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PubMed2006

Methicillin resistant Staphylococcus aureus: is it a problem for nasal surgery?

Methicillin resistant Staphylococcus aureus (MRSA) is becoming ever more prevalent in the UK, and the proportion of MRSA to methicillin sensitive Staphylococcus aureus (MSSA) seems to be increasing. New strains of MRSA are ever developing resistance to antibiotic treatment, increasing morbidity and mortality of infection. Staphylococcus aureus is part of the normal flora of the nose, and MRSA colonizes the nose in infection. However, nasal surgery is rarely complicated by staphylococcal infections, and MRSA infection following nasal surgery is rare. The authors present a literature review of MRSA infection, its relation to the nasal cavity, and infection following nasal surgery.

Carrier State↗

PubMed2003

Cost effect of managing methicillin-resistant Staphylococcus aureus in a long-term care facility.

OBJECTIVES: The purpose of this study was to measure the total consumption of resources involved in the care of a long-term care facility (LTCF) resident infected with methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: A retrospective cohort study. SETTING: A 375-bed LTCF that provides two levels of care. PARTICIPANTS: Ninety LTCF residents infected with Staphylococcus aureus (mean age +/- standard deviation for methicillin-sensitive Staphylococcus aureus (MSSA) patients = 85 +/- 8.8, for MRSA patients = 82 +/- 9.5, P =.127; 49 MSSA and 41 MRSA patients). Inclusion criteria consisted of identification of a positive S. aureus culture in addition to symptoms/signs consistent with infection. Patients colonized with S. aureus were excluded. MEASUREMENTS: A standardized data collection tool was used to conduct chart and database review throughout the defined infection period. The type of information collected included demographic, infection characterization, antibiotic regimen, resource assessment, and cost data. The cost data were further categorized into total pharmaceutical, infection management, physician care, nursing care, and total infection cost. RESULTS: One hundred eleven cases were identified, with 90 cases eligible for evaluation. No difference in population demographics was noted between groups. A significantly higher number of patients in the MRSA group had an indwelling device (P <.001), pressure ulcer(s) (P =.028), or diabetes mellitus (P =.007). There was a significantly higher number of patients with congestive heart failure in the MSSA group (P =.047), but no difference existed in the primary infection site (P =.297) or the incidence of patients with more than two comorbidities (P =.509). The infection characterization variables included were also similar between groups. The most prevalent infection site was the urinary tract (48%) followed by skin/skin structure (38%). Because the majority of patients (82%) developed infection at least 30 days after their LTCF admission, the infections may be considered to have been largely LTCF acquired. The median infection management cost of an MRSA infection was six times greater than that of a MSSA infection (P <.001), whereas the median associated nursing care cost was two times greater (P =.001). The median overall infection cost associated with MRSA was 1.95 times greater than that of MSSA (median (range): MSSA 1,332 US dollars (268-7,265 US dollars) vs MRSA 2,607 US dollars (849-8,895 US dollars), P <.001). Nursing care cost constituted the major portion of the overall infection cost in both groups (MSSA 51%, MRSA 48%). Evaluation of antimicrobial management revealed that infected residents were treated with a wide array of combination therapies (65% of patients received combination therapy). CONCLUSIONS: The management of a resident infected with MRSA was much more costly to the LTCF than that of an MSSA-infected patient. The general care of the patient and not the specific antibiotic regimen influenced the large difference in cost between groups. The approach to the antibiotic management of these patients was variable. A more streamlined approach to infection management that facilitates a faster cure rate may dramatically lower resource consumption and improve patient outcomes.

Aged↗

PubMed2000

Limitation of adhesion and growth of Listeria monocytogenes on stainless steel surfaces by Staphylococcus sciuri biofilms.

The adhesion and subsequent development of Listeria monocytogenes on stainless steel was studied in the absence and in the presence of a Staphylococcus sciuri biofilm. In the three growth media studied, the percentage of adherent cells was reduced to nearly the same extent by the presence of 1-day biofilms of Staph. sciuri for the two strains of L. monocytogenes studied. One-day biofilms of Staph. sciuri exhibited the same exopolysaccharide content per square centimetre, although they colonized from 3.5 to 35% of the stainless steel depending on the growth media. This suggests that extracellular substances rather than cell-to-cell interactions were involved in the decreased adhesion. After 3 days of culture, Staphylococcus biofilms prevented the adherent L. monocytogenes population from increasing within the biofilm, leading to an average logarithmic cfu difference of 0.9-2.7 between the pure and mixed culture. A competition for nutrients by Staph. sciuri was observed in one of the three media. A role for extracellular polysaccharides produced by the Staphylococcus biofilm in preventing the adhesion of L. monocytogenes and in modifying the balance existing between its planktonic and biofilm phase is hypothesized. A higher proportion of L. monocytogenes cells was observed in the planktonic phase in mixed cultures, suggesting that the extracellular substances produced by Staph sciuri biofilms and involved in the decreased adhesion of L. monocytogenes could modify the balance existing between planktonic and biofilm populations. In addition, co-cultures of L. monocytogenes and Staph. sciuri in broth showed competition for nutrients for Staph. sciuri in one of the three media.

Bacterial Adhesion↗

PubMed1998

Cloning, purification and characterisation of the lipase from Staphylococcus epidermidis--comparison of the substrate selectivity with those of other microbial lipases.

On the chromosome of Staphylococcus epidermidis RP62A the lipase gene (gehSE1) is immediately flanked by the icaAA'BC operon, which is involved in biofilm formation. Since lipase production might play a role in staphylococcal skin colonisation as well, we studied the biochemical properties of the staphylococcal lipases more closely. The DNA sequence and the deduced protein sequence revealed that gehSE1 is very similar to the lipase sequence of S. epidermidis strain 9. Like other staphylococcal lipases, gehSE1 is organised as a preproenzyme. The part of gehSE1 coding for the mature lipase was cloned and overexpressed as a fusion protein with an N-terminal histidine tag in Escherichia coli. The lipase was purified to homogeneity using a combination of precipitation techniques, metal-affinity chromatography and gel filtration. Biochemical characterisation showed that this lipase is closely related to the lipase from Staphylococcus aurelis NCTC8530. Both enzymes have a pH optimum around 6, are very stable at low pH, and need calcium as a cofactor for catalytic activity. The preferred substrates are small triacylglycerols, with a maximum activity toward tributyrylglycerol. Comparison of the substrate selectivity with those of other microbial lipases showed that phospholipids are generally poor substrates for lipases. An exception is the lipase from Staphylococcus hyicus, which prefers phospholipids as a substrate, distinguishing this staphylococcal lipase from other microbial lipases. These results are discussed in view of the structure/function relationships of staphylococcal lipases, and the possible involvement of these enzymes in biological processes such as skin colonisation and pathogenesis.

Amino Acid Sequence↗

PubMed2003

Staphylococcus lugdunensis vertebral osteomyelitis.

We report a case of vertebral osteomyelitis due to the coagulase-negative staphylococcus, Staphylococcus lugdunensis. This is only the second such case reported in the literature in an immunocompetent host. When the patient's lumbar spine inflammatory mass was drained, the coagulase-negative staphylococcus obtained was discarded as a likely contaminant. We discuss the situation when coagulase-negative staphylococci require further identification and look at the unique features of S. lugdunensis. Isolation of S. lugdunensis is usually significant, and the organism should not be discarded as a contaminant without careful consideration.

Aged↗

PubMed2002

Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus.

We investigated the contamination of room door handles by Staphylococcus aureus in wards of a university hospital. Door handles in 53 (27.0%) of 196 rooms were contaminated by methicillin-sensitive Staphylococcus aureus (MSSA) and/or methicillin-resistant Staphylococcus aureus (MRSA); MSSA was detected on door handles of 41 rooms (20.9%), MRSA on door handles of 17 rooms (8.7%), and MSSA and MRSA on the same door handles of five rooms (2.6%). The density of MSSA contamination was 1-2.6x10(4) colony forming units (cfu)/door handle, and that of MRSA was 1-6.0x10(3) cfu/door handle. The MRSA contamination rate on door handles of rooms with patients with MRSA was 19.0% (4/21 rooms) while that on door handles of rooms with patients without MRSA was 7.4% (13/175); the difference was not significant. These results suggest extensive contamination of MSSA and MRSA in the hospital environment.

Environmental Microbiology↗

PubMed1995

The Staphylococcus aureus enterotoxin B superantigen induces specific T cell receptor down-regulation by increasing its internalization.

Superantigens are able to stimulate T lymphocyte populations expressing T cell antigen receptors (TCR) belonging to particular V beta families. Moreover, the presence of these superantigens may induce long term unresponsiveness (anergy) of these sensitive cells. Some bacterial toxins are potent superantigens. We have analyzed in vitro the capacity of some Staphylococcus aureus enterotoxin superantigens to modulate T cell antigen receptor expression and the cellular mechanisms involved. Staphylococcus enterotoxin B (SEB) induced rapid down-regulation of surface T cell antigen receptors in V beta 3-expressing T lymphocytes, as assessed by flow cytometry. This phenomenon was a consequence of the direct interaction between the toxin and the TCR since it was observed in the absence of cells expressing major histocompatibility complex class II molecules. The cellular mechanism involved in SEB-induced down-regulation of TCR was further investigated. Immunofluorescence and confocal microscopy experiments showed that toxin B induced intracellular accumulation of TCR.CD3 in endocytic vesicles. Moreover, SEB induced an increase in T cell receptor endocytosis as measured using radiolabeled Fab fragments of an anti-CD3 monoclonal antibody. Taken together, our observations indicate that Staphylococcus enterotoxin B superantigen induced changes in the dynamics of surface T cell receptors, which resulted in the fast reduction of membrane receptor numbers.

CD3 Complex↗

PubMed2003

IsdG and IsdI, heme-degrading enzymes in the cytoplasm of Staphylococcus aureus.

Staphylococcus aureus requires iron for growth and utilizes heme as a source of iron during infection. Staphylococcal surface proteins capture hemoglobin, release heme from hemoglobin and transport this compound across the cell wall envelope and plasma membrane into the bacterial cytoplasm. Here we show that Staphylococcus aureus isdG and isdI encode cytoplasmic proteins with heme binding properties. IsdG and IsdI cleave the tetrapyrrol ring structure of heme in the presence of NADPH cytochrome P450 reductase, thereby releasing iron. Further, IsdI complements the heme utilization deficiency of a Corynebacterium ulcerans heme oxygenase mutant, demonstrating in vivo activity of this enzyme. Although Staphylococcus epidermidis, Listeria monocytogenes, and Bacillus anthracis encode homologues of IsdG and IsdI, these proteins are not found in other bacteria or mammals. Thus, it appears that bacterial pathogens evolved different strategies to retrieve iron from scavenged heme molecules and that staphylococcal IsdG and IsdI represent examples of bacterial heme-oxygenases.

Base Sequence↗

PubMed2004

Urinary tract infection due to Staphylococcus lugdunensis in a healthy child.

Staphylococcus lugdunensis is being increasingly reported as a pathogen with an outcome resembling that of Staphylococcus aureus rather than coagulase-negative staphylococci. The authors describe a case of a child with left grade II vesicoureteral reflux and pyelonephritis caused by Staphylococcus lugdunensis. The child was successfully treated with cefotaxime.

Cefotaxime↗

PubMed2005

Effectiveness of topical taurolidine versus ciprofloxacin, ofloxacin, and fortified cefazolin in a rabbit Staphylococcus aureus keratitis model.

PURPOSE: Taurolidine is a broad-spectrum, non antibiotic antimicrobial agent, not previously tested against the common causes of bacterial keratitis. This study, employing an experimental rabbit model of Staphylococcus aureus keratitis, investigated the effectiveness of topical taurolidine in reducing the number of bacteria, and its effectiveness was compared with topical ciprofloxacin, ofloxacin, and 5% cefazolin. METHODS: The right corneas of all rabbits were intrastromally injected with 100 colony-forming units of Staphylococcus aureus ATCC strain 25923. The animals were divided into the following seven groups: Group 1 (6 rabbits) received taurolidine, group 2 (6 rabbits) received ciprofloxacin, group 3 (6 rabbits) received ofloxacin, group 4 (6 rabbits)received cefazolin, group 5 (5 rabbits) received polyvinylpyrrolidone (vehicle),group 6 (4 rabbits) received sterile water, and group 7 (4 rabbits) was left un-treated (control group). The eyes were topically treated every 30 min with the above-mentioned substances from 4 to 9 h postinjection. One hour after the last drop administration (at 10 h postinjection), signs of inflammation were scored in a masked fashion by slit-lamp examination. Then, their corneas were processed. The number of colony-forming units (cfu) per cornea in all eyes was also determined. RESULTS: All antimicrobial (taurolidine, ciprofloxacin, ofloxacin, and cefazolin) treatments significantly reduced cfu numbers and slit-lamp examination scores compared with untreated eyes, eyes that received the vehicle, or eyes with sterile water (all p values <0.05). Regarding cfu numbers, although taurolidine therapy was significantly less effective than ciprofloxacin or ofloxacin,there was no significant difference between taurolidine and cefazolin groups.However, taurolidine had similar clinical examination scores with the other antimicrobials, while it had lower scores than the vehicle, sterile water, or un-treated eyes. CONCLUSIONS: The results obtained in this study suggest that topicaltaurolidine is an effective, novel ocular chemotherapeutic agent for the therapy of rabbit experimental Staphylococcus aureus keratitis. This drug may be a useful and promising ocular antimicrobial.

Administration, Topical↗

PubMed1997

Multi-resistant Staphylococcus haemolyticus in a neonatal unit in New Delhi.

We describe a cluster of infections in a neonatal nursery due to an infrequently reported staphylococcal species, Staphylococcus haemolyticus. S. haemolyticus resistant to penicillin, methicillin, gentamicin, erythromycin, chloramphenicol and tetracycline (PMGECT) was isolated from a series of infections in neonates (conjunctivitis 6, blood 2, pustules 2) over a period of 3 weeks in a neonatal nursery. Surveillance cultures from 22 neonates, their mothers in an adjacent maternity ward and staff revealed that S. haemolyticus with three resistance patterns (PMGECT, PMG and PME) was circulating in the unit. It was isolated from two caesarian wounds, the nose/ear/umbilicus of six asymptomatic infants and from the noses of three mothers and one nurse. S. haemolyticus showed a higher frequency of resistance to antibiotics than Staphylococcus aureus and Staphylococcus epidermidis isolated from the unit at the same time. Local and asymptomatic infections were treated with local neosporin application whereas netilmicin was used to treat systemic infection. Infections were controlled by emphasising the importance of handwashing, asepsis and eye care.

Bacteremia↗

PubMed2001

Molecular analysis of coagulase-negative Staphylococcus isolates from blood cultures: prevalence of genotypic variation and polyclonal bacteremia.

Fifty-seven coagulase-negative Staphylococcus isolates from 22 inpatients who had > or =2 blood cultures that were positive for Staphylococcus within 24 hours were analyzed to determine the frequency of polyclonal bacteremia. Patients were considered to have bacteremia (14 patients) or contamination of sample (8 patients) on the basis of clinical criteria. Nine colonies were randomly selected from each blood culture and genotyped by means of SmaI digestion/pulsed-field gel electrophoresis. Relatedness was determined by calculation of the Dice coefficient of banding-pattern similarity (S(AB)). Analysis of bacteremic isolates demonstrated the presence of a single species in 35 of 41 blood cultures, 1 related variant in 5 blood cultures (87%-92% S(AB)), and an unrelated strain in 1 blood culture (79% S(AB)). Analysis of contaminated samples demonstrated the presence of a single strain in 10 of 16 blood cultures and 1-3 variants (28%-97% S(AB)) in the remainder. Genotype diversity was significantly more common in the contaminated samples (P=.036). Almost all coagulase-negative Staphylococcus bacteremias were monoclonal.

Adult↗

PubMed2006

Diminished susceptibility to daptomycin accompanied by clinical failure in a patient with methicillin-resistant Staphylococcus aureus bacteremia.

We cared for a patient with methicillin-resistant Staphylococcus aureus bacteremia who experienced clinical failure with daptomycin. The failure was accompanied by progressive elevation of the daptomycin minimum inhibitory concentration during treatment. DNA fingerprinting confirmed that the minimum inhibitory concentration elevation occurred within the same strain of methicillin-resistant Staphylococcus aureus. This observation provides important new information to clinicians who adopt this promising drug for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus.

Aged, 80 and over↗

PubMed2006

Family outbreaks of invasive community-associated methicillin-resistant Staphylococcus aureus infection.

Outbreaks of invasive methicillin-resistant Staphylococcus aureus infection within families are unusual. We investigated 2 family clusters of invasive methicillin-resistant Staphylococcus aureus infection, including 1 in which a young mother died of fulminant pneumonia. Although surveillance via culture of family contacts of patients with invasive methicillin-resistant Staphylococcus aureus infection is not currently recommended, such clusters should stimulate reevaluation of preventive measures.

Adolescent↗

PubMed1998

Staphylococcus aureus nasal colonization in patients with cirrhosis: prospective assessment of association with infection.

OBJECTIVE: To determine if Staphylococcus aureus colonization of the anterior nares was a risk factor for S aureus infection in patients with cirrhosis and to determine the predictors of S aureus infection in colonized patients. DESIGN: Prospective cohort study. PATIENTS: 84 consecutive patients with cirrhosis admitted to the liver transplant unit of a university-affiliated Veterans' Affairs Medical Center. RESULTS: Overall, 39 (46%) of the 84 patients were nasal carriers of S aureus, of which 24 (29%) were methicillin-resistant Staphylococcus aureus (MRSA) and 15 (18%) were methicillin-sensitive Staphylococcus aureus (MSSA). Only MRSA, but never MSSA, carriage was acquired in the hospital; all 15 of the MSSA versus 14 (58%) of the 24 MRSA carriers were nasal carriers on first (admission) culture (P=.001). Of the 10 (42%) of 24 MRSA carriers who were not colonized on admission, 3 became MRSA carriers within 1 month, and 7 acquired MRSA carriage more than a month later. Higher Child-Pugh score was independently associated with MRSA carriage (odds ratio [OR], 1.54; 95% confidence interval [CI95], 1.1-2.3). S aureus nasal carriers (9 [23%] of 39) were significantly more likely to develop S aureus infections than noncarriers (2 [4%] of 45; P=.02). Central venous catheter use was associated independently with S aureus infections in the carriers (OR, 4.1; CI95 2.8-6.1). Mortality was significantly higher in carriers who developed S aureus infections as compared to those who did not (57% vs 13%; P=.022); S aureus infection was an independent predictor of mortality in the carriers (OR, 8.7; CI95, 1.2-63.8). CONCLUSIONS: Colonization of the anterior nares was a significant predictor of S aureus infection in patients with cirrhosis.

Adult↗

PubMed1996

Tracking the evolutionary origin of the methicillin resistance gene: cloning and sequencing of a homologue of mecA from a methicillin susceptible strain of Staphylococcus sciuri.

The gene mecA, a central genetic determinant of methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci of human origin, has an unknown extra species origin in these human pathogens. After screening isolates representing over 15 different species within the genus Staphylococcus we could identify only one--S. sciuri--in which each of over 150 independent isolates showed positive hybridization with a mecA-specific DNA probe isolated from a methicillin-resistant strain of S. aureus, (MRSA). Yet, the majority of these isolates showed no resistance to penicillin or methicillin. The mecA gene homologue was cloned and sequenced from a S. sciuri strain and the sequence of mecA was compared to that of the mecA of prototype strains of methicillin resistant S. aureus and S. epidermidis. Similarly to mecA of MRSA, the mecA homologue of S. sciuri was composed of a putative transglycosylase and a transpeptidase domain the latter showing all the conserved motifs typical of the active sites of the penicillin binding domain of transpeptidases. Overall similarity between the deduced amino acid sequences of mecA of MRSA and the mecA homologue of S. sciuri was 88%. On the other hand, comparison of the transpeptidase domain of the S. sciuri mecA to the corresponding domain alone of the MRSA mecA showed a similarity of 96% and an identity of 91%, while comparison of the putative transglycosylase domains of the two bacteria showed only a 80% similarity and 68% identity of amino acid sequences. Our data suggests that mecA of methicillin-resistant strains of staphylococci pathogenic to Man originated within the genus of Staphylococcus from an evolutionary relative of the mecA homologue that we have identified in S. sciuri and which may perform a normal physiological function in this bacterium unrelated to beta-lactam resistance.

Animals↗

PubMed2000

Methicillin-resistant Staphylococcus aureus: phylogenetic relatedness between European epidemic clones and Swiss sporadic strains.

We have compared the phylogenetic diversity of methicillin-resistant Staphylococcus aureus (MRSA) strains from Switzerland and their phylogenetic relationships with European epidemic clones, using multiprimer random amplification polymorphic DNA (RAPD). Strains included 24 European epidemic clones (59 strains), 66 sporadic strains isolated in Switzerland in 1996-1997, and 15 reference strains of five other Staphylococcus species. Similarity and clustering analysis with the Jaccard's coefficient showed that the maximum genetic distance between MRSA strains was 0.43, whereas the minimum genetic distance between the six Staphylococcus species was 0.97, indicating that the method permits phylogenetic hierarchization. The 24 MRSA clones reported to be epidemic in European countries during the 1990s were distributed into seven different genetic clusters with a maximum distance of 0.29 among them. This clustering pattern was confirmed by the analysis of a subset of MRSA strains by multilocus enzyme electrophoresis at 12 loci. Most of the sporadic Swiss strains were distributed into these seven different genetic clusters, together with the epidemic MRSA clones. This suggests that there is no phylogenetic cluster specific to epidemic clones of MRSA.

Clone Cells↗

PubMed1992

Ventriculoatrial shunt infection caused by Staphylococcus warneri: case report and review.

Staphylococcus warneri, a coagulase-negative species, is a rare cause of infection of cerebrospinal fluid (CSF) shunts. In one recently studied case of ventriculoatrial shunt infection, the repeated isolation of S. warneri (i.e., from all of six blood cultures and from a CSF sample obtained directly from the valve of the shunt) suggested that this organism can be clinically significant. Review of the literature clearly indicates that S. warneri is a rare but potentially dangerous pathogen in both immunocompetent and immunocompromised hosts with prosthetic devices. The removal of the infected shunt in association with systemic and local antibiotic administration probably constitutes the treatment of choice in such infections. Further experience is needed to determine the prevalence and the pathogenic significance of S. warneri and of the related organisms Staphylococcus epidermidis and Staphylococcus saprophyticus in patients with prosthetic devices.

Bacteremia↗