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Rath A, Kieninger B, Caplunik-Pratsch A, Fritsch J, Mirzaliyeva N, Holzmann T, Bender JK, Werner G, Schneider-Brachert W. Concerning emergence of a new vancomycin-resistant Enterococcus faecium strain ST1299/CT1903/vanA at a tertiary university centre in South Germany. J Hosp Infect 2024; 143:25-32. [PMID: 37852539 DOI: 10.1016/j.jhin.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND vanB-carrying vancomycin-resistant Enterococcus faecium (VREfm) of the sequence types 80 (ST80) and ST117 have dominated Germany in the past. In 2020, our hospital witnessed a sharp increase in the proportion of vanA-positive VREfm. AIM To attempt to understand these dynamics through whole-genome sequencing (WGS) and analysis of nosocomial transmissions. METHODS At our hospital, the first VREfm isolate per patient, treated during 2020, was analysed retrospectively using specific vanA/vanB PCR, WGS, multi-locus sequence typing (MLST), and core-genome (cg) MLST. Epidemiologic links between VRE-positive patients were assessed using hospital occupancy data. FINDINGS Isolates from 319 out of 356 VREfm patients were available for WGS, of which 181 (56.7%) fulfilled the ECDC definition for nosocomial transmission. The high load of nosocomial cases is reflected in the overall high clonality rate with only three dominating sequence (ST) and complex types (CT), respectively: the new emerging strain ST1299 (100% vanA, 77.4% CT1903), and the well-known ST80 (90.0% vanB, 81.0% CT1065) and ST117 (78.0% vanB, 65.0% CT71). The ST1299 isolates overall, and the subtype CT1903 in particular, showed high isolate clonality, which demonstrates impressively high spreading potential. Overall, 152 out of 319 isolates had an allelic cgMLST difference of ≤3 to another, including 91 (59.6%) ST1299. Occupancy data identified shared rooms (3.7%), shared departments (6.2%), and VRE-colonized prior room occupants (0.6%) within 30 days before diagnosis as solid epidemiological links. CONCLUSION A new emerging VREfm clone, ST1299/CT1903/vanA, dominated our institution in 2020 and has been an important driver of the increasing VREfm rates.
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Affiliation(s)
- A Rath
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
| | - B Kieninger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Caplunik-Pratsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - J Fritsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - N Mirzaliyeva
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - T Holzmann
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - J K Bender
- Department of Infectious Diseases, Division of Nosocomial Pathogens and Antibiotic Resistances, Robert Koch Institute, Wernigerode, Germany
| | - G Werner
- Department of Infectious Diseases, Division of Nosocomial Pathogens and Antibiotic Resistances, Robert Koch Institute, Wernigerode, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Eichel VM, Last K, Brühwasser C, von Baum H, Dettenkofer M, Götting T, Grundmann H, Güldenhöven H, Liese J, Martin M, Papan C, Sadaghiani C, Wendt C, Werner G, Mutters NT. Epidemiology and outcomes of vancomycin-resistant enterococcus infections: a systematic review and meta-analysis. J Hosp Infect 2023; 141:119-128. [PMID: 37734679 DOI: 10.1016/j.jhin.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
Vancomycin-resistant enterococci (VRE) cause many infections in the healthcare context. Knowledge regarding the epidemiology and burden of VRE infections, however, remains fragmented. We aimed to summarize recent studies on VRE epidemiology and outcomes in hospitals, long-term-care facilities (LTCFs) and nursing homes worldwide based on current epidemiological reports. We searched MEDLINE/PubMed, the Cochrane Library, and Web of Science for observational studies, which reported on VRE faecium and faecalis infections in in-patients published between January 2014 and December 2020. Outcomes were incidence, infection rate, mortality, length of stay (LOS), and healthcare costs. We conducted a meta-analysis on mortality (PROSPERO registration number: CRD42020146389). Of 681 identified publications, 57 studies were included in the analysis. Overall quality of evidence was moderate to low. VRE incidence was rarely and heterogeneously reported. VRE infection rate differed highly (1-55%). The meta-analysis showed a higher mortality for VRE faecium bloodstream infections (BSIs) compared with VSE faecium BSIs (risk ratio, RR 1.46; 95% confidence interval (CI) 1.17-1.82). No difference was observed when comparing VRE faecium vs VRE faecalis BSI (RR 1.00, 95% CI 0.52-1.93). LOS was higher in BSIs caused by E. faecium vs E. faecalis. Only three studies reported healthcare costs. In contrast to previous findings, our meta-analysis of included studies indicates that vancomycin resistance independent of VRE species may be associated with a higher mortality. We identified a lack of standardization in reporting outcomes, information regarding healthcare costs, and state-of-the-art microbiological species identification methodology, which may inform the set-up and reporting of future studies.
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Affiliation(s)
- V M Eichel
- Heidelberg University Hospital, Center for Infectious Diseases, Section of Hospital and Environmental Hygiene, Heidelberg, Germany
| | - K Last
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.
| | - C Brühwasser
- Heidelberg University Hospital, Center for Infectious Diseases, Section of Hospital and Environmental Hygiene, Heidelberg, Germany; Infection Prevention and Hospital Hygiene, University Hospital Innsbruck, Innsbruck, Austria
| | - H von Baum
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | | | - T Götting
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Grundmann
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Güldenhöven
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - J Liese
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - M Martin
- Institute for Infection Prevention and Hospital Hygiene, SLK-Kliniken Heilbronn GmbH, Germany
| | - C Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - C Sadaghiani
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - C Wendt
- MVZ Labor Dr. Limbach, Department of Hygiene, Heidelberg, Germany
| | - G Werner
- Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci (NRC), Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - N T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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Nand KN, Jordan TB, Yuan X, Basore DA, Zagorevski D, Clarke C, Werner G, Hwang JY, Wang H, Chung JJ, McKenna A, Jarvis MD, Singh G, Bystroff C. Bacterial production of recombinant contraceptive vaccine antigen from CatSper displayed on a human papilloma virus-like particle. Vaccine 2023:S0264-410X(23)01114-3. [PMID: 37833124 DOI: 10.1016/j.vaccine.2023.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/15/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023]
Abstract
CatSper is a voltage dependent calcium ion channel present in the principal piece of sperm tail. It plays a crucial role in sperm hyperactivated motility and so in fertilization. Extracellular loops of mouse sperm CatSper were used to develop a vaccine to achieve protection from pregnancy. These loops were inserted at one of the three hypervariable regions of Human Papilloma Virus (HPV) capsid protein (L1). Recombinant vaccines were expressed in E.coli as inclusion body (IB), purified, refolded and assembled into virus-like particles (VLP) in vitro, and adsorbed on alum. Four vaccine candidates were tested in Balb/C mice. All the constructs proved immunogenic, one showed contraceptive efficacy. This recombinant contraceptive vaccine is a non-hormonal intervention and is expected to give long-acting protection from undesired pregnancies.
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Affiliation(s)
- K N Nand
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - T B Jordan
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - X Yuan
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - D A Basore
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States; Department of Health and Natural Science, Mercy College, Dobbs Ferry, NY, United States
| | - D Zagorevski
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - C Clarke
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - G Werner
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - J Y Hwang
- Dept of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, United States
| | - H Wang
- Dept of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, United States
| | - J-J Chung
- Dept of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, United States; Department of Gynecology and Obstetrics, Yale University School of Medicine, New Haven, CT, United States
| | - A McKenna
- Bioresearch Core, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - M D Jarvis
- Bioresearch Core, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - G Singh
- Bioresearch Core, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - C Bystroff
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States.
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Kresken M, Pfeifer Y, Werner G. Temocillin susceptibility in Enterobacterales with an ESBL/AmpC phenotype. Int J Antimicrob Agents 2020; 57:106223. [PMID: 33166691 DOI: 10.1016/j.ijantimicag.2020.106223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022]
Affiliation(s)
- M Kresken
- Antiinfectives Intelligence GmbH, Rheinbach, Germany; Rheinische Fachhochschule Köln GmbH, Cologne, Germany.
| | - Y Pfeifer
- Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | - G Werner
- Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
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Hasan MN, Fraiwan A, An R, Alapan Y, Ung R, Akkus A, Xu JZ, Rezac AJ, Kocmich NJ, Creary MS, Oginni T, Olanipekun GM, Hassan-Hanga F, Jibir BW, Gambo S, Verma AK, Bharti PK, Riolueang S, Ngimhung T, Suksangpleng T, Thota P, Werner G, Shanmugam R, Das A, Viprakasit V, Piccone CM, Little JA, Obaro SK, Gurkan UA. Paper-based microchip electrophoresis for point-of-care hemoglobin testing. Analyst 2020; 145:2525-2542. [PMID: 32123889 DOI: 10.1039/c9an02250c] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nearly 7% of the world's population live with a hemoglobin variant. Hemoglobins S, C, and E are the most common and significant hemoglobin variants worldwide. Sickle cell disease, caused by hemoglobin S, is highly prevalent in sub-Saharan Africa and in tribal populations of Central India. Hemoglobin C is common in West Africa, and hemoglobin E is common in Southeast Asia. Screening for significant hemoglobin disorders is not currently feasible in many low-income countries with the high disease burden. Lack of early diagnosis leads to preventable high morbidity and mortality in children born with hemoglobin variants in low-resource settings. Here, we describe HemeChip, the first miniaturized, paper-based, microchip electrophoresis platform for identifying the most common hemoglobin variants easily and affordably at the point-of-care in low-resource settings. HemeChip test works with a drop of blood. HemeChip system guides the user step-by-step through the test procedure with animated on-screen instructions. Hemoglobin identification and quantification is automatically performed, and hemoglobin types and percentages are displayed in an easily understandable, objective way. We show the feasibility and high accuracy of HemeChip via testing 768 subjects by clinical sites in the United States, Central India, sub-Saharan Africa, and Southeast Asia. Validation studies include hemoglobin E testing in Bangkok, Thailand, and hemoglobin S testing in Chhattisgarh, India, and in Kano, Nigeria, where the sickle cell disease burden is the highest in the world. Tests were performed by local users, including healthcare workers and clinical laboratory personnel. Study design, methods, and results are presented according to the Standards for Reporting Diagnostic Accuracy (STARD). HemeChip correctly identified all subjects with hemoglobin S, C, and E variants with 100% sensitivity, and displayed an overall diagnostic accuracy of 98.4% in comparison to reference standard methods. HemeChip is a versatile, mass-producible microchip electrophoresis platform that addresses a major unmet need of decentralized hemoglobin analysis in resource-limited settings.
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Affiliation(s)
- Muhammad Noman Hasan
- Case Biomanufacturing and Microfabrication Laboratory, Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Denkel LA, Maechler F, Schwab F, Kola A, Weber A, Gastmeier P, Pfäfflin F, Weber S, Werner G, Pfeifer Y, Pietsch M, Leistner R. Infections caused by extended-spectrum β-lactamase-producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae. Clin Microbiol Infect 2019; 26:1046-1051. [PMID: 31809805 DOI: 10.1016/j.cmi.2019.11.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Infections as a result of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are considered infections with a high public health burden. In this study, we aimed to identify incidences of and risk factors for healthcare-associated infections (HAIs) after rectal colonization with ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP). METHODS This prospective cohort study was performed in 2014 and 2015. Patients colonized with ESBL-EC or ESBL-KP were monitored for subsequent HAI with ESBL-E and other pathogens. In the case of an ESBL-E infection, rectal and clinical isolates were compared using pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) for ESBL-KP isolates. Proportional hazard models were applied to identify risk factors for HAIs, and to analyse competing risks. RESULTS Among all patients admitted to the hospital during the study period, 13.6% were rectally screened for third-generation cephalosporin-resistant Enterobacterales (3GCREB). A total of 2386 rectal carriers of ESBL-EC and 585 of ESBL-KP were included in the study. Incidence density (ID) for HAI with ESBL-E was 2.74 per 1000 patient days at risk (95% confidence interval (CI) 2.16-3.43) among carriers of ESBL-EC, while it was 4.44 per 1000 patient days at risk (95% CI 3.17-6.04) among carriers of ESBL-KP. In contrast, ID for HAI with other pathogens was 4.36 per 1000 patient days at risk (95% CI 3.62-5.21) among carriers of ESBL-EC, and 5.00 per 1000 patient days at risk (95% CI 3.64-6.69) among carriers of ESBL-KP. Cox proportional hazard regression analyses identified colonization with ESBL-KP (HR = 1.58, 95% CI 1.068-2.325) compared with ESBL-EC as independent risk factor for HAI with ESBL-E. The results were consistent over all competing risk analyses. CONCLUSIONS Clinicians should be aware of the increased risk of ESBL-E infections among patients colonized with ESBL-KP compared with ESBL-EC that might be caused by underlying diseases, higher pathogenicity of ESBL-KP and other factors.
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Affiliation(s)
- L A Denkel
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Maechler
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - A Kola
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - A Weber
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Pfäfflin
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - S Weber
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine and Medical Centre University of Freiburg, Freiburg, Germany
| | - G Werner
- Unit of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Y Pfeifer
- Unit of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - M Pietsch
- Unit of Enteropathogenic Bacteria and Legionella, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - R Leistner
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
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Stroka J, von Holst C, Anklam E, Reutter M, Barmark A, Brera C, Burdaspal P, Daily S, Declercq B, de Jong J, Eckstein H, Eklund E, Felgueiras I, Goto T, Hagler W, Joerissen U, Lew H, Ligi-Martins M, MacDonald S, Macho L, Marzna I, McGrath E, Michelet JY, Nordkvist E, Noutio K, Pascale M, Roos A, Schwadorf K, Spanjer M, Szymanski L, Visconti A, Walsh M, Werner G, Whitaker T, Wilson D, Worswick R. Immunoaffinity Column Cleanup with Liquid Chromatography Using Post-Column Bromination for Determination of Aflatoxin B1 in Cattle Feed: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.6.1179] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A collaborative study was conducted to evaluate the effectiveness of an immunoaffinity column cleanup liquid chromatography (LC) method for determination of aflatoxin B1 in cattle feed at a possible future European regulatory limit (1 ng/g). The test portion was extracted with acetone–water (85 + 15), filtered, diluted with water, and applied to an immunoaffinity column. The column was washed with water to remove interfering compounds, and the purified aflatoxin B1 was eluted with methanol. Aflatoxin B1 was separated and determined by reversed-phase liquid chromatography (RP–LC) and detected by fluorescence after post column derivatization (PCD) involving bromination. PCD was achieved with either pyridinium hydrobromide perbromide (PBPB), used by 14 laboratories, or an electrochemical cell and addition of bromide to the mobile phase, used by 7 laboratories. Both derivatization techniques were not significantly different when compared by the t-test; the method was statistically evaluated for all laboratories together (bromination and PBPB). The cattle feed samples, both spiked and naturally contaminatedwithaflatoxinB1, were sent to 21 laboratories in 14 different countries (United States, Japan, and Europe). Test portions were spiked at levels of 1.2 and 3.6 ng/g for aflatoxin B1. Recoveries ranged from 74 to 157%. Based on results for spiked samples (blind pairs at 2 levels) as well as naturally con-taminated samples (blind pairs at 3 levels), the relative standard deviation for repeatability (RSDr) ranged from 5.9 to 8.7%. The relative standard deviation for reproducibility (RSDR) ranged from 17.5 to 19.6%. The method showed acceptable within-and between-laboratory precision for this matrix, as evidenced by HORRAT values, at the target levels of determination for aflatoxin B1. No major differences in RSD were observed, showing that the composition of the feeds was not a factor for the samples tested and that the method was applicable for all materials used.
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Affiliation(s)
- Joerg Stroka
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg, B-2440 Geel, Belgium
| | - Christoph von Holst
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg, B-2440 Geel, Belgium
| | - Elke Anklam
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg, B-2440 Geel, Belgium
| | - Matthias Reutter
- Institut für Tiergesundheit und Lebensmittelqualität der Landwirtschaftskammer Schleswig Holstein, Landwirtschaftliche Untersuchungs-und Forschungsanstalt, Gutenbergstrasse 75-77, D-24116 Kiel, Germany
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8
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Messler S, Klare I, Wappler F, Werner G, Ligges U, Sakka SG, Mattner F. Reduction of nosocomial bloodstream infections and nosocomial vancomycin-resistant Enterococcus faecium on an intensive care unit after introduction of antiseptic octenidine-based bathing. J Hosp Infect 2018; 101:264-271. [PMID: 30408504 DOI: 10.1016/j.jhin.2018.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/31/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vancomycin-resistant Enterococcus faecium (VRE) is emerging in German intensive care units (ICUs). On a 32-bed surgical ICU at a university hospital, increasing numbers of nosocomial cases occurred despite enforcement of hand hygiene and environmental disinfection. AIM To introduce universal octenidine-based bathing in order to reduce the burden of VRE. METHODS Between January 2012 and March 2014, patients were screened for VRE on admission and twice weekly. Active surveillance was undertaken for VRE infections and colonizations, and for bloodstream infections (BSI) with any pathogen. Intervention in this before-after study comprised of standardized octenidine-based bathing. Distinct subgroups of VRE colonizations or infections were defined and used for statistical analysis of frequency, prevalence and incidence density. FINDINGS In the pre-intervention period (January 2012 to April 2013), the admission prevalence of VRE was 4/100 patients and the mean incidence density of nosocomial cases was 7.55/1000 patient-days (PD). Pulsed-field gel electrophoresis analysis revealed prevalence of three vanA and two vanB clusters. In the post-intervention period (August 2013 to March 2014), the admission prevalence of VRE was 2.41/100 patients and the mean incidence density of nosocomial cases was 2.61/1000 PD [P = 0.001 (pre- vs post-intervention)]. Thirteen nosocomial VRE infections were identified in the pre-intervention period, compared with one nosocomial VRE infection in the post-intervention period. Incidence densities of BSI pre- and post-intervention were 2.98 and 2.06/1000 PD (P = 0.15), respectively. CONCLUSION The epidemiology of emerging VRE appeared as a complex mix of admitted cases and transmissions in small clusters, challenging infection control measures. The implementation of universal octenidine-based bathing combined with a standardized washing regime led to a significant reduction in nosocomial VRE.
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Affiliation(s)
- S Messler
- Institute for Hygiene, Medical Centre Cologne-Merheim, Köln, Germany.
| | - I Klare
- Robert Koch Institute, Wernigerode, Germany
| | - F Wappler
- Department of Anaesthesia and Operative Intensive Care Medicine, Medical Centre Cologne-Merheim, University Witten/Herdecke, Köln, Germany
| | - G Werner
- Robert Koch Institute, Wernigerode, Germany
| | - U Ligges
- Department of Statistics, Technical University Dortmund, Dortmund, Germany
| | - S G Sakka
- Department of Anaesthesia and Operative Intensive Care Medicine, Medical Centre Cologne-Merheim, University Witten/Herdecke, Köln, Germany
| | - F Mattner
- Institute for Hygiene, Medical Centre Cologne-Merheim, Köln, Germany
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Shaw TD, Fairley DJ, Schneiders T, Pathiraja M, Hill RLR, Werner G, Elborn JS, McMullan R. The use of high-throughput sequencing to investigate an outbreak of glycopeptide-resistant Enterococcus faecium with a novel quinupristin-dalfopristin resistance mechanism. Eur J Clin Microbiol Infect Dis 2018; 37:959-967. [PMID: 29478197 PMCID: PMC5916979 DOI: 10.1007/s10096-018-3214-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/13/2018] [Indexed: 12/01/2022]
Abstract
High-throughput sequencing (HTS) has successfully identified novel resistance genes in enterococci and determined clonal relatedness in outbreak analysis. We report the use of HTS to investigate two concurrent outbreaks of glycopeptide-resistant Enterococcus faecium (GRE) with an uncharacterised resistance mechanism to quinupristin-dalfopristin (QD). Seven QD-resistant and five QD-susceptible GRE isolates from a two-centre outbreak were studied. HTS was performed to identify genes or predicted proteins that were associated with the QD-resistant phenotype. MLST and SNP typing on HTS data was used to determine clonal relatedness. Comparative genomic analysis confirmed this GRE outbreak involved two distinct clones (ST80 and ST192). HTS confirmed the absence of known QD resistance genes, suggesting a novel mechanism was conferring resistance. Genomic analysis identified two significant genetic determinants with explanatory power for the high level of QD resistance in the ST80 QD-resistant clone: an additional 56aa leader sequence at the N-terminus of the lsaE gene and a transposon containing seven genes encoding proteins with possible drug or drug-target modification activities. However, HTS was unable to conclusively determine the QD resistance mechanism and did not reveal any genetic basis for QD resistance in the ST192 clone. This study highlights the usefulness of HTS in deciphering the degree of relatedness in two concurrent GRE outbreaks. Although HTS was able to reveal some genetic candidates for uncharacterised QD resistance, this study demonstrates the limitations of HTS as a tool for identifying putative determinants of resistance to QD.
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Affiliation(s)
- Timothy D Shaw
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK. .,Department of Medical Microbiology, Kelvin Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
| | - D J Fairley
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.,Department of Medical Microbiology, Kelvin Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - T Schneiders
- Division of Infection and Pathway Medicine, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - M Pathiraja
- Department of Medical Microbiology, Kelvin Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - R L R Hill
- Antimicrobial Resistance & Healthcare-Associated Infection, Public Health England, London, UK
| | - G Werner
- National Reference Centre for Staphylococci and Enterococci, Robert Koch-Institute, Wernigerode Branch, Berlin, Germany
| | - J S Elborn
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - R McMullan
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.,Department of Medical Microbiology, Kelvin Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, UK
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Schmidt R, Werner G, Schuberth H. Die Bestimmung der heteroazeotropen Eigenschaften der Systeme n-Hexan/Methanol und Methylcyclohexan/ Methanol mit einer neuen Gleichgewichtsapparatur (G 15). Z PHYS CHEM 2017. [DOI: 10.1515/zpch-1969-24244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fiedler S, Bender JK, Klare I, Halbedel S, Grohmann E, Szewzyk U, Werner G. Tigecycline resistance in clinical isolates of Enterococcus faecium is mediated by an upregulation of plasmid-encoded tetracycline determinants tet(L) and tet(M). J Antimicrob Chemother 2015; 71:871-81. [PMID: 26682961 DOI: 10.1093/jac/dkv420] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/05/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Tigecycline represents one of the last-line therapeutics to combat multidrug-resistant bacterial pathogens, including VRE and MRSA. The German National Reference Centre for Staphylococci and Enterococci has received 73 tigecycline-resistant Enterococcus faecium and Enterococcus faecalis isolates in recent years. The precise mechanism of how enterococci become resistant to tigecycline remains undetermined. This study documents an analysis of the role of efflux pumps in tigecycline resistance in clinical isolates of Enterococcus spp. METHODS Various tigecycline MICs were found for the different isolates analysed. Tigecycline-resistant strains were analysed with respect to genome and transcriptome differences by means of WGS and RT-qPCR. Genes of interest were cloned and expressed in Listeria monocytogenes for verification of their functionality. RESULTS Detailed comparative whole-genome analyses of three isogenic strains, showing different levels of tigecycline resistance, revealed the major facilitator superfamily (MFS) efflux pump TetL and the ribosomal protection protein TetM as possible drug resistance proteins. Subsequent RT-qPCR confirmed up-regulation of the respective genes. A correlation of gene copy number and level of MIC was inferred from further qPCR analyses. Expression of both tet(L) and tet(M) in L. monocytogenes unequivocally demonstrated the potential to increase tigecycline MICs upon acquisition of either locus. CONCLUSIONS Our results indicate that increased expression of two tetracycline resistance determinants, a tet(L)-encoded MFS pump and a tet(M)-encoded ribosomal protection protein, is capable of conferring tigecycline resistance in enterococcal clinical isolates.
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Affiliation(s)
- S Fiedler
- Division of Nosocomial Pathogens and Antibiotic Resistances, National Reference Centre for Staphylococci and Enterococci, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - J K Bender
- Division of Nosocomial Pathogens and Antibiotic Resistances, National Reference Centre for Staphylococci and Enterococci, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - I Klare
- Division of Nosocomial Pathogens and Antibiotic Resistances, National Reference Centre for Staphylococci and Enterococci, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - S Halbedel
- Division of Enteropathogenic Bacteria and Legionella, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - E Grohmann
- Department of Life Sciences and Technology, Beuth University of Applied Sciences, Berlin, Germany Division of Infectious Diseases, University Medical Centre Freiburg, Freiburg, Germany
| | - U Szewzyk
- Environmental Microbiology, Technical University Berlin, Berlin, Germany
| | - G Werner
- Division of Nosocomial Pathogens and Antibiotic Resistances, National Reference Centre for Staphylococci and Enterococci, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
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Werner G, Grensemann J, Helmers A, Wappler F, Sakka SG. Carbapenemase-producing Klebsiella pneumoniae with two different gene expression patterns. Minerva Anestesiol 2015; 81:1273-1274. [PMID: 26372115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- G Werner
- Department of Anesthesiology and Operative Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Cologne, Germany -
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Neu E, Traub M, Michailov M, Schumitz H, Dahlheim H, Werner G, Foltinova J, Birkenbihl P, Danler-Oppl H, Senn T, Welscher U, Moro N. On neuro-vascular factors of idiopathic hypertension including cerebral apoplexy. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Orvin K, Carrie D, Richardt G, Desmet W, Assali A, Werner G, Ikari Y, Fujii K, Goicolea J, Dangoisse V, Manari A, Saito S, Wijns W, Kornowski R. Comparison of sirolimus eluting stent with bioresorbable polymer to everolimus eluting stent with permanent polymer in bifurcation lesions: Results from CENTURY II trial. Catheter Cardiovasc Interv 2015; 87:1092-100. [DOI: 10.1002/ccd.26150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/21/2015] [Indexed: 11/10/2022]
Affiliation(s)
- K Orvin
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - D. Carrie
- Department of Cardiology; University Toulouse-Rangueil Hospital; France
| | - G. Richardt
- Segeberger Kliniken GmbH; Bad Segeberg Germany
| | - W. Desmet
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
| | - A. Assali
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - G. Werner
- Medizinische Klinik I; Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Y. Ikari
- Department of Cardiology; Tokai University School of Medicine; Kanagawa Japan
| | - K. Fujii
- Department of Cardiology; Sakurabashi-Watanabe Hospital; Osaka Japan
| | - J. Goicolea
- Interventional Cardiology; Hospital Universitario Puerta De Hierro/Majadahonda; Madrid Spain
| | | | - A. Manari
- Department of Interventional Cardiology; Azienda Ospedaliera-IRCCS S. Maria Nuova; Viale Risorgimento Italy
| | - S. Saito
- Shonan Kamakura General Hospital; Kanagawa Japan
| | - W. Wijns
- Cardiovascular Centre Aalst; OLV Hospital; Belgium
| | - R. Kornowski
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
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Ryan L, O'Mahony E, Wrenn C, FitzGerald S, Fox U, Boyle B, Schaffer K, Werner G, Klare I. Epidemiology and molecular typing of VRE bloodstream isolates in an Irish tertiary care hospital. J Antimicrob Chemother 2015; 70:2718-24. [PMID: 26142479 DOI: 10.1093/jac/dkv185] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 06/10/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Ireland has the highest rate of vancomycin-resistant Enterococcus faecium (VREfm) isolated from blood of nosocomial patients in Europe, which rose from 33% (110/330) in 2007 to 45% (178/392) in 2012. No other European country had a VREfm rate from blood cultures of >25%. Our aim was to elucidate the reasons for this significantly higher rate in Ireland. METHODS The epidemiology and molecular typing of VRE from bloodstream infections (BSIs) was examined in a tertiary care referral hospital and isolates were compared with those from other tertiary care referral centres in the region. RESULTS The most common source of VRE BSIs was intra-abdominal sepsis, followed by line-related infection and febrile neutropenia. Most of the isolates were positive for vanA; 52% (43/83) possessed the esp gene and 12% (10/83) possessed the hyl gene. Genotyping by SmaI macrorestriction analysis (PFGE) of isolates revealed clonal relatedness between bloodstream isolates and environmental isolates. VRE BSI isolates from two other tertiary care hospitals in the Dublin region showed relatedness by PFGE analysis. MLST revealed four STs (ST17, ST18, ST78 and ST203), all belonging to the clonal complex of hospital-associated strains. CONCLUSIONS Irish VRE BSI isolates have virulence factor profiles as previously reported from Europe. Typing analysis shows the spread of individual clones within the hospital and between regional tertiary care hospitals. Apart from transmission of VRE within the hospital and transfer of colonized patients between Irish hospitals, no other explanation for the persistently high VREfm BSI rate in Ireland has been found.
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Affiliation(s)
- L Ryan
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E O'Mahony
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C Wrenn
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S FitzGerald
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - U Fox
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - B Boyle
- Department of Clinical Microbiology, St James's Hospital, Dublin 8, Ireland
| | - K Schaffer
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - G Werner
- German National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - I Klare
- German National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
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Fröhling PT, Kokot F, Vetter K, Hohmann WD, Werner G, Grossmann I, Schmicker R, Lindenau K. Treatment of renal osteodystrophy in advanced renal failure during predialysis time. Contrib Nephrol 2015; 37:62-5. [PMID: 6609046 DOI: 10.1159/000408551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Lindenau K, Kokot F, Vetter K, Hohmann WD, Werner G, Buder R, Grossmann I, Fröhling PT. How to prevent renal osteodystrophy. Contrib Nephrol 2015; 37:66-9. [PMID: 6609047 DOI: 10.1159/000408552] [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] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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18
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Cuny C, Layer F, Werner G, Harmsen D, Daniels-Haardt I, Jurke A, Mellmann A, Witte W, Köck R. State-wide surveillance of antibiotic resistance patterns and spa types of methicillin-resistant Staphylococcus aureus from blood cultures in North Rhine-Westphalia, 2011-2013. Clin Microbiol Infect 2015; 21:750-7. [PMID: 25704447 DOI: 10.1016/j.cmi.2015.02.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 10/30/2014] [Revised: 01/09/2015] [Accepted: 02/12/2015] [Indexed: 11/25/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of bacteraemia. We aimed to obtain a complete picture of severe MRSA infections by characterizing all MRSA isolates from bloodstream infections in the largest German federal state (North Rhine-Westphalia, 18 million inhabitants) using S. aureus protein A (spa) sequence-typing and antimicrobial susceptibility testing. MRSA isolates (n = 1952) were collected prospectively (2011-2013) and spa-typed. Among 181 different spa types, t003 (n = 746 isolates; 38.2%) and t032 (n = 594; 30.4%) were predominant. Analysis of the geographical occurrence of spa clonal complexes (spa-CCs) and spa types revealed divergent distribution between federal state districts for spa-CCs 003 (p < 0.001; including t003, p < 0.001 and t264, p < 0.001), 008 (p 0.021), 011 (p 0.002), 032 (p < 0.001; including t022, p 0.014 and t032, p < 0.001) and spa type t2807 (p < 0.001). MICs of antimicrobial substances were tested using broth microdilution. Of all isolates, 96% were resistant to fluoroquinolones, 78% to erythromycin, 70% to clindamycin, 4% to gentamicin, 2% to rifampicin, 0.4% to daptomycin, 0.1% to linezolid and 0% to vancomycin, respectively. Vancomycin MICs of 2 mg/L involved 0.5% of the isolates. In conclusion, the detection of regional molecular clusters added valuable information for epidemiological case tracing and allowed conclusions to be reached on the importance of newly emerging MRSA reservoirs, such as livestock (spa-CC011), for MRSA bacteraemia in some parts of the federal state. Susceptibility testing revealed broad resistance to substances used for oral treatment, but demonstrated that those antibiotics that are mostly applied for treatment of MRSA bacteraemia and important combination partners were highly susceptible.
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Affiliation(s)
- C Cuny
- Robert Koch-Institute, National Reference Laboratory for Staphylococci and Enterococci, Wernigerode, Germany
| | - F Layer
- Robert Koch-Institute, National Reference Laboratory for Staphylococci and Enterococci, Wernigerode, Germany
| | - G Werner
- Robert Koch-Institute, National Reference Laboratory for Staphylococci and Enterococci, Wernigerode, Germany
| | - D Harmsen
- Department of Periodontology, University Hospital Münster, Münster, Germany
| | | | - A Jurke
- Centre for Health North Rhine-Westphalia, Münster, Germany
| | - A Mellmann
- Institute of Hygiene, University Hospital Münster, Münster, Germany
| | - W Witte
- Robert Koch-Institute, National Reference Laboratory for Staphylococci and Enterococci, Wernigerode, Germany
| | - R Köck
- Institute of Hygiene, University Hospital Münster, Münster, Germany; Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
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Klare I, Witte W, Wendt C, Werner G. [Vancomycin-resistant enterococci (VRE). Recent results and trends in development of antibiotic resistance]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 55:1387-400. [PMID: 23114437 DOI: 10.1007/s00103-012-1564-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Enterococci (mainly E. faecalis, E. faecium) are important nosocomial pathogens predominantly affecting older and/or immunocompromised patients. The bacteria possess a broad spectrum of intrinsic and acquired antibiotic resistance properties. Among these, the transferrable glycopeptide resistance of the vanA and vanB genotypes in vancomycin-resistant enterococci (VRE; reservoir: E. faecium) as well as resistance to last resort antibiotics (e.g. linezolid and tigecycline) are of special concern. Enterococci (including VRE) are easily transferred in hospitals; however, colonizations are far more frequent than infections. Resistance frequencies for vancomycin in clinical E. faecium isolates have remained at a relatively constant level of 8-15% (but with local or regional variations) in recent years whereas frequencies for teicoplanin resistance have shown a slight decrease. Glycopeptide resistance trends correlate with a spread of hospital-associated E. faecium strains carrying the vanA and, with rising frequency in recent years, the vanB gene cluster, the latter being associated with teicoplanin susceptibility. This increased occurrence of vanB-positive E. faecium strains may be caused by an increased use of antibiotics selecting enterococci and VRE as well as due to methodological reasons (e.g. reduced EUCAST MIC-breakpoints for glycopeptides; increased use and sensitive performance of chromogenic VRE agars, increased use of molecular diagnostic assays).
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Affiliation(s)
- I Klare
- Nationales Referenzzentrum für Staphylokokken und Enterokokken, Robert Koch-Institut, Burgstrasse 37, Wernigerode, Germany.
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Goering RV, Köck R, Grundmann H, Werner G, Friedrich AW, on behalf of the ESCMID Study Group. From theory to practice: molecular strain typing for the clinical and public health setting. Euro Surveill 2013; 18:20383. [DOI: 10.2807/ese.18.04.20383-en] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kuch A, Willems RJL, Werner G, Coque TM, Hammerum AM, Sundsfjord A, Klare I, Ruiz-Garbajosa P, Simonsen GS, van Luit-Asbroek M, Hryniewicz W, Sadowy E. Insight into antimicrobial susceptibility and population structure of contemporary human Enterococcus faecalis isolates from Europe. J Antimicrob Chemother 2011; 67:551-8. [DOI: 10.1093/jac/dkr544] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Hegstad K, Mikalsen T, Coque TM, Werner G, Sundsfjord A. Mobile genetic elements and their contribution to the emergence of antimicrobial resistant Enterococcus faecalis and Enterococcus faecium. Clin Microbiol Infect 2011; 16:541-54. [PMID: 20569265 DOI: 10.1111/j.1469-0691.2010.03226.x] [Citation(s) in RCA: 234] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mobile genetic elements (MGEs) including plasmids and transposons are pivotal in the dissemination and persistence of antimicrobial resistance in Enterococcus faecalis and Enterococcus faecium. Enterococcal MGEs have also been shown to be able to transfer resistance determinants to more pathogenic bacteria such as Staphylococcus aureus. Despite their importance, we have a limited knowledge about the prevalence, distribution and genetic content of specific MGEs in enterococcal populations. Molecular epidemiological studies of enterococcal MGEs have been hampered by the lack of standardized molecular typing methods and relevant genome information. This review focuses on recent developments in the detection of MGEs and their contribution to the spread of antimicrobial resistance in clinically relevant enterococci.
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Affiliation(s)
- K Hegstad
- Reference Centre for Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North-Norway.
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Arnold E, Werner G. La spirométrie séparée en pratique phtisiologique. Respiration 2010. [DOI: 10.1159/000191250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Werner G. Trennung der Seltenen Erden durch flüssigen Ionenaustausch; Untersuchung der Ionenaustauscheigenschaften von Dinonylnaphthalinsulfonsäure durch Papierchromatographie mit umgekehrten Phasen. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/zfch.19650050415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The job of a strength and conditioning coach is to prepare athletes for a successful outcome in their sport. Methods must be grounded in science and proved effective through research and trial and error. A comprehensive sports performance team includes physician, physical therapist, or athletic trainer; strength and conditioning coach; sport coach; and, when possible, sports psychologist and sports nutritionist. This article serves to help members of a sports performance team gain an understanding of the role of a strength and conditioning coach.
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Affiliation(s)
- Greg Werner
- Strength and Conditioning Kinesiology, James Madison University, Harrisonburg, VA 22807, USA.
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Böttner A, Werner G. Ueber Duodenalspülungen bei der perniziösen Anämie. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0028-1141170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Werner G, Arnold E. Observations sur l’électrocardiogramme des tuberculeux pulmonaires. Respiration 2009. [DOI: 10.1159/000191382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Petrich W, Lewandrowski KB, Muhlestein JB, Hammond MEH, Januzzi JL, Lewandrowski EL, Pearson RR, Dolenko B, Früh J, Haass M, Hirschl MM, Köhler W, Mischler R, Möcks J, Ordóñez–Llanos J, Quarder O, Somorjai R, Staib A, Sylvén C, Werner G, Zerback R. Potential of mid-infrared spectroscopy to aid the triage of patients with acute chest pain. Analyst 2009; 134:1092-8. [DOI: 10.1039/b820923e] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A, Klare I, Kristinsson KG, Leclercq R, Lester CH, Lillie M, Novais C, Olsson-Liljequist B, Peixe LV, Sadowy E, Simonsen GS, Top J, Vuopio-Varkila J, Willems RJ, Witte W, Woodford N. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill 2008. [DOI: 10.2807/ese.13.47.19046-en] [Citation(s) in RCA: 286] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vancomycin-resistant enterococci (VRE) first appeared in the late 1980s in a few European countries. Nowadays, six types of acquired vancomycin resistance in enterococci are known; however, only VanA and to a lesser extent VanB are widely prevalent. Various genes encode acquired vancomycin resistance and these are typically associated with mobile genetic elements which allow resistance to spread clonally and laterally. The major reservoir of acquired vancomycin resistance is Enterococcus faecium; vancomycin-resistant Enterococcus faecalis are still rare. Population analysis of E. faecium has revealed a distinct subpopulation of hospital-acquired strain types, which can be differentiated by molecular typing methods (MLVA, MLST) from human commensal and animal strains. Hospital-acquired E. faecium have additional genomic content (accessory genome) including several factors known or supposed to be virulence-associated. Acquired ampicillin resistance is a major phenotypic marker of hospital-acquired E. faecium in Europe and experience has shown that it often precedes increasing rates of VRE with a delay of several years. Several factors are known to promote VRE colonisation and transmission; however, despite having populations with similar predispositions and preconditions, rates of VRE vary all over Europe.
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Affiliation(s)
- G Werner
- Robert Koch-Institute, Wernigerode Branch, Wernigerode, Germany
| | - T M Coque
- University Hospital Ramón y Cajal, Madrid, Spain
| | | | - R Hope
- Health Protection Agency Centre for Infections, London, United Kingdom
| | | | - A Johnson
- Health Protection Agency Centre for Infections, London, United Kingdom
| | - I Klare
- Robert Koch-Institute, Wernigerode Branch, Wernigerode, Germany
| | - K G Kristinsson
- Department of Clinical Microbiology, Landspitali University Hospital, Reykjavik, Iceland
| | - R Leclercq
- National Reference Centre for Antimicrobial Resistance, Laboratory for Enterococci, University Hospital, Caen, France
| | - C H Lester
- Statens Serum Institute, Copenhagen, Denmark
| | - M Lillie
- Health Protection Agency Centre for Infections, London, United Kingdom
| | - C Novais
- Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal
- REQUIMTE, Faculty of Pharmacy, University of Porto, Portugal
| | | | - L V Peixe
- REQUIMTE, Faculty of Pharmacy, University of Porto, Portugal
| | - E Sadowy
- National Medicines Institute, Warsaw, Poland
| | - G S Simonsen
- Norwegian Surveillance System for Antimicrobial Resistance, University Hospital of North Norway, Tromsø, Norway
| | - J Top
- University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - R J Willems
- University Medical Centre Utrecht, Utrecht, the Netherlands
| | - W Witte
- Robert Koch-Institute, Wernigerode Branch, Wernigerode, Germany
| | - N Woodford
- Health Protection Agency Centre for Infections, London, United Kingdom
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Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A, Klare I, Kristinsson KG, Leclercq R, Lester CH, Lillie M, Novais C, Olsson-Liljequist B, Peixe LV, Sadowy E, Simonsen GS, Top J, Vuopio-Varkila J, Willems RJ, Witte W, Woodford N. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill 2008. [PMID: 19021959 DOI: 10.2807/ese.13.47.19046-en/cite/plaintext] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Nowadays, six types of acquired vancomycin resistance in enterococci are known; however, only VanA and to a lesser extent VanB are widely prevalent. Various genes encode acquired vancomycin resistance and these are typically associated with mobile genetic elements which allow resistance to spread clonally and laterally. The major reservoir of acquired vancomycin resistance is Enterococcus faecium; vancomycin-resistant Enterococcus faecalis are still rare. Population analysis of E. faecium has revealed a distinct subpopulation of hospital-acquired strain types, which can be differentiated by molecular typing methods (MLVA, MLST) from human commensal and animal strains. Hospital-acquired E. faecium have additional genomic content (accessory genome) including several factors known or supposed to be virulence-associated. Acquired ampicillin resistance is a major phenotypic marker of hospital-acquired E. faecium in Europe and experience has shown that it often precedes increasing rates of VRE with a delay of several years. Several factors are known to promote VRE colonisation and transmission; however, despite having populations with similar predispositions and preconditions, rates of VRE vary all over Europe.
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Affiliation(s)
- G Werner
- Robert Koch-Institute, Wernigerode Branch, Wernigerode, Germany.
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Werner G, Bieger W, Blum B, Hentschel HD, Huber C, Penz M. Wirkungen einer Serie von Ganzkörpermassagen auf zahlreiche Parameter des Immunsystems. Phys Rehab Kur Med 2008. [DOI: 10.1055/s-2008-1061859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Werner G, Gfrorer S, Fleige C, Witte W, Klare I. Tigecycline-resistant Enterococcus faecalis strain isolated from a German intensive care unit patient. J Antimicrob Chemother 2008; 61:1182-3. [DOI: 10.1093/jac/dkn065] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [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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Borgmann S, Schulte B, Wolz C, Gruber H, Werner G, Goerke C, Klare I, Beyser K, Heeg P, Autenrieth IB. Discrimination between epidemic and non-epidemic glycopeptide-resistant E. faecium in a post-outbreak situation. J Hosp Infect 2007; 67:49-55. [PMID: 17669548 DOI: 10.1016/j.jhin.2007.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 06/01/2007] [Indexed: 11/27/2022]
Abstract
Vancomycin-resistant enterococci (VRE) have been isolated in increasing numbers. Hospital-adapted VRE exhibit relatively high pathogenicity by expressing factors like enterococcal surface protein (Esp), which facilitates epidemic spread. By contrast, 'community-acquired' VRE show low pathogenicity and non-epidemic features. In 2004 and 2005 an extended outbreak of VRE occurred at a university hospital in Southwestern Germany and an infection control programme was implemented to confine the outbreak. Pulsed-field gel electrophoresis (PFGE), esp PCR, multiple-locus variable number of tandem repeat analysis (MLVA), purK1 typing and multiple-locus sequence typing (MLST) were performed on representative VRE isolates. Twenty-six non-epidemic and two epidemic VRE types (MLST203, MLST280) were identified by PFGE. Seven of the non-outbreak VRE types were esp gene negative, whereas 19 non-outbreak and both epidemic VRE types were esp positive. Eight MLVA types were identified. MLVA type 1 included five PFGE types and MLVA type 159 included 16 PFGE types. Currently there is no efficient method available to identify non-epidemic VRE and avoid unnecessary isolation of patients. More than 50% non-epidemic clones were esp positive; nevertheless, esp PCR appears to be the most promising approach to identify non-epidemic VRE.
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Affiliation(s)
- S Borgmann
- Institute for Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.
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Werner G, Essig A, Bartel M, Wellinghausen N, Klare I, Witte W, Poppert S. P1626 Detection of resistance to linezolid in Enterococcus spp. by fluorescence in situ hybridisation using locked nucleic acid probes. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71465-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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37
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Vonberg RP, Chaberny IF, Kola A, Mattner F, Borgmann S, Dettenkofer M, Jonas D, Fahr AM, Klare I, Werner G, Weist K, Wendt C, Gastmeier P. Prävention und Kontrolle der Ausbreitung von Vancomycin-resistenten Enterokokken. Anaesthesist 2007; 56:151-7. [PMID: 17171367 DOI: 10.1007/s00101-006-1123-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 10/23/2022]
Abstract
The incidence of vancomycin-resistant enterococci (VRE), especially E. faecium, is increasing in several German hospitals and some facilities have experienced VRE outbreaks. The German National Nosocomial Infection Surveillance System has also noticed a sharp increase in the incidence of nosocomial VRE infections per 10,000 patients from 0.5 in 2003 to 11.0 in 2005 accompanied by a rise in VRE-associated mortality. However, the reasons of this increase remain unknown. As VRE may cause severe nosocomial infections, transmission must be restricted. This article provides the guidelines as defined by the workshop of the German Society for Hygiene and Microbiology for the prevention of VRE transmission in both, endemic and epidemic, settings. The following topics are discussed: indication for VRE screening, microbiological diagnostics, general infection control measures (isolation precautions and use of protective clothing) and additional hygiene measures in the nosocomial VRE outbreak setting.
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Affiliation(s)
- R-P Vonberg
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Abstract
The overuse and misuse of antibiotics pose a serious danger to public health by contributing to the development of bacteria resistant to treatment.
In 2001, the European Commission launched a strategy to combat the threat of antimicrobial resistance to human, animal and plant health, which includes data collection, surveillance, research, awareness-raising exercises and the phasing out of antibiotics for non-medical use in animals. The Council Recommendation on the prudent use of antibiotics in human medicine adopted in 2002 was a component in this strategy, outlining clear-cut measures in human medicine that EU Member States could take to reduce antimicrobial resistance.
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Affiliation(s)
- G Werner
- European Commission, Public Health Directorate, Luxembourg - Robert Koch-Institute, Wernigerode Branch, Germany
| | - S Bronzwaer
- European Commission, Public Health Directorate, Luxembourg - European Food Safety Authority (EFSA), Parma, Italy
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Markowitz VM, Korzeniewski F, Palaniappan K, Szeto E, Werner G, Padki A, Zhao X, Dubchak I, Hugenholtz P, Anderson I, Lykidis A, Mavromatis K, Ivanova N, Kyrpides NC. The integrated microbial genomes (IMG) system. Nucleic Acids Res 2006; 34:D344-8. [PMID: 16381883 PMCID: PMC1347387 DOI: 10.1093/nar/gkj024] [Citation(s) in RCA: 302] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The integrated microbial genomes (IMG) system is a new data management and analysis platform for microbial genomes provided by the Joint Genome Institute (JGI). IMG contains both draft and complete JGI genomes integrated with other publicly available microbial genomes of all three domains of life. IMG provides tools and viewers for analyzing genomes, genes and functions, individually or in a comparative context. IMG allows users to focus their analysis on subsets of genes and genomes of interest and to save the results of their analysis. IMG is available at http://img.jgi.doe.gov.
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Affiliation(s)
- Victor M. Markowitz
- Biological Data Management and Technology Center, Lawrence Berkeley National Laboratory1 Cyclotron Road, Berkeley, CA, USA
| | - Frank Korzeniewski
- Biological Data Management and Technology Center, Lawrence Berkeley National Laboratory1 Cyclotron Road, Berkeley, CA, USA
| | - Krishna Palaniappan
- Biological Data Management and Technology Center, Lawrence Berkeley National Laboratory1 Cyclotron Road, Berkeley, CA, USA
| | - Ernest Szeto
- Biological Data Management and Technology Center, Lawrence Berkeley National Laboratory1 Cyclotron Road, Berkeley, CA, USA
| | - Greg Werner
- Genome Data Systems, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
| | - Anu Padki
- Genome Data Systems, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
| | - Xueling Zhao
- Genome Data Systems, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
| | - Inna Dubchak
- Genomics Division, Lawrence Berkeley National Laboratory1 Cyclotron Road, Berkeley, CA, USA
| | - Philip Hugenholtz
- Microbial Ecology Program, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
| | - Iain Anderson
- Microbial Genome Analysis Program, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
| | - Athanasios Lykidis
- Microbial Genome Analysis Program, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
| | - Konstantinos Mavromatis
- Microbial Genome Analysis Program, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
| | - Natalia Ivanova
- Microbial Genome Analysis Program, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
| | - Nikos C. Kyrpides
- Microbial Genome Analysis Program, Department of Energy Joint Genome Institute2800 Mitchell Drive, Walnut Creek, CA, USA
- To whom correspondence should be addressed. Tel: +1 925 296 5718; Fax: +1 925 296 5720;
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Odin P, Oehlwein C, Storch A, Polzer U, Werner G, Renner R, Shing M, Ludolph A, Schüler P. Efficacy and safety of high-dose cabergoline in Parkinson's disease. Acta Neurol Scand 2006; 113:18-24. [PMID: 16367894 DOI: 10.1111/j.1600-0404.2005.00514.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 11/26/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of high-dose (up to 20 mg/day) cabergoline in Parkinson's disease (PD) patients with motor fluctuations and/or dyskinesias. MATERIALS AND METHODS Thirty-four PD patients had cabergoline up-titrated and their levodopa (L-dopa) reduced over a maximum of 20 weeks, followed by at least 6 weeks steady cabergoline dosing. Primary endpoint was change in mean hyperkinesia intensity at the final visit (week 26). RESULTS Mean (+/- SD) cabergoline was increased from 6.43 +/- 2.66 to 12.78 +/- 5.67 mg/day and mean L-dopa reduced from 606.6 +/- 263.9 to 370.6 +/- 192.5 mg/day. A significant reduction (P < 0.001) in mean hyperkinesia intensity occurred from baseline (day 0) to week 26. Improvements in 'on with dyskinesias', mean dystonia intensity (P < 0.05), time spent in 'severe off' condition, severity of 'off' periods as well as clinical/patient global impression, and health-related quality of life were observed. Twenty-four drug-related adverse events were recorded of which four were regarded as serious. CONCLUSION High-dose cabergoline was well tolerated and provided significant improvements in the Parkinson symptomatology and a reduced requirement for L-dopa.
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Affiliation(s)
- P Odin
- Department of Neurology, Central Hospital, D-27574 Bremerhaven, Germany.
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Klare I, Konstabel C, Mueller-Bertling S, Werner G, Strommenger B, Kettlitz C, Borgmann S, Schulte B, Jonas D, Serr A, Fahr AM, Eigner U, Witte W. Spread of ampicillin/vancomycin-resistant Enterococcus faecium of the epidemic-virulent clonal complex-17 carrying the genes esp and hyl in German hospitals. Eur J Clin Microbiol Infect Dis 2005; 24:815-25. [PMID: 16374593 DOI: 10.1007/s10096-005-0056-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of vancomycin-resistant Enterococcus faecium isolation was low (<or=5%) in German hospitals before 2003. Within the second half of 2003 and the first half of 2004, however, increasing frequencies of up to 14% were noticed in several hospitals in southwestern Germany. This increase was attributed mainly to the occurrence and spread of epidemic-virulent ampicillin/vancomycin-resistant, vanA- and vanB-positive E. faecium clones, most of which exhibited the virulence factors enterococcal surface protein (esp) and bacteriocin activity and some which exhibited hyaluronidase (hyl). E. faecium possessing hyaluronidase was initially found in U.S. hospitals and recently detected in several European hospitals and, subsequently, in German hospitals as well. Ampicillin/vancomycin-resistant E. faecium clones originating mainly from southwestern German hospitals were characterized by multilocus sequence typing since different sequence types (STs) belonging to the clonal complex-17 are currently disseminated worldwide. Multilocus sequence typing revealed that, in 1998 and 1999, ampicillin/vancomycin-resistant E. faecium clone ST-117 was prevalent in various German hospitals, while in 2003 and 2004, clone ST-203 dominated in several hospitals located in southwestern Germany. Both sequence types display single-locus variants of ST-78, which was frequently recorded in various Italian hospitals between 2000 and 2003, and all of these STs belong to the clonal complex-17. Expression of linezolid resistance was observed in ampicillin/glycopeptide-resistant E. faecium strains (VanA type) from two tertiary hospitals in southwestern Germany due to mutations in domain V of the 23S rDNA (G2576T). While in one hospital the resistance emerged during linezolid therapy, in the other hospital resistance was caused by transfer of an identical linezolid/ampicillin/glycopeptide-resistant E. faecium strain. In conclusion, it is very important to monitor the occurrence of epidemic-virulent clonal complex-17 strains of E. faecium to prevent their spread in hospitals, especially if they are resistant to glycopeptides and linezolid.
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Affiliation(s)
- I Klare
- Robert Koch Institute, Wernigerode Branch, Burgstr. 37, 38855, Wernigerode, Germany.
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Odin P, Oehlwein C, Storch A, Polzer U, Werner G, Renner R, Shing M, Ludolph A, Schüler P. High dose dopamine agonist treatment and combination of dopamine agonists. Akt Neurol 2005. [DOI: 10.1055/s-2005-916304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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43
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Witte W, Braulke C, Cuny C, Strommenger B, Werner G, Heuck D, Jappe U, Wendt C, Linde HJ, Harmsen D. Emergence of methicillin-resistant Staphylococcus aureus with Panton?Valentine leukocidin genes in central Europe. Eur J Clin Microbiol Infect Dis 2004; 24:1-5. [PMID: 15599784 DOI: 10.1007/s10096-004-1262-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [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: 10/26/2022]
Abstract
The aim of the present study was to investigate strains of methicillin-resistant Staphylococcus aureus (MRSA) for the presence of the lukS-lukF determinant of Panton-Valentine leukocidin and to further characterize strains found to contain the genes. During the past 2 years, MRSA containing the lukS-lukF genes for Panton-Valentine leukocidin, particularly those emerging outside of hospitals, have become of interest. MRSA strains sent to the national reference center in Germany were investigated for lukS-lukF by polymerase chain reaction (PCR). If the presence of lukS-lukF was demonstrated, strains were further characterized by molecular typing (determination of SmaI pattern, spa sequence, and multilocus sequence type), PCR demonstration of resistance genes, and characterization of the SCCmec element. Since the end of 2002, MRSA containing Panton-Valentine leukocidin genes have been demonstrated as the causative agent of 28 cases of infection (9 community-acquired cases, 19 sporadic nosocomial cases) in different areas of Germany. Twenty-seven of these 28 isolates exhibited a unique pattern of genomic typing: all exhibited multilocus sequence type 80, spa sequence type 44, and a SmaI macrorestriction pattern that corresponds to a community-acquired strain of MRSA from France and Switzerland. In addition to resistance to oxacillin, the strains exhibited resistance to ciprofloxacin, tetracycline (tetM), and fusidic acid, the last of which is encoded by the far-1 gene. The far-1 gene was shown to be located on the plasmid. One isolate corresponded to community MRSA (cMRSA) of multilocus sequence type 1 from the USA.
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Affiliation(s)
- W Witte
- Robert Koch Institute, Wernigerode Branch, Burgstrasse 37, 38855 Wernigerode, Germany.
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Witte W, Strommenger B, Klare I, Werner G. [Antibiotic-resistant nosocomial pathogens. Part I: diagnostic and typing methods]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47:352-62. [PMID: 15205778 DOI: 10.1007/s00103-004-0810-y] [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: 10/26/2022]
Abstract
For use in human chemotherapy, there are several different substances for nearly each substance group available which cannot all be checked in routine susceptibility testing. If the bacterial resistance mechanisms and cross-resistance conferred by them are known, particular test substances can be selected and the results are interpreted on the basis of cross-resistance. Test substances correspond to those mentioned in guidelines for section sign 23 IfSG (German law on protection against infection). Due to suboptimal in vitro expression of different resistance mechanisms, it is necessary to perform additional tests besides routine agar-diffusion or microbroth MIC assays. These are preferentially tests for molecular demonstration of resistance genes. Emergence and spread of antibiotic-resistant nosocomial pathogens can be traced by typing. When selecting a typing method, it is important to assess work load, discriminatory power, and reproducibility. In future the availability of microarray technology will enable routine laboratories to demonstrate particular virulence-associated traits.
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Affiliation(s)
- W Witte
- Bereich Wernigerode, Robert Koch-Institut, Wernigerode.
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Halle E, Padberg J, Rosseau S, Klare I, Werner G, Witte W. Linezolid-Resistant Enterococcus faecium and Enterococcus faecalis Isolated from a Septic Patient: Report of First Isolates in Germany. Infection 2004; 32:182-3. [PMID: 15188081 DOI: 10.1007/s15010-004-3009-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [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: 01/15/2003] [Accepted: 01/13/2004] [Indexed: 11/26/2022]
Abstract
Here we report the first German case of necrotizing pancreatitis, peritonitis, and septic shock caused by linezolid-resistant Enterococcus faecium and Enterococcus faecalis.
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Affiliation(s)
- E Halle
- Institute for Microbiology and Hygiene, Charité Medical University, Berlin, D-10117 Berlin, Germany.
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Strommenger B, Cuny C, Werner G, Witte W. Obvious lack of association between dynamics of epidemic methicillin-resistant Staphylococcus aureus in central Europe and agr specificity groups. Eur J Clin Microbiol Infect Dis 2003; 23:15-9. [PMID: 14652782 DOI: 10.1007/s10096-003-1046-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [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: 11/28/2022]
Abstract
During the past 8 years, changes in the prevalence and spread of different epidemic methicillin-resistant Staphylococcus aureus (MRSA) have been observed in central Europe, with the emergence of new strains possessing fewer resistance characters. This has also been demonstrated at the level of particular hospitals. Since variation in agr specificity type has been proposed as a possible reason for population dynamics in Staphylococcus aureus, the agr specificity groups of different epidemic MRSA strains were investigated by PCR using agr group-specific primers. Four of the "old" as well as two "new" epidemic strains exhibited agr specificity group I. One group of epidemic MRSA strains, which has been observed since the beginning of the 1990s, exhibited the agr specificity group II. Sequencing the variable part ( agrB-D-C) of the agr locus revealed only six relevant nucleotide changes within this region, with three of them modifying the Shine-Dalgarno sequence region of agrC. On the basis of the results obtained, it is proposed that the dynamics observed in the population of MRSA in Germany is not due to different agr group specificities in "old" and "new" epidemic clones.
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Affiliation(s)
- B Strommenger
- Wernigerode Branch, Robert Koch Institute, Burgstrasse 37, 38855 Wernigerode, Germany
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47
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Klare I, Werner G, Witte W. Enterococci. Habitats, infections, virulence factors, resistances to antibiotics, transfer of resistance determinants. Contrib Microbiol 2002; 8:108-22. [PMID: 11764728 DOI: 10.1159/000060406] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- I Klare
- Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany.
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Cuny C, Werner G, Braulke C, Klare I, Witte W. Diagnostics of Staphylococci with Special Reference to MRSA. Diagnostik von Staphylokokken mit besonderer Berucksichtigung von MRSA. ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1439-0477.2002.02037.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schmitz FJ, Witte W, Werner G, Petridou J, Fluit AC, Schwarz S. Characterization of the translational attenuator of 20 methicillin-resistant, quinupristin/dalfopristin-resistant Staphylococcus aureus isolates with reduced susceptibility to glycopeptides. J Antimicrob Chemother 2001; 48:939-41. [PMID: 11733488 DOI: 10.1093/jac/48.6.939] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Werner G, Hildebrandt B, Witte W. The newly described msrC gene is not equally distributed among all isolates of Enterococcus faecium. Antimicrob Agents Chemother 2001; 45:3672-3. [PMID: 11724034 PMCID: PMC90897 DOI: 10.1128/aac.45.12.3672-3673.2001] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [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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