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PubMed1989

Ciprofloxacin for methicillin-resistant Staphylococcus aureus infections.

Thirty-seven patients with methicillin-resistant Staphylococcus aureus infections and/or colonization were treated with oral ciprofloxacin (750 mg twice a day). Clinical cure or improvement of infections occurred in 91% of the patients, and bacteriologic cure occurred in 60%. Ciprofloxacin therapy suppressed methicillin-resistant S. aureus colonization in 55% of the patients. Ciprofloxacin-resistant strains emerged in 6 of the 37 patients.

Ciprofloxacin↗
PubMed2005

Management of Staphylococcus aureus infections.

Because of high incidence, morbidity, and antimicrobial resistance, Staphylococcus aureus infections are a growing concern for family physicians. Strains of S. aureus that are resistant to vancomycin are now recognized. Increasing incidence of unrecognized community-acquired methicillin-resistant S. aureus infections pose a high risk for morbidity and mortality. Although the incidence of complex S. aureus infections is rising, new antimicrobial agents, including daptomycin and linezolid, are available as treatment. S. aureus is a common pathogen in skin, soft-tissue, catheter-related, bone, joint, pulmonary, and central nervous system infections. S. aureus bacteremias are particularly problematic because of the high incidence of associated complicated infections, including infective endocarditis. Adherence to precautions recommended by the Centers for Disease Control and Prevention, especially handwashing, is suboptimal.

Anti-Bacterial Agents↗
PubMed1994

Epidemiology of Staphylococcus aureus infections in patients on hemodialysis.

OBJECTIVE: To determine the epidemiology of Staphylococcus aureus infections in hemodialysis patients. METHOD: S aureus isolates from surveillance cultures and from sites of infection were evaluated by both bacteriophage typing and restriction endonuclease digestion of plasmid DNA. SETTING: A hemodialysis unit in Brugge, Belgium. ORGANISMS: S aureus isolates from 11 chronic hemodialysis patients who had participated in the placebo arm of a previously reported placebo-mupirocin comparative study. RESULTS: Of 75 S aureus isolates evaluated, 63 were from cultures of nares and 12 from infections (three arteriovenous fistula infections, four wound infections, and five bacteremias). All isolates were typed by bacteriophages and 56 (75%) had plasmids. Three patients developed 12 infections. Eleven infections were caused by isolates previously identified in surveillance cultures. Only one infection was caused by a strain not identified previously in surveillance cultures. CONCLUSION: These results support the hypothesis that S aureus isolates causing infections in hemodialysis patients are of endogenous origin.

Aged↗
PubMed2006

Risk factors for recurrence in patients with Staphylococcus aureus infections complicated by bacteremia.

Recurrence is a common complication of Staphylococcus aureus infections. A shorter duration of antibiotic treatment for a S. aureus infection has been previously suggested as a possible risk factor for recurrence. We conducted a retrospective cohort study of patients with S. aureus infection complicated by bacteremia who survived their initial treatment (N = 397) at the VA Maryland Health Care System from 1995 to 2004 to determine if 2 weeks or less of antibiotic therapy is significantly associated with a higher rate of recurrence. Recurrence was defined as recurrence of infection because of S. aureus with the same susceptibility to methicillin within 1 year of treatment of the initial bacteremia. Seventeen percent of patients who survived their initial infection had a recurrence of infection. Mean duration of antibiotic therapy in those who recurred was longer than in those who did not recur (21 versus 18 days, P = .18). No evidence was found to support an association between a duration of therapy of 14 days or less and an increased risk for recurrence (RR, 0.68; 95% CI, 0.44-1.04). However, being HIV infected (OR, 4.59; 95% CI, 1.61-13.10), having diabetes (OR, 2.02; 95% CI, 1.13-3.61) and having an infection due to a methicillin-resistant S. aureus (MRSA) (OR, 2.11; 95% CI, 1.17-3.80) were independent risk factors for recurrence. In conclusion, 2 weeks or less of antibiotic therapy was not associated with an increased risk for recurrence. However, patients with diabetes or HIV infection and patients with MRSA infections are at an increased risk for recurrence and should be followed more closely.

Aged↗
PubMed2000

Methicillin-resistant Staphylococcus aureus infections in 2 pediatric outpatients.

Methicillin-resistant Staphylococcus aureus (MRSA) infections are an emerging problem in children. The following are 2 case reports of unsuspected MRSA infections: the first is an infant with cervical adenitis and the second is a child with a deep infection of the toe. Both patients failed outpatient therapy with oral cephalosporins and required hospitalization for surgical drainage. Both patients had cultures positive for MRSA at surgery. Neither patient had any risk factors for acquiring MRSA. Thus, outpatients with presumed staphylococcal infections who fail oral therapy with cephalosporins may be infected with MRSA.

Ambulatory Care↗
PubMed2001

Evolving antimicrobial chemotherapy for Staphylococcus aureus infections: Our backs to the wall.

Staphylococcus aureus is responsible for many nosocomial and community-acquired infections. Its evolving resistance to traditional antimicrobial chemotherapy and emerging prevalence outside of the healthcare environment are serious concerns. This review of the changing epidemiology of methicillin-resistant S. aureus, the emergence of vancomycin (glycopeptide)-resistant isolates, and the mechanisms of resistance to beta-lactams and glycopeptides provides an update for clinicians regarding effective strategies for treatment.

Anti-Bacterial Agents↗
PubMed2002

Lactobacillus fermentum RC-14 inhibits Staphylococcus aureus infection of surgical implants in rats.

Staphylococcus aureus is a common cause of community and hospital-acquired infections. Moreover, the clinical impact of S. aureus is on the rise because of the global increase in the incidence of multidrug-resistant strains and its growing prevalence as a major cause of surgical infections. As a result, there is a pressing need to identify new antistaphylococcal agents and preventative strategies that will help in the management of these types of infections. This report describes the successful use of a probiotic, Lactobacillus fermentum RC-14, and its secreted biosurfactant to inhibit surgical implant infections caused by S. aureus. L. fermentum RC-14 and its secreted biosurfactant both significantly inhibited S. aureus infection and bacteria adherence to surgical implants.

Animals↗
PubMed2006

Methicillin-resistant Staphylococcus aureus infection following arthroscopy of the knee joint.

Arthroscopic surgery of the knee is considered to be a safe procedure. We had a microbiologically confirmed infection of methicillin-resistant Staphylococcus aureus (MRSA). Although various rare infective cases are reported following arthroscopy of the knee joint, to the best of our knowledge there is no previous report of MRSA infection following arthroscopy of the knee joint.

Adult↗
PubMed2005

The genetics of staphylococcal biofilm formation--will a greater understanding of pathogenesis lead to better management of device-related infection?

Staphylococcus epidermidis and Staphylococcus aureus are common causes of biofilm-mediated prosthetic device-related infection. The polysaccharide adhesion mechanism encoded by the ica operon is currently the best understood mediator of biofilm development, and represents an important virulence determinant. More recently, the contributions of other virulence regulators, including the global regulators agr, sarA and sigmaB, to the biofilm phenotype have also been investigated. Nevertheless, little has changed at the bedside; the clinical and laboratory diagnosis of device-related infection can be difficult, and biofilm resistance frequently results in failure of therapy. This review assesses the way in which advances in the understanding of biofilm genetics may impact on the clinical management of device-related infection.

Adhesins, Bacterial↗
PubMed2005

Relative roles of complement factor 3 and mannose-binding lectin in host defense against infection.

Staphylococcus aureus is a major cause of severe nosocomial and community-acquired infections. Phagocytes and humoral molecules, including complement, have been proposed to cooperate in host defense against gram-positive bacteria. Circumstantial evidence indicates a role for complement, but this has not been formally defined. Complement activation is initiated by the classical, alternative, or lectin pathway, with the latter requiring mannose-binding lectin (MBL, also known as mannose-binding protein). MBL is an oligomeric serum protein that recognizes carbohydrates decorating a broad range of infectious agents, including S. aureus. We previously reported that MBL null mice were highly susceptible to S. aureus infection, confirming that MBL plays a key role in first-line host defense. In this study, we evaluated the relative roles of C3 and MBL against S. aureus infection by generating MBL x C3 null mice to compare with C3 single null mice. C3 deficiency alone significantly reduced survival to 19% from 97% of wild-type mice (P < 0.0001). Surprisingly, an additional MBL deficiency reduced the survival further to 7% (P < 0.0001). However, the MBL deficiency alone had a smaller though significant effect on survival, which was 77% (P = 0.018 versus wild-type mice). These results confirm an essential function for complement in host resistance against S. aureus infection but also identify an MBL-dependent mechanism that is C3 independent.

Animals↗
PubMed1999

Methicillin-Resistant Staphylococcus aureus Infections.

Methicillin-resistant Staphylococcus aureus (MRSA) has continued to spread and cause serious nosocomial infections. Failure to control MRSA may result in higher rates of use of glycopeptides, which may, in turn, lead to higher rates of glycopeptide resistance. Resistance to glycopeptides has recently begun to appear in S. aureus. Transfer of glycopeptide-resistance genes from enterococci to S. aureus has been documented in laboratory experiments but has not yet been found in clinical isolates. Over time, MRSA is becoming more common in various subsets of the general population. Some studies claim that many MRSA-colonized outpatients and their close contacts have had no health care contacts, but these studies have usually not considered contacts in outpatient clinics. Several other recent studies have found that all or a vast majority of patients with MRSA have had frequent contact with health care providers. Failure to wash hands and disinfect equipment between patients, which has been commonly seen in studies of health care worker compliance with infection control measures, may explain much of the continuing spread. The source of spread of antibiotic-resistant microbes can be likened to an iceberg, with clinically obvious infections representing the tip of the iceberg and most of the spread coming from clinically inapparent colonized patients who represent most of the reservoir for transmission. Surveillance cultures to identify this reservoir are important to the control of spread with effective barrier precautions. Such precautions have been shown to reduce the spread of MRSA 15.6-fold compared with standard precautions.

Journal Article↗
PubMed2006

Community-acquired methicillin-resistant Staphylococcus aureus infections in children.

Methicillin-resistant Staphylococcus aureus (MRSA) is now an established community pathogen in many areas of the United States as well as the world. Community-acquired MRSA (CA-MRSA) infections have changed several aspects of staphylococcal infections in children including the epidemiology, clinical manifestations, laboratory approach, antibiotic management, and prevention.

Adolescent↗
PubMed2006

Helenalin reduces Staphylococcus aureus infection in vitro and in vivo.

Staphylococcus (S.) aureus is a major udder pathogen causing bovine mastitis. Some pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), enhance extracellular and intracellular growth of S. aureus, indicating that the inflammatory process favors S. aureus infection. Helenalin is a sesquiterpene lactone with potent anti-inflammatory properties. This study was designed to evaluate the effects of helenalin on S. aureus infection. First, in vitro experiments were conducted. These studies revealed that proliferation of S. aureus in bovine mammary epithelial MAC-T cells treated in the presence or absence of TNF-alpha was markedly reduced in the presence of helenalin. Secondly, in vivo effects of helenalin were investigated. Lactating mice treated in the presence or absence of helenalin were challenged by the intramammary route with S. aureus and the bacteria in the mammary glands were counted 12 h after infection. Significantly less numbers of bacteria were recovered from the infected glands of helenalin-treated mice compared with untreated mice. Moreover, histological examination of mammary tissue from helenalin-treated mice that were challenged with S. aureus indicated that helenalin is able to significantly reduce leukocyte infiltration in the mammary gland following S. aureus inoculation. Our results show that helenalin reduces S. aureus intracellular growth and experimental S. aureus infection. We conclude that helenalin may be of potential interest in the treatment of S. aureus-induced mastitis in the bovine species.

Animals↗
PubMed2006

First case of Staphylococcus pseudintermedius infection in a human.

We present the first clinical report of a Staphylococcus pseudintermedius infection in a human. Biochemically, S. pseudintermedius can be easily misidentified as S. aureus. Therefore, the final microbiological identification requires the combination of phenotypic and genotypic tests.

Bacterial Typing Techniques↗
PubMed1987

Recognition and importance of Staphylococcus epidermidis infections.

The bacteriology, epidemiology, pathogenesis, clinical features, antimicrobial susceptibility, and therapy of Staphylococcus epidermidis infections are reviewed. Staph. epidermidis is often regarded as a culture contaminant, but its importance as a pathogen has been recognized in recent years. Except for native-valve endocarditis, most Staph. epidermidis infections are hospital-acquired. Staph. epidermidis is a common cause of infections involving indwelling foreign devices, surgical wound infections, and bacteremia in immunocompromised patients. The occult nature of these infections and low virulence of the organism make diagnosis and treatment difficult. Staph. epidermidis isolates from nosocomial infections frequently are resistant to methicillin; however, resistant isolates often appear to be susceptible to methicillin unless reliable methods of susceptibility testing are used. Cross-resistance between methicillin and cephalosporins occurs in vitro. Virtually all Staph. epidermidis isolates are susceptible in vitro to vancomycin and rifampin. Penicillin G, semisynthetic penicillinase-resistant penicillins, and cephalosporins are effective for the treatment of methicillin-sensitive Staph. epidermidis infections. Vancomycin is the drug of choice for infections caused by methicillin-resistant organisms. Vancomycin, combined with rifampin or gentamicin, or both, is recommended for therapy of serious infections caused by methicillin-resistant strains. Staph. epidermidis is an important pathogen in immunocompromised patients and patients who develop nosocomial bacteremia; treatment usually consists of antimicrobial therapy and removal of indwelling catheters or devices.

Catheterization↗
PubMed2001

Methicillin-resistant Staphylococcus aureus infection in vascular surgical patients.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is emerging as a major problem in vascular surgical practice. The aim of this study was to review the management of patients with MRSA infection complicating vascular surgical operations. METHODS: Data were obtained from the vascular audit, case notes, intensive therapy unit (ITU) notes, high dependency unit (HDU) notes and microbiological records of patients who underwent either arterial reconstruction (n = 464) or limb amputation (n = 110) between April 1994 and October 1998. RESULTS: Forty-nine vascular surgical patients developed clinical MRSA infection (9%). Clinical MRSA infection in patients who had undergone aorto-iliac reconstruction (n = 18) was associated with a 56% mortality (n = 10) and the most common infections were bacteraemia (55%) and pneumonia (50%). MRSA infection occurred in 17 patients who had undergone infra-inguinal bypass and was associated with a 29% mortality (n = 5). The most common site of MRSA infection was the groin wound (76%) leading to anastomotic dehiscence and death in one patient (11%) and necessitating wound debridement in 4 patients (22%). MRSA infection of the groin wound in the presence of a prosthetic graft (n = 3) led to anastomotic dehiscence in 2 patients, and graft excision in 2 patients. Similar complications were not observed in the presence of an underlying autogeneous long saphenous vein graft (n = 16). MRSA infection following major lower limb amputation (n = 14) was associated with death in 5 patients (36%). Wound infection in 10 amputees (71%) led to revision of the amputation to a higher level in 2 (14%) and wound debridement in 2 (14%). CONCLUSIONS: MRSA infection has a high mortality in vascular surgical patients in general, and following aorto-iliac reconstruction in particular. Autogeneous vein may confer some protection against local complications following groin wound infection. Strategies aimed at reducing the incidence of infection, including strict adherence to infection control procedures, may reduce the severity of this problem.

Adolescent↗
PubMed1994

[Clinical studies on the time-difference combination therapy with netilmicin and minocycline in methicillin-resistant Staphylococcus aureus infections].

Twenty-eight patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were clinically studied for the effectiveness of the time-difference combination use of netilmicin (NTL) and minocycline (MINO). The patients were treated with NTL 100 mg and two hours later, with MINO 100 mg intravenously, twice daily, in the morning and evening for 14 days. Of 26 patients, MRSA was eradicated in 16 (61.5%), decreased in one, and unchanged in nine. Superinfections occurred with Serratia marcescens and Pseudomonas aeruginosa in two patients. The clinical efficacies were assessed in two patients with septicemia, 16 with pneumonia, and eight with chronic bronchitis. The obtained results were excellent in four patients, good in 15, fair in six, and poor in one patient. The rate of effectiveness was 73.1% (19/26). The overall clinical effectiveness judged by the committee was good in 19, fair in five, and poor in two patients. The efficacy rate was also 73.1% (19/26). Coagulase type II of MRSA was found in 23 patients, and coagulase type III in three patients, with overall clinical efficacy rates of 73.9% (17/23) and 66.7% (2/3), respectively. A side effect of eruption was observed in one patient, and its incidence was 3.6% (1/28). Abnormal laboratory test results were observed in 16 patients (57.1%), including abnormal liver function in 14 patients, abnormal kidney function in three, and increased eosinophils in three. Laboratory abnormalities occurred twelve of 16 bedridden patients, and this rate was higher than that in non bedridden patients. However, these abnormalities were all mild, transient, and immediately recovered after the treatment. In conclusion, the time-difference combination therapy using NTL and MINO was effective in the treatment of MRSA infections.

Adolescent↗