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Antimicrobial agents for treatment of serious infections caused by resistant Staphylococcus aureus and enterococci.

As clinicians increasingly contend with infections due to staphylococci or enterococci resistant to, or failing treatment with, traditional antimicrobial agents, understanding the potential roles of older as well as more recently introduced antimicrobial agents becomes important. Older agents, such as clindamycin and trimethoprim-sulfamethoxazole, have been used to treat infections due to community-acquired methicillin-resistant Staphylococcus aureus. Among the licensed agents, quinupristin-dalfopristin, linezolid, daptomycin, and tigecycline are active in vitro against most strains of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium, but these agents differ in their approved clinical indications. New agents currently under investigation may further expand treatment options.

Anti-Bacterial Agents↗

Life-threatening community-acquired methicillin-resistant Staphylococcus aureus infection in Australia.

Eight patients with invasive bacteremic community-acquired methicillin-resistant Staphylococcus aureus infection in southeast Queensland, Australia, are reported. One patient died of septic shock. Haematogenous seeding to lungs, bone, and other sites was common. All isolates carried the virulence factor Panton-Valentine leukocidin and were either the southwest Pacific clone or the newly described Queensland clone. Clinicians should consider community-acquired methicillin-resistant Staphylococcus aureus infection in any patient presenting to hospital with severe staphylococcal sepsis or pneumonia.

Adolescent↗

Analysis of different genetic traits and their association with biofilm formation in Staphylococcus epidermidis isolates from central venous catheter infections.

The aim of the present study was to characterize clinical isolates of Staphylococcus epidermidis, one of the bacterial species most often implicated in foreign-body-associated infections, for their ability to form biofilms and for the presence of mecA and IS256 element. Sixty-seven Staphylococcus epidermidis clinical isolates, obtained from implantable medical devices, were investigated. Overall, 70% of the strains were positive for ica operon genes, 85% possessed atlE, and 46% contained aap. In 89% of the population, the Congo red agar test confirmed the correlation between the presence of ica genes and slime expression. Almost all of the strains could be classified as biofilm producers by both the crystal violet assay and microscopy. The bacterial population studied showed a very high frequency of strains positive for mecA as well as for the IS256 element. Although well-structured biofilms have been previously observed only in those strains possessing genes belonging to the ica operon, this study demonstrates that strains lacking specific biofilm-formation determinants can be isolated from catheters and can form a biofilm in vitro. Hence, different and yet-to-be identified factors may work together in the formation and organization of complex staphylococcal microbial communities and sustain infections associated with implanted medical devices.

Anti-Bacterial Agents↗

Characterization of epidemic and nonepidemic methicillin-resistant Staphylococcus aureus strains in a university hospital in northeast Germany.

The aim of this study was to analyze methicillin-resistant Staphylococcus aureus strains isolated during a 1-year period by means of pulsed-field gel electrophoresis, resistance phenotyping and determination of biochemical features. Eight different resistance phenotypes with the predominant resistance type Pen Oxa Cip (penicillin, oxacillin, ciprofloxacin) were observed. None of the strains tested exhibited decreased susceptibility to vancomycin, but two strains were resistant to mupirocin. Genetic relatedness of methicillin-resistant Staphylococcus aureus isolates could be shown for two outbreaks, one of which was caused by a clone with an epidemic potential concerning duration of colonization/infection of patients and dissemination of the strains in the hospital.

Anti-Bacterial Agents↗

Staphylococcus lugdunensis endocarditis in a young, previously healthy female.

Reported here is a case of native valve infective endocarditis in which Staphylococcus lugdunensis was isolated from blood cultures as well as from the mitral valve. It is suggested that tube coagulase-negative staphylococci isolated from blood cultures of patients with infective endocarditis be considered carefully for possible clinical significance. The use of the ornithine carboxylase test as a simple screening method for identification of Staphylococcus lugdunensis is recommended.

Adult↗

Emergence, mechanism, and clinical implications of reduced glycopeptide susceptibility in Staphylococcus aureus.

In order to understand the mechanism(s) of the resistance/reduced susceptibility of Staphylococcus aureus to glycopeptide antibiotics, the current data on the modes of action of glycopeptides were reviewed. In addition, the different test systems for detecting vancomycin resistance and the clinical relevance of resistant Staphylococcus aureus were analyzed. Finally, strategies to prevent the nosocomial spread of these bacteria are presented, as are new therapeutic options.

Anti-Bacterial Agents↗

Enhancement of antimicrobial effects of various antibiotics against methicillin-resistant Staphylococcus aureus (MRSA) by combination with fosfomycin.

The present study was designed to evaluate the efficacy of fosfomycin used in combination with drugs that were found to be less effective against methicillin-resistant Staphylococcus aureus (MRSA). Twelve different antibiotics were tested against 32 strains of MRSA isolated from the wounds of burn patients admitted to the Burn Unit at Tokyo Women's Medical University Hospital. These antibiotics - fosfomycin (FOM), flomoxef sodium (FMOX), imipenem (IPM), cefotiam (CTM), cefmetazole (CMZ), ampicillin (ABPC), sulbactam/cefoperazone (SBT/CPZ), minocycline (MINO), ofloxacin (OFLX), and panipenem (PAPM) - were used either alone or in combination. Arbekacin (ABK) and vancomycin (VCM) were used for comparing efficacy in controlling bacterial growth. While both ABK and VCM were, as expected, found to be effective in suppressing in vitro bacterial growth, all ten other agents when used alone were found to be ineffective. In contrast, these agents, when used in combination with FOM, showed remarkable efficacy against all strains of MRSA tested. Based upon the in vitro findings, it is suggested that FOM, in combination with other antimicrobial agents, such as IPM, PAPM, CMZ, and SBT/CPZ may be used instead of ABK and/or VCM to curtail the emergence of Staphylococcus aureus strains that are resistant to these latter two drugs.

Anti-Bacterial Agents↗

Different susceptibilities of Staphylococcus and Gram-negative rods to epigallocatechin gallate.

We examined the antibacterial effects of epigallocatechin gallate (EGCg, the main constituent of tea catechins) against various strains of Staphylococcus and Gram-negative rods. Compared to the minimum inhibitory concentrations (MICs) of EGCg against S. aureus, S. epidermidis, S. hominis, and S. haemolyticus (50-100 micro g/ml), higher MICs (>or=800 micro g/ml) were observed against Gram-negative rods, including Escherichia coli, Klebsiella pneumoniae, Salmonella typhi, Proteus mirabilis, Pseudomonas aeruginosa, and Serratia marcescens. And difference was observed between the binding abilities of EGCg with viable S. aureus and with E. coli. The bactericidal activity of EGCg for S. aureus was blocked dose-dependently by purified peptidoglycan but not by lipopolysaccharide or dextran. It was also found that peptone and protein, but not amino acids, in the culture medium greatly affected the antibacterial activity of EGCg. These results indicate that the structure of the bacterial cell wall and the different affinities of EGCg with the various cell wall components are responsible for the different susceptibilities of Staphylococcus and Gram-negative rods to EGCg.

Anti-Bacterial Agents↗

Glycopeptide resistance in Staphylococcus aureus: is it a real threat?

Following the discovery in 1992 that resistance to vancomycin could be transferred in vitro from a strain of Staphylococcus haemolyticus to Staphylococcus aureus, the threat that a similar event could happen in vivo has existed. In 1996, the threat became a reality in Japan followed by reports of low-level heteroresistant S. aureus from elsewhere in the world. However, the threat has not gone away; indeed it has become more intimidating within the past 2 years with the isolation of higher-level resistance to vancomycin transferred on a plasmid from Enterococcus faecalis. The mechanisms of resistance are different in each of the types of S. aureus with reduced susceptibility to the glycopeptides: in one hetero-vancomycin intermediate-susceptible S. aureus (hVISA) and vancomycin intermediate-susceptible S. aureus (VISA), cell wall biosynthesis is altered, hindering glycopeptide reaching its target, and in the other vancomycin-resistant S. aureus (VRSA) the target is altered. This review attempts to place into context the threat posed to patients by the appearance of strains of S. aureus more resistant to one of the key therapeutic agents used in our hospitals. It will do so by raising a number of important questions followed by the presentation of experimental evidence that may or may not provide answers that heighten or lower the threat.

Anti-Bacterial Agents↗

Antimicrobial activity of everninomicin against clinical isolates of Enterococcus spp., Staphylococcus spp., and Streptococcus spp. tested by Etest.

The in-vitro antimicrobial activity of everninomicin, a novel oligosaccharide antibiotic, was tested against clinical isolates of 11 methicillin-susceptible Staphylococcus aureus (MSSA) strains, 11 methicillin-resistant S. aureus (MRSA) strains, 22 Staphylococcus epidermidis strains, 23 Enterococcus faecalis strains, 23 Enterococcus faecium strains, 23 Enterococcus avium strains, 27 Streptococcus pneumoniae strains, 22 Streptococcus pyogenes strains, and 20 Streptococcus agalactiae strains. The minimum inhibitory concentrations (MICs) of everninomicin were determined by Etest and compared with those of vancomycin, teicoplanin, and minocycline. The Etest showed that everninomicin exhibited excellent activity (MIC, <0.016 to 1.5 microg/ml) against the gram-positive cocci tested. The antimicrobial activity of everninomicin against S. aureus and S. epidermidis was stronger than that of vancomycin, teicoplanin, and minocycline, in particular against MRSA, with an MIC50 of 0.38 microg/ml and an MIC90 of 0.5 microg/ml. Against strains of enterococci and streptococci, everninomicin was more active than vancomycin, but as active as teicoplanin.

Aminoglycosides↗

Nano-mechanical exploration of the surface and sub-surface of hydrated cells of Staphylococcus epidermidis.

The surface of hydrated cells of Staphylococcus epidermidis has been probed using an atomic force microscope. While local force measurements over the surface of bacteria reveal a heterogeneous chemical surface, with heterogeneous mechanical properties, different kinds of force curves appear with high frequency, and are thought to provide information on features contributing strongly to the overall mechanical and surface behaviour of the cell. Force curves often present two different mechanical regimes, being the first one (outer) of about 48 nm thick, and presenting a local relative elasticity of about 0.08 N/m, which is about a third of the relative elasticity of the inner part of the cell wall, harder, with a relative elasticity of about 0.24 N/m, in water. Both regimes appears as straight lines in the force versus distance curves (the 'corresponding' stress-strain curves in contact mechanics), but hysteresis is observed between the approach and the retraction line in the inner regime, indicating a degree of viscoelasticity. No viscoelasticity is observed in the outer regime, however, which presents quite linear and juxtaposed approach-retraction lines. These kinds of force curves do not present measurable pull-off forces nor snap-in forces, which indicates an almost null interaction between tip and bacterial surface, which could be in agreement with the measured very high hydrophobicity of this strain. Another kind of force curve has been observed recurrently, showing peaks in the retraction curves. Adhesive pull-off forces were measured giving an average of about 2 nN. Interestingly, however, these force curves appear only when quite irregular and wavy retraction curves are present, from the very beginning of its trace (maximum indentation). This leads us to think that these pull-off forces measured by our AFM do not give information on surface forces-unbinding events at the surface of the bacteria, but could be related to events at the sub-surface of the cell surface. Oscillations seen in the retraction curve in the portion corresponding to the contact with the bacteria surface could be due to rupture phenomena within the multilayered cell wall architecture expected in Gram-positive bacteria as Staphylococcus epidermidis, which could result in local irreversible deformations of the cell surface. Imaging with a sharp tip in contact mode sometimes leads to surface damage. Force curves recorded over damaged parts of the cell surface showed a completely different behaviour, in many cases with two well-defined high-adhesion peaks, and also interestingly, with snap-in forces of about 0-2 nN, which seems to indicate a completely different electrical/hydrophobicity state only a few nanometers down from the surface. Similar indentation effects can occur in the contact of a bacterial cell with a solid surface, even when showing only atomic-molecular-scale roughness, thus interacting not only with the very surface of the cell, especially when soft layers are present in the outer. Our results highlight the importance of the cell surface mechanical properties and their interplay with purely surface properties when analyzing cell-material interaction, and show the AFM as a useful method for investigating this.

Bacterial Adhesion↗

Antimicrobial resistance in Staphylococcus pseudintermedius isolated from asymptomatic and symptomatic dogs in Montevideo, Uruguay: characterization of MRSP strains and genetic determinants of resistance.

Staphylococcus pseudintermedius&#xa0;is a common opportunistic pathogen in dogs and an increasing concern in veterinary medicine due to rising antimicrobial resistance, particularly to methicillin. This study aimed to characterize resistance profiles and genetic mechanisms in isolates from healthy and diseased dogs in Montevideo, Uruguay. A total of 133 isolates was analyzed (83 from clinical infections and 50 from asymptomatic carriers). Antimicrobial susceptibility was assessed by disk diffusion following veterinary guidelines. Resistance genes and SCCmec types were detected by PCR. Ten representative isolates underwent whole genome sequencing. High resistance rates were observed for penicillin (81%), erythromycin (49.6%), and clindamycin (45%). Overall, 48.9% of isolates were multidrug-resistant. Phenotypic resistance to oxacillin was detected in 26% of isolates; however, 23% carried mecA gene and were therefore classified as genotypic MRSP. These isolates were more frequent among dogs with clinical infections. These strains showed higher resistance to all antimicrobials tested. SCCmec type V was the most prevalent, and greater genetic diversity was found among isolates from symptomatic dogs. Genomic analysis revealed circulating strains of unassigned sequence types (STs), a variety of resistance genes within specific lineages, the circulation of SCCmec XIV cassette carrying strains, and an Oxacillin-susceptible Methicillin-resistant Staphylococcus pseudintermedius (OS-MRSP) isolate. These findings demonstrate the clinical and epidemiological relevance of&#xa0;S. pseudintermedius&#xa0;in Uruguay and the role of asymptomatic dogs as reservoirs of resistant strains. The results emphasize the need for surveillance, prudent antimicrobial use, and integrated control strategies within a One Health framework.

Animals↗

Lemierre syndrome variant: Staphylococcus aureus associated with thrombosis of both the right internal jugular vein and the splenic vein after the exploration of a river cave.

BACKGROUND: Lemierre syndrome is a rare and potentially fatal entity characterized by septic emboli from thrombosis of the internal jugular vein after oropharyngeal infection. The etiologic agent is not always an anaerobic bacterium. We report a patient with a Lemierre syndrome variant who presented with thrombosis of both the right internal jugular vein and the splenic vein as well as septic pulmonary emboli caused by Staphylococcus aureus, which proved resistant to methicillin, amoxicillin, and ciprofloxacin. The patient was thought to have acquired the infection during the exploration of a river cave in Turkey 10 days before his admission to the hospital. Such caves are natural reservoirs of infectious microorganisms. METHODS: The patient had a physical examination, coagulation screening tests, tests of thrombin generation and fibrinolysis, coagulation inhibitors, activated protein C resistance, early and late serological tests (including autoantibodies), computed tomographic studies of the chest and abdomen, and bacterial examination of peripheral blood. Bacterial investigations were made on samples collected from the river cave. RESULTS: After having undergone a 6 week course of antimicrobial treatment and anticoagulant therapy, the patient recovered from the infection with no residual complications, and the signs and symptoms of Lemierre syndrome resolved. CONCLUSION: The results probably indicate an exposure of the patient to soil-based Staphylococcus aureus. This observation suggests the action of environmental factors that may contribute to the development of this rare syndrome.

Adult↗

The intercellular adhesin locus ica is present in clinical isolates of Staphylococcus aureus from bacteremic patients with infected and uninfected prosthetic joints.

Although polysaccharide intercellular adhesin (PIA) is thought to be crucial in the pathogenesis of prosthetic device infections caused by Staphylococcus epidermidis, its role in prosthetic device infections caused by Staphylococcus aureus is unknown. To assess the clinical impact of PIA production, isolates from 15 prospectively identified cases of S. aureus bacteremia in patients with prosthetic joints (8 infected, 7 uninfected) were characterized for biofilm production, hemagglutination, and the presence of a 419-bp amplification product within icaA. Although icaA was present in all 15 isolates, none of the isolates produced hemagglutination and only one isolate (from a patient with an uninfected prosthetic device) weakly produced biofilm in vitro. These results support the observation that the ica locus is conserved between S. epidermidis and S. aureus and that PIA may be expressed only under in vivo conditions. Future investigations should include animal models to approximate the complex milieu surrounding implanted prosthetic medical devices.

Adhesins, Bacterial↗

Methicillin-resistant Staphylococcus epidermidis blepharitis.

Blepharoconjunctivitis caused by methicillin-resistant strains of Staphylococcus epidermidis occurred in two hospitalized patients, a 74-year-old man and a 19-year-old man. Both strains were resistant to multiple courses of topical antibiotic therapy. Successful treatment in both cases depended upon antibiotic sensitivity testing. These methicillin-resistant strains of S. epidermidis, like methicillin-resistant strains of Staphylococcus aureus, demonstrated almost complete cross-resistance to cephalosporins despite apparent sensitivity on Kirby-Bauer disk sensitivity testing. Topical vancomycin was curative in one case. In the other case, treatment with topical gentamicin, intravenous cefoperazone, and oral rifampin led to resolution of the symptoms.

Adult↗

Southern hybridization analysis of the mecA deletion from methicillin-resistant Staphylococcus aureus.

Genomic organization of methicillin-resistant Staphylococcus aureus strains and their methicillin-susceptible subclones were analyzed by pulsed-field gel electrophoresis and Southern hybridization with DNA fragments of methicillin-resistance gene mecA and an insertion element IS431 as probes. The entire mecA gene was deleted in all the seven methicillin-susceptible subclones studied, and the size of the deletion varied from 20 to 100 kilobases depending on each subclone. In six of the seven subclones, however, the downstream deletion end points were confined within a 2.0 kilobase HindIII-HindIII fragment containing a part of IS431 which was located 2.6 kilobase downstream of mecA gene. The results indicated that the intramolecular transposition of IS431 is responsible for the mecA deletion in methicillin-resistant Staphylococcus aureus.

Blotting, Southern↗

Molecular cloning and sequencing of the epidermal cell differentiation inhibitor gene from Staphylococcus aureus.

We recently purified to homogeneity a protein inhibiting differentiation of cultured keratinocytes from extracellular products of Staphylococcus aureus, and named it epidermal cell differentiation inhibitor (EDIN). In the present study, we isolated and sequenced the structural gene coding for EDIN from Staphylococcus aureus E-1 using oligonucleotide probes on the basis of the partial amino acid sequence of the purified EDIN. DNA sequencing of the cloned DNA revealed an open reading frame encoding 247 amino acids as a precursor of EDIN, which included an NH2-terminal signal sequence of 35 amino acid residues. Processing of this precursor produces a mature EDIN protein composed of 212 amino acids with a calculated Mr of 23,782. The EDIN shared 35% amino acid homology with the ADP-ribosyltransferase C3 of Clostridium botulinum. These results with biological properties of EDIN described previously indicate that EDIN is a novel protein.

Amino Acid Sequence↗

In vitro [3H]-erythromycin binding to Staphylococcus aureus.

Characteristics of erythromycin binding to Staphylococcus aureus were determined by using kinetics and equilibrium binding experiments. Both methods yielded identical values of the dissociation constant, i.e. 0.1 muM. This value was in accord with that found with a bacterial extract of ribosomes which are the organelles where erythromycin exerts its action. This good agreement shows that the dissociation constant of erythromycin determined with intact bacteria is a good reflect of specific bacterial receptors of macrolides, i.e. ribosomes. In addition, mechanism of uptake of the antibiotic by Staphylococcus aureus was investigated. Passive diffusion process was shown to be mainly responsible for this phenomenon.

Erythromycin↗