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Kaneko H, Kanai M, Saito T, Yanagi Y, Kobayashi H, Kurihara R, Ikeda M, Nemoto O, Baba N, Matsuzaki Y, Sawamura D, Shimoe F, Inaba Y, Kobayashi Y, Kawasaki S, Ueki T, Funatsu S, Shirahama S, Oba M, Hasegawa T, Furukawa H, Miyata T, Isonokami M, Fujita S, Nakaminami H. Significant increase in the prevalence of Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus, particularly the USA300 variant ΨUSA300, in the Japanese community. Microbiol Spectr 2023; 11:e0124823. [PMID: 37929951 PMCID: PMC10715091 DOI: 10.1128/spectrum.01248-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
IMPORTANCE USA300 is an MRSA clone producing PVL, a toxin associated with SSTIs. ΨUSA300 is a USA300 variant recently identified in Japan by Takadama et al. (15). Here, we found that the prevalence rate of PVL-positive MRSA in S. aureus was elevated in the Japanese community, and ΨUSA300 accounted for most of them. ΨUSA300 strains have been isolated from several areas in Japan and were associated with deep-seated SSTIs. This study highlighted the emerging threat posed by ΨUSA300 in Japan.
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Affiliation(s)
- Hiroshi Kaneko
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Miki Kanai
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Takumi Saito
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yuka Yanagi
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Hana Kobayashi
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Rikuto Kurihara
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Masami Ikeda
- Department of Dermatology, Takamatsu Red Cross Hospital, Kagawa, Japan
| | | | - Naoko Baba
- Department of Dermatology, Kanagawa Children’s Medical Center, Kanagawa, Japan
| | - Yasushi Matsuzaki
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Daisuke Sawamura
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | | | | | | | | | - Toru Ueki
- Ueki Dermatology Plastic Surgery, Tokyo, Japan
| | | | - Shigeho Shirahama
- Department of Dermatology, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Misao Oba
- Department of Dermatology, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | | | | | - Toshiko Miyata
- Division of Dermatology, Saitama Citizens Medical Center, Saitama, Japan
| | | | | | - Hidemasa Nakaminami
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
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Fu P, Nijiati Y, Li T, Wu X, Wang Z, Zhou J, Wang C, Ning B. Clinical and molecular characteristics of methicillin-resistant Staphylococcus aureus in bone and joint infection among children. Ann Clin Microbiol Antimicrob 2023; 22:104. [PMID: 37993871 PMCID: PMC10666310 DOI: 10.1186/s12941-023-00654-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE To investigate the characteristics of Methicillin-Resistant Staphylococcus aureus (MRSA) in bone and joint infection (BJI) among children. METHODS A total of 338 patients diagnosed with BJI from 2013 to 2022 in Children's Hospital of Fudan University were enrolled. Demographic information, microbiology culture results and laboratory findings, including white blood counts (WBC), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR) were collected and analyzed. MRSA was confirmed by antimicrobial susceptibility testing. Other MRSA-caused infections were randomly selected for comparison. Twenty-three virulence and antimicrobial resistance (AMR) genes were screened for MRSA strains. Multilocus sequence typing (MLST) and Staphylococcal protein A (spa) typing were performed using PCR amplification and sequencing. RESULTS Of the identified pathogens in BJI, MRSA accounted for 21.0% (47/224). Patients with BJI had high levels of initial CRP, white blood cell count (WBC) and IL-6. ST59 (43.9%) and t437 (37.6%) were the main MRSA subtypes isolated from the children. The major genotypes in BJI were ST59-t437 (29.8%) and ST22-t309 (14.9%), with high carriage of hemolysins including hla (94.4-100%), hlb (66.2-93.3%), and hld (100%). Notably, Panton-Valentine leukocidin (pvl) had a high prevalence (53.3%) in ST22-t309-MRSA. Other virulence genes including tst, seg and sei were more commonly detected in ST22-t309-MRSA (40.0-46.7%) than in ST59-t437-MRSA (4.2-9.9%). High-carriage AMR genes in MRSA included aph(3')/III (66.7-80%), ermB (57.5-73.3%) and ermC (66.7-78.9%). MRSA presented high-resistance to erythromycin (52.0-100%) and clindamycin (48.0-92.5%), different genotypes displayed variation in their susceptibilities to antibiotics. CONCLUSIONS The major MRSA genotype in BJI was ST59-t437, followed by ST22-t309, with a higher prevalence of the pvl gene. Continuous surveillance of pvl-positive ST22-t309-MRSA in pediatric BJI infections is thus required.
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Affiliation(s)
- Pan Fu
- Department of Clinical Microbiology Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
- Nosocomial Infection Control Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yaxier Nijiati
- Orthopedics Department, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Tingting Li
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xia Wu
- Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zixuan Wang
- Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Jinlan Zhou
- Pediatric Intensive Care Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Chuanqing Wang
- Department of Clinical Microbiology Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
- Nosocomial Infection Control Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| | - Bo Ning
- Orthopedics Department, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
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McGuire E, Neill C, Collin SM, Higgins H, Guy R, Ganner M, Coelho J, Pichon B, Hope R, Brown CS. Is Panton-Valentine leucocidin (PVL) toxin associated with poor clinical outcomes in patients with community-acquired Staphylococcus aureus bacteraemia? J Med Microbiol 2023; 72. [PMID: 37097840 DOI: 10.1099/jmm.0.001683] [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] [Indexed: 04/26/2023] Open
Abstract
Introduction. Panton-Valentine leucocidin (PVL) toxin is a potential determinant of virulence associated with S. aureus infection.Gap Statement. The contribution of PVL to S. aureus pathogenicity remains unclear.Aim. To compare clinical outcomes in hospitalized patients with PVL-positive and PVL-negative community-acquired (CA) S. aureus bacteraemia.Methods. Three national datasets were combined to provide clinical and mortality data for patients with CA S. aureus blood culture isolates sent to the UK reference laboratory for PVL testing, August 2018 to August 2021. Multivariable logistic regression models were built for the effect of PVL positivity on 30 day all-cause mortality and 90 day readmission.Results. In 2191 cases of CA S. aureus bacteraemia, there was no association between PVL and mortality (adjusted odds ratio, aOR: 0·90, 95 % confidence interval, CI: 0·50-1·35, P=0·602) and no difference in median LOS (14 versus 15 days, P=0.169). PVL-positive cases had lower odds of readmission (aOR 0·74, CI 0·55-0.98, P=0·038). There was no evidence that MRSA status modified this effect (P=0·207).Conclusions. In patients with CA S. aureus bacteraemia PVL toxin detection was not associated with worse outcomes.
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Affiliation(s)
- Emma McGuire
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
| | - Claire Neill
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
| | - Simon M Collin
- University of Bristol, Beacon House, Queens Road, Bristol, BS8 1QU, UK
| | - Hannah Higgins
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
| | - Rebecca Guy
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
| | - Mark Ganner
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
| | - Juliana Coelho
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
| | - Bruno Pichon
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
| | - Russell Hope
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
| | - Colin S Brown
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency (UKHSA), 1 Colindale Avenue, London, NW9 5EQ, UK
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Mahdi NB. Prevalence of Panton-Valentine leukocidin and toxic shock syndrome toxin-1 genes in methicillin-resistant Staphylococcus aureus isolated from nose of restaurant workers in Kirkuk city. J Adv Pharm Technol Res 2023; 14:34-38. [PMID: 36950468 PMCID: PMC10026320 DOI: 10.4103/japtr.japtr_508_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 03/24/2023] Open
Abstract
Staphylococcus aureus resides naturally in the nasal cavity of healthy individuals, including those working in restaurants, so they may be a source for spreading this bacterium to restaurant customers directly or indirectly through cooked meals. This bacterium has several virulence factors enabling it to cause many diseases in different parts of the body. It has also the capability to resist conventional antibiotics including methicillin. To investigate methicillin-resistant S. aureus (MRSA), 170 nasal swabs were collected from food preparation workers in 30 restaurants (5-6 workers in each restaurant) in Kirkuk city. After collection, the samples were directly transferred to the laboratory and cultured on selective media like mannitol salt agar (MSA). Microbiological examination including morphological, biochemical, and confirmatory tests showed that 24/170 of collected samples were positive for S. aureus with a rate of 14.12%. Among 24 isolates, 20 (83.3%) belonged to MRSA. All isolates were resistant to oxacillin and penicillin (100%), whereas sensitive to other antibiotics (gentamicin, chloramphenicol, and rifampicin). Polymerase chain reaction exhibited that 13 (65%) of MRSA isolates have toxic shock syndrome toxin-1 gene and only 4 (20%) have Panton-Valentine leukocidin gene.
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Affiliation(s)
- Najdat Bahjat Mahdi
- Department of Biology, College of Education for Pure Science, University of Kirkuk, Kirkuk, Iraq
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Yildirim F, Sudagidan M, Aydin A, Akyazi I, Bayrakal GM, Yavuz O, Gurel A. In Vivo Pathogenicity of Methicillin-Susceptible Staphylococcus aureus Strains Carrying Panton-Valentine Leukocidin Gene. Life (Basel) 2022; 12. [PMID: 36556491 DOI: 10.3390/life12122126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Toxin-producing Staphylococcus aureus strains posing a potential risk for public health have long been a topic of scientific research. Effects of Panton-Valentine leukocidin (PVL) on tissue destruction mechanisms and activities of inflammatory cells were presented in animal models of pneumonia and skin infections induced by PVL-producing S. aureus strains. This study aimed to demonstrate the in vivo pathogenicity of PVL-producing S. aureus strains isolated from some foodstuffs, which can be a potential risk to public health. PVL-positive methicillin-susceptible S. aureus (MSSA) strains M1 and YF1B-b isolated from different foodstuffs and a PVL-positive MSSA strain HT480 (positive control) were administered to New Zealand rabbits. Blood samples were harvested three and six hours after the intratracheal inoculation. Lung tissue samples were collected for gross and microscopic exams and immunohistochemical (IHC) demonstration of IL-6, IL8, IL-10, and TNF-α expressions. Serum cytokine levels were also measured by ELISA. The strains isolated from lung tissue samples were confirmed by pulsed-field gel electrophoresis. The development of acute necrotising pneumonia and a significant elevation in IL-6, IL-8, IL-10, and TNF-α expressions demonstrated the significance of foodborne PVL-positive MSSA strains in public health for the first time.
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Zhang L, Li X, Wang R. A fatal case of pneumonia and sepsis caused by sequence type 398 methicillin-susceptible Staphylococcus aureus carrying Pantone-Valentine leukocidin in China. J Infect Chemother 2022; 28:1329-1331. [PMID: 35654720 DOI: 10.1016/j.jiac.2022.05.011] [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: 03/15/2022] [Revised: 04/24/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
Abstract
Staphylococcus aureus (S. aureus) sequence type 398 (ST398) has aroused great concern for its spread throughout the world. ST398 community-acquired MRSA (CA-MRSA) has been given greater emphasis because of its high virulence and high probability of treatment failure. Herein, A 22-year-old male was admitted to our hospital with a history of fever, chest pain and dyspnea for 2 days. A chest CT scan showed infiltrative and nodular shadows. The sequence type of the isolates from blood culture was ST398, the virulence genes detected was PVL gene (lukS-PV and lukF-PV). Despite resuscitation efforts, he died of multiple organ failure on admission 3rd day. This is the first described case of severe pneumonia and sepsis due to hematogenous spread of scalp furuncles caused by Panton-Valentine leukocidin (PVL) positive community-acquired methicillin-susceptible S. aureus (CA-MSSA) ST398 strains in an immunocompentent adult in mainland China. This report highlight the emergence CA-PVL-MSSA ST398 infection and its association with life-threatening infections. Early decolonization and identification of ST398 is critical. Severe skin and soft tissue infections should be suspected for ST398 PVL-MSSA.
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Affiliation(s)
- Lizhong Zhang
- Department of Laboratory Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
| | - Xiaoyan Li
- Department of Respiratory Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Ruixue Wang
- Department of Laboratory Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
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Kaneko H, Kim ES, Yokomori S, Moon SM, Song KH, Jung J, Park JS, Kim HB, Nakaminami H. Comparative Genomic Analysis of the Human Variant of Methicillin-Resistant Staphylococcus aureus CC398 in Japan and Korea. Microb Drug Resist 2022; 28:330-337. [PMID: 35021886 DOI: 10.1089/mdr.2021.0203] [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] [Indexed: 11/12/2022] Open
Abstract
Staphylococcus aureus clonal complex (CC) 398 is a major clonal type of livestock-associated methicillin-resistant S. aureus and comprise both a human variant and a livestock-associated variant. We have previously identified three sequence type (ST) 1232 strains from Japanese patients (THI2018-120 and N1195) and a Vietnamese patient (S36). In this study, we found an ST1232 strain in a Korean patient (BDH17) and compared the genomes of the ST1232 strains isolated in Korea and Japan. Whole-genome sequencing and a phylogenetic tree based on single nucleotide polymorphisms showed that all ST1232 strains were human variants of S. aureus CC398 and were similar to a common lineage of Southeast Asia. All strains carried ϕSa2, ϕSa3, and Tn554, which included Panton-Valentine leukocidin, immune evasion cluster, and antimicrobial resistance genes, respectively. THI2018-120 and N1195 carried slightly different staphylococcal cassette chromosome mec element from BDH17 due to the insertion of a IS30 family. In addition, the strains originating from Japanese patients possessed a unique genetic element, blaZ-Tn4001-Tn554 element. In this study, we found that the ST1232 strains isolated in Korea and Japan are genetically closely related to each other. However, presence of the unique genetic elements suggests that the strains originating from Japanese patients may have evolved independently in Japan.
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Affiliation(s)
- Hiroshi Kaneko
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Shiho Yokomori
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Song Mi Moon
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyoung-Ho Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jongtak Jung
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hong Bin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hidemasa Nakaminami
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
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Pichon M, Micaelo M, Rasoanandrasana S, Menn AM. Molecular characterization of Staphylococcus aureus isolates derived from severe pneumonia: a retrospective monocentre study. Infect Dis (Lond) 2021; 53:811-819. [PMID: 34382901 DOI: 10.1080/23744235.2021.1963472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is endowed with a repertoire of virulence factors potentially implicated in its pathogenicity and ability to cause invasive disease. The main objective of this study was to describe the bacterial genotype, including virulence genes and affiliation to clonal complexes (CCs), encountered in severe pneumonia. METHODS DNA microarray was used to analyse 18 S. aureus isolates from patients hospitalized with severe pneumonia between 2017 and 2019. RESULTS Among 18 S. aureus isolates, 14 were methicillin-susceptible S. aureus (MSSA), and 4 methicillin-resistant S. aureus (MRSA). There were 14 community-acquired, 3 healthcare-associated, and 1 hospital-acquired infections. Different radiological presentations were observed: necrotizing pneumonia (n = 8, 44%), alveolar consolidation (n = 7, 39%), alveolar-interstitial infiltrates (n = 3, 17%). Sixteen patients (89%) required ICU hospitalization, 13 (72%) an invasive mechanical ventilation, and 12 (67%) a vasopressor support. Mortality affected 6 patients (33%). Panton-Valentine leukocidin (PVL), staphylococcal enterotoxins, toxic shock syndrome toxine-1 (TSST-1) encoding genes were documented in nine (50%), 12 (67%), one (6%) of the isolates, respectively. Accessory regulator gene group I was the most reported (n = 9, 50%) and was found in five deaths. The majority of isolates were affiliated to CC152 (n = 6), followed by CC15 (n = 3), CC45 (n = 2), CC30 (n = 2), CC1 (n = 2), CC8 (n = 1), CC9 (n = 1), and CC25 (n = 1). All the CC152 isolates were PVL-positive. CONCLUSION CC152-PVL positive S. aureus strains were the most prevalent in severe pneumonia. Other virulence gene profiles were found coupled to additional clonal lineages. A genotyping strategy contributes to describe the current circulating strains and bacterial genetic backgrounds.
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Affiliation(s)
- Maud Pichon
- Service de Médecine Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Maïte Micaelo
- Service de Microbiologie, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | | | - Anne-Marie Menn
- Service de Médecine Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
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Hayakawa K, Yamaguchi T, Ono D, Suzuki H, Kamiyama J, Taguchi S, Kiyota K. Two Cases of Intrafamilial Transmission of Community-Acquired Methicillin-Resistant Staphylococcus aureus Producing Both PVL and TSST-1 Causing Fatal Necrotizing Pneumonia and Sepsis. Infect Drug Resist 2020; 13:2921-2927. [PMID: 32903848 PMCID: PMC7445494 DOI: 10.2147/idr.s262123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/10/2020] [Accepted: 08/06/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction Staphylococcus aureus produces numerous toxins, such as toxic shock syndrome toxin 1 (TSST-1) and Panton–Valentine leukocidin (PVL). We isolated community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains producing both TSST-1 and PVL isolated from severe necrotizing pneumonia cases in a Nepali family. Detection of these CA-MRSA strains is rare in the world, and infection with these strains can take a rapidly progressive and lethal course. In this study, we traced the clinical course of this case and conducted a genetic analysis of the isolated strains. Case Report We described 2 familial cases (a 20-year-old male and 61-year-old female) of severe necrotizing pneumonia caused by CA-MRSA with the TSST-1 and PVL genes. A 20-year-old Nepalese male was admitted to our hospital after a 3-day history of high fever and coughing. Despite resuscitation efforts, he died of multiple organ failure. A 61-year-old Nepalese female was admitted to our hospital with a complaint of high fever and dyspnea for 1 day. She was the grandmother of the male subject and mostly stayed at his residence in Japan. We administered intravenous antibiotics, including anti-MRSA antibiotics, and she improved in 2 weeks. The sequence type of the isolates was ST22/SCCmec type IVa, and the spa type was t005. The virulence genes detected were as follows: PVL gene (lukSF-pv), TSST-1 gene (tst-1), sec, seg, sei, sel, sem, sen, seo, and seu. ST22 was not the dominant CA-MRSA clone type in Japan. Some of the reports demonstrated that PVL-/TSST-1-positive ST22-MRSA strains are prevalent in Nepal. Therefore, the MRSA strains were thought to be acquired from Nepal. Conclusion These cases highlight the emergence of TSST-1- and PVL-positive CA-MRSA infection and its association with life-threatening community-acquired necrotizing pneumonia. Clinicians should note the possibility of introducing MRSA strains from abroad and be aware of this illness to initiate appropriate treatment.
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Affiliation(s)
- Katsura Hayakawa
- Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Tetsuo Yamaguchi
- Department of Microbiology and Infection Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Daisuke Ono
- Department of Microbiology and Infection Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Hajime Suzuki
- Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Jiro Kamiyama
- Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Shigemasa Taguchi
- Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Kazuya Kiyota
- Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, Saitama, Japan
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Mairi A, Touati A, Lavigne JP. Methicillin-Resistant Staphylococcus aureus ST80 Clone: A Systematic Review. Toxins (Basel) 2020; 12:toxins12020119. [PMID: 32075074 PMCID: PMC7076798 DOI: 10.3390/toxins12020119] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 01/09/2023] Open
Abstract
This review assessed the molecular characterization of the methicillin-resistant Staphylococcus aureus (MRSA)-ST80 clone with an emphasis on its proportion of total MRSA strains isolated, PVL production, spa-typing, antibiotic resistance, and virulence. A systematic review of the literature was conducted on MRSA-ST80 clone published between 1 January 2000 and 31 August 2019. Citations were chosen for a review of the full text if we found evidence that MRSA-ST80 clone was reported in the study. For each isolate, the country of isolation, the sampling period, the source of isolation (the type of infection, nasal swabs, or extra-human), the total number of MRSA strains isolated, number of MRSA-ST80 strains, antibiotic resistance patterns, PVL production, virulence genes, and spa type were recorded. The data from 103 articles were abstracted into an Excel database. Analysis of the data showed that the overall proportion of MRSA-ST80 has been decreasing in many countries in recent years. The majority of MRSA-ST80 were PVL positive with spa-type t044. Only six reports of MRSA-ST80 in extra-human niches were found. This review summarizes the rise of MRSA-ST80 and the evidence that suggests that it could be in decline in many countries.
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Affiliation(s)
- Assia Mairi
- Laboratoire d’Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia 06000, Algeria; (A.M.); (A.T.)
| | - Abdelaziz Touati
- Laboratoire d’Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia 06000, Algeria; (A.M.); (A.T.)
| | - Jean-Philippe Lavigne
- VBMI, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, 30029 Nîmes, France
- Correspondence: ; Tel.: +33-4666-832-02
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Bryant AE, Gomi S, Katahira E, Huang DB, Stevens DL. The effects of iclaprim on exotoxin production in methicillin-resistant and vancomycin-intermediate Staphylococcus aureus. J Med Microbiol 2019; 68:456-466. [PMID: 30676310 DOI: 10.1099/jmm.0.000929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Extracellular protein toxins contribute to the pathogenesis of Staphylococcus aureus infections. The present study compared the effects of iclaprim and trimethoprim - two folic acid synthesis inhibitors - with nafcillin and vancomycin on production of Panton-Valentine leukocidin (PVL), alpha haemolysin (AH) and toxic-shock syndrome toxin I (TSST-1) in methicillin-resistant and vancomycin-intermediate S. aureus (MRSA and VISA, respectively). METHODOLOGY Northern blotting and RT-PCR were used to assess gene transcription; toxin-specific bioassays were used to measure protein toxin production. RESULTS As shown previously, sub-inhibitory concentrations (sub-MIC) of nafcillin increased and prolonged MRSA toxin gene transcription and enhanced PVL, TSST-1 and AH production. Sub-inhibitory doses of iclaprim and trimethoprim delayed maximal AH gene (hla) transcription and suppressed AH production; both drugs delayed, but neither reduced, maximal TSST-1 production. Trimethoprim significantly increased lukF-PV expression and PVL production compared to both untreated and iclaprim-treated cultures. Higher concentrations of iclaprim and trimethoprim markedly suppressed MRSA growth, mRNA synthesis and toxin production. In VISA, iclaprim, vancomycin and nafcillin variably increased tst and hla expression, but only nafcillin increased toxin production. Despite its ability to increase hla expression, iclaprim was the most potent inhibitor of AH production. CONCLUSIONS We conclude that, due to its ability to suppress toxin production, iclaprim should be effective against severe staphylococcal infections caused by toxin-producing MRSA and VISA strains, especially given its ability to concentrate at sites of infection such as skin and skin structures and the lung.
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Affiliation(s)
- Amy E Bryant
- 1 University of Washington School of Medicine, Seattle, WA, USA
| | - Sumiko Gomi
- 2 Veterans Affairs Medical Center, Boise, ID, USA
| | - Eva Katahira
- 2 Veterans Affairs Medical Center, Boise, ID, USA
| | | | - Dennis L Stevens
- 1 University of Washington School of Medicine, Seattle, WA, USA
- 2 Veterans Affairs Medical Center, Boise, ID, USA
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Klein S, Menz MD, Zanger P, Heeg K, Nurjadi D. Increase in the prevalence of Panton-Valentine leukocidin and clonal shift in community-onset methicillin-resistant Staphylococcus aureus causing skin and soft-tissue infections in the Rhine-Neckar Region, Germany, 2012-2016. Int J Antimicrob Agents 2018; 53:261-267. [PMID: 30412736 DOI: 10.1016/j.ijantimicag.2018.10.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 06/22/2018] [Revised: 09/14/2018] [Accepted: 10/14/2018] [Indexed: 11/17/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) remains a major challenge for patient care. Community-associated (CA)-MRSA often have a fitness and virulence advantage compared with their nosocomial counterparts. Increased mobility, travel activities and migration accelerate the intercontinental spread of virulent CA-MRSA strains. Outpatient clinics are the most important route of entry for CA-MRSA into hospitals. However, systematic data on CA-MRSA in Germany are limited. In this study, community-onset (CO)-MRSA skin and soft-tissue infection (SSTI) isolates in the Rhine-Neckar Region from 2012-2016 were characterised to gain an insight into their molecular epidemiology and to monitor potential introduction of virulent and dominant MRSA strains into our hospital. A total of 2475 patients with S. aureus SSTI were identified in the outpatient departments of our hospital, of which 94 (3.8%) were MRSA. In addition, 40.4% of the CO-MRSA harboured the virulence factor Panton-Valentine leukocidin (PVL). ST8-t008-MRSA-IVa/c (23.7%; 9/39) and ST80-t044-MRSA-IVc (15.8%; 6/38) were the predominant PVL-positive MRSA. Molecular typing and epidemiological data revealed that 42.6% (40/94) of strains could be traced back to a local origin and 44.7% (42/94) were endemic outside of Europe. Resistance to quinolones, clindamycin and macrolides was common, whilst resistance to trimethoprim/sulfamethoxazole, tetracycline, mupirocin, chlorhexidine and fusidic acid was low. No resistance to rifampicin, fosfomycin or linezolid was observed. This study provides insight into the clonal composition of CO-MRSA in the Rhine-Neckar Region. The increase of PVL-positive MRSA and the introduction of imported strains may affect the local MRSA landscape in the near future and should be monitored closely.
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Affiliation(s)
- Sabrina Klein
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Monja-Dorina Menz
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Philipp Zanger
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany; Heidelberg University Hospital, Institute of Public Health, Heidelberg, Germany
| | - Klaus Heeg
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Dennis Nurjadi
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
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Song KH, Kim ES, Park KH, Choi HJ, Kim KH, Lee S, Hwang JH, Choo EJ, Park Y, Lee EJ, Kim YK, Jeon MH, Moon C, Hwang JH, Park JS, Park KU, Choe PG, Bang JH, Oh MD, Kim HB. Clinical and Molecular Characterization of Panton-Valentine Leukocidin-Positive Invasive Staphylococcus aureus Infections in Korea. Microb Drug Resist 2018; 25:450-456. [PMID: 30379606 DOI: 10.1089/mdr.2018.0238] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
AIM Panton-Valentine leukocidin (PVL) is a virulent cytotoxin and an indicator of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. In this study, we evaluated the prevalence and clinical and molecular characteristics of PVL-positive invasive S. aureus (ISA) infections in Korea. RESULTS A collection of 1,962 nonduplicate clinical isolates were screened for multilocus sequence typing, staphylococcal cassette chromosome mec (SCCmec), accessory gene regulator typing, major toxins, and antimicrobial susceptibility. Twenty-eight (1.4%) PVL-positive S. aureus samples were found; of them 19 (67.9%) were MRSA (8 CA and 11 healthcare-associated infections). Seventeen patients (60.7%) were men (median age: 63 years; range: 13-93 years) and 12 patients (42.9%) had no underlying comorbidities. The most common infections were skin and skin structure infection (SSSI) and pneumonia. The 30-day mortality rate was 37.0%. The most common PVL-positive MRSA clones were ST8-SCCmec IVa and ST30-SCCmec IVc along with their single-locus variants. Antimicrobial susceptibility and toxin-gene profile differed according to the clone. CONCLUSIONS ISA infections caused by PVL-positive strains are rare in Korea, with the two most common infections being SSSI and pneumonia. Our findings indicated that several PVL-positive MRSA clones, predominantly ST8-SCCmecIVa and ST30-SCCmecIVc, were circulating and causing sporadic cases of ISA infections in the community and hospital settings.
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Affiliation(s)
- Kyoung-Ho Song
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Eu Suk Kim
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Kyung-Hwa Park
- 3 Department of Infectious Diseases, Chonnam National University Medical School , Gwangju, Republic of Korea
| | - Hee Jung Choi
- 4 Department of Internal Medicine, School of Medicine, Ewha Womans University , Seoul, Republic of Korea
| | - Kye-Hyung Kim
- 5 Department of Internal Medicine, Pusan National University School of Medicine , Busan, Republic of Korea
| | - Shinwon Lee
- 6 Department of Internal Medicine, Daegu Fatima Hospital , Daegu, Republic of Korea
| | - Jeong-Hwan Hwang
- 7 Department of Internal Medicine, Chonbuk National University Medical School , Jeonju, Republic of Korea
| | - Eun Ju Choo
- 8 Department of Internal Medicine, Soonchunhyang University Bucheon Hospital , Bucheon, Republic of Korea
| | - Yoonseon Park
- 9 Department of Internal Medicine, National Health Insurance Service Ilsan Hospital , Goyang, Republic of Korea
| | - Eun Jung Lee
- 10 Department of Internal Medicine, Soonchunhyang University Seoul Hospital , Seoul, Republic of Korea
| | - Young Keun Kim
- 11 Department of Internal Medicine, Yonsei University Wonju College of Medicine , Wonju, Republic of Korea
| | - Min Hyok Jeon
- 12 Department of Internal Medicine, Soonchunhyang University Cheonan Hospital , Cheonan, Republic of Korea
| | - Chisook Moon
- 13 Department of Internal Medicine, Inje University College of Medicine , Busan, Republic of Korea
| | - Joo-Hee Hwang
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Jeong Su Park
- 14 Department of Laboratory Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Kyoung Un Park
- 14 Department of Laboratory Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- 2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Ji Hwan Bang
- 2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea.,15 Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center , Seoul, Republic of Korea
| | - Myoung-Don Oh
- 2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Hong Bin Kim
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
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Saeed K, Bal AM, Gould IM, David MZ, Dryden M, Giannitsioti E, Hijazi K, Meisner JA, Esposito S, Scaglione F, Tattevin P, Voss A. An update on Staphylococcus aureus infective endocarditis from the International Society of Antimicrobial Chemotherapy (ISAC). Int J Antimicrob Agents 2019; 53:9-15. [PMID: 30240836 DOI: 10.1016/j.ijantimicag.2018.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/13/2018] [Accepted: 09/16/2018] [Indexed: 12/18/2022]
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Faridi A, Kareshk AT, Fatahi-Bafghi M, Ziasistani M, Ghahraman MRK, Seyyed-Yousefi SZ, Shakeri N, Kalantar-Neyestanaki D. Detection of methicillin-resistant Staphylococcus aureus (MRSA) in clinical samples of patients with external ocular infection. Iran J Microbiol 2018; 10:215-219. [PMID: 30483372 PMCID: PMC6243151] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Staphylococcus aureus is the main Gram-positive bacteria isolated from patients with ocular infections. Herein, we describe the pattern of antibiotic resistance, presence of resistance genes including ermA, ermB, ermC, msrA, mecA and the pvl cytotoxin gene in S. aureus isolates collected from patients with external ocular infection. MATERIALS AND METHODS In this study, 8 S. aureus isolates were collected from 81 patients that suffered from eye damage. Antibacterial susceptibility of isolates was determined using the Kirby-Bauer disk diffusion method. Resistance genes including ermA, ermB, ermC, msrA, mecA and the pvl virulence gene were detected by PCR method. Staphylococcal cassette chromosome mec (SCCmec) in MRSA isolates were detected by the multiplex-PCR method. RESULTS Three isolates were resistant to cefoxitin which is considered MRSA. The mecA gene was identified in MRSA isolates. SCCmec type IV and the pvl gene were detected in one of the MRSA isolates that was recovered from a diabetic patient. CONCLUSION The emergence of S. aureus isolates belonging to SCCmec type IV and pvl gene among patients with ocular infection is very serious; therefore, identify genetic characterization of MRSA isolates for empirical therapy and infection control is very important.
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Affiliation(s)
- Ashkan Faridi
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Amir Tavakoli Kareshk
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mehdi Fatahi-Bafghi
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahsa Ziasistani
- Pathology and Stem Cell Research Center, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Noshin Shakeri
- Shahid Labafi Nejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Kalantar-Neyestanaki
- Department of Microbiology and Virology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran,Corresponding author: Davood Kalantar-Neyestanaki, Ph.D, Department of Microbiology and Virology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran. Tel/Fax: +98 34 332 57665,
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Olaniyi RO, Pancotto L, Grimaldi L, Bagnoli F. Deciphering the Pathological Role of Staphylococcal α-Toxin and Panton-Valentine Leukocidin Using a Novel Ex Vivo Human Skin Model. Front Immunol 2018; 9:951. [PMID: 29867940 PMCID: PMC5953321 DOI: 10.3389/fimmu.2018.00951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/29/2017] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus alpha-toxin and Panton-Valentine leukocidin (PVL) have been reported to play critical roles in different animal models of skin infection. These models, however, do not completely recapitulate the human disease due to the host specificity of these toxins as well as the intrinsic anatomical and immunological differences between animals and humans. Human skin explants represent a valid alternative to animal models for studying skin infections. Herein, we developed a human skin explant wound model to study the pathogenic role of alpha-toxin and PVL; inflammatory responses elicited by these toxins; and the neutralizing ability of antibodies to mitigate skin damage. Different concentrations of alpha-toxin and/PVL were applied to superficial wounds on human skin explants. Treatment with alpha-toxin resulted in high tissue toxicity and loss of skin epithelial integrity. PVL induced a milder but significant toxicity with no loss of skin structural integrity. The combination of both toxins resulted in increased tissue toxicity as compared with the individual toxins alone. Treatment of the skin with these toxins also resulted in a decrease of CD45-positive cells in the epidermis. In addition, both toxins induced the release of pro-inflammatory cytokines and chemokines. Finally, antibodies raised against alpha-toxin were able to mitigate tissue toxicity in a concentration-dependent manner. Results from this study confirm the key role of α-toxin in staphylococcal infection of the human skin and suggest a possible cooperation of the two toxins in tissue pathology.
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Affiliation(s)
| | | | - Luca Grimaldi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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17
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Garbacz K, Piechowicz L, Podkowik M, Mroczkowska A, Empel J, Bania J. Emergence and spread of worldwide Staphylococcus aureus clones among cystic fibrosis patients. Infect Drug Resist 2018; 11:247-255. [PMID: 29503574 PMCID: PMC5826090 DOI: 10.2147/idr.s153427] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to assess the relatedness of molecular types of Staphylococcus aureus isolates colonizing cystic fibrosis (CF) patients with their antimicrobial resistance and prevalence of toxin genes. Methods A total of 215 isolates from the airways of 107 patients with CF were tested for spa and SCCmec type, antimicrobial resistance and carriage of toxin genes. Results t015, t084, t091, t700 and t002 were the largest group (approximately 25%) among all 69 identified spa types. Five new spa types, t14286, t14287, t14288, t14289 and t14290, were identified and registered. Isolates from CF patients were clustered into 11 multi-locus sequence typing clonal complexes, with CC30, CC22, CC97, CC45, CC15 and CC5 being the most frequent ones. Twelve (5.6%) methicillin-resistant S. aureus (MRSA) isolates and 102 (47.7%) multidrug-resistant isolates were identified, along with three SCCmec types (I, III and V). All isolates (both MRSA and methicillin-sensitive S. aureus) were Panton–Valentine leucocidin-negative, and 56.7% harbored egc genes. This was the first study documenting the presence of ST398-V-t571 livestock-associated MRSA in a European patient with CF. Conclusion These findings imply that individuals with CF can also be colonized with animal-related ST398 MRSA, and justify constant monitoring of staphylococcal colonization and identification of epidemic S. aureus clones in this group.
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Affiliation(s)
- Katarzyna Garbacz
- Department of Oral Microbiology, Medical University of Gdansk, Gdansk, Poland
| | - Lidia Piechowicz
- Department of Medical Microbiology, Medical University of Gdansk, Gdansk, Poland
| | - Magdalena Podkowik
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Aneta Mroczkowska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Joanna Empel
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Jacek Bania
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
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Saeed K, Gould I, Esposito S, Ahmad-Saeed N, Ahmed SS, Alp E, Bal AM, Bassetti M, Bonnet E, Chan M, Coombs G, Dancer SJ, David MZ, De Simone G, Dryden M, Guardabassi L, Hanitsch LG, Hijazi K, Krüger R, Lee A, Leistner R, Pagliano P, Righi E, Schneider-Burrus S, Skov RL, Tattevin P, Van Wamel W, Vos MC, Voss A. Panton-Valentine leukocidin-positive Staphylococcus aureus: a position statement from the International Society of Chemotherapy. Int J Antimicrob Agents 2017; 51:16-25. [PMID: 29174420 DOI: 10.1016/j.ijantimicag.2017.11.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/11/2017] [Accepted: 11/09/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Kordo Saeed
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke & Winchester, UK and University of Southampton Medical School, Southampton, UK.
| | - Ian Gould
- Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - Silvano Esposito
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Nusreen Ahmad-Saeed
- Public Health England-Southampton and University of Southampton, Southampton, UK
| | - Salman Shaheer Ahmed
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Abhijit M Bal
- Department of Microbiology, University Hospital Crosshouse, NHS Ayrshire & Arran & Honorary Clinical Senior Lecturer Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Eric Bonnet
- Department of Infectious Diseases, Hôpital Joseph Ducuing, Toulouse, France
| | - Monica Chan
- Department of Infectious Diseases, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore and Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
| | - Geoffrey Coombs
- School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| | | | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Giuseppe De Simone
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Matthew Dryden
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke & Winchester, UK and University of Southampton Medical School, Southampton, UK; Rare and Imported Pathogens Department, Public Health England, UK
| | - Luca Guardabassi
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Leif G Hanitsch
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karolin Hijazi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Renate Krüger
- Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andie Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Pasquale Pagliano
- AORN dei Colli, D. Cotugno Hospital, Department of Infectious Diseases, Naples, Italy
| | - Elda Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | | | - Robert Leo Skov
- MVZ Synlab, Leverkusen, Department of Clinical Microbiology, Leverkusen, Germany and Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 35033 Rennes cedex, France
| | - Willem Van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Centre and Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Rozencwajg S, Bréchot N, Schmidt M, Hékimian G, Lebreton G, Besset S, Franchineau G, Nieszkowska A, Leprince P, Combes A, Luyt CE. Co-infection with influenza-associated acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Int J Antimicrob Agents 2017; 51:427-433. [PMID: 29174419 DOI: 10.1016/j.ijantimicag.2017.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 08/15/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 12/19/2022]
Abstract
The co-infection frequency and impact among influenza-associated acute respiratory distress syndrome (ARDS) patients requiring extracorporeal membrane oxygenation (ECMO) are not known. This retrospective observational analysis concerned data prospectively collected from patients admitted to our medical intensive care unit (ICU) who received ECMO support for influenza-associated ARDS between 2009-2016. Co-infection was defined as occurring within 48 h following ICU admission. Among the 77 ARDS patients requiring ECMO support, 39 (51%) developed co-infections, with Staphylococcus aureus [18 (46%) of the co-infected patients] being the most prevalent pathogen. Panton-Valentin leukocidin (PVL)-producing S. aureus was isolated from 10 patients (56% of S. aureus co-infections and 26% of all co-infections). Co-infected patients were comparable with those without co-infection, except for BMI, initial disease severity and antibiotic treatment prior to admission. Co-infection was associated with higher in-ICU mortality (62% vs. 29%; P = 0.006) and with fewer ECMO-free days [median (IQR) 0 (0-19) vs. 23 (0-46); P = 0.004] and fewer mechanical ventilation-free days [0 (0-0) vs. 6 (0-35); P = 0.003] on Day 60. Multivariable analysis retained age >49 years, pre-ECMO Simplified Acute Physiology Score (SAPS) II score >70 and co-infection as independent predictors of hospital mortality. In conclusion, co-infection is frequent in ECMO-treated patients with influenza-associated ARDS, affecting ca. 50%, and is independently associated with poor outcome. Staphylococcus aureus was the most frequently identified pathogen, with a high rate of PVL-positive S. aureus. Whether specific therapy targeting PVL-producing S. aureus should be given remains to be determined.
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Affiliation(s)
- Sacha Rozencwajg
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Nicolas Bréchot
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Schmidt
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Guillaume Hékimian
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Lebreton
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sébastien Besset
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Franchineau
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ania Nieszkowska
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pascal Leprince
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Combes
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Charles-Edouard Luyt
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
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Syed MA, Shah SHH, Sherafzal Y, Shafi-Ur-Rehman S, Khan MA, Barrett JB, Woodley TA, Jamil B, Abbasi SA, Jackson CR. Detection and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus from Table Eggs in Haripur, Pakistan. Foodborne Pathog Dis 2017; 15:86-93. [PMID: 29068720 DOI: 10.1089/fpd.2017.2336] [Citation(s) in RCA: 12] [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] [Indexed: 11/13/2022] Open
Abstract
Table eggs are nutritionally important food consumed globally. Despite being protected inside the hard shell and a semipermeable membrane, the egg contents may be contaminated with microbes and thus become a possible carrier of infectious agents to humans. A number of medically significant bacterial species such as Salmonella enterica, Listeria monocytogenes, and Yersinia enterocolitica have already been reported from table eggs. More important is the presence of antimicrobial-resistant bacterial strains in this food source. The present study was aimed at detection and characterization of Staphylococcus aureus from table eggs collected from different retail shops in Haripur city of Pakistan. Staphylococci were isolated from 300 eggs collected from December 2015 to May 2016. S. aureus isolates were tested for antimicrobial susceptibility using broth microdilution and characterized using pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec) typing, and spa typing. The presence of Panton-Valentine leukocidin and antimicrobial resistance genes were detected using PCR. Staphylococci were isolated from 21.3% (64/300) of the table eggs tested. Of those, 59% (38/64) were identified as S. aureus, of which 33 (86.8%) were positive for mecA (MRSA, methicillin-resistant S. aureus). All MRSA were multidrug resistant (resistant to two or more antimicrobial classes), contained aac-aph (encoding aminoglycosides), and were pvl+. Using MLST, spa typing, and SCCmec typing, three genotypic patterns were assigned: ST8-t8645-MRSA-IV, associated with USA300; and ST772-t657-MRSA-IV and ST772-t8645-MRSA-IV, both characteristic of the Bengal Bay community-associated MRSA clone. Molecular typing by PFGE revealed that the bacterial population was highly homogenous with only two patterns observed. This study is the first report of detection of human-associated pvl+ MRSA from table eggs. The genetic similarities of MRSA present in the eggs to that of humans may suggest human to poultry transmission of MRSA via contamination.
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Affiliation(s)
- Muhammad Ali Syed
- 1 Department of Microbiology, University of Haripur , Haripur, Pakistan
| | | | - Yasmin Sherafzal
- 1 Department of Microbiology, University of Haripur , Haripur, Pakistan
| | | | | | - John B Barrett
- 2 Bacterial Epidemiology and Antimicrobial Resistance Research Unit, U.S. National Poultry Research Center, USDA-ARS , Athens, Georgia
| | - Tiffanie A Woodley
- 2 Bacterial Epidemiology and Antimicrobial Resistance Research Unit, U.S. National Poultry Research Center, USDA-ARS , Athens, Georgia
| | - Bushra Jamil
- 3 Department of Biosciences, COMSATS Institute of Information Technology , Islamabad, Pakistan
| | | | - Charlene R Jackson
- 2 Bacterial Epidemiology and Antimicrobial Resistance Research Unit, U.S. National Poultry Research Center, USDA-ARS , Athens, Georgia
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21
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Manafi A, Khodabandehloo M, Rouhi S, Ramazanzadeh R, Shahbazi B, Narenji H. Molecular Epidemiology Survey of Staphylococcus aureus Panton-Valentine Leukocidin-positive Isolated from Sanandaj, Iran. Adv Biomed Res 2017; 6:87. [PMID: 28828338 PMCID: PMC5549542 DOI: 10.4103/abr.abr_243_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 12/01/2022] Open
Abstract
Background: Staphylococcus aureus strains that are Panton–Valentine leukocidin (PVL) positive cause severe skin and soft tissue infections as well as necrotizing pneumonia. The presence of PVL gene is a marker for methicillin-resistant S. aureus; therefore, survey on prevalence and phylogenetic distribution of PVL is of great importance for public health. The aim of this research was molecular epidemiology survey of S. aureus PVL positive, isolated from two tertiary hospitals of Sanandaj. Materials and Methods: A total of 264 staphylococci isolates were collected from clinical specimens, hospital personnel and hospital environment of two tertiary hospitals of Sanandaj, in 2012 (Toohid and Besat). Bacterial cultures and biochemical tests were performed for S. aureus detection. Then, polymerase chain reaction (PCR) and repetitive sequence-based PCR (rep-PCR) were used for the determination of prevalence and molecular epidemiology of S. aureus PVL, respectively. Data were analyzed using the Fisher's exact test (P < 0.05). Results: From 264 staphylococci isolates, 88 (33.33%) were detected as S. aureus. Furthermore, 20 out of 88 (22.72%) strains of S. aureus were PVL positive according to PCR results. Rep-PCR showed six main clusters of S. aureus samples. PVL had similar clonality between different samples. No significant relationship was observed between PVL positive S. aureus and rep-PCR patterns (P = 0.98). Conclusion: These results showed that a clone of S. aureus PVL positive has spread between the community and hospital settings. Therefore, appropriate measures are required to prevent the spread of staphylococci and other bacteria in hospitals.
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Affiliation(s)
- Abbas Manafi
- Form the Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mazaher Khodabandehloo
- Cellular and Molecular Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Samaneh Rouhi
- Form the Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Cellular and Molecular Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Rashid Ramazanzadeh
- Cellular and Molecular Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Babak Shahbazi
- Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hanar Narenji
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Togashi A, Aung MS, Yoto Y, Akane Y, Tsugawa T, Kawaguchiya M, Tsutsumi H, Kobayashi N. First report of Panton-Valentine leukocidin-positive methicillin-susceptible Staphylococcus aureus ST88 harbouring ΦSa2usa isolated from refractory breast abscesses in Japan. New Microbes New Infect 2016; 13:62-4. [PMID: 27453786 PMCID: PMC4941198 DOI: 10.1016/j.nmni.2016.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/27/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022] Open
Abstract
A methicillin-susceptible Staphylococcus aureus with Panton–Valentine leukocidin (PVL) genes was isolated from refractory breast abscesses of 12-year-old girl in Japan, and classified into ST88, spa-t1245 and coa-IIIa. This strain harboured PVL phage ΦSa2usa, which is usually found in ST8 community-acquired methicillin-resistant S. aureus clone USA300.
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Affiliation(s)
- A Togashi
- Department of Paediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M S Aung
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Y Yoto
- Department of Paediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Y Akane
- Department of Paediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - T Tsugawa
- Department of Paediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M Kawaguchiya
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - H Tsutsumi
- Department of Paediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - N Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
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23
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Muhlebach MS, Heltshe SL, Popowitch EB, Miller MB, Thompson V, Kloster M, Ferkol T, Hoover WC, Schechter MS, Saiman L; STAR-CF Study Team. Multicenter Observational Study on Factors and Outcomes Associated with Various Methicillin-Resistant Staphylococcus aureus Types in Children with Cystic Fibrosis. Ann Am Thorac Soc 2015; 12:864-71. [PMID: 25745825 DOI: 10.1513/AnnalsATS.201412-596OC] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Methicillin-resistant Staphylococcus aureus (MRSA) prevalence continues to increase in patients with cystic fibrosis (CF) in the United States, reaching 26.5% in 2012. Approximately 30% of strains are SCCmec (staphylococcal cassette chromosome mec) IV type, frequently USA300, which in the general population have different genotypic and phenotypic features than SCCmec II type. OBJECTIVES We hypothesized that risk factors for acquisition and outcomes in patients with CF differed for "health care-associated" (SCCmec II) versus "community-associated" (SCCmec IV) MRSA strains. METHODS To determine the role of SCCmec type and Panton-Valentine leukocidin (PVL), MRSA isolates from patients not more than 18 years old at seven CF centers were typed and the association of potential risk factors and subsequent clinical course was assessed, using data provided by the CF Patient Registry. MEASUREMENTS AND MAIN RESULTS Participants with chronic MRSA (295) had typeable isolates and clinical data; 205 (69.5%) had SCCmec II PVL(-), 39 (13.2%) had SCCmec IV PVL(-), and 51 (17.3%) had SCCmec IV PVL(+) strains. SCCmec IV, compared with SCCmec II, increased during the study period, 1996-2010 (P = 0.03). SCCmec II was associated with Pseudomonas aeruginosa-positive cultures and three or more clinic visits in the 6 months preceding the first positive MRSA culture (adjusted odds ratio, 2.05; 95% confidence interval, 1.13-3.74; P = 0.019). Lung function and anthropometrics remained unchanged in the 6 months after initial MRSA detection compared with the 6 months prior. Although CF care increased for participants in both groups in the 6 months after MRSA detection, inhaled antibiotics were prescribed more frequently in those with SCCmec II strains and increased hospitalizations occurred in those with SCCmec IV PVL(-) strains compared with those with PVL(+) strains (adjusted difference, 34.10%; 95% confidence interval, 7.58-60.61; P = 0.012). Participants in both groups had an increase in CF care in the 2 years after MRSA detection compared with the 2 years prior. CONCLUSIONS Increased exposure to CF clinics and P. aeruginosa may constitute risk factors for acquisition of SCCmec II MRSA strains. Clinical interventions increased 6 months and 2 years after initial MRSA detection regardless of SCCmec type.
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24
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Vignaroli C, Di Sante L, Stano P, Varaldo PE, Camporese A. Recurrent skin infection associated with nasal carriage of Panton-Valentine leukocidin-positive methicillin-susceptible Staphylococcus aureus closely related to the EMRSA-15 clone. Future Microbiol 2015; 11:17-21. [PMID: 26674061 DOI: 10.2217/fmb.15.125] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report the case of a soldier with recurrent skin infection associated with nasal carriage of a Panton-Valentine leukocidin (PVL)-producing methicillin-susceptible Staphylococcus aureus (MSSA), closely related to the EMRSA-15 clone. MSSA isolates causing infection not requiring hospitalization usually go unnoticed; however, their typing may be useful to understand the global distribution of successful staphylococcal lineages related to epidemic clones. PVL-positive MSSA strains might serve as reservoirs from which virulent methicillin-resistant strains may evolve and spread.
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Affiliation(s)
- Carla Vignaroli
- Dipartimento di Scienze della Vita e dell'Ambiente, Università Politecnica delle Marche, via Brecce Bianche, 60131 Ancona, Italy
| | - Laura Di Sante
- Dipartimento di Scienze della Vita e dell'Ambiente, Università Politecnica delle Marche, via Brecce Bianche, 60131 Ancona, Italy
| | - Paola Stano
- S.C. Microbiologia Clinica e Virologia, Azienda per l'Assistenza Sanitaria N.5 'Friuli Occidentale', Presidio Ospedaliero di Pordenone, Pordenone, Italy
| | - Pietro E Varaldo
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Camporese
- S.C. Microbiologia Clinica e Virologia, Azienda per l'Assistenza Sanitaria N.5 'Friuli Occidentale', Presidio Ospedaliero di Pordenone, Pordenone, Italy
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25
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Rovira G, Cooke EF, Mucavele H, Sitoe A, Madrid L, Nhampossa T, Garrine M, Massora S, Cossa A, Mandomando I, Bassat Q. The Challenge of Diagnosing and Treating Staphylococcus aureus Invasive Infections in a Resource-limited Sub-Saharan Africa Setting: A Case Report. J Trop Pediatr 2015; 61:397-402. [PMID: 26187541 DOI: 10.1093/tropej/fmv045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Community-acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA) is responsible for the majority of skin and soft-tissue infections. CA-MSSA can also cause life-threatening infections, possibly in relation to particular virulence factors, including Panton-Valentine leukocidin (PVL). METHODS We describe a severe CA-MSSA necrotizing pneumonia complicated with multifocal osteomyelitis, pericardial effusion and endocarditis in a 6-year-old boy admitted to a Mozambican hospital. Staphylococcus aureus isolation and antibiotic susceptibility testing were performed by conventional microbiology. Additionally, microarray assay was used for molecular characterization. RESULTS Blood culture confirmed the presence of S. aureus susceptible to most antimicrobial agents, including methicillin. Molecular characterization confirmed the presence of PVL, together with alpha and beta haemolysin genes. CONCLUSIONS To our knowledge, this is the first reported case of disseminated CA-MSSA disease with confirmed PVL exotoxin in sub-Saharan Africa. PVL-positive CA-MSSA should be considered in the differential diagnosis of community-acquired pneumonia, making laboratory testing a higher priority.
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Affiliation(s)
- Gemma Rovira
- EAP Sardenya-Hospital de la Santa Creu i Sant Pau, Barcelona, 08025, Spain
| | - Elisa F Cooke
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital 12 de Octubre, Madrid, 28041, Spain
| | - Helio Mucavele
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Lola Madrid
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, 08036, Spain
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique, CP264
| | - Marcelino Garrine
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Sergio Massora
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique, CP264
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, 08036, Spain
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26
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Nurjadi D, Schäfer J, Friedrich-Jänicke B, Mueller A, Neumayr A, Calvo-Cano A, Goorhuis A, Molhoek N, Lagler H, Kantele A, Van Genderen PJJ, Gascon J, Grobusch MP, Caumes E, Hatz C, Fleck R, Mockenhaupt FP, Zanger P. Predominance of dfrG as determinant of trimethoprim resistance in imported Staphylococcus aureus. Clin Microbiol Infect 2015; 21:1095.e5-9. [PMID: 26344335 DOI: 10.1016/j.cmi.2015.08.021] [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: 05/19/2015] [Revised: 07/09/2015] [Accepted: 08/25/2015] [Indexed: 12/11/2022]
Abstract
To investigate the global occurrence of trimethoprim-sulfamethoxazole resistance and the genetic mechanisms of trimethoprim resistance, we analysed Staphylococcus aureus from travel-associated skin and soft-tissue infections treated at 13 travel clinics in Europe. Thirty-eight per cent (75/196) were trimethoprim-resistant and 21% (41/196) were resistant to trimethoprim-sulfamethoxazole. Among methicillin-resistant S. aureus, these proportions were 30% (7/23) and 17% (4/23), respectively. DfrG explained 92% (69/75) of all trimethoprim resistance in S. aureus. Travel to South Asia was associated with the highest risk of acquiring trimethoprim-sulfamethoxazole-resistant S. aureus. We conclude that globally dfrG is the predominant determinant of trimethoprim resistance in human S. aureus infection.
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Affiliation(s)
- D Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany.
| | - J Schäfer
- Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany
| | - B Friedrich-Jänicke
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Mueller
- Missionsärztliche Klinik, Würzburg, Germany
| | - A Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - A Calvo-Cano
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Goorhuis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - N Molhoek
- Instituut voor Tropische Ziekten, Havenziekenhuis, Rotterdam, The Netherlands
| | - H Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - A Kantele
- Department of Medicine, University of Helsinki, Finland; Inflammation Centre, Clinic of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - P J J Van Genderen
- Instituut voor Tropische Ziekten, Havenziekenhuis, Rotterdam, The Netherlands
| | - J Gascon
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - E Caumes
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - C Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - R Fleck
- Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany
| | - F P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Zanger
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany; Institute of Public Health, Unit of Epidemiology and Biostatistics, Heidelberg University Hospital, Heidelberg, Germany
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27
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Rájová J, Pantůček R, Petráš P, Varbanovová I, Mašlaňová I, Beneš J. Necrotizing pneumonia due to clonally diverse Staphylococcus aureus strains producing Panton-Valentine leukocidin: the Czech experience. Epidemiol Infect 2016; 144:507-15. [PMID: 26201459 DOI: 10.1017/S0950268815001521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A prospective study (2007-2013) was undertaken to investigate clinical features and prognostic factors of necrotizing pneumonia caused by Staphylococcus aureus producing Panton-Valentine leukocidin (PVL) in the Czech Republic. Twelve cases of necrotizing pneumonia were detected in 12 patients (median age 25 years) without severe underlying disease. Eight cases occurred in December and January and the accumulation of cases in the winter months preceding the influenza season was statistically significant (P < 0·001). The course of pneumonia was very rapid, leading to early sepsis and/or septic shock in all but one patient. Seven patients died and mortality was fourfold higher in those patients presenting with primary pneumonia than with pneumonia complicating other staphylococcal/pyogenic infection elsewhere in the body. The S. aureus isolates displayed considerable genetic variability and were assigned to five lineages CC8 (n = 3), CC15 (n = 2), CC30 (n = 2), CC80 (n = 1), and CC121 (n = 3) and one was a singleton of ST154 (n = 1), all were reported to be associated with community-acquired infection. Four strains were methicillin resistant. The high case-fatality rate can only be reduced by improving the speed of diagnosis and a rapid test to detect S. aureus in the airways is needed.
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28
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Schaumburg F, Gast B, Sannon H, Mellmann A, Becker K. Is Africa the origin of major Haitian Staphylococcus aureus lineages? Int J Infect Dis 2015; 34:1-2. [PMID: 25722279 DOI: 10.1016/j.ijid.2015.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/18/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
| | - Birgit Gast
- Albert Schweitzer Hospital, Deschapelles, Haiti
| | | | | | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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29
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Nurjadi D, Friedrich-Jänicke B, Schäfer J, Van Genderen PJJ, Goorhuis A, Perignon A, Neumayr A, Mueller A, Kantele A, Schunk M, Gascon J, Stich A, Hatz C, Caumes E, Grobusch MP, Fleck R, Mockenhaupt FP, Zanger P. Skin and soft tissue infections in intercontinental travellers and the import of multi-resistant Staphylococcus aureus to Europe. Clin Microbiol Infect 2015; 21:567.e1-10. [PMID: 25753191 DOI: 10.1016/j.cmi.2015.01.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [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: 11/16/2014] [Revised: 12/28/2014] [Accepted: 01/16/2015] [Indexed: 11/24/2022]
Abstract
Staphylococcus aureus is emerging globally. Treatment of infections is complicated by increasing antibiotic resistance. We collected clinical data and swabs of returnees with skin and soft tissue infections (SSTI) at 13 travel-clinics in Europe (www.staphtrav.eu). Sixty-two percent (196/318) SSTI patients had S. aureus-positive lesions, of which almost two-thirds (122/196) were Panton-Valentine leukocidin (PVL) positive. PVL was associated with disease severity, including hospitalization for SSTI (OR 5.2, 95% CI 1.5-18.2). In returnees with SSTI, longer travel and more intense population contact were risk factors for nasal colonization with PVL-positive S. aureus. Imported S. aureus frequently proved resistant to trimethoprim-sulfamethoxazole (21%), erythromycin (21%), tetracycline (20%), ciprofloxacin (13%), methicillin (12%) and clindamycin (8%). Place of exposure was significantly (p < 0.05) associated with predominant resistance phenotypes and spa genotypes: Latin America (methicillin; t008/CC24/304), Africa (tetracycline, trimethoprim-sulfamethoxazole; t084/CC84, t314/singleton, t355/CC355), South Asia (trimethoprim-sulfamethoxazole, ciprofloxacin; t021/CC21/318), South-East Asia (clindamycin; t159/CC272). USA300-like isolates accounted for 30% of all methicillin-resistant S. aureus imported to Europe and were predominantly (71%) acquired in Latin America. Multi-resistance to non-β-lactams were present in 24% of imports and associated with travel to South Asia (ORcrude 5.3, 95% CI 2.4-11.8), even after adjusting for confounding by genotype (ORadjusted 3.8, 95% 1.5-9.5). Choosing randomly from compounds recommended for the empiric treatment of severe S. aureus SSTI, 15% of cases would have received ineffective antimicrobial therapy. These findings call for the development of regionally stratified guidance on the antibiotic management of severe imported S. aureus disease and put the infected and colonized traveller at the centre of interventions against the global spread of multi-resistant S. aureus.
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Affiliation(s)
- D Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany; Institute of Tropical Medicine, Eberhard Karls Universität, Tübingen, Germany
| | - B Friedrich-Jänicke
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Spandauer Damm, Berlin, Germany
| | - J Schäfer
- Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany
| | - P J J Van Genderen
- Instituut voor Tropische Ziekten, Havenziekenhuis, TG Rotterdam, The Netherlands
| | - A Goorhuis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Perignon
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - A Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - A Mueller
- Missionsärztliche Klinik, Würzburg, Germany
| | - A Kantele
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - M Schunk
- Abteilung für Infektions- und Tropenmedizin der Ludwig-Maximilians-Universität, München, Germany
| | - J Gascon
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Stich
- Missionsärztliche Klinik, Würzburg, Germany
| | - C Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - E Caumes
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - M P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R Fleck
- Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany
| | - F P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Spandauer Damm, Berlin, Germany
| | - P Zanger
- Institute of Tropical Medicine, Eberhard Karls Universität, Tübingen, Germany; Institute of Public Health, Unit of Epidemiology and Biostatistics, Heidelberg University Hospital, Heidelberg, Germany.
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Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has become one of the leading etiologies of nosocomial pneumonia as a result of an increase in staphylococcal infections caused by methicillin-resistant strains paired with extended ventilatory support of critically, and often, chronically ill patients. The prevalence of community-acquired MRSA pneumonia, which historically affects younger patients and is often preceded by an influenza-like illness, is also increasing. A high index of suspicion and early initiation of appropriate antibiotics are key factors for the successful treatment of this disease. Even with early diagnosis and appropriate treatment, MRSA pneumonia still carries an unacceptably high mortality rate. This article will review historical differences between hospital-acquired and community-acquired MRSA pneumonia, as well as, clinical features of, diagnosis and treatment of MRSA pneumonia.
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Affiliation(s)
- Christian Woods
- Medstar Washington Hospital Center, Room 2A-38A, 110 Irving St NW, Washington, DC 20010, USA
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Chen J, Luo Y, Zhang S, Liang Z, Wang Y, Zhang Y, Zhou G, Jia Y, Chen L, She D. Community-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin in a Chinese teenager: case report and literature review. Int J Infect Dis 2014; 26:17-21. [PMID: 24980464 DOI: 10.1016/j.ijid.2014.02.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 01/11/2014] [Revised: 02/22/2014] [Accepted: 02/28/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) has now been established as an important community-acquired pathogen. Although necrotizing pneumonia caused by community-acquired MRSA (CA-MRSA) strains producing Panton-Valentine leukocidin (PVL) has been reported with increasing frequency in many countries, it has been reported in only a few children younger than 1 year of age in Mainland China. METHODS We describe a case of life-threatening necrotizing pneumonia due to PVL-positive CA-MRSA in a 15-year-old previously healthy female who presented with high fever, shivering, a dry cough, and dyspnea. Details of the clinical outcomes, microbiological data, and therapies for this patient were collected and compared with those of cases reported in the literature on CA-MRSA. RESULTS Computed tomography (CT) findings showed cavitary consolidations in both lungs and bilateral pleural effusion. MRSA strains isolated from the patient's sputum and pleural fluid were susceptible to most non-β-lactam antimicrobial agents except for clindamycin and erythromycin. Both of these isolates tested positive for the mecA gene as well as PVL genes, and were identified as ST59-MRSA-SCCmec type IV-spa type t437. The patient was treated successfully with linezolid, fosfomycin, and teicoplanin. CONCLUSIONS To our knowledge, this is the first report from Mainland China of necrotizing pneumonia due to PVL-positive CA-MRSA among those aged older than 1 year. CA-MRSA necrotizing pneumonia should be considered in the differential diagnosis of severe community-acquired pneumonia, particularly in previously healthy individuals.
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Affiliation(s)
- Jie Chen
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China
| | - Yanping Luo
- Department of Microbiology, Chinese People's Liberation Army General Hospital, Beijing, PR China
| | - Shu Zhang
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China
| | - Zhixin Liang
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China
| | - Ying Wang
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China
| | - Ying Zhang
- Department of Microbiology, Chinese People's Liberation Army General Hospital, Beijing, PR China
| | - Guang Zhou
- Department of Microbiology, Chinese People's Liberation Army General Hospital, Beijing, PR China
| | - Yanhong Jia
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China
| | - Liangan Chen
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China.
| | - Danyang She
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China.
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32
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Elisabeth P, Maria S, Irene G, Helen G, Apostolos A. Success stories about severe pneumonia caused by Panton-Valentine leucocidin-producing Staphylococcus aureus. Braz J Infect Dis 2014; 18:341-5. [PMID: 24690428 PMCID: PMC9427482 DOI: 10.1016/j.bjid.2013.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 09/07/2013] [Revised: 11/16/2013] [Accepted: 11/23/2013] [Indexed: 11/16/2022] Open
Abstract
We describe three cases of community-acquired necrotizing pneumonia which were caused by Panton-Valentine leucocidin-producing strains of Staphylococcus aureus (one of them methicillin sensitive). All cases were successfully treated without any sequelae for the patients due to the prompt initiation of adequate antimicrobial therapy. High suspicion toward this fatal pathogen was the key to the successful outcome of the patients.
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Affiliation(s)
| | - Souli Maria
- 4th University Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Galani Irene
- 4th University Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Giamarellou Helen
- 4th University Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Armaganidis Apostolos
- 2nd University Department of Critical Care, Attikon University Hospital, Athens, Greece
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Fritz SA, Tiemann KM, Hogan PG, Epplin EK, Rodriguez M, Al-Zubeidi DN, Bubeck Wardenburg J, Hunstad DA. A serologic correlate of protective immunity against community-onset Staphylococcus aureus infection. Clin Infect Dis 2013; 56:1554-61. [PMID: 23446627 DOI: 10.1093/cid/cit123] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is among the leading causes of human infection. Widespread drug resistance, emergence of highly virulent strains, and the ability of S. aureus to colonize >30% of the human population contribute to this organism's pathogenic success. Human serologic responses to S. aureus and their relationship to protective immunity remain incompletely defined, challenging the strategic development of efficacious vaccines. METHODS We measured humoral responses to 2 staphylococcal exotoxins, α-hemolysin (Hla) and Panton-Valentine leukocidin (PVL; LukF-PV/LukS-PV subunits), both premier targets of current vaccine and immunotherapy development. We correlated acute and convalescent serum antibody levels with incidence of recurrent infection over 12 months follow-up in 235 children with S. aureus colonization, primary or recurrent skin and soft tissue infection, or invasive disease. RESULTS Cutaneous infection elicited transient increases in anti-Hla and anti-PVL antibodies; however, subsequent infection risk was similar between primary and recurrent cutaneous infection cohorts. Patients with invasive infections had the lowest preexisting titers against Hla and LukF but displayed the highest convalescent titers. Across cohorts, convalescent anti-Hla titers correlated with protection against subsequent S. aureus infection. CONCLUSIONS Cutaneous S. aureus infection does not reliably provoke durable, protective immune responses. This study provides the first link between protection from disease recurrence and the humoral response to Hla, a virulence factor already implicated in disease pathogenesis. These observations can be utilized to refine ongoing vaccine and immunotherapy efforts and inform the design of clinical trials.
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Affiliation(s)
- Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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