Multicenter Antimicrobial Resistance Surveillance of Clinical Isolates from Major Hospitals - China, 2022

What is already known about this topic?

Bacterial resistance surveillance is crucial for monitoring and understanding the trends and spread of drug-resistant bacteria.

What is added by this report?

The number of strains collected in 2022 increased compared to 2021. The top five bacteria, including Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii, remained largely unchanged. The detection rate of methicillin-resistant strains continued to decrease. Among clinical Enterobacterales isolates, the resistance rate to carbapenems was generally below 13%, except for Klebsiellaspp., which had a resistance range of 20.4% to 21.9%. Most clinical Enterobacterales isolates were highly susceptible to tigecycline, colistin, and polymyxin B, with resistance rates ranging from 0.1% to 12.6%. The detection rate of meropenem-resistant P. aeruginosa and meropenem-resistant Acinetobacter baumannii showed a decreasing trend for the fourth consecutive year.

What are the implications for public health practice?

Multidrug-resistant bacteria remain a significant public health challenge in clinical antimicrobial treatment. To effectively address bacterial resistance, it is essential to enhance both bacterial resistance surveillance and the prudent use of antimicrobial agents.

Phytochemicals and quaternary phosphonium ionic liquids: Connecting the dots to develop a new class of antimicrobial agents

INTRODUCTION

The infections by multidrug-resistant bacteria are a growing threat to human health, and the efficacy of the available antibiotics is gradually decreasing. As such, new antibiotic classes are urgently needed.

OBJECTIVES

This study aims to evaluate the antimicrobial activity, safety and mechanism of action of phytochemical-based triphenylphosphonium (TPP+) conjugates.

METHODS

A library of phytochemical-based TPP+ conjugates was repositioned and extended, and its antimicrobial activity was evaluated against a panel of Gram-positive (methicillin-resistant Staphylococcus aureus - MRSA) and Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii) and fungi (Candida albicans, Cryptococcus neoformans var. grubii). The compounds' cytotoxicity and haemolytic profile were also evaluated. To unravel the mechanism of action of the best compounds, the alterations in the surface charge, bacterial membrane integrity, and cytoplasmic leakage were assessed.

RESULTS

Structure-activity-toxicity data revealed the contributions of the different structural components (phenolic ring, carbon-based spacers, carboxamide group, alkyl linker) to the compounds' bioactivity and safety. Dihydrocinnamic derivatives 5 m and 5n stood out as safe, potent and selective antibacterial agents against S. aureus (MIC < 0.25 µg/mL; CC50 > 32 µg/mL; HC10 > 32 µg/mL). Mechanistic studies suggest that the antibacterial activity of compounds 5 m and 5n may result from interactions with the bacterial cell wall and membrane.

CONCLUSIONS

Collectively, these studies demonstrate the potential of phytochemical-based TPP+ conjugates as a new class of antibiotics.

Molecular evidence of β-lactam resistant Staphylococcus aureus in equids with respiratory tract infections: Frequency and resistance modulation strategy

The emergence of antimicrobial-resistant strains in Staphylococcus aureus (β-lactam and methicillin-resistant) is an overwhelming issue worldwide. Using the purposive sampling technique, 217 equids samples were collected from district Layyah which were subjected to culturing followed by genotypic identification of mecA and blaZ genes by PCR. This study revealed that by phenotypic methods, a prevalence of 44.24%, 56.25%, and 47.92% was found for S. aureus, MRSA, and β-lactam resistant S. aureus in equids. While genotypically, MRSA was found in 29.63% and β-lactam resistant S. aureus in 28.26% of equids. In-vitro antibiotic susceptibility testing against S. aureus isolates harboring both mecA and blaZ genes showed a high resistance against Gentamicin (75%), followed by Amoxicillin (66.67%) and Trimethoprim+sulfamethoxazole (58.34%). In an attempt to re-sensitize the resistant bacteria to antibiotics, a combination of antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) was used which revealed synergistic effect of Gentamicin and Trimethoprim+sulfamethoxazole with Phenylbutazone; and Amoxicillin with Flunixin meglumine. Analysis of risk factors revealed significant association with the S. aureus-associated respiratory infection in equids. Phylogenetic analysis of mecA and blaZ genes showed a high resemblance of study isolate's sequences with each other and variable resemblance with already reported isolates obtained from different samples of neighboring countries. This study reports the first molecular characterization and phylogenetic analysis of β-lactam and methicillin resistant S. aureus in equids in Pakistan. Moreover, this study will help in the resistance modulation of resistant antibiotics (Gentamicin, Amoxicillin, Trimethoprim+sulfamethoxazole) and provide a good insight into planning an effective therapeutic regime.

Identification and structure-activity relationships for a series of N, N-disubstituted 2-aminobenzothiazoles as potent inhibitors of S. aureus

An internal collection of commercial and synthetically derived small molecule compounds was screened against several drug-resistant bacterial pathogens. Compound 1, a known N, N-disubstituted 2-aminobenzothiazole, was found to be a potent inhibitor of Staphylococcus aureus and several associated clinically relevant strains of methicillin-resistant S. aureus suggesting a possible novel mechanism of inhibition. It failed to show activity in any of the Gram-negative pathogens it was tested in. Evaluation in Escherichia coli BW25113 and Pseudomonas aeruginosa PAO1, as well as in their respective hyperporinated and efflux pump-deletion mutants revealed that activity in Gram-negative bacteria is diminished because this benzothiazole scaffold is a substrate for bacterial efflux pumps. Several analogs of 1 were synthesized to generate basic structure-activity relationships for the scaffold which highlighted that the N-propyl imidazole moiety was critical for the observed antibacterial activity.

The second nationwide surveillance of antibacterial susceptibility patterns of pathogens isolated from skin and soft-tissue infections in dermatology departments in Japan

The present study compared trends in antimicrobial resistance patterns in pathogens isolated from skin and soft-tissue infections (SSTIs) in Japan with those of a nationwide survey conducted in 2013. Three organisms that caused most of the SSTIs were collected from 12 dermatology departments in medical centers and 12 dermatology clinics across Japan between April 2019 and August 2020. A total of 390 strains, including 267 Staphylococcus aureus, 109 coagulase-negative staphylococci (CNS), and 14 Streptococcus pyogenes strains were submitted to a central laboratory for antimicrobial susceptibility testing. Patient demographic and clinical information was collated. Methicillin-resistant S. aureus (MRSA) was detected in 25.8% (69/267) of the S. aureus strains. The prevalence of MRSA between the present study and the 2013 survey did not differ significantly. Furthermore, there were no significant differences in MIC values and susceptibility patterns of the MRSA strains to other agents, regardless of a history of hospitalization within 1 year or invasive medical procedures. Methicillin-resistant CNS (MRCNS) was detected in 48.6% (53/109) of CNS isolates, higher than the 35.4% prevalence in the 2013 survey. This difference could be attributed to the heterogeneity in the members of the MRCNS, which comprises multiple staphylococci species, between the 2013 and 2019 surveys. However, it was noted that the susceptibility profiles of the MRCNS to each antibiotic were not significantly different from those identified in the 2013 survey. Most strains of S. pyogenes were susceptible to each antibiotic, similar to the 2013 survey. Continuous monitoring of trends in pathogen and susceptibility profiles is important to advise local public health efforts regarding the appropriate treatment of SSTIs.

Modifications to a Biphenolic Antibacterial Compound: Activity against ESKAPE Pathogens

Forty-four analogs of honokiol, a compound with known antibacterial activity, especially with respect to oral bacteria, were synthesized to explore the structure-activity relationships against the ESKAPE pathogens. Compounds with high therapeutic indices (hemolysis20 /MIC) were identified. In particular, ester-linked compounds that would be less than environmentally durable than biaryl ether antibacterials such as the broadly used triclosan were found to be active. MRSA mutants could be generated against some, but not all, of the highly active compounds. Based on gene sequencing results, membrane permeability, intracellular sodium, and intracellular pH assays revealed overlapping mechanisms of action.

Isovitexin Protects Mice from Methicillin-Resistant Staphylococcus aureus-Induced Pneumonia by Targeting Sortase A

The rise of methicillin-resistant Staphylococcus aureus (MRSA) has resulted in significant morbidity and mortality, and clinical treatment of MRSA infections has become extremely difficult. Sortase A (SrtA), a virulence determinant that anchors numerous virulence-related proteins to the cell wall, is a prime druggable target against S. aureus infection due to its crucial role in the pathogenicity of S. aureus. Here, we demonstrate that isovitexin, an active ingredient derived from a variety of traditional Chinese medicines, can reversibly inhibit SrtA activity in vitro with a low dose (IC₅₀=24.72 μg/ml). Fluorescence quenching and molecular simulations proved the interaction between isovitexin and SrtA. Subsequent point mutation experiments further confirmed that the critical amino acid positions for SrtA binding to isovitexin were Ala-92, Ile-182, and Trp-197. In addition, isovitexin treatment dramatically reduced S. aureus invasion of A549 cells. This study shows that treatment with isovitexin could alleviate pathological injury and prolong the life span of mice in an S. aureus pneumonia model. According to our research, isovitexin represents a promising lead molecule for the creation of anti-S. aureus medicines or adjuncts.

Anti-hepatitis C virus drug simeprevir: a promising antimicrobial agent against MRSA

Staphylococcus aureus is a major human pathogen, and the appearance of methicillin-resistant S. aureus (MRSA) renders S. aureus infections more challenging to treat. Therefore, new antimicrobial drugs are urgently needed to combat MRSA infections. Drug repurposing is an effective and feasible strategy. Here, we reported that the clinically approved anti-hepatitis C virus drug simeprevir had strong antibacterial activity against MRSA, with a minimum inhibitory concentration of 2-8 µg/mL. Simeprevir did not easily induce in vitro resistance. In addition, simeprevir significantly prevented S. aureus biofilm formation. Furthermore, simeprevir displayed limited toxicity in in vitro and in vivo assays. Moreover, simeprevir showed synergistic antimicrobial effects against both type and clinical strains of S. aureus. Simeprevir combined with gentamicin effectively reduced the bacterial burden in an MRSA-infected subcutaneous abscess mouse model. Results from a series of experiments, including membrane permeability assay, membrane potential assay, intracellular ATP level assay, and electron microscope observation, demonstrated that the action of simeprevir may be by disrupting bacterial cell membranes. Collectively, these results demonstrated the potential of simeprevir as an antimicrobial agent for the treatment of MRSA infections. KEY POINTS: • Simeprevir showed strong antibacterial activity against MRSA. • The antibacterial mechanism of simeprevir was mediated by membrane disruption and intracellular ATP depletion. • In vitro and in vivo synergistic antimicrobial efficacy between simeprevir and gentamicin was found.

MALDI-TOF MS method for differentiation of methicillin-sensitive and methicillin-resistant Staphylococcus aureus using (E)-Propyl α-cyano-4-Hydroxyl cinnamylate

Differentiating methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MRSA and MSSA) is crucial for clinical diagnosis and anti-microbial treatment. Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) is an efficient tool for identifying pathogenic microorganisms at the bacterial species level. Here, we found that MRSA and MSSA can be differentiated by MALDI-TOF MS by employing (E)-propylα-cyano-4-hydroxyl cinnamylate (CHCA-C3) as the matrix, which shows great performance for proteins/peptides, especially hydrophobic proteins. The results show that the mass spectra profile of standard MRSA (ATCC 43300) is significantly different from the profiles of standard MSSA strains (ATCC 25923 and 29213) when using CHCA-C3 as the matrix compared to traditional matrix. The mass profiles had great reproducibility and were scarcely influenced by the growth medium. Due to the enhanced discrimination ability of CHCA-C3, we collected the mass spectra of 62 clinical S. aureus strains and selected four representative peaks for principal component analysis, which showed great differentiation. Our results suggest that employing a suitable matrix could enhance the discrimination ability of antibiotic-resistant bacteria by MALDI-TOF MS.

Efficacy and safety of daptomycin in Japanese pediatric participants with complicated skin and soft tissue infections or bacteremia caused by gram-positive cocci

INTRODUCTION

Complicated skin and soft tissue infections (cSSTIs) and bacteremia caused by Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), are common causes of infection for children worldwide. Here, the safety and efficacy of daptomycin in Japanese pediatric participants are reported.

METHODS

This open-label, single-arm phase 2 study (NCT03643952) enrolled Japanese pediatric participants (age 1-17 years) with cSSTI or bacteremia caused by gram-positive cocci. Participants received age-adjusted doses of intravenous daptomycin for 5 to up to 14 days (cSSTI) or 5 to up to 42 days (bacteremia). The primary objective was safety and tolerability; efficacy among participants with infections caused by MRSA was a secondary objective.

RESULTS

A total of 18 participants (cSSTI, n = 14; bacteremia, n = 4) were enrolled across 12 study sites in Japan. The most common pathogen was S. aureus (15/18 [83.3%]), including methicillin-susceptible and -resistant isolates. Adverse events (AE) were reported in 42.9% (6/14) of participants with cSSTI and 100% (4/4) of participants with bacteremia. No deaths, serious AEs, discontinuations of study medication due to an AE, or events of clinical interest occurred in the study. In participants with infections caused by MRSA, 87.5% [7/8] achieved favorable clinical response at test of cure (TOC) visit (cSSTI, 85.7% [6/7]; bacteremia, 100% [1/1]). In this population, favorable microbiological response at TOC was achieved by 71.4% (5/7) of participants with cSSTI and 100% (1/1) of participants with bacteremia.

CONCLUSIONS

Daptomycin was well tolerated, exhibited a favorable safety profile, and was effective for the treatment of cSSTI or bacteremia in Japanese children.

Chemical composition and antibacterial effects of some essential oils individually and in combination with sodium benzoate against methicillin-resistant Staphylococcus aureus and Yersinia enterocolitica

Side effects of chemical preservatives and drug resistance have raised interest in use of herbal products. This study aimed to examine the chemical composition and antibacterial effects of Cuminum cyminum, Mentha spicata, and Mentha longifolia essential oils individually and in combination with sodium benzoate against methicillin-resistant Staphylococcus aureus and Yersinia enterocolitica. The essential oils were analyzed by gas chromatography-mass spectrometry. Disc diffusion and microdilution assays were used for in vitro antimicrobial screening. The main components were cumin aldehyde, carvone, and pulegone in C. cyminum, M. spicata, and M. longifolia essential oils, respectively. Antibacterial data analysis showed significant differences between different antibacterial effects of essential oils individually and in combination with sodium benzoate. In terms of individual effects, antibacterial effect of M. longifolia and C. cyminum essential oils were the highest against methicillin-resistant S. aureus and Y. enterocolitica, respectively. The antibacterial effects of sodium benzoate combined with essential oils showed significant differences with the individual effect of sodium benzoate in most cases. The results indicated that the combined effect of these essential oils with sodium benzoate could reduce the use of sodium benzoate as an antimicrobial agent, which could decrease its possible side effects. Thus, for more significant effects, these essential oils could be combined with other agents for the preservation of drug and food products.

Molecular characterization of invasive Staphylococcus aureus strains isolated from patients with diabetes in Iran: USA300 emerges as the major type

There have been few studies focused on the molecular characterization of invasive Staphylococcus aureus strains in patients with diabetes in Iran. In the present study, 20 invasive S. aureus strains recovered from the patients with diabetes characterized by the virulence and resistance analysis, biofilm formation, staphylocoagulase (SC) typing, S. aureus protein A locus (spa) typing staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence typing (MLST). Virulence gene detection indicated a high prevalence of strains encoding the pvl genes (50%), a low prevalence of the tst and seg gene (each of them was 5%) and a markedly high prevalence of fnbB (95%), fnbA (85%), icaD (75%), icaA (65%). A total of 3 coagulase types (III, 85%; II, 10%; V, 5%), 2 agr types (I, 90%; II 10%) and 2 SCCmec types (IV, 65%; III, 35%) and four different clones namely ST8-MRSA-IV/t008 (50%) (USA300), ST239-MRSA-III/t030 (35%), ST5-MRSA-IV/t002 (10%), and ST45-MRSA-IV/t038 (5%) were detected in this study. Eighty-five percent of the isolates were biofilm producers. All the 4 high-level mupirocin resistance (HLMUPR) strains belonged to CC/ST8-MRSA-IV/t008 clone and carried mupA gene. Fusidic acid-resistant isolate belonged to ST239-SCCmec III/t030 clone. One vancomycin-intermediate resistance isolates was detected in our study, which belonged to ST5-MRSA-IVt002. Circulating clone in MRSA strains (USA300) isolated from the patients with diabetes highlighting the possibility of transmission of these microorganisms' clones between hospital, community, and environments. However, further studies require providing critical insights into the importance of continued controlling and treatment of S. aureus infections in patients with diabetes.

The effect of subinhibitory concentration of chlorhexidine on the evolution of vancomycin-intermediate Staphylococcus aureus and the induction of mutations in walKR and vraTSR systems

The molecular mechanism underlying the development of vancomycin-intermediate Staphylococcus aureus (VISA) remains unclear. The abuses of antibacterial compounds lead to a change in the bacterial susceptibility patterns. Therefore, we examined the effect of Chlorhexidine (CHX) on in vitro development of VISA and reported CHX-selected VISA mutant Tm1 with phenotypic features similar to the clinical VISA isolates. WalKR, VraTSR, and GraSR are the most common regulatory systems involved in VISA evaluation. The expression of these systems, as well as walKR-regulated autolysins and VraTSR-regulated cell wall stimulon, were compared, by RT-qPCR, between the mutant and parental strains. The results revealed the downregulation of walKR, vraTSR, atlA, sle1, lytM, and pbpB genes in Tm1. The complete sequences of walKR and vraTSR genes was compared using the Sanger sequencing method. We detected Walk.R55C, WalR.A38T, and VraS·N340-D347del novel mutations in Tm1. These mutations were classified as deleterious mutations and predicted to affect protein function using the SIFT prediction algorithm. Novel mutations in Tm1 confirm the genetic diversity of VISA isolates. We suggest that WalKR and VraTSR may be involved in sense and response to CHX. In this regard, CHX may have a role in cell wall degradation of S. aureus and the emergence of VISA due to mutations in the CA domain of the Walk and VraS and the REC domain of WalR. Therefore, CHX should be used with caution.

Chemical evaluation and antibacterial activity of novel bioactive compounds from endophytic fungi in Nelumbo nucifera

The objective of this study was to characterize an endophytic fungi producing-bioactive compound from the aquatic plant, Nelumbo nucifera. All parts of such plant were cleaned with surface sterilization technique and cultured on potato dextrose agar to isolate endophytic fungi. The identification was characterized by morphological and molecular technique. Fungal isolates were screened to discover antimicrobial activities by disc diffusion method against Methicillin-resistant Staphylococcus aureus DMST20651 (MRSA). MIC and MBC for those crude fungal extracts were determined. Finally, the chemical profile of crude extract was determined by gas chromatography and mass spectrometry. Six endophytic fungi were isolated from the surface-satirized parts of N. nucifera. Based on disc diffusion assay, the highest antibacterial activity against MRSA was isolate ST9.1 identified as Aspergillus cejpii. Results demonstrated that the ethyl acetate extraction had more active fractions with MIC of 2.5 mg/ml and MBC concentration of 50.0 mg/ml. The crude extracts were developed to identify the chemical constituents by gas chromatography and mass spectrometry. The major component of crude extract of endophytic fungi was 5-(1H-Indol-3-yl)-4,5-dihydro-[1,2,4]triazin-3-ylamine (C₁₁H₁₁N₅). Thus, the plant could be used in the treatment of infectious diseases caused by bacterial pathogen.

Microbial spectrum, antibiotic susceptibility profile, and biofilm formation of diabetic foot infections (2014-18): a retrospective multicenter analysis

This study identifies the risk factors, microbiological properties, antimicrobial susceptibility patterns, mortality, and clinical complications associated with organisms causing diabetic foot infections (DFIs) with or without antibiotic treatment using data from a retrospective multicenter surveillance. Specimens collected from different hospitals were cultured and the extended-spectrum β-lactamase (ESBL) excretion was estimated. The antibacterial susceptibility pattern and biofilm formation were completed along with the recommended standard methods. Overall, 792 diabetic foot patients (DFPs) were enrolled and a total of 1803 causative organisms were isolated. Polymicrobial infection was identified in 48.5% of the patients. The isolated Gram-positive pathogens (46.7%) were higher than Gram-negative (38.6%) or anaerobes (7.9%). The predominant pathogens were S. aureus (22.2%), methicillin-resistant S. aureus (7.7%), Enterococcus spp. (12.8%), Pseudomonas aeruginosa (9.4%), E. coli (7.9%), Klebsiella spp. (7.5%), Proteus mirabilis (8.9%), coagulase negative staphylococci (CoNS) (6.6%), anaerobic organisms (5.9%), and fungi (2.3%). Vancomycin and clindamycin exhibited no activity against Gram-positive bacteria. However, meropenem and imipenem displayed high activity against the Gram-negative isolates. Out of the 765 tested strains, 251 showed moderate (15.8%) to high (34%) level biofilm-producing phenotype. DFIs were widespread among the diabetic patients with different microbial etiology and the major organisms were aerobic organisms. Our findings may provide an insight into the development of appropriate therapeutic strategies for the management of DFIs.

Survival of Methicillin-Resistant Staphylococcus aureus in Fish and Shrimp under Different Storage Conditions

ABSTRACT

Foods that are extensively handled during preparation and stored without refrigeration are often associated with staphylococcal food poisoning. This problem is more confounding when contaminating strains belong to the methicillin-resistant Staphylococcus aureus (MRSA) group. In this study, we investigated the survivability of MRSA in two seafood matrices under different storage conditions. MRSA was inoculated at 6 and 3 log CFU/g into all sample groups of peeled shrimp (Parapeneopsis stylifera) stored at -20°C, Bombay duck fish (Harpadon nehereus) stored in ice, and dried Bombay duck fish stored at 30 ± 2°C. The populations of MRSA in frozen peeled shrimp inoculated with MRSA at 6 log CFU/g were reduced by 1.52 log CFU/g, whereas in samples inoculated with 3 log CFU/g levels remained stable after 60 days of storage. In fresh Bombay duck fish inoculated with 6 log CFU/g and stored in ice for 18 days, MRSA levels decreased by 2.75 log CFU/g. In contrast, in fresh fish inoculated with 3 log CFU/g the total viable count increased by 3.02 log CFU/g over 16 days of ice storage. In dried fish stored at 30 ± 2°C, MRSA levels declined by 3.27 log CFU/g in samples inoculated with 6 log CFU/g and by 0.91 log CFU/g in samples inoculated with 3 log CFU/g. These results suggest that the survival of MRSA depends on the temperature of storage and the inoculum level. In our study, MRSA survival was higher when inoculated at 3 log CFU/g regardless of the seafood matrix and storage temperature.

HIGHLIGHTS

Genetic diversity and biofilm formation analysis of Staphylococcus aureus causing urinary tract infections in Tehran, Iran

INTRODUCTION

Over the past decades, prevalence of biofilm-forming Staphylococcus aureus strains has significantly increased in urinary tract infections. The aim of this study was to investigate prevalence of biofilm forming and adhesion encoding genes and to analyze distribution of different agr and spa types in S. aureus isolates.

METHODOLOGY

In the present study, 75 S. aureus isolates obtained from patients with urinary tract infections were examined for susceptibility to antimicrobial agents. Adhesion, biofilm, and spa encoding genes were detected by PCR screening; agr types were determined using multiplex PCR.

RESULTS

Among the 75 isolates, 72% were biofilm producers and 28% were non-biofilm producers. Notably, the ability to produce biofilm was higher among MRSA strains ompared to MSSA strains. The most prevalent biofilm forming gene was icaD (77.3%), followed by icaA (76%), icaB (57.3%) and icaC (50.7%). Adhesion genes clfA, clfB, fnbB, can, fnbA, ebp and bap were detected in 94.7%, 92%, 68%, 64%, 64%, 60% and 5.3% of the isolates, respectively. The spa types t426 and t7789 were found among the non-MDR isolates. It was found that t790, t084, t7789 and t325 spa types were biofilm producers, while t426 and t1339 spa types were non-biofilm producers.

CONCLUSION

Biofilm encoding genes icaD and spa type t790 and agr type III were the most prevalent factors among MDR biofilm producer isolates. The study emphasized that identification of genes and characterization of molecular types involved in biofilm formation should be considered.

Bacterial isolation and antibiotic susceptibility from diabetic foot ulcers in Kenya using microbiological tests and comparison with RT-PCR in detection of S. aureus and MRSA

OBJECTIVES

Diabetic foot ulcers (DFUs) often lead to hospital admissions, amputations and deaths; however, there is no up-to-date information on microbial isolates from DFUs and no mention of utilization of molecular techniques in Sub-Saharan Africa. We conducted a cross-sectional study among 83 adult patients at a tertiary hospital in Kenya over 12 months. The study aimed to isolate, identify bacteria, their antibiotic susceptibility patterns in active DFUs, and to compare standard microbiological methods versus a real-time PCR commercial kit in the detection of Staphylococcus aureus DNA and methicillin-resistant S. aureus (MRSA) DNA.

RESULTS

Eighty swabs (94%) were culture-positive; 29% were Gram-positive and 65% were Gram-negative. The main organisms isolated were S. aureus (16%), Escherichia coli (15%), Proteus mirabilis (11%), Klebsiella pneumoniae (7%) and Pseudomonas aeruginosa (7%). The bacterial isolates showed resistance to commonly used antibiotics such as ampicillin, amoxicillin, cefepime, ceftazidime, cefuroxime, clindamycin, erythromycin, piperacillin-tazobactam, tetracycline and trimethoprim-sulphamethoxazole (TMPSMX). Thirty-one percent of the S. aureus isolated and 40% of the Gram-negatives were multi-drug resistant organisms (MDROs). There was a high prevalence of nosocomial bacteria. MRSA were not identified using culture methods but were identified using PCR. PCR was more sensitive but less specific than culture-based methods to identify S. aureus.

Open-Label Randomized Trial of Early Clinical Outcomes of Ceftaroline Fosamil Versus Vancomycin for the Treatment of Acute Bacterial Skin and Skin Structure Infections at Risk of Methicillin-Resistant Staphylococcus aureus

Introduction

Acute bacterial skin and skin structure infections (ABSSSIs) remain among the most common infectious processes seen in the clinical setting. For patients with complicated ABSSSIs deemed to require intravenous antibiotics, vancomycin remains the mainstay therapy. Ceftaroline has been shown to be non-inferior to vancomycin and may result in faster resolution of signs of infection.

Methods

Multicenter, prospective, open-label, randomized trial of ceftaroline versus vancomycin for the treatment of adult patients admitted for management of ABSSSIs from April 2012 to May 2016; 166 patients in the clinically evaluable (CE) group were needed to determine a 20% difference in primary outcome of clinical response at day 2 or 3 of antibiotics. Clinical response was defined as cessation of spread of lesion and improvement in systemic signs/symptoms of infection. A secondary outcome was a ≥ 20% reduction in lesion size at day 2 or 3 of antibiotics.

Results

One hundred seventy-four patients were enrolled in the intention-to-treat (ITT) group and 108 were CE. Among CE patients, 54 were randomized to ceftaroline and 54 to vancomycin. Baseline characteristics were similar except patients in the ceftaroline arm were older and had a non-significantly higher degree of comorbidities (median Charlson score 2 vs. 4, respectively). Cellulitis was the most common type of ABSSSI (85.2% vs. 79.6%, respectively). Rapid diagnostic testing of available cultures (n = 55) demonstrated high agreement with clinical microbiology for identification of Staphylococcus aureus (100%) and MRSA (100%). There was no significant difference in primary outcome of day 2 or 3 clinical response (50.0% vs. 51.9%).

Conclusion

Early clinical response between vancomycin- and ceftaroline-treated ABSSSIs was similar. Patients with ABSSSIs rarely remained hospitalized for > 2–3 days, thus limiting our ability to critically assess clinical outcomes.

Trial Registration

ClinicalTrials.gov identifier, NCT02582203.

Funding

Allergan plc.

Staphylococcus aureus at an Indian tertiary hospital: Antimicrobial susceptibility and minimum inhibitory concentration (MIC) creep of antimicrobial agents

OBJECTIVES

Staphylococcus aureus causes a variety of symptoms and diseases and has been associated with high morbidity and mortality. A global population drift in clinical S. aureus isolates towards reduced antimicrobial susceptibility is being reported. In this study, the antimicrobial susceptibility profile and minimum inhibitory concentration (MIC) creep of vancomycin, linezolid, teicoplanin and rifampicin against clinical S. aureus isolates at an Indian tertiary centre from January 2012 to December 2016 were investigated.

METHODS

All consecutive, non-duplicate S. aureus isolates (n=1466) recovered from hospitalised patients identified by VITEK^®2 were included in the study. Clinical isolates were tested against 20 antibiotics and were evaluated according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical significance of the MIC creeps of four antimicrobials (vancomycin, linezolid, teicoplanin and rifampicin) was ascertained.

RESULTS

S. aureus isolates recovered from all clinical samples demonstrated high resistance to ampicillin, ciprofloxacin and penicillin (75-100%) and low resistance to amikacin, linezolid, netilmicin, nitrofurantoin, teicoplanin and vancomycin (0-13%). The MIC₉₀ values (MIC required to inhibit 90% of the isolates) for vancomycin, linezolid and rifampicin decreased, whereas the MIC₉₀ for teicoplanin increased. The change in the geometric mean MIC of rifampicin was found to be statistically significant. A statistically significant and progressive MIC creep was observed for teicoplanin and rifampicin.

CONCLUSION

Despite remaining susceptible, S. aureus is not inert to antibiotic pressure. Implementation of preventive measures in healthcare settings is required worldwide to combat the increasing number of infections by this pathogen.

Antimicrobial and antioxidant activities of triterpenoid and phenolic derivatives from two Cameroonian Melastomataceae plants: Dissotis senegambiensis and Amphiblemma monticola

Background

Antimicrobial resistance is a serious threat against humankind and the search for new therapeutics is needed. This study aims to investigate the antimicrobial and antioxidant activities of ethanol extracts and compounds isolated from Dissotis senegambiensis and Amphiblemma monticola, two Cameroonian Melastomataceae species traditionally used for the treatment of fever, malaria and infectious diseases.

Methods

The plant extracts were prepared by maceration in ethanol. Standard chromatographic and spectroscopic methods were used to isolate and identify fourteen compounds from the two plant species [1–6 (from D. senegambiensis), 3, 4 and 7–14 (from A. monticola)]. A two-fold serial micro-dilution method was used to determine the minimum inhibitory concentration (MIC) against four bacterial strains including two resistant bacterial strains, methicillin resistant S. aureus (MRSA3) and methicillin resistant S. aureus (MRSA4) and three yeast strains.

Results

The fractionation of EtOH extracts afforded fourteen compounds belonging to triterpenoid and phenolic derivatives. The ethanol extracts, compounds 3, 5–8, 10 and the mixture of 10 + 12 were active against all the tested bacterial and fungal species. Compound 7 (MIC = 16–32 μg/mL) and 10 (MIC = 8–16 μg/mL) displayed the largest antibacterial and antifungal activities, respectively. Compounds 7, 10 and the mixture of 10 + 12 showed prominent antibacterial activity against methicillin- resistant S. aureus (MRSA) which is in some cases equal to that of ciprofloxacin used as reference antibacterial drug. Compound 8 also showed high radical-scavenging activities and ferric reducing power when compared with vitamin C and butylated hydroxytoluene used as reference antioxidants. The tested samples were non-toxic to normal cells highlighting their good selectivity.

Conclusions

The result of this investigation reveals the potential of D. senegambiensis and A. monticola as well as the most active compounds in the search for new antimicrobial and antioxidant agents. So, further investigations are needed.

Electronic supplementary material

The online version of this article (10.1186/s12906-018-2229-2) contains supplementary material, which is available to authorized users.

Emergence of multidrug-resistant sequence type 45 strains among mecA-positive borderline oxacillin-resistant Staphylococcus aureus causing bacteraemia in a medical centre in Taiwan

Clinical data related to bacteraemia caused by mecA-positive borderline oxacillin-resistant Staphylococcus aureus (BORSA) isolates [minimum inhibitory concentrations (MICs) of 0.5-4 mg/L] are limited. Patients aged ≥15 years with bacteraemia due to BORSA who were admitted to the emergency department of a Taiwanese tertiary hospital between January 2001 and December 2015 were evaluated. Clinical characteristics of patients with bacteraemia caused by BORSA, methicillin-susceptible S. aureus and methicillin-resistant S. aureus (MRSA) were compared. MICs of 12 antibiotics were determined by agar dilution. Genetic characteristics of 64 available BORSA isolates were analysed by detection of the SCCmec gene, the mecA promoter region sequence and multilocus sequence typing (MLST). Pulsed-field gel electrophoresis (PFGE) was performed to identify the clonality of the emerging ST isolates. The quinolone resistance genes were analysed for the emerging ciprofloxacin-resistant ST45 clone isolates. Among the 65 BORSA bacteraemic patients, in-hospital mortality was 24.6%, significantly lower than that of MRSA patients (38.5%) (P = 0.03). Underlying conditions were similar between BORSA and MRSA patients, but with less dialysis in the former (P = 0.01). Multivariate analysis revealed that septic shock [odds ratio (OR) = 15.95] and bacteraemia originating from lower respiratory tract infection (OR = 5.78) were two independent risk factors for 30-day mortality. The ST45 clone with high-level ciprofloxacin resistance (MICs of 8-128 mg/L) replaced ST59 as the predominant clone since 2012, although no major clustering was detected. In conclusion, the emerging multidrug-resistant ST45 clone has replaced ST59 as the most common among BORSA isolates.

Molecular characterization of nasal methicillin resistant Staphylococcus aureus isolates from workers of an automaker company in southeast Iran

Colonization of methicillin resistant Staphylococccus aureus (MRSA) can occur more commonly in healthy people who live in close together or are in close physical contact with each other. Having knowledge about the molecular characteristics of these strains provides considerable discernment into the epidemiology of this important microorganism. A total of 806 nasal swabs were collected from healthy workers of an automaker company in the southeast of Iran and were analyzed to detect MRSA isolates. Multilocus sequence typing (MLST), spa typing, and detection of staphylococcal cassette chromosome mec (SCCmec) were performed. The presence of genes encoding Panton-Valentine Leukocidin (PVL) and Arginine Catabolic Mobile Element (ACME) were also investigated. Carriage rate of S. aureus was 20%. Among 10 identified MRSA, no acme was found while high prevalence of pvl (60%) was of great concern. Seven different spa types including five new ones were identified. The most frequent sequence type was the novel one; ST 3373 (n = 3), followed by each of ST22, ST88, ST859 (n = 2) and ST1955 (n = 1). MRSA isolates were clustered into two main clonal complexes; CC22 (n = 6) and CC88 (n = 4). Low genetic diversity with the dominance of CC22, SCCmecIV was found. Distribution of previously found hospital-associated MRSA was demonstrated among our isolates.

The impact of methicillin-resistant S. aureus on length of stay, readmissions and costs: a register based case-control study of patients hospitalized in Norway

Background

Patients with methicillin-resistant S. aureus (MRSA) are thought to incur additional costs for hospitals due to longer stay and contact isolation. The aim of this study was to assess the costs associated with MRSA in Norwegian hospitals.

Methods

Analyses were based on data fromSouth-Eastern Norway for the year 2012 as registered in the Norwegian Surveillance System for Communicable Diseases and the Norwegian Patient Registry. We used a matched case-control method to compare MRSA diagnosed inpatients with non-MRSA inpatients in terms of length of stay, readmissions within 30 days from discharge, as well as the Diagnosis-Related Group (DRG) based costs.

Results

Norwegian patients with MRSA stayed on average 8 days longer in hospital than controls, corresponding to a ratio of mean duration of 2.08 (CI 95%, 1.75–2.47) times longer.A total of 14% of MRSA positive inpatients were readmitted compared to 10% among controls. However, the risk of readmission was not significantly higher for patients with MRSA. DRG based hospital costs were 0.37 (95% CI, 0.19–0.54) times higher among cases than controls, with a mean cost of EUR13,233(SD 26,899) and EUR7198(SD 18,159) respectively.

Conclusion

The results of this study indicate that Norwegian patients with MRSA have longer hospital stays, and higher costs than those without MRSA.

aureus in acute bacterial skin and skin structure infections

Methicillin-resistant Staphylococcus aureus acute bacterial skin and skin structure infections (MRSA ABSSSIs) are associated with a significant clinical and economic burden; however, rapid identification of MRSA remains a clinical challenge. This study aimed to use a novel method of predictive modeling to determine those at highest risk of MRSA ABSSSIs. Risk factors for MRSA ABSSSI were derived from a combination of previously published literature and multivariable logistic regression of individual patient data (IPD) using the 'adaptation method.' A risk-scoring tool was derived from weight-proportional integer-adjusted coefficients of the predictive model. Likelihood ratios were used to adjust posterior probability of MRSA. Risk factors were identified from 12 previously published studies and adapted based on IPD (n = 231). Risk factors were: history of diabetes with obesity (adapted odds ratio [aOR] = 1.1), prior antibiotics (90 days) (aOR = 2.6), chronic kidney disease/hemodialysis (aOR = 1.4), intravenous drug use (aOR = 2.8), previous MRSA exposure/infection (12 months) (aOR = 2.8), previous hospitalization (12 months) (aOR = 7.5), and HIV/AIDS (aOR = 4.0). Baseline prevalence of MRSA was 42.7%. Scores ranged from 0 - 8 points. Post-test probability of MRSA: score 0 = 35.0%; score 1 - 2 = 45.0%; score 3 = 63.0%. The newly derived risk-scoring tool is proof-of-concept of the adaptation method. This study is hypothesis generating and such a tool remains to be validated for clinical use.

Comparison of different phenotypic and genotypic methods for the detection of methicillin-resistant Staphylococcus aureus

Background:

Staphylococcus aureus is known as a powerful pathogen that causes various infections. Emergence of methicillin-resistant S. aureus (MSRA) is responsible for nosocomial and community-acquired infections worldwide.

Aims:

The present study aimed to evaluate the performance and ability of eight different phenotypic and genotypic methods for the detection of MSRA.

Materials and Methods:

A total of 186 S. aureus isolates were defined as methicillin-susceptible S. aureus (MSSA; 95) and MSRA (91) using polymerase chain reaction (PCR) as the gold standard. Susceptibility to methicillin was investigated using oxacillin, methicillin, cefotetan, cefoxitin, and cefmetazole disks, by oxacillin Adata Tab and strips. For all S. aureus isolates minimal inhibitory concentrations of oxacillin were determined using the broth microdilution method according to Clinical and Laboratory Standards Institute guidelines.

Results:

Among the diagnostic methods studied, broth microdilution and the cefoxitin disk had the highest specificity (98.9 and 94.7%), sensitivity (100 and 98.9%), and concordance with PCR results (98.9 and 93.6%). The cefotetan and cefmetazole disks had the lowest concordance with PCR results.

Conclusion:

Our results suggest that microdilution and cefoxitin disk methods have high sensitivities compared with other methods for detection of MSRA. The cefoxitin disk method may be preferred in clinical laboratories because it is easy to perform and does not require special equipment.

Population genetics and the evolution of virulence in Staphylococcus aureus

Staphylococcus aureus is one of the most important human pathogens, causing life-threatening infection in the community and hospital setting. The population genetics of S. aureus and the evolution of virulence is the focus of this review. We describe the various techniques in determining S. aureus population structure and discuss the insights gained from whole genome sequencing of various S. aureus strains. The emergence of community-acquired, methicillin-resistant S. aureus provides a framework for the discussion on evolution of virulence, and the role of horizontal gene transfer in the development of virulence and antibiotic resistance is explored. The knowledge generated from population genetics has the potential to inform strategies to assist in the prevention or treatment of this highly successful human pathogen.