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PubMed1990

Synergism between cefotaxime and fosfomycin in the therapy of methicillin and gentamicin resistant Staphylococcus aureus infection in rabbits.

An experimental model of infected subcutaneous fibrin clots in rabbits was used to study the synergism between cefotaxime and fosfomycin in infection with methicillin and gentamicin resistant Staphylococcus aureus (MGRSA), and to determine the efficacy of a simplified schedule of administration. The bactericidal activity of cefotaxime and fosfomycin against MGRSA was investigated giving the drugs in one full or two divided doses either alone or in combination. The pharmacokinetics of the drugs were correlated with the antibacterial efficacy obtained over 12 hours of treatment. The results confirmed that the combination of cefotaxime and fosfomycin is highly synergistic in experimental MGRSA infection. Higher bactericidal activity was obtained with a regimen of 6-hourly drug administration which resulted in persistent levels of both drugs in serum as well as at the site of infection.

Analysis of Variance↗
PubMedDate not supplied

Nosocomial infections: methicillin resistant Staphylococcus auerus in wound infection in Ibadan, Nigeria.

In a study of 188 cases of wound infection seen in the University College Hospital, Ibadan, between December 1994 and April 1995, 78 strains of Staphylococcus aureus were methicilin resistant (MRSA). The disc sensitivity pattern of the MRSA was determined using the method of Kirby et al., and the MICs of common antibacterial agents to the MRSA were determined by agar dilution method. Vancomycin, ofloxacin and ciprofloxacin offered the best effective treatment for MRSA wound infections, and are recommended as reserved drugs while gentamicin and cotrimoxazole are first line drugs.

Anti-Bacterial Agents↗
PubMed2003

Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis.

A systematic review of the English-language literature was performed to determine the overall benefit of mupirocin therapy in reducing the rate of Staphylococcus aureus infection among patients undergoing hemodialysis (HD) or peritoneal dialysis (PD). Included studies met the following criteria: they were randomized clinical trials or cohort studies; cohorts consisted of adults (age, > or =18 years) requiring HD or PD; mupirocin therapy was administered to the treatment group, and placebo or no therapy was administered to the control group; and the primary outcome of interest was the difference in the number of S. aureus infections among mupirocin-treated and -untreated patients. Ten studies described in 9 articles were analyzed. A total of 2445 patients were included in the analysis. Use of mupirocin reduced the rate of S. aureus infections by 68% (95% confidence interval [CI], 57%-76%) among all patients undergoing dialysis; risk reductions were 80% (95% CI, 65%-89%) among patients undergoing HD and 63% (95% CI, 50%-73%) among patients undergoing PD. When data were stratified by type of infection, S. aureus bacteremia was found to be reduced by 78% among patients undergoing HD, and peritonitis and exit-site infections were found to be reduced by 66% and 62%, respectively, among patients undergoing PD. Mupirocin prophylaxis substantially reduces the rate of S. aureus infection in the dialysis population. Optimal regimens that minimize the emergence of mupirocin resistance need to be explored.

Adult↗
PubMedDate not supplied

Characteristics, control, and treatment of methicillin-resistant Staphylococcus aureus infections.

The history, in vitro characteristics, epidemiology, clinical observations, control measures, and therapy of methicillin-resistant Staphylococcus aureus (MRSA) infections are reviewed. Strains of MRSA have been implicated in nosocomial infections, particularly in hospitals associated with medical schools. In vitro, MRSA cultures usually have only a small percentage of organisms that are resistant to methicillin. Patient-specific risk factors for acquiring MRSA infections have been identified in uncontrolled and controlled studies. Environmental culturing to identify sources of contamination has been nonproductive. Physical control measures such as good handwashing and proper isolation have produced variable results in dealing with MRSA. Other suggested measures for reducing the incidence of MRSA colonization include: increasing the nurse-to-patient ratio in intensive-care units; treatment of patients and hospital employees who are colonized with MRSA; and restriction of antibiotics. The drug of choice for treating MRSA infections is vancomycin given intravenously (peripherally or centrally) or by Ommaya reservoir (for CNS infections if bactericidical concentrations are not reached with i.v. doses). Vancomycin may be used empirically for patients at high risk for developing MRSA infections before culture-and-sensitivity reports are available.

Humans↗
PubMed1988

Alteration of sleep in rabbits by Staphylococcus aureus infection.

Abundant evidence suggests that sleep might be altered during infectious disease, although the relationship between sleep and infectious disease has never been examined systematically. To address this issue, we determined the effects of Staphylococcus aureus infection on rabbit sleep. Rabbits inoculated intravenously with S. aureus demonstrated the expected physiological changes consistent with a state of infectious disease (e.g., lymphopenia, neutrophilia, and fever), as well as time-dependent changes in sleep patterns. The sleep changes were characterized initially by increases in (i) the time spent in slow-wave sleep, (ii) the electroencephalographic slow-wave amplitudes during slow-wave sleep, and (iii) the duration of individual bouts of slow-wave sleep. At 20 to 36 h after inoculation, sleep responses fell to levels below corresponding control values for 6 to 12 h. At 6 to 10 h after inoculation, rapid-eye-movement sleep was suppressed and remained at low levels throughout the remainder of the 48-h recording period. These effects of bacterial infection on sleep were attenuated by antibiotic (cephalothin) therapy. Inoculation with killed bacteria produced similar changes in sleep and other physiological parameters, although significantly higher numbers of organisms were required to produce equivalent responses. We postulate that changes in sleep may represent an adaptive response of the host to infectious disease.

Animals↗
PubMed2005

Community-acquired disseminated methicillin-resistant Staphylococcus aureus infection: case report and clinical implications.

A 6-year-old girl with community-acquired disseminated infection caused by methicillin-resistant Staphylococcus aureus (MRSA) is described. She had sepsis, meningo-encephalitis, pyomyositis, osteomyelitis, pericarditis and pulmonary embolisation caused by a multi-resistant strain of MRSA. Vancomycin is not routinely recommended as the first-line antimicrobial agent for suspected Staphylococcus aureus infection; however, it should be considered pending susceptibility results in patients presenting with severe sepsis in areas where the prevalence of MRSA is high.

Bone Diseases, Infectious↗
PubMed2005

Use of intranasal mupirocin to prevent methicillin-resistant Staphylococcus aureus infection in intensive care units.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) causes severe morbidity and mortality in intensive care units (ICUs) worldwide. The purpose of this study was to determine whether intranasal mupirocin prophylaxis is useful to prevent ICU-acquired infections with MRSA. MATERIALS AND METHODS: We conducted a 4-year observational retrospective study in a 15-bed adult medical ICU. During the first 2-year period mupirocin ointment was included in the MRSA control programme; during the second, mupirocin was not used. The main endpoint was the number of endogenous ICU-acquired infections with MRSA. RESULTS: The number of endogenous acquired infections was significantly higher during the second period than during the first (11 versus 1; P = 0.02), although there was no significant difference in the total number of patients infected with MRSA between the two periods. We also observed that nasal MRSA decolonisation was significantly higher in the mupirocin period than in mupirocin-free period (P = 0.002). CONCLUSION: Our findings suggest that intranasal mupirocin can prevent endogenous acquired MRSA infection in an ICU. Further double-blind, randomised, placebo-controlled studies are needed to demonstrate its cost-effectiveness and its impact on resistance.

Administration, Intranasal↗
PubMed2001

Application of the California mastitis test in intramammary Streptococcus agalactiae and Staphylococcus aureus infections of camels (Camelus dromedarius) in Kenya.

A study was conducted on 207 lactating camels in six herds in Kenya to evaluate the California mastitis test (CMT) for the detection of intramammary infections (IMIs) caused by Streptococcus agalactiae and Staphylococcus aureus and to investigate the prevalence of both the pathogens in the camel udder. IMI with S. agalactiae was found in 12% of all camels sampled. IMI with S. aureus was present in 11% of all camels sampled. The herd-level prevalence of IMI varied between 0 and 50% for S. agalactiae and between 0 and 13% for S. aureus. Longitudinal observations over 10-12 months confirmed persistent infections for both pathogens. Observations in one herd suggested that camel pox was a contributing factor in spreading and exacerbating S. agalactiae udder infections.The CMT had quarter-level sensitivities of 77 and 68% for S. agalactiae and S. aureus in camels, respectively. The CMT specificities were 91% for both the pathogens.

Animals↗
PubMed2004

Preliminary study of community-acquired Staphylococcus aureus infection in Manaus Hospital, Amazonia Region, Brazil.

Methicillin resistant Staphylococcus aureus is considered a public health problem with a strong potential for dissemination and high rates of morbidity and mortality. In this study we describe bacteriological and epidemiological characteristics of Staphylococcus aureus in Manaus (Amazon region). During the one-year study period (2000-2001), sixteen cases of acute pyogenic multiple abscess were evaluated. Community-acquired S. aureus was identified as causative agent in 10 (62.5%) patients. The strains tested with antimicrobials by discs diffusion method, exhibited a high rate of sensitivity to cephalexin (100%), erythromycin (90%). Oxacillin-susceptible Staphylococcus aureus was 90%. No isolate was resistant to Vancomycin. To our knowledge, no series of community-acquired Staphylococcus aureus in Manaus hospital has been published. Our partial results showed a high rate of antimicrobial sensitivity among community-acquired Staphylococcus aureus in the hospital of Tropical Medicine Institute of Manaus, Amazon Region.

Abscess↗
PubMedDate not supplied

The burden of Staphylococcus aureus infections on hospitals in the United States: an analysis of the 2000 and 2001 Nationwide Inpatient Sample Database.

BACKGROUND: Previous studies have investigated the impact of Staphylococcus aureus infections on individual hospitals, but to date, no study using nationally representative data has estimated this burden. METHODS: This is a retrospective analysis of the 2000 and 2001 editions of the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample database, which represents a stratified 20% sample of hospitals in the United States. All inpatient discharge data from 994 hospitals in 28 states during 2000 and from 986 hospitals in 33 states during 2001, representing approximately 14 million inpatient stays, were analyzed to determine the association of S aureus infections with length of stay, total charges, and in-hospital mortality. RESULTS: Staphylococcus aureus infection was reported as a discharge diagnosis for 0.8% of all hospital inpatients, or 292 045 stays per year. Inpatients with S aureus infection had, on average, 3 times the length of hospital stay (14.3 vs 4.5 days; P<.001), 3 times the total charges (48,824 US dollars vs 14,141 US dollars; P<.001), and 5 times the risk of in-hospital death (11.2% vs 2.3%; P<.001) than inpatients without this infection. Even when controlling for hospital fixed effects and for patient differences in diagnosis-related groups, age, sex, race, and comorbidities, the differences in mean length of stay, total charges, and mortality were significantly higher for hospitalizations associated with S aureus. CONCLUSIONS: Staphylococcus aureus infections represent a considerable burden to US hospitals, particularly among high-risk patient populations. The potential benefits to hospitals in terms of reduced use of resources and costs as well as improved outcomes from preventing S aureus infections are significant.

Age Factors↗
PubMed2006

Ocular methicillin-resistant Staphylococcus aureus infections in a newborn intensive care cohort.

PURPOSE: To examine the occurrence and outcome of methicillin-resistant Staphylococcus aureus ophthalmologic infections in a newborn intensive care unit cohort. DESIGN: Noninterventional case series. METHODS: Over a 13-month period, 29 neonates were colonized with methicillin-resistant S. aureus in a newborn intensive care unit outbreak. Patients were followed prospectively during the course of colonization and infection. The frequency and type of ophthalmologic infection was recorded, and patients were treated according to clinical need. RESULTS: Eleven of these patients were found to have purulent conjunctivitis. No serious ocular disease ensued in any of these. Spontaneous resolution occurred in some patients, while others improved after either topical or systemic antibiotic treatment. CONCLUSION: Despite invasive infection caused by methicillin-resistant S. aureus, serious ophthalmologic infection was not found.

Anti-Bacterial Agents↗
PubMed2003

Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization.

Studies evaluating the risk of methicillin-resistant Staphylococcus aureus (MRSA)-associated sequelae in colonized or infected inpatients have not extended follow-up into the period after discharge from the hospital. We determined the 18-month risk of MRSA infection among 209 adult patients newly identified as harboring MRSA. Twenty-nine percent of patients (60 patients) developed subsequent MRSA infections (90 infections). These infections were often severe. Twenty-eight percent of infections (25 of 90) involved bacteremia, and 56% (50 of 90) involved pneumonia, soft tissue infection, osteomyelitis, or septic arthritis. Eighty percent of patients (48 of 60) with subsequent MRSA infection developed the infection at a new site, and 49% of new MRSA infections (44 of 90) first became manifest after discharge from the hospital. Accurate assessment of the risk of MRSA-associated sequelae requires prolonged follow-up after discharge.

Aged↗
PubMed2002

Enhanced Th1 response to Staphylococcus aureus infection in human lactoferrin-transgenic mice.

Lactoferrin (Lf) is an iron-binding protein of external secretions and neutrophil secondary granules with antimicrobial and immunomodulatory activities. To further define these properties of Lf, we have investigated the response to Staphylococcus aureus infection in transgenic mice carrying a functional human Lf gene. The transgenic mice cleared bacteria significantly better than congenic littermates, associated with a trend to reduced incidence of arthritis, septicemia, and mortality. We identified two pathways by which S. aureus clearance was enhanced. First, human Lf directly inhibited the growth of S. aureus LS-1 in vitro. Second, S. aureus-infected transgenic mice exhibited enhanced Th1 immune polarization. Thus, spleen cells from infected transgenic mice produced higher levels of TNF-alpha and IFN-gamma and less IL-5 and IL-10 upon stimulation ex vivo with the exotoxin toxic shock syndrome toxin-1 compared with congenic controls. To confirm that these effects of Lf transgene expression could occur in the absence of live bacterial infection, we also showed that Lf-transgenic DBA/1 mice exhibited enhanced severity of collagen-induced arthritis, an established model of Th1-induced articular inflammation. Higher levels of stainable iron in the spleens of transgenic mice correlated with human Lf distribution, but all other parameters of iron metabolism did not differ between transgenic mice and wild-type littermates. These results demonstrate that human Lf can mediate both antimicrobial and immunomodulatory activities with downstream effects on the outcome of immune pathology in infectious and inflammatory disease.

Adjuvants, Immunologic↗
PubMed2004

Community-associated methicillin-resistant Staphylococcus aureus infections in Pacific Islanders--Hawaii, 2001-2003.

Methicillin-resistant Staphylococcus aureus (MRSA) is emerging as a cause of skin and soft-tissue infections in persons who have little or no contact with health-care settings. The majority of these infections are mild, involving skin and soft tissue; however, certain cases can progress to invasive tissue infections, bacteremia, and death. Transmission of MRSA has been reported most frequently in certain populations (e.g., children, sports participants, or jail inmates). Persons in the American Indian or Alaska Native population in the United States and aboriginals and Pacific Islanders (PIs) in Australia have high rates of MRSA colonization and infection. In 2003, clinicians reported an increased number of skin abscesses caused by MRSA among patients examined in ambulatory care settings. This report summarizes the findings of a retrospective study of community-associated MRSA (CA-MRSA) infections in Hawaii that identified a higher proportion of cases among PIs than were identified among Asians, compared with their respective proportions in the Hawaii population. Efforts to prevent CA-MRSA in Hawaii should focus on identifying factors causing the disproportionate number of infections among PIs.

Adolescent↗
PubMed1998

Septic arthritis following Staphylococcus aureus infection in mice lacking inducible nitric oxide synthase.

Nitric oxide (NO), produced in large amounts by inducible NO synthase (iNOS), has emerged recently as an important microbicidal and immunomodulatory mediator. We have investigated its role in bacterial septic arthritis caused by Staphylococcus aureus infection using iNOS-deficient mice. The incidence, rate of development, and severity of arthritis were greater in iNOS-deficient than in heterozygous or wild-type control mice. Similarly, the incidence and severity of septicemia and mortality were significantly higher in iNOS-deficient mice compared with controls. Increased TNF-alpha synthesis in vivo and in vitro and enhanced IFN-gamma compared with IL-4 production in vitro in iNOS-mutant mice demonstrated exaggerated Th1 polarization of the host response. These data indicate that high output NO production is not a prerequisite for severe articular destruction and imply that NO is of importance in synovial defense against staphylococcal infection.

Animals↗
PubMed1984

Oral rifampin and trimethoprim/sulfamethoxazole therapy in asymptomatic carriers of methicillin-resistant Staphylococcus aureus infections.

During a hospital outbreak of methicillin-resistant Staphylococcus aureus (MRSA) disease in 30 patients we studied the use of rifampin and trimethoprim/sulfamethoxazole (TMP/SMX) in managing asymptomatic carriers. The outbreak persisted despite control measures including "barrier" precautions, screening cultures, identification of affected persons and rapid hospital discharge of affected patients. The MRSA strain was susceptible to both rifampin and TMP/SMX and in vitro the combination was not antagonistic. Fourteen carriers received a five-day course of rifampin and TMP/SMX given by mouth. Twelve patients were evaluable. Cultures remained persistently positive in four patients, three of whom had foreign bodies that could not be removed. Among the eight with an initial response, two relapsed to the carrier state more than six months after treatment. During the study the outbreak resolved. These data suggest that rifampin and TMP/SMX may decrease the number of MRSA-colonized patients, but may not permanently eradicate the MRSA carrier state.

Adult↗