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Shoaib M, Aqib AI, Muzammil I, Majeed N, Bhutta ZA, Kulyar MFEA, Fatima M, Zaheer CNF, Muneer A, Murtaza M, Kashif M, Shafqat F, Pu W. MRSA compendium of epidemiology, transmission, pathophysiology, treatment, and prevention within one health framework. Front Microbiol 2023; 13:1067284. [PMID: 36704547 PMCID: PMC9871788 DOI: 10.3389/fmicb.2022.1067284] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Staphylococcus aureus is recognized as commensal as well as opportunistic pathogen of humans and animals. Methicillin resistant strain of S. aureus (MRSA) has emerged as a major pathogen in hospitals, community and veterinary settings that compromises the public health and livestock production. MRSA basically emerged from MSSA after acquiring SCCmec element through gene transfer containing mecA gene responsible for encoding PBP-2α. This protein renders the MRSA resistant to most of the β-lactam antibiotics. Due to the continuous increasing prevalence and transmission of MRSA in hospitals, community and veterinary settings posing a major threat to public health. Furthermore, high pathogenicity of MRSA due to a number of virulence factors produced by S. aureus along with antibiotic resistance help to breach the immunity of host and responsible for causing severe infections in humans and animals. The clinical manifestations of MRSA consist of skin and soft tissues infection to bacteremia, septicemia, toxic shock, and scalded skin syndrome. Moreover, due to the increasing resistance of MRSA to number of antibiotics, there is need to approach alternatives ways to overcome economic as well as human losses. This review is going to discuss various aspects of MRSA starting from emergence, transmission, epidemiology, pathophysiology, disease patterns in hosts, novel treatment, and control strategies.
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Affiliation(s)
- Muhammad Shoaib
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs/Lanzhou Institute of Husbandry and Pharmaceutical Sciences of the Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Amjad Islam Aqib
- Department of Medicine, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Iqra Muzammil
- Department of Medicine, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Noreen Majeed
- Institute of Microbiology, University of Agriculture, Faisalabad, Pakistan
| | - Zeeshan Ahmad Bhutta
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | | | - Mahreen Fatima
- Faculty of Biosciences, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | | | - Afshan Muneer
- Department of Zoology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Maheen Murtaza
- Department of Zoology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Muhammad Kashif
- Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Furqan Shafqat
- Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Wanxia Pu
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs/Lanzhou Institute of Husbandry and Pharmaceutical Sciences of the Chinese Academy of Agricultural Sciences, Lanzhou, China
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Detection of Methicillin Resistance and β-Lactamase Production in Staphylococcus aureus Isolates: A Cross Sectional Study from a Tertiary Care Hospital. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nosocomial infections are proving to be a menace for the whole health care system, with methicillin resistant Staphylococcus aureus (MRSA) being a very notorious causative agent. Along with the role of mecA gene producing penicillin-binding protein (PBP2a), production of beta-lactamase enzyme by Staphylococcus aureus makes the organism resistant to all β-lactam agents. This study aims at phenotypic detection of methicillin resistance and β-Lactamase production in all S. aureus isolates by Cefoxitin disk diffusion test and Penicillin zone-edge test, respectively. In this prospective cross-sectional study, samples were obtained from patients admitted to different departments and were processed according to the standard laboratory protocols. As per the CLSI guidelines, phenotypic detection of resistance to methicillin was done by Cefoxitin Disk Diffusion test, whereas production of beta-lactamase enzyme was phenotypically detected by penicillin zone edge test. Among 179 isolates of S. aureus, 116 (64.8%) were MRSA, whereas the remaining 63 (35.2%) isolates were methicillin-sensitive Staphylococcus aureus (MSSA). Staphylococcus aureus infection among ICU and non-ICU patients were found to be 24(13%) and 155(86.6%) respectively. Among 24 ICU patients, 19 had MRSA infection, whereas among 155 non-ICU patients, 97 had MRSA infection. Out of 63 MSSA isolates, only 2 (3.17%) were found to be sensitive to Penicillin by Zone-edge test, 04 isolates showed presence of β-lactamase production, while remaining 57 isolates were resistant to Penicillin. At the same time, several class of antibiotics were found to be ineffective against these MRSA isolates. Cases of methicillin-resistant and b–lactamase producing Staphylococcus aureus infections are on the rise in our hospital settings.
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Preeja PP, Kumar SH, Shetty V. Prevalence and Characterization of Methicillin-Resistant Staphylococcus aureus from Community- and Hospital-Associated Infections: A Tertiary Care Center Study. Antibiotics (Basel) 2021; 10:antibiotics10020197. [PMID: 33670648 PMCID: PMC7922968 DOI: 10.3390/antibiotics10020197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023] Open
Abstract
The community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become increasingly prevalent in both community and hospital settings. The aim of this study was to determine the prevalence, molecular characteristics and antibiotic resistance profiles of CA-MRSA from community- and hospital-associated infections in a tertiary care hospital in Mangalore, India. Of 520 S. aureus isolates, 362 were from inpatients (IP) and 158 were from outpatients (OP). One-hundred and thirty-two MRSA isolates obtained from 94 inpatients and 38 outpatients with complete clinical details were further analyzed. Of these, 81 (61.4%) were CA-MRSA (IP-47.9%, OP-94.7%) and 51 (38.6%) were HA-MRSA (IP-52.1%, OP-5.3%). All (100%) MRSA isolates were mecA gene positive. SCCmec typing identified SCCmec type IV (50.6%) and SCCmec type V (66.7%) in CA-MRSA, while SCCmec type I (41.2%), SCCmec type III (19.6%), SCCmec type IV (31.4%) and SCCmec type V (25.5%) were detected in HA-MRSA isolates. The Panton–Valentine Leukocidin (PVL) gene was found in 70.4% of CA-MRSA, 43.1% of HA-MRSA with SCCmec type IV and SCCmec type V, and in 7.8% of true HA-MRSA. The antibiotic resistance profiles were determined by the disc diffusion method. Resistance to cefoxitin was used to identify MRSA. A significant difference (p < 0.05) was observed between CA-MRSA and HA-MRSA with respect to resistance against cephalexin, cefotaxime, levofloxacin, linezolid and teicoplanin. CA-MRSA was predominantly resistant to ciprofloxacin (86.4%), erythromycin (66.7%), ofloxacin (49.4%), cefotaxime (44.4%), gentamicin (40.7%) and clindamycin (40.7%), while HA-MRSA showed resistance against ciprofloxacin (80.4%), erythromycin (80.1%), cefotaxime (70.6%),ofloxacin (58.8%), clindamycin (47.1%) and levofloxacin (41.2%).This study reports the prevalence of CA-MRSA in community and hospital settings and the possibility of multidrug-resistant CA-MRSA replacing HA-MRSA in hospitals. The observations from our study emphasize the need for urgent measures to manage this emerging crisis in healthcare settings.
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Affiliation(s)
- Puthiya Purayil Preeja
- Department of Microbiology, KS Hegde Medical Academy, Nitte (Deemed to Be University), Mangalore 5750181, India;
| | - Sanath H. Kumar
- QC Laboratory, Post Harvest Technology, ICAR-Central Institute of Fisheries Education, Mumbai 400061, India;
| | - Veena Shetty
- Department of Microbiology, KS Hegde Medical Academy, Nitte (Deemed to Be University), Mangalore 5750181, India;
- Correspondence:
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Abimannan N, Sumathi G, Krishnarajasekhar OR, Sinha B, Krishnan P. Clonal clusters and virulence factors of methicillin-resistant Staphylococcus Aureus: Evidence for community-acquired methicillin-resistant Staphylococcus Aureus infiltration into hospital settings in Chennai, South India. Indian J Med Microbiol 2019; 37:326-336. [PMID: 32003329 DOI: 10.4103/ijmm.ijmm_18_271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Objective Staphylococcus aureus is one of the major pathogens of nosocomial infections as wells as community-acquired (CA) infections worldwide. So far, large-scale comprehensive molecular and epidemiological characterisation of S. aureus from very diverse settings has not been carried out in India. The objective of this study is to evaluate the molecular, epidemiological and virulence characteristics of S. aureus in both community and hospital settings in Chennai, southern India. Methods S. aureus isolates were obtained from four different groups (a) healthy individuals from closed community settings, (b) inpatients from hospitals, (c) outpatients from hospitals, representing isolates of hospital-community interface and (d) HIV-infected patients to define isolates associated with the immunocompromised. Antibiotic susceptibility testing, multiplex polymerase chain reactions for detection of virulence and resistance determinants, molecular typing including Staphylococcal cassette chromosome mec (SCCmec) and agr typing, were carried out. Sequencing-based typing was done using spa and multilocus sequence typing (MLST) methods. Clonal complexes (CC) of hospital and CA methicillin-resistant S. aureus (MRSA) were identified and compared for virulence and resistance. Results and Conclusion A total of 769 isolates of S. aureus isolates were studied. The prevalence of MRSA was found to be 7.17%, 81.67%, 58.33% and 22.85% for groups a, b, c and d, respectively. Of the four SCCmec types (I, III, IV and V) detected, SCCmec V was found to be predominant. Panton-Valentine leucocidin toxin genes were detected among MRSA isolates harbouring SCCmec IV and V. A total of 78 spa types were detected, t657 being the most prevalent. 13 MLST types belonging to 9 CC were detected. CC1 (ST-772, ST-1) and CC8 (ST238, ST368 and ST1208) were found to be predominant among MRSA. CA-MRSA isolates with SCCmec IV and V were isolated from all study groups including hospitalised patients and were found to be similar by molecular tools. This shows that CA MRSA has probably infiltrated into the hospital settings.
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Affiliation(s)
- Nagarajan Abimannan
- Department of Microbiology, University of Madras, Chennai; Department of Microbiology, Food Analysis Laboratory, Tamil Nadu Food Safety and Drugs Administration, Madurai, Tamil Nadu, India
| | - G Sumathi
- Institute of Microbiology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - O R Krishnarajasekhar
- Department of Thoracic Medicine, Government Hospital of Thoracic Medicine, Chennai, Tamil Nadu, India
| | - Bhanu Sinha
- Institute for Hygiene and Medical Microbiology, University of Wuerzburg, Wuerzburg, Germany; Department of Medical Microbiology, University Medical Center, Groningen, Netherlands
| | - Padma Krishnan
- Department of Microbiology, University of Madras, Chennai, Tamil Nadu, India
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Chatterjee A, Rai S, Guddattu V, Mukhopadhyay C, Saravu K. Is methicillin-resistant Staphylococcus Aureus infection associated with higher mortality and morbidity in hospitalized patients? A cohort study of 551 patients from South Western India. Risk Manag Healthc Policy 2018; 11:243-250. [PMID: 30584380 PMCID: PMC6284536 DOI: 10.2147/rmhp.s176517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To determine morbidity and mortality of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) infections in a tertiary health care facility. Methods A cohort study among hospitalized adult patients with culture proven MRSA or MSSA monoinfection were recruited in a tertiary referral center in South India from November 2011 to December 2012. Results Of total 551 subjects, 284 (52%) had MRSA and 267 (48%) MSSA infection. A total of 184 (65%) subjects had health care-associated MRSA (HA-MRSA) and 100 (35%) community-associated MRSA (CA-MRSA). Chronic kidney disease and recent antibiotic use had significant association with MRSA. MRSA patients had significant respiratory infection (OR 2.24 [1.04, 5.16]) and bacteremia (OR 2.24 [10.40, 5.16]), relative to MSSA. MSSA group had better survival function compared to MRSA group (P=0.028). Median duration of ICU stays were 5 days (IQR 4, 8) and 2 days (IQR 2, 2) in MRSA and MSSA, respectively. Complications such as acute kidney injury, sepsis, multiorgan dysfunction, need for supportive measures were more in the MRSA group. Conclusion MRSA imposes a huge burden in Indian scenario and HA-MRSA remains the main culprit. Patients with history of chronic kidney disease and recent use of antibiotics were found to be at a higher risk. Patients with MRSA infections tend to have poorer outcomes in terms of longer hospital stay, greater complications, and mortality.
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Affiliation(s)
- Aparajita Chatterjee
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India, ,
| | - Shipra Rai
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India, ,
| | - Vasudeva Guddattu
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India
| | - Kavitha Saravu
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India, , .,Manipal McGill Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India,
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Mave V, Chandanwale A, Kagal A, Khadse S, Kadam D, Bharadwaj R, Dohe V, Robinson ML, Kinikar A, Joshi S, Raichur P, McIntire K, Kanade S, Sachs J, Valvi C, Balasubramanian U, Kulkarni V, Milstone AM, Marbaniang I, Zenilman J, Gupta A. High Burden of Antimicrobial Resistance and Mortality Among Adults and Children With Community-Onset Bacterial Infections in India. J Infect Dis 2017; 215:1312-1320. [PMID: 28329303 PMCID: PMC5853545 DOI: 10.1093/infdis/jix114] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/01/2017] [Indexed: 01/27/2023] Open
Abstract
Background In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors, and outcomes of antimicrobial-resistant infections are limited. Methods A prospective study of adults and children hospitalized for acute febrile illness was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of community-onset antimicrobial-resistant infections. Results Among 1524 patients hospitalized with acute febrile illness, 133 isolates were found among 115 patients with community-onset infections; 66 isolates (50.0%) were multidrug resistant and, of 33 isolates tested for carbapenem susceptibility, 12 (36%) were resistant. Multidrug-resistant infections were associated with recent antecedent antibiotic use (adjusted odds ratio [aOR], 4.17; 95% confidence interval [CI], 1.19-19.7) and were independently associated with mortality (aOR, 6.06; 95% CI, 1.2-55.7). Conclusion We found a high burden of community-onset antimicrobial-resistant infection among patients with acute febrile illness in India. Multidrug-resistant infection was associated with prior antibiotic use and an increased risk of mortality.
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Affiliation(s)
- Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Ajay Chandanwale
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Sandhya Khadse
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Dileep Kadam
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Renu Bharadwaj
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Vaishali Dohe
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Matthew L Robinson
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Aarti Kinikar
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Samir Joshi
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Priyanka Raichur
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Katie McIntire
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Savita Kanade
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Jonathan Sachs
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Chhaya Valvi
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Usha Balasubramanian
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Vandana Kulkarni
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Aaron M Milstone
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivan Marbaniang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
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Subramanian A, Chitalia VK, Bangera K, Vaidya SP, Warke R, Chowdhary A, Deshmukh RA. Evaluation of Hiaureus TM Coagulase Confirmation Kit in Identification of Staphylococcus aureus. J Clin Diagn Res 2017; 11:DC08-DC13. [PMID: 28384859 DOI: 10.7860/jcdr/2017/24021.9265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Staphylococcus aureus is a facultative anaerobic Gram positive coccal bacterium whose incidence ranges to different infections. It is a cause of various uncomplicated skin infections, abscesses, septicaemia/bacteraemia, gastroenteritis, endocarditis, toxic shock syndrome and food intoxications. Various methods with varied time, sensitivities, specificities and costs are available, but may not be used as a reliable test for the identification and differentiation of S. aureus. Therefore, there is a need to evaluate newer tests. AIM To compare the conventional tests with a commercial available kit for reliable, cost effective identification and confirmation of S. aureus. MATERIALS AND METHODS The current prospective study was conducted in the Department of Clinical Pathology, Haffkine Institute for a period of six months. A total of 341 clinical isolates of staphylococci isolated from pus, urine, blood culture and sterile body fluids were subjected to conventional tests like Tube Coagulase Test (TCT) using Rabbit Plasma (RP) and Human Plasma (HP), culture media such as Mannitol Salt Agar (MSA) and Deoxyribonuclease (DNase) media in parallel to HiaureusTM Coagulase Confirmation Kit (HACCK), a commercially available kit for identification of S. aureus. Amplification of the femA gene was used as a comparative reference point test to calculate the sensitivity, specificity and concordance values of the conventional tests. RESULTS Amongst the coagulase based tests, HACCK was 100% sensitive and specific. The TCT using RP was 98.58% sensitive while TCT using HP was less sensitive (95.37%). A total of 100% specificity was observed for TCT using RP while TCT using HP was 96.68% specific. The MSA and DNase media were 97.86% vs 96.44% and 96.67% vs 91.67% sensitive and specific respectively. The combination tests had varying sensitivity and specificity ranges. The HACCK demonstrated 100% concordance with femA amplification and was labelled as an ideal perfect test (κ=1) with MSA as an alternative test for S. aureus identification. CONCLUSION The HACCK can be used as an exclusive, reliable and cost effective test for identification of S. aureus. Alternatively, in view of the cost factor MSA either as a single test or in combination with TCT using HP could be used as screening tests and confirm discordant results with HACCK.
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Affiliation(s)
- Arunagiri Subramanian
- Ph.D. Scholar, Department of Clinical Pathology, Haffkine Institute , Mumbai, Maharashtra, India
| | - Vidushi K Chitalia
- Research Fellow, Department of Clinical Pathology, Haffkine Institute , Mumbai, Maharashtra, India
| | - Kushminda Bangera
- Senior Molecular Biology Executive, Department of Molecular Biology, HiMedia Laboratories , Mumbai, Maharashtra, India
| | - Shashikant P Vaidya
- Assistant Director and Head, Department of Clinical Pathology, Haffkine Institute , Mumbai, Maharashtra, India
| | - Rajas Warke
- Director, Department of Molecular Biology, HiMedia Laboratories , Mumbai, Maharashtra, India
| | - Abhay Chowdhary
- Professor and Head, Department of Microbiology, Grant Medical College and Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Ranjana A Deshmukh
- Former Director and Visiting Scientist, Department of Virology and Immunology, Haffkine Institute , Mumbai, Maharashtra, India
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Gopal S, Divya KC. Can methicillin-resistant Staphylococcus aureus prevalence from dairy cows in India act as potential risk for community-associated infections?: A review. Vet World 2017; 10:311-318. [PMID: 28435193 PMCID: PMC5387658 DOI: 10.14202/vetworld.2017.311-318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/30/2017] [Indexed: 12/03/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is classified as hospital associated (HA), community associated (CA), livestock associated (LA) and is a global concern. Developing countries, like India, are densely populated country challenging for public hygiene practices. HA-MRSA is comfortably recorded in India, and CA-MRSA is also reported as increasing one. CA-MRSA is serious disease which affects the community as endemic. MRSA is one among major mastitis-causing organisms in India as LA-MRSA. There were reports for transmission of MRSA as community between milk handlers and cow in global perspective. In India reports of MRSA in short among milk handlers and also transmission between animal and human. Hence, proper monitoring of MRSA transmission in India should be elucidated in account among milk handlers and dairy cows to avoid emerging CA-MRSA as outbreak.
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Affiliation(s)
- Sathish Gopal
- Department of Animal Biotechnology, Madras Veterinary College, Chennai, Tamil Nadu, India
| | - Kurunchi C Divya
- Genomics Laboratory. Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India
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Huh K, Chung DR. Changing epidemiology of community-associated methicillin-resistant Staphylococcus aureus in the Asia-Pacific region. Expert Rev Anti Infect Ther 2016; 14:1007-1022. [PMID: 27645549 DOI: 10.1080/14787210.2016.1236684] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become an important threat to public health in the Asia-Pacific region, which is characterized by a large population and relatively insufficient resources. Better understanding on the current status of CA-MRSA in the region is of paramount importance. Areas covered: This article reviews the published literatures on the prevalence, molecular epidemiology, colonization, and hospital spread of CA-MRSA. Expert commentary: The burden of CA-MRSA has been increasing in the past two decades. The molecular epidemiology of CA-MRSA in the Asia-Pacific region shows a marked diversity in each country. Still, some strains - multilocus sequence type (MLST) ST59, ST30, ST72, ST8, and ST772 - are unique clones that have successfully established themselves as predominant, often spreading into nosocomial settings. More coordinated and comprehensive surveillance to understand the true epidemiology of CA-MRSA in the Asia-Pacific region is urgently needed.
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Affiliation(s)
- Kyungmin Huh
- a Division of Infectious Diseases, Department of Internal Medicine , Armed Forces Capital Hospital , Seongnam , Korea
| | - Doo Ryeon Chung
- b Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea
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Iniyan AM, Kannan RR, Vincent SGP. Characterization of Culturable Actinomycetes Associated with Halophytic Rhizosphere as Potential Source of Antibiotics. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s40011-015-0601-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Bouchiat C, El-Zeenni N, Chakrakodi B, Nagaraj S, Arakere G, Etienne J. Epidemiology of Staphylococcus aureus in Bangalore, India: emergence of the ST217 clone and high rate of resistance to erythromycin and ciprofloxacin in the community. New Microbes New Infect 2015; 7:15-20. [PMID: 26110062 PMCID: PMC4475830 DOI: 10.1016/j.nmni.2015.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/24/2015] [Accepted: 05/06/2015] [Indexed: 11/07/2022] Open
Abstract
This study aimed to determine the antibiotic susceptibility pattern of Staphylococcus aureus (SA) and the circulating clones in Bangalore, India. Susceptibility testing was performed for all cases of SA infections in a tertiary-care hospital. Panton-Valentine leucocidin (PVL) encoding genes were detected, and sequence type and spa type were determined. Out of the 92 collected strains, 52.2% were methicillin-resistant SA (MRSA), isolated from community-acquired (CA) infections in 60.4% and hospital-acquired (HA) infections in 39.6%. S. aureus isolates were also highly resistant to erythromycin (54.3%) and ciprofloxacin (70.6%) in methicillin-susceptible SA (MSSA) and MRSA, as well as in CA and HA infections. MRSA were found to be significantly more resistant to gentamicin (p <0.001), cotrimoxazole (p <0.001) and ciprofloxacin (p 0.001) than MSSA, but no significant difference was observed between CA- and HA-SA. ST217 appeared as a new emerging and prevalent clone, but ST772 remained the predominant clone, all being PVL-positive isolates. Our study points out the high prevalence of MRSA, even in the community, and the worrying increase of resistance to ciprofloxacin and erythromycin among CA-MSSA. Emergence of clone ST217 is reported for the first time in India.
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Affiliation(s)
- C Bouchiat
- Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Lyon, France ; Faculté de medicine, Université Claude Bernard-Lyon, Lyon, France ; Centre national de référence des staphylocoques, Lyon, France
| | - N El-Zeenni
- Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Lyon, France
| | - B Chakrakodi
- Society for Innovation and Development, Indian Institute of Science, Bangalore, India
| | - S Nagaraj
- St. John's Hospital and Medical College, Bangalore, India
| | - G Arakere
- Society for Innovation and Development, Indian Institute of Science, Bangalore, India
| | - J Etienne
- Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Lyon, France ; Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Lyon, France ; Faculté de medicine, Université Claude Bernard-Lyon, Lyon, France
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12
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Abstract
Not only is Asia the most populous region in the world, but inappropriate therapy, including self-medication with over-the-counter antimicrobial agents, is a common response to infectious diseases. The high antibiotic selective pressure among the overcrowded inhabitants creates an environment that is suitable for the rapid development and efficient spread of numerous multidrug-resistant pathogens. Indeed, Asia is among the regions with the highest prevalence rates of healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-associated methicillin-resistant S. aureus (CA-MRSA) in the world. Most hospitals in Asia are endemic for multidrug-resistant methicillin-resistant S. aureus (MRSA), with an estimated proportion from 28% (in Hong Kong and Indonesia) to >70% (in Korea) among all clinical S. aureus isolates in the early 2010s. Isolates with reduced susceptibility or a high level of resistance to glycopeptides have also been increasingly identified in the past few years. In contrast, the proportion of MRSA among community-associated S. aureus infections in Asian countries varies markedly, from <5% to >35%. Two pandemic HA-MRSA clones, namely multilocus sequence type (ST) 239 and ST5, are disseminated internationally in Asia, whereas the molecular epidemiology of CA-MRSA in Asia is characterized by clonal heterogeneity, similar to that in Europe. In this review, the epidemiology of S. aureus in both healthcare facilities and communities in Asia is addressed, with an emphasis on the prevalence, clonal structure and antibiotic resistant profiles of the MRSA strains. The novel MRSA strains from livestock animals have been considered to constitute a public health threat in western countries. The emerging livestock-associated MRSA strains in Asia are also included in this review.
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Affiliation(s)
- C-J Chen
- Division of Paediatric Infectious Diseases, Chang Gung Memorial Hospital and Children's Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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13
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Bowen AC, Tong SYC, Chatfield MD, Carapetis JR. The microbiology of impetigo in indigenous children: associations between Streptococcus pyogenes, Staphylococcus aureus, scabies, and nasal carriage. BMC Infect Dis 2014; 14:727. [PMID: 25551178 PMCID: PMC4299569 DOI: 10.1186/s12879-014-0727-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/18/2014] [Indexed: 12/04/2022] Open
Abstract
Background Impetigo is caused by both Streptococcus pyogenes and Staphylococcus aureus; the relative contributions of each have been reported to fluctuate with time and region. While S. aureus is reportedly on the increase in most industrialised settings, S. pyogenes is still thought to drive impetigo in endemic, tropical regions. However, few studies have utilised high quality microbiological culture methods to confirm this assumption. We report the prevalence and antimicrobial resistance of impetigo pathogens recovered in a randomised, controlled trial of impetigo treatment conducted in remote Indigenous communities of northern Australia. Methods Each child had one or two sores, and the anterior nares, swabbed. All swabs were transported in skim milk tryptone glucose glycogen broth and frozen at –70°C, until plated on horse blood agar. S. aureus and S. pyogenes were confirmed with latex agglutination. Results From 508 children, we collected 872 swabs of sores and 504 swabs from the anterior nares prior to commencement of antibiotic therapy. S. pyogenes and S. aureus were identified together in 503/872 (58%) of sores; with an additional 207/872 (24%) sores having S. pyogenes and 81/872 (9%) S. aureus, in isolation. Skin sore swabs taken during episodes with a concurrent diagnosis of scabies were more likely to culture S. pyogenes (OR 2.2, 95% CI 1.1 – 4.4, p = 0.03). Eighteen percent of children had nasal carriage of skin pathogens. There was no association between the presence of S. aureus in the nose and skin. Methicillin-resistance was detected in 15% of children who cultured S. aureus from either a sore or their nose. There was no association found between the severity of impetigo and the detection of a skin pathogen. Conclusions S. pyogenes remains the principal pathogen in tropical impetigo; the relatively high contribution of S. aureus as a co-pathogen has also been confirmed. Children with scabies were more likely to have S. pyogenes detected. While clearance of S. pyogenes is the key determinant of treatment efficacy, co-infection with S. aureus warrants consideration of treatment options that are effective against both pathogens where impetigo is severe and prevalent. Trial registration This trial is registered; ACTRN12609000858291. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0727-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Asha C Bowen
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. .,Princess Margaret Hospital for Children, Perth, Western Australia, Australia. .,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
| | - Steven Y C Tong
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. .,Royal Darwin Hospital, Darwin, Northern Territory, Australia.
| | - Mark D Chatfield
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
| | - Jonathan R Carapetis
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia. .,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
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14
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Mutale W, Sahay KM, Hartley J, Thompson D, Ratnasinghe D, Hudson L, Hulse E, Fellows G. Community acquired Panton-Valentine Leukocidin (PVL) positive Methicilin Resistant Staphylococcal aureus cerebral abscess in an 11-month old boy: a case study. BMC Res Notes 2014; 7:862. [PMID: 25435087 PMCID: PMC4265436 DOI: 10.1186/1756-0500-7-862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022] Open
Abstract
Background Brain abscess are uncommon childhood infection. Brain abscess caused by Panton-Valentine Leukocidin positive Community acquired Methicillin Resistant Staphylococcal aureus have never been reported in the United Kingdom. Case presentation We report a case of a previously well 11-month old boy of Indian origin who developed a parietal lobe abscess from PVL positive CA-MRSA. Conclusion This case is one of the few described cases of brain abscess caused by PVL CA-MRSA in children. The unusual (insidious) presentation, the absence of a clear staphylococcal focus and the unexpected finding of a CA-MRSA in this patient highlight the challenges of managing such cases in clinical settings and the potential future risk to public health.
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Affiliation(s)
- Wilbroad Mutale
- London School of Hygiene and Tropical Medicine, Clinical Research Unit, London, UK.
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15
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Li H, Zhang C, Liu P, Liu W, Gao Y, Sun S. In vitro interactions between fluconazole and minocycline against mixed cultures of Candida albicans and Staphylococcus aureus. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 48:655-61. [PMID: 24856422 DOI: 10.1016/j.jmii.2014.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/09/2013] [Accepted: 03/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE It is difficult to manage coinfections in critically ill patients, especially in the presence of mixed-species biofilms. The aim of this study was to seek an effective drug combination for managing the dual-species biofilm of Candida albicans and Staphylococcus aureus. METHODS The interaction between fluconazole and minocycline against polymicrobial planktonic cells and polymicrobial biofilms formed over four different time intervals (4 hours, 8 hours, 12 hours, and 24 hours) was investigated using a microdilution checkerboard method. To explore whether the combined effects against the polymicrobial cultures involved calcium regulation, the effects of benidipine and ethylene glycol tetraacetic acid were characterized using a plate streaking method and a liquid-based quantitative method. RESULTS Fluconazole combined with minocycline exerted strong effects against polymicrobial planktonic cells and polymicrobial biofilms formed over 4 hours, 8 hours, and 12 hours. The addition of benidipine and ethylene glycol tetraacetic acid enhanced the activity of the drug combination, suggesting that the combined effects may involve the perturbation of calcium homeostasis. CONCLUSION Fluconazole in combination with minocycline is a potential approach for counteracting C. albicans-S. aureus dual-species biofilms.
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Affiliation(s)
- Hui Li
- School of Pharmaceutical Sciences, Shandong University, Jinan 250012, Shandong Province, China
| | - Caiqing Zhang
- Department of Respiratory Medicine, Qianfoshan Hospital Affiliated to Shandong University, Jinan 250014, Shandong Province, China
| | - Ping Liu
- School of Pharmaceutical Sciences, Shandong University, Jinan 250012, Shandong Province, China
| | - Weiguo Liu
- Department of Pharmacy, Qianfoshan Hospital Affiliated to Shandong University, Jinan 250014, Shandong Province, China
| | - Yuan Gao
- School of Pharmaceutical Sciences, Shandong University, Jinan 250012, Shandong Province, China
| | - Shujuan Sun
- Department of Pharmacy, Qianfoshan Hospital Affiliated to Shandong University, Jinan 250014, Shandong Province, China.
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16
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Alvarez-Uria G, Zachariah S, Thomas D. High prescription of antimicrobials in a rural district hospital in India. Pharm Pract (Granada) 2014; 12:384. [PMID: 25035714 PMCID: PMC4100948 DOI: 10.4321/s1886-36552014000200003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 05/09/2014] [Indexed: 11/11/2022] Open
Abstract
Background The World Health Organization (WHO) recommends surveillance of antibiotic use as part of the
strategy to fight against antimicrobial resistance. However, there is little information about the
antibiotic consumption in developing countries, especially in rural areas. Objective The objective of this study was to describe the antimicrobial consumption in a rural hospital in
India Methods The study was performed in a district hospital situated in Anantapur, Andhra Pradesh. In
accordance with WHO recommendations, we used the defined daily dose (DDD) methodology to measure the
antibiotic use during one year (from 1st August 2011 to 1st August 2012). The antibiotic use was
measured using DDDs/100 admissions and DDDs/100 patient-days for inpatients, and DDDs/100 visits for
outpatients. Results During the study period, there were 15,735 admissions and 250,611 outpatient visits. Antibiotics
were prescribed for 86% of inpatients and 12.5% of outpatients. Outpatient
prescriptions accounted for 2/3 of the overall antibiotic consumption. For inpatients, the total
antibiotic use was 222 DDDs/ 100 patient-days, 693 DDDs/ 100 admissions and the mean number of
antibiotics prescribed was 1.8. For outpatients, the total antibiotic use was 86 DDDs/ 100
outpatient visits and the mean number of antibiotics prescribed was 1.2. The most common antibiotics
prescribed were aminopenicillins and 3rd generation cephalosporins for inpatients, and tetracyclines
and quinolones for outpatients. In a sample of patients with diarrhoea or upper respiratory tract
infections (URTI), the proportion of patients who received antibiotics was 84% (95%
confidence interval [CI], 67-93) and 52% (95% CI, 43-62), respectively. Conclusion In this rural setting, the use of antimicrobials was extremely high, even in conditions with a
predominantly viral aetiology such as diarrhoea or URTI.
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Affiliation(s)
- Gerardo Alvarez-Uria
- Fundación Vicente Ferrer- Rural Development Trust Hospital , Bathalapalli ( India ).
| | - Seeba Zachariah
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education & Research . Anantapur ( India ).
| | - Dixon Thomas
- Department of Pharmacy Practice, Nirmala College of Pharmacy , Ernakulam ( India ).
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17
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Chaudhari CN, Tandel K, Grover N, Bhatt P, Sahni AK, Sen S, Prahraj AK. In vitro vancomycin susceptibility amongst methicillin resistant Staphylococcus aureus. Med J Armed Forces India 2014; 70:215-9. [PMID: 25378772 DOI: 10.1016/j.mjafi.2013.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/23/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vancomycin is drug of choice for treatment of Methicillin Resistant Staphylococcus aureus (MRSA) infections. S. aureus with reduced vancomycin susceptibility (SA-RVS) is on rise. Current guidelines of detection of SA-RVS are based on MIC (Minimum Inhibitory Concentration) by broth or agar dilution methods. Vancomycin MIC by E test (Epsilometer Test) is an alternative. A study was undertaken to know the prevalence of SA-RVS and compare vancomycin MIC by agar dilution and E test. METHODS A prospective study was undertaken at tertiary care hospital; 232 clinical MRSA isolates were included. Vancomycin MIC was undertaken by agar dilution method and E test. RESULTS All isolates were sensitive to Linezolid. Two MRSA isolates had vancomycin MIC ≥4 μg/ml; vancomycin MIC50 and MIC90 of MRSA isolates was 0.5 and 0.2 μg/ml respectively by agar dilution method. There was agreement over 93.5% isolates in vancomycin susceptibility by agar dilution and E test. E test had sensitivity and positive predictive value of 1.0 (CI - 0.34-1.0) and 0.5 (CI - 0.17-0.83) respectively compare to agar dilution method. CONCLUSIONS MRSA isolates continues to be susceptible to vancomycin and Linezolid. E test was found equally suitable in initial screening for vancomycin susceptibility. Due to geographic variation in prevalence, there is need of ongoing surveillance of SA-RVC.
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Affiliation(s)
- C N Chaudhari
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - K Tandel
- Medical Officer (Microbiology), Military Hospital Gwalior, India
| | - N Grover
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - P Bhatt
- Resident, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - A K Sahni
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - S Sen
- Senior Advisor (Pathology, Microbiology & Virology), Army Hospital (R&R), Delhi Cantt 10, India
| | - A K Prahraj
- Professor & Head (Microbiology), AIIMS, Bhubaneswar, Orissa, India
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18
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Čivljak R, Giannella M, Di Bella S, Petrosillo N. Could chloramphenicol be used against ESKAPE pathogens? A review of in vitro data in the literature from the 21st century. Expert Rev Anti Infect Ther 2014; 12:249-64. [PMID: 24392752 DOI: 10.1586/14787210.2014.878647] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The widespread use of antibiotics has been associated with the emergence of antimicrobial resistance among bacteria. 'ESKAPE' (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acintobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) pathogens play a major role in the rapidly changing scenario of antimicrobial resistance in the 21st century. Chloramphenicol is a broad spectrum antibiotic that was abandoned in developed countries due to its association with fatal aplastic anemia. However, it is still widely used in the developing world. In light of the emerging problem of multi-drug resistant pathogens, its role should be reassessed. Our paper reviews in vitro data on the activity of chloramphenicol against ESKAPE pathogens. Susceptibility patterns for Gram-positives were good, although less favorable for Gram-negatives. However, in combination with colistin, chloramphenicol was found to have synergistic activity. The risk-benefit related to chloramphenicol toxicity has not been analyzed. Therefore, extra precautions should be taken when prescribing this agent.
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Affiliation(s)
- Rok Čivljak
- University of Zagreb School of Medicine, "Dr. Fran Mihaljević" University Hospital for Infectious Diseases, Mirogojska 8, 10 000 Zagreb, Croatia
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Sowash MG, Uhlemann AC. Community-associated methicillin-resistant Staphylococcus aureus case studies. Methods Mol Biol 2014; 1085:25-69. [PMID: 24085688 DOI: 10.1007/978-1-62703-664-1_2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past decade, the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has changed the landscape of S. aureus infections around the globe. Initially recognized for its ability to cause disease in young and healthy individuals without healthcare exposures as well as for its distinct genotype and phenotype, this original description no longer fully encompasses the diversity of CA-MRSA as it continues to expand its niche. Using four case studies, we highlight a wide range of the clinical presentations and challenges of CA-MRSA. Based on these cases we further explore the globally polygenetic background of CA-MRSA with a special emphasis on generally less characterized populations.
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Affiliation(s)
- Madeleine G Sowash
- Division of Infectious Diseases, Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, NY, USA
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20
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Tong SYC, Kearns AM. Community-associated MRSA from the Indian subcontinent. THE LANCET. INFECTIOUS DISEASES 2013; 13:734-5. [DOI: 10.1016/s1473-3099(13)70231-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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