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Chang JW, Kuo FC, Lin TC, Chin TW, Yang LY, Chen HH, Fan YH, Yang HH, Liu CS, Tsai HL. Long-term complications and outcomes of augmentation cystoplasty in children with neurogenic bladder. Sci Rep 2024; 14:4214. [PMID: 38378755 PMCID: PMC10879155 DOI: 10.1038/s41598-024-54431-z] [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: 11/08/2023] [Accepted: 02/13/2024] [Indexed: 02/22/2024] Open
Abstract
Augmentation cystoplasty (AC) is an effective surgical procedure for patients with neurogenic bladder whenever conservative treatments have failed. The present study aimed to determine the risks of metabolic complications, malignancy, long-term outcomes and histopathologic changes of native bladder and the augmented intestine after AC in children with neurogenic bladder. Pediatric patients < 18 years who underwent AC between 2000 and 2020 were enrolled. Early postoperative complications, long-term outcomes and histopathologic changes in mucosal biopsies of native bladder and the augmented intestine after AC were reviewed. Twenty-two patients with a mean age of 7.6 ± 4.4 years were included. The ileum was used in 19 patients and the sigmoid colon in 3 patients. The length of hospital stay was 14.8 ± 6.8 days. Post-operatively, the urinary continence rate improved from 22.7 to 81.8% (p < 0.001). Hydronephrosis resolved in 17 of 19 patients. Vesicoureteral reflux resolved in 16 (64.0%) of the refluxing ureter units and was downgraded in 7 (28.0%). Grades of hydronephrosis and reflux significantly improved following AC (p < 0.001). The estimated glomerular filtration rate also significantly increased (p = 0.012). Formation of urinary tract stones was the most frequent late complication (in 8 patients, 36.4%). Life-threatening spontaneous bladder perforation occurred in 1 patient. After a mean follow-up of 13.4 ± 5.9 years, there were no cases of mortality, new-onset symptomatic metabolic acidosis, or changes in serum electrolytes. Of the 17 patients who were followed for > 10 years, no cases of malignancy or metaplastic changes were identified in the native bladder or augmented bowel epithelium. AC is a safe and effective procedure with low surgical and metabolic complication rates. In addition, AC provides a satisfactory continence rate and long-term protection of renal function, increases functional capacity, and regresses reflux and hydronephrosis. Individualized surveillance is recommended for the early identification of urolithiasis and metabolic disturbances.
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Affiliation(s)
- Jei-Wen Chang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Cheng Kuo
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Tzu-Ching Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tai-Wai Chin
- Department of Pediatric Surgery, Changhua Christian Children Hospital, Changhua, Taiwan
| | - Ling-Yu Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Hung Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hua Fan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Hsin Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Chin-Su Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Hsin-Lin Tsai
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan.
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Tseng YW, Huang CW, Chen CC, Er TK. Assessment of antibiotic resistance patterns in Central Taiwan during the COVID-19 pandemic: A retrospective study. J Infect Public Health 2024; 17:229-235. [PMID: 38118294 DOI: 10.1016/j.jiph.2023.11.026] [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: 10/07/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing worldwide public health issue due to the overuse and inappropriate use of antibiotics. AMR has been more prevalent during the coronavirus pandemic of 2019 (COVID-19) compared to previous periods. Therefore, this study was conducted to evaluate the AMR profile of common bacteria that were isolated for routine analysis during the pandemic of COVID-19 in Central Taiwan. The main goal of this study was to examine and analyze the AMR patterns both before and after the start of the COVID-19 pandemic. METHODS We conducted a retrospective analysis of clinical samples collected from two different time periods: the 1-year period before the onset of the COVID-19 pandemic (January 2019 to December 2019) and the 2-year period following the start of the pandemic (September 2020 to September 2022). The data for this study were obtained from clinical records, and both bacterial identification and antibiotic susceptibility testing were performed using the Phoenix identification system. RESULTS Among the 8152 bacterial isolates obtained during the study period from September 2020 to September 2022, 4022 (49.3%) were Escherichia coli, 1346 (16.5%) were Klebsiella pneumoniae, 1156 (14.2%) were Staphylococcus aureus, 887 (10.9%) were Pseudomonas aeruginosa, 376 (4.6%) were Enterococcus faecium, and 365 (4.5%) were Acinetobacter baumannii. The overall prevalence of resistant bacteria during the COVID-19 pandemic was as follows: vancomycin-resistant Enterococcus, 69%; carbapenem-resistant A. baumannii, 65%; methicillin-resistant S. aureus, 49%; carbapenem-resistant K. pneumoniae, 29%; carbapenem-resistant P. aeruginosa, 17%; and carbapenem-resistant E. coli, 2%. Carbapenem-resistant A. baumannii, vancomycin-resistant Enterococcus, carbapenem-resistant K. pneumoniae, and carbapenem-resistant E. coli increased by 19%, 10%, 2%, and 1%, respectively. On the other hand, carbapenem-resistant P. aeruginosa and methicillin-resistant S. aureus decreased by 6%, respectively. CONCLUSION This study provides a comprehensive assessment of AMR during the COVID-19 pandemic in Central Taiwan. Understanding the prevalence of AMR is crucial for preventing infection and formulating disease prevention policies. Further research is warranted to elucidate the correlation between AMR and the severity of infection in COVID-19 patients.
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Affiliation(s)
- Yu-Wei Tseng
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Chien-Wen Huang
- Division of Chest Medicine, Department of Internal Medicine, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chih-Chieh Chen
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Tze-Kiong Er
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Nursing, Asia University, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Xing Y, Xue M, Xiao Z, Hu X, Zhai J, Zhang C, Jiang N, Fan Y, Meng Y, Zhou Y. Isolation and identification of Chryseobacterium indologenes and its pathological changes in Pelodiscus sinensis. JOURNAL OF FISH DISEASES 2024; 47:e13864. [PMID: 37723838 DOI: 10.1111/jfd.13864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
The Chinese revered a species of aquatic reptile known as Pelodiscus sinensis as both an edible and medicinal species. When artificially breeding, many deaths occurred at the farmed P. sinensis, mainly due to excessive breeding density, water contamination, and turtles biting each other secondary to bacterial infections. In this study, an isolate of gram-negative bacteria WH0623 was isolated from the liver and kidney of diseased P. sinensis to trace the potential pathogen of this disease. Based on biochemical characteristics and 16S rRNA gene sequencing analyses, this isolated strain of WH0623 was identified as Chryseobacterium indologenes. The strain's median lethal dose (LD50 ) was 3.3 × 105 colony-forming units (CFU)/g per fish weight tested using artificial infection. Histopathological analysis revealed pathological changes, including cell swelling, hyperaemia, and necrosis in many tissues. Antibiotic susceptibility tests revealed that the bacteria WH0623 was susceptible to doxycycline, sulphonamides, ceftazidime, norfloxacin, and ciprofloxacin. These antibiotics could treat the disease. In conclusion, the pathogen causing the death of farmed P. sinensis was isolated and identified, and a drug-sensitive test was conducted. Our findings contribute to the future diagnosis and treatment of the disease.
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Affiliation(s)
- Yangyang Xing
- College of Fisheries and Life Science, Shanghai Ocean University, Shanghai, China
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Mingyang Xue
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Zidong Xiao
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Xiaowei Hu
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Jiale Zhai
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Chunjie Zhang
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Nan Jiang
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Yuding Fan
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Yan Meng
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Yong Zhou
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
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Macrolide resistance genes and mobile genetic elements in waterways from pig farms to the sea in Taiwan. J Glob Antimicrob Resist 2022; 29:360-370. [DOI: 10.1016/j.jgar.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022] Open
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Dayie NTKD, Sekoh DNK, Tetteh-Quarcoo PB, Dayie AD, Osei MM, Kotey FCN, Donkor ES. Staphylococcus aureus Nasopharyngeal Carriage and Antimicrobial Resistance among Adults with Sickle Cell Disease at the Korle Bu Teaching Hospital in Accra, Ghana. Microbiol Insights 2022; 15:11786361221133959. [PMID: 36339725 PMCID: PMC9629541 DOI: 10.1177/11786361221133959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Sickle cell disease (SCD) patients are an important risk group for Staphylococcus aureus ( S. aureus) carriage and infections. Little is, however, known about the nasopharyngeal carriage epidemiology of the pathogen in this vulnerable population. Aim: The aim of this study was to evaluate S. aureus and methicillin-resistant S. aureus (MRSA) nasopharyngeal carriage prevalence, carriage determinants, and antimicrobial resistance among SCD adults in Ghana. Methodology: Nasopharyngeal swabs, obtained from 200 SCD adults recruited at the Korle Bu Teaching Hospital, were cultured for S. aureus, and these isolates were subjected to antimicrobial susceptibility testing via the Kirby-Bauer method. Results: The prevalence of S. aureus carriage was 41.5% (n = 83), and that of MRSA carriage was 1.0% (n = 2). Moreover, carriage of coagulase-negative Staphylococcus (CoNS) was the only determinant of S. aureus carriage identified (OR = 0.012, P < .0001). However, neither this variable nor the other features of the participants emerged as a determinant of MRSA carriage. The antimicrobial resistance rates decreased across penicillin (98.8%, n = 82), tetracycline (54.2%, n = 45), gentamicin (32.5%, n = 27), ciprofloxacin (21.7%, n = 18), erythromycin (18.1%, n = 15), clindamycin (10.8%, n = 9), amoxicillin-clavulanic acid (10.8%, n = 9), teicoplanin (1.2%, n = 1), and linezolid (0.0%, n = 0), and the multidrug resistance rate was 45.8% (n = 38). Conclusion: The nasopharyngeal carriage prevalence of S. aureus in the current study was high, while that of MRSA was low. The isolates were highly resistant to several of the antibiotics tested, but not teicoplanin and linezolid, making these antibiotics suitable for treatment of S. aureus infections among the SCD population.
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Affiliation(s)
- Nicholas TKD Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Deborah NK Sekoh
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
- FleRhoLife Research Consult, Teshie, Accra, Ghana
| | | | - Alberta D Dayie
- Department of Chemistry, University of Cape Coast, Cape Coast, Ghana
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
- FleRhoLife Research Consult, Teshie, Accra, Ghana
| | - Fleischer CN Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
- FleRhoLife Research Consult, Teshie, Accra, Ghana
| | - Eric S Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
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Tsai YT, Lee YL, Lu MC, Shao PL, Lu PL, Cheng SH, Ko WC, Lin CY, Wu TS, Yen MY, Wang LS, Liu CP, Lee WS, Shi ZY, Chen YS, Wang FD, Tseng SH, Lin CN, Chen YH, Sheng WH, Lee CM, Tang HJ, Lin CY, Chen YH, Hsueh PR. Nationwide surveillance of antimicrobial resistance in invasive isolates of Streptococcus pneumoniae in Taiwan from 2017 to 2019. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:215-224. [PMID: 34219043 DOI: 10.1016/j.jmii.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Streptococcus pneumoniae causes pneumonia and other invasive diseases, and is a leading cause of mortality in the elderly population. The present study aimed to provide current antimicrobial resistance and epidemiological profiles of S. pneumoniae infections in Taiwan. METHODS A total of 252 nonduplicate S. pneumoniae isolates were collected from patients admitted to 16 hospitals in Taiwan between January 2017 and December 2019, and were analyzed. The minimum inhibitory concentration of antibiotics was determined using the Vitek 2 automated system for antimicrobial susceptibility testing. Furthermore, epidemiological profiles of S. pneumoniae infections were analyzed. RESULTS Among the strains analyzed, 88% were recognized as invasive pneumococcal strains. According to the Clinical and Laboratory Standards Institute criteria for non-meningitis, the prevalence of penicillin-non-susceptible S. pneumoniae demonstrated a declining trend from 43.6% in 2017 to 17.2% in 2019. However, the rate of penicillin-non-susceptible S. pneumoniae was 85.7% based on the criteria for meningitis. Furthermore, the prevalence of ceftriaxone-non-susceptible S. pneumoniae was 62.7% based on the criteria for meningitis. Isolates demonstrated higher susceptibility toward doripenem and ertapenem than toward meropenem and imipenem. An increased rate of non-susceptibility toward levofloxacin was observed in southern Taiwan (15.1%) and elderly patients (≥65 years; 11.4%). Most isolates were susceptible to vancomycin and linezolid. CONCLUSION Empirical treatment with ceftriaxone monotherapy for pneumococcal meningitis should be carefully monitored owing to its high non-susceptibility rate. The susceptibility rates of most isolates to penicillin (used for treating non-meningitis pneumococcal diseases), carbapenems (ertapenem and doripenem), respiratory quinolones (moxifloxacin and levofloxacin), vancomycin, and linezolid suggested the potential of these antibiotics in treating pneumococcal diseases in Taiwan.
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Affiliation(s)
- Yu-Te Tsai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
| | - Min-Chi Lu
- Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Lan Shao
- Department of Pediatrics, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Hsing Cheng
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Chi-Ying Lin
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Muh-Yong Yen
- Division of Infectious Diseases, Taipei City Hospital, and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Lih-Shinn Wang
- Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Zhi-Yuan Shi
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yao-Shen Chen
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Der Wang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Hui Tseng
- Center for Disease Control and Prevention, Ministry of Health and Welfare, Taiwan
| | - Chao-Nan Lin
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Taiwan; Animal Disease Diagnostic Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Yu-Hui Chen
- Infection Control Center, Chi Mei Hospital, Liouying, Taiwan
| | - Wang-Huei Sheng
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Ming Lee
- Department of Internal Medicine, St Joseph's Hospital, Yunlin County, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Yu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Po-Ren Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Huang YC, Chen CJ, Lauderdale TLY. Detection, spread and phylogeny of meticillin-resistant Staphylococcus aureus sequence type 45 in Taiwan. Microb Genom 2021; 7:000555. [PMID: 33843577 PMCID: PMC8208682 DOI: 10.1099/mgen.0.000555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022] Open
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) sequence type (ST) 45 was reported in the literature to have been first identified in 2006 in Taiwan. The present study was carried out to explore and trace the emergence, transmission and evolutional dynamics of MRSA ST45 in Taiwan. We identified MRSA ST45 isolates retrospectively from two collections of MRSA isolates, namely TSAR (Taiwan Surveillance of Antimicrobial Resistance) surveys and the CGMH (Chang Gung Memorial Hospital)-based laboratory collection. Representative ST45 isolates were selected for whole-genome sequencing (WGS) analysis. A total of 9554 MRSA isolates was included in this study. Among the 3766 MRSA isolates biennially collected from TSAR surveys between 1998 and 2014, ST45 accounted for 133 (3.53 %) MRSA isolates, was first identified in 2004, and the prevalence rate peaked in 2010 (up to 10.77 %). Among the 5788 MRSA isolates collected between 1995 and 2017 by the CGMH-based laboratory, 257 isolates (4.44 %) were characterized as ST45, with most identified from nursing homes since 2012. Of the 75 isolates randomly selected for WGS, two clades were identified. The major clade, clade II, comprised 63 isolates and was phylogenetically relatively close to those isolates identified from Singapore. All but one of the isolates in clade I, the minor clade, were identified from non-Taiwanese people, mostly from newly recruited foreign workers in 2017, and were phylogenetically relatively close to one isolate from the USA (CA-347). Conclusively, the emergence of MRSA ST45 strain in Taiwan can be traced back to 2004 and the strain is connected to South-East Asian countries. Since its emergence, transmission and spread of MRSA ST45 has occurred in Taiwan.
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Affiliation(s)
- Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan, Taiwan, ROC
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan, Taiwan, ROC
| | - Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan, Taiwan, ROC
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan, Taiwan, ROC
| | - Tsai-Ling Yang Lauderdale
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan, Taiwan, ROC
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Morshedtalab Z, Rahimi G, Emami-Nejad A, Farasat A, Mohammadbeygi A, Ghaedamini N, Negahdary M. Antibacterial Assessment of Zinc Sulfide Nanoparticles against Streptococcus pyogenes and Acinetobacter baumannii. Curr Top Med Chem 2021; 20:1042-1055. [PMID: 32250224 DOI: 10.2174/1381612826666200406095246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/13/2019] [Accepted: 03/06/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Due to the appearance of resistant bacterial strains against the antimicrobial drugs and the reduced efficiency of these valuable resources, the health of a community and the economies of countries have been threatened. OBJECTIVE In this study, the antibacterial assessment of zinc sulfide nanoparticles (ZnS NPs) against Streptococcus pyogenes and Acinetobacter baumannii has been performed. METHODS ZnS NPs were synthesized through a co-precipitation method using polyvinylpyrrolidone (PVP), polyvinyl alcohol (PVA) and polyethylene glycol (PEG-4000). The size and morphology of the synthesized ZnS NPs were determined by a scanning electron microscope (SEM) and it was found that the average size of the applied NPs was about 70 nm. In order to evaluate the antibacterial effect of the synthesized ZnS NPs, various concentrations (50μg/mL, 100 μg/mL and 150 μg/mL) of ZnS NPs were prepared. Antibacterial assessments were performed through the disc diffusion method in Mueller Hinton Agar (MHA) culture medium and also the optical density (OD) method was performed by a UV-Vis spectrophotometer in Trypticase™ Soy Broth (TSB) medium. Then, in order to compare the antibacterial effects of the applied NPs, several commercial antibiotics including penicillin, amikacin, ceftazidime and primaxin were used. RESULTS The achieved results indicated that the antibacterial effects of ZnS NPs had a direct relation along with the concentrations and the concentration of 150 μg/mL showed the highest antibacterial effect in comparison with others. In addition, the ZnS NPs were more effective on Acinetobacter baumannii. CONCLUSION The findings of this research suggest a novel approach against antibiotic resistance.
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Affiliation(s)
| | - Ghasem Rahimi
- Agro Industrial Complex of Medicinal Plants ( SPAD), Shiraz, Iran
| | - Asieh Emami-Nejad
- Department of Biology, Payame Noor University (PNU), P.O.Box 19395-3697, Tehran, Iran
| | - Alireza Farasat
- Cellular and Molecular Research Center, Research Institute for prevention of Non- Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Azita Mohammadbeygi
- Department of Immunology, Shahid Beheshti International University, Tehran, Iran
| | - Nahid Ghaedamini
- Department of Biology, Payame Noor University (PNU), P.O.Box 19395-3697, Tehran, Iran
| | - Masoud Negahdary
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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9
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Su YC, Hung WW, Lin JM, Chang CC, Chen YH, Lai YL, Tseng SP, Lu PL, Yamamoto T, Teng LJ, Hung WC. Tracking the evolution of the two successful CC59 methicillin-resistant Staphylococcus aureus clones in Taiwan: the divergence time of the two clades is estimated to be the 1980s. Int J Antimicrob Agents 2020; 56:106047. [PMID: 32544568 DOI: 10.1016/j.ijantimicag.2020.106047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
Clonal complex 59 (CC59) is the dominant community-associated methicillin-resistant Staphylococcus aureus (MRSA) strain in Taiwan and includes the Asian-Pacific clone with Panton-Valentine leukocidin (PVL)-negative/staphylococcal cassette chromosome mec (SCCmec) IVg and the Taiwan clone characterised as PVL-positive/SCCmec V (5C2&5). Nevertheless, data on the evolutionary history of the two dominant CC59 MRSA clones in Taiwan are scarce. In this study, a total of 258 CC59 S. aureus strains from Taiwan were classified by multiple-locus variable-number tandem repeat analysis (MLVA), which revealed two major clusters (MT1 and MT2) with distinct mobile genetic elements (MGEs). However, sequencing and PCR mapping of the β-lactamase-producing plasmid revealed no difference among all CC59 S. aureus strains. Bayesian evolutionary analysis of 18 of the CC59 S. aureus strains based on core genome alignment revealed two clades: (i) Clade A, which shared the samples with MT1, had the features of mainly harbouring gentamicin-resistant MES6272-2 or MES4578, φSA3 translocation in νSaβ and SCCmec IVg; and (ii) Clade B, which shared the samples with MT2, had the features of mainly harbouring streptomycin-resistant MESPM1, PVL phage and SCCmec V (5C2&5). Based on the time-calibrated phylogenetic tree, the estimated time of divergence of the two clades was in the 1980s. These results suggest that the CC59 S. aureus progenitor acquired a β-lactamase-producing plasmid and then developed the varied genetic backgrounds, which were associated with the acquisition and maintenance of distinct MGEs, leading to differences in antimicrobial susceptibility profiles and molecular virulence determinants.
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Affiliation(s)
- Yong-Chao Su
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Wen Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jia-Mi Lin
- Department of Microbiology and Immunology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Chia Chang
- Department of Microbiology and Immunology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - You-Han Chen
- Department of Microbiology and Immunology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Lin Lai
- Department of Microbiology and Immunology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sung-Pin Tseng
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Liang Lu
- Division of Infection, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tatsuo Yamamoto
- Department of Epidemiology, Genomics, and Evolution, International Medical Education and Research Center, Niigata, Japan
| | - Lee-Jene Teng
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Chun Hung
- Department of Microbiology and Immunology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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10
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Appiah VA, Pesewu GA, Kotey FCN, Boakye AN, Duodu S, Tette EMA, Nyarko MY, Donkor ES. Staphylococcus aureus Nasal Colonization among Children with Sickle Cell Disease at the Children's Hospital, Accra: Prevalence, Risk Factors, and Antibiotic Resistance. Pathogens 2020; 9:pathogens9050329. [PMID: 32354004 PMCID: PMC7280972 DOI: 10.3390/pathogens9050329] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of this study was to investigate S. aureus carriage among children with sickle cell disease (SCD), including the prevalence, risk factors, and antibiotic resistance. The study was cross-sectional, and involved 120 children with SCD recruited at the Princess Marie Louise Children’s Hospital (PML) in Accra and 100 apparently healthy children from environs of the hospital. Nasal swab samples were collected from the study participants and cultured for bacteria. Confirmation of S. aureus and methicillin-resistant Staphylococcus aureus (MRSA) isolates were done using the tube coagulase test and mecA polymerase chain reaction, respectively. All the S. aureus isolates were tested against standard antimicrobial agents using the Kirby-Bauer method. A structured questionnaire was used to obtain the socio-demographic and clinical data of the study participants. Binary logistic regression was used to identify determinants of S. aureus and MRSA carriage among the study participants. The nasal carriage prevalence of S. aureus was 33.3% (n = 40) and 10% (n = 10) among the participants of the SCD and control groups, respectively. As regards MRSA nasal carriage prevalence, the respective values were 3.33% (n = 4) and 0.00% (n = 0). SCD was significantly associated with S. aureus colonization (p < 0.0001, OR = 4.045), but not MRSA colonization (p = 0.128). In the SCD group, the significant predictors of S. aureus carriage were increasing age (p = 0.003; OR = 1.275) and living in self-contained apartments (p = 0.033; OR = 3.632), whereas male gender (p = 0.018; OR = 0.344) and the practice of self-medication (p = 0.039; OR = 0.233) were protective of S. aureus carriage. In the control group, a history of hospitalization in the past year was a risk factor for the carriage of S. aureus (p = 0.048; OR = 14.333). Among the participants of the SCD and control groups, respectively, the resistance prevalence recorded by S. aureus against the various antibiotics investigated were penicillin (100% each), cotrimoxazole (27.5% vs. 20%), tetracycline (25% vs. 50%), rifampicin (82.5% vs. 50%), erythromycin (30% vs. 20%), clindamycin (32.5% vs. 50%), gentamicin (7.5% vs. 20%), cefoxitin (27.5% vs. 20%), linezolid (30% vs. 40%), and fusidic acid (95% vs. 80%). The proportion of S. aureus isolates that were multidrug resistant (MDR) was 92.5% (37/40) in the SCD group and 100% (10/10) in the control group.
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Affiliation(s)
- Vera A. Appiah
- Department of Medical Laboratory Science, School of Biomedical and Allied Health Sciences, University of Ghana, Legon P. O. Box LG 54, Accra, Ghana
| | - George A. Pesewu
- Department of Medical Laboratory Science, School of Biomedical and Allied Health Sciences, University of Ghana, Legon P. O. Box LG 54, Accra, Ghana
| | - Fleischer C. N. Kotey
- FleRhoLife Research Consult, Teshie P. O. Box TS 853, Accra, Ghana
- Department of Medical Microbiology, University of Ghana Medical School, Accra P. O. Box 4236, Ghana
| | - Alahaman Nana Boakye
- Department of Medical Laboratory Science, School of Biomedical and Allied Health Sciences, University of Ghana, Legon P. O. Box LG 54, Accra, Ghana
- FleRhoLife Research Consult, Teshie P. O. Box TS 853, Accra, Ghana
| | - Samuel Duodu
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon P. O. Box LG 54, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon P. O. Box LG 54, Accra, Ghana
| | - Edem M. A. Tette
- Department of Community Health, University of Ghana Medical School, Accra P. O. Box 4236, Ghana
| | - Mame Y. Nyarko
- Princess Marie Louise Children’s Hospital, Accra P. O. Box GP 122, Ghana
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra P. O. Box 4236, Ghana
- Correspondence: or ; Tel.: +233-553-527-140
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11
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Su PY, Huang AH, Lai CH, Lin HF, Lin TM, Ho CH. Extensively drug-resistant Haemophilus influenzae - emergence, epidemiology, risk factors, and regimen. BMC Microbiol 2020; 20:102. [PMID: 32345232 PMCID: PMC7189504 DOI: 10.1186/s12866-020-01785-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/07/2020] [Indexed: 02/01/2023] Open
Abstract
Background Concern about Haemophilus influenzae infection has been increasing over recent decades. Given the emergence of H. influenzae with severe drug resistance, we assessed the prevalence of as well as risk factors and potential therapies for extensively drug-resistant (XDR) H. influenzae infection in Taiwan. Results In total, 2091 H. influenzae isolates with disk diffusion-based antibiotic susceptibility testing from 2007 to 2018 were enrolled. H. influenzae strains resistant to ampicillin, chloramphenicol, levofloxacin, and trimethoprim-sulfamethoxazole tended to be isolated from patient wards (≧41%), whereas those resistant to amoxicillin-clavulanate, cefotaxime, and cefuroxime were more likely to be isolated from intensive care units (approximately 50%). XDR H. influenzae was first identified in 2007, and its incidence did not significantly change thereafter. Overall prevalence of single, multiple, and extensively drug-resistant H. influenzae over 2007–2018 was 21.5% (n = 450), 26.6% (n = 557), and 2.5% (n = 52), respectively. A stepwise logistic regression analysis revealed that blood culture (odds ratio: 4.069, 95% confidence intervals: 1.339–12.365, P = 0.013) was an independent risk factor for XDR H. influenzae infection. No nosocomial transmission of XDR H. influenzae observed. Antibiotic susceptibility testing results demonstrated that cefotaxime was effective against 78.8% (n = 41) of the XDR strains. Conclusions The presence of XDR H. influenzae strains was identified in Taiwan, and cefotaxime was efficacious against most of these strains.
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Affiliation(s)
- Pei-Yi Su
- Department of Laboratory Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Ay-Huey Huang
- Department of Laboratory Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Chung-Hsu Lai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Hsiu-Fang Lin
- Department of Laboratory Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Tsun-Mei Lin
- Department of Medical Laboratory Science, College of Medicine, I-Shou University, No.8, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan
| | - Cheng-Hsun Ho
- Department of Medical Laboratory Science, College of Medicine, I-Shou University, No.8, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan.
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12
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Jayaweera JAAS, Pilapitiya S, Kumbukgolla W. The relationship between the exposure to healthcare settings and colonization with methicillin-resistant Staphylococcus aureus among medical students. Germs 2020; 10:34-43. [PMID: 32274358 DOI: 10.18683/germs.2020.1183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 01/01/2023]
Abstract
Introduction Medical students who engage in clinical learning in healthcare settings can be potential methicillin-resistant Staphylococcus aureus (MRSA) carriers. Methods This is a descriptive cross-sectional study having a follow-up approach. Three batches of medical students who were studying at the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (1st, 3rd and 5th study years of MBBS course) were screened for nasal and axillary MRSA colonization. The first-year students were screened before and 6 months after clinical learning. The knowledge of the students about infection control was scored (percentage) using a questionnaire in the one week before and later one year after the hospital exposure. Data was compared using two-sample t test. Results The percentage of MRSA colonization was 6.36% (7/110) and 49.57% (59/119) before clinical exposure and after 2.5 years of exposure, respectively (p<0.012). The percentage of correct responses obtained by the students for the questionnaire about infection control was 28% and 66.9% one week before the exposure to the hospitals and one year after the exposure to the hospitals, consecutively. Conclusions MRSA carriage was significantly associated with the time duration of the clinical training of the medical students. The knowledge of students about infection control was significantly inadequate one week before the hospital exposure and they have gained the knowledge only after being exposed to the hospitals.
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Affiliation(s)
- Jayaweera Arachchige Asela Sampath Jayaweera
- Rajarata University of Sri Lanka, MBBS, MPhil, Pg. Dip. Micro., MSc Biostatistics, MD Clinical Microbiology, Senior Lecturer, Department of Microbiology, Faculty of Medicine and Allied Sciences, Saliyapura 50008, Sri Lanka
| | - Senaka Pilapitiya
- Rajarata University of Sri Lanka, MBBS, MD Medicine, Senior Lecturer and Consultant Physician, Department of Medicine, Faculty of Medicine and Allied Sciences, Saliyapura 50008, Sri Lanka
| | - Widuranga Kumbukgolla
- Rajarata University of Sri Lanka, BSc, MPhil, PhD, Senior Lecturer, Department of Biochemistry, Faculty of Medicine and Allied Sciences, Saliyapura 50008, Sri Lanka
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13
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Osonga F, Akgul A, Miller RM, Eshun GB, Yazgan I, Akgul A, Sadik OA. Antimicrobial Activity of a New Class of Phosphorylated and Modified Flavonoids. ACS OMEGA 2019; 4:12865-12871. [PMID: 31460413 PMCID: PMC6681995 DOI: 10.1021/acsomega.9b00077] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/03/2019] [Indexed: 06/01/2023]
Abstract
The surge of resistant food pathogens is a major threat worldwide. Previous research conducted on phytochemicals has shown their antibacterial activity against pathogenic bacteria. The design of antimicrobial agents to curb pathogenic disease remains a challenge demanding critical attention. Flavonoids such as apigenin and quercetin were evaluated against Gram-positive and Gram-negative bacteria. The results indicated that the antibacterial activity of each flavonoid occurred at a different minimum inhibitory concentration. However, the antimicrobial activity results of the modified flavonoids were also reported, and it was observed that the Gram-positive bacteria were more susceptible in comparison to the Gram-negative bacteria. The cell wall structure of the Gram-positive and Gram-negative bacteria could be the main reason for the bacteria susceptibility. Modified flavonoids could be used as a suitable alternative antimicrobial agent for the treatment of infectious diseases. Our results indicated 100% inhibition of Listeria monocytogenes, Pseudomonas aeruginosa, and Aeromonas hydrophila with modified flavonoids.
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Affiliation(s)
- Francis
J. Osonga
- Department
of Chemistry, Center for Research
in Advanced Sensing Technologies & Environmental Sustainability
(CREATES), State University of New York
at Binghamton, PO Box 6000, Binghamton, New York 13902, United States
| | - Ali Akgul
- Department of Basic
Sciences, College of Veterinary Medicine and Department of Sustainable
Bioproducts, College of Forest Resources, Mississippi State University, Starkville, Mississippi 39762, United States
| | - Roland M. Miller
- Department
of Chemistry, Center for Research
in Advanced Sensing Technologies & Environmental Sustainability
(CREATES), State University of New York
at Binghamton, PO Box 6000, Binghamton, New York 13902, United States
| | - Gaddi B. Eshun
- Department
of Chemistry, Center for Research
in Advanced Sensing Technologies & Environmental Sustainability
(CREATES), State University of New York
at Binghamton, PO Box 6000, Binghamton, New York 13902, United States
| | - Idris Yazgan
- Department
of Chemistry, Center for Research
in Advanced Sensing Technologies & Environmental Sustainability
(CREATES), State University of New York
at Binghamton, PO Box 6000, Binghamton, New York 13902, United States
| | - Ayfer Akgul
- Department of Basic
Sciences, College of Veterinary Medicine and Department of Sustainable
Bioproducts, College of Forest Resources, Mississippi State University, Starkville, Mississippi 39762, United States
| | - Omowunmi A. Sadik
- Department
of Chemistry, Center for Research
in Advanced Sensing Technologies & Environmental Sustainability
(CREATES), State University of New York
at Binghamton, PO Box 6000, Binghamton, New York 13902, United States
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14
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Donkor ES, Kotey FCN, Dayie NTKD, Duodu S, Tetteh-Quarcoo PB, Osei MM, Tette EMA. Colonization of HIV-Infected Children with Methicillin-Resistant Staphylococcus aureus. Pathogens 2019; 8:E35. [PMID: 30884909 PMCID: PMC6470964 DOI: 10.3390/pathogens8010035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) poses a public health threat owing to its extensive resistance to antibiotics, association with persistent outbreaks, and markedly increased healthcare costs. Moreover, HIV-infected individuals are at a greater risk for colonization with MRSA, and may act as reservoirs for subsequent transmission to other individuals. In Ghana, little is known about MRSA in relation to at-risk populations, such as HIV-infected children. The aim of this study was to investigate nasal carriage of S. aureus and MRSA among HIV-infected children in Accra, including the prevalence, risk factors and antibiotic resistance. METHODOLOGY The study was cross-sectional, and involved 107 children with HIV infection and an equal number of sex- and age group- matched apparently healthy controls recruited from the Princess Marie Louis Children's Hospital in Accra. Nasal swab specimens were collected from the study participants and cultured for bacteria. S. aureus isolates were confirmed by the coagulase test while MRSA was confirmed by PCR of the mecA gene. Antimicrobial susceptibility testing of S. aureus isolates was done by the Kirby Bauer method. A structured questionnaire was used to collect data on demographic, household and clinical features of the study participants. A logistic regression analysis was performed to identify determinants of S. aureus and MRSA carriage among participants of both study groups. RESULTS The carriage prevalence of S. aureus and MRSA were 44.9% (48) and 5.6% (6), respectively, among the HIV-infected individuals, and the corresponding values within the control group were 23.4% (25) and 0.9% (1). There was a significant association between HIV infection and S. aureus colonization (p < 0.001), but not MRSA colonization (p = 0.055). The main predictor of S. aureus colonization in both study groups was absence of colonization with coagulase negative staphylococcus (p < 0.001). Furthermore, the main predictor of MRSA colonization was regular hand washing with soap (p = 0.043); this was observed among HIV-infected individuals but not the control group. The proportion of S. aureus isolates that were multidrug resistant was 62.3% (33/53) in the HIV-infected group and 80% (20/25) in the control group (p = 0.192). CONCLUSIONS HIV infection is a risk factor for nasal colonization of S. aureus among children in Accra but may not be for MRSA. Both the HIV-infected and uninfected children are reservoirs of multidrug resistant S. aureus. Demographic, household and clinical features appear to have little or no relationship with S. aureus and MRSA colonization in the study children.
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Affiliation(s)
- Eric S Donkor
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
| | - Fleischer C N Kotey
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
- FleRhoLife Research Consult, P. O. Box TS 853, Teshie, Accra, Ghana.
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Samuel Duodu
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
| | - Patience B Tetteh-Quarcoo
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Edem M A Tette
- Department of Community Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana.
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15
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Chen CJ, Huang YC. Emergence of livestock-associated methicillin-resistant Staphylococcus aureus: Should it be a concern? J Formos Med Assoc 2018; 117:658-661. [PMID: 29754805 DOI: 10.1016/j.jfma.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Chih-Jung Chen
- Division of Paediatric Infectious Diseases, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Division of Paediatric Infectious Diseases, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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16
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Lin CY, Wang JH, Lin KH, Ho YL, Ho CM. Methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility in Taiwan. Tzu Chi Med J 2018; 30:135-140. [PMID: 30069120 PMCID: PMC6047320 DOI: 10.4103/tcmj.tcmj_145_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Staphylococcus aureus is a versatile pathogen which can cause various mild to life-threatening infectious diseases. The evolution of S. aureus resistance is notorious, from penicillin and oxacillin to vancomycin. Vancomycin, introduced in 1956, was once considered a most reliable antibiotic for methicillin-resistant S. aureus (MRSA); unfortunately, the first strain of S. aureus with decreased susceptibility to vancomycin emerged in 1996. Vancomycin has been approved in Taiwan since 1983, and the prevalence rates of heteroresistant vancomycin-intermediate S. aureus (hVISA) and vancomycin-intermediate S. aureus (VISA) in 2003 were 0.7% and 0.2%, respectively. However, a ten-fold increase of hVISA and VISA to 10% and 2.7%, respectively, in 2012-2013 could indicate a challenging clinical situation in Taiwan. The most commonly reported staphylococcal cassette chromosome mec (SCCmec) types of hVISA and VISA are usually SCCmec type III or II, typical nosocomial MRSA strains. Preventing the spread of resistant pathogens through infection control interventions and judicious antibiotic stewardship is a serious medical issue.
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Affiliation(s)
- Chien-Yu Lin
- Department of Laboratory Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Jui-Hsing Wang
- Division of Infectious Disease, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Kai-Hsiang Lin
- Department of Laboratory Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Yu-Ling Ho
- Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Cheng-Mao Ho
- Department of Laboratory Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Division of Infectious Disease, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Department of Nursing, Hungkuang University, Taichung, Taiwan.,Department of Clinical Pathology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
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17
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Zheng PX, Chan YC, Chiou CS, Hsieh CL, Chiang-Ni C, Wu JJ. Highly prevalent emmSTG840.0 and emmSTC839.0 types of erythromycin non-susceptible group G Streptococcus isolated from bacteremia in southern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:831-838. [PMID: 28711431 DOI: 10.1016/j.jmii.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/09/2016] [Accepted: 12/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Group G Streptococcus (GGS) infections in human have increased. Treatment relied on antibiotic therapy, including erythromycin. However, information regarding the dominant strains and erythromycin susceptibility in GGS bacteremia is limited. METHODS A total of 134 GGS were isolated from patients with bacteremia in a university hospital of southern Taiwan during 1993-2010. The erythromycin susceptibility was determined by disc diffusion and agar dilution assays. The bacterial species was determined by MALDI-TOF. The presence of erythromycin-resistant genes and emm types were determined by polymerase chain reaction and sequence. The clonal spreading was analyzed by pulsed-field gel electrophoresis with SmaI or SgrAI digestion. RESULTS The annual erythromycin non-susceptible rate varied, with an average of 40.3%. All erythromycin non-susceptible strains belonged to the Streptococcus dysgalactiae. No erythromycin non-susceptible strains belong to the anginosus group. The most prevalent erythromycin-resistant gene was mefA (57.4%), followed by ermB (37%), and ermA (3.7%). The N terminal hyper variable region of emm was sequenced to determine the emm type, and only S. dysgalactiae had the emm gene. The most prevalent emm types were emmSTG840.0 (17.2%), emmSTG485.0 (10.4%), and emmSTC839.0 (9.0%). 73% and 47% of the strains with only mefA and ermB belonged to emmSTG840.0 and emmSTC839.0 types, respectively. Pulsed-field gel electrophoresis showed that different clones of emmSTG840.0 and emmSTC839.0 strains were spread in this region during the 18 years of surveillance. CONCLUSION Our data indicate that there were dominant emm types with erythromycin non-susceptibility in S. dysgalactiae isolated from bacteremia in Taiwan, and thus constant surveillance is warranted.
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Affiliation(s)
- Po-Xing Zheng
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Yuen-Chi Chan
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Shun Chiou
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - Cheng-Lu Hsieh
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chuan Chiang-Ni
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Jiunn-Jong Wu
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan.
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Novel Structure of Enterococcus faecium-Originated ermB-Positive Tn1546-Like Element in Staphylococcus aureus. Antimicrob Agents Chemother 2016; 60:6108-14. [PMID: 27480862 DOI: 10.1128/aac.01096-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/22/2016] [Indexed: 11/20/2022] Open
Abstract
We determined the resistance determinants in 274 erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA) isolates during a 13-year period, 2000 to 2012. The resistance phenotypes, inducible macrolide-lincosamide-streptogramin (iMLS), constitutive MLS (cMLS), and macrolide-streptogramin (MS) resistance phenotypes, were examined by a double-disk diffusion D test. The ermB gene was more frequent (35%; 97/274) than ermC (27%; 75/274) or ermA (21%; 58/274). All 97 ermB-positive isolates harbored Tn551 and IS1216V The majority (89/97) of ermB-positive isolates displayed the cMLS phenotype and carried mobile element structure (MES)-like structures, which has been previously reported in sequence type 59 (ST59) methicillin-resistant S. aureus (MRSA). The remaining 8 ermB-carrying isolates, belonging to ST7 (n = 4), ST5 (n = 3), and ST59 (n = 1), were sasK intact and did not carry MES-like structures. Unlike a MES-like structure that was located on the chromosome, the ermB elements on sasK-intact isolates were located on plasmids by S1 nuclease pulsed-field gel electrophoresis (PFGE) analysis and conjugation tests. Sequence data for the ermB-containing region (14,566 bp) from ST59 NTUH_3874 revealed that the best match was a Tn1546-like element in plasmid pMCCL2 DNA (GenBank accession number AP009486) of Macrococcus caseolyticus Tn1546 is recognized as an enterococcal transposon and was known from the vancomycin resistance gene cluster in vancomycin-resistant Enterococcus (VRE). So far, acquisitions of Tn1546 in S. aureus have occurred in clonal complex 5 (CC5) MRSA, but not in MSSA. This is the first report that MSSA harbors an Enterococcus faecium-originated ermB-positive Tn1546-like element located on a plasmid.
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Ho CM, Lin CY, Ho MW, Lin HC, Chen CJ, Lin LC, Lu JJ. Methicillin-resistant Staphylococcus aureus isolates with SCCmec type V and spa types t437 or t1081 associated to discordant susceptibility results between oxacillin and cefoxitin, Central Taiwan. Diagn Microbiol Infect Dis 2016; 86:405-411. [PMID: 27650515 DOI: 10.1016/j.diagmicrobio.2016.08.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/03/2016] [Accepted: 08/24/2016] [Indexed: 01/21/2023]
Abstract
Staphylococcus aureus isolates with discordant susceptibility results between oxacillin and cefoxitin obtained using automated microbiology systems are infrequently observed. From April 2013 to December 2014, 1956 methicillin-resistant S. aureus (MRSA) and 1761 methicillin-susceptible S. aureus isolates were obtained from different patients. Forty isolates (1.1% and 2% in case of S. aureus and MRSA, respectively) with discordant susceptibility results (oxacillin susceptible and cefoxitin resistant) and carrying mecA gene were obtained. Except 2 SCCmec type IV isolates, 38 MRSA isolates were all SCCmec type V (VT or non-VT), which were further divided into VT (n=22) and non-VT (n=16). The most common spa type in VT and non-VT isolates were t437 (n=19) and t1081 (n=13), respectively. Only 55% of patients received effective antimicrobial agents; 2 mortalities were not attributable to MRSA infection. Using standard agar dilution, 17 MRSA isolates (0.46% and 0.87% in case of S. aureus and MRSA, respectively) had oxacillin MIC in the susceptible ranges (oxacillin-susceptible MRSA [OS-MRSA]); all carried SCCmec type V (VT, n=8; non-VT, n=9). The most common spa-MLST types of OS-MRSA in VT and non-VT were t437-ST59 (n=4) and t1081-ST45 (n=7), respectively. Concomitant testing by both cefoxitin- and oxacillin-based methods is a practical strategy for OS-MRSA detection in the clinical laboratories. Continuous monitoring of OS-MRSA isolates is necessary to elucidate their impact in clinical infectious diseases.
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Affiliation(s)
- Cheng-Mao Ho
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Nursing, Hungkuang University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chien-Yu Lin
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Mao-Wang Ho
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Chuan Lin
- Department of Infectious Diseases, Children's Hospital, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chao-Jung Chen
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Lee-Chung Lin
- Department of Laboratory Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Kweu-Shan, Taoyuan, Taiwan
| | - Jang-Jih Lu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Laboratory Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Kweu-Shan, Taoyuan, Taiwan.
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Huang YC, Su LH, Wu TL, Lin TY. Molecular Surveillance of Clinical Methicillin-ResistantStaphylococcus aureusIsolates in Neonatal Intensive Care Units. Infect Control Hosp Epidemiol 2016; 26:157-60. [PMID: 15756886 DOI: 10.1086/502520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBackground and Objective:Methicillin-resistantStaphylococcus aureus(MRSA) has become an important nosocomial pathogen in our neonatal intensive care units (NICUs) and accounts for almost allS. aureusclinical isolates. The objective of this study was to assess the relatedness of these MRSA strains.Design:MRSA clinical isolates were collected from infants hospitalized in our NICUs. Pulsed-field gel electrophoresis withSmaI digestion was used to fingerprint these isolates.Setting:Level-III NICUs in a university-affiliated children's hospital.Results:Between 1998 and 2000, a total of 122 MRSA clinical isolates were collected from 104 infants hospitalized in our NICUs. Fifteen infants had multiple isolates (range, 2 to 4 isolates). The sources of specimens included blood (72), pus (23), sputum (15), body fluids (3), and catheter tips (9). A total of 4 genotypes with 20 subtypes were identified. There were 2 genotypes in 1998, 2 genotypes in 1999, and 4 genotypes in 2000. All but 2 isolates belonged to either genotype A (63.1%; 7 subtypes) or genotype C (35.2%; 11 subtypes). Among the 15 infants with multiple isolates, the genotypes of the isolates from a single episode of MRSA infection were different in 2 of 12 cases, and reinfection with a new strain was noted in 3 of 5 cases with recurrent infections.Conclusions:Two predominant MRSA clones prevailed in our NICUs between 1998 and 2000. Polyclonal bacteremia and reinfection with a new strain were noted.
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Liu EYM, Chang JC, Lin JC, Chang FY, Fung CP. Important Mutations Contributing to High-Level Penicillin Resistance in Taiwan 19F-14, Taiwan 23F-15, and Spain 23F-1 of Streptococcus pneumoniae Isolated from Taiwan. Microb Drug Resist 2016; 22:646-654. [PMID: 27042760 DOI: 10.1089/mdr.2015.0261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Penicillin-resistant Streptococcus pneumoniae is a serious concern worldwide. In this study, we analyzed the cause of β-lactam resistance in pandemic multidrug-resistant clones. A total of 41 penicillin-nonsusceptible clinical isolates were collected from 1996 to 2012. Sero- and molecular typing confirmed that these isolates were clonal types of Taiwan19F-14, Taiwan23F-15, and Spain23F-1. Sero-switching was found in four isolates. All isolates were multidrug resistant. Sequencing analysis of the penicillin binding proteins (PBPs) was performed on PBP1a, 2b, and 2x, and a large number of mutations were identified in comparing to clinical penicillin-susceptible isolates and the recipient strain R6 used for homologous recombination. The T451A substitution was the key amino acid in PBP2b that contributed to penicillin resistance. T338A in PBP2x played a role in resistance and reached the highest level of resistance when combined with other mutations in PBP2x. High-level penicillin resistance could not be obtained without the combination of mutations in PBP1a with PBP2b and 2x. The amino acid substitutions in PBP1a, 2b, and 2x were the crucial factors for β-lactam resistance.
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Affiliation(s)
- Esther Yip-Mei Liu
- 1 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University , Taipei, Taiwan
| | - Jen-Chang Chang
- 2 Institute of Infectious Diseases and Vaccinology, National Health Research Institutes , Zhunan, Taiwan
| | - Jung-Chung Lin
- 3 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Feng-Yee Chang
- 3 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Chang-Phone Fung
- 1 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University , Taipei, Taiwan .,4 Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University , Taipei, Taiwan
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Al Yousef SA. Surveillance of Antibiotic-Resistant Bacteria in King Khalid Hospital, Hafr Al-Batin, Saudi Arabia, During 2013. Jundishapur J Microbiol 2016; 9:e19552. [PMID: 27942366 PMCID: PMC5136423 DOI: 10.5812/jjm.19552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 11/10/2014] [Accepted: 11/20/2014] [Indexed: 12/23/2022] Open
Abstract
Background Research to understand and control the emergence and spread of antimicrobial resistance has become a public health priority. Objectives This study was conducted to study epidemiology and resistant pattern of bacteria causing infection in different King Khalid hospital units. Patients and Methods All samples were sent to the lab and routinely processed according to the standard microbiological procedures. Then, the cultures yielding growth were selected for the study. Identification and antibiotic susceptibility test for all clinical isolates were processed by using MicroScan instrumentation. A total of 428 clinical samples were collected within 8 months; out of them, 300 clinical isolates were subjected to validation test. Results Escherichia coli, Klebsiella pneumonia, and Pseudomonas aeruginosa were the commonly identified Gram-negative bacteria. Staphylococcus aureus was the only identified Gram-positive bacterium. The most common infections were taken from the wounds (39.0%), urinary tract (32.3%), and bloodstream (17.8%). The most common antibiotic-resistant bacteria were found on female surgical ward (100%) followed by ICU (90.2%), and male surgical ward (88.2%). The overall results of antibiotic resistance were 100% for S. aureus, 93.3% K. pneumonia, 75.7 % E. coli, and 100% for P. aeruginosa. Staphylococcus aureus showed high resistance to ampicillin and linezolid (94.1%). High (86.95%) and full resistance (100%) against ampicillin were observed from E. coli and K. pneumonia, respectively. P. aeruginosa was fully resistant to 4 antibiotics of cefazoline, cefoxitin, tetracycline, and trimethoprim-sulfamethoxazole. Conclusions The study was useful in determining the risk factors and defining different hospital units which should be targeted for measures to prevent infection.
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Affiliation(s)
- Sulaiman Ali Al Yousef
- Department of Medical Laboratory Technology, College of Medical Applied Science, University of Dammam, Hafr Al Batin, Saudi Arabia
- Corresponding author: Sulaiman Ali Al Yousef, Department of Medical Laboratory Technology, College of Medical Applied Science, University of Dammam, Hafr Al Batin, Saudi Arabia. Tel: +96-6137200296, Fax: +96-6137246041, E-mail:
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Kao KC, Chen CB, Hu HC, Chang HC, Huang CC, Huang YC. Risk Factors of Methicillin-Resistant Staphylococcus aureus Infection and Correlation With Nasal Colonization Based on Molecular Genotyping in Medical Intensive Care Units: A Prospective Observational Study. Medicine (Baltimore) 2015; 94:e1100. [PMID: 26181545 PMCID: PMC4617090 DOI: 10.1097/md.0000000000001100] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common and important cause of colonization and infection in medical intensive care units (ICU). The aim of this study was to assess association factors between MRSA nasal colonization and subsequent infections in medical ICU patients by clinical investigation and molecular genotyping. A prospective cohort observational analysis of consecutive patients admitted to medical ICUs between November 2008 and May 2010 at a tertiary teaching hospital were included. To detect MRSA colonization, the specimens from the nares were obtained within 3 days of admission to the ICU and again 1 week following admission to the ICU. Genetic relatedness for colonized and clinical isolates from each study patient with MRSA infection were analyzed and compared. A total of 1266 patients were enrolled after excluding 195 patients with already present MRSA infections. Subsequent MRSA infection rates were higher in patients with nasal colonization than in those without (39.1% versus 14.7%, respectively). Multivariate Poisson regression analysis demonstrated that nasal MRSA colonization (relative risk [RR]: 2.50; 95% confidence interval [CI]: 1.90-3.27; P < 0.001) was independent predictors for subsequent MRSA infections. History of tracheostomy, however, was a protective predictor in all patients (RR: 0.38; 95% CI: 0.18-0.79; P = 0.010) and in patients with MRSA nasal colonization (RR: 0.22; 95% CI: 0.55-0.91; P = 0.037). Molecular genetics studies revealed that most MRSA isolates were healthcare-associated clones and that nasal and clinical isolates exhibited up to 75% shared identity. Methicillin-resistant S. aureus nasal colonization was significantly associated with subsequent MRSA infection among medical ICU patients. Previous MRSA infection was associated with subsequent MRSA infections, and history of tracheostomy associated with reducing this risk. Most MRSA isolates were healthcare-associated strains that were significantly correlated between nasal and clinical isolates.
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Affiliation(s)
- Kuo-Chin Kao
- Department of Thoracic Medicine and Respiratory Therapy, Chang Gung University College of Medicine, Linkou (K-CK, H-CH, C-CH); Department of Dermatology, Chang Gung University College of Medicine, Keelung (C-BC); Department of Pediatrics, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan (H-CC, Y-CH)
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Abstract
Not only is Asia the most populous region in the world, but inappropriate therapy, including self-medication with over-the-counter antimicrobial agents, is a common response to infectious diseases. The high antibiotic selective pressure among the overcrowded inhabitants creates an environment that is suitable for the rapid development and efficient spread of numerous multidrug-resistant pathogens. Indeed, Asia is among the regions with the highest prevalence rates of healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-associated methicillin-resistant S. aureus (CA-MRSA) in the world. Most hospitals in Asia are endemic for multidrug-resistant methicillin-resistant S. aureus (MRSA), with an estimated proportion from 28% (in Hong Kong and Indonesia) to >70% (in Korea) among all clinical S. aureus isolates in the early 2010s. Isolates with reduced susceptibility or a high level of resistance to glycopeptides have also been increasingly identified in the past few years. In contrast, the proportion of MRSA among community-associated S. aureus infections in Asian countries varies markedly, from <5% to >35%. Two pandemic HA-MRSA clones, namely multilocus sequence type (ST) 239 and ST5, are disseminated internationally in Asia, whereas the molecular epidemiology of CA-MRSA in Asia is characterized by clonal heterogeneity, similar to that in Europe. In this review, the epidemiology of S. aureus in both healthcare facilities and communities in Asia is addressed, with an emphasis on the prevalence, clonal structure and antibiotic resistant profiles of the MRSA strains. The novel MRSA strains from livestock animals have been considered to constitute a public health threat in western countries. The emerging livestock-associated MRSA strains in Asia are also included in this review.
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Affiliation(s)
- C-J Chen
- Division of Paediatric Infectious Diseases, Chang Gung Memorial Hospital and Children's Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Pai HH, Chen WC, Peng CF. Cockroaches as Potential Vectors of Nosocomial Infections. Infect Control Hosp Epidemiol 2015; 25:979-84. [PMID: 15566034 DOI: 10.1086/502330] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To determine the possible role of cockroaches in the epidemiology of nosocomial infections.Design:Epidemiologic investigation of bacteria and fungi in cockroaches and evaluation of the antibiotic resistance of the bacteria isolated from the insects.Setting:Ninety hospitals in Kaohsiung City and Kaohsiung County in Taiwan.Methods:Cockroaches were collected in clinical and nonclinical areas and microorganisms were isolated from their external surface and alimentary tract. The susceptibilities of Staphylococcus aureus, Enterococcus species, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Serratia marcescens, and Proteus species to 17 antibiotics were tested.Results:Cockroach infestation was found in 46.7% of the hospitals studied. Two hundred three cockroaches were collected (139 Periplaneta americana and 64 Blattella germanica). Periplaneta americana was found more often in nonclinical areas (64.5%) and B. germanica in clinical areas (78.1%). There was no statistically significant difference between Periplaneta americana (98.6%) and B. germanica (96.9%) regarding overall isolation rate (P > .05). However, 33 species of bacteria and 16 species of fungi were isolated from Periplaneta americana and only 23 and 12, respectively, from B. germanica. Resistance to ampicillin (13.7% to 100%), chloramphenicol (14.3% to 71.4%), tetracycline (14.3% to 73.3%), and trimethoprim-sulfamethoxazole (14.3% to 57.1%) was found in two gram-positive and five gram-negative bacteria.Conclusion:Because cockroach infestation occurred in more than 40% of the hospitals and nearly all of the cockroaches harbored bacteria with multidrug resistance and fungi, cockroaches may play a potential role in the epidemiology of nosocomial infections in those hospitals.
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Affiliation(s)
- Hsiu-Hua Pai
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
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Tao CW, Hsu BM, Ji WT, Hsu TK, Kao PM, Hsu CP, Shen SM, Shen TY, Wan TJ, Huang YL. Evaluation of five antibiotic resistance genes in wastewater treatment systems of swine farms by real-time PCR. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 496:116-121. [PMID: 25064719 DOI: 10.1016/j.scitotenv.2014.07.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/05/2014] [Accepted: 07/07/2014] [Indexed: 05/21/2023]
Abstract
Antibiotics are widely used in livestock for infection treatment and growth promotion. Wastes from animal husbandry are a potential environmental source of antibiotic-insensitive pathogens, and the removal efficiency of the resistance genotypes in current wastewater treatment plants (WWTPs) is unknown. In this study, quantitative PCR was used for evaluating antibiotic resistance genes in wastewater treatment processes. Six wastewater treatment plants in different swine farms were included in this study, and five antibiotic resistance genes (ARGs) were tested for each treatment procedure. All of the tested ARGs including tetA, tetW, sulI, sulII, and blaTEM genes were detected in six swine farms with considerable amounts. The results showed that antibiotic resistance is prevalent in livestock farming. The ARG levels were varied by wastewater treatment procedure, frequently with the highest level at anaerobic treatment tank and lowest in the activated sludge unit and the effluents. After normalizing the ARG levels to 16S rRNA gene copies, the results showed that ARGs in WWTP units fluctuated partly with the quantity of bacteria. Regardless of its importance in biodegradation, the anaerobic procedure may facilitate bacterial growth thus increasing the sustainability of the antibiotic resistance genotypes. After comparing the copy numbers in influx and efflux samples, the mean removal efficiency of ARGs ranged between 33.30 and 97.56%. The results suggested that treatments in the WWTP could partially reduce the spread of antibiotic-resistant bacteria, and additional procedures such as sedimentation may not critically affect the removal efficiency.
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Affiliation(s)
- Chi-Wei Tao
- Section of Respiratory Therapy, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Bing-Mu Hsu
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC.
| | - Wen-Tsai Ji
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC
| | - Tsui-Kang Hsu
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Po-Min Kao
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC
| | - Chun-Po Hsu
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC; Dalin Junior High School, Chiayi, Taiwan, ROC
| | - Shu-Min Shen
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC
| | - Tzung-Yu Shen
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC
| | - Terng-Jou Wan
- Department and Graduate School of Safety Health and Environmental Engineering, National Yunlin University of Science and Technology, Yunlin, Taiwan, ROC
| | - Yu-Li Huang
- Department of Safety Health and Environmental Engineering, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan, ROC
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Use of Topical Colistin in Multiple Drug-Resistant Pseudomonas aeruginosa Bacterial Keratitis. Cornea 2014; 33:923-7. [DOI: 10.1097/ico.0000000000000184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu PC, Lo WT, Chen SJ, Wang CC. Molecular characterization of Group A streptococcal isolates causing scarlet fever and pharyngitis among young children: A retrospective study from a northern Taiwan medical center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 47:304-10. [DOI: 10.1016/j.jmii.2013.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 01/03/2013] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
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Chen CJ, Huang YC, Su LH, Wu TL, Huang SH, Chien CC, Chen PY, Lu MC, Ko WC. Molecular epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus bloodstream isolates in Taiwan, 2010. PLoS One 2014; 9:e101184. [PMID: 24967822 PMCID: PMC4072725 DOI: 10.1371/journal.pone.0101184] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/03/2014] [Indexed: 12/05/2022] Open
Abstract
The information of molecular characteristics and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) is essential for control and treatment of diseases caused by this medically important pathogen. A total of 577 clinical MRSA bloodstream isolates from six major hospitals in Taiwan were determined for molecular types, carriage of Panton-Valentine leukocidin (PVL) and sasX genes and susceptibilities to 9 non-beta-lactam antimicrobial agents. A total of 17 genotypes were identified in 577 strains by pulsotyping. Five major pulsotypes, which included type A (26.2%, belonging to sequence type (ST) 239, carrying type III staphylococcal chromosomal cassette mec (SCCmec), type F (18.9%, ST5-SCCmecII), type C (18.5%, ST59-SCCmecIV), type B (12.0%, ST239-SCCmecIII) and type D (10.9%, ST59-SCCmecVT/IV), prevailed in each of the six sampled hospitals. PVL and sasX genes were respectively carried by ST59-type D strains and ST239 strains with high frequencies (93.7% and 99.1%, respectively) but rarely detected in strains of other genotypes. Isolates of different genotypes and from different hospitals exhibited distinct antibiograms. Multi-resistance to ≥3 non-beta-lactams was more common in ST239 isolates (100%) than in ST5 isolates (97.2%, P = 0.0347) and ST59 isolates (8.2%, P<0.0001). Multivariate analysis further indicated that the genotype, but not the hospital, was an independent factor associated with muti-resistance of the MRSA strains. In conclusion, five common MRSA clones with distinct antibiograms prevailed in the major hospitals in Taiwan in 2010. The antimicrobial susceptibility pattern of invasive MRSA was mainly determined by the clonal distribution.
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Affiliation(s)
- Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
| | - Lin-Hui Su
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tsu-Lan Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Huan Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chun-Chih Chien
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan
| | - Po-Yen Chen
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Min-Chi Lu
- Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Carbapenem-resistant Pseudomonas aeruginosa in Taiwan: Prevalence, risk factors, and impact on outcome of infections. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:52-9. [PMID: 24662016 DOI: 10.1016/j.jmii.2014.01.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/25/2013] [Accepted: 01/02/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prevalence and clinical impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) is unclear in Taiwan. We aim to clarify these clinical issues by using data from the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program. METHODS Patients from five hospitals with their P. aeruginosa isolates collected by TSAR II-VII (2000-2010) program were considered as the potential study population. All patients with CRPA were enrolled as case patients. Patients with carbapenem-susceptible P. aeruginosa were randomly selected in a 1:1 ratio to case patients as control patients. CRPA isolates were tested for the presence of carbapenemase-producing genes. The clinical data were collected to identify risk factors for CRPA carriage and mortality of P. aeruginosa infection. RESULTS The overall prevalence of CRPA was 10.2% (349/3408), which increased significantly by the TSAR period (p = 0.007). Among the 164 enrolled patients, the risk factor for carrying CRPA was previous fluoroquinolone exposure (p = 0.004). The risk factors for mortality among 80 patients with infection by P. aeruginosa included: intensive care unit (ICU) setting, receipt of antifungal therapy, and presence of invasive devices (p = 0.001, 0.010, and 0.017; respectively). Carbapenem resistance did not play a role. Among the 82 CRPA isolates enrolled in this study, 15 isolates were found to carry carbapenemase-producing genes. CONCLUSION In Taiwan, the prevalence of CRPA and carriage of carbapenemase-producing genes was high. However, carbapenem resistance did not play a role in the mortality of patients with P. aeruginosa infections.
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Zheng PX, Chiang-Ni C, Wang SY, Tsai PJ, Kuo CF, Chuang WJ, Lin YS, Liu CC, Wu JJ. Arrangement and number of clustered regularly interspaced short palindromic repeat spacers are associated with erythromycin susceptibility in emm12, emm75 and emm92 of group A streptococcus. Clin Microbiol Infect 2013; 20:516-23. [PMID: 24118239 DOI: 10.1111/1469-0691.12379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/19/2013] [Accepted: 08/23/2013] [Indexed: 12/13/2022]
Abstract
Clustered regularly interspaced short palindromic repeats (CRISPR) are composed of numerous repeat-spacer units and are considered a prokaryotic defence system against foreign nucleic acids. Since antibiotic-resistant genes are frequently encoded in foreign nucleic acids, the aim of this study was to test whether erythromycin susceptibility in group A streptococcus (Streptococcus pyogenes) is associated with characteristics of CRISPR elements. Erythromycin susceptibility of 330 isolates collected between 1997 and 2003 was analysed. Among 29 emm types, emm12, emm75 and emm92 showed significant changes in erythromycin-resistance rates. By sequencing the spacers from two CRISPR loci, spacer contents in emm12, emm75 and emm92 strains were associated with erythromycin susceptibility. Strains with fewer spacers were more resistant to erythromycin. Moreover, in emm4 strains, which showed no significant change in their annual erythromycin-resistance rate, CRISPR type and number of spacers were not correlated with erythromycin susceptibility. These results highlight a novel association between CRISPR spacer content and erythromycin susceptibility in group A streptococcus.
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Affiliation(s)
- P-X Zheng
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Characterization and complete genome sequence analysis of Staphylococcus aureus bacteriophage SA12. Virus Genes 2013; 47:389-93. [PMID: 23775760 DOI: 10.1007/s11262-013-0938-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
Abstract
Staphylococcus aureus is a well-known pathogen that causes several serious diseases in humans and animals. As part of the efforts to control this pathogen, a newly isolated bacteriophage, SA12, which specifically targets S. aureus, was characterized, and its genome was completely sequenced. Host range and bacteriophage challenge tests demonstrated its specific and efficient host lysis of S. aureus. The genome of phage SA12 consists of 42,902 bp length double-stranded DNA with 58 predicted ORFs-encoding phage structure, DNA manipulation, packaging, host lysis, and regulation proteins. The characterization and genome study of phage SA12 in this report is useful for understanding S. aureus-targeting bacteriophages and provides basic information for the further development of phage-based biocontrol agents against S. aureus.
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Affiliation(s)
- Ellen A. Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Tien N, You BJ, Chang HL, Lin HS, Lee CY, Chung TC, Lu JJ, Chang CC. Comparison of genospecies and antimicrobial resistance profiles of isolates in the Acinetobacter calcoaceticus-Acinetobacter baumannii complex from various clinical specimens. Antimicrob Agents Chemother 2012; 56:6267-71. [PMID: 23006758 PMCID: PMC3497195 DOI: 10.1128/aac.01304-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/16/2012] [Indexed: 12/30/2022] Open
Abstract
This study was conducted to compare the prevalences of antimicrobial resistance profiles of clinical isolates in the Acinetobacter calcoaceticus-Acinetobacter baumannii complex from sterile and nonsterile sites and to further study the relationship of antimicrobial resistance profiles and genospecies by amplified rRNA gene restriction analysis (ARDRA). A total of 1,381 isolates were tested with 12 different antibiotics to show their antimicrobial susceptibility profiles. A total of 205 clinical isolates were further analyzed by ARDRA of the intergenic spacer (ITS) region of the 16S-23S rRNA gene. It was found that the overall percentage of isolates from nonsterile sites (urine, sputum, pus, or catheter tip) that were resistant to the 12 antibiotics tested was significantly higher than that of isolates from sterile sites (cerebrospinal fluid [CSF], ascites fluid, and bloodstream) (46% versus 22%; P < 0.05). After ARDRA, it was found that 97% of the 62 isolates resistant to all antibiotics tested were the A. baumannii genospecies, which was identified in only 31% of the isolates susceptible to all antibiotics tested. More genospecies diversity was identified in the isolates susceptible to all antibiotics tested, including genospecies of 13TU (34%), genotype 3 (29%), and A. calcoaceticus (5%). Furthermore, as 91% (10/11) of the isolates from CSF were susceptible to all antibiotics tested, the A. calcoaceticus-A. baumannii complex isolates with multidrug resistance could be less invasive than the more susceptible isolates. This study also indicated current emergence of carbapenem-, fluoroquinolone-, aminoglycoside-, and cephalosporin-resistant A. calcoaceticus-A. baumannii complex isolates in Taiwan.
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Affiliation(s)
- Ni Tien
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Bang-Jau You
- School of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, China Medical University, Taichung, Taiwan
| | - Hui-Lan Chang
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Shen Lin
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Yi Lee
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tung-Ching Chung
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Jang-Jih Lu
- Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chao-Chin Chang
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, Taiwan
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Correlation between carbapenem consumption and resistance to carbapenems among Enterobacteriaceae isolates collected from patients with intra-abdominal infections at five medical centers in Taiwan, 2006-2010. Int J Antimicrob Agents 2012; 40 Suppl:S24-8. [PMID: 22749055 DOI: 10.1016/s0924-8579(12)70006-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We investigated the trend in resistance to carbapenems among isolates of Enterobacteriaceae that had been collected from patients with intra-abdominal infections at five medical centers in Taiwan from 2006 to 2010 and evaluated the correlation between resistance to carbapenems and consumption of said agents as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). During the study period, the usage of ertapenem and that of total carbapenems (ertapenem, imipenem, and meropenem) increased significantly from 6.13 to 13.38 defined daily doses per 1000 patient-days for ertapenem and from 20.43 to 34.25 defined daily doses per 1000 patient-days for total carbapenems. The most common species were Escherichia coli (n = 1095), Klebsiella spp. (n = 663), and Enterobacter spp. (n = 202). The susceptibility of all isolates to ertapenem and to imipenem varied during the study period. For ertapenem, the rates of nonsusceptibility ranged from 3.5% to 10.3% and those for imipenem ranged from 3.5% to 10.7%. Although the use of carbapenems increased during the study period, there was no marked increase in resistance to carbapenems. Continuous monitoring of resistance trends is necessary so that antimicrobial prescription policies can be adjusted and infection control intervention programs can be implemented.
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Nasal carriage rate and molecular epidemiology of methicillin-resistant Staphylococcus aureus among medical students at a Taiwanese university. Int J Infect Dis 2012; 16:e799-803. [PMID: 22878173 DOI: 10.1016/j.ijid.2012.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/09/2012] [Accepted: 07/02/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate whether clinical exposure in the hospital affects nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among medical students. METHODS A total of 322 medical students, both pre-clinical (n=167) and clinical (n=155), were recruited. Specimens were obtained from the nares of the subjects for the detection of S. aureus. A questionnaire was completed for each subject. All the MRSA isolates were further molecularly characterized. RESULTS The overall S. aureus carriage rate was 19.3%, with a rate of 16.8% for pre-clinical students and 21.9% for clinical students (p=0.26). The carriage rate of MRSA was 2.2%, with a rate of 2.4% for pre-clinical students and 1.9% for clinical students (p=0.54). There was no significant difference between the pre-clinical and clinical students in terms of nasal carriage of S. aureus and MRSA. All seven MRSA isolates were categorized as community strains in Taiwan. The risk factors for acquisition of S. aureus included male gender, age ≥23 years, and not taking antibiotics in the past year. CONCLUSIONS As in the general population, less than 5% of medical students in northern Taiwan harbored MRSA, categorized as community strains, in their nares. The carriage of MRSA was not affected by clinical exposure in the hospital for 1-2 years.
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Chuang CC, Hsiao CH, Tan HY, Ma DHK, Lin KK, Chang CJ, Huang YC. Staphylococcus aureus ocular infection: methicillin-resistance, clinical features, and antibiotic susceptibilities. PLoS One 2012; 8:e42437. [PMID: 22880135 PMCID: PMC3413655 DOI: 10.1371/journal.pone.0042437] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) infection is an important public health issue. The study aimed to determine the prevalence of ocular infections caused by MRSA and to identify the clinical characteristics and antibiotic susceptibility of ocular MRSA infections by comparing those of ocular methicillin-sensitive S. aureus (MSSA) infections. Methodology/Principal Findings The medical records of the patients (n = 519) with culture-proven S. aureus ocular infections seen between January 1, 1999 and December 31, 2008 in Chang Gung Memorial Hospital were retrospectively reviewed. Two hundred and seventy-four patients with MRSA and 245 with MSSA ocular infections were identified. The average rate of MRSA in S. aureus infections was 52.8% and the trend was stable over the ten years (P value for trend = 0.228). MRSA ocular infections were significantly more common among the patients with healthcare exposure (P = 0.024), but 66.1% (181/274) patients with MRSA ocular infections had no healthcare exposure. The most common clinical presentation for both MRSA and MSSA ocular infections was keratitis; MRSA and MSSA caused a similar disease spectrum except for lid infections. MRSA was significantly more resistant than MSSA to clindamycin, erythromycin and sulfamethoxazole/trimethoprim (all P<0.001). Conclusions/significance We demonstrated a paralleled trend of ocular MRSA infection in a highly prevalent MRSA country by hospital-based survey. Except for lid disorder, MRSA shared similar spectrum of ocular pathology with MSSA. Since S. aureus is a common ocular pathogen, our results raise clinician’s attention to the existence of highly prevalent MRSA.
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Affiliation(s)
- Chih-Chun Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Ophthalmology, Yuan-Sheng Hospital, Changhua, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ken-Kuo Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail:
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Lee YT, Chen SC, Lee MC, Hung HC, Huang HJ, Lin HC, Wu DJ, Tsao SM. Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections. J Antibiot (Tokyo) 2012; 65:311-6. [DOI: 10.1038/ja.2012.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lin CJ, Siu LK, Ma L, Chang YT, Lu PL. Molecular Epidemiology of Ciprofloxacin-Resistant Extended-Spectrum β-Lactamase–ProducingKlebsiella pneumoniaein Taiwan. Microb Drug Resist 2012; 18:52-8. [DOI: 10.1089/mdr.2011.0060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chi-Jan Lin
- Division of Infectious Diseases, National Health Research Institutes, Miaoli County, Taiwan
| | - L. Kristopher Siu
- Division of Infectious Diseases, National Health Research Institutes, Miaoli County, Taiwan
| | - Ling Ma
- Division of Infectious Diseases, National Health Research Institutes, Miaoli County, Taiwan
| | - Ya-Ting Chang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Ahmad TA, El-Sayed LH, Haroun M, Hussein AA, El Ashry ESH. Development of immunization trials against Klebsiella pneumoniae. Vaccine 2011; 30:2411-20. [PMID: 22100884 DOI: 10.1016/j.vaccine.2011.11.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/18/2011] [Accepted: 11/01/2011] [Indexed: 11/17/2022]
Abstract
Klebsiella pneumoniae is the most common cause of nosocomial respiratory tract and premature intensive care infections, and the second most frequent cause of Gram-negative bacteraemia and urinary tract infections. Drug resistant isolates remain an important hospital-acquired bacterial pathogen, add significantly to hospital stays, and are especially problematic in high impact medical areas such as intensive care units. Many investigations worldwide proved the increasing resistance of such pathogen, resulting in an average rate of 1.63 outbreak every year. A variety of preventive measures were applied to reduce such incidences. Immunotherapy and passive immunization researches as well found their way to the treatment of Klebsiella. During the last 40 years, many trials for constructing effective vaccines were followed. This up-to-date review classifies such trials and documents them in a progressive way. A following comment discusses each group benefits and defects.
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Affiliation(s)
- Tarek A Ahmad
- Biotechnology Department, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt.
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Huang YC, Lien RI, Su LH, Chou YH, Lin TY. Successful control of methicillin-resistant Staphylococcus aureus in endemic neonatal intensive care units--a 7-year campaign. PLoS One 2011; 6:e23001. [PMID: 21857979 PMCID: PMC3155524 DOI: 10.1371/journal.pone.0023001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 07/05/2011] [Indexed: 11/19/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important nosocomial pathogens in the intensive care unit (ICU) worldwide, including Taiwan. Since 1997, our neonatal ICUs (NICUs) had become endemic for MRSA. Methodology/Principal Findings To control MRSA spread in our NICUs, we implemented a series of infection control measures stepwise, including reinforcement of hand hygiene since January 2000, augmentation of aseptic care over the insertion site of central venous catheter since July 2001, introduction of alcohol-based handrubs since April 2003, surveillance culture for MRSA and cohort care for the colonized patients between March 2003 and February 2004, and surveillance culture with subsequent decolonization of MRSA between August 2005 and July 2006. After implementation of these measures, MRSA healthcare-associated infection (HAI) density reduced by 92%, from 5.47 episodes per 1000 patient-days in 1999 to 0.45 episodes per 1000 patient-days in 2006; MRSA bloodstream infection reduced from 40 cases in 1999 to only one case in 2006. Compared to those obtained during the period of surveillance culture without decolonization, both rates of MRSA colonization (8.6% vs. 41%, p<0.001) and infection (1.1% vs. 12%, p<0.001) decreased significantly during the period of surveillance and decolonization. Molecular analysis of the clinical isolates during the study period showed that the endemic clone, which dominated between 1998 and 2005, almost disappeared in 2006, while the community clones increased significantly in 2006–2007. Conclusion/Significance Through infection control measures, MRSA HAIs can be successfully controlled, even in areas with high levels of endemic MRSA infections such as our NICUs.
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Affiliation(s)
- Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.
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Hraoui M, Boubaker IBB, Doloy A, Redjeb SB, Bouvet A. Molecular Mechanisms of Tetracycline and Macrolide Resistance andemmCharacterization ofStreptococcus pyogenesIsolates in Tunisia. Microb Drug Resist 2011; 17:377-82. [DOI: 10.1089/mdr.2010.0160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Manel Hraoui
- Faculté de Médecine de Tunis, Laboratoire de Recherche “Résistance aux Antimicrobiens,” Tunis, Tunisia
| | | | - Alexandra Doloy
- Service de Microbiologie - Hygiène, Hôtel Dieu, Assistance Publique–Hôpitaux de Paris, Université Paris Descartes, Laboratoire associé au Centre National de Référence des Streptocoques pour les streptocoques du groupe A, Paris, France
| | - SaÏda Ben Redjeb
- Faculté de Médecine de Tunis, Laboratoire de Recherche “Résistance aux Antimicrobiens,” Tunis, Tunisia
| | - Anne Bouvet
- Service de Microbiologie - Hygiène, Hôtel Dieu, Assistance Publique–Hôpitaux de Paris, Université Paris Descartes, Laboratoire associé au Centre National de Référence des Streptocoques pour les streptocoques du groupe A, Paris, France
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Lu SY, Chang FY, Cheng CC, Lee KD, Huang YC. Methicillin-resistant Staphylococcus aureus nasal colonization among adult patients visiting emergency department in a medical center in Taiwan. PLoS One 2011; 6:e18620. [PMID: 21695178 PMCID: PMC3113794 DOI: 10.1371/journal.pone.0018620] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 03/07/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Within the past 10 years, methicillin-resistant Staphylococcus aureus (MRSA) has not only been a hospital pathogen but also a community pathogen. To understand the carriage rate of methicillin-resistant Staphylococcus aureus (MRSA) among the adult patients visiting emergency department (ED), we conducted this study. METHODOLOGY/PRINCIPAL FINDINGS From May 21 to August 12, 2009, a total of 502 adult patients visiting emergency department (ED) of a tertiary care hospital in northern Taiwan were recruited in this study and surveyed for nasal carriage of MRSA. A questionnaire regarding the risk factors for MRSA acquisition was also obtained. The overall prevalence of MRSA nasal carriage among the patients was 3.8%. The carriage rate was significantly higher in patients with risk factors for MRSA acquisition (5.94%) than those without risk factors (2.12%). Patients with urinary complaints, diabetes mellitus, chronic kidney disease and current percutaneous tube usage were significantly associated with MRSA colonization. By multiple logistic regression analysis, only current usage of catheters or tubes was the independent predictor for MRSA nasal colonization. Of the 19 MRSA, most isolates belonged to one of two linages, characterized as sequence type (ST) 239 (32%) and ST 59 (58%). The latter linage, accounting for 83% of 6 isolates from patients without risk factors, is a community-associated (CA) clone in Taiwan, while the former linage is among healthcare-associated clones. CONCLUSION/SIGNIFICANCE A substantial proportion of patients visiting ED, particularly with current usage of percutaneous catheter or tubes, in northern Taiwan carried MRSA, mostly community strains, in nares.
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Affiliation(s)
- Sheng-Yun Lu
- College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Fang-Yu Chang
- College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Ching-Chung Cheng
- College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Keong-Diong Lee
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
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Kuo CY, Hwang KP, Hsieh YC, Cheng CH, Huang FL, Shen YH, Huang YC, Chiu CH, Chen PY, Lin TY. Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine. Vaccine 2011; 29:5171-7. [PMID: 21621578 DOI: 10.1016/j.vaccine.2011.05.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. To evaluate the effect of the vaccination, we conducted an active, prospective, large-scale, long-term, and multicenter study to assess the prevalence of nasopharyngeal Streptococcus pneumoniae carriage in Taiwanese children. METHODS This study was performed at three tertiary teaching hospitals in northern, central, and southern Taiwan. Questionnaires provided demographic, family/household, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and serotypes. In addition, influenza virus and Staphylococcus aureus were recovered from nasopharyngeal and nasal swabs, respectively. RESULTS Between July 2005 and July 2008, 857 pneumococcal strains were recovered from a total of 6057 children aged >2 months to 5 years (carriage rate, 14.1%). Carriage rates differed geographically and varied with subject age. In a multivariate analysis, having at least one sibling, attendance at day-care centers, a history of otitis media, and history of upper respiratory tract infection in the previous 2 weeks were each associated with a higher risk of pneumococcal colonization of the nasopharynx. Staphylococcus aureus nasal colonization was inversely associated with nasopharyngeal carriage of pneumococcus (p=0.000; odds ratio [OR]: 0.48; 95% CI: 0.39-0.58). Daycare attendance was the only risk factor for carriage of penicillin non-susceptible S. pneumoniae (OR: 2.37; 95% CI: 1.22-4.88). Although vaccination rates rose from 2005 to 2008, no concomitant decrease in S. pneumoniae carriage occurred. The rate of penicillin resistance among S. pneumoniae isolates was 92.8% (using the meningitis criteria). The prevalence of cefotaxime resistance (21.6%) was higher than that of penicillin (6.9%; non-meningitis criteria). Slightly more than half (57.4%) of the isolates belonged to strains covered by the heptavalent pneumococcal conjugate vaccine when both vaccine and vaccine-related serotypes were included. CONCLUSIONS Although vaccination rates rose from 2005 to 2008, no concomitant decrease occurred in S. pneumoniae carriage. Interaction between S. aureus and S. pneumoniae may influence vaccination efficacy. These findings provide baseline data to further compare pneumococcal carriage rates and antibiotic resistance patterns in Taiwanese children as vaccination rates continue to increase.
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Affiliation(s)
- Chen-Yen Kuo
- Department of Pediatrics, Chang Gung Children's Hospital, College of Medicine, Chang Gung University, 5 Fu-Hsin Street, Kwei-Shan Hsiang, Taoyuan, Taiwan
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Lo WT, Wang CC. Panton-Valentine leukocidin in the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Pediatr Neonatol 2011; 52:59-65. [PMID: 21524624 DOI: 10.1016/j.pedneo.2011.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 05/17/2010] [Accepted: 06/22/2010] [Indexed: 11/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen that causes serious infectious diseases and was endemic in hospitals by the late 1960s. Beginning with its first report in the late 1990s, the rapid emergence of community-associated MRSA (CA-MRSA) worldwide responsible for a wide spectrum of diseases ranging from minor skin infections to fatal necrotizing pneumonia has been found in previously healthy individuals without established risk factors for MRSA acquisition. Recently, various virulence determinants unique to CA-MRSA have been uncovered, which explain how the pathogen spreads easily and causes severe CA-MRSA infections among humans. However, the role of Panton-Valentine leukocidin (PVL) in the pathogenesis of CA-MRSA infection is currently a matter of much debate because of conflicting data from epidemiologic studies of CA-MRSA infections and various murine disease models. Identifying specialized pathogenic traits of CA-MRSA and the concerted regulation of these factors remains a challenge that will foster development of vaccines and therapies designed to control CA-MRSA infections. This review focuses on the current status of molecular epidemiology associated with CA-MRSA in Taiwan and progresses toward understanding the enhanced virulence properties of CA-MRSA, with an emphasis on the role of Panton-Valentine leukocidin.
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Affiliation(s)
- Wen-Tsung Lo
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Community-associated meticillin-resistant Staphylococcus aureus in children in Taiwan, 2000s. Int J Antimicrob Agents 2011; 38:2-8. [PMID: 21397461 DOI: 10.1016/j.ijantimicag.2011.01.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 01/17/2011] [Indexed: 11/21/2022]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) has been increasingly identified as the major cause of community-associated (CA) infections in previously healthy hosts since the late 1990s. CA-MRSA strains were recognised as a novel pathogen that is genetically different from healthcare-associated MRSA, and five major epidemic clones have been identified worldwide. In Taiwan, a significantly increasing rate of MRSA carriage and infection amongst healthy subjects was observed in the past decade. Up to 9.5% of healthy Taiwanese children carried MRSA in the nares and >50% of paediatric CA S. aureus infections were MRSA. The adult population was also affected, but this was relatively limited. The majority of CA-MRSA isolates in Taiwan belonged to the sequence type (ST) 59 lineage, defined by multilocus sequence typing, and were multiresistant to non-β-lactams. The clone of ST59 lineage can be further classified into at least two major clones by pulsed-field gel electrophoresis (PFGE) typing, staphylococcal chromosomal cassette mec (SCCmec) elements and Panton-Valentine leukocidin (PVL) genes. The clone characterised as ST59/PFGE type C/SCCmec IV/PVL-negative was prevalent amongst the colonising isolates, whereas ST59/PFGE type D/SCCmec V(T)/PVL-positive was prevalent amongst the clinical isolates. Evidence suggested that the ST59 CA-MRSA clone was not only circulating in Taiwan but also in other areas of the world. In this article, the current status of CA-MRSA in Taiwan was extensively reviewed. The information provided here is not only important for local public health but can also enhance a general understanding of the successful epidemic clones of CA-MRSA worldwide.
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Lo WT, Lin WJ, Chiueh TS, Lee SY, Wang CC, Lu JJ. Changing trends in antimicrobial resistance of major bacterial pathogens, 1985-2005: a study from a medical center in northern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:131-8. [PMID: 21439516 DOI: 10.1016/j.jmii.2010.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/02/2009] [Accepted: 02/10/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antimicrobial resistance is a major health problem worldwide. We evaluated the antimicrobial resistance trends of 16 major bacterial pathogens at a tertiary medical center in northern Taiwan. METHODS We conducted a retrospective review of annual summary documents for antimicrobial susceptibility of clinically isolated gram-positive and gram-negative bacteria from 1985 to 2005. The numbers of isolates and susceptibilities were calculated for three 7-year periods: first period, 1985-1991; second period, 1992-1998; and the third period, 1999-2005. RESULTS During the 21-year period, 219,715 bacterial pathogens were identified. A significant increase in incidence over time was found for methicillin-resistant Staphylococcus aureus, methicillin-resistant S epidermidis, penicillin-nonsusceptible Streptococcus pneumoniae, erythromycin-resistant S pneumoniae, vancomycin-resistant enterococci, cefotaxime/ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae, and imipenem-resistant Acinetobacter baumannii. Additionally, a significant increase in ciprofloxacin resistance rates over time from 1996 to 2005 was noted for E coli, Enterobacter cloacae, and A baumannii (through 1997 to 2005). However, a significant decrease in erythromycin resistance rate with time from 1999 to 2005 was found for Groups A and B streptococci, non-A, B, D streptococci, and S pneumoniae. CONCLUSION Resistance to antimicrobial agents increased rapidly in the past two decades in Taiwan and has become very common in major bacterial pathogens. Continuous enforcement of policies to limit use of antimicrobial agents and active surveillance of antimicrobial resistance through a nationwide system are both warranted.
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Affiliation(s)
- Wen-Tsung Lo
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Antimicrobial Drug Resistance in Taiwan. J Formos Med Assoc 2011; 110:4-13. [DOI: 10.1016/s0929-6646(11)60002-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 07/19/2010] [Accepted: 08/03/2010] [Indexed: 01/08/2023] Open
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Changes in the nasal colonization with methicillin-resistant Staphylococcus aureus in children: 2004-2009. PLoS One 2010; 5:e15791. [PMID: 21209954 PMCID: PMC3012095 DOI: 10.1371/journal.pone.0015791] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 11/29/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is an important cause of infection, particularly in persons colonized with this organism. This study compared the annual prevalence and microbiological characteristics of methicillin-resistant S. aureus (MRSA) nasal colonization in Taiwanese children from 2004 through 2009. Risk factors for MRSA were determined for the overall study period. METHODS Children from birth to ≤14 years of age presenting for health maintenance visits or attending 1 of 57 kindergartens were recruited. Nasal swabs were obtained, and a questionnaire was administered. The prevalence and microbiological characteristics of MRSA colonization were also calculated for two 3-year periods: 2004-2006 and 2007-2009. RESULTS Cultures of the anterior nares were positive for S. aureus in 824 (25.8%) of the 3,200 children, and MRSA colonization was found in 371 (11.6%) children. The prevalence of S. aureus colonization decreased from 28.1% in 2004-2006 to 23.3% in 2007-2009 (p<0.01), whereas the prevalence of MRSA colonization increased from 8.1% to 15.1% during this period (p<0.0001). Multivariate analysis revealed that the independent risk factors for MRSA carriage were different for male and female children, and also among age groups. Most MRSA isolates belonged to sequence type 59 (ST59) (86.3%); however, a multiresistant MRSA clone with ST338 background emerged in 2007-2009. Ten (62.5%) of the 16 MRSA isolates expressed the genotypic profile ST338/staphylococcal cassette chromosome mec V(T)/Panton-Valentine leukocidin-positive/staphylococcal enterotoxin B-positive, and differed only in their antimicrobial susceptibility patterns. CONCLUSION The prevalence of nasal colonization by MRSA increased among healthy Taiwanese children from 2004-2006 to 2007-2009, despite an overall decrease in the prevalence of nasal colonization by S. aureus. A multiresistant MRSA clone characterized as ST338 was identified from these children.
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Wide host range and strong lytic activity of Staphylococcus aureus lytic phage Stau2. Appl Environ Microbiol 2010; 77:756-61. [PMID: 21148689 DOI: 10.1128/aem.01848-10] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In searching for an alternative antibacterial agent against multidrug-resistant Staphylococcus aureus, we have isolated and characterized a lytic staphylophage, Stau2. It possesses a double-stranded DNA genome estimated to be about 134.5 kb and a morphology resembling that of members of the family Myoviridae. With an estimated latency period of 25 min and a burst size of 100 PFU/infected cell, propagation of Stau2 in liquid culture gave a lysate of ca. 6 × 10(10) PFU/ml. It was stable at pH 5 to 13 in normal saline at room temperature for at least 4 weeks and at -85°C for more than 2 years, while 1 × 10(9) out of 2 × 10(12) PFU/ml retained infectivity after 36 months at 4°C. Stau2 could lyse 80% of the S. aureus isolates (164/205) obtained from hospitals in Taiwan, with complete lysis of most of the isolates tested within 3 h; however, it was an S. aureus-specific phage because no lytic infection could be found in the coagulase-negative staphylococci tested. Its host range among S. aureus isolates was wider than that of polyvalent phage K (47%), which can also lyse many other staphylococcal species. Experiments with mice demonstrated that Stau2 could provide 100% protection from lethal infection when a multiplicity of infection of 10 was administered immediately after a challenge with S. aureus S23. Considering these results, Stau2 could be considered at least as a candidate for topical phage therapy or an additive in the food industry.
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