocin resistance in SSTI-associated MSSA from two large Belgian laboratories. Resistant MSSA isolates sent to the Belgian Staphylococci Reference Centre were spa-typed and analysed for the presence of the eta and etb virulence genes and the mupA resistance gene. In addition, we whole genome sequenced MSSA isolates collected between October 2021 and September 2023.ResultsMupirocin resistance increased between 2013 and 2023 from 0.5-1.5% to 1.7-5.6%. Between 2018 and 2023, 91.4% (64/70) of mupirocin-resistant isolates were co-resistant to fusidic acid. By September 2023, between 8.9% (15/168) and 10.1% (11/109) of children isolates from the two laboratories were co-resistant. Of the 33 sequenced isolates, 29 were sequence type 121, clonal and more distantly related to the European epidemic fusidic acid-resistant impetigo clone (EEFIC) observed in Belgium in 2020. These isolates carried the mupA and fusB genes conferring resistance to mupirocin and fusidic acid, respectively, and the eta and etb virulence genes.ConclusionWe highlight the spread of a mupirocin-resistant EEFIC in children, with a seasonal trend for the third quarter of the year. This is of concern because this variant is resistant to the two main topical antibiotics used to treat impetigo in Belgium.
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Affiliation(s)
- Nicolas Yin
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
| | - Charlotte Michel
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
| | - Nadia Makki
- Department of microbiology, Algemeen Medisch Laboratorium (AML), Antwerp, Belgium
| | - Ariane Deplano
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
| | - Alisha Milis
- Department of microbiology, Algemeen Medisch Laboratorium (AML), Antwerp, Belgium
| | - Benoit Prevost
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
| | | | - Marie Hallin
- Centre for environmental health and occupational health, Public health school, Université libre de Bruxelles, Brussels, Belgium
- European Plotkin institute for vaccinology (EPIV), Faculty of medicine, Université libre de Bruxelles, Brussels, Belgium
- These authors contributed equally to the work and share the last authorship
| | - Delphine Martiny
- National reference centre for Staphylococcus aureus and other species, Department of microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Université libre de Bruxelles, Brussels, Belgium
- Faculty of medicine and pharmacy, Université de Mons, Mons, Belgium
- These authors contributed equally to the work and share the last authorship
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You C, Wu Z, Liao M, Ye X, Li L, Yang T. Associated Outcomes of Different Intravenous Antibiotics Combined with 2% Mupirocin Ointment in the Treatment of Pediatric Patients with Staphylococcal Scalded Skin Syndrome. Clin Cosmet Investig Dermatol 2023; 16:1691-1701. [PMID: 37404367 PMCID: PMC10315143 DOI: 10.2147/ccid.s417764] [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: 04/18/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023]
Abstract
Purpose To compare treatment duration, influencing factors, and costs among intravenous antibiotic groups combined with 2% mupirocin ointment for treating staphylococcal scalded skin syndrome (SSSS). Patients and Methods Sex, age, onset days before admission, febrile status, white blood cell (WBC) count, and C-reactive protein (CRP) level were recorded as baseline characteristics for 253 included patients. The antibiotic sensitivity results were statistically compared by Cochran's Q test. Kruskal-Wallis tests were used to compare days and the total costs of hospitalization with different intravenous antibiotic applications. Mann-Whitney U-tests or Spearman's rank correlation tests were used for the univariate analysis. Finally, a multivariate linear regression model was employed to determine the variables with statistical significance. Results The sensitivity rates of oxacillin (84.62%), vancomycin (100%), and mupirocin (100%) were significantly higher than those of clindamycin (7.69%) (p<0.0001). The duration of intravenous ceftriaxone administration was significantly longer than that of amoxicillin-clavulanic acid, cefathiamidine, and cefuroxime (p<0.01). The total hospitalization costs for cefathiamidine were significantly higher than those for amoxicillin-clavulanic acid and cefuroxime (p<0.05). According to the multiple linear regression, ages ≥60 months old were correlated with shorter treatment duration (β=-1.48, [95% CI: -2.29, -0.66] for amoxicillin-clavulanic acid, and β=-1.44, [95% CI: -2.06, -0.83] for cefathiamidine, and β=-0.96, [95% CI: -1.58, -0.34] for cefuroxime) (all p<0.01). In multivariate analysis for cefathiamidine, higher WBC count (β=0.05, [95% CI: 0.01, 0.10], p<0.05) and CRP level (β=1.12, [95% CI: 0.14, 2.10], p<0.05) were associated with longer treatment course. Conclusion Oxacillin resistance was rare, and clindamycin resistance was high in pediatric patients with SSSS in our district. Intravenous amoxicillin-clavulanic acid and cefuroxime combined with topical mupirocin were favorable due to a shorter intravenous treatment course and lower costs. Younger age, elevated WBC count, and CRP levels could indicate a longer course of treatment with intravenous antibiotics.
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Affiliation(s)
- Cong You
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Zhiwei Wu
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Mingyi Liao
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Xiaoying Ye
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Longnian Li
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Tao Yang
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
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Vendrik KEW, Kuijper EJ, Dimmendaal M, Silvis W, Denie-Verhaegh E, de Boer A, Postma B, Schoffelen AF, Ruijs WLM, Koene FMHPA, Petrignani M, Hooiveld M, Witteveen S, Schouls LM, Notermans DW. An unusual outbreak in the Netherlands: community-onset impetigo caused by a meticillin-resistant Staphylococcus aureus with additional resistance to fusidic acid, June 2018 to January 2020. Euro Surveill 2022; 27:2200245. [PMID: 36695440 PMCID: PMC9732922 DOI: 10.2807/1560-7917.es.2022.27.49.2200245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022] Open
Abstract
In this retrospective observational study, we analysed a community outbreak of impetigo with meticillin-resistant Staphylococcus aureus (MRSA), with additional resistance to fusidic acid (first-line treatment). The outbreak occurred between June 2018 and January 2020 in the eastern part of the Netherlands with an epidemiological link to three cases from the north-western part. Forty nine impetigo cases and eight carrier cases were identified, including 47 children. All but one impetigo case had community-onset of symptoms. Pharmacy prescription data for topical mupirocin and fusidic acid and GP questionnaires suggested an underestimated outbreak size. The 57 outbreak isolates were identified by the Dutch MRSA surveillance as MLVA-type MT4627 and sequence type 121, previously reported only once in 2014. Next-generation sequencing revealed they contained a fusidic acid resistance gene, exfoliative toxin genes and an epidermal cell differentiation inhibitor gene. Whole-genome multilocus sequence typing revealed genetic clustering of all 19 sequenced isolates from the outbreak region and isolates from the three north-western cases. The allelic distances between these Dutch isolates and international isolates were high. This outbreak shows the appearance of community-onset MRSA strains with additional drug resistance and virulence factors in a country with a low prevalence of antimicrobial resistance.
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Affiliation(s)
- Karuna E W Vendrik
- Leiden University Medical Center, Leiden, the Netherlands
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Ed J Kuijper
- Leiden University Medical Center, Leiden, the Netherlands
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Marieke Dimmendaal
- Municipal health service North and East Gelderland, Warnsveld, The Netherlands
| | - Welmoed Silvis
- Laboratory for Medical Microbiology and Public Health (LabMicTA), Hengelo, The Netherlands
| | | | | | - Bent Postma
- Slingeland Hospital, Doetinchem, The Netherlands
| | - Annelot F Schoffelen
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Wilhelmina L M Ruijs
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Fleur M H P A Koene
- Medical Laboratory Services, Willemstad, Curacao
- Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Sandra Witteveen
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Leo M Schouls
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Daan W Notermans
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
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Weiss A, Delavenne E, Matias C, Lagler H, Simon D, Li P, Hansen JU, Dos Santos TP, Jana B, Priemel P, Bangert C, Bauer M, Eberl S, Nussbaumer-Pröll A, Anne Österreicher Z, Matzneller P, Quint T, Weber M, Nielsen HM, Rades T, Johansen HK, Westh H, Kim W, Mylonakis E, Friis C, Guardabassi L, Pace J, Lundberg CV, M'Zali F, Butty P, Sørensen N, Nielsen HB, Toft-Kehler R, Guttman-Yassky E, Stingl G, Zeitlinger M, Sommer M. Topical niclosamide (ATx201) reduces Staphylococcus aureus colonization and increases Shannon diversity of the skin microbiome in atopic dermatitis patients in a randomized, double-blind, placebo-controlled Phase 2 trial. Clin Transl Med 2022; 12:e790. [PMID: 35522900 PMCID: PMC9076020 DOI: 10.1002/ctm2.790] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background In patients with atopic dermatitis (AD), Staphylococcus aureus frequently colonizes lesions and is hypothesized to be linked to disease severity and progression. Treatments that reduce S. aureus colonization without significantly affecting the skin commensal microbiota are needed. Methods and findings In this study, we tested ATx201 (niclosamide), a small molecule, on its efficacy to reduce S. aureus and propensity to evolve resistance in vitro. Various cutaneous formulations were then tested in a superficial skin infection model. Finally, a Phase 2 randomized, double‐blind and placebo‐controlled trial was performed to investigate the impact of ATx201 OINTMENT 2% on S. aureus colonization and skin microbiome composition in patients with mild‐to‐severe AD (EudraCT:2016‐003501‐33). ATx201 has a narrow minimal inhibitory concentration distribution (.125–.5 μg/ml) consistent with its mode of action – targeting the proton motive force effectively stopping cell growth. In murine models, ATx201 can effectively treat superficial skin infections of methicillin‐resistant S. aureus. In a Phase 2 trial in patients with mild‐to‐severe AD (N = 36), twice‐daily treatment with ATx201 OINTMENT 2% effectively reduces S. aureus colonization in quantitative colony forming unit (CFU) analysis (primary endpoint: 94.4% active vs. 38.9% vehicle success rate, p = .0016) and increases the Shannon diversity of the skin microbiome at day 7 significantly compared to vehicle. Conclusion These results suggest that ATx201 could become a new treatment modality as a decolonizing agent.
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Affiliation(s)
- Anne Weiss
- UNION Therapeutics, Hellerup, Denmark.,Novo Nordisk Foundation for Biosustainability, Technical University of Denmark, Lyngby, Denmark
| | | | | | - Heimo Lagler
- Department of Medicine 1, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Wien, Austria
| | | | - Ping Li
- UNION Therapeutics, Hellerup, Denmark
| | - Jon U Hansen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Teresa Pires Dos Santos
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Bimal Jana
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Petra Priemel
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Christine Bangert
- Department of Dermatology, Medical University of Vienna, Wien, Austria
| | - Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | - Sabine Eberl
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | | | | | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | - Tamara Quint
- Department of Dermatology, Medical University of Vienna, Wien, Austria
| | - Maria Weber
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | | | - Thomas Rades
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Helle Krogh Johansen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Wooseong Kim
- Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Eleftherios Mylonakis
- Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Christian Friis
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Luca Guardabassi
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - John Pace
- UNION Therapeutics, Hellerup, Denmark
| | | | | | | | | | | | | | | | - Georg Stingl
- Department of Dermatology, Medical University of Vienna, Wien, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | - Morten Sommer
- UNION Therapeutics, Hellerup, Denmark.,Novo Nordisk Foundation for Biosustainability, Technical University of Denmark, Lyngby, Denmark
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Tsirigotaki M, Giormezis N, Maraki S, Spiliopoulou I, Galanakis E. Predominance of community-associated, methicillin-susceptible Staphylococcus aureus infections among hospitalized children and adolescents. J Med Microbiol 2022; 71. [PMID: 35358031 DOI: 10.1099/jmm.0.001511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Staphylococcus aureus infections cause significant morbidity and mortality in children and adolescents.Gap Statement. There is limited data on the characteristics of S. aureus infections requiring hospitalization in childhood.Aim.To investigate the molecular epidemiology and antibiotic resistance of S. aureus clinical isolates from children and adolescents.Methodology.All S. aureus isolates recovered from patients aged <18 years, admitted to a referral hospital, with culture-proven invasive or non-invasive infections during the 4 year period 2015 to 2018 were analysed for antimicrobial resistance, virulence genes, PFGE and multilocus sequence typing (MLST). Cases were assigned to community-associated, community-onset healthcare-associated or hospital-associated infections based on epidemiological case definitions.Results.Among 139 S. aureus infections, 88.5 % (123/139) were caused by methicillin-susceptible isolates (MSSA) and 73.4 % (102/139) were classified as community-associated infections. tst and lukS/lukF-PV genes were more common among MRSA as compared to MSSA isolates (tst, p 0.04; lukS/lukF-PV, p 0.007). Invasive disease was noted in 22/139 patients (15.8 %). Staphylococcal scalded skin syndrome caused by fusidic-resistant MSSA increased over time (22.8 % in 2017-2018 vs 8.3 % in 2015-2016, OR 3.24; 95 % CI 1.10-8.36; P 0.03). By PFGE genotyping, 22 pulsotypes were identified. A total of five sequence types (STs) were identified among 58 isolates analysed by MLST. More than one third of MSSA isolates (40/123, 32.5 %) and 13/23 (56.5 %) of SSSS isolates belonged to pulsotype 1, classified as sequence type 121 (ST121). MRSA isolates were equally distributed to pulsotypes A (ST30), B (ST239), C (ST80), H (ST225). ST121 isolates carried fnbA (40/40), eta/etb genes (29/40), exhibited high resistance to fusidic acid and were increasingly resistant to mupirocin.Conclusion.In our population, community-associated MSSA was the predominant cause of S. aureus infections characterized by polyclonality, increasing resistance to fusidic acid and mupirocin. PFGE type 1 ST121 clone, harboured exfoliative toxin genes and was associated with rising trends of SSSS.
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Affiliation(s)
- Maria Tsirigotaki
- Department of Paediatrics, School of Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Giormezis
- National Reference Laboratory for Staphylococci, School of Medicine, University of Patras, Patras, Greece
| | - Sofia Maraki
- Department of Microbiology, Heraklion University Hospital, Crete, Greece
| | - Iris Spiliopoulou
- National Reference Laboratory for Staphylococci, School of Medicine, University of Patras, Patras, Greece
| | - Emmanouil Galanakis
- Department of Paediatrics, School of Medicine, University of Crete, Heraklion, Greece
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7
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Characteristic, antibiotic resistance and molecular typing of Staphylococcus aureus isolated from intensive care unit and burn patients based on coagulase gene analysis. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Mupirocin-Resistant Staphylococcus aureus in Iran: A Biofilm Production and Genetic Characteristics. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7408029. [PMID: 35075429 PMCID: PMC8783719 DOI: 10.1155/2022/7408029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/29/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
The spread of mupirocin-resistant Staphylococcus aureus strains in hospitals and communities is a universal challenge. Limited data is available on the genetic features of high-level mupirocin resistant- (HLMUPR-) S. aureus isolates in Tehran. In the present research, we investigated 48 high-level mupirocin resistance S. aureus by antimicrobial activity, virulence analysis, biofilm formation, multilocus sequence typing (MLST), and staphylocoagulase (SC) typing. All the HLMUPR strains were positive for mupA gene. The frequency of multidrug resistance was 97.9%. Twenty-one (43.8%) were toxinogenic with 14 producing pvl (29.2%), 5 tst (10.4%), and two eta (4.2%). Among the HLMUPR isolates, biofilm production was detected in 45 (89.6%) isolates with complete dominance clfB, clfA genes, and a noticeably high frequency fnbA (95.8%), followed by fnbB (93.8%), eno and icaD (each 83.3%), sdrC (81.3%), ebps (79.2%), icaA (75%), sdrD (66.7%), fib (60.4%), sdrE (50%), cna (41.7%), and bap (4.2%). Coagulase typing distinguished isolates into four genotypic patterns including III (50%), II (27.1%), and type IVa (22.9%). A total of three clonal complexes (CCs) and 4 sequence types (STs) including CC/ST22 as the most prevalent (52.1%), CC8/ST239 (20.8%), CC/ST8 (16.7%), and CC/ST5 (10.4%) were identified in current work. According to our analysis, nonbiofilm producer isolates belonged to CC8/ST239 (6.3%) and CC/ST8 (4.2%). Fusidic acid-resistant isolates belonged to CC/ST45 (n = 3) and CC8/ST239 (n = 1). Observations highlighted the circulation of the CC/ST22 HLMUPR S. aureus strains with strong biofilm-production ability in our hospitals, indicating the possibility of transmission of this type between community and hospital.
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Azarian T, Cella E, Baines SL, Shumaker MJ, Samel C, Jubair M, Pegues DA, David MZ. Genomic Epidemiology and Global Population Structure of Exfoliative Toxin A-Producing Staphylococcus aureus Strains Associated With Staphylococcal Scalded Skin Syndrome. Front Microbiol 2021; 12:663831. [PMID: 34489877 PMCID: PMC8416508 DOI: 10.3389/fmicb.2021.663831] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022] Open
Abstract
Staphylococci producing exfoliative toxins are the causative agents of staphylococcal scalded skin syndrome (SSSS). Exfoliative toxin A (ETA) is encoded by eta, which is harbored on a temperate bacteriophage ΦETA. A recent increase in the incidence of SSSS in North America has been observed; yet it is largely unknown whether this is the result of host range expansion of ΦETA or migration and emergence of established lineages. Here, we detail an outbreak investigation of SSSS in a neonatal intensive care unit, for which we applied whole-genome sequencing (WGS) and phylogenetic analysis of Staphylococcus aureus isolates collected from cases and screening of healthcare workers. We identified the causative strain as a methicillin-susceptible S. aureus (MSSA) sequence type 582 (ST582) possessing ΦETA. To then elucidate the global distribution of ΦETA among staphylococci, we used a recently developed tool to query extant bacterial WGS data for biosamples containing eta, which yielded 436 genomes collected between 1994 and 2019 from 32 countries. Applying population genomic analysis, we resolved the global distribution of S. aureus with lysogenized ΦETA and assessed antibiotic resistance determinants as well as the diversity of ΦETA. The population is highly structured with eight dominant sequence clusters (SCs) that generally aligned with S. aureus ST clonal complexes. The most prevalent STs included ST109 (24.3%), ST15 (13.1%), ST121 (10.1%), and ST582 (7.1%). Among strains with available data, there was an even distribution of isolates from carriage and disease. Only the SC containing ST121 had significantly more isolates collected from disease (69%, n = 46) than carriage (31%, n = 21). Further, we identified 10.6% (46/436) of strains as methicillin-resistant S. aureus (MRSA) based on the presence of mecA and the SCCmec element. Assessment of ΦETA diversity based on nucleotide identity revealed 27 phylogroups, and prophage gene content further resolved 62 clusters. ΦETA was relatively stable within lineages, yet prophage variation is geographically structured. This suggests that the reported increase in incidence is associated with migration and expansion of existing lineages, not the movement of ΦETA to new genomic backgrounds. This revised global view reveals that ΦETA is diverse and is widely distributed on multiple genomic backgrounds whose distribution varies geographically.
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Affiliation(s)
- Taj Azarian
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL, United States
| | - Eleonora Cella
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL, United States
| | - Sarah L Baines
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Margot J Shumaker
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Carol Samel
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, PA, United States
| | - Mohammad Jubair
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL, United States
| | - David A Pegues
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, United States.,Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael Z David
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, United States
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Yang T, Wang J, Cao J, Zhang X, Lai Y, Li L, Ye X, You C. Antibiotic-resistant profile and the factors affecting the intravenous antibiotic treatment course of generalized Staphylococcal Scalded Skin Syndrome: a retrospective study. Ital J Pediatr 2021; 47:169. [PMID: 34362428 PMCID: PMC8344213 DOI: 10.1186/s13052-021-01120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background Staphylococcal Scalded Skin Syndrome (SSSS) is caused by a special type of Staphylococcus aureus (S.aureus) which can produce exfoliative toxins. The generalized SSSS is recommended to be admitted and treated with intravenous antibiotics. However, there were limited reports on whether personal and clinical factors can have impacts on the duration of intravenous antibiotic application for pediatric patients with generalized SSSS. We performed a study to assess the factors affecting intravenous antibiotic treatment course of SSSS patients. Additionally, the positive culture rates of S.aureus in different samples and the antibiotic-resistant profile were investigated. Methods Two hundred nineteen patients with generalized SSSS were included. Gender, age, area, season, maximum axillary temperature, white blood cell (WBC) count, C-reactive protein (CRP) level, types of intravenous antibiotics, and types of external antibiotics were recorded as the baseline. Simple linear regression was applied in the univariate analysis to determine the variables with statistical significance and then these variables were further examined in multivariate linear regression model. The positive culture rates of S.aureus in different sample sources were calculated and the drug sensitivity results were statistically compared by pairwise Chi square test. Results According to the multiple linear regression, older ages (β = − 0.01, p < 0.05) and external application of fusidic acid (β = − 1.57, p < 0.05) were associated with shorter treatment course, elevated leukocytes (β = 0.11, p < 0.001) and CRP level (β = 1.64, p < 0.01) were associated with longer treatment course. The positive culture rates of periorificial swabs, throat swabs, and blood samples were 54.55, 30.77, and 5.97% respectively. The resistant rates of levofloxacin (8.33%), gentamycin (8.33%), tetracycline (25%), oxacillin (8.33%), vancomycin (0%) were significantly lower than the ones of erythromycin (100%), trimethoprim-sulfamethoxazole (TMP/SMX) (83.33%), clindamycin (91.67%), penicillin G(100%) (p < 0.001). Conclusion Elevated leukocytes and CRP level indicated prolonged intravenous antibiotic treatment course. Older ages and external application of fusidic acid helped to reduce the treatment course. Compared with blood samples, the culture positive rates of S.aureus in periorificial and throat swabs were higher. Oxacillin and vancomycin resistance was rare and clindamycin resistance was common. Clindamycin monotherapy for SSSS should be avoided.
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Affiliation(s)
- Tao Yang
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China
| | - Jiangyi Wang
- Department of Dermatology and Venereology, The General Hospital of Tianjin Medical University, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Junya Cao
- Department of Dermatology and Venereology, The General Hospital of Tianjin Medical University, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xinyue Zhang
- Department of Dermatology and Venereology, The General Hospital of Tianjin Medical University, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Yun Lai
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China
| | - Longnian Li
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China
| | - Xiaoying Ye
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China
| | - Cong You
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China.
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11
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Giormezis N, Doudoulakakis A, Tsilipounidaki K, Militsopoulou M, Kalogeras G, Stamouli V, Kolonitsiou F, Petinaki E, Lebessi E, Spiliopoulou I. Emergence of a mupirocin-resistant, methicillin-susceptible Staphylococcus aureus clone associated with skin and soft tissue infections in Greece. BMC Microbiol 2021; 21:203. [PMID: 34215177 PMCID: PMC8254358 DOI: 10.1186/s12866-021-02272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus causes various infections, including skin and soft tissue infections (SSTIs). In this study, methicillin-susceptible S. aureus (MSSA) from SSTIs among patients in three tertiary-care hospitals in Greece were studied in terms of antimicrobial resistance, clonal distribution, toxin and adhesin genes carriage. RESULTS During a five-year period (2014-2018), 6145 S. aureus were recovered from 13,244 patients with SSTIs and tested for antimicrobial susceptibility. MSSA were 4806 (78.21 %) including 1484 isolates with mupirocin minimum inhibitory concentration (MIC) > 64 mg/L (30.88 %). Two hundred and sixty representative mupirocin-resistant MSSA were analyzed for genes encoding Panton-Valentine leukocidin (PVL, lukS/lukF-PV), exfoliative toxins (eta, etb), adhesin FnbA (fnbA) and resistance genes mupA (high-level resistance to mupirocin), fusB (fusidic acid), aminoglycosides' modifying enzymes, ermA, ermC and msrA (macrolides/lincosamides) by PCRs. Strains were classified into clones by PFGE and MLST. All mupirocin-resistant MSSA were penicillin-resistant; 92.7 % expressed resistance to fusidic acid and 88.9 % to tobramycin. All 260 molecularly analyzed isolates were mupA-positive; all fusidic acid-resistant (241/260) carried fusB whereas, the tobramycin-resistant ones (230), ant(4')-Ia. The majority carried eta (93.85 %), etb (98.08 %) and fnbA (88.85 %). PFGE typing revealed a mostly unvarying population; 260 MSSA were grouped into three types. One major eta/etb-positive clone comprising of 258/260 strains (99.2 %), PFGE type 1, was classified as ST121, including nine strains co-carrying PVL. Another PVL-positive strain was identified as ST1, and one toxins-negative as ST21. CONCLUSIONS A mupirocin-resistant MSSA clone, ST121, carrying resistance, exfoliative toxins and adhesin genes, was spread and predominated in SSTIs from patients in Greece during the five-year studied period.
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Affiliation(s)
- Nikolaos Giormezis
- Department of Microbiology, School of Medicine, University of Patras, 26504, Patras, Greece.,National Reference Laboratory for Staphylococci, University of Patras, Patras, Greece
| | | | | | - Maria Militsopoulou
- Department of Microbiology, University General Hospital of Patras, Patras, Greece
| | - George Kalogeras
- Department of Microbiology P. & A, Kyriakou Children's Hospital, Athens, Greece
| | - Vasiliki Stamouli
- Department of Microbiology, University General Hospital of Patras, Patras, Greece
| | - Fevronia Kolonitsiou
- Department of Microbiology, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Efthimia Petinaki
- Department of Microbiology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Evangelia Lebessi
- Department of Microbiology P. & A, Kyriakou Children's Hospital, Athens, Greece
| | - Iris Spiliopoulou
- Department of Microbiology, School of Medicine, University of Patras, 26504, Patras, Greece. .,National Reference Laboratory for Staphylococci, University of Patras, Patras, Greece.
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12
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Soltani M, Hajikhani B, Zamani S, Haghighi M, Hashemi A, Nasiri MJ, Dadashi M, Pourhossein B, Goudarzi M. Molecular characterization of Staphylococcus aureus strains isolated from hospitalized patients based on coagulase gene polymorphism analysis: High frequency of vancomycin-intermediate S. aureus and the emergence of coagulase type II in Iran. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Hajikhani B, Goudarzi M, Kakavandi S, Amini S, Zamani S, van Belkum A, Goudarzi H, Dadashi M. The global prevalence of fusidic acid resistance in clinical isolates of Staphylococcus aureus: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2021; 10:75. [PMID: 33933162 PMCID: PMC8088720 DOI: 10.1186/s13756-021-00943-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIM Staphylococcus aureus (S. aureus) is one of the most common pathogens causing nosocomial and community-acquired infections with high morbidity and mortality rates. Fusidic acid has been increasingly used for the treatment of infections due to methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA). The present study aimed to determine the precise prevalence of fusidic acid resistant MRSA (FRMRSA), fusidic acid resistant MSSA (FRMSSA), and total fusidic acid resistant S. aureus (FRSA) on a global scale. METHODS Several international databases including Medline, Embase, and the Web of Sciences were searched (2000-2020) to discern studies addressing the prevalence of FRSA, FRMRSA, and FRMSSA. STATA (version14) software was used to interpret the data. RESULTS Of the 1446 records identified from the databases, 215 studies fulfilled the eligibility criteria for the detection of FRSA (208 studies), FRMRSA (143 studies), and FRMSSA (71 studies). The analyses manifested that the global prevalence of FRSA, FRMRSA, and FRMSSA was 0.5%, 2.6% and 6.7%, respectively. CONCLUSION This meta-analysis describes an increasing incidence of FRSA, FRMSSA, and FRMRSA. These results indicate the need for prudent prescription of fusidic acid to stop or diminish the incidence of fusidic acid resistance as well as the development of strategies for monitoring the efficacy of fusidic acid use.
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Affiliation(s)
- Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sareh Kakavandi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sana Amini
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Zamani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alex van Belkum
- Data Analytics Unit, bioMérieux 3, Route de Port Michaud, La Balme Les Grottes, France
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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14
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Navidinia M, Mohammadi A, Arjmand R, Dadashi M, Goudarzi M. Molecular typing, biofilm formation, and analysis of adhesion factors in Staphylococcus aureus strains isolated from urinary tract infections. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2020.101008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Emergence and spread of coagulase type III and staphylococcal cassette chromosome mec type IV among mupirocin-resistant Staphylococcus aureus isolated from wound infections. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Comparative activity of ozenoxacin and other quinolones in Staphylococcus aureus strains overexpressing the efflux pump-encoding genes mepA and norA. Int J Antimicrob Agents 2020; 56:106082. [DOI: 10.1016/j.ijantimicag.2020.106082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/26/2020] [Accepted: 07/05/2020] [Indexed: 11/18/2022]
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17
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Addressing the challenges in antisepsis: focus on povidone iodine. Int J Antimicrob Agents 2020; 56:106064. [DOI: 10.1016/j.ijantimicag.2020.106064] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/21/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
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18
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Torrelo A, Grimalt R, Masramon X, Albareda López N, Zsolt I. Ozenoxacin, a New Effective and Safe Topical Treatment for Impetigo in Children and Adolescents. Dermatology 2020; 236:199-207. [PMID: 31958794 DOI: 10.1159/000504536] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/04/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Ozenoxacin is a topical antibiotic approved in Europe to treat non-bullous impetigo in adults and children aged ≥6 months. This analysis evaluated the efficacy and safety of ozenoxacin in paediatric patients by age group. METHODS Pooled data for patients aged 6 months to <18 years who had participated in a phase I or in two phase III clinical trials of ozenoxacin 1% cream were analysed by age group: 0.5-<2, 2-<6, 6-<12, and 12-<18 years. RESULTS The combined population comprised 529 patients with non-bullous impetigo treated with ozenoxacin (n = 239), vehicle (n = 201), or retapamulin as internal validation control (n = 89). Studies were well matched for extent and severity of impetigo and therapeutic schedule (twice daily application for 5 days). The clinical success rate after 5 days' treatment (day 6-7, end of therapy), and microbiological success rates after 3-4 days' treatment and at the end of therapy, were significantly higher with ozenoxacin than vehicle (p < 0.0001 for all comparisons). Clinical and bacterial eradication rates were higher with ozenoxacin than vehicle in each age group. No safety concerns were identified with ozenoxacin. One (0.3%) of 327 plasma samples exceeded the lower limit of quantification for ozenoxacin, but the low concentration indicated negligible systemic absorption. CONCLUSION This combined analysis supports the efficacy and safety of ozenoxacin administered twice daily for 5 days. Ozenoxacin 1% cream is a new option to consider for treatment of non-bullous impetigo in children aged 6 months to <18 years.
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Affiliation(s)
- Antonio Torrelo
- Department of Dermatology, Children's Hospital del Niño Jesús, Madrid, Spain
| | - Ramon Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Xavier Masramon
- SAIL (Servicio de Asesoría a la Investigación y Logística) SL, Barcelona, Spain
| | | | - Ilonka Zsolt
- Medical Department, Ferrer Internacional SA, Barcelona, Spain,
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Morrissey I, Cantón R, Vila J, Gargallo-Viola D, Zsolt I, Garcia-Castillo M, López Y. Microbiological profile of ozenoxacin. Future Microbiol 2019; 14:773-787. [DOI: 10.2217/fmb-2019-0089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore the antibacterial spectrum of ozenoxacin and compare its in vitro activity with that of other antibacterial agents. Materials & methods: In 2010, 10,054 isolates were collected from 128 centers worldwide. Minimum inhibitory concentrations against Gram-positive and Gram-negative isolates were determined for 23 and 13 antibacterial agents, respectively. Results: Ozenoxacin exhibited high in vitro activity against susceptible, and methicillin- or levofloxacin-resistant, Gram-positive bacteria. Ozenoxacin was one or two dilutions less active against Enterobacteriaceae isolates, except for Escherichia coli, than other quinolones. Conclusion: Ozenoxacin is a potent antimicrobial agent mainly against susceptible and resistant strains of Gram-positive isolates (staphylococci and streptococci), and shows activity against some Gram-negative isolates.
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Affiliation(s)
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Vila
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Service, Biomedical Diagnostic Center, Hospital Clinic, University of Barcelona, Spain
- Institute of Global Health of Barcelona (ISGlobal), Barcelona, Spain
| | | | - Ilonka Zsolt
- Medical Department, Ferrer Internacional, Barcelona, Spain
| | - Maria Garcia-Castillo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Yuly López
- Institute of Global Health of Barcelona (ISGlobal), Barcelona, Spain
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20
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Wang J, Sang L, Chen Y, Sun S, Chen D, Xie X. Characterisation of Staphylococcus aureus strain causing severe respiratory disease in rabbits. WORLD RABBIT SCIENCE 2019. [DOI: 10.4995/wrs.2019.10454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
<em>Staphylococcus aureus</em> is acknowledged as one of the important pathogens isolated from humans and animals. However, the <em>S. aureus</em> causing severe respiratory diseases in rabbits have not been well characterised. A <em>S. aureus</em> named FZHW001, isolated from the lungs of dead rabbits with severe respiratory disease, was characterised by artificial infection of rabbits, detection of virulence factors, multi-locus sequencing typing and antimicrobial susceptibility test. The FZHW001 infected rabbits showed identical respiratory symptoms to those of naturally infected ones, and the isolate could spread through directed contact among rabbits. The isolate was typed into clonal complex 121 and carried 7 of 13 tested virulence factors. Furthermore, the isolate was identified to be methicillin-susceptible <em>S. aureus</em> and was susceptible to 7 of 12 tested antibiotics. This study first describes the characteristics of <em>S. aureus</em> isolated from rabbits causing severe respiratory disease, which will help in further understanding the pathogenic mechanisms of <em>S. aureus</em> in rabbits.
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21
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Zhang F, Bai B, Xu GJ, Lin ZW, Li GQ, Chen Z, Cheng H, Sun X, Wang HY, Chen YW, Zheng JX, Deng QW, Yu ZJ. Eravacycline activity against clinical S. aureus isolates from China: in vitro activity, MLST profiles and heteroresistance. BMC Microbiol 2018; 18:211. [PMID: 30545293 PMCID: PMC6293590 DOI: 10.1186/s12866-018-1349-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Mortality rates for patients with Staphylococcus aureus (S. aureus) infections have improved only modestly in recent decades and S. aureus infections remain a major clinical challenge This study investigated the in vitro antimicrobial activity of erevacycline (erava) against clinical S. aureus isolates from China, as well as the heteroresistance frequency of erava and sequence types (STs) represented in the sample. Results A sample of 328 non-duplicate clinical S. aureus isolates, including 138 methecillin-resistant (MRSA) and 190 methecillin-sensitive (MSSA) isolates, were collected retrospectively in China. Erava exhibited excellent in vitro activity (MIC50 ≤ 0.25 mg/L) against MRSA and MSSA, including isolates harboring Tet specific resistance genes. The frequency of erava heteroresistance in MSSA with erava MICs = 0.5 mg/L was 13.79% (4/29); no MRSA with erava MICs ≤0.5 mg/L exhibited heteroresistance. Heteroresistance- derived clones had no 30S ribosome subunit mutations, but their erava MICs (range, 1–4 mg/L) were suppressed dramatically in the presence of efflux protein inhibitors. Conclusions Conclusively, erava exhibited excellent in vitro activity against S. aureus, however hints of erava heteroresistance risk and MIC creep were detected, particularly among MSSA with MICs of 0.5 mg/L. Electronic supplementary material The online version of this article (10.1186/s12866-018-1349-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fan Zhang
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Department of Tuberculosis, Shenzhen Nanshan Center for Chronic Disease Control, No 7, Huaming Road, Nanshan District, Shenzhen, 518054, China
| | - Bing Bai
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Guang-Jian Xu
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Zhi-Wei Lin
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, 200032, China
| | - Gui-Qiu Li
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Zhong Chen
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, 200032, China
| | - Hang Cheng
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Xiang Sun
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Hong-Yan Wang
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Yan-Wei Chen
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Jin-Xin Zheng
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, 200032, China
| | - Qi-Wen Deng
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China. .,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.
| | - Zhi-Jian Yu
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China. .,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.
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22
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Khoshnood S, Heidary M, Asadi A, Soleimani S, Motahar M, Savari M, Saki M, Abdi M. A review on mechanism of action, resistance, synergism, and clinical implications of mupirocin against Staphylococcus aureus. Biomed Pharmacother 2018; 109:1809-1818. [PMID: 30551435 DOI: 10.1016/j.biopha.2018.10.131] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 12/20/2022] Open
Abstract
Mupirocin (MUP), bactroban, or pseudomonic acid is a natural crotonic acid derivative drug extracted from Pseudomonas fluorescens which is produced by modular polyketide synthases. This antibiotic has a unique chemical structure and mechanism of action. It is a mixture of A-D pseudomonic acids and inhibits protein synthesis through binding to bacterial isoleucyl-tRNA synthetase. MUP is often prescribed to prevent skin and soft tissue infections caused by S. aureus isolates and where the MRSA isolates are epidemic, MUP may be used as a choice drug for nasal decolonization. It is also used for prevention of recurring infections and control the outbreaks. The emergence of MUP resistance has been increasing particularly among methicillin-resistant Staphylococcus aureus (MRSA) isolates in many parts of the world and such resistance is often related with MUP widespread uses. Although both low-level and high-level MUP resistance were reported among MRSA isolates, the rate of resistance is different in various geographic areas. In this review, we will report the global prevalence of MUP resistance, discuss synergism and mechanism of action of MUP, and provide new insights into the clinical use of this antibiotic.
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Affiliation(s)
- Saeed Khoshnood
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Heidary
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Arezoo Asadi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saleh Soleimani
- Department of Biology, Payame Noor University, Isfahan, Iran
| | - Moloudsadat Motahar
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Savari
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Saki
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahtab Abdi
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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23
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Doudoulakakis A, Spiliopoulou I, Syridou G, Giormezis N, Militsopoulou M, Lebessi E, Tsolia M. Emergence of staphylococcal scalded skin syndrome associated with a new toxinogenic, methicillin-susceptible Staphylococcus aureus clone. J Med Microbiol 2018; 68:48-51. [PMID: 30418106 DOI: 10.1099/jmm.0.000871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A sharp increase in staphylococcal scalded skin syndrome (SSSS) cases has been recorded in our settings since 2015, with 31 cases having been documented during the period 2014-2017. The molecular investigation of strains from the above period showed the emergence of a methicillin-susceptible, mupirocin- and fusidic acid-resistant Staphyloccocus aureus clone that belongs to the ST121 complex and carries both epidermolysin (eta/etb) genes. We concluded that the SSSS caused by the newly emerged, highly virulent community-associated-methicillin sensitive S. aureus strains that have been encountered lately is more severe than impetigo. Physicians should be aware of the probability of SSSS epidemics from strains that are resistant to mupirocin and fusidic acid, which have been used irrationally and excessively.
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Affiliation(s)
| | - Iris Spiliopoulou
- 2National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece
| | | | - Nikolaos Giormezis
- 2National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece
| | - Maria Militsopoulou
- 2National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece
| | - Evangelia Lebessi
- 1Department of Microbiology P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Maria Tsolia
- 42nd Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, Greece
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24
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Neubauer HC, Hall M, Wallace SS, Cruz AT, Queen MA, Foradori DM, Aronson PL, Markham JL, Nead JA, Hester GZ, McCulloh RJ, Lopez MA. Variation in Diagnostic Test Use and Associated Outcomes in Staphylococcal Scalded Skin Syndrome at Children's Hospitals. Hosp Pediatr 2018; 8:530-537. [PMID: 30139766 PMCID: PMC6317540 DOI: 10.1542/hpeds.2018-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The incidence of staphylococcal scalded skin syndrome (SSSS) is rising, but current practice variation in diagnostic test use is not well described. Our aim was to describe the variation in diagnostic test use in children hospitalized with SSSS and to determine associations with patient outcomes. METHODS We performed a retrospective (2011-2016) cohort study of children aged 0 to 18 years from 35 children's hospitals in the Pediatric Health Information System database. Tests included blood culture, complete blood count, erythrocyte sedimentation rate, C-reactive protein level, serum chemistries, and group A streptococcal testing. K-means clustering was used to stratify hospitals into groups of high (cluster 1) and low (cluster 2) test use. Associations between clusters and patient outcomes (length of stay, cost, readmissions, and emergency department revisits) were assessed with generalized linear mixed-effects modeling. RESULTS We included 1259 hospitalized children with SSSS; 84% were ≤4 years old. Substantial interhospital variation was seen in diagnostic testing. Blood culture was the most commonly obtained test (range 62%-100%), with the most variation seen in inflammatory markers (14%-100%). Between hospital clusters 1 and 2, respectively, there was no significant difference in adjusted length of stay (2.6 vs 2.5 days; P = .235), cost ($4752 vs $4453; P = .591), same-cause 7-day readmission rate (0.8% vs 0.4%; P = .349), or emergency department revisit rates (0.1% vs 0.6%; P = .148). CONCLUSIONS For children hospitalized with SSSS, lower use of diagnostic tests was not associated with changes in outcomes. Hospitals with high diagnostic test use may be able to reduce testing without adversely affecting patient outcomes.
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Affiliation(s)
- Hannah C Neubauer
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas;
| | - Matt Hall
- Department of Biostatistics, Children's Hospital Association, Lenexa, Kansas
| | - Sowdhamini S Wallace
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Andrea T Cruz
- Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Mary Ann Queen
- Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri
| | - Dana M Foradori
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Paul L Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Jessica L Markham
- Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri
| | - Jennifer A Nead
- Department of Pediatrics, Upstate Golisano Children's Hospital, Syracuse, New York; and
| | - Gabrielle Z Hester
- Department of Hospital Medicine, Children's Minnesota, Minneapolis, Minnesota
| | - Russell J McCulloh
- Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri
| | - Michelle A Lopez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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25
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Emergence of Staphylococcus epidermidis Clinical Isolates with Resistance to Both Mupirocin and Fusidic Acid. Jundishapur J Microbiol 2018. [DOI: 10.5812/jjm.62697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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Staphylococcal-scalded skin syndrome: evaluation, diagnosis, and management. World J Pediatr 2018; 14:116-120. [PMID: 29508362 DOI: 10.1007/s12519-018-0150-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Staphylococcal-scalded skin syndrome (SSSS), also known as Ritter disease, is a potentially life-threatening disorder and a pediatric emergency. Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition. The purpose of this article is to familiarize physicians with the evaluation, diagnosis, and treatment of SSSS. DATA SOURCES A PubMed search was completed in Clinical Queries using the key terms "Staphylococcal scalded skin syndrome" and "Ritter disease". RESULTS SSSS is caused by toxigenic strains of Staphylococcus aureus. Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation. The diagnosis is mainly clinical, based on the findings of tender erythroderma, bullae, and desquamation with a scalded appearance especially in friction zones, periorificial scabs/crusting, positive Nikolsky sign, and absence of mucosal involvement. Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin, oxacillin, or flucloxacillin is essential until cultures are available to guide therapy. Clarithromycin or cefuroxime may be used should the patient have penicillin allergy. If the patient is not improving, critically ill, or in communities where the prevalence of methicillin-resistant S. aureus is high, vancomycin should be used. CONCLUSION A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.
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Otarigho B, Falade MO. Analysis of antibiotics resistant genes in different strains of Staphylococcus aureus. Bioinformation 2018; 14:113-122. [PMID: 29785070 PMCID: PMC5953858 DOI: 10.6026/97320630014113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 12/20/2022] Open
Abstract
The control of Staphylococcus aureus infection is being hampered by methicillin and other resistant strains. The identification of the unique antibiotic resistant genes from the genomes of various strains of S. aureus is of interest. We analyzed 11 S. aureus genomes sequences for Antibiotics Resistance Genes (ARGs) using CARD 2017 platform. We identified 32 ARGs across 11 S. aureus strains. Tet(38), norB, lmrB, mepA and mepR were present across genomes except for S. aureus strain UTSW MRSA 55. The mepA and mepR were found across 11 different genomes. However, FosB3, vgaALC, mphC and SAT-4 were found in UTSW MRSA 55, S.a. strain ISU935 and S.a. strain FDAARGOS_159. The prevalent mode of mechanism of antibiotics resistant was efflux pump complex or subunit conferring antibiotic resistance as well as protein(s). Analysis of norB, ImrB, norA, ImrB, tet (38), sav1866 and mecA have 12 to 14 TMHs. The results help in the understanding of Staphylococcus aureus pathogenesis in the context of antibiotic resistance.
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Affiliation(s)
- Benson Otarigho
- Department of Biological Science, Edo University, Iyamho, Edo State, Nigeria
- Department of Molecular Microbiology and Immunology, School of Medicine, Oregon Health and Science University, Portland, OR USA
| | - Mofolusho O. Falade
- Cellular Parasitology Programme, Cell Biology and Genetics Unit, Department of Zoology, University of Ibadan, Ibadan, Nigeria
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