Antibiotic susceptibility and genotypic characterization of methicillin-resistant Staphylococcus aureus strains in eastern France.
TL;DR: Changes over four years in the characteristics of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in a French university hospital by analysis of antibiotic susceptibility and restriction fragment length polymorphism using pulsed field gel electrophoresis were studied.
About: This article is published in Journal of Hospital Infection.The article was published on 2000-12-01. It has received 28 citations till now. The article focuses on the topics: Methicillin-resistant Staphylococcus aureus & Amikacin.
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TL;DR: Multivariate analysis with a Poisson regression model showed that the use of antimicrobials was associated with the incidence of acquisition of MRSA, independently of the other variables studied, but it did not allow us to determine the hierarchy of the different antimicrobial classes with respect to the effect.
Abstract: The objective of our study was to determine whether antibiotic pressure in the units of a teaching hospital affects the acquisition of methicillin-resistant Staphylococcus aureus (MRSA), independently of the other collective risk factors previously shown to be involved (MRSA colonization pressure, type of hospitalization unit, and care workload). The average incidence of acquisition of MRSA during the 1-year study period was 0.31 cases per 1000 days of hospitalization, and the use of ineffective antimicrobials reached 504.54 daily defined doses (DDDs) per 1000 days of hospitalization. Univariate analysis showed that acquisition of MRSA was significantly correlated with the use of all antimicrobials, as well as correlated with the use of each class of antimicrobial and with colonization pressure. Multivariate analysis with a Poisson regression model showed that the use of antimicrobials was associated with the incidence of acquisition of MRSA, independently of the other variables studied, but it did not allow us to determine the hierarchy of the different antimicrobial classes with respect to the effect.
107 citations
TL;DR: The present study genotyped nMMRSA isolates obtained from hospitals in two cities in Brazil and confirmed the genetic relationship of the Brazilian isolates with USA800, which were responsible for severe nosocomial infections in compromised adults and elderly patients in Brazil.
50 citations
TL;DR: The results suggest that the high prevalence of hGISA among patients was due to the clonal spread of a multiresistant strain of S. aureus over a 5-year period.
Abstract: We investigated the prevalence, molecular epidemiology, and clinical significance of heterogeneous glycopeptide-intermediate Staphylococcus aureus (hGISA) isolates in 48 liver transplant recipients infected or colonized with methicillin-resistant S. aureus over a 5-year period. Strains were screened for hGISA on Mueller-Hinton agar containing 5 mg of teicoplanin per liter. Heterogeneous glycopeptide resistance was confirmed by the E-test method with a dense inoculum and a simplified method of population analysis. hGISA strains were found in 13 (27%) of the 48 patients studied. Eleven of the 13 strains shared a common multiresistant phenotype with homogeneous methicillin resistance and gentamicin resistance, and they were closely related according to the results of pulsed-field gel electrophoresis. Only 2 of the 13 patients infected or colonized with hGISA strains had previously received glycopeptide therapy. Most patients were successfully treated with vancomycin, but one patient who failed to respond to vancomycin subsequently died. These results suggest that the high prevalence of hGISA among our patients was due to the clonal spread of a multiresistant strain.
41 citations
Cites background from "Antibiotic susceptibility and genot..."
...Since 1992, these multiresistant strains have been progressively replaced in French hospitals by new gentamicin-susceptible clones characterized by heterogeneous resistance to methicillin and susceptibility to various other antibiotics, such as rifampin (3, 5)....
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...Site of infection NS Lower respiratory tract 6/10 (60) 11/30 (37) Abdomen 4/10 (40) 7/30 (23) Wound 3/10 (30) 12/30 (40) Intravascular device 1/10 (10) 5/30 (17) Other 0 1/30 (3)...
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...This changing epidemiology is probably related to the fitness and competitive growth advantage of new clones (3, 17)....
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TL;DR: It is suggested that intranasal mupirocin can prevent endogenous acquired MRSA infection in an ICU, and further double-blind, randomised, placebo-controlled studies are needed to demonstrate its cost-effectiveness and its impact on resistance.
Abstract: Introduction
Methicillin-resistant Staphylococcus aureus (MRSA) causes severe morbidity and mortality in intensive care units (ICUs) worldwide. The purpose of this study was to determine whether intranasal mupirocin prophylaxis is useful to prevent ICU-acquired infections with MRSA.
37 citations
Cites background from "Antibiotic susceptibility and genot..."
...This pathogen causes severe morbidity and mortality in hospitals worldwide [1-3]....
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TL;DR: Results suggest CC22 SCCmecIV will remain a successful healthcare-associated clone, and resistance to meticillin and gentamicin is likely to be maintained even in the absence of antibiotic pressure, and many large MGEs are not a fitness burden.
Abstract: Healthcare-associated (HA) meticillin-resistant Staphylococcus aureus (MRSA) clone CC22 SCCmecIV (EMRSA-15) has recently overtaken CC30/ST36 SCCmecII (EMRSA-16) as the dominant clone in UK hospitals. CC22 SCCmecIV shows greater fitness than CC30 SCCmecII, although both are successful global pathogens. The aim of this study was to test whether mobile genetic elements (MGEs), specifically SCCmec and large plasmids encoding resistance genes, are a burden and contribute to this fitness difference. Thirty-nine clinical isolates of MRSA and meticillin-sensitive S. aureus from lineages CC30 and CC22 with a variety of antibiotic resistance genes were grown in the absence of antibiotics. A range of relative fitness measures were used to compare clinical isolates with and without SCCmecII and SCCmecIV. The same fitness measures were used to compare eight isolates with and without naturally occurring large antibiotic resistance plasmids carrying gentamicin resistance (determined by microarray) and an isolate with an introduced plasmid. Growth rate, competitive ability during co-culture and survival after desiccation were then compared. Carriage of SCCmecII contributed to the reduced fitness of CC30 MRSA. However, we found no evidence of a fitness cost due to carriage of SCCmecIV in CC22, or large antibiotic resistance plasmids in CC30 or multiple resistances in both lineages. In conclusion, many large MGEs are not a fitness burden. Surprisingly, lineage background was the most important determinant of fitness. Our results suggest CC22 SCCmecIV will remain a successful healthcare-associated clone, and resistance to meticillin and gentamicin is likely to be maintained even in the absence of antibiotic pressure.
28 citations
Cites background from "Antibiotic susceptibility and genot..."
...Interestingly, antibiotic resistance plasmid carriage is not universal at St George’s Healthcare NHS trust and elsewhere (Bertrand et al., 2000; Robert et al., 2006) despite this lack of cost and even with high antibiotic usage (Knight et al., 2012)....
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...Evidence for a cost is inferred from other bacteria and a lack of resistance spread in the presence of a high selective pressure (Bertrand et al., 2000; Björkman & Andersson, 2000; Laurent et al., 2001; Robert et al., 2006)....
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...Interestingly, antibiotic resistance plasmid carriage is not universal at St George’s Healthcare NHS trust and elsewhere (Bertrand et al., 2000; Robert et al., 2006) despite this lack of cost and even with high antibiotic usage (Knight et al....
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...Evidence for a cost is inferred from other bacteria and a lack of resistance spread in the presence of a high selective pressure (Bertrand et al., 2000; Björkman & Andersson, 2000; Laurent et al., 2001; Robert et al., 2006)....
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References
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TL;DR: This research presents a novel, scalable and scalable approach that allows for real-time assessment of the severity of the infection and its impact on patients’ health.
Abstract: FRED C. TENOVER,* ROBERT D. ARBEIT, RICHARD V. GOERING, PATRICIA A. MICKELSEN, BARBARA E. MURRAY, DAVID H. PERSING, AND BALA SWAMINATHAN National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333; Veterans Affairs Medical Center, Boston, Massachusetts 02130; Creighton University, Omaha, Nebraska 68178; Stanford University Medical Center, Stanford, California 94305; University of Texas Medical School, Houston, Texas 77030; and Mayo Clinic, Rochester, Minnesota 55905
7,784 citations
TL;DR: The Centers for Disease Control (CDC) developed a new set of definitions for surveillance of nosocomial infections as mentioned in this paper, which combine specific clinical findings with results of laboratory and other tests that include recent advances in diagnostic technology.
5,297 citations
4,692 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
TL;DR: In order to obtain pan-European data on methicillin-resistantStaphylococcus aureus (MRSA), 43 laboratories from 10 European countries each screened 200 consecutive Staphyloccus Aureus isolates for MRSA resistance only one isolate per patient was permitted All participants used a uniform oxacillin-supplemented screening plate and sent to Munich for reconfirmation and further susceptibility testing as mentioned in this paper.
Abstract: In order to obtain pan-European data on methicillin-resistantStaphylococcus aureus (MRSA), 43 laboratories from ten European countries each screened 200 consecutiveStaphylococcus aureus isolates for methicillin resistance Only one isolate per patient was permitted All participants used a uniform oxacillin-supplemented screening plate MRSA isolates were sent to Munich for reconfirmation and further susceptibility testing Phage typing of the MRSA strains was performed in Denmark Of the 7,333Staphylococcus aureus strains screened, 936 (128%) were methicillin resistant The proportion of MRSA in the various European countries ranged from 30% in Spain, France and Italy Rates of resistance to the non-glycopeptide antibiotics were lowest for rifampin and highest for ciprofloxacin Sixty percent of the methicillin-resistant strains originated from patients in surgical and medical departments, with wounds being the most common isolation source MRSA was found more frequently in intensive care patients Only 13% of the strains were non-typable, and 76% of the isolates belonged to phage group III For each area phage typing detected one or a few dominating (epidemic) types, but 46% of the strains did not belong to these types; the MRSA population is thus a mixture of epidemic and non-epidemic strains MRSA seems to be a growing problem, especially in southern Europe, where incidence and rates of antibiotic resistance are alarmingly high
737 citations