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PubMed2006

Management of community-associated methicillin-resistant Staphylococcus aureus infections in children.

In recent years, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a pathogen in children without established risk factors, and its prevalence in the United States is increasing. Although many CA-MRSA infections are mild, primarily involving the skin and soft tissues, the organism can cause serious, invasive, and life-threatening infections. To provide a comprehensive review of the epidemiology, clinical features, therapy, and prevention of CA-MRSA infections in children, we performed MEDLINE (1966-January 2006) and Cochrane Library searches, and reviewed abstracts for relevance to S. aureus infections. Only articles pertaining to CA-MRSA infections in pediatrics were closely examined. As a genetically distinct pathogen, CA-MRSA is generally susceptible to multiple non-beta-lactam antimicrobials. The optimal treatment for CA-MRSA infections in pediatric patients has not been well studied. Common antibiotics used include clindamycin, trimethoprim-sulfamethoxazole, vancomycin, and rifampin. Rational empiric antimicrobial therapy for infections caused by S. aureus requires consideration of the possibility of methicillin resistance. The local prevalence and susceptibilities of CA-MRSA, severity of infection, and individual risk factors should be considered in selecting treatment.

Anti-Bacterial Agents↗
PubMed1995

Staphylococcus aureus infections in haemodialysis patients: pathophysiology and use of nasal mupirocin for prevention.

Staphylococcus aureus is the most frequently (42%) isolated micro-organism during bacteraemic episodes in haemodialysis patients. Nasal carriage of S. aureus is of major importance in determining the risk of subsequent infections. Indeed, nasal carriage of S. aureus is highly prevalent in uraemic patients from the onset of maintenance dialysis therapy. The strains isolated simultaneously from the nares and the hands are usually the same. Likewise, infecting S. aureus strains and those isolated from nasal surveillance cultures obtained in the same patient are usually similar. S. aureus infections in haemodialysis patients are thus mostly to be considered as auto-infections. The nares are therefore an elective site for the prevention of S. aureus infections in haemodialysis patients. This has been demonstrated with oral rifampin, and more recently with nasal mupirocin, which is highly effective. Long-term application of nasal mupirocin (e.g. once per week) is cost-effective and is only rarely associated with the emergence of mupirocin-resistance in S. aureus.

Anti-Bacterial Agents↗
PubMed1976

Imported methicillin-resistant Staphylococcus aureus infection: a case report.

The first isolate of a methicillin-resistant strain of Staphylococcus aureus at the Wellington Hospital was made on 31 March 1976, from a man who had emigrated from the United Kingdom in 1973. The infection was successfully treated with co-trimoxazole and fucidin. The epidemiological implications of this infection are discussed.

Cloxacillin↗
PubMed2005

Superiority of surgical versus medical treatment in patients with Staphylococcus aureus infective endocarditis.

BACKGROUND: We present here the clinical features and outcome of 54 patients affected by a Staphylococcus aureus infective endocarditis at the Amiens hospital between 1990 and 2000. The patients operated-on, group A (20 patients), were compared to the population of patients treated by exclusive antibiotherapy, group B (34 patients). PATIENTS AND METHOD: The male gender predominated with a sex ratio of 2.6. The mean age of the global population was 58.7+/-1.6 years. Time between onset of endocarditis symptoms and treatment (entire group) ranged from 1 to 120 days (mean 14.4 days). The main portal of entry were, respectively, for group A and group B: cutaneous 55% and 44.1%; intravascular material 5% and 8.8%; and rhinopharynx 5% and 8.8%. Seventy-five percent of the Staphylococcus aureus isolated were Methi-S. The main surgical treatment indication were: hemodynamic failure (HF) (30%), unstable infection with collapse (UI) (30%), UI+HF (10%), voluminous vegetation (20%) and embolism event (10%). RESULTS: The hospital mortality rate were respectively for the entire group, group A and group B: 25%, 35% and to 41% (ns). For group A, the operative mortality was lower(21%) after the first week. The actuarial survival rate (Kaplan-Meier) after 24 months was 54./+/-6.9% for the global population and 74+/-10.6% for group A and 43+/-8.5 for group B (p<0.001). The multivariate analysis finds severe sepsis and index of comorbidity as independent factors related to the global late mortality and, respectively, the age and the severe sepsis for group A, and the cardiac insufficiency for group B. CONCLUSION: The surgical treatment seems to be the best way to improve the results after Staphylococcus aureus endocarditis. The severity of the sepsis remains the most severe prognostic element, whatever the treatment adopted may be.

Anti-Bacterial Agents↗
PubMedDate not supplied

The effects of oral RNA and intraperitoneal nucleoside-nucleotide administration on methicillin-resistant Staphylococcus aureus infection in mice.

The effects of oral RNA and intraperitoneal nucleoside-nucleotide mixture administration on methicillin-resistant Staphylococcus aureus (MRSA) strain 8985N infection were studied in mice. BALB/c mice were fed a nucleic acid-free diet or nucleic acid-free diet supplemented with 0.5% or 2.5% ribonucleic acid (RNA) for 30 days. Nucleoside-nucleotide mixture or saline (control) was intraperitoneally administered daily to these rats except for the 2.5% RNA group, which received saline only. On the 10th day of this treatment, the mice were inoculated intravenously with the viable MRSA organisms. Susceptibility to the MRSA was determined by animal survival and recovery of the MRSA from the organs. The survival rates in the three groups that were administered saline were 29%, 35%, and 40% for nucleic acid-free diet, 0.5% RNA, and 2.5% RNA groups, respectively, whereas in the two groups that received the nucleoside-nucleotide mixture the rates were 69% for the nucleic acid-free diet group and 55% for 0.5% RNA group. The susceptibility of the mice to the MRSA challenge was not affected by dietary RNA, which indicates the ineffectiveness of oral RNA. The combined survival rate in the two nucleoside-nucleotide groups (64%) was statistically different (p < .01) from that in the three saline groups (34%). There was a greater reduction in viable organism recovery in the kidney and spleen of the surviving mice that had been administered the nucleoside-nucleotide mixture than in those administered saline.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed2004

Infected aortic aneurysms: clinical outcome and risk factor analysis.

PURPOSE: Infected aortic aneurysms are difficult to treat, and are associated with significant mortality. Hospital survival is poor in patients with severe aortic infection, Salmonella species infection, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location. We reviewed the clinical outcome in 46 patients with primary infected aortic aneurysms and identified clinical variables associated with prognosis. METHODS: Data were collected by means of retrospective chart review. Univariate and multivariate logistic regression models were used for risk factor analysis. RESULTS: Between August 1995 and March 2003, 48 patients with primary infected aortic aneurysms were treated at our hospitals. Two patients with negative culture results were excluded. Of the remaining 46 patients, 35 patients had aortic aneurysms infected with Salmonella species and 11 patients had aortic aneurysms infected with microorganisms other than Salmonella species. There were 20 suprarenal infections and 26 infrarenal infections. Surgical debridement and in situ graft replacement were performed in 35 patients, with an early mortality rate of 11%. The incidence of late prosthetic graft infection was 10%. The 90-day mortality rate in patients operated on was 0% for elective operation and 36% for nonelective operation (P =.006, Fisher exact test). Independent predictors of aneurysm-related death were advanced age, non-Salmonella infection, and no operation. CONCLUSION: With timely surgical intervention and prolonged antibiotic treatment, in situ graft replacement provides an excellent outcome in patients with primary infected aortic aneurysms and elective operation. Mortality is still high in patients undergoing urgent operation. Advanced age, non-Salmonella infection, and no operation are major determinants of mortality.

Adult↗
PubMed1999

Molecular genotyping of Staphylococcus aureus strains: comparison of repetitive element sequence-based PCR with various typing methods and isolation of a novel epidemicity marker.

Repetitive sequence-based (Rep)-PCR genotyping as described here is based on the presence of homologues of Mycoplasma pneumoniae repeat-like elements in Staphylococcus. In this study we comparatively evaluated the usefulness of rep-PCR typing with two sets of well-defined collections of Staphylococcus aureus strains. Rep-PCR analysis of the first collection of S. aureus strains (n = 59) and one Staphylococcus intermedius strain showed 14 different rep-PCR patterns, with each pattern harboring 6 to 15 DNA fragments. The discriminatory power of rep-PCR typing compared well to those of arbitrarily primed PCR (average of 20 types) and pulsed-field gel electrophoresis (11 types). S. aureus strain collection I comprised four outbreak-related groups of isolates. The isolates in only one group were found to have identical rep-PCR profiles. However, in an analysis of isolates from three additional independent local outbreaks (n for outbreaks 1 and 2 = 5, n for outbreak 3 = 12), identical rep-PCR types were found among strains isolated during each outbreak. Therefore, we conclude that rep-PCR genotyping may be an easy and fast method for monitoring of the epidemiology of nosocomial Staphylococcus infections. Rep-PCR analysis of strain collection II, which consisted of epidemic and nonepidemic methicillin-resistant S. aureus (MRSA) strains, revealed that a cluster of similar rep-PCR profiles was found among MRSA isolates which were more frequently isolated and which were most often associated with outbreaks.

Bacterial Typing Techniques↗
PubMed1997

Osteoarticular bacterial infections are rare in HIV-infected patients. 14 cases found among 4,023 HIV-infected patients.

Among 4,023 HIV-infected patients admitted to a large Italian university hospital in the period 1985-1996, 14 had concomitant HIV and bacterial osteoarticular infections. Staphylococcus aureus infections were commonest and were diagnosed in 8 patients. Intravenous drug addiction was the only risk factor significantly associated with the development of osteoarticular infection (p = 0.04). In contrast, no statistical correlations were found with age, sex, absolute number of circulating T-CD4+ lymphocytes, neutrophils and stage of HIV infection. In conclusion, osteoarticular infections are uncommon in HIV-infected patients and are more directly related to parenteral drug abuse than to HIV.

Adult↗
PubMed1982

Community-acquired methicillin-resistant Staphylococcus aureus infections: a new source for nosocomial outbreaks.

Over a 19-month period, 165 patients with 183 infections caused by community-acquired, methicillin-resistant Staphylococcus aureus were seen at Henry Ford Hospital in Detroit, Michigan. The proportion of community-acquired staphylococcal infections resistant to methicillin rose from 3 % in March 1980 to 38% in September 1981. Drug abuse, serious underlying illness, previous antimicrobial therapy, and previous hospitalization were all associated with the development of this infection. Concurrent with the community epidemic was a nosocomial epidemic of methicillin-resistant S. aureus infection, which accounted for 30.6% of all nosocomial staphylococcal infections in January 1981. Control measures that included isolation, discharge precautions for carriers, and eradication of employee carriage were effective in preventing nosocomial transmission. The prevalence of methicillin-resistant S. aureus carriage among employees was 0.7%. Methicillin-resistant S. aureus may originate in the community as well as in the hospital, and presents a threat to patients in both settings.

Cross Infection↗
PubMed1994

[Tufted folliculitis of the scalp].

INTRODUCTION: Tufted hair folliculitis is a localized scarring bacterial folliculitis due to Staphylococcus aureus. We present two cases. OBSERVATIONS: Both patients were in their thirties. The first had had an inflammatory sclerous lesion of the vertex for three years, and the second an alopecial scarring lesion. Clinically there were tufts of hair within or around the lesions. Staphylococcus aureus was found in biopsy samples which showed hairs or composed follicles. Prolonged treatment with oral antibiotics led to progressive limitation of the lesions. DISCUSSION: Tufted hair folliculitis is a characteristic folliculitis of the scalp showing scar formation and the presence of Staphylococcus aureus. The review of the literature raises the question of the role of local immunity and the nature of the hair tufts: primary anomaly or secondary to Staphylococcus infection? The therapeutic attitude is not well defined but prolonged treatment with oral antibiotics can stabilize the lesions.

Adult↗
PubMed1991

Effect of naturally occurring coagulase-negative staphylococci infections on new infections by mastitis pathogens in the bovine.

Microbiological data from 1123 uninfected quarters and 216 quarters with preexisting coagulase-negative staphylococci infections were analyzed to determine the influence of infection status on subsequent new infection rate. Overall, prevalence of new infections in uninfected quarters was approximately two times that in quarters already harboring a coagulase-negative Staphylococcus infection. New infections by coagulase-negative staphylococci were greater in uninfected quarters than in quarters with preexisting coagulase-negative staphylococci infections. However, no differences were observed between uninfected and infected quarters in number of new infections by major pathogens (Staphylococcus aureus, streptococci, and coliforms). No differences were observed in uninfected or coagulase-negative Staphylococcus-infected quarters in infections with minor pathogens compared with major pathogens. The influence of individual coagulase-negative Staphylococcus species on new infections was also analyzed. However, numbers of existing infections by Staphylococcus species other than Staphylococcus chromogenes were limited. Therefore, the protective capacity of each coagulase-negative Staphylococcus species was difficult to assess. Overall, a significant restriction of bacterial invasion was observed in quarters with a preexisting infection. These results suggest that quarters harboring a coagulase-negative Staphylococcus infection suppress colonization of the mammary gland by mastitis-causing pathogens.

Animals↗
PubMed2006

The mutant selection window in rabbits infected with Staphylococcus aureus.

BACKGROUND: The mutant selection window hypothesis, originally based on agar plate assays, may lead to new antimicrobial dosing strategies that severely restrict the acquisition of resistance. However, it has not been directly tested in an animal model of infection. METHODS: Local infection with Staphylococcus aureus was established in rabbits, and the infected animals were treated orally with various doses of levofloxacin. Changes in levofloxacin concentration, levofloxacin susceptibility, and counts of total and resistant viable bacteria were monitored at the site of infection. RESULTS: S. aureus lost levofloxacin susceptibility when drug concentrations at the site of infection fluctuated between the lower and upper boundaries of the window, defined in vitro as the minimum inhibitory concentration (MIC)(99) and the mutant prevention concentration (MPC), respectively. The upper boundary of the selection window in vivo was estimated as an AUC(24)/MPC value of ~25 h, where AUC(24) is the area under the drug concentration time curve in a 24-h interval. The lower boundary was estimated as an AUC(24)/MIC value of ~20 h. CONCLUSIONS: The mutant selection window exists in vivo, and its boundaries fit well with those determined in vitro. Maintenance of antimicrobial concentrations above the window is expected to suppress the outgrowth of resistant mutant subpopulations.

Administration, Oral↗
PubMed1999

Efficacy and pharmacodynamics of teicoplanin given daily during the first 3 days and then on alternate days for methicillin-resistant Staphylococcus aureus infections.

Fifteen evaluable patients (mean age, 67 years) were enrolled to assess the efficacy of teicoplanin, 6 mg/kg given daily during the first 3 days and then on alternate days, for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. Eight patients had soft tissue infections, four catheter-associated bacteraemia, two osteomyelitis and one pneumonia. Clinical cure was observed in 13 of 15 patients. Both clinical and bacteriological failures were shown in the two patients with osteomyelitis. The mean serum levels of teicoplanin (mg/L) were 22, 8 and 6.7 for peak, 24 h and 48 h troughs, respectively. The dosage employed in this study proved effective in non-deep-seated MRSA infections.

Adult↗
PubMedDate not supplied

[Serological diagnosis of Staphylococcus aureus infections using anti-A beta telchoic acid antibodies assay (author's transl)].

225 contol subjects, 12 hospitalized staphylococcus free (34 sera) and 16 S. aureus infected patients (79 sera) were tested for anti-A beta teichoic acid antibodies, using counter-immunoelectrophoresis. Anti-alpha and gamma haemolysins antibodies were dosed in parallel in 164 sera. Less than 5 per cent of control sera (3,11 per cent) have an antibody titre higher than 1/8; this titre is therefore selected as threshold level of positivity. Ten of the 12 hospitalized patients without staphylococcal infections are below this level. 31,6 per cent of staphylococcus infected patients have higher serum titers; only 3,7 per cent have no antibodies. In the others, a significant rise in titres is observed. There is no correlation between anti-alpha and gamma staphylolysin and anti-teichoic acid antibodies titres. The method suggested, both easy and rapid, could be used in association with anti-staphylolysin dosage for serological diagnosis of staphylococcal infections.

Adult↗
PubMed1993

Prevention and treatment of Staphylococcus aureus infections with recombinant cytokines.

Antibiotic therapy is only moderately efficacious for bovine Staphylococcus aureus mastitis. We have used recombinant bovine cytokines to activate the natural host defenses, to prevent and treat bovine mastitis. Uninfected mammary glands infused with GM-CSF or IL-2 increased the percentage of phagocytic cells in the milk by 2-3 fold. IL-1 increased the number of polymorphonuclear cells in the milk, enhanced their inducible oxygen radical formation, and had no effect on phagocytosis. Treatment with IL-2 increased the number of polymorphonuclear cells in the milk, enhanced their inducible oxygen radical formation, and enhanced their phagocytosis. GM-CSF had no effect on the number polymorphonuclear cells in the milk but enhanced their inducible oxygen radical formation, and enhanced their phagocytosis. All cytokines were effective in preventing S. aureus infections (20-100%). 52% of all chronically infected mammary gland quarters treated with three doses of IL-2 responded to therapy and 32% of the treated quarters remained cured. 75% of all mammary glands treated with three doses of IL-1 beta responded to therapy by clearing the infection and 22% of the treated glands remained cured. These studies demonstrate that recombinant bovine cytokines can be used effectively to prevent infections as well as treat established chronic infection.

Animals↗
PubMed1989

The prevention of infection with Staphylococcus aureus in continuous ambulatory peritoneal dialysis.

We describe the control of wound infection with Staphylococcus aureus in patients undergoing continuous ambulatory peritoneal dialysis at St. Thomas' Hospital. Forty-nine percent of 61 catheters inserted in 1985 and 1986 became infected, and the majority of these infections were acquired in hospital. Infection was impossible to eradicate and was frequently associated with the subsequent development of S. aureus peritonitis, which was the most important cause of catheter loss. Strict adherence to aseptic techniques for catheter insertion and care, combined with eradication of S. aureus carriage, reduced the infection rate to 12% for the 50 catheters inserted in 1987, abolished hospital-acquired infection and reduced the S. aureus peritonitis rate tenfold, without the use of prophylactic antibiotics. S. aureus infection is a serious but avoidable complication of continuous ambulatory peritoneal dialysis.

Anti-Infective Agents, Local↗