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Oliveira MC, Boriollo MFG, de Souza AC, da Silva TA, da Silva JJ, Magalhães-Guedes KT, Dias CTDS, Bernardo WLDC, Höfling JF, de Sousa CP. Oral Staphylococcus Species and MRSA Strains in Patients with Orofacial Clefts Undergoing Surgical Rehabilitation Diagnosed by MALDI-TOF MS. Pathogens 2024; 13:763. [PMID: 39338954 PMCID: PMC11434827 DOI: 10.3390/pathogens13090763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
This study investigated the occurrence and dynamics of oral Staphylococcus species in patients with orofacial clefts undergoing surgical rehabilitation treatment. Patients (n = 59) were statistically stratified and analyzed (age, gender, types of orofacial clefts, surgical history, and types of previous surgical rehabilitation). Salivary samples were obtained between hospitalization and the return to the specialized medical center. Microbiological diagnosis was performed by classical methods, and MALDI-TOF MS. MRSA strains (SCCmec type II, III, and IV) were characterized by the Decision Tree method. A total of 33 (55.9%) patients showed oral staphylococcal colonization in one, two, or three sampling steps. A high prevalence has been reported for S. aureus (including HA-, MRSA and CA-MRSA), followed by S. saprophyticus, S. epidermidis, S. sciuri, S. haemolyticus, S. lentus, S. arlettae, and S. warneri. The dynamics of oral colonization throughout surgical treatment and medical follow-up may be influenced by (i) imbalances in staphylococcal maintenance, (ii) efficiency of surgical asepsis or break of the aseptic chain, (iii) staphylococcal neocolonization in newly rehabilitated anatomical oral sites, and (iv) total or partial maintenance of staphylococcal species. The highly frequent clinical periodicity in specialized medical and dental centers may contribute to the acquisition of MRSA in these patients.
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Affiliation(s)
- Mateus Cardoso Oliveira
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (FOP/UNICAMP), 901 Limeira Ave, Piracicaba 13414-903, SP, Brazil; (M.C.O.); (T.A.d.S.); (J.J.d.S.); (W.L.d.C.B.); (J.F.H.)
- Center for Nursing and Health, State University of Southwest Bahia (UESB), José Moreira Sobrinho Avenue, Jequié 45205-490, BA, Brazil
| | - Marcelo Fabiano Gomes Boriollo
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (FOP/UNICAMP), 901 Limeira Ave, Piracicaba 13414-903, SP, Brazil; (M.C.O.); (T.A.d.S.); (J.J.d.S.); (W.L.d.C.B.); (J.F.H.)
- Department of Morphology and Pathology & Biotechnology Graduate Program (PPGBiotec), Center for Biological and Health Sciences (CCBS), Federal University of São Carlos (UFSCar), Km 235 Washington Luís Road, São Carlos 13565-905, SP, Brazil;
| | - Angélica Cristina de Souza
- Department of Biology, Federal University of Lavras (UFLA), s/n Edmir Sá Santos Rotary Interchange, Lavras 37203-202, MG, Brazil;
| | - Thaísla Andrielle da Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (FOP/UNICAMP), 901 Limeira Ave, Piracicaba 13414-903, SP, Brazil; (M.C.O.); (T.A.d.S.); (J.J.d.S.); (W.L.d.C.B.); (J.F.H.)
| | - Jeferson Júnior da Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (FOP/UNICAMP), 901 Limeira Ave, Piracicaba 13414-903, SP, Brazil; (M.C.O.); (T.A.d.S.); (J.J.d.S.); (W.L.d.C.B.); (J.F.H.)
| | - Karina Teixeira Magalhães-Guedes
- Department of Bromatological Analysis, Pharmacy Faculty, Federal University of Bahia (UFBA), 147 Barão de Jeremoabo Street, Salvador 40170-115, BA, Brazil
| | - Carlos Tadeu dos Santos Dias
- Department of Exact Sciences, College of Agriculture, University of São Paulo (ESALQ/USP), 11 Pádua Dias Ave, Piracicaba 13418-900, SP, Brazil;
| | - Wagner Luís de Carvalho Bernardo
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (FOP/UNICAMP), 901 Limeira Ave, Piracicaba 13414-903, SP, Brazil; (M.C.O.); (T.A.d.S.); (J.J.d.S.); (W.L.d.C.B.); (J.F.H.)
| | - José Francisco Höfling
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (FOP/UNICAMP), 901 Limeira Ave, Piracicaba 13414-903, SP, Brazil; (M.C.O.); (T.A.d.S.); (J.J.d.S.); (W.L.d.C.B.); (J.F.H.)
| | - Cristina Paiva de Sousa
- Department of Morphology and Pathology & Biotechnology Graduate Program (PPGBiotec), Center for Biological and Health Sciences (CCBS), Federal University of São Carlos (UFSCar), Km 235 Washington Luís Road, São Carlos 13565-905, SP, Brazil;
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Islam S, Nasrin N, Tithi NS, Khatun F, Asaduzzaman M, Topa AF, Kabir MF, Haque FKM, Jubair M, Rahman M, Lehmann C. Antimicrobial Susceptibility and Genomic Profiles of Multidrug-Resistant Staphylococcus aureus from Nasopharynx of Asymptomatic Children in Dhaka, Bangladesh. Life (Basel) 2024; 14:971. [PMID: 39202713 PMCID: PMC11355696 DOI: 10.3390/life14080971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024] Open
Abstract
Children carrying Staphylococcus aureus in their nasopharynx are at a higher risk of contracting systemic infection. Due to lack of sufficient information regarding such carriage, this study was conducted to explore the prevalence, antibiotic susceptibility, and genomic profiles of S. aureus isolated from nasopharyngeal samples of 163 randomly selected asymptomatic Bangladeshi children aged from 5-<15 years. Antibiotic susceptibility pattern and genomic analysis of the samples were conducted using standard microbiological methods and genomic tools. The carriage was confirmed in 44 (27%) children who were mostly well nourished without respiratory symptoms in the last 3 months. Higher carriage was observed among the younger age group (5-<10 years) who completed vaccines for pneumonia (p = 0.002) and influenza (p = 0.004). Among the isolates, 84.1% were multidrug-resistant and 47.5% (n = 40) were methicillin-resistant S. aureus (MRSA). All the isolates (100%) were resistant to cefixime with higher resistance to ampicillin (95.5%) and penicillin (90.9%). Among the three investigated isolates, two were ST80 (ID-1 and ID-52) and one was a novel strain (ID-19) with the presence of aph-Stph, blaI, blaZ, dha1, fosB, lmrS, mepA, norA, and tet38 genes. The current research demonstrates a high incidence of multidrug-resistant S. aureus and reports the first instance of ST80 in asymptomatic children in Bangladesh.
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Affiliation(s)
- Sufia Islam
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh; (N.N.); (N.S.T.); (F.K.); (A.F.T.)
| | - Nishat Nasrin
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh; (N.N.); (N.S.T.); (F.K.); (A.F.T.)
| | - Nigar Sultana Tithi
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh; (N.N.); (N.S.T.); (F.K.); (A.F.T.)
| | - Farjana Khatun
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh; (N.N.); (N.S.T.); (F.K.); (A.F.T.)
| | - Muhammad Asaduzzaman
- Department of Clinical Pharmacy and Pharmacology, University of Dhaka, Dhaka 1000, Bangladesh;
- School of Pharmacy, BRAC University, Dhaka 1212, Bangladesh
| | - Anika Fatema Topa
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh; (N.N.); (N.S.T.); (F.K.); (A.F.T.)
| | - Md Farhad Kabir
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh;
| | | | - Mohammad Jubair
- Genome Centre, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.J.); (M.R.)
| | - Mustafizur Rahman
- Genome Centre, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.J.); (M.R.)
- Virology Laboratory, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1X5, Canada;
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McDonald K, Rodriguez A, Muthukrishnan G. Humanized Mouse Models of Bacterial Infections. Antibiotics (Basel) 2024; 13:640. [PMID: 39061322 PMCID: PMC11273811 DOI: 10.3390/antibiotics13070640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/02/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Bacterial infections continue to represent a significant healthcare burden worldwide, causing considerable mortality and morbidity every year. The emergence of multidrug-resistant bacterial strains continues to rise, posing serious risks to controlling global disease outbreaks. To develop novel and more effective treatment and vaccination programs, there is a need for clinically relevant small animal models. Since multiple bacterial species have human-specific tropism for numerous virulence factors and toxins, conventional mouse models do not fully represent human disease. Several human disease characteristic phenotypes, such as lung granulomas in the case of Mycobacterium tuberculosis infections, are absent in standard mouse models. Alternatively, certain pathogens, such as Salmonella enterica serovar typhi and Staphylococcus aureus, can be well tolerated in mice and cleared quickly. To address this, multiple groups have developed humanized mouse models and observed enhanced susceptibility to infection and a more faithful recapitulation of human disease. In the last two decades, multiple humanized mouse models have been developed to attempt to recapitulate the human immune system in a small animal model. In this review, we first discuss the history of immunodeficient mice that has enabled the engraftment of human tissue and the engraftment methods currently used in the field. We then highlight how humanized mouse models successfully uncovered critical human immune responses to various bacterial infections, including Salmonella enterica serovar Typhi, Mycobacterium tuberculosis, and Staphylococcus aureus.
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Affiliation(s)
- Katya McDonald
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Adryiana Rodriguez
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
| | - Gowrishankar Muthukrishnan
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA
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Tsirigotaki M, Galanakis E. Impact of vaccines on Staphylococcus aureus colonization: A systematic review and meta-analysis. Vaccine 2023; 41:6478-6487. [PMID: 37777451 DOI: 10.1016/j.vaccine.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/17/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Concerns regarding vaccine effects on microbial ecology have led to interest in the non-targeted effects of vaccinations. OBJECTIVES To systematically review the literature related to the impact of vaccines on S. aureus carriage. METHODS We conducted a systematic search of MEDLINE, Scopus and clinical trials.gov for studies that assessed vaccine effects on S. aureus carriage in children and adults using predefined inclusion and exclusion criteria. Generic inverse variance meta-analysis was done using random-effects models. RESULTS Of 1,686 studies screened, 34 were eligible for inclusion, of which 22 were observational and 12 randomized controlled studies (RCTs). 88.2% (30/34) provided data on pneumococcal conjugate vaccines (PCV), 23.5% on influenza vaccines (8/34), 6% on other vaccines (2/34) and 20.6% on more than one vaccine (7/34). Most studies tested nasopharyngeal specimens (82.3%, 28/34). Among children aged more than 18-24 months, evidence suggested no effect of PCV on S. aureus colonization [2 RCTs, pooled OR 1.09 (95% CI 0.94-1.25), p 0.25; 7 observational studies, pooled OR: 1.02 (95% CI 0.83-1.25), p 0.86]. A transient increase in S. aureus carriage in PCV-vaccinated infants 9-15 months was shown [2 RCTs, pooled OR 1.11 (95% CI 1.00-1.23), p 0.06; 4 observational studies, pooled OR 1.64 (95% CI 1.00-2.68), p 0.05]. A reduction in S. aureus carriage was observed after influenza vaccination [4 observational studies; OR 0.85 (95% CI 0.78-0.94), p 0.0001]. Based on the Grading of Recommendations Assessment, Development and Evaluation, the quality of evidence was considered low for randomized and very low for non-randomized trials. CONCLUSION Evidence did not suggest long-term effects of pneumococcal vaccinations on S. aureus nasopharyngeal carriage in children, however transient niche changes may occur in infants. Influenza vaccination was related to decreased rates of S. aureus carriage. Data regarding other vaccines is scarce. Further research and ongoing surveillance are needed to monitor colonization changes.
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Esposito S, Blasi F, Curtis N, Kaplan S, Lazzarotto T, Meschiari M, Mussini C, Peghin M, Rodrigo C, Vena A, Principi N, Bassetti M. New Antibiotics for Staphylococcus aureus Infection: An Update from the World Association of Infectious Diseases and Immunological Disorders (WAidid) and the Italian Society of Anti-Infective Therapy (SITA). Antibiotics (Basel) 2023; 12:742. [PMID: 37107104 PMCID: PMC10135047 DOI: 10.3390/antibiotics12040742] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Staphylococcus aureus is an extremely virulent pathogen that is capable of quickly evolving and developing antibiotic resistance. To overcome this problem, new antibiotics have been developed. Some of these have been licenced for use in clinical practice, mainly for the treatment of adults with acute skin and soft tissue infections, in addition to both community-acquired pneumonia (CAP) and nosocomial pneumonia (hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia). In this paper, the main characteristics and clinical use of new licenced anti-staphylococcal drugs have been discussed. In vitro studies have demonstrated that some new anti-staphylococcal antibiotics have better antimicrobial activity and, at least in certain cases, more favourable pharmacokinetic properties and higher safety and tolerability than the presently available anti-staphylococcal drugs. This suggests that they may have a potential use in reducing the risk of failure of S. aureus therapy. However, an in-depth analysis of microbiological and clinical studies carried out with these new drugs seems to indicate that further studies need to be conducted before the problem of resistance of S. aureus to the antibiotics available today can be completely solved. Considering the overall available research, the drugs that are active against S. aureus appear to present a great therapeutic opportunity for overcoming resistance to traditional therapy. There are advantages in the pharmacokinetic characteristics of some of these drugs and they have the potential to reduce hospital stays and economic costs associated with their use.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, 20122 Milan, Italy
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Infectious Diseases, The Royal Children’s Hospital Melbourne, Parkville, VIC 3010, Australia
| | - Sheldon Kaplan
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tiziana Lazzarotto
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marianna Meschiari
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, 21110 Varese, Italy
| | - Carlos Rodrigo
- Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, 08916 Barcelona, Spain
- Germans Trias i Pujol Research Institute, Carretera de Can Ruti, Camí de les Escoles, 08916 Badalona, Spain
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | | | - Matteo Bassetti
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Garriga Ferrer-Bergua L, Borrull Senra AM, Pérez Velasco C, Montero Valladares C, Collazo Vallduriola I, Moya Villanueva S, Velasco Zúñiga R, Pérez Alba M, de la Torre Espí M. Rate of methicillin-resistant Staphylococcus aureus in pediatric emergency departments in Spain. An Pediatr (Barc) 2022; 97:95-102. [PMID: 35788335 DOI: 10.1016/j.anpede.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/17/2021] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION Staphylococcus aureus is a common germ in bacterial infections in children. The rate of methicillin-resistant S. aureus (MRSA) is increasing lately. OBJECTIVES The main aim is to know the rate of positive cultures to MRSA in Spanish pediatric emergency departments. The secondary aims are to analyse the risk factors for MRSA isolation (patient origin, history of hospitalization or surgery in the previous 90 days, antibiotherapy in the previous 60 days, presence of comorbidity, invasive devices, prior MRSA isolation) and to analyse the morbidity of these infections. METHODOLOGY Retrospective multicenter study (07/01/2017-06/30/2018) with review of patient histories with isolation of S. aureus in samples of any origin obtained in 8 pediatric emergency departments of the Infectious Diseases Working Group of the Spanish Society of pediatric Emergencies. RESULTS During this period, S. aureus was detected in 403 patients (average age 75.8 ± 59.2 months; 54.8% male): 28.8% hospital-related infections (HRI) and 71.2% community-related infections (CRI). Overall, MRSA rate was 16.6% (95% CI: 13-20.2%); 18.1% in HRI and 16.2% in CRI (p > 0.05). The highest rates of MRSA were obtained in skin abscesses (29.3%, CI 95%: 21.8-36.8%), patients not born in Spain (52%; CI 95%: 32-72%) or patients with a previous MRSA infection (90%; CI 95% 71.4-100%). 167 (41%) patients were admitted, 12 (3%) had complications and 4 (1%) suffered sequels. There were no deaths. CONCLUSIONS The overall MRSA rate was one in 6 staphylococcal infections. Higher MRSA rates were detected in samples of suppurating skin injuries and in foreign children or in children with a history of previous MRSA infection. In suppurative skin lesions, early drainage is essential and the change to an antibiotic with MRSA coverage should be considered if the evolution is inadequate.
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Cella E, Sutcliffe CG, Tso C, Paul E, Ritchie N, Colelay J, Denny E, Grant LR, Weatherholtz RC, Hammitt LL, Azarian T. Carriage prevalence and genomic epidemiology of Staphylococcus aureus among Native American children and adults in the Southwestern USA. Microb Genom 2022; 8. [PMID: 35551692 PMCID: PMC9465076 DOI: 10.1099/mgen.0.000806] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Native American individuals in the Southwestern USA experience a higher burden of invasive Staphylococcus aureus disease than the general population. However, little is known about S. aureus carriage in these communities. A cross-sectional study was conducted to determine the carriage prevalence, risk factors and genomic epidemiology of S. aureus among Native American children (<5 years, n=121) and adults (≥18 years, n=167) in the Southwestern USA. Short- and long-read sequencing data were generated using Illumina and Oxford Nanopore Technology platforms to produce high-quality hybrid assemblies, and antibiotic-resistance, virulence and pangenome analyses were performed. S. aureus carriage prevalence was 20.7 % among children, 30.2 % among adults 18–64 years and 16.7 % among adults ≥65 years. Risk factors among adults included recent surgery, prior S. aureus infection among household members, and recent use of gyms or locker rooms by household members. No risk factors were identified among children. The bacterial population structure was dominated by clonal complex 1 (CC1) (21.1 %), CC5 (22.2 %) and CC8 (22.2 %). Isolates from children and adults were intermixed throughout the phylogeny. While the S. aureus population was diverse, the carriage prevalence was comparable to that in the general USA population. Genomic and risk-factor data suggest household, community and healthcare transmission are important components of the local epidemiology.
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Affiliation(s)
- Eleonora Cella
- University of Central Florida, 4110 Libra Drive, Orlando, FL 32816, USA
| | - Catherine G Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Carol Tso
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Ella Paul
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Nina Ritchie
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Janene Colelay
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Estar Denny
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Lindsay R Grant
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA.,Present address: Global Pneumococcal Vaccines, Scientific Affairs and Epidemiology, Pfizer Inc, USA
| | - Robert C Weatherholtz
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Laura L Hammitt
- Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD 21231, USA
| | - Taj Azarian
- University of Central Florida, 4110 Libra Drive, Orlando, FL 32816, USA
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Clearance of mixed biofilms of Streptococcus pneumoniae and methicillin-susceptible/resistant Staphylococcus aureus by antioxidants N-acetyl-L-cysteine and cysteamine. Sci Rep 2022; 12:6668. [PMID: 35461321 PMCID: PMC9035182 DOI: 10.1038/s41598-022-10609-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/07/2022] [Indexed: 12/01/2022] Open
Abstract
Biofilm-associated infections are of great concern because they are associated with antibiotic resistance and immune evasion. Co-colonization by Staphylococcus aureus and Streptococcus pneumoniae is possible and a threat in clinical practice. We investigated the interaction between S. aureus and S. pneumoniae in mixed biofilms and tested new antibiofilm therapies with antioxidants N-acetyl-l-cysteine (NAC) and cysteamine (Cys). We developed two in vitro S. aureus–S. pneumoniae mixed biofilms in 96-well polystyrene microtiter plates and we treated in vitro biofilms with Cys and NAC analyzing their effect by CV staining and viable plate counting. S. pneumoniae needed a higher proportion of cells in the inoculum and planktonic culture to reach a similar population rate in the mixed biofilm. We demonstrated the effect of Cys in preventing S. aureus biofilms and S. aureus–S. pneumoniae mixed biofilms. Moreover, administration of 5 mg/ml of NAC nearly eradicated the S. pneumoniae population and killed nearly 94% of MSSA cells and 99% of MRSA cells in the mixed biofilms. The methicillin resistance background did not change the antioxidants effect in S. aureus. These results identify NAC and Cys as promising repurposed drug candidates for the prevention and treatment of mixed biofilms by S. pneumoniae and S. aureus.
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Hirose M, Aung MS, Fukuda A, Yahata S, Fujita Y, Saitoh M, Hirose Y, Urushibara N, Kobayashi N. Antimicrobial Resistance and Molecular Epidemiological Characteristics of Methicillin-Resistant and Susceptible Staphylococcal Isolates from Oral Cavity of Dental Patients and Staff in Northern Japan. Antibiotics (Basel) 2021; 10:antibiotics10111316. [PMID: 34827254 PMCID: PMC8615198 DOI: 10.3390/antibiotics10111316] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
The acquisition of drug resistance and virulence by staphylococcal species colonizing humans is a growing public health concern. The present study was conducted to investigate the prevalence, antimicrobial resistance and genetic characteristics of Staphylococcus isolates from the oral cavity and skin (hand) of systemically healthy subjects with dental disease and dental staff in northern Japan. Among a total of 133 subjects (91 patients and 42 staff), 87 coagulase-positive Staphylococcus (83 S. aureus/4 S. argenteus) and 162 coagulase-negative Staphylococcus (CoNS) isolates were recovered from 59 (44.4%) and 95 (71.4%) subjects, respectively. Three oral isolates were methicillin-resistant S. aureus (MRSA) (3.6%, 3/83) that were genotyped as ST8-SCCmec-IVl, ST4775(CC1)-SCCmec-IVa and ST6562(CC8)-SCCmec-IVa. Remarkably, the ST6562 isolate harbored PVL genes on ΦSa2usa and type I ACME (arginine catabolic mobile element). Four methicillin-susceptible isolates were identified as S. argenteus belonging to ST1223 and ST2250, which harbored enterotoxin genes egc-2 and sey, respectively. Among the fourteen CoNS species identified, methicillin-resistant (MR) isolates were detected in five species (11 isolates, 13.3% of CoNS), with S. saprophyticus and S. haemolyticus being the most common. ACME was prevalent in only S. epidermidis and S. capitis. These findings indicated the potential distribution of USA300 clone-like MRSA, toxigenic S. argenteus and MR-CoNS in the oral cavity of dental patients.
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Affiliation(s)
- Mina Hirose
- Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu 061-0293, Japan; (M.H.); (A.F.); (S.Y.); (Y.F.); (M.S.)
| | - Meiji Soe Aung
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (N.U.); (N.K.)
- Correspondence: ; Tel.: +81-11-611-2111
| | - Atsushi Fukuda
- Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu 061-0293, Japan; (M.H.); (A.F.); (S.Y.); (Y.F.); (M.S.)
| | - Shoko Yahata
- Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu 061-0293, Japan; (M.H.); (A.F.); (S.Y.); (Y.F.); (M.S.)
| | - Yusuke Fujita
- Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu 061-0293, Japan; (M.H.); (A.F.); (S.Y.); (Y.F.); (M.S.)
| | - Masato Saitoh
- Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu 061-0293, Japan; (M.H.); (A.F.); (S.Y.); (Y.F.); (M.S.)
| | - Yukito Hirose
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu 061-0293, Japan;
| | - Noriko Urushibara
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (N.U.); (N.K.)
| | - Nobumichi Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (N.U.); (N.K.)
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Patel C, Bhoojhawon G, Weiner L, Wilson D, Zhorne D, Kinn P. Evaluating the Role of Staphylococcus aureus Nasal PCR in Pediatric Head and Neck Infections. J Pediatr Pharmacol Ther 2021; 26:734-739. [PMID: 34588938 DOI: 10.5863/1551-6776-26.7.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Vancomycin is often empirically used in the management of head and neck infections (HNIs) in children. The objective of this study was to determine the utility of Staphylococcus aureus (SA) nasal PCR to facilitate de-escalation of vancomycin for pediatric HNIs. METHODS This was a single-center, retrospective cohort study of pediatric patients who received empiric intravenous vancomycin for a diagnosis of HNIs between January 2010 and December 2019. Subjects were excluded if they met any of the following: confirmed/suspected coinfection of another site, dialysis, immunocompromised status, admission to the NICU, alternative diagnosis that did not require antibiotics, or readmission for HNIs within 30 days of previous admission. The primary outcome was time to de-escalation of vancomycin. Total duration of antibiotics, treatment failure, hospital length of stay (LOS), and incidence of acute kidney injury (AKI) were also assessed. RESULTS Of the 575 patients identified, 124 patients received an SA nasal PCR. The median time to de-escalation was 39.5 hours in those patients compared with 53.7 hours in patients who did not have a SA nasal PCR (p = 0.002). No difference was noted in total duration of all methicillin-resistant Staphylococcus aureus antibiotics, hospital LOS, treatment failure, and AKI. CONCLUSIONS In a large cohort of pediatric patients with HNIs, those who underwent testing with an SA nasal PCR spent less time receiving intravenous vancomycin, although their LOS was not significantly reduced. Further investigation is needed to better define the role of SA nasal PCRs in determining antibiotic therapy for HNIs.
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Manos J. Current and Emerging Therapies to Combat Cystic Fibrosis Lung Infections. Microorganisms 2021; 9:1874. [PMID: 34576767 PMCID: PMC8466233 DOI: 10.3390/microorganisms9091874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
The ultimate aim of any antimicrobial treatment is a better infection outcome for the patient. Here, we review the current state of treatment for bacterial infections in cystic fibrosis (CF) lung while also investigating potential new treatments being developed to see how they may change the dynamics of antimicrobial therapy. Treatment with antibiotics coupled with regular physical therapy has been shown to reduce exacerbations and may eradicate some strains. Therapies such as hypertonic saline and inhaled PulmozymeTM (DNase-I) improve mucus clearance, while modifier drugs, singly and more successfully in combination, re-open certain mutant forms of the cystic fibrosis transmembrane conductance regulator (CFTR) to enable ion passage. No current method, however, completely eradicates infection, mainly due to bacterial survival within biofilm aggregates. Lung transplants increase lifespan, but reinfection is a continuing problem. CFTR modifiers normalise ion transport for the affected mutations, but there is conflicting evidence on bacterial clearance. Emerging treatments combine antibiotics with novel compounds including quorum-sensing inhibitors, antioxidants, and enzymes, or with bacteriophages, aiming to disrupt the biofilm matrix and improve antibiotic access. Other treatments involve bacteriophages that target, infect and kill bacteria. These novel therapeutic approaches are showing good promise in vitro, and a few have made the leap to in vivo testing.
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Affiliation(s)
- Jim Manos
- Infection, Immunity and Inflammation, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney 2006, Australia
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Garriga Ferrer-Bergua L, Borrull Senra AM, Pérez Velasco C, Montero Valladares C, Collazo Vallduriola I, Moya Villanueva S, Velasco Zúñiga R, Pérez Alba M, de la Torre Espí M. [Rate of methicillin-resistant Staphylococcus aureus in pediatric emergency departments in Spain]. An Pediatr (Barc) 2021; 97:S1695-4033(21)00223-X. [PMID: 34289947 DOI: 10.1016/j.anpedi.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Staphylococcusaureus (S. aureus) is a common germ present in bacterial infections in children. Lately, the rate of methicillin-resistant S. aureus (MRSA) is increasing. OBJECTIVES The main aim of this study is to know the rate of positive cultures to MRSA in Spanish pediatric emergency departments. The secondary aims are to analyze the risk factors for MRSA isolation (patient origin, history of hospitalization or surgery in the previous 90 days, antibiotherapy in the previous 60 days, presence of comorbidity, invasive devices, prior MRSA isolation) and to analyze the morbidity of these infections. METHODOLOGY Retrospective multicenter study (07/01/2017-06/30/2018) with review of patient histories with isolation of S. aureus in samples of any origin obtained in 8 pediatric emergency departments of the Infectious Diseases Working Group of the Spanish Society of Pediatric Emergencies. RESULTS During this period, S. aureus was detected in 403 patients (average age 75.8±59.2 months; 54.8% male): 28.8% hospital-related infections and 71.2% community-related infections. Overall, MRSA rate was 16.6% (95% CI: 13-20.2%); 18.1% in hospital-related infections and 16.2% in community-related infections (P>.05). The highest rates of MRSA were obtained in skin abscesses (29.3%, 95% CI: 21.8-36.8%), patients not born in Spain (52%; 95% CI: 32-72%) or patients with a previous MRSA infection (90%; 95% CI: 71.4-100%). 167 (41%) patients were admitted, 12 (3%) had complications and 4 (1%) suffered sequels. There were no deaths. CONCLUSIONS The overall MRSA rate was one in six staphylococcal infections. Higher MRSA rates were detected in samples of suppurating skin injuries and in foreign children or in children with a history of previous MRSA infection. In suppurative skin lesions, early drainage is essential and the change to an antibiotic with MRSA coverage should be considered if the evolution is inadequate.
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Absence of methicillin-resistant Staphylococcus aureus colonization among immunocompetent healthy adults: Insights from a longitudinal study. PLoS One 2021; 16:e0253739. [PMID: 34191834 PMCID: PMC8244897 DOI: 10.1371/journal.pone.0253739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 06/12/2021] [Indexed: 11/29/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has long been known as a major cause of hospital-acquired (HA-MRSA) infections worldwide. For the past twenty years, an increasing number of studies have described its emergence in the community as well. In Portugal, a country with a high-prevalence of HA-MRSA, there are only limited data available on the epidemiology of MRSA in the community. We studied the prevalence of S. aureus and MRSA colonization among healthy adults in Portugal. Between February 2015 and December 2016, a longitudinal study was conducted in which 87 adults aged 25–50 years old were followed for six months. For each participant nasopharyngeal, oropharyngeal and saliva samples were obtained monthly and, in some cases, weekly. A total of 1,578 samples (n = 526 for each sampling site) were examined for the presence of S. aureus and MRSA by classical culture-based methods. Fifty-seven adults (65.5%) carried S. aureus at least once during the six months period of the study: 19.5% were persistent S. aureus carriers and 46.0% were intermittent carriers. Carriage rates per sampling site were 20.5% in nasopharynx, 18.3% in oropharynx, and 13.5% in saliva. Simultaneous screening of the three sampling sites increased detection of S. aureus, which overall occurred in 34.4% of the 526 sampling time-points. No MRSA were isolated. In conclusion, this study adds novel information about the MRSA scenario in the Portuguese community. Our results indicate that, in Portugal, MRSA does not seem to circulate among healthy adults without risk factors and therefore this age group does not constitute, at the current time, a reservoir of MRSA in the community.
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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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Del Rosal T, Méndez-Echevarría A, Garcia-Vera C, Escosa-Garcia L, Agud M, Chaves F, Román F, Gutierrez-Fernandez J, Ruiz de Gopegui E, Ruiz-Carrascoso G, Ruiz-Gallego MDC, Bernet A, Quevedo SM, Fernández-Verdugo AM, Díez-Sebastian J, Calvo C. Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study. Infect Drug Resist 2020; 13:4643-4651. [PMID: 33380814 PMCID: PMC7767716 DOI: 10.2147/idr.s282880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children. Methods Cross-sectional study of patients <14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018. Results A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9–35.1) and 1.44% (95% CI 0.9–2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥5 years (OR 1.10, 95% CI 1.07–1.12), male sex (OR 1.43, 95% CI 1.17–1.76), urban setting (OR 1.46, 95% CI 1.08–1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093–1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57–8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p<0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin. Conclusions The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.
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Affiliation(s)
- Teresa Del Rosal
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Ana Méndez-Echevarría
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Cesar Garcia-Vera
- "José Ramón Muñoz Fernández" Health Care Center, Aragón Health Service, Zaragoza, Spain
| | - Luis Escosa-Garcia
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Martin Agud
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Chaves
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Federico Román
- Laboratory of Nosocomial Infections, Department of Bacteriology, CNM, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Enrique Ruiz de Gopegui
- Department of Clinical Microbiology, Hospital Universitari Son Espases. Servicio de Microbiología, Palma de Mallorca, Spain
| | | | | | - Albert Bernet
- Section of Microbiology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Sara Maria Quevedo
- Department of Microbiology, Hospital Universitario Severo Ochoa, Leganes, Spain
| | | | | | - Cristina Calvo
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
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Revisiting Bacterial Interference in the Age of Methicillin-resistant Staphylococcus aureus: Insights Into Staphylococcus aureus Carriage, Pathogenicity and Potential Control. Pediatr Infect Dis J 2019; 38:958-966. [PMID: 31274832 PMCID: PMC6692185 DOI: 10.1097/inf.0000000000002411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Bacteria compete with each other for local supremacy in biologic and environmental niches. In humans, who host an array of commensal bacteria, the presence of one species or strain can sometimes prevent colonization by another, a phenomenon known as "bacterial interference." We describe how, in the 1960s, infants (and later adults) were actively inoculated with a relatively benign strain of Staphylococcus aureus, 502A, to prevent colonization with an epidemic S. aureus strain, 80/81. This introduced bacterial interference as a clinical approach to disease prevention, but little was known about the mechanisms of interference at that time. Since then, much has been learned about how bacteria interact with each other and the host to establish carriage, compete for niches and shift from harmless commensal to invasive pathogen. We provide an overview of these findings and summarize recent studies in which the genome and function of 502A were compared with those of the current epidemic strain, USA300, providing insight into differences in their invasiveness and immunogenicity. Although staphylococcal vaccines have been developed, none has yet been approved for clinical use. Further studies of staphylococcal strains and the molecular characteristics that lead to exclusion of specific bacteria from some niches may provide an alternative path to disease prevention.
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Esposito S, Pennoni G, Mencarini V, Palladino N, Peccini L, Principi N. Antimicrobial Treatment of Staphylococcus aureus in Patients With Cystic Fibrosis. Front Pharmacol 2019; 10:849. [PMID: 31447669 PMCID: PMC6692479 DOI: 10.3389/fphar.2019.00849] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus is a ubiquitous human commensal pathogen. It is commonly isolated in cystic fibrosis (CF) patients and is considered one of the main causes of the recurrent acute pulmonary infections and progressive decline in lung function that characterize this inherited life-threatening multisystem disorder. However, the true role of S. aureus in CF patients is not completely understood. The main aim of this narrative review is to discuss the present knowledge of the role of S. aureus in CF patients. Literature review showed that despite the fact that the availability and use of drugs effective against S. aureus have coincided with a significant improvement in the prognosis of lung disease in CF patients, clearly evidencing the importance of S. aureus therapy, how to use old and new drugs to obtain the maximal effectiveness has not been precisely defined. The most important problem remains that the high frequency with which S. aureus is carried in healthy subjects prevents the differentiation of simple colonization from infection. Moreover, although experts recommend antibiotic administration in CF patients with symptoms and in those with persistent detection of S. aureus, the best antibiotic approach has not been defined. All these problems are complicated by the evidence that the most effective antibiotic against methicillin-resistant S. aureus (MRSA) cannot be used in patients with CF with the same schedules used in patients without CF. Further studies are needed to solve these problems and to assure CF patients the highest level of care.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Cystic Fibrosis Center of Umbria Region, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Guido Pennoni
- Pediatric Unit, Cystic Fibrosis Center of Umbria Region, Branca Hospital, Branca, Italy
| | - Valeria Mencarini
- Pediatric Unit, Cystic Fibrosis Center of Umbria Region, Branca Hospital, Branca, Italy
| | - Nicola Palladino
- Pediatric Unit, Cystic Fibrosis Center of Umbria Region, Branca Hospital, Branca, Italy
| | - Laura Peccini
- Pediatric Clinic, Cystic Fibrosis Center of Umbria Region, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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Mascaro V, Capano MS, Iona T, Nobile CGA, Ammendolia A, Pavia M. Prevalence of Staphylococcus aureus carriage and pattern of antibiotic resistance, including methicillin resistance, among contact sport athletes in Italy. Infect Drug Resist 2019; 12:1161-1170. [PMID: 31123413 PMCID: PMC6511236 DOI: 10.2147/idr.s195749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/19/2019] [Indexed: 11/23/2022] Open
Abstract
Background and purpose: Athletes participating in contact or collision sports have a great chance of acquiring Staphylococcus aureus infections. The risk factors for colonization and infections include frequent antibiotic use, close contact situations, skin trauma, sharing of sports equipment, and poor hygiene. Therefore, our specific goals were to determine (1) prevalence of S. aureus among different types of contact sport athletes which were barely studied in the European region, (2) antimicrobial resistance of S. aureus isolates, and (3) association of carriage with particular risk factors of spor t practices. Patients and methods: A cross-sectional study was conducted among contact or collision sport athletes in Italy. A questionnaire was used to gather information about sociodemographic characteristics, specific sport activities, and participants’ health conditions. Swabs were collected from the nares, oropharynx, and fingers and tested for S. aureus isolation and antimicrobial susceptibility. Results:S. aureus was carried by 42% of 238 enrolled athletes. Colonization was associated with number of weekly training days, sharing of sports equipment, not taking a shower immediately after training, and a previous history of pharyngitis or sinusitis and skin manifestations. Isolates were resistant to clindamycin (24.8%) and erythromycin (15.8%). Of all athletes, 1.3% carried methicillin-resistant S. aureus (MRSA); MRSA were 3% of all S. aureus isolates. No strains were resistant to sulfamethoxazole/trimethoprim. Conclusion: Our results have shown a high prevalence of S. aureus carriage and a relevant resistance to antimicrobials used for the treatment of S. aureus infections. Prevention efforts aimed at reducing S. aureus colonization, and thus potentially reducing infections, should be improved.
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Affiliation(s)
- Valentina Mascaro
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Maria Simona Capano
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Teresa Iona
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | | | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
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Hirose M, Aung MS, Fukuda A, Murata Y, Saitoh M, Kobayashi N. Prevalence and Genetic Characteristics of Methicillin-Resistant Staphylococcus aureus and Coagulase-Negative Staphylococci Isolated from Oral Cavity of Healthy Children in Japan. Microb Drug Resist 2019; 25:400-407. [PMID: 30694723 DOI: 10.1089/mdr.2018.0333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Prevalence and genetic characteristics of methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci in oral cavity of healthy children were studied in Hokkaido, northern main island of Japan. From saliva of 526 children, a total of 248 staphylococcal isolates comprising S. aureus (n = 143), S. epidermidis (n = 84), S. warneri (n = 13), S. haemolyticus (n = 5), S. hominis (n = 2), and S. intermedius (n = 1) were recovered. Presence of mecA was confirmed in 6.3% of S. aureus, 50% of S. epidermidis, and 7.7% in S. warneri. SCCmec was mostly classified into type IV, and ACME (arginine catabolic mobile element)-arcA was detected in S. epidermidis (23.8%) and S. intermedius. Nine MRSA isolates belonged to staphylocoagulase gene (coa) type Ia, IIa, IIIa, VIIb/sequence type 1 (ST1), ST5, ST8, ST89, ST120, and were negative for PVL (Panton-Valentine leukocidin) genes. These isolates included two clones of emerging community-acquired MRSA (CA-MRSA) that had been described recently in Japan: ST5/SCCmec IVc, which resembles the "Pediatric clone," and ST8/SCCmec IVl belonging to coa-IIIa/agr-I with sasL gene, designated "CA-MRSA/J" clone. Various enterotoxin genes were found in all the MRSA and some methicillin-susceptible S. aureus (MSSA) isolates examined, while tst-1 was detected in four MRSA isolates. Notably, a variant of elastin-binding protein gene (ebpS-v) was identified in ST120 MRSA and ST45 MSSA isolates, and exfoliative toxin D gene (etd) was detected in an MSSA isolate. The present study revealed the presence of MRSA, including the novel CA-MRSA clones, and high prevalence of methicillin-resistant S. epidermidis in oral cavity of healthy children in Japan.
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Affiliation(s)
- Mina Hirose
- 1 Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Japan
| | - Meiji Soe Aung
- 2 Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Fukuda
- 1 Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Japan
| | - Yukie Murata
- 1 Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Japan
| | - Masato Saitoh
- 1 Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Japan
| | - Nobumichi Kobayashi
- 2 Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
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School environmental contamination of methicillin-sensitive Staphylococcus aureus as an independent risk factor for nasal colonization in schoolchildren: An observational, cross-sectional study. PLoS One 2018; 13:e0208183. [PMID: 30500843 PMCID: PMC6269093 DOI: 10.1371/journal.pone.0208183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022] Open
Abstract
Objective We aim to assess the similarities of proportional, phenotypic, and molecular characteristics between the school environment and schoolchildren on methicillin-sensitive S. aureus (MSSA) isolates. Methods A cross-sectional study was conducted between March 2016 and August 2016 in eight elementary schools in Guangzhou, China. Nasal swabs from students and environmental swabs from school environments were collected. Univariate and multivariate logistic regression analyses under a multistage stratified cluster cross-sectional survey design were performed to access the prevalence relationship and influencing factors, respectively. Phenotypic and molecular characterizations of MSSA isolates were conducted using the Kirby-Bauer disk diffusion method and polymerase chain reaction assays, respectively. Results In total, 1705 schoolchildren and 1240 environmental samples from 40 classes in eight elementary schools obtained between March and August 2016 were include in this study. The rates of MSSA prevalence among schoolchildren and the environment were 11.44% (195/1705) and 4.60% (57/1240), respectively. The odds ratios and 95% confidence intervals (CIs) on the prevalence of MSSA isolates were 1.11 (95% CI, 1.05–1.29; P = 0.010) and 1.04 (95% CI, 1.01–1.07; P = 0.003) for the school or class environment and students, respectively. Similar phenotypic and molecular characteristics were identified between schoolchildren and the environment. A cause and effect relationship could not be established because the study design was cross-sectional. Conclusions Because of the cross-sectional design, we can reveal the association between school environment and schoolchildren on MSSA, but it is not a cause and effect relationship.
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Paternina-de la Ossa R, Prado SID, Cervi MC, Lima DAFDS, Martinez R, Bellissimo-Rodrigues F. Is community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) an emerging pathogen among children in Brazil? Braz J Infect Dis 2018; 22:371-376. [PMID: 30389351 PMCID: PMC9428034 DOI: 10.1016/j.bjid.2018.10.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022] Open
Abstract
Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil. Objective To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital. Methods This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients’ medical records. Results We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54–5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16–22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013). Conclusions CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections.
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Affiliation(s)
- Rolando Paternina-de la Ossa
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Seila Israel do Prado
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil; Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Comissão de Controle de Infecção Hospitalar, Ribeirão Preto, SP, Brazil
| | - Maria Célia Cervi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | | | - Roberto Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clinica Médica, Ribeirão Preto, SP, Brazil
| | - Fernando Bellissimo-Rodrigues
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Comissão de Controle de Infecção Hospitalar, Ribeirão Preto, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Social, Ribeirão Preto, SP, Brazil.
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22
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Esposito S, Terranova L, Macchini F, Bianchini S, Biffi G, Viganò M, Pelucchi C, Leva E, Principi N. Staphylococcus aureus colonization and risk of surgical site infection in children undergoing clean elective surgery: A cohort study. Medicine (Baltimore) 2018; 97:e11097. [PMID: 29979379 PMCID: PMC6076197 DOI: 10.1097/md.0000000000011097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Staphylococcus aureus persistently colonizes the skin and nasopharynx of approximately 20% to 30% of individuals, with the highest rates in younger children. To avoid clinical problems for carriers and the spread of S aureus to other hospitalized patients, screening and decolonization of carriers undergoing surgery has been recommended. However, the best approach to patients undergoing clean surgery is not precisely defined. To evaluate whether children carrying S aureus admitted to the hospital for clean elective surgery have an increased risk of postoperative surgical infections, 393 infants and children (77.1% males; mean age ± standard deviation, 7.6 ± 4.5 years) who were scheduled for clean elective surgery procedures were evaluated for S aureus carriage on the day of intervention and 5 days after it. Both anterior nares and pharyngeal swabs were collected. S aureus was identified using the RIDAGENE methicillin-resistant S aureus (MRSA) system (R-Biopharm AG, Darmstadt, Germany), according to the manufacturer's instructions. At admission, 138 (35.1%) children screened positive for S aureus. MRSA was identified in 40 (29.0% of S aureus positive subjects) cases. The carriage rates of S aureus and MRSA varied considerably with age, and in children <2 years old the rate was significantly lower than in any other age group (P < .05). Surgical site infection was demonstrated in 4 out of 109 (3.7%) children who were initially colonized by S aureus and in 5 out of 201 (2.5%) children with a negative screening, without any statistically significant difference between groups (P = .72). None of these children had MRSA. These results seem to suggest that children undergoing clean elective surgery do not need to be screened for S aureus colonization because, although positive, they have no increased risk of surgical site infection. Following this statement, preoperative procedures should be simplified with relevant advantages from a clinical, social, and economic point of view.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia
| | | | - Francesco Macchini
- Unit for Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
| | - Sonia Bianchini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia
| | - Giulia Biffi
- Pediatric Highly Intensive Care Unit, Università degli Studi di Milano
| | - Martino Viganò
- Pediatric Highly Intensive Care Unit, Università degli Studi di Milano
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Ernesto Leva
- Unit for Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Università degli Studi di Milano
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23
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Antri K, Akkou M, Bouchiat C, Bes M, Martins-Simoes P, Dauwalder O, Tristan A, Meugnier H, Rasigade JP, Etienne J, Vandenesch F, Laurent F, Ramdani-Bouguessa N. High levels of Staphylococcus aureus and MRSA carriage in healthy population of Algiers revealed by additional enrichment and multisite screening. Eur J Clin Microbiol Infect Dis 2018; 37:1521-1529. [PMID: 29948361 DOI: 10.1007/s10096-018-3279-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
The purpose of the research is to characterize Staphylococcus aureus colonization in healthy population of Algiers, to assess the impact on diagnostic performance of systematic additional broth enrichment, and to ascertain the additional benefits of multiple site screening. In order to more accurately determine the prevalence of S. aureus colonization, the swab specimens from multiple screening sites were incubated in brain-heart broth before agar plating. From 2009 to 2011, 1176 samples were collected from 459 participants (201 adults and 258 children). The additional enrichment detection step significantly increased S. aureus detection rates (p < 0.0001). S. aureus nasal detection was positive in 37.8% of adults, and the addition of throat samplings significantly increased the S. aureus detection rate up to 54.7% (p < 0.001). S. aureus nasal detection was positive in 37.6% of children. The addition of throat samplings in children significantly increased the S. aureus detection rate up to 53.1% (p < 0.001) and that of anal samplings up to 59.7%. The overall prevalence of methicillin-resistant S. aureus was 5.2% (3% of adults and 7% of children). spa typing of all isolates revealed a diverse but strongly clonal S. aureus population structure. This approach involving multiple anatomical sampling sites and an additional enrichment of the swabs before conventional culture significantly increases the detection rate of S. aureus carriers and may prove valuable to improve global S. aureus infection prevention.
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Affiliation(s)
- Kenza Antri
- Service de Microbiologie, Centre Hospitalo-Universitaire Mustapha Bacha, Algiers, Algeria.,Département de Biologie Cellulaire et Moléculaire, Faculté des Sciences Biologiques, Université des Sciences et de la Technologie Houari-Boumediène, Algiers, Algeria
| | - Madjid Akkou
- Institut des Sciences Vétérinaires, Université Blida1, 09000, Blida, Algeria.
| | - Coralie Bouchiat
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Michèle Bes
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Patricia Martins-Simoes
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Olivier Dauwalder
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Anne Tristan
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Hélène Meugnier
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Jean-Philippe Rasigade
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Jerome Etienne
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - François Vandenesch
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Nadjia Ramdani-Bouguessa
- Service de Microbiologie, Centre Hospitalo-Universitaire Mustapha Bacha, Algiers, Algeria.,Laboratoire d'analyses Médicales, Baraki, Algiers, Algeria
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24
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Cessation from Smoking Improves Innate Host Defense and Clearance of Experimentally Inoculated Nasal Staphylococcus aureus. Infect Immun 2018; 86:IAI.00912-17. [PMID: 29311241 DOI: 10.1128/iai.00912-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022] Open
Abstract
Staphylococcus aureus nasal carriage is transient in most humans and usually benign, but dissemination of S. aureus to extranasal sites causes the majority of clinical infections, and S. aureus is a major cause of serious infections in the United States. A better understanding of innate nasal decolonization mechanisms is urgently needed, as are relevant models for studying S. aureus clearance. Here, we screened a population of healthy smokers for nasal S. aureus carriage and compared the participants' abilities to clear experimentally applied nasal S. aureus before and after completion of a smoking cessation program. We determined that cigarette smoking increases the mean nasal S. aureus load (2.6 × 104 CFU/swab) compared to the load observed in healthy nonsmokers (1.7 × 103 CFU/swab) and might increase the rate of S. aureus nasal carriage in otherwise-healthy adults: 22 of 99 smokers carried S. aureus at the screening visit, while only 4 of 30 nonsmokers screened positive during the same time period. Only 6 of 19 experimental inoculation studies in active smokers resulted in S. aureus clearance within the month of follow-up, while in the cessation group, 6 of 9 subjects cleared nasal S. aureus and carriage duration averaged 21 ± 4 days. Smoking cessation associated with enhanced expression of S. aureus-associated interleukin-1β (IL-1β) and granulocyte colony-stimulating factor (G-CSF) in nasal fluids. Participants who failed to clear S. aureus exhibited a higher nasal S. aureus load and elevated nasal interleukin-1 receptor antagonist (IL-1RA) expression at the preexperiment study visits. We conclude that smokers exhibit higher S. aureus loads than nonsmokers and that innate immune pathways, including G-CSF expression and signaling through the IL-1 axis, are important mediators of nasal S. aureus clearance.
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25
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Concia E, Viscoli C, Del Bono V, Giannella M, Bassetti M, De Rosa GF, Durante Mangoni E, Esposito S, Giusti M, Grossi P, Menichetti F, Pea F, Petrosillo N, Tumbarello M, Stefani S, Venditti M, Viale P. The current role of glycopeptides in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in not neutropenic adults: the viewpoint of a group of Italian experts. J Chemother 2018; 30:157-171. [PMID: 29380676 DOI: 10.1080/1120009x.2017.1420610] [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: 10/18/2022]
Abstract
Staphylococcus aureus is still an important problem in clinical and therapeutic area, worldwide. In Italy, in recent years, methicillin resistance remained stable, yet considerably high, the percentage of strains of MRSA being around 40%. It was deemed interesting and timely to carry out a consensus conference using the RAND/UCLA method to collect the opinion of a group of experts in infectious diseases on the role of glycopeptides in the management of MRSA infections within several clinical scenarios and namely in pneumonia, bacteremia and endocarditis, joint replacement infections, skin and soft tissue infections, diabetic foot, abdominal infections and central nervous system infections. The scenarios proposed by the Scientific Committee have been validated by a group of experts in infectious diseases and then voted in three meetings of infectious disease specialists. The results obtained on each individual condition were analyzed and therapeutic recommendations on each of these were released.
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Affiliation(s)
- Ercole Concia
- a Università degli Studi di Verona, Italy - Dipartimento Diagnostica e Sanità Pubblica - Sezione Malattie Infettive
| | - Claudio Viscoli
- b A.O.U. IRCCS San Martino/Università degli Studi, Genova, Italy - Clinica delle Malattie Infettive
| | - Valerio Del Bono
- b A.O.U. IRCCS San Martino/Università degli Studi, Genova, Italy - Clinica delle Malattie Infettive
| | - Maddalena Giannella
- c Università degli Studi di Bologna/Ospedale Sant'Orsola-Malpighi, Bologna, Italy - Dipartimento di Scienze Mediche e Chirurgiche, Settore Malattie Infettive
| | - Matteo Bassetti
- d A.O.U. Santa Maria della Misericordia, Udine, Italy - Clinica di Malattie Infettive (Bassetti), Istituto di Farmacologia Clinica (Pea)
| | | | | | - Silvano Esposito
- g Università degli Studi di Salerno, Italy, Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana"
| | - Massimo Giusti
- h A.O. San Giovanni Bosco, Torino, Italy - Reparto di Medicina Interna A
| | - Paolo Grossi
- i Università degli Studi dell'Insubria, Varese, Italy - Dipartimento di Medicina Interna - Malattie infettive e tropicali
| | - Francesco Menichetti
- j A.O.U. Pisana, Pisa, Italy - Direttore di Unità Operativa - U.O. Malattie Infettive
| | - Federico Pea
- d A.O.U. Santa Maria della Misericordia, Udine, Italy - Clinica di Malattie Infettive (Bassetti), Istituto di Farmacologia Clinica (Pea)
| | - Nicola Petrosillo
- k Istituto Nazionale Malattie Infettive "Lazzaro Spallanzani", Roma, Italy - U.O.C. Infezioni Sistemiche e dell'Immunodepresso
| | - Mario Tumbarello
- l Università Cattolica del Sacro Cuore, Roma, Italy - Facoltà di Medicina e Chirurgia, Clinica delle Malattie Infettive
| | - Stefania Stefani
- m Università degli Studi di Catania, Italy - Dipartimento di Scienze Biomediche e Biotecnologiche
| | - Mario Venditti
- n Università "La Sapienza"/A.O. Policlinico Umberto I, Roma, Italy - Dipartimento di Sanità Pubblica e Malattie Infettive
| | - Pierluigi Viale
- c Università degli Studi di Bologna/Ospedale Sant'Orsola-Malpighi, Bologna, Italy - Dipartimento di Scienze Mediche e Chirurgiche, Settore Malattie Infettive
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26
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Streptococcus pneumoniae Modulates Staphylococcus aureus Biofilm Dispersion and the Transition from Colonization to Invasive Disease. mBio 2018; 9:mBio.02089-17. [PMID: 29317512 PMCID: PMC5760742 DOI: 10.1128/mbio.02089-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Streptococcus pneumoniae and Staphylococcus aureus are ubiquitous upper respiratory opportunistic pathogens. Individually, these Gram-positive microbes are two of the most common causative agents of secondary bacterial pneumonia following influenza A virus infection, and they constitute a significant source of morbidity and mortality. Since the introduction of the pneumococcal conjugate vaccine, rates of cocolonization with both of these bacterial species have increased, despite the traditional view that they are antagonistic and mutually exclusive. The interactions between S. pneumoniae and S. aureus in the context of colonization and the transition to invasive disease have not been characterized. In this report, we show that S. pneumoniae and S. aureus form stable dual-species biofilms on epithelial cells in vitro. When these biofilms are exposed to physiological changes associated with viral infection, S. pneumoniae disperses from the biofilm, whereas S. aureus dispersal is inhibited. These findings were supported by results of an in vivo study in which we used a novel mouse cocolonization model. In these experiments, mice cocolonized in the nares with both bacterial species were subsequently infected with influenza A virus. The coinfected mice almost exclusively developed pneumococcal pneumonia. These results indicate that despite our previous report that S. aureus disseminates into the lungs of mice stably colonized with these bacteria following influenza A virus infection, cocolonization with S. pneumoniae in vitro and in vivo inhibits S. aureus dispersal and transition to disease. This study provides novel insight into both the interactions between S. pneumoniae and S. aureus during carriage and the transition from colonization to secondary bacterial pneumonia. In this study, we demonstrate that Streptococcus pneumoniae can modulate the pathogenic potential of Staphylococcus aureus in a model of secondary bacterial pneumonia. We report that host physiological signals related to viral infection cease to elicit a dispersal response from S. aureus while in a dual-species setting with S. pneumoniae, in direct contrast to results of previous studies with each species individually. This study underscores the importance of studying polymicrobial communities and their implications in disease states.
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27
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Host Physiologic Changes Induced by Influenza A Virus Lead to Staphylococcus aureus Biofilm Dispersion and Transition from Asymptomatic Colonization to Invasive Disease. mBio 2016; 7:mBio.01235-16. [PMID: 27507829 PMCID: PMC4981728 DOI: 10.1128/mbio.01235-16] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Staphylococcus aureus is a ubiquitous opportunistic human pathogen and a major health concern worldwide, causing a wide variety of diseases from mild skin infections to systemic disease. S. aureus is a major source of severe secondary bacterial pneumonia after influenza A virus infection, which causes widespread morbidity and mortality. While the phenomenon of secondary bacterial pneumonia is well established, the mechanisms behind the transition from asymptomatic colonization to invasive staphylococcal disease following viral infection remains unknown. In this report, we have shown that S. aureus biofilms, grown on an upper respiratory epithelial substratum, disperse in response to host physiologic changes related to viral infection, such as febrile range temperatures, exogenous ATP, norepinephrine, and increased glucose. Mice that were colonized with S. aureus and subsequently exposed to these physiologic stimuli or influenza A virus coinfection developed pronounced pneumonia. This study provides novel insight into the transition from colonization to invasive disease, providing a better understanding of the events involved in the pathogenesis of secondary staphylococcal pneumonia. In this study, we have determined that host physiologic changes related to influenza A virus infection causes S. aureus to disperse from a biofilm state. Additionally, we report that these same host physiologic changes promote S. aureus dissemination from the nasal tissue to the lungs in an animal model. Furthermore, this study identifies important aspects involved in the transition of S. aureus from asymptomatic colonization to pneumonia.
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28
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Persistence, Discordance and Diversity of Staphylococcus aureus Nasal and Oropharyngeal Colonization in School-aged Children. Pediatr Infect Dis J 2016; 35:744-8. [PMID: 27088586 DOI: 10.1097/inf.0000000000001173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The anterior nares are regarded as the primary site for Staphylococcus aureus colonization, although studies have highlighted the potential importance of colonization at extra-nasal sites, including the oropharynx. Accordingly, the aims of this study were to assess the prevalence, persistence and molecular epidemiology of S. aureus colonization in the nares and oropharynx of Māori and Pacific children, a population with strikingly high rates of S. aureus infection. METHODS A cross-sectional study of predominantly Māori and Pacific school-aged children in Auckland, New Zealand was performed in October 2013, and swabs were taken from the nares and oropharynx. Sampling was repeated from the same schools in October 2014. All S. aureus isolates underwent antimicrobial susceptibility testing and spa typing. RESULTS Overall, 506/893 (56.7%) children were colonized with S. aureus, and the colonization prevalence was significantly higher in the oropharynx than nares (41.1% vs. 31.5%; P < 0.001). Longitudinal colonization was significantly higher in the oropharynx than the nares, and children with longitudinal oropharyngeal colonization were more likely to be colonized with the same spa type than those colonized in the nares (67.6% vs. 37.0%; P = 0.01). Approximately 40% of children had discordant spa types at the nares and oropharynx. CONCLUSIONS Oropharyngeal S. aureus colonization represents a significant reservoir of S. aureus and it is possible that the oropharynx may represent a protected anatomical niche, enabling persistent colonization with the same S. aureus strain. Future study should attempt to better understand the determinants of oropharyngeal carriage.
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29
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Ebruke C, Dione MM, Walter B, Worwui A, Adegbola RA, Roca A, Antonio M. High genetic diversity of Staphylococcus aureus strains colonising the nasopharynx of Gambian villagers before widespread use of pneumococcal conjugate vaccines. BMC Microbiol 2016; 16:38. [PMID: 26969294 PMCID: PMC4788959 DOI: 10.1186/s12866-016-0661-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/02/2016] [Indexed: 11/29/2022] Open
Abstract
Background With the global efforts of reducing pneumococcal disease through widespread introduction of pneumococcal vaccines, concerns have emerged on the potential increase of morbidity and mortality from S. aureus disease. Little is known however, of the carriage rates of S. aureus or of its’ relationship with carriage of S. pneumoniae in rural Africa, and West Africa in particular where very high rates of carriage of S. pneumoniae have been reported. This study aims to evaluate the prevalence, antibiotic susceptibility patterns and genotypes of S. aureus isolated from the nasopharynx of healthy individuals in rural Gambia before the introduction of routine use of pneumococcal conjugate vaccines in the country. Results Overall prevalence of S. aureus nasopharyngeal carriage was 25.2 %. All S. aureus isolates tested were susceptible to methicillin. Resistant was observed for sulphamethoxazole-trimethoprim (15 %) and tetracycline (34.3 %). We found 59 different sequence types (ST), 35 of which were novel. The most prevalent sequence types were ST 15 (28 %) and ST 5 (4 %). Eighty two percent (494/600) of study individuals were S. pneumoniae carriers with S. pneumoniae carriage rates decreasing with increasing age groups. S. aureus carriage among pneumococcal carriers was slightly lower than among non-pneumococcal carriers (24.3 versus 29.3 %; p = 0.324). There were no associations of carriage between these two bacteria across the 4 age groups. However, analysis of pooled data children < 2 years and children 2 to < 5 years of age showed a statistically significant inverse association (24.1 and 50.0 % for S. aureus carriage among S. pneumoniae carriers and non-carriers respectively; p = 0.015). Conclusions We report that nasopharyngeal carriage of S. aureus in rural Gambia is high in all age groups, with approximately 1 out of 4 individuals being carriers in the pre-pneumococcal vaccination era. There are indications that nasopharyngeal carriage of S.aureus could be inversely related to carriage of S. pneumoniae amongst younger children in The Gambian and that S. aureus clones in The Gambia show significant genetic diversity suggesting worldwide dissemination. Findings from this study provide a useful background for impact studies evaluating the introduction of pneumococcal vaccines or other interventions targeting the control of S. aureus infections and disease.
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Affiliation(s)
- Chinelo Ebruke
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel M Dione
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Brigitte Walter
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Archibald Worwui
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | | | - Anna Roca
- Disease Control and Elimination, Medical Research Council Unit, Banjul, The Gambia
| | - Martin Antonio
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. .,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK.
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30
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Esposito S, Marseglia GL, Colombo C, Iughetti L, Terranova L, Ierardi V, Gambino M, Principi N. Interaction between Streptococcus pneumoniae and Staphylococcus aureus in paediatric patients suffering from an underlying chronic disease. Int J Immunopathol Pharmacol 2015; 28:497-507. [PMID: 26395386 DOI: 10.1177/0394632015601486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/27/2015] [Indexed: 11/16/2022] Open
Abstract
Little is known about the interaction between Streptococcus pneumoniae and Staphylococcus aureus in school-age children and adolescents suffering from an underlying chronic disease. To increase our knowledge in this regard, an oropharyngeal swab was obtained from school-age children and adolescents suffering from asthma (n = 423), cystic fibrosis (CF) (n = 212) and type 1 diabetes mellitus (DM1) (n = 296). S. pneumoniae detection and serotyping were performed using a real-time polymerase chain reaction, and S. aureus detection was performed using the RIDAGENE MRSA system. Among asthmatic, CF and DM1 patients, both pathogens were identified in 65/423 (15.4%), 21/212 (9.9%) and 62/296 (20.9%) children, respectively; S. pneumoniae alone was identified in 127/434 (30.0%), 21/212 (9.9%) and 86/296 (29.1%), respectively; S. aureus alone was identified in 58/434 (13.7%), 78/212 (36.8%) and 49/296 (16.6%), respectively. S. pneumoniae colonisation rates were higher in younger children and declined with age, whereas the frequency of S. aureus colonisation was quite similar in the different age groups. Among asthmatic and CF patients aged 6-9 years, S. aureus carriage was significantly higher in children who were positive for S. pneumoniae (P <0.05). No significant association emerged between S. aureus carriage and carriage of S. pneumoniae serotypes included in the pneumococcal conjugate vaccines (PCVs). This study shows for the first time that school-age children and adolescents with asthma, CF and DM1 are frequently colonised by S. pneumoniae and S. aureus and that no negative relationship seems to exist between these pathogens. Moreover, the supposed protection offered by PCV administration against S. aureus colonisation was not demonstrated.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, University of Pavia, IRCCS Policlinico "S. Matteo" Foundation, Pavia, Italy
| | - Carla Colombo
- Cystic Fibrosis Center, Lombardia Region, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Iughetti
- Pediatric Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Terranova
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Ierardi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monia Gambino
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Johnson K, Frei R, Heininger U. Prospective, cross-sectional study on MSSA and MRSA colonisation in hospitalised children. Eur J Pediatr 2015; 174:1255-62. [PMID: 26272252 DOI: 10.1007/s00431-015-2606-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/21/2015] [Accepted: 07/26/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED There is a global trend for an increase in prevalence of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonisation in children. A decade ago, MRSA colonisation was studied in Swiss paediatric hospitals and revealed an extraordinarily low proportion (<1 %). The primary goal of this study was to determine if the current proportion of nasal colonisation with MRSA in hospitalised children was still favourable. We aimed to screen all children from the age of 0-16 years admitted to the paediatric and surgical wards at the University Children's Hospital Basel (UKBB) during 8 pre-defined surveillance weeks. After obtaining consent, a nasal swab was taken and analysed for growth of S. aureus. Furthermore, a standardised questionnaire was completed by interview with a parent. Of 535 eligible children, 340 (64 %) were enrolled. Mean age was 6.2 years (median 4.3, IQR 1 to 11.25), 111 (33 %) children were colonised with S. aureus but no MRSA was found. CONCLUSION The prevalence of MRSA in children admitted to the UKBB during this surveillance period was zero. General MRSA screening in hospitalised children continues to be unjustified in our area. WHAT IS KNOWN • The prevalence of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonisation in children is increasing in many regions worldwide. • Surveillance for MRSA colonisation in healthcare settings varies considerably. WHAT IS NEW • Periodic and risk-factor-based surveillance for MRSA colonisation is sufficient when regional prevalence is low.
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Affiliation(s)
- Kristen Johnson
- University Children's Hospital, Spitalstrasse 33, PO Box, CH 4031, Basel, Switzerland,
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