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Räz AK, Andreoni F, Boumasmoud M, Bergada-Pijuan J, Schweizer TA, Mairpady Shambat S, Hasse B, Zinkernagel AS, Brugger SD. Limited Adaptation of Staphylococcus aureus during Transition from Colonization to Invasive Infection. Microbiol Spectr 2023; 11:e0259021. [PMID: 37341598 PMCID: PMC10433843 DOI: 10.1128/spectrum.02590-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 05/24/2023] [Indexed: 06/22/2023] Open
Abstract
Staphylococcus aureus carriage is a risk factor for invasive infections. Unique genetic elements favoring the transition from colonizing to invasive phenotype have not yet been identified, and phenotypic adaptation traits are understudied. We therefore assessed phenotypic and genotypic profiles of 11 S. aureus isolate pairs sampled from colonized patients simultaneously suffering from invasive S. aureus infections. Ten out of 11 isolate pairs displayed the same spa and multilocus sequence type, suggesting colonization as an origin for the invasive infection. Systematic analysis of colonizing and invasive isolate pairs showed similar adherence, hemolysis, reproductive fitness properties, antibiotic tolerance, and virulence in a Galleria mellonella infection model, as well as minimal genetic differences. Our results provide insights into the similar phenotypes associated with limited adaptation between colonizing and invasive isolates. Disruption of the physical barriers of mucosa or skin was identified in the majority of patients, further emphasizing colonization as a major risk factor for invasive disease. IMPORTANCE S. aureus is a major pathogen of humans, causing a wide range of diseases. The difficulty to develop a vaccine and antibiotic treatment failure warrant the exploration of novel treatment strategies. Asymptomatic colonization of the human nasal passages is a major risk factor for invasive disease, and decolonization procedures have been effective in preventing invasive infections. However, the transition of S. aureus from a benign colonizer of the nasal passages to a major pathogen is not well understood, and both host and bacterial properties have been discussed as being relevant for this behavioral change. We conducted a thorough investigation of patient-derived strain pairs reflecting colonizing and invasive isolates in a given patient. Although we identified limited genetic adaptation in certain strains, as well as slight differences in adherence capacity among colonizing and invasive isolates, our work suggests that barrier breaches are a key event in the disease continuum of S. aureus.
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Affiliation(s)
- Anna K. Räz
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Federica Andreoni
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mathilde Boumasmoud
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Judith Bergada-Pijuan
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tiziano A. Schweizer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Srikanth Mairpady Shambat
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio D. Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Congdon ST, Guaglione JA, Ricketts OMA, Murphy KV, Anderson MG, Trowbridge DA, Al-Abduladheem Y, Phillips AM, Beausoleil AM, Stanley AJ, Becker TJ, Silver AC. Prevalence and antibiotic resistance of Staphylococcus aureus associated with a college-aged cohort: life-style factors that contribute to nasal carriage. Front Cell Infect Microbiol 2023; 13:1195758. [PMID: 37441241 PMCID: PMC10333693 DOI: 10.3389/fcimb.2023.1195758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
Staphylococcus aureus is an opportunistic human pathogen that can frequently be found at various body locations, such as the upper respiratory tract, nostrils, skin, and perineum. S. aureus is responsible for causing a variety of conditions, which range from minor skin infections and food poisoning to life-threatening sepsis and endocarditis. Furthermore, S. aureus has developed resistance to numerous antimicrobial agents, which has made treatment of S. aureus infections difficult. In the present study, we examined lifestyle factors that could increase the likelihood of S. aureus carriage, the overall prevalence of S. aureus, as well as assessed the antibiotic resistance profiles of the S. aureus isolates among a population of college students. Five hundred nasal samples were collected and analyzed via selective growth media, coagulase and protein A testing, as well as polymerase chain reaction and DNA sequencing. One hundred four out of the 500 samples collected (21%) were identified as containing S. aureus. The S. aureus isolates were resistant to penicillin (74%), azithromycin (34%), cefoxitin (5%), ciprofloxacin (5%), tetracycline (4%), and trimethoprim (1%), but sensitive to gentamicin and rifampin. Lastly, we identified several lifestyle factors (i.e., pet exposure, time spent at the university recreational facility, musical instrument usage, and tobacco usage) positively correlated with S. aureus nasal colonization.
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Affiliation(s)
- Sean T. Congdon
- Department of Biology, University of Hartford, West Hartford, CT, United States
| | - John A. Guaglione
- Department of Biology, University of Hartford, West Hartford, CT, United States
| | | | - Kyle V. Murphy
- Department of Biology, University of Hartford, West Hartford, CT, United States
| | - Megan G. Anderson
- Department of Biology, University of Hartford, West Hartford, CT, United States
| | - Darby A. Trowbridge
- Department of Biology, University of Hartford, West Hartford, CT, United States
| | | | | | | | - Alexus J. Stanley
- Department of Biology, University of Hartford, West Hartford, CT, United States
| | - Timothy J. Becker
- Department of Computing Sciences, University of Hartford, West Hartford, CT, United States
| | - Adam C. Silver
- Department of Biology, University of Hartford, West Hartford, CT, United States
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Tsikopoulos K, Meroni G, Kaloudis P, Pavlidou E, Gravalidis C, Tsikopoulos I, Drago L, Romano CL, Papaioannidou P. Is nanomaterial- and vancomycin-loaded polymer coating effective at preventing methicillin-resistant Staphylococcus aureus growth on titanium disks? An in vitro study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1415-1422. [PMID: 36976333 DOI: 10.1007/s00264-023-05757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Periprosthetic joint infections induced by methicillin-resistant Staphylococcus aureus (MRSA) pose a major socioeconomic burden. Given the fact that MRSA carriers are at high risk for developing periprosthetic infections regardless of the administration of eradication treatment pre-operatively, the need for developing new prevention modalities is high. METHODS The antibacterial and antibiofilm properties of vancomycin, Al2O3 nanowires, and TiO2 nanoparticles were evaluated in vitro using MIC and MBIC assays. MRSA biofilms were grown on titanium disks simulating orthopedic implants, and the infection prevention potential of vancomycin-, Al2O3 nanowire-, and TiO2 nanoparticle-supplemented Resomer® coating was evaluated against biofilm controls using the XTT reduction proliferation assay. RESULTS Among the tested modalities, high- and low-dose vancomycin-loaded Resomer® coating yielded the most satisfactory metalwork protection against MRSA (median absorbance was 0.1705; [IQR = 0.1745] vs control absorbance 0.42 [IQR = 0.07]; p = 0.016; biofilm reduction was 100%; and 0.209 [IQR = 0.1295] vs control 0.42 [IQR = 0.07]; p < 0.001; biofilm reduction was 84%, respectively). On the other hand, polymer coating alone did not provide clinically meaningful biofilm growth prevention (median absorbance was 0.2585 [IQR = 0.1235] vs control 0.395 [IQR = 0.218]; p < 0.001; biofilm reduction was 62%). CONCLUSIONS We advocate that apart from the well-established preventative measures for MRSA carriers, loading implants with bioresorbable Resomer® vancomycin-supplemented coating may decrease the incidence of early post-op surgical site infections with titanium implants. Of note, the payoff between localized toxicity and antibiofilm efficacy should be considered when loading polymers with highly concentrated antimicrobial agents.
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Affiliation(s)
- Konstantinos Tsikopoulos
- 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece, 54124.
| | - Gabriele Meroni
- One Health Unit, Department of Biomedical Surgical and Dental Sciences, School of Medicine, Università degli Studi di Milano, Milan, Italy
| | - Panagiotis Kaloudis
- 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece, 54124
| | - Eleni Pavlidou
- Condensed Matter and Materials Section, Department of Physics, Faculty of Exact Sciences, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece, 54124
| | - Christoforos Gravalidis
- Condensed Matter and Materials Section, Department of Physics, Faculty of Exact Sciences, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece, 54124
| | - Ioannis Tsikopoulos
- 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece, 54124
| | - Lorenzo Drago
- Laboratory of Clinical Microbiology and Microbiome, Department of Biomedical Sciences for Health. School of Medicine, University of Milan, Milan, Italy
| | | | - Paraskevi Papaioannidou
- 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece, 54124
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Nasal Carriage and Methicillin Resistance of Staphylococcus aureus among Schoolchildren in Sana'a City, Yemen. Int J Microbiol 2021; 2021:5518317. [PMID: 34035816 PMCID: PMC8121562 DOI: 10.1155/2021/5518317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/11/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Staphylococcus aureus (S. aureus) is a frequent cause of serious health problems with high morbidity and mortality. The risk of S. aureus infections is increased with the emergence of methicillin-resistant S. aureus (MRSA). This study aims to determine the nasal carriage rate of both S. aureus and MRSA among schoolchildren in Sana'a city. Methods This is a cross-sectional study conducted from January 2018 to May 2020. Five hundred and thirty-six students were enrolled. Their age ranged from 5 to 19 years with the mean age and standard deviation equal to 13.3 ± 3.5 years. Nasal swabs were collected from each student for culturing and methicillin susceptibility testing. Results Students with positive culture were 271 (51%) males and 265 (49%) females. S. aureus was isolated from 129 (24%) students whereas the overall prevalence of MRSA was 8 (1.5%). S. aureus was significantly recovered from students at the age group of 10–14 years (χ2 = 7.02; p=0.03), females than males (OR = 1.96; χ2 = 10.75; p=0.001), and students who were admitted into hospitals (OR = 1.6; χ2 = 4.89; p=0.03). Nevertheless, there were no significant differences between MRSA carriage and students' age (χ2 = 2.3; p=0.32), gender (OR = 1.02; χ2 = 0.001; p=0.63), and hospital admission (OR = 1.4; χ2 = 0.25; p=0.62). Conclusions The prevalence of MRSA is low among schoolchildren in Sana'a city. Age, gender, and previous hospital admission were statistically associated with nasal carriage of S. aureus but not MRSA nasal carriage.
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Zhu H, Jin H, Zhang C, Yuan T. Intestinal methicillin-resistant Staphylococcus aureus causes prosthetic infection via 'Trojan Horse' mechanism: Evidence from a rat model. Bone Joint Res 2020; 9:152-161. [PMID: 32431806 PMCID: PMC7229338 DOI: 10.1302/2046-3758.94.bjr-2019-0205.r1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aims Methicillin-resistant Staphylococcus aureus (MRSA) can cause wound infections via a 'Trojan Horse' mechanism, in which neutrophils engulf intestinal MRSA and travel to the wound, releasing MRSA after apoptosis. The possible role of intestinal MRSA in prosthetic joint infection (PJI) is unknown. Methods Rats underwent intestinal colonization with green fluorescent protein (GFP)-tagged MRSA by gavage and an intra-articular wire was then surgically implanted. After ten days, the presence of PJI was determined by bacterial cultures of the distal femur, joint capsule, and implant. We excluded several other possibilities for PJI development. Intraoperative contamination was excluded by culturing the specimen obtained from surgical site. Extracellular bacteraemia-associated PJI was excluded by comparing with the infection rate after intravenous injection of MRSA or MRSA-carrying neutrophils. To further support this theory, we tested the efficacy of prophylactic membrane-permeable and non-membrane-permeable antibiotics in this model. Results After undergoing knee surgery eight or 72 hours after colonization, five out of 20 rats (25.0%) and two out of 20 rats (10.0%) developed PJI, respectively. Strikingly, 11 out of 20 rats (55.0%) developed PJI after intravenous injection of MRSA-carrying neutrophils that were isolated from rats with intestinal MRSA colonization. None of the rats receiving intravenous injections of MRSA developed PJI. These results suggest that intestinal MRSA carried by neutrophils could cause PJI in our rat model. Ten out of 20 (50.0%) rats treated with non-membrane-permeable gentamicin developed PJI, whereas only one out of 20 (5.0%) rats treated with membrane-permeable linezolid developed PJI. Conclusion Neutrophils as carriers of intestinal MRSA may play an important role in PJI development.Cite this article: Bone Joint Res. 2020;9(4):152-161.
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Affiliation(s)
- Hongyi Zhu
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Institute of Microsurgery on Extremities, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hanqiang Jin
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Institute of Microsurgery on Extremities, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Institute of Microsurgery on Extremities, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ting Yuan
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Institute of Microsurgery on Extremities, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
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Kanagasingham KC, Ho KM, Robinson JO. Positive nasal Staphylococcus aureus polymerase chain reaction assay is not sensitive in predicting concurrent or subsequent Staphylococcus aureus infection in critically ill patients. Anaesth Intensive Care 2020; 48:196-202. [PMID: 32340469 DOI: 10.1177/0310057x20911925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Staphylococcal infection is associated with significant morbidity and mortality in critically ill patients. Using data from 16,681 patients who had a nasal Staphylococcus aureus polymerase chain reaction (PCR) assay on admission to the intensive care unit (ICU) of Royal Perth Hospital between March 2006 and September 2016, this retrospective cohort study assessed whether nasal S. aureus colonisation on admission to an ICU was predictive of concurrent or subsequent S. aureus infections. Culture-proven S. aureus infections were identified using the hospital microbiology database. Of the 16,681 patients included, 565 (3.4%) had a positive methicillin-resistant S. aureus (MRSA) assay, 146 (0.9%) had a positive methicillin-sensitive S. aureus (MSSA) assay and eight (0.05%) had both positive MRSA and MSSA assays. Of those 565 patients with a positive MRSA PCR assay, 79 (13.8%) had concurrent or subsequent MRSA infections. Of those 146 patients with a positive MSSA PCR assay, only 5 (3.4%) had MSSA infection. The sensitivity and specificity for the MRSA PCR assay in predicting concurrent or subsequent MRSA infection were 72.7% (95% confidence intervals (CI) 63.4%-80.8%) and 97.0% (95% CI 96.8%-97.3%), respectively. The sensitivity and specificity for the MSSA PCR assay in predicting concurrent or subsequent MSSA infection were 3.3% (95% CI 1.1%-7.6%) and 99.1% (95% CI 98.9%-99.2%), respectively. Both nasal MRSA and MSSA PCR assays had a high specificity and negative predictive value in predicting MRSA and MSSA infections, respectively, suggesting that in centres without endemic S. aureus infections, a negative nasal MRSA or MSSA PCR assay may be useful to reduce unnecessary empirical antibiotic therapy against S. aureus.
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Affiliation(s)
| | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Australia.,School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - J Owen Robinson
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia.,Department of Infectious Diseases and Microbiology, Royal Perth Hospital, Perth, Australia
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Li SM, Zhou YF, Li L, Fang LX, Duan JH, Liu FR, Liang HQ, Wu YT, Gu WQ, Liao XP, Sun J, Xiong YQ, Liu YH. Characterization of the Multi-Drug Resistance Gene cfr in Methicillin-Resistant Staphylococcus aureus (MRSA) Strains Isolated From Animals and Humans in China. Front Microbiol 2018; 9:2925. [PMID: 30538695 PMCID: PMC6277690 DOI: 10.3389/fmicb.2018.02925] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 11/14/2018] [Indexed: 01/03/2023] Open
Abstract
We investigated cfr-positive and -negative MRSA strains isolated from animals and humans in different geographical areas of China, from 2011 to 2016. Twenty cfr-positive strains (15.6%) were identified from 128 MRSA strains including 17 from food animals and three from humans. The resistance rates and prevalence of the tested antibiotic resistance genes (ARGs) in the cfr-positive MRSA isolates were higher than that in the cfr-negative MRSA isolates. All cfr-positive MRSA isolates were co-carrying fexA and ermC, and had significantly higher optrA incidence rate vs. the cfr-negative isolates (P < 0.05). In addition, multilocus sequence typing (MLST) assays showed that ST9 and spa-type t899 were the most prevalent ST and spa types in the study strains. However, all of the 20 cfr-positive and 10 randomly selected cfr-negative MRSA isolates were clonally unrelated as determined by pulsed-field gel electrophoresis (PFGE) analyses. Importantly, the cfr gene was successfully transferred to a recipient Staphylococcus aureus strain RN4220 from 13 of the 20 cfr-positive MRSA isolates by electroporation. Among these 13 cfr-positive MRSA isolates, two different genetic contexts surrounding cfr were determined and each was associated with one type of cfr-carrying plasmids. Of note, the predominant genetic context of cfr was found to be a Tn558 variant and locate on large plasmids (∼50 kb) co-harboring fexA in 11 of the 13 MRSA isolates. Furthermore, the cfr gene was also identified on small plasmids (∼ 7.1 kb) that co-carried ermC in two of the 13 MRSA isolates. Our results demonstrated a high occurrence of multi-drug resistance in cfr-positive MRSA isolates, and the spread of cfr might be attributed to horizontal dissemination of similar cfr-carrying transposons and plasmids.
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Affiliation(s)
- Shu-Min Li
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Yu-Feng Zhou
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China.,LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Liang Li
- LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Liang-Xing Fang
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Jia-Hong Duan
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Fan-Rui Liu
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Hua-Qing Liang
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Yu-Ting Wu
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Wei-Qi Gu
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Xiao-Ping Liao
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Jian Sun
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Yan-Qiong Xiong
- LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States.,Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Ya-Hong Liu
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
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Bebell LM, Ayebare A, Boum Y, Siedner MJ, Bazira J, Schiff SJ, Metlay JP, Bangsberg DR, Ttendo S, Firth PG. Prevalence and correlates of MRSA and MSSA nasal carriage at a Ugandan regional referral hospital. J Antimicrob Chemother 2017; 72:888-892. [PMID: 27999030 DOI: 10.1093/jac/dkw472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023] Open
Abstract
Background Despite increasing antimicrobial resistance globally, data are lacking on prevalence and factors associated with Staphylococcus aureus (SA) and MRSA carriage in resource-limited settings. Objectives To determine the prevalence of SA and MRSA nasal carriage and factors associated with carriage among Ugandan regional referral hospital patients. Methods We enrolled a cross-section of 500 adults, sampling anterior nares for SA and MRSA carriage using Cepheid Xpert SA Nasal Complete. Results Mean age was 37 years; 321 (64%) were female and 166 (33%) were HIV infected. Overall, 316 (63%) reported risk factors for invasive SA infection; 368 (74%) reported current antibiotic use. SA was detected in 29% and MRSA in 2.8%. MRSA and MSSA carriers were less likely than SA non-carriers to be female (50% and 56% versus 68%, P = 0.03) or to have recently used β-lactam antibiotics (43% and 65% versus 73%, P = 0.01). MRSA carriers were more likely to have open wounds than MSSA carriers and SA non-carriers (71% versus 27% and 40%, P = 0.001) and contact with pigs (21% versus 2% and 6%, P = 0.008). MRSA carriage ranged from 0% of HIV clinic participants to 8% of inpatient surgical ward participants ( P = 0.01). In multivariable logistic regression analysis, male sex was independently associated with SA carriage (OR 1.68, 95% CI 1.12-2.53, P = 0.01) and recent β-lactam antibiotic use was associated with reduced odds of SA carriage (OR 0.61, 95% CI 0.38-0.97, P = 0.04). Conclusions MRSA nasal carriage prevalence was low and associated with pig contact, open wounds and surgical ward admission, but not with HIV infection.
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Affiliation(s)
- Lisa M Bebell
- Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.,Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Boston, MA 02114, USA
| | - Arnold Ayebare
- Epicentre Research Base, PO Box 1956, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yap Boum
- Epicentre Research Base, PO Box 1956, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.,Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Boston, MA 02114, USA
| | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Steven J Schiff
- Center for Neural Engineering and Center for Infectious Disease Dynamics, Departments of Engineering Science and Mechanics, Neurosurgery and Physics, The Pennsylvania State University, University Park, PA, USA
| | - Joshua P Metlay
- Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA
| | - David R Bangsberg
- Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.,Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Boston, MA 02114, USA
| | - Stephen Ttendo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul G Firth
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Gagnaire J, Verhoeven PO, Grattard F, Rigaill J, Lucht F, Pozzetto B, Berthelot P, Botelho-Nevers E. Epidemiology and clinical relevance of Staphylococcus aureus intestinal carriage: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2017; 15:767-785. [PMID: 28726558 DOI: 10.1080/14787210.2017.1358611] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Recent data highlight the importance of screening more than one site for improving the detection of S. aureus colonization. Intestinal carriage is frequently under-investigated and its clinical impact ought to be defined a better way. Areas covered: This review and meta-analysis provide an updated overview of prevalence, characteristics and clinical significance of S. aureus intestinal carriage in different populations, both for methicillin-susceptible and -resistant S. aureus strains. Expert commentary: Intestinal S. aureus carriage is documented with higher prevalence in children and in patients with S. aureus skin and soft tissue infections. This site of colonization was shown to be associated with a high risk of dissemination in the environment and with S. aureus infection. Intestinal carriage is frequently retrieved in nasal carriers, reflecting probably an association with a high bacterial load. Exclusive intestinal carriage present in one third of intestinal carriers can be associated with infection. Comparative genotyping analysis of different strains from nasal and extra-nasal sites of carriage, including the intestinal ones, in the same individuals, would allow a better comprehension of the pathophysiology of S. aureus endogenous infection. It could also permit to improve the prevention of these infections by decolonization of sites implicated in infection genesis.
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Affiliation(s)
- Julie Gagnaire
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,b Infectious Diseases Department , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Paul O Verhoeven
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Florence Grattard
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Josselin Rigaill
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Frédéric Lucht
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,b Infectious Diseases Department , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Bruno Pozzetto
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Philippe Berthelot
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,b Infectious Diseases Department , University Hospital of Saint-Etienne , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Elisabeth Botelho-Nevers
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,b Infectious Diseases Department , University Hospital of Saint-Etienne , Saint-Etienne , France
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Bojang E, Jafali J, Perreten V, Hart J, Harding-Esch EM, Sillah A, Mabey DCW, Holland MJ, Bailey RL, Roca A, Burr SE. Short-term increase in prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus following mass drug administration with azithromycin for trachoma control. BMC Microbiol 2017; 17:75. [PMID: 28351345 PMCID: PMC5371190 DOI: 10.1186/s12866-017-0982-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/11/2017] [Indexed: 11/27/2022] Open
Abstract
Background Mass drug administration (MDA) with azithromycin is a corner-stone of trachoma control however it may drive the emergence of antimicrobial resistance. In a cluster-randomized trial (Clinical trial gov NCT00792922), we compared the reduction in the prevalence of active trachoma in communities that received three annual rounds of MDA to that in communities that received a single treatment round. We used the framework of this trial to carry out an opportunistic study to investigate if the increased rounds of treatment resulted in increased prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus. Three cross-sectional surveys were conducted in two villages receiving three annual rounds of MDA (3 × treatment arm). Surveys were conducted immediately before the third round of MDA (CSS-1) and at one (CSS-2) and six (CSS-3) months after MDA. The final survey also included six villages that had received only one round of MDA 30 months previously (1 × treatment arm). Results In the 3 × treatment arm, a short-term increase in prevalence of S. aureus carriage was seen following MDA from 24.6% at CSS-1 to 38.6% at CSS-2 (p < 0.001). Prevalence fell to 8.8% at CSS-3 (p < 0.001). A transient increase was also seen in prevalence of carriage of azithromycin resistant (AzmR) strains from 8.9% at CSS-1 to 34.1% (p < 0.001) in CSS-2 and down to 7.3% (p = 0.417) in CSS-3. A similar trend was observed for prevalence of carriage of macrolide-inducible-clindamycin resistant (iMLSB) strains. In CSS-3, prevalence of carriage of resistant strains was higher in the 3 × treatment arm than in the 1 × treatment (AzmR 7.3% vs. 1.6%, p = 0.010; iMLSB 5.8% vs. 0.8%, p < 0.001). Macrolide resistance was attributed to the presence of msr and erm genes. Conclusions Three annual rounds of MDA with azithromycin were associated with a short-term increase in both the prevalence of nasopharyngeal carriage of S. aureus and prevalence of carriage of AzmR and iMLSBS. aureus. Trial registration This study was ancillary to the Partnership for the Rapid Elimination of Trachoma, ClinicalTrials.gov NCT00792922, registration date November 17, 2008.
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Affiliation(s)
- Ebrima Bojang
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia
| | - James Jafali
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia
| | - Vincent Perreten
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, CH-3012, Bern, Switzerland
| | - John Hart
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Emma M Harding-Esch
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ansumana Sillah
- National Eye Health Programe, Ministry of Health and Social Welfare, Kanifing, The Gambia
| | - David C W Mabey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Martin J Holland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Robin L Bailey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Anna Roca
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah E Burr
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia. .,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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11
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Silvestri L, Weir WI, Gregori D, Taylor N, Zandstra DF, van Saene JJM, van Saene HKF. Impact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth 2016; 31:2236-2244. [PMID: 28089599 DOI: 10.1053/j.jvca.2016.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Oropharyngeal overgrowth of microorganisms in the critically ill is a risk factor for lower respiratory tract infection and subsequent invasion of the bloodstream. Oral chlorhexidine has been used to prevent pneumonia, but its effect on bloodstream infection never has been assessed in meta-analyses. The authors explored the effect of oral chlorhexidine on the incidence of bloodstream infection, the causative microorganism, and on all-cause mortality in critically ill patients. DESIGN Systematic review and meta-analysis of published studies. SETTING Intensive care unit. PARTICIPANTS The study comprised critically ill patients receiving oral chlorhexidine (test group) and placebo or standard oral care (control group). INTERVENTIONS PubMed and the Cochrane Register of Controlled Trials were searched. Odds ratios (ORs) were pooled using the random-effects model. MEASUREMENTS AND MAIN RESULTS Five studies including 1,655 patients (832 chlorhexidine and 823 control patients) were identified. The majority of information was from studies at low or unclear risk bias; 1 study was at high risk of bias. Bloodstream infection and mortality were not reduced significantly by chlorhexidine (OR 0.74; 95% confidence interval [CI] 0.37-1.50 and OR 0.69; 95% CI 0.31-1.53, respectively). In the subgroup of surgical, mainly cardiac, patients, chlorhexidine reduced bloodstream infection (OR 0.47; 95% CI 0.22-0.97). Chlorhexidine did not affect any microorganism significantly. CONCLUSION In critically ill patients, oropharyngeal chlorhexidine did not reduce bloodstream infection and mortality significantly and did not affect any microorganism involved. The presence of a high risk of bias in 1 study and unclear risk of bias in others may have affected the robustness of these findings.
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Affiliation(s)
- Luciano Silvestri
- Department of Anaesthesia and Intensive Care, S. Giovanni di Dio Hospital, Gorizia, Italy; Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - William I Weir
- Department of Cardiothoracic Surgery, London Chest Hospital, London, UK
| | - Dario Gregori
- Department of Cardiological, Thoracic and Vascular Sciences, Unit of Biostatistics Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Nia Taylor
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | | | - Joris J M van Saene
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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12
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Selva Martínez L, Viana D, Corpa Arenas JM. Staphylococcus aureus nasal carriage could be a risk for development of clinical infections in rabbits. WORLD RABBIT SCIENCE 2015. [DOI: 10.4995/wrs.2015.3960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
<p>Although nasal carriage has been described as a risk factor for <em>Staphylococcus aureus</em> infections in humans, there is a scarcity of studies about <em>S. aureus</em> nasal carriers in animals. In rabbits, <em>S. aureus</em> is one of the most important pathogens responsible for a number of different types of infections. This study was designed to determine the extent of staphylococcal nasal carriage and to establish whether a relationship exists between nasal carriage and development of lesions. One hundred and sixteen rabbits with and without chronic signs of staphylococcosis from 6 industrial rabbitries were monitored. Nasal swabs for microbiological assessments were obtained from all animals. Microbiological results showed that 56% of the animals carried <em>S. aureus</em> in their nasal cavities with significantly higher incidence in animals with staphylococcal-related lesions (84.2%) compared to apparently healthy animals (28.8%). Additionally, the <em>S. aureus</em> strains isolated from the nasal cavity and lesions were clonally related in 91.7% of animals. This suggests that nasal carriage of <em>S. aureus</em> in rabbits could be a risk for development of clinical infections.</p>
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13
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Qiao B, Cui JY, Sun L, Yang S, Zhao YL. Cross-priming amplification targeting the coagulase gene for rapid detection of coagulase-positive Staphylococci. J Appl Microbiol 2015; 119:188-95. [PMID: 25913490 DOI: 10.1111/jam.12836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/07/2015] [Accepted: 04/15/2015] [Indexed: 11/26/2022]
Abstract
AIMS To develop and evaluate cross-priming amplification (CPA) combined with immuno-blotting for the detection of coagulase-positive Staphylococci including Staphylococcus aureus. METHODS AND RESULTS Twenty-four sets of cross and detection primers were designed according to four sequences of coagulase gene in Staph. aureus. The most specific primer pair was screened out for the next amplification and interaction. The specificity was evaluated in a total of 53 species of Staph. aureus and non-Staph. aureus. Two red lines indicating positive were always observed on the BioHelix Express strip for 12 subspecies of Staph. aureus. In contrast, only one signal line showing negative results was detected in all of non-Staph. aureus samples. The limit of detection (LOD) of CPA was 3·6 ± 2·7 fg for the genomic DNA, which is about 100 and 10 times sensitive than those of PCR and loop-mediated isothermal amplification respectively. For the pure culture of Staph. aureus and milk powders, the LODs of CPA were about 1·34 CFU per reaction and 5·2 ± 3·7 CFU per 100 g of milk powder respectively. The CPA method was also successfully applied to evaluate the contamination of Staph. aureus in 318 samples of daily food. CONCLUSIONS CPA is a very sensitive and rapid method to detect Staph. aureus by simple laboratory instrument. SIGNIFICANCE AND IMPACT OF THE STUDY It is the first report on the application of the CPA with immuno-blotting for detection of coagulase-positive Staphylococci including Staph. aureus.
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Affiliation(s)
- B Qiao
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, China
| | - J-Y Cui
- School of Life Science, Shandong Province Key Laboratory of Applied Mycology, Qingdao International Center on Microbes Utilizing Biogas, Qingdao Agricultural University, Qingdao, Shandong Province, China
| | - L Sun
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - S Yang
- School of Life Science, Shandong Province Key Laboratory of Applied Mycology, Qingdao International Center on Microbes Utilizing Biogas, Qingdao Agricultural University, Qingdao, Shandong Province, China.,Key Laboratory of Systems Bioengineering, Ministry of Education, Tianjin University, Tianjin, China
| | - Y-L Zhao
- Department of Medical Microbiology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
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Uncoupling of pro- and anti-inflammatory properties of Staphylococcus aureus. Infect Immun 2015; 83:1587-97. [PMID: 25644014 DOI: 10.1128/iai.02832-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Staphylococcus aureus is a Gram-positive bacterium that is carried by a quarter of the healthy human population and that can cause severe infections. This pathobiosis has been linked to a balance between Toll-like receptor 2 (TLR2)-dependent pro- and anti-inflammatory responses. The relationship between these two types of responses is unknown. Analysis of 16 nasal isolates of S. aureus showed heterogeneity in their capacity to induce pro- and anti-inflammatory responses, suggesting that these two responses are independent of each other. Uncoupling of these responses was corroborated by selective signaling through phosphoinositol 3-kinase (PI3K)-Akt-mTOR and extracellular signal-regulated kinase (ERK) for the anti-inflammatory response and through p38 for the proinflammatory response. Uncoupling was also observed at the level of phagocytosis and phagosomal processing of S. aureus, which were required solely for the proinflammatory response. Importantly, the anti-inflammatory properties of an S. aureus isolate correlated with its ability to modulate T cell immunity. Our results suggest the presence of anti-inflammatory TLR2 ligands in the staphylococcal cell wall, whose identification may provide templates for novel immunomodulatory drugs.
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