Antibiotic resistance in staphylococci.
TL;DR: Few anti-staphylococcal agents were launched from 1970 to 1995, but the situation is now improving, and S. aureus is a resilient foe, able to regain its importance if drugs are used profligately or if hygiene is slackened.
About: This article is published in International Journal of Antimicrobial Agents.The article was published on 2000-11-01. It has received 448 citations till now. The article focuses on the topics: Teicoplanin & Antibiotic resistance.
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TL;DR: A novel multiplex PCR assay allowing for concomitant detection of the methicillin resistance (mecA gene) to facilitate detection and classification of all currently described SCCmec types and subtypes I, II, III, IVa, b, c, d, and V is demonstrated.
Abstract: Staphylococcal cassette chromosome mec (SCCmec) typing is essential for understanding the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA). SCCmec elements are currently classified into types I to V based on the nature of the mec and ccr gene complexes, and are further classified into subtypes according to their junkyard region DNA segments. Previously described traditional SCCmec PCR typing schemes require multiple primer sets and PCR experiments, while a previously published multiplex PCR assay is limited in its ability to detect recently discovered types and subtypes such as SCCmec type V and subtypes IVa, b, c, and d. We designed new sets of SCCmec type- and subtype-unique and specific primers and developed a novel multiplex PCR assay allowing for concomitant detection of the methicillin resistance (mecA gene) (also serving as an internal control) to facilitate detection and classification of all currently described SCCmec types and subtypes I, II, III, IVa, b, c, d, and V. Our assay demonstrated 100% sensitivity and specificity in accurately characterizing 54 MRSA strains belonging to the various known SCCmec types and subtypes, when compared with previously described typing methods. Further application of our assay in 453 randomly selected local clinical isolates confirmed its feasibility and practicality. This novel assay offers a rapid, simple, and feasible method for SCCmec typing of MRSA, and may serve as a useful tool for clinicians and epidemiologists in their efforts to prevent and control infections caused by this organism.
1,028 citations
Cites background from "Antibiotic resistance in staphyloco..."
...Methicillin, the first semisynthetic penicillin to be developed, was introduced in 1959 to overcome the problem of penicillin-resistant Staphylococcus aureus due to -lactamase (penicillinase) production (17)....
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TL;DR: The evidence that better prescribing can reduce resistance rates is mixed, and although changes to hospital regimens may reduce one resistance problem, other opportunistic bacteria may fill the vacant niche; the best that can reasonably be anticipated is an improved balance between the accumulation of resistance and new antibacterial development.
Abstract: The basic mechanisms of antibacterial resistance are well known, but critical new aspects continue to be discovered. Recently discovered factors with major implications for the emergence, dissemination, and maintenance of resistance include multidrug efflux, hypermutability, integrons, and plasmid addiction. Some resistances are widespread and others local, with prevalence rates often worst in newly prosperous countries and in those specialist units where antibacterial use is heaviest. Multidrug-resistant epidemic strains are critical to the total accumulation of resistance (e.g., among Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae), but it remains unclear why some bacterial lineages achieve epidemic spread whereas others that are equally resistant do not. The correlation between in vitro resistance and treatment failure is imperfect, but resistance undoubtedly increases mortality, morbidity, and costs in many settings. Recent concern has led to a plethora of governmental and agency reports advocating less antibacterial use, better antibacterial use, better infection control, and the development of new antibacterials. The evidence that better prescribing can reduce resistance rates is mixed, and although changes to hospital regimens may reduce one resistance problem, other opportunistic bacteria may fill the vacant niche. Overall, the best that can reasonably be anticipated is an improved balance between the accumulation of resistance and new antibacterial development.
569 citations
Cites background from "Antibiotic resistance in staphyloco..."
...aureus lineages, and among different coagulase-negative species [35]....
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TL;DR: Methicillin-resistant Staphylococcus aureus has undergone rapid evolutionary changes and epidemiologic expansion and has led to an important change in the choice of antibiotics in the management of community-acquired infections and has also led to the development of novel antimicrobials.
Abstract: Methicillin-resistant Staphylococcus aureus, first identified just over 4 decades ago, has undergone rapid evolutionary changes and epidemiologic expansion. It has spread beyond the confines of health care facilities, emerging anew in the community, where it is rapidly becoming a dominant pathogen. This has led to an important change in the choice of antibiotics in the management of community-acquired infections and has also led to the development of novel antimicrobials.
467 citations
Cites background from "Antibiotic resistance in staphyloco..."
...aureus, although in the presence of constitutive expression of macrolide-lincosamide-streptogramin resistance, it is only bacteriostatic [65]....
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TL;DR: Data suggest that CA-MRSA strains may represent a new acquisition of SCCmec DNA in a previously susceptible genetic background that was capable of causing nmTSS via superantigen production.
Abstract: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a growing public health concern that has been associated with pediatric fatalities. It is hypothesized that the evolution of CA-MRSA is a recent event due to the acquisition of mec DNA by previously methicillin-susceptible strains that circulated in the community. This study investigated the genetic relatedness between CA-MRSA, hospital-associated MRSA (HA-MRSA), and nonmenstrual toxic shock syndrome (nmTSS) isolates. Thirty-one of 32 CA-MRSA isolates were highly related as determined by pulsed-field gel electrophoresis and spa typing yet were distinguishable from 32 HA-MRSA strains. The 31 related CA-MRSA isolates produced either staphylococcal enterotoxin B (n = 5) or C (n = 26), and none made TSS toxin 1. All CA-MRSA isolates tested contained a type IV staphylococcal cassette chromosome mec (SCCmec) element. In comparison, none of the HA-MRSA isolates (n = 32) expressed the three superantigens. Antibiotic susceptibility patterns were different between the CA-MRSA and HA-MRSA isolates; CA-MRSA was typically resistant only to β-lactam antibiotics. Six of twenty-one nmTSS isolates were indistinguishable or highly related to the CA-MRSA isolates. MnCop, an nmTSS isolate obtained in Alabama in 1986, was highly related to the CA-MRSA isolates except that it did not contain an SCCmec element. These data suggest that CA-MRSA strains may represent a new acquisition of SCCmec DNA in a previously susceptible genetic background that was capable of causing nmTSS. CA-MRSA poses a serious health risk not only because it is resistant to the antibiotics of choice for community-acquired staphylococcal infections but also because of its ability to cause nmTSS via superantigen production.
370 citations
TL;DR: As selective pressure from β-lactam use continues, multiple β-Lactamases per organism are increasingly common, including pathogens carrying three different carbapenemase genes, warranting close attention to increased infection control measures and stewardship of the β- lactam-containing drugs in an effort to control selection of even more deleterious pathogens.
Abstract: SUMMARY β-Lactam antibiotics have been widely used as therapeutic agents for the past 70 years, resulting in emergence of an abundance of β-lactam-inactivating β-lactamases. Although penicillinases in Staphylococcus aureus challenged the initial uses of penicillin, β-lactamases are most important in Gram-negative bacteria, particularly in enteric and nonfermentative pathogens, where collectively they confer resistance to all β-lactam-containing antibiotics. Critical β-lactamases are those enzymes whose genes are encoded on mobile elements that are transferable among species. Major β-lactamase families include plasmid-mediated extended-spectrum β-lactamases (ESBLs), AmpC cephalosporinases, and carbapenemases now appearing globally, with geographic preferences for specific variants. CTX-M enzymes include the most common ESBLs that are prevalent in all areas of the world. In contrast, KPC serine carbapenemases are present more frequently in the Americas, the Mediterranean countries, and China, whereas NDM metallo-β-lactamases are more prevalent in the Indian subcontinent and Eastern Europe. As selective pressure from β-lactam use continues, multiple β-lactamases per organism are increasingly common, including pathogens carrying three different carbapenemase genes. These organisms may be spread throughout health care facilities as well as in the community, warranting close attention to increased infection control measures and stewardship of the β-lactam-containing drugs in an effort to control selection of even more deleterious pathogens.
350 citations
References
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TL;DR: In an elegant series of clinical observations and laboratory studies published in 1880 and 1882, Ogston described staphylococcal disease and its role in sepsis and abscess formation.
Abstract: Micrococcus, which, when limited in its extent and activity, causes acute suppurative inflammation (phlegmon), produces, when more extensive and intense in its action on the human system, the most virulent forms of septicaemia and pyaemia.1 In an elegant series of clinical observations and laboratory studies published in 1880 and 1882, Ogston described staphylococcal disease and its role in sepsis and abscess formation.1,2 More than 100 years later, Staphylococcus aureus remains a versatile and dangerous pathogen in humans. The frequencies of both community-acquired and hospital-acquired staphylococcal infections have increased steadily, with little change in overall mortality. Treatment of these infections . . .
5,550 citations
"Antibiotic resistance in staphyloco..." refers background in this paper
...[2] Lowry FD....
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...aureus is an infrequent but serious cause of pneumonia, mostly in debilitated patients on ventilators, or following influenza [1,2]....
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...hospitals in the United Kingdom [10,33], they constitute nearly 40% of those from bacteraemias [2] (Table 2)....
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...Staphylococcus aureus is a classical pathogen, causing infections at many sites [1,2]....
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...This latter proportion has risen dramatically since 1993, apparently reflecting the emergence and dissemination of EMRSA 15 and 16 (Table 2) [2,34]....
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Book•
01 Jan 2005
TL;DR: Antimicrobial combinations / Satish K. Pillai, Robert C. Moellering, Jr., and George M. Eliopoulos -- Genetic and biochemical mechanisms of bacterial resistance to antimicrobial agents.
Abstract: The Breakpoint 1 Matthew A. Wikler, Paul G. Ambrose Antimicrobial Susceptibility on Solid Media 8 John D. Turnidge, Jan M. Bell Susceptibility Testing of Antimicrobials in Liquid Media 61 Daniel Amsterdam Antimicrobial Susceptibility Testing of Anaerobic Bacteria 144 David W. Hecht Antimycobacterial Agents: In Vitro Susceptibility Testing and Mechanisms of Action and Resistance 155 Clark B. Inderlied and Kevin A. Nash Antifungal Drugs: Mechanisms of Action, Drug Resistance, Susceptibility Testing, and Assays of Activity in Biological Fluids 226 Michael A. Pfaller, Daniel J. Diekema, and Michael G. Rinaldi Antimicrobial Susceptibility Testing for Some Atypical Microorganisms (Chlamydia, Mycoplasma, Rickettsia, Ehrlichia, Coxiella, and Spirochetes) 266 Jean-Marc Rolain, Didier Raoult Applications, Significance of, and Methods for the Measurement of Antimicrobial Concentrations in Human Body Fluids 290 Roger D. Klein and Stephen C. Edberg Antimicrobial Combinations 365 Satish K. Pillai, Robert C. Moellering, Jr., and George M. Eliopoulos Genetic and Biochemical Mechanisms of Bacterial Resistance to Antimicrobial Agents 441 Louis B. Rice and Robert A. Bonomo Molecular Methods for the Detection of Antibacterial Resistance Genes 509 Margareta Ieven Molecular Mechanisms of Action for Antimicrobial Agents: General Principles and Mechanisms for Selected Classes of Antibiotics 532 Charles W. Stratton The Antivirogram and the Modes of Action of Antiviral Agents, HIV, Hepatitis, Influenza, and Cytomegalovirus 564 Pierre Dellamonica, Vincent Calvez, Anne-Genevieve Marcelin, Albert Tran, Pierre-Marie Roger, Marie-Christine Mazeron, and Bruno Lina Disinfectants and Antiseptics, Modes of Action, Mechanisms of Resistance, and Testing 615 Joseph M. Ascenzi, Martin S. Favero Evaluation of Antimicrobials in Experimental Animal Infections 654 Terry O' Reilly, D. A. Andes, Ch. Ostergaard, N. Frimodt-Moller Extravascular Antimicrobial Distribution and the Respective Blood and Urine Concentrations in Humans 719 David M. Bamberger, John W. Foxworth, Darcie L. Bridwell, Christopher S. Shain, and Dale N. Gerding Epidemiology of Antimicrobial Resistance: Species Prevalence, Susceptibility Profiles, and Resistance Trends 815 Thomas R. Fritsche, Helio S. Sader, Ronald N. Jones Index 851
2,397 citations
TL;DR: Therapy was resumed with the com -bination of arbekacin and ampicillin/sulbactam which has been shown to have synergic activity against MRSA.
Abstract: (MRSA) with reduced suscept-ibility to vancomycin (MIC 8 mg/L). The strain was isolated from a surgical wound infection which was refrac -tory to vancomycin therapy.In May 1996, a 4 month-old male infant underwent heartsurgery for pulmonary atresia. Two weeks followingsurgery, the infant became febrile and developed a purulent discharge from the sternal surgical incision site;culture of the purulent material yielded MRSA. The patientwas treated with vancomycin (45 mg/kg daily) for 29 days,but fever and discharge of pus continued, and the C-reactive protein (CRP) remained elevated (40 mg/L). Thetreatment was changed to a combination of vancomycin andarbekacin (an aminoglycoside approved for MRSA infec-tion in Japan). After 12 days of this regimen, the purulentdischarge subsided, the wound began to heal, and the CRPdeclined from 40 to 9 mg/L. The antimicrobial therapy wasdiscontinued. However, 12 days later the surgical siteappeared inflamed with the development of a subcutaneousabscess accompanied by a sudden onset of fever and a raised CRP level of 35 mg/L. Therapy was resumed with the com -bination of arbekacin and ampicillin/sulbactam which hasbeen shown to have synergic activity against MRSA.
2,023 citations
"Antibiotic resistance in staphyloco..." refers background in this paper
...[44] Hiramatsu K, Hanaki H, Ino T, Yabutu K, Oguri T, Tenover...
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...The first of these was isolated in Japan in 1996 from a patient who had received protracted vancomycin for a sternal wound infection [44]....
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...Although small in biological terms, these reductions in susceptibility are associated with clinical failure [44–46], reflecting the narrow therapeutic index of the glycopeptides....
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...Consequently, GISA have a thickened wall, which is suggested to sequester the vancomycin or teicoplanin molecules, thereby preventing them from reaching their target site [25,44]....
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Book•
05 Nov 2004TL;DR: Mandell, Douglas, and Bennett's principles and practice of infectious diseases / , Mandell,Douglas, and Bennetts' principles and practices of infectious disease /, and more.
Abstract: Mandell, Douglas, and Bennett's principles and practice of infectious diseases / , Mandell, Douglas, and Bennett's principles and practice of infectious diseases / , کتابخانه دیجیتال جندی شاپور اهواز
1,854 citations