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Chegene Lorestani R, Shojaeian A, Rostamian M. Phenotypic, genotypic, and metabolic resistance mechanisms of ESKAPE bacteria to chemical disinfectants: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2023; 21:1097-1123. [PMID: 37674347 DOI: 10.1080/14787210.2023.2256975] [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: 12/31/2022] [Revised: 07/31/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The presence of resistant ESKAPE pathogens to antimicrobials including chemical disinfectants (ChDs) is a serious threat to public health worldwide. In the present study, we systematically reviewed published reports on mechanisms beyond ChD resistance of ESKAPE bacteria. RESEARCH DESIGN AND METHODS Several databases without date limitations were searched. Studies focused on the ChD resistance/tolerance mechanisms of ESKAPE bacteria were included. Meta-analysis was done to assess the frequency of tolerance and genes in ESKAPE clinical isolates. By screening of initial 6733 records, finally, 41 studies were included. RESULTS The overall tolerance to at least one ChD was 48.6%. Pseudomonas aeruginosa and Acinetobacter baumannii were highly ChD-resistant. In several studies, phenotypic changes including changes in general morphology, pump function, cell surface, and membrane, as well as metabolic changes were observed after ChD addition. The resistance gene frequency was 70.2% for norfloxacin efflux pump genes, 40.6% for qac major facilitator superfamily genes, and 22.2% for qac small multidrug resistance genes. CONCLUSION We systematically reviewed the effect of various mechanisms in the resistance process of ESKAPE bacteria to ChDs. However, except for the impact of genes, the numbers of studies investigating other mechanisms were very limited, demanding carrying out more studies in this field.
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Affiliation(s)
- Roya Chegene Lorestani
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Shojaeian
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Alsolami A, ALGhasab NS, Alharbi MSM, Bashir AI, Saleem M, Syed Khaja AS, Aldakheel DF, Rakha E, Alshammari JA, Taha TE, Melibari Z, Alharbi YH, Almutlag AA, Said KB. Community-Acquired Methicillin-Resistant Staphylococcus aureus in Hospitals: Age-Specificity and Potential Zoonotic-Zooanthroponotic Transmission Dynamics. Diagnostics (Basel) 2023; 13:2089. [PMID: 37370983 DOI: 10.3390/diagnostics13122089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) lineages are a devastating clinical and public health issue. Data on local lineage profiles are limited. We report on the frequency of community-acquired and hospital-acquired cases (CA-MRSA, HA-MRSA). We studied 147 isolates from King Khalid tertiary care hospitals (KKH), each from a case in a patient and including 33 patients at the Maternity and Children's Hospital (MCH). Of the 147 isolates, 87 males (59%) and 60 females (41%) were in KKH. The overwhelming majority (80%; n = 119/147) were CA-MRSA in KKH. Intriguingly, despite significant differences between males (70%) and females (53%), lineage-acquisition remained age-specific around 58-60 years in both genders. However, while CA-MRSA dominated early in life (0-20, 70% MCH), it increased with age in KKH adults; 21-50 (28%), >50 (59%) until the overall 80% (n = 144/180). Major specimens included skin-wounds, surgeries (70.3%), blood (13.5%), sputum (8.8%), very rarely urine (4.1%), and nasal (3.4%), albeit most patients showed severe enteritis and necrotizing pneumonia. Antibiograms showed high beta lactam resistances, including amoxicillin-clavulanate (83%), oxacillin (84%), cefoxitin FOX (100%), penicillin and ampicillin (~100%), as well as high resistance (82%) to carbapenem. Fortunately, high susceptibility was seen to non-beta lactams and, to a lesser extent, gentamicin, erythromycin, and fusidic acid; 33%, 34%, and 38%, respectively, in KKH. A similar pattern was seen in MCH except for a low resistance pattern to gentamicin CN, clindamycin CD, erythromycin E, and tobramycin TOB; 34%, 31%, 39%, and 41%, respectively, except for fusidic acid. These findings have significant clinical implications for MRSA patient management strategies. Clinical- and lineage-profiles imply host-selection and zoonotic-zooanthroponotic transmission dynamics. Future molecular typing, sequencing, and characterization of dominant clone(s) is imperative.
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Affiliation(s)
- Ahmed Alsolami
- Department of Internal Medicine, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Naif Saad ALGhasab
- Department of Cardiology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Mohammed S M Alharbi
- Department of Internal Medicine, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Abdelhafiz I Bashir
- Department of Physiology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Mohd Saleem
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | | | - Dakheel F Aldakheel
- Medical Coordination Unit, Ha'il General Hospital, Ha'il 55428, Saudi Arabia
| | - Ehab Rakha
- Departments of Microbiology, King Khalid Hospital, Ha'il 55421, Saudi Arabia
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Jabar Aziz Alshammari
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Taha E Taha
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ziyad Melibari
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Yaseer H Alharbi
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Ali A Almutlag
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Kamaleldin B Said
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
- Genomics, Bioinformatics and Systems Biology, Carleton University, 1125 Colonel-By Drive, Ottawa, ON K1S 5B6, Canada
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Bonn CM, Rafiqullah IM, Crawford JA, Qian YM, Guthrie JL, Matuszewska M, Robinson DA, McGavin MJ. Repeated Emergence of Variant TetR Family Regulator, FarR, and Increased Resistance to Antimicrobial Unsaturated Fatty Acid among Clonal Complex 5 Methicillin-Resistant Staphylococcus aureus. Antimicrob Agents Chemother 2023; 67:e0074922. [PMID: 36744906 PMCID: PMC10019231 DOI: 10.1128/aac.00749-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Resistance-nodulation-division (RND) superfamily efflux pumps promote antibiotic resistance in Gram-negative pathogens, but their role in Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) is undocumented. However, recent in vitro selections for resistance of S. aureus to an antimicrobial fatty acid, linoleic acid, and an antibiotic, rhodomyrtone, identified H121Y and C116R substitution variants, respectively, in a TetR family regulator, FarR, promoting increased expression of the RND pump FarE. Hypothesizing that in vivo selection pressures have also promoted the emergence of FarR variants, we searched available genome data and found that strains with FarRH121Y from human and bovine hosts have emerged sporadically in clonal complexes (CCs) CC1, CC30, CC8, CC22, and CC97, whereas multiple FarR variants have occurred within CC5 hospital-associated (HA)-MRSA. Of these, FarRE160G and FarRE93EE were exclusive to CC5, while FarRC116Y, FarRP165L, and FarRG166D also occurred in nonrelated CCs, primarily from bovine hosts. Within CC5, FarRC116Y and FarRG166D strains were polyphyletic, each exhibiting two emergence events. FarRC116Y and FarRE160G were individually sufficient to confer increased expression of FarE and enhanced resistance to linoleic acid (LA). Isolates with FarRE93EE were most closely related to S. aureus N315 MRSA and exhibited increased resistance independently of FarRE93EE. Accumulation of pseudogenes and additional polymorphisms in FarRE93EE strains contributed to a multiresistance phenotype which included fosfomycin and fusidic acid resistance in addition to increased linoleic acid resistance. These findings underscore the remarkable adaptive capacity of CC5 MRSA, which includes the polyphyletic USA100 lineage of HA-MRSA that is endemic in the Western hemisphere and known for the acquisition of multiple resistance phenotypes.
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Affiliation(s)
- Camryn M. Bonn
- Department of Microbiology, University of Western Ontario, London, Ontario, Canada
| | - Iftekhar M. Rafiqullah
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - John A. Crawford
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Yi Meng Qian
- Department of Microbiology, University of Western Ontario, London, Ontario, Canada
| | - Jennifer L. Guthrie
- Department of Microbiology, University of Western Ontario, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Marta Matuszewska
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - D. Ashley Robinson
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Center for Immunology and Microbial Research, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Martin J. McGavin
- Department of Microbiology, University of Western Ontario, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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A Sequalae of Lineage Divergence in Staphylococcus aureus from Community-Acquired Patterns in Youth to Hospital-Associated Profiles in Seniors Implied Age-Specific Host-Selection from a Common Ancestor. Diagnostics (Basel) 2023; 13:diagnostics13050819. [PMID: 36899963 PMCID: PMC10001379 DOI: 10.3390/diagnostics13050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
The rapidly changing epidemiology of Staphylococcus aureus and evolution of strains with enhanced virulence is a significant issue in global healthcare. Hospital-associated methicillin-resistant S. aureus (HA-MRSA) lineages are being completely replaced by community-associated S. aureus (CA-MRSA) in many regions. Surveillance programs tracing the reservoirs and sources of infections are needed. Using molecular diagnostics, antibiograms, and patient demographics, we have examined the distributions of S. aureus in Ha'il hospitals. Out of 274 S. aureus isolates recovered from clinical specimens, 181 (66%, n = 181) were MRSA, some with HA-MRSA patterns across 26 antimicrobials with almost full resistances to all beta-lactams, while the majority were highly susceptible to all non-beta-lactams, indicating the CA-MRSA type. The rest of isolates (34%, n = 93) were methicillin-susceptible, penicillin-resistant MSSA lineages (90%). The MRSA in men was over 56% among total MRSA (n = 181) isolates and 37% of overall isolates (n = 102 of 274) compared to MSSA in total isolates (17.5%, n = 48), respectively. However, these were 28.4% (n = 78) and 12.4% (n = 34) for MRSA and MSSA infections in women, respectively. MRSA rates per age groups of 0-20, 21-50, and >50 years of age were 15% (n = 42), 17% (n = 48), and 32% (n = 89), respectively. However, MSSA in the same age groups were 13% (n = 35), 9% (n = 25), and 8% (n = 22). Interestingly, MRSA increased proportional to age, while MSSA concomitantly decreased, implying dominance of the latter ancestors early in life and then gradual replacement by MRSA. The dominance and seriousness of MRSA despite enormous efforts in place is potentially for the increased use of beta-lactams known to enhance virulence. The Intriguing prevalence of the CA-MRSA patterns in young otherwise healthy individuals replaced by MRSA later in seniors and the dominance of penicillin-resistant MSSA phenotypes imply three types of host- and age-specific evolutionary lineages. Thus, the decreasing MSSA trend by age with concomitant increase and sub-clonal differentiation into HA-MRSA in seniors and CA-MRSA in young and otherwise healthy patients strongly support the notion of subclinal emergences from a resident penicillin-resistant MSSA ancestor. Future vertical studies should focus on the surveillance of invasive CA-MRSA rates and phenotypes.
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Sarwar S, Saleem S, Shahzad F, Jahan S. Identifying and elucidating the resistance of Staphylococcus aureus isolated from hospital environment to conventional disinfectants. Am J Infect Control 2023; 51:178-183. [PMID: 35644295 DOI: 10.1016/j.ajic.2022.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Staphylococcus aureus is a nosocomial pathogen, detection and elucidation of its resistance mechanisms to conventional disinfectants may aid in limiting its spread on environmental surfaces in health care settings. In the current study, disinfectant susceptibility of S. aureus strains isolated from the hospital environment as well as possible associations between the presence of disinfectant-resistance genes and reduced susceptibility to disinfectants was investigated. METHODS A total of 245 samples were collected from the hospital environmental surfaces. The minimum inhibitory (MIC) and bactericidal concentrations (MBC) of disinfectants against S. aureus isolates were determined using the micro-broth dilution method. The qac genes (qacA, qacE, and qacΔE1) were detected by PCR and confirmed by sanger sequencing. RESULTS A total of 47 S. aureus strains were isolated, with more than 85% of them showing methicillin resistance. The qacA, qacE, and qac∆E1 genes were found in 23.4%, 29.7%, and 4.2% isolates respectively. All the isolates with qac genes had higher MIC and MBC values to selected disinfectants. CONCLUSIONS Significant methicillin resistant S. aureus (MRSA) contamination in the hospital environment was detected. Furthermore, higher qac gene frequencies were found in MRSA isolates that also correlated with higher MIC/MBC values to different disinfectants. The study proposes that hospitals should develop policies to determine disinfectant MICs against the common environmental isolates to contain the spread of resistant strains.
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Affiliation(s)
- Samreen Sarwar
- Department of Microbiology, University of Health Sciences, Lahore, Punjab, Pakistan.
| | - Sidrah Saleem
- Department of Microbiology, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Faheem Shahzad
- Department of Immunology, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Shah Jahan
- Department of Immunology, University of Health Sciences, Lahore, Punjab, Pakistan
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Phenotypic and molecular detection of biofilm formation in clinical methicillin-resistant Staphylococcus aureus isolates from Malaysia. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2022. [DOI: 10.1080/16583655.2022.2147387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chavignon M, Coignet L, Bonhomme M, Bergot M, Tristan A, Verhoeven P, Josse J, Laurent F, Butin M. Environmental Persistence of Staphylococcus capitis NRCS-A in Neonatal Intensive Care Units: Role of Biofilm Formation, Desiccation, and Disinfectant Tolerance. Microbiol Spectr 2022; 10:e0421522. [PMID: 36409142 PMCID: PMC9769769 DOI: 10.1128/spectrum.04215-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
The clone Staphylococcus capitis NRCS-A is responsible for late-onset sepsis in neonatal intensive care units (NICUs) worldwide. Over time, this clone has evolved into three subgroups that are increasingly adapted to the NICU environment. This study aimed to decipher the mechanisms involved in NRCS-A persistence in NICUs. Twenty-six S. capitis strains belonging to each of the three NRCS-A clone subgroups and two other non-NRCS-A groups from neonates (alpha clone) or from adult patients ("other strains") were compared based on growth kinetics and ability to form biofilm as well as tolerance to desiccation and to different disinfectants. S. capitis biofilm formation was enhanced in rich medium and decreased under conditions of nutrient stress for all strains. However, under conditions of nutrient stress, NRCS-A strains presented an enhanced ability to adhere and form a thin biofilm containing more viable and culturable bacteria (mean 5.7 log10 CFU) than the strains from alpha clone (mean, 1.1 log10 CFU) and the "other strains" (mean, 4.2 log10 CFU) (P < 0.0001). The biofilm is composed of bacterial aggregates with a matrix mainly composed of polysaccharides. The NRCS-A clone also showed better persistence after a 48-h desiccation. However, disinfectant tolerance was not enhanced in the NRCS-A clone in comparison with that of strains from adult patients. In conclusion, the ability to form biofilm under nutrient stress and to survive desiccation are two major advantages for clone NRCS-A that could explain its ability to persist and settle in the specific environment of NICU settings. IMPORTANCE Neonatal intensive care units (NICUs) host extremely fragile newborns, including preterm neonates. These patients are very susceptible to nosocomial infections, with coagulase-negative staphylococci being the species most frequently involved. In particular, a Staphylococcus capitis clone named NRCS-A has emerged worldwide specifically in NICUs and is responsible for severe nosocomial sepsis in preterm neonates. This clone is specifically adapted to the NICU environment and is able to colonize and maintain on NICU surfaces. The present work explored the mechanisms involved in the persistence of the NRCS-A clone in the NICU environment despite strict hygiene measures. The ability to produce biofilm under nutritional stress and to resist desiccation appear to be the two main advantages of NRCS-A in comparison with other strains. These findings are pivotal to provide clues for subsequent development of targeted methods to combat NRCS-A and to stop its dissemination.
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Affiliation(s)
- Marie Chavignon
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Ludivine Coignet
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Mélanie Bonhomme
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Marine Bergot
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Anne Tristan
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Paul Verhoeven
- Centre International de Recherche en Infectiologie (CIRI), Team GIMAP (Groupe sur l’Immunité des Muqueuses et Agents Pathogènes), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jérôme Josse
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Frédéric Laurent
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Marine Butin
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
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Muneeb KH, Sudha S, Sivaraman GK, Ojha R, Mendem SK, Murugesan D, Raisen CL, Shome B, Holmes M. Whole-genome sequence analysis of Staphylococcus aureus from retail fish acknowledged the incidence of highly virulent ST672-MRSA-IVa/t1309, an emerging Indian clone, in Assam, India. ENVIRONMENTAL MICROBIOLOGY REPORTS 2022; 14:412-421. [PMID: 34796671 DOI: 10.1111/1758-2229.13024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
The epidemiology and toxigenicity of MRSA in the fishery environment are poorly understood. In this study, methicillin-resistant Staphylococcus aureus (MRSA) (n = 1) and methicillin-susceptible S. aureus (MSSA) (n = 2) from retail fish were subjected to comprehensive genome analysis. Here, we report the occurrence of ST672-MRSA-IV/t1309 and ST5-MSSA/t105 for the first time from India in the fishery environment. The resistome of the isolates was in concordance with their phenotypic resistance pattern. Phenotypically, the resistance profile of MSSA isolates (n = 2) was AMP-CLI-ERY-NOR-PEN. For MRSA (n = 1), it was AMP-CFZ-CLI-ERY-NOR-OXA-PEN. The antibiotic efflux genes and mutations in the antibiotic target accounted for fluoroquinolone resistance whereas methicillin resistance was conferred through possession of a mecA gene. Similarly, all three isolates carried a similar array of virulence factors. The conjugative plasmid inc18 and rep family 10 plasmids were found in two of the three isolates. This study documents the MRSA carrying SCCmec IVa elements which are the markers of community-associated MRSA (CA-MRSA). Through the possession of SCCmec IV elements, which are smaller than other types of SCCmec, MRSA can contribute to the rapid dissemination of antimicrobial resistance and virulence factors. In short, our findings highlighted that the presence of ST672-MRSA in fishery environments may pose a risk to human health.
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Affiliation(s)
- K H Muneeb
- Microbiology Fermentation and Biotechnology Division, ICAR-Central Institute of Fisheries Technology, Kochi, 682 029, India
- Department of Biotechnology, Faculty of Sciences, Cochin University of Science and Technology, Kochi, India
| | - S Sudha
- Microbiology Fermentation and Biotechnology Division, ICAR-Central Institute of Fisheries Technology, Kochi, 682 029, India
| | - G K Sivaraman
- Microbiology Fermentation and Biotechnology Division, ICAR-Central Institute of Fisheries Technology, Kochi, 682 029, India
| | - Rakshit Ojha
- Department of Disease Investigation, ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - Suresh Kumar Mendem
- Department of Disease Investigation, ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - Devi Murugesan
- Department of Disease Investigation, ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - C L Raisen
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Bibek Shome
- Department of Disease Investigation, ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - Mark Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Kaiser-Thom S, Gerber V, Collaud A, Hurni J, Perreten V. Prevalence and WGS-based characteristics of Staphylococcus aureus in the nasal mucosa and pastern of horses with equine pastern dermatitis. BMC Vet Res 2022; 18:79. [PMID: 35209904 PMCID: PMC8867626 DOI: 10.1186/s12917-021-03053-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Many contributing factors are involved in the development of equine pastern dermatitis (EPD). Among the most frequently suspected is Staphylococcus aureus, known for its pathogenic potential in skin and soft tissue infections. We therefore investigated the association between S. aureus carriage and EPD. RESULTS One hundred five EPD-affected horses and 95 unaffected controls were examined for the presence of methicillin-resistant and -susceptible Staphylococcus aureus (MRSA and MSSA) on the pastern skin and in the nostrils. S. aureus isolates were cultivated from swab samples on selective MSSA and MRSA chromogenic agar and identified using MALDI-TOF MS. Isolates were analysed by Illumina whole genome sequencing for genetic relatedness (cgMLST, spa typing), and for the presence of antimicrobial resistance and virulence determinants. A markedly higher proportion of samples from EPD-affected horses proved positive for S. aureus, both from the pastern (59.0 % vs. 6.3 % in unaffected horses; P<0.001), and from the nose (59.0 % vs. 8.4 %; P<0.001). Isolates belonged to 20 sequence types (ST) with lineages ST15-t084 (spa) (18 %), ST1-t127 (13 %), and ST1-t1508 (12 %) being predominant. Eight S. aureus were MRSA ST398-t011 and ST6239-t1456, and contained the staphylococcal cassette chromosome SCCmecIVa. Antimicrobial resistance genes were almost equally frequent in pastern and in nasal samples, whereas some virulence factors such as the beta-hemolysin, ESAT-6 secretion system, and some enterotoxins were more abundant in isolates from pastern samples, possibly enhancing their pathogenic potential. CONCLUSIONS The markedly higher prevalence of S. aureus containing specific virulence factors in affected skin suggests their contribution in the development and course of EPD.
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Affiliation(s)
- Sarah Kaiser-Thom
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, Swiss Institute of Equine Medicine (ISME), University of Bern, and Agroscope, Bern, Switzerland
| | - Vinzenz Gerber
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, Swiss Institute of Equine Medicine (ISME), University of Bern, and Agroscope, Bern, Switzerland
| | - Alexandra Collaud
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Joel Hurni
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, Swiss Institute of Equine Medicine (ISME), University of Bern, and Agroscope, Bern, Switzerland.,Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Vincent Perreten
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
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Van den Poel B, Saegeman V, Schuermans A. Increasing usage of chlorhexidine in health care settings: blessing or curse? A narrative review of the risk of chlorhexidine resistance and the implications for infection prevention and control. Eur J Clin Microbiol Infect Dis 2022; 41:349-362. [DOI: 10.1007/s10096-022-04403-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/11/2022] [Indexed: 12/18/2022]
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Lynch L, Shrotri M, Brown CS, Heathcock RT. Is decolonisation to prevent PVL-positive Staphylococcus aureus infection in the population effective? A systematic review. J Hosp Infect 2021; 121:91-104. [PMID: 34973237 DOI: 10.1016/j.jhin.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/26/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Panton-Valentine Leukocidin (PVL) producing Staphylococcus aureus is associated with recurrent skin and soft tissue infections and occasionally invasive infections. There is limited evidence to support current public health guidance on decolonisation of cases and household contacts. METHODS This systematic review (CRD42020189906) investigated the efficacy of decolonisation against PVL-positive S. aureus to inform future public health practice. It included studies of cases with PVL-positive infections providing information on the efficacy of decolonisation of cases, carriers, or contacts of cases. Studies were assessed for the risk of bias using the GRADE approach and summarised to inform a narrative synthesis. RESULTS The search identified 20, mostly observational, studies with small samples and lacking control groups. Studies with longer follow-ups found that, while early post-decolonisation screening was negative for most individuals, testing over subsequent months identified re-colonisation in some. There is no high quality evidence to show whether decolonisation is effective in reducing (re)infection or long-term carriage of PVL-positive S. aureus and the low quality evidence available indicates it may not be effective in eradicating carriage or reducing future disease. Furthermore, there may be risks associated with decolonisation, for example, potentially increased risk of infection from other microbes, opportunity costs and negative impacts of repeated testing for asymptomatic carriage. CONCLUSIONS Further research is required to better understand what affects the ability of decolonisation efforts to reduce risk to cases and their contacts, including strain, host and environmental factors.
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Affiliation(s)
- Lucy Lynch
- Public Health England, London, United Kingdom.
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12
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Mbindyo CM, Gitao GC, Plummer PJ, Kulohoma BW, Mulei CM, Bett R. Antimicrobial Resistance Profiles and Genes of Staphylococci Isolated from Mastitic Cow's Milk in Kenya. Antibiotics (Basel) 2021; 10:antibiotics10070772. [PMID: 34202836 PMCID: PMC8300721 DOI: 10.3390/antibiotics10070772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
Increasing numbers of potentially zoonotic multidrug-resistant (MDR) staphylococci strains, associated with mastitis in dairy cows, are being reported globally and threaten disease management in both animal and human health. However, the prevalence and antimicrobial resistance profiles of these strains, including methicillin-resistant staphylococci (MRS), in Kenya is not well known. This study investigated the drug resistance profiles and genes carried by 183 staphylococci isolates from 142 dairy cows representing 93 farms recovered from mastitis milk of dairy cows in two selected counties in Kenya. Staphylococci isolates were characterized by phenotypic characteristics, polymerase chain reaction (PCR) amplification, partial sequencing and susceptibility testing for 10 antimicrobial drugs. Detection of seven resistance genes to the various antimicrobial drugs was conducted using PCR. Overall, phenotypic resistance among the staphylococci ranged between 66.1% for ampicillin and 3.5% for fluoroquinolones. Twenty-five percent (25%) of S. aureus and 10.8% of the coagulase-negative staphylococci (CoNS) isolates, were methicillin-resistant staphylococci phenotypically (defined as resistance to cefoxitin disk diffusion). The most common genes found in S. aureus and CoNS were blaZ and strB at 44.3% and 26%, and 78% and 50%, respectively. MDR was observed in 29.67% and 16.3% of S. aureus and CoNS, respectively. These findings pose a threat to bovine mastitis treatment and management as well as human health.
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Affiliation(s)
- Christine M. Mbindyo
- Department of Veterinary Pathology, Microbiology and Parasitology, College of Agriculture and Veterinary Sciences, University of Nairobi, Nairobi P.O. Box 29053-00625, Kenya;
- Correspondence: or
| | - George C. Gitao
- Department of Veterinary Pathology, Microbiology and Parasitology, College of Agriculture and Veterinary Sciences, University of Nairobi, Nairobi P.O. Box 29053-00625, Kenya;
| | - Paul Joseph Plummer
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA;
- Department of Veterinary Microbiology and Preventative Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
- National Institute for Antimicrobial Resistance Research and Education, Ames, IA 50010, USA
| | - Benard W. Kulohoma
- Centre for Biotechnology and Bioinformatics, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya;
| | - Charles M. Mulei
- Department of Clinical Studies, College of Agriculture and Veterinary Sciences, University of Nairobi, Nairobi P.O. Box 29053-00625, Kenya;
| | - Rawlynce Bett
- Department of Animal Production, College of Agriculture and Veterinary Sciences, University of Nairobi, Nairobi P.O. Box 29053-00625, Kenya;
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Sarkhoo E, Udo EE, Boswihi SS, Monecke S, Mueller E, Ehricht R. The Dissemination and Molecular Characterization of Clonal Complex 361 (CC361) Methicillin-Resistant Staphylococcus aureus (MRSA) in Kuwait Hospitals. Front Microbiol 2021; 12:658772. [PMID: 34025612 PMCID: PMC8137340 DOI: 10.3389/fmicb.2021.658772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) belonging to clonal complex 361 (CC361-MRSA) is rare among patients’ populations globally. However, CC361-MRSA has been isolated with an increasing trend among patients in Kuwait hospitals since 2010. This study investigated the molecular characteristics of CC361-MRSA isolated from patients in Kuwait hospitals in 2016–2018 to understand their genetic relatedness and virulence determinants. Of 5,223 MRSA isolates investigated by DNA microarray, 182 (3.4%) isolates obtained in 2016 (N = 55), 2017 (N = 56), and 2018 (N = 71) were identified as CC361-MRSA. The CC361-MRSA isolates were analyzed further using antibiogram, spa typing and multi locus sequence typing (MLST). Most of the isolates were resistant to fusidic acid (64.8%), kanamycin (43.4%), erythromycin (36.3%), and clindamycin (14.3%) encoded by fusC, aphA3, and erm(B)/erm(C) respectively. Nine isolates (4.9%) were resistant to linezolid mediated by cfr. The isolates belonged to 22 spa types with t3841 (N = 113), t315 (N = 16), t1309 (N = 14), and t3175 (N = 5) constituting 81.3% of the spa types, four genotypes (strain types), CC361-MRSA-[V/VT + fus] (N = 112), CC361-MRSA-IV, WA MRSA-29 (N = 36), CC361-MRSA-V, WA MRSA-70/110 (N = 33) and CC361-MRSA-[V + fus] variant (N = 1). MLST conducted on 69 representative isolates yielded two sequence types: ST361 (11/69) and ST672 (58/69). All CC361-MRSA isolates were positive for cap8, agr1, and the enterotoxin egc gene cluster (seg, sei, selm, seln, selo, and selu). The tst1 was detected in 19 isolates. The immune evasion cluster (IEC) genes type B (scn, chp, and sak) and type E (scn and sak) were detected in 20 and 152 isolates, respectively. The CC361-MRSA circulating in Kuwait hospitals consisted of two closely related sequence types, ST361 and ST672 with ST672-MRSA [V/VT + fus] as the dominant genotype. The dissemination of these newly emerged clones and the emergence of linezolid resistance limits therapeutic options, as well as present significant challenges for the control of MRSA infections in Kuwait hospitals.
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Affiliation(s)
- Eiman Sarkhoo
- Faculty of Medicine, Department of Microbiology, Kuwait University, Kuwait City, Kuwait
| | - Edet E Udo
- Faculty of Medicine, Department of Microbiology, Kuwait University, Kuwait City, Kuwait
| | - Samar S Boswihi
- Faculty of Medicine, Department of Microbiology, Kuwait University, Kuwait City, Kuwait
| | - Stefan Monecke
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,InfectoGnostics Research Campus Jena, Jena, Germany
| | - Elke Mueller
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,InfectoGnostics Research Campus Jena, Jena, Germany
| | - Ralf Ehricht
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,InfectoGnostics Research Campus Jena, Jena, Germany.,Institute of Physical Chemistry, Friedrich Schiller University Jena, Jena, Germany
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Azrad M, Shmuel C, Leshem T, Hamo Z, Baum M, Rokney A, Agay-Shay K, Peretz A. Reduced Susceptibility to Chlorhexidine among Staphylococcus aureus Isolates in Israel: Phenotypic and Genotypic Tolerance. Antibiotics (Basel) 2021; 10:antibiotics10030342. [PMID: 33807049 PMCID: PMC8005201 DOI: 10.3390/antibiotics10030342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Antiseptic use for body decolonization is the main activity applied to prevent healthcare-associated infections, including those caused by S. aureus. Consequentially, tolerance to several antiseptics such as chlorhexidine gluconate (CHG) has developed. This study aimed to estimate the prevalence of CHG tolerance among S. aureus strains in Israel and to evaluate factors that may affect this tolerance. Furthermore, it tested the associations between phenotypic and genotypic CHG tolerance. S. aureus strains (n = 190) were isolated from clinical samples of patients admitted to various medical institutions in Israel. Phenotypic susceptibility to CHG was assessed by determining minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Genotypic tolerance was detected using real-time PCR for detection of qac A/B genes. MIC for the antibiotic mupirocin was determined using the Etest method. Presence of the Panton-Valentine Leucocidin (pvl) toxin, mecA and mecC genes was detected using an eazyplex® MRSAplus kit (AmplexDiagnostics GmbH, Gars, Germany). CHG tolerance was observed in 13.15% of the isolates. An association between phenotypic and genotypic tolerance to CHG was observed. Phenotypic tolerance to CHG was associated with methicillin resistance but not with mupirocin resistance. Additionally, most of the CHG-tolerant strains were isolated from blood cultures. In conclusion, this work shed light on the prevalence of reduced susceptibility to CHG among S. aureus strains in Israel and on the characteristics of tolerant strains. CHG-tolerant strains were more common than methicillin-resistant ones in samples from invasive infections. Further research should be performed to evaluate risk factors for the development of CHG tolerance.
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Affiliation(s)
- Maya Azrad
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
| | - Chen Shmuel
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
| | - Tamar Leshem
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
| | - Zohar Hamo
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
| | - Moti Baum
- Central Government Laboratories, Israel Ministry of Health, Jerusalem 9446724, Israel; (M.B.); (A.R.)
| | - Assaf Rokney
- Central Government Laboratories, Israel Ministry of Health, Jerusalem 9446724, Israel; (M.B.); (A.R.)
| | - Keren Agay-Shay
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel;
| | - Avi Peretz
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel;
- Correspondence: ; Tel.: +972-4-665-2322
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Goudarzi H, Goudarzi M, Sabzehali F, Fazeli M, Salimi Chirani A. Genetic analysis of methicillin‐susceptible
Staphylococcus aureus
clinical isolates: High prevalence of multidrug‐resistant ST239 with strong biofilm‐production ability. J Clin Lab Anal 2020; 34:e23494. [PMID: 32696587 PMCID: PMC7676197 DOI: 10.1002/jcla.23494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background The distributions of methicillin‐susceptible Staphylococcus aureus (MSSA) are divers geographically with different genetic backgrounds. Data related to molecular characteristics of MSSA compare to methicillin‐resistant Staphylococcus aureus (MRSA) is sparse. Methods In this cross‐sectional study, antimicrobial susceptibility testing, virulence genes analysis, biofilm formation, accessory gene regulator (agr) typing, and multilocus sequence typing (MLST) characterized on 75 MSSA isolates. Results Multidrug‐resistance MSSA was found to be 84%. Forty‐eight (64%) isolates were toxinogenic with 34 and 14 isolates carrying pvl and tst representing 45.3% and 18.7%. The most common SE genes were sed (20%), sec (16%), and sea (16%). Fifty‐five (73.3%) isolates were confirmed as biofilm producer with a markedly high prevalence of fnbA (93.3%), fnbB (86.7%), icaA (65.3%), icaD (53.3%), can (24%), ebp (10.7%), and bap (1.3%). A total of 3 agr types (I, 73.3%; III, 16%; II, 10.7%) and 4 clonal complexes (CCs) and sequence types (STs), namely CC8/ST293 (45.3%), CC/ST22 (28%), CC/ST30 (16%), and CC/ST5 (10.7%) were detected in this study. All the high and low‐level mupirocin resistance strains belonged to ST239 and ST22 strains, respectively. All the fusidic acid‐resistant isolates carried fusC and belonged to ST30. Conclusions These findings indicated that ST239 with strong biofilm production ability is the most common type in MSSA strains isolated from patients. It seems that the antimicrobial resistance profiles, toxin, and biofilm formation were closely associated with specific STs. Further studies are required to identify and control of these clonal lineages in our area.
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Affiliation(s)
- Hossein Goudarzi
- Department of Microbiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mehdi Goudarzi
- Department of Microbiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fattaneh Sabzehali
- Department of Microbiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Maryam Fazeli
- Department of Virology Pasteur Institute of Iran Tehran Iran
| | - Alireza Salimi Chirani
- Department of Microbiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
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16
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Addressing the challenges in antisepsis: focus on povidone iodine. Int J Antimicrob Agents 2020; 56:106064. [DOI: 10.1016/j.ijantimicag.2020.106064] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/21/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
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Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Staphylococcus aureus Decolonization. Antimicrob Agents Chemother 2020; 64:AAC.00682-20. [PMID: 32571829 PMCID: PMC7449185 DOI: 10.1128/aac.00682-20] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA) infections. The two most commonly used agents for decolonization are intranasal mupirocin 2% ointment and chlorhexidine wash, but the increasing emergence of resistance and treatment failure has underscored the need for alternative therapies. This article discusses povidone iodine (PVP-I) as an alternative decolonization agent and is based on literature reviewed during an expert’s workshop on resistance and MRSA decolonization. Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA) infections. The two most commonly used agents for decolonization are intranasal mupirocin 2% ointment and chlorhexidine wash, but the increasing emergence of resistance and treatment failure has underscored the need for alternative therapies. This article discusses povidone iodine (PVP-I) as an alternative decolonization agent and is based on literature reviewed during an expert’s workshop on resistance and MRSA decolonization. Compared to chlorhexidine and mupirocin, respectively, PVP-I 10 and 7.5% solutions demonstrated rapid and superior bactericidal activity against MRSA in in vitro and ex vivo studies. Notably, PVP-I 10 and 5% solutions were also active against both chlorhexidine-resistant and mupirocin-resistant strains, respectively. Unlike chlorhexidine and mupirocin, available reports have not observed a link between PVP-I and the induction of bacterial resistance or cross-resistance to antiseptics and antibiotics. These preclinical findings also translate into clinical decolonization, where intranasal PVP-I significantly improved the efficacy of chlorhexidine wash and was as effective as mupirocin in reducing surgical site infection in orthopedic surgery. Overall, these qualities of PVP-I make it a useful alternative decolonizing agent for the prevention of S. aureus infections, but additional experimental and clinical data are required to further evaluate the use of PVP-I in this setting.
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Abstract
β-Lactam antibiotics have been widely used as therapeutic agents for the past 70 years, resulting in emergence of an abundance of β-lactam-inactivating β-lactamases. Although penicillinases in Staphylococcus aureus challenged the initial uses of penicillin, β-lactamases are most important in Gram-negative bacteria, particularly in enteric and nonfermentative pathogens, where collectively they confer resistance to all β-lactam-containing antibiotics. Critical β-lactamases are those enzymes whose genes are encoded on mobile elements that are transferable among species. Major β-lactamase families include plasmid-mediated extended-spectrum β-lactamases (ESBLs), AmpC cephalosporinases, and carbapenemases now appearing globally, with geographic preferences for specific variants. CTX-M enzymes include the most common ESBLs that are prevalent in all areas of the world. In contrast, KPC serine carbapenemases are present more frequently in the Americas, the Mediterranean countries, and China, whereas NDM metallo-β-lactamases are more prevalent in the Indian subcontinent and Eastern Europe. As selective pressure from β-lactam use continues, multiple β-lactamases per organism are increasingly common, including pathogens carrying three different carbapenemase genes. These organisms may be spread throughout health care facilities as well as in the community, warranting close attention to increased infection control measures and stewardship of the β-lactam-containing drugs in an effort to control selection of even more deleterious pathogens.
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Hospital clones of Panton-Valentine leukocidin-positive and methicillin-resistant Staphylococcus aureus circulating in the Tehran community. J Glob Antimicrob Resist 2019; 22:177-181. [PMID: 31874221 DOI: 10.1016/j.jgar.2019.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The emergence of Panton-Valentine leukocidin (PVL)-positive Staphylococcus aureus has become a serious challenge in hospital and community settings. Therefore, this study was designed to determine the molecular characteristics and genetic relationship of PVL-positive S. aureus. METHODS A total of 116 S. aureus isolates were collected from outpatients and inpatients within 48 h after admission. For PVL-positive strains, antibiogram testing, toxin gene profile, agr grouping, SCCmec typing and genotyping by pulsed-field gel electrophoresis (PFGE) were performed. RESULTS Of 116 isolates, 13 (11.2%) harboured the PVL gene, 5 isolates (38.4%) were methicillin-resistant S. aureus (MRSA) with agr group I and SCCmec III. Of these, four strains were hospital-associated MRSA (HA-MRSA) that moved to the community and one strain was atypical community-associated MRSA (CA-MRSA), with characteristics of being PVL-positive, susceptible to all tested antibiotics, including clindamycin, with SCCmec III. This was recovered from a burn patient less than 24 h after the patient's admission and fulfilled the Centers for Disease Control and Prevention (CDC) criteria for CA-MRSA, except for the type of SCCmec. High diversity was found among PVL-positive strains by PFGE. All PVL gene-positive strains had hly and psms genes, but the tsst-1 gene was found just in methicillin-susceptible S. aureus (MSSA). CONCLUSION The results indicate that the distribution of the PVL gene in MSSA isolates was higher than in MRSA strains, and various PVL-positive resistant and virulent clones of HA-MRSA are circulating in the community. Therefore, implementing systematic surveillance is necessary for the evaluation of common PVL-positive S. aureus clones in the community.
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20
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Baraldi MM, Gnatta JR, Padoveze MC. Risks and benefits of using chlorhexidine gluconate in handwashing: A systematic literature review. Am J Infect Control 2019; 47:704-714. [PMID: 30642673 DOI: 10.1016/j.ajic.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antimicrobial soaps containing chlorhexidine gluconate (CHG) are indicated for hand hygiene (HH) in specific situations. This study aimed to identify whether the continuous use of CHG for HH affects the reduction of healthcare-associated infections (HAI), the selection of microorganisms resistant to CHG, or hands skin damage. METHODS Systematic review was performed using the protocol of the Joanna Briggs Institute, including clinical trials and observational comparative studies. Search was conducted via PubMed, Medline, CINAHL, LILACS, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Google Scholar, and gray literature. To evaluate outcomes, 3 independent reviews were conducted: HAI rates, presence of resistance genes or higher minimum inhibitory or bactericidal concentration, and damage to skin integrity. RESULTS Studies showed no significant difference in HAI rates when using CHG for HH. Among 13 studies, 10 suggested an association with use of and tolerance to CHG. The use of CHG was associated with skin reaction events. CONCLUSIONS Strong evidence regarding the risks and benefits of CHG for HH is still lacking. Due to potential risk of selecting mutants carrying genes for cross-resistance to CHG and antibiotics, it is advisable to reserve the use of CHG for purposes other than HH.
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Affiliation(s)
- Marcia Maria Baraldi
- School of Nursing, University of São Paulo and Hospital Alemão Oswaldo Cruz São Paulo, São Paulo, Brazil.
| | | | - Maria Clara Padoveze
- Department of Collective Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
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Miyajima E, Harada D, Nakaminami H, Kitamura Y, Tamura T, Kawakubo T, Noguchi N. Decreased Prevalence of qacA-Positive Methicillin-Resistant Staphylococcus aureus in Hospitalized Patients in Tokyo, Japan. Microb Drug Resist 2019; 25:1032-1040. [PMID: 30964376 DOI: 10.1089/mdr.2018.0351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Presence of methicillin-resistant Staphylococcus aureus (MRSA) strains carrying plasmid-borne multidrug efflux pump-encoding gene, qacA/B, is a serious issue for infection control in hospitals, because they can survive hand hygiene. The qacA/B genes are divided into five subtypes: qacA, qacBI, qacBII, qacBIII, and qacBIV. The aim of this study was to investigate the prevalence and risk factors of hospitalized patients infected by respective qacA/B-positive MRSA strains between 2010 and 2016 in Tokyo, Japan. Of the 600 total MRSA strains observed, the qacA/B-positive strains constituted 19.8% (199 isolates), of which 56.8% (113 isolates), 28.6% (57 isolates), and 14.6% (29 isolates) were classified as qacA, qacBIII, and qacBII-positive strains, respectively. The prevalence of qacA-positive MRSA strains significantly decreased from July 2010 to June 2011 (34.0%) to July 2015 to May 2016 (5.3%) (p < 0.05). When staphylococcal cassette chromosome (SCC)mec types of the respective qacA/B-positive strains were determined, 81.4% of the qacA-positive strains were classified into SCCmec type II, which has recently been decreasing in hospital-acquired MRSA in Japan. Risk factor analysis showed that there were no specific clinical departments associated with the presence of qacA-positive strains. Our findings suggest that change in the MRSA clonal lineages impact to decrease the prevalence of qacA-positive strains in Japanese hospitals.
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Affiliation(s)
- Eri Miyajima
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Dai Harada
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.,Department of Pharmacy, The Jikei University Hospital, Tokyo, Japan
| | - Hidemasa Nakaminami
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | | | - Taku Tamura
- Central Clinical Laboratory, The Jikei University Hospital, Tokyo, Japan
| | - Takashi Kawakubo
- Department of Pharmacy, The Jikei University Hospital, Tokyo, Japan
| | - Norihisa Noguchi
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
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Molecular Analysis and Integron Carriage of Mupirocin-Resistant Staphylococcus aureus Strains Isolated from Burn Wound Infections, Tehran, Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.84764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Vijayakumar R, Sandle T. A review on biocide reduced susceptibility due to plasmid‐borne antiseptic‐resistant genes—special notes on pharmaceutical environmental isolates. J Appl Microbiol 2018; 126:1011-1022. [DOI: 10.1111/jam.14118] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/22/2022]
Affiliation(s)
- R. Vijayakumar
- Department of Biology College of Science in Zulfi, Majmaah University Majmaah Saudi Arabia
| | - T. Sandle
- Bio Products Laboratory Elstree, Hertfordshire UK
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Suhaili Z, Rafee P'A, Mat Azis N, Yeo CC, Nordin SA, Abdul Rahim AR, Al-Obaidi MMJ, Mohd Desa MN. Characterization of resistance to selected antibiotics and Panton-Valentine leukocidin-positive Staphylococcus aureus in a healthy student population at a Malaysian University. Germs 2018; 8:21-30. [PMID: 29564245 DOI: 10.18683/germs.2018.1129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/17/2017] [Accepted: 12/25/2017] [Indexed: 11/08/2022]
Abstract
Introduction This study aims to assess the antimicrobial susceptibility profiles of Staphylococcus aureus strains isolated from university students and to determine the prevalence of constitutive and inducible clindamycin resistance, the latter being able to cause therapeutic failure due to false in vitro clindamycin susceptibility. Methods S. aureus strains were isolated from the nasal swabs of 200 health sciences students of a Malaysian university. Twelve classes of antibiotics were used to evaluate the antimicrobial susceptibility profiles with the macrolide-lincosamide-streptogramin B (MLSB) phenotype for inducible clindamycin resistance determined by the double-diffusion test (D-test). Carriage of resistance and virulence genes was performed by PCR on S. aureus isolates that were methicillin resistant, erythromycin resistant and/or positive for the leukocidin gene, pvl (n=15). Results Forty-nine isolates were viable and identified as S. aureus with four of the isolates characterized as methicillin-resistant S. aureus (MRSA; 2.0%). All isolates were susceptible to the antibiotics tested except for penicillin (resistance rate of 49%), erythromycin (16%), oxacillin (8%), cefoxitin (8%) and clindamycin (4%). Of the eight erythromycin-resistant isolates, iMLSB was identified in five isolates (three of which were also MRSA). The majority of the erythromycin-resistant isolates harbored the msrA gene (four iMLSB) with the remaining iMLSB isolate harboring the ermC gene. Conclusion The presence of MRSA isolates which are also iMLSB in healthy individuals suggests that nasal carriage may play a role as a potential reservoir for the transmission of these pathogens.
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Affiliation(s)
- Zarizal Suhaili
- MSc, BSc, Dip. Med. Lab Tech. Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, School of Animal Science, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin, Besut Campus, 22200 Besut, Terengganu, Malaysia
| | - Putri 'Amira Rafee
- MSc, Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Norhidayah Mat Azis
- MSc, Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Chew Chieng Yeo
- PhD, Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, Kuala Terengganu, Terengganu, Malaysia
| | - Syafinaz Amin Nordin
- MPath, Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Abdul Rachman Abdul Rahim
- PhD, Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Mazen M Jamil Al-Obaidi
- PhD, Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Mohd Nasir Mohd Desa
- PhD, Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Laboratory of Halal Science Research, Halal Products Research Institute, Universiti Putra Malaysia, 43400 Serdang, Malaysia
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