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Keikha M, Karbalaei M. Global distribution of heterogeneous vancomycin-intermediate Staphylococcus aureus strains (1997-2021): a systematic review and meta-analysis. J Glob Antimicrob Resist 2024; 37:11-21. [PMID: 38336227 DOI: 10.1016/j.jgar.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Heterogeneous vancomycin-intermediate Staphylococcus aureus is considered one of the main causes in treatment failure of vancomycin, which leads to poor clinical outcomes. Herein, we comprehensively evaluated characteristics such as global prevalence, trend, and genetic backgrounds of these strains. METHODS In this study, we conducted a meta-analysis based on PRISMA checklist 2020. In the beginning, global databases were searched to achieve the studies related to the prevalence of hVISA in clinical isolates of methicillin-resistant Staphylococcus aureus. After retrieving the eligible English studies, the prevalence of hVISA isolates and their trend changes were assessed using event rate with 95% confidence intervals. RESULTS In the present study, the prevalence of 114 801 MRSA isolates (of 124 studies) was 64%. According to our results, although the frequency of infection with hVISA is increasing in recent years, there is not a significant difference between Asian countries and Europe/America (6.1% vs. 6.8%). In addition, infection with hVISA bacteria was higher in bacteraemic patients than other infections (9.4% vs. 5.5%), which increases hospitalization, treatment costs, and mortality in these patients. Isolates harbouring SCCmec types II and III are most common genotypes in hVISA strains. CONCLUSIONS The prevalence of hVISA is increasing, which will reduce the effectiveness of vancomycin treatment in the coming years. The presence of hVISA stains in blood samples was higher than the other samples, which is threatening for bacteraemic patients. The results of the current study indicate a universal program to identify and control the spread of such strains in nosocomial infections.
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Affiliation(s)
- Masoud Keikha
- Department of Microbiology and Virology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Mohsen Karbalaei
- Department of Microbiology and Virology, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran; Bio Environmental Health Hazards Research Center, Jiroft University of Medical Sciences, Jiroft, Iran.
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2
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Bongiorno D, Musso N, Caruso G, Lazzaro LM, Caraci F, Stefani S, Campanile F. Staphylococcus aureus ST228 and ST239 as models for expression studies of diverse markers during osteoblast infection and persistence. Microbiologyopen 2021; 10:e1178. [PMID: 33970534 PMCID: PMC8087985 DOI: 10.1002/mbo3.1178] [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] [Received: 09/08/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 01/21/2023] Open
Abstract
The ability of S. aureus to infect bone and osteoblasts is correlated with its incredible virulence armamentarium that can mediate the invasion/internalization process, cytotoxicity, membrane damage, and intracellular persistence. We comparatively analyzed the interaction, persistence, and modulation of expression of selected genes and cell viability in an ex vivo model using human MG‐63 osteoblasts of two previously studied and well‐characterized S. aureus clinical strains belonging to the ST239‐SCCmecIII‐t037 and ST228‐SCCmecI‐t041 clones at 3 h and 24 h post‐infection (p.i). S. aureus ATCC12598 ST30‐t076 was used as a control strain. Using imaging flow cytometry (IFC), we found that these strains invaded and persisted in MG‐63 osteoblasts to different extents. The invasion was evaluated at 3 h p.i and persistence at 24 h p.i., in particular: ATCC12598 internalized in 70% and persisted in 50% of MG‐63 cells; ST239‐SCCmecIII internalized in 50% and persisted in 45% of MG‐63 cells; and ST228‐SCCmecI internalized in 30% and persisted in 20% of MG‐63 cells. During the infection period, ST239‐III exerted significant cytotoxic activity resulting from overexpression of hla and psmA and increased expression of the genes involved in adhesion, probably due to the release and re‐entry of bacteria inside MG‐63 cells at 24 h p.i. The lower invasiveness of ST228‐I was also associated with non‐cytotoxic activity inside osteoblasts. This clone was unable to activate sufficient cellular reaction and succumbed inside MG‐63 cells. Our findings support the idea of considering new strategies, based on a translational approach—eukaryotic host–pathogen interaction (EHPI)—and to be applied on a large scale, to predict S. aureus /osteoblast interaction and treat bone infections. Such strategies rely on the study of the genetic and biochemical basis of both pathogen and host.
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Affiliation(s)
- Dafne Bongiorno
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Medical Molecular Microbiology and Antibiotic Resistance laboratory (MMARLab, University of Catania, Catania, Italy
| | - Nicolò Musso
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Giuseppe Caruso
- Department of Drug Sciences and Health Science, University of Catania, Catania, Italy
| | - Lorenzo Mattia Lazzaro
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Medical Molecular Microbiology and Antibiotic Resistance laboratory (MMARLab, University of Catania, Catania, Italy
| | - Filippo Caraci
- Department of Drug Sciences and Health Science, University of Catania, Catania, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Medical Molecular Microbiology and Antibiotic Resistance laboratory (MMARLab, University of Catania, Catania, Italy
| | - Floriana Campanile
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Medical Molecular Microbiology and Antibiotic Resistance laboratory (MMARLab, University of Catania, Catania, Italy
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3
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Divyakolu S, Chikkala R, Ratnakar KS, Sritharan V. Hemolysins of <i>Staphylococcus aureus</i>—An Update on Their Biology, Role in Pathogenesis and as Targets for Anti-Virulence Therapy. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/aid.2019.92007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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4
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Xu J, Pang L, Ma XX, Hu J, Tian Y, Yang YL, Sun DD. Phenotypic and Molecular Characterisation of Staphylococcus Aureus with Reduced Vancomycin Susceptibility Derivated in Vitro. Open Med (Wars) 2018; 13:475-486. [PMID: 30426085 PMCID: PMC6227741 DOI: 10.1515/med-2018-0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 08/27/2018] [Indexed: 02/05/2023] Open
Abstract
Vancomycin has been the primary agent used to treat serious Methicillin-resistant Staphylococcus aureus (MRSA) infection for many years. However, the rise of MRSA infection rates and the extensive use of vancomycin have led to the emergence of reduced vancomycin susceptibility. Therefore, four typical Staphylococcus aureus (S. aureus) strains from different clinical specimens were derivated by vancomycin in vitro to better clarify their phenotypic and molecular characteristics. Some experiments, such as stepwise selection of vancomycin-resistant strains, pulsed-field gel electrophoresis (PFGE), antimicrobial susceptibility test, population analysis profile-area under the curve (PAP-AUC), molecular typing, transmission electron microscopy, δ-hemolysin expression, autolysis assay, biofilm assay and quantitative real-time polymerase chain reaction (qPCR) for gene expression were carried out to compare the derivated bacteria with their parental strains. Results showed that the observed phenotypes of vancomycin-resistant strains such as hemolysin, autolysis and biofilm significantly reduced, which were associated with vancomycin resistance capability of the selected strain. The changes of phenotype and regulatory genes expression were inversely proportional to the vancomycin minimum inhibitory concentration (MICvan). Most heterogeneous vancomycin intermediate Staphylococcus aureus (hVISA) or VISA strains belonged to spa type t570 and agr group II. In summary, the clinical isolated vancomycin susceptible Staphylococcus aureus (VSSA), hVISA and VISA could be derivated into high vancomycin-resistant VISA in vitro, but it was difficult for them to develop into vancomycin resistant Staphylococcus aureus (VRSA). VISA and hVISA could gradually adapt to the environment with the vancomycin concentration that continuously elevates.
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Affiliation(s)
- Jia Xu
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, PR China.,Department of Medical Microbiology, Key Laboratory of Environmental Pollution and Microecology of Liaoning Province, Shenyang Medical College, Shenyang, PR China
| | - Long Pang
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, PR China
| | - Xiao Xue Ma
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China
| | - Jian Hu
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, PR China.,Department of Clinical Laboratory, Yixing Hospital of Traditional Chinese Medicine, Yixing, Jiangsu, PR China
| | - Yuan Tian
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, PR China
| | - Ya Li Yang
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, PR China
| | - Dan Dan Sun
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, PR China
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5
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Betts JW, Abdul Momin HF, Phee LM, Wareham DW. Comparative activity of tedizolid and glycopeptide combination therapies for the treatment of Staphylococcus aureus infections: an in vitro and in vivo evaluation against strains with reduced susceptibility to glycopeptides. J Med Microbiol 2018; 67:265-271. [DOI: 10.1099/jmm.0.000671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- J. W. Betts
- Antimicrobial Research Group, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - H. F. Abdul Momin
- Antimicrobial Research Group, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - L. M. Phee
- Antimicrobial Research Group, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Division of Infection, Barts Healthcare NHS Trust, London, UK
| | - D. W. Wareham
- Antimicrobial Research Group, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Division of Infection, Barts Healthcare NHS Trust, London, UK
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6
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Capone A, Cafiso V, Campanile F, Parisi G, Mariani B, Petrosillo N, Stefani S. In vivo development of daptomycin resistance in vancomycin-susceptible methicillin-resistant Staphylococcus aureus severe infections previously treated with glycopeptides. Eur J Clin Microbiol Infect Dis 2016; 35:625-31. [PMID: 26815434 DOI: 10.1007/s10096-016-2581-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/11/2016] [Indexed: 11/25/2022]
Abstract
Our aim was to describe the clinical and microbiological features of four cases of severe vancomycin-susceptible methicillin-resistant Staphylococcus aureus (MRSA) infections in which the vancomycin non-susceptibility development and daptomycin resistance occurred under therapy with teicoplanin (three cases) and daptomycin switched to vancomycin (one case). Clinical data were retrospectively reviewed. On nine clinical epidemiologically unrelated daptomycin-susceptible (DAP-S) and daptomycin-resistant (DAP-R) MRSA, we performed: (i) DAP-VAN-TEC-CFX-RIF minimum inhibitory concentrations (MICs); (ii) glycopeptide resistance detection (GRD) by δ-hemolysis; (iii) glycopeptide population analysis; (iv) molecular characterization by PFGE-MLST-SCCmec-agr-typing; (v) rpoB and mprF single nucleotide polymorphisms (SNPs); (vi) dltA-mprF-atl-sceD expression by real-time quantitative polymerase chain reaction (qPCR). Three out of the four patients did not survive despite salvage treatment; two died with active MRSA infection and one died because of Stenotrophomonas maltophilia sepsis. The fourth patient, in which a reversion to a DAP-S phenotype occurred, survived with daptomycin plus trimethoprim/sulfamethoxazole and oxacillin treatment, and endovascular device removal. Daptomycin resistance development was preceded by a stable heterogeneous vancomycin-intermediate S. aureus (hVISA) or VISA phenotype acquisition, while in one case, daptomycin resistance was preceded by an unstable daptomycin heteroresistance (hDAP) behavior reverting to DAP-S during vancomycin plus rifampin therapy followed by high doses of daptomycin. All DAP-R strains showed hVISA or DAP-R traits, including mutations and/or up-regulation of genes involved in cell wall turnover and cell membrane perturbation. In our study, daptomycin resistance arose during glycopeptide therapy. The emergence of DAP-R isolates was preceded by a stable VISA or hVISA phenotype or by instability reverting to a DAP-S heteroresistant phenotype. Daptomycin, as first-line therapy for the treatment of severe MRSA infections, should be used at optimal dosage combined with other agents such as beta-lactams, to prevent daptomycin resistance occurrence.
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Affiliation(s)
- A Capone
- National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - V Cafiso
- Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy.
| | - F Campanile
- Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy
| | - G Parisi
- Department of Microbiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - B Mariani
- Department of Microbiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - N Petrosillo
- National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - S Stefani
- Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy
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7
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Hu HC, Kao KC, Chiu LC, Chang CH, Hung CY, Li LF, Liu TP, Lin LC, Chen NH, Huang CC, Yang CT, Lu JJ. Clinical outcomes and molecular typing of heterogenous vancomycin-intermediate Staphylococcus aureus bacteremia in patients in intensive care units. BMC Infect Dis 2015; 15:444. [PMID: 26497595 PMCID: PMC4619030 DOI: 10.1186/s12879-015-1215-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is one of most common pathogens in humans. Methicillin-resistant S. aureus (MRSA) accounts for 64 % of S. aureus bacteremia isolated in intensive care units (ICUs), and heteroresistant vancomycin-intermediates S. aureus (hVISA) is a phenotype of MRSA. However, studies focusing on the hVISA impact on critically ill patients are scarce. METHODS This was a retrospective study conducted in a tertiary medical center from January 2009 to December 2010. All adult patients in ICUs with MRSA bloodstream infection were eligible. A modified population analysis profile and area under the curve method was applied to all isolates to confirm hVISA phenotype. Multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec) and the accessory gene regulator (agr) typing were performed individually. Clinical outcomes including in-hospital mortality, length of stay in intensive care unit and hospital after MRSA bacteremia of the patients were also analyzed. RESULTS A total of 48 patients were enrolled and 14 patients were confirmed to have the hVISA phenotype. The prevalence of hVISA was 29.2 %. There was no difference in the age, sex, comorbidity, Charlson's comorbidity score and previous vancomycin therapy between the hVISA and VSSA groups. The hVISA group had a significantly higher in-hospital mortality than the VSSA group (13/14 versus 22/34; p = 0.046). All of the 14 hVISA patients had an MIC = 2 mg/L by E-test and this represented a significant association between high MIC and the development of hVISA (p < 0.001). MLST analysis showed all the isolates in the hVISA group were ST239, while ST239 (14/34; 41.2 %) and ST5 (12/34; 35.3 %) were predominant in the VSSA group (p = 0.007). A comparison of the survivor and non-survivor group showed that the hVISA phenotype (OR 11.8; 95 % CI 1.1-126.99; p = 0.042) and sequential organ failure assessment (SOFA) score (OR 1.39; 95 % CI 1.07-1.81; p = 0.014) were independent factors significantly associated with in-hospital mortality. CONCLUSIONS Patients in ICUs with MRSA bacteremia may have a higher in-hospital mortality if they have the hVISA phenotype. SOFA score is also predictor of mortality.
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Affiliation(s)
- Han-Chung Hu
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Respiratory Therapy, Chang Gung University, College of Medicine, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Kuo-Chin Kao
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Respiratory Therapy, Chang Gung University, College of Medicine, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Li-Chung Chiu
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Chih-Hao Chang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Chen-Yiu Hung
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Li-Fu Li
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Tsui-Ping Liu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at LinKou, 5, Fu-Shin St., Kwei-Shan, Taoyuan, 333, Taiwan.
| | - Lee-Chung Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at LinKou, 5, Fu-Shin St., Kwei-Shan, Taoyuan, 333, Taiwan.
| | - Ning-Hung Chen
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Chung-Chi Huang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Respiratory Therapy, Chang Gung University, College of Medicine, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Cheng-Ta Yang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Respiratory Therapy, Chang Gung University, College of Medicine, Taoyuan, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at LinKou, 5, Fu-Shin St., Kwei-Shan, Taoyuan, 333, Taiwan. .,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan.
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Methicillin-Resistant Staphylococcus aureus Grown on Vancomycin-Supplemented Screening Agar Displays Enhanced Biofilm Formation. Antimicrob Agents Chemother 2015; 59:7906-10. [PMID: 26459889 DOI: 10.1128/aac.00568-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/30/2015] [Indexed: 11/20/2022] Open
Abstract
Brain heart infusion agar containing 3 mg/liter vancomycin (BHI-V3) was used to screen for heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA). There was markedly greater biofilm formation by isolates that grew on BHI-V3 than by strains that did not grow on BHI-V3. Increased biofilm formation by hVISA may be mediated by FnbA- and polysaccharide intercellular adhesin-dependent pathways, and upregulation of atlA and sarA may also contribute to enhanced biofilm formation by hVISA upon prolonged exposure to vancomycin.
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9
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Chang SC, Liu TP, Chen CJ, Lin LC, Lu JJ. Detection of heterogeneous vancomycin-intermediate Staphylococcus aureus isolates using a combination of δ-hemolysis assay and Etest. Diagn Microbiol Infect Dis 2014; 81:246-50. [PMID: 25600843 DOI: 10.1016/j.diagmicrobio.2014.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/16/2014] [Accepted: 12/21/2014] [Indexed: 12/23/2022]
Abstract
This study evaluated the δ-hemolysis assay for detection of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) isolates. The assay was performed using Columbia or trypticase soy blood agar plates without vancomycin at 37°C with 5% CO2, and the test isolate was streaked perpendicularly 1mm away from S. aureus RN4220. One hundred thirty-eight methicillin-resistant S. aureus (MRSA) bloodstream isolates with vancomycin MICs of 0.75-2 μg/mL were screened for hVISA by the δ-hemolysis assay and Etest glycopeptide resistance detection (GRD) method. The δ-hemolysis assay could be read at 24h and was more sensitive and specific than the Etest GRD at 24h and 48 h for detection of hVISA. Because most hVISA isolates have a vancomycin MIC of 2 μg/mL, we recommend screening MRSA isolates first using Etest for those with an MIC of 2 μg/mL and then performing the δ-hemolysis assay on these isolates for hVISA.
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Affiliation(s)
- Shih-Cheng Chang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsui-Ping Liu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lee-Chung Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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10
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Cafiso V, Bertuccio T, Purrello S, Campanile F, Mammina C, Sartor A, Raglio A, Stefani S. dltA overexpression: A strain-independent keystone of daptomycin resistance in methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2013; 43:26-31. [PMID: 24183798 DOI: 10.1016/j.ijantimicag.2013.10.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/04/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
The mechanisms leading to reduced susceptibility to daptomycin (DAP) are multifactorial and have not been fully elucidated. We analysed, by sequencing and expression studies, the role of the major molecular targets (cell-envelope charge genes, dltA, mprF, cls2; cell-wall turnover and autolysis genes, sceD, atl) involved in the emergence of DAP resistance in three series of isogenic clinical methicillin-resistant Staphylococcus aureus (MRSA) in which DAP resistance emerged after a heterogeneous glycopeptide-intermediate S. aureus (hGISA) step under teicoplanin and DAP therapy. All of the isolates had different genotypes and were δ-haemolysin negative, reflecting a strain proclivity to acquire DAP/glycopeptide non-susceptibility under antibiotic pressure. DAP exposure led to the emergence of DAP resistance after an hGISA step probably in parallel with the timing of the two antimicrobial administrations and, in two of three cases, in conditions of DAP underdosage. Real-time qPCR data revealed that all DAP-resistant (DAP-R) isolates had dltA overexpression, whereas mprF upregulation was found only in DAP-R strains with the S295L and T345I amino acid substitutions. Strains that were heteroresistant to DAP did not possess DAP-R-like characteristics. DAP-R strains presented high cls2 expression and no known cls2 mutations, and moreover exhibited sceD and atl upregulation. In conclusion, these findings highlight that dltA overexpression is the common pathway of resistance among genotypically different series of isolates and may represent the keystone of DAP resistance in MRSA, leading to electrostatic repulsion and, indirectly, to a reduction of autolysin activity. mprF mutations related to increased transcription may play a role in this complex phenomenon.
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Affiliation(s)
- Viviana Cafiso
- Department of Biomedical Sciences-Microbiology, University of Catania, Via Androne 81, 95124 Catania, Italy
| | - Taschia Bertuccio
- Department of Biomedical Sciences-Microbiology, University of Catania, Via Androne 81, 95124 Catania, Italy
| | - Simona Purrello
- Department of Biomedical Sciences-Microbiology, University of Catania, Via Androne 81, 95124 Catania, Italy
| | - Floriana Campanile
- Department of Biomedical Sciences-Microbiology, University of Catania, Via Androne 81, 95124 Catania, Italy
| | - Caterina Mammina
- Department of Sciences for Healthy Promotion 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Assunta Sartor
- Microbiology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Annibale Raglio
- USC Microbiologia e Virologia, AO Ospedali Riuniti, Bergamo, Italy
| | - Stefania Stefani
- Department of Biomedical Sciences-Microbiology, University of Catania, Via Androne 81, 95124 Catania, Italy.
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11
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Bal A, Garau J, Gould I, Liao C, Mazzei T, Nimmo G, Soriano A, Stefani S, Tenover F. Vancomycin in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) infection: End of an era? J Glob Antimicrob Resist 2013; 1:23-30. [DOI: 10.1016/j.jgar.2013.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/24/2013] [Indexed: 10/27/2022] Open
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12
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Gagnaire J, Dauwalder O, Boisset S, Khau D, Freydière AM, Ader F, Bes M, Lina G, Tristan A, Reverdy ME, Marchand A, Geissmann T, Benito Y, Durand G, Charrier JP, Etienne J, Welker M, Van Belkum A, Vandenesch F. Detection of Staphylococcus aureus delta-toxin production by whole-cell MALDI-TOF mass spectrometry. PLoS One 2012; 7:e40660. [PMID: 22792394 PMCID: PMC3391297 DOI: 10.1371/journal.pone.0040660] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 06/11/2012] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to detect the Staphylococcus aureus delta-toxin using Whole-Cell (WC) Matrix Assisted Laser Desorption Ionization-Time-of-Flight (MALDI-TOF) mass spectrometry (MS), correlate delta-toxin expression with accessory gene regulator (agr) status, and assess the prevalence of agr deficiency in clinical isolates with and without resistance to methicillin and glycopeptides. The position of the delta-toxin peak in the mass spectrum was identified using purified delta-toxin and isogenic wild type and mutant strains for agr-rnaIII, which encodes delta-toxin. Correlation between delta-toxin production and agr RNAIII expression was assessed by northern blotting. A series of 168 consecutive clinical isolates and 23 unrelated glycopeptide-intermediate S. aureus strains (GISA/heterogeneous GISA) were then tested by WC-MALDI-TOF MS. The delta-toxin peak was detected at 3005±5 Thomson, as expected for the naturally formylated delta toxin, or at 3035±5 Thomson for its G10S variant. Multivariate analysis showed that chronicity of S. aureus infection and glycopeptide resistance were significantly associated with delta-toxin deficiency (p = 0.048; CI 95%: 1.01-10.24; p = 0.023; CI 95%: 1.20-12.76, respectively). In conclusion, the S. aureus delta-toxin was identified in the WC-MALDI-TOF MS spectrum generated during routine identification procedures. Consequently, agr status can potentially predict infectious complications and rationalise application of novel virulence factor-based therapies.
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Affiliation(s)
- Julie Gagnaire
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
| | - Olivier Dauwalder
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
- Université de Lyon, Domaine de la Buire, Lyon, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
| | - Sandrine Boisset
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
- Université de Lyon, Domaine de la Buire, Lyon, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
| | - David Khau
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
| | - Anne-Marie Freydière
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
| | - Florence Ader
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
- Hospices Civils de Lyon, Service de Maladies Infectieuses, Lyon, France
| | - Michèle Bes
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
| | - Gerard Lina
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
- Université de Lyon, Domaine de la Buire, Lyon, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
| | - Anne Tristan
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
- Université de Lyon, Domaine de la Buire, Lyon, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
| | - Marie-Elisabeth Reverdy
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
| | - Adrienne Marchand
- Laboratoire de Chimie et Microbiologie de l’Eau - UMR 6008 CNRS, IBMIG - UFR Sciences Fondamentales et Appliquées, Université de Poitiers, Poitiers, France
| | - Thomas Geissmann
- Université de Lyon, Domaine de la Buire, Lyon, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
| | - Yvonne Benito
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
- Université de Lyon, Domaine de la Buire, Lyon, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
| | - Géraldine Durand
- bioMérieux S.A, Microbiology Research & Development unit, La Balme Les Grottes, France
| | - Jean-Philippe Charrier
- bioMérieux S.A, Technology Research Department, Technology platform, Marcy L’Etoile France
| | - Jerome Etienne
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
- Université de Lyon, Domaine de la Buire, Lyon, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
| | - Martin Welker
- bioMérieux S.A, Microbiology Research & Development unit, La Balme Les Grottes, France
| | - Alex Van Belkum
- bioMérieux S.A, Microbiology Research & Development unit, La Balme Les Grottes, France
| | - François Vandenesch
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Bron, France
- Université de Lyon, Domaine de la Buire, Lyon, France
- INSERM U851, Bacterial Pathogenesis and Innate Immunity laboratory, Lyon, France
- * E-mail:
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