1
|
Fait A, Silva SF, Abrahamsson JÅH, Ingmer H. Staphylococcus aureus response and adaptation to vancomycin. Adv Microb Physiol 2024; 85:201-258. [PMID: 39059821 DOI: 10.1016/bs.ampbs.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Antibiotic resistance is an increasing challenge for the human pathogen Staphylococcus aureus. Methicillin-resistant S. aureus (MRSA) clones have spread globally, and a growing number display decreased susceptibility to vancomycin, the favoured antibiotic for treatment of MRSA infections. These vancomycin-intermediate S. aureus (VISA) or heterogeneous vancomycin-intermediate S. aureus (hVISA) strains arise from accumulation of a variety of point mutations, leading to cell wall thickening and reduced vancomycin binding to the cell wall building block, Lipid II, at the septum. They display only minor changes in vancomycin susceptibility, with varying tolerance between cells in a population, and therefore, they can be difficult to detect. In this review, we summarize current knowledge of VISA and hVISA. We discuss the role of genetic strain background or epistasis for VISA development and the possibility of strains being 'transient' VISA with gene expression changes mediated by, for example, VraTSR, GraXSR, or WalRK signal transduction systems, leading to temporary vancomycin tolerance. Additionally, we address collateral susceptibility to other antibiotics than vancomycin. Specifically, we estimate how mutations in rpoB, encoding the β-subunit of the RNA polymerase, affect overall protein structure and compare changes with rifampicin resistance. Ultimately, such in-depth analysis of VISA and hVISA strains in terms of genetic and transcriptional changes, as well as changes in protein structures, may pave the way for improved detection and guide antibiotic therapy by revealing strains at risk of VISA development. Such tools will be valuable for keeping vancomycin an asset also in the future.
Collapse
Affiliation(s)
- Anaëlle Fait
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark; Department of Environmental Systems Science, ETH Zürich, Zürich, Switzerland
| | - Stephanie Fulaz Silva
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | - Hanne Ingmer
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark.
| |
Collapse
|
2
|
Muriel CM, García-Goez JF, Ortega D, Martínez D, Rosselli D. Risk factors for therapeutic failure in adults with methicillin-resistant Staphylococcus aureus (MRSA) infection treated with vancomycin in a high-complexity hospital in Cali, Colombia. LE INFEZIONI IN MEDICINA 2024; 32:45-51. [PMID: 38456024 PMCID: PMC10917555 DOI: 10.53854/liim-3201-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
Objective To determine the risk factors associated with therapeutic failure of vancomycin in hospitalized adult patients with methicillin-resistant Staphylococcus aureus (MRSA) infections. Design Case-control study. Setting Conducted in a high complexity hospital in Cali, Colombia. Participants Adult hospitalized from January 1, 2015, to December 31, 2021, with MRSA infections with confirmed microbiological isolation. Methods Cases were patients with therapeutic failure of vancomycin (mortality, poor clinical improvement, change of antibiotic used, early relapse, or persistence of positive blood cultures) and control patients were those who did not present failure. Significant variables from the bivariate analysis were included in a multiple analysis with an asymmetric logistic regression model. Results A total of 105 patients were included in the study, 28 in the treatment group and 77 in the control group. The median age was 49 years and 59 (56%) of participants were men. The following variables: age (OR 1.034; 95% CI 1.007-1.061, p=0.011), osteomyelitis/ septic arthritis (OR 6.035; 95% CI 2.282-15.956, p=0.000) and minimum inhibitory concentration (MIC) (OR 5.971; 95% CI 1.321-26.979, p=0.020) were found to be independent risk factors associated with therapeutic failure of vancomycin. Vancomycin trough levels were not different between cases and controls (OR 0.976; 95% CI 0.911-1.044, p=0.478). Conclusions When a multiple analysis was performed to control for confounding factors, only 3 variables were found to be significant and were considered risk factors for therapeutic failure of vancomycin in adult patients with MRSA infection: age, MIC, and osteomyelitis/ septic arthritis.
Collapse
Affiliation(s)
| | | | - Delia Ortega
- Pontificia Universidad Javeriana, Cali, Colombia
| | - Diana Martínez
- Institute of Statistics, Universidad del Valparaiso, Chile
| | - Diego Rosselli
- Pontificia Universidad Javeriana, Cali, Colombia
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
3
|
Westgeest AC, Lambregts MMC, Ruffin F, Korn RE, Webster ME, Kair JL, Parsons JB, Maskarinec SA, Kaplan S, Dekkers OM, de Boer MGJ, Fowler VG, Thaden JT. Female Sex and Mortality in Patients with Staphylococcus aureus Bacteremia: A Systematic Review and Meta-analysis. JAMA Netw Open 2024; 7:e240473. [PMID: 38411961 PMCID: PMC10900971 DOI: 10.1001/jamanetworkopen.2024.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Importance Staphylococcus aureus is the leading cause of death due to bacterial bloodstream infection. Female sex has been identified as a risk factor for mortality in S aureus bacteremia (SAB) in some studies, but not in others. Objective To determine whether female sex is associated with increased mortality risk in SAB. Data Sources MEDLINE, Embase, and Web of Science were searched from inception to April 26, 2023. Study Selection Included studies met the following criteria: (1) randomized or observational studies evaluating adults with SAB, (2) included 200 or more patients, (3) reported mortality at or before 90 days following SAB, and (4) reported mortality stratified by sex. Studies on specific subpopulations (eg, dialysis, intensive care units, cancer patients) and studies that included patients with bacteremia by various microorganisms that did not report SAB-specific data were excluded. Data Extraction and Synthesis Data extraction and quality assessment were performed by 1 reviewer and verified by a second reviewer. Risk of bias and quality were assessed with the Newcastle-Ottawa Quality Assessment Scale. Mortality data were combined as odds ratios (ORs). Main Outcome and Measures Mortality at or before 90-day following SAB, stratified by sex. Results From 5339 studies retrieved, 89 were included (132 582 patients; 50 258 female [37.9%], 82 324 male [62.1%]). Unadjusted mortality data were available from 81 studies (109 828 patients) and showed increased mortality in female patients compared with male patients (pooled OR, 1.12; 95% CI, 1.06-1.18). Adjusted mortality data accounting for additional patient characteristics and treatment variables were available from 32 studies (95 469 patients) and revealed a similarly increased mortality risk in female relative to male patients (pooled adjusted OR, 1.18; 95% CI, 1.11-1.27). No evidence of publication bias was encountered. Conclusions and Relevance In this systematic review and meta-analysis, female patients with SAB had higher mortality risk than males in both unadjusted and adjusted analyses. Further research is needed to study the potential underlying mechanisms.
Collapse
Affiliation(s)
- Annette C. Westgeest
- Division of Infectious Diseases, Duke University, Durham, North Carolina
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Merel M. C. Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Felicia Ruffin
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Rachel E. Korn
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Maren E. Webster
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jackson L. Kair
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Joshua B. Parsons
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | | | - Samantha Kaplan
- Medical Center Library and Archives, Duke University, Durham, North Carolina
| | - Olaf M. Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark G. J. de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Vance G. Fowler
- Division of Infectious Diseases, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Joshua T. Thaden
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| |
Collapse
|
4
|
Kim YH, Park J, Chung HS. Genetic characterization of tetracycline-resistant Staphylococcus aureus with reduced vancomycin susceptibility using whole-genome sequencing. Arch Microbiol 2023; 206:24. [PMID: 38103051 DOI: 10.1007/s00203-023-03760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/09/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023]
Abstract
This study aimed to analyze the genetic characteristics of Staphylococcus aureus with reduced vancomycin susceptibility (RVS-SA). Whole-genome sequencing was performed on 27 RVS-SA clinical isolates, and comparative genomic analysis was performed using S. aureus reference strains. Pan-genome orthologous groups (POGs) were identified that were present in RVS-SA but absent in the reference strains, but further analysis showed that the presence of these POGs was influenced by tetracycline resistance rather than vancomycin resistance. Therefore, we restricted our analysis to tetracycline-resistant (tetR) RVS-SA and tetR vancomycin-susceptible S. aureus (VSSA). Phylogenomic analysis showed them to be closely related, and further analysis revealed the presence of an uncharacterized protein SAB0394 and the absence of lytA in tetR RVS-SA, which are involved in cell wall thickening. In summary, using whole-genome sequencing we identified gain or loss of genes in tetR RVS-SA strains. These findings provide insights into the investigation of mechanisms associated with reduced vancomycin susceptibility and have the potential to contribute to the development of molecular biomarkers for the rapid and efficient detection of RVS-SA.
Collapse
Affiliation(s)
- Yu-Hee Kim
- Advanced Biomedical Research Institute, Ewha Womans University Seoul Hospital, Seoul, Korea
- Ewha Education and Research Center for Infection, Ewha Womans University Medical Center, Seoul, Korea
| | - Junghun Park
- Ewha Education and Research Center for Infection, Ewha Womans University Medical Center, Seoul, Korea
| | - Hae-Sun Chung
- Ewha Education and Research Center for Infection, Ewha Womans University Medical Center, Seoul, Korea.
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, 25 Magokdong-ro 2-gil, Gangseo-gu, Seoul, 07804, Republic of Korea.
| |
Collapse
|
5
|
Preexisting Atrial Fibrillation Associated with Higher Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections: Analysis of the National Inpatient Sample. Interdiscip Perspect Infect Dis 2022; 2022:8965888. [PMID: 35911626 PMCID: PMC9325627 DOI: 10.1155/2022/8965888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022] Open
Abstract
Background The purpose of this study was to investigate the prevalence of preexisting atrial fibrillation (AF) in patients with MRSA-BSI during a three-year period and the impact of preexisting AF on MRSA-BSI outcomes. Methods This was a retrospective analysis performed using the National Inpatient Sample (NIS) over a three-year period (2016, 2017, 2018) for patients with MRSA-BSI as a principal diagnosis with and without preexisting AF. The primary outcome was mortality with secondary outcomes of acute coronary syndrome, cardiac arrest, cardiogenic shock, endocarditis, respiratory failure, acute kidney injury, length of stay, hospital cost, and patient charge. A univariate and multivariable logistic regression analysis estimated clinical outcomes. Results Preexisting AF in patients with MRSA-BSI significantly increased the primary outcome of the study, mortality (1.67% vs. 0.66%, p=0.030) with an adjusted odds ratio (AOR) of 1.98 (95% CI, 1.1–3.7). Secondary outcomes showed increased likelihood of cardiac arrest with MRSA-BSI and AF (0.48% vs. 0.2%, p=0.025) with an AOR 3.59 (CI 1.18–11.0), ACS (3.44% vs. 1.21%, p=0.008) with an AOR of 1.81 (CI 1.16–2.80), respiratory failure (8.92% vs. 4.02%, p=0.045) with an AOR 1.39 (CI 1.01–1.91), prolonged LOS (6.4 vs. 5.4 days, p=0.0001), increased hospital cost ($13,374 vs. $11,401, p=0.0001), and increased overall patient charge ($50,091 vs. $43,018, p=0.0001). Secondary outcomes that showed statistical significance included ACS (1,497 (3.44%) vs. 113 (1.21%), p=0.008) with an AOR of 1.81 (CI 1.16–2.80), cardiac arrest (209 (0.48%) vs. 19 (0.2%), p=0.025) with an AOR 3.59 (CI 1.18–11.0), and respiratory failure (3,881 (8.92%) vs. 374 (4.02%), p=0.045 with an AOR 1.39 (CI 1.01–1.91). Conclusions Preexisting AF is a significant risk factor for mortality in patients admitted for MRSA-BSI and increases risk for cardiac arrest, respiratory failure, and ACS. Considerations should focus on early treatment and source control, especially with AF given the mortality risk, increased hospitalization cost, and prolonged LOS.
Collapse
|
6
|
Different Antimicrobial Susceptibility Testing Methods to Determine Vancomycin Susceptibility and MIC for Staphylococcus aureus with Reduced Vancomycin Susceptibility. Diagnostics (Basel) 2022; 12:diagnostics12040845. [PMID: 35453893 PMCID: PMC9032043 DOI: 10.3390/diagnostics12040845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/19/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
The methods and results obtained using commercialized automation systems used for antimicrobial susceptibility testing are not entirely consistent. Therefore, we evaluated different antimicrobial susceptibility testing methods to determine vancomycin susceptibility and minimum inhibitory concentration (MIC) for Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS). A total of 128 clinical isolates of S. aureus were tested, including 99 isolates showing an MIC of ≥2 µg/mL using the VITEK2 system (VITEK2). Antimicrobial susceptibility tests were performed using the Sensititre system (Sensititre), Phoenix M50 system (Phoenix), and MicroScan WalkAway 96 Plus system (MicroScan). Vancomycin MICs were determined using the broth microdilution method (BMD) and Etest. Essential agreement and category agreement for each method were compared with BMD results as the reference method. The BMD and Etest showed complete essential agreement (100%). VITEK2, Sensititre, and Phoenix showed high essential agreement (>99%), while MicroScan showed the lowest essential agreement (92.2%). The MIC MICs determined via Etest, VITEK2, and MicroScan tended to be higher than that determined via BMD. When comparing BMD with Etest, the category agreement was 93.8% and minor errors were observed for eight isolates. VITEK2, Sensititre, and Phoenix showed category agreements of 96.1%, 96.1%, and 99.2%, respectively, while MicroScan showed the lowest category agreement of 85.2%. The determination of vancomycin susceptibility and MIC for S. aureus varied among the methods. Caution should be taken when interpreting RVS and intermediate results for S. aureus. For confirmation of SA-RVS results, it would be appropriate to test with BMD or a more reliable testing method.
Collapse
|
7
|
Hernández-Aristizábal I, Ocampo-Ibáñez ID. Antimicrobial Peptides with Antibacterial Activity against Vancomycin-Resistant Staphylococcus aureus Strains: Classification, Structures, and Mechanisms of Action. Int J Mol Sci 2021; 22:7927. [PMID: 34360692 PMCID: PMC8347216 DOI: 10.3390/ijms22157927] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 12/27/2022] Open
Abstract
The emergence of bacteria resistant to conventional antibiotics is of great concern in modern medicine because it renders ineffectiveness of the current empirical antibiotic therapies. Infections caused by vancomycin-resistant Staphylococcus aureus (VRSA) and vancomycin-intermediate S. aureus (VISA) strains represent a serious threat to global health due to their considerable morbidity and mortality rates. Therefore, there is an urgent need of research and development of new antimicrobial alternatives against these bacteria. In this context, the use of antimicrobial peptides (AMPs) is considered a promising alternative therapeutic strategy to control resistant strains. Therefore, a wide number of natural, artificial, and synthetic AMPs have been evaluated against VRSA and VISA strains, with great potential for clinical application. In this regard, we aimed to present a comprehensive and systematic review of research findings on AMPs that have shown antibacterial activity against vancomycin-resistant and vancomycin-intermediate resistant strains and clinical isolates of S. aureus, discussing their classification and origin, physicochemical and structural characteristics, and possible action mechanisms. This is the first review that includes all peptides that have shown antibacterial activity against VRSA and VISA strains exclusively.
Collapse
Affiliation(s)
| | - Iván Darío Ocampo-Ibáñez
- Research Group of Microbiology, Industry and Environment, Faculty of Basic Sciences, Universidad Santiago de Cali, Cali 760035, Colombia;
| |
Collapse
|
8
|
Talha KM, Ishaq H, Ramesh R, Tariq W, Arshad V, Baddour LM, Sohail MR, Palraj R. Association between high vancomycin minimum inhibitory concentration and clinical outcomes in patients with methicillin-resistant Staphylococcus aureus bacteraemia - A retrospective cohort study. Eur J Clin Microbiol Infect Dis 2021; 40:1503-1510. [PMID: 33609261 DOI: 10.1007/s10096-021-04200-x] [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: 08/25/2020] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to determine the role of high (≥ 1.5 mg/L) vancomycin minimum inhibitory concentration (VMIC) in predicting clinical outcomes in patients with methicillin-resistant Staphylococcus aureus bacteraemia (MRSAB). A retrospective study was conducted at Mayo Clinic, Minnesota. Patients ≥ 18 years with a 3-month follow-up were included. Outcomes were defined as 30-day all-cause in-hospital mortality, median duration of bacteraemia, metastatic infectious complications, and relapse of MRSAB. A total of 475 patients with MRSAB were identified, and 93 (19.6%) of them had high VMIC isolates. Sixty-four percent of patients were male with a mean age of 69.0 years. Active solid organ malignancy and skin and soft tissue infection as source of MRSAB were associated with high VMIC, while septic arthritis as a complication was significantly associated with low VMIC on multivariate analysis. Eighty-one (17.1%) patients died within 30 days of hospitalization, with no significant difference in mortality rates between the two groups. In-hospital mortality, median duration of bacteraemia, and metastatic infectious complications were not significantly associated with high VMIC MRSAB.
Collapse
Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Hassan Ishaq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rommel Ramesh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
9
|
Pidwill GR, Gibson JF, Cole J, Renshaw SA, Foster SJ. The Role of Macrophages in Staphylococcus aureus Infection. Front Immunol 2021; 11:620339. [PMID: 33542723 PMCID: PMC7850989 DOI: 10.3389/fimmu.2020.620339] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022] Open
Abstract
Staphylococcus aureus is a member of the human commensal microflora that exists, apparently benignly, at multiple sites on the host. However, as an opportunist pathogen it can also cause a range of serious diseases. This requires an ability to circumvent the innate immune system to establish an infection. Professional phagocytes, primarily macrophages and neutrophils, are key innate immune cells which interact with S. aureus, acting as gatekeepers to contain and resolve infection. Recent studies have highlighted the important roles of macrophages during S. aureus infections, using a wide array of killing mechanisms. In defense, S. aureus has evolved multiple strategies to survive within, manipulate and escape from macrophages, allowing them to not only subvert but also exploit this key element of our immune system. Macrophage-S. aureus interactions are multifaceted and have direct roles in infection outcome. In depth understanding of these host-pathogen interactions may be useful for future therapeutic developments. This review examines macrophage interactions with S. aureus throughout all stages of infection, with special emphasis on mechanisms that determine infection outcome.
Collapse
Affiliation(s)
- Grace R. Pidwill
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, United Kingdom
- Florey Institute, University of Sheffield, Sheffield, United Kingdom
| | - Josie F. Gibson
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, United Kingdom
- Florey Institute, University of Sheffield, Sheffield, United Kingdom
- The Bateson Centre, University of Sheffield, Sheffield, United Kingdom
| | - Joby Cole
- Florey Institute, University of Sheffield, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Stephen A. Renshaw
- Florey Institute, University of Sheffield, Sheffield, United Kingdom
- The Bateson Centre, University of Sheffield, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Simon J. Foster
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, United Kingdom
- Florey Institute, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
10
|
Association between high vancomycin minimum inhibitory concentration and clinical outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: a meta-analysis. Infection 2021; 49:803-811. [PMID: 33394368 DOI: 10.1007/s15010-020-01568-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/14/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the relationship between high vancomycin minimum inhibitory concentrations (MIC), in patients with methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), and both mortality and complicated bacteremia. METHODS Embase, Medline, EBM, Scopus and Web of Science were searched for studies published from January 1st 2014 to February 29th 2020. "High" vancomycin MIC cut off was defined as ≥ 1.5 mg/L. Three referees independently reviewed studies that compared outcomes in patients with MRSAB stratified by vancomycin MIC. Subgroup analyses were performed for rates of mortality and complicated bacteremia. RESULTS A total of 13 studies with 2089 patients were included. Overall, mortality was 27.7% and 23.3% in the high and low vancomycin MIC group, respectively. No significant difference was found between vancomycin MIC groups for overall mortality, in-hospital mortality, late mortality, persistent bacteremia, severe sepsis or septic shock, acute renal failure, septic emboli or endocarditis, and osteomyelitis or septic arthritis. Early mortality was significantly associated with low vancomycin MIC. Mortality in studies using broth microdilution method (BMD) and need for mechanical ventilation were significantly associated with high vancomycin MIC. CONCLUSION Overall mortality and complicated bacteremia were not significantly associated with high vancomycin MICs in a patient with MRSAB. Randomized controlled trials to assess the utility of vancomycin MIC values in predicting mortality and other adverse clinical outcomes are warranted.
Collapse
|
11
|
Shariati A, Dadashi M, Moghadam MT, van Belkum A, Yaslianifard S, Darban-Sarokhalil D. Global prevalence and distribution of vancomycin resistant, vancomycin intermediate and heterogeneously vancomycin intermediate Staphylococcus aureus clinical isolates: a systematic review and meta-analysis. Sci Rep 2020; 10:12689. [PMID: 32728110 PMCID: PMC7391782 DOI: 10.1038/s41598-020-69058-z] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/15/2020] [Indexed: 12/22/2022] Open
Abstract
Vancomycin-resistant Staphylococcus aureus (VRSA), Vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA) are subject to vancomycin treatment failure. The aim of the present study was to determine their precise prevalence and investigate prevalence variability depending on different years and locations. Several international databases including Medline (PubMed), Embase and Web of Sciences were searched (data from 1997 to 2019) to identify studies that addressed the prevalence of VRSA, VISA and hVISA among human clinical isolates around the world. Subgroup analyses and meta-regression were conducted to indicate potential source of variation. Publication bias was assessed using Egger's test. Statistical analyses were conducted using STATA software (version 14.0). Data analysis showed that VRSA, VISA and hVISA isolates were reported in 23, 50 and 82 studies, with an overall prevalence of 1.5% among 5855 S. aureus isolates, 1.7% among 22,277 strains and 4.6% among 47,721 strains, respectively. The overall prevalence of VRSA, VISA, and hVISA before 2010 was 1.2%, 1.2%, and 4%, respectively, while their prevalence after this year has reached 2.4%, 4.3%, and 5.3%. The results of this study showed that the frequency of VRSA, VISA and hVISA after 2010 represent a 2.0, 3.6 and 1.3-fold increase over prior years. In a subgroup analysis of different strain origins, the highest frequency of VRSA (3.6%) and hVISA (5.2%) was encountered in the USA while VISA (2.1%) was more prevalent in Asia. Meta-regression analysis showed significant increasing of VISA prevalence in recent years (p value ≤ 0.05). Based on the results of case reports (which were not included in the calculations mentioned above), the numbers of VRSA, VISA and hVISA isolates were 12, 24 and 14, respectively, among different continents. Since the prevalence of VRSA, VISA and hVISA has been increasing in recent years (especially in the Asian and American continents), rigorous monitoring of vancomycin treatment, it's the therapeutic response and the definition of appropriate control guidelines depending on geographical regions is highly recommended and essential to prevent the further spread of vancomycin-resistant S. aureus.
Collapse
Affiliation(s)
- Aref Shariati
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
- Non Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Majid Taati Moghadam
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Alex van Belkum
- Open Innovation and Partnerships, Route de Port Michaud, 38390, La Balme Les Grottes, France
| | - Somayeh Yaslianifard
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
12
|
Kim HJ, Choi Q, Kwon GC, Koo SH. Molecular epidemiology and virulence factors of methicillin-resistant Staphylococcus aureus isolated from patients with bacteremia. J Clin Lab Anal 2020; 34:e23077. [PMID: 31721291 PMCID: PMC7083439 DOI: 10.1002/jcla.23077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/15/2019] [Accepted: 09/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The various virulence factors of methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) are associated with a high mortality rate worldwide. Further studies are warranted to confirm the significant relationship between the strains and virulence genes. Here, we prospectively investigated the molecular characteristics underlying the genotypes and virulence factors of MRSA isolated from patients with bacteremia. METHODS We collected 59 MRSA isolates from adult patients with bacteremia. Antimicrobial susceptibility results were obtained with the Vitek2 automated system. Genotypes were identified with multi-locus sequence typing (MLST) and pulse-field gel electrophoresis (PFGE), and 21 virulence genes were detected with polymerase chain reaction (PCR). RESULTS The 59 MRSA isolates mainly comprised ST5 (n = 31, 52.5%) and ST72 (n = 22, 37.2%). Most ST5 isolates and all ST72 isolates were clustered into one and two PFGE groups, respectively. The mean number of virulence genes was higher in ST5 than in ST72. Sel was more frequently detected in ST5 than in ST72, whereas sec and sed were found only in ST5. ST5 had significantly higher resistance against many antibiotics than ST72. CONCLUSION Most MRSA isolates causing bacteremia were ST5 (CC5) and ST72 (CC8), and those belonging to the same STs were divided into only a few PFGE groups. ST5 was associated with higher antibiotic resistance and staphylococcal superantigen toxin genes, than ST72, which may be related to its higher virulence.
Collapse
Affiliation(s)
- Hyun Jin Kim
- Department of Laboratory MedicineChungnam National University HospitalDaejeonKorea
| | - Qute Choi
- Department of Laboratory MedicineChungnam National University HospitalDaejeonKorea
| | - Gye Cheol Kwon
- Department of Laboratory MedicineChungnam National University HospitalDaejeonKorea
| | - Sun Hoe Koo
- Department of Laboratory MedicineChungnam National University HospitalDaejeonKorea
| |
Collapse
|
13
|
Ahmad O, Crawford TN, Myint T. Comparing the Outcomes of Ceftaroline Plus Vancomycin or Daptomycin Combination Therapy Versus Monotherapy in Adults with Complicated and Prolonged Methicillin-Resistant Staphylococcus Aureus Bacteremia Initially Treated with Supplemental Ceftaroline. Infect Dis Ther 2020; 9:77-87. [PMID: 31776844 PMCID: PMC7054513 DOI: 10.1007/s40121-019-00277-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia confers considerable morbidity and mortality. Although vancomycin or daptomycin monotherapy is usually curative, prolonged bacteremia necessitating supplemental ceftaroline has occurred. The practice has led to the question of whether to continue with ceftaroline following bacteremia resolution. METHODS Adult patients hospitalized with MRSA bacteremia at the University of Kentucky Medical Center between January 2015 and December 2017 were retrospectively reviewed. Study subjects required supplemental ceftaroline due to 4 or more days of bacteremia despite vancomycin or daptomycin. They additionally had accompanying native valve infective endocarditis, osteomyelitis, or brain abscess. Patients were divided into two cohorts. One group continued with ceftaroline plus vancomycin or daptomycin following bacteremia resolution (combination therapy group). The other group received vancomycin or daptomycin alone (monotherapy group). All involved received 6-8 weeks of therapy. Patients' Pitt bacteremia score (PBS) and Charlson comorbidity index (CCI) values were calculated. Treatment outcomes of inpatient mortality, recurrence of bacteremia, 30-day readmission, acute kidney injury, and leukopenia were recorded and compared. RESULTS A total of 30 patients comprised the study population. 15 patients were assigned to each cohort. The median PBS value of the combination therapy group was 2, compared with 1 among the monotherapy group. The median CCI score of both groups was 0. No statistically significant difference in the aforementioned treatment outcomes was seen between the two groups. CONCLUSION In subjects with complicated and prolonged MRSA bacteremia requiring supplemental ceftaroline, clinical outcomes did not differ among patients prescribed vancomycin or daptomycin alone following bacteremia resolution versus patients who continued combination therapy.
Collapse
Affiliation(s)
- Omar Ahmad
- Division of Infectious Diseases, University of Kentucky, Lexington, KY, USA.
| | - Timothy N Crawford
- Department of Population and Public Health Sciences, Wright State University, Dayton, OH, USA
| | - Thein Myint
- Division of Infectious Diseases, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
14
|
Park JW, Lee H, Kim JW, Kim B. Characterization of Infections with Vancomycin-Intermediate Staphylococcus aureus (VISA) and Staphylococcus aureus with Reduced Vancomycin Susceptibility in South Korea. Sci Rep 2019; 9:6236. [PMID: 30996231 PMCID: PMC6470132 DOI: 10.1038/s41598-019-42307-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/29/2019] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to describe the characteristics of infections with Staphylococcus aureus with reduced vancomycin susceptibility (SARVS) including vancomycin-intermediate S. aureus (VISA) in South Korea, using data from the national sentinel surveillance system during 2014-2016. A total of 66 patients infected or colonized with SA-RVS were reported using the sentinel surveillance system. Among them, VISA was confirmed in 14 isolates (21.2%) and no vancomycin-resistant S. aureus (VRSA) was detected. Most of patients had any kind of indwelling devices (81.8%, 54/66) and underwent surgical procedures in the previous 6 months (84.8%, 56/66). Patients who admitted to an intensive care unit (ICU) in the previous 3 months were 68.2% (45/66). Furthermore, patients who used vancomycin or had MRSA in the previous 1 month were 54.5% (36/66) and 59.1% (39/66), respectively. Upon review of the medical records, 54.5% (36/66) of patients were classified as having SA-RVSassociated infection and 30-day mortality was 19.4% (7/36). Our findings revealed that there was no VRSA in South Korea. SA-RVS including VISA existed particularly in patients who had indwelling devices, history of surgical procedure, and history of ICU admission.
Collapse
Affiliation(s)
- Jung Wan Park
- Department of Healthcare-Associated Infection Control, Korea Centers for Disease Control and Prevention, Cheongju, South Korea
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyungmin Lee
- Department of Healthcare-Associated Infection Control, Korea Centers for Disease Control and Prevention, Cheongju, South Korea
| | - Jung Wook Kim
- Division of Antimicrobial Resistance, Center for Infectious Diseases Research, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, South Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
| |
Collapse
|
15
|
El-Nahhal YZ, Al_Shareef AT, Alagha MR. Measurements of C-Reactive Protein for Successful Management and Follow-Up Treatment of Neonatal Sepsis and Nosocomial Infection. Health (London) 2019. [DOI: 10.4236/health.2019.116060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
16
|
Joo EJ. Microbiological and genotypic factors affecting mortality in methicillin-resistant Staphylococcus aureus bacteremia. Korean J Intern Med 2019; 34:63-64. [PMID: 30612420 PMCID: PMC6325435 DOI: 10.3904/kjim.2018.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Eun-Jeong Joo
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Eun-Jeong Joo, M.D. Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea Tel: +82-2-2001-8533 Fax: +82-2-2001-1596 E-mail:
| |
Collapse
|