1
|
Piewngam P, Otto M. Staphylococcus aureus colonisation and strategies for decolonisation. THE LANCET. MICROBE 2024; 5:e606-e618. [PMID: 38518792 PMCID: PMC11162333 DOI: 10.1016/s2666-5247(24)00040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/24/2024]
Abstract
Staphylococcus aureus is a leading cause of death by infectious diseases worldwide. Treatment of S aureus infections is difficult due to widespread antibiotic resistance, necessitating alternative approaches and measures for prevention of infection. Because S aureus infections commonly arise from asymptomatic colonisation, decolonisation is considered a key approach for their prevention. Current decolonisation procedures include antibiotic-based and antiseptic-based eradication of S aureus from the nose and skin. However, despite the widespread implementation and partial success of such measures, S aureus infection rates remain worrisome, and resistance to decolonisation agents is on the rise. In this Review we outline the epidemiology and mechanisms of S aureus colonisation, describe how colonisation underlies infection, and discuss current and novel approaches for S aureus decolonisation, with a focus on the latest findings on probiotic strategies and the intestinal S aureus colonisation site.
Collapse
Affiliation(s)
- Pipat Piewngam
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
2
|
Zhou C, Pawline MB, Pironti A, Morales SM, Perault AI, Ulrich RJ, Podkowik M, Lejeune A, DuMont A, Stubbe FX, Korman A, Jones DR, Schluter J, Richardson AR, Fey PD, Drlica K, Cadwell K, Torres VJ, Shopsin B. Microbiota and metabolic adaptation shape Staphylococcus aureus virulence and antimicrobial resistance during intestinal colonization. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.11.593044. [PMID: 38766195 PMCID: PMC11100824 DOI: 10.1101/2024.05.11.593044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Depletion of microbiota increases susceptibility to gastrointestinal colonization and subsequent infection by opportunistic pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). How the absence of gut microbiota impacts the evolution of MRSA is unknown. The present report used germ-free mice to investigate the evolutionary dynamics of MRSA in the absence of gut microbiota. Through genomic analyses and competition assays, we found that MRSA adapts to the microbiota-free gut through sequential genetic mutations and structural changes that enhance fitness. Initially, these adaptations increase carbohydrate transport; subsequently, evolutionary pathways largely diverge to enhance either arginine metabolism or cell wall biosynthesis. Increased fitness in arginine pathway mutants depended on arginine catabolic genes, especially nos and arcC, which promote microaerobic respiration and ATP generation, respectively. Thus, arginine adaptation likely improves redox balance and energy production in the oxygen-limited gut environment. Findings were supported by human gut metagenomic analyses, which suggest the influence of arginine metabolism on colonization. Surprisingly, these adaptive genetic changes often reduced MRSA's antimicrobial resistance and virulence. Furthermore, resistance mutation, typically associated with decreased virulence, also reduced colonization fitness, indicating evolutionary trade-offs among these traits. The presence of normal microbiota inhibited these adaptations, preserving MRSA's wild-type characteristics that effectively balance virulence, resistance, and colonization fitness. The results highlight the protective role of gut microbiota in preserving a balance of key MRSA traits for long-term ecological success in commensal populations, underscoring the potential consequences on MRSA's survival and fitness during and after host hospitalization and antimicrobial treatment.
Collapse
Affiliation(s)
- Chunyi Zhou
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Miranda B. Pawline
- Department of Medicine, Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Alejandro Pironti
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Antimicrobial-Resistant Pathogens Program, New York University Grossman School of Medicine, New York, NY 10016, USA
- Microbial Computational Genomic Core Lab, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Sabrina M. Morales
- Department of Medicine, Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Andrew I. Perault
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Robert J. Ulrich
- Department of Medicine, Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Magdalena Podkowik
- Department of Medicine, Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY 10016, USA
- Antimicrobial-Resistant Pathogens Program, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Alannah Lejeune
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Ashley DuMont
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | | | - Aryeh Korman
- Metabolomics Core Resource Laboratory, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Drew R. Jones
- Metabolomics Core Resource Laboratory, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Jonas Schluter
- Institute for Systems Genetics, Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Anthony R. Richardson
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Paul D. Fey
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Karl Drlica
- Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ 07102, USA
- Department of Microbiology, Biochemistry & Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, NJ 07102, USA
| | - Ken Cadwell
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University, Grossman School of Medicine, New York, NY 10016, USA
| | - Victor J. Torres
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Antimicrobial-Resistant Pathogens Program, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Bo Shopsin
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Department of Medicine, Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY 10016, USA
- Antimicrobial-Resistant Pathogens Program, New York University Grossman School of Medicine, New York, NY 10016, USA
| |
Collapse
|
3
|
Kaushik A, Kest H, Sood M, Steussy BW, Thieman C, Gupta S. Biofilm Producing Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Humans: Clinical Implications and Management. Pathogens 2024; 13:76. [PMID: 38251383 PMCID: PMC10819455 DOI: 10.3390/pathogens13010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Since its initial description in the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has developed multiple mechanisms for antimicrobial resistance and evading the immune system, including biofilm production. MRSA is now a widespread pathogen, causing a spectrum of infections ranging from superficial skin issues to severe conditions like osteoarticular infections and endocarditis, leading to high morbidity and mortality. Biofilm production is a key aspect of MRSA's ability to invade, spread, and resist antimicrobial treatments. Environmental factors, such as suboptimal antibiotics, pH, temperature, and tissue oxygen levels, enhance biofilm formation. Biofilms are intricate bacterial structures with dense organisms embedded in polysaccharides, promoting their resilience. The process involves stages of attachment, expansion, maturation, and eventually disassembly or dispersion. MRSA's biofilm formation has a complex molecular foundation, involving genes like icaADBC, fnbA, fnbB, clfA, clfB, atl, agr, sarA, sarZ, sigB, sarX, psm, icaR, and srtA. Recognizing pivotal genes for biofilm formation has led to potential therapeutic strategies targeting elemental and enzymatic properties to combat MRSA biofilms. This review provides a practical approach for healthcare practitioners, addressing biofilm pathogenesis, disease spectrum, and management guidelines, including advances in treatment. Effective management involves appropriate antimicrobial therapy, surgical interventions, foreign body removal, and robust infection control practices to curtail spread within healthcare environments.
Collapse
Affiliation(s)
- Ashlesha Kaushik
- Division of Pediatric Infectious Diseases, St. Luke’s Regional Medical Center, Unity Point Health, 2720 Stone Park Blvd, Sioux City, IA 51104, USA
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
- Master of Science, Healthcare Quality and Safety, Harvard Medical School, Boston, MA 02115, USA
| | - Helen Kest
- Division of Pediatric Infectious Diseases, St. Joseph’s Children’s Hospital, 703 Main Street, Paterson, NJ 07503, USA;
| | - Mangla Sood
- Department of Pediatrics, Indira Gandhi Medical College, Shimla 171006, India;
| | - Bryan W. Steussy
- Division of Microbiology, St. Luke’s Regional Medical Center, Unity Point Health, 2720 Stone Park Blvd, Sioux City, IA 51104, USA;
| | - Corey Thieman
- Division of Pharmacology, St. Luke’s Regional Medical Center, Unity Point Health, 2720 Stone Park Blvd, Sioux City, IA 51104, USA;
| | - Sandeep Gupta
- Division of Pulmonary and Critical Care, St. Luke’s Regional Medical Center, Unity Point Health, 2720 Stone Park Blvd, Sioux City, IA 51104, USA;
| |
Collapse
|
4
|
Zasowski EJ, Ali M, Anugo A, Ibragimova N, Dotson KM, Endres BT, Begum K, Alam MJ, Garey KW. Comparison of Risk Stratification Approaches to Identify Patients with Clostridioides difficile Infection at Risk for Multidrug-Resistant Organism Gut Microbiota Colonization. Infect Dis Ther 2023; 12:2005-2015. [PMID: 37436677 PMCID: PMC10505131 DOI: 10.1007/s40121-023-00843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Multidrug-resistant organisms (MDRO) commonly colonize the gut microbiota of patients with Clostridioides difficile infection (CDI). This increases the likelihood of systemic infections with these MDROs. To help guide MDRO screening and/or empiric antibiotic therapy, we derived and compared predictive indices for MDRO gut colonization in patients with CDI. METHODS This was a multicenter, retrospective cohort study of adult patients with CDI from July 2017 to April 2018. Stool samples were screened for MDRO via growth and speciation on selective antibiotic media and confirmed using resistance gene polymerase chain reaction. A regression-based risk score for MDRO colonization was constructed. Predictive performance via area under the receiver operating characteristic curve (aROC) of this index was compared with two other simplified risk stratification approaches: (1) prior healthcare exposure and/or high-CDI risk antibiotics; (2) number of prior high-CDI risk antibiotics. RESULTS 50 (20.8%) of 240 included patients had MDRO colonization; 35 (14.6%) VRE, 18 (7.5%) MRSA, 2 (0.8%) CRE. Prior fluoroquinolone (aOR 2.404, 95% CI 1.095-5.279) and prior vancomycin (1.996, 95% CI 1.014-3.932) were independently associated with MDRO colonization while prior clindamycin (aOR 3.257, 95% CI 0.842-12.597) and healthcare exposure (aOR 2.138, 95% CI 0.964-4.740) were retained as explanatory variables. The regression-based risk score significantly predicted MDRO colonization (aROC 0.679, 95% CI 0.595-0.763), but was not significantly more predictive than prior healthcare exposure + prior antibiotics (aROC 0.646, 95% CI 0.565-0.727) or number of prior antibiotic exposures (aROC 0.642, 95% CI 0.554-0.730); P > 0.05 for both comparisons. CONCLUSION A simplified approach using prior healthcare exposure and receipt of prior antibiotics known to increase CDI risk identified patients at risk for MDRO gut microbiome colonization as effectively as individual patient/antibiotic risk modeling.
Collapse
Affiliation(s)
- Evan J Zasowski
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA.
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA, USA.
| | - Maryam Ali
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Ada Anugo
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Nayle Ibragimova
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Kierra M Dotson
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Bradley T Endres
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Khurshida Begum
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - M Jahangir Alam
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| |
Collapse
|
5
|
Piewngam P, Khongthong S, Roekngam N, Theapparat Y, Sunpaweravong S, Faroongsarng D, Otto M. Probiotic for pathogen-specific Staphylococcus aureus decolonisation in Thailand: a phase 2, double-blind, randomised, placebo-controlled trial. THE LANCET. MICROBE 2023; 4:e75-e83. [PMID: 36646104 PMCID: PMC9932624 DOI: 10.1016/s2666-5247(22)00322-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Decolonisation is considered a valuable means to reduce Staphylococcus aureus infection rates. However, previous topical strategies targeting the nose or skin had little success, and oral antibiotic-based decolonisation is ill advised because of eradication of the microbiota and development of antibiotic resistance. We previously showed that the probiotic Bacillus subtilis significantly diminished S aureus at the main intestinal colonisation site via specific bacterial interaction in mice; in this study, we tested this probiotic approach to control S aureus colonisation in humans. METHODS We did a single-centre, phase 2, double-blind, randomised, placebo-controlled trial in adults from the Songkhla region of Thailand who were colonised by S aureus. Eligible participants were adults (aged ≥18 years) without history of intestinal disease, antibiotic treatment, or hospital admission within the previous 90 days. Participants were excluded if they were pregnant, breastfeeding, taking probiotics, or had diarrhoea. Participants were allocated (1:1) to groups by computer randomisation in blocks of four, and research coordinators were masked to group allocation. Participants received 250 mg of probiotic B subtilis MB40 or placebo once per day for 30 days and S aureus colonisation was determined after the last dose was received. The primary outcome was colonisation by S aureus (continuous, mean decrease in colony-forming-unit count) in the intestine (by faecal counts) and nares (by nasal swabs) after intervention (30-day regimen of B subtilis probiotic). This trial is registered with the Thai Clinical Trials Registry, TCTR20210128003. FINDINGS The trial was done between Jan 29 and June 30, 2021, with enrolment taking place from Jan 29 to April 6, 2021. 115 participants were colonised by S aureus, either in the intestine (n=84), nose (n=50), or both (n=19), and were randomly assigned to treatment (n=55) and placebo groups (n=60). Oral probiotic B subtilis resulted in significant reduction of S aureus in stool (96·8%; p<0·0001) and nose (65·4%; p=0·0002). There were no differences in adverse effects or significant microbiome changes between the intervention and placebo groups. INTERPRETATION B subtilis probiotic eliminated more than 95% of the total S aureus colonising the human body without altering the microbiota. This probiotic strategy offers several key advantages over presently used decolonisation strategies for potential use in people with chronic or long-term risk of S aureus infection. Furthermore, by establishing a defining role of the intestinal colonisation site, our findings call for revisiting fundamental notions about S aureus colonisation. FUNDING National Research Council of Thailand and US National Institutes of Health.
Collapse
Affiliation(s)
- Pipat Piewngam
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | - Sunisa Khongthong
- Faculty of Veterinary Science, Rajamangala University of Technology Srivijaya, Nakhon Si Thammarat, Thailand
| | - Natthrit Roekngam
- Department of Pharmaceutical Technology, Prince of Songkla University, Songkhla, Thailand
| | - Yongyuth Theapparat
- Interdisciplinary Graduate School of Nutraceutical and Functional Food, Prince of Songkla University, Songkhla, Thailand
| | - Somkiat Sunpaweravong
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Damrongsak Faroongsarng
- Drug Delivery System Excellence Centre, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
6
|
Molendijk MM, Phan MVT, Bode LGM, Strepis N, Prasad DK, Worp N, Nieuwenhuijse DF, Schapendonk CME, Boekema BKHL, Verbon A, Koopmans MPG, de Graaf M, van Wamel WJB. Microcalorimetry: A Novel Application to Measure In Vitro Phage Susceptibility of Staphylococcus aureus in Human Serum. Viruses 2022; 15:14. [PMID: 36680055 PMCID: PMC9865112 DOI: 10.3390/v15010014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Infections involving antibiotic resistant Staphylococcus aureus (S. aureus) represent a major challenge to successful treatment. Further, although bacteriophages (phages) could be an alternative to antibiotics, there exists a lack of correlation in phage susceptibility results between conventional in vitro and in vivo assays. This discrepancy may hinder the potential implementation of bacteriophage therapy. In this study, the susceptibility of twelve S. aureus strains to three commercial phage cocktails and two single phages was assessed. These S. aureus strains (including ten clinical isolates, five of which were methicillin-resistant) were compared using four assays: the spot test, efficiency of plating (EOP), the optical density assay (all in culture media) and microcalorimetry in human serum. In the spot test, EOP and optical density assay, all cocktails and single phages lysed both methicillin susceptible and methicillin resistant S. aureus strains. However, there was an absence of phage-mediated lysis in high concentrations of human serum as measured using microcalorimetry. As this microcalorimetry-based assay more closely resembles in vivo conditions, we propose that microcalorimetry could be included as a useful addition to conventional assays, thereby facilitating more accurate predictions of the in vivo susceptibility of S. aureus to phages during phage selection for therapeutic purposes.
Collapse
Affiliation(s)
- Michèle M. Molendijk
- Department Medical Microbiology and Infectious Diseases, Erasmus MC, 3015 Rotterdam, The Netherlands
- Department of Viroscience, Erasmus MC, 3015 Rotterdam, The Netherlands
| | - My V. T. Phan
- Department of Viroscience, Erasmus MC, 3015 Rotterdam, The Netherlands
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda
| | - Lonneke G. M. Bode
- Department Medical Microbiology and Infectious Diseases, Erasmus MC, 3015 Rotterdam, The Netherlands
| | - Nikolas Strepis
- Department Medical Microbiology and Infectious Diseases, Erasmus MC, 3015 Rotterdam, The Netherlands
| | - Divyae K. Prasad
- Department of Viroscience, Erasmus MC, 3015 Rotterdam, The Netherlands
| | - Nathalie Worp
- Department of Viroscience, Erasmus MC, 3015 Rotterdam, The Netherlands
| | | | | | | | - Annelies Verbon
- Department Medical Microbiology and Infectious Diseases, Erasmus MC, 3015 Rotterdam, The Netherlands
| | | | - Miranda de Graaf
- Department of Viroscience, Erasmus MC, 3015 Rotterdam, The Netherlands
| | - Willem J. B. van Wamel
- Department Medical Microbiology and Infectious Diseases, Erasmus MC, 3015 Rotterdam, The Netherlands
| |
Collapse
|
7
|
Chand S, Rrapi R, Gabel CK, Song S, Shah R, El Saleeby C, Kroshinsky D. Groin and buttocks involvement and methicillin-resistant Staphylococcus aureus nasal swab independently predict cutaneous abscess and methicillin-resistant Staphylococcus aureus infection in inpatient pediatric cellulitis: A retrospective cohort study. J Am Acad Dermatol 2022; 87:1205-1207. [PMID: 35288201 DOI: 10.1016/j.jaad.2022.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Sidharth Chand
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Renajd Rrapi
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen K Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Song
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Radhika Shah
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Chadi El Saleeby
- Department of Pediatrics, Divisions of Hospital Medicine and Infectious Disease, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
8
|
Yoshiyama N, Tsuneyoshi S, Nishi JI, Ishii H. Infective costochondritis and multiple abscesses in a healthy adult. BMJ Case Rep 2021; 14:14/1/e240948. [PMID: 33452067 PMCID: PMC7813321 DOI: 10.1136/bcr-2020-240948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Naomasa Yoshiyama
- Department of Emergency Medicine, Fukuoka-ken Saiseikai Futsukaichi Byoin, Chikushino, Fukuoka, Japan
| | - Shingo Tsuneyoshi
- Department of Internal Medicine, Fukuoka-ken Saiseikai Futsukaichi Byoin, Chikushino, Fukuoka, Japan
| | - Jun-ichiro Nishi
- Department of Emergency Medicine, Fukuoka-ken Saiseikai Futsukaichi Byoin, Chikushino, Fukuoka, Japan
| | - Hidehiro Ishii
- Department of Internal Medicine, Fukuoka-ken Saiseikai Futsukaichi Byoin, Chikushino, Fukuoka, Japan
| |
Collapse
|
9
|
Algammal AM, Hetta HF, Elkelish A, Alkhalifah DHH, Hozzein WN, Batiha GES, El Nahhas N, Mabrok MA. Methicillin-Resistant Staphylococcus aureus (MRSA): One Health Perspective Approach to the Bacterium Epidemiology, Virulence Factors, Antibiotic-Resistance, and Zoonotic Impact. Infect Drug Resist 2020; 13:3255-3265. [PMID: 33061472 PMCID: PMC7519829 DOI: 10.2147/idr.s272733] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major human pathogen and a historically emergent zoonotic pathogen with public health and veterinary importance. In humans, MRSA commonly causes severe infectious diseases, including food poisoning, pyogenic endocarditis, suppurative pneumonia, otitis media, osteomyelitis, and pyogenic infections of the skin, soft tissues. In the horse, MRSA could cause a localized purulent infection and botryomycosis; in cattle and ewe, localized pyogenic infection and severe acute mastitis with marked toxemia; in sheep, abscess disease resembles caseous lymphadenitis caused by anaerobic strains; in dogs and cats, pustular dermatitis and food poisoning; in pig, exudative epidermatitis “greasy pig disease; in birds, MRSA causes bumble-foot. The methicillin resistance could be determined by PCR-based detection of the mecA gene as well as resistance to cefoxitin. In Egypt, MRSA is one of the important occasions of subclinical and clinical bovine mastitis, and the prevalence of MRSA varies by geographical region. In this review, we are trying to illustrate variable data about the host susceptibility, diseases, epidemiology, virulence factors, antibiotic resistance, treatment, and control of MRSA infection.
Collapse
Affiliation(s)
- Abdelazeem M Algammal
- Department of Bacteriology, Immunology and Mycology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assuit University, Assuit 71515, Egypt.,Department of Internal Medicine, University of Cincinnati, College of Medicine, Cincinnati, OH 45267-0595, USA
| | - Amr Elkelish
- Botany Department, Faculty of Science, Suez Canal University, Ismailia 41522, Egypt
| | - Dalal Hussien H Alkhalifah
- Biology Department, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh 11451, Saudi Arabia
| | - Wael N Hozzein
- Bioproducts Research Chair, Zoology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia.,Botany and Microbiology Department, Faculty of Science, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, AlBeheira, Egypt
| | - Nihal El Nahhas
- Department of Botany and Microbiology, Faculty of Science, Alexandria University, Alexandria 21515, Egypt
| | - Mahmoud A Mabrok
- Fish Diseases and Management, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt.,Fish Infectious Diseases Research Unit (FID RU), Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
| |
Collapse
|
10
|
Tan K, Deng D, Ma X, Cui Y, Tian Z. Pediococcus acidilactici P25 Protected Caenorhabditis elegans against Enterotoxigenic Escherichia coli K88 Infection and Transcriptomic Analysis of Its Potential Mechanisms. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7340312. [PMID: 32337270 PMCID: PMC7150717 DOI: 10.1155/2020/7340312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/11/2020] [Indexed: 02/07/2023]
Abstract
Enterotoxigenic Escherichia coli (ETEC) K88 is a zoonotic pathogen. Previous studies have shown that lactic acid bacteria (LAB) have great potential in promoting health and resisting pathogenic infections; however, relatively little research has been done on the Pediococcus genus of LAB. This study is aimed at exploring the mechanisms imparted by Pediococcus acidilactici P25 against ETEC K88 in Caenorhabditis elegans. The probiotic performance of P25 was investigated in vitro. Colonization of K88 in the intestinal tract of C. elegans and abundance of enterotoxin genes were measured. In addition, the transcriptome of C. elegans infected by K88 was analyzed. The result showed that P25 possessed the ability to produce acid, as well as high tolerances to acidic and high bile salt concentrations. Coculture revealed that the growth of ETEC K88 was significantly inhibited by the presence of P25. The median survival of C. elegans fed P25 was 2 days longer than the group infected with K88 alone (P < 0.01). At the same time, the number of colonizing K88 and the abundances of estB and elt were reduced by up to 71.70% and 2.17 times, respectively, by P25. Transcriptome data indicated that P25 affected expression of genes relative to innate immune response and upregulated the abundance of genes in multiple pathways of C. elegans, including peroxisome, longevity, and mitogen-activated protein kinase (MAPK) pathways. These results demonstrated that in the presence of P25, K88 colonization and their expression of enterotoxin genes were reduced. This was accomplished through the alteration of environmental parameters (pH and bile salt) as well as through the promotion of the innate immune response processes, increased longevity, and increased antipathogenic bacteria-related pathways. This work highlights the potential application of P. acidilactici P25 as a probiotic resistant to ETEC K88.
Collapse
Affiliation(s)
- Keqin Tan
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science (South China) of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Engineering Technology Research Center of Animal Meat Quality and Safety Control and Evaluation, Guangzhou, China 510640
| | - Dun Deng
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science (South China) of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Engineering Technology Research Center of Animal Meat Quality and Safety Control and Evaluation, Guangzhou, China 510640
| | - Xianyong Ma
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science (South China) of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Engineering Technology Research Center of Animal Meat Quality and Safety Control and Evaluation, Guangzhou, China 510640
| | - Yiyan Cui
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science (South China) of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Engineering Technology Research Center of Animal Meat Quality and Safety Control and Evaluation, Guangzhou, China 510640
| | - Zhimei Tian
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science (South China) of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Engineering Technology Research Center of Animal Meat Quality and Safety Control and Evaluation, Guangzhou, China 510640
| |
Collapse
|
11
|
Garcia DR, Deckey D, Haglin JM, Emanuel T, Mayfield C, Eltorai AE, Spake CS, Jarrell JD, Born CT. Commonly Encountered Skin Biome-Derived Pathogens after Orthopedic Surgery. Surg Infect (Larchmt) 2019; 20:341-350. [DOI: 10.1089/sur.2018.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dioscaris R. Garcia
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David Deckey
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jack M. Haglin
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Toby Emanuel
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cory Mayfield
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam E.M. Eltorai
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carole Sl Spake
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John D. Jarrell
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher T. Born
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
12
|
Abstract
There are a plethora of probiotic formulae that supposedly benefit human health on the market. However, the scientific underpinnings of the claimed benefits have remained poorly established. Scientific evidence is now increasingly being provided that explains those benefits, for example, by immune-stimulatory effects or inter-bacterial competition between beneficial and pathogenic bacteria. In our recent study (Piewngam et al. Nature 2018), we show that Bacillus colonization of the human intestine is negatively correlated with that of the human pathogen, Staphylococcus aureus. This type of colonization resistance is achieved by secretion of a class of lipopeptides by Bacillus species that inhibits S. aureus quorum-sensing signaling, which we found is crucial for S. aureus intestinal colonization. Here, we discuss what these findings imply for the general role of S. aureus intestinal colonization, the role of quorum-sensing in that process, and potential alternative ways to control S. aureus infection.
Collapse
Affiliation(s)
- Pipat Piewngam
- Pathogen Molecular Genetics Section, National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, MD, USA
| | - Michael Otto
- Pathogen Molecular Genetics Section, National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, MD, USA,CONTACT Michael Otto Pathogen Molecular Genetics Section, National Institute of Allergy and Infectious Diseases, The National Institutes of Health, 50 South Drive, Bethesda, MD 20814
| |
Collapse
|
13
|
McNeil JC, Fritz SA. Prevention Strategies for Recurrent Community-Associated Staphylococcus aureus Skin and Soft Tissue Infections. Curr Infect Dis Rep 2019; 21:12. [PMID: 30859379 DOI: 10.1007/s11908-019-0670-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Staphylococcus aureus skin and soft tissue infections (SSTI) are a major source of morbidity. More than half of patients experiencing SSTI will have at least one recurrent infection. These infections frequently cluster in households. Given the burden these infections pose to patients and healthcare, prevention strategies are of major clinical importance and represent an active area of research. Bacterial colonization is frequently an early and critical step in the pathogenesis of infection. As such, strategies to prevent reinfection have aimed to decrease staphylococcal colonization of the skin and mucus membranes, a process referred to as decolonization. RECENT FINDINGS Treatment of acute SSTI with incision and drainage and systemic antibiotics is the mainstay of therapy for healing of the acute infection. Systemic antibiotics also provide benefit through reduced incidence of recurrent SSTI. Education for patients and families regarding optimization of personal and household hygiene measures, and avoidance of sharing personal hygiene items, is an essential component in prevention efforts. For patients experiencing recurrent SSTI, or in households in which multiple members have experienced SSTI, decolonization should be recommended for all household members. A recommended decolonization regimen includes application of intranasal mupirocin and antiseptic body washes with chlorhexidine or dilute bleach water baths. For patients who continue to experience recurrent SSTI, periodic decolonization should be considered. Personal decolonization with topical antimicrobials and antiseptics reduces the incidence of recurrent S. aureus SSTI. Future avenues for investigation include strategies for household environmental decontamination as well as manipulation of the host microbiota.
Collapse
Affiliation(s)
- J Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, CB 8116, St. Louis, MO, 63110, USA.
| |
Collapse
|
14
|
Millar EV, Rice GK, Schlett CD, Elassal EM, Cer RZ, Frey KG, Hamilton T, Ellis MW, Tribble DR, Bishop-Lilly KA, Bennett JW. Genomic epidemiology of MRSA infection and colonization isolates among military trainees with skin and soft tissue infection. Infection 2019; 47:729-737. [DOI: 10.1007/s15010-019-01282-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
|
15
|
Copin R, Sause WE, Fulmer Y, Balasubramanian D, Dyzenhaus S, Ahmed JM, Kumar K, Lees J, Stachel A, Fisher JC, Drlica K, Phillips M, Weiser JN, Planet PJ, Uhlemann AC, Altman DR, Sebra R, van Bakel H, Lighter J, Torres VJ, Shopsin B. Sequential evolution of virulence and resistance during clonal spread of community-acquired methicillin-resistant Staphylococcus aureus. Proc Natl Acad Sci U S A 2019; 116:1745-1754. [PMID: 30635416 PMCID: PMC6358666 DOI: 10.1073/pnas.1814265116] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The past two decades have witnessed an alarming expansion of staphylococcal disease caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). The factors underlying the epidemic expansion of CA-MRSA lineages such as USA300, the predominant CA-MRSA clone in the United States, are largely unknown. Previously described virulence and antimicrobial resistance genes that promote the dissemination of CA-MRSA are carried by mobile genetic elements, including phages and plasmids. Here, we used high-resolution genomics and experimental infections to characterize the evolution of a USA300 variant plaguing a patient population at increased risk of infection to understand the mechanisms underlying the emergence of genetic elements that facilitate clonal spread of the pathogen. Genetic analyses provided conclusive evidence that fitness (manifest as emergence of a dominant clone) changed coincidently with the stepwise emergence of (i) a unique prophage and mutation of the regulator of the pyrimidine nucleotide biosynthetic operon that promoted abscess formation and colonization, respectively, thereby priming the clone for success; and (ii) a unique plasmid that conferred resistance to two topical microbiocides, mupirocin and chlorhexidine, frequently used for decolonization and infection prevention. The resistance plasmid evolved through successive incorporation of DNA elements from non-S. aureus spp. into an indigenous cryptic plasmid, suggesting a mechanism for interspecies genetic exchange that promotes antimicrobial resistance. Collectively, the data suggest that clonal spread in a vulnerable population resulted from extensive clinical intervention and intense selection pressure toward a pathogen lifestyle that involved the evolution of consequential mutations and mobile genetic elements.
Collapse
Affiliation(s)
- Richard Copin
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - William E Sause
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Yi Fulmer
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - Divya Balasubramanian
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Sophie Dyzenhaus
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Jamil M Ahmed
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - Krishan Kumar
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - John Lees
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Anna Stachel
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - Jason C Fisher
- Division of Pediatric Surgery, Department of Surgery, New York University School of Medicine, New York, NY 10016
| | - Karl Drlica
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ 07103
- Department of Microbiology, Biochemistry, and Molecular Genetics, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ 07103
| | - Michael Phillips
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - Jeffrey N Weiser
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Paul J Planet
- Department of Pediatric Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, PA 19104
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY 10032
| | - Deena R Altman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY 10029
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Jennifer Lighter
- Division of Pediatric Infectious Diseases, Department of Pediatrics, New York University School of Medicine, New York, NY 10016
| | - Victor J Torres
- Department of Microbiology, New York University School of Medicine, New York, NY 10016;
| | - Bo Shopsin
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016;
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| |
Collapse
|
16
|
Association Between Contact Sports and Colonization with Staphylococcus aureus in a Prospective Cohort of Collegiate Athletes. Sports Med 2018; 47:1011-1019. [PMID: 27577687 DOI: 10.1007/s40279-016-0618-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Athletes have a higher risk of infection with Staphylococcus aureus than the general population. Most studies in athletes have included primarily male contact sports participants and have not assessed S. aureus carriage over time. We aimed to examine the epidemiology and risk factors of S. aureus carriage in a cohort of male and female collegiate athletes. STUDY DESIGN We conducted a prospective cohort study of 377 varsity collegiate athletes from August 2008 to April 2010. A baseline questionnaire ascertained risk factors for colonization. Nasal and oropharyngeal swabs were obtained at enrollment and monthly thereafter to detect S. aureus colonization. The primary outcome was S. aureus colonization, both with methicillin-susceptible and methicillin-resistant S. aureus, as defined by bacterial culture and molecular confirmation. Secondary outcomes were time to colonization with S. aureus and carriage profile, defined as non-carrier, intermittent carrier, or persistent carrier. RESULTS Overall, 224 contact sports and 153 non-contact sports athletes were enrolled. Contact sports athletes had a higher risk of carrying S. aureus over time: They had higher odds of being colonized with MRSA (OR 2.36; 95 % CI 1.13-4.93) and they tended to carry S. aureus for longer periods of time (intermittent carriage OR 3.60; 95 % CI 2.02-6.40; persistent carriage OR 2.39; 95 % CI 1.21-4.72). Athletes engaged in contact sports also acquired S. aureus more quickly (HR 1.61; 95 % CI 1.02-2.55). CONCLUSIONS Staphylococcus aureus carriage was common in contact sports athletes. These findings suggest that efforts to prevent transmission of S. aureus among athletes should be focused on contact sports teams.
Collapse
|
17
|
Remitting infections due to community-acquired Panton–Valentine leukocidin-producing Staphylococcus aureus in the Milan area. J Infect Public Health 2018; 11:255-259. [DOI: 10.1016/j.jiph.2017.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/03/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022] Open
|
18
|
Smith TC, Hellwig EJ, Wardyn SE, Kates AE, Thapaliya D. Longitudinal Case Series of Staphylococcus aureus Colonization and Infection in Two Cohorts of Rural Iowans. Microb Drug Resist 2018; 24:455-460. [PMID: 29298107 DOI: 10.1089/mdr.2017.0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Examine the relationship between colonization with Staphylococcus aureus in the community and symptomatic infection in two cohorts of Iowans. DESIGN Case series within cohort study. PARTICIPANTS Rural Iowans selected from the Keokuk Rural Health Study, the Agricultural Health Study, and the Iowa Voter Registry. METHODS Longitudinal study within established cohorts evaluating documented S. aureus infections with samples available for molecular typing. RESULTS We examined this relationship in two cohorts of Iowans with a combined 11 incident cases of S. aureus SSTI, for which samples were available. Seven of the 11 individuals (63.6%) were colonized at baseline, in the nose (3/7, 42.9%), or in both the nose and throat (57.1%). All seven cases had matching sequence types between colonization and infection isolates. CONCLUSIONS Staphylococcus aureus causes millions of skin and soft tissue infections yearly. Although colonization with S. aureus is a frequent antecedent to infection, many studies investigating the link between colonization and infection have taken place in a clinical setting, particularly in urban hospitals. Our study has shown similar results in a rural community setting to those previously seen in clinics.
Collapse
Affiliation(s)
- Tara C Smith
- 1 Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University , Kent, Ohio
| | - Emily J Hellwig
- 1 Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University , Kent, Ohio
| | - Shylo E Wardyn
- 2 Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Ashley E Kates
- 3 Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison , Madison, Wisconsin
| | - Dipendra Thapaliya
- 1 Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University , Kent, Ohio
| |
Collapse
|
19
|
Sannasiddappa TH, Lund PA, Clarke SR. In Vitro Antibacterial Activity of Unconjugated and Conjugated Bile Salts on Staphylococcus aureus. Front Microbiol 2017; 8:1581. [PMID: 28878747 PMCID: PMC5572772 DOI: 10.3389/fmicb.2017.01581] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/03/2017] [Indexed: 12/12/2022] Open
Abstract
Bile salts are potent antimicrobial agents and are an important component of innate defenses in the intestine, giving protection against invasive organisms. They play an important role in determining microbial ecology of the intestine and alterations in their levels can lead to increased colonization by pathogens. We have previously demonstrated survival of the opportunistic pathogen Staphylococcus aureus in the human colonic model. Thus investigating the interaction between S. aureus and bile salts is an important factor in understanding its ability to colonize in the host intestine. Harnessing bile salts may also give a new avenue to explore in the development of therapeutic strategies to control drug resistant bacteria. Despite this importance, the antibacterial activity of bile salts on S. aureus is poorly understood. In this study, we investigated the antibacterial effects of the major unconjugated and conjugated bile salts on S. aureus. Several concentration-dependent antibacterial mechanisms were found. Unconjugated bile salts at their minimum inhibitory concentration (cholic and deoxycholic acid at 20 and 1 mM, respectively) killed S. aureus, and this was associated with increased membrane disruption and leakage of cellular contents. Unconjugated bile salts (cholic and deoxycholic acid at 8 and 0.4 mM, respectively) and conjugated bile salts (glycocholic and taurocholic acid at 20 mM) at their sub inhibitory concentrations were still able to inhibit growth through disruption of the proton motive force and increased membrane permeability. We also demonstrated that unconjugated bile salts possess more potent antibacterial action on S. aureus than conjugated bile salts.
Collapse
Affiliation(s)
| | - Peter A Lund
- Institute of Microbiology and Infection, School of Biosciences, University of BirminghamBirmingham, United Kingdom
| | - Simon R Clarke
- School of Biological Sciences, University of ReadingReading, United Kingdom
| |
Collapse
|
20
|
Gagnaire J, Verhoeven PO, Grattard F, Rigaill J, Lucht F, Pozzetto B, Berthelot P, Botelho-Nevers E. Epidemiology and clinical relevance of Staphylococcus aureus intestinal carriage: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2017; 15:767-785. [PMID: 28726558 DOI: 10.1080/14787210.2017.1358611] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Recent data highlight the importance of screening more than one site for improving the detection of S. aureus colonization. Intestinal carriage is frequently under-investigated and its clinical impact ought to be defined a better way. Areas covered: This review and meta-analysis provide an updated overview of prevalence, characteristics and clinical significance of S. aureus intestinal carriage in different populations, both for methicillin-susceptible and -resistant S. aureus strains. Expert commentary: Intestinal S. aureus carriage is documented with higher prevalence in children and in patients with S. aureus skin and soft tissue infections. This site of colonization was shown to be associated with a high risk of dissemination in the environment and with S. aureus infection. Intestinal carriage is frequently retrieved in nasal carriers, reflecting probably an association with a high bacterial load. Exclusive intestinal carriage present in one third of intestinal carriers can be associated with infection. Comparative genotyping analysis of different strains from nasal and extra-nasal sites of carriage, including the intestinal ones, in the same individuals, would allow a better comprehension of the pathophysiology of S. aureus endogenous infection. It could also permit to improve the prevention of these infections by decolonization of sites implicated in infection genesis.
Collapse
Affiliation(s)
- Julie Gagnaire
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,b Infectious Diseases Department , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Paul O Verhoeven
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Florence Grattard
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Josselin Rigaill
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Frédéric Lucht
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,b Infectious Diseases Department , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Bruno Pozzetto
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Philippe Berthelot
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,b Infectious Diseases Department , University Hospital of Saint-Etienne , Saint-Etienne , France.,c Laboratory of Infectious Agents and Hygiene , University Hospital of Saint-Etienne , Saint-Etienne , France
| | - Elisabeth Botelho-Nevers
- a GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) , University of Lyon , Saint-Etienne , France.,b Infectious Diseases Department , University Hospital of Saint-Etienne , Saint-Etienne , France
| |
Collapse
|
21
|
Botelho-Nevers E, Gagnaire J, Verhoeven PO, Cazorla C, Grattard F, Pozzetto B, Berthelot P, Lucht F. Decolonization of Staphylococcus aureus carriage. Med Mal Infect 2016; 47:305-310. [PMID: 27856080 DOI: 10.1016/j.medmal.2016.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/25/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
Staphylococcus aureus nasal colonization is a well-known independent risk factor for infection caused by this bacterium. Screening and decolonization of carriers have been proven effective in reducing S. aureus infections in some populations. However, a gap remains between what has been proven effective and what is currently done. We aimed to summarize recommendations and current knowledge of S. aureus decolonization to answer the following questions: Why? For whom? How? When? And what are the perspectives?
Collapse
Affiliation(s)
- E Botelho-Nevers
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France.
| | - J Gagnaire
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - P O Verhoeven
- Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - C Cazorla
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France
| | - F Grattard
- Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - B Pozzetto
- Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - P Berthelot
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - F Lucht
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France
| |
Collapse
|
22
|
Creech CB, Al-Zubeidi DN, Fritz SA. Prevention of Recurrent Staphylococcal Skin Infections. Infect Dis Clin North Am 2016; 29:429-64. [PMID: 26311356 DOI: 10.1016/j.idc.2015.05.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Staphylococcus aureus infections pose a significant health burden. The emergence of community-associated methicillin-resistant S aureus has resulted in an epidemic of skin and soft tissue infections (SSTI), and many patients experience recurrent SSTI. As S aureus colonization is associated with subsequent infection, decolonization is recommended for patients with recurrent SSTI or in settings of ongoing transmission. S aureus infections often cluster within households, and asymptomatic carriers serve as reservoirs for transmission; therefore, a household approach to decolonization is more effective than measures performed by individuals alone. Novel strategies for the prevention of recurrent SSTI are needed.
Collapse
Affiliation(s)
- C Buddy Creech
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell, Jr. Children's Hospital at Vanderbilt, S2323 MCN, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Duha N Al-Zubeidi
- Department of Pediatrics, Children's Mercy Hospital Infection Prevention and Control, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Stephanie A Fritz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116, St Louis, MO 63110, USA.
| |
Collapse
|
23
|
Jiménez-Truque N, Saye EJ, Soper N, Saville BR, Thomsen I, Edwards KM, Creech CB. Longitudinal Assessment of Colonization With Staphylococcus aureus in Healthy Collegiate Athletes. J Pediatric Infect Dis Soc 2016; 5:105-13. [PMID: 27199467 PMCID: PMC5407133 DOI: 10.1093/jpids/piu108] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/13/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Staphylococcus aureus is the leading cause of skin and soft tissue infections in the United States, and S. aureus colonization increases the risk of infection. Although athletes have a higher risk of infection with S. aureus than the general population, most studies in athletes have not assessed colonization. METHODS We conducted a prospective cohort study of Vanderbilt University varsity athletes from August 2008 to April 2010. We assessed nasal and oropharyngeal colonization with methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains by obtaining swabs at enrollment and monthly thereafter until the end of the study. The athletes were also monitored for skin and soft tissue infections. RESULTS We enrolled 377 athletes and trainers (224 in contact sports and 153 in noncontact sports). The total S. aureus colonization prevalence ranged from 34% to 62%, and for MRSA it ranged from 8% to 29%. The colonization rate in the summer was significantly higher than that in the winter (odds ratio for MRSA [ORMRSA], 1.70 [95% confidence interval (CI), 1.23-2.35]; ORMSSA, 1.38 [95% CI, 1.05-1.82]). Of 603 MRSA isolates, 75% carried the staphylococcal cassette chromosome mec (SCCmec) type IV, and 5% carried the genes encoding Panton-Valentine leukocidin. Nine symptomatic S. aureus infections occurred, 7 of which were between July and September. CONCLUSIONS The S. aureus colonization rate is higher than previously reported and fluctuated over time in this prospective cohort of athletes. The higher colonization prevalence during summer might explain the infectious outbreak during the summer months and may represent a key intervention time for preventing S. aureus disease in athletes.
Collapse
Affiliation(s)
| | | | | | - Benjamin R. Saville
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | |
Collapse
|
24
|
Claassen-Weitz S, Shittu AO, Ngwarai MR, Thabane L, Nicol MP, Kaba M. Fecal Carriage of Staphylococcus aureus in the Hospital and Community Setting: A Systematic Review. Front Microbiol 2016; 7:449. [PMID: 27242671 PMCID: PMC4861718 DOI: 10.3389/fmicb.2016.00449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/18/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND RATIONALE Staphylococcus aureus fecal carriage has been identified as a potential source for nosocomial transmission and a risk factor for disease development. This systematic review determined the overall S. aureus [including methicillin susceptible and resistant S. aureus (MSSA and MRSA)] fecal carriage rates within the community and healthcare settings. METHODOLOGY Peer-reviewed articles indexed in Medline, Scopus, Academic Search Premier, Africa-Wide Information, CINAHL, and Web of Science were identified using applicable and controlled vocabulary through to 11 November 2015. Eligible studies were ascertained by three independent reviewers. Random-effects meta-analyses of proportions were performed to determine S. aureus, MSSA and MRSA fecal carriage rates reported by eligible studies. RESULTS Twenty six studies were included in this review. The pooled estimates for S. aureus, MSSA and MRSA fecal carriage were 26% (95% confidence interval (CI): 16.8-36.3%), 86% (95% confidence interval (CI): 65.9-97.9%) and 10% (95% CI: 0.7-27.0%), respectively. Fecal S. aureus carriage rates increased on average from 10 to 65% during the first 8 weeks of life, followed by an average carriage rate of 64% at 6 months and 46% at 1 year of life. Genotyping techniques were employed mainly in studies conducted in developed countries and comprised largely of gel-based techniques. Six studies reported on the role of S. aureus fecal strains in diarrhea (n = 2) and the risk for acquiring infections (n = 4). Eight of the 26 studies included in this review performed antibiotic susceptibility testing of S. aureus fecal isolates. CONCLUSION This study provides evidence that screening for S. aureus fecal carriage, at least in populations at high risk, could be an effective measure for the prevention of S. aureus transmission and infection in the healthcare and community setting. More well-structured studies need to be conducted and sequence-based genotyping techniques should be employed for the comparison of isolates on a global scale in both developing and developed countries.
Collapse
Affiliation(s)
- Shantelle Claassen-Weitz
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
| | - Adebayo O. Shittu
- Department of Microbiology, Obafemi Awolowo UniversityIle-Ife, Nigeria
| | - Michelle R. Ngwarai
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster UniversityHamilton, ON, Canada
| | - Mark P. Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- National Health Laboratory Service of South Africa, Groote Schuur HospitalCape Town, South Africa
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
| |
Collapse
|
25
|
Muenks CE, Hogan PG, Wang JW, Eisenstein KA, Burnham CAD, Fritz SA. Diversity of Staphylococcus aureus strains colonizing various niches of the human body. J Infect 2016; 72:698-705. [PMID: 27045982 DOI: 10.1016/j.jinf.2016.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES As individuals may be colonized with multiple strains of Staphylococcus aureus at different body sites, the objectives of this study were to determine whether S. aureus polyclonal colonization exists within one body niche and the optimal sampling sites and culture methodology to capture the diversity of S. aureus strains in community-dwelling individuals. METHODS Swabs were collected from the nares, axillae, and inguinal folds of 3 children with community-associated S. aureus infections and 11 household contacts, all with known S. aureus colonization. S. aureus isolates were recovered from each body niche using 4 culture methods and evaluated for polyclonality using phenotypic and genotypic strain characterization methodologies. RESULTS Within individuals, the mean (range) number of phenotypes and genotypes was 2.4 (1-4) and 3.1 (1-6), respectively. Six (43%) and 10 (71%) participants exhibited phenotypic and genotypic polyclonality within one body niche, respectively. Broth enrichment yielded the highest analytical sensitivity for S. aureus recovery, while direct plating to blood agar yielded the highest genotypic strain diversity. CONCLUSIONS This study revealed S. aureus polyclonality within a single body niche. Culture methodology and sampling sites influenced the analytical sensitivity of S. aureus colonization detection and the robustness of phenotypic and genotypic strain recovery.
Collapse
Affiliation(s)
- Carol E Muenks
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey W Wang
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kimberly A Eisenstein
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Carey-Ann D Burnham
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
26
|
Meyer Sauteur PM, Leimer N, Chan PK, Relly C, Seidl K, Zinkernagel AS, Berger C. Methicillin-resistant Staphylococcus aureus eradication in young infants should include the diaper area and treat housing contacts. Acta Paediatr 2015; 104:e581-4. [PMID: 26341723 DOI: 10.1111/apa.13179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/27/2015] [Accepted: 09/01/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Patrick M. Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center (CRC); University Children's Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Nadja Leimer
- Division of Infectious Diseases and Hospital Epidemiology; University Hospital and University of Zurich; University of Zurich; Zurich Switzerland
| | - Pik Ki Chan
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center (CRC); University Children's Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center (CRC); University Children's Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Kati Seidl
- Division of Infectious Diseases and Hospital Epidemiology; University Hospital and University of Zurich; University of Zurich; Zurich Switzerland
| | - Annelies S. Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology; University Hospital and University of Zurich; University of Zurich; Zurich Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center (CRC); University Children's Hospital of Zurich; University of Zurich; Zurich Switzerland
| |
Collapse
|
27
|
Misawa Y, Kelley KA, Wang X, Wang L, Park WB, Birtel J, Saslowsky D, Lee JC. Staphylococcus aureus Colonization of the Mouse Gastrointestinal Tract Is Modulated by Wall Teichoic Acid, Capsule, and Surface Proteins. PLoS Pathog 2015. [PMID: 26201029 PMCID: PMC4511793 DOI: 10.1371/journal.ppat.1005061] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Staphylococcus aureus colonizes the nose, throat, skin, and gastrointestinal (GI) tract of humans. GI carriage of S. aureus is difficult to eradicate and has been shown to facilitate the transmission of the bacterium among individuals. Although staphylococcal colonization of the GI tract is asymptomatic, it increases the likelihood of infection, particularly skin and soft tissue infections caused by USA300 isolates. We established a mouse model of persistent S. aureus GI colonization and characterized the impact of selected surface antigens on colonization. In competition experiments, an acapsular mutant colonized better than the parental strain Newman, whereas mutants defective in sortase A and clumping factor A showed impaired ability to colonize the GI tract. Mutants lacking protein A, clumping factor B, poly-N-acetyl glucosamine, or SdrCDE showed no defect in colonization. An S. aureus wall teichoic acid (WTA) mutant (ΔtagO) failed to colonize the mouse nose or GI tract, and the tagO and clfA mutants showed reduced adherence in vitro to intestinal epithelial cells. The tagO mutant was recovered in lower numbers than the wild type strain in the murine stomach and duodenum 1 h after inoculation. This reduced fitness correlated with the in vitro susceptibility of the tagO mutant to bile salts, proteases, and a gut-associated defensin. Newman ΔtagO showed enhanced susceptibility to autolysis, and an autolysin (atl) tagO double mutant abrogated this phenotype. However, the atl tagO mutant did not survive better in the mouse GI tract than the tagO mutant. Our results indicate that the failure of the tagO mutant to colonize the GI tract correlates with its poor adherence and susceptibility to bactericidal factors within the mouse gut, but not to enhanced activity of its major autolysin. Staphylococcus aureus persistently colonizes ~20% of the human population, and 40–60% of humans are intermittently colonized by this bacterium. The most common reservoir for S. aureus is the anterior nares, and the incidence of staphylococcal disease in higher in individuals who are colonized. Rectal colonization by S. aureus isolates, reflecting gastrointestinal (GI) carriage, has recently been recognized as an important reservoir from which person to person transmission occurs. We developed a murine model of S. aureus GI colonization to investigate bacterial factors that promote staphylococcal colonization of the gut. We identified several surface-associated S. aureus antigens that modulate colonization of the GI tract and identified a surface glycopolymer (cell wall teichoic acid) as critical for the early steps in colonization. The failure of the teichoic acid mutant to colonize the GI tract can be attributed to its defects in bacterial adherence and to its enhanced susceptibility to mammalian host defenses unique to the gastrointestinal tract. Efforts to develop antimicrobials that target WTA may lead to an overall reduction in asymptomatic colonization by antibiotic-resistant S. aureus and may impact the incidence of invasive disease.
Collapse
Affiliation(s)
- Yoshiki Misawa
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kathryn A. Kelley
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xiaogang Wang
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Linhui Wang
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Wan Beom Park
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Johannes Birtel
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David Saslowsky
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jean C. Lee
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
28
|
Agrawal V, Wright A, Mehta B, Zhu C, Lindholm E, Lee YW, Emran MA. Risk Factors Associated With Abscess Formation in Children 5 Years of Age and Younger. Clin Pediatr (Phila) 2015; 54:543-50. [PMID: 25395611 DOI: 10.1177/0009922814556058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
From 1997 to 2009, hospitalization rates have doubled for pediatric patients with soft tissue abscesses requiring incision and drainage. Despite this increasing national burden, few studies have been conducted to identify the risk factors associated with abscess formation. Our study evaluates a collection of physiological and lifestyle parameters that may serve as risk factors for abscess formation among pediatric patients 5 years of age or younger. Our results indicate family history and age 2 years and younger are associated with higher risk of abscess formation. Furthermore, methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus were prevalent pathogens associated with abscess in our study group. Pediatricians may employ these novel parameters to educate parents and/or guardians of high-risk groups on preventing abscess formation to alleviate the burden of incision & dragining requiring abscess on health care costs.
Collapse
Affiliation(s)
- Vaidehi Agrawal
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Avery Wright
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Brinda Mehta
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Chunxiao Zhu
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Erin Lindholm
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Yong-Woo Lee
- Department of Statistics, Texas A&M University, Corpus Christi, TX, USA
| | - Mohammad Ali Emran
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| |
Collapse
|
29
|
Calderwood MS. Editorial Commentary: Duration of Colonization With Methicillin-Resistant Staphylococcus aureus: A Question With Many Answers. Clin Infect Dis 2015; 60:1497-9. [PMID: 25648241 PMCID: PMC4412190 DOI: 10.1093/cid/civ082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 12/05/2022] Open
Affiliation(s)
- Michael S Calderwood
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
30
|
Nasal carriage of methicillin-resistant Staphylococcus aureus during the first 2 years of life in children in northern Taiwan. Pediatr Infect Dis J 2015; 34:131-5. [PMID: 25144800 DOI: 10.1097/inf.0000000000000517] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most reported studies of methicillin-resistant Staphylococcus aureus (MRSA) carriage have represented 1 time point. To better understand dynamic changes of nasal MRSA carriage, we conducted this longitudinal study in Taiwan. METHODS We recruited 304 newborn babies and obtained samples from nares for detection of S. aureus within 3 days of life, and obtained further samples periodically up to 2 years of age. A total of 12 samplings were attempted to be obtained. RESULTS Totally, 273 subjects with ≥9 samples were included for analysis. One hundred and ten subjects (40%) harbored MRSA, on one or more occasions; of these 82 (75%) had ≥2 positive specimens and 84 (76%) had colonization ≤4 months of age. Fourteen infants (5.1%) carried MRSA within 3 days of life, the rate peaked at the age of 2 months (21%) and it was lowest (3.1%) at the age of 18 months. All but 4 first MRSA isolates from the colonized subjects carried either staphylococcal cassette chromosome (SCCmec) IV or V(T). Of 32 subjects with ≥4 MRSA isolates, all isolates from the same subject were genetically indistinguishable in 17 (53%) and genetically related in an additional 9 (28%). Five episodes of skin and soft tissue infections (SSTIs) were identified in 4 subjects. CONCLUSION In Taiwan, during the first 2 years of life, two-fifths of the children ever harbored MRSA, whereas fewer than 2% of them had SSTIs. Three-fourths of the colonization occurred within the first 4 months and were persistent. More than half of the persistent colonizing isolates were genetically indistinguishable.
Collapse
|
31
|
Lambe CI, Hoare KJ. Skin Infections in Young People (Aged 14–18 Years). J Sch Nurs 2014; 30:156-64. [DOI: 10.1177/1059840513501087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Skin infections are a major cause of preventable hospitalization, with young people being particularly susceptible. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection typically presents as skin infection. CA-MRSA infection rates have increased rapidly in the past decade. Exploration of literature specific to young people aged 14–18 years is therefore timely. Integrative review using the methods described by Whittemore and Knafl was undertaken. Electronic databases of Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and Google databases were searched for English-language articles published after 1990. Twenty primary studies were included and the findings are reported here. Data analysis revealed factors influencing skin infections in young people may be host-, transmission-, or pathogen-specific. Strategies to address host and transmission factors may be effective in controlling skin infection rates in young people.
Collapse
|
32
|
Emergence of new CMRSA7/USA400 methicillin-resistant Staphylococcus aureus spa types in Alberta, Canada, from 2005 to 2012. J Clin Microbiol 2014; 52:2439-46. [PMID: 24789179 DOI: 10.1128/jcm.00505-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most significant pathogens affecting global public health and health care systems. In Canada and the United States, the spread of MRSA is primarily attributed to a single dominant epidemic clone: CMRSA10/USA300. Despite this, the CMRSA7/USA400 epidemic clone has been reported to be the predominate epidemic clone in several Canadian provinces and some parts of the United States. This study examined the epidemiology of CMRSA7/USA400 MRSA in Alberta, Canada, from June 2005 to December 2012. Molecular characterization of CMRSA7/USA400 isolates was done using spa, SCCmec, PVL, and PFGE typing and identified two predominant spa types in Alberta: t128 and t1787. Although closely related, these spa types have distinct geographic distributions. From 2010 to 2012, the number of t128 infections has remained stable while there has been a nearly 3-fold increase in the number of provincial t1787 infections, accompanied by 10-fold increases in t1787 infection rates in some communities. Most t128 and t1787 patients were First Nations or Inuit people, and isolates were usually from skin and soft tissue infections in outpatients. t128 patients were significantly older than t1787 patients. Antimicrobial susceptibility testing showed higher mupirocin resistance in t1787 than in t128 MRSA. Improved strategies to reduce or stabilize t1787 infections in Alberta are needed.
Collapse
|
33
|
Gesualdo F, Onori M, Bongiorno D, Campanile F, Carloni E, Mancinelli L, Russo C, Villani A, Valentini D, Raponi M, Tozzi AE, Stefani S. Methicillin-resistant Staphylococcus aureus nasal colonization in a department of pediatrics: a cross-sectional study. Ital J Pediatr 2014; 40:3. [PMID: 24410796 PMCID: PMC3896672 DOI: 10.1186/1824-7288-40-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We describe methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage at admission in patients admitted to a Department of Pediatrics. METHODS All patients received a nasal swab at admission. A questionnaire was administered and molecular genetics analyses were performed on all identified MRSA isolates. RESULTS We enrolled 785 patients, affected with both acute and chronic diseases. MRSA nasal colonization prevalence was 1.15% (CI: 0.5607%-2.093%). Methicillin-sensitive Staphylococcus aureus (MSSA) nasal colonization prevalence at admission was 19.75% (CI 17.07%-22.64%). Only one MRSA isolate carried the SCCmec V variant; all other isolates carried the SCCmecIV variant. Five out of 9 MRSA-colonized patients had an underlying condition. Antibiotic therapy in the previous 6 months was a protective factor for both MRSA (OR 0,66; 95% CI: 0,46-0,96) and MSSA (OR 0,65; 95% CI: 0,45-0,97) colonization. A tendency to statistical significance was seen in the association between hospitalization in the 6 months prior to admission and MRSA colonization at admission (OR 4,92; 95% CI: 0,97-24,83). No patient was diagnosed with an S. aureus infection during hospitalization. CONCLUSIONS The majority of our MRSA colonizing isolates have community origins. Nevertheless, most MRSA-colonized patients had been hospitalized previously, suggesting that strains that circulate in the community also circulate in hospital settings. Further studies should elucidate the role of children with frequent contact with health care institutions in the circulation of antibiotic resistant strains between the hospital and the community.
Collapse
|
34
|
Verhoeven PO, Gagnaire J, Botelho-Nevers E, Grattard F, Carricajo A, Lucht F, Pozzetto B, Berthelot P. Detection and clinical relevance of Staphylococcus aureus nasal carriage: an update. Expert Rev Anti Infect Ther 2013; 12:75-89. [PMID: 24308709 DOI: 10.1586/14787210.2014.859985] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Staphylococcus aureus nasal carriage is a well-defined risk factor of infection with this bacterium. The increased risk of S. aureus infection in nasal carriers is supported by the fact that the strains isolated from both colonization and infection sites are indistinguishable in most of the cases. Persistent nasal carriage seems to be associated with an increased risk of infection and this status could be defined now in clinical routine by using one or two quantitative nasal samples. There is evidence for supporting the detection of nasal carriage of S. aureus in patients undergoing cardiac surgery and in those undergoing hemodialysis in order to implement decolonization measures. More studies are needed to determine which carriers have the highest risk of infection and why decolonization strategies failed to reduce S. aureus infection in some other groups of patients.
Collapse
Affiliation(s)
- Paul O Verhoeven
- GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes), University of Lyon, 42023 Saint-Etienne, France
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Fecal carriage of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in healthy children. Antimicrob Agents Chemother 2013; 58:1261-2. [PMID: 24277049 DOI: 10.1128/aac.02466-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
36
|
Rasigade JP, Vandenesch F. Staphylococcus aureus: a pathogen with still unresolved issues. INFECTION GENETICS AND EVOLUTION 2013; 21:510-4. [PMID: 23994773 DOI: 10.1016/j.meegid.2013.08.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 12/11/2022]
Abstract
Staphylococcus aureus is a major human pathogen, and considerable research efforts have been put forward to improve our understanding of its complex pathogenesis. In spite of these efforts, the burden of staphylococcal infections is still on the rise. This review focuses on a selected set of crucial unresolved questions regarding this pathogen, namely: (i) the nature of the driving forces behind the rise and decline of methicillin-resistant S.aureus (MRSA) clones; (ii) the mechanisms by which a commensal becomes a pathogen; (iii) the molecular underpinnings of toxin overexpression in hypervirulent MRSA clones such as USA300; and (iv) the repeated failures of anti-S.aureus vaccine approaches.
Collapse
Affiliation(s)
- Jean-Philippe Rasigade
- UMR U1111 INSERM Université de Lyon, Site Laënnec, 8 rue Guillaume Paradin, 69372 Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Est, 69 Boulevard Pinel, 69677 Bron, France
| | - François Vandenesch
- UMR U1111 INSERM Université de Lyon, Site Laënnec, 8 rue Guillaume Paradin, 69372 Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Est, 69 Boulevard Pinel, 69677 Bron, France.
| |
Collapse
|
37
|
MRSA nasal colonization in children: prevalence meta-analysis, review of risk factors and molecular genetics. Pediatr Infect Dis J 2013; 32:479-85. [PMID: 23340553 DOI: 10.1097/inf.0b013e3182864e4c] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report a meta-analysis of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization prevalence in children and a review of the risk factors as well as molecular genetic characterization. METHODS All relevant studies reporting prevalence data on MRSA nasal colonization in children published between January 2000 and August 2010 were retrieved from the MEDLINE database and analyzed. RESULTS After screening 544 studies, 50 studies were included. We obtained an estimate of MRSA prevalence of 2.7% (95% confidence interval [CI]: 2.2-3.1); of 5.2% (95% CI: 3.1-7.3) in children with underlying conditions and of 2.3% (95% CI: 1.8-2.7) in healthy children; 5.4% (95% CI: 3.1-7.7) in children recruited in hospitals and 3% (95% CI: 2.4-3.6) in children recruited in the community. Staphylococcal cassette chromosome mec type IV is the most diffused cassette globally. CONCLUSION The hospital remains the environment where the microorganism circulates most. Children with underlying conditions could act as vectors of microorganisms between the hospital and the community. MRSA prevention strategies should be tailored to each specific institution, taking into account the nosocomial prevalence of MRSA nasal colonization and infections, and the prevalence of nasal colonization in the community that refers to the specific health care center.
Collapse
|
38
|
Fritz SA, Hogan PG, Hayek G, Eisenstein KA, Rodriguez M, Krauss M, Garbutt J, Fraser VJ. Staphylococcus aureus colonization in children with community-associated Staphylococcus aureus skin infections and their household contacts. ACTA ACUST UNITED AC 2012; 166:551-7. [PMID: 22665030 DOI: 10.1001/archpediatrics.2011.900] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To measure prevalence of Staphylococcus aureus colonization in household contacts of children with acute S aureus skin and soft tissue infections (SSTI), determine risk factors for S aureus colonization in household contacts, and assess anatomic sites of S aureus colonization in patients and household contacts. DESIGN Cross-sectional study. SETTING St Louis Children's Hospital Emergency Department and ambulatory wound center and 9 community pediatric practices affiliated with a practice-based research network. PARTICIPANTS Patients with community-associated S aureus SSTI and S aureus colonization (in the nose, axilla, and/or inguinal folds) and their household contacts. OUTCOME MEASURES Colonization of household contacts of pediatric patients with S aureus colonization and SSTI. RESULTS Of 183 index patients, 112 (61%) were colonized with methicillin-resistant S aureus (MRSA); 54 (30%), with methicillin-sensitive S aureus (MSSA); and 17 (9%), with both MRSA and MSSA. Of 609 household contacts, 323 (53%) were colonized with S aureus: 115 (19%) with MRSA, 195 (32%) with MSSA, and 13 (2%) with both. Parents were more likely than other household contacts to be colonized with MRSA (odds ratio, 1.72; 95% CI, 1.12 to 2.63). Methicillin-resistant S aureus colonized the inguinal folds more frequently than MSSA (odds ratio, 1.67; 95% CI, 1.16 to 2.41), and MSSA colonized the nose more frequently than MRSA (odds ratio, 1.75; 95% CI, 1.19 to 2.56). CONCLUSIONS Household contacts of children with S aureus SSTI had a high rate of MRSA colonization compared with the general population. The inguinal fold is a prominent site of MRSA colonization, which may be an important consideration for active surveillance programs in hospitals.
Collapse
Affiliation(s)
- Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Ave., St Louis, MO 63110, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Anderson AS, Miller AA, Donald RGK, Scully IL, Nanra JS, Cooper D, Jansen KU. Development of a multicomponent Staphylococcus aureus vaccine designed to counter multiple bacterial virulence factors. Hum Vaccin Immunother 2012; 8:1585-94. [PMID: 22922765 PMCID: PMC3601133 DOI: 10.4161/hv.21872] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Staphylococcus aureus is a major cause of healthcare-associated infections and is responsible for a substantial burden of disease in hospitalized patients. Despite increasingly rigorous infection control guidelines, the prevalence and corresponding negative impact of S. aureus infections remain considerable. Difficulties in controlling S. aureus infections as well as the associated treatment costs are exacerbated by increasing rates of resistance to available antibiotics. Despite ongoing efforts over the past 20 years, no licensed S. aureus vaccine is currently available. However, learnings from past clinical failures of vaccine candidates and a better understanding of the immunopathology of S. aureus colonization and infection have aided in the design of new vaccine candidates based on multiple important bacterial pathogenesis mechanisms. This review outlines important considerations in designing a vaccine for the prevention of S. aureus disease in healthcare settings.
Collapse
|
40
|
Unwin S, Robinson I, Schmidt V, Colin C, Ford L, Humle T. Does confirmed pathogen transfer between sanctuary workers and great apes mean that reintroduction should not occur? Commentary on "Drug-resistant human Staphylococcus aureus findings in sanctuary apes and its threat to wild ape populations". Am J Primatol 2012; 74:1076-83. [PMID: 22899168 DOI: 10.1002/ajp.22069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/08/2012] [Indexed: 11/09/2022]
Abstract
This commentary discusses the findings and conclusions of the paper "Drug resistant human Staphylococcus aureus findings in sanctuary apes and its threat to wild ape populations." This paper confirms the zoonotic transfer of Staphylococcus aureus in a sanctuary setting. The assertion that this in itself is enough to reconsider the conservation potential of ape reintroduction provides an opportunity to discuss risk analysis of pathogen transmission, following IUCN guidelines, using S. aureus as an example. It is concluded that ape reintroduction projects must have disease risk mitigation strategies that include effective biosecurity protocols and pathogen surveillance. These strategies will assist with creating a well planned and executed reintroduction. This provides one way to enforce habitat protection, to minimise human encroachment and the risks from the illegal wildlife trade. Thus reintroduction must remain a useful tool in the conservation toolbox.
Collapse
Affiliation(s)
- Steve Unwin
- Animal Health Centre, Chester Zoo, Chester, United Kingdom
| | | | | | | | | | | |
Collapse
|
41
|
Tieder JS, Marks M. The best relevant articles in pediatric hospital medicine. Hosp Pediatr 2012; 2:1-7. [PMID: 24319806 DOI: 10.1542/hpeds.2011-0018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Joel S Tieder
- Department of Pediatrics, Seattle Children's Hospital and the University of Washington, Seattle, Washington, USA
| | | |
Collapse
|
42
|
Fritz SA, Hogan PG, Hayek G, Eisenstein KA, Rodriguez M, Epplin EK, Garbutt J, Fraser VJ. Household versus individual approaches to eradication of community-associated Staphylococcus aureus in children: a randomized trial. Clin Infect Dis 2011; 54:743-51. [PMID: 22198793 DOI: 10.1093/cid/cir919] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Community-associated Staphylococcus aureus infections often affect multiple members of a household. We compared 2 approaches to S. aureus eradication: decolonizing the entire household versus decolonizing the index case alone. METHODS An open-label, randomized trial enrolled 183 pediatric patients (cases) with community-onset S. aureus skin abscesses and colonization of anterior nares, axillae, or inguinal folds from 2008 to 2009 at primary and tertiary centers. Participants were randomized to decolonization of the case alone (index group) or of all household members (household group). The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily chlorhexidine body washes. Colonization of cases and subsequent skin and soft tissue infection (SSTI) in cases and household contacts were ascertained at 1, 3, 6, and 12 months. RESULTS Among 147 cases with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 50% of cases in the index group and 51% in the household group (P = 1.00). Among 126 cases completing 12-month follow-up, S. aureus was eradicated from 54% of the index group versus 66% of the household group (P = .28). Over 12 months, recurrent SSTI was reported in 72% of cases in the index group and 52% in the household group (P = .02). SSTI incidence in household contacts was significantly lower in the household versus index group during the first 6 months; this trend continued at 12 months. CONCLUSIONS Household decolonization was not more effective than individual decolonization in eradicating community-associated S. aureus carriage from cases. However, household decolonization reduced the incidence of subsequent SSTI in cases and their household contacts. CLINICAL TRIALS REGISTRATION NCT00731783.
Collapse
Affiliation(s)
- Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110, USA.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Tong SYC, Chen LF, Fowler VG. Colonization, pathogenicity, host susceptibility, and therapeutics for Staphylococcus aureus: what is the clinical relevance? Semin Immunopathol 2011; 34:185-200. [PMID: 22160374 DOI: 10.1007/s00281-011-0300-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 10/28/2011] [Indexed: 12/20/2022]
Abstract
Staphylococcus aureus is a human commensal that can also cause a broad spectrum of clinical disease. Factors associated with clinical disease are myriad and dynamic and include pathogen virulence, antimicrobial resistance, and host susceptibility. Additionally, infection control measures aimed at the environmental niches of S. aureus and therapeutic advances continue to impact upon the incidence and outcomes of staphylococcal infections. This review article focuses on the clinical relevance of advances in our understanding of staphylococcal colonization, virulence, host susceptibility, and therapeutics. Over the past decade key developments have arisen. First, rates of nosocomial methicillin-resistant S. aureus (MRSA) infections have significantly declined in many countries. Second, we have made great strides in our understanding of the molecular pathogenesis of S. aureus in general and community-associated MRSA in particular. Third, host risk factors for invasive staphylococcal infections, such as advancing age, increasing numbers of invasive medical interventions, and a growing proportion of patients with healthcare contact, remain dynamic. Finally, several new antimicrobial agents active against MRSA have become available for clinical use. Humans and S. aureus co-exist, and the dynamic interface between host, pathogen, and our attempts to influence these interactions will continue to rapidly change. Although progress has been made in the past decade, we are likely to face further surprises such as the recent waves of community-associated MRSA.
Collapse
Affiliation(s)
- Steven Y C Tong
- Division of Infectious Diseases and International Health, Duke University Medical Center, Box 102359, Durham, NC 27705, USA.
| | | | | |
Collapse
|
44
|
Risk factors for household transmission of community-associated methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2011; 30:927-32. [PMID: 21617572 DOI: 10.1097/inf.0b013e31822256c3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a community pathogen. Community-associated (CA) MRSA infections have occurred among multiple members of a household. We describe the incidence of and risk factors for MRSA colonization among household contacts of children with CA-MRSA infections. METHODS MRSA-infected children <18 years of age who lacked established healthcare-associated MRSA risk factors were identified through surveillance at 12 Minnesota hospital laboratories. Nasal swab specimens and information on medical history and hygiene behaviors were collected from case-patients and enrolled household contacts during home visits. S. aureus isolates obtained from nasal cultures were screened for oxacillin resistance. RESULTS In all, 236 households consisting of 236 case-patients and 712 household contacts were enrolled. Home visits were conducted on an average of 69 days after the onset of symptom in case-patients (range: 16-178 days). Twenty-nine (13%) case-patients and 82 (12%) household contacts had MRSA nasal colonization. Nasal MRSA colonization in ≥ 1 household contact occurred in 58 (25%) households. Household contacts who assisted the case-patient to bathe or who shared balms/ointments/lotion with the case-patient were more likely to be colonized (P < 0.01, P < 0.05), whereas those who reported using antibacterial versus nonantibacterial soap for hand washing were less likely to be colonized (P < 0.05) with MRSA clonally related to the case-patient infection isolate. CONCLUSIONS Only 13% of case-patients had MRSA nasal colonization on an average of 69 days after their initial MRSA infection. CA-MRSA colonization may be short-lived or may occur at non-nasal sites. One quarter of households had at least one household contact colonized with MRSA. Modifiable behaviors, such as sharing personal items, may contribute to transmission.
Collapse
|
45
|
Evaluation of the impact of direct plating, broth enrichment, and specimen source on recovery and diversity of methicillin-resistant Staphylococcus aureus isolates among HIV-infected outpatients. J Clin Microbiol 2011; 49:4126-30. [PMID: 21998435 DOI: 10.1128/jcm.05323-11] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We compared recovery of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) from nasal and groin swab specimens of 600 HIV-infected outpatients by selective and nonselective direct plating and broth enrichment. Swabs were collected at baseline, 6-month, and 12-month visits and cultured by direct plating to mannitol salt agar (MSA) and CHROMagar MRSA (CM) and overnight broth enrichment with subculture to MSA (broth). MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for the Panton-Valentine leukocidin. At each visit, 13 to 15% of patients were colonized with MRSA and 30 to 33% were colonized with methicillin-susceptible S. aureus (MSSA). Broth, CM, and MSA detected 95%, 82%, and 76% of MRSA-positive specimens, respectively. MRSA recovery was significantly higher from broth than CM (P ≤ 0.001) or MSA (P ≤ 0.001); there was no significant difference in recovery between MSA and CM. MSSA recovery also increased significantly when using broth than when using MSA (P ≤ 0.001). Among specimens collected from the groin, broth, CM, and MSA detected 88%, 54%, and 49% of the MRSA-positive isolates, respectively. Broth enrichment had a greater impact on recovery of MRSA from the groin than from the nose compared to both CM (P ≤ 0.001) and MSA (P ≤ 0.001). Overall, 19% of MRSA-colonized patients would have been missed with nasal swab specimen culture only. USA500/Iberian and USA300 were the most common MRSA strains recovered, and USA300 was more likely than other strain types to be recovered from the groin than from the nose (P = 0.05).
Collapse
|
46
|
Shilo N, Quach C. Pulmonary infections and community associated methicillin resistant Staphylococcus aureus: a dangerous mix? Paediatr Respir Rev 2011; 12:182-9. [PMID: 21722847 DOI: 10.1016/j.prrv.2010.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The incidence of complicated pneumonias in children is increasing with a concurrent increase in the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. CA-MRSA is distinct from hospital associated MRSA [HA-MRSA] in regards to its genotype, epidemiology, and clinical course. Unlike HA-MRSA, CA-MRSA often strikes young, previously healthy children. Pneumonias caused by CA-MRSA have a rather distinct presentation. Because of its pore-forming toxins, namely Panton-Valentine leukocidin (PVL) and alpha-hemolysin, extensive necrotizing disease with corresponding hypoxaemia and hypercarbia is common. Other features include multilobar disease, leucopenia, haemoptysis, and high mortality rates. A previous influenza-like illness or skin and soft tissue infection [SSTI] often precede the development of pneumonia due to CA-MRSA. Vancomycin is recommended as first-line empiric therapy for suspected CA-MRSA infections. However, vancomycin is not an ideal agent for the treatment of pneumonia given its poor concentrating ability in alveolar fluid. Linezolid and clindamycin have also been used in the treatment of CA-MRSA pneumonia and ongoing research is looking for alternative antimicrobials. Recent studies have continued to report a lack of correlation between nasal colonization and active infections due to CA-MRSA. Given that the role of nasal colonization in CA-MRSA infection is not clear, the utility of decolonization treatment has been a point of debate. Finally, patients with cystic fibrosis are becoming increasingly colonized with MRSA as opposed to MSSA. There is some accumulating evidence that patients with MRSA show a more rapid deterioration in their degree of obstructive disease as measured by forced expiratory volume in one second (FEV(1)). However, it still is not clear whether MRSA is a marker for worsening disease or whether it actually is a cause of disease progression in cystic fibrosis. More longitudinal data is needed to understand how MRSA colonization impacts the course of disease in cystic fibrosis.
Collapse
Affiliation(s)
- Natalie Shilo
- Division of Respirology, Department of Pediatrics, The Montreal Children’s Hospital, McGill University Health Center, McGill University, Québec, Canada
| | | |
Collapse
|
47
|
The influence of Staphylococcus aureus on gut microbial ecology in an in vitro continuous culture human colonic model system. PLoS One 2011; 6:e23227. [PMID: 21858036 PMCID: PMC3153491 DOI: 10.1371/journal.pone.0023227] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 07/13/2011] [Indexed: 01/16/2023] Open
Abstract
An anaerobic three-stage continuous culture model of the human colon (gut model), which represent different anatomical areas of the large intestine, was used to study the effect of S. aureus infection of the gut on the resident faecal microbiota. Studies on the development of the microbiota in the three vessels were performed and bacteria identified by culture independent fluorescence in situ hybridization (FISH). Furtheremore, short chain fatty acids (SCFA), as principal end products of gut bacterial metabolism, were measured along with a quantitative assessment of the predominant microbiota. During steady state conditions, numbers of S. aureus cells stabilised until they were washed out, but populations of indigenous bacteria were transiently altered; thus S. aureus was able to compromise colonisation resistance by the colonic microbiota. Furthermore, the concentration of butyric acid in the vessel representing the proximal colon was significantly decreased by infection. Thus infection by S. aureus appears to be able to alter the overall structure of the human colonic microbiota and the microbial metabolic profiles. This work provides an initial in vitro model to analyse interactions with pathogens.
Collapse
|
48
|
Golding GR, Levett PN, McDonald RR, Irvine J, Quinn B, Nsungu M, Woods S, Khan M, Ofner-Agostini M, Mulvey MR. High rates of Staphylococcus aureus USA400 infection, Northern Canada. Emerg Infect Dis 2011; 17:722-5. [PMID: 21470471 PMCID: PMC3377391 DOI: 10.3201/eid1704.100482] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Surveillance of Staphylococcus aureus infections in 3 northern remote communities of Saskatchewan was undertaken. Rates of methicillin-resistant infections were extremely high (146–482/10,000 population), and most (98.2%) were caused by USA400 strains. Although USA400 prevalence has diminished in the United States, this strain is continuing to predominate throughout many northern communities in Canada.
Collapse
|
49
|
Garber M, Alverson B, Burke M, Alverson B. Should I prescribe antibiotics after draining an abscess in a young child? Should I pack his wound? Do I prescribe decolonizing measures? Hosp Pediatr 2011; 1:56-60. [PMID: 24510931 DOI: 10.1542/hpeds.2011-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
50
|
WANINGER KEVINN, ROONEY THOMASP, MILLER JAMESE, BERBERIAN JEREMY, FUJIMOTO ALYSSA, BUTTARO BETTINAA. Community-Associated Methicillin-Resistant Staphylococcus aureus Survival on Artificial Turf Substrates. Med Sci Sports Exerc 2011; 43:779-84. [DOI: 10.1249/mss.0b013e3182006819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|