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PubMedDate not supplied

Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections.

In a six-month period in 1978 61 patients at a university hospital became colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA). Ninety-three percent of patients with MRSA were on surgical services. Patients with burns acquired MRSA more frequently than did other acutely ill surgical patients (p less than .001), and often remained colonized for 30 days or more. The interval between admission and acquisition of S. aureus, number of antibiotics received, duration of antibiotic therapy before becoming colonized, and cost of hospitalization, were significantly greater in patients with MRSA infection than in matched controls with nosocomial methicillin-sensitive S. aureus infections. Acquisition of MRSA was epidemiologically associated with exposure to certain hospital personnel. Fourteen (6%) of 220 personnel exposed to MRSA patients harbored MRSA intranasally. Three of 14 colonized personnel carried MRSA intermittently for three or more months. Appropriate control measures failed to terminate the outbreak.

Burns↗
PubMed2004

Potential use of solid phase immunoassays in the diagnosis of coagulase-negative staphylococcal infections.

Staphylococcus epidermidis is a major nosocomial pathogen, even though it is a member of the normal bacterial flora of skin and the mucous membranes. A major complication is the development of biofilms on implanted medical devices. Diagnosis of coagulase-negative staphylococcal infections relies on the presence of clinical manifestation of infections and on microbiologic evidence, usually obtained after the removal of the biomaterial. Solid-phase immunoassays have not yet been used for routine diagnosis of coagulase-negative staphylococcal infections and distinction between pathogenic and normal cocci. The enzyme immunoassays developed in the last decade are presented in this review article. Serodiagnosis has been attempted by determining antibodies against bacterial cells, mixtures of S. epidermidis slime antigens and discrete slime antigens. Detection or typing of staphylococcal cells has been performed by specific antibodies and lectins. There is still a long way until the application of such assays in the routine clinical laboratory and large clinical studies are necessary.

Antibodies, Bacterial↗
PubMed2002

Community-acquired methicillin-resistant Staphylococcus aureus infections in discharging ears.

OBJECTIVES: Although community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections have recently become an increasing problem in various fields of medicine, they have rarely been studied in the ear. The purpose of this study was to determine the prevalence of community-acquired MRSA infections in discharging ears and to compare the epidemiology of MRSA with that of other pathogens. MATERIAL AND METHODS: Between August 2000 and February 2002, 248 isolates recovered from 221 discharging ears of patients with 3 disease entities (chronic otitis media, acute otitis externa and granular myringitis) were prospectively analyzed using bacteriology. The isolates analyzed using bacteriology were divided into three groups: MRSA, methicillin-susceptible S. aureus (MSSA) and non-SA. RESULTS: S. aureus was found in 108 (43.5%) isolates and MRSA in 27. Therefore, the percentage of MRSA among the S. aureus isolates was 25.0% (27/108). The prevalence of community-acquired MRSA infections in discharging ears was 12.2% (27/221) and the MRSA strains were highly susceptible to vancomycin, teicoplanin, fusidic acid and minocycline. The MRSA-infected patients were older than those infected with other groups of pathogens. Also, MRSA infections appeared to be more common in chronic otitis media than in acute otitis externa or granular myringitis. CONCLUSIONS: Community-acquired MRSA represents an increasing problem. In this study, MRSA strains were highly susceptible to vancomycin, teicoplanin, fusidic acid and minocycline.

Acute Disease↗
PubMed2001

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

BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infections have increased dramatically from 1990 to 2000. OBJECTIVES: The objectives of this retrospective study were to report the frequency of CAMRSA isolates, to describe the spectrum of disease observed in children infected with CAMRSA and to compare the antibiotic susceptibility patterns of community-acquired and nosocomial methicillin-resistant S. aureus (MRSA) infections. METHODS: All cases of S. aureus including MRSA infections were identified by a computer-assisted search of the Vitek system culture results from 1990 to 2000 and review of the minutes of Infection Control Committee meetings. RESULTS: MRSA was isolated from 147 children (77 boys; 2 weeks to 17 years) from October 1, 1990, to December 31, 2000. Seven cases of CAMRSA were identified from 1990 to 1996, and 53 cases were identified from 1997 to 2000 with 35 cases occurring in 2000. Of the 128 children whose medical records were reviewed, 60 (47%) had CAMRSA infections. In 53 (88%) of these 60 children no risk factor for MRSA was identified. Soft tissue infections accounted for 48 (91%) of the 53 cases of the CAMRSA in children without known risk factors. CAMRSA isolates from children without known risk factors were more susceptible to trimethoprim-sulfamethoxazole (98% vs. 82%; P < 0.005) and clindamycin (92% vs. 57%; P < 0.001) and less susceptible to tetracycline (54% vs. 95%; P < 0.001) than were nosocomial MRSA isolates. CONCLUSIONS: The emergence of CAMRSA as a cause of common infections may require a change in the initial selection of antibiotics to assure appropriate coverage in critically ill children.

Adolescent↗
PubMed2004

Molecular epidemiology and control of nosocomial methicillin-resistant Staphylococcus aureus infection in a teaching hospital.

BACKGROUND AND PURPOSE: Nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection is difficult to control. Due to a dramatic increase in the nosocomial MRSA infection rate at our hospital from 2000 to 2001, this study was conducted to identify the source of these infections and the effectiveness of control measures. METHODS: 179 healthcare workers (HCWs) were screened for carriage of MRSA. Starting in April 2001, all patients with MRSA infection or colonization were put in strict contact and cohort isolation. The bacterial isolates of HCW carriers and patients with MRSA infection from April 2001 to September 2001 were subjected to antimicrobial susceptibility testing by disk-diffusion method and molecular typing by pulsed-field gel electrophoresis (PFGE). RESULTS: Fifteen HCWs were found to be carriers of MRSA. They were all given topical mupirocin treatment. After these interventions, the nosocomial MRSA infection rate decreased from 1.23 to 0.53 per 1000 patient-days. All 61 MRSA isolates available for antimicrobial susceptibility testing and molecular typing were multidrug resistant. PFGE study revealed 2 predominant types, type C and type Y, comprising 36 and 12 isolates, respectively. CONCLUSIONS: The current study demonstrates the importance of measures to control nosocomial MRSA infections in hospitals that already have a high incidence of endemic MRSA infection. Elimination of carriage by healthcare workers, and strict contact and cohort isolation are the main effective measures.

Anti-Bacterial Agents↗
PubMed1991

Correlation of in-vitro parameters of antimicrobial activity with prophylactic efficacy in an intradermal model of Staphylococcus aureus infection.

Cephalosporins differ in their ability to prevent staphylococcal wound infection. Although the reasons for the observed differences are not fully understood, the susceptibility of cephalosporins to hydrolysis by staphylococcal beta-lactamase has been correlated with failures of prophylaxis. To investigate the effect of beta-lactamase stability and other in-vitro parameters of the bacterial-antimicrobial interaction on the efficacy of antimicrobial prophylaxis, two beta-lactamase-stable agents, cefuroxime and cefmetazole were compared to cefazolin and cefamandole in an in-vivo model of intradermal infection employing four strains of Staphylococcus aureus. Following intraperitoneal administration of a single dose of cephalosporin or placebo, guinea pigs were inoculated at multiple intradermal sites with 2 x 10(7) cfu of a strain of staphylococcus. For three strains, the area of induration at 24 h following inoculation was significantly smaller in guinea pigs receiving prophylaxis with cephalosporins versus placebo; no cephalosporin was effective against the fourth strain. Differences were also noted among the cephalosporins; prophylaxis with cefuroxime and cefmetazole resulted in smaller lesions than seen in animals given cefazolin or cefamandole. Poor correlation was noted between results of the in-vivo model and in-vitro determinants of the bacterial-antimicrobial interaction which were MIC values, time-kill curves, and the rates of beta-lactamase-mediated cephalosporin hydrolysis by the different strains. The model demonstrated unexplained failures of prophylaxis and unexpected differences in efficacy of various cephalosporins as has been described before. This study highlights the need for an improved animal model of surgical antimicrobial prophylaxis and the identification of in-vitro determinants that predict in-vivo prophylactic efficacy more accurately.

Animals↗
PubMed2004

Regulation of chemokine gene expression and secretion in Staphylococcus aureus-infected osteoblasts.

Staphylococcus aureus is the major cause of osteomyelitis or bone infection, leading to major morbidity, often in children. Little is known about immunopathogenesis of osteomyelitis, although uncontrolled inflammation is a major clinical feature. This study investigated effects of dexamethasone, PGE(2) and T(h)2 cytokines, all potential down-regulatory mediators, on control of S. aureus-induced C-X-C (CXCL8, CXCL10) and C-C (CCL5, CCL2) chemokine gene expression and secretion from human osteoblastic MG-63 cells and primary NHOst cells. Chemokine mRNA expression and secretion were reduced 50-75% by dexamethasone, whereas PGE(2) doubled mRNA accumulation, as detected by RNase protection assay and RT-PCR, but decreased chemokine secretion 33-71% (P < 0.05). IL-10 reduced chemokine mRNA accumulation by 20-40% in MG-63 cells. IL-4 and -13 decreased CXCL8 but not CXCL10 gene expression. IL-10 and IL-13 reduced S. aureus-induced osteoblast C-X-C chemokine secretion, whereas IL-4 decreased CXCL8 secretion 2.5-fold and increased CXCL10 secretion 3-fold (all P < 0.05). In contrast, T(h)2 cytokines increased C-C chemokine secretion from MG-63 osteoblastic cells (P < 0.05), and IL-4 and IL-13 caused similar up-regulation of CCL2 secretion from primary osteoblasts. In summary, during S. aureus infection of osteoblasts, T(h)2 cytokines, dexamethasone and PGE(2) have diverse, sometime upregulatory actions on C-C and C-X-C chemokines due to both pre- and post-transcriptional effects on chemokine secretion.

Cell Line↗
PubMed2000

Systemic and local immune response of cows to intramammary infection with Staphylococcus aureus.

The association between Staphylococcus aureus chronic mammary gland infection and the resulting immune response expressed by the production of specific IgG and IgA antibodies in blood and milk was studied in Israeli Holstein cows. Specific antibodies of the IgG class were detected in sera of 82.6 per cent of the cows chronically infected by S aureus, while in 17.4 per cent no such antibodies could be detected. Specific IgG antibodies to S aureus were neither detected in sera of cows free of mammary infection nor in those infected with different coagulase-negative staphylococci (CNS) such as S intermedius, S chromogenes or S haemolyticus. In milk, specific IgG antibodies to S aureus were detected only in cows with positive serology. The end point dilutions in the milk were 5 to 30 per cent of that of blood from the same cow. No significant difference in IgG titres was found in the same cow if the quarter was infected with S aureus or not. Specific antibodies to S aureus of the IgA class could not be detected in the sera of any of the cows included in this study. In milk, a specific IgA antibody was detected only in the samples from the S aureus infected quarters in which S aureus was isolated at the time of the experiment. In the same cow, quarters infected by S aureus were found to have a significantly higher IgA titre (P < 0.0001) than that of the non-infected ones.

Animals↗
PubMed2006

[Effect of human beta defensin 2 on Staphylococcus aureus infection: in vivo study with transgenic mice].

OBJECTIVE: To investigate the effect of human beta defensin 2 (HBD-2) on Staphylococcus aureus infection. METHODS: A minigene of HBD-2 containing pCMV promoter, full length of HBD-2 cDNA, and BGH polyA tail was generated by PCR amplification and introduced into the fertilized oocytes of C57/ICR hybridized mouse by microinjection. After gestation of 3 - 4 weeks, immunohistochemistry was used to detect the expression of HBD-2 peptide in different tissues of the transgenic young mice. Staphylococcus aureus was cultured and injected intraperitoneally to wild type mice and transgenic mice to observe their surviving status. RESULTS: PCR showed that the HBD-2 fragment had been successfully integrated into the chromosome of the mice. A widespread expression of HBD-2 gene was found in many tissues of the transgenic mice: trachea, lung, intestine, esophagus, testis, spleen, skin, endothelium, brain, etc. Four of the 7 transgenic mice survived the Staphylococcus aureus infection, and 10 wild type mice all died within 24 hours. CONCLUSION: HBD-2 may play an important role ion the host defense against Staphylococcus aureus infection.

Animals↗
PubMed2001

A hospital-acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a surgeon carrier.

Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital-acquired pathogen, infection with which often leads to major morbidity and mortality. The principal mode of transmission for MRSA is transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff. From January 16 1997 to April 2 1997, five patients who had undergone open-heart surgery in a hospital located in northern Taiwan, developed surgical wound infections and mediastinitis caused by MRSA. All patients were hospitalized in two adjacent surgical intensive care units (ICUs) following their respective operations. Consequently, the hospital's infection control team commenced investigation of the outbreak. Pulsed-field gel electrophoresis (PFGE) has been shown to be a good technique for epidemiological typing. By analysing cultures taken from staff by PFGE, it was demonstrated that this outbreak was most likely to be initiated by a surgeon with MRSA carriage. After elimination of the carrier state using topical mupirocin treatment, the outbreak was controlled without further incident.

Adolescent↗
PubMed1988

Cross-infection between animals and man: possible feline transmission of Staphylococcus aureus infection in humans?

An outbreak of epidemic methicillin-resistant Staphylococcus aureus occurred on a rehabilitation geriatric ward. Intensive screening of patients and staff revealed an unusually high carriage rate in the nursing staff (38%), thought to be related to a ward cat which was heavily colonized from the environment. Infection control measures and removal of the cat led to rapid resolution of the outbreak.

Aged↗
PubMed1977

Intramammary infections in a dairy herd with a low incidence of Streptococcus agalactiae and Staphylococcus aureus infections.

In a dairy herd with a low incidence of intrammary infections due to Streptococcus agalactiae and Staphylococcus aureus, clinical mastitis remained a serious problem despite good control of nonclinical mastitis through postmilking teat disinfection and antibiotic therapy of known infected quarters at the end of lactation. During the 2-year study, the incidence of clinical mastitis was 0.88 cases/cow-year; 32.2% were caused by streptococcal species other than Str agalactiae and 33.5% by gram-negative organisms. Among all new infections detected, 54.1% were caused by streptococcal species other than Str agalactiae and 25.7% by gram-negative bacteria. Among new infections, 41.6% occurred during the nonlactating period or within a few days of calving. Incidence of clinical mastitis was highest in the 1st month of lactation. Among 84 gram-negative infections, 42.8% were caused by Klebsiella pneumoniae, 20.2% by Escherichia coli, and 23.8% by Enterobacter spp. Among the many serotypes of K pneumoniae and E coli, none was predominant.

Animals↗
PubMed2005

Mortality risk factors with nosocomial Staphylococcus aureus infections in intensive care units: results from the German Nosocomial Infection Surveillance System (KISS).

INTRODUCTION: As the number of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections in German intensive care units increases, the problem of MRSA infection as such is becoming ever more serious. The aim of this study was to investigate whether mortality rates from nosocomial MRSA pneumonia and primary bloodstream infections (BSI) differ significantly from those of nosocomial pneumonia and primary BSI caused by methicillin-susceptible S. aureus (MSSA). METHODS: For the analysis data from the ICU component of the German nosocomial infection surveillance system (KISS) were used (January 1997 to June 2002). To identify mortality risk factors a logistic regression analysis with step-wise variable selection was conducted including all cases of nosocomial S. aureus pneumonia and primary BSI. The possible risk factors that were evaluated were age > median, male gender, time in the ICU before infection > median, type of ICU, type and size of hospital, intubation, CVC use, total parenteral nutrition, year of investigation, infection caused by MRSA. RESULTS: Data from 274 ICUs and 505,487 ICU patients were recorded and a total of 6,888 cases of nosocomial pneumonia and 2,357 cases of primary BSI identified, of which 1,851 cases of S. aureus pneumonia and 378 cases of S. aureus primary BSI were considered for analysis. 59 of the 349 patients with MRSA pneumonia (16.9%) and 105 of the 1,502 patients with MSSA pneumonia (7.0%) died. 16 of the 95 patients with primary MRSA BSI (16.8%) and 17 of the 283 patients with primary MSSA BSI died (6.0%). Four factors were significantly associated with mortality from S. aureus pneumonia, one of them being pneumonia caused by MRSA (OR = 2.62; CI95 1.69-4.02). Only MRSA was significantly associated with death from S. aureus primary BSI (OR = 3.84; CI95 1.51-10.2). CONCLUSION: Nosocomial pneumonia and primary BSI from MRSA may be associated with death, but the cause-effect relationship of severity of illness and MRSA remains to be determined due to the limitations of surveillance data.

Cross Infection↗
PubMed2006

Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns--Chicago and Los Angeles County, 2004.

Methicillin-resistant Staphylococcus aureus (MRSA) infection has long been associated with exposure in health-care settings but emerged in the late 1990s among previously healthy adults and children in the community. Community-associated MRSA (CA-MRSA) infections most commonly are skin and soft-tissue infections; however, certain cases can progress to invasive tissue infections, bacteremia, and death. This report describes two independent investigations by local health departments, assisted by CDC, into outbreaks of MRSA skin infection among otherwise healthy, full-term newborns delivered at hospitals in Chicago, Illinois, and Los Angeles County, California. In both locations, MRSA transmission likely occurred in the newborn nursery; however, laboratory testing identified the MRSA strain as one that was described initially in association with CA-MRSA infections and outbreaks and that differs from predominant health-care-associated MRSA (HA-MRSA) strains. The findings from these investigations underscore 1) the need for health-care providers to be aware that MRSA can cause skin infections among otherwise healthy newborns and 2) the importance of adhering to standard infection-control practices, including consistent hand hygiene, in newborn nurseries.

Chicago↗
PubMed2006

Efficacy of vaccination and antimicrobial treatment to eliminate chronic intramammary Staphylococcus aureus infections in dairy cattle.

OBJECTIVE: To determine whether a combination of vaccination and extended intramammary antimicrobial treatment would eliminate chronic intramammary Staphylococcus aureus infections in lactating dairy cows. DESIGN: Randomized controlled clinical trial. ANIMALS: 50 dairy cows with chronic mastitis caused by S aureus. PROCEDURE: Cows were identified and paired within herd on the basis of days in milk, lactation number, milk production, and numbers of quarters infected. Treated cows (n=20) received 3 doses of a polyvalent S aureus bacterin on days 1, 15, and 21 of the study along with intramammary administration of pirlimycin in all 4 quarters once daily for 5 treatments (days 16 to 20). Control cows (n=23) received no treatment. Follow-up samples for bacteriologic culture were collected for at least 3 months after treatment to determine treatment success rates. RESULTS: Significantly more S aureus infections were eliminated from treated cows (8/20 [40%]), compared with control cows (2/23 [9%]). The proportion of infected quarters that yielded negative results throughout the follow-up period was also significantly higher in treated cows (13/28 [46%]) than in control cows (2/41 [5%]). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that a combination of vaccination and antimicrobial treatment can be successful in eliminating some cases of chronic intramammary S aureus infections in dairy cattle. However, it is important to consider extended treatment protocols carefully because many cows are likely to remain infected with S aureus despite treatment and vaccination.

Animals↗
PubMed2001

Surveillance and control of methicillin-resistant Staphylococcus aureus infections in French hospitals.

OBJECTIVE: To assess the way French hospitals conduct surveillance for, and control infections caused by, methicillin-resistant Staphylococcus aureus (MRSA), and to evaluate the incidence of these infections. DESIGN: Retrospective analysis of sample surveillance data. SETTING: Representative sample of French hospitals. PARTICIPANTS: Representative sample of 38 French public hospitals. METHODS: Hospitals were selected randomly in 1996, taking into account their location and number of beds. Administrative data, surveillance denominators used, antimicrobial resistance rates, and infection control practices were analyzed for the period 1990 to 1995. The same 38 centers were contacted 3 years later, in 1998, to reassess their surveillance and control activities. RESULTS: French hospitals were slow to implement MRSA surveillance programs; only 5% had such programs in 1990, when the median incidence per admission (0.37%) and per patient-days (0.04%) of MRSA infections was already high. Despite the implementation of surveillance programs in 66% of French hospitals in 1995 and 87% in 1998, the MRSA infection rates remained stable from 1990 to 1995 and increased from 1995 to 1998. The proportion of French hospitals having a policy for the transfer of MRSA-infected patients to other hospitals increased from 47% in 1995 to 61% in 1998, whereas screening for MRSA colonization (42%-53%) and isolation for colonized or infected patients (87%-89%) remained stable. CONCLUSIONS: This first national survey showed that French hospitals probably were not optimally prepared to control and prevent MRSA infections, since they were slow to respond to the growing problem.

Cross Infection↗
PubMed2002

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

More than 40% of Staphylococcus aureus strains isolated in hospitals are methicillin-resistant, thus posing daily problems regarding therapy. The treatment of these infections is principally based on glycopeptides. The need or not to combine them, first-line or second-line, with another antibiotic, remains a subject for debate. In this article, we have endeavoured to demonstrate the validity of arguments which plead in favour of using glycopeptides in combination, and not as single-drug therapy.

Anti-Bacterial Agents↗