Fulminant Staphylococcal Infections

Mortality risk factors and fulminant sub-phenotype in anaerobic bacteremia: a 10-year retrospective, multicenter, observational cohort study

PURPOSE

During the last decade, the incidence of anaerobic bacteremia (AB) has been increasing. Patients with AB may develop complex underlying diseases, which can occasionally be accompanied by fatal or fulminant outcomes. However, the risk factors for AB-related mortality remain unclear. Herein, we sought to elucidate the risk factors for AB-related mortality.

METHODS

In this multicenter, retrospective, observational study, we enrolled patients with culture-proven AB from six tertiary hospitals in Japan, between January 2012 and December 2021. Data on patient and infection characteristics, laboratory findings, treatment, and outcome were collected, and their associations with mortality were analyzed.

RESULTS

A total of 520 participants were included. The 30-day mortality in the study cohort was 14.0% (73 patients), and malignant tumors were frequently observed comorbidities in 48% of the entire cohort. Multivariable logistic regression analysis showed a Charlson comorbidity score of > 6, serum creatinine level of > 1.17 mg/dL, and hypotension to be independent risk factors for 30-day mortality in AB (odds ratios [ORs] 2.12, 2.25, and 5.12, respectively; p < 0.05), whereas drainage significantly reduced this risk (OR, 0.28; p < 0.0001). Twelve patients (2.3% of the whole cohort and 16.4% of the deceased patients) presented with extremely rapid progression leading to fatal outcome, consistent with "fulminant AB."

CONCLUSIONS

This study identified acute circulatory dysfunction and performance of drainage as independent predictive factors for 30-day AB-related mortality and revealed the existence of a fulminant AB sub-phenotype. Our findings could serve as a practical guide to predict the clinical outcomes of AB.

Nasal Carriage by Staphylococcus aureus among Healthcare Workers and Students Attending a University Hospital in Southern Brazil: Prevalence, Phenotypic, and Molecular Characteristics

Background

Staphylococcus aureus can asymptomatically colonize the human anterior nares and skin, and nasal colonization by this bacterium represents a potential risk for development of invasive infections. The aim of this study was to determine the prevalence of S. aureus nasal carriage among healthcare workers and students attending a university hospital and to characterize the isolates phenotypically and molecularly.

Methods

A cross-sectional study was performed with 324 volunteers. Cultures from nasal samples were obtained and S. aureus isolates were characterized according to their antimicrobial susceptibility profile and four virulence factors-encoding genes. MRSA isolates were characterized regarding their oxacillin/cefoxitin susceptibility, SCCmec, and REP-PCR types. Potential risks for S. aureus and MRSA carriage were analyzed.

Results

Of 324 nasal samples, 42.9% were identified as S. aureus, of which 28.8% were MRSA. S. aureus carriers were significantly higher in males and students (OR = 2.898, 95%CI 1.553-5.410); however, no variables were associated with MRSA carriage. All isolates were susceptible to vancomycin and the highest rate of resistance was observed for penicillin (90.6%). All isolates harbored the coa gene, and 97.8%, the icaA gene; 15.8% and 6.5% were positive for tst and lukS-PV/lukF-PV genes, respectively. Among MRSA isolates, 45% carried the mecA gene but were phenotypically susceptible to oxacillin/cefoxitin; two harbored the tst and none had lukS-PV/lukF-PV genes. All MRSAs were distributed into six SCCmec types and type I (62.5%) was the most frequent. REP-PCR typing identified four main clusters among MRSA isolates.

Conclusion

High prevalence of healthcare workers and students were identified as nasal carriers of S. aureus exhibiting different antimicrobial resistance profiles, including mecA-positive oxacillin-susceptible S. aureus (OS-MRSA) and the presence of virulence-encoding genes. Both cohorts may represent potential sources for the emergence of a successful S. aureus strain highly adapted to the hospital environment.

Using genomics to understand meticillin- and vancomycin-resistant Staphylococcus aureus infections

Resistance to meticillin and vancomycin in Staphylococcus aureus significantly complicates the management of severe infections like bacteraemia, endocarditis or osteomyelitis. Here, we review the molecular mechanisms and genomic epidemiology of resistance to these agents, with a focus on how genomics has provided insights into the emergence and evolution of major meticillin-resistant S. aureus clones. We also provide insights on the use of bacterial whole-genome sequencing to inform management of S. aureus infections and for control of transmission at the hospital and in the community.

An active domain HF-18 derived from hagfish intestinal peptide effectively inhibited drug-resistant bacteria in vitro/vivo

Antibiotic resistance is spreading faster than the development of new antibiotics into clinical practice. Currently, the design of antimicrobial peptides (AMPs), potential new antibacterial agents with rare antimicrobial resistance, is the available strategy to enhance the antimicrobial activity and lower the toxicity of AMPs. In this study, a peptide derived from hagfish intestinal peptide was designed and termed as HF-18 (GFFKKAWRKVKKAFRRVL). After antimicrobial/bactericidal test in vitro, we found that HF-18 exhibited a potent antimicrobial activity with MIC of only 4 μg/ml against drug-resistant Staphylococcus aureus (S. aureus). Meanwhile, it eliminated the test bacteria within 1 h, suggesting its rapid bactericidal effect. Importantly, this peptide had no obvious hemolytic activity and cytotoxicity to mammalian cells. Furthermore, its notable antimicrobial effects in vivo was confirmed again in S. aureus induced mouse bacteremia and skin wound infection, reflecting as the decrease in bacterial counts in mouse lung or skin (up to 1.9 or 3.5 log CFU respectively), and including the inhibitory activity on inflammatory cytokines secretion. The possible mechanisms underlying HF-18 against drug-resistant S. aureus may attribute that HF-18 neutralized the negative charge in S. aureus surface and then disrupted the integrity of cell membranes to enhance the permeation of bacterial membrane, showing as the increased uptake of NPN and PI and the obvious morphology changes of S. aureus. In addition, this peptide bound to bacterial genomic DNA to suppress the expression of Panton-Valentine leukocidin (pvl) and nuclease (nuc) genes, which play major roles in S. aureus virulence. The properties of HF-18 suggest a path towards developing antibacterial agents that has stronger antibacterial activity and greater security for clinical treatment of infection induced by S. aureus, especially drug-resistant S. aureus.