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[Detection of methicillin-resistant Staphylococcus aureus using PCR and non-radioactive DNA probes: III. Mutations of the fem A gene in clinical strains of Staphylococcus aureus].

Methicillin resistance in S. aureus is primarily due to the presence of the mec A gene. However, in addition to mec, the phenotypic expression of methicillin resistance requires the presence of an additional gene(s), fem A which is chromosomally encoded. Previous studies suggest an increase in the biochemical function of fem A gene products due to base substitutions in the region upstream of the fem A gene and in its coding frame. The partial nucleotide sequences of fem A regions in reference and clinical strains of S.aureus were therefore analyzed by PCR-direct solid-phase sequencing and suitable DNA probes. Amplified target DNAs of 251, 330 and 271 bp were resolved on ethidium bromide-stained gels and hybridized with DNA probes conjugated to alkaline phosphatase. In ATCC 12600 strain, a palindromic sequence was conserved in the region upstream of fem A. However, it was destroyed by the occurrence of mutations in other reference, and clinical strains tested regardless of whether they are methicillin-susceptible or resistant. Furthermore, in the coding frame of fem A, two missense mutations were present in MSSA and MRSA without any regularity. These findings suggest that mutations in the fem A region may not be a single factor essential for regulation of methicillin resistance, although fem A probably functions cooperatively with mec A.

Base Sequence↗

Incidence of nasal carriers of Staphylococcus aureus in and outside hospital environment and antibiotic sensitivity of isolated staphylococcus strains.

This study was carried out on 100 nasal swabs collected from medical personnel (nurses and doctors) and patients inside hospital environment and also from 50 individuals outside hospital. The swabs were inoculated on different culture media for isolation of /staphylococci which were further identified as S. aureus either by classic bacteriologic methods or by one of rapid screening test of S. aureus. The isolated strains were tested for antibiotic sensitivity to some of B-Lactam antibiotics and to other antibiotics. The results showed that significantly higher percentage of coagulase + ve Staph. were isolated from newborn nursery (90%), operating theatre (71.4%) and hemodialysis unit (60%) than those isolated from intensive care unit, cancer chemotherapy, surgery, chest, internal medicine departments (25%, 26.6%, 31.2%, 33.3%, 50%) respectively. It also showed significant difference in isolation rate between persons at the hospital (patients, doctors and nurses) 44% and controls (normal population) 26%. Most isolates of coagulase + ve Staph. were resistant to penicillin G (93.2%), Streptomycin (77.3%), tetracycline (61.4%) and sensitive to cefamandole (95.4%). All coagulase+ve Staph. isolates were resistant to sulphonamide and methicillin and all sensitive to vancomycin.

Carrier State↗

Staphylococcus aureus peritonitis is associated with Staphylococcus aureus nasal carriage in peritoneal dialysis patients.

Although the definition of S. aureus nasal carriage in peritoneal dialysis patients is variable, carriage is often defined as 2 or more positive cultures for S. aureus. We investigated the relationship between S. aureus infections and nasal carriage (defined as 1 or more positive nose cultures) in 138 patients on peritoneal dialysis. By this definition, approximately 50% of the patients were carriers. The rates of S. aureus exit-site infection (0.28/year vs 0.43/year, p < 0.001) and peritonitis (0.08/year vs 0.20/year, p < 0.001) were lower in the noncarriers (patients with no positive nose cultures) than in those patients who had 1 or more positive nose cultures. Patients with only 1 positive nose culture had a similar S. aureus exit-site infection rate (0.31/year vs 0.28/year), but a higher peritonitis rate (0.24/year vs 0.08/year, p < 0.001) compared to those patients with no positive nose cultures. However, patients with 2 or more positive nose cultures were at increased risk for both S. aureus exit-site infections and peritonitis. This relationship held even when only patients with frequent nose cultures were included in the analysis. Thus patients with even 1 positive nose culture for S. aureus are at risk for S. aureus peritonitis and should not be classified as noncarriers.

Carrier State↗

[Combined Staphylococcus-Proteus-Pseudomonas vaccine. II. The toxicity of the vaccine in "chronic" experiments and its ability to protect animals against Proteus and Staphylococcus infections].

The combined preparation consisting of the antigenic complexes of staphylococci (1 part), Proteus (1 part) and P. aeruginosa parts) was capable of protecting mice from infection with staphylococci, Proteus and P. aeruginosa and prolonging the survival time of rabbits under the conditions of the development of staphylococcal sepsis. The staphylococcal component of the combined preparation possessed adjuvant activity, increasing the immunogenicity of Proteus antigen. The combined vaccine enhanced a short-time increase in the nonspecific resistance of the animals. The moderate toxicity of the preparation permits making multiple injections of the preparation to mice without inhibiting the weight gain of the animals.

Animals↗

Staphylococcus aureus resistance to antibiotics and spread of phage types.

OBJECTIVE: The aim of this study was to identify the phage groups of Staphylococcus aureus strains, their prevalence, and resistance of different phage groups to antibiotics. MATERIALS AND METHODS: A total of 294 Staphylococcus aureus strains in Kaunas hospitals were obtained; they were phage typed and their resistance to antibiotics was determined. We used the method of routine dilution to test 17 antibiotics against the isolates. Susceptibility of Staphylococcus aureus to studied antibiotics was estimated on the basis of National Committee for Clinical Laboratory Standards according to minimal inhibition concentration of each antibiotic. Staphylococcus aureus strains were phage typed by the international diagnostic set of Staphylococci bacteriophages (Moscow, Russia). RESULTS: After evaluating the resistance of obtained Staphylococcus aureus strains to oxacillin/methicillin, it was determined that 5.8% of Staphylococcus aureus were resistant to methicillin. Almost all strains (93.75%) of methicillin-resistant Staphylococcus aureus were susceptible to the fusidic acid, 18.75%--to ciprofloxacin; 31.25% of methicillin-resistant Staphylococcus aureus strains were susceptible to gentamicin, 37.5%--to doxycycline, and just 6.25%--to erythromycin. The strains of methicillin-susceptible Staphylococcus aureus are susceptible to many studied antibiotics. The strains of methicillin-susceptible Staphylococcus aureus are most resistant to penicillin--83.1% and to erythromycin--29.9%. Phage typing revealed that 20.9% of methicillin-susceptible Staphylococcus aureus and 56.2% of methicillin-resistant Staphylococcus aureus were nontypable. CONCLUSIONS: Using the international set of bacteriophages, 79.1% of methicillin-susceptible Staphylococcus aureus and 43.8% of methicillin-resistant Staphylococcus aureus strains were phage typed. Among the strains of methicillin-resistant Staphylococcus aureus, phagotype 77 of phagogroup III was the most common and among the strains of methicillin-susceptible Staphylococcus aureus--phagotype 3C of phagogroup II.

Anti-Bacterial Agents↗

Synergy between Staphylococcus aureus and Pseudomonas aeruginosa in a rat model of complex orthopaedic wounds.

BACKGROUND: We observed an interaction in animals inoculated concomitantly with Staphylococcus aureus and Pseudomonas aeruginosa during a study of the efficacy of surfactants for disinfection of orthopaedic wounds. This led us to investigate whether synergy could be demonstrated between Staphylococcus aureus and Pseudomonas aeruginosa in a rat model of complex orthopaedic wounds. METHODS: A wire was implanted into the spinous process of a lumbar vertebra of Sprague-Dawley rats through a dorsal incision. Animals were divided into two groups: group one was inoculated with either Staphylococcus aureus or Pseudomonas aeruginosa, and group two received a polymicrobial inoculation with both test organisms in varying concentrations. After inoculation, the wounds were irrigated and closed. On postoperative day 14, all animals were killed and specimens from the wounds were cultured. The number of colony-forming units (CFU) of Staphylococcus aureus or Pseudomonas aeruginosa needed to cause infection in 50% of the animals (ID50) was determined with use of the Reed-Muench method. The infection rate associated with each inoculum combination was calculated, and the two groups were compared. RESULTS: The ID50 was 2.8 x 10(4) CFU for Staphylococcus aureus and 4.8 x 10(5) CFU for Pseudomonas aeruginosa. The combination of 10(3) CFU of Staphylococcus aureus with low concentrations (10(2), 10(3), or 10(4) CFU) of Pseudomonas aeruginosa yielded infection rates that were higher than those found with either organism alone at the same concentrations. The combination of 10(3) CFU of Staphylococcus aureus and 10(3) CFU of Pseudomonas aeruginosa yielded a 75% infection rate, which was significantly higher (p = 0.004) than that associated with 10(3) CFU of either organism alone. As the Pseudomonas aeruginosa concentration was increased (to 10(5), 10(6), and 10(7) CFU), this trend reversed, and the infection rate decreased to 33% (p = 0.004). Low concentrations of Pseudomonas aeruginosa (0 to 10(5) CFU) combined with 10(6) CFU of Staphylococcus aureus yielded infection rates ranging from 83% to 100%. At the higher concentrations of Pseudomonas aeruginosa (10(6) and 10(7) CFU), however, the infection rate again decreased, to 33% (p = 0.005). Only Staphylococcus aureus was isolated from the cultures of the specimens from the animals that had received a polymicrobial inoculum. CONCLUSIONS: Synergy between Staphylococcus aureus and Pseudomonas aeruginosa was demonstrated when low levels of each organism were present in the wound. As the Pseudomonas aeruginosa concentration was increased, the infection rates fell well below what would be anticipated, suggesting that low concentrations of Pseudomonas aeruginosa enhance the ability of Staphylococcus aureus to cause infection in this orthopaedic wound model. At the same time, the presence of Staphylococcus aureus in the ratios tested decreased the rate of infection by Pseudomonas aeruginosa. CLINICAL RELEVANCE: Staphylococcus aureus is a pathogen commonly seen in orthopaedic patients. The pathogenicity of Staphylococcus aureus was shown to be increased in the presence of anaerobic bacteria. This study is the first one that we are aware of that demonstrated synergy between Staphylococcus aureus and Pseudomonas aeruginosa, at low concentrations, in a wound model while at the same time showing that Staphylococcus aureus lowers the rate of Pseudomonas aeruginosa infection.

Animals↗

Methicillin-resistant Staphylococcus aureus infection in a cardiac surgical unit.

BACKGROUND: Increased antibiotic resistance of common bacteria is attributed in part to the widespread use of various antibiotic agents. Prophylactic and therapeutic antibiotic treatments are routinely used in cardiac surgical units, and it is no surprise that methicillin-resistant Staphylococcus aureus infection is becoming a major cause of surgical infections in cardiac patients. METHODS: We reviewed our experience with patients who underwent cardiac surgery and experienced infection caused by methicillin-resistant Staphylococcus aureus. Between 1992 and 2000 at the Montreal Heart Institute, 39 patients had methicillin-resistant Staphylococcus aureus surgical infections, and 13,199 patients underwent cardiac surgery. The yearly incidence of methicillin-resistant Staphylococcus aureus infection, the relative risk of acute mediastinitis and of superficial wound infections or other types of methicillin-resistant Staphylococcus aureus infection episodes, and the effect of preventive measures were analyzed. RESULTS: The annual incidence of methicillin-resistant Staphylococcus aureus acute mediastinitis decreased from 0.37% (5/1321) of cardiac patients in 1992 and 0.44% (6/1355) in 1993 to 0% between 1994 and 1997, 0.13% (2/1528) in 1999, and 0% (0/1700) in 2000. The total incidence of methicillin-resistant Staphylococcus aureus infection, including mediastinitis, superficial and deep sternal and leg wound infection, and all systemic infection episodes ranged from 0.68% of patients in 1992 and 0.96% of patients in 1993 to 0.46% of patients in 1999 and 0.53% of patients in 2000. The relative risk of severe mediastinal methicillin-resistant Staphylococcus aureus infection to all other methicillin-resistant Staphylococcus aureus infection episodes decreased from 1.65 in 1992 to 0.41 in 1999 and 0 in 2000. Beginning in 1993, all patients given a diagnosis methicillin-resistant Staphylococcus aureus infection and all nasal carriers of methicillin-resistant Staphylococcus aureus were strictly isolated on the surgical unit, and vancomycin was used as the prophylactic antibiotic agent for cardiac surgery in these patients. Moreover, since 1998, all patients admitted in the hospital were screened, and nasal carriers were isolated and treated with topical antibiotic ointment. CONCLUSION: Mediastinal and other infections caused by methicillin-resistant Staphylococcus aureus have a significant morbidity in cardiac surgical patients. After an outbreak of methicillin-resistant Staphylococcus aureus mediastinal infections, several preventive measures to control methicillin-resistant Staphylococcus aureus contamination of surgical patients were implemented (nasal screening, preventive isolation, application of mupirocin, prophylaxis with vancomycin and alcohol gels) and were effective in decreasing the incidence of methicillin-resistant Staphylococcus aureus infection and mediastinitis after cardiac surgery.

Acute Disease↗

[Resistance of Staphylococcus aureus isolated from burn wounds to antibiotics].

OBJECTIVE: To determine the colonization rate of Staphylococcus aureus in burn wounds and to assess the variation in the resistance of Staphylococcus aureus strains to antibiotics. MATERIAL AND METHODS: A retrospective study of 72 patients with burn wounds was carried out during 1997 and 2003. Specimens taken from burn wounds at first, fifth, and later every seventh day of hospitalization were placed in transport medium. Isolates were grown on mannitol salt agar. Cultures of Staphylococcus aureus were determined using plasmacoagulase and DNA-ase tests. The resistance of Staphylococcus aureus strains to penicillin, oxacillin, ceftazidime, vancomycin, gentamicin, kanamycin, tobramycin, doxycycline, ciprofloxacin, cefepime, fusidic acid, and clindamycin was determined. The isolated strains of Staphylococcus aureus were tested for resistance to methicillin by performing a disc diffusion method using commercial discs (Oxoid) (5 microg methicillin per disk and 1 microg oxacillin per disk). RESULTS: During 1997-2003, a total of 221 Staphylococcus aureus cultures were isolated from burn wounds. More than one-fourth of all isolated Staphylococcus aureus strains (25.3%) were resistant to methicillin; 64% of methicillin-sensitive Staphylococcus aureus strains were resistant to clindamycin and 28-30% - to gentamicin and kanamycin. The resistance rate of methicillin-resistant Staphylococcus aureus strains to doxycycline, clindamycin, oxacillin, tobramycin, gentamicin, and kanamycin was 78.5-98%. Majority of Staphylococcus aureus strains were non-susceptible to ceftazidime (91-100%); the rate of resistance to clindamycin decreased from 99% to 36%, (p<0.05) and to ciprofloxacin - increased from 55-65% to 81% (p<0.05). CONCLUSIONS: Staphylococcus aureus was the most prevalent pathogen isolated from burn wounds. On the first day of hospitalization Staphylococcus aureus isolates were obtained from 25.3% of patients; 12.5% of patients with burn wounds had methicillin-resistant Staphylococcus aureus at the end of the first week of hospitalization and 66% of patients--after two weeks and later. The resistance of methicillin-susceptible Staphylococcus aureus to gentamicin, tobramycin, and clindamycin decreased. The resistance of methicillin-resistant Staphylococcus aureus to clindamycin decreased and to ciprofloxacin--increased.

Anti-Bacterial Agents↗

Identification of Staphylococcus species by 16S-23S rDNA intergenic spacer PCR analysis.

To investigate whether 16S-23S rDNA (rDNA) spacer region length polymorphisms are suitable for the identification of Staphylococcus strains, the 16S-23S rDNA intergenic spacer region lengths of 221 strains belonging to 31 species were studied by using a PCR-based method. Each species presented a specific 16S-23S pattern made of 1-8 fragments ranging from 104-771 bp, with the exception of the species Staphylococcus warnei, Staphylococcus caprae and Staphylococcus piscifermentans, which presented larger or smaller fragments. Very few species showed more than one pattern, Staphylococcus saprophyticus subsp. saprophyticus and Staphylococcus aureus being the most heterogeneous species (five different patterns for eight strains). Five clinical strains that could not be identified at the species level by phenotypical tests were finally identified using this method. Discrimination between some species that showed close patterns (Staphylococcus aureus/Staphylococcus chromogenes/Staphylococcus equorum, Staphylococcus aureus/staphylococcus intermedius, Staphylococcus delphini/Staphylococcus felis, Staphylococcus gallinarum, Staphylococcus delphini/Staphylococcus felis, Staphylococcus vitulus/Staphylococcus auricularis) was further achieved after Dral digestion of the PCR products. Although it does not allow discrimination of subspecies, the use of 16S-23S spacer region length data determined by PCR-mediated amplification is suitable for the identification of the 31 Staphylococcus species tested in this study. The method is rapid, easy and may be a useful tool for the identification of Staphylococcus species in the clinical microbiology laboratory.

DNA, Ribosomal↗

Rapid identification of Staphylococcus epidermidis.

During the collection of airborne bacteria in a museum in England some bacterial strains were isolated which due to their fatty acid profiles were clearly identified as members of the genus Staphylococcus. As fatty acid compositions of coagulase-negative staphylococci are very similar, differing only in quantities but not in qualities, further identification at the species level without a fatty acid database was not achieved. Investigation of the isolates using the Staph ID 32 API system resulted in an identification of the isolates as Staphylococcus epidermidis (probabilities of 79.7-95.5%). For further genotypic characterization of these isolates, some Staphylococcus epidermidis strains from different sources and the type strains of Staphylococcus aureus, Staphylococcus capitis, Staphylococcus epidermidis, Staphylococcus gallinarum, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus warneri and Staphylococcus xylosus were subjected to repetitive-sequence PCR, including enterobacterial repetitive intergenic consensus (ERIC) PCR, BOX-PCR and repetitive extragenic palindromic unit sequence (REP) PCR. ERIC- and BOX-PCR yielded a species-specific banding pattern for all Staphylococcus epidermidis strains. Furthermore, all staphylococcal reference strains investigated exhibited distinct banding patterns, clearly distinguishable from that of Staphylococcus epidermidis. No species-specific banding patterns could be observed after REP-PCR. As species identification of coagulase-negative staphylococci by fatty acid analyses and biochemical tests is known to be difficult ERIC- and BOX-PCR seem to be excellent tools for the identification of Staphylococcus epidermidis isolates.

Air Microbiology↗

[A study on the mechanism of drug resistance in Staphylococcus aureus].

OBJECTIVE: To inquire into the mechanism of drug resistance in Staphylococcus aureus. METHODS: A total of 198 strains of Staphylococcus aureus were isolated from the samples sent to the Clinical Laboratory of Microbiology,West China Hospital. The resistance of Staphylococcus aureus to Methicillin was assayed with agar dilution. Staphylococcus aureus mecA gene was measured by PCR assay and beta-lactamase was detected by Nitrocephin. RESULTS: The rate of resistance to methicillin was 64.65% in 198 strains of Staphylococcus aureus; 118 strains of methicillin-resistant staphylococcus aureus(MRSA) were found to have high level resistance in 128 MRSA;10 strains of MRSA were found to have low level resistance; 41(58.57%) strains of methicillin-sensitive Staphylococcus aureus (MSSA) expressed beta-lactamase; 2 Staphylococcus aureus had mecA among them; 67 Staphylococcus aureus expressed beta-lactamase in high level resistance, 63(53.39%)Staphylococcus aureus expressed beta-lactamase in high level resistance, among them, 5 Staphylococcus aureus had mecA; 40.00% MRSA expressed beta-lactamase in low level resistance, 55 MRSA did not express beta-lactamase in high level resistance, which had all mecA; 9 Staphylococcus aureus did not express beta-lactamase in low level resistance, among them, 5 Staphylococcus aureus had mecA. The difference in expression of beta-lactamase was statistically significant between MSSA and MRSA; MRSA(53.39%) was lower than MSSA (58.57%); the other differences were not significant. The difference in having mecA was statistically significant between MRSA(having high resistant level and no expression of beta-lactamase) and the others; MRSA had higher mecA than did the others. CONCLUSION: The resistance in Staphylococcus aureus mainly involved two mechanisms: the expression of beta-lactamase and the expression of mecA.

Bacterial Proteins↗

Identification of coagulase-negative staphylococci other than Staphylococcus epidermidis by automated ribotyping.

As routine identification of coagulase-negative staphylococci is problematic, the performance of automated ribotyping was evaluated for identification of coagulase-negative staphylococci other than Staphylococcus epidermidis. In total, 177 isolates were tested, comprising 149 isolates from blood samples, 15 isolates that were not identified by internal transcribed spacer (ITS)-PCR in a previous study, and 13 reference strains. The identification results were compared with those obtained by the API 20 Staph system, with standard phenotypic and molecular methods as reference. Most (n = 166; 93.8%) isolates were identified correctly by automated ribotyping. For 61 isolates, API 20 Staph and ribotyping were in agreement, but for 105 isolates, ribotyping provided correct identification and API 20 Staph did not. Four isolates not identified by automated ribotyping were recognised correctly by API 20 Staph. The remaining seven isolates could not be identified by either of the two methods. Automated ribotyping was able to distinguish Staphylococcus capitis reliably from Staphylococcus caprae. The results demonstrate the value of automated ribotyping for identification of coagulase-negative Staphylococcus (CoNS) isolates from human sources and may help to clarify the clinical relevance of CoNS species. In addition, automated ribotyping was able to detect polymorphisms that may be useful for epidemiological purposes within S. capitis, Staphylococcus hominis, Staphylococcus haemolyticus, Staphylococcus simulans, S. caprae, Staphylococcus warneri, Staphylococcus lugdunensis, Staphylococcus schleiferi, Staphylococcus sciuri, Staphylococcus pasteuri and Staphylococcus xylosus.

Phenotype↗

Characterization of the most frequently encountered Staphylococcus sp. in cats.

Ninety three staphylococci isolated from clinical specimens from cats were characterized and identified. Because the biochemical characteristics of Staphylococcus felis were very similar to those of Staphylococcus simulans, results were submitted to numerical analysis and DNA homology. Forty-two isolates (45%) were identified as S. felis, and 4 isolates (4%) as S. simulans. The other species identified, in order of their frequency were, 12 Staphylococcus aureus (13%), 9 Staphylococcus intermedius (10), 6 Staphylococcus sciuri (6), 6 Staphylococcus epidermidis (6), 2 Staphylococcus haemolyticus (2), 2 Staphylococcus xylosus (2), 1 Staphylococcus capitis (1), 1 Staphylococcus equorum (1), 1 Staphylococcus gallinarum (1) and 1 Staphylococcus lentus (1).

Animals↗