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PubMed2002

[Antibiotic combinations in Staphylococcus aureus infections: arguments against].

In a case of severe infection due to Staphylococcus aureus, generally accepted practice involves the use of a combination of antibiotics. This article examines the type and quality of the experimental and clinical data which has been collected in this context. Published findings suggest that the arguments in favour of combinations are usually theoretical, and that a demonstration of the superiority of combinations has never been made by comparative, randomised studies.

Anti-Bacterial Agents↗

PubMed2007

Impact of methicillin-resistant Staphylococcus aureus infection on outcome after esophagectomy.

BACKGROUND: Infection with methicillin-resistant Staphylococcus aureus (MRSA) has reached endemic proportions in the United Kingdom. The aim of the present study was to determine the frequency of MRSA infection in patients undergoing esophagectomy and to report its impact on patient outcome. PATIENTS AND METHODS: The study population was 98 patients undergoing esophagectomy for carcinoma during the years 1998-2004. Patient information was collected prospectively and entered into a computerized database and analyzed retrospectively by univariate and multivariate analysis. RESULTS: Overall, 20 of the 98 patients (20%) developed infection with MRSA after esophagectomy. Patients who developed MRSA infection had greater levels of postoperative morbidity, longer intensive care unit (ICU) stays (median 2 days versus 1 day, P = 0.005) and hospital stays (21 days versus 16 days, P < 0.001) compared to those who did not develop infection. Multivariate analysis identified preoperative chemotherapy (P = 0.006) and readmission to the ICU (P = 0.007) as significant risk factors with MRSA infection. Overall, 17 of 46 patients (37%) who received neoadjuvant chemotherapy developed MRSA infection, compared to 3 of 52 (6%) who did not receive this treatment (P = 0.0001). CONCLUSIONS: Overall, one in five patients undergoing esophagectomy developed MRSA infection, with those patients who received neoadjuvant chemotherapy identified as being at greatest risk of this complication. This is an alarming finding, as neoadjuvant chemotherapy is the standard of care for patients with esophageal carcinoma in the United Kingdom.

Adult↗

PubMed2006

[Staphylococcus aureus infections: new challenges from an old pathogen].

Staphylococcus aureus is a versatile organism with several virulent characteristics and resistance mechanisms at its disposal. It is also a significant cause of a wide range of infectious diseases in humans. S. aureus often causes life-threatening deep seated infections like bacteremia, endocarditis and pneumonia. While traditionally confined mostly to the hospital setting, methicillin-resistant S. aureus (MRSA) is now rapidly becoming rampant in the community. Community-acquired MRSA is particularly significant because of its potential for unchecked spread within households and its propensity for causing serious skin and pulmonary infections. Because of the unfavorable outcome of many MRSA infections with the standard glycopeptide therapy, new antimicrobial agents belonging to various classes have been introduced and have been evaluated in clinical trials for their efficacy in treating resistant staphylococcal infections. A number of preventive strategies have also been suggested to contain the spread of such infections. In this review, we address the recent changes in the epidemiology of S. aureus and their impact on the clinical manifestations and management of serious infections. We also discuss new treatment modalities for MRSA infections and emphasize the importance of preventive approaches.

Humans↗

PubMed1991

Antiribitol-teichoic acid antibody (ARTA) in diagnosis of deep seated Staphylococcus aureus infections.

Antiribitol-teichoic acid antibody (ARTA) was detected in sera of 30 out of 50 patients (60%) with various acute deep seated Staphylococcus aureus infections and 5 out of 10 chronic osteomyelitis cases, whereas none of the sera from 50 patients with superficial Staphylococcus aureus infections as well from 50 patients without Staphylococcus aureus infections showed antibody response (p less than 0.01). This test is a definite advantage in diagnosis of deep seated staphylococcal infections like endocarditis, lung disease, meningitis and specially in osteomyelitis cases where organisms cannot be isolated and therefore helps in predicting the need for long term antimicrobial therapy.

Adult↗

PubMed2006

Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates.

BACKGROUND: Community-acquired, methicillin-resistant Staphylococcus aureus infections are increasing among children. OBJECTIVE: Our goal is to describe the clinical presentation of neonatal community-acquired S aureus disease and provide molecular analyses of the infecting isolates. PATIENTS AND METHODS: We retrospectively reviewed the demographics and hospital course of term and near-term previously healthy neonates, < or = 30 days of age, with community-acquired S aureus infections presenting after nursery discharge between August 2001 and March 2005 at Texas Children's Hospital. Prospectively collected isolates were characterized by pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec type, and the presence of PVL genes. RESULTS: Of 89 S aureus infections, 61 were methicillin-resistant S aureus; S aureus infections increased each year. Methicillin-resistant S aureus infections increased from 10 of 20 to 30 of 36 infections from 2002 to 2004. Most subjects, 65 of 89, were male. Symptoms began at 7 to 12 days of age for 26 of 45 male infants with methicillin-resistant S aureus. Most infections, 77 of 89, involved skin and soft tissue; 28 of 61 methicillin-resistant S aureus versus 7 of 28 methicillin-susceptible S aureus infections required drainage. Invasive manifestations included shock, musculoskeletal and urinary tract infection, perinephric abscess, bacteremia, empyema/lung abscess, and a death. Maternal S aureus or skin-infection history occurred with 13 of 61 methicillin-resistant S aureus versus 1 of 28 methicillin-susceptible S aureus infections. The predominant community clone, USA300 (PVL genes +), accounted for 55 of 57 methicillin-resistant S aureus and 3 of 25 methicillin-susceptible S aureus isolates. CONCLUSIONS: Community-acquired methicillin-resistant S aureus is a substantial and increasing proportion of S aureus infections in previously healthy neonates. Male infants 7 to 12 days of age are affected most often. Neonatal community-acquired S aureus infection may be associated with concurrent maternal infection. USA300 is the predominant clone among these neonatal isolates in our region.

Community-Acquired Infections↗

PubMed2005

The emergence of severe, community-acquired methicillin-resistant Staphylococcus aureus infections.

The number of community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections is rapidly increasing. Most CA-MRSA infections are localized soft tissue infections; however, severe life-threatening infections have been occasionally described. This report serves to increase the awareness of severe CA-MRSA infections by presenting a fulminant CA-MRSA infection with sepsis, endocarditis, septic pulmonary emboli, and extensive soft tissue and bone destruction. A review of the literature revealed 14 cases of severe CA-MRSA infections with a median age of 13 y; 93% had no underlying medical condition. Only 1 case was initially treated with antibiotics effective for MRSA. The fatality rate was 64%, and 40% of patients who survived had significant disabilities.

Adult↗

PubMed2006

Healthy children with invasive community-acquired methicillin-resistant Staphylococcus aureus infections.

Reports of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in the pediatric community have exploded during the past decade. These infections typically result in mild skin and soft tissue infections that can be managed simply with oral antimicrobials. Recently, there have been reports of invasive CA-MRSA infecting children without risk factors, with isolated cases of life-threatening disease. We report 2 atypical cases of invasive CA-MRSA infecting previously healthy children.

Adolescent↗

PubMed2004

Staphylococcus aureus infections in Australasian neonatal nurseries.

OBJECTIVE: To study the incidence and outcome of systemic infections with methicillin sensitive (MSSA) and methicillin resistant Staphylococcus aureus (MRSA) infections in Australasian neonatal nurseries. METHODS: Prospective longitudinal study of systemic infections (clinical sepsis plus positive cultures of blood and/or cerebrospinal fluid) in 17 Australasian neonatal nurseries. RESULTS: The incidence of early onset sepsis with S aureus, mainly MSSA, was 19 cases per 244 718 live births or 0.08 per 1000. From 1992 to 1994, MRSA infections caused only 8% of staphylococcal infections. From 1995 to 1998, there was an outbreak of MRSA infection, in two Melbourne hospitals. The outbreak resolved, after the use of topical mupirocin and improved handwashing. Babies with MRSA sepsis were significantly smaller than babies with MSSA sepsis (mean birth weight 1093 v 1617 g) and more preterm (mean gestation 27.5 v 30.3 weeks). The mortality of MRSA sepsis was 24.6% compared with 9.9% for MSSA infections. The mortality of early onset MSSA sepsis, however, was 39% (seven of 18) compared with 7.3% of late onset MSSA infection presenting more than two days after birth. CONCLUSIONS: S aureus is a rare but important cause of early onset sepsis. Late onset MRSA infections carried a higher mortality than late onset MSSA infections, but babies with early onset MSSA sepsis had a particularly high mortality.

Australia↗

PubMed1989

Effect of segregation on prevention of intramammary infections by Staphylococcus aureus.

Effectiveness of segregating cows with Staphylococcus aureus intramammary infections was studied over 1 yr. Nine herds were split into control (n = 5) or segregated (n = 4) groups. Cows with S. aureus intramammary infections were milked last in segregated herds. Monthly milk samples were collected aseptically for microbiologic analysis. Mean incidences of S. aureus intramammary infections were 3.7 and 4.3 cases/100 cow-mo in segregated and control herds. The mean prevalence of S. aureus intramammary infections decreased in both segregated and control herds during the study. Mean percentages of cows with S. aureus intramammary infections at the beginning and end of the study were 33.7 and 21.5 in segregated herds and 25.3 and 15.0 in control herds. Cows in all herds with S. aureus intramammary infections were preferentially culled. There were no significant differences in incidence and prevalence of S. aureus intramammary infections between groups, suggesting that S. aureus intramammary infections can be controlled without segregation.

Animals↗

PubMed2002

Methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis infections in the cornea.

PURPOSE: To describe the incidence and clinical management of corneal infections with methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE). METHODS: The incidence of methicillin-resistant Staphylococcus (MRS) at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, was reviewed during the 5-year period from January 1996 to December 2000. Clinical aspects of MRS colonization or infection in the eye were investigated. RESULTS: Methicillin-resistant S. aureus or MRSE was detected from 30 eyes with ocular diseases; post-keratoplasty (11 eyes), ocular surface disorders without operation (9 eyes), and others (10 eyes). Among the 30 eyes, 12 manifested keratitis. Eight cases (8 eyes) occurred after keratoplasty, including four postoperative cases in patients with Stevens-Johnson syndrome, and two bilateral cases (4 eyes) in patients with acute-phase Stevens-Johnson syndrome. The degree of MRS keratitis was classified into 4 groups: asymptomatic carrier or conjunctivitis, intraepithelial infiltrations, superficial keratitis, and severe keratitis leading to corneal perforation. All cases of keratitis were treated successfully with topical ofloxacin (OFLX), vancomycin (VCM), or arbekacin (ABK). CONCLUSION: Factors associated with ocular MRS colonization were long-term use of antibiotics and/or steroids, and hospitalization. Patients who had undergone keratoplasty or who had Stevens-Johnson syndrome were at increased risk of MRS keratitis. Superficial stromal infiltrations, minimal melting, and minimal stromal scarring are characteristic of MRS keratitis. Therapy for MRS keratitis is summarized. Ofloxacin, VCM, and ABK are effective in the treatment of MRS keratitis. Vancomycin eye ointment is effective as the final choice in serious cases.

Adult↗

PubMed1986

Urinary tract infection with Staphylococcus saprophyticus.

A case of urinary tract infection with Staphylococcus saprophyticus is presented. This gram-positive organism can cause urethral symptomatology in males and females without history of catheterization or urinary tract abnormality. Evidence suggests that S. saprophyticus is a cause of sexually transmitted urethritis.

Adult↗

PubMed1998

A molecular epidemiologic study of methicillin-resistant Staphylococcus aureus infection in patients undergoing middle ear surgery.

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections after middle ear surgery has recently increased at our hospital. Most of these infections were thought to be hospital-acquired when medical personnel in contact with an MRSA-infected patient may have inadvertently transmitted the pathogen to other patients. To prevent further transmission it is essential that such sources of MRSA infection and transmission routes be selected out and eradicated. Therefore, it is necessary to determine whether the strains of MRSA isolated from infected patients are identical to those obtained from medical personnel in order to prove a reciprocal transmission of organisms between medical personnel and patients. Surveillance bacterial cultures from the anterior nares and hands of medical personnel working in the Department of Otolaryngology, Korea University Guro Hospital, were performed at two different time points: 6 December 1994 and 17 June 1996. Ribotyping with Southern blot technique was used to compare 12 MRSA strains from medical carriers with 60 strains identified from the otorrhea of MRSA-infected patients undergoing middle ear surgery. As results, six different MRSA strains were identified (types I, II, III, IV, V and VI) from ribotyping with EcoR1. One distinct subtype, type I strain, was the most frequently identified strain in both medical carriers and patients. Results also showed that 6 MRSA isolates from 10 medical carriers and 20 from 30 patients contained type I ribotype at first culture. Two medical carriers' isolates and 13 isolates from 30 patients shared the same type I strain at the second surveillance culture. In all, 41 out of 72 MRSA strains (56.9%) shared an identical ribotype pattern. Postoperative MRSA infection rates after treatment of medical carriers and the application of rigorous preventive procedures decreased from 11.9 to 5.7% after first culture and 9.0 to 7.7% following second cultures. These findings confirm that MRSA transmission can occur between medical personnel and patients and that effective preventive measures can reduce the postoperative infection rate.

Blotting, Southern↗

PubMed1992

Methicillin-resistant Staphylococcus aureus infection.

Elderly patients with chronic illnesses are at increased risk of becoming colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA). Therapeutic choices for the treatment of MRSA have been limited by the ever-expanding resistance of organisms and drug toxicity. In hospitals, the MRSA carrier state has been associated with increased risk of infection and possible dissemination of the organism to other patients. The epidemiology of MRSA and its significance in long-term care have been less well defined. Isolation procedures and steps to contain or eradicate MRSA should be accommodated to the individual needs of the facility and its resources.

Age Factors↗

PubMed2003

Relationship of relapsing hip prosthesis infection by Staphylococcus aureus with gamma interferon deficiency.

Infections complicate 0.5 to 1% of surgeries for total hip prostheses. Staphylococcus species are the most common etiological agents. The role of host factors in the persistence of such infections despite appropriate therapy has yet to be determined. We report the defective immune response characterized by oversecretion of tumor necrosis factor and interleukin 10 and by undersecretion of gamma interferon in such a patient. Further study may determine the prevalence of such deficits and the most appropriate therapy for these patients.

Arthroplasty, Replacement, Hip↗

PubMed2003

Vaccination with nontoxic mutant toxic shock syndrome toxin 1 protects against Staphylococcus aureus infection.

To investigate whether vaccination with nontoxic mutant toxic shock syndrome toxin 1 (mTSST-1) can protect against Staphylococcus aureus infection, mice were vaccinated with mTSST-1 and challenged with viable S. aureus. Survival in the mTSST-1-vaccinated group was higher, and bacterial counts in organs were significantly lower than those of control mice. Passive transfer of mTSST-1-specific antibodies also provided protection against S. aureus-induced septic death. Interferon (IFN)-gamma production in the serum samples and spleens from vaccinated mice was significantly decreased compared with that in controls, whereas interleukin-10 titers were significantly higher in vaccinated mice. IFN-gamma and tumor necrosis factor-alpha production in vitro were significantly inhibited by serum samples from mTSST-1-immunized mice but not from control mice. These results suggest that vaccination with mTSST-1 devoid of superantigenic properties provides protection against S. aureus infection and that the protection might be mediated by TSST-1-neutralizing antibodies as well as by the down-regulation of IFN-gamma production.

Animals↗

PubMedDate not supplied

The economic impact of Staphylococcus aureus infection in New York City hospitals.

We modeled estimates of the incidence, deaths, and direct medical costs of Staphylococcus aureus infections in hospitalized patients in the New York City metropolitan area in 1995 by using hospital discharge data collected by the New York State Department of Health and standard sources for the costs of health care. We also examined the relative impact of methicillin-resistant versus -sensitive strains of S. aureus and of community-acquired versus nosocomial infections. S. aureus-associated hospitalizations resulted in approximately twice the length of stay, deaths, and medical costs of typical hospitalizations; methicillin-resistant and -sensitive infections had similar direct medical costs, but resistant infections caused more deaths (21% versus 8%). Community-acquired and nosocomial infections had similar death rates, but community-acquired infections appeared to have increased direct medical costs per patient ($35,300 versus $28,800). The results of our study indicate that reducing the incidence of methicillin-resistant and -sensitive nosocomial infections would reduce the societal costs of S. aureus infection.

Community-Acquired Infections↗

PubMedDate not supplied

Staphylococcus aureus infections in dialysis patients: focus on prevention.

Staphylococcus aureus infections are a major cause of morbidity and hospitalization in dialysis patients. The risk of infection relates to the type of access. Patients with acute hemodialysis (HD) catheters are at the greatest risk of S. aureus bacteremia, followed by tunneled HD catheters, and grafts. Patients with a fistula have a rate similar to that of peritoneal (PD) patients. In PD patients, however, S. aureus is the second most common cause of peritonitis, is often associated with a catheter infection, and frequently requires catheter removal for resolution. S. aureus infections in dialysis patients are much more common in nasal carriers. S. aureus moves from the nasal reservoir to the hands and skin, and from there to infect the access. Therefore, prevention of infection can be aimed at treating the carriage or in applying antibiotics at the catheter exit site, thus preventing colonization and subsequent infection of the catheter. For HD patients with a permanent access (either fistula or graft), intranasal mupirocin, twice a day for 5 days followed by a once weekly application, is effective in reducing the risk of S. aureus bacteremia. Cost analysis indicates that treating all patients would result in more cost savings than treating just carriers. For patients with acute HD catheters, exit site mupirocin applied as part of routine care during each HD treatment, reduces the risk of S. aureus exit site infection and bacteremia. For PD patients, S. aureus infections can be diminished by using mupirocin at the exit site as part of daily exit site care. Prophylaxis against S. aureus is under utilized in dialysis patients and, if implemented, could lower the rate of these serious infections.

Anti-Bacterial Agents↗

PubMed2005

Prevention of Staphylococcus aureus infections: advances in vaccine development.

Staphylococcus aureus is a ubiquitous bacterial species that causes serious disease in a minority of carriers, particularly in hospital settings. S. aureus disease is difficult to treat, and antibiotic-resistant strains have become common. Prevention of S. aureus disease would therefore be the best way to limit the morbidity and mortality caused by this organism, but its virulence is determined by a number of different factors, making design of a widely effective vaccine difficult. Here, various S. aureus virulence factors and attempts to develop vaccines or other protective drugs based on these factors are reviewed. In particular, the results of a Phase III clinical study of a vaccine directed at capsular polysaccharides types 5 and 8 are discussed.

Animals↗