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D Heuck

Bio: D Heuck is an academic researcher from Robert Koch Institute. The author has contributed to research in topics: Methicillin-resistant Staphylococcus aureus & Panton–Valentine leukocidin. The author has an hindex of 14, co-authored 23 publications receiving 986 citations.

Papers
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Journal ArticleDOI
TL;DR: The value of spa typing in combination with BURP (based upon repeat pattern) grouping analysis as a frontline tool in the epidemiological typing of S. aureus is determined, based on a random collection of clinical isolates sent to the German Reference Centre for Staphylococci within a 6-month period.
Abstract: We determined the value of spa typing in combination with BURP (based upon repeat pattern) grouping analysis as a frontline tool in the epidemiological typing of Staphylococcus aureus, based on a random collection of 1,459 clinical isolates sent to the German Reference Centre for Staphylococci within a 6-month period. The application was found to be helpful for the classification of isolates into the particular clonal lineages currently prevalent in Germany. Due to its major advantages because of the ease of interpretation and the exchangeability of the results, the use of spa typing greatly simplifies communication between laboratories on both the national and the international levels. Thus, it is an excellent tool for national and international surveillance of S. aureus as well as for analysis of the short-term local epidemiology. However, to overcome the limitations of the BURP grouping method in terms of typing accuracy and discriminatory power, the results of the default BURP grouping method must be interpreted with caution. Additional markers, like staphylococcal chromosomal cassette mec, lineage-specific genes, or alternative DNA polymorphisms, are indispensable. They should be selected by dependence on the clonal lineage indicated by spa typing and subsequent BURP analysis as well as on the basis of the particular question to be addressed.

253 citations

Journal ArticleDOI
TL;DR: Investigation of strains of methicillin-resistant Staphylococcus aureus for the presence of the lukS–lukF determinant of Panton–Valentine leukocidin and to further characterize strains found to contain the genes revealed a unique pattern of genomic typing.
Abstract: The aim of the present study was to investigate strains of methicillin-resistant Staphylococcus aureus (MRSA) for the presence of the lukS–lukF determinant of Panton–Valentine leukocidin and to further characterize strains found to contain the genes. During the past 2 years, MRSA containing the lukS–lukF genes for Panton–Valentine leukocidin, particularly those emerging outside of hospitals, have become of interest. MRSA strains sent to the national reference center in Germany were investigated for lukS–lukF by polymerase chain reaction (PCR). If the presence of lukS–lukF was demonstrated, strains were further characterized by molecular typing (determination of SmaI pattern, spa sequence, and multilocus sequence type), PCR demonstration of resistance genes, and characterization of the SCCmec element. Since the end of 2002, MRSA containing Panton–Valentine leukocidin genes have been demonstrated as the causative agent of 28 cases of infection (9 community-acquired cases, 19 sporadic nosocomial cases) in different areas of Germany. Twenty-seven of these 28 isolates exhibited a unique pattern of genomic typing: all exhibited multilocus sequence type 80, spa sequence type 44, and a SmaI macrorestriction pattern that corresponds to a community-acquired strain of MRSA from France and Switzerland. In addition to resistance to oxacillin, the strains exhibited resistance to ciprofloxacin, tetracycline (tetM), and fusidic acid, the last of which is encoded by the far-1 gene. The far-1 gene was shown to be located on the plasmid. One isolate corresponded to community MRSA (cMRSA) of multilocus sequence type 1 from the USA.

137 citations

Journal ArticleDOI
TL;DR: In this paper, the authors attribute Panton-Valentine leucocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA) to clonal lineages by molecular typing with special reference to isolates exhibiting spa type t008/multilocus sequence type (MLST) ST8 [widely disseminated in the USA as ‘community-associated MRSA (caMRSA), USA300’].
Abstract: Objectives: The aim of this paper is to attribute Panton-Valentine leucocidin (PVL)-positive methicillinresistant Staphylococcus aureus (MRSA) to clonal lineages by molecular typing with special reference to isolates exhibiting spa type t008/multilocus sequence type (MLST) ST8 [widely disseminated in the USA as ‘community-associated MRSA (caMRSA) USA300’]. Methods :P VL-positive MRSA (n 5 117) were detected among 4815 MRSA sent to the German National Reference Laboratory for typing. These isolates were analysed by PFGE, spa typing, multilocus sequence typing, grouping of SCCmec elements and PCR detection of arcA, msr(A), mph(B) and the � 6 AT repeat unit in the SACOL0058 sequence. Results: Among the 117 isolates, 80 exhibited spa type t044 (corresponding to MLST ST80) and 23 exhibited spa type t008/MLST ST8. Other spa types were sporadically represented. Further characterization of isolates exhibiting t008/ST8 by PCR [arcA, msr(A), mph(B), � 6 AT repeat signature] indicates the arrival of caMRSA ‘USA300’ in Central Europe. Conclusions: caMRSA ST80 still predominate; however, caMRSA ST8 exhibiting the characteristics of the ‘USA300’ clone became the second most frequent. Routine detection of this clone in clinical bacteriology can be easily performed by PCR.

111 citations

Journal ArticleDOI
TL;DR: Investigation of dermatology outpatients with inflammatory skin diseases, leg ulcers, and skin infections for Panton-Valentine leukocidin (PVL)-positive S. aureus finds far-1-coded FUS resistance represents a typical marker for the widespread CA-MRSA ST080 in Europe, especially in Germany.

64 citations

Journal ArticleDOI
TL;DR: This report describes a successful strategy for terminating the transmission of epidemic strains of S. aureus among a nonhospitalized population in a German village.
Abstract: Background. Skin infections due to Staphylococcus aureus have recently become a public concern, mainly because of emerging resistance against widely used antibiotics and specific virulence determinants. Strains harboring the lukS-lukF gene (which codes for Panton-Valentine leukocidin) are frequently associated with severe furunculosis. Generally applicable strategies for the control of community outbreaks of furunculosis have not been defined. Methods. We report the investigation and successful termination of an outbreak of furunculosis due to lukSlukF–positive S. aureus in a German village ( ). Nasal swab specimens were obtained from village residents. n p 144 A retrospective cohort study was conducted. Nasally colonized persons, persons who had current furuncles or who had experienced relapsing furuncles since 2002, and their family members underwent stringent decolonization measures using mupirocin nasal ointment and disinfecting wash solution. Multiple nasal swab specimens were obtained to monitor the long-term outcome of decolonization measures. Results. From January 1998 through December 2004, 42 cases and 59 relapses of furunculosis were identified by active case finding. Of 140 participants tested, 51 (36%) were found to be nasally colonized with S. aureus .I n 9 participants, the strain was positive for lukS-lukF. No methicillin resistance was detected. Risk of furunculosis was associated with contact with case patients (relative risk, 6.8; 95% confidence interval, 3.2–14.3) and nasal colonization with a lukS-lukF–positive strain of S. aureus (relative risk, 3.6; 95% confidence interval, 2.3–5.9). Passive surveillance implemented in January 2005 did not detect any case of lukS-lukF–positive, S. aureus–associated furuncles in this village. Conclusion. This report describes a successful strategy for terminating the transmission of epidemic strains of S. aureus among a nonhospitalized population.

64 citations


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TL;DR: These guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system infections.
Abstract: Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.

3,370 citations

Journal ArticleDOI
TL;DR: This guideline addresses the wide array of SSTIs that occur in this population and emphasizes the importance of clinical skills in promptly diagnosing SSTI, identifying the pathogen, and administering effective treatments in a timely fashion.
Abstract: A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.

1,856 citations

Journal ArticleDOI
TL;DR: This review details the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection and addresses the therapy of these infections and strategies for their prevention.
Abstract: Summary: Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

1,807 citations

Journal ArticleDOI
TL;DR: In this paper, the authors used sequence typing of the spa gene repeat region to study the epidemiology of MRSA at a German university hospital during two periods of 10 and 4 months, respectively.
Abstract: The spa gene of Staphylococcus aureus encodes protein A and is used for typing of methicillin-resistant Staphylococcus aureus (MRSA) We used sequence typing of the spa gene repeat region to study the epidemiology of MRSA at a German university hospital One hundred seven and 84 strains were studied during two periods of 10 and 4 months, respectively Repeats and spa types were determined by Ridom StaphType, a novel software tool allowing rapid repeat determination, data management and retrieval, and Internet-based assignment of new spa types following automatic quality control of DNA sequence chromatograms Isolates representative of the most abundant spa types were subjected to multilocus sequence typing and pulsed-field gel electrophoresis One of two predominant spa types was replaced by a clonally related variant in the second study period Ten unique spa types, which were equally distributed in both study periods, were recovered The data show a rapid dynamics of clone circulation in a university hospital setting spa typing was valuable for tracking of epidemic isolates The data show that disproval of epidemiologically suggested transmissions of MRSA is one of the main objectives of spa typing in departments with a high incidence of MRSA

1,544 citations

Journal ArticleDOI
TL;DR: The biochemistry of the bacterial cell can accommodate the challenges from the host and agents that interfere with bacterial iron metabolism may prove extremely valuable for chemotherapy of diseases.
Abstract: ▪ Abstract The ability of pathogens to obtain iron from transferrins, ferritin, hemoglobin, and other iron-containing proteins of their host is central to whether they live or die. To combat invading bacteria, animals go into an iron-withholding mode and also use a protein (Nramp1) to generate reactive oxygen species in an attempt to kill the pathogens. Some invading bacteria respond by producing specific iron chelators—siderophores—that remove the iron from the host sources. Other bacteria rely on direct contact with host iron proteins, either abstracting the iron at their surface or, as with heme, taking it up into the cytoplasm. The expression of a large number of genes (>40 in some cases) is directly controlled by the prevailing intracellular concentration of Fe(II) via its complexing to a regulatory protein (the Fur protein or equivalent). In this way, the biochemistry of the bacterial cell can accommodate the challenges from the host. Agents that interfere with bacterial iron metabolism may prove ex...

1,452 citations