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Jauneikaite E, Ferguson T, Mosavie M, Fallowfield JL, Davey T, Thorpe N, Allsopp A, Shaw AM, Fudge D, O'Shea MK, Wilson D, Morgan M, Pichon B, Kearns AM, Sriskandan S, Lamb LE. Staphylococcus aureus colonization and acquisition of skin and soft tissue infection among Royal Marines recruits: a prospective cohort study. Clin Microbiol Infect 2019; 26:381.e1-381.e6. [PMID: 31357012 DOI: 10.1016/j.cmi.2019.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Skin and soft tissue infections (SSTIs) are a serious health issue for military personnel. Of particular importance are those caused by methicillin-resistant Staphylococcus aureus and Panton-Valentine leucocidin (PVL)-positive S. aureus (PVL-SA), as they have been associated with outbreaks of SSTIs. A prospective observational study was conducted in Royal Marine (RM) recruits to investigate the prevalence of PVL-SA carriage and any association with SSTIs. METHODS A total of 1012 RM recruits were followed through a 32-week training programme, with nose and throat swabs obtained at weeks 1, 6, 15 and 32. S. aureus isolates were characterized by antibiotic susceptibility testing, spa typing, presence of mecA/C and PVL genes. Retrospective review of the clinical notes for SSTI acquisition was conducted. RESULTS S. aureus colonization decreased from Week 1 to Week 32 (41% to 26%, p < 0.0001). Of 1168 S. aureus isolates, three out of 1168 (0.3%) were MRSA and ten out of 1168 (0.9%) PVL-positive (all MSSA) and 169 out of 1168 (14.5%) were resistant to clindamycin. Isolates showed genetic diversity with 238 different spa types associated with 25 multi-locus sequence type (MLST) clonal complexes. SSTIs were seen in 35% (351/989) of recruits with 3 training days lost per recruit. SSTI acquisition rate was reduced amongst persistent carriers (p < 0.0283). CONCLUSIONS Nose and throat carriage of MRSA and PVL-SA was low among recruits, despite a high incidence of SSTIs being reported, particularly cellulitis. Carriage strains were predominantly MSSA with a marked diversity of genotypes. Persistent nose and/or throat carriage was not associated with SSTI acquisition. Putative person-to-person transmission within troops was identified based on spa typing requiring further research to confirm and explore potential transmission routes.
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Affiliation(s)
- E Jauneikaite
- Department of Medicine, Imperial College London, London, UK; NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare-associated Infections, Imperial College London, London, UK; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - T Ferguson
- Department of Medicine, Imperial College London, London, UK
| | - M Mosavie
- Department of Medicine, Imperial College London, London, UK; NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare-associated Infections, Imperial College London, London, UK
| | | | - T Davey
- Institute of Naval Medicine, Alverstoke, UK
| | - N Thorpe
- Institute of Naval Medicine, Alverstoke, UK
| | - A Allsopp
- Institute of Naval Medicine, Alverstoke, UK
| | - A M Shaw
- Institute of Naval Medicine, Alverstoke, UK
| | - D Fudge
- Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
| | - M K O'Shea
- Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK; Institute of Microbiology and Infection, The University of Birmingham, Birmingham, UK
| | - D Wilson
- Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
| | - M Morgan
- Department of Microbiology, Royal Devon and Exeter Hospital, Exeter, UK
| | - B Pichon
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - A M Kearns
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - S Sriskandan
- Department of Medicine, Imperial College London, London, UK; NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare-associated Infections, Imperial College London, London, UK
| | - L E Lamb
- Department of Medicine, Imperial College London, London, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK; Royal Free London NHS Foundation Trust, London, UK.
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2
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Garvey MI, Pichon B, Bradley CW, Moiemen NS, Oppenheim B, Kearns AM. Improved understanding of an outbreak of meticillin-resistant Staphylococcus aureus in a regional burns centre via whole-genome sequencing. J Hosp Infect 2016; 94:401-404. [PMID: 27729168 DOI: 10.1016/j.jhin.2016.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 09/10/2016] [Indexed: 11/17/2022]
Affiliation(s)
- M I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
| | - B Pichon
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, Colindale, London, UK
| | - C W Bradley
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - N S Moiemen
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - B Oppenheim
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - A M Kearns
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, Colindale, London, UK
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Haill C, Fletcher S, Archer R, Jones G, Jayarajah M, Frame J, Williams A, Kearns AM, Jenks PJ. Prolonged outbreak of meticillin-resistant Staphylococcus aureus in a cardiac surgery unit linked to a single colonized healthcare worker. J Hosp Infect 2013; 83:219-25. [PMID: 23369471 DOI: 10.1016/j.jhin.2012.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND In low- as well as in high-prevalence settings, healthcare workers (HCWs) may be a substantial, under-recognized, reservoir of meticillin-resistant Staphylococcus aureus (MRSA) and an important potential source of transmission to patients. AIM To report an outbreak of MRSA in a cardiac surgery unit in England over a 10-month period. METHODS Cases were defined as patients and staff on the cardiac surgery unit from whom the outbreak strain was newly isolated between 20 May 2011 and 16 March 2012. Representative isolates from all cases were characterized by spa-typing, pulsed-field gel electrophoresis and multi-locus variable-number tandem-repeat analysis (MLVA). FINDINGS Four patients appeared to acquire MRSA during their inpatient stay on the cardiac surgery unit. All four patients and one HCW were found to be carrying an identical epidemic (E)MRSA-15 strain (spa t032, pulsotype A, MLVA profile 16-6-3-1-1-17-1-4). No other members of staff were found to be colonized with MRSA. The colonized HCW was thought to be the source of the outbreak and was decolonized using a combination of nasal mupirocin, chlorhexidine body wash and oral rifampicin and doxycycline. CONCLUSIONS This report highlights recent changes in the epidemiology of MRSA in England and suggests an important role for colonized HCWs in the transmission of MRSA to patients. Screening HCWs may provide an increasingly valuable strategy in managing linked hospital acquisitions and well-defined outbreaks where initial investigation does not reveal a source.
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Affiliation(s)
- C Haill
- Department of Microbiology, Derriford Hospital, Plymouth, UK
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4
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Pichon B, Hill R, Laurent F, Larsen AR, Skov RL, Holmes M, Edwards GF, Teale C, Kearns AM. Development of a real-time quadruplex PCR assay for simultaneous detection of nuc, Panton-Valentine leucocidin (PVL), mecA and homologue mecALGA251. J Antimicrob Chemother 2012; 67:2338-41. [DOI: 10.1093/jac/dks221] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mohamed DH, Saberesheikh S, Kearns AM, Saunders NA. Putative link between Staphylococcus aureus bacteriophage serotype and community association. Int J Med Microbiol 2012; 302:135-44. [PMID: 22673403 DOI: 10.1016/j.ijmm.2012.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 02/02/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) from humans can be broadly separated into 3 groups: healthcare-associated (HA), community-associated (CA), and livestock-associated (LA) MRSA. Initially based on epidemiological features, division into these classes is becoming increasingly problematic. The sequencing of S. aureus genomes has highlighted variations in their accessory components, which likely account for differences in pathogenicity and epidemicity. In particular, temperate bacteriophages have been regarded as key players in bacterial pathogenesis. Bacteriophage-associated Panton-Valentine leukocidin genes (luk-PV) are regarded as epidemiological markers of the CA-MRSA due to their high prevalence in CA strains. This paper describes the development and application of a partial composite S. aureus virulence-associated gene microarray. Epidemic, pandemic, and sporadic lineages of UK HA and CA S. aureus were compared. Phage structural genes linked with CA isolates were identified and in silico analysis revealed these to be correlated with phage serogroup. CA strains predominantly carried a PVL-associated phage either of the A or Fb serogroup, whilst HA strains predominantly carried serogroup Fa or B phages. We speculate that carriage of a serogroup A/Fb PVL-associated phage rather than the luk-PV genes specifically is correlated with CA status.
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Affiliation(s)
- D H Mohamed
- Microbiology Services Division, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT, UK.
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Haill C, Allwood A, Kearns AM, Jenks PJ. Staff-to-patient transmission of meticillin-resistant Staphylococcus aureus: do bacterial factors play a role? J Hosp Infect 2011; 79:275-7. [PMID: 21813207 DOI: 10.1016/j.jhin.2011.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 06/23/2011] [Indexed: 11/19/2022]
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7
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Rao GG, Kearns AM, Edwards GFS. Decline and fall of epidemic meticillin-resistant Staphylococcus aureus-16. J Hosp Infect 2011; 79:269-70. [PMID: 21664721 DOI: 10.1016/j.jhin.2011.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 02/25/2011] [Indexed: 11/20/2022]
Abstract
Epidemic meticillin-resistant Staphylococcus aureus-16, which was widespread throughout the UK and the rest of the world, has declined markedly in recent years. The reasons for this are not clear.
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Affiliation(s)
- G Gopal Rao
- Department of Microbiology, North West London Hospitals, London, UK.
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8
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Johnson AP, Sharland M, Goodall CM, Blackburn R, Kearns AM, Gilbert R, Lamagni TL, Charlett A, Ganner M, Hill R, Cookson B, Livermore D, Wilson J, Cunney R, Rossney A, Duckworth G. Enhanced surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in children in the UK and Ireland. Arch Dis Child 2010; 95:781-5. [PMID: 20515969 DOI: 10.1136/adc.2010.162537] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the incidence and demographic features of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in children in the UK and Ireland and to characterise MRSA isolated from cases. DESIGN Prospective surveillance study. SETTING Children aged <16 years hospitalised with bacteraemia due to MRSA. METHODS Cases were ascertained by active surveillance involving paediatricians reporting to the British Paediatric Surveillance Unit and by routine laboratory surveillance. Patient characteristics were obtained using questionnaires sent to reporting paediatricians. MRSA isolates were characterised using molecular and phenotypic techniques including antimicrobial susceptibility testing. RESULTS 265 episodes of MRSA bacteraemia were ascertained, involving 252 children. The overall incidence rate was 1.1 per 100 000 child population per year (95% CI 0.9 to 1.2): 61% of the children were aged <1 year (a rate of 9.7 cases per 100 000 population per year (95% CI 8.2 to 11.4)) and 35% were <1 month. Clinical data were obtained from 115 cases. The clinical presentation varied, with fever present in only 16% of neonates compared with 72% of older children. A history of invasive procedure was common, with 32% having had intravascular lines and 13% having undergone surgery. 62% of patients for whom data were available were receiving high-dependency care (46% in SCBU/NICU and 16% in PICU). Of 93 MRSA isolates studied, 73% belonged to epidemic strains widely associated with nosocomial infection in the UK and Ireland. CONCLUSIONS MRSA bacteraemia in children was relatively uncommon and was predominantly seen in very young children, often those receiving neonatal or paediatric intensive care. Bacteraemia predominantly involved well-documented epidemic strains of MRSA associated with nosocomial infection.
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Affiliation(s)
- A P Johnson
- Department of Healthcare-Associated Infections & Antimicrobial Resistance, HPA Centre for Infections, London NW9 5EQ, UK.
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Abstract
Within the framework of the Health Protection Agency's programme of enhanced surveillance of Staphylococcus aureus with Panton-Valentine Leucocidin (PVL-SA) in England and Wales conducted during 2005-2006, we identified 720 PVL-SA, representing a two-fold increase between 2005 (n = 224) and 2006 (n = 496). The number of PVL-methicillin-resistant S. aureus rose from 119 to 159 in that period. Isolates were referred by 112 centres and included outbreaks of PVL-related disease in community and healthcare settings. One hundred individuals had systemic disease symptoms. Planned systematic surveillance-based studies aim to better address the question of whether these increases reflect an increasing prevalence of PVL-SA and/or improved case ascertainment of PVL-related syndromes.
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Affiliation(s)
- M J Ellington
- Staphylococcus Reference Unit, Centre for Infections, Health Protection Agency, London, UK
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Hill RLR, Kearns AM, Nash J, North SE, Pike R, Newson T, Woodford N, Calver R, Livermore DM. Linezolid-resistant ST36 methicillin-resistant Staphylococcus aureus associated with prolonged linezolid treatment in two paediatric cystic fibrosis patients. J Antimicrob Chemother 2010; 65:442-5. [DOI: 10.1093/jac/dkp494] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Cooke FJ, Gkrania-Klotsas E, Howard JC, Stone M, Kearns AM, Ganner M, Carmichael AJ, Brown NM. Clinical, molecular and epidemiological description of a cluster of community-associated methicillin-resistant Staphylococcus aureus isolates from injecting drug users with bacteraemia. Clin Microbiol Infect 2009; 16:921-6. [PMID: 19912266 DOI: 10.1111/j.1469-0691.2009.02969.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an increasing problem, predominantly in previously healthy individuals including notable risk groups such as the homeless, those who play close-contact sports, military personnel, men who have sex with men (MSM) and injecting drug users (IDUs). Over a 5-month period, four IDUs were admitted to Addenbrooke's Hospital, Cambridge, UK, with MRSA bacteraemia. All four patients presented with complex clinical features, with more than one focus of infection, and were linked epidemiologically. The atypical antibiogram of the MRSA isolates (ciprofloxacin-susceptible) prompted further characterization, both phenotypically (antibiotic resistance typing; phage typing) and genotypically (detection of toxin genes by PCR; pulsed-field gel electrophoresis (PFGE); Staphylococcal chromosome cassette (SCC) mec typing; multi-locus sequence typing (MLST)). All four isolates had similar antibiograms, were Panton-Valentine Leucocidin (PVL) toxin gene-negative, harboured SCCmec type IV and were closely related as shown by phage typing and PFGE. These isolates were representatives of a community-associated clone, ST1-MRSA-IV, known to be circulating in IDUs in the UK since 2001. This paper presents a detailed description of the clinical, microbiological and epidemiological features of a series of CA-MRSA bacteraemias in IDUs in the UK.
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Affiliation(s)
- F J Cooke
- Clinical Microbiology and Public Health Laboratory, Health Protection Agency, Cambridge, UK.
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12
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Ellington MJ, Ganner M, Warner M, Cookson BD, Kearns AM. Polyclonal multiply antibiotic-resistant methicillin-resistant Staphylococcus aureus with Panton-Valentine leucocidin in England. J Antimicrob Chemother 2009; 65:46-50. [DOI: 10.1093/jac/dkp386] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Loeffler A, Kearns AM, Ellington MJ, Smith LJ, Unt VE, Lindsay JA, Pfeiffer DU, Lloyd DH. First isolation of MRSA ST398 from UK animals: a new challenge for infection control teams? J Hosp Infect 2009; 72:269-71. [PMID: 19481297 DOI: 10.1016/j.jhin.2009.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 04/09/2009] [Indexed: 10/20/2022]
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14
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Cunnington A, Brick T, Cooper M, Danin J, Hunt D, Jeanes A, Kearns AM, Nolan M, Lyall H. Severe invasive Panton-Valentine Leucocidin positive Staphylococcus aureus infections in children in London, UK. J Infect 2009; 59:28-36. [PMID: 19560210 DOI: 10.1016/j.jinf.2009.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 05/14/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the features of invasive Panton-Valentine Leucocidin positive Staphylococcus aureus (PVL-SA) in children at a London teaching hospital, from 2004 to 2008. METHODS Retrospective case note review. RESULTS Eleven previously healthy children, 7 male, median age 9 years (range 7 months-13 years), had invasive infections due to unrelated community-acquired meticillin-sensitive PVL-SA. Possible risk factors were identified in 10 cases. Eight patients had complicated musculoskeletal infections, 2 had pneumonia, and 1 had a massive retropharyngeal abscess. At admission neutropenia was present in 2 patients, deep vein thrombosis in 3, and initial blood cultures were positive in 8. Patients with musculoskeletal involvement had a median of 3 (range 1-6) sites of infection, and required median 5 (range 1-11) operative procedures. Eight patients were admitted to PICU, 7 had septic shock. Median duration of hospital stay was 51 (range 14-255) days. One child died and 5 have long-term morbidity. CONCLUSIONS The clinical features of invasive PVL-SA in this series were similar to those reported from USA and Europe. Musculoskeletal infection was the most common manifestation, frequently progressing to multiple sites and severe sepsis. Most cases had risk factors and clinical features which might have allowed earlier diagnosis, and possibly improved outcome.
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Affiliation(s)
- A Cunnington
- Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
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15
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Otter JA, Klein JL, Watts TL, Kearns AM, French GL. Identification and control of an outbreak of ciprofloxacin-susceptible EMRSA-15 on a neonatal unit. J Hosp Infect 2007; 67:232-9. [PMID: 17933423 DOI: 10.1016/j.jhin.2007.07.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 07/27/2007] [Indexed: 11/17/2022]
Abstract
We report the identification and control of an outbreak of a ciprofloxacin-susceptible strain of UK epidemic meticillin-resistant Staphylococcus aureus (EMRSA)-15 on a neonatal unit (NNU). All babies were screened for MRSA on admission using ciprofloxacin-containing media which did not detect the outbreak strain. The first identified case was a premature baby who developed MRSA bacteraemia with associated tibial osteomyelitis and multiple subcutaneous abscesses. The outbreak strain was subsequently identified in the nasopharyngeal secretions of a second child who was not clinically infected. Screening of all patients on the NNU using non-ciprofloxacin-media identified two other colonised babies. All four patient isolates were EMRSA-15, spa type t022, SCCmec IV, Panton-Valentine leucocidin (PVL) negative, indistinguishable by pulsed-field gel electrophoresis and susceptible to all non-beta-lactam antimicrobials tested. The outbreak strain was cultured from four of 48 environmental sites in a communal milk-expressing room. Unsupervised movement of mothers to and from the milk-expressing room may have contributed to the outbreak. Control measures included cohort isolation of affected babies, improved environmental cleaning, increased emphasis on hand hygiene and education of mothers. Ciprofloxacin-containing media should be used with caution for MRSA screening in settings where ciprofloxacin-susceptible strains (including community-associated MRSA) are increasing in prevalence.
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Affiliation(s)
- J A Otter
- Infection and Immunology Delivery Unit, St Thomas' Hospital and King's College London, London, UK
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16
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Monecke S, Slickers P, Ellington MJ, Kearns AM, Ehricht R. High diversity of Panton-Valentine leukocidin-positive, methicillin-susceptible isolates of Staphylococcus aureus and implications for the evolution of community-associated methicillin-resistant S. aureus. Clin Microbiol Infect 2007; 13:1157-64. [PMID: 17949441 DOI: 10.1111/j.1469-0691.2007.01833.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In total, 100 Staphylococcus aureus isolates from diverse cases of skin and soft-tissue infection at a university hospital in Saxony, Germany, were characterised using diagnostic microarrays. Virulence factors, including Panton-Valentine leukocidin (PVL), were detected and the isolates were assigned to clonal groups. Thirty isolates were positive for the genes encoding PVL. Only three PVL-positive methicillin-resistant S. aureus (MRSA) isolates were found, two of which belonged to European clone ST80-MRSA IV and one to USA300 strain ST8-MRSA IV. The remaining methicillin-susceptible PVL-positive isolates belonged to a variety of different multilocus sequence types. The predominant strains were agrI/ST22, agrII/CC5, agrIII/CC30 and agrIV/ST121. In order to check for possible bias caused by regional or local outbreak strains, an additional 18 methicillin-susceptible, PVL-positive isolates from the UK were tested. Approximately two-thirds of the UK isolates belonged to types that also comprised approximately two-thirds of the isolates from Saxony. Some methicillin-susceptible PVL-positive isolates (agrI/ST152, agrIII/ST80 and agrIII/ST96) closely resembled known epidemic community-acquired MRSA (CaMRSA) strains. These findings indicate that the current rise in PVL-positive CaMRSA could be caused by the dissemination of novel SCCmec elements among pre-existing PVL-positive strains, rather than by the spread of PVL phages among MRSA strains.
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Affiliation(s)
- S Monecke
- Institute for Medical Microbiology and Hygiene, Faculty of Medicine Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
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David MD, Kearns AM, Gossain S, Ganner M, Holmes A. Community-associated meticillin-resistant Staphylococcus aureus: nosocomial transmission in a neonatal unit. J Hosp Infect 2006; 64:244-50. [PMID: 16928408 DOI: 10.1016/j.jhin.2006.06.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 06/09/2006] [Indexed: 11/24/2022]
Abstract
Community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen, increasingly reported worldwide to cause infections in individuals without classical risk factors for acquiring healthcare-associated MRSA (HA-MRSA). This report describes the first documented transmission of CA-MRSA in a healthcare setting in the UK, involving four babies and a member of staff in a neonatal unit. Detailed microbiological characterization of the isolates revealed that they represented a single clone with the following characteristics: multi-locus sequence type (MLST) 1; staphylococcal cassette chromosome mec (SCCmec) type IVa; protein A (spa) type t127; agr group 3, and encoding enterotoxins A and H. The Panton-Valentine leukocidin genes were not detected. The CA-MRSA strain appeared to be circulating alongside several subtypes of epidemic MRSA-15, the most prevalent HA-MRSA in the UK. A combination of infection control measures contained the outbreak. This report highlights the changing epidemiology of MRSA in the UK, and emphasizes the need for healthcare personnel to be alert to the fact that CA-MRSA can occur not only in the community but also in the healthcare setting.
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Affiliation(s)
- M D David
- West Midlands Public Health Laboratory, Birmingham Heartlands Hospital, Birmingham, UK
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18
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Aires-de-Sousa M, Boye K, de Lencastre H, Deplano A, Enright MC, Etienne J, Friedrich A, Harmsen D, Holmes A, Huijsdens XW, Kearns AM, Mellmann A, Meugnier H, Rasheed JK, Spalburg E, Strommenger B, Struelens MJ, Tenover FC, Thomas J, Vogel U, Westh H, Xu J, Witte W. High interlaboratory reproducibility of DNA sequence-based typing of bacteria in a multicenter study. J Clin Microbiol 2006; 44:619-21. [PMID: 16455927 PMCID: PMC1392649 DOI: 10.1128/jcm.44.2.619-621.2006] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Current DNA amplification-based typing methods for bacterial pathogens often lack interlaboratory reproducibility. In this international study, DNA sequence-based typing of the Staphylococcus aureus protein A gene (spa, 110 to 422 bp) showed 100% intra- and interlaboratory reproducibility without extensive harmonization of protocols for 30 blind-coded S. aureus DNA samples sent to 10 laboratories. Specialized software for automated sequence analysis ensured a common typing nomenclature.
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Affiliation(s)
- M Aires-de-Sousa
- Department of Periodontology, University Hospital Münster, Waldeyerstrasse 30, D-48149 Münster, Germany
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Holmes A, Ganner M, McGuane S, Pitt TL, Cookson BD, Kearns AM. Staphylococcus aureus isolates carrying Panton-Valentine leucocidin genes in England and Wales: frequency, characterization, and association with clinical disease. J Clin Microbiol 2005; 43:2384-90. [PMID: 15872271 PMCID: PMC1153723 DOI: 10.1128/jcm.43.5.2384-2390.2005] [Citation(s) in RCA: 280] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus isolates carrying the genes that encode for Panton-Valentine leucocidin (PVL), a highly potent toxin, have been responsible for recent outbreaks of severe invasive disease in previously healthy children and adults in the United States of America and Europe. To determine the frequency of PVL-positive isolates sent to the Staphylococcus Reference Unit (United Kingdom) for epidemiological purposes, we tested 515 isolates of S. aureus, and 8 (1.6%) were positive for the PVL locus. A further 470 isolates were selected to explore the association of PVL-positive S. aureus with clinical disease. Of these, 23 (4.9%) were PVL positive and most were associated with skin and soft tissue infections (especially abscesses). The PVL genes were also detected in isolates responsible for community-acquired pneumonia, burn infections, bacteremia, and scalded skin syndrome. Genotyping by pulsed-field gel electrophoresis and multilocus sequence typing revealed that the PVL-positive isolates were from diverse genetic backgrounds, although one prevalent clone of 12 geographically dispersed methicillin-resistant S. aureus (MRSA) isolates was identified (ST80). All 12 isolates were stapylococcal cassette chromosome mec type IVc, had an agr3 allele, and shared a common toxin gene profile (sea-see, seg-sej, eta, etb, and tst negative but etd positive). ST80 strains with similar genetic characteristics have been responsible for community-acquired infections in France and Switzerland. The remaining PVL-positive isolates were mostly methicillin-sensitive S. aureus and belonged to 12 different sequence types, including ST22 and ST30, which are closely related to the most prevalent MRSA clones in United Kingdom hospitals, EMRSA-15 and EMRSA-16, respectively.
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Affiliation(s)
- A Holmes
- Laboratory of Healthcare-Associated Infection, Centre for Infections, Health Protection Agency, London, NW9 5HT, United Kingdom.
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El-Zimaity D, Kearns AM, Dawson SJ, Price S, Harrison GAJ. Survey, characterization and susceptibility to fusidic acid of Staphylococcus aureus in the Carmarthen area. J Antimicrob Chemother 2004; 54:441-6. [PMID: 15269197 DOI: 10.1093/jac/dkh373] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This retrospective study was designed to investigate the possible reasons for an apparent increase in fusidic acid resistance among Staphylococcus aureus. MATERIALS AND METHODS The Datastore records of the Communicable Disease Surveillance Centre, Wales, UK were reviewed in conjunction with information concerning the prescribing of fusidic acid. RESULTS During the 5 year study period (1997-2001), a rise in the incidence of fusidic acid resistance was noted, particularly among paediatric patients presenting with infected eczema and impetigo, which may be related to the observed increase in prescriptions of topical fusidic acid. Extended phenotypic and genotypic characterization of a limited number (n=31) of isolates from 2002 showed that fusidic acid-resistant strains of S. aureus were typically from patients with impetigo and isolates fell into a single clonal group. Conversely, isolates from other skin disease (eczema, dermatitis and abscesses) were usually susceptible to fusidic acid and proved a diverse group. CONCLUSION This study provides valuable data on the prevalence of fusidic acid-resistant S. aureus, the genetic background of the strains, and their association with clinical disease in both the healthcare environment and community setting in the catchment area served by the Laboratory.
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Affiliation(s)
- D El-Zimaity
- Microbiology Carmarthenshire, National Public Health Service for Wales, West Wales General Hospital, Carmarthen SA31 2AF, UK
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Eastham KM, Freeman R, Kearns AM, Eltringham G, Clark J, Leeming J, Spencer DA. Clinical features, aetiology and outcome of empyema in children in the north east of England. Thorax 2004; 59:522-5. [PMID: 15170039 PMCID: PMC1747032 DOI: 10.1136/thx.2003.016105] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The incidence of empyema in children in the UK is increasing. The reason for this is unclear. A prospective study was undertaken to investigate the clinical features, aetiology, and outcome of cases of empyema and parapneumonic effusion presenting to a tertiary paediatric respiratory centre between February 1997 and August 2001. METHOD Routine bacterial culture of blood and pleural fluid was performed for 47 cases. Forty three pleural fluid specimens, culture negative for pneumococcus, were analysed for pneumococccal DNA by real time polymerase chain reaction (PCR). Penicillin susceptibility was determined for DNA positive specimens using complementary PCR assay. Capsular serotype specific antigen detection was by enzyme immunoassay (EIA) using monoclonal antibodies to serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F. Clinical data were obtained from patient notes, supplemented by a postal questionnaire. RESULTS The median (range) age of the patients was 5.6 (0.6-16.9) years and 70% were male. The median (range) duration of illness before referral to hospital was 5 (0-25) days. Forty five (96%) had received antibiotics before referral; 32 (68%) required decortication and eight (21%) thoracocentesis. Median postoperative stay was 4 days (2-8). Thirty two (75%) pneumococcal culture negative specimens were pneumococcal DNA positive; 17 (53%) of these were serotype 1. All were penicillin sensitive. CONCLUSIONS Pneumococcus is the major pathogen in childhood empyema and serotype 1 is the prevalent serotype. This has implications for vaccine development and immunisation strategy as the current 7-valent pneumococcal conjugate vaccine does not protect against serotype 1.
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Affiliation(s)
- K M Eastham
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
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Sheppard CL, Harrison TG, Kearns AM, Guiver M, Creek M, Evans R, Smith MD, Eltringham G, Cartwright KA, George RC. Diagnosis of invasive pneumococcal infection by PCR amplification of Streptococcus pneumoniae genomic fragments in blood: a multi-centre comparative study. Commun Dis Public Health 2003; 6:221-7. [PMID: 14708272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The increasing interest in the prevention of pneumococcal disease by immunisation necessitates improved organism-specific surveillance. This is particularly the case with regard to the contribution of Streptococcus pneumoniae infection to community-acquired pneumonia where blood cultures are often negative and sputum culture results ambiguous. Examination by PCR of blood samples taken at hospital admission offers one possibility for such improvement. The sensitivity, specificity and convenience of three pneumolysin gene PCR assays were compared in a large study, using EDTA blood from 175 patients (95 with proven pneumococcal bacteraemia, 80 with bacteraemia due to other organisms). The assays used were a PCR-enzyme immunoassay, a hybridisation probe assay run on the Roche LightCycler and a hydrolysis probe (TaqMan) assay run on an ABI 7700. Overall samples from only 57% of patients with bacteraemic pneumococcal infection yielded a positive result in at least one assay. Individual sensitivities ranged from 45% (TaqMan/ABI) through 35% (PCR-EIA) to 21% (Hybridisation/LightCycler). Specificity (PCR negative in the 80 control patients) ranged from 97-100%. The TaqMan/ABI assay was run in two centres and concordance between results was 91.4%, discrepancies being associated with very weakly positive samples. Overall, the TaqMan/ABI was the most sensitive and convenient assay; however, this method does not appear to offer any significant improvement over conventional blood cultures and is unlikely to be sufficiently sensitive to confirm a pneumococcal aetiology for non-bacteraemic pneumococcal pneumonia. For the present, therefore, blood culture is the preferred option.
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Affiliation(s)
- C L Sheppard
- Health Protection Agency, Respiratory and Systemic Infection Laboratory, Specialist and Reference Microbiology Division, 61 Colindale Avenue, London NW9 5HT
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Abstract
Tuberculosis in solid organ transplant recipients is associated with relatively high morbidity and mortality and is often extra-pulmonary. Reactivation of dormant infection is the usual mode of acquisition with donor and nosocomial transmission occurring infrequently. We report two cases of probable donor transmitted extra-pulmonary infection where both isolates of Mycobacterium tuberculosis proved to be indistinguishable using hemi-nested inverse PCR of the IS 6110 region.
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Affiliation(s)
- J C Graham
- Microbiology Department, Freeman Hospital, High Heaton, UK.
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Kearns AM, Turner AJ, Taylor CE, George PW, Freeman R, Gennery AR. LightCycler-based quantitative PCR for rapid detection of human herpesvirus 6 DNA in clinical material. J Clin Microbiol 2001; 39:3020-1. [PMID: 11499395 PMCID: PMC88288 DOI: 10.1128/jcm.39.8.3020-3021.2001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kearns AM, Draper B, Wipat W, Turner AJ, Wheeler J, Freeman R, Harwood J, Gould FK, Dark JH. LightCycler-based quantitative PCR for detection of cytomegalovirus in blood, urine, and respiratory samples. J Clin Microbiol 2001; 39:2364-5. [PMID: 11414242 PMCID: PMC88149 DOI: 10.1128/jcm.39.6.2364-2365.2001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
A novel real-time quantitative PCR (QPCR) assay is described for monitoring CMV DNA load in clinical specimens using the LightCycler. The assay is rapid (< 40 min), easy to carry out, robust, reliable and is capable of detecting from 10 to over 2 x 10(5) CMV DNA copies with a wide linear range. Amplification and detection occur simultaneously, avoiding the need for post-PCR analysis and thereby minimising the risk of carryover contamination. The assay proved to be accurate, specific and reproducible when evaluated in three different laboratories. In addition, LightCycler results were comparable with those of TaqMan, an independent real-time QPCR assay.
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Affiliation(s)
- A M Kearns
- Public Health Laboratory, General Hospital, Westgate Road, NE4 6BE, Newcastle upon Tyne, UK.
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Graham JC, Phillips JA, Murphy OM, Kearns AM, Gould FK, Freeman R. Use of mastalex to detect methicillin resistance in coagulase-negative staphylococci. J Antimicrob Chemother 2000; 46:850. [PMID: 11062215 DOI: 10.1093/jac/46.5.850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wheeler J, Murphy OM, Freeman R, Kearns AM, Steward M, Lee MJ. PCR can add to detection of pneumococcal disease in pneumonic patients receiving antibiotics at admission. J Clin Microbiol 2000; 38:3907. [PMID: 11184177 PMCID: PMC87511 DOI: 10.1128/jcm.38.10.3907-3907.2000] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kearns AM, Wheeler J, Freeman R, Seiders PR, Perry J, Whatmore AM, Dowson CG. Pneumolysin detection identifies atypical isolates of Streptococcus pneumoniae. J Clin Microbiol 2000; 38:1309-10. [PMID: 10755884 PMCID: PMC88616 DOI: 10.1128/jcm.38.3.1309-1310.2000] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kearns AM, Barrett A, Marshall C, Freeman R, Magee JG, Bourke SJ, Steward M. Epidemiology and molecular typing of an outbreak of tuberculosis in a hostel for homeless men. J Clin Pathol 2000; 53:122-4. [PMID: 10767827 PMCID: PMC1763283 DOI: 10.1136/jcp.53.2.122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate a possible outbreak of tuberculosis in a hostel for homeless men using IS6110 profiling, a polymerase chain reaction (PCR) based fingerprinting technique. METHODS Eight cases of tuberculosis were diagnosed in residents of the hostel over a period of 28 months. To provide epidemiological data, a heminested inverse PCR (HIP) assay targeting the insertion sequence IS6110 together with its upstream flanking region was used to fingerprint the eight isolates of M tuberculosis under investigation. RESULTS The HIP technique gave IS6110 profiles which showed that while three isolates were clearly distinct, the remaining five strains were indistinguishable, suggesting the latter were representatives of a single outbreak strain. CONCLUSIONS The HIP assay proved discriminatory and facilitated repeated testing for the direct comparison of strains as more patients presented over the protracted course of this outbreak.
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Affiliation(s)
- A M Kearns
- Molecular Biology Unit, General Hospital, Newcastle upon Tyne, UK
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Graham JC, Murphy OM, Stewart D, Kearns AM, Galloway A, Freeman R. Comparison of PCR detection of mecA with methicillin and oxacillin disc susceptibility testing in coagulase-negative staphylococci. J Antimicrob Chemother 2000; 45:111-3. [PMID: 10629021 DOI: 10.1093/jac/45.1.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The provisional BSAC method for the detection of methicillin sensitivity in coagulase-negative staphylococci (CNS) requires incubation of isolates for 48 h and raises the problem of timely reporting of susceptibility data. The forthcoming withdrawal of methicillin raises another difficulty. We evaluated 42 clinically significant CNS blood culture isolates by PCR, methicillin and oxacillin disc testing and by using methicillin Etests. Our results suggest that, although oxacillin disc susceptibility testing is a reasonable first line step, optimal and timely detection of resistance or susceptibility may require a combination of phenotypic and genotypic methods.
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Affiliation(s)
- J C Graham
- Public Health and Clinical Microbiology Laboratory, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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Kearns AM, Freeman R, Murphy OM, Seiders PR, Steward M, Wheeler J. Rapid PCR-based detection of Streptococcus pneumoniae DNA in cerebrospinal fluid. J Clin Microbiol 1999; 37:3434. [PMID: 10515740 PMCID: PMC85600 DOI: 10.1128/jcm.37.10.3434-3434.1999] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
A multiplex PCR was developed to detect the coagulase gene (coa; pathognomic of Staphylococcus aureus) and the mecA gene (characteristically encoding for methicillin resistance in staphylococci) in a single, rapid test. Suitable primers for the gene targets and an internal, amplification control were incorporated into a multiplex PCR assay, which was then optimized on a capillary air thermal cycler to improve the turnaround time of the test to approximately 1.5 hours. The assay was evaluated with 111 fresh clinical isolates of staphylococci. The multiplex PCR correctly distinguished between isolates of S. aureus, which were sensitive to methicillin (MSSA) and those resistant to it (MRSA). It also correctly differentiated between similar isolates of coagulase negative staphylococci (MSSE and MRSE respectively). It was concluded that this multiplex PCR was a rapid and reliable method for the detection of methicillin-resistant staphylococci.
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Affiliation(s)
- A M Kearns
- Public Health Laboratory, General Hospital, Westgate Road, Newcastle upon Tyne, England, UK
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Kearns AM, Magee JG, Gennery A, Steward M, Graham C, Seiders PR, Freeman R. Rapid identification of Mycobacterium bovis BCG by the detection of the RD1 deletion using a multiplex PCR technique. Int J Tuberc Lung Dis 1999; 3:635-8. [PMID: 10423228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
The BCG vaccine strain cannot, with confidence, be differentiated from other members of the Mycobacterium tuberculosis complex on phenotypic tests alone. Isolates from clinical sites not associated with vaccination may be confused with M. tuberculosis. A characteristic of BCG strains is the deletion of the genomic region RD1; detection of this forms the basis of a multiplex polymerase chain reaction (PCR) assay to distinguish BCG strains. In this study, 28 M. tuberculosis complex strains were analysed by the PCR assay. A DNA sequence displaying the characteristic deletion was detected in all eleven of the BCG strains tested and was not found in representatives of other members of the complex, including M. bovis. Thus, the assay affords a rapid, simple and effective method for the discrimination of the BCG vaccine strain from other members of the M. tuberculosis complex.
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Affiliation(s)
- A M Kearns
- Regional Centre for Mycobacteriology, Public Health Laboratory, Newcastle upon Tyne, United Kingdom
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Kearns AM, Freeman R, Steward M, Magee JG. A rapid polymerase chain reaction technique for detecting M tuberculosis in a variety of clinical specimens. J Clin Pathol 1998; 51:922-4. [PMID: 10070334 PMCID: PMC501028 DOI: 10.1136/jcp.51.12.922] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A rapid in-house polymerase chain reaction (PCR) assay is described for the direct detection of Mycobacterium tuberculosis complex in clinical material. Its performance is compared with two kit based systems. The results of the in-house assay were comparable with the commercial assays, detecting M tuberculosis in 100% of smear positive, culture positive samples. The in-house assay proved to be rapid, easy, and inexpensive to perform, and the inclusion of an internal inhibitor control permitted validation of the PCR results.
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Affiliation(s)
- A M Kearns
- Public Health Laboratory, General Hospital, Newcastle upon Tyne, UK
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Hannan PC, Kearns AM, Sisson PR, Freeman R. Differentiation of strains of Mycoplasma fermentans from various sources by pyrolysis mass spectrometry. J Med Microbiol 1997; 46:348-53. [PMID: 9128200 DOI: 10.1099/00222615-46-4-348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Mycoplasma fermentans has attracted much interest both as a cofactor for the progression of AIDS and as a pathogenic agent in non-AIDS related diseases. Previous studies with serological and genetic techniques suggest that M. fermentans represents a homogeneous group of organisms, with no significant differences identified among the strains examined. In this study, 25 cultures of M. fermentans, including isolates from human sources and tissue culture cells, were compared by pyrolysis mass spectrometry (PMS). It was possible to distinguish the 'type' strain PG-18 from an AIDS-associated M. fermentans strain 'incognitus' by this technique. PMS was also able to differentiate laboratory-induced aminoglycoside-resistant variants from their fully susceptible parents. Four AIDS-associated isolates were distinguished from each other, whilst five European cell culture isolates were shown to be closely related, as were six M. fermentans isolates from an outbreak of acute respiratory infection in Canada. PMS has proved useful in distinguishing isolates of M. fermentans, providing epidemiological data. In addition, PMS may help in determining the likely origin of a given isolate, and in the future may be of use in assessing the role of this micro-organism in human disease.
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Affiliation(s)
- P C Hannan
- Mycoplasma Experience Ltd, Reigate, Surrey
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Abstract
The action of white blood cells (WBC) against Proteus mirabilis was assayed in 22 children following meningitis or septicaemia and compared with that in control groups of: (1) adult volunteers, (2) children undergoing minor surgical procedures for non-infective conditions, and (3) children being investigated for suspected renal disease. WBC bacterial killing tests were normal in all 55 adult volunteers. Abnormal results were obtained in 11 of 22 (50%) children with meningitis or septicaemia, 10 of 21 (47.6%) children undergoing surgery and six of 13 (46%) children with suspected renal disease, thereby indicating that there were no significant differences in phagocytic function among these three groups. Of children aged 1 year or less, 75% had abnormal phagocytic function. The significance of this finding is discussed.
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Affiliation(s)
- A M Kearns
- Department of Clinical Microbiology, General Hospital, Newcastle-upon-Tyne, UK
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Abstract
Six strains each of Enterococcus faecium and E. faecalis were investigated with respect to their resistance to heat and sodium hypochlorite. All enterococci survived the temperatures and holding times specified by the Department of Health (DoH) for the disinfection of 'foul and used' or 'infected' linen (65 degrees C for 10 min or 71 degrees C for 3 min). In addition, three strains (one E. faecium and two E. faecalis) could withstand 150 ppm available chlorine for 5 min, the treatment suggested by the DoH for the disinfection of heat labile materials. Further, our results showed that four strains of E. faecium were able to survive the British Standard for heat disinfection of bedpans (80 degrees C for 1 min). The significance of these findings with particular reference to the potential for enterococci to survive and disseminate in the hospital environment is discussed.
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Affiliation(s)
- A M Kearns
- Public Health Laboratory, General Hospital, Newcastle upon Tyne, UK
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Ragunathan PL, Potkins DV, Watson JG, Kearns AM, Carroll A. Neonatal meningitis due to Salmonella typhimurium treated with ciprofloxacin. J Antimicrob Chemother 1990; 26:727-8. [PMID: 2079456 DOI: 10.1093/jac/26.5.727] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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45
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al-Zahawi MF, Kearns AM, Sprott MS, Joudeh M, Snodgrass CA. A study of three blood culture media for isolating genital mycoplasmas from obstetrical and gynaecological patients. J Infect 1990; 21:143-50. [PMID: 2230173 DOI: 10.1016/0163-4453(90)91623-l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mycoplasma species are often found colonising the female genital tract. Their ability to become invasive and pathogenic, however, is often ignored, since attempts may not be made to culture these organisms from the bloodstream. We have investigated the ability of three types of blood culture media to support the growth of genital mycoplasmas. The media studied included brain-heart infusion broth, brain-heart infusion broth supplemented with 30% V/V sucrose and fastidious anaerobe broth. Genital mycoplasmas were cultured from the latter medium only. Since this was the sole medium which was liquoid-free, the inhibitory effects of liquoid on Mycoplasma spp. is discussed. This study comprised an investigation of 75 patients in obstetric and gynaecological wards with postpartum or post-operative fever. Genital mycoplasmas were isolated from five (6.7%) patients, four with Ureaplasma urealyticum and one with M. hominis. The value of considering these organisms in the differential diagnosis of fever in 'at risk' patients and of including appropriate media for their isolation is emphasised.
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Affiliation(s)
- M F al-Zahawi
- Regional Public Health Laboratory, Newcastle upon Tyne, U.K
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Pattman RS, Sprott MS, Kearns AM. Trichomonal vaginitis refractory to conventional treatment. Genitourin Med 1989; 65:349. [PMID: 2511138 PMCID: PMC1194396 DOI: 10.1136/sti.65.5.349-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
After a recent report showing the in vitro susceptibility to mebendazole of a strain of Trichomonas vaginalis that was resistant to metronidazole, we present two cases of metronidazole resistant infection, both of which failed to respond to oral mebendazole.
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Affiliation(s)
- R S Pattman
- Department of Genitourinary Medicine, Newcastle General Hospital
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Shanmugaratnam K, Sprott MS, Pattman RS, Kearns AM, Watson PG. Single dose ciprofloxacin to treat women with gonorrhoea. Genitourin Med 1989; 65:129. [PMID: 2753512 PMCID: PMC1194306 DOI: 10.1136/sti.65.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
Samples of middle ear effusions from 102 children with serous and mucoid otitis media were cultured for mycoplasmas and bacteria. No sample yielded mycoplasmas but bacteria were cultured from 48 (47 per cent). Organisms commonly regarded as pathogens were present in 25 samples (Haemophilus influenzae 17, Streptococcus pneumoniae four, other streptococci four). The only sample from which anaerobic bacteria were isolated was from a patient with cholesteatoma.
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Affiliation(s)
- C Diamond
- ENT Department, Freeman Hospital, Newcastle upon Tyne
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