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Consensus PCR and microarray for diagnosis of the genus Staphylococcus, species, and methicillin resistance.

We propose the use of DNA microarray for the discrimination of homologous products after a single PCR amplification with consensus primers. The method was applied to Staphylococcus identification. The femA nucleotide sequences, which are phylogenetically conserved among the staphylococci, were first amplified using a consensus primer pair together with the mecA sequence, a molecular marker for methicillin resistance. Products were then identified on a glass array. The microarray contained five selective DNA capture probes for the simultaneous and differential identification of the five most clinically relevant staphylococcal species (S. aureus, S. epidermidis, S. haemolyticus, S. hominis, and S. saprophyticus), while a consensus capture probe could detect all femA sequences, allowing the identification of the genus Staphylococcus. The mecA sequence hybridized to a specific capture probe. The identification was univocal because only a single capture probe had to be present for each sequence to be identified. The hybridization and identification processes were completed in less than 2 h. Current results demonstrate that low-density microarrays are powerful multigenotypic post-PCR analyzers and could compete with conventional bacteria identification.

Bacterial Proteins↗

PCR primers for the detection of staphylococcal enterotoxins K, L, and M and survey of staphylococcal enterotoxin types in Staphylococcus aureus isolates from food poisoning cases in Taiwan.

Staphylococcal enterotoxins (SEs) are important causative agents in gastroenteritidis and food poisoning cases. They are serologically grouped into five major classical types, i.e., SEA, SEB, SEC, SED, and SEE. In addition, new SEs, such as SEG through SEM, have recently been identified and characterized. In an attempt to survey the distribution of classical and new SEs in organisms responsible for staphylococcal infections in Taiwan, we developed PCR primers for the genes that define the SEK, SEL, and SEM types. Bacterial strains other than sek, sel, and sem Staphylococcus aureus, including strains of other Staphylococcus species, did not generate any false-positive results when examined with these primers. The expression potential for the sek, sel, and sem types were also determined by reverse transcription-PCR. Together with the PCR primers specific for the classical SEs and other new SEs, including SEG, SEH, SEI, and SEJ, we surveyed the SE genes in S. aureus strains isolated from food poisoning cases. For 147 S. aureus isolates originating from food poisoning cases, 109 (74.1%) were positive for one or more SE genes. Of them, the major classical enterotoxin type was sea (28.6%), followed by seb (20.4%), sec (8.2%), and sed (2.0%). For the new SE types, sei (30.6%) was detected the most often, followed by sek (18.4%), sem (12.9%), and sel (8.2%). Also, 64 (43.5%) of the total bacterial strains had more than one enterotoxin gene.

Base Sequence↗

Staphylococcus aureus infections of captive dolphins (Tursiops truncatus) and oceanarium personnel.

Samples from blowhole and pharynx of 1 dolphin ill with a respiratory tract infection and 31 healthy dolphins at 2 oceanariums were examined by bacteriologic cultural technique. During the same period, nasal and volar forearm skin samples were collected from 32 healthy personnel and from a furuncle on the forearm of 1 attendant. Coagulase-positive staphylococci were isolated from 8 dolphins (including the ill dolphin) and from 14 persons. Antibiotic sensitivity patterns (8 drugs were tested) differed markedly for the staphylococcal isolates recovered from dolphins, as compared with those from persons. Staphylocci from the dolphins were totally or partially sensitive to every antibiotic, whereas almost all of the isolates from persons were resistant to penicillin and ampicillin, as well as to certain other antibiotics. Staphylococcus bacteriophage typing revealed that only 1 isolate from a dolphin could be typed (type D11). Six of the isolates from persons were typable, but no isolate was sensitive to only type D11. It was concluded that, although Staphylococcus aureus could be isolated commonly from captive dolphins, there was no evidence of cross infection between the dolphins and the oceanarium personnel.

Animals↗

Lytic patterns of Staphylococcus epidermidis type 1.

In typing of Staphylococcus epidermidis higher concentrations of phages should be used in view of the danger of committing an error while typing at RTD only. Lytic patterns may be divided into long and short ones. The latter possess greater identification value. There are several phage types of Staphylococcus epidermidis type 1 which are more common. Phage type A 9c is chiefly encountered in hospital environments.

Bacteriophage Typing↗

Slime-producing Staphylococcus epidermidis and S. aureus in acute bacterial conjunctivitis in soft contact lens wearers.

In recent years, an increase in ocular pathologies related to soft contact lens has been observed. The most common infectious agents were Staphylococcus spp. Some strains produce an extracellular polysaccharidic slime that can cause severe infections. Polysaccharide synthesis is under genetic control and involves a specific intercellular adhesion (ica) locus, in particular, icaA and icaD genes. Conjunctival swabs from 97 patients with presumably bacterial bilateral conjunctivitis, wearers of soft contact lenses were examined. We determined the ability of staphylococci to produce slime, relating it to the presence of icaA and icaD genes. We also investigated the antibiotic susceptibility and Pulsed Field Gel Electrophoresis (PFGE) patterns of the clinical isolates. We found that 74.1% of the S. epidermidis strains and 61.1% of the S. aureus strains isolated were slime producers and showed icaA and icaD genes. Both S. epidermidis and S. aureus slime-producing strains exhibited more surface hydrophobicity than non-producing slime strains. The PFGE patterns overlapped in S. epidermidis strains with high hydrophobicity. The similar PFGE patterns were not related to biofilm production. We found scarce matching among the Staphylococcus spp. studied, slime production, surface hydrophobicity and antibiotic susceptibility.

Adolescent↗

Phage types and drug susceptibility patterns of Staphylococcus aureus from two hospitals in northwest Ethiopia.

Fifty-eight Staphylococcus aureus strains from Gonder College of Medical Sciences Hospital, (43 isolates from patients and 15 from carriers) and 28 from Debre Tabor Hospital (14 each from patients and carriers), both in northwest Ethiopia, were phage typed in 1988. Eighty-one of the 86 strains were recognized by their phage types. A multiresistant strain of type 29 was frequent among Gonder patients'. This strain was also recovered from the hospital personnel. Other well known multiresistant strains of phage type NT/A994 and 85/A994 were identified among patients from Gonder and phage type 85/A994 was recovered from 5 patients and 4 carriers from Debre Tabor. These findings suggest cross-infection with virulent strains of Staphylococcus aureus in both hospitals. All 86 phage-typed strains were tested for susceptibility to 7 antibiotics. A high frequency of multiple resistance was observed. Double resistance to penicillin and tetracycline was frequent among patients strains from Gonder. Among strains of phage type 85/A994 multiresistance to penicillin, chloramphenicol, tetracycline, streptomycin, erythromycin and oxacillin was found. Strains of phage type 85/A994 and NT/A994 were resistant to mercury. No plasmid DNA was detected in one strain of 85/A994 investigated.

Bacteriophage Typing↗

[Isolation of Staphylococcus in Northern Norway. Identification and effects of antibacterial agents].

53 Staphylococcus aureus and 100 Staphylococcus epidermidis consecutive routine isolates were collected from hospitalized (H) and non-hospitalized (NH) patients in Northern Norway. A coagulase slide test for rapid identification of the cell-bound coagulase of S. aureus was just as sensitive as slower tests such as the tube test for free coagulase, anaerobic acid production from mannitol, and the DNase test. Close to 80% of S. aureus isolates showed beta-lactamase production. There was no difference in sensitivity between S. aureus strains isolated from H patients and NH patients respectively. All strains were sensitive to erythromycin, oxacillin, cephalothin, tetracyclin, trimethoprim, gentamicin, clindamycin, vancomycin, and rifampicin. Most isolates showed strong sensitivity to other cephalosporins than cephalothin (although less sensitive to 3. generation cephalosporins), fucidic acid and chloramphenicol. Thus, with exception of the first generation penicillins, in our region S. aureus is still strongly sensitive to most antimicrobial agents used both in hospital and in ambulatory practice. Approximately 50% of the 68 S. epidermidis isolates from urine showed beta-lactamase activity, as against almost 80% of other clinical specimens. Urine isolates were fairly often trimethoprim resistant (29.4%) and had a slightly higher resistance than S. aureus had to several antimicrobial agents. There was no difference in the resistance pattern among urinary isolates from H patients and from NH patients respectively. S. epidermidis isolates from 32 other clinical specimens from H patients showed a substantially higher pattern of resistance compared with urine isolates. Resistance against gentamicin was found in 40.6%, and against oxacillin in 9.4%. Gentamicin resistant strains were also resistant to several other broad spectrum agents. All strains were highly sensitive to vancomycin and clindamycin.

Anti-Bacterial Agents↗

[Antibiotic activities of cefuzoname and the representative cephalosporins against clinically isolated methicillin resistant strains of Staphylococcus].

Incidences of methicillin-resistant strains of Staphylococcus (MRS) have been increasing because of the extensive uses of cephalosporins and semisynthetic beta-lactamase-resistant penicillins. Most of these strains are known to be resistant to beta-lactam antibiotics due to their production of penicillinases and mutated penicillin-binding proteins. Our recent clinical isolates of MRS were also suspected to be this type because of their temperature sensitive resistance to methicillin. We studied in vitro antibiotic activity of cefuzoname (CZON) a cephalosporin developed against Staphylococcus, against these MRS in comparison with those of the representative cephalosporins, cefazolin (CEZ), cefamandole (CMD), cefotiam (CTM), cefoperazone (CPZ) and cefpiramide (CPM). It was found that CZON was the most active against MRS among these cephalosporins under normal body temperatures as well as at lower temperatures.

Cefamandole↗

Transferability of antibiotic resistance determinants in strains of Staphylococcus aureus belonging to different phage groups.

A total of 107 donor strains of Staphylococcus aureus isolated from clinical material, with a high incidence of multiresistant strains belonging predominantly to phage group III, were tested for transmission of determinants of resistance to 6 antibiotics using mixed cultures of donor strains and the recipient Staphylococcus aureus strain 5849-fur-r, rif-r. The capability of strains to transfer resistance markers to the recipient was found to depend neither on phage group nor phage type to which the donor strain belonged, but strains possessing multiple resistance to antibiotics effectuated transfers at comparatively higher frequencies.

Anti-Bacterial Agents↗

[In vitro study of strains of Staphylococcus: choice of an antibiotic].

The aim of this study is to determine the best antibiotic in presumptive staphylococcal infection and/or bacteriologically established staphylococcal infection before results of antibiotic sensitivity tests are available. 382 strains were analyzed. Only sensitivity or resistance to antibiotics were considered. Vancomycin is the best antistaphylococcal agent (3% resistance rate on the 382 strains), (11% resistance rate on Methicillin-resistant Staphylococcus aureus strains). Pristinamycin and Virginiamycin also yield excellent scores but are less efficient against Methicillin-resistant staphylococci (21%). Cefalotin is still an excellent antistaphylococcal agent (7%). Fosfomycin is especially valuable against polyresistant staphylococci, with a 26% resistance rate on Methicillin-resistant Staphylococcus aureus. Lastly, significant increases in resistance rates relative to 1966 staphylococci strains are found only for penicillin (68% versus 78%) and rifamycin (3.6% versus 8%).

Anti-Bacterial Agents↗

Nosocomial scalded skin syndrome. Ritter's disease caused by phage group 3 Staphylococcus aureus.

Three cases of generalized exfoliative staphylococcal scalded skin syndrome (SSSS) were encountered during a 25-day period in a nursery for premature infants. A single strain of Staphylococcus aureus, phage type 42E/54/75 (group 3), was recovered from each of the three infants and from no others. Two of the three isolates were tested and both produced epidermolytic toxin (ET). Most cases of SSSS have been associated with phage group 2 strains. To our knowledge, this is the first report of a nursery outbreak caused by a phage group 3 staphylococcus. It illustrates that ET production and not phage type distinguishes S aureus strains that are associated with SSSS.

Cross Infection↗

In vitro adhesion of Staphylococcus strains to rabbit tissues.

Differences in the in vitro adhesion of Staphylococcus strains on rabbit tissues were evaluated by viable unit counts and radio-labeling. Among coagulase-positive strains, two freshly isolated strains and the Cowan I strain adhered much more than the Wood 46 strain especially to peritoneum. In addition, the Smith strain, which is coagulase-positive and encapsulated, showed on rabbit peritoneum a degree of adhesion smaller than that of the Cowan I strain and similar to that of the Wood 46 strain. These quantitative results were corroborated by examination of the bacteria on thin sections of peritoneum or on whole mesentery samples with fluorescence microscopy. With fluorochroming either with acridine orange or fluorescent homologous antibodies, we could detect a preferential localization of the bacteria on the epithelium and also on fibers of the mesentery. Even if the Cowan I strain produces Protein A, this substance does not seem to have been involved in the adhesion of this strain to rabbit tissues, since IgG did not affect the degree of its adhesion. Treatment by Na metaperiodate of the peritoneum had an inhibitory effect of about 50% on the degree of adhesion; several other known inhibitors had no effect. The higher affinity of the Cowan I strain for the peritoneum or the mesentery, when compared with the Wood 46 strain, is an observation which could contribute to the study and understanding of adhesion, presumably an element of the experimental pathogenicity of Staphylococcus.

Animals↗

Cure of prophage in Staphylococcus aureus by furocoumarin photoadditions.

In a previous report curing of prophage in Staphylococcus aureus by treatment with 8-methoxypsoralen plus near-UV (365 nm) radiation was described. In the present work the use of angelicin and 4,5',8-trimethylpsoralen and repeated irradiation show that monoadducts and DNA interstrand cross-links formed by furocoumarin photoaddition are involved in the curing of the prophage responsible for the suppression of the lipolytic activity in a putative repair proficient strain of Staphylococcus aureus.

DNA Adducts↗

Prevalence of coagulase-positive staphylococci, other than Staphylococcus aureus, in bovine mastitis.

OBJECTIVE: To determine prevalence and relevance of coagulase-positive Staphylococcus hyicus and S intermedius intramammary infections (IMI) in dairy cows and determine the ability of the 4-hour tube coagulase (TC) test to differentiate the coagulase-positive staphylococci (CPS). DESIGN: Prevalence of CPS was determined for primiparous cows (point prevalence and prevalence at first parturition) and multiparous cows (point prevalence) of 2 herd groups: < 6% CPS IMI prevalence = low prevalence (LP); > 10% CPS IMI prevalence = high prevalence (HP). SAMPLE POPULATION: For prevalence, cows of 22 dairy herds. For TC, 1,038 CPS strains isolated from cow milk. PROCEDURE: Speciation of CPS from aseptically collected composite milk samples was performed. Coagulase-positive isolates from 4 cow groups were tested for their ability to coagulate rabbit plasma by 4 hours: LP and HP primiparous cows at parturition, and LP and HP cows any time after first parturition. RESULTS: Of 487 CPS in the prevalence study, 82.1% were S aureus, 17.7% were coagulase-positive S hyicus, and 0.2% were S intermedius. Of all CPS IMI in LP herds, 34% were coagulase-positive S hyicus; of all CPS IMI in HP herds, 9% were coagulase-positive S hyicus. Coagulase-positive S hyicus appeared to persist to the end of lactation in 4 cows (mean linear somatic cell count = 3.7). The TC test was > or = 97% sensitive, < or = 33% specific, and had a predictive value positive range of 60 to 97% for S aureus isolates. CONCLUSION: Coagulase-positive S hyicus appears capable of inducing chronic, low-grade IMI. Staphylococcus intermedius does not appear to be an important mastitis pathogen. The TC test is not valid to use as the sole method to differentiate CPS species.

Animals↗

[Multicenter study of Staphylococcus susceptibility to antibiotics in Moscow and St. Petersburg].

Antibiotic susceptibility of 898 Staphylococcus strains isolated in 9 medical centres of Moscow and St. Petersburg was tested. The frequency of methicillin resistant staphylococci (MRS) ranged from 0 to 40 per cent for Staphylococcus aureus and from 0 to 65.9 per cent for coagulase negative staphylococci (CNS). The highest frequencies of MRS were in hematologic, oncologic and traumatologic units as well as in intensive care units for newborns. The frequencies of MRS in St. Petersburg were much lower than those in Moscow. Among the methicillin susceptible staphylococci the frequency of the isolates that produced beta-lactamases amounted to 81 per cent for S. aureus and to 60 per cent for CNS. Practically 100 per cent of the isolates was susceptible to ampicillin/sulbactam and cephalosporins of the 1st, 2nd and 3rd generations. 86-99 per cent of the isolates was susceptible to erythromycin, clindamycin, tetracycline, gentamicin and trimethoprim/sulfamethoxasole. All the MRS isolates were susceptible to vancomycin. 95, 84 and 70 per cent of the S.aureus strains were susceptible to fusidin, rifampicin and ciprofloxacin, respectively. The susceptibility of the CNS isolates was somewhat lower.

Ampicillin Resistance↗

Antimicrobial resistance of community and hospital acquired Staphylococcus aureus isolates to oxacillin and glycopeptides.

OBJECTIVE: To determine sensitivity pattern of Staphylococcus aureus isolates from the community and hospitals to methicillin, glycopeptides and other antimicrobial agents. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Private Pathology Laboratory in Lahore from January 2001 to April 2002. SUBJECTS AND METHODS: A total of 714 Staphylococcus aureus (S.aureus) isolates from the community and hospital were tested. Community acquired S.aureus strains (n=434) were isolated from specimens like pus from boils/pimples and nasal swabs of patients with asthma attending a local allergy clinic. The hospital acquired S.aureus (n=280) were isolated from specimens like pus from wounds/discharging sinuses, ear swabs, blood and urine. All the isolates were subjected to sensitivity test against Oxacillin, Vancomycin, Teicoplanin, Penicillin, Imipenem, Cefipime and other anti-staphylococcal agents by standard Kirby-Bauer disk diffusion method. Beta lactamase production by all the isolates was also determined by acidimetric test. RESULTS: Significantly higher number of hospital acquired S.aureus isolates (p<0.01) were beta lactamase producing (96.07%) as compared to community acquired (81.79%). Methicillin (Oxacillin) resistance was also higher among hospital strains (31.1%) as compared to community ones (14.1%). No isolate from the community showed resistance to glycopeptides. While 0.3 percent and 0.7 percent of all S.aureus isolates were interpreted as resistant to Vancomycin and Teicoplanin respectively as there was no zone of inhibition. The resistance to these drugs was a bit higher among the MRSA (1.1% and 2.3% respectively). More than 90% of nosocomial MRSA strains were sensitive to Ofloxacin and Fucidic Acid. Resistance to Erythromycin, Lincomycin and Gentamicin was 70.1, 33.3 and 39.1% in that order. In general resistance to different antimicrobial was lower among S.aureus strains of community origin as compared to those of hospital origin. CONCLUSION: Methicillin and multiple drug resistance is quite a significant problem in nosocomial as well as community acquired S.aureus strains. Moreover, it appears that resistance to glycopeptides has also emerged in our nosocomial S. aureus strains. Microbiology laboratories should make efforts not only to regularly screen S.aureus isolates for sensitivity to glycopeptides but also to determine MIC of the isolates.

Cross Infection↗

Staphylococcus aureus catheter-associated bacteremia. Minimal effective therapy and unusual infectious complications associated with arterial sheath catheters.

OBJECTIVE: To determine factors that predict complications and examine outcomes of Staphylococcus aureus bacteremia according to the duration of antibiotic therapy. METHODS: Clinical data were extracted from charts of patients with positive blood cultures for S aureus at a single institution during a 2-year period. RESULTS: Of 102 patients with S aureus bacteremia, 55 were considered to have bacteremia attributable to an intravascular catheter, including five patients who were bacteremic after percutaneous transluminal coronary angioplasty. Among the other 50 patients with S aureus catheter-associated bacteremia, infection was community acquired in 18 and nosocomial in 32. Septic pulmonary emboli were more common in patients with community-acquired S aureus catheter-associated bacteremia, most of whom had Hickman catheters or venous access disks. Delayed removal of the infected catheter was associated with persistence of bacteremia (P = .01). With patients with early complications excluded, patients treated for 10 to 15 days had clinical characteristics similar to those of patients treated with longer courses of antibiotics and had similarly low rates of relapse (0% vs 4.7%). In contrast, treatment with parenteral antibiotics for less than 10 days appeared to be inadequate in that relapse occurred in two of three such patients. Staphylococcus aureus catheter-associated bacteremia associated with percutaneous transluminal coronary angioplasty was complicated by a femoral artery mycotic aneurysm in two of five patients. CONCLUSION: Approximately one third of S aureus catheter-related bacteremias were community acquired, reflecting increased usage of intravascular devices for home parenteral support. A 10- to 15-day course of parenteral antibiotics was equivalent to longer courses of therapy in patients without early complications.

Adult↗

Staphylococcus aureus bacteremia among elderly vs younger adult patients: comparison of clinical features and mortality.

BACKGROUND: Previous studies give conflicting results regarding the effect of age on outcomes in Staphylococcus aureus bacteremia (SAB). These studies have been limited by retrospective design or small sample size. METHODS: We conducted a prospective cohort study of 385 patients with SAB aged 18 to 90 years. The setting was a large academic medical center. We observed patients from diagnosis of SAB to discharge or death. Discharged patients were contacted 12 weeks after their first positive culture findings. Data were collected on demographics, comorbid conditions, focus of infection, length of stay, and outcome. Primary outcomes were total mortality and death due to SAB. RESULTS: Comparisons were made between 145 patients, aged 66 to 90 years, and 240 patients, aged 18 to 60 years. Forty-three (29.7%) of the elderly patients and 36 (15%) of the younger patients died. Death directly attributable to SAB occurred in 21 (14.5%) older and 15 (6.3%) younger patients. After adjusting for confounding variables, older patients continued to have higher total mortality (odds ratio, 2.21; 95% confidence interval, 1.32-3.70), and higher mortality from SAB (odds ratio, 2.30; 95% confidence interval, 1.13-4.69). Infection with methicillin-resistant S aureus was associated with higher total mortality in the elderly (odds ratio, 2.59; 95% confidence interval, 1.23-5.43). CONCLUSIONS: Staphylococcus aureus bacteremia among the elderly is associated with high mortality. Both total mortality and mortality directly attributable to SAB are more than twice as likely in older patients. Infection with methicillin-resistant S aureus carries a worse prognosis than infection with methicillin-sensitive S aureus in the elderly.

Adult↗