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Rashki S, Dawi EA, Zilaei MR, Safardoust-Hojaghan H, Ghanbari M, Ryadh A, Lafta HA, Khaledi A, Salavati-Niasari M. ZnO/chitosan nanocomposites as a new approach for delivery LL37 and evaluation of the inhibitory effects against biofilm-producing Methicillin-resistant Staphylococcus aureus isolated from clinical samples. Int J Biol Macromol 2023; 253:127583. [PMID: 37866577 DOI: 10.1016/j.ijbiomac.2023.127583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
Modification surface of chitosan nanoparticles using ZnO nanoparticles is important interest in drug delivery because of the beneficial properties. In this study, we proposed a chitosan/ZnO nanocomposite for the targeted delivery of antibacterial peptide (LL37). Synthesized LL37-loaded chitosan/ZnO nanocomposite (CS/ZnO/LL37-NCs) was based on the ionotropic gelation method. The antibacterial activity of the synthesized platform versus Methicillin-resistant Staphylococcus aureus (MRSA) was determined by the microdilution method in 10 mM sodium phosphate buffer. The biofilm formation inhibitory was also evaluated using microtiter plate method. In addition, the ability of CS/ZnO/LL37-NCs on the icaA gene expression level was assessed by the Real-Time PCR. The loading and release investigations confirmed the suitability of CS/ZnO-NCs for LL37 encapsulation. Results showed 6 log10 CFU/ml reduction in MRSA treated with the CS/ZnO/LL37-NPs. Moreover, CS/ZnO/LL37-NCs showed 81 % biofilm formation inhibition than LL37 alone. Also, icaA gene expression decreased 1-fold in the face of CS/ZnO/LL37-NCs. In conclusion, the modification surface of chitosan nanoparticles with ZnO nanoparticles is a suitable chemical platform for the delivery of LL37 that could be used as a promising nanocarrier for enhancing the delivery of antibacterial peptide and improving the antibacterial activity of LL37.
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Affiliation(s)
- Somaye Rashki
- Department of Microbiology, Faculty of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Elmuez A Dawi
- College of Humanities and Sciences, Department of Mathematics, and Science, Ajman University, P.O. Box 346, Ajman, UAE.
| | - Mohammad Reza Zilaei
- Department of Microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Mojgan Ghanbari
- Institute of Nano Science and Nano Technology, University of Kashan, P.O. Box 87317-51167, Kashan, Iran
| | - Abrar Ryadh
- Medical Laboratory Techniques Department, College of Techniques, Al-Mustaqbal University, 51001 Hillah, Iraq
| | - Holya A Lafta
- Medical Laboratory Techniques Department, Al-Nisour University College, Baghdad, Iraq
| | - Azad Khaledi
- Department of Microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Masoud Salavati-Niasari
- Institute of Nano Science and Nano Technology, University of Kashan, P.O. Box 87317-51167, Kashan, Iran.
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Leitão AC, Ferreira TL, Gurgel do Amaral Valente Sá L, Rodrigues DS, de Souza BO, Barbosa AD, Moreira LEA, de Andrade Neto JB, Cabral VPDF, Rios MEF, Cavalcanti BC, Silva J, Marinho ES, Dos Santos HS, de Moraes MO, Júnior HVN, da Silva CR. Antibacterial activity of menadione alone and in combination with oxacillin against methicillin-resistant Staphylococcus aureus and its impact on biofilms. J Med Microbiol 2023; 72. [PMID: 37707372 DOI: 10.1099/jmm.0.001751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Introduction. Antibiotic resistance is a major threat to public health, particularly with methicillin-resistant Staphylococcus aureus (MRSA) being a leading cause of antimicrobial resistance. To combat this problem, drug repurposing offers a promising solution for the discovery of new antibacterial agents.Hypothesis. Menadione exhibits antibacterial activity against methicillin-sensitive and methicillin-resistant S. aureus strains, both alone and in combination with oxacillin. Its primary mechanism of action involves inducing oxidative stress.Methodology. Sensitivity assays were performed using broth microdilution. The interaction between menadione, oxacillin, and antioxidants was assessed using checkerboard technique. Mechanism of action was evaluated using flow cytometry, fluorescence microscopy, and in silico analysis.Aim. The aim of this study was to evaluate the in vitro antibacterial potential of menadione against planktonic and biofilm forms of methicillin-sensitive and resistant S. aureus strains. It also examined its role as a modulator of oxacillin activity and investigated the mechanism of action involved in its activity.Results. Menadione showed antibacterial activity against planktonic cells at concentrations ranging from 2 to 32 µg ml-1, with bacteriostatic action. When combined with oxacillin, it exhibited an additive and synergistic effect against the tested strains. Menadione also demonstrated antibiofilm activity at subinhibitory concentrations and effectively combated biofilms with reduced sensitivity to oxacillin alone. Its mechanism of action involves the production of reactive oxygen species (ROS) and DNA damage. It also showed interactions with important targets, such as DNA gyrase and dehydroesqualene synthase. The presence of ascorbic acid reversed its effects.Conclusion. Menadione exhibited antibacterial and antibiofilm activity against MRSA strains, suggesting its potential as an adjunct in the treatment of S. aureus infections. The main mechanism of action involves the production of ROS, which subsequently leads to DNA damage. Additionally, the activity of menadione can be complemented by its interaction with important virulence targets.
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Affiliation(s)
- Amanda Cavalcante Leitão
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Thais Lima Ferreira
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Lívia Gurgel do Amaral Valente Sá
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
- Christus University Center, Fortaleza, CE, Brazil
| | - Daniel Sampaio Rodrigues
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Beatriz Oliveira de Souza
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Amanda Dias Barbosa
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Lara Elloyse Almeida Moreira
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | | | - Vitória Pessoa de Farias Cabral
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | | | | | - Jacilene Silva
- Department of Chemistry, Theoretical Chemistry and Electrochemistry Group (GQTE), State University of Ceará, Limoeiro do Norte, CE, Brazil
| | - Emmanuel Silva Marinho
- Department of Chemistry, Theoretical Chemistry and Electrochemistry Group (GQTE), State University of Ceará, Limoeiro do Norte, CE, Brazil
| | - Hélcio Silva Dos Santos
- Center for Exact Sciences and Technology, Acaraú Valley State University, Sobral, CE, Brazil
| | | | - Hélio Vitoriano Nobre Júnior
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Cecília Rocha da Silva
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
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Adesida SA, Iyebeye MI, Aina OO, Peters RF, Ezeaku CC, Amosun EA. Chemical composition and healing potential of essential oil of Dennettia tripetala on methicillin-resistant Staphylococcus aureus: infected wound model. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022. [DOI: 10.1186/s43088-022-00272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Dennettia tripetala (Pepperfruit) is an important medicinal plant in some West African communities. This study was designed to examine the antibacterial properties and wound-healing abilities of D. tripetala essential oil on mice with methicillin-resistant Staphylococcus aureus (MRSA) infections. Gas chromatography-mass spectrometry (GC–MS) was used to analyse the essential oil (EO) extracted by hydro-distillation from the dried fruits of D. tripetala. MRSA was identified using 30 µg cefoxitin disk, CHROMagar, and Polymerase Chain Reaction. Congo red agar and tube technique were used to assess the production of biofilms. The antimicrobial susceptibility for both antibiotics and essential oil was determined by Kirby Bauer and broth dilution methods. Eleven male mice were used in the invivo study, and each animal had wound infection on the dorsal inter-scapular skin region created with a 6 mm biopsy punch and 50 μl (adjusted to 0.5 McFarland standard) of MRSA. The size of the wound and its histological characteristics were used to estimate healing rate.
Results
The GC–MS investigation of the essential oil revealed six compounds, with benzene (2-nitroethyl) being the most prominent. Out of the eighteen (18) isolates examined, 12 MRSA strains were identified using the three methods for methicillin resistance determination, with about 80% of them being classified as biofilm producers. More than 60% of the MRSA isolates were resistant to erythromycin, fusidic acid, gentamicin and trimethoprim/sulfamethoxazole. The essential oil had greater antibacterial activity than the reference antibiotic, vancomycin. The essential oil had a minimum inhibitory concentration of 80 l/ml and a minimum bactericidal concentration of 160 l/ml (v/v). Haematoxylin and eosin staining revealed that the skin tissue that had been exposed to D. tripetala essential oil had a thicker epithelial layer, numerous fibroblasts, a build-up of collagen, and many blood cells.
Conclusions
The results showed that D. tripetala essential oil has powerful anti-staphylococcal properties as well as the capacity to expedite wound healing. This suggests that D. tripetala essential oil could be a successful candidate for developing a topical agent for wound management.
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de Oliveira DM, de Oliveira DBC, Nunes YRF, de Almeida Alves TM, Kohlhoff M, Andrade AA, Cota BB. Natural Occurring Phenolic Derivatives from Mauritia flexuosa (Buriti) Stems and Their Potential Antibacterial Activity against Methicillin-Resistant Staphylococcus aureus (MRSA). Chem Biodivers 2022; 19:e202100788. [PMID: 35146890 DOI: 10.1002/cbdv.202100788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/13/2022] [Indexed: 11/12/2022]
Abstract
Mauritia flexuosa Linnaeus filius (buriti or aguage; Arecaceae) is a palm used by traditional medicine in Brazil to treat dysentery and diarrhea. Our group showed that the soluble dichloromethane (CH2 Cl2 ) fraction from EtOH extract from M. flexuosa stems inhibited the growth of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) and it is rich in phenolic compounds. This study aimed to isolate new phenolic compounds from CH2 Cl2 fraction from M. flexuosa stems with in vitro antibacterial activity. The crude CH2 Cl2 fraction was fractionated by gel permeation chromatography (GPC) followed by semi-preparative RP-HPLC. The antibacterial activity was evaluated using the broth microdilution method against MSSA (ATCC 29213) and MRSA (clinical isolate 155). All compounds were also tested against Gram-negative (Escherichia coli; ATCC 35218) bacteria and two fungi species (Candida albicans; ATCC 14053 and Trichophyton rubrum; ATCC MYA 4438). The chemical structures of isolated compounds were determined by analysis and comparison with literature data of their NMR and HRMS spectra and optical activity. The chemical investigation yielded seven aromatic compounds, of which four, (2S,15S)-2,15-dimethyl-2,15-dioxa-1,8(1,4)-dibenzenacyclotetradecaphane (1), (2S,5S)-1-(4-hydroxyphenyl)hexane-2,5-diol (3), bruguierol E (4), and buritin (5) were previously unreported and three are known compounds identified as 6-(4'-hydroxyphenyl) hexan-2-one (2), (+)-(2R,3R)-dihydrokaempferol (6), and (+)-(2R)-naringenin (7). Compounds 1 and 7 showed antibacterial activity against MRSA and MSSA with minimum inhibitory concentrations (MICs) of between 62.5 and 31.3 μg/mL, respectively. Our preliminary findings support that CH2 Cl2 fraction from buriti, a typical species of flooded areas of Brazilian savanna, and its aromatic phenolic compounds are active against MSSA and MRSA contributing with understanding about the traditional use of this species.
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Affiliation(s)
- Djalma Menezes de Oliveira
- Department of Science and Technology, State University of Bahia Southwest, José Moreira Sobrinho Avenue, 45206-191, Jequié, Bahia, Brazil
| | - Diego Batista Carneiro de Oliveira
- Laboratory of Microbiology, Federal University of Triângulo Mineiro, Pça Manoel Terra, 330, Abadia, 38025-015, Uberaba, Minas Gerais, Brazil
| | - Yule Roberta Ferreira Nunes
- Ecology Laboratory and Plant Propagation, Department of General Biology, Estadual University of Montes Claros, University Campus Prof. Darcy Ribeiro, 39401-089, Montes Claros, Minas Gerais, Brazil
| | - Tânia Maria de Almeida Alves
- Laboratory of Chemistry Bioactive Natural Products, René Rachou Institute, Oswaldo Cruz Foundation, Augusto de Lima Avenue, 1715, Barro Preto, 30190-002, Belo Horizonte, Minas Gerais, Brazil
| | - Markus Kohlhoff
- Laboratory of Chemistry Bioactive Natural Products, René Rachou Institute, Oswaldo Cruz Foundation, Augusto de Lima Avenue, 1715, Barro Preto, 30190-002, Belo Horizonte, Minas Gerais, Brazil
| | - Anderson Assunção Andrade
- Laboratory of Microbiology, Federal University of Triângulo Mineiro, Pça Manoel Terra, 330, Abadia, 38025-015, Uberaba, Minas Gerais, Brazil
| | - Betania Barros Cota
- Laboratory of Chemistry Bioactive Natural Products, René Rachou Institute, Oswaldo Cruz Foundation, Augusto de Lima Avenue, 1715, Barro Preto, 30190-002, Belo Horizonte, Minas Gerais, Brazil
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Wangoye K, Mwesigye J, Tungotyo M, Twinomujuni Samba S. Chronic wound isolates and their minimum inhibitory concentrations against third generation cephalosporins at a tertiary hospital in Uganda. Sci Rep 2022; 12:1195. [PMID: 35075152 PMCID: PMC8786920 DOI: 10.1038/s41598-021-04722-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023] Open
Abstract
Globally, the burden of chronic wound infections is likely to increase due to the rising levels of bacterial resistance to antibiotics. In the United States of America alone, more than 6.5 million chronic wounds with evidence of bacterial infection are diagnosed every year. In addition, the polymicrobial environment in chronic wound infections has been observed from several studies as a risk factor for development of resistance to many antibiotics including the third generation cephalosporins currently used in Mbarara Regional Referral Hospital for treatment of chronic wound infections. Therefore the main objective of this study was to determine the prevalence of chronic wound isolates and their minimum inhibitory concentrations (MIC) against third generation cephalosporins. This study was a cross-sectional descriptive and analytical survey of bacterial isolates from chronic wound infection among 75 study participants admitted in the surgical ward of Mbarara Regional Referral Hospital (MRRH), a tertiary Hospital in Western Uganda. Standard laboratory bacterial culture and identification techniques as well as broth microdilution method were used to isolate, identify pathogens and test for MIC respectively. We found that 69/75 study participants had samples with bacterial growth and the most prevalent pathogens isolated were staphylococcus aureus (40.6%) and Klebsiella spp. (29%). Generally, most isolates were susceptible to cefoperazone + sulbactum 2 g (Sulcef) and ceftriaxone 1 g (Epicephin). The overall prevalence of isolates in chronic wound infection among patients admitted in the surgical ward of MRRH was 92% and the most prevalent isolates were Staphylococcus aureus, Klebsiella species and proteus species respectively. The observed MIC values were higher than the CLSI clinical breakpoint, implying a decreasing trend in susceptibility of chronic wound isolates to third generation cephalosporins.
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Affiliation(s)
- Khalim Wangoye
- Department of Pharmacy and Pharmacology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - James Mwesigye
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Martin Tungotyo
- Department of Surgery, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Silvano Twinomujuni Samba
- Department of Pharmacy and Pharmacology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Salvador BC, Lucchetta RC, Sarti FM, Ferreira FF, Tuesta EF, Riveros BS, Nogueira KS, Almeida BMM, Borba HHL, Wiens A. Cost-Effectiveness of Molecular Method Diagnostic for Rapid Detection of Antibiotic-Resistant Bacteria. Value Health Reg Issues 2021; 27:12-20. [PMID: 34784543 DOI: 10.1016/j.vhri.2021.07.009] [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: 11/12/2020] [Revised: 05/18/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to perform a cost-effectiveness analysis (CEA) of the molecular diagnostic method (MM) associated with conventional diagnostic method (CM) compared with the CM alone, for the detection of resistant profile in bacteremia, from the perspective of the Brazilian Public Health System, in intensive care units setting. METHODS The clinical parameters regarding methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Gram-negative bacteria (CRGNB), and vancomycin-resistant Enterococcus spp. (VRE) infections were collected from searches on PubMed, Scopus, and SciELO, using specific keywords. Data on direct medical costs to treat these infections were collected according to Brazilian Public Health System perspective from Brazilian databases, in tables of 2018 to 2019. CEA was performed after building a dynamic model, which was calibrated and validated according to international recommendations. The incremental cost-effectiveness ratio of the MM + CM compared with the CM was calculated using the outcomes "avoided death" and "avoided resistant infections." One-way sensitivity analyses were performed. RESULTS This CEA demonstrated that the MM + CM was dominant in all scenarios. Estimates showed that for MRSA, CRGNB, and VRE infections, every avoided death would lead to savings of Brazilian real (R$) 4.9 million ($937 301), R$2.2 million ($419 899), and R$1.3 million ($248 919), respectively. The same infections assessed by avoided resistant infections savings were projected to be R$24 964 ($4686), R$40 260 ($7558), and R$23 867 ($4480). CONCLUSIONS MM leads to cost reduction and increased benefits, optimizing the use of financial resources on the health system in the intensive care unit setting, in bacteremia caused by MRSA, CRGNB, and VRE.
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Affiliation(s)
- Bianca C Salvador
- Department of Pharmacy, Federal University of Parana, Curitiba, Parana, Brazil
| | - Rosa C Lucchetta
- Department of Pharmacy, Federal University of Parana, Curitiba, Parana, Brazil
| | - Flávia M Sarti
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fernando F Ferreira
- Department of Physics, School of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Esteban F Tuesta
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Keite S Nogueira
- Bacteriology Laboratory, Department of Pathology, Clinical Hospital, Federal University of Parana, Curitiba, Parana, Brazil
| | - Bernardo M M Almeida
- Hospital Epidemiology Service, Clinical Hospital, Federal University of Parana, Curitiba, Parana, Brazil
| | - Helena H L Borba
- Department of Pharmacy, Federal University of Parana, Curitiba, Parana, Brazil
| | - Astrid Wiens
- Department of Pharmacy, Federal University of Parana, Curitiba, Parana, Brazil.
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Insights into the epidemiology of community-associated methicillin-resistant Staphylococcus aureus in special populations and at the community-healthcare interface. Braz J Infect Dis 2021; 25:101636. [PMID: 34672988 PMCID: PMC9392173 DOI: 10.1016/j.bjid.2021.101636] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
The current epidemic proportions of infections caused by Staphylococcus aureus strains and especially by methicillin-resistant S. aureus (MRSA) are one of today's many threats to global public health, particularly in underdeveloped countries where significant gaps on the subject exist. The rapid spread and diversification of pandemic clones that exhibit remarkably increasing virulence and antimicrobial resistance pose a risk to the effective prevention and treatment of a wide range of infections. Undoubtedly, the remarkable versatility involving the pathogenesis and resistance of these bacteria is perpetuated through geographic and temporal factors inherent to clonal evolution and is reflected in the dramatic epidemiological changes of MRSA which, after decades prevailing in healthcare settings, have emerged in the community. Denominated community-associated [CA]-MRSA, these strains are particularly prevalent in some population groups, facilitating the spread of successful clones that are potentially capable of triggering severe community-acquired infections. Therefore, a broad approach to local epidemiological aspects in less studied regions, but nonetheless at latent risk of endemic spread that may reach global proportions, is necessary. In Brazil, despite limited molecular epidemiology data, CA-MRSA strains predominantly characterized as SCCmec IV, often classified as CC30-ST30, CC5-ST5 and CC8-ST8, seem to be spreading across different population groups in different regions of the country. Another important fact addressed in this review is the identification of the ST398-MRSA-IV/V clone and methicillin-susceptible S. aureus (MSSA) in healthy individuals from the community. Although susceptible to methicillin, the ST398 clone is associated with severe infections in humans and animals, denominated livestock-associated MRSA. It is therefore important to encourage assertive actions by all government sectors and by society, with a reassessment of current public health measures in light of the new perspectives arising from the scientific and epidemiological data on MRSA.
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Suarez Carneiro MAM, Silva LDS, Diniz RM, Saminez WFDS, Oliveira PVD, Pereira Mendonça JS, Colasso AHM, Soeiro Silva IS, Jandú JJB, Sá JCD, Figueiredo CSSES, Correia MTDS, Nascimento da Silva LC. Immunomodulatory and anti-infective effects of Cratylia mollis lectin (Cramoll) in a model of wound infection induced by Staphylococcus aureus. Int Immunopharmacol 2021; 100:108094. [PMID: 34508942 DOI: 10.1016/j.intimp.2021.108094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022]
Abstract
This work evaluated the immunomodulatory and anti-infective effects of Cratylia mollis lectin (Cramoll) in a model of wound infection induced by S. aureus. Swiss mice were divided into 3 groups (n = 12/group): non-inoculated (Control group); inoculated with S. aureus (Sa group); inoculated with S. aureus and treated with Cramoll (Sa + Cramoll group). In each animal, one lesion (64 mm2) was induced on the back and contaminated with S. aureus (~4.0 × 106 CFU/wound). The treatment with Cramoll (5 μg/animal/day) started 1-day post-infection (dpi) and extended for 10 days. Clinical parameters (wound size, inflammatory aspects, etc.) were daily recorded; while cytokines levels, bacterial load and histological aspects were determined in the cutaneous tissue at 4th dpi or 11th dpi. The mice infected with S. aureus exhibited a delay in wound contraction and the highest inflammatory scores. These effects were impaired by the treatment with Cramoll which reduced the release of key inflammatory mediators (TNF-α, NO, VEGF) and the bacterial load at wound tissue. Histological evaluations showed a restauration of skin structures in the animals treated with Cramoll. Taken together, these results provide more insights about the healing and immunomodulatory properties of Cramoll and suggest this lectin as a lead compound for treatment of wound infection.
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Affiliation(s)
| | - Lucas Dos Santos Silva
- Laboratório de Patogenicidade Microbiana, Universidade Ceuma, 65075-120 São Luís, MA, Brazil
| | - Roseana Muniz Diniz
- Laboratório de Patogenicidade Microbiana, Universidade Ceuma, 65075-120 São Luís, MA, Brazil
| | | | | | | | | | | | - Jannyson José Braz Jandú
- Laboratório de Bioquímica de Proteínas, Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, 50740-570 Recife, Brazil
| | - Joicy Cortez de Sá
- Laboratório de Patogenicidade Microbiana, Universidade Ceuma, 65075-120 São Luís, MA, Brazil
| | | | - Maria Tereza Dos Santos Correia
- Laboratório de Bioquímica de Proteínas, Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, 50740-570 Recife, Brazil
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Goes ICRDS, Romero LC, Turra AJ, Gotardi MA, Rodrigues TFSDO, Santos LDO, Dores JCD, Nascimento MUD, Cavalleri AC, Pinheiro-Hubinger L, Eller LKW, Pereira VC. Prevalence of nasal carriers of methicillin-resistant Staphylococcus aureus in primary health care units in Brazil. Rev Inst Med Trop Sao Paulo 2021; 63:e14. [PMID: 33656137 PMCID: PMC7924983 DOI: 10.1590/s1678-9946202163014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/21/2021] [Indexed: 11/22/2022] Open
Abstract
Nasal carriage of Staphylococcus aureus by healthcare workers is of great clinical importance as it facilitates the contamination of medical devices and cross-transmission. However, studies regarding the epidemiology and dissemination of S. aureus and Methicillin-resistant S. aureus (MRSA) within the Primary Health Care in Brazil are scarce. The current study aimed to detect and characterize S. aureus and MRSA strains from the nasal cavities of 63 healthcare working in primary health care units in order to determine the prevalence of S. aureus and MRSA, biofilm formation and resistance profile of these isolates. PCR reactions were performed for detecting mecA, icaA and icaD genes. The phenotypic antimicrobial susceptibility was assessed by the disk diffusion method and biofilm formation by the Congo Red Agar (CRA) method. The MRSA isolates were typed for the Staphylococcal Cassette Chromosome mec (SCCmec). The prevalence of nasal carriage of S. aureus was 74.6%, of which 72.3% were MRSA carrying SCCmec type I (24.4%), III (34.1%), IV (36.6%). Two (4.9%) isolates presented a non-typeable cassette by the performed technique. The antimicrobial susceptibility evaluation evidenced penicillin resistance in 66.1% of S. aureus, erythromycin resistance in 49.2%, while 37.3% were resistant to oxacillin, 28.8% to cefoxitin, 5.1% to levofloxacin and 5.1% to clindamycin. All isolates were biofilm producers and 96.6% of the strains contained the ica biofilm-forming genes (icaA and/or icaD). We have demonstrated a high prevalence of S. aureus and MRSA carriage among health care working in Primary Health Care units, the presence of SCCmec types I, III and IV, in addition to their high ability to form biofilm, factors that possibly contribute to the dissemination and persistence of these pathogens within the primary care services. These observations highlight the importance of broadening the perspective of Health Care-Associated Infections prevention, including all health care levels, which are currently little explored. In addition, the dynamics and resistance mechanisms of S. aureus transmission still need to be further clarified to enable the implementation of more effective prevention measures.
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Affiliation(s)
| | - Letícia Calixto Romero
- Universidade Estadual Paulista, Departamento de Ciências Químicas e Biológicas, Botucatu, São Paulo, Brazil
| | - Ana Julia Turra
- Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil
| | | | | | | | | | | | | | - Luiza Pinheiro-Hubinger
- Universidade Estadual Paulista, Departamento de Ciências Químicas e Biológicas, Botucatu, São Paulo, Brazil
- Instituto Lauro de Souza Lima, Departamento de Patologia, Bauru, São Paulo, Brazil
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10
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Teixeira NB, Castelo Branco Fortaleza CM, de Souza MC, Monteiro Pereira TA, de Camargo Colenci BP, Ribeiro de Souza da Cunha MDL. Molecular characterization of methicillin-resistant Staphylococcus aureus among insulin-dependent diabetic individuals in Brazil. Ann Clin Microbiol Antimicrob 2021; 20:12. [PMID: 33568148 PMCID: PMC7876813 DOI: 10.1186/s12941-020-00401-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with diabetes mellitus, especially insulin-dependent diabetic patients, are a risk group for staphylococcal infections. Asymptomatic infection with Staphylococcus aureus is common and favors dissemination of the microorganism, rendering these individuals a source of infection. This study aimed to characterize the resistance profile, clonal profile and sequence type, as well as to analyze the prevalence and risk factors for nasal and oropharyngeal carriage of methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) isolated from insulin-dependent diabetic individuals in the city of Botucatu, SP, Brazil. METHODS Staphylococcus aureus was collected from the nasopharynx and oropharynx of 312 community-dwelling insulin-dependent diabetic individuals over a period of 3 years (October 2015 to December 2018). The isolates were characterized by susceptibility profiling, detection of the mecA gene, SCCmec typing, and molecular typing by PFGE and MLST. The risk factors associated with S. aureus and MRSA carriage were determined by logistic regression analysis. RESULTS The overall prevalence of colonization with S. aureus and MRSA was 30.4% and 4.8%, respectively. Fifteen of the 112 S. aureus isolates carried the mecA gene; SCCmec type IV was identified in 10 isolates, SCCmec type I in three, and SCCmec type II in two. Among the 15 resistant isolates (MRSA), four were susceptible to oxacillin/cefoxitin by the disc diffusion method and one MSSA isolate was resistant to sulfamethoxazole/trimethoprim. The analysis of risk factors revealed a protective effect of age and lung disease, while lower-extremity ulcers were a risk factor for S. aureus. For MRSA, only male gender was significantly associated as a risk factor in multivariate analysis. Clonal profile analysis demonstrated the formation of clusters among MRSA isolates from different patients, with the identification of ST5-IV, ST5-I, and ST8-IV. Isolates carrying ST398 were identified among MSSA and MRSA (ST398-IV). CONCLUSION Our findings reinforce the importance of epidemiological studies of S. aureus carriage, especially in populations at high risk of infections such as diabetics. The data suggest widespread dissemination of MRSA in the population of insulin-dependent diabetic patients studied, as well as the emergence of important lineages among these individuals.
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Affiliation(s)
- Nathalia Bibiana Teixeira
- Departamento de Infectologia, Dermatologia, Diagnóstico Por Imagem e Radioterapia, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.
- Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.
- Departamento de Ciências Químicas e Biológicas - Setor Microbiologia e Imunologia, Instituto de Biociências de Botucatu (IBB)-Laboratório de Bacteriologia. Rua Plínio Silva, CEP: 18618-970 - Distrito de Rubião Júnior, Botucatu, SP, Brasil.
| | - Carlos Magno Castelo Branco Fortaleza
- Departamento de Infectologia, Dermatologia, Diagnóstico Por Imagem e Radioterapia, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Matheus Cristovam de Souza
- Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Thais Aline Monteiro Pereira
- Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Bibiana Prada de Camargo Colenci
- Departamento de Clínica Médica - Endocrinologia, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Maria de Lourdes Ribeiro de Souza da Cunha
- Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
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11
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Leme RCP, Bispo PJM, Salles MJ. Community-genotype methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Latin America: a systematic review. Braz J Infect Dis 2021; 25:101539. [PMID: 33607082 PMCID: PMC9392117 DOI: 10.1016/j.bjid.2021.101539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/07/2020] [Accepted: 12/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) emerged in the 1990s as a global community pathogen primarily involved in skin and soft tissue infections (SSTIs) and pneumonia. To date, the CG-MRSA SSTI burden in Latin America (LA) has not been assessed. OBJECTIVE The main objective of this study was to report the rate and genotypes of community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) causing community-onset skin and soft tissue infections (CO-SSTIs) in LA over the last two decades. In addition, this research determined relevant data related to SSTIs due to CG-MRSA, including risk factors, other invasive diseases, and mortality. DATA SOURCES Relevant literature was searched and extracted from five major databases: Embase, PubMed, LILACS, SciELO, and Web of Science. METHODS A systematic review was performed, and a narrative review was constructed. RESULTS An analysis of 11 studies identified epidemiological data across LA, with Argentina presenting the highest percentage of SSTIs caused by CG-MRSA (88%). Other countries had rates of CG-MRSA infection ranging from 0 to 51%. Brazil had one of the lowest rates of CG-MRSA SSTI (4.5-25%). In Argentina, being younger than 50 years of age and having purulent lesions were predictive factors for CG-MRSA CO-SSTIs. In addition, the predominant genetic lineages in LA belonged to sequence types 8, 30, and 5 (ST8, ST30, and ST5). CONCLUSION There are significant regional differences in the rates of CG-MRSA causing CO-SSTIs. It is not possible to conclude whether or not CG-MRSA CO-SSTIs resulted in more severe SSTI presentations or in a higher mortality rate.
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Affiliation(s)
- Rodrigo Cuiabano Paes Leme
- Universidade Federal de São Paulo (UNIFESP), Departamento de Doenças Infecciosas, Laboratório Especial de Microbiologia Clínica (LEMC), São Paulo, SP, Brazil.
| | - Paulo José Martins Bispo
- Harvard Medical School, Infectious Diseases Institute, Department of Ophthalmology, Massachusetts, United States
| | - Mauro José Salles
- Universidade Federal de São Paulo (UNIFESP), Departamento de Doenças Infecciosas, Laboratório Especial de Microbiologia Clínica (LEMC), São Paulo, SP, Brazil; Santa Casa de São Paulo, Faculdade de Ciências Médicas, São Paulo, SP, Brazil
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12
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Maloney SE, McGrath KV, Ahonen MJR, Soliman DS, Feura ES, Hall HR, Wallet SM, Maile R, Schoenfisch MH. Nitric Oxide-Releasing Hyaluronic Acid as an Antibacterial Agent for Wound Therapy. Biomacromolecules 2020; 22:867-879. [PMID: 33372774 DOI: 10.1021/acs.biomac.0c01583] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Taking advantage of their respective wound-healing roles in physiology, the dual activity of hyaluronic acid (HA) and nitric oxide (NO) was combined to create a single-agent wound therapeutic. Carboxylic acid groups of HA (6 and 90 kDa) were chemically modified with a series of alkylamines via carbodiimide chemistry to provide secondary amines for subsequent N-diazeniumdiolate NO donor formation. The resulting NO-releasing HA derivatives stored 0.3-0.6 μmol NO mg-1 and displayed diverse release kinetics (5-75 min NO-release half-lives) under physiological conditions. The 6 kDa HA with terminal primary amines and intermediate release kinetics exhibited broad-spectrum bactericidal activity against common wound pathogens, including planktonic methicillin-resistant Staphylococcus aureus as well as planktonic and biofilm-based multidrug-resistant Pseudomonas aeruginosa. The treatment of infected murine wounds with NO-releasing HA facilitated more rapid wound closure and decreased the quantity of the P. aeruginosa genetic material in the remaining wound tissue. Hyaluronidase readily degraded the HA derivatives, indicating that NO donor modification did not prohibit endogenous biodegradation pathways.
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Affiliation(s)
- Sara E Maloney
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Kyle V McGrath
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Mona Jasmine R Ahonen
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Daniel S Soliman
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Evan S Feura
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Hannah R Hall
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Shannon M Wallet
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States.,Division of Oral, Craniofacial, and Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Robert Maile
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States.,Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States.,North Carolina Jaycee Burn Center Research Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Mark H Schoenfisch
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States.,Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
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13
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The History of Methicillin-Resistant Staphylococcus aureus in Brazil. ACTA ACUST UNITED AC 2020; 2020:1721936. [PMID: 33082892 PMCID: PMC7563066 DOI: 10.1155/2020/1721936] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/21/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022]
Abstract
Since the emergence of MRSA in the 1960s, a gradual increase in infections by resistant bacteria has been observed. Clinical manifestations may vary from brand to critical condition due to host risk factors, as well as pathogen virulence and resistance. The high adaptability and pathogenic profile of MRSA clones contributed to its spread in hospital and community settings. In Brazil, the first MRSA isolates were reported in the late 1980s, and since then different genetic profiles, such as the Brazilian epidemic clone (BEC) and other clones considered a pandemic, became endemic in the Brazilian population. Additionally, Brazil's MRSA clones were shown to be able to transfer genes involved in multidrug resistance and enhanced pathogenic properties. These events contributed to the rise of highly resistant and pathogenic MRSA. In this review, we present the main events which compose the history of MRSA in Brazil, including numbers and locations of isolation, as well as types of staphylococcal cassette chromosome mec (SCCmec) found in the Brazilian territory.
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Effect of manuka honey on biofilm-associated genes expression during methicillin-resistant Staphylococcus aureus biofilm formation. Sci Rep 2020; 10:13552. [PMID: 32782291 PMCID: PMC7419495 DOI: 10.1038/s41598-020-70666-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) are among the most important biofilm-forming pathogens responsible for hard-to-treat infections. Looking for alternatives to antibiotics that prevent biofilm formation, we investigated the effects of manuka honey on the transcriptional profile of genes essential for staphylococcal biofilm formation using qRT-PCR. mRNA from two hospital MRSA strains (strong and weak biofilm producer) were isolated after 4, 8, 12 and 24 h from cells grown in biofilm. Manuka honey at 1/2 minimum biofilm inhibition concentration (MBIC) significantly reduced MRSA cell viability in biofilm. Manuka honey downregulated the genes encoding laminin- (eno), elastin- (ebps) and fibrinogen binding protein (fib), and icaA and icaD involved in biosynthesis of polysaccharide intercellular adhesin in both weakly and strongly adhering strain compared to the control (untreated biofilm). Expression levels of cna (collagen binding protein) and map/eap (extracellular adherence protein—Eap) were reduced in weakly adhering strain. The lowest expression of investigated genes was observed after 12 h of manuka honey treatment at 1/2 MBIC. This study showed that the previously unknown mechanism of manuka honey action involved inhibition of S. aureus adhesion due to reduction in expression of crucial genes associated with staphylococcal biofilm.
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15
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Ozdamar M. Nasal colonization with methicillin-resistant Staphylococcus aureus at admission among high-risk Turkish and international patients. Acta Microbiol Immunol Hung 2020; 67:73-78. [PMID: 32160784 DOI: 10.1556/030.2020.01081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/03/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to detect the frequency of methicillin-resistant Staphylococcus aureus (MRSA) colonization at admission in a group of presumably high-risk international or Turkish patients referred to our center for elective operations, some of whom were from countries with an unknown prevalence of MRSA infection or colonization. METHODS The results of nasal swab screening for MRSA colonization performed using a specific algorithm between 2011 and 2018 in a private medical center were retrospectively reviewed. Presence of MRSA was ascertained using culture and/or real-time polymerase chain reaction (real-time PCR). RESULTS A total of 3,795 patients were included in the study. More than half of the patients were ≤19 years of age (2,094, 55.2%), and MRSA positivity was more common among these patients. Turkish patients constituted 24.5% of the study population. International patients were most frequently referred from Iraq (55.92%), Libya (11.44%), Romania (2.69%), and Bulgaria (1.98%). MRSA positivity was significantly more common among patients referred from other countries when compared to Turkish nationals (11.5% vs. 4.4%, P = 0.00001). Countries with the highest prevalence rates of MRSA colonization were as follows with decreasing order: United Arab Emirates, 25.0%; Georgia, 23.1%; Russia, 22.7%; Iraq, 13.0%, Romania, 12.7%. Other countries with high number of admitted patients (>70 patients) had the following MRSA rates: Turkey, 4.4%; Libya, 6.0%; Bulgaria, 5.3%. CONCLUSIONS Although MRSA has a low prevalence in our center, a variation in the rate of MRSA positivity was observed across patients from different countries. Absence hospital acquired contamination or outbreaks in our institution may be attributed to the screening algorithm used and underscores the importance of risk analysis for patients referred from geographical locations with unknown MRSA frequency, to reduce the risk of transmission.
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16
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Pereira-Franchi EPL, Barreira MRN, da Costa NDSLM, Riboli DFM, Abraão LM, Martins KB, Victória C, Cunha MDLRDSD. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in the Brazilian primary health care system. Trop Med Int Health 2019; 24:339-347. [PMID: 30549385 DOI: 10.1111/tmi.13192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the molecular epidemiology and to georeference Staphylococcus aureus isolated from wounds and nares of patients seen at Basic Health Units (BHUs) of a Brazilian city. METHODS Observational, cross-sectional study conducted from 2010 to 2013. A total of 119 S. aureus strains isolated from the wounds and nares of 88 patients were studied. The isolates were characterised by identifying virulence genes encoding enterotoxins A-E, haemolysins α, β and δ, exfoliatins A, B and D, biofilm production, Panton-Valentine Leukocidin and toxic shock syndrome toxin 1, and by pulsed-field gel electrophoresis (PFGE), multilocus sequence and spa typing. RESULTS Eighteen methicillin-resistant Staphylococcus aureus (MRSA) (6 SCCmec type II and 12 SCCmec type IV) and 101 (85%) MSSA were identified. PFGE typing resulted in the formation of eight clusters, with STs 1, 5, 8, 30, 188, 1176 and 1635 and spa type t002 being the predominant types among MSSA. The 18 MRSA belonged to STs 5, 8 and 1176 and spa types t002 and t062. CONCLUSION The results demonstrate widespread dissemination of MSSA and MRSA clones carrying haemolysin, biofilm and toxin genes. Kernel density estimation revealed the highest density of S. aureus in the 4, 5 and 8 BHUs.
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Affiliation(s)
- Eliane Patricia Lino Pereira-Franchi
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Maria Rachel Nogueira Barreira
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Natália de Sousa Lima Moreira da Costa
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Danilo Flávio Moraes Riboli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Ligia Maria Abraão
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil.,Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Katheryne Benini Martins
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
| | - Cassiano Victória
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinaria e Zootecnia, Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Botucatu, Brazil
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Paternina-de la Ossa R, Prado SID, Cervi MC, Lima DAFDS, Martinez R, Bellissimo-Rodrigues F. Is community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) an emerging pathogen among children in Brazil? Braz J Infect Dis 2018; 22:371-376. [PMID: 30389351 PMCID: PMC9428034 DOI: 10.1016/j.bjid.2018.10.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022] Open
Abstract
Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil. Objective To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital. Methods This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients’ medical records. Results We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54–5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16–22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013). Conclusions CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections.
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Affiliation(s)
- Rolando Paternina-de la Ossa
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Seila Israel do Prado
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil; Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Comissão de Controle de Infecção Hospitalar, Ribeirão Preto, SP, Brazil
| | - Maria Célia Cervi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | | | - Roberto Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clinica Médica, Ribeirão Preto, SP, Brazil
| | - Fernando Bellissimo-Rodrigues
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Comissão de Controle de Infecção Hospitalar, Ribeirão Preto, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Social, Ribeirão Preto, SP, Brazil.
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