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King T, Schindler R, Chavda S, Conly J. Dimensions of poverty as risk factors for antimicrobial resistant organisms in Canada: a structured narrative review. Antimicrob Resist Infect Control 2022; 11:18. [PMID: 35074013 PMCID: PMC8785485 DOI: 10.1186/s13756-022-01059-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Few studies have assessed the relationship between poverty and the risk of infection with antimicrobial resistant organisms (AROs). We sought to identify, appraise, and synthesize the available published Canadian literature that analyzes living in poverty and risk of AROs. Methods A structured narrative review methodology was used, including a systematic search of three databases: MedLINE, EMBASE and Web of Science for articles pertaining to poverty, and infection with AROs in Canada between 1990 and 2020. Poverty was broadly defined to include economic measures and associated social determinants of health. Based on inclusion and exclusion criteria, there were 889 initial articles, and 43 included in the final review. The final articles were extracted using a standard format and appraised using the Joanna Briggs Institute Levels of Evidence framework. Results Of 43 studies, 15 (35%) related to methicillin-resistant Staphylococcus aureus (MRSA). One study found a 73% risk reduction (RR 0.27, 95%CI 0.19–0.39, p = < 0.0001) in community-acquired MRSA (CA-MRSA) infection for each $100,000 income increase. Results pertaining to homelessness and MRSA suggested transmission was related to patterns of frequent drug use, skin-to-skin contact and sexual contact more than shelter contact. Indigenous persons have high rates of CA-MRSA, with more rooms in the house being a significant protective factor (OR 0.86, p = 0.023). One study found household income over $60,000 (OR 0.83, p = 0.039) in univariate analysis and higher maternal education (OR 0.76, 95%CI 0.63–0.92, p = 0.005) in multivariate analysis were protective for otitis media due to an ARO among children. Twenty of 43 (46.5%) articles pertained to tuberculosis (TB). Foreign-born persons were four times more likely to have resistant TB compared to Canadian-born persons. None of the 20 studies used income in their analyses. Conclusions There is an association between higher income and protection from CA-MRSA. Mixed results exist regarding the impact of homelessness and MRSA, demonstrating a nuanced relationship with behavioural risk factors. Higher income and maternal education were associated with reduced ARO-associated acute otitis media in children in one study. We do not have a robust understanding of the social measures of marginalization related to being foreign-born that contribute to higher rates of resistant TB infection. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01059-1.
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2
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Groves RA, Mapar M, Aburashed R, Ponce LF, Bishop SL, Rydzak T, Drikic M, Bihan DG, Benediktsson H, Clement F, Gregson DB, Lewis IA. Methods for Quantifying the Metabolic Boundary Fluxes of Cell Cultures in Large Cohorts by High-Resolution Hydrophilic Liquid Chromatography Mass Spectrometry. Anal Chem 2022; 94:8874-8882. [PMID: 35700271 PMCID: PMC9244871 DOI: 10.1021/acs.analchem.2c00078] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
![]()
Metabolomics is a
mainstream approach for investigating the metabolic
underpinnings of complex biological phenomena and is increasingly
being applied to large-scale studies involving hundreds or thousands
of samples. Although metabolomics methods are robust in smaller-scale
studies, they can be challenging to apply to larger cohorts due to
the inherent variability of liquid chromatography mass spectrometry
(LC-MS). Much of this difficulty results from the time-dependent changes
in the LC-MS system, which affects both the qualitative and quantitative
performances of the instrument. Herein, we introduce an analytical
strategy for addressing this problem in large-scale microbial studies.
Our approach quantifies microbial boundary fluxes using two zwitterionic
hydrophilic interaction liquid chromatography (ZIC-HILIC) columns
that are plumbed to enable offline column equilibration. Using this
strategy, we show that over 397 common metabolites can be resolved
in 4.5 min per sample and that metabolites can be quantified with
a median coefficient of variation of 0.127 across 1100 technical replicates.
We illustrate the utility of this strategy via an analysis of 960
strains of Staphylococcus aureus isolated
from bloodstream infections. These data capture the diversity of metabolic
phenotypes observed in clinical isolates and provide an example of
how large-scale investigations can leverage our novel analytical strategy.
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Affiliation(s)
- Ryan A Groves
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Maryam Mapar
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Raied Aburashed
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Luis F Ponce
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Stephanie L Bishop
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Thomas Rydzak
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Marija Drikic
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Dominique G Bihan
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Hallgrimur Benediktsson
- Cumming School of Medicine, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary T2N 1N4, Canada.,Alberta Precision Laboratories, Calgary T2L 2K8, Canada
| | - Fiona Clement
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary T2N 1N4, Canada
| | - Daniel B Gregson
- Cumming School of Medicine, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary T2N 1N4, Canada.,Alberta Precision Laboratories, Calgary T2L 2K8, Canada.,Cumming School of Medicine, Department of Medicine, University of Calgary, Calgary T2N 1N4, Canada
| | - Ian A Lewis
- Department of Biological Sciences, University of Calgary, Calgary T2N 1N4, Canada
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3
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Marks LR, Calix JJ, Wildenthal JA, Wallace MA, Sawhney SS, Ransom EM, Durkin MJ, Henderson JP, Burnham CAD, Dantas G. Staphylococcus aureus injection drug use-associated bloodstream infections are propagated by community outbreaks of diverse lineages. COMMUNICATIONS MEDICINE 2021; 1:52. [PMID: 35602233 PMCID: PMC9053277 DOI: 10.1038/s43856-021-00053-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background The ongoing injection drug use (IDU) crisis in the United States has been complicated by an emerging epidemic of Staphylococcus aureus IDU-associated bloodstream infections (IDU-BSI). Methods We performed a case-control study comparing S. aureus IDU-BSI and non-IDU BSI cases identified in a large US Midwestern academic medical center between Jan 1, 2016 and Dec 21, 2019. We obtained the whole-genome sequences of 154 S. aureus IDU-BSI and 91 S. aureus non-IDU BSI cases, which were matched with clinical data. We performed phylogenetic and comparative genomic analyses to investigate clonal expansion of lineages and molecular features characteristic of IDU-BSI isolates. Results Here we show that patients with IDU-BSI experience longer durations of bacteremia and have lower medical therapy completion rates. In phylogenetic analyses, 45/154 and 1/91 contemporaneous IDU-BSI and non-IDU BSI staphylococcal isolates, respectively, group into multiple, unique clonal clusters, revealing that pathogen community transmission distinctively spurs IDU-BSI. Lastly, multiple S. aureus lineages deficient in canonical virulence genes are overrepresented among IDU-BSI, which may contribute to the distinguishable clinical presentation of IDU-BSI cases. Conclusions We identify clonal expansion of multiple S. aureus lineages among IDU-BSI isolates, but not non-IDU BSI isolates, in a community with limited access to needle exchange facilities. In the setting of expanding numbers of staphylococcal IDU-BSI cases consideration should be given to treating IDU-associated invasive staphylococcal infections as a communicable disease.
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Affiliation(s)
- Laura R. Marks
- grid.4367.60000 0001 2355 7002Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO USA
| | - Juan J. Calix
- grid.4367.60000 0001 2355 7002Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO USA
| | - John A. Wildenthal
- grid.4367.60000 0001 2355 7002Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO USA
| | - Meghan A. Wallace
- grid.4367.60000 0001 2355 7002Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO USA
| | - Sanjam S. Sawhney
- grid.4367.60000 0001 2355 7002The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO USA
| | - Eric M. Ransom
- grid.4367.60000 0001 2355 7002Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO USA
| | - Michael J. Durkin
- grid.4367.60000 0001 2355 7002Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO USA
| | - Jeffrey P. Henderson
- grid.4367.60000 0001 2355 7002Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO USA
| | - Carey-Ann D. Burnham
- grid.4367.60000 0001 2355 7002Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO USA
| | - Gautam Dantas
- grid.4367.60000 0001 2355 7002The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO USA
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4
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Adly M, Woo TE, Traboulsi D, Klassen D, Hardin J. Understanding Dermatologic Concerns Among Persons Experiencing Homelessness: A Scoping Review and Discussion for Improved Delivery of Care. J Cutan Med Surg 2021; 25:616-626. [PMID: 33818163 PMCID: PMC8640276 DOI: 10.1177/12034754211004558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There is a paucity of information surrounding dermatologic care for persons experiencing homelessness (PEH). This scoping review aims to map existing literature and provide a summary of the most common cutaneous manifestations among PEH, risk factors for dermatologic disease, describe any reported interventions, as well as identify research gaps for future studies. Search strategies developed for MEDLINE and hand searching yielded 486 articles. Out of the 486 articles screened, 93 articles met the inclusion criteria. The majority were cohort studies, cross-sectional studies, and case-control studies concentrated in North America and Europe. Excluding the pediatric population, the prevalence of dermatologic conditions ranged from 16.6% to 53.5%. Common skin conditions described in PEH were: acne, psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen simplex chronicus. There were no studies comparing the extent or severity of these cutaneous diseases in PEH and the general population. PEH have a higher prevalence of skin infections and non-melanoma skin cancers. This scoping review has direct implications on public health interventions for PEH and highlights the need for evidence-based interventions to provide optimum and safe dermatologic healthcare for PEH. We propose several recommendations for improved care delivery, including addressing upstream factors and comorbidities impacting skin health, providing trauma informed care, reducing barriers to care, preventing and managing skin conditions, as well as including PEH in the planning and implementation of any proposed intervention.
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Affiliation(s)
- Merna Adly
- 704012129 University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Taylor Evart Woo
- Department of Dermatology, Cumming School of Medicine, Calgary, AB, Canada
| | - Danya Traboulsi
- Department of Dermatology, Cumming School of Medicine, Calgary, AB, Canada
| | - David Klassen
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - Jori Hardin
- Department of Dermatology, Cumming School of Medicine, Calgary, AB, Canada
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5
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Blinick R, Chaya N, Zalta B, Haramati LB, Shmukler A. Cracking the Opium Den: Cardiothoracic Manifestations of Drug Abuse. J Thorac Imaging 2021; 36:W16-W31. [PMID: 32102017 DOI: 10.1097/rti.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recreational drug use is increasing worldwide, with emergency room visits and total deaths from drug overdose rising in recent years. Complications from prescription and recreational drug use may result from the biochemical effects of the drugs themselves, impurities mixed with substances, or from causes related to the method of drug administration. The presentation of drug overdose may be complex due to multisubstance abuse, including cigarette smoking and alcoholism, and can impact any organ system. Patients may present without history, and radiologists may be the first clinicians to suggest the diagnosis. We aim to explore the cardiothoracic manifestations of drug abuse and their multimodality imaging manifestations.
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Affiliation(s)
| | - Nathan Chaya
- Montefiore Medical Center, Bronx
- Staten Island University Hospital, Staten Island, NY
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6
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Watkins RR, David MZ. Approach to the Patient with a Skin and Soft Tissue Infection. Infect Dis Clin North Am 2021; 35:1-48. [PMID: 33494872 DOI: 10.1016/j.idc.2020.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The diagnosis of a skin and soft tissue infection (SSTI) requires careful attention to a patient's history, physical examination, and diagnostic test results. We review for many bacterial, viral, fungal, and parasitic pathogens that cause SSTIs the clues for reaching a diagnosis, including reported past medical history, hobbies and behaviors, travel, insect bites, exposure to other people and to animals, environmental exposures to water, soil, or sand, as well as the anatomic site of skin lesions, their morphology on examination, and their evolution over time. Laboratory and radiographic tests are discussed that may be used to confirm a specific diagnosis.
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Affiliation(s)
- Richard R Watkins
- Division of Infectious Diseases, Cleveland Clinic Akron General, 224 West Exchange Street, Akron, OH 44302, USA; Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Blockley Hall 707, Philadelphia, PA 19104, USA; Department of Epidemiology, Biostatistics and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
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7
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McClure JA, Lakhundi S, Niazy A, Dong G, Obasuyi O, Gordon P, Chen S, Conly JM, Zhang K. Staphylococcus aureus ST59: Concurrent but Separate Evolution of North American and East Asian Lineages. Front Microbiol 2021; 12:631845. [PMID: 33643261 PMCID: PMC7902796 DOI: 10.3389/fmicb.2021.631845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/20/2021] [Indexed: 11/30/2022] Open
Abstract
Despite initially being described in North America, Staphylococcus aureus (SA) sequence type ST59 is the most commonly isolated sequence type in Eastern Asia. The origins and evolution of this strain type remains unclear and therefore we gathered a collection of ST59 isolates from Canada and mainland China for a detailed genetic analysis of the lineage. Bayesian inference phylogenomic analysis of our isolates, along with previously published ST59 sequences indicated that the lineage could be divided into 6 distinct subgroups (WGS-1 thorough 6), each having distinct molecular characteristics. Analysis also demonstrated the concurrent but separate evolution of North American and East Asian lineages, as well as the extensive diversification of the East Asian lineage. The presence of a mobile element structure (MES) was found to be the major difference between these two continental lineages, absent in all North American isolates, and present in all East Asian ones. Other mobile genetic elements, such as the Immune Evasion Complex (IEC), Panton Valentine Leukocidin (PVL), and Staphylococcal Cassette Chromosome mec (SCCmec), showed significant variability within each sub-group and likely represents local selective pressures rather than major characteristics defining the groups. Our analysis also demonstrated the existence of a more ancient ST59 sub-lineage from North America, which was MES negative and contained some of the earliest reported ST59 isolates. Combined with the existence of a MES negative isolate from Taiwan, predicted to have appeared prior to diversification of the East Asian lineages, these results hint at the possibility of a North American origin for the lineage, which gained hold in Eastern Asia following acquisition of MES, and subsequently diversified.
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Affiliation(s)
- Jo-Ann McClure
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Precision Laboratories/University of Calgary, Calgary, AB, Canada
| | - Sahreena Lakhundi
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Amani Niazy
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - George Dong
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Osahon Obasuyi
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Gordon
- Centre for Health Genomics and Informatics, University of Calgary, Calgary, AB, Canada
| | - Sidong Chen
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China
| | - John M Conly
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Precision Laboratories/University of Calgary, Calgary, AB, Canada.,Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada.,The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Kunyan Zhang
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Precision Laboratories/University of Calgary, Calgary, AB, Canada.,Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada.,The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
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8
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Zhang J, Conly J, McClure J, Wu K, Petri B, Barber D, Elsayed S, Armstrong G, Zhang K. A Murine Skin Infection Model Capable of Differentiating the Dermatopathology of Community-Associated MRSA Strain USA300 from Other MRSA Strains. Microorganisms 2021; 9:microorganisms9020287. [PMID: 33573328 PMCID: PMC7912111 DOI: 10.3390/microorganisms9020287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 12/31/2022] Open
Abstract
USA300 is a predominant and highly virulent community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain that is a leading cause of skin and soft tissue infections. We established a murine intradermal infection model capable of demonstrating dermatopathological differences between USA300 and other MRSA strains. In this model, USA300 induced dermonecrosis, uniformly presenting as extensive open lesions with a histologically documented profound inflammatory cell infiltrate extending below the subcutis. In contrast, USA400 and a colonizing control strain M92 caused only localized non-ulcerated skin infections associated with a mild focal inflammatory infiltrate. It was also determined that the dermonecrosis induced by USA300 was associated with significantly increased neutrophil recruitment, inhibition of an antibacterial response, and increased production of cytokines/chemokines associated with disease severity. These results suggest that induction of severe skin lesions by USA300 is related to over-activation of neutrophils, inhibition of host antibacterial responses, and selective alteration of host cytokine/chemokine profiles.
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Affiliation(s)
- Jack Zhang
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
| | - John Conly
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
- Department of Medicine, University of Calgary, Calgary, AB T2N4N1, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services, Alberta Precision Laboratories, University of Calgary, Calgary, AB T2N4N1, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1, Canada
| | - JoAnn McClure
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Centre for Antimicrobial Resistance, Alberta Health Services, Alberta Precision Laboratories, University of Calgary, Calgary, AB T2N4N1, Canada
| | - Kaiyu Wu
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
| | - Bjӧrn Petri
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1, Canada
| | - Duane Barber
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
| | - Sameer Elsayed
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
- Department of Medicine, University of Western Ontario, London, ON N6A5C1, Canada
| | - Glen Armstrong
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
| | - Kunyan Zhang
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
- Department of Medicine, University of Calgary, Calgary, AB T2N4N1, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services, Alberta Precision Laboratories, University of Calgary, Calgary, AB T2N4N1, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1, Canada
- Correspondence: ; Tel.: +1-403-210-8484
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9
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Lang R, Gill MJ, Vu Q, Viczko J, Naugler C, Church D. Longitudinal evaluation of risk factors and outcomes of blood stream infections due to Staphylococcus species in persons with HIV: An observational cohort study. EClinicalMedicine 2021; 31:100675. [PMID: 33554080 PMCID: PMC7846664 DOI: 10.1016/j.eclinm.2020.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Staphylococcal blood stream infections (SBSI) are a significant cause of morbidity and mortality, however there is little data on such infections in persons with HIV (PWH) in the combination antiretroviral therapy era, particularly when divided by species; methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative Staphylococcus (CoNS). METHODS Using linked longitudinal clinical and microbiologic databases, all cases of SBSI in PWH accessing care at Southern Alberta Clinic were identified and demographic features and outcomes characterized. We compared participants with SBSI to those with no SBSI and determined the 1-year all-cause mortality following SBSI and longitudinally over the study period. FINDINGS From 2000 to 2018, 130 SBSI occurred in 95 PWH over 21,526 patient-years follow-up. MSSA caused 38.4%, MRSA 26.1% and CoNS 35.3% of SBSI. Highest risks for SSBI were in Hepatitis C coinfection, low CD4 nadir, Indigenous/Metis ethnicity and in persons who use injection drugs (PWID). During follow-up, 423 deaths occurred in all PWH. Mortality rates for PWH with SBSI was 74.9/1000 patient-years (95% CI 59.2-94.9) compared with no SBSI 16.0/1000 patient-years (95% CI 14.4-17.7). The mortality Hazard Ratio was 2.61(95% CI 1.95-3.49, P= <0.001) for SBSI compared to no SBSI, following adjusting for confounding. Seventy deaths occurred in persons with SBSI with 40% in the first year. Higher 1-year mortality rates occurred in hospital-acquired infections. INTERPRETATION Incidence rates of SBSI are high in PWH, with identified characteristics that further increase this risk. PWH who experience SBSI have a significant mortality risk within the first year of follow-up, however they also have greater long-term all-cause mortality compared to those with no SBSI. Further investigation is needed in PWH evaluating host, environment and pathogen differences that lead to differing rates of SBSI and mortality seen here. FUNDING No funding was received for this work.
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Affiliation(s)
- Raynell Lang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
| | - M. John Gill
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
- Southern Alberta HIV Clinic, Alberta Health Services, Calgary, Alta, Canada
| | - Quang Vu
- Southern Alberta HIV Clinic, Alberta Health Services, Calgary, Alta, Canada
| | - Jeannine Viczko
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
| | - Chris Naugler
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
| | - Deirdre Church
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
- Corresponding author at: Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, 9- 3535 Research Rd NW, Calgary, Alta T2L2K8, Canada.
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10
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Packer S, Pichon B, Thompson S, Neale J, Njoroge J, Kwiatkowska RM, Oliver I, Telfer M, Doumith M, Buunaaisie C, Heinsbroek E, Hopewell-Kelly N, Desai M, Hope V, Williams OM, Kearns A, Hickman M, Gobin M. Clonal expansion of community-associated meticillin-resistant Staphylococcus aureus (MRSA) in people who inject drugs (PWID): prevalence, risk factors and molecular epidemiology, Bristol, United Kingdom, 2012 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 30940316 PMCID: PMC6446509 DOI: 10.2807/1560-7917.es.2019.24.13.1800124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: In 2015, Bristol (South West England) experienced a large increase in cases of meticillin-resistant Staphylococcus aureus (MRSA) infection in people who inject drugs (PWID). Aim: We aimed to characterise and estimate the prevalence of MRSA colonisation among PWID in Bristol and test evidence of a clonal outbreak. Methods: PWID recruited through an unlinked-anonymous community survey during 2016 completed behavioural questionnaires and were screened for MRSA. Univariable logistic regression examined associations with MRSA colonisation. Whole-genome sequencing used lineage-matched MRSA isolates, comparing PWID (screening and retrospective bacteraemia samples from 2012-2017) with non-PWID (Bristol screening) in Bristol and national reference laboratory database samples. Results: The MRSA colonisation prevalence was 8.7% (13/149) and was associated with frequently injecting in public places (odds ratio (OR): 5.5; 95% confidence interval (CI):1.34–22.70), recent healthcare contact (OR: 4.3; 95% CI: 1.34–13.80) and injecting in groups of three or more (OR: 15.8; 95% CI: 2.51–99.28). People reporting any one of: injecting in public places, injection site skin and soft tissue infection or hospital contact accounted for 12/13 MRSA positive cases (sensitivity 92.3%; specificity 51.5%). Phylogenetic analysis identified a dominant clade associated with infection and colonisation among PWID in Bristol belonging to ST5-SCCmecIVg. Conclusions: MRSA colonisation in Bristol PWID is substantially elevated compared with general population estimates and there is evidence of clonal expansion, community-based transmission and increased infection risk related to the colonising strain. Targeted interventions, including community screening and suppression therapy, education and basic infection control are needed to reduce MRSA infections in PWID.
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Affiliation(s)
- Simon Packer
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - Bruno Pichon
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Stephen Thompson
- Public health laboratory Bristol, Public Health England, Bristol, United Kingdom
| | - Jane Neale
- Bristol Drugs Project, Bristol, United Kingdom
| | - Jacquelyn Njoroge
- Blood Borne Virus Section, HIV & STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - Rachel M Kwiatkowska
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, United Kingdom.,Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - Isabel Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, United Kingdom.,Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | | | - Michel Doumith
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | | | - Ellen Heinsbroek
- Blood Borne Virus Section, HIV & STI Department, National Infection Service, Public Health England, London, United Kingdom
| | | | - Monica Desai
- Blood Borne Virus Section, HIV & STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom.,Blood Borne Virus Section, HIV & STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - Owen Martin Williams
- Public health laboratory Bristol, Public Health England, Bristol, United Kingdom
| | - Angela Kearns
- Authors contributed equally to the work and share last authorship.,Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Mathew Hickman
- Authors contributed equally to the work and share last authorship.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.,NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, United Kingdom
| | - Maya Gobin
- Authors contributed equally to the work and share last authorship.,Field Epidemiology Service, Public Health England, Bristol, United Kingdom
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11
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De Oliveira DMP, Forde BM, Kidd TJ, Harris PNA, Schembri MA, Beatson SA, Paterson DL, Walker MJ. Antimicrobial Resistance in ESKAPE Pathogens. Clin Microbiol Rev 2020; 23:788-99. [PMID: 32404435 DOI: 10.1111/imb.12124] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Antimicrobial-resistant ESKAPE ( Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens represent a global threat to human health. The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the treatment options for serious infections, increased the burden of disease, and increased death rates due to treatment failure and requires a coordinated global response for antimicrobial resistance surveillance. This looming health threat has restimulated interest in the development of new antimicrobial therapies, has demanded the need for better patient care, and has facilitated heightened governance over stewardship practices.
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Affiliation(s)
- David M P De Oliveira
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Brian M Forde
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Timothy J Kidd
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Patrick N A Harris
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - David L Paterson
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
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12
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De Oliveira DMP, Forde BM, Kidd TJ, Harris PNA, Schembri MA, Beatson SA, Paterson DL, Walker MJ. Antimicrobial Resistance in ESKAPE Pathogens. Clin Microbiol Rev 2020; 33:e00181-19. [PMID: 32404435 PMCID: PMC7227449 DOI: 10.1128/cmr.00181-19] [Citation(s) in RCA: 834] [Impact Index Per Article: 208.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Antimicrobial-resistant ESKAPE ( Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens represent a global threat to human health. The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the treatment options for serious infections, increased the burden of disease, and increased death rates due to treatment failure and requires a coordinated global response for antimicrobial resistance surveillance. This looming health threat has restimulated interest in the development of new antimicrobial therapies, has demanded the need for better patient care, and has facilitated heightened governance over stewardship practices.
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Affiliation(s)
- David M P De Oliveira
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Brian M Forde
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Timothy J Kidd
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Patrick N A Harris
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - David L Paterson
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
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13
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Molecular Characterization and Pathogenicity of Staphylococcus aureus Isolated from Benin-City, Nigeria. Microorganisms 2020; 8:microorganisms8060912. [PMID: 32560236 PMCID: PMC7356805 DOI: 10.3390/microorganisms8060912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 11/16/2022] Open
Abstract
While numerous studies examine the epidemiology and molecular characterization of Staphylococcus aureus in most developed countries, the detailed molecular characterization and molecular epidemiology of S. aureus strains and clones in Africa is lacking. We determined the molecular epidemiology and virulence of 81 non-duplicate isolates of S. aureus from Benin-City, Nigeria, collected during January–July 2016, and compared with global strains. Forty-seven isolates (58.0%) were found to be methicillin-sensitive Staphylococcus aureus (MSSA), while 34 (42.0%) were methicillin-resistant Staphylococcus aureus (MRSA). ST152-MSSA (24.7%) and ST7-MRSA-V (19.8%) were the dominant groups identified, which were not genetically related to global predominant strains, but rather exhibited regional dominance. An interesting finding of the study was the presence of highly related strains in the region, which differed primarily in their methicillin resistance gene carriage, staphylococcal cassette chromosome mec (SCCmec), with 99.4–99.7% relatedness between the genomes of the strains within the MRSA–MSSA pairs. This suggests that the strains within a pair are experiencing gain or loss of SCCmec within local conditions, with evolution continuing to diversify the strains to a small degree. This study represents the most comprehensive genetic and virulence study of S. aureus in Nigeria.
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14
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Wu K, Conly J, McClure JA, Kurwa HA, Zhang K. Arginine Catabolic Mobile Element in Evolution and Pathogenicity of the Community-Associated Methicillin-Resistant Staphylococcus aureus Strain USA300. Microorganisms 2020; 8:microorganisms8020275. [PMID: 32085445 PMCID: PMC7074830 DOI: 10.3390/microorganisms8020275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/14/2020] [Indexed: 01/11/2023] Open
Abstract
USA300 is a predominant community-associated methicillin-resistant Staphylococcus aureus strain which carries an arginine catabolic mobile element (ACME). ACME contains potential virulence factors including an arginine deiminase (arc) pathway and an oligopeptide permease (opp-3) system, which are proposed to play a role in bacterial virulence and transmission. However, the role of ACME in evolution and pathogenicity of USA300 remains to be elucidated. ACME and arcA deletion mutants were created by allelic replacement from a USA300 clinical isolate. By comparing wild type and isogenic ACME deletion USA300 strains, ACME was shown not to contribute to bacterial survival on plastic surfaces, and mouse skin surfaces. ACME did not contribute to bacterial virulence in cell invasion and cytotoxicity assays, invertebrate killing assays and a mouse skin infection model. Wild-type ACME negative USA300 clinical isolates showed similar associations with invasive anatomic sites as ACME positive isolates. Our experiments also demonstrated that ACME can spontaneously excise from the bacterial chromosome to generate an ACME deletion strain at a low frequency. Our results do not support that the ACME element alone is a significant factor in the transmission and virulence of USA300 strain, and ACME may have been coincidently incorporated into the genome of USA300.
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Affiliation(s)
- Kaiyu Wu
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AL T2N 4N1, Canada; (K.W.); (J.C.)
| | - John Conly
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AL T2N 4N1, Canada; (K.W.); (J.C.)
- Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, Calgary, AL T2N 4N1, Canada
- Department of Medicine, University of Calgary, Calgary, AL T2N 4N1, Canada;
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AL T2N 4N1, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Public Laboratories/University of Calgary, Calgary, AL T2N 4N1, Canada;
| | - Jo-Ann McClure
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Public Laboratories/University of Calgary, Calgary, AL T2N 4N1, Canada;
| | - Habib A. Kurwa
- Department of Medicine, University of Calgary, Calgary, AL T2N 4N1, Canada;
| | - Kunyan Zhang
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AL T2N 4N1, Canada; (K.W.); (J.C.)
- Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, Calgary, AL T2N 4N1, Canada
- Department of Medicine, University of Calgary, Calgary, AL T2N 4N1, Canada;
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AL T2N 4N1, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Public Laboratories/University of Calgary, Calgary, AL T2N 4N1, Canada;
- Correspondence: ; Tel.: +1-403-210-8484
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15
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Conceição T, Martins H, Rodrigues S, de Lencastre H, Aires-de-Sousa M. Staphylococcus aureus nasal carriage among homeless population in Lisbon, Portugal. Eur J Clin Microbiol Infect Dis 2019; 38:2037-2044. [PMID: 31332610 DOI: 10.1007/s10096-019-03638-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage is a major risk factor for infection, namely among populations in the community with inherent prompting factors, such as the homeless. In Portugal, there are no data on S. aureus/MRSA nasal carriage among the homeless community. A total of 84 homeless individuals living in Lisbon (34 with no permanent address and 50 living in shelter) were nasally screened for S. aureus/ MRSA. All isolates were characterized to determine antimicrobial susceptibility and clonal type. A total of 43 (51.2%) S. aureus carriers were identified, including a single individual colonized with MRSA (1.2%). S. aureus carriage rate was higher among individuals with no permanent address (58.8% versus 46%), younger (45.7 ± 12.7 versus 52.5 ± 10.8 years), and with diagnosis of asthma (9% versus 0%). The single MRSA belonged to the EMRSA-15 clone (PFGE D, ST15-SCCmec IVh, and spa type t790). Almost half of the methicillin-susceptible S. aureus (MSSA) isolates (41.9%, n = 18) belonged to two major clones, ST398-t1451 (n = 13) and ST30-t399/t11980/t12808 associated with PFGE I (n = 5). A high proportion of isolates showed non-susceptibility to mupirocin (64%), erythromycin (45%), and fusidic acid (20%) and induced resistance to clindamycin (39%). None of the isolates harboured PVL. Our results suggest that the homeless population of Lisbon does not constitute a reservoir of MRSA in the community, but harbour the highly transmissible ST398-t1451 MSSA lineage.
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Affiliation(s)
- Teresa Conceição
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal.
| | - Hugo Martins
- Unidade de Atendimento Urgente Adultos, Hospital Lusíadas Lisboa, Lisbon, Portugal.,Urgência Geral, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Lisbon, Portugal.,Departamento Formação, Investigação e Planeamento, VOXLisboa, Lisbon, Portugal
| | - Suzilaine Rodrigues
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal
| | - Hermínia de Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal.,Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, USA
| | - Marta Aires-de-Sousa
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal.,Escola Superior de Saúde da Cruz Vermelha Portuguesa (ESSCVP), Lisbon, Portugal
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16
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Gill VC, Ma I, Guo M, Gregson DB, Naugler C, Church DL. Sociodemographic and geospatial associations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in a large Canadian city: an 11 year retrospective study. BMC Public Health 2019; 19:914. [PMID: 31288765 PMCID: PMC6617829 DOI: 10.1186/s12889-019-7169-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background The first Canadian outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was identified in 2004 in Calgary, Alberta. Using a novel model of MRSA population-based surveillance, sociodemographic risk associations, yearly geospatial dissemination and prevalence of CA-MRSA infections over an 11 year period was identified in an urban healthcare jurisdiction of Calgary. Methods Positive MRSA case records, patient demographics and laboratory data were obtained from a centralized Laboratory Information System of Calgary Laboratory Services in Calgary, Alberta, Canada between 2004 and 2014. Public census data was obtained from Statistics Canada, which was used to match with laboratory data and mapped using Geographic Information Systems. Results During the study period, 52.5% of positive MRSA infections in Calgary were CA-MRSA cases. The majority were CMRSA10 (USA300) clones (94.1%; n = 4255), while the remaining case (n = 266) were CMRSA7 (USA400) clones. Period prevalence of CMRSA10 increased from 3.6 cases/100000 population in 2004, to 41.3 cases/100000 population in 2014. Geospatial analysis demonstrated wide dissemination of CMRSA10 annually in the city. Those who are English speaking (RR = 0.05, p < 0.0001), identify as visible minority Chinese (RR = 0.09, p = 0.0023) or visible minority South Asian (RR = 0.25, p = 0.015), and have a high median household income (RR = 0.27, p < 0.0001) have a significantly decreased relative risk of CMRSA10 infections. Conclusions CMRSA10 prevalence increased between 2004 and 2007, followed by a stabilization of cases by 2014. Certain sociodemographic factors were protective from CMRSA10 infections. The model of MRSA population-surveillance and geomap outbreak events can be used to track the epidemiology of MRSA in any jurisdiction. Electronic supplementary material The online version of this article (10.1186/s12889-019-7169-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victoria C Gill
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Irene Ma
- Department of Pathology and Laboratory Medicine Cumming School of Medicine, University of Calgary, 3535 Research Rd NW, Calgary, Alberta, T2L 2K8, Canada
| | - Maggie Guo
- Department of Pathology and Laboratory Medicine Cumming School of Medicine, University of Calgary, 3535 Research Rd NW, Calgary, Alberta, T2L 2K8, Canada.,Alberta Public Laboratories, 3535 Research Road NW, Calgary, Alberta, T2L 2K8, Canada
| | - Dan B Gregson
- Department of Pathology and Laboratory Medicine Cumming School of Medicine, University of Calgary, 3535 Research Rd NW, Calgary, Alberta, T2L 2K8, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.,Alberta Public Laboratories, 3535 Research Road NW, Calgary, Alberta, T2L 2K8, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine Cumming School of Medicine, University of Calgary, 3535 Research Rd NW, Calgary, Alberta, T2L 2K8, Canada.,Department of Family Medicne, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.,Alberta Public Laboratories, 3535 Research Road NW, Calgary, Alberta, T2L 2K8, Canada
| | - Deirdre L Church
- Department of Pathology and Laboratory Medicine Cumming School of Medicine, University of Calgary, 3535 Research Rd NW, Calgary, Alberta, T2L 2K8, Canada. .,Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada. .,Alberta Public Laboratories, 3535 Research Road NW, Calgary, Alberta, T2L 2K8, Canada.
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17
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Complete Genome Sequences of Two USA300-Related Community-Associated Methicillin-Resistant Staphylococcus aureus Clinical Isolates. Microbiol Resour Announc 2019; 8:8/18/e00404-19. [PMID: 31048386 PMCID: PMC6498241 DOI: 10.1128/mra.00404-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
USA300 is a predominant community-associated methicillin-resistant Staphylococcus aureus strain causing significant morbidity and mortality in North America. We present the full annotated genome sequences of two methicillin-resistant Staphylococcus aureus isolates related to the USA300 pulsotype with the goal of studying the evolutionary relationships of this highly successful strain type. USA300 is a predominant community-associated methicillin-resistant Staphylococcus aureus strain causing significant morbidity and mortality in North America. We present the full annotated genome sequences of two methicillin-resistant Staphylococcus aureus isolates related to the USA300 pulsotype with the goal of studying the evolutionary relationships of this highly successful strain type.
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18
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A Review of Infections in People Who Use Nonprescription Drugs. CANADIAN JOURNAL OF ADDICTION 2018. [DOI: 10.1097/cxa.0000000000000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Harper K, Wood G, Sebastien L, Kellen W. Outcomes of hip and knee total joint arthroplasty in a Canadian inmate population over a 10-year
period. Can J Surg 2018; 61:350-354. [PMID: 30247820 PMCID: PMC6153105 DOI: 10.1503/cjs.015117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 11/01/2022] Open
Abstract
Background Little information exists regarding the risk of complications in inmates who receive total hip or knee arthroplasties in Canada. Inmates tend to be less healthy owing to socioeconomic factors and an increased number of medical and psychiatric comorbidities. We compared revision and complication rates of total joint replacements in a cohort of incarcerated Canadians versus a cohort of non-inmates. Methods We obtained a list of all Canadian inmate inpatient hospital visits with diagnostic/procedure codes of primary hip or knee arthroplasty within the last 10 years from our institution’s discharge abstract database. Demographic data and information related to the perioperative course, along with any data related to postoperative complications/readmissions, were obtained through manual chart review. Results The inmate group consisted of 20 men (mean age 58 yr) with a total of 24 primary total joint arthroplasties; the comparison group included 171 men (mean age 62 yr). Postoperatively, the inmates had a 4-fold increased risk of major complication compared with non-inmates (33.3% v. 7.6%; odds ratio 4.21, p = 0.01). The inmates’ revision rate was 20.8% compared with 5.8% in the comparison group (p = 0.03). The most common cause for revision in the inmate group was infection, with a rate of 16.7% compared with 3.5% in the comparison group (p = 0.03). Conclusion Patients requiring total joint arthroplasty who are inmates in the Canadian penitentiary system are at increased risk of complication and revision surgeries following total joint arthroplasty.
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Affiliation(s)
- Kelly Harper
- From the Department of Surgery, Queens University, Kingston, Ont. (Wood, Lalonde [at the time of writing], Walsh, Harper); and the Department of Orthopaedic Surgery, University of Missouri, Columbia, Mo. (Lalonde)
| | - Gavin Wood
- From the Department of Surgery, Queens University, Kingston, Ont. (Wood, Lalonde [at the time of writing], Walsh, Harper); and the Department of Orthopaedic Surgery, University of Missouri, Columbia, Mo. (Lalonde)
| | - Lalonde Sebastien
- From the Department of Surgery, Queens University, Kingston, Ont. (Wood, Lalonde [at the time of writing], Walsh, Harper); and the Department of Orthopaedic Surgery, University of Missouri, Columbia, Mo. (Lalonde)
| | - Walsh Kellen
- From the Department of Surgery, Queens University, Kingston, Ont. (Wood, Lalonde [at the time of writing], Walsh, Harper); and the Department of Orthopaedic Surgery, University of Missouri, Columbia, Mo. (Lalonde)
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20
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Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev 2018; 31:e00020-18. [PMID: 30209034 PMCID: PMC6148192 DOI: 10.1128/cmr.00020-18] [Citation(s) in RCA: 754] [Impact Index Per Article: 125.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus, a major human pathogen, has a collection of virulence factors and the ability to acquire resistance to most antibiotics. This ability is further augmented by constant emergence of new clones, making S. aureus a "superbug." Clinical use of methicillin has led to the appearance of methicillin-resistant S. aureus (MRSA). The past few decades have witnessed the existence of new MRSA clones. Unlike traditional MRSA residing in hospitals, the new clones can invade community settings and infect people without predisposing risk factors. This evolution continues with the buildup of the MRSA reservoir in companion and food animals. This review focuses on imparting a better understanding of MRSA evolution and its molecular characterization and epidemiology. We first describe the origin of MRSA, with emphasis on the diverse nature of staphylococcal cassette chromosome mec (SCCmec). mecA and its new homologues (mecB, mecC, and mecD), SCCmec types (13 SCCmec types have been discovered to date), and their classification criteria are discussed. The review then describes various typing methods applied to study the molecular epidemiology and evolutionary nature of MRSA. Starting with the historical methods and continuing to the advanced whole-genome approaches, typing of collections of MRSA has shed light on the origin, spread, and evolutionary pathways of MRSA clones.
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Affiliation(s)
- Sahreena Lakhundi
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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21
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Olubamwo OO, Onyeka IN, Aregbesola A, Ronkainen K, Tiihonen J, Föhr J, Kauhanen J. Determinants of hospitalizations for pneumonia among Finnish drug users. SAGE Open Med 2018; 6:2050312118784311. [PMID: 30013782 PMCID: PMC6041852 DOI: 10.1177/2050312118784311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 05/28/2018] [Indexed: 11/17/2022] Open
Abstract
Objective The study examined the determinants of being hospitalized for pneumonia in a large cohort of drug users. Methods Information of 4817 clients seeking treatment for illicit drug use was linked with the Finnish hospital discharge register to identify those who were hospitalized with main/primary diagnoses of pneumonia during 1997-2013. Cox regression models were used to examine the association between age, gender, homelessness, and route of drug administration of the primary drug at initial clinical consultation and pneumonia hospitalization. Findings were presented as adjusted hazard ratios and 95% confidence intervals. Results There were 354 persons diagnosed with pneumonia, with a total of 522 hospitalizations at the end of 2013. The univariate Cox models revealed that being over 44 years of age, male gender, homelessness, and intravenous drug use at initial clinical consultation increased the risk of being hospitalized for pneumonia. In the fully adjusted multivariate model, being over 44 years was the strongest factor independently associated with pneumonia hospitalization (adjusted hazard ratio: 2.67, 95% confidence interval: 1.56-4.57, p < 0.001), followed by homelessness (adjusted hazard ratio: 1.75, 95% confidence interval: 1.38-2.22, p < 0.001) and intravenous drug use (adjusted hazard ratio: 1.27, 95% confidence interval: 1.01-1.59, p = 0.041). Of the 354 clients hospitalized for pneumonia, 31.9% (n = 113) were rehospitalized within 30 days of being discharged. One-third of the reasons for the 30-day rehospitalization were pneumonia-related. Conclusion Vaccination, measures addressing housing instability, safe injecting and good hygienic practices, and treating underlying drug use problems could help to reduce morbidity for pneumonia in this cohort.
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Affiliation(s)
- Olubunmi O Olubamwo
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ifeoma N Onyeka
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Alex Aregbesola
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Ronkainen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jaana Föhr
- Helsinki Deaconess Institute, Helsinki, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Haysom L, Cross M, Anastasas R, Moore E, Hampton S. Prevalence and Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Custodial Populations: A Systematic Review. JOURNAL OF CORRECTIONAL HEALTH CARE 2018; 24:197-213. [DOI: 10.1177/1078345818765271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Leigh Haysom
- Justice Health and Forensic Mental Health Network, Adolescent Health, NSW, Australia
| | - Melanie Cross
- Macquarie University, Sydney, New South Wales, Australia
| | | | - Elizabeth Moore
- Justice Health and Forensic Mental Health Network, Adolescent Health, NSW, Australia
| | - Stephen Hampton
- Justice Health and Forensic Mental Health Network, Medical Administration Unit, NSW, Australia
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An outbreak in intravenous drug users due to USA300 Latin-American variant community-acquired methicillin-resistant Staphylococcus aureus in France as early as 2007. Eur J Clin Microbiol Infect Dis 2017; 36:2495-2501. [DOI: 10.1007/s10096-017-3092-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/09/2017] [Indexed: 12/25/2022]
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Leibler JH, León C, Cardoso LJP, Morris JC, Miller NS, Nguyen DD, Gaeta JM. Prevalence and risk factors for MRSA nasal colonization among persons experiencing homelessness in Boston, MA. J Med Microbiol 2017; 66:1183-1188. [PMID: 28771129 DOI: 10.1099/jmm.0.000552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Homeless individuals face an elevated risk of methicillin-resistant Staphylococcus aureus (MRSA) infection. Identifying the prevalence and risk factors for MRSA nasal colonization may reduce infection risk. A cross-sectional study was conducted at a health clinic for homeless persons in Boston, MA, USA (n=194). In-person interviews and nasal swab specimens were collected. MRSA isolates were genotyped using pulse-field gel electrophoresis (PFGE) and assessed for antibiotic susceptibility. The prevalence of MRSA nasal colonization was 8.3 %. Seventy-five percent of isolates reflected clonal similarity to USA300. USA100 (18.8 %) and USA500 (6.3 %) were also recovered. Resistance to erythromycin (81.3 %), levofloxacin (31.3 %) and clindamycin (23.1 %) was identified. Recent inpatient status, endocarditis, haemodialysis, heavy drinking, not showering daily and transience were positively associated with MRSA nasal colonization. Carriage of community-acquired MRSA strains predominated in this population, although nosocomial strains co-circulate. Attention to behavioural and hygiene-related risk factors, not typically included in MRSA prevention efforts, may reduce risk.
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Affiliation(s)
- Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Casey León
- Boston Health Care for the Homeless Program, Boston, MA, USA
| | | | - Jennifer C Morris
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Nancy S Miller
- Clinical Microbiology and Molecular Diagnostics Laboratory, Boston Medical Center, Boston, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Daniel D Nguyen
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jessie M Gaeta
- Boston Health Care for the Homeless Program, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Methicillin-resistant Staphylococcus aureus and antibiotic use in septorhinoplasty: case report and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:e177-e181. [DOI: 10.1016/j.oooo.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 01/28/2023]
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26
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Complete Genome Sequence of a Community-Associated Methicillin-Resistant Staphylococcus aureus Hypervirulent Strain, USA300-C2406, Isolated from a Patient with a Lethal Case of Necrotizing Pneumonia. GENOME ANNOUNCEMENTS 2017; 5:5/22/e00461-17. [PMID: 28572329 PMCID: PMC5454212 DOI: 10.1128/genomea.00461-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
USA300 is a predominant community-associated methicillin-resistant Staphylococcus aureus strain causing significant morbidity and mortality. We present here the full annotated genome of a USA300 hypervirulent clinical strain, USA300-C2406, isolated from a patient with a lethal case of necrotizing pneumonia, to gain a better understanding of USA300 hypervirulence.
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27
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Ugarte Torres A, Chu A, Read R, MacDonald J, Gregson D, Louie T, Delongchamp J, Ward L, McClure J, Zhang K, Conly J. The epidemiology of Staphylococcus aureus carriage in patients attending inner city sexually transmitted infections and community clinics in Calgary, Canada. PLoS One 2017; 12:e0178557. [PMID: 28542601 PMCID: PMC5444836 DOI: 10.1371/journal.pone.0178557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/15/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although the nares represent the most common carriage site for traditional hospital-associated strains of Staphylococcus aureus (SA), the predominant site of carriage of SA in the community is less certain. METHODS We conducted a cross-sectional study in 285 patients attending sexually transmitted diseases and inner-city clinics to evaluate the prevalence, body site colonisation and risk factors associated with carriage of methicillin susceptible SA (MSSA). All isolates were characterized by pulsed field gel electrophoresis, staphylococcal cassette chromosome mec, staphylococcal protein A and multilocus sequence typing. RESULTS The prevalence of colonisation with SA was 57.5% (164/285); 162 (56.8%) participants were colonized with MSSA, and 4 (1.4%) with methicillin-resistant SA (MRSA), 2 of them were co-colonised with both MRSA and MSSA. The most common sites of colonisation were the throat (73.1%), nares (65.2%) and interdigital web spaces of the hand (21.3%). Three out of 4 MRSA isolates were USA300-MRSA strains. Twelve MSSA isolates were closely related to the USA300 CA-MRSA. We identified sexual behaviours such as having more than 6 heterosexual sexual partners in the last 6 months and trimming pubic hair to be independently associated with MSSA colonisation, and more specifically practicing oral sex as a risk factor for throat colonisation. CONCLUSION There is a high prevalence of MSSA carriage in this population, with a low prevalence of MRSA. The throat was the most common site of carriage and sexual behaviours were found to be risk factors for MSSA colonisation. Close strain relatedness of MSSA and USA300-MRSA isolates suggests either gain or loss of the SCCmec element, respectively.
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Affiliation(s)
- Alejandra Ugarte Torres
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Angel Chu
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Sexually Transmitted Infections Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - Ron Read
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Sexually Transmitted Infections Clinic, Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Cumming School of Medicine, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Judy MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Infection Prevention & Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Daniel Gregson
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine and Alberta Health Services, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine and Alberta Health Services, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Louie
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Cumming School of Medicine, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Infection Prevention & Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Johanna Delongchamp
- Centre for Antimicrobial Resistance, Alberta Health Services and University of Calgary, Alberta, Canada
| | - Linda Ward
- Infection Prevention & Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Joann McClure
- Centre for Antimicrobial Resistance, Alberta Health Services and University of Calgary, Alberta, Canada
| | - Kunyan Zhang
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Cumming School of Medicine, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine and Alberta Health Services, Calgary, Alberta, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services and University of Calgary, Alberta, Canada
- Calgary Laboratory Services, Alberta Health Services, Calgary, Alberta, Canada
| | - John Conly
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Cumming School of Medicine, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine and Alberta Health Services, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine and Alberta Health Services, University of Calgary, Calgary, Alberta, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services and University of Calgary, Alberta, Canada
- Calgary Laboratory Services, Alberta Health Services, Calgary, Alberta, Canada
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Ottomeyer M, Graham CD, Legg AD, Cooper ES, Law CD, Molani M, Matevossian K, Marlin J, Williams C, Newman R, Wasserman JA, Segars LW, Taylor TAH. Prevalence of Nasal Colonization by Methicillin-Resistant Staphylococcus aureus in Persons Using a Homeless Shelter in Kansas City. Front Public Health 2016; 4:234. [PMID: 27826546 PMCID: PMC5078475 DOI: 10.3389/fpubh.2016.00234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/06/2016] [Indexed: 12/03/2022] Open
Abstract
Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) plays an important role in the epidemiology and pathogenesis of disease. Situations of close-quarter contact in groups are generally regarded as a risk factor for community-acquired MRSA strains due to transmission via fomites and person-to-person contact. With these criteria for risk, homeless individuals using shelter facilities, including showers and toilets, should be considered high risk for colonization and infection. The aim of this study was to determine the prevalence of nasal colonization of MRSA in a homeless population compared to established rates of colonization within the public and a control group of subjects from a neighboring medical school campus, and to analyze phylogenetic diversity among the MRSA strains. Nasal samples were taken from the study population of 332 adult participants and analyzed. In addition, participants were surveyed about various lifestyle factors in order to elucidate potential patterns of behavior associated with MRSA colonization. Homeless and control groups both had higher prevalence of MRSA (9.8 and 10.6%, respectively), when compared to the general population reported by previous studies (1.8%). However, the control group had a similar MRSA rate compared to health-care workers (4.6%), while the homeless population had an increased prevalence. Risk factors identified in this study included male gender, age over 50 years, and use of antibiotics within the past 3 months. Phylogenetic relationships between nine of the positive samples from the homeless population were analyzed, showing eight of the nine samples had a high degree of relatedness between the spaA genes of the MRSA strains. This indicates that the same MRSA strain might be transmitted from person-to-person among homeless population. These findings increase our understanding of key differences in MRSA characteristics within homeless populations, as well as risks for MRSA associated with being homeless, such as age and gender, which may then be a useful tool in guiding more effective prevention, treatment, and health care for homeless individuals.
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Affiliation(s)
- Megan Ottomeyer
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Charles D Graham
- Department of Internal Medicine, University of Nevada School of Medicine , Reno, NV , USA
| | - Avery D Legg
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City , Kansas City, MO , USA
| | - Elizabeth S Cooper
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Chad D Law
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Mariam Molani
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Karine Matevossian
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Jerry Marlin
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | | | - Ramon Newman
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Jason A Wasserman
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine , Rochester, MI , USA
| | - Larry W Segars
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Tracey A H Taylor
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine , Rochester, MI , USA
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Dahlman D, Berge J, Nilsson AC, Kral AH, Bjorkman P, Hakansson AC. Opioid and amphetamine dependence is associated with methicillin-resistantStaphylococcus aureus(MRSA): An epidemiological register study with 73,201 Swedish in- and outpatients 1997–2013. Infect Dis (Lond) 2016; 49:120-127. [DOI: 10.1080/23744235.2016.1237038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Rennert-May E, Conly J. Antimicrobial stewardship: a Canadian perspective. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2016. [DOI: 10.1108/ijhg-02-2016-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to explore the current state of antimicrobial stewardship implementation and development within Canada at both a federal and provincial level.
Design/methodology/approach
– Narrative review.
Findings
– There have been several prominent conferences and reports in Canada regarding the development and implementation of antimicrobial stewardship programs over the past two decades. However, despite the knowledge that there is a need for standardization of programs across Canada with accurate mechanisms and infrastructure in place for implementation and evaluation of these programs, there is still a lack of consistency across the country. In addition pharmacy information regarding inpatient and outpatient antimicrobial use is not uniformly reliable. Recently, the Public Health Agency of Canada using the Pan-Canadian Public Health Network as a vehicle organized a task group to help facilitate the working relationships among the provincial, territorial and federal governments in terms of implementing antimicrobial stewardship programs. This network has the potential to enhance and standardize programs across the country.
Originality/value
– This paper looks at Canadian policy regarding antimicrobial stewardship at a federal as well as provincial level. Historic conferences, reports and discussions are highlighted emphasizing the progressive changes over the past two decades and highlight many of the challenges that Canada continues to face.
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Mullen LA, O’Keefe C. Management of Skin and Soft Tissue Infections in a County Correctional Center. JOURNAL OF CORRECTIONAL HEALTH CARE 2015; 21:355-64. [DOI: 10.1177/1078345815599790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Community-associated methicillin-resistant Staphylococcus aureus: prevalence in skin and soft tissue infections at emergency departments in the Greater Toronto Area and associated risk factors. CAN J EMERG MED 2015; 11:439-46. [DOI: 10.1017/s1481803500011635] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA), which is caused primarily by the Canadian methicillin-resistantStaphylococcus aureus-10 (CMRSA-10) strain (also known as the USA300 strain) has emerged rapidly in the United States and is now emerging in Canada. We assessed the prevalence, risk factors, microbiological characteristics and outcomes of CA-MRSA in patients with purulent skin and soft tissue infections (SSTIs) presenting to emergency departments (EDs) in the Greater Toronto Area.Methods:Patients withStaphylococcus aureusSSTIs who presented to 7 EDs between Mar. 1 and Jun. 30, 2007, were eligible for inclusion in this study. Antimicrobial susceptibilities and molecular characteristics of MRSA strains were identified. Demographic, risk factor and clinical data were collected through telephone interviews.Results:MRSA was isolated from 58 (19%) of 299 eligible patients. CMRSA-10 was identified at 6 of the 7 study sites and accounted for 29 (50%) of all cases of MRSA. Telephone interviews were completed for 161 of the eligible patients. Individuals with CMRSA-10 were younger (median 34 v. 63 yr,p= 0.002), less likely to report recent antibiotic use (22% v. 67%,p= 0.046) or health care–related risk factors (33% v. 72%,p= 0.097) and more likely to report community-related risk factors (56% v. 6%,p= 0.008) than patients with other MRSA strains. CMRSA-10 SSTIs were treated with incision and drainage (1 patient), antibiotic therapy (3 patients) or both (5 patients), and all resolved. CMRSA-10 isolates were susceptible to clindamycin, tetracycline and trimethoprimsulfamethoxazole.Conclusion:CA-MRSA is a significant cause of SSTIs in the Greater Toronto Area, and can affect patients without known community-related risk factors. The changing epidemiology of CA-MRSA necessitates further surveillance to inform prevention strategies and empiric treatment guidelines.
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Mohammad H, Reddy PVN, Monteleone D, Mayhoub AS, Cushman M, Seleem MN. Synthesis and antibacterial evaluation of a novel series of synthetic phenylthiazole compounds against methicillin-resistant Staphylococcus aureus (MRSA). Eur J Med Chem 2015; 94:306-16. [PMID: 25771109 DOI: 10.1016/j.ejmech.2015.03.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/04/2015] [Accepted: 03/06/2015] [Indexed: 01/26/2023]
Abstract
Methicillin-resistant Staphylococcus aureus infections are a significant global health challenge in part due to the emergence of strains exhibiting resistance to nearly all classes of antibiotics. This underscores the urgent need for the rapid development of novel antimicrobials to circumvent this burgeoning problem. Previously, whole-cell screening of a library of 2,5-disubstituted thiazole compounds revealed a lead compound exhibiting potent antimicrobial activity against MRSA. The present study, conducting a more rigorous analysis of the structure-activity relationship of this compound, reveals a nonpolar, hydrophobic functional group is favored at thiazole-C2 and an ethylidenehydrazine-1-carboximidamide moiety is necessary at C5 for the compound to possess activity against MRSA. Furthermore, the MTS assay confirmed analogs 5, 22d, and 25 exhibited an improved toxicity profile (not toxic up to 40 μg/mL to mammalian cells) over the lead 1. Analysis with human liver microsomes revealed compound 5 was more metabolically stable compared to the lead compound (greater than eight-fold improvement in the half-life in human liver microsomes). Collectively the results presented demonstrate the novel thiazole derivatives synthesized warrant further exploration for potential use as future antimicrobial agents for the treatment of multidrug-resistant S. aureus infections.
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Affiliation(s)
- Haroon Mohammad
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN 47907, USA
| | - P V Narasimha Reddy
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy, and the Purdue Center for Cancer Research, West Lafayette, IN 47907, USA
| | - Dennis Monteleone
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy, and the Purdue Center for Cancer Research, West Lafayette, IN 47907, USA
| | | | - Mark Cushman
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy, and the Purdue Center for Cancer Research, West Lafayette, IN 47907, USA
| | - Mohamed N Seleem
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN 47907, USA.
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Borgundvaag B, Ng W, Rowe B, Katz K. Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments. CAN J EMERG MED 2015. [DOI: 10.2310/8000.2013.130798] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACTBackground:Community-associated methicillin-resistantStaphylococcus aureus(MRSA) is an increasingly common cause of skin and soft tissue infection (SSTI) worldwide. The prevalence of MRSA in SSTIs across Canada has not been well described. Studies in the United States have shown significant geographic variability in the prevalence of MRSA. This study characterizes the geographic prevalence and microbiology of MRSA in patients presenting to Canadian emergency departments with SSTIs.Methods:Using a prospective, observational design, we enrolled patients with acute purulent SSTIs presenting to 17 hospital emergency departments and 2 community health centres (spanning 6 Canadian provinces) between July 1, 2008, and April 30, 2009. Eligible patients were those whose wound cultures grewS. aureus. MRSA isolates were characterized by antimicrobial susceptibility testing and pulsed-field gel electrophoresis. All patients were subjected to a structured chart audit, and patients whose wound swabs grew MRSA were contacted by telephone to gather detailed information regarding risk factors for MRSA infection, history of illness, and outcomes.Results:Of the 1,353S. aureus–positive encounters recorded, 431 (32%) grew MRSA and 922 (68%) wounds grew methicillin-susceptibleS. aureus. We observed significant variation in both the prevalence of MRSA (11–100%) and the proportion of community-associated strains of MRSA (0– 100%) across our study sites, with a significantly higher prevalence of MRSA in western Canada.Interpretation:MRSA continues to emerge across Canada, and the prevalence of MRSA in SSTIs across Canada is variable and higher than previously expected.
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Neofytos D, Kuhn B, Shen S, Hua Zhu X, Jungkind D, Flomenberg P. Emergence of Staphylococcal Cassette ChromosomemecType IV Methicillin-ResistantStaphylococcus aureusas a Cause of Ventilator-Associated Pneumonia. Infect Control Hosp Epidemiol 2015; 28:1206-9. [PMID: 17828701 DOI: 10.1086/520746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 05/14/2007] [Indexed: 11/03/2022]
Abstract
Staphylococcal cassette chromosomemec(SCCmec) type IV methicillin-resistantStaphylococcus aureus(MRSA) strains were identified in 8 (19.5%) of 41 consecutive patients with MRSA ventilator-associated pneumonia (VAP) in this retrospective, observational study. There were no significant differences in VAP severity and crude mortality rates between patients with SCCmectype II strains and patients with SCCmectype IV strains.
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Affiliation(s)
- D Neofytos
- Division of Infectious Diseases and Environmental Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Buehlmann M, Frei R, Fenner L, Dangel M, Fluckiger U, Widmer AF. Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers. Infect Control Hosp Epidemiol 2015; 29:510-6. [DOI: 10.1086/588201] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective.To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistantStaphylococcus aureus(MRSA) carriers and to identify factors influencing decolonization treatment failure.Design.Prospective cohort study from January 2002 to April 2007, with a mean follow-up period of 36 months.Setting.University hospital with 750 beds and 27,000 admissions/year.Patients.Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.Interventions.Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites.Results.The mean age (± standard deviation [SD]) age of the 62 patients was 66.2 ± 19 years. The most frequent locations of MRSA colonization were the nose (42 patients [68%]), the throat (33 [53%]), perianal area (33 [53%]), rectum (36 [58%]), and inguinal area (30 [49%]). Decolonization was completed in 87% of patients after a mean (±SD) of 2.1 ± 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.Conclusion.This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course.
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Chui L, Li V. Technical and Software Advances in Bacterial Pathogen Typing. METHODS IN MICROBIOLOGY 2015. [DOI: 10.1016/bs.mim.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buick S, Joffe AM, Taylor G, Conly J. A consensus development conference model for establishing health policy for surveillance and screening of antimicrobial-resistant organisms. Clin Infect Dis 2014; 60:1095-101. [PMID: 25542896 DOI: 10.1093/cid/ciu1168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Canadian Consensus Development Conference on Surveillance and Screening for Antimicrobial-Resistant Organisms (AROs) was sponsored by the Alberta Ministry of Health to provide evidence to update policies for ARO screening in acute care settings. A rigorous evidence-based literature review completed before the conference concluded that that neither universal nor targeted screening of patients was associated with a reduction in hospital-acquired ARO colonization, infection, morbidity, or mortality. Leading international clinicians, scientists, academics, policy makers, and administrators presented current evidence and clinical experience, focusing on whether and how hospitals should screen patients for AROs as part of broader ARO control strategies. An unbiased and independent "jury" with a broad base of expertise from complementary disciplines considered the evidence and released a consensus statement of 22 recommendations. Policy highlights included developing an integrated "One Health" strategy, fully resourcing basic infection control practices, not performing universal screening, and focusing original research to determine what works.
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Affiliation(s)
| | - A Mark Joffe
- Infection Prevention and Control, Alberta Health Services Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton
| | - Geoffrey Taylor
- Infection Prevention and Control, Alberta Health Services Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton
| | - John Conly
- Infection Prevention and Control, Alberta Health Services Department of Medicine, Snyder Institute for Chronic Diseases and Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Prevalence and behavioural risk factors of Staphylococcus aureus nasal colonization in community-based injection drug users. Epidemiol Infect 2014; 143:2430-9. [PMID: 25434806 DOI: 10.1017/s0950268814003227] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aims of this study were to identify Staphylococcus aureus nasal colonization prevalence, behavioural risk factors, and to determine staphylococcal protein A (spa) types in community-based injection drug users (IDUs). Nasal swabs were collected and methicillin susceptibility testing and spa/SCCmec typing were performed on S. aureus isolates. Generalized estimating equations were used to report adjusted odds ratios and 95% confidence intervals. Of the 440 participants, 24·1% were colonized and 5·7% had methicillin-resistant S. aureus (MRSA). Colonization was associated with age, employment/marital status, and the presence of scabs but not with sexually transmitted disease co-infection, HIV status, antibiotic use, hospitalization, or drug treatment programme participation. The USA300 MRSA clone spa types were most common, but 15/49 spa types were new to one of the international databases. Community-based IDUs appear to have different risk factors compared to IDUs from clinical studies. In addition, the number of newly identified spa types indicates a diverse, understudied population.
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Hadley S. Resistant Gram-Positive Infections: Where Have We Been, Where Are We Now, and Where Are We Going? Clin Ther 2014; 36:1298-302. [DOI: 10.1016/j.clinthera.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
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Amin AN, Cerceo EA, Deitelzweig SB, Pile JC, Rosenberg DJ, Sherman BM. Hospitalist perspective on the treatment of skin and soft tissue infections. Mayo Clin Proc 2014; 89:1436-51. [PMID: 24974260 DOI: 10.1016/j.mayocp.2014.04.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/15/2014] [Accepted: 04/22/2014] [Indexed: 01/17/2023]
Abstract
The prevalence of skin and soft tissue infections (SSTIs) has been increasing in the United States. These infections are associated with an increase in hospital admissions. Hospitalists play an increasingly important role in the management of these infections and need to use hospital resources efficiently and effectively. When available, observation units are useful for treating low-risk patients who do not require hospital admission. Imaging tools may help to exclude abscesses and necrotizing soft tissue infections; however, surgical exploration remains the principal means of diagnosing necrotizing soft tissue infections. The most common pathogens that cause SSTIs are streptococci and Staphylococcus aureus. Methicillin-resistant S aureus (MRSA) is a prevalent pathogen, and concerns are increasing regarding the unclear distinctions between community-acquired and hospital-acquired MRSA. Other less frequent pathogens that cause SSTIs include Enterococcus species, Escherichia coli, Klebsiella species, Enterobacter species, and Pseudomonas aeruginosa. Cephalexin and clindamycin are suitable options for infections caused by streptococcal species and methicillin-susceptible S aureus. The increasing resistance of S aureus and Streptococcus pyogenes to erythromycin limits its use in these infections, and better alternatives are available. Parenteral cefazolin, nafcillin, or oxacillin can be used in hospitalized patients with nonpurulent cellulitis caused by streptococci and methicillin-susceptible S aureus. When oral MRSA therapy is indicated, clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or linezolid is appropriate. Vancomycin, linezolid, daptomycin, tigecycline, telavancin, and ceftaroline fosamil are intravenous options that should be used in MRSA infections that require patient hospitalization. In the treatment of patients with SSTIs, hospitalists are at the forefront of providing proper patient care that reduces hospital costs, duration of therapy, and therapeutic failures. This review updates guidelines on the management of SSTIs with a focus on infections caused by S aureus, particularly MRSA, and outlines the role of the hospitalist in the effective management of SSTIs.
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Affiliation(s)
- Alpesh N Amin
- Department of Medicine, University of California at Irvine, Irvine.
| | - Elizabeth A Cerceo
- Department of Hospital Medicine, Cooper University Health Care, Camden, NJ
| | | | - James C Pile
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - David J Rosenberg
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY
| | - Bradley M Sherman
- Department of Medicine, Glen Cove Hospital, North Shore-LIJ University Health System, Oyster Bay, NY
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Toro CM, Janvier J, Zhang K, Fonseca K, Gregson D, Church D, Laupland K, Rabin H, Elsayed S, Conly J. Community-associated methicillin-resistant Staphylococcus aureus necrotizing pneumonia without evidence of antecedent viral upper respiratory infection. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2014; 25:e76-82. [PMID: 25285117 PMCID: PMC4173983 DOI: 10.1155/2014/952603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND USA300 community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains causing necrotizing pneumonia have been reported in association with antecedent viral upper respiratory tract infections (URI). METHODS A case series of necrotizing pneumonia presenting as a primary or coprimary infection, secondary to CA-MRSA without evidence of antecedent viral URI, is presented. Cases were identified through the infectious diseases consultation service records. Clinical and radiographic data were collected by chart review and electronic records. MRSA strains were isolated from sputum, bronchoalveolar lavage, pleural fluid or blood cultures and confirmed using standard laboratory procedures. MRSA strains were characterized by susceptibility testing, pulsed-field gel electrophoresis, spa typing, agr typing and multilocus sequence typing. Testing for respiratory viruses was performed by appropriate serological testing of banked sera, or nucleic acid testing of nasopharyngeal or bronchoalveloar lavage specimens. RESULTS Ten patients who presented or copresented with CA necrotizing pneumonia secondary to CA-MRSA from April 2004 to October 2011 were identified. The median length of stay was 22.5 days. Mortality was 20.0%. Classical risk factors for CA-MRSA were identified in seven of 10 (70.0%) cases. Chest tube placement occurred in seven of 10 patients with empyema. None of the patients had historical evidence of antecedent URI. In eight of 10 patients, serological or nucleic acid testing testing revealed no evidence of acute viral coinfection. Eight strains were CMRSA-10 (USA300). The remaining two strains were a USA300 genetically related strain and a USA1100 strain. CONCLUSION Pneumonia secondary to CA-MRSA can occur in the absence of an antecedent URI. Infections due to CA-MRSA are associated with significant morbidity and mortality. Clinicians need to have an awareness of this clinical entity, particularly in patients who are in risk groups that predispose to exposure to this bacterium.
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Affiliation(s)
| | - Jack Janvier
- Departartments of Medicine, University of Calgary
| | - Kunyan Zhang
- Departartments of Medicine, University of Calgary
| | - Kevin Fonseca
- Microbiology, Immunology and Infectious Diseases, University of Calgary
- Provincial Laboratory of Alberta, Alberta Health Services
| | - Dan Gregson
- Departartments of Medicine, University of Calgary
- Pathology and Laboratory Medicine, University of Calgary
- The Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Alberta Health Services – Calgary Zone and University of Calgary
- Calgary Laboratory Services
| | - Deirdre Church
- Departartments of Medicine, University of Calgary
- Pathology and Laboratory Medicine, University of Calgary
- The Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Alberta Health Services – Calgary Zone and University of Calgary
- Calgary Laboratory Services
| | - Kevin Laupland
- Departartments of Medicine, University of Calgary
- Pathology and Laboratory Medicine, University of Calgary
- The Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Alberta Health Services – Calgary Zone and University of Calgary
- Calgary Laboratory Services
- Departments of Critical Care Medicine, University of Calgary
- Community Health Sciences, University of Calgary
| | - Harvey Rabin
- Departartments of Medicine, University of Calgary
- Microbiology, Immunology and Infectious Diseases, University of Calgary
- The Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Alberta Health Services – Calgary Zone and University of Calgary
| | - Sameer Elsayed
- Departments of Medicine, University of Western Ontario, London, Ontario
- Microbiology and Infectious Diseases, University of Western Ontario, London, Ontario
| | - John Conly
- Departartments of Medicine, University of Calgary
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Waldenburger S, Vogel U, Goebeler M, Kolb-Mäurer A. Community-acquired skin infections caused by Staphylococcus aureus: What is the role of the Panton-Valentine leukocidin toxin? J Dtsch Dermatol Ges 2013; 12:59-66. [PMID: 24393315 DOI: 10.1111/ddg.12228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 08/27/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The data concerning frequency and relevance of the toxin Panton-Valentine leukocidin (PVL) in skin infections caused by Staphylococcus aureus is controversial. The objective of the study was the identification of the role of the toxin in community-acquired skin infections caused by S. aureus. PATIENTS AND METHODS We performed a retrospective analysis of 112 patients with the diagnosis of skin infections caused by S. aureus. Frequency of PVL was investigated by PCR for the lukSF gene. Risk factors and severity of the disease were analyzed. Furthermore, spa typing was done in 55 of the isolated S. aureus. RESULTS PVL occurred in 45 % of patients with skin infections caused by methicillin-susceptible S. aureus; methicillin-resistant strains were positive in 63 %. Mean age was 30.9 years in PVL-positive infections and thus statistically highly significantly lower than in PVL-negative infections. There was no correlation between presence of PVL and severity and course of skin infections or presence of special risk factors. The spa types showed a high variability in PVL-positive as well as in PVL-negative strains. CONCLUSIONS In our study the PVL status of S. aureus isolated from skin infections was neither correlated with methicillin-resistance nor with the severity of disease. Remarkably, PVL-positive S. aureus strains appeared to be more frequent in younger than in older patients. Our results demonstrate that routine determination of PVL status is not required since the outcome has no diagnostic or therapeutic consequences in daily dermatological practice.
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Affiliation(s)
- Stefanie Waldenburger
- Department of Dermatology, Venereology and Allergology, University Clinic of Würzburg, Germany
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Mégarbane B, Chevillard L. The large spectrum of pulmonary complications following illicit drug use: features and mechanisms. Chem Biol Interact 2013; 206:444-51. [PMID: 24144776 DOI: 10.1016/j.cbi.2013.10.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/16/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
Damage to lungs may occur from systemic as well as inhalational exposure to various illegal drugs of abuse. Aspiration pneumonia probably represents the most common pulmonary complication in relation to consciousness impairment. Some pulmonary consequences may be specifically related to one given drug. Prolonged smoking of marijuana may result in respiratory symptoms suggestive of obstructive lung disease. Non-cardiogenic pulmonary edema has been attributed to heroin, despite debated mechanisms including attempted inspiration against a closed glottis, hypoxic damage to alveolar integrity, neurogenic vasoactive response to stress, and opiate-induced anaphylactoid reaction. Naloxone-related precipitated withdrawal resulting in massive sympathetic response with heart stunning has been mistakenly implicated. In crack users, acute respiratory syndromes called "crack-lung" with fever, hemoptysis, dyspnea, and pulmonary infiltration on chest X-rays have been reported up-to 48h after free-base cocaine inhalation, with features of pulmonary edema, interstitial pneumonia, diffuse alveolar hemorrhage, and eosinophil infiltration. The high-temperature of volatilized cocaine and the presence of impurities, as well as cocaine-induced local vasoconstriction have been suggested to explain alveolar damage. Some other drug-related pulmonary insults result from the route of drug self-administration. In intravenous drug users, granulomatous pneumonia with multinodular patterns on thoracic imaging is due to drug contaminants like talcum. Septic embolism from right-sided endocarditis represents an alternative diagnosis in case of sepsis from pulmonary origin. Following inhalation, pneumothorax, and pneumomediastinum have been attributed to increased intrathoracic pressure in relation to vigorous coughing or repeated Valsalva maneuvers, in an attempt to absorb the maximal possible drug amount. In conclusion, pulmonary consequences of illicit drugs are various, resulting in both acute life-threatening conditions and long-term functional respiratory sequelae. A better understanding of their spectrum and the implicated mechanisms of injury should help to improve patient management.
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Affiliation(s)
- Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, Paris, France; INSERM U1144, Paris-Descartes University, Variability of the response to psychotropic drugs, Paris, France.
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Reducing the adverse impact of injection drug use in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013; 23:106-7. [PMID: 23997772 DOI: 10.1155/2012/297530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chuang YY, Huang YC. Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Asia. THE LANCET. INFECTIOUS DISEASES 2013; 13:698-708. [PMID: 23827369 DOI: 10.1016/s1473-3099(13)70136-1] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In Asia, most reports on the epidemiology of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) are from developed countries, with few data from resource-limited countries, not because of low actual prevalence, but probably because of scarce diagnostic facilities. The rate of MRSA in all community-associated S. aureus infections in Asian countries ranges from 2·5% to 39%. Unlike the predominance of USA300-sequence type (ST) 8 staphylococcal cassette chromosome mec (SCCmec) type IV in the USA, the molecular epidemiology of CA-MRSA in Asia is characterised by clonal heterogeneity, similar to that in Europe. The emergence of CA-MRSA is a threat in both community and hospital settings because such strains are now more prevalent than are health-care-associated MRSA (HA-MRSA) strains. Many epidemic clones are in circulation in Asia and with scarce data available, concern has arisen that CA-MRSA could have devastating results if it becomes epidemic in resource-poor regions. The epidemiology of CA-MRSA in Asia is closely linked with the health of both developing and developed countries. The present situation of CA-MRSA in Asia is important not only for local public health, but also to provide a better understanding of the successful epidemic clones of this global pathogen.
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Affiliation(s)
- Yu-Yu Chuang
- Department of Pediatrics, St Mary's Hospital, Luodong, Taiwan
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Draft Genome Sequence of Methicillin-Susceptible Staphylococcus aureus Strain 06BA18369, a Pathogen Associated with Skin and Soft Tissue Infections in Northern Saskatchewan, Canada. GENOME ANNOUNCEMENTS 2013; 1:1/3/e00389-13. [PMID: 23814031 PMCID: PMC3695427 DOI: 10.1128/genomea.00389-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Here, we announce the draft sequence of a representative methicillin-susceptible Staphylococcus aureus (MSSA) isolate (06BA18369) whose strain type (spa type t311) was commonly isolated from skin and soft tissue coinfections with Streptococcus pyogenes. This strain sequence provides insight into a highly successful community-associated MSSA strain type.
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The changing epidemiology of methicillin-resistant Staphylococcus aureus: 50 years of a superbug. Am J Infect Control 2013; 41:448-51. [PMID: 23219674 DOI: 10.1016/j.ajic.2012.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 06/27/2012] [Accepted: 06/27/2012] [Indexed: 11/20/2022]
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Abdallah SA, Al-Asfoor KK, Salama MF, Al-Awadi BM. Prospective Analysis Methicillin-resistant Staphylococcus aureus and its Risk Factors. J Glob Infect Dis 2013; 5:19-25. [PMID: 23599613 PMCID: PMC3628228 DOI: 10.4103/0974-777x.107170] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Since the early nineties, a new methicillin-resistant Staphylococcus aureus (MRSA) has existed in a form correlating with community health personnel. Community-acquired MRSA (CA-MRSA) could be differentiated from healthcare-associated MRSA (HA-MRSA) microbiologically, epidemiologically, and molecularly. Aims: To determine the prevalence, risk factors of MRSA infections in community and hospital. Settings: The incidence and risk factors for CA-MRSA and HA-MRSA among patients of medical, surgical, and pediatrics wards and ICU at a Kuwaiti teaching hospital between 1 March 2011 and 30 November 2011 were studied. Materials and Methods: Cultures for MRSA were taken from nasal (nostril), groin, axilla, wound, sputum, or throat, and the inguinal area in all enrolled patients upon admission. All preserved isolates were examined for their susceptibility to different types of antibiotics. Results and Conclusion: A total of 71 MRSA patients admitted to different hospital wards were examined. Among these patients, 52 (73.2%) were carriers of MRSA before they were admitted to the hospital. Nineteen patients (26.8%) were found to have acquired MRSA during their stay in the hospital. Twenty-nine patients (40.8%) were given mupirocin local skin antibiotic. Binomial and the t-test (paired) were used to compare the prevalence of CA-MRSA and HA-MRSA; significant correlation (P < 0.05) between the type of MRSA and different wards, sites, and lengths of hospital stay was found. The level of serum albumin that is routinely measured at hospital admission is a predictor to MRSA infection. This study suggests that S. aureus and MRSA should become a national priority for disease control to avoid outbreaks.
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Affiliation(s)
- Soad A Abdallah
- Department of Microbiology, General Science Unit, College of Nursing, PAAET, Kuwait ; On Tenured Leave from Women's College for Arts,Science and Education, Ain Shams University, Cairo, Egypt
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Nichol KA, Adam HJ, Roscoe DL, Golding GR, Lagace-Wiens PRS, Hoban DJ, Zhanel GG, Zhanel GG, Hoban DJ, Adam HJ, Karlowsky JA, Baxter MR, Nichol KA, Lagace-Wiens PRS, Walkty A. Changing epidemiology of methicillin-resistant Staphylococcus aureus in Canada. J Antimicrob Chemother 2013; 68 Suppl 1:i47-55. [DOI: 10.1093/jac/dkt026] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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