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Geethan I, HarriVishnu M, Sindhanai V, Subashankar A, KanniRaj M. In Vitro Study of Gentamicin Elution from Tendon Grafts. Indian J Orthop 2023; 57:1118-1125. [PMID: 37384018 PMCID: PMC10293150 DOI: 10.1007/s43465-023-00897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/18/2023] [Indexed: 06/30/2023]
Abstract
Background Though vancomycin-soaked graft reduces the infection rate after ACL reconstruction, concerns exist regarding this usage. Gentamicin has been used for graft soakage with satisfactory clinical results but gentamicin's elution characteristics are unknown. Methods Thirty Bovine tendon grafts were harvested from ten limbs under sterile conditions. Three tendons from each of the limbs were allotted into three groups and soaked in either saline, gentamicin or vancomycin. Pre-soakage and post-soakage swabs were cultured. Soaked grafts were immersed in a 10 ml saline solution for 5 min (initial washout) and then in another 10 ml saline solution (sustained release) for 10 min. No 1 Whatman filter paper was immersed in the solutions and placed on culture plates streaked with coagulase-negative Staphylococcus aureus (CONS) and methicillin-resistant Staphylococcus aureus (MRSA), and inhibition was noted. The difference between the two proportions was assessed by two proportion t-test for p < 0.05. Results No organism was cultured in the pre-soakage or post-soakage swab in any specimen. Specimens from one limb were excluded since saline-soakage showed inhibition. Elution from gentamicin-soaked graft inhibited CONS in eight out of nine samples in initial washout and all samples in sustained release solution but inhibited MRSA only in one sample in sustained release solution and the initial washout solution. Vancomycin elution inhibited both organisms in all samples. Conclusions Gentamicin elution from tendon graft achieves minimal inhibitory concentration against susceptible organisms. Though its clinical utility is restricted by limited antimicrobial spectrum, and it could be used where the risk of contamination by MRSA is low.
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Affiliation(s)
- I. Geethan
- Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Perambalur, 620021 India
- 20-A, Mahalakshmi Nagar, K K Nagar Post, Trichy, 620021 India
- Knee and Shoulder Surgery, Arthroscopy Centre Trichy, Tiruchirappalli, India
| | - M. HarriVishnu
- Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Perambalur, 620021 India
| | - V. Sindhanai
- Department of Microbiology, Dhanalakshmi Srinivasan Medical College, Perambalur, India
| | - A. Subashankar
- Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Perambalur, 620021 India
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Alanazi AK, Alqasmi MH, Alrouji M, Kuriri FA, Almuhanna Y, Joseph B, Asad M. Antibacterial Activity of Syzygium aromaticum (Clove) Bud Oil and Its Interaction with Imipenem in Controlling Wound Infections in Rats Caused by Methicillin-Resistant Staphylococcus aureus. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27238551. [PMID: 36500645 PMCID: PMC9736006 DOI: 10.3390/molecules27238551] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of infection worldwide. Clove oil's ability to inhibit the growth of MRSA was studied through in vitro and in vivo studies. The phytochemical components of clove oil were determined through gas chromatography-mass spectrometry (GC-MS) analysis. The antibacterial effects of clove oil and its interaction with imipenem were determined by studying MIC, MBC, and FIC indices in vitro. The in vivo wound-healing effect of the clove oil and infection control were determined using excision wound model rats. The GC-MS analysis of clove oil revealed the presence of 16 volatile compounds. Clove oil showed a good antibacterial effect in vitro but no interaction was observed with imipenem. Clove bud oil alone or in combination with imipenem healed wounds faster and reduced the microbial load in wounds. The findings of this study confirmed the antibacterial activity of clove oil in vitro and in vivo and demonstrated its interaction with imipenem.
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Affiliation(s)
- Abdulaziz Khaleef Alanazi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
- Medical Laboratory, Hafar Albatin Central Hospital, Hafar Albatin 39513, Saudi Arabia
| | - Mohammed Hussein Alqasmi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Mohammed Alrouji
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Fahd A. Kuriri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Yasir Almuhanna
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
- Correspondence: ; Tel.: +966-506253022
| | - Babu Joseph
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Mohammed Asad
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
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Antimicrobial PHAs coatings for solid and porous tantalum implants. Colloids Surf B Biointerfaces 2019; 182:110317. [PMID: 31323450 DOI: 10.1016/j.colsurfb.2019.06.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Biomaterial-associated infections (BAI) are the major cause of failure of indwelling medical devices. The risk of BAI can end dramatically in the surgical removal of the affected device. Therefore, a major effort must be undertaken to guarantee the permanence of the implant. In this regard, we have developed antimicrobial coatings for tantalum (Ta) implants, using polyhydroxyalkanoates (PHAs) as matrices for carrying an active principle. The dip-coating technique was successfully used for covering solid Ta discs. An original PHA emulsion flow process was developed for the coating of porous Ta structures, specially for the inner surfaces. The complete characterization of the biopolymer coatings, their antibacterial properties, toxicity and biointegration were analyzed. Thus, non-toxic, well-biointegrated homogeneous biopolymer coatings were attained, which showed antibacterial properties. By using biodegradable PHAs, the resulting drug delivery system assured the protection of Ta against bacterial infections for a period of time.
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Abia ALK, Ubomba-Jaswa E, Momba MNB. High prevalence of multiple-antibiotic-resistant (MAR) Escherichia coli in river bed sediments of the Apies River, South Africa. ENVIRONMENTAL MONITORING AND ASSESSMENT 2015; 187:652. [PMID: 26419380 DOI: 10.1007/s10661-015-4879-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/16/2015] [Indexed: 06/05/2023]
Abstract
This study aimed at investigating the presence of antibiotic-resistant Escherichia coli in river bed sediments of the Apies River, Gauteng, South Africa, in order to better inform health management decisions designed to protect users of the river. Overall, 180 water and sediment samples were collected at 10 sites along the Apies River from January to February 2014. E. coli was enumerated using the Colilert® 18/Quanti-Tray® 2000 (IDEXX). Isolates were purified by streaking on eosin methylene blue agar followed by the indole test. Pure E. coli isolates were tested for resistance to nine antibiotics by the Kirby-Bauer disc diffusion method. Over 98% of the isolates were resistant to at least one of the antibiotics tested. The highest resistance was observed against nitrofurantoin (sediments) and ampicillin (water). Over 80% of all resistant isolates showed multiple antibiotic resistance (resistance to ≥3 antibiotics). The abundance of E. coli in the sediments not only adds to the evidence that sediments are a reservoir for bacteria and possibly other pathogens including antibiotic-resistant bacteria but also suggests that antibiotic-resistant genes could be transferred to pathogens due to the high prevalence of multiple-antibiotic-resistant (MAR) strains of E. coli observed in the sediment. Using untreated water from the Apies River following resuspension for drinking and other household purposes could pose serious health risks for users. Our results suggest that river bed sediments could serve as reservoirs for MAR bacteria including pathogens under different climatic conditions and their analysis could provide information of public health concerns.
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Affiliation(s)
- Akebe Luther King Abia
- Department of Environmental, Water and Earth Science, Tshwane University of Technology, Arcadia Campus, 175 Nelson Mandela Drive, Private Bag X 680, Pretoria, 0001, South Africa.
| | - Eunice Ubomba-Jaswa
- Natural Resources and the Environment, CSIR, PO Box 395, Pretoria, 0001, South Africa
| | - Maggy Ndombo Benteke Momba
- Department of Environmental, Water and Earth Science, Tshwane University of Technology, Arcadia Campus, 175 Nelson Mandela Drive, Private Bag X 680, Pretoria, 0001, South Africa.
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SCCmec and spa types of methicillin-resistant Staphylococcus aureus strains in Israel. Detection of SCCmec type V. Eur J Clin Microbiol Infect Dis 2007; 27:385-90. [DOI: 10.1007/s10096-007-0426-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022]
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Bougnoux ME, Kac G, Aegerter P, d'Enfert C, Fagon JY. Candidemia and candiduria in critically ill patients admitted to intensive care units in France: incidence, molecular diversity, management and outcome. Intensive Care Med 2007; 34:292-9. [PMID: 17909746 DOI: 10.1007/s00134-007-0865-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 09/02/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the concomitant incidence, molecular diversity, management and outcome of nosocomial candidemia and candiduria in intensive care unit (ICU) patients in France. DESIGN A 1-year prospective observational study in 24 adult ICUs. PATIENTS Two hundred and sixty-two patients with nosocomial candidemia and/or candiduria. MEASUREMENTS AND RESULTS Blood and urine samples were collected when signs of sepsis were present. Antifungal susceptibility of Candida strains was determined; in addition, all blood and 72% of urine C. albicans isolates were analyzed by using multi-locus sequence type (MLST). The mean incidences of candidemia and candiduria were 6.7 and 27.4/1000 admissions, respectively. Eight percent of candiduric patients developed candidemia with the same species. The mean interval between ICU admission and candidemia was 19.0 +/- 2.9 days, and 17.2 +/- 1.1 days for candiduria. C. albicans and C. glabrata were isolated in 54.2% and 17% of blood and 66.5% and 21.6% of urine Candida-positive cultures, respectively. Fluconazole was the most frequently prescribed agent. In all candidemic patients, the prescribed curative antifungal agent was active in vitro against the responsible identified strain. Crude ICU mortality was 61.8% for candidemic and 31.3% for candiduric patients. Seventy-five percent of the patients were infected with a unique C. albicans strain; cross-transmission between seven patients was suggested in one hospital. CONCLUSIONS Candidemia is late-onset ICU-acquired infection associated with high mortality. No difference in susceptibility and genetic background were found between blood and urine strains of Candida species.
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Affiliation(s)
- Marie-Elisabeth Bougnoux
- Hôpital Necker-Enfants Malades, Service de Bactériologie, Virologie, Parasitologie et Hygiène, 149, rue de Sèvres, 75473 Paris Cedex 15, France.
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Donnio PY, Février F, Bifani P, Dehem M, Kervégant C, Wilhelm N, Gautier-Lerestif AL, Lafforgue N, Cormier M, Le Coustumier A. Molecular and epidemiological evidence for spread of multiresistant methicillin-susceptible Staphylococcus aureus strains in hospitals. Antimicrob Agents Chemother 2007; 51:4342-50. [PMID: 17709473 PMCID: PMC2167970 DOI: 10.1128/aac.01414-06] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The excision of the staphylococcal chromosomal cassette mec (SCCmec) from methicillin-resistant Staphylococcus aureus (MRSA) strains results in methicillin-susceptible S. aureus (MSSA) strains. In order to determine the proportion and diversity of multidrug-resistant MSSA (MR-MSSA) strains derived from MRSA strains, 247 mecA-negative isolates recovered in 60 French hospitals between 2002 and 2004 were characterized. The spa types of all strains were determined, and a subset of the strains (n = 30) was further genotyped by multilocus sequence typing. The IDI-MRSA assay was used to test the isolates for the presence of the SCCmec element, which was detected in 68% of all isolates analyzed. Molecular analysis of the samples suggested that 92% of the MR-MSSA isolates were derived from MRSA clones of diverse genetic backgrounds, of which the clone of sequence type 8 and SCCmec type IV(A) accounted for most of the samples. High variations in incidence data and differences in the molecular characteristics of the isolates from one hospital to another indicate that the emergence of MR-MSSA resulted from independent SCCmec excisions from epidemic MRSA isolates, as well as the diffusion of methicillin-susceptible strains after the loss of SCCmec. MR-MSSA could constitute a useful model for the study of the respective genetic and environmental factors involved in the dissemination of S. aureus in hospitals.
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Affiliation(s)
- Pierre-Yves Donnio
- Département de Bactériologie-Virologie et Hygiène Hospitalière, Centre Hospitalier Universitaire, 35033 Rennes, France.
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Amorim ML, Faria NA, Oliveira DC, Vasconcelos C, Cabeda JC, Mendes AC, Calado E, Castro AP, Ramos MH, Amorim JM, de Lencastre H. Changes in the clonal nature and antibiotic resistance profiles of methicillin-resistant Staphylococcus aureus isolates associated with spread of the EMRSA-15 clone in a tertiary care Portuguese hospital. J Clin Microbiol 2007; 45:2881-8. [PMID: 17626175 PMCID: PMC2045296 DOI: 10.1128/jcm.00603-07] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two hundred eighty methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates recovered from a tertiary care hospital in Oporto, Portugal, between 2003 and 2005 were studied by a combination of molecular typing techniques in order to investigate the genetic backgrounds associated with the changes in the resistance phenotypes observed since 2001 and compare them to those previously found in the hospital. All MRSA isolates were grouped into resistance profiles for a panel of seven antibiotics and characterized by pulsed-field gel electrophoresis (PFGE) and SCCmec (staphylococcal cassette chromosome mec) typing. Representative isolates of PFGE types were further studied by spa typing and multilocus sequence typing. Our findings clearly document that the increasing isolation of nonmultiresistant MRSA strains was associated with the decline (from 69% in 1996 to 2000 to 12% in 2003 to 2005) and massive replacement of the multiresistant Brazilian clone (ST239-IIIA) by the epidemic EMRSA-15 clone (ST22-IV), in which resistance to antibiotics other than beta-lactams is very rare, as the major clone (80% of isolates). The Iberian clone (ST247-IA), a major clone in 1992 to 1993, was represented in the present study by just one isolate. Two other pandemic MRSA clones were detected, as sporadic isolates, for the first time in our hospital: the New York/Japan (ST5-II) and the EMRSA-16 (ST36-II) clones. Furthermore, the pattern of susceptibility of MRSA isolates both to gentamicin and to trimethoprim-sulfamethoxazole was shown to be an excellent phenotypic marker for the discrimination of the EMRSA-15 clone from other nonmultiresistant MRSA clones present in our hospital.
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Affiliation(s)
- M L Amorim
- Laboratório de Genética Molecular, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa (ITQB/UNL), Oeiras, Portugal
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Robert J, Bismuth R, Lemaitre N, Jarlier V. Gentamicin-susceptible or gentamicin-resistant methicillin-resistant Staphylococcus aureus: a case-case study. Infect Control Hosp Epidemiol 2006; 27:879-83. [PMID: 16874652 DOI: 10.1086/506406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 02/21/2005] [Indexed: 11/03/2022]
Abstract
Gentamicin-susceptible methicillin-resistant Staphylococcus aureus (GS-MRSA) strains are replacing gentamicin-resistant MRSA (GR-MRSA) strains. We showed that exposure to other patients harboring GS-MRSA was the major risk factor for GS-MRSA acquisition, and that antimicrobial exposure, especially to beta-lactams, was strongly associated with acquisition of GR-MRSA but not GS-MRSA. Gentamicin use was significantly associated with GR-MRSA acquisition in univariate analysis only.
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Affiliation(s)
- Jérôme Robert
- Laboratoire de Bactériologie-Hygiène, Faculté de Médecine Pitié-Salpétriêre, Université Pierre et Marie Curie, Paris, France.
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Zorgani AA, Shahen A, Zaidi M, Franka M. A profile and spectrum of four cases of methicillin-resistant Staphylococcus aureus in a burns intensive care unit. ANNALS OF BURNS AND FIRE DISASTERS 2006; 19:5-10. [PMID: 21991012 PMCID: PMC3188021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Indexed: 05/31/2023]
Abstract
This report describes and evaluates four patients with hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas infections at the Burns and Plastic Surgery Hospital, in Libya, between August 1999 and August 2002. Neither rifampicin nor vancomycin was used to treat these patients. Inhalation injury with major burns (> 60% total body surface area), a major degree of burns (3rd degree), and septicaemia caused by both MRSA and multi-resistant P. aeruginosa invariably proved fatal. One patient responded well to antibiotic therapy, but the other three died in spite of similar therapy. Vancomycin and rifampicin should be established as the first choice to treat MRSA infection, and infected wounds need aggressive management with antibiotics prior to skin grafting.
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Affiliation(s)
- A A Zorgani
- Burns and Plastic Surgery Hospital, Tripoli, Libya
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Résistance bactérienne aux antibiotiques. Données de l'observatoire national de l'épidemiologie de la résistance bactérienne (ONERBA). Med Mal Infect 2005; 35:155-69. [PMID: 15911185 DOI: 10.1016/j.medmal.2004.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Accepted: 07/15/2004] [Indexed: 10/25/2022]
Abstract
This quantitative data (MIC, diameter of inhibition), presented as distribution curves, had for aim to identify and describe, among major bacterial species relevant for clinical use, sub-populations according to their sensitivity level. This information lead the Antibiogram Committee of the French Microbiological Society to establish and redefine breaking points necessary to classify bacteria in three clinical groups: sensitive, intermediately resistant, and resistant. This classification takes into account, for each species, MIC distribution, pharmacokinetic and pharmacodynamic data, and results of microclinical studies. Global data for the bacterial resistance of major species is obtained from laboratories included in the network. Results are stratified according to simple information, easily obtained in the laboratory: out patient or hospitalized patient, hospitalizing unit, duration, etc. This global data is used, most of the time, to assess the prevalence of species resistance. ONERBA (in collaboration with the national public health system) is part of the European Network for the Surveillance of Bacterial Resistance. This network was created in 1999 and includes 28 countries. ONERBA manages two networks: Ile-de-France (8 general hospitals) and AZAY-resistance (15 university hospitals). They work on E. coli, S. aureus, and Enterococcus (S. pneumoniae is observed by the National Reference Center and regional centers of pneumococcus surveillance).
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Huang V, Rybak MJ. Pharmacodynamics of cefepime alone and in combination with various antimicrobials against methicillin-resistant Staphylococcus aureus in an in vitro pharmacodynamic infection model. Antimicrob Agents Chemother 2005; 49:302-8. [PMID: 15616309 PMCID: PMC538893 DOI: 10.1128/aac.49.1.302-308.2005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Treatment options for gram-positive resistant bacteria are limited; therefore, efforts to evaluate therapy options in the critical care population are warranted. Cefepime has broad-spectrum activity against gram-negative and gram-positive organisms. We have previously demonstrated that the combination of cefepime with vancomycin, linezolid, or quinupristin-dalfopristin had an improved or enhanced effect against methicillin-resistant Staphylococcus aureus (MRSA). We investigated various regimens of cefepime alone and in combination against two clinical MRSA isolates (R2481 and R2484) in an established in vitro pharmacodynamic model. Human pharmacokinetic regimen simulations were as follows: cefepime, 2 g every 8 h (q8h) (C8) and 12 h (C12), continuous-infusion 2-g loading dose followed by 4 g alone or in combination with gentamicin and tobramycin (1.0 or 2.0 [G1 and G2 or TB1 and TB2] mg/kg of body weight q12h and 5.0 [G5 or TB5] mg/kg q24h), arbekacin (ARB) (100 mg q12h), linezolid (LIN) (600 mg q12h), tigecycline (TIG) (100 mg q24h), or daptomycin (DAP) (6 mg/kg q24h) for 48 h. The MICs for cefepime, gentamicin, tobramycin, ARB, LIN, TIG, and DAP for the two clinical MRSA isolates (R2481 and R2484) were 4 and 4, 0.25 and 0.5, 128 and 0.5, 0.5 and 0.125, 2 and 4, 0.25 and 0.25, and 0.0625 and 0.125 microg/ml, respectively. At 48 h, combinations of C12 and C8 plus ARB, G1, or G5 (range, -2.05- to -4.32-log(10) decrease) demonstrated enhanced lethality against R2481 (resistant to tobramycin) (P < 0.05). A similar relationship was demonstrated against R2484 with cefepime plus ARB, gentamicin, or tobramycin (range, -2.05- to -3.63-log(10) decrease) (P < 0.05). A 99.9% kill was achieved with cefepime plus aminoglycoside combinations as early as 2 h and maintained throughout the 48-h period. TIG was antagonistic when combined with C12 against both isolates. DAP alone achieved 99.9% kill for up to 48 h for both isolates and was the most active agent against R2481 and R2484 (-2.89- and -3.61-log(10) decrease at 48 h); therefore, combination therapy did not enhance lethality. Overall, the most potent combinations noted were cefepime in combination with low- and high-dose aminoglycosides. Further investigations with combination therapies are warranted.
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Affiliation(s)
- Vanthida Huang
- Anti-Infective Research Laboratory, Pharmacy Practice-4148, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Detroit, MI 48201, USA
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van der Mee-Marquet N, Domelier AS, Girard N, Quentin R. Epidemiology and typing of Staphylococcus aureus strains isolated from bloodstream infections. J Clin Microbiol 2005; 42:5650-7. [PMID: 15583295 PMCID: PMC535234 DOI: 10.1128/jcm.42.12.5650-5657.2004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We carried out an epidemiological study covering 2,365,067 patient days of hospitalization between 2000 and 2003. During this time, 413 Staphylococcus aureus bloodstream infections occurred. This corresponds to 15% of the 2,676 bloodstream infections observed during this period in the 31 hospitals in our region of France, which has 2.5 million inhabitants. The incidence of nosocomial S. aureus bloodstream infections was 0.11 per 1,000 days of hospitalization. The prevalence of methicillin-resistant S. aureus (MRSA) strains, of which 13% were nonmultiresistant MRSA (NORSA), was 33%, and this percentage was stable over the 4 years. In contrast, the prevalence of S. aureus strains susceptible to methicillin but resistant to quinolones or susceptible to methicillin but multiresistant to antibiotics (EMSSA strains) increased from 4% in 2000 to 23% in 2003. As previously reported, MRSA strains were mostly recovered from nosocomial bloodstream infections, whereas NORSA strains-generally considered to be responsible for community-acquired infections-were always isolated from nosocomial bloodstream infections. Pulsed-field gel electrophoresis (PFGE) analysis of 109 MRSA strains and 15 EMSSA strains demonstrated clonal diffusion of the three major French MRSA clones and revealed considerable genetic heterogeneity among EMSSA strains. Although no epidemiologically related NORSA strains clustered in particular PFGE groups, the distribution of MRSA strains isolated from bloodstream infections according to the portal of entry (vascular devices, pulmonary, and urinary) was not random for the major PFGE clones, suggesting that each MRSA lineage displays particular virulence features.
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Preney L, Caillon J, Vaucel J, Ygout JF, Donnio PY. Geographic dissemination of methicillin-resistant Staphylococcus aureus strains: a French regional study. ACTA ACUST UNITED AC 2004; 53:4-8. [PMID: 15620602 DOI: 10.1016/j.patbio.2004.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Accepted: 01/16/2004] [Indexed: 10/26/2022]
Abstract
The aim of this study was to compare methicillin-resistant Staphylococcus aureus strains collected in eight hospitals located in the same region of France (Brittany) over a short period (January 1999-July 2000). Ninety-two isolates of methicillin-resistant S. aureus were characterised by their pulsotype and their antibiotype. Pulsotype analysis permitted the definition of three clusters. Two of them comprised 83% of the studied isolates. Phenotypic analysis showed two major antibiotypes, widespread in Brittany but with a heterogeneous geographic distribution and one antibiotype fitting the definition of glycopeptide intermediate S. aureus. These data argue for the high epidemicity of methicillin-resistant S. aureus among the same region.
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Affiliation(s)
- L Preney
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
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Lescat M, Dupeyron C, Faubert E, Mangeney N. Pulse-field gel electrophoresis typing of methicillin-resistant Staphylococcus aureus strains susceptible to aminoglycosides isolated from 1993 to 2002. J Hosp Infect 2004; 57:253-7. [PMID: 15236856 DOI: 10.1016/j.jhin.2004.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Accepted: 02/20/2004] [Indexed: 11/25/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) susceptible strains to aminoglycosides (AS-MRSA) have been increasingly isolated in the Albert Cheneiver Hospital during the past 10 years. The aim of this study was first, to analyse the genotypes and the profiles of resistance to antibiotics and second to compare the AS-MRSA with the MRSA resistant to gentamicin (GR-MRSA) and with MRSA resistant to kanamycin and tobramycin, but susceptible to gentamicin (GS-MRSA), previously studied in our laboratory. All the AS-MRSA consecutively isolated from clinical samples (carriage isolates excluded) from 01/01/1993 to 31/12/2002 (33 isolates) were typed by DNA macrorestriction. Their susceptibilities to other anti-staphylococcal drugs (erythromycin, lincomycin, tetracycline, rifampicin, fusidic acid and fosfomycin) were studied by the French standard disk method. The 33 strains showed a heterogeneous resistance to oxacillin and fell into five phenotypes. The main phenotype (51.5% of the AS-MRSA strains) was susceptible to the six antibiotics studied. DNA macrorestriction defined 24 genotypes (percentage similarity <80%). Among them 16 genotypes contained only one strain each, and none contained more than three isolates. Conversely the comparison with GR-MRSA and GS-MRSA isolated during the same period showed that the strains were not closely linked. The diversity of our isolates showed that it was not an epidemic phenomenon, in contrast to the results of similar studies. Our findings may be explained by the patients coming mostly from different hospital units. This work indicates the need for further studies on the genome, to determine whether AS-MRSA have derived from strains that occurred before aminoglycosides came into clinical use.
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Affiliation(s)
- M Lescat
- Laboratoire de Microbiologie, Hôpital Albert Chenevier, 40 rue de Mesly, 94000 Creteil, France
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17
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Bertrand X, Muller A, Thouverez M, Talon D. Retour vers la sensibilité aux antibiotiques des souches de Staphylococcus aureus résistant à la méticilline (SARM) : relation entre génotype et antibiotype. ACTA ACUST UNITED AC 2004; 52:480-5. [PMID: 15465268 DOI: 10.1016/j.patbio.2004.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 03/24/2004] [Indexed: 11/21/2022]
Abstract
The objective of our study was to investigate the relationship between molecular epidemiology and antibiotic susceptibility of MRSA during a four-year period. In this aim, we determined the antibiotype of all MRSA identified during a yearly period of 3 months and typed 50 consecutive non-replicate MRSA isolates of each year. We also recorded antibiotic use. Susceptibility rates to gentamicin, tobramycin and ofloxacin remained stable, respectively, 95, 16 and 4%. In contrast, the proportion of MRSA susceptible to erythromycin progressively increased from 7.0% to 32.5% (P < 0.001). PFGE analysis of genomic DNA from the 200 isolates revealed 15 different clones. We identified two epidemic clones, which contained 150 (clone A) and 28 isolates (clone C), respectively. The proportion of isolates belonging to clone A decreased during the study from 86% to 66%. Conversely, clone C increased from 4% to 22%. The increase of erythromycin-susceptibility within MRSA was caused by the emergence of clone C. Non-epidemic strains were more frequently susceptible to ofloxacin (31.8% vs. 1.1%) and tobramycin (45.4% vs. 16.8%) than epidemic strains. Antimicrobial use had not significantly varied during the study. The proportion of beta-lactams, fluoroquinolones, macrolides and aminosides was 71.8, 13.9, 5.0 and 3.8% of the total antibiotic use, respectively. In our hospital, MRSA isolates became more susceptible to antimicrobial of minor use. The selection pressure exerted by beta-lactams and fluoroquinolones was in favor of the spread of strains resistant to these both major antibiotic classes.
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Affiliation(s)
- X Bertrand
- Service d'hygiène hospitalière et d'épidémiologie moléculaire, CHU Jean-Minjoz, 25030 Besançon, France.
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18
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Acco M, Ferreira F, Henriques J, Tondo E. Identification of multiple strains of Staphylococcus aureus colonizing nasal mucosa of food handlers. Food Microbiol 2003. [DOI: 10.1016/s0740-0020(03)00049-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Thouverez M, Muller A, Hocquet D, Talon D, Bertrand X. Relationship between molecular epidemiology and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) in a French teaching hospital. J Med Microbiol 2003; 52:801-806. [PMID: 12909658 DOI: 10.1099/jmm.0.05252-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to investigate the relationship between molecular epidemiology and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) over a period of 4 years. The antibiotype of all MRSA isolates that were identified during a yearly period of 3 months was determined; 50 consecutive non-replicate MRSA isolates were typed each year. Susceptibility rates to gentamicin, tobramycin and ofloxacin remained stable (95, 16 and 4 %, respectively). In contrast, the proportion of MRSA isolates susceptible to erythromycin increased progressively from 10.5 to 32.5 % (P < 0.001). PFGE analysis of genomic DNA from 200 isolates revealed the presence of 15 different clones. Two epidemic clones were identified, which contained 150 (clone A) and 28 (clone C) isolates. Non-epidemic strains were more frequently susceptible to ofloxacin (31.8 versus 1.1 %) and tobramycin (45.4 versus 16.8 %) than epidemic strains; those isolates that were susceptible to all antibiotics tested belonged to sporadic clones. The increase of erythromycin susceptibility within MRSA isolates was caused by the emergence of clone C. This study suggests that when selection pressure exerted by an antibiotic is insufficient (i.e. below a threshold level), fitness advantages play a predominant role in the dissemination of MRSA clones. The balance between the selection pressure exerted by antibiotics and the disadvantage of lower replication rates of resistant strains in the absence of antibiotics complicates the biological model of clonal dissemination of epidemic MRSA strains.
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Affiliation(s)
- Michelle Thouverez
- Service d'Hygiène Hospitalière et d'Epidémiologie Moléculaire1 and Service de Bactériologie2, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
| | - Arno Muller
- Service d'Hygiène Hospitalière et d'Epidémiologie Moléculaire1 and Service de Bactériologie2, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
| | - Didier Hocquet
- Service d'Hygiène Hospitalière et d'Epidémiologie Moléculaire1 and Service de Bactériologie2, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
| | - Daniel Talon
- Service d'Hygiène Hospitalière et d'Epidémiologie Moléculaire1 and Service de Bactériologie2, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
| | - Xavier Bertrand
- Service d'Hygiène Hospitalière et d'Epidémiologie Moléculaire1 and Service de Bactériologie2, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
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20
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Watson J, Givney R, Beard-Pegler M, Rose B, Merlino J, Vickery A, Gottlieb T, Bradbury R, Harbour C. Comparative analysis of multidrug-resistant, non-multidrug-resistant, and archaic methicillin-resistant Staphylococcus aureus isolates from Central Sydney, Australia. J Clin Microbiol 2003; 41:867-72. [PMID: 12574303 PMCID: PMC149719 DOI: 10.1128/jcm.41.2.867-872.2003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this study, the phenotypic and genotypic characteristics of 50 methicillin-resistant Staphylococcus aureus (MRSA) isolates (43 contemporary and 7 archaic strains from the mid-1960s) from four Sydney hospitals in the central Sydney area were compared. Phenotypic analysis based on antibiotic profiles and phage typing patterns categorized the MRSA isolates into three major groups: multidrug resistant (mMRSA), non-multidrug resistant (nmMRSA), and archaic. The nmMRSA isolates could be further subdivided into nmMRSA group 1, which was phage typeable and similar to the archaic group; nmMRSA group 2, which was non-phage typeable and only resistant to ciprofloxacin; and nmMRSA group 3, which was also nontypeable and generally resistant to other antibiotics. The characterization of all five phenotypic groups was then extended by genetic analysis. Restriction fragment length polymorphism (RFLP) analysis showed the 50 isolates could be sorted into 20 group-specific pulsotypes. mecI gene deletions and mutations at various percentages among the five MRSA groups were detected by sequencing. Several mec promoter mutations were also found. The overall findings indicated that nmMRSA strains may have independently acquired mec DNA and are more likely to be newly emergent strains than nmMRSA variants.
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Affiliation(s)
- Jason Watson
- Department of Infectious Diseases and Immunology, University of Sydney, Australia
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Albertini MT, Benoit C, Berardi L, Berrouane Y, Boisivon A, Cahen P, Cattoen C, Costa Y, Darchis P, Delière E, Demontrond D, Eb F, Golliot F, Grise G, Harel A, Koeck JL, Lepennec MP, Malbrunot C, Marcollin M, Maugat S, Nouvellon M, Pangon B, Ricouart S, Roussel-Delvallez M, Vachée A, Carbonne A, Marty L, Jarlier V. Surveillance of methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBLE) in Northern France: a five-year multicentre incidence study. J Hosp Infect 2002; 52:107-13. [PMID: 12398076 DOI: 10.1053/jhin.2002.1286] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to measure the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and of Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBLE), and to evaluate the impact of the national guidelines for multidrug-resistant bacteria (MDRB) prevention in hospitals of Northern France, a multicentre study was conducted for three months every year starting in 1996, in volunteer hospital laboratories. All clinical specimens positive for MRSA and ESBLE were prospectively surveyed. During the five-year surveillance period, the overall proportion of MRSA was 38.4% in the 28,534 strains of S. aureus, and that of ESBLE was 11.4% in the 6121 strains of Klebsiella pneumoniae and 47.7% in the 2353 strains of Enterobacter aerogenes. The overall incidence rates of clinical specimens positive for MRSA, ESBL-K. pneumoniae and E. aerogenes were 0.84. 0.05 and 0.12/1000 hospital-days (HD), respectively. In the 23 hospitals that participated in the survey every year, the proportion and incidence of ESBLE decreased. Hence, despite recommendations as for isolation precautions, MRSA remains poorly controlled and requires more effective measures.
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Talon D, Delière E, Bertrand X. Characterization of methicillin-resistant Staphylococcus aureus strains susceptible to tobramycin. Int J Antimicrob Agents 2002; 20:174-9. [PMID: 12385695 DOI: 10.1016/s0924-8579(02)00173-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Gentamicin-susceptible, methicillin-resistant, Stapylococcus aureus strains (GS-MRSA) emerged in 1992 in various Parisian hospitals and have subsequently been isolated from all French hospitals. This new GS-MRSA epidemic clone accounted for 50% of MRSA strains in 1996 and for 85% in 2000 in our hospital. We have observed a parallel increase in the prevalence of tobramycin and amikacin-susceptible GS-MRSA (TKS-MRSA). The number of TKS-MRSA strains per 100 MRSA strains has steadily increased from 3.1 in 1996 to 24.0 in 2000. Genotypic characterization of TKS-MRSA strains showed that these strains are a phenotypic variant of the dominant clone of GS-MRSA. To improve our understanding of the changes in methicillin-resistant Staphylococcus aureus (MRSA) susceptibility to non-beta-lactam antibiotics, gentamicin- and amikacin-susceptible MRSA (TKS-MRSA) from our acute-care hospital were compared with TKS-MRSA isolated from a long-term care hospital located in another region of France. The nature of the care facility did not seem to play a major role in the hospital dissemination of TKS-MRSA. We also found that changes in antibiotic use alone do not account for the emergence of these strains.
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Affiliation(s)
- D Talon
- Service d'Hygiène hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Jean Minjoz, Besançon 25030, France.
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23
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Mangeney N, Drollee K, Cloitre V, Bordes M, Faubert E, Dupeyron C. Comparative pulsed-field gel electrophoresis typing of gentamicin-resistant and -susceptible methicillin-resistant Staphylococcus aureus strains isolated in France between 1991 and 1998. Changes in antibiotic susceptibility. J Hosp Infect 2002; 51:262-8. [PMID: 12183140 DOI: 10.1053/jhin.2002.1254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Using macrorestriction of genomic DNA and pulsed-field gel electrophoresis, we examined 504 non-redundant, infection-causing human isolates of methicillin-resistant Staphylococcus aureus susceptible (G(S): 238 isolates) or resistant to gentamicin (G(R): 266 isolates). The strains were isolated at Albert Chenevier Hospital (Créteil, France) between 1 January 1991 and 31 December 1998. Their susceptibility to erythromycin, lincomycin, tetracycline, rifampicin, fusidic acid and fosfomycin was also studied. Seventy-six genotypes were identified (percentage similarity<80). Ten types, each containing at least eight strains, predominated. G(R) strains showed higher genetic polymorphism than G(S) strains: the 266 G(R) isolates belonged to 67 genotypes, five of which predominated (44, 42, 38, 30 and 15 isolates); the 238 G(S) isolates belonged to only 18 types, four of which predominated (112, 83, 11 and 10 isolates). Fifty-six percent of G(R) strains (34 Gt) were resistant to erythromycin, lincomycin, tetracycline and rifampicin, and were isolated at relatively stable frequencies. Resistance to five antibiotics studied (susceptible to fusidic acid) was observed among 16.5% of G(R) strains. The frequency of strains with this profile diminished from 30% in the early 1990s to 10% in 1998. One hundred and twenty-six G(S) isolates were susceptible to all six antibiotics; this profile was only found from 1993 onwards, and was increasingly frequent (60% of G(S) strains in 1996). Resistance to erythromycin and lincomycin only was found in 70 G(S) isolates; this profile accounted for approximately half the isolates in 1992/1993 and only one-third in 1998. These results, obtained over an eight-year period, show an overall increase in antibiotic susceptibility. They confirm the spread of two major clones of MRSA-G(S) and support the hypotheses that G(S) strains derive from G(R) strains that have lost the aac6'-aph2" gene; and that G(S) strains are genetically related to those that were present before the use of gentamicin and persisted at a low frequency until 1992-1993.
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Affiliation(s)
- N Mangeney
- Laboratoire de Microbiologie, Hôpital Albert Chenevier, Créteil, France.
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24
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Senna JPM, Pinto CA, Carvalho LPS, Santos DS. Comparison of pulsed-field gel electrophoresis and PCR analysis of polymorphisms on the mec hypervariable region for typing methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2002; 40:2254-6. [PMID: 12037102 PMCID: PMC130718 DOI: 10.1128/jcm.40.6.2254-2256.2002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two hundred fifty-four methicillin-resistant Staphylococcus aureus (MRSA) strains typed by pulsed-field gel electrophoresis (PFGE) were tested by PCR for the mec-associated hypervariable region (HVR-PCR) to determine their number of direct repeat units (DRUs). Eight different groups of repeats were found among the MRSA strains and compared to 28 pulsotypes classified by PFGE. Some MRSA strains belonging to the same pulsotype showed different numbers of DRUs. HVR-PCR was rapid, easy to perform, and reproducible and has the ability to obtain an unambiguous positive result for each isolate analyzed. However, this technique shows a discriminatory power inferior to that of PFGE. We conclude that PFGE is a more reliable method of typing MRSA than HVR-PCR.
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Affiliation(s)
- J P M Senna
- Group of Molecular and Functional Microbiology, Department of Molecular Biology and Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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25
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Sopena N, Garcia-Nuñez M, Prats R, Pedro-Botet ML, Elia S, Nieto J, Sabrià M. Appearance of methicillin-resistant Staphylococcus aureus (MRSA) sensitive to gentamicin in a hospital with a previous endemic distinct MRSA. Eur J Epidemiol 2002; 17:317-21. [PMID: 11767956 DOI: 10.1023/a:1012779617702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Since 1990 a clone of gentamicin and methicillin-resistant Staphylococcus aureus (MRSA) has remained endemic in our hospital, but since January 1996 a gentamicin-sensitive strain has progressively replaced the previous clone. We characterized the phenotypic and molecular pattern of the MRSA strains isolated in our hospital in 1996 and compared prospectively the epidemiological, clinical and evolutionary characteristics of ninety patients infected or colonized by gentamicin-sensitive MRSA (GS-MRSA) (49) and by gentamicin-resistant MRSA (GR-MRSA) (41). Finally we studied the variation of aminoglycoside consumption in our hospital from 1989 to 1996. We observed two antibiotypes (GS-MRSA and GR-MRSA) corresponding to two major chromosomal patterns. Patients with GS-MRSA usually acquired the infection 72 hours after hospital admission. No significant differences were observed in epidemiological characteristics, clinical presentation and evolution between patients with GS-MRSA and GR-MRSA. Since 1989 aminoglycoside intake in our hospital has decreased by 46%.
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Affiliation(s)
- N Sopena
- Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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26
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Asseray N, Caillon J, Roux N, Jacqueline C, Bismuth R, Kergueris MF, Potel G, Bugnon D. Different aminoglycoside-resistant phenotypes in a rabbit Staphylococcus aureus endocarditis infection model. Antimicrob Agents Chemother 2002; 46:1591-3. [PMID: 11959609 PMCID: PMC127149 DOI: 10.1128/aac.46.5.1591-1593.2002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The impact of different types of enzymatic resistance on the in vivo antibacterial activity of aminoglycosides (amikacin, gentamicin, and netilmicin) was studied in the rabbit endocarditis model with four strains of Staphylococcus aureus. Animals were treated in a manner simulating the administration of a single daily human dose. Amikacin had no effect on the three kanamycin-resistant strains despite apparent susceptibility in the disk diffusion test. Gentamicin appears to be the preferable aminoglycoside for treatment of staphylococcal infections.
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Affiliation(s)
- N Asseray
- Laboratoire d'Antibiologie, UER de Médecine, Nantes, France
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27
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Sola C, Gribaudo G, Vindel A, Patrito L, Bocco JL. Identification of a novel methicillin-resistant Staphylococcus aureus epidemic clone in Córdoba, Argentina, involved in nosocomial infections. J Clin Microbiol 2002; 40:1427-35. [PMID: 11923368 PMCID: PMC140375 DOI: 10.1128/jcm.40.4.1427-1435.2002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are increasingly a main health concern worldwide for hospitalized patients. In addition, the prevalence of community-acquired infection has risen continuously during the last few years. Some MRSA clones spread easier than others within the hospital environment and therefore are frequently implicated in outbreaks. Thus, the spread of a unique epidemic multiresistant clone, the so-called South American clone, is the main cause of nosocomial infections produced by this bacterium in Brazil and in some regions of Argentina, Chile, and Uruguay. In the present work we describe the identification of a novel clone of MRSA that is involved in nosocomial infections and that shows a prevalence as high as that for the South American clone. A total of 53 consecutive single-patient MRSA isolates were recovered during a 3-month period (May to July 1999) from six different hospitals (955 beds) in Córdoba. The isolates were initially typed according the antibiotic resistance and phage susceptibility patterns, followed by genotyping using pulsed-field gel electrophoresis (PFGE). PFGE analysis of the 53 MRSA isolates revealed six major types (A to F) and 25 subtypes. The B-type DNA pattern was indistinguishable from that of the South American epidemic clone observed in 34% of the isolates. A novel highly prevalent clone, showing the A-type DNA pattern and representing 38% of the isolates, was also identified. Moreover, the most frequent subtype of the A clonal family triggered an outbreak in a hospital 2 months later, further confirming its epidemic feature.
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Affiliation(s)
- Claudia Sola
- Departamento de Bioquímica Clinica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Ciudad Universitaria, 5000 Córdoba, Argentina
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28
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dos Santos Nascimento J, dos Santos KRN, Gentilini E, Sordelli D, de Freire Bastos MDC. Phenotypic and genetic characterisation of bacteriocin-producing strains of Staphylococcus aureus involved in bovine mastitis. Vet Microbiol 2002; 85:133-44. [PMID: 11844620 DOI: 10.1016/s0378-1135(01)00476-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fifty strains of Staphylococcus spp. isolated from bovine mastitis cases in several herds from different Argentinian provinces were screened for antimicrobial substances. Twelve strains exhibited a high antagonistic activity against the indicator strain (Corynebacterium fimi) and were chosen for further characterisation. The antimicrobial substances were sensitive to proteolytic enzymes suggesting that they might be bacteriocins (Bac). These strains were identified as S. aureus by the amplification of the femA gene. Plasmid profile analysis of these strains revealed the presence of at least one plasmid. Eleven strains carried a plasmid with a size similar to that of pRJ6 (8.0kb), which encodes aureocin A70, a bacteriocin produced by the Brazilian S. aureus strain A70 isolated from commercial milk. The other strain harboured a much larger plasmid. PCR experiments, using specific primers for amplification of the bacteriocin operon found in pRJ6, showed that all strains had the expected 525bp amplicon, suggesting that the bacteriocin produced may be related to aureocin A70. The genomic DNA of all Bac(+) strains was then analysed by pulsed-field gel electrophoresis (PFGE) in order to investigate clonal relationships amongst strains. Based on the results of PFGE experiments, 10 out of the 12 Bac(+) strains belonged to the same clone. The remaining two strains are possibly related to the prevalent clone. The aureocin A70 producer-strain belonged to a distinct clone.
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Affiliation(s)
- Janaína dos Santos Nascimento
- Departamento de Microbiologia Geral, Instituto de Microbiologia-UFRJ, CCS-Bloco 1, Cidade Universitária, 21941-590, Rio de Janeiro, Brazil
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29
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Donnio PY, Louvet L, Preney L, Nicolas D, Avril JL, Desbordes L. Nine-year surveillance of methicillin-resistant Staphylococcus aureus in a hospital suggests instability of mecA DNA region in an epidemic strain. J Clin Microbiol 2002; 40:1048-52. [PMID: 11880436 PMCID: PMC120266 DOI: 10.1128/jcm.40.3.1048-1052.2002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The distributions of the antibiotic resistance patterns in a population of Staphylococcus aureus isolates from a teaching hospital were studied over a 9-year period. The results indicate the existence of successive major epidemic methicillin-resistant strains and the emergence of a methicillin-susceptible strain with an unusual resistance pattern. Our findings suggest that this methicillin-susceptible S. aureus strain could be derived from the dominant gentamicin-susceptible methicillin-resistant S. aureus strain with the loss of a 40-kb DNA fragment.
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Affiliation(s)
- Pierre-Yves Donnio
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire. UPRES 12-54 Microbiologie, Université de Rennes 1, 35033 Rennes Cedex 9, France.
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30
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Tronel H, Huc B, Bertrand X, Thouverez M, Marchal A, Talon D. Aspects épidémiologiques de Staphylococcus aureus résistant à la méticilline dans un centre hospitalier de taille moyenne. Med Mal Infect 2002. [DOI: 10.1016/s0399-077x(02)00359-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Scanvic-Hameg A, May-Michelangeli L, Le Turdu F. Apport du kit Servitex Staphylocoque MRSA® dans le diagnostic rapide des souches de Staphylococcus aureus résistantes à la méticilline. Med Mal Infect 2002. [DOI: 10.1016/s0399-077x(01)00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Blanc DS, Francioli P, Le Coustumier A, Gazagne L, Lecaillon E, Gueudet P, Vandenesch F, Etienne J. Reemergence of gentamicin-susceptible strains of methicillin-resistant Staphylococcus aureus in France: a phylogenetic approach. J Clin Microbiol 2001; 39:2287-90. [PMID: 11376072 PMCID: PMC88126 DOI: 10.1128/jcm.39.6.2287-2290.2001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The reemergence of gentamicin-susceptible (Gen(s)) methicillin-resistant Staphylococcus aureus (MRSA) isolates in France between 1992 and 1996 was investigated using a phylogenetic approach (multiprimer randomly amplified polymorphic DNA typing). Eighty-six percent (65 of 85) of the French strains were grouped into one phylogenetic cluster within which all but one Gen(s) strain were grouped into a subcluster. Thus, the reemergence of Gen(s) MRSA strains in France was likely due to the spread of one specific clone which belonged to a cluster comprising most French gentamicin-resistant (Gen(r)) strains. This suggests that the Gen(s) clone has emerged from a Gen(r) strain of this cluster.
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Affiliation(s)
- D S Blanc
- Division autonome de médecine préventive hospitalière, CHU Vaudois, 1011 Lausanne, Switzerland.
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33
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Carricajo A, Vermesch R, Aubert G. In vitro activity of cefpirome and vancomycin in combination against gentamicin-susceptible and gentamicin-resistant Staphylococcus aureus. Clin Microbiol Infect 2001; 7:218-26. [PMID: 11422245 DOI: 10.1046/j.1198-743x.2001.00238.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Carricajo
- Department of Bacteriology, Hopital Bellevue, CHU Saint Etienne, 42055 Saint Etienne Cedex 02, France.
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Quentin C, Grobost F, Fischer I, Dutilh B, Brochet JP, Jullin J, Lagrange I, Noury P, Larribet G, Andre C, Dupouey S, Boissinot D. [Antibiotic resistance of Staphylococcus aureus in urban experience: 6 month study in Aquitaine]. PATHOLOGIE-BIOLOGIE 2001; 49:33-40. [PMID: 11265221 DOI: 10.1016/s0369-8114(00)00008-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Antibiotic resistance of Staphylococcus aureus has been surveyed by eight city laboratories of the Aquitaine area, during a six month-period (january to june 1998). Antibiotic susceptibility testing has been performed by the disk diffusion method, and the results have been collected and analysed using the SIRscan system. After elimination of the redundant strains, a total of 747 isolates has been retained. They were mainly isolated from pus (64%) collected from patients of the community (40%) or hospitalized in 30 private clinics or nursing homes. The percentages of resistant strains (community/institutions) were: benzylpenicillin: 90% (87/92%), oxacillin: 39% (23/50%), kanamycin: 37% (22/47%); gentamicin: 13% (8/16%), tobramycin: 37% (21/47%), amikacin: 21% (13/27%); netilmicin: 6% (5/7%), erythromycin: 33% (30/35%), spiramycin: 72% (77/69%), lincomycin: 24% (17/29%), pristinamycin: 2% (1/2%), tetracycline: 17% (14/19%); pefloxacin: 40% (25/50%), fosfomycin: 9% (6/12%), rifampicin: 10% (7/13%), fusidic acid: 14% (11/15%), cotrimoxazole and vancomycin: 0%. Meticillin-susceptible strains of S. aureus were mostly sensitive to other antibiotics (< or = 6% resistant strains, except for erythromycin: 22%). Among meticillin-resistant S. aureus, heterogeneous strains with a KT phenotype, and various resistance patterns to the remaining antibiotics were predominant (61%), compared to the homogeneous strains with a KTG phenotype and multiresistant to the other antibiotics (32%). The frequencies of resistant strains were highly variable depending on the specimen, the laboratory and the health care institution, except for cotrimoxazole and vancomycin which were always active.
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Affiliation(s)
- C Quentin
- Laboratoire de Microbiologie, UFR des Sciences Pharmaceutiques, Université de Bordeaux 2, Bordeaux, France.
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Pournaras S, Slavakis A, Polyzou A, Sofianou D, Maniatis AN, Tsakris A. Nosocomial spread of an unusual methicillin-resistant Staphylococcus aureus clone that is sensitive to all non-beta-lactam antibiotics, including tobramycin. J Clin Microbiol 2001; 39:779-81. [PMID: 11158151 PMCID: PMC87820 DOI: 10.1128/jcm.39.2.779-781.2001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Between January and December 1999, in Hippokration General Hospital, Thessaloniki, Greece, a large proportion of the methicillin-resistant Staphylococcus aureus isolates (34.4%) exhibited susceptibility to virtually all alternative non-beta-lactam antibiotics, including tobramycin. Twenty-five of them were selected randomly for further testing; all belonged to a unique genotype and were characterized as heterogeneously resistant to oxacillin. The aadD gene, encoding tobramycin resistance, failed to be amplified in all cases, indicating absence of the gene or the entire plasmid pUB110 from the mec DNA.
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Affiliation(s)
- S Pournaras
- Department of Microbiology, Hippokration General Hospital, Thessaloniki, Greece
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Bertrand X, Thouverez M, Talon D. Antibiotic susceptibility and genotypic characterization of methicillin-resistant Staphylococcus aureus strains in eastern France. J Hosp Infect 2000; 46:280-7. [PMID: 11170759 DOI: 10.1053/jhin.2000.0841] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We studied changes over four years in the characteristics of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in a French university hospital by analysis of antibiotic susceptibility and restriction fragment length polymorphism using pulsed field gel electrophoresis. Changes were considered in relation to regional and national frameworks. The proportion of gentamicin-susceptible methicillin-resistant S. aureus (GS-MRSA) among MRSA increased from 22.6% in 1994 to 86.8% in 1998. We first isolated strains of GS-MRSA susceptible to tobramycin and amikacin (TKS-MRSA) in 1996 from patients in eight wards. The number of TKS-MRSA strains per 100 MRSA was 6.1 in 1997, 14.5 in 1998, and 18.9 in 1999. Pattern A, the major DNA pattern identified, accounted for 78.6% of isolates in 1998. This pattern was found in TKS-MRSA and TKR-MRSA strains, but not in Gentamicin-resistant MRSA strains (GR-MRSA). Fitness analysis showed that GR-MRSA strains had much lower replication rates than GS-MRSA strains, but there was no difference between TKS-MRSA and TKR-MRSA strains. Aminoglycoside consumption remained constant between 1994 and 1998. The spread of TKS-MRSA in our hospital since 1996 may relate to the "total use threshold", as the level of tobramycin/amikacin use is below that required for selection of TKR-MRSA.
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Affiliation(s)
- X Bertrand
- Service d'Hygiène hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Jean Minjoz, 25030 Besançon, France
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Shimizu A, Fujita M, Igarashi H, Takagi M, Nagase N, Sasaki A, Kawano J. Characterization of Staphylococcus aureus coagulase type VII isolates from staphylococcal food poisoning outbreaks (1980-1995) in Tokyo, Japan, by pulsed-field gel electrophoresis. J Clin Microbiol 2000; 38:3746-9. [PMID: 11015395 PMCID: PMC87468 DOI: 10.1128/jcm.38.10.3746-3749.2000] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2000] [Accepted: 08/01/2000] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus coagulase type VII strains have been the strains most frequently isolated from staphylococcal food poisoning outbreaks in Tokyo, Japan. We applied pulsed-field gel electrophoresis (PFGE) of chromosomal DNA digested with SmaI to characterize 129 coagulase type VII strains. These were isolated from 129 cases occurring in outbreaks in 35 districts during a 16-year period (1980-1995). The 129 outbreak strains were classified into three types, designated A (n = 115), B (n = 10), and C (n = 4). Types A and C were further divided into 33 (A1 to A33) and 4 (C1 to C4) subtypes, respectively. Strains of the same subtypes were isolated from food poisoning cases in the same districts at time intervals of 1 or 2 to 5 years. PFGE typing appears to be a useful method for subdividing strains of S. aureus coagulase type VII. A combination of coagulase typing and PFGE typing would provide more detailed information than the former method alone in epidemiologic investigations of staphylococcal food poisoning.
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Affiliation(s)
- A Shimizu
- Department of Microbiology and Immunology, Faculty of Agriculture, Kobe University, Nada-ku, Kobe-shi, Hyogo 657-0013, Japan.
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Galdbart JO, Morvan A, El Solh N. Phenotypic and molecular typing of nosocomial methicillin-resistant Staphylococcus aureus strains susceptible to gentamicin isolated in france from 1995 to 1997. J Clin Microbiol 2000; 38:185-90. [PMID: 10618085 PMCID: PMC88693 DOI: 10.1128/jcm.38.1.185-190.2000] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant strains susceptible to gentamicin (Gm(s) MRSA) have emerged since 1993 in several French hospitals. To study whether particular clones have spread in various French cities and whether some clones are related to gentamicin-resistant (Gm(r)) MRSA strains, various methods (antibiotyping, phage typing, determination of SmaI macrorestriction patterns before and after hybridization with IS256 transposase and aacA-aphD probes) were used to compare 62 Gm(s) MRSA strains isolated from 1995 to 1997 in nine cities and 15 Gm(r) MRSA strains. Eighteen major SmaI genotypes were identified, of which 11 included only Gm(s) MRSA strains and 5 included only Gm(r) MRSA strains. Each of the Gm(r) MRSA strains contained 6 to 13 SmaI fragments hybridizing with the insertion sequence IS256, of which a single band also hybridized with the aacA-aphD gene. No such hybridizing sequences were detected in 60 of the 62 Gm(s) MRSA strains. Thus, the divergence between Gm(r) and Gm(s) MRSA strains is revealed, not only by their distributions in distinct SmaI genotypes but also by the differences in hybridization patterns. Two of the 62 Gm(s) MRSA strains had the uncommon feature of carrying several SmaI bands hybridizing with IS256, suggesting that they are possibly related to the Gm(r) MRSA strains grouped in the same SmaI genotype. Five of the 11 SmaI genotypes including only Gm(s) MRSA strains contained strains from diverse cities, isolated during different years and with different antibiograms, suggesting that some clones have spread beyond their cities of origin and persisted.
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Affiliation(s)
- J O Galdbart
- Unité des Staphylocoques, National Reference Center for Staphylococci Institut Pasteur, 75724 Paris Cedex 15, France
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Lelièvre H, Lina G, Jones ME, Olive C, Forey F, Roussel-Delvallez M, Nicolas-Chanoine MH, Bébéar CM, Jarlier V, Andremont A, Vandenesch F, Etienne J. Emergence and spread in French hospitals of methicillin-resistant Staphylococcus aureus with increasing susceptibility to gentamicin and other antibiotics. J Clin Microbiol 1999; 37:3452-7. [PMID: 10523533 PMCID: PMC85665 DOI: 10.1128/jcm.37.11.3452-3457.1999] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Oxacillin (methicillin) resistance in methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increased incidence of resistance to other antibiotics, which has increased since it was first reported in 1969. In 1992 a new phenotype of MRSA arose in France; this was characterized by a heterogeneous expression of resistance to oxacillin and susceptibility to various antibiotics, including gentamicin but also tetracycline, minocycline, lincomycin, pristinamycin, co-trimoxazole, rifampin, and fusidic acid. In French hospitals a longitudinal nationwide surveillance of antibiotic resistance in S. aureus has allowed for the detection of changes in antibiotic susceptibility profiles. Seven French clinical laboratories (six from the mainland and one from the West Indies) reported the results of susceptibility testing of 57,347 S. aureus strains isolated in their institutes between 1992 and 1998. Over a 7-year period the incidence of isolation of gentamicin-susceptible MRSA (GS-MRSA) strains has steadily increased to represent, in 1998, 46.8 to 94.4% of the MRSA strains, irrespective of the overall incidence of MRSA. Two predominant types recognized by pulsed-field gel electrophoresis (PFGE) accounted for the majority of the GS-MRSA in different mainland hospitals, both differing from the predominant type observed in the French West Indies. Some GS-MRSA and gentamicin-resistant MRSA (GR-MRSA) strains had closely related PFGE profiles, and hybridization studies confirmed the lack in GS-MRSA of the aac6'-aph2" gene, which confers resistance to all aminoglycosides, with conservation of the ant4' gene, which confers resistance to kanamycin, tobramycin, and amikacin. Thus, it is likely that certain GS-MRSA strains could have emerged from GR-MRSA strains by excision or deletion of the aac6'-aph2" gene.
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Affiliation(s)
- H Lelièvre
- Centre National de Référence des Toxémies à Staphylocoques, EA 1655, Faculté de Médecine, 69372 Lyon Cedex 08, France
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Methicillin-resistant Staphylococcus aureus in French hospitals: A 2-month survey in 43 hospitals, 1995. Infect Control Hosp Epidemiol 1999; 20:478-86. [PMID: 10432160 DOI: 10.1086/501656] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in patients hospitalized in French public hospitals. DESIGN A 2-month survey that included 163,573 patients and 140,114 admissions. SETTING AND PATIENTS Forty-three public or public-affiliated hospitals throughout France, including 12 university-affiliated hospitals. Information was recorded on all patients having MRSA recovered from culture of any clinical sample. RESULTS The overall median incidence rate (per 1,000 admissions) of clinically detected MRSA was 5.9 (range, 1.8-15.8); median rates were similar in hospitals affiliated or not affiliated to universities (6.4 and 5.9, respectively). Smaller unaffiliated hospitals (<500 beds) had higher MRSA incidence rates (mean, 7.2) than larger (>500 beds) unaffiliated hospitals or university hospitals (mean, 6.7 and 6.1, respectively). The incidence density (per 1,000 patient-days) of MRSA was higher in intensive-care units [ICUs] 2.39/1,000) than in surgical (0.80/1,000) and medical (0.70/1,000) wards, respectively; comparable rates were recorded in rehabilitation units (0.67/1,000), whereas in long-term-stay units, the incidence density of MRSA was 0.27/1,000 patient-days. Of 958 MRSA isolates, 660 (69%) also were resistant to all aminoglycosides. In 411 (43%) of 958 patients, the MRSA isolate was considered imported (ie, first recovered within 72 hours of the patient's admission to the unit). More than one half (53%) of imported cases were transfer patients from other hospitals, and 17% originated from ICUs. CONCLUSION MRSA is extensive in French hospitals. All categories of hospitals are involved to a similar extent, and there is intense circulation of patients colonized or infected with MRSA between units and hospitals. Containment of MRSA would mandate increasing resources devoted to infection control, especially in smaller hospitals, and control programs should involve notification of carriers and screening of patients at risk of MRSA carriage on admission to detect carriers and to implement isolation precautions rapidly.
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SHIMIZU A, ANZAI T, FUJITA M, KAKUTANI O, TAKAGI M, NAGASE N. Molecular Epidemiology of Staphylococcus aureus Isolates from Horses by Pulsed-Field Gel Electrophoresis. J Equine Sci 1999. [DOI: 10.1294/jes.10.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Akira SHIMIZU
- Department of Microbiology and Immunology, Faculty of Agriculture, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe-shi, Hyogo 657-0013, Japan
| | - Toru ANZAI
- Epizootic Research Station, Equine Research Institute, Japan Racing Association, 1400-4 Shiba, Kokubunji-machi, Shimotsuga-gun, Tochigi 329-0412, Japan
| | - Manabu FUJITA
- Department of Microbiology and Immunology, Faculty of Agriculture, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe-shi, Hyogo 657-0013, Japan
| | - Osamu KAKUTANI
- Department of Microbiology and Immunology, Faculty of Agriculture, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe-shi, Hyogo 657-0013, Japan
| | - Michihiro TAKAGI
- Department of Microbiology and Immunology, Faculty of Agriculture, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe-shi, Hyogo 657-0013, Japan
| | - Naoko NAGASE
- Department of Microbiology and Immunology, Faculty of Agriculture, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe-shi, Hyogo 657-0013, Japan
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Monnet DL. Methicillin-Resistant Staphylococcus aureus and Its Relationship to Antimicrobial Use: Possible Implications for Control. Infect Control Hosp Epidemiol 1998. [DOI: 10.2307/30141779] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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