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Staphylococcus lugdunensis as a cause of abscesses in the perineal area.

The first two patients with skin infections in the perineal area due to Staphylococcus lugdunensis are described. One had an abscess of the Bartholin gland, and the other presented with several cutaneous abscesses in the pubic area, which had a prolonged and recurrent clinical course despite appropriate antibiotic treatment. This report emphasizes the pathogenic role of Staphylococcus lugdunensis and the importance of identifying coagulase-negative staphylococci to species level in some instances.

Abscess↗

Community-acquired pneumonia due to Staphylococcus cohnii in an HIV-infected patient: case report and review.

Coagulase-negative staphylococci recently have been implicated as a cause of serious infections in immunocompromised individuals. An unusual case of community-acquired pneumonia due to Staphylococcus cohnii in an HIV-infected drug user is described. Results of a study conducted to examine the prevalence of infection due to Staphylococcus cohnii strains and their antibiotic-sensitivity patterns show a low frequency but a high morbidity. These results and a brief review of the literature emphasize the importance of these organisms and other staphylococcal species as emerging opportunistic pathogens in patients with AIDS.

AIDS-Related Opportunistic Infections↗

European multicentre evaluation of a commercial system for identification of methicillin-resistant Staphylococcus aureus.

A commercial system for the rapid detection of methicillin-resistant Staphylococcus aureus, the BBL Crystal MRSA test (C-MRSA ID; Becton Dickinson, USA), was evaluated prospectively and compared with a polymerase chain reaction test for the presence of the mecA gene. Ten European centres tested a total of 676 isolates of Staphylococcus aureus from blood cultures. The system correctly identified 661 (97.8%) isolates within 4 h. All but three mecA gene-negative isolates (99.4% specificity) yielded a negative C-MRSA ID reaction, and 158 of 170 mecA gene-positive isolates were accurately detected (92.9% sensitivity). After repeated testing of discrepant results, sensitivity and specificity increased to 99% and 100%, respectively.

Bacteriological Techniques↗

Types of methicillin-resistant Staphylococcus aureus associated with high mortality in patients with bacteremia.

Forty-seven strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from 47 patients with bacteremia were analyzed by chromosomal DNA digestion pattern using pulsed-field gel electrophoresis and evaluated for serological coagulase type, enterotoxin type, and toxic shock syndrome toxin-1 production. The mortality rate was significantly higher in the older patients (> or = 51 years of age) than in the younger patients (< or = 50 years of age) (50% vs. 4%, p = 0.0007). Methicillin-resistant Staphylococcus aureus strains of serological coagulase type II were more likely to be associated with mortality in older patients than were strains of the other types (p = 0.037).

Adolescent↗

Molecular epidemiology for local outbreaks of methicillin resistant Staphylococcus aureus (MRSA). The need for several methods.

Subtyping isolates may be useful for epidemiological studies of methicillin-resistant-Staphylococcus aureus (MRSA) outbreaks. Among subtyping methods, DNA-based techniques have been applied very effectively for this purpose. An outbreak of MRSA infections took place in one hospital in Barcelona early during 1991. From the beginning of the outbreak to December 92, 70 MRSA isolates from different patients and sources were collected. All strains were evaluated by restriction endonuclease analysis of plasmid DNA (REAP) and macrorestriction endonuclease analysis of genomic DNA using Sma I and pulsed-field-gel-electrophoresis (PFGE). Plasmid screening and REAP using Hind III demonstrated two plasmid subtypes: subtype A showing a large plasmid, and subtype B showing the same large plasmid plus a smaller one. Subtypes A and B corresponded to the more recent and older isolates, respectively, suggesting the loss of the small plasmid during the epidemic. PFGE using Sma I displayed two closely related profiles (PFGE subtype A and A'; CS = 0.90). These subtypes were different from those subtypes exhibited from 4 methicillin-susceptible-Staphylococcus aureus (MSSA) isolates from the same hospital and from 2 epidemiologically unrelated MRSA isolates. Almost all isolates showing PFGE subtype A preceded those isolates showing PFGE subtype A'. This fact and the similarity between both subtypes suggested minor chromosomal DNA rearrangement during the outbreak from a unique strain. While PFGE using Sma I is a useful tool in evaluation of clonal dissemination, our data suggest epidemic or local outbreaks may need several methods to best delineate the source and spread of MRSA strains. The reproducibility and discriminatory power of REAP makes it a useful adjunct in this context.

Anti-Bacterial Agents↗

Comparative evaluation of a new molecular method for typing Staphylococcus epidermidis.

The discriminatory powers of several techniques for typing Staphylococcus epidermidis were evaluated in an epidemiological study of bacteria isolated from intensive care patients and from neonates. Genomic DNA fingerprinting using BclI restriction endonuclease was an effective epidemiological marker. The distinct restriction fragment profiles produced with this enzyme were highlighted with specific probes in a Southern blot technique. Cloned Escherichia coli rRNA gene probes proved to have lower discriminatory power and be less suitable for intraspecies typing. However, a panel of random genomic Staphylococcus epidermidis DNA clones provided almost the same level of discrimination as the DNA fingerprinting technique and also provided a clearer profile. DNA and gene fingerprinting techniques were reproducible and highly discriminatory compared to typing based on antigen and plasmid profiles, antibiotic susceptibility patterns and biotypes.

Blotting, Southern↗

Occurrence of methicillin-resistant Staphylococcus aureus in a department of orthopedic surgery 1970 to 1986.

The incidence of methicillin-resistant (and multiply-resistant) strains of Staphylococcus aureus in the Department of Orthopedic Surgery at Odense University Hospital fell from 15% of all strains in 1970 to less than 0.5% in 1986. This decrease occurred more slowly in the orthopedic department than in the rest of the hospital. A retrospective survey of 30 episodes of infection due to methicillin-resistant Staphylococcus aureus from 1979 to 1986 indicates that this slower decrease may be due to the relatively frequent occurrence of chronic infections in orthopedic surgery.

Anti-Bacterial Agents↗

A probe for the detection of methicillin-resistant Staphylococcus aureus.

An approximately 300 base pair DNA fragment for use as a probe was isolated from methicillin-resistant Staphylococcus aureus DNA partially digested with Sau3AI. This probe hybridized with 25 methicillin-resistant clinical isolates of Staphylococcus aureus belonging to 18 different phage types, but not with 41 clinical isolates susceptible to methicillin.

DNA Fingerprinting↗

Comparison of test systems for recognition of methicillin resistance in Staphylococcus aureus.

Methicillin resistance in Staphylococcus aureus can be difficult to recognize because it may be expressed in only a small portion of the population. The optimal reference to use in comparing different test systems is controversial. In this study MIC values of less than or equal to 4 mg/l as observed in two experiments, each including 12 test systems (24 h incubation), were used to define strains as methicillin-susceptible. This strict standard was used to compare 24 quantitative and 36 agar diffusion test systems applied to 61 strains. These test systems included six agar media (Mueller Hinton, Oxoid and BBL; and Iso-Sensitest, Oxoid; all with and without 5% NaCl), three broth media of the same type, two incubation temperatures (30 degrees C and 37 degrees C), two incubation times (24 h and 48 h) and five disc types [methicillin 10 micrograms (M 10), three types of methicillin 5 micrograms (M 5) and oxacillin 1 microgram (O 1)]. Standardized high inocula were used. It was concluded that 24 h incubation is preferable to 48 h; at 24 h, differences in recognition of methicillin-resistant Staphylococcus aureus (MRSA) among 12 quantitative test systems were not statistically significant; incubation at 30 degrees C gave slightly better results in diffusion tests. Reproducibility of quantitative data (Friedman test) was better on Mueller Hinton media (p less than 0.001) than on Iso-Sensitest medium in both dilution and agar diffusion test systems. The rank order of discs was M 5 greater than M 10 greater than O 1 (p less than 0.001). An inhibition zone of less than 13 mm with a M 5 micrograms (BBL) disc should be interpreted as MRSA.

Culture Media↗

Lipase versus teichoic acid and alpha-toxin as antigen in an enzyme immunoassay for serological diagnosis of Staphylococcus aureus infections.

Titres of IgG antibodies to Staphylococcus aureus lipase were analysed in 448 sera from patients suspected of having Staphylococcus aureus infections and the results compared to those for the routinely used staphylococcal antigens teichoic acid and alpha-toxin. The results indicated that determination of serum antibodies to lipase is a sensitive assay for serological diagnosis of staphylococcal infections and increased sensitivity may be achieved by selection of optimal antigen combinations.

Adolescent↗

Ciprofloxacin resistance in methicillin- and gentamicin-resistant Staphylococcus aureus.

A total of 112 Staphylococcus aureus strains resistant to methicillin and gentamicin were collected from 31 centres in 22 countries worldwide. Many strains were multi-resistant. In tests to determine the susceptibility of the organisms to ciprofloxacin 16 strains (14.3%), originating from France, the FRG, Israel and Italy, were shown to be resistant to this agent. To limit ciprofloxacin resistance, a reappraisal is necessary of fluoroquinolone usage against methicillin- and gentamicin-resistant Staphylococcus aureus.

Ciprofloxacin↗

Restriction endonuclease analysis of Staphylococcus aureus plasmid DNA from three continents.

Staphylococcus aureus isolates (n = 1201) from 20 centers in Europe, the USA and Brazil were evaluated for the presence of epidemiologic markers. Plasmid typing and restriction endonuclease analysis of plasmid DNA confirmed the presence of an apparently identical plasmid in 13% of clinical isolates. The plasmid was recovered from all 20 hospitals studied, with an overall frequency of greater than 10% on each of the three continents. Since relatively few staphylococcal plasmids may be shared by epidemiologically unrelated strains, there are inherent limitations to this otherwise useful technique. Additionally, these data demonstrate the importance of including unrelated strains of Staphylococcus aureus from the local region as controls when molecular typing methods are performed.

Brazil↗

Immediate and long-term efficacy of systemic antibiotics for eradicating nasal colonization with Staphylococcus aureus.

The efficacy of nine antibiotics used in different nonrandomized regimens for eradicating nasal colonization with Staphylococcus aureus was investigated in 72 patients. Dicloxacillin, erythromycin and three cephalosporins had eradicated colonization in about 75% of cases at early follow-up (less than or equal to 20 days) and in less than or equal to 50% at late follow-up (greater than or equal to 20 days). Clindamycin had eradicated colonization in all 13 patients at both follow-up times. One of two patients was successfully treated with fleroxacin, as were three of five with enoxacin. Among 21 patients treated with ofloxacin, colonization was eradicated in 20 (95%) at early follow-up and in all six of those from whom late follow-up cultures were obtained. Thus, clindamycin and ofloxacin appear to be useful systemic antibiotics for eradicating nasal colonization with Staphylococcus aureus.

Adult↗

Comparison of ampicillin/sulbactam and amoxicillin/clavulanic acid for detection of borderline oxacillin-resistant Staphylococcus aureus.

Borderline oxacillin-resistant Staphylococcus aureus (BORSA) may be misidentified as intrinsically methicillin-resistant Staphylococcus aureus (MRSA) in the clinical laboratory. Under disk diffusion testing conditions designed to maximize detection of MRSA (incubation at 32 degrees C, pre-induction with methicillin, or plating on 4% NaCl-supplemented agar), BORSA strains also tend to appear resistant to semisynthetic penicillins. Under these conditions, ampicillin/sulbactam appears to be more accurate than amoxicillin/clavulanic acid for differentiating BORSA from MRSA.

Amoxicillin↗

Comparison of four genotyping assays for epidemiological study of methicillin-resistant Staphylococcus aureus.

Twenty-six methicillin-resistant Staphylococcus aureus strains were genetically differentiated by interrepeat PCR and the results compared with those of ribotyping, pulsed-field gel electrophoresis (PFGE) and random amplified polymorphic DNA analysis obtained in a previous study for the same strains. The comparison showed that the PCR-mediated assays were as discriminatory as PFGE, whereas ribotyping was the least powerful genotyping method. Due to the ease of performance, PCR fingerprinting may become the method of choice for establishing clonal relationship among Staphylococcus aureus isolates.

Genetic Techniques↗

Activity of glycopeptides in combination with amikacin or rifampin against Staphylococcus epidermidis biofilms on plastic catheters.

The in vitro activity of vancomycin and teicoplanin (fourfold the MBC), alone and in combination with amikacin (16 mg/l) or rifampin (1 mg/l), against Staphylococcus epidermidis (slime-producing and non slime-producing strains) biofilms on different plastic catheters was evaluated. The addition of amikacin or rifampin significantly increased the activity of glycopeptides against sessile bacteria. With the slime-producing strain, these combinations were able to sterilize the surface of Vialon and polyvinylchloride catheters. It is concluded that the in vitro activity of glycopeptides against Staphylococcus epidermidis biofilms on plastic catheters can be increased by the addition of amikacin or rifampin.

Amikacin↗

Activation of human basophils by Staphylococcus aureus Cowan I. II. Alternative F(ab')-mediated mechanism.

We investigated the capacity of Staphylococcus aureus Cowan I (Cowan Staph A+) and Staphylococcus aureus Wood 46 (Wood Staph A-) to induce histamine release from human basophils in vitro. Cowan Staph A+ (3 X 10(6) to 3 X 10(8)/ml), which synthesizes protein A (Staph A), stimulated the release of histamine from basophils, whereas Wood Staph A- (3 X 10(6) to 3 X 10(9)/ml), which does not synthesize Staph A, did not induce histamine secretion. Soluble Staph A (10(-3) to 10 micrograms/ml) also induced histamine secretion from human basophils, Hyperiodination of Staph A, which destroys over 90% of the original Fc reactivity without altering the Fab binding site, did not alter this protein's ability to induce histamine release. The stimulating effect of Staph A was suppressed by preincubation with human polyclonal IgG and a human monoclonal IgM, which have F(ab')-Staph A reactivity. In contrast, rabbit IgG and a human monoclonal IgM possessing only Fc-Staph A reactivity did not inhibit Staph A activity. Preincubation with Staph A or Cowan Staph A+ resulted in complete cross-desensitization to a subsequent challenge with homologous and heterologous stimuli. These results indicate that Staph A and Cowan Staph A+ activate human basophils by interacting with the F(ab')2 region of IgE and/or IgG present on the cell surface.

Basophils↗

Effect of BMY-28100, a new cephalosporin, on Staphylococcus aureus nasal carriage.

In order to examine the in vivo activity of BMY-28100, serial quantitative nasal cultures were taken from 52 nasal carriers of Staphylococcus aureus following administration of the antimicrobial. Nasal carriage rates and mean log titers decreased significantly during (days 2-4 and 5-8) and following (days 1-2 and 6-7) treatment. No change in antibiotic sensitivities was noted in follow-up isolates, and the MIC90 remained at 2mcg/ml. BMY-28100 demonstrated good in vivo activity against Staphylococcus aureus.

Adult↗